Sexual Risk Behavior: a Multi-System Model of Risk and Protective Factors in South African Adolescents.

Adolescent sexual risk behavior has typically been studied within singular, isolated systems. Using a multi-system approach, this study examined a combination of individual, proximal, and distal factors in relation to sexual risk behavior among adolescents. A large cross-sectional sample of 2561 adolescent (M = 14.92, SD = 1.70) males (n = 1282) and females in Grades 8 (n = 1225) and 10 completed a range of self-report measures. Hierarchical ordinal logistic regression results supported a multi-system perspective of adolescent sexual risk behavior. Although individual and peer levels were identified as the primary contributors to the final model, a range of factors at varying levels of proximity to the individual were associated with sexual risk behavior. Specifically, being male, black, attaining increased age, greater alcohol use (individual level), parent risk behavior (family/home level), and peer risk behavior, feeling more pressure from peers to have sex (peer level), and lower social cohesion (community level) were associated with increased sexual risk behavior. These findings suggest multiple individual, proximal, and distal factors are salient to understanding sexual risk behavior among adolescents. Implications of the findings for interventions targeting the prevention of adolescent sexual risk behavior are discussed.