Centre for Geographic Medicine Research Coast, Kenya Medical Research Institute (KEMRI), Kilifi, Kenya.
Utrecht Centre for Child and Adolescent Studies, Utrecht University, Utrecht, The Netherlands.
PLoS One. 2020 Nov 12;15(11):e0242186. doi: 10.1371/journal.pone.0242186. eCollection 2020.
Adolescents tend to experience heightened vulnerability to risky and reckless behavior. Adolescents living in rural settings may often experience poverty and a host of risk factors which can increase their vulnerability to various forms of health risk behavior (HRB). Understanding HRB clustering and its underlying factors among adolescents is important for intervention planning and health promotion. This study examines the co-occurrence of injury and violence, substance use, hygiene, physical activity, and diet-related risk behaviors among adolescents in a rural setting on the Kenyan coast. Specifically, the study objectives were to identify clusters of HRB; based on five categories of health risk behavior, and to identify the factors associated with HRB clustering.
A cross-sectional survey was conducted of a random sample of 1060 adolescents aged 13-19 years living within the area covered by the Kilifi Health and Demographic Surveillance System. Participants completed a questionnaire on health behaviors which was administered via an Audio Computer-Assisted Self-Interview. Latent class analysis on 13 behavioral factors (injury and violence, hygiene, alcohol tobacco and drug use, physical activity, and dietary related behavior) was used to identify clustering and stepwise ordinal logistic regression with nonparametric bootstrapping identified the factors associated with clustering. The variables of age, sex, education level, school attendance, mental health, form of residence and level of parental monitoring were included in the initial stepwise regression model.
We identified 3 behavioral clusters (Cluster 1: Low-risk takers (22.9%); Cluster 2: Moderate risk-takers (67.8%); Cluster 3: High risk-takers (9.3%)). Relative to the cluster 1, membership of higher risk clusters (i.e. moderate or high risk-takers) was strongly associated with older age (p<0.001), being male (p<0.001), depressive symptoms (p = 0.005), school non-attendance (p = 0.001) and a low level of parental monitoring (p<0.001).
There is clustering of health risk behaviors that underlies communicable and non-communicable diseases among adolescents in rural coastal Kenya. This suggests the urgent need for targeted multi-component health behavior interventions that simultaneously address all aspects of adolescent health and well-being, including the mental health needs of adolescents.
青少年往往更容易冒险和鲁莽行事。生活在农村地区的青少年可能经常面临贫困和一系列风险因素，这会增加他们遭受各种健康风险行为（HRB）的脆弱性。了解农村青少年 HRB 的聚类及其潜在因素对于干预计划和健康促进非常重要。本研究旨在探讨肯尼亚沿海农村地区青少年在伤害和暴力、物质使用、卫生、身体活动和饮食相关风险行为方面的 HRB 聚类及其相关因素。
对居住在基利菲健康和人口监测系统覆盖区域内的 1060 名 13-19 岁青少年进行了一项横断面调查。参与者完成了一份关于健康行为的问卷，该问卷通过音频计算机辅助自我访谈进行。对 13 项行为因素（伤害和暴力、卫生、烟酒毒品使用、身体活动和饮食相关行为）进行潜在类别分析，以确定聚类，逐步有序逻辑回归和非参数引导确定与聚类相关的因素。年龄、性别、教育水平、在校出勤率、心理健康、居住形式和父母监督水平等变量被纳入初始逐步回归模型。
我们确定了 3 种行为聚类（聚类 1：低风险行为者（22.9%）；聚类 2：中度风险行为者（67.8%）；聚类 3：高风险行为者（9.3%））。与聚类 1 相比，较高风险聚类（即中度或高风险行为者）的成员与年龄较大（p<0.001）、男性（p<0.001）、抑郁症状（p=0.005）、不上学（p=0.001）和低水平的父母监督（p<0.001）密切相关。
肯尼亚农村沿海地区青少年的传染病和非传染病健康风险行为存在聚类。这表明迫切需要针对青少年健康和福祉的各个方面的多组分健康行为干预措施，包括青少年的心理健康需求。
