Ssewanyana Derrick, Abubakar Amina, Mabrouk Adam, Kagonya Vincent A, Nasambu Carophine, Dzombo Judith Tumaini, Angwenyi Vibian, Kabue Margaret, Scerif Gaia, Newton Charles R
Neuroassement Group, Kenya Medical Research Institute (KEMRI)/Wellcome Trust Research Programme, Centre for Geographic Medicine Research, Kilifi, Kenya.
Alliance for Human Development, Lunenfeld-Tanenbaum Research Institute, Toronto, ON, Canada.
Front Reprod Health. 2021 Jul 21;3:659665. doi: 10.3389/frph.2021.659665. eCollection 2021.
Sexual risk behavior during adolescence is an important public health problem. Self-esteem and hopefulness are potentially important psychological factors that may play a role in the behavioral regulation mechanisms of adolescents. These factors are inadequately explored in sub-Saharan Africa. This study aimed at exploring patterns and associated factors for sexual risk behavior (SRB), self-esteem, and hopefulness among adolescents from a resource-poor setting in Kenya. A cross-sectional study conducted in 2019 among 296 adolescents (12-17 years old) from rural Kilifi ( = 133) and urban informal settings of Nairobi ( = 163) in Kenya. Participants completed the Kilifi Health Risk Behavior Questionnaire, Rosenberg self-esteem questionnaire, and Hope scale administered computerized tablets. A binary outcome variable based on the experience of adolescents of at least one of the five forms of SRB: transactional sex, sexual violence, intergenerational sex, early sexual debut, and condom non-use was generated. Bi-variate analysis was conducted to summarize various social-demographic and psychosocial factors. A multivariable logistic regression model was fitted to investigate factors associated with the occurrence of SRB, self-esteem, and hopefulness among adolescents. About 13% of the participants had experienced a form of SRB, and among these, 36% reported co-occurrence of multiple forms of SRB. Adolescent SRB was largely characterized by having experienced sexual violence, as well as intergenerational and transactional sex. Higher scores of hopefulness were reported among adolescents who never experienced SRB ( = 0.03) at bivariate analysis level. However, both self-esteem and hopefulness were not significantly associated with the occurrence of SRB in the adjusted logistic regression analysis. Having depressive symptoms (Adj. OR = 3.8, 95% CI: 1.39-10.4), feeling unsafe in the neighborhood (Adj. OR = 3.4, 95% CI: 1.6-7.2), and being in higher compared with lower primary education level (Adj. OR = 0.3, 95% CI: 0.1-0.8) were statistically significantly associated with the occurrence of SRB. Targeted reproductive health interventions, designed with the cognizance of structural and social drivers of adolescent SRB, are needed to concurrently tackle multiple forms of SRB. It is important to integrate mental health promotion within these interventions. More research is needed to understand the mechanisms and implications of self-esteem and hopefulness for adolescent sexual and reproductive health.
青春期的性风险行为是一个重要的公共卫生问题。自尊和希望感是潜在的重要心理因素，可能在青少年的行为调节机制中发挥作用。在撒哈拉以南非洲地区，对这些因素的研究尚不充分。本研究旨在探索肯尼亚资源匮乏地区青少年的性风险行为（SRB）、自尊和希望感的模式及相关因素。2019年对肯尼亚基利菲农村地区（n = 133）和内罗毕城市非正式定居点（n = 163）的296名青少年（12 - 17岁）进行了一项横断面研究。参与者通过电脑平板电脑完成了基利菲健康风险行为问卷、罗森伯格自尊问卷和希望量表。基于青少年是否经历过以下五种SRB形式中的至少一种生成了一个二元结局变量：交易性行为、性暴力、代际性行为、过早性行为初次和不使用避孕套。进行了双变量分析以总结各种社会人口学和心理社会因素。拟合了一个多变量逻辑回归模型来研究与青少年SRB发生、自尊和希望感相关的因素。约13%的参与者经历过某种形式的SRB，其中36%报告同时存在多种形式的SRB。青少年SRB的主要特征是经历过性暴力以及代际和交易性行为。在双变量分析水平上，从未经历过SRB的青少年报告的希望感得分更高（p = 0.03）。然而，在调整后的逻辑回归分析中，自尊和希望感均与SRB的发生无显著关联。有抑郁症状（调整后比值比 = 3.8，95%置信区间：1.39 - 10.4）、在社区中感到不安全（调整后比值比 = 3.4，95%置信区间：1.6 - 7.）以及小学教育水平较高与较低相比（调整后比值比 = 0.3，95%置信区间：0.1 - 0.8）与SRB的发生在统计学上显著相关。需要在认识到青少年SRB的结构和社会驱动因素的基础上设计有针对性的生殖健康干预措施，以同时应对多种形式的SRB。在这些干预措施中纳入心理健康促进很重要。需要更多研究来了解自尊和希望感对青少年性与生殖健康的机制及影响。
