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Clustering of health risk behaviors among adolescents in Kilifi, Kenya, a rural Sub-Saharan African setting

Abstract:
Background
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.
Methods
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.
Results
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).
Conclusion
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.
Publication status:
Published
Peer review status:
Peer reviewed

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Publisher copy:
10.1371/journal.pone.0242186

Authors


More by this author
Role:
Author
ORCID:
0000-0002-7848-7643
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Institution:
University of Oxford
Division:
MSD
Sub department:
Psychiatry
Role:
Author
ORCID:
0000-0002-6999-5507
More by this author
Role:
Author
ORCID:
0000-0002-1389-1813


Publisher:
Public Library of Science
Journal:
PloS One More from this journal
Volume:
15
Issue:
11
Article number:
e0242186
Publication date:
2020-11-12
Acceptance date:
2020-10-29
DOI:
EISSN:
1932-6203
ISSN:
1932-6203
Pmid:
33180831


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