The Occurrence of Sexual Risk Behaviors and Its Association With Psychological Well-Being Among Kenyan Adolescents

Objective: Sexual risk behavior during adolescence is an important public health problem. Self-esteem and hopefulness are potentially important psychological factorsthat may play a role in the behavioral regulation mechanisms of adolescents. Thesefactors are inadequately explored in sub-Saharan Africa. This study aimed at exploringpatterns and associated factors for sexual risk behavior (SRB), self-esteem, andhopefulness among adolescents from a resource-poor setting in Kenya.Method: A cross-sectional study conducted in 2019 among 296 adolescents (12–17years old) from rural Kilifi (n = 133) and urban informal settings of Nairobi (n = 163) inKenya. Participants completed the Kilifi Health Risk Behavior Questionnaire, Rosenbergself-esteem questionnaire, and Hope scale administered via computerized tablets. Abinary outcome variable based on the experience of adolescents of at least one ofthe five forms of SRB: transactional sex, sexual violence, intergenerational sex, earlysexual debut, and condomnon-use was generated. Bi-variate analysis was conducted tosummarize various social-demographic and psychosocial factors. A multivariable logisticregressionmodel was fitted to investigate factors associated with the occurrence of SRB,self-esteem, and hopefulness among adolescents.Results: About 13% of the participants had experienced a form of SRB, and amongthese, 36% reported co-occurrence of multiple forms of SRB. Adolescent SRB waslargely characterized by having experienced sexual violence, as well as intergenerationaland transactional sex. Higher scores of hopefulness were reported among adolescentswho never experienced SRB (P = 0.03) at bivariate analysis level. However, bothself-esteem and hopefulness were not significantly associated with the occurrence ofSRB 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.Conclusion: Targeted reproductive health interventions, designed with the cognizanceof structural and social drivers of adolescent SRB, are needed to concurrently tacklemultiple forms of SRB. It is important to integrate mental health promotion within theseinterventions. More research is needed to understand the mechanisms and implicationsof self-esteem and hopefulness for adolescent sexual and reproductive health.