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


PLoS One

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. Ssewanyana, D., Abubakar, A., Newton, Crjc, Otiende, M., Mochamah, G., Nyundo, C., Walumbe, D., Nyutu, G., Amadi, D., Doyle, A. M., Ross, D. A., Nyaguara, A., Williams, T. N., Bauni, E.

Pages:e0242186, Volume:15, Edition:11/13/2020, Date,


Notes:Ssewanyana, Derrick|Abubakar, Amina|Newton, Charles R J C|Otiende, Mark|Mochamah, George|Nyundo, Christopher|Walumbe, David|Nyutu, Gideon|Amadi, David|Doyle, Aoife M|Ross, David A|Nyaguara, Amek|Williams, Thomas N|Bauni, Evasius|eng|202800/Z/16/Z/WT_/Wellcome Trust/United Kingdom|MC_PC_MR/R019606/1/MRC_/Medical Research Council/United Kingdom|091758/WT_/Wellcome Trust/United Kingdom|084535/WT_/Wellcome Trust/United Kingdom|Research Support, Non-U.S. Gov’t|2020/11/13 06:00|PLoS One. 2020 Nov 12;15(11):e0242186. doi: 10.1371/journal.pone.0242186. eCollection 2020.

ISBN: 1932-6203 (Electronic)|1932-6203 (Linking) Permanent ID: PMC7660520 Chugai Pharmaceutical Co., Ltd., and GlaxoSmithKline K.K. This does not alter our adherence to PLOS ONE policies on sharing data and materials. Accession Number: 33180831

Author Address: 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.|Institute for Human Development, Aga Khan University, Nairobi, Kenya.|Department of Psychiatry, Warneford Hospital, University of Oxford, Oxford, United Kingdom.|INDEPTH (International Network for field sites with continuous Demographic Evaluation of Populations and Their Health in developing countries), East Legon, Accra, Ghana.|London School of Hygiene & Tropical Medicine, Bloomsbury, London, United Kingdom.|Department of Medicine, Imperial College, South Kensington Campus, London, United Kingdom.