Health Risk Behavior among adolescents and its socio-neuro-biological determinants in the context of HIV at the coast of Kenya

Research on adolescents’ health risk behavior (HRB) is meagre, especially among a steadily increasing group of adolescents living with HIV in sub-Saharan Africa. In this thesis, I validate HRB measures, describe patterns and underlying determinants of HRB, and investigate the association between executive functioning (EF) and HRB patterns of perinatally HIV infected adolescents and their respective control groups in Kilifi, a rural coastal setting of Kenya. A significant minority of adolescents in Kilifi experiences sexual risk and violence and consumes substances such as, home brewed alcohol and khat. Also engagement in passive leisure and sedentary activities, and preference for oily and sugar dense processed foods was found. Some inter-related risk factors were poor coping strategies, and school drop-out (individual level); household poverty and poor parenting behavior (interpersonal level); urbanization, poor state of healthcare and social services, detrimental social norms and customs, and poor implementation of policies (community and public policy levels). A psychometrically sound HRB tool, the Kilifi Health Risk Behavior Questionnaire, was assembled. Four subgroups of adolescents were identified in relation to HRB. HIV was not related to a specific adolescent subgroup. Membership to higher risk was strongly associated with internalizing problems, older age and adolescents’ reports of their caretaker’s tobacco use. Higher EF and school attendance were protective. There is need for appropriate multi-component interventions which integrate treatments for internalizing mental health problems and deficits in EF and support school attendance.