Risk-stratified analysis of sex risk behaviors and correlates among school-going adolescents in Argentina: insights from a national survey

Introduction

As a crucial stage of human development, adolescence is characterized by a period of significant physical, emotional, and psychological changes. During this time, individuals explore their identities, experiment with newfound independence, and establish relationships. A significant aspect of adolescent development is the emergence of sexual behaviors and relationships [1]. Sexual behaviors among adolescents include abstinence, masturbation, and partnered sex [2]. However, risky sexual behaviors, such as early sexual debut, having multiple sex partners, and not using condoms, pose significant public health challenges due to their potential negative impacts on later sexual and reproductive health [3]. These behaviors expose adolescents to the risk of unwanted pregnancies, sexually transmitted infections (STIs), and ultimately impaired health [4]. Furthermore, sex risk behaviors among adolescents can reinforce cycles of inequality and contribute to the burden of disease and healthcare costs [4, 5].

The prevalence of sexual behaviors is influenced by various factors such as race, religion, culture, and economic status and varies among adolescents from different countries [3]. Argentina, with a population of over 45 million people and 16 % of whom are adolescents aged 10–18 years [6], has undergone significant socioeconomic changes and made noteworthy advancements in healthcare and education [7]. However, as in many other countries, the sexual health of adolescents remains a matter of concern in Argentina [8]. In 2021, a study examined the trends of various health risk behaviors among Argentinian adolescents across three different surveys conducted in 2007, 2012, and 2018 [9]. The findings indicated multiple sexual partners were one of the five health risk behaviors that decreased over time among boys, while it did not significantly change among girls. Additionally, the rate of condom use did not show any significant changes, regardless of age and sex. Nonetheless, this study did not provide detailed information on the correlates of sex risk behaviors among adolescents in Argentina.

Therefore, this study provides insights into the potential risk factors and correlates of sex risk behaviors, stratifying the target population based on the level of predicted granular risk based on the number of sexual partners and condom use in their last sexual encounter. Stratification helps in identifying adolescents engaged in the riskiest behaviors, such as having multiple partners without using condoms. This approach captures the complexity of sex risk behaviors and their associated factors among school-going adolescents [10]. By focusing on this high-risk group, interventions can be more effectively targeted to address their specific needs and challenges promote healthy sexual behaviors and improve the overall well-being of Argentine adolescents.

Materials and methods

Results

Discussion

This is one the first studies that shed light on the association between level of risk for sexual behaviors and various demographic, mental and physical, and substance-related factors among a nationally representative sample of Argentinian adolescents in grades 8–12th, leveraging the data from Argentina GSHS 2018. The findings showed that older adolescents faced significantly higher risks for moderate and high-risk sexual behaviors compared to younger peers. Older adolescents consistently exhibited heightened risks for engaging in moderate and high-risk sexual behaviors compared to their younger counterparts [13, 14]. This aligns with the developmental stage of adolescence, where older individuals tend to explore more complex social interactions, potentially leading to increased sexual experimentation [15]. Gender differences were notable, with females exhibiting lower risks for moderate-risk sexual behaviors but no significant variation in high-risk sexual behaviors compared to males. These gender differences resonate with existing literature, indicating that females generally tend to engage in fewer risky sexual behaviors [16], [17], [18]. This discrepancy might stem from varying societal expectations, social norms, and perceptions of acceptable behavior between genders [16, 18]. However, recent studies have suggested that adolescence is a time of risk sensitivity, rather than a time of universal increases in risk-taking behavior [19]. Therefore, it is crucial to identify age-specific risk factors and gender-related nuances to mitigate sexual health vulnerabilities among adolescents.

Psychosocial factors such as loneliness, anxiety, and suicidal thoughts/actions were significantly associated with increased sexual risk behaviors among Argentinian adolescents in this study. Loneliness has been linked to higher rates of depression [20], anxiety [21], suicide [22] and sexual risk behaviors [23, 24]. These findings align with broader research emphasizing the interplay between psychological distress and risky behaviors among young individuals [25]. Experiences of physical attacks or bullying were also associated with increased sexual risk behaviors among Argentinian adolescents in this study. These forms of violence can have a profound impact on the mental and emotional well-being of students, as well as their academic performance and overall development [26]. Research has shown that students who experience these forms of violence are more likely to engage in risky behaviors, including sexual risk behaviors [26]. The connection between violence and risky behaviors can be explained by factors such as feelings of helplessness, low self-esteem, and lack of support from peers or adults [26]. Therefore, given the high prevalence of bullying experiences in this study sample (22–27 %), implementing comprehensive support systems within schools and communities to address the psychosocial well-being of adolescents should be a priority. This includes counseling services, support groups, and mental health awareness campaigns to address loneliness, anxiety, and experiences of violence [27].

Skipping school within the past 30 days displayed a notable association with increased risk behaviors among Argentinian adolescents, indicating a significant correlation between absenteeism and engagement in risky behaviors. Research has consistently shown that youths who feel connected to their school are less likely to engage in various risky behaviors, including early sexual initiation, drug use, as well as violence, and gang involvement [28]. Feeling connected to school is associated with a sense of being cared for, supported, and belonging, which plays a critical role in promoting students’ health and development [28]. Youth feel connected to their school, they are less likely to experience poor mental health, sexual health risks, substance use, and violence [28]. This study indicated approximately 40 % of sexually active Argentinian adolescents have skipped school at least once in the last 30 days; therefore, interventions aiming at fostering a sense of school connectedness is crucial for promoting healthy behaviors and protecting against risk factors. Additionally, the study showed that parental understanding of adolescent problems and awareness of their free time activities appeared as protective factors against risky sexual behaviors. These factors seem to have a protecting effect across multiple risk levels, underscore the importance of parental involvement and awareness in mitigating risky behaviors [29, 30]. Thus, recommendations should be aimed at strengthening the parent-adolescent relationship, improving parental understanding of adolescent issues, and heightening awareness of their activities to create a supportive environment that minimizes risky behaviors.

In this study, substance use – marijuana, amphetamines, cigarettes, and alcohol – presented higher risk for moderate and high-risk sexual behaviors among Argentinian adolescents which is consistent with findings from previous studies in similar settings [31], [32], [33], [34]. Adolescence is characterized by heightened reward-driven behavior, marked by increases in sensation seeking and novelty seeking, which is thought to be linked to the development of the dopamine system [35]. This behavior is associated with the drive to seek new and more complex experiences, which may contribute to risky behaviors such as substance use and risky sexual behavior [36]. These findings highlight the need for effective prevention and intervention strategies tailored to the specific needs of adolescents in various settings, including schools, families, and communities, to effectively prevent substance use among adolescents [37].

Starting alcohol consumption before the age of 14 was associated with both moderate and high-risk sexual behaviors among Argentinian adolescents in this study. Early initiation of drinking has been linked to participation in various risky behaviors such as multiple sexual partners, and unprotected intercourse among adolescents [38]. Approximately 65 % of adolescent started drinking alcohol before age 14 which underscore the importance of early intervention strategies targeting alcohol consumption among Argentinian adolescents to reduce the incidences of consequent sex risk behaviors. Additionally, instances of problematic drinking behaviors such as getting drunk or encountering trouble while intoxicated were linked to increased risks of engaging in moderate and high-risk sexual behaviors among the study sample which aligned with previous studies [39]. As almost 20 % of the sexually active adolescents in this study had an episode of problematic drunkenness, employing a multidisciplinary approach involving healthcare professionals, educators, and community leaders to address the complex interplay between problematic drinking and risky sexual behaviors is crucial.

Another distinctive finding in this study was a higher level of risky sexual behavior among adolescents who experienced hunger in the past 30 days. Research has shown that food insecurity during adolescence is associated with various adverse outcomes, including deteriorated mental health, risky behaviors, and bitter experiences [40]. Therefore, it is recommended that all adolescents should be screened for food insecurity [41]. Adolescence represents a vulnerable stage of life and hunger can cause developmental disruptions with major implications for public health. Thus, future surveillance efforts should include robust measures of adolescent food insecurity collected longitudinally to better understand the extent to which food insecurity affects adolescents and how it relates to risky behaviors and adverse experiences.

Conclusions

The study explored sexual risk behaviors among Argentinean adolescents, revealing several notable findings. Males and older adolescents were more likely to engage in risky sexual behaviors. Psychosocial factors such as loneliness, anxiety, and experiences of violence were significantly associated with increased sexual risk behaviors. Moreover, substance use, especially alcohol initiation before age 14 and drinking behaviors, revealed strong associations with increased sexual risk behaviors. Parental involvement, on the other hand, exhibited protective effects against risky sexual behaviors. Policies should advocate for enhanced mental health support systems, including counseling services within schools and communities and engaging parents to strengthen the parent-adolescent relationship and to enhance parental awareness of adolescent issues and activities.