Sexual Risk Behavior: a Multi-System Model of Risk and Protective Factors in South African Adolescents Kaymarlin Govender 1 & Richard G. Cowden 2 & Kwaku Oppong Asante 3 & Gavin George 1 & Candice Reardon 1 # Society for Prevention Research 2019 Abstract Adolescent sexual risk behavior has typically been studied within singular, isolated systems. Using a multi-system approach, this study examined a combination of individual, proximal, and distal factors in relation to sexual risk behavior among adolescents. A large cross-sectional sample of 2561 adolescent (M age = 14.92, SD age = 1.70) males (n = 1282) and females in Grades 8 (n = 1225) and 10 completed a range of self-report measures. Hierarchical ordinal logistic regression results supported a multi-system perspective of adolescent sexual risk behavior. Although individual and peer levels were identified as the primary contributors to the final model, a range of factors at varying levels of proximity to the individual were associated with sexual risk behavior. Specifically, being male, black, attaining increased age, greater alcohol use (individual level), parent risk behavior (family/home level), and peer risk behavior, feeling more pressure from peers to have sex (peer level), and lower social cohesion (community level) were associated with increased sexual risk behavior. These findings suggest multiple individual, proximal, and distal factors are salient to understanding sexual risk behavior among adolescents. Implications of the findings for interventions targeting the prevention of adolescent sexual risk behavior are discussed. Keywords Adolescents . Ecological . Multi-system . Protective factors . Risk factors . Sexual risk behavior . Youth Adolescence is a critical developmental period characterized by marked changes in a person’ s internal attributes (e.g., physio- logical, psychological) and external environment (e.g., social, cultural). During this phase, individuals formulate sexual, gender, and self-identities (Schlüter-Müller et al. 2015). They also interrogate the assumptions and people (i.e., parents) that governed their past thoughts and actions. As adolescents devel- op their sense of autonomy (Labouvie-Vief 2015), they often experience a shift in the circle of individuals that influence them (i.e., away from parents towards peers) and begin to participate in experimental behaviors and activities (Liao et al. 2013; van de Bongardt et al. 2014). Often underprepared for the typically abrupt transformations that occur, adolescents must apply their developing decision-making abilities to potentially risky situa- tions (Leijenhorst et al. 2010) in which they may be conflicted by a combination of individual (e.g., sensation-seeking tenden- cies) and socio-contextual (e.g., peers) influences (Casey 2011). As reward-seeking processes tend to develop earlier in adoles- cence than self-regulatory processes (Steinberg 2008), deci- sions can favor risk behaviors that may have detrimental health consequences (Reyna et al. 2015). Although a variety of health risk behaviors (e.g., alcohol use, physical inactivity) emerge during adolescence (Houck et al. 2016; Sawyer et al. 2012), susceptibility to adverse health consequences is pronounced for adolescents growing up in countries that carry the global burden of infectious dis- eases (Patton et al. 2016). In South Africa, where HIV preva- lence (up to 7.1%) and incidence (up to 1.5%) rates among * Kaymarlin Govender Govenderk2@ukzn.ac.za Richard G. Cowden richardgregorycowden@gmail.com Kwaku Oppong Asante kwappong@gmail.com Gavin George georgeg@ukzn.ac.za Candice Reardon candiceannereardon@gmail.com 1 Health Economics and HIV and AIDS Research Division, University of KwaZulu-Natal, Westville Campus, Private Bag X54001, Durban 4000, South Africa 2 Department of Psychology, University of the Free State, 205 Nelson Mandela Drive, Bloemfontein, Free State 9301, South Africa 3 Department of Psychology, University of Ghana, Legon Boundary, Accra, Ghana Prevention Science https://doi.org/10.1007/s11121-019-01015-3