Clustered risk: An ecological understanding of sexual activity among adolescent boys and girls in two urban slums in Monrovia, Liberia.


Department of Social and Behavioral Sciences, Harvard TH Chan School of Public Health, 677 Huntington Avenue, Boston, MA, 02115, USA. Electronic address: [Email]


Many young people experience sexual debut before they are able to manage risk in order to avoid adverse consequences. Gender norms, social position, and power can undermine an adolescent's ability to exercise agency in their first sexual encounters and negotiate safer sexual behavior. This study examines the intersection of psychosocial and interpersonal factors with the social and physical environment to form an ecological understanding of how the determinants that shape sexual activity differ between boys and girls in two urban slums in Monrovia, Liberia. This study focuses on three different levels: 1) intrapersonal and psychosocial factors, 2) the role of the family and other interpersonal relationships, and 3) the overall community structure. Fifty-three adolescents aged 15-17 years (27 males and 26 females) were recruited to participate in a concept mapping exercise. Concept mapping is a participatory research method that uses both qualitative and quantitative approaches through 1) group discussion, 2) brainstorming, 3) sorting factors into meaningful clusters, and 4) interpretation of the results to create a visual map. Cluster maps include both positive and negative factors that participants believe to influence adolescent sexual activity in their communities, including parental pressure, transactional sex, family status, goals and aspirations, and poverty. The influence of these factors diverged according to participant gender. Participants described how psychosocial, interpersonal, family, and community factors interact with economic and social forces to influence their sexual experience and combine to exacerbate the prevalence of transactional and forced sex. The results highlight the need for multi-level interventions to shape adolescent sexual and reproductive health in positive, rather than harmful, ways.


Adolescents,Concept mapping,Global health,Liberia,Low and middle-income countries,Sexual and reproductive health,Social disparities,Urban slums,

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