Determinants of High-Risk Behaviors Among Vulnerable Adolescents: A Mixed-Methods Study in Southwest Iran

Living in marginalized areas with challenging socio-economic contexts can make teenagers vulnerable. This study aimed to investigate high-risk behaviors and their determinants amongst teenage students living in marginalized areas of Southwest Iran. This was a cross-sectional study with mixed-method desgin, in which 421 students completed a questionnaire in September 2018, and seven focused group discussions were conducted from October 2018 to January 2019 in a marginalized district of Shiraz, Southwest of Iran. Descriptive statistics were used to describe the data, and multiple logistic regression was used for statistical analysis. Quantitative data were analyzed using STATA14 (Stata Corporation, College Station, TX, USA) software, and qualitative data analysis was done using comparative content analysis. The risk behaviors examined in this study were tobacco, alcohol, sexual relations, and substance use. In total, 34.7% of the participants were engaged in at least one of the high-risk behaviors. Based on multiple logistic regression analysis, parents’ marital status (ORDivorced&Dead/Living together=3.50, P=0.016), fathers’job (ORUnemployment/Employment=6.61, P=0.004), family history for addiction (ORYes/No=2.62, P=0.001), and friendship with the opposite sex (ORYes/No=2.56, P<0.001) were among the observed risk factors for high-risk behaviors. Qualitative results indicated that family-related conflicts, personal characteristics, and environmental challenges are predisposing determinants for involving in high-risk behaviors among teenagers. High-risk behaviors are mostly prevalent among adolescents living in marginalized areas. To combat and mitigate the consequences of these behaviors, policymakers must focus on reducing social injustice, improving teenagers’ resiliency and family solidarity, and creating a safe environment.