Neighborhood-Level Influences and Adolescent Health Risk Behaviors in Rural and Urban Sub-Saharan Africa: A Systematic Review.

The impact of neighborhoods on adolescent engagement in health-risk behaviors (HRBs), such as substance use and sexual activity, has been well documented in high-income countries; however, evidence from low and middle-income country settings is limited, particularly in sub-Saharan African (SSA) countries. Neighborhoods and communities in SSA continue to experience urbanization, epidemiologic transition, and the simultaneous presence of large populations living in rurality and urbanicity. This is a dynamic context for exploring adolescent health challenges. This review seeks to identify and summarize existing literature that investigates adolescent engagement in HRBs when compared across rural and urban neighborhoods across SSA. We performed searches using three electronic databases, targeted grey literature searches and scanned reference lists of included studies. Following dual-screening, our search yielded 23 relevant studies that met all inclusion criteria. These were categorized into six broad themes including studies on: (1) sexual risk taking, (2) injury-related, (3) violence, (4) eating and/or exercise-related, (5) substance use, and (6) personal hygiene. We found that neighborhood factors relating to accessibility and availability of health information and care impacted adolescent engagement in HRBs in rural and urban areas. Urbanization of areas of SSA plays a role in differences in engagement in HRBs between rural and urban dwelling adolescents.