title: Protective and risk factors associated with adolescent sexual and reproductive health in the English-speaking Caribbean: a literature review.
abstract: OBJECTIVE
  To identify risk and protective factors associated with adolescent sexual and reproductive health (ASRH) in the English-speaking Caribbean through a structured literature review.
  
  
  METHODS
  Peer-reviewed articles published between January 1998 and December 2009 focused on the sexual and reproductive health of adolescents, aged 10-19 years, were included in this review. Articles were organized according to Bronfenbrenner's ecological systems theory. Research gaps were also identified.
  
  
  RESULTS
  A total of 30 studies assessed ASRH. At the individual level, gender, psychosocial well-being, and mental health were key factors associated with ASRH. Within the microsystem, the quality of the parent-adolescent relationship, the presence of violence, substance abuse or mental health problems in the family, and peer relationships were important determinants of ASRH. Within the macrosystem, cultural attitudes had an effect on youth's sexual behavior and generally, safer sex practices appear to be increasing. Within the chronosystem, a history of physical and sexual abuse was associated with several ASRH outcomes.
  
  
  CONCLUSIONS
  A research agenda that incorporates a multisystem approach and advocates for the inclusion of socially marginalized youth is needed to fully understand and adequately address ASRH in the Caribbean.
authors.affiliation: Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland 21205, USA.
authors.forename: Nanlesta A
authors.initials: NA
authors.lastname: Pilgrim
authors.forename: Robert Wm
authors.initials: RW
authors.lastname: Blum
mesh_terms: D000293:Adolescent; D000294:Adolescent Behavior; D017691:Caribbean Region; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D060728:Reproductive Health; D012307:Risk Factors; D021841:Safe Sex; D012931:Social Environment; D055815:Young Adult