Monitoring of patterns and correlates of health behaviours among adolescents serves to provide strong evidence to guide adolescent interventions and programs. Using data derived from the four Botswana AIDS Impact surveys (2001–2013), this study assesses patterns and correlates of health risk behaviours among adolescents in Botswana. Samples of adolescents were drawn from each survey and used for data analysis. Estimates of adolescents’ health risk behaviours generally showed fluctuating patterns across all the four surveys. After sex disaggregation, inconsistent condom, multiple sexual partnerships and alcohol & substance use increased overtime among males while among females all health risk behaviours still showed a fluctuating pattern. Multivariate results indicated that the odds of reporting inconsistent condom use were significantly high male adolescents who reported multiple sexual partnerships between 2001–2013 surveys (e.g.in 2001, AOR = 1.02, C.I. = 1.00–2.30; 2004, AOR = 1.07, C.I. = 1.01–3.72; 2008, AOR = 2.46, C.I. = 1.03–4.10; 2013, AOR = 2.59, C.I. = 1.16–4.23). Moreover, males who reported alcohol and substance use were more likely to report inconsistent condom use, and the odds of inconsistent condom use among these males were highest in 2004 (AOR = 5.5, C.I. = 1.18–15.9). Among females, the odds of reporting inconsistent condom use and multiple sexual partnerships were significantly high among those who reported alcohol and substance use. All the comparisons were statistically significant at 5% level. These results highlight the need to strengthen adolescent’s behavioural programs in order to reduce health-damaging behaviours among adolescents.

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