Risky Sexual Behavior and Associated Factors among Adolescents Aged 15-19 Years at Governmental High Schools in Aksum Town, Tigray, Ethiopia, 2019: An Institution-Based, Cross-Sectional Study

Individual and relational dynamics perceived to influence the sexual behaviour of adolescents in Ethiopia: a qualitative study

Background

There are 1.2 billion adolescents in the world today, more than ever before, making up 16% of the world's population and nearly one-fourth of the total population in Sub-Saharan Africa. Adolescents are facing life-threatening health challenges attributed to sexual and reproductive health issues such as unwanted pregnancies, unsafe abortions, and sexually transmitted infections, including the human immunodeficiency virus, and acquired immunodeficiency syndrome. The aim of this research is to explore the individual and relational levels of factors that drive adolescents to engage in risky sexual behaviour.

Methods

A qualitative phenomenological study design was used from February to June 2020. Adolescents and health professionals were selected purposefully. A total of 12 individual in-depth interviews, five focus group discussions with adolescents, and eight key informant interviews with health professionals were conducted using a semi-structured guide. Data analysis was performed using thematic analysis with ATLAS Ti version 7 software. Credibility, dependability, transferability, and confirmability were used to ensure the trustworthiness of the data.

Results

In this study, two themes were identified; individual level factors such as sexual desire and emotion driven sex, limited knowledge of sexual and reproductive health, and a permissive attitude towards sexual activities drive adolescents to engage in risky sexual behaviour; and relational level factors such as, limited family support and involvement, negative peer pressure and influence, male partner dominance during the partnership, and pressuring females to engage in sexual intercourse were perceived factors influencing adolescents to engage in risky sexual behaviour.

Conclusion

Various individual-level and relational-level factors are influencing adolescents to engage in risky sexual behaviour. Socially and culturally acceptable, comprehensive sexual education should be provided for in-school and out-school adolescents to enhance their knowledge, attitude, and skill about sexual and reproductive health. Interventions at the peer and partner level should be considered to enhance the life skills that enable them to resist pressure from peers and their partners. Child-parent communication on sexual and reproductive health matters should be promoted.

Risky sexual behavior and associated factors among out-of-school youths in Addis Ababa, Ethiopia; mixed methods study

INTRODUCTION

Sexual risky behaviors, as defined by the World Health Organization, encompass a spectrum of sexual activities that heighten the likelihood of negative outcomes related to sexual and reproductive health. Despite the implementation of various healthcare programs and interventions, youths continue to encounter challenges in accessing reproductive health services. Consequently, they remain vulnerable to engaging in high-risk sexual behaviors; 50.36% of adolescents in Ethiopia. Therefore, this study was aimed to determine the prevalence of risky sexual behavior and associated factors among out-of-school Youths in Addis Ababa, Ethiopia; 2023.

METHODS

A community based cross sectional mixed methods study was conducted among 701 youths in Addis Ababa from September 1st to 30th, 2023. The quantitative data were collected through face to face interview using a pre-tested structured questionnaire, while qualitative data were gathered through in depth interviews and focus group discussions. For the quantitative study, the study samples were chosen using systematic sampling. Conversely, purposive sampling was employed for the qualitative study. Variables with P-value ≤ 0.25 in the bivariate analysis were considered as candidates for the multivariable analysis. Statistical significance was declared at a P-value less than 0.05.

RESULTS

The prevalence of risky sexual behavior among out of school students in Addis Ababa was 40.6% (95%CI: 36.8, 44.1). Age 15-19 years (AOR: 2.52; 95%CI: 1.61, 3.94), being female (AOR: 2.84; 95%CI: 1.93, 4.18), fathers who were unable to read and write (AOR: 4.13; 95%CI: 2.04, 8.37), alcohol consumption (AOR: 2.07; 95%CI: 1.33, 3.19), peer pressure (AOR: 2.59; 95%CI: 1.81, 3.72), live together with either of biological parent (AOR: 2.32; 95%CI: 1.52, 3.55), watching pornography (AOR: 2.10; 95%CI: 1.11, 3.97) and parental monitoring (AOR: 0.59; 95%CI: 0.39, 0.90) were factors associated with risky sexual behavior.

CONCLUSION AND RECOMMENDATIONS

A lower prevalence of risky sexual behavior compared to prior research efforts. Age, gender, educational level of the husband, alcohol consumption, peer pressure, living arrangements, exposure to pornography, and family monitoring emerged as significant factors associated with risky sexual behavior. Therefore, government should prioritize strategies to reduce substance use, mitigate the impact of watching pornography, and enhance parent-youth connectedness.

Risk-stratified analysis of sex risk behaviors and correlates among school-going adolescents in Argentina: insights from a national survey

OBJECTIVES

This study was conducted to address a critical gap in understanding adolescent sexual health risks in Argentina, a country that has undergone substantial socio-economic changes that made significant strides in education and healthcare.

METHODS

A secondary data analysis of the 2018 Argentina Global School-based Student Health Survey was performed. In this study, 23,262 sexually active adolescents were categorized into four risk groups based on the predicted granular risk: number of sexual partners and condom use in their last sexual encounter.

RESULTS

Males and older adolescents were more prone to high-risk sexual behaviors. Additionally, key psychosocial factors such as loneliness, anxiety, experiences of violence, and school absenteeism were significantly associated with high-risk sexual behaviors. Early alcohol use and recent experiences of hunger were also identified as strong predictors of heightened sexual risk behaviors. Conversely, positive parental engagement and awareness exhibited protective factors.

CONCLUSIONS

These findings highlight the necessity for policy interventions that focus on mental health support, parental involvement, and awareness of adolescent issues and activities.

Risky sexual behavior and associated factors among reproductive age women in eastern African countries: a multilevel analysis of the recent demographic and health survey

INTRODUCTION

Risky sexual behavior exposes an individual to the risk of contracting sexually transmitted infections including human immunodeficiency virus (HIV). Even though risky sexual behavior is a devastating problem in low- and middle-income countries, studies on risky sexual behavior and associated factors among reproductive-age women in Eastern African countries are limited. Therefore, this study aimed to assess the magnitude of risky sexual behavior and associated factors among reproductive-age women in Eastern African countries that help to target high-risk groups and set appropriate intervention.

METHOD

The appended and recent Demographic and Health Survey dataset of 10 Eastern African countries from 2012 to 2022 was used for data analysis. A total of 111,895 participants were included in this study as a weighted sample. Associated factors were determined using a multilevel mixed-effects logistic regression model. Significant factors in the multilevel mixed-effect logistic regression model were declared significant at p-values < 0.05. The adjusted odds ratio (AOR) and confidence interval (CI) were used to interpret the results.

RESULT

The overall magnitude of risky sexual behavior among reproductive-age women in Eastern African countries was 28.16% (95% CI 27.90%, 28.43%), which ranged from 3.80% in Ethiopia to 67.13% in Kenya. In the multivariable analysis, being a younger woman, being an educated woman, being tested for human immunodeficiency virus, having work, drinking alcohol, and being an urban dweller were factors that were significantly associated with higher odds of risky sexual behavior.

CONCLUSION

The overall magnitude of risky sexual behavior among reproductive-age women in Eastern African countries was high. Individual-level (being a younger woman, being an educated woman, being tested for human immunodeficiency virus, having work, and drinking alcohol) and community-level (being an urban dweller) variables were associated with higher odds of risky sexual behavior. Therefore, policymakers and other stakeholders should give special consideration to urban dwellers, educated, worker and younger women. Better to improve the healthy behavior of women by minimizing alcohol consumption and strengthening HIV testing and counseling services to reduce the magnitude of risky sexual behavior.

Prevalence, medication adherence, and determinants of type 2 diabetes mellitus during Coronavirus Disease 2019 pandemic among adults in Tanzania

Introduction

Excessive consumption of comfort foods, which are mostly high in carbs, and limitations on outdoor and gym-based physical activities, for instance, are associated with foods high in the glycemic index and raise the risk of obesity and type 2 diabetes. In pandemic and or epidemic situations, peoples' lifestyles may change significantly to lead them to non-communicable diseases. However, lifestyle changes and the occurrence of type 2 diabetes mellitus during the Coronavirus Disease 2019 pandemic among adults have not been well established in Tanzania. This study assessed the prevalence, medication adherence, and determinants of type 2 diabetes mellitus among adults in the country.

Methods

A community-based analytical cross-sectional study was conducted in Dodoma region, Tanzania between September and October 2020 of which 107 adults aged above 18 years were studied regardless of whether they were newly diagnosed with type 2 diabetes mellitus or not using a quantitative research approach. Interviewer-administered lifestyle habits and medication adherence structured questionnaires benchmarked from previous studies served as the main tools of data collection. The statistical package for social sciences computer program was used to analyze the data descriptively for frequencies and percentages and by regression analysis model to determine the association between variables with a 95% confidence interval and 5% significance level.

Results

With a mean age of 31 ± 2.527 years, 59.8% of the respondents were female. 60.7% and 11.7% of the respondents had unhealthy and moderate lifestyle choices respectively. The prevalence of type 2 diabetes mellitus accounted for 63.9% of the respondents of which 44.6% were diagnostically confirmed during the Coronavirus Disease 2019 pandemic against 19.3% of respondents who were diagnosed before the pandemic. Medication adherence among the type 2 diabetes mellitus respondents accounted for 77.9% of the study respondents. Type 2 diabetes mellitus was significantly associated with being in the 36-55 age group (AOR = 1.054; 95% CI: 0.292, 3.162; p < 0.05); being female (AOR = 1.398; 95% CI: 0.205, 3.048; p < 0.05); having a job (AOR = 2.597; 95% CI: 1.243, 4.402, p < 0.05); and having unhealthy lifestyle habits (AOR = 3.301; 95% CI: 1.199, 6.52; p < 0.05).

Conclusion

The majority of adults had type 2 diabetes mellitus of which most of them were confirmed to have the disease during the Coronavirus Disease 2019 pandemic. Few type 2 diabetes mellitus adults did not adhere to their medications as recommended. Their sociodemographic characteristics profiles and unhealthy lifestyles significantly led them to have the problem. The treatment of the disease above and health promotion activities may need to take unhealthy lifestyle choices and certain sociodemographic profiles of adults into consideration to assist in preventing the problem.

Agenda-setting in policies related to high-risk sexual behaviours, stimulants, and alcohol abuse in Iranian adolescents

BACKGROUND

This research article retrospectively analyses the agenda-setting approach of policies concerning high-risk sexual behaviours, stimulant and alcohol abuse among Iranian adolescents.

METHODS

This qualitative case study policy analysis involved analysing 51 national documents and conducting interviews with 49 policy-makers and executives. Purposive sampling with a snowball strategy and semi-structured interviews were used. The data was analysed using the framework analysis method, with Kingdon's multiple streams framework serving as the analytical framework.

RESULTS

The study has identified the confluence of several factors, including the problem stream, the policy stream and the political stream. Within the problem stream, several factors contributed, such as the prevalence of high-risk behaviours, strong scientific evidence on these behaviours, changes in human immunodeficiency virus (HIV) transmission patterns, increased statistics of poisoning and deaths related to alcohol abuse, and the visit of Iran's supreme leader to the slums of Mashhad city. The policy stream has two periods of denial and acceptance. The denial period includes considering these high-risk behaviours to be the consequences of western culture, emphasis on the religious aspects and sinfulness of these behaviours, resisting the prevalence of anomalous behavioural patterns, abstinence and religious obligation of chastity, and avoiding ethical corruption. The acceptance period includes adolescents training, fear messages, promotional and cultural activities, parent training, school staff training, providing psychiatric services for withdrawal, counselling and reference to receive specialized services. The political stream involves global attention towards non-communicable diseases and high-risk behaviours, and the significant impact of preventing these behaviours during adolescence on the health status of society. Also, the supreme leader's attention to social harms, and the establishment of the National Committee for Prevention and Control of Alcohol, have played significant roles.

CONCLUSIONS

While the problem stream helped to highlight the problem and increase policy-makers' attention, the politics stream played a significant role. Despite international evidence on the effectiveness of training in sexual issues in reducing high-risk behaviours, it did not succeed in being added to the agenda. The policy stream was heavily influenced by ideology and the political parties in power, affecting evidence-based policy-making. In countries with an ideological approach, the political stream plays a vital role in setting problems on the agenda.

Factors affecting students' attitudes towards reproductive health in the north of Iran: Designing an educational program

BACKGROUND

It is essential to empower young people to promote reproductive health (RH) and develop effective educational programs to prevent risky behaviors. This study aimed to investigate the factors affecting students' attitudes towards RH based on the ecological model and then design an educational program.

METHODS

This cross-sectional study was conducted on 461 female students aged 18-29 in the north of Iran. This study was done in two stages. In the first stage, factors affecting the attitude towards RH including demographic questionnaire, interpersonal communication skills, family communication pattern, depression, stress and anxiety, body self-image, and self-confidence were determined. In the second stage, an educational program was designed based on the most effective factors. Independent t-test, ANOVA, and multiple linear regression were employed using SPSS version 20 software. Also, STATA version 15 software was utilized for statistical modeling to predict the best predictive model of attitude towards RH.

RESULTS

47.7% of students had a good attitude toward RH. The majority of students had problems with interpersonal communication skills (60.7%). Also, 28.5% experienced depression, 35.8% anxiety, and 12.8% stress at different levels. More than a quarter of the students (26.5%) had poor body self-image and 18.7% had Undesirable self-esteem. Interpersonal skills (P = 0.002), family communication pattern (P = 0.004), stress (p = 0.019), anxiety (P = 0.001), and body self-image (P = 0.034) have a significant relationship with the attitude towards RH. The multiple regression showed that the most important effective factor on RH is the dialogue orientation of family communication pattern (P = 0.041), stress (P = 0.002), and anxiety (P = 0.001).

CONCLUSION

Stress and anxiety management training and the use of dialogue orientation in the family communication pattern for young female students are recommended based on the scientific model.

The influence of depressive symptoms and school-going status on risky behaviors: a pooled analysis among adolescents in six sub-Saharan African countries

BACKGROUND

Evidence from sub-Saharan Africa (SSA) regarding risky behaviors among adolescents remains scarce, despite the large population (approximately 249 million out of 1.2 billion globally in 2019) of adolescents in the region. We aimed to examine the potential influence of depressive symptoms and school-going status on risky behaviors among adolescents in six SSA countries.

METHODS

We used individual cross-sectional data from adolescents aged 10-19 based in eight communities across six SSA countries, participating in the ARISE Network Adolescent Health Study (N = 7,661). Outcomes of interest were cigarette or tobacco use, alcohol use, other substance use, getting into a physical fight, no condom use during last sexual intercourse, and suicidal behavior. We examined the proportion of adolescents reporting these behaviors, and examined potential effects of depressive symptoms [tertiles of 6-item Kutcher Adolescent Depression Scale (KADS-6) score] and school-going status on these behaviors using mixed-effects Poisson regression models. We also assessed effect modification of associations by sex, age, and school-going status.

RESULTS

The proportion of adolescents reporting risky behaviors was varied, from 2.2% for suicidal behaviors to 26.2% for getting into a physical fight. Being in the higher tertiles of KADS-6 score was associated with increased risk of almost all risky behaviors [adjusted risk ratio (RR) for highest KADS-6 tertile for alcohol use: 1.70, 95% confidence interval (95% CI): 1.48-1.95, p < 0.001; for physical fight: 1.52, 95% CI: 1.36-1.70, p < 0.001; for suicidal behavior: 7.07, 95% CI: 2.69-18.57, p < 0.001]. Being in school was associated with reduced risk of substance use (RR for alcohol use: 0.73, 95% CI: 0.53-1.00, p = 0.047), and not using a condom (RR: 0.81, 95% CI: 0.66-0.99, p = 0.040). There was evidence of modification of the effect of school-going status on risky behaviors by age and sex.

CONCLUSION

Our findings reinforce the need for a greater focus on risky behaviors among adolescents in SSA. Addressing depressive symptoms among adolescents, facilitating school attendance and using schools as platforms to improve health may help reduce risky behaviors in this population. Further research is also required to better assess the potential bidirectionality of associations.

HIV-Related Knowledge and Sexual Behaviors among Teenagers: Implications for Public Health Interventions

Background: Teenagers are at a turning point in people's physical and psychological maturity and are also in a critical period in reproductive and sexual health. It is reported that the initial age at first sexual behavior is younger than decades ago, which implies that the risky sexual behavior among teenagers may be on the rise. However, it is unclear about the changes of sexual knowledge and behaviors in recent years. Methods: Based on the national sentinel surveillance survey in 2011-2021 among students in Hangzhou, we selected out teenagers aged 10-19 years as our study sample. Demographic characteristics (gender, age, marital status, etc.), knowledge of HIV and sexual behaviors were collected. The sexual knowledge score and sexual behaviors were analyzed, and their influencing factors were explored. Results: In total, 1355 teenagers were incorporated in this study; the awareness rates of sexual knowledge in 2011, 2013, 2014 and 2021 were 74.9%, 71.8%, 89.3% and 95.8%, respectively, which showed an overall upward trend. The results of binary logistic regression showed that the survey year, whether students had received and participated in HIV-related publicity services and whether they had sexual behaviors, had a significant influence on whether the awareness rate ≥ 75%. The survey year and whether the awareness rate ≥ 75% had a significant influence on whether students had sexual behaviors. Conclusions: Both the average scores and awareness rates of teenagers' sexual knowledge showed an overall upward trend from 2011 to 2021. Teenagers' initial sexual behavior was at a low age, and the proportion of teenagers who had fixed, temporary and commercial heterosexual sex was still relatively high despite no significant increasing. Therefore, we should further strengthen health education on the risks of sexual behaviors from schools, families and health-related institutions to ensure teenagers receive HIV-related publicity services.

Prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda

BACKGROUND

The use of psychoactive substances such as alcohol, heroin and marijuana is associated with negative health outcomes such as sexual violence and unintended pregnancies, and risky sexual behaviours. Although there is evidence linking psychoactive substance use and risky sexual behaviours such as inconsistent condom use and multiple sexual relationships, there is limited data on sex under the influence of psychoactive substances among young people. This study aimed to investigate the prevalence and predictors of sex under the influence of psychoactive substances among young people in informal settlements in Kampala, Uganda.

METHODS

A cross-sectional study was conducted among 744 sexually active young psychoactive substance users in informal settlements in Kampala, Uganda. Data were collected through face-to-face interviews using a digitalized structured questionnaire, preloaded on the Kobocollect mobile application. The questionnaire captured data on the socio-demographic characteristics of the respondents, history of psychoactive substance use, and sexual behaviours. Data were analysed using STATA Version 14.0. A modified Poisson regression model was used to determine the predictors of sex under the influence of psychoactive substances.. Adjusted prevalence ratios at a p-value value ≤ 0.05 with a 95% confidence interval were considered.

RESULTS

About 61.0% (454/744) of the respondents had had sex under the influence of psychoactive substances in the last 30 days. The predictors of sex under the influence of psychoactive substances were being female (PR 1.18, 95% CI: 1.04-1.34), being 20-24 years of age (PR: 1.22, 95% CI: 1.04-1.44), being married (PR 1.15, 95% CI: 1.01-1.31) or divorced/separated (PR 1.43, 95% CI: 1.26-1.61), not living with biological parents or guardians (PR 1.22, 95% CI: 0.99-1.50), earning 71 USD and below (PR 0.86, 95% CI: 0.79-1.03) and using alcohol (PR 1.43, 95% CI: 1.25-1.69), marijuana (PR 1.16, 95% CI: 1.02-1.31) and khat (PR 1.25, 95% CI: 1.10-1.42) in the last 30 days.

CONCLUSION

The study found that a high proportion of sexually active young people in informal settlements in Kampala, Uganda had engaged in sex under the influence of psychoactive substances in the past 30 days. The study also identified several factors associated with sex under the influence of psychoactive substances, including being female, being aged 20-24 years, being married or divorced or separated, not living with biological parents or guardians, and using alcohol, marijuana, or khat in the past 30 days. Our findings suggest the need for targeted sexual and reproductive health programs that incorporate risk-reduction interventions aimed at reducing sex under the influence of psychoactive substances, especially among females and those who do not live with their parents.

Factors affecting risk-taking behaviors among sexually active adolescents tested for HIV/STD

OBJECTIVE

The purpose of this secondary data analysis was to identify potential contributors to high-risk sexual behaviors among sexually active adolescents who were tested for HIV and STDs compared to those who did not test for HIV and STDs.

METHOD

Data from the 2019 Youth Risk Behavior Survey (YRBS) was used to explore potential predictors of risky behaviors among those tested for HIV/STD. A sample size of 3226 from the YRBS data base was used to explore predictors using Chi-square and logistic regressions analyses.

RESULTS

Most adolescents reported not being tested for HIV (77.4%) and STD (83.9%). There were statistical differences between those tested for HIV and condom use, sexual intercourse before the age of 13 years, sexual intercourse with multiple people, and use of marijuana. Similar findings were found with adolescents tested for STDs.

CONCLUSION

Findings of this study support the recommendations for a better understanding of the associations between drug use, early initiation of sexual activity, and condom use. Development of appropriate public health educational interventions can help decrease risky behaviors among these adolescents.

Level and determinants of knowledge, attitude, and practice of risky sexual behavior among adolescents in Harar, Ethiopia

Background

Adolescence is a transition period of advancement from a state of immature sexual characteristics to sexual and reproductive maturity; an improvement in the mental form progressing to the mental maturity of a grown-up adult; and a period of transition from total socioeconomic dependence to relative independence. An adolescent is defined as a person aged between 10 and 19 years. This study assessed the level and determinant factors of knowledge, attitude, and practice of risky sexual behavior among secondary school adolescents in Harar, Eastern Ethiopia, 2022.

Methods

A school-based cross-sectional study design was employed. From the total population of adolescents, 387 respondents were sampled. A simple random sampling method was used to select study participants. The data was collected by using a self-administered questionnaire and analyzed using SPSS version 26.

Result

Among the participants, 47.3% had good knowledge of risky sexual behavior. 41.9% had a positive attitude toward risky sexual behavior. 36.1% of students had started sexual activity before they reached 18 years old. Out of 9.3% of respondents who have had sexual intercourse, almost 50% of them had multiple partners. Students who live in urban areas were three times (adjusted odds ratio: 3.3, 95% CI: 1.6, 6.6) more likely to have good knowledge about risky sex than their counterparts in rural settings.

Conclusion

There is a significant number of risky sexual behaviors, such as having a different sexual partner and having unprotected sex with a non-regular partner. Being female, in urban residence, not having pocket money, and attending parties have significant associations with having good knowledge about risky sex. Harari Regional Educational and Health Bureau should provide repeated tailored information that can specifically address the attitude of the adolescents toward risky sexual behavior using different media, teachers, and school clubs in respect of sexual and reproductive health. The existing adolescent reproductive health program should be strengthened and evaluated to improve the sexual behavior of adolescents.

Risky sexual behaviors and their associated factors within high school students from Collège Saint André in Kigali, Rwanda: An institution-based cross-sectional study

Background

Risky sexual behaviors (RSBs) remain public health concerns in adolescents from sub-Saharan Africa (SSA), and these practices may increase vulnerability to reproductive health problems if no early healthcare strategies are implemented. While previous studies reported that adolescents are engaged in these RSBs due to diverse influences such as the teenage stage, urbanization, and change in the environment they experience, there is a shortage of studies on RSB among adolescents in SSA. This study assessed the magnitude of RSBs and the RSB-associated factors among in-school adolescents.

Methods

School-based cross-sectional study was conducted among 263 Saint Andre school students in Kigali, Rwanda, from July 3, 2020, to September 30, 2020. Systematic random sampling techniques were employed. All data were entered into Epi-Data and analyzed using SPSS version 25. Chi-square tests and multivariable logistic regression analyses were applied to determine factors associated with risky sexual behaviors. Confidence intervals (CIs) of 95% and 5% for statistical significance were maintained.

Results

Of 263 participants, 109 (41%) experienced RSB in their lifetime. Among them, 66 respondents (60.55%) utilized contraceptive methods to prevent sexual and reproductive problems that can be caused by unprotected sexual intercourse. The students who experienced domestic violence had increased odds of experiencing RSB [odds ratio (OR) = 4.22; 95% CI: 1.6-11.23] than their counterparts. Those in grade 11 (OR = 2.68; 95% CI: 1.06-6.78) and grade 12 (OR = 4.39; 95% CI: 1.82-10.56) were more likely to practice RSB than those in grade 10. Alcohol users were almost more likely to experience RSB (OR = 3.9; 95% CI: 1.97-5.5) than their counterparts. Those who lived away from their biological parents had higher likelihood of experiencing RSB (OR = 2.5; 95% CI: 1.14-4.42) than those who lived with one or both parents. Students who experienced peer pressure were more likely to engage in RSB (OR = 3.9; 95% CI: 2.01-7.51) than their counterparts.

Conclusion

Promoting specific intervention programs built upon the factors associated with RSB among high school students needs to be prioritized.

Unmarried Sri Lankan youth: sexual behaviour and contraceptive use

Background

Youth are at high risk for casual and unprotected sexual activities even before marriage. The objective of the study is to describe the sexual behavior, and contraceptive use among unmarried youth of Sri Lanka and to assess the factors associated with sexual behaviour.

Methods

An observational descriptive cross-sectional study was conducted in three selected districts in Sri Lanka from 1st March 2019 to 31st January 2020 among 1057 never-married youth using a self-administered questionnaire. Both stratified cluster sampling and snowball sampling were used to select the eligible never-married youth. Factors associated with sexual intercourse were assessed using logistic regression.

Results

Compared to boys (26%), more girls (35%) were engaged in unprotected sexual intercourse. Among sexually active unmarried youth aged less than 20 years, 10% had sexual intercourse with an unknown person. Unmarried Tamil and estate sector youth displayed significantly lower chances of sexual intercourse compared to Sinhala and urban counterparts (OR = 0.390, CI = 0.213-0.715, p = 0.002 and OR = 0.807, CI = 0.709-0.978, p = 0.020 respectively). Youth in the rural (69.5%) and urban sectors (87.3%) tend to use contraceptives during intercourse compared to the youth in the Estate sector (51.1%).

Conclusions

A significant portion of youth are exposed to sexual risk behavior including unprotected sexual intercourse even before marriage which can contribute to many social and health consequences. Focus interventions are needed to address the issue.

Psychological Factors and Sexual Risk Behaviors: A Multidimensional Model Based on the Chilean Population

Human immunodeficiency virus (HIV) is a global health problem, with sexual risk behaviors (SRB) being the main routes of spreading the virus. Evidence indicates that different psychological factors influence SRB (e.g., attitude towards condoms, sexual self-concept, sexual sensation seeking, knowledge of sexual risk behaviors, risk perception). This study proposes an explanatory model of sexual risk behaviors in young people and adults. The sample consisted of 992 young people and adults aged between 18 and 35 years. The model presented good levels of fit (X2 = 3311.433, df = 1471, CFI = 0.964, TLI = 0.959, RMSEA = 0.036), explaining 56% of the variance of sexual activity with multiple partners, 77% of the inadequate use of protective barriers, and 58.8% of sexual activity under the influence of alcohol or drugs from a set of psychological factors in self-report measures. The details of the results offer novel contextual evidence for the prioritization of prevention-oriented psychosocial interventions.

Experiences of Getting Reproductive Health Information from Friends as the Most Influenced Factor on Human Immunodeficiency Virus (HIV) Risk Behavior in Adolescents

BACKGROUND: Adolescents are a vulnerable group to reproductive health and sexuality problems. The problem of drug use and premarital sexual behavior is the focus of attention for adolescents because it can be a risk of HIV transmission. Providing information from various parties regarding reproductive health is expected to reduce adolescents risk of carrying out HIV risk behaviors. AIM: This study purpose was to analyze the experience of obtaining reproductive health information (from friends, parents, community, community leaders, social media, and organizations) that most influence HIV risk behavior in adolescents. METHODS: This cross-sectional study was conducted on adolescents aged 15–19 years living with their parents in Surakarta. The research sample was 450 teenagers. The sampling used convenience sampling technique and data collection using a questionnaire. Data analysis was performed using Chi-square and Fisher’s exact test in bivariate analysis and logistic regression in multivariate analysis. RESULTS: Information from friends is the most influential factor on HIV risk behavior in adolescents (OR = 0.314, CI = 0.090–1.102). Teenagers who get information from friends tend to carry out HIV risk behaviors because the information is not credible and comprehensive and is more toward the negative, namely, pornography. CONCLUSION: Reproductive health information from friends is not necessarily correct. Efforts to improve the skills of adolescents to find credible sources of information on reproductive health and sexuality are needed to reduce the risk of HIV transmission.

Determinants of risky sexual behaviour among undergraduate students at the University of Gondar, Northwest Ethiopia

Risky sexual behaviour (RSB) is defined as behaviours leading to sexually transmitted diseases and unintended pregnancies. According to the Joint United Nations Program on HIV/AIDS, HIV infection was very high among adolescents and youths living in sub-Saharan Africa including Ethiopia. This study was aimed to assess the prevalence of RSB and associated factors among undergraduate students at the University of Gondar.An institution-based cross-sectional study was conducted from June to July 2019 and a simple random sampling technique was employed to select 420 students. Data were collected using a structured self-administered questionnaire, entered into Epi-info version 7.0 and exported to Statistical Package for Social Sciences (SPSS) version 25 for analysis, and presented in frequencies, percentages and tables. Bivariable and multivariable logistic regression analysis were carried out to identify variables having significant association with RSB.The prevalence of RSB among undergraduate students at the University of Gondar was 44.0%. Age [adjusted odds ratio (AOR): 2.12; 95% confidence interval (CI) (1.19-3.79)], residence [AOR: 2.14; 95% CI (1.22-3.75)], living arrangement [AOR: 9.79; 95% CI (5.34-17.9)], daily religious attendance[AOR: 0.57; 95% CI (0.33-0.99)], drink alcohol [AOR: 9.19; 95% CI (3.74-22.59)] and having information about reproductive health and sexually transmitted diseases [AOR:3.05; 95% CI (1.00-9.27)] were factors significantly associated with RSB.Nearly half of the respondents engaged in risky sexual activity. This prevalence is high and the students are at high risk of exposure to sexually transmitted diseases that need reproductive health intervention like counselling and discussion. Creating awareness is needed for the students regarding reproductive health and the risk of sexually transmitted diseases. In addition, giving special attention is required for students who use alcohol, who did not live with family and who have urban residence.

The Occurrence of Sexual Risk Behaviors and Its Association With Psychological Well-Being Among Kenyan Adolescents

Objective: Sexual risk behavior during adolescence is an important public health problem. Self-esteem and hopefulness are potentially important psychological factors that may play a role in the behavioral regulation mechanisms of adolescents. These factors are inadequately explored in sub-Saharan Africa. This study aimed at exploring patterns and associated factors for sexual risk behavior (SRB), self-esteem, and hopefulness among adolescents from a resource-poor setting in Kenya.

Method: A cross-sectional study conducted in 2019 among 296 adolescents (12–17 years old) from rural Kilifi (n = 133) and urban informal settings of Nairobi (n = 163) in Kenya. Participants completed the Kilifi Health Risk Behavior Questionnaire, Rosenberg self-esteem questionnaire, and Hope scale administered via computerized tablets. A binary outcome variable based on the experience of adolescents of at least one of the five forms of SRB: transactional sex, sexual violence, intergenerational sex, early sexual debut, and condom non-use was generated. Bi-variate analysis was conducted to summarize various social-demographic and psychosocial factors. A multivariable logistic regression model was fitted to investigate factors associated with the occurrence of SRB, self-esteem, and hopefulness among adolescents.

Results: About 13% of the participants had experienced a form of SRB, and among these, 36% reported co-occurrence of multiple forms of SRB. Adolescent SRB was largely characterized by having experienced sexual violence, as well as intergenerational and transactional sex. Higher scores of hopefulness were reported among adolescents who never experienced SRB (P = 0.03) at bivariate analysis level. However, both self-esteem and hopefulness were not significantly associated with the occurrence of SRB in the adjusted logistic regression analysis. Having depressive symptoms (Adj. OR = 3.8, 95% CI: 1.39–10.4), feeling unsafe in the neighborhood (Adj. OR = 3.4, 95% CI: 1.6–7.2), and being in higher compared with lower primary education level (Adj. OR = 0.3, 95% CI: 0.1–0.8) were statistically significantly associated with the occurrence of SRB.

Conclusion: Targeted reproductive health interventions, designed with the cognizance of structural and social drivers of adolescent SRB, are needed to concurrently tackle multiple forms of SRB. It is important to integrate mental health promotion within these interventions. More research is needed to understand the mechanisms and implications of self-esteem and hopefulness for adolescent sexual and reproductive health.