Risky Sexual Behavior and Associated Factors Among Secondary School Students in Mirab Abaya District, Southern Ethiopia, 2024

Risky Sexual Behavior and Associated Factors Among Secondary School Students in Mirab Abaya District, Southern Ethiopia, 2024 | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Risky Sexual Behavior and Associated Factors Among Secondary School Students in Mirab Abaya District, Southern Ethiopia, 2024 Yegetaneh Hailegiorgis, Mekdes Kondale, Zeleke Gebru, Eden Hailegiorgis This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5820398/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction : Ethiopia prioritized adolescent and youth health programmes in recent years; particularly in sexual and reproductive health and youth development. Despite these efforts, significant challenges remain, risky sexual behavior among adolescents poses significant public health challenges, including high rates of unintended pregnancies and sexually transmitted infections. Objective : To assess the magnitude of risky sexual behavior and factors associated with it among secondary school students in Mirab Abaya district, Southern Ethiopia, 2024. Method : A school-based cross-sectional study was carried out on 389 students selected by simple random sampling method from September 30 to October 14, 2024. The data were collected using a self-administered structured pretested questionnaire and analyzed using the statistical package for social science version 27. Binary logistic regression analysis was employed to identify the associated variables with the outcome variable. Variables found to have a p-value of <0.25 in the bivariable analysis were passed to multivariable analysis. Result : From 408 students, 389 participated, with a response rate of 95%. The prevalence of risky sexual behavior was 30.10% (95% CI: 25.65%–34.55%). Substance use (AOR = 3.85, 95% CI: 1.44–10.22), watching pornographic movies (AOR = 2.10, 95% CI: 1.64–5.61), neglectful parental monitoring (AOR = 3.71, 95% CI: 1.39–9.86), peer pressure (AOR = 3.46, 95% CI: 1.30–9.88), authoritative parental monitoring (AOR = 0.18, 95% CI: 0.07–0.49). Students’ knowledge (AOR = 2.33, 95% CI: 1.53–6.17) and attitudes (AOR = 2.58, 95% CI: 1.89–6.90) were significantly associated with risky sexual behavior. Conclusion and recommendation : The magnitude reported here is significant which demand crucial attention. Educational campaigns should be implemented to address the risks associated with substance use. Efforts should be made to improve the availability of condom, parental engagement in discussions regarding sexuality, and establishment of peer-led health clubs within schools to fostering supportive environments and promoting healthier choices among students. Risky sexual behavior secondary school students sexual and reproductive health problem Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Figure 6 Background Over the last decade, worldwide trends in adolescent sexual behavior have shown significant shifts. Particularly, there has been an overall improvements in access to sexual health education and an increase in contraceptive use (1). Despite these improvement, adolescent’s risky sexual behavior (RSB) remains a significant public health challenge. RSB refers to behaviors those increase the risk of sexually transmitted infections (STI), unintended pregnancies and related complications and consequences (2). It include unprotected sex and multiple sexual partners, early sexual experience, or having sex by chance or causal sex with non-regular sexual partner such as commercial sex workers (3). Adolescence is a critical developmental stage characterised by significant physical, emotional, and social changes, typically occurring between the ages of 10 and 19. During this period, individuals experience heightened curiosity about sexuality and increased peer influence, which can lead to RSB (4). Globally, many adolescents are engaging in sexual activity at younger ages and the prevalence of having multiple sexual partners are also concerning (5). According to the youth risk behavior surveillance system among US high school adolescents in 2021, 30% students are engaged in sexual activity before 18 and 48% of students did not use a condom the last time they had sexual intercourse (6) . Rates of STIs have continued to grow, reaching epidemic proportions; adolescents, for example, comprise approximately 30% of all new STI cases worldwide (7). And of concern are the increases in the rates of HIV infection in this group. As of 2021, approximately 38 million people are living with HIV globally, with adolescents aged 10-19 accounting for about 5%, or roughly 1.7 million individuals. In Sub-Saharan Africa, the situation is more severe, with around 19 million people living with HIV, representing nearly two-thirds of the global total. In this region, adolescents make up about 10% of new infections, particularly affecting young women who face higher rates of infection (8). A study on Rwandan high school adolescent in 2023 has found that 41% of participants reported engaging in RSB (9). Evidence also shows that the major sexual and reproductive health (SRH) problems among adolescents and youth in Ethiopia are RSB (10). According to a systematic and meta-analysis report among high school adolescent in Ethiopia, 40% of students are engaged in RSB (11). Adolescents account about 30% of all new HIV infections (8). These statistics highlight the critical state of HIV prevalence worldwide especially among adolescents and emphasise the urgent need for targeted prevention and intervention strategies. Literature show youths’ RSB are associated with various factors, including socio-demographic and econimic factors, substance abuse, exposure to pornography, lack of comprehensive knowledge, poor attitude of adolescents towards RSB, and peer pressure and lack of parental monitoring are among the most common factors (12–14). RSB is a priority public health concern for adolescents and youth because of the high prevalence of HIV/AIDS and STIs. Increased risk of young people for STIs related with unsafe sexual practices, such as unprotected sex is a sensitive and significant issue in sexually active age groups (15). The consequences of young people’s sexual behavior when not using contraception have become a global issue mainly because it is related with pregnancy and STIs (16). Ethiopia has been making efforts to mitigate the underlying factors contributing to RSB that pose significant health risks for adolescents and youths. This is being achieved through the implementation of revised national adolescent and youth health strategies (NAYH 2021-2025) (17), which focus on enhancing health literacy, improving equitable access to health services, elevating the quality of these services, and strengthening leadership and accountability. Subsequently, there has been a gradual increase in awareness of sexual health and condom use among Ethiopian adolescents. However, the median age at which adolescents engage in sexual activity is decreasing, with figures dropping from 21.2 years for women and 23.2 years for men in 2011 (18) to 16.6 years for women and 21.2 years for men in 2016 (19). Additionally, the median age at first birth has declined to 18.7 years, as reported in 2019 (20). This trend suggests that the age at first sexual experience is likely even lower and therefore more people are even engaging in RSB. A recent meta-analysis (in 2023) has identified a pooled prevalence of 40% for RSB among high school adolescents in Ethiopia (11). Both unwanted pregnancy and STIs are significant public health concerns in Ethiopia. Estimates suggest around 26.6% of pregnancies in Ethiopia are unintended (21). The prevalence of STI among pregnant women is also higher (16.7%) compared to some other regions (22). Adolescents who have experienced abuse by others and had antisocial behaviors have been found to have an increased chance of involving in RSB (23). And parental practices such as parent child-relationships, parental monitoring and parents and adolescent’s communication about sexuality are protective against RSB (12). This is due to their sexual activeness and tendency to frequently engage in unsafe sexual practices, such as unprotected sex (24). RSB among school students remains a serious problem and these behaviors are even increasing (24). In Ethiopia, despite studies being conducted in this particular issue, research tends to concentrate on major towns and universities, neglecting the diverse contexts of smaller towns or rural areas. Nevertheless, according to central statistical agency (CSA) report in 2016, majority of Ethiopian adolescents and youths are reside in rural areas, with 79 percent of total males population (19,466,543) and 78% of total females population (19,079,177) and the fact that the comprehensive knowledge of HIV among adolescents and youth, especially among rural males and females is very low compared to urban areas (39% vs 49% and 16% vs 39% respectively) shows the need for focusing on rural adolescents (10). In the context of Mirab Abaya, very little data is known regarding the extent of RSB and associated factors among the students, despite the fact that these issues are now prevalent among high school students (25). Therefore, assessing the RSB of high school students is a part of crucial step to decrease RSB and its consequences. Thus, this study, was conducted to assess RSB and identify factors associated with RSB among high school students in Mirab Abaya district in 2024. Methods and materials Study area and period This study was conducted in the secondary schools of Mirab Abaya district, Gamo Zone, South Ethiopia. Mirab Abaya is one of the districts Gamo zone, South Ethiopia. This district is bordered on the east and south by lake Abaya, which separates it from the Oromia region on the east and Arba Minch Zuria district at the south, in the west by Chencha district, in the northwest by Boroda district, and on the north by the Wolayita zone. According to projected population data for 2024 by the CSA, this particular district has a total population of 217,560 comprising 108,691 men and 108,869 women (26). Birbir town is one of the six administrative towns in the Gamo zone. It is administrative centre of Mirab Abaya district, located 389 km south Addis Ababa, and situated between 6°22’25.59” north Latitude and 37°43’59” east Longitude (27). The district has six secondary schools in total. These are Wajifo secondary school, Dega Birbir secondary school, Ankober secondary school, Omo Lante secondary school, Dodone Abaya secondary school, and Birbir town secondary school. The first five schools are located in the rural kebeles of the districts, whereas the latter is found in the Birbir town administration. The study was conducted from September 30 to October 14, 2024. Study design and participants A school-based cross-sectional study was conducted. The source population consisted of all secondary school students in this district. The study population included students from selected secondary schools who met the eligibility criteria. The sample population comprised randomly selected students from these schools who also fulfilled the eligibility requirements. The study unit was secondary school students, specifically those enrolled in grades 9 to 12. Students who had dropped out of school or were absent during the data collection period were excluded from the study. Sample size determination Sample size is determined using single population proportion formula. The value of “p” is set at 22% based on previous RSB study among students in Arba Minch town (28). Confidence level(z) of 95% and degree of precision(d) of 5% was applied, total population of school (N) was 3,917. An additional 10% of sample size was added as a contingency for non-responses and design effect was also considered (multiplying by 1.5). Accordingly, the sample size calculated was 263. Finite population correction formula was applied since the calculated sample size (263) is greater than 5% (=196) of the size of source population (3,917). Sample size after correction: n = 247 Non-response rate: 10% of 247 = 25 Sample size: n = 247 + 25 = 272 Design effect (D eff ): 1.5 x 272 = 408 Therefore, the final sample size was= 408 Sampling procedure As shown on figure 1, In a lottery method, two secondary schools were randomly chosen from a total of six in the district. The selected schools were Birbir Town Secondary School and Ankober Secondary School. A complete list of students from each school’s attendance records was compiled as the sampling frame. Next, each student was assigned a unique code based on their grade level. Using Microsoft Excel, random numbers were generated to select study participants proportionally from each grade level. Totaly, computer generated random sample of 408 students was chosen, ensuring that every student had an equal chance of being included in the study. For the academic year 2024/25, the total enrollment in all secondary schools in the Mirab Abaya district was 3,917 students. Study variables The dependent variable is Risky sexual behavior. Independent variable include Socio-demographic and economic factors such as:- Age of the student, Sex of the student, Educational level of the student, Religion of the student, Living situation, Educational status of the student’s father, Educational status of the student’s mother, Occupational status of the student’s father, Occupational status of the student’s mother, Pocket money of the student. Behavior related factors such as:- Habit of substance use and Habit of watching pornographic movies. External factors such as:- Parental monitoring and Peer pressure. SRH related factors such as:- Knowledge about RSB and Attitude towards RSB. Operational definitions A, Risky sexual behavior : refers to students’ act of engaging in early initiated sexual intercourse OR sex by chance with unknown person or irregular partner (e.g. commercial sex workers) OR have multiple sexual partner OR using condom inconsistently (29). Early initiation of sexual intercourse : students’ engaging in sexual activity before the age of 18 (30). Non-regular sexual partner : students’ engaging in sexual intercourse by chance with an unknown or irregular partner at any age (29). Multiple sexual partner : students’ status of having more than one sexual partner in life time (29,31). Inconsistent use of condom : failure to use condom at least once during sexual intercourse (29,32,33). B, Pocket money : refers to the amount of money given to students by parents or guardians for different purposes per month (34). It was categorised as 2000 ETB (35). C, Substance use : refers to the use of at least one of alcohol, cigarettes, Khat or illicit drugs (shisha, hashish, cocaine, marijuana) “frequently” by students in the past 12 months (36,37). In this study, “frequently” means 4 or more times per month; while “occasionally” means 1 to 3 times per month (38). D, Watching pornographic movies : refers to students’ viewing of any form of videos of pornography accessed regardless of the format (e.g., online streaming, DVDs) that primarily depict sexual content intended to arouse viewers (39). Students those watched pornographic videos “frequently” in the past 12 months were classified as having a “habit of watching pornographic movies,” while the others were not. In this study, “frequently” means 4 or more times per month; while “occasionally” means 1 to 3 times per month (39). E, Parental monitoring : refers to students’ perception of how their parents or guardians are aware of and actively involved in controlling and guiding them with respect to the matters of RSB (40). Eight 5-point Likert scale questions were used to assess participants’ responses, with each statement assigned a numerical score ranging from 1 to 5. The scoring was as follows: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, and Strongly Disagree = 1 [75]. The scores from all eight items were summed, and percentiles were used to classify the responses. A uthoritative p arental monitoring : students perceiving their parents or guardians as those attempt to control their behavior by putting rules, discussing and reasoning (41). P ermissive p arental monitoring : students perceiving their parents or guardians as which are reluctant to impose limits on them (41). N eglectful parental monitoring : students perceiving their parents or guardians as those totally uninvolved and make no demands on their children and they are often indifferent, dismissive, or even completely neglectful (41). Students scoring below the 33.3 rd percentile (29.00) were categorised as having a perception of “neglectful parental monitoring.” Those scoring between the 33.3 rd (29.00) and 66.6 th percentiles (34.00) were classified as having a perception of “permissive parental monitoring,” Students scoring at or above the 66.6 th percentile (34.00) were considered to have a perception of “authoritative parental monitoring.” F, P eer pressure : The degree to which students perceive that they are influenced by their peers to conform to group norms, behaviors, or attitudes in the matters of RSB (42). Four items of 5-point Likert scale questions were used to assess participants’ responses regarding peer pressure, with each statement assigned a numerical score ranging from 1 to 5. The scoring was as follows: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, and Strongly Disagree = 1. The scores from all 4 items were summed, and the median (10.01) was used to classify the responses. High peer pressure : Students scoring the median (10.01) and above were categorised as experiencing “high peer pressure.” Low peer pressure : Students scoring below the median (10.01) were classified as having “low peer pressure.” G, Knowledge : refers to the awareness and understanding that secondary school students possess regarding RSB (43). It was measured by using 10 “Yes” or “No” questions delivered to study participants. Each correct response was given a score of one, and a wrong answer was given a score of zero. After computation, the median score (10.00) was used to determine the overall knowledge of RSB among respondents (44). Adequate knowledge about RSB : students those scored, a median score of 10.00 and above was considered to have adequate knowledge about RSB. Inadequate knowledge about RSB : students those scored below the median score of 10.00 was considered to have inadequate knowledge about RSB. H, Attitude : refers to students’ positive or negative evaluation regarding RSB [82]. Eight 5 point Likert scale questions were used to rate the participant`s response and each statement is assigned a numerical score ranging from 1 to 5. These are Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, Strongly Disagree = 1 (45). Positive questions were summed from the lowest score (1 = strongly disagree) to the highest score (5 = strongly agree) and negative questions are summed from the lowest score (1 = strongly agree) to the Higher score (5 = strongly disagree). After recoding, the total score was calculated by summing the scores of all 8 items. The median score (22.00) was used to evaluate the degree of favourability or unfavorability toward the RSB. Students who scored at or above the median score (22.00) were considered to have a favourable attitude, while those who scored below the median score (22.00) were regarded as having an unfavourable attitude towards RSB. Data collection instruments and procedure The questionnaire was prepared in English after reviewing different literature (2,22,46–48) interpreted into the Amharic and then translated back to English. Data were gathered from 389 randomly selected respondents by two degree holders from a health background, specifically youth-friendly service workers, who received training from the principal investigator. The collectors were supervised by one supervisor with an MPH from September 30 to October 14, 2024. A pre-test was conducted on 20 students from Omo Lante high school, who were not included in the main study. Necessary corrections were made based on the findings of the pre-test before the actual data collection. The structured questionnaire was organised into five section:- socio-demographic and economic items, RSB items, behavior-related items, items of external factors and SRH-related items. Data processing and analysis The data collected was exported to the statistical package for social science (SPSS) version 27 for analysis. Descriptive statistics was used to summarize the magnitude of RSB and other variables. The results were summarized and presented in tables, charts, and graphs. Binary logistic regression was employed to identify the association. Before the inclusion of independent variables in the binary logistic regression model, the Hosmer-Lemeshow goodness of fit statistics was used to check if the data fit the model. Both the crude odds ratio (COR) and the adjusted odds ratio (AOR) with a 95% CI was calculated to determine the significance of an association between exposure and outcome variables. Variables found to have a p-value of <0.25 in the bivariable analysis were passed to multivariable analysis. In the multivariable analysis variables with p-value of <0.05 was considered significant. Data quality assurance The data was collected using self-administered questionnaire. Completeness of daily data collection was checked by the supervisor each day. The questionnaire was initially prepared in English and evaluated by experienced researchers. Follow-up was conducted during data collection to ensure adherence to protocols. Additionally, the overall data collection process, including its completeness and accuracy, was assessed by the supervisor. Results of Cronbach’s Alpha obtained from the analysis shows that for items of parental monitoring (α=0.898), for items of peer pressure (α=0.757), and for items of attitude towards risky sexual behavior (α=0.776). Results Socio-demographic and economic factors As shown in table 1, Among 408 secondary school students in Mirab Abaya district selected for this study, 389 participated, resulting in a response rate of 95%. The remaining 19 students did not participate due to time constraints. Among the 389 participants, 53.70% are female students and 46.3% are male students. The majority of participants (77.90%) live with their parents, while 21.9% reside in privately rented houses. Risky Sexual Behavior The prevalence of risky sexual behavior was 30.10% (95% CI: 25.65%–34.55%). Out of 389 respondents, 205 (52.70%) had history of sexual intercourse. The mean age for the 205 students who have engaged in sexual intercourse was 16.91 years, with a standard deviation of 1.940 years see table 2 and figure 2. Behavior related factors Table 3 shows that out of the total 389 participants, when asked about their habit regarding substance uses, 34 students (8.70%) reported “Yes” for drinking alcohol in the past 12 months while 25 students (73.53%), among those who drunk alcohol, 16 (47.06%) did it frequently. Similarly, out of 389 participants, 23 students (5.90%) reported “Yes” for watching pornographic movies in the same period while 20 (86.96%) students, among those who have watched, rushed in to sex after watching. External factors Majority of the participants, 127 (32.60%), 152 (39.10%), and 182 (46.80%) had “Agreed” that their parents had family rules regarding sexuality, need permission from their parents to go anywhere, and talk about sex, sexuality and its consequences, respectively. On the other hand, majority 188 (48.30%) responded “Disagree” for their parents allowing them to stay at friend’s house overnight while 181 (46.50%) had responded “Strongly disagree” for their parents not minding if they get a boyfriend/girlfriend; externa factors are summarized in figure 3 and figure 4. Knowledge about risky sexual behavior Students were evaluated for knowledge about RSB. Accordingly, out of 389 participants, 368 (94.60%) considered engaging in sexual activity before the age of 18 to be risky. Similarly, 368 (94.60%) believed that inconsistent condom use increases the risk of STIs. However, majority 346 (88.90%) believe that having multiple sexual partners does not lower the risk of STIs, while 43 (11.10%) think it does. Out of 389 participants, 369 (94.90%) considered casual sexual encounters without prior knowledge of a partner’s sexual health status to be risky, while 20 (5.10%) did not. See figure 5. Attitude towards risky sexual behavior The participants also reported their agreement and disagreement on different attitude items ranging from “strongly agree to strongly disagree”. Among 389 participants, majority 191 (49.10)%) disagreed with the statement that having multiple sexual partners enables choosing the best one while only 59 (15.20)% agreed. And 179 (46.00%) agreed that condoms reduce sexual pleasure, while 52 (13.4%) disagreed. See figure 6. Associated factors with risky sexual behavior Bivariable analysis of independent variables with risky sexual behavior Table 4 shows us that out of the 16 independent variables examined, 8 were identified as significant at α=0.25. These factors include student’s living status, pocket money, substance use habit, habit of watching pornographic movies, parental monitoring, peer pressure, knowledge and attitudes toward RSB. Multivariable analysis of independent variables with risky sexual behavior When we see table 5, in the multivariable analysis, 6 independent variables were identified as being associated with RSB. These variables include: habit of substance use, habit of watching pornographic movies, parental monitoring, peer pressure, knowledge about RSB, and attitudes towards RSB. Students who engage in substance use are approximately 3.85 times more likely to engage in RSB compared to those who do not use substances. Students who watch pornographic movies have about 2.10 times the odds of engaging in RSB compared to those who do not watch such content. Students with neglectful parental monitoring have approximately 3.71 times the odds of engaging in RSB compared to their peers with permissive parental monitoring. Conversely, students with authoritative parental monitoring are around 81.6% less likely to engage in RSB compared to those with permissive parental monitoring. High peer pressure is associated with approximately 3.46 times the odds of engaging in RSB when compared to students experiencing low peer pressure. Students with inadequate knowledge about RSB are about 2.33 times more likely to engage in such behavior compared to those with adequate knowledge. And, students with a favourable attitude toward RSB have approximately 2.58 times the odds of engaging in such behavior compared to those with an unfavourable attitude. Discussions Addressing the issue of RSB among adolescents is crucial, especially in a rapidly evolving health landscape like Ethiopia, where significant strides have been made in prioritising SRH programs for youth (49). Despite these efforts, the magnitude of RSB remains alarmingly high, leading to dire public health consequences such as unintended pregnancies and STI (21,22). In the present study, it was found that 30.1% of secondary school students in the Mirab Abaya district of South Ethiopia region engaged in RSB. This figure contrasts sharply with a study conducted in Brasil, which reported a prevalence of only 9% among undergraduate students in a city in Southern Brasil (50); The level of sexual education provided in schools can significantly influence students’ understanding of sexual health (51). Even though not conclusive, the study conducted in Brasil may benefit from more comprehensive sexual education programs may have empowered students with skills about safe sexual practices. Conversely, in the Mirab Abaya district, limited access to resources and education on sexual health may have contributed to higher rates of risky behavior when compared with the aforementioned study. Some studies conducted in Africa report lower rates of RSB compared to the findings of this study. For instance, a study in Uganda indicated a prevalence of 18.8% (47), while a study done in Nigeria reported a rate of 19.2% (52), both figures are relatively lower than the 30.1% observed here. With respect to the study conducted in Nigeria, several factors may explain the discrepancy, including differences in socio-economic status and levels of health literacy between the two countries. Additionally, the mean age of participants in the study done in Nigeria was 15.2 years (±1.4), compared to 17.8 years (±1.780) in this study. This age difference is critical; older adolescents may be more likely to engage in sexual activities and face different pressures compared to their younger counterparts. As individuals mature, they may encounter increased social influences and peer dynamics that can impact their sexual behavior. When we compare this with study conducted in Ethiopia, the magnitude of RSB in this study is slightly lower than the pooled prevalence reported by one study which is 40% (53), This discrepancy might be attributed to the fact that systematic review encompasses a broader geographical scope and diverse population characteristics, which may lead to variations in reported prevalence rates. And the figure reported in this study is higher than studies conducted different areas in Ethiopia like, 17.2% in Aksum secondary school (23), 13.7% in Humera (54), 12.8% Gondar secondary and preparatory school (55), 19% Tana Haik high school in Bahir Dar (29), 25.2% Mizan, Bonga, and Tepi preparatory schools (56), 17.9% in Boditi primary and secondary school in Wolayita (57) and 22.4% Arba Minch secondary and preparatory school in Gamo (28). This higher magnitude in Mirab Abaya may be due to socio-economic conditions, cultural norms, and the level of access to sexual health education may vary significantly across different regions, with some areas benefiting from more comprehensive programs than others. Second this may be also result from social desirability bias, where individuals under report risky behaviors due to stigma or fear of judgment. This study align with study conducted at Jimma zone preparatory schools which reported 32.3% of preparatory students are engaged in RSB (58). When compared to studies conducted in Ethiopia, such as the 82.2% prevalence reported in Pawe district, Benishangul Gumuz (2), and the 68.2% prevalence in Horu Guduru, East Wollaga (59), the figure of 30.1% found in this study is notably lower. This variation could be due to several factors, including differences in socio-cultural contexts and the availability of sexual health education. In regions like Pawe and Guduru, the higher rates of RSB may be influenced by less effective educational programs that do not adequately address safe sexual practices. In examining the association between substance use and RSB, this study found that, students who engage in substance use are approximately 3.85 times more likely to engage in RSB compared to those who do not use substances. This is may be due to substances such as alcohol and drugs can impair cognitive functions, leading to poor decision-making; when individuals are under the influence, they may underestimate risks, such as not using protection during sexual encounters or engaging in sexual activity (60). This figure is higher than the 3.2 OR reported in a study conducted in Italy (61), which might suggest us that while substance use is a significant factor in both contexts, the interaction between substance use and RSB may be influenced by cultural, social, and external factors unique to each setting. Italy’s relatively lower AOR might reflect the varying levels of access to sexual education and health resources, which could mitigate the impact of substance use on RSB among Italian adolescents. Conversely, the OR found in this study is lower than that reported in studies from Kenya (OR = 6.02) (62) and Nigeria (52), where the associations were markedly stronger that the OR reported in this study. Finding from Haramaya, revealed that students who used substances were 2.81 times more likely to engage in RSB (63). Comparatively, the finding of this study is consistent with a study conducted in Injibara (64). In this research, students who watch pornographic movies have about 2.10 times the odds of engaging in RSB compared to those who do not watch such content. This finding aligns with research from Indonesia, which noted that higher levels of pornography addiction correlate with increased RSB among students (65). The significant relationship observed in both studies suggests there may be a common underlying mechanism where exposure to pornography is associated with RSB. Similarly, a study from Nigeria reported an AOR of 2.705 for RSB linked to pornography consumption which is relatively similar with finding of this study (66). Comparatively, other studies conducted in Ethiopia present varying OR for the association between watching pornography and RSB. For instance, a systematic review and meta-analysis indicated an even stronger association, with an AOR of 4.21 (67). In contrast, a study from Adigrat University found a lower AOR of 1.6 (68), indicating that while watching pornographic videos is a factor, its influence can vary significantly based on social dynamics. The disparities in findings may also reflect differences in study populations, methodologies, and the degree of pornography exposure or addiction measured across different contexts. Furthermore, studies from Injibara and Gedeo Zone reported AOR of 1.58 and 2.51, respectively (64,69). In comparison to this study, the research conducted in Arba Minch reported a notably higher AOR of 8.80 (28). This discrepancy may be due to the urban nature of Arba Minch town, where access to and consumption of pornographic materials could be more prevalent than this study which focused on school from a rural setting, where both the exposure to and availability of such content may be significantly lower than the earlier. In this work, students with neglectful parental monitoring have approximately 3.71 times the odds of engaging in RSB compared to their peers with permissive parental monitoring. While, students with authoritative parental monitoring are around 81.6% less likely to engage in RSB compared to those with permissive parental monitoring. A study in the US found that adolescents perceiving less parental monitoring had 1.7 times the odds of testing positive for a STI, highlighting the detrimental impact of inadequate parental oversight on adolescent sexual health (70). While, research from Dares salaam, Tanzania, indicated that students with high parental monitoring were more exposed to RSB, with an AOR of 1.54 (71). This paradox may suggest that while parental monitoring is generally protective, its effectiveness can vary based on the quality and nature of the monitoring employed. Focusing on studies conducted in Ethiopia, findings reveal a consistent pattern where parental monitoring significantly influences RSB. In Harar, high parental monitoring was associated with a 28% reduction in the incidence rate of RSB (72), while in Wolayita Sodo, students lacking parental monitoring exhibited an AOR of 1.86 for increased RSB (73). Similarly, in Gedeo, adolescents without parental monitoring were 2.10 times more likely to engage in RSB (69). In the current study, high peer pressure is associated with approximately 3.46 times the odds of engaging in RSB when compared to students experiencing low peer pressure. This stresses the importance of social dynamics in shaping adolescent behavior, as the desire for acceptance and recognition among peers could drive individuals to partake in actions that contradict their values or risk perceptions. The finding aligns with research conducted in Singapore, which reported that peer pressure was a critical factor influencing RSB, yielding an odds ratio of 3.84 (95% CI: 2.27–6.50) (74). Similarly, a study conducted in Rwanda found that peer pressure was significantly associated with RSB among high school students, with an odds ratio of 3.9 (95% CI: 2.01–7.51) (75). In contrast, studies from other regions in Ethiopia reported varying degrees of association between peer pressure and RSB, with AORs ranging from 1.90 (95% CI: 1.37–2.64) in Injibara (64) to 4.22 in Guduru (59). These variations may be attributed to contextual factors such as cultural norms of the regions studied. In this study, students with inadequate knowledge about RSB are about 2.33 times more likely to engage in such behavior compared to those with adequate knowledge. This finding is lower when compared with research conducted in Vietnam, which reported an AOR of 4.03 (76). Studies conducted in Ethiopia have also highlighted the significant relationship between knowledge and RSB. For instance, research among undergraduate students at the University of Gondar found an AOR of 3.05 associated with knowledge (77). Similarly, a study of high school students in the Amhara region reported an even higher AOR of 4.53 (33) while knowledge in Arba Minch showed an AOR of 2.89 (28). In the assessment of attitude, students with a favourable attitude toward RSB have approximately 2.58 times the odds of engaging in such behavior compared to those with an unfavourable attitude. This finding is consistent with a study conducted in the US, which reported positive association between attitudes toward RSB and actual engagement in such behaviors, with an AOR of 3.74 (78). In all its odds, the higher figure observed in the US study may be attributed to a more liberal lifestyle prevalent in that context, where attitudes toward RSB are generally more accepting. This cultural acceptance could lead to a greater likelihood of individuals acting on their favourable attitudes. In contrast, our study setting might reflect more conservative social norms. Similarly, research from KwaZulu-Natal University in South Africa indicated that favourable attitudes toward RSB were also significantly linked to the likelihood of engaging in those behaviors, yielding an AOR of 3.09 (79). Research in East Wollega found a positive association, though with a lower AOR of 1.22 (80), while a study in Harar reported an AOR of 2.11 (81). When we see the limitations of the study, the cross-sectional design employed capture a snapshot of behaviors and factors at a single point in time, which may not reflect changes over time or the directionality of relationships. There is also risk of under-reporting RSB due to the sensitivity of the subject, influenced by social desirability bias. Participants may feel compelled to provide responses they believe are more socially acceptable. Recall bias may have affected the reliability of information regarding the age of first sexual intercourse, condom use, the number of sexual partners and recalling past Behaviors. And Reliance solely on quantitative data may limit the understanding of the complex factors such as cultural attitudes and individual experiences that can influence students’ RSB. Conclusion and recommendations The findings underscore the need for targeted interventions and comprehensive sexual health education to address this critical public health issue. The analysis identified six key independent variables that are significantly associated with RSB: substance use, consumption of pornographic material, parental monitoring style, peer pressure, knowledge about RSB, and attitudes towards RSB. Addressing the issue of risky sexual behavior among secondary school students in the Mirab Abaya district of South Ethiopia requires a multifaceted approach. Mirab Abaya district health office is encouraged to implement educational campaigns focused on the substance use, highlighting its strong association with RSB by through community outreach to raise awareness. This study revealed that, from those not using condom during sexual intercourse, 38.68% reported that it is “difficult to get condom”. Therefore, to address the reported difficulty in obtaining condoms by establishing easily accessible distribution points in schools and community centres. Consider providing free or subsidised condoms as part of health services. As figures from this study shows, 27.3% of students that their family have no rules regarding sexuality; and 29.7% of students that their family don’t talk with students about sex, sexuality, and its consequences. So the office is recommended to organise educational sessions for parents to enhance their monitoring knowledge, skills and encourage open discussions about sexuality and its consequences. The absence of youth-friendly services in Ankober Kebele of the district could represent a gap in the provision of essential sexual and reproductive health resources for adolescents. This lack of services leaves young people vulnerable to risky sexual behaviors and health issues, as they may not have access to reliable information, counseling, and medical care tailored to their specific needs. In a rapidly evolving health landscape, particularly in regions like Ethiopia where adolescent health is a growing concern, the establishment of youth-friendly services is critical. Young people often rely on peers or the internet for sexual and reproductive information, which can be misleading or inaccurate, further exacerbating the issue of RSB. While Birbir offers some youth-friendly services, the effectiveness of these services is hindered by the insufficient training of professionals. Health workers play a crucial role in delivering appropriate and sensitive care to adolescents, and without adequate training, they may be ill-equipped to address the unique needs and concerns of young people. It is crucial that health care workers in Birbir receive specialized training focused on adolescent health. In addition to the district’s health office, partnerships with NGOs working in the district, such as Pathfinder International and Engender Health, can facilitate workshops and training sessions that equip professionals with the necessary skills to engage effectively with youth. Comprehensive sexual health education programs should be given in schools. These programs must not only cover the basics of sexual health but also address the socio-cultural factors influencing RSB identified in this study. Schools should collaborate with local NGOs currently working in the district, such as Pathfinder International and Engender Health, to develop age-appropriate reproductive health education that encompass topics such as consent, safe sexual practices, and the implications of substance use on sexual health. In this study, 27% of all students in the study use substances and 27.7% of students reported that they feel pressured by their friends to engage in sexual activity. Therefore, it is better if schools establish peer-led RH clubs to empower students to discuss topics related to substance use, sexuality and peer pressure. This could help reduce stigma and promote healthier choices. Next, schools can disseminate health information regarding the consequences of substance use, RSB through cooperation with district’s health authorities. And facilitating regular meetings between parents and school bodies to discuss rules and communication regarding sexuality, thereby fostering a supportive environment for students is also instrumental. Re-empowering the dedicated YFS that provide confidential counselling and health education on SRH ensuring that young people feel comfortable seeking help. Offer training for health professionals on adolescent sexual health issues, emphasising the importance of addressing substance use and peer pressure in consultations. Partner with local schools to conduct regular health check-ups and educational sessions, focusing on preventive and promotion measures related to RSB. And actively engage in counselling sessions that address the impacts of substance use and peer pressure on RSB, equipping students with coping strategies and information. We encourage NGOs operating in the local area, such as Compassion International, Engender Health, Mercy Corps and Pathfinder International to actively support the development of health education materials that emphasize the importance of condom use. Our research indicates that among 205 students who have initiated sexual intercourse, 51.71% do not use condoms, highlighting a critical gap in sexual health education. Implementing culturally appropriate social and Behavior change communication campaigns can effectively address misconceptions and promote safe practices among adolescents. Parents can foster open discussions about sexuality to overcome cultural taboos and reduce stigma. Community leaders can enhance this effort by organizing educational sessions for both parents and adolescents on sexual health. The Health Development Armies (HDA) can collaborate with health extension workers to facilitate these programs and advocate for more youth-friendly services, as the district currently has only one underutilized center. Regular discussions between parents and youth, starting from an early age, are crucial for addressing the changes during adolescence and determining the right time to begin relationships. Parents need to communicate frankly about STIs, including HIV/AIDS, the risks of unwanted pregnancies, and the effects of alcohol, substances, khat, and smoking. Additionally, parents should advocate for balanced social media use by encouraging adolescents to set limits on screen time, engage in offline activities, and develop a healthy relationship with technology. Maintaining open dialogues about social media experiences, including challenges and peer pressures, will foster a supportive environment. Abbreviations AIDS:- Acquired Immune Deficiency Syndrome; AOR:- Adjusted Odds Ratios; CI:- Confidence Interval; COR:- Crude Odds Ratio; CSA:- Central Statistical Agency; EDHS:- Ethiopian Demographic and Health Survey; HIV:- Human Immune Deficiency Virus; OR:- Odds Ratio; RH:- Reproductive Health; SPSS:- Statistical Package for Social Sciences; SRH:- Sexual and Reproductive Health; STI:- Sexually Transmitted Infection; UNAIDS:- United Nations Programme on HIV/AIDS; UNDP:- United Nations Development Programme; USA:- United States of America; WHO:- World Health Organization Declarations Ethics approval and consent to participate The data collection was carried out after obtaining approval for the proposal from the Arba Minch University Department of Public Health Institutional Review Board (IRB) on 19 th July 2024 G.C., with reference number IRB/23193/2024. Permission to conduct the research in the proposed setting was obtained from officials of educational office and school principals. To ensure the participants’ right to self-determination and privacy, they were informed both verbally and in writing about the study. The data collectors clearly informed them that they had the right to decide voluntarily whether to participate in the study and the right to refuse participation.For students of under 18 years of ages, assent forms were signed by parents and guardians to let them to be included in the study. The participants’ right to privacy was protected throughout the study through anonymity. The study was anonymous, and the questionnaire was administered in a classroom with adequate space between each participant. The information gained during data collection was kept confidential. And a closed cardboard box was provided for participants to submit their completed questionnaires. Consent for publication Consent for publication was be obtained from all study participants. Availability of data and materials The whole data of the atudy will be made available, without undue reservation when needed. Competing interests The authors declare that they have no competing interests. Funding This work was funded by Arba Minch University. The funder had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript. Authors’ contributions Yegetaneh Hailegiorgis take part in planning and designing the study, monitored the data collection process, and analysed the data. Mekdes Kondale and Zeleke Gebru served as main advisors, participating in the study’s planning and providing guidance in writing the manuscript. Eden Hailegiorgis gave advise the behavioral aspect of the study and provided guidance in writing the manuscript. All advisors reviewed and approved the final manuscript. Acknowledgements I acknowledge Arba Minch University, College of Medicine and Health Sciences for organizing and funding the study. I would like to express our heartfelt gratitude to the study participants from Mirab Abaya district, whose consent and involvement were crucial for this research. I also appreciate the cooperation of the Mirab Abaya district Health Office, Education Office, Secondary schools in the district as well as the invaluable support from the data collectors and health extension workers in the study area. References Organization WH. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization; 2023. Agajie M, Belachew T, Tilahun T, Amentie M. Risky sexual behavior and associated factors among high school youth in Pawe Woreda, Benishangul Gumuz Region. Sci J Clin Med. 2015;4(4):67–75. Samuel L, Angamo MT. Substance use and sexual risk behavior and factors associated with HIV transmission in southern Ethiopia. Int J Pharm Sci Res. 2012;3(4):1080. Usonwu I, Ahmad R, Curtis-Tyler K. Parent–adolescent communication on adolescent sexual and reproductive health in sub-Saharan Africa: a qualitative review and thematic synthesis. Reprod Health. 2021;18:1–15. Mpofu JJ. Overview and methods for the youth risk behavior surveillance system—United States, 2021. MMWR Suppl. 2023;72. Mpofu JJ. Overview and methods for the youth risk behavior surveillance system—United States, 2021. MMWR supplements. 2023;72. Oster E. Correction Appendix for “Sexually Transmitted Infections, Sexual Behavior and the HIV/AIDS Epidemic”, Quarterly Journal of Economics May 2005. Economics. 2005; UN A. Global HIV & AIDS statistics — Fact sheet [Internet]. 2022 [cited 2024 Apr 17]. Available from: https://www.unaids.org/en/resources/fact-sheet. Ndagijimana E, Biracyaza E, Nzayirambaho M. Risky sexual behaviors and their associated factors within high school students from Collège Saint André in Kigali, Rwanda: An institution-based cross-sectional study. Frontiers in Reproductive Health. 2023 Mar . Ministry of Health E. Reproductive Health, Family Planning and Adolescent Health Desk [Internet]. Available from: https://www.moh.gov.et/en/initiatives-4-%0Acol/Adolescent_and_Youth_Health_Program Daka D, Shaweno D. Magnitude of risky sexual behavior among high school adolescents in Ethiopia: a cross-sectional study. J Public Heal Epidemiol. 2014;6(7):211–5. Cherie A, Berhanie Y. Assessment of parenting practices and styles and adolescent sexual behavior among high school adolescents in Addis Ababa, Ethiopia. 2015; Abebe M, Tsion A, Netsanet F. Living with parents and risky sexual behaviors among preparatory school students in Jimma zone, South west Ethiopia. Afr Health Sci. 2013;13(2):498–506. Tilahun M, Ayele G. Factors associated with age at first sexual initiation among youths in Gamo Gofa, south west Ethiopia: a cross sectional study. BMC Public Health. 2013;13:1–6. Animaw W, Bogale B. Sexual & Reproductive Healthcare. 2013; Turnbull T, Van Schaik P, Van Wersch A. Adolescents’ preferences regarding sex education and relationship education. Health Educ J. 2010;69(3):277–86. Democratic F, Of R, Health MOF. National Adolescents and Youth Health. 2021;(December 2021). Central Statistical Agency [Ethiopia], ICF International. Ethiopia Demographic and Health Survey 2011. Heal San Fr. 2012;1–452. [Ethiopia] CSA, International I. Ethiopia Demographic and Health Survey 2016. Heal San Fr. 2016;1(1):107–10. Ethiopian Public Health Institute (EPHI), ICF. Ethiopia Mini Demographic and Health Survey 2019. Heal San Fr [Internet]. 2021;1–207. Available from: https://dhsprogram.com/pubs/pdf/FR363/FR363.pdf Teshale AB, Tesema GA. Magnitude and associated factors of unintended pregnancy in Ethiopia: a multilevel analysis using 2016 EDHS data. BMC Pregnancy Childbirth. 2020;20:1–8. Asres AW, Endalew MM, Mengistu SY. Prevalence and trends of sexually transmitted infections among pregnant women in Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study. Pan Afr Med J. 2022;42(1). Srahbzu M, Tirfeneh E. 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. Biomed Res Int. 2020;2020(1):3719845. de Guzman MR, Bosch KR. G07-1715 high-risk behaviors among youth. 2007; Yigzaw MT, Yalew AW, Mesfin AB, Demisie AS. Sexual initiation and factors associated with it among Addis Ababa University undergraduate students, Addis Ababa, Ethiopia. Am J Heal Res. 2014;2(5):260–70. Mirab Abaya [Internet]. Available from: https://en.wikipedia.org/wiki/Mirab_Abaya Library, T.R.H.C.D. Birbir, Southern Nations, Nationalities, and People’s Region, Ethiopia. [cited June 2024 17]; Available from: https://www.mindat.org/feature- 342056.html. Mersha A, Teji K, Darghawth R, Gebretsadik W, Shibiru S, Bante A, et al. Risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia. J public Heal Epidemiol. 2018;10(12):429–42. Amare H, Azage M, Negash M, Getachew A, Desale A, Abebe N. Risky sexual behavior and associated factors among adolescent students in Tana Haik high school, Bahir Dar, Northern Ethiopia. Int J HIV/AIDS Prev Educ Behav Sci. 2017;3(4):41. Underwood JM, Brener N, Thornton J, Harris WA, Bryan LN, Shanklin SL, et al. Overview and methods for the youth risk behavior surveillance system—United States, 2019. MMWR Supplements. 2020;69(1):1. Yarinbab TE, Tawi NY, Darkiab I, Debele F, Ambo WA. Risky sexual behaviors and associated factors among students of mizan aman college of health science, Southwest Ethiopia: cross-sectional study. JOJ Nurs Heal Care. 2018;8(3):805–12. Tadesse G, Yakob B. Risky sexual behaviors among female youth in Tiss Abay, a semi-urban area of the Amhara Region, Ethiopia. PloS one. 2015 Mar 4;10(3):e0119050. Kassa GM, Degu G, Yitayew M, Misganaw W, Muche M, Demelash T, Mesele M, Ayehu M. Risky sexual behaviors and associated factors among Jiga high school and preparatory school students, Amhara Region, Ethiopia. International scholarly research notices. 2016; A. A. Shah, Z. F. Syed, and S. H. B. J. B. M. Aslam, “Pocket Money as a proxy for Family Income,” Int. J. Soc. Sci. Educ., vol. 2, no. 4, pp. 688–693, 2012. Girmay A, Mariye T. Risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum town, northern Ethiopia, 2018. BMC Res Notes. 2019;12:1–7. Shegute T, Wasihun Y. Prevalence of substance use in university students, Ethiopia. Subst Abus Res Treat. 2021;15:11782218211003558. Tesfaye G, Derese A, Hambisa MT. Substance use and associated factors among university students in Ethiopia: a cross-sectional study. J Addict. 2014;2014. Kebede D, Alem A, Mitike G, Enquselassie F, Berhane F, Abebe Y, et al. Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia. BMC Public Health. 2005;5:1–8. Habesha T, Aderaw Z, Lakew S. Assessment of exposure to sexually explicit materials and factors associated with exposure among preparatory school youths in Hawassa City, Southern Ethiopia: a cross-sectional institution based survey. Reprod Health. 2015;12:1–12. Baumrind D. The influence of parenting style on adolescent competence and substance use. J Early Adolesc. 1991;11(1):56–95. Dinka, B., DETERMINANT OF RISKY SEXUAL behaviourS AMONG STUDENTS OF ADDIS KETEMA SECONDARY AND PREPARATORY SCHOOL, ADDIS ABABA, ETHIOPIA 2021/22. 2021. Wakgari, M., The Influences of Family, Peers and School Clubs on Adolescents’ Sexual behaviour and Risk Perception. 2007. Henok A, Kassa A, Lenda A, Nibret A, Lamaro T. Knowledge, attitude and practice of risky sexual behavior and condom utilization among regular students of Mizan-Tepi university, South West Ethiopia. J Child Adolesc Behav. 2015;3(5):244. Kassie AA, Gudayu TW, Araya BM. Knowledge, attitude, and preventive practices towards sexually transmitted infections among preparatory school students in West Gojjam Zone, Ethiopia. Adv Public Heal. 2020;2020(1):6894394. Osanyin GE, Ogunyemi DO, Oluwole EO, Oyekanmi OD. Knowledge, attitude and preventive practices of sexually transmitted infections among unmarried youths in an urban community in Lagos State, Nigeria. African J Prim Heal Care Fam Med. 2020;12(1):1–7. Anteneh Messele Birhanu AMB, Telake Azale Bisetegn TAB, Solomon Meseret Woldeyohannes SMW. High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis. 2014; Anyanwu MU, Tamwesigire I. A cross-sectional study of prevalence and predictors of risky sexual behavior among school-going adolescents in Mbarara municipality, Uganda. Afr Health Sci. 2023;23(3):109--116. Admassu TW, Wolde YT, Kaba M. Ethiopia has a long way to go meeting adolescent and youth sexual reproductive health needs. Reprod Health. 2022;19(Suppl 1):130. FDRE M of H. National Reproductive Health Strategy [Internet]. Addis Ababa; 2016. 1–57 p. Available from: https://www.prb.org/wp-content/uploads/2020/06/Ethiopia-National-Reproductive-Health-Strategy-2016-2020.pdf Gräf DD, Mesenburg MA, Fassa AG. Risky sexual behavior and associated factors in undergraduate students in a city in Southern Brazil. Rev Saude Publica. 2020;54:41. Chavula MP, Zulu JM, Hurtig AK. Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review. Reprod Health. 2022;19(1):1–25. Olaoye T, Agbede C. Prevalence and personal predictors of risky sexual behaviour among in-school adolescents in the Ikenne Local Government Area, Ogun State, Nigeria. Int J Adolesc Med Health. 2022;34(3). Aynalem BY, Alemu AA, Zeleke LB, Kassa GM. Risky sexual behavior and associated factors among secondary and above-education-level students in Ethiopia: A systematic review and meta-analysis. J Fam Med Prim Care. 2022;11(9):5024–30. Dadi AF, Teklu FG. Risky sexual behavior and associated factors among grade 9–12 students in Humera secondary school, western zone of Tigray, NW Ethiopia, 2014. Sci J Public Heal. 2014;2(5):410–6. Kasahun AW, Yitayal M, Girum T, Mohammed B. Risky sexual behavior and associated factors among high school students in Gondar City, Northwest Ethiopia. Int J Public Heal Sci. 2017;6(3):257–65. Kahsay T, Jejaw AKM, Mulatu K. Risky Sexual Behaviors and Associated Factors Among Mizan, Bonga and Tepi Preparatory School Students, Southwestern, Ethiopia, 2016: A Cross Sectional Study. J Aids Clin Res Sex Transm Dis. 2017;1–4. Deresse D, Debebe S. Magnitude of risky sexual behavior among high school adolescents in Ethiopia: A cross-sectional study. J Public Heal Epidemiol. 2014;6(7):211–5. Fentahun N, Mamo A. Risky sexual behaviors and associated factors among male and female students in Jimma Zone preparatory schools, South West Ethiopia: comparative study. Ethiopian journal of health sciences. 2014 Apr 15;24(1):59-68. Wakasa BF, Oljira L, Demena M, Regassa LD, Daga WB. Risky sexual behaviour and associated factors among sexually experienced secondary school students in Guduru, Ethiopia. Preventive medicine reports. 2021 Sep 1;23:101398. Ramey T, Regier PS. Cognitive impairment in substance use disorders. CNS Spectr. 2019;24(1):102–13. Flesia L, Cavalieri F, Angelini S, Bottesi G, Ghisi M, Tonon E, Roldan AP, Di Nisio A, Garolla A, Ferlin A, Foresta C. Health-related lifestyles, substance-related behaviors, and sexual habits among Italian young adult males: an epidemiologic study. Sexua. Kabiru CW, Orpinas P. Factors associated with sexual activity among high-school students in Nairobi, Kenya. Journal of adolescence. 2009 Aug 1;32(4):1023-39. Shore H, Shunu A. Risky sexual behavior and associated factors among youth in Haramaya Secondary and Preparatory School, East Ethiopia, 2015. Journal of Public Health and Epidemiology. 2017 Apr 30;9(4):84-91. Adal MA, Abiy SA, Reta MM, Asres MS, Animut Y. Prevalence of risky sexual behavior and associated factors among Injibara University students, Northwest Ethiopia. Frontiers in Reproductive Health. 2024 Mar 28;6:1356790. Yunengsih W, Setiawan A. Contribution of pornographic exposure and addiction to risky sexual behavior in adolescents. Journal of public health research. 2021 May;10(1_suppl):jphr-2021. Ikenna Macdonald Nwigwe, N. E. Agbapuonwu. Risky sexual behaviours and associated risky determinants among students’ of federal polytechnic, Oko, Anambra State. GSC Biol Pharm Sci. 2023;23(2):074–84. Kebede N, Bayou FD, Ayele FY, Kefale B, Mekonen AM, Dessie AM, Tsega Y. Prevalence and associated factors of early initiation of sexual intercourse among youth in Ethiopia: systematic review and meta-analysis. BMC Public Health. 2023 Oct 23;23(1):2072. Gebremariam G, Adhanom G, Hagos S, Berihu T. Pre-Marital Sexual Debut and Associated Factors among Unmarried Regular Students of Adigrat University, Northern Ethiopia. Wondimagegne YA, Anbese AT. Risky sexual behaviors and associated factors among adolescent in Gedeo Zone, South Ethiopia: a community based cross-sectional study. Scientific Reports. 2024 Aug 28;14(1):19908. DiClemente RJ, Wingood GM, Crosby R, Sionean C, Cobb BK, Harrington K, Davies S, Hook III EW, Oh MK. Parental monitoring: Association with adolescents’ risk behaviors. Pediatrics. 2001 Jun 1;107(6):1363-8. Mlunde LB, Poudel KC, Sunguya BF, Mbwambo JK, Yasuoka J, Otsuka K, Ubuguyu O, Jimba M. A call for parental monitoring to improve condom use among secondary school students in Dar es Salaam, Tanzania. BMC Public Health. 2012 Dec;12:1-1. Kassahun EA, Gelagay AA, Muche AA, Dessie AA, Kassie BA. Factors associated with early sexual initiation among preparatory and high school youths in Woldia town, northeast Ethiopia: a cross-sectional study. BMC Public Health. 2019;19:1–8. Azeze GA, Gebeyehu NA, Wassie AY, Mokonnon TM. Factors associated with risky sexual behaviour among secondary and preparatory students in Wolaita Sodo town, Southern Ethiopia; Institution based cross-sectional study. Afr Health Sci. 2021;21(4):1830–41. Wong M-L, Chan R, Koh D, Tan H-H, Lim F, Emmanuel S, et al. Premarital Sexual Intercourse Among Adolescents in an Asian Country: Multilevel Ecological Factors. Pediatrics. 2009;124:e44-52. Ndagijimana E, Biracyaza E, Nzayirambaho M. Risky sexual behaviors and their associated factors within high school students from Collège Saint André in Kigali, Rwanda: An institution-based cross-sectional study. Front Reprod Heal. 2023;5(March):1–10. Ngoc Do H, Ngoc Nguyen D, Quynh Thi Nguyen H, Tuan Nguyen A, Duy Nguyen H, Phuong Bui T, Bich Thi Vu T, Thanh Le K, Tuan Nguyen D, Tat Nguyen C, Gia Vu L. Patterns of risky sexual behaviors and associated factors among youths and adolescents in Vietnam. I. Tekletsadik EA, Ayisa AA, Mekonen EG, Workneh BS, Ali MS. Determinants of risky sexual behaviour among undergraduate students at the University of Gondar, Northwest Ethiopia. Epidemiology & Infection. 2022 Jan;150:e2. Warner TD. Adolescent sexual risk taking: The distribution of youth behaviors and perceived peer attitudes across neighbourhood contexts. Journal of Adolescent Health. 2018 Feb 1;62(2):226-33. Mutinta G, Govender K, Gow J, George G. An investigation on students’ risky sexual behavior at KwaZulu-Natal University, Durban, South Africa. American Journal of Sexuality Education. 2013 July 1;8(3):121-39. Tolera FH, Girma E, Mamo A, Babure ZK. Risky sexual behaviors and associated factors among high and preparatory school youth, East Wollega, Ethiopia, 2017: A cross-sectional study design. Journal of Public Health and Epidemiology. 2019 Jan 31;11(1):1-2. Mesele J, Alemayehu A, Demise A, Yusuf M, Abubeker F, Ahmed M, Jemal A. Level and determinants of knowledge, attitude, and practice of risky sexual behavior among adolescents in Harar, Ethiopia. SAGE Open Medicine. 2023 Jan;11:20503121221145539. Tables Tables 1 to 6 are available in the Supplementary Files section Additional Declarations No competing interests reported. Supplementary Files Tables.docx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5820398","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":404099029,"identity":"9d5d95ea-c1e7-4b1e-b4e4-260341d896fa","order_by":0,"name":"Yegetaneh Hailegiorgis","email":"","orcid":"","institution":"International Rescue Committee Ethiopia Program","correspondingAuthor":false,"prefix":"","firstName":"Yegetaneh","middleName":"","lastName":"Hailegiorgis","suffix":""},{"id":404099030,"identity":"c9942038-3bc7-4257-9672-3d26d7c5bdd7","order_by":1,"name":"Mekdes Kondale","email":"","orcid":"","institution":"Unit of Reproductive Health, Department of Public Health, College of Medicine and Health Sciences, Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Mekdes","middleName":"","lastName":"Kondale","suffix":""},{"id":404099031,"identity":"6e0403da-6450-4bb0-8453-495ff7375776","order_by":2,"name":"Zeleke Gebru","email":"","orcid":"","institution":"Unit of Reproductive Health, Department of Public Health, College of Medicine and Health Sciences, Arba Minch University","correspondingAuthor":false,"prefix":"","firstName":"Zeleke","middleName":"","lastName":"Gebru","suffix":""},{"id":404099032,"identity":"c9526873-d108-46a2-9a3b-f0a71b933651","order_by":3,"name":"Eden Hailegiorgis","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA8ElEQVRIiWNgGAWjYFCCBAZmBgYbHjb25gNAnoQMsVrS5Ph4jiWAtPAQq+WwsZyEjwGIS1gLP3vysccFv5gT2yR4Pr+6UWPBw8B++OgGfFoke56lG8/sY0tsk+7dZp1zDOgwnrS0G/i0GNzIMZPm7eFJbJM5u804hw2oRYLHDK8W+xv534BaJIAOy3lmnPOPCC0GEjls0jw/DIzZJHKYH+e2EaFF4swzoMMaEuTYeI6ZMef2SfCwEfILf3vyM2meP/955NubH3/O+VYnx89++BheLWDA2Aam2CTAJEHlYPAHTDJ/IE71KBgFo2AUjDQAAMwcREs1aGfaAAAAAElFTkSuQmCC","orcid":"","institution":"Unit of Health Promotion and Behavioral Science, Department of Public Health, College of Medicine and Health Sciences, Arba Minch University","correspondingAuthor":true,"prefix":"","firstName":"Eden","middleName":"","lastName":"Hailegiorgis","suffix":""}],"badges":[],"createdAt":"2025-01-13 13:38:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5820398/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5820398/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":75500841,"identity":"14dc0461-c729-45fc-87b7-d5397e960c4b","added_by":"auto","created_at":"2025-02-05 08:57:19","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":221634,"visible":true,"origin":"","legend":"\u003cp\u003eSchematic presentation of the sampling procedure in assessing the magnitude of risky sexual behavior and associated factors among secondary school students of Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/0dfef90985d8cfe548b4348e.png"},{"id":75501140,"identity":"0f649a41-bc85-41b1-a5c2-4d4f51e6dfcc","added_by":"auto","created_at":"2025-02-05 09:05:19","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":54326,"visible":true,"origin":"","legend":"\u003cp\u003eRisky sexual behavior among secondary school students of Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/a73080bc02f9c4e45e98de77.png"},{"id":75502662,"identity":"a639182d-5789-496b-8355-74a4087f88b6","added_by":"auto","created_at":"2025-02-05 09:13:19","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":33941,"visible":true,"origin":"","legend":"\u003cp\u003eParental monitoring status of secondary school students of Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/bd812229b3db02cae186fd9e.png"},{"id":75501142,"identity":"eb5136c4-9e4e-47b2-8812-675eb874cb4f","added_by":"auto","created_at":"2025-02-05 09:05:19","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":30269,"visible":true,"origin":"","legend":"\u003cp\u003ePeer pressure status of secondary school students of Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/7af77e8ee4572e6c2d83a076.png"},{"id":75500850,"identity":"b966bf62-ef47-48d7-ba7f-4e27440ce594","added_by":"auto","created_at":"2025-02-05 08:57:19","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":131489,"visible":true,"origin":"","legend":"\u003cp\u003eKnowledge about risky sexual behavior of secondary school students of Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/304af7dc4b88c86b94656c2e.png"},{"id":75500854,"identity":"c3d98218-f28a-464e-a855-de9ee400736c","added_by":"auto","created_at":"2025-02-05 08:57:20","extension":"png","order_by":6,"title":"Figure 6","display":"","copyAsset":false,"role":"figure","size":39992,"visible":true,"origin":"","legend":"\u003cp\u003eAttitude towards risky sexual behavior among secondary school students of Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e","description":"","filename":"6.png","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/e017b2b91ce640f35bb1bc7d.png"},{"id":75503119,"identity":"81791e9b-2e50-401b-be1b-b8a26d1bec47","added_by":"auto","created_at":"2025-02-05 09:21:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1393239,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/18ab5e68-df4f-4d98-b451-0efcb5c3ed45.pdf"},{"id":75501139,"identity":"b593bcb9-db59-47fc-b157-0296e9897bc3","added_by":"auto","created_at":"2025-02-05 09:05:19","extension":"docx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":55240,"visible":true,"origin":"","legend":"","description":"","filename":"Tables.docx","url":"https://assets-eu.researchsquare.com/files/rs-5820398/v1/d4b2074afe4da1115834b28c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Risky Sexual Behavior and Associated Factors Among Secondary School Students in Mirab Abaya District, Southern Ethiopia, 2024","fulltext":[{"header":"Background","content":"\u003cp\u003eOver\u0026nbsp;the last decade, worldwide trends in adolescent sexual behavior have shown significant shifts. Particularly, there has been an overall improvements in access to sexual health education and an increase in contraceptive use (1). Despite these improvement, adolescent\u0026rsquo;s risky sexual behavior (RSB) remains a significant public health challenge.\u003c/p\u003e\n\u003cp\u003eRSB refers to behaviors those increase the risk of sexually transmitted infections (STI), unintended pregnancies and related complications and consequences (2). It include unprotected sex and multiple sexual partners, early sexual experience, or having sex by chance or causal sex with non-regular sexual partner such as commercial sex workers (3).\u003c/p\u003e\n\u003cp\u003eAdolescence is a critical developmental stage characterised by significant physical, emotional, and social changes, typically occurring between the ages of 10 and 19. During this period, individuals experience heightened curiosity about sexuality and increased peer influence, which can lead to RSB\u0026nbsp;(4).\u003c/p\u003e\n\u003cp\u003eGlobally, many adolescents are engaging in sexual activity at younger ages and the prevalence of having multiple sexual partners are also concerning (5).\u0026nbsp;According to the youth risk behavior surveillance system among US high school adolescents in 2021, 30% students are engaged in sexual activity before 18 and 48% of students did not use a condom the last time they had sexual intercourse\u0026nbsp;(6)\u003cem\u003e.\u0026nbsp;\u003c/em\u003eRates of STIs have continued to grow, reaching epidemic proportions; adolescents, for example, comprise approximately 30% of all new STI cases worldwide\u0026nbsp;(7). And of concern are the increases in the rates of HIV infection in this group. As of 2021, approximately 38 million people are living with HIV globally, with adolescents aged 10-19 accounting for about 5%, or roughly 1.7 million individuals.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eIn Sub-Saharan Africa, the situation is more severe, with around 19 million people living with HIV, representing nearly two-thirds of the global total. In this region, adolescents make up about 10% of new infections, particularly affecting young women who face higher rates of infection (8).\u0026nbsp;A study on Rwandan high school adolescent in 2023 has found that 41% of participants reported engaging in RSB\u0026nbsp;(9).\u003c/p\u003e\n\u003cp\u003eEvidence also shows that the major sexual and reproductive health (SRH) problems among adolescents and youth in Ethiopia are RSB (10).\u0026nbsp;According to a systematic and meta-analysis report among high school adolescent in Ethiopia, 40% of students are engaged in RSB\u0026nbsp;(11). Adolescents account about 30% of all new HIV infections\u0026nbsp;(8). These statistics highlight the critical state of HIV prevalence worldwide especially among adolescents and emphasise the urgent need for targeted prevention and intervention strategies.\u003c/p\u003e\n\u003cp\u003eLiterature show youths\u0026rsquo;\u0026nbsp;RSB\u0026nbsp;are associated with various factors, including socio-demographic and econimic factors, substance abuse, exposure to pornography, lack of comprehensive knowledge, poor attitude of adolescents towards\u0026nbsp;RSB, and peer pressure and lack of parental monitoring are among the most common factors (12\u0026ndash;14).\u003c/p\u003e\n\u003cp\u003eRSB is a priority public health concern for adolescents and youth because of the high prevalence of HIV/AIDS and STIs. Increased risk of young people for STIs related with unsafe sexual practices, such as unprotected sex is a sensitive and significant issue in sexually active age groups\u0026nbsp;(15). The consequences of young people\u0026rsquo;s sexual\u0026nbsp;behavior\u0026nbsp;when not using contraception have become a global issue mainly because it is related with pregnancy and STIs\u0026nbsp;(16).\u003c/p\u003e\n\u003cp\u003eEthiopia has been making efforts to mitigate the underlying factors contributing to RSB that pose significant health risks for adolescents and youths. This is being achieved through the implementation of revised national adolescent and youth health strategies (NAYH 2021-2025) (17), which focus on enhancing health literacy, improving equitable access to health services, elevating the quality of these services, and strengthening leadership and accountability.\u003c/p\u003e\n\u003cp\u003eSubsequently, there has been a gradual increase in awareness of sexual health and condom use among Ethiopian adolescents. However, the median age at which adolescents engage in sexual activity is decreasing, with figures dropping from 21.2 years for women and 23.2 years for men in 2011 (18) to 16.6 years for women and 21.2 years for men in 2016 (19). Additionally, the median age at first birth has declined to 18.7 years, as reported in 2019 (20). This trend suggests that the age at first sexual experience is likely even lower and therefore more people are even engaging in RSB. A recent meta-analysis (in 2023) has identified a pooled prevalence of 40% for RSB among high school adolescents in Ethiopia (11).\u003c/p\u003e\n\u003cp\u003eBoth unwanted pregnancy and STIs are significant public health concerns in Ethiopia. Estimates suggest around 26.6% of pregnancies in Ethiopia are unintended (21). The prevalence of STI among pregnant women is also higher (16.7%) compared to some other regions (22).\u003c/p\u003e\n\u003cp\u003eAdolescents who have experienced abuse by others and had antisocial behaviors have been found to have an increased chance of involving in RSB (23). And parental practices such as parent child-relationships, parental monitoring and parents and adolescent\u0026rsquo;s communication about sexuality are protective against RSB (12). This is due to their sexual activeness and tendency to frequently engage in unsafe sexual practices, such as unprotected sex (24).\u0026nbsp;RSB\u0026nbsp;among school students remains a serious problem and these behaviors are even increasing\u0026nbsp;(24).\u003c/p\u003e\n\u003cp\u003eIn Ethiopia, despite studies being conducted in this particular issue, research tends to concentrate on major towns and universities, neglecting the diverse contexts of smaller towns or rural areas. Nevertheless, according to central statistical agency (CSA) report in 2016, majority of Ethiopian adolescents and youths are reside in rural areas, with 79 percent of total males population (19,466,543) and 78% of total females population (19,079,177) and the fact that the comprehensive knowledge of HIV among adolescents and youth, especially among rural males and females is very low compared to urban areas (39% vs 49% and 16% vs 39% respectively) shows the need for focusing on rural adolescents (10). In the context of Mirab Abaya, very little data is known regarding the extent of RSB and associated factors among the students, despite the fact that these issues are now prevalent among high school students (25). Therefore, assessing the RSB of high school students is a part of crucial step to decrease RSB and its consequences. Thus, this study, was conducted to assess RSB and identify factors associated with RSB among high school students in Mirab Abaya district in 2024.\u003c/p\u003e"},{"header":"Methods and materials","content":"\u003ch2\u003eStudy area and period\u003c/h2\u003e\n\u003cp\u003eThis study was conducted in the secondary schools of Mirab Abaya district, Gamo Zone, South Ethiopia. Mirab Abaya is one of the districts Gamo zone, South Ethiopia. This district is bordered on the east and south by lake Abaya, which separates it from the Oromia region on the east and Arba Minch Zuria district at the south, in the west by Chencha district, in the northwest by Boroda district, and on the north by the Wolayita zone.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eAccording to projected population data for 2024 by the CSA, this particular district has a total population of 217,560 comprising 108,691 men and 108,869 women (26).\u003c/p\u003e\n\u003cp\u003eBirbir town is one of the six administrative towns in the Gamo zone. It is administrative centre of Mirab Abaya district, located 389 km south Addis Ababa, and situated between 6\u0026deg;22\u0026rsquo;25.59\u0026rdquo; north Latitude and 37\u0026deg;43\u0026rsquo;59\u0026rdquo; east Longitude (27).\u003c/p\u003e\n\u003cp\u003eThe district has six secondary schools in total. These are Wajifo secondary school, Dega Birbir secondary school, Ankober secondary school, Omo Lante secondary school, Dodone Abaya secondary school, and Birbir town secondary school. The first five schools are located in the rural kebeles of the districts, whereas the latter is found in the Birbir town administration.\u003c/p\u003e\n\u003cp\u003eThe\u0026nbsp;study was conducted from September 30 to October 14, 2024.\u003c/p\u003e\n\u003ch2\u003eStudy design and participants\u003c/h2\u003e\n\u003cp\u003eA school-based cross-sectional study was conducted. The source population consisted of all secondary school students in this district. The study population included students from selected secondary schools who met the eligibility criteria. The sample population comprised randomly selected students from these schools who also fulfilled the eligibility requirements. The study unit was secondary school students, specifically those enrolled in grades 9 to 12. Students who had dropped out of school or were absent during the data collection period were excluded from the study.\u003c/p\u003e\n\u003ch2\u003eSample size determination\u003c/h2\u003e\n\u003cp\u003eSample size is determined using single population proportion formula. The value of \u0026ldquo;p\u0026rdquo; is set at 22% based on previous RSB study among students in Arba Minch town (28). Confidence level(z) of 95% and degree of precision(d) of 5% was applied, total population of school (N) was 3,917. An additional 10% of sample size was added as a contingency for non-responses and design effect was also considered (multiplying by 1.5).\u003c/p\u003e\n\u003cp\u003e\u003cimg src=\"data:image/png;base64,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\"\u003e\u003c/p\u003e\n\u003cp\u003eAccordingly, the sample size\u0026nbsp;calculated was 263.\u003c/p\u003e\n\u003cp\u003eFinite population correction formula was applied since the calculated sample size (263) is greater than 5% (=196) of the size of source population (3,917).\u003c/p\u003e\n\u003cp\u003eSample size after correction: n = 247\u003c/p\u003e\n\u003cp\u003eNon-response rate: 10% of 247 = 25\u003c/p\u003e\n\u003cp\u003eSample size: n = 247 + 25 =\u0026nbsp;272\u003c/p\u003e\n\u003cp\u003eDesign effect (D\u003csub\u003eeff\u003c/sub\u003e): 1.5 x 272 = 408\u003c/p\u003e\n\u003cp\u003eTherefore, the final sample size was=\u0026nbsp;408\u003c/p\u003e\n\u003ch2\u003eSampling procedure\u003c/h2\u003e\n\u003cp\u003eAs shown on figure 1, In a lottery method, two secondary schools were randomly chosen from a total of six in the district. The selected schools were Birbir Town Secondary School and Ankober Secondary School. A complete list of students from each school\u0026rsquo;s attendance records was compiled as the sampling frame.\u003c/p\u003e\n\u003cp\u003eNext, each student was assigned a unique code based on their grade level. Using Microsoft Excel, random numbers were generated to select study participants proportionally from each grade level. Totaly, computer generated random sample of 408 students was chosen, ensuring that every student had an equal chance of being included in the study. For the academic year 2024/25, the total enrollment in all secondary schools in the Mirab Abaya district was 3,917 students.\u003c/p\u003e\n\u003ch2\u003eStudy variables\u003c/h2\u003e\n\u003cp\u003eThe dependent variable is Risky sexual behavior.\u003c/p\u003e\n\u003cp\u003eIndependent variable include Socio-demographic and economic factors such as:- Age of the student, Sex of the student, Educational level of the student, Religion of the student, Living situation, Educational status of the student\u0026rsquo;s father, Educational status of the student\u0026rsquo;s mother, Occupational status of the student\u0026rsquo;s father, Occupational status of the student\u0026rsquo;s mother, Pocket money of the student. Behavior related factors such as:-\u0026nbsp;Habit of substance use and\u0026nbsp;Habit of watching pornographic movies.\u0026nbsp;External factors such as:- Parental monitoring and Peer pressure. SRH related factors such as:- Knowledge about\u0026nbsp;RSB and\u0026nbsp;Attitude towards\u0026nbsp;RSB.\u003c/p\u003e\n\u003ch2\u003eOperational definitions\u003c/h2\u003e\n\u003cp\u003e\u003cstrong\u003eA, Risky sexual behavior\u003c/strong\u003e: refers to\u0026nbsp;students\u0026rsquo;\u0026nbsp;act of engaging in early initiated sexual intercourse\u0026nbsp;OR\u0026nbsp;sex by chance with unknown person or irregular partner (e.g. commercial sex workers)\u0026nbsp;OR have multiple sexual partner OR using condom inconsistently\u0026nbsp;(29).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEarly initiation of sexual\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eintercourse\u003c/strong\u003e: students\u0026rsquo; engaging in sexual activity before the age of 18 (30).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eNon-regular sexual partner\u003c/strong\u003e: students\u0026rsquo; engaging in sexual intercourse by chance with an unknown or irregular partner at any age\u0026nbsp;(29).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMultiple sexual partner\u003c/strong\u003e: students\u0026rsquo; status of having more than one sexual partner in life time\u0026nbsp;(29,31).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInconsistent\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;use of condom\u003c/strong\u003e: failure to use condom at least once during sexual intercourse\u0026nbsp;(29,32,33).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eB, Pocket money\u003c/strong\u003e:\u0026nbsp;refers to the amount of money given to students by parents or guardians for different purposes per month (34). It was\u0026nbsp;categorised as\u0026nbsp;\u0026lt;1000 ETB,\u0026nbsp;1000-2000 ETB, and \u0026gt;2000 ETB\u0026nbsp;(35).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eC, Substance use\u003c/strong\u003e: refers to the use of at least one of alcohol, cigarettes, Khat or illicit drugs (shisha, hashish, cocaine, marijuana) \u0026ldquo;frequently\u0026rdquo; by students in the past 12 months (36,37). In this study, \u0026ldquo;frequently\u0026rdquo; means 4 or more times per month; while\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026ldquo;occasionally\u0026rdquo; means 1 to 3 times per month (38).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eD, Watching pornographic movies\u003c/strong\u003e:\u0026nbsp;refers to\u0026nbsp;students\u0026rsquo;\u0026nbsp;viewing of any form of videos of pornography accessed regardless of the format (e.g., online streaming, DVDs) that primarily depict sexual content intended to arouse viewers (39). Students those watched pornographic videos \u0026ldquo;frequently\u0026rdquo; in the past 12 months were classified as having a \u0026ldquo;habit of watching pornographic movies,\u0026rdquo; while the others were not. In this study, \u0026ldquo;frequently\u0026rdquo; means 4 or more times per month; while\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u0026ldquo;occasionally\u0026rdquo; means 1 to 3 times per month (39).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eE, Parental monitoring\u003c/strong\u003e: refers to students\u0026rsquo; perception of how\u0026nbsp;their parents or guardians are aware of and actively involved in controlling and\u0026nbsp;guiding\u0026nbsp;them\u0026nbsp;with respect to the matters of RSB\u0026nbsp;(40).\u0026nbsp;Eight 5-point Likert scale questions were used to assess participants\u0026rsquo; responses, with each statement assigned a numerical score ranging from 1 to 5. The scoring was as follows: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, and Strongly Disagree = 1\u0026nbsp;[75].\u0026nbsp;The scores from all eight items were summed, and percentiles were used to classify the responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eA\u003c/strong\u003e\u003cstrong\u003euthoritative p\u003c/strong\u003e\u003cstrong\u003earental monitoring\u003c/strong\u003e: students perceiving their\u0026nbsp;parents or guardians as\u0026nbsp;those\u0026nbsp;attempt to control\u0026nbsp;their behavior\u0026nbsp;by\u0026nbsp;putting\u0026nbsp;rules, discussing and reasoning\u0026nbsp;(41).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eP\u003c/strong\u003e\u003cstrong\u003eermissive p\u003c/strong\u003e\u003cstrong\u003earental monitoring\u003c/strong\u003e: students perceiving their\u0026nbsp;parents or guardians as which\u0026nbsp;are\u0026nbsp;reluctant to impose limits\u0026nbsp;on them\u0026nbsp;(41).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eN\u003c/strong\u003e\u003cstrong\u003eeglectful\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eparental monitoring\u003c/strong\u003e: students perceiving their\u0026nbsp;parents or guardians as\u0026nbsp;those totally uninvolved\u0026nbsp;and\u0026nbsp;make no demands\u0026nbsp;on\u0026nbsp;their children and they are often indifferent, dismissive, or even completely neglectful\u0026nbsp;(41).\u003c/p\u003e\n\u003cp\u003eStudents scoring below the 33.3\u003csup\u003erd\u003c/sup\u003e percentile (29.00) were categorised as having a perception of \u0026ldquo;neglectful parental monitoring.\u0026rdquo; Those scoring between the 33.3\u003csup\u003erd\u003c/sup\u003e (29.00) and 66.6\u003csup\u003eth\u003c/sup\u003e percentiles (34.00) were classified as having a perception of \u0026ldquo;permissive parental monitoring,\u0026rdquo; Students scoring at or above the 66.6\u003csup\u003eth\u003c/sup\u003e percentile (34.00) were considered to have a perception of \u0026ldquo;authoritative parental monitoring.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eF, P\u003c/strong\u003e\u003cstrong\u003eeer pressure\u003c/strong\u003e:\u0026nbsp;The degree to which students perceive that they are influenced by their peers to conform to group norms, behaviors, or attitudes in the matters of RSB\u0026nbsp;(42).\u0026nbsp;Four items of 5-point Likert scale questions were used to assess participants\u0026rsquo; responses regarding peer pressure, with each statement assigned a numerical score ranging from 1 to 5. The scoring was as follows: Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, and Strongly Disagree = 1. The scores from all 4 items were summed, and the median (10.01) was used to classify the responses.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eHigh peer pressure\u003c/strong\u003e: Students scoring the median (10.01) and above were categorised as experiencing \u0026ldquo;high peer pressure.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eLow peer pressure\u003c/strong\u003e: Students scoring below the median (10.01) were classified as having \u0026ldquo;low peer pressure.\u0026rdquo;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eG,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eKnowledge\u003c/strong\u003e:\u0026nbsp;refers to the awareness and understanding that secondary school students possess regarding\u0026nbsp;RSB\u0026nbsp;(43).\u0026nbsp;It\u0026nbsp;was\u0026nbsp;measured\u0026nbsp;by\u0026nbsp;using 10\u0026nbsp;\u0026ldquo;Yes\u0026rdquo;\u0026nbsp;or\u0026nbsp;\u0026ldquo;No\u0026rdquo;\u0026nbsp;questions delivered to study participants. Each correct response\u0026nbsp;was\u0026nbsp;given a score of one, and a wrong answer\u0026nbsp;was\u0026nbsp;given a score of zero.\u0026nbsp;After computation,\u0026nbsp;the median score\u0026nbsp;(10.00)\u0026nbsp;was used\u0026nbsp;to determine the overall knowledge of RSB among respondents\u0026nbsp;(44).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAdequate knowledge\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eabout\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRSB\u003c/strong\u003e: students those scored, a median score\u0026nbsp;of 10.00\u0026nbsp;and above was\u0026nbsp;considered to have\u0026nbsp;adequate knowledge about\u0026nbsp;RSB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eInadequate knowledge\u003c/strong\u003e\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eabout\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eRSB\u003c/strong\u003e: students those scored below the median score of 10.00 was considered to have inadequate knowledge about\u0026nbsp;RSB.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eH,\u0026nbsp;\u003c/strong\u003e\u003cstrong\u003eAttitude\u003c/strong\u003e: refers to students\u0026rsquo; positive or negative evaluation regarding\u0026nbsp;RSB\u0026nbsp;[82].\u0026nbsp;Eight 5 point\u0026nbsp;Likert scale\u0026nbsp;questions were\u0026nbsp;used to\u0026nbsp;rate\u0026nbsp;the participant`s response and each statement is assigned a numerical score ranging from 1 to 5. These are Strongly Agree = 5, Agree = 4, Neutral = 3, Disagree = 2, Strongly Disagree = 1\u0026nbsp;(45).\u003c/p\u003e\n\u003cp\u003ePositive questions were summed from the lowest score (1 = strongly disagree) to the highest score (5 = strongly agree) and negative questions are summed from the lowest score (1 = strongly agree) to the Higher score (5 = strongly disagree).\u003c/p\u003e\n\u003cp\u003eAfter recoding, the total score was calculated by summing the scores of all 8 items. The median score\u0026nbsp;(22.00)\u0026nbsp;was used to evaluate the degree of\u0026nbsp;favourability\u0026nbsp;or\u0026nbsp;unfavorability\u0026nbsp;toward the\u0026nbsp;RSB. Students who scored at or above the median score\u0026nbsp;(22.00)\u0026nbsp;were considered to have a\u0026nbsp;favourable\u0026nbsp;attitude, while those who scored below the median score\u0026nbsp;(22.00)\u0026nbsp;were regarded as having an\u0026nbsp;unfavourable\u0026nbsp;attitude\u0026nbsp;towards RSB.\u003c/p\u003e\n\u003ch2\u003eData collection\u0026nbsp;instruments and procedure\u003c/h2\u003e\n\u003cp\u003eThe questionnaire was prepared in English after reviewing different literature (2,22,46\u0026ndash;48)\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003einterpreted into the Amharic and then\u0026nbsp;translated back to English.\u0026nbsp;Data were gathered from 389 randomly selected respondents\u0026nbsp;by two degree holders from a health background, specifically youth-friendly service workers, who received training from the principal investigator.\u0026nbsp;The collectors were supervised by one supervisor with an MPH from\u0026nbsp;September 30 to October 14, 2024. A pre-test was conducted on 20 students from Omo Lante high school, who were not included in the main study. Necessary corrections were made based on the findings of the pre-test before the actual data collection. The structured questionnaire was organised into five section:- socio-demographic and economic items, RSB items, behavior-related items, items of external\u0026nbsp;factors and SRH-related items.\u003c/p\u003e\n\u003ch2\u003eData processing and analysis\u003c/h2\u003e\n\u003cp\u003eThe data collected was exported to the statistical package for social science (SPSS) version 27 for analysis. Descriptive statistics was used to summarize the magnitude of RSB and other variables. The results were summarized and presented in tables, charts, and graphs. Binary logistic regression was employed to identify the association. Before the inclusion of independent variables in the binary logistic regression model, the Hosmer-Lemeshow goodness of fit statistics was used to check if the data fit the model. Both the crude odds ratio (COR) and the adjusted odds ratio (AOR) with a 95% CI was calculated to determine the significance of an association between exposure and outcome variables. Variables found to have a p-value of \u0026lt;0.25 in the bivariable analysis were passed to multivariable analysis. In the multivariable analysis variables with p-value of \u0026lt;0.05\u0026nbsp;was\u0026nbsp;considered significant.\u003c/p\u003e\n\u003ch2\u003eData quality assurance\u003c/h2\u003e\n\u003cp\u003eThe data was collected using self-administered questionnaire.\u0026nbsp;Completeness of daily data collection was checked by the supervisor each day. The questionnaire was initially prepared in English and evaluated by experienced researchers. Follow-up was conducted during data collection to ensure adherence to protocols. Additionally, the overall data collection process, including its completeness and accuracy, was assessed by the supervisor.\u003c/p\u003e\n\u003cp\u003eResults of Cronbach\u0026rsquo;s Alpha obtained from the analysis shows that for items of parental monitoring (\u0026alpha;=0.898), for items of peer pressure (\u0026alpha;=0.757), and for items of attitude towards risky sexual behavior (\u0026alpha;=0.776).\u003c/p\u003e"},{"header":"Results","content":"\u003ch2\u003eSocio-demographic and economic\u0026nbsp;factors\u003c/h2\u003e\n\u003cp\u003eAs shown in table 1, Among 408 secondary school students in Mirab Abaya district selected for this study, 389 participated, resulting in a response rate of 95%. The remaining 19 students did not participate due to time constraints. Among the 389 participants, 53.70% are female students and 46.3% are male students.\u003c/p\u003e\n\u003cp\u003eThe majority of participants (77.90%) live with their parents, while 21.9% reside in privately rented houses.\u003c/p\u003e\n\u003ch2\u003eRisky Sexual Behavior\u003c/h2\u003e\n\u003cp\u003eThe prevalence of risky sexual behavior was 30.10% (95% CI: 25.65%\u0026ndash;34.55%). Out of 389 respondents, 205 (52.70%) had history of sexual intercourse. The mean age for the 205 students who have engaged in sexual intercourse was 16.91 years, with a standard deviation of 1.940 years see table 2 and figure 2.\u003c/p\u003e\n\u003ch2\u003eBehavior related factors\u003c/h2\u003e\n\u003cp\u003eTable 3 shows that out of the total 389 participants, when asked about their habit regarding substance uses, 34 students (8.70%) reported \u0026ldquo;Yes\u0026rdquo; for drinking alcohol in the past 12 months while 25 students (73.53%), among those who drunk alcohol, 16 (47.06%) did it frequently.\u003c/p\u003e\n\u003cp\u003eSimilarly, out of 389 participants, 23 students (5.90%) reported \u0026ldquo;Yes\u0026rdquo; for watching pornographic movies in the same period while 20 (86.96%) students, among those who have watched, rushed in to sex after watching.\u003c/p\u003e\n\u003ch2\u003eExternal factors\u003c/h2\u003e\n\u003cp\u003eMajority of the participants, 127 (32.60%), 152 (39.10%), and 182 (46.80%) had \u0026ldquo;Agreed\u0026rdquo; that their parents had family rules regarding sexuality, need permission from their parents to go anywhere, and talk about sex, sexuality and its consequences, respectively.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOn the other hand, majority 188 (48.30%) responded \u0026ldquo;Disagree\u0026rdquo; for their parents allowing them to stay at friend\u0026rsquo;s house overnight while 181 (46.50%) had responded \u0026ldquo;Strongly disagree\u0026rdquo; for their parents not minding if they get a boyfriend/girlfriend; externa factors are summarized in figure 3 and figure 4.\u003c/p\u003e\n\u003ch2\u003eKnowledge about risky sexual\u0026nbsp;behavior\u003c/h2\u003e\n\u003cp\u003eStudents were evaluated for knowledge about\u0026nbsp;RSB. Accordingly, out of 389 participants, 368 (94.60%) considered engaging in sexual activity before the age of 18 to be risky.\u0026nbsp;Similarly, 368 (94.60%) believed that inconsistent condom use increases the risk of STIs.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, majority 346 (88.90%) believe that having multiple sexual partners does not lower the risk of STIs, while 43 (11.10%) think it does.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eOut of 389 participants, 369 (94.90%) considered casual sexual encounters without prior knowledge of a partner\u0026rsquo;s sexual health status to be risky, while 20 (5.10%) did not. See figure 5.\u003c/p\u003e\n\u003ch2\u003eAttitude towards risky sexual behavior\u003c/h2\u003e\n\u003cp\u003eThe participants also reported their agreement and disagreement on different attitude items ranging from \u0026ldquo;strongly agree to strongly disagree\u0026rdquo;.\u003c/p\u003e\n\u003cp\u003eAmong 389 participants, majority 191 (49.10)%) disagreed with the statement that having multiple sexual partners enables choosing the best one while only 59 (15.20)% agreed.\u003c/p\u003e\n\u003cp\u003eAnd 179 (46.00%) agreed that condoms reduce sexual pleasure, while 52 (13.4%) disagreed. See figure 6.\u003c/p\u003e\n\u003ch2\u003eAssociated factors with risky sexual behavior\u003c/h2\u003e\n\u003ch3\u003eBivariable analysis of independent variables with risky sexual behavior\u003c/h3\u003e\n\u003cp\u003eTable 4 shows us that out of the 16 independent variables examined, 8 were identified as significant at \u0026alpha;=0.25. These factors include student\u0026rsquo;s living status, pocket money, substance use habit, habit of watching pornographic movies, parental monitoring, peer pressure, knowledge and attitudes toward RSB.\u003c/p\u003e\n\u003ch3\u003eMultivariable analysis of independent variables with risky sexual behavior\u003c/h3\u003e\n\u003cp\u003eWhen we see table 5, in the multivariable analysis, 6 independent variables were identified as being associated with RSB. These variables include: habit of substance use, habit of watching pornographic movies, parental monitoring, peer pressure, knowledge about RSB, and attitudes towards RSB.\u003c/p\u003e\n\u003cp\u003eStudents who engage in substance use are approximately 3.85 times more likely to engage in RSB compared to those who do not use substances. Students who watch pornographic movies have about 2.10 times the odds of engaging in RSB compared to those who do not watch such content.\u003c/p\u003e\n\u003cp\u003eStudents with neglectful parental monitoring have approximately 3.71 times the odds of engaging in RSB compared to their peers with permissive parental monitoring. Conversely, students with authoritative parental monitoring are around 81.6% less likely to engage in RSB compared to those with permissive parental monitoring.\u003c/p\u003e\n\u003cp\u003eHigh peer pressure is associated with approximately 3.46 times the odds of engaging in RSB when compared to students experiencing low peer pressure.\u003c/p\u003e\n\u003cp\u003eStudents with inadequate knowledge about RSB are about 2.33 times more likely to engage in such behavior compared to those with adequate knowledge. And, students with a favourable attitude toward RSB have approximately 2.58 times the odds of engaging in such behavior compared to those with an unfavourable attitude.\u003c/p\u003e"},{"header":"Discussions","content":"\u003cp\u003eAddressing the issue of RSB among adolescents is crucial, especially in a rapidly evolving health landscape like Ethiopia, where significant strides have been made in prioritising SRH programs for youth (49). Despite these efforts, the\u0026nbsp;magnitude\u0026nbsp;of\u0026nbsp;RSB\u0026nbsp;remains alarmingly high, leading to dire public health consequences such as unintended pregnancies and\u0026nbsp;STI\u0026nbsp;(21,22).\u003c/p\u003e\n\u003cp\u003eIn the present study, it was found that 30.1% of secondary school students in the Mirab Abaya district of South Ethiopia region engaged in RSB. This figure contrasts sharply with a study conducted in Brasil, which reported a prevalence of only 9% among undergraduate students in a city in Southern Brasil\u003cstrong\u003e\u0026nbsp;\u003c/strong\u003e(50); The level of sexual education provided in schools can significantly influence students\u0026rsquo; understanding of sexual health\u0026nbsp;(51). Even though not conclusive, the study conducted in Brasil may benefit from more comprehensive sexual education programs may have empowered students with skills about safe sexual practices. Conversely, in the Mirab Abaya district, limited access to resources and education on sexual health may have contributed to higher rates of risky behavior when compared with the aforementioned study.\u003c/p\u003e\n\u003cp\u003eSome studies conducted in Africa report lower rates of RSB compared to the findings of this study. For instance, a study in Uganda indicated a prevalence of 18.8%\u0026nbsp;(47), while a study done in Nigeria reported a rate of 19.2% (52), both figures are relatively lower than the 30.1% observed here. With respect to the study conducted in Nigeria, several factors may explain the discrepancy, including differences in socio-economic status and levels of health literacy between the two countries. Additionally, the mean age of participants in the study done in Nigeria was 15.2 years (\u0026plusmn;1.4), compared to 17.8 years (\u0026plusmn;1.780) in this study. This age difference is critical; older adolescents may be more likely to engage in sexual activities and face different pressures compared to their younger counterparts. As individuals mature, they may encounter increased social influences and peer dynamics that can impact their sexual behavior.\u003c/p\u003e\n\u003cp\u003eWhen we compare this with study conducted in Ethiopia, the magnitude of RSB in this study is slightly lower than the pooled prevalence reported by one study which is 40% (53), This discrepancy might be attributed to the fact that systematic review encompasses a broader geographical scope and diverse population characteristics, which may lead to variations in reported prevalence rates.\u003c/p\u003e\n\u003cp\u003eAnd the figure reported in this study is higher than studies conducted different areas in Ethiopia like,\u0026nbsp;17.2% in Aksum secondary school (23), 13.7% in Humera (54), 12.8% Gondar secondary and preparatory school (55), 19% Tana Haik high school in Bahir Dar (29), 25.2% Mizan, Bonga, and Tepi preparatory schools (56), 17.9% in Boditi primary and secondary school in Wolayita (57) and 22.4% Arba Minch secondary and preparatory school in Gamo (28). This higher magnitude in Mirab Abaya may be due to socio-economic conditions, cultural norms, and the level of access to sexual health education may vary significantly across different regions, with some areas benefiting from more comprehensive programs than others. Second this may be also result from social desirability bias, where individuals under report risky behaviors due to stigma or fear of judgment.\u003c/p\u003e\n\u003cp\u003eThis study align with study conducted at Jimma zone preparatory schools which reported 32.3% of preparatory students are engaged in\u0026nbsp;RSB\u0026nbsp;(58).\u003c/p\u003e\n\u003cp\u003eWhen compared to studies conducted in Ethiopia, such as the 82.2% prevalence reported in Pawe district, Benishangul Gumuz\u0026nbsp;(2), and the 68.2% prevalence in Horu Guduru, East Wollaga\u0026nbsp;(59), the figure of 30.1% found in this study is notably lower. This variation could be due to several factors, including differences in socio-cultural contexts and the availability of sexual health education. In regions like Pawe and Guduru, the higher rates of RSB may be influenced by less effective educational programs that do not adequately address safe sexual practices.\u003c/p\u003e\n\u003cp\u003eIn examining the association between substance use and RSB, this study found that, students who engage in substance use are approximately 3.85 times more likely to engage in RSB compared to those who do not use substances. This is may be due to substances such as alcohol and drugs can impair cognitive functions, leading to poor decision-making; when individuals are under the influence, they may underestimate risks, such as not using protection during sexual encounters or engaging in sexual activity (60).\u003c/p\u003e\n\u003cp\u003eThis figure is higher than the 3.2 OR reported in a study conducted in Italy\u0026nbsp;(61), which might suggest us that while substance use is a significant factor in both contexts, the interaction between substance use and RSB may be influenced by cultural, social, and external factors unique to each setting. Italy\u0026rsquo;s relatively lower AOR might reflect the varying levels of access to sexual education and health resources, which could mitigate the impact of substance use on RSB among Italian adolescents.\u003c/p\u003e\n\u003cp\u003eConversely, the OR found in this study is lower than that reported in studies from Kenya (OR = 6.02) (62) and Nigeria (52), where the associations were markedly stronger that the OR reported in this study.\u003c/p\u003e\n\u003cp\u003eFinding from Haramaya, revealed that students who used substances were 2.81 times more likely to engage in RSB\u0026nbsp;(63).\u0026nbsp;Comparatively, the finding of this study is consistent with a study conducted in Injibara\u0026nbsp;(64).\u003c/p\u003e\n\u003cp\u003eIn this research, students who watch pornographic movies have about 2.10 times the odds of engaging in RSB compared to those who do not watch such content.\u0026nbsp;This finding aligns with research from Indonesia, which noted that higher levels of pornography addiction correlate with increased RSB among students (65). The significant relationship observed in both studies suggests there may be a common underlying mechanism where exposure to pornography is associated with RSB. Similarly, a study from Nigeria reported an AOR of 2.705 for RSB linked to pornography consumption which is relatively similar with finding of this study (66).\u003c/p\u003e\n\u003cp\u003eComparatively, other studies conducted in Ethiopia present varying OR for the association between watching pornography and RSB. For instance, a systematic review and meta-analysis indicated an even stronger association, with an AOR of 4.21 (67).\u003c/p\u003e\n\u003cp\u003eIn contrast, a study from Adigrat University found a lower AOR of 1.6 (68), indicating that while watching pornographic videos is a factor, its influence can vary significantly based on social dynamics. The disparities in findings may also reflect differences in study populations, methodologies, and the degree of pornography exposure or addiction measured across different contexts. Furthermore, studies from Injibara and Gedeo Zone reported AOR of 1.58 and 2.51, respectively (64,69).\u003c/p\u003e\n\u003cp\u003eIn comparison to this study, the research conducted in Arba Minch reported a notably higher AOR of 8.80 (28). This discrepancy may be due to the urban nature of Arba Minch town, where access to and consumption of pornographic materials could be more prevalent than this study which focused on school from a rural setting, where both the exposure to and availability of such content may be significantly lower than the earlier.\u003c/p\u003e\n\u003cp\u003eIn this work, students with neglectful parental monitoring have approximately 3.71 times the odds of engaging in RSB compared to their peers with permissive parental monitoring. While, students with authoritative parental monitoring are around 81.6% less likely to engage in RSB compared to those with permissive parental monitoring.\u003c/p\u003e\n\u003cp\u003eA study in the US found that adolescents perceiving less parental monitoring had 1.7 times the odds of testing positive for a STI, highlighting the detrimental impact of inadequate parental oversight on adolescent sexual health (70). While, research from Dares salaam, Tanzania, indicated that students with high parental monitoring were more exposed to RSB, with an AOR of 1.54 (71). This paradox may suggest that while parental monitoring is generally protective, its effectiveness can vary based on the quality and nature of the monitoring employed.\u003c/p\u003e\n\u003cp\u003eFocusing on studies conducted in Ethiopia, findings reveal a consistent pattern where parental monitoring significantly influences RSB. In Harar, high parental monitoring was associated with a 28% reduction in the incidence rate of RSB (72), while in Wolayita Sodo, students lacking parental monitoring exhibited an AOR of 1.86 for increased RSB (73). Similarly, in Gedeo, adolescents without parental monitoring were 2.10 times more likely to engage in RSB (69).\u003c/p\u003e\n\u003cp\u003eIn the current study, high peer pressure is associated with approximately 3.46 times the odds of engaging in RSB when compared to students experiencing low peer pressure.\u0026nbsp;This stresses the importance of social dynamics in shaping adolescent behavior, as the desire for acceptance and recognition among peers could drive individuals to partake in actions that contradict their values or risk perceptions.\u003c/p\u003e\n\u003cp\u003eThe finding aligns with research conducted in Singapore, which reported that peer pressure was a critical factor influencing RSB, yielding an odds ratio of 3.84 (95% CI: 2.27\u0026ndash;6.50) (74). Similarly, a study conducted in Rwanda found that peer pressure was significantly associated with RSB among high school students, with an odds ratio of 3.9 (95% CI: 2.01\u0026ndash;7.51) (75).\u003c/p\u003e\n\u003cp\u003eIn contrast, studies from other regions in Ethiopia reported varying degrees of association between peer pressure and RSB, with AORs ranging from 1.90 (95% CI: 1.37\u0026ndash;2.64) in Injibara (64) to 4.22 in Guduru (59). These variations may be attributed to contextual factors such as cultural norms of the regions studied.\u003c/p\u003e\n\u003cp\u003eIn this study, students with inadequate knowledge about RSB are about 2.33 times more likely to engage in such behavior compared to those with adequate knowledge.\u0026nbsp;This finding is lower when compared with research conducted in Vietnam, which reported an AOR of 4.03 (76).\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eStudies conducted in Ethiopia have also highlighted the significant relationship between knowledge and RSB. For instance, research among undergraduate students at the University of Gondar found an AOR of 3.05 associated with knowledge (77). Similarly, a study of high school students in the Amhara region reported an even higher AOR of 4.53 (33) while knowledge in Arba Minch showed an AOR of 2.89 (28).\u003c/p\u003e\n\u003cp\u003eIn the assessment of attitude, students with a favourable attitude toward RSB have approximately 2.58 times the odds of engaging in such behavior compared to those with an unfavourable attitude.\u0026nbsp;This finding is consistent with a study conducted in the US, which reported positive association between attitudes toward RSB and actual engagement in such behaviors, with an AOR of 3.74\u0026nbsp;(78). In all its odds, the higher figure observed in the US study may be attributed to a more liberal lifestyle prevalent in that context, where attitudes toward RSB are generally more accepting. This cultural acceptance could lead to a greater likelihood of individuals acting on their favourable attitudes. In contrast, our study setting might reflect more conservative social norms.\u003c/p\u003e\n\u003cp\u003eSimilarly, research from KwaZulu-Natal University in South Africa indicated that favourable attitudes toward RSB were also significantly linked to the likelihood of engaging in those behaviors, yielding an AOR of 3.09 (79).\u003c/p\u003e\n\u003cp\u003eResearch in East Wollega found a positive association, though with a lower AOR of 1.22 (80), while a study in Harar reported an AOR of 2.11 (81).\u003c/p\u003e\n\u003cp\u003eWhen we see the limitations of the study, the cross-sectional design employed capture a snapshot of behaviors and factors at a single point in time, which may not reflect changes over time or the directionality of relationships.\u003c/p\u003e\n\u003cp\u003eThere is also risk of under-reporting RSB due to the sensitivity of the subject, influenced by social desirability bias. Participants may feel compelled to provide responses they believe are more socially acceptable.\u003c/p\u003e\n\u003cp\u003eRecall bias may have affected the reliability of information regarding the age of first sexual intercourse, condom use, the number of sexual partners and recalling past Behaviors. And\u003c/p\u003e\n\u003cp\u003eReliance solely on quantitative data may limit the understanding of the complex factors such as cultural attitudes and individual experiences that can influence students\u0026rsquo; RSB.\u003c/p\u003e"},{"header":"Conclusion and recommendations","content":"\u003cp\u003eThe findings underscore the need for targeted interventions and comprehensive sexual health education to address this critical public health issue. The analysis identified six key independent variables that are significantly associated with RSB: substance use, consumption of pornographic material, parental monitoring style, peer pressure, knowledge about RSB, and attitudes towards RSB. Addressing the issue of risky sexual behavior among secondary school students in the Mirab Abaya district of South Ethiopia requires a multifaceted approach.\u003c/p\u003e\n\u003cp\u003eMirab Abaya district health office is encouraged to implement educational campaigns focused on the substance use, highlighting its strong association with RSB by through community outreach to raise awareness.\u003c/p\u003e\n\u003cp\u003eThis study revealed that, from those not using condom during sexual intercourse,\u0026nbsp;38.68% reported that it is “difficult to get condom”. Therefore, to address\u0026nbsp;the reported difficulty in obtaining condoms by establishing easily accessible distribution points in schools and community centres. Consider providing free or subsidised condoms as part of health services.\u003c/p\u003e\n\u003cp\u003eAs figures from this study shows, 27.3% of students that their family have no\u0026nbsp;rules regarding sexuality; and\u0026nbsp;29.7% of students that their family don’t talk with students about sex, sexuality, and its consequences. So the office is recommended to\u0026nbsp;organise educational sessions for parents to enhance their monitoring knowledge, skills and encourage open discussions about sexuality and its consequences.\u003c/p\u003e\n\u003cp\u003eThe absence of youth-friendly services in Ankober Kebele of the district could represent a gap in the provision of essential sexual and reproductive health resources for adolescents. This lack of services leaves young people vulnerable to risky sexual behaviors and health issues, as they may not have access to reliable information, counseling, and medical care tailored to their specific needs. In a rapidly evolving health landscape, particularly in regions like Ethiopia where adolescent health is a growing concern, the establishment of youth-friendly services is critical. Young people often rely on peers or the internet for sexual and reproductive information, which can be misleading or inaccurate, further exacerbating the issue of RSB.\u003c/p\u003e\n\u003cp\u003eWhile Birbir offers some youth-friendly services, the effectiveness of these services is hindered by the insufficient training of professionals. Health workers play a crucial role in delivering appropriate and sensitive care to adolescents, and without adequate training, they may be ill-equipped to address the unique needs and concerns of young people.\u003c/p\u003e\n\u003cp\u003eIt is crucial that health care workers in Birbir receive specialized training focused on adolescent health. In addition to the district’s health office, partnerships with NGOs working in the district, such as Pathfinder International and Engender Health, can facilitate workshops and training sessions that equip professionals with the necessary skills to engage effectively with youth.\u003c/p\u003e\n\u003cp\u003eComprehensive sexual health education programs should be given in schools. These programs must not only cover the basics of sexual health but also address the socio-cultural factors influencing RSB identified in this study. Schools should collaborate with local NGOs currently working in the district, such as Pathfinder International and Engender Health, to develop age-appropriate reproductive health education that encompass topics such as consent, safe sexual practices, and the implications of substance use on sexual health.\u003c/p\u003e\n\u003cp\u003eIn this study, 27% of all students in the study use substances and 27.7% of students reported that they feel pressured by their friends to engage in sexual activity.\u0026nbsp;Therefore, it is better if schools establish peer-led RH clubs to empower students to discuss topics related to substance use, sexuality and peer pressure. This could help reduce stigma and promote healthier choices.\u003c/p\u003e\n\u003cp\u003eNext, schools can disseminate health information regarding the consequences of substance use, RSB through cooperation with district’s health authorities. And facilitating regular meetings between parents and school bodies to discuss rules and communication regarding sexuality, thereby fostering a supportive environment for students is also instrumental.\u003c/p\u003e\n\u003cp\u003eRe-empowering the dedicated YFS that provide confidential counselling and health education on SRH ensuring that young people feel comfortable seeking help.\u003c/p\u003e\n\u003cp\u003eOffer training for health professionals on adolescent sexual health issues, emphasising the importance of addressing substance use and peer pressure in consultations.\u003c/p\u003e\n\u003cp\u003ePartner with local schools to conduct regular health check-ups and educational sessions, focusing on preventive and promotion measures related to RSB. And actively engage in counselling sessions that address the impacts of substance use and peer pressure on RSB, equipping students with coping strategies and information.\u003c/p\u003e\n\u003cp\u003eWe encourage NGOs operating in the local area, such as Compassion International, Engender Health, Mercy Corps and Pathfinder International to actively support the development of health education materials that emphasize the importance of condom use. Our research indicates that among 205 students who have initiated sexual intercourse, 51.71% do not use condoms, highlighting a critical gap in sexual health education. Implementing culturally appropriate social and Behavior change communication campaigns can effectively address misconceptions and promote safe practices among adolescents.\u003c/p\u003e\n\u003cp\u003eParents can foster open discussions about sexuality to overcome cultural taboos and reduce stigma. Community leaders can enhance this effort by organizing educational sessions for both parents and adolescents on sexual health. The Health Development Armies (HDA) can collaborate with health extension workers to facilitate these programs and advocate for more youth-friendly services, as the district currently has only one underutilized center.\u003c/p\u003e\n\u003cp\u003eRegular discussions between parents and youth, starting from an early age, are crucial for addressing the changes during adolescence and determining the right time to begin relationships. Parents need to communicate frankly about STIs, including HIV/AIDS, the risks of unwanted pregnancies, and the effects of alcohol, substances, khat, and smoking.\u003c/p\u003e\n\u003cp\u003eAdditionally, parents should advocate for balanced social media use by encouraging adolescents to set limits on screen time, engage in offline activities, and develop a healthy relationship with technology. Maintaining open dialogues about social media experiences, including challenges and peer pressures, will foster a supportive environment.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cp\u003eAIDS:- Acquired Immune Deficiency Syndrome; AOR:- Adjusted Odds Ratios; CI:- Confidence Interval; COR:- Crude Odds Ratio; CSA:- Central Statistical Agency; EDHS:- Ethiopian Demographic and Health Survey; HIV:- Human Immune Deficiency Virus; OR:- Odds Ratio; RH:- Reproductive Health; SPSS:- Statistical Package for Social Sciences; SRH:- Sexual and Reproductive Health; STI:- Sexually Transmitted Infection; UNAIDS:- United Nations Programme on HIV/AIDS; UNDP:- United Nations Development Programme; USA:- United States of America; WHO:- World Health Organization\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eEthics approval and consent to participate\u003c/p\u003e\n\u003cp\u003eThe data collection was carried out after obtaining approval for the proposal from the Arba Minch University Department of Public Health Institutional Review Board (IRB) on 19\u003csup\u003eth\u003c/sup\u003e July 2024 G.C., with reference number IRB/23193/2024. Permission to conduct the research in the proposed setting was obtained from officials of educational office and school principals. To ensure the participants\u0026rsquo; right to self-determination and privacy, they were informed both verbally and in writing about the study. The data collectors clearly informed them that they had the right to decide voluntarily whether to participate in the study and the right to refuse participation.For students of under 18 years of ages, assent forms were signed by parents and guardians to let them to be included in the study.\u003c/p\u003e\n\u003cp\u003eThe participants\u0026rsquo; right to privacy was protected throughout the study through anonymity. The study was anonymous, and the questionnaire was administered in a classroom with adequate space between each participant. The information gained during data collection was kept confidential. And\u0026nbsp;a closed cardboard box was provided for participants to submit their completed questionnaires.\u003c/p\u003e\n\u003cp\u003eConsent for publication\u003c/p\u003e\n\u003cp\u003eConsent for publication was be obtained from all study participants.\u003c/p\u003e\n\u003cp\u003eAvailability of data and materials\u003c/p\u003e\n\u003cp\u003eThe whole data of the atudy will be made available, without undue reservation when needed.\u003c/p\u003e\n\u003cp\u003eCompeting interests\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003eFunding\u003c/p\u003e\n\u003cp\u003eThis work was funded by Arba Minch University. The funder had no role in study design, data collection, analysis, decision to publish, or preparation of the manuscript.\u003c/p\u003e\n\u003cp\u003eAuthors\u0026rsquo; contributions\u003c/p\u003e\n\u003cp\u003eYegetaneh Hailegiorgis take part in planning and designing the study, monitored the data collection process, and analysed the data. Mekdes Kondale and Zeleke Gebru served as main advisors, participating in the study\u0026rsquo;s planning and providing guidance in writing the manuscript. Eden Hailegiorgis gave advise the behavioral aspect of the study and provided guidance in writing the manuscript. All advisors reviewed and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003eAcknowledgements\u003c/p\u003e\n\u003cp\u003eI acknowledge Arba Minch University, College of Medicine and Health Sciences for organizing and funding the study. I would like to express our heartfelt gratitude to the study participants from Mirab Abaya district, whose consent and involvement were crucial for this research. I also appreciate the cooperation of the Mirab Abaya district Health Office, Education Office, Secondary schools in the district as well as the invaluable support from the data collectors and health extension workers in the study area.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eOrganization WH. Trends in maternal mortality 2000 to 2020: estimates by WHO, UNICEF, UNFPA, World Bank Group and UNDESA/Population Division. World Health Organization; 2023.\u003c/li\u003e\n \u003cli\u003eAgajie M, Belachew T, Tilahun T, Amentie M. Risky sexual behavior and associated factors among high school youth in Pawe Woreda, Benishangul Gumuz Region. Sci J Clin Med. 2015;4(4):67\u0026ndash;75.\u003c/li\u003e\n \u003cli\u003eSamuel L, Angamo MT. Substance use and sexual risk behavior and factors associated with HIV transmission in southern Ethiopia. Int J Pharm Sci Res. 2012;3(4):1080.\u003c/li\u003e\n \u003cli\u003eUsonwu I, Ahmad R, Curtis-Tyler K. Parent\u0026ndash;adolescent communication on adolescent sexual and reproductive health in sub-Saharan Africa: a qualitative review and thematic synthesis. Reprod Health. 2021;18:1\u0026ndash;15.\u003c/li\u003e\n \u003cli\u003eMpofu JJ. Overview and methods for the youth risk behavior surveillance system\u0026mdash;United States, 2021. MMWR Suppl. 2023;72.\u003c/li\u003e\n \u003cli\u003eMpofu JJ. Overview and methods for the youth risk behavior surveillance system\u0026mdash;United States, 2021. MMWR supplements. 2023;72.\u003c/li\u003e\n \u003cli\u003eOster E. Correction Appendix for \u0026ldquo;Sexually Transmitted Infections, Sexual Behavior and the HIV/AIDS Epidemic\u0026rdquo;, Quarterly Journal of Economics May 2005. Economics. 2005;\u003c/li\u003e\n \u003cli\u003eUN A. Global HIV \u0026amp; AIDS statistics \u0026mdash; Fact sheet [Internet]. 2022 [cited 2024 Apr 17]. Available from: https://www.unaids.org/en/resources/fact-sheet.\u003c/li\u003e\n \u003cli\u003eNdagijimana E, Biracyaza E, Nzayirambaho M. Risky sexual behaviors and their associated factors within high school students from Coll\u0026egrave;ge Saint Andr\u0026eacute; in Kigali, Rwanda: An institution-based cross-sectional study. Frontiers in Reproductive Health. 2023 Mar .\u003c/li\u003e\n \u003cli\u003eMinistry of Health E. Reproductive Health, Family Planning and Adolescent Health Desk [Internet]. Available from: https://www.moh.gov.et/en/initiatives-4-%0Acol/Adolescent_and_Youth_Health_Program\u003c/li\u003e\n \u003cli\u003eDaka D, Shaweno D. Magnitude of risky sexual behavior among high school adolescents in Ethiopia: a cross-sectional study. J Public Heal Epidemiol. 2014;6(7):211\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eCherie A, Berhanie Y. Assessment of parenting practices and styles and adolescent sexual behavior among high school adolescents in Addis Ababa, Ethiopia. 2015;\u003c/li\u003e\n \u003cli\u003eAbebe M, Tsion A, Netsanet F. Living with parents and risky sexual behaviors among preparatory school students in Jimma zone, South west Ethiopia. Afr Health Sci. 2013;13(2):498\u0026ndash;506.\u003c/li\u003e\n \u003cli\u003eTilahun M, Ayele G. Factors associated with age at first sexual initiation among youths in Gamo Gofa, south west Ethiopia: a cross sectional study. BMC Public Health. 2013;13:1\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eAnimaw W, Bogale B. Sexual \u0026amp; Reproductive Healthcare. 2013;\u003c/li\u003e\n \u003cli\u003eTurnbull T, Van Schaik P, Van Wersch A. Adolescents\u0026rsquo; preferences regarding sex education and relationship education. Health Educ J. 2010;69(3):277\u0026ndash;86.\u003c/li\u003e\n \u003cli\u003eDemocratic F, Of R, Health MOF. National Adolescents and Youth Health. 2021;(December 2021).\u003c/li\u003e\n \u003cli\u003eCentral Statistical Agency [Ethiopia], ICF International. Ethiopia Demographic and Health Survey 2011. Heal San Fr. 2012;1\u0026ndash;452.\u003c/li\u003e\n \u003cli\u003e[Ethiopia] CSA, International I. Ethiopia Demographic and Health Survey 2016. Heal San Fr. 2016;1(1):107\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eEthiopian Public Health Institute (EPHI), ICF. Ethiopia Mini Demographic and Health Survey 2019. Heal San Fr [Internet]. 2021;1\u0026ndash;207. Available from: https://dhsprogram.com/pubs/pdf/FR363/FR363.pdf\u003c/li\u003e\n \u003cli\u003eTeshale AB, Tesema GA. Magnitude and associated factors of unintended pregnancy in Ethiopia: a multilevel analysis using 2016 EDHS data. BMC Pregnancy Childbirth. 2020;20:1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eAsres AW, Endalew MM, Mengistu SY. Prevalence and trends of sexually transmitted infections among pregnant women in Mizan Tepi University Teaching Hospital, Southwest Ethiopia: a cross-sectional study. Pan Afr Med J. 2022;42(1).\u003c/li\u003e\n \u003cli\u003eSrahbzu M, Tirfeneh E. 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. Biomed Res Int. 2020;2020(1):3719845.\u003c/li\u003e\n \u003cli\u003ede Guzman MR, Bosch KR. G07-1715 high-risk behaviors among youth. 2007;\u003c/li\u003e\n \u003cli\u003eYigzaw MT, Yalew AW, Mesfin AB, Demisie AS. Sexual initiation and factors associated with it among Addis Ababa University undergraduate students, Addis Ababa, Ethiopia. Am J Heal Res. 2014;2(5):260\u0026ndash;70.\u003c/li\u003e\n \u003cli\u003eMirab Abaya [Internet]. Available from: https://en.wikipedia.org/wiki/Mirab_Abaya\u003c/li\u003e\n \u003cli\u003eLibrary, T.R.H.C.D. Birbir, Southern Nations, Nationalities, and People\u0026rsquo;s Region, Ethiopia. [cited June 2024 17]; Available from: https://www.mindat.org/feature- 342056.html.\u003c/li\u003e\n \u003cli\u003eMersha A, Teji K, Darghawth R, Gebretsadik W, Shibiru S, Bante A, et al. Risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia. J public Heal Epidemiol. 2018;10(12):429\u0026ndash;42.\u003c/li\u003e\n \u003cli\u003eAmare H, Azage M, Negash M, Getachew A, Desale A, Abebe N. Risky sexual behavior and associated factors among adolescent students in Tana Haik high school, Bahir Dar, Northern Ethiopia. Int J HIV/AIDS Prev Educ Behav Sci. 2017;3(4):41.\u003c/li\u003e\n \u003cli\u003eUnderwood JM, Brener N, Thornton J, Harris WA, Bryan LN, Shanklin SL, et al. Overview and methods for the youth risk behavior surveillance system\u0026mdash;United States, 2019. MMWR Supplements. 2020;69(1):1.\u003c/li\u003e\n \u003cli\u003eYarinbab TE, Tawi NY, Darkiab I, Debele F, Ambo WA. Risky sexual behaviors and associated factors among students of mizan aman college of health science, Southwest Ethiopia: cross-sectional study. JOJ Nurs Heal Care. 2018;8(3):805\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eTadesse G, Yakob B. Risky sexual behaviors among female youth in Tiss Abay, a semi-urban area of the Amhara Region, Ethiopia. PloS one. 2015 Mar 4;10(3):e0119050.\u003c/li\u003e\n \u003cli\u003eKassa GM, Degu G, Yitayew M, Misganaw W, Muche M, Demelash T, Mesele M, Ayehu M. Risky sexual behaviors and associated factors among Jiga high school and preparatory school students, Amhara Region, Ethiopia. International scholarly research notices. 2016;\u003c/li\u003e\n \u003cli\u003eA. A. Shah, Z. F. Syed, and S. H. B. J. B. M. Aslam, \u0026ldquo;Pocket Money as a proxy for Family Income,\u0026rdquo; Int. J. Soc. Sci. Educ., vol. 2, no. 4, pp. 688\u0026ndash;693, 2012.\u003c/li\u003e\n \u003cli\u003eGirmay A, Mariye T. Risky sexual behavior practice and associated factors among secondary and preparatory school students of Aksum town, northern Ethiopia, 2018. BMC Res Notes. 2019;12:1\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eShegute T, Wasihun Y. Prevalence of substance use in university students, Ethiopia. Subst Abus Res Treat. 2021;15:11782218211003558.\u003c/li\u003e\n \u003cli\u003eTesfaye G, Derese A, Hambisa MT. Substance use and associated factors among university students in Ethiopia: a cross-sectional study. J Addict. 2014;2014.\u003c/li\u003e\n \u003cli\u003eKebede D, Alem A, Mitike G, Enquselassie F, Berhane F, Abebe Y, et al. Khat and alcohol use and risky sex behaviour among in-school and out-of-school youth in Ethiopia. BMC Public Health. 2005;5:1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eHabesha T, Aderaw Z, Lakew S. Assessment of exposure to sexually explicit materials and factors associated with exposure among preparatory school youths in Hawassa City, Southern Ethiopia: a cross-sectional institution based survey. Reprod Health. 2015;12:1\u0026ndash;12.\u003c/li\u003e\n \u003cli\u003eBaumrind D. The influence of parenting style on adolescent competence and substance use. J Early Adolesc. 1991;11(1):56\u0026ndash;95.\u003c/li\u003e\n \u003cli\u003eDinka, B., DETERMINANT OF RISKY SEXUAL behaviourS AMONG STUDENTS OF ADDIS KETEMA SECONDARY AND PREPARATORY SCHOOL, ADDIS ABABA, ETHIOPIA 2021/22. 2021.\u003c/li\u003e\n \u003cli\u003eWakgari, M., The Influences of Family, Peers and School Clubs on Adolescents\u0026rsquo; Sexual behaviour and Risk Perception. 2007.\u003c/li\u003e\n \u003cli\u003eHenok A, Kassa A, Lenda A, Nibret A, Lamaro T. Knowledge, attitude and practice of risky sexual behavior and condom utilization among regular students of Mizan-Tepi university, South West Ethiopia. J Child Adolesc Behav. 2015;3(5):244.\u003c/li\u003e\n \u003cli\u003eKassie AA, Gudayu TW, Araya BM. Knowledge, attitude, and preventive practices towards sexually transmitted infections among preparatory school students in West Gojjam Zone, Ethiopia. Adv Public Heal. 2020;2020(1):6894394.\u003c/li\u003e\n \u003cli\u003eOsanyin GE, Ogunyemi DO, Oluwole EO, Oyekanmi OD. Knowledge, attitude and preventive practices of sexually transmitted infections among unmarried youths in an urban community in Lagos State, Nigeria. African J Prim Heal Care Fam Med. 2020;12(1):1\u0026ndash;7.\u003c/li\u003e\n \u003cli\u003eAnteneh Messele Birhanu AMB, Telake Azale Bisetegn TAB, Solomon Meseret Woldeyohannes SMW. High prevalence of substance use and associated factors among high school adolescents in Woreta Town, Northwest Ethiopia: multi-domain factor analysis. 2014;\u003c/li\u003e\n \u003cli\u003eAnyanwu MU, Tamwesigire I. A cross-sectional study of prevalence and predictors of risky sexual behavior among school-going adolescents in Mbarara municipality, Uganda. Afr Health Sci. 2023;23(3):109--116.\u003c/li\u003e\n \u003cli\u003eAdmassu TW, Wolde YT, Kaba M. Ethiopia has a long way to go meeting adolescent and youth sexual reproductive health needs. Reprod Health. 2022;19(Suppl 1):130.\u003c/li\u003e\n \u003cli\u003eFDRE M of H. National Reproductive Health Strategy [Internet]. Addis Ababa; 2016. 1\u0026ndash;57 p. Available from: https://www.prb.org/wp-content/uploads/2020/06/Ethiopia-National-Reproductive-Health-Strategy-2016-2020.pdf\u003c/li\u003e\n \u003cli\u003eGr\u0026auml;f DD, Mesenburg MA, Fassa AG. Risky sexual behavior and associated factors in undergraduate students in a city in Southern Brazil. Rev Saude Publica. 2020;54:41.\u003c/li\u003e\n \u003cli\u003eChavula MP, Zulu JM, Hurtig AK. Factors influencing the integration of comprehensive sexuality education into educational systems in low- and middle-income countries: a systematic review. Reprod Health. 2022;19(1):1\u0026ndash;25.\u003c/li\u003e\n \u003cli\u003eOlaoye T, Agbede C. Prevalence and personal predictors of risky sexual behaviour among in-school adolescents in the Ikenne Local Government Area, Ogun State, Nigeria. Int J Adolesc Med Health. 2022;34(3).\u003c/li\u003e\n \u003cli\u003eAynalem BY, Alemu AA, Zeleke LB, Kassa GM. Risky sexual behavior and associated factors among secondary and above-education-level students in Ethiopia: A systematic review and meta-analysis. J Fam Med Prim Care. 2022;11(9):5024\u0026ndash;30.\u003c/li\u003e\n \u003cli\u003eDadi AF, Teklu FG. Risky sexual behavior and associated factors among grade 9\u0026ndash;12 students in Humera secondary school, western zone of Tigray, NW Ethiopia, 2014. Sci J Public Heal. 2014;2(5):410\u0026ndash;6.\u003c/li\u003e\n \u003cli\u003eKasahun AW, Yitayal M, Girum T, Mohammed B. Risky sexual behavior and associated factors among high school students in Gondar City, Northwest Ethiopia. Int J Public Heal Sci. 2017;6(3):257\u0026ndash;65.\u003c/li\u003e\n \u003cli\u003eKahsay T, Jejaw AKM, Mulatu K. Risky Sexual Behaviors and Associated Factors Among Mizan, Bonga and Tepi Preparatory School Students, Southwestern, Ethiopia, 2016: A Cross Sectional Study. J Aids Clin Res Sex Transm Dis. 2017;1\u0026ndash;4.\u003c/li\u003e\n \u003cli\u003eDeresse D, Debebe S. Magnitude of risky sexual behavior among high school adolescents in Ethiopia: A cross-sectional study. J Public Heal Epidemiol. 2014;6(7):211\u0026ndash;5.\u003c/li\u003e\n \u003cli\u003eFentahun N, Mamo A. Risky sexual behaviors and associated factors among male and female students in Jimma Zone preparatory schools, South West Ethiopia: comparative study. Ethiopian journal of health sciences. 2014 Apr 15;24(1):59-68.\u003c/li\u003e\n \u003cli\u003eWakasa BF, Oljira L, Demena M, Regassa LD, Daga WB. Risky sexual behaviour and associated factors among sexually experienced secondary school students in Guduru, Ethiopia. Preventive medicine reports. 2021 Sep 1;23:101398.\u003c/li\u003e\n \u003cli\u003eRamey T, Regier PS. Cognitive impairment in substance use disorders. CNS Spectr. 2019;24(1):102\u0026ndash;13.\u003c/li\u003e\n \u003cli\u003eFlesia L, Cavalieri F, Angelini S, Bottesi G, Ghisi M, Tonon E, Roldan AP, Di Nisio A, Garolla A, Ferlin A, Foresta C. Health-related lifestyles, substance-related behaviors, and sexual habits among Italian young adult males: an epidemiologic study. Sexua.\u003c/li\u003e\n \u003cli\u003eKabiru CW, Orpinas P. Factors associated with sexual activity among high-school students in Nairobi, Kenya. Journal of adolescence. 2009 Aug 1;32(4):1023-39.\u003c/li\u003e\n \u003cli\u003eShore H, Shunu A. Risky sexual behavior and associated factors among youth in Haramaya Secondary and Preparatory School, East Ethiopia, 2015. Journal of Public Health and Epidemiology. 2017 Apr 30;9(4):84-91.\u003c/li\u003e\n \u003cli\u003eAdal MA, Abiy SA, Reta MM, Asres MS, Animut Y. Prevalence of risky sexual behavior and associated factors among Injibara University students, Northwest Ethiopia. Frontiers in Reproductive Health. 2024 Mar 28;6:1356790.\u003c/li\u003e\n \u003cli\u003eYunengsih W, Setiawan A. Contribution of pornographic exposure and addiction to risky sexual behavior in adolescents. Journal of public health research. 2021 May;10(1_suppl):jphr-2021.\u003c/li\u003e\n \u003cli\u003eIkenna Macdonald Nwigwe, N. E. Agbapuonwu. Risky sexual behaviours and associated risky determinants among students\u0026rsquo; of federal polytechnic, Oko, Anambra State. GSC Biol Pharm Sci. 2023;23(2):074\u0026ndash;84.\u003c/li\u003e\n \u003cli\u003eKebede N, Bayou FD, Ayele FY, Kefale B, Mekonen AM, Dessie AM, Tsega Y. Prevalence and associated factors of early initiation of sexual intercourse among youth in Ethiopia: systematic review and meta-analysis. BMC Public Health. 2023 Oct 23;23(1):2072.\u003c/li\u003e\n \u003cli\u003eGebremariam G, Adhanom G, Hagos S, Berihu T. Pre-Marital Sexual Debut and Associated Factors among Unmarried Regular Students of Adigrat University, Northern Ethiopia.\u003c/li\u003e\n \u003cli\u003eWondimagegne YA, Anbese AT. Risky sexual behaviors and associated factors among adolescent in Gedeo Zone, South Ethiopia: a community based cross-sectional study. Scientific Reports. 2024 Aug 28;14(1):19908.\u003c/li\u003e\n \u003cli\u003eDiClemente RJ, Wingood GM, Crosby R, Sionean C, Cobb BK, Harrington K, Davies S, Hook III EW, Oh MK. Parental monitoring: Association with adolescents\u0026rsquo; risk behaviors. Pediatrics. 2001 Jun 1;107(6):1363-8.\u003c/li\u003e\n \u003cli\u003eMlunde LB, Poudel KC, Sunguya BF, Mbwambo JK, Yasuoka J, Otsuka K, Ubuguyu O, Jimba M. A call for parental monitoring to improve condom use among secondary school students in Dar es Salaam, Tanzania. BMC Public Health. 2012 Dec;12:1-1.\u003c/li\u003e\n \u003cli\u003eKassahun EA, Gelagay AA, Muche AA, Dessie AA, Kassie BA. Factors associated with early sexual initiation among preparatory and high school youths in Woldia town, northeast Ethiopia: a cross-sectional study. BMC Public Health. 2019;19:1\u0026ndash;8.\u003c/li\u003e\n \u003cli\u003eAzeze GA, Gebeyehu NA, Wassie AY, Mokonnon TM. Factors associated with risky sexual behaviour among secondary and preparatory students in Wolaita Sodo town, Southern Ethiopia; Institution based cross-sectional study. Afr Health Sci. 2021;21(4):1830\u0026ndash;41.\u003c/li\u003e\n \u003cli\u003eWong M-L, Chan R, Koh D, Tan H-H, Lim F, Emmanuel S, et al. Premarital Sexual Intercourse Among Adolescents in an Asian Country: Multilevel Ecological Factors. Pediatrics. 2009;124:e44-52.\u003c/li\u003e\n \u003cli\u003eNdagijimana E, Biracyaza E, Nzayirambaho M. Risky sexual behaviors and their associated factors within high school students from Coll\u0026egrave;ge Saint Andr\u0026eacute; in Kigali, Rwanda: An institution-based cross-sectional study. Front Reprod Heal. 2023;5(March):1\u0026ndash;10.\u003c/li\u003e\n \u003cli\u003eNgoc Do H, Ngoc Nguyen D, Quynh Thi Nguyen H, Tuan Nguyen A, Duy Nguyen H, Phuong Bui T, Bich Thi Vu T, Thanh Le K, Tuan Nguyen D, Tat Nguyen C, Gia Vu L. Patterns of risky sexual behaviors and associated factors among youths and adolescents in Vietnam. I.\u003c/li\u003e\n \u003cli\u003eTekletsadik EA, Ayisa AA, Mekonen EG, Workneh BS, Ali MS. Determinants of risky sexual behaviour among undergraduate students at the University of Gondar, Northwest Ethiopia. Epidemiology \u0026amp; Infection. 2022 Jan;150:e2.\u003c/li\u003e\n \u003cli\u003eWarner TD. Adolescent sexual risk taking: The distribution of youth behaviors and perceived peer attitudes across neighbourhood contexts. Journal of Adolescent Health. 2018 Feb 1;62(2):226-33.\u003c/li\u003e\n \u003cli\u003eMutinta G, Govender K, Gow J, George G. An investigation on students\u0026rsquo; risky sexual behavior at KwaZulu-Natal University, Durban, South Africa. American Journal of Sexuality Education. 2013 July 1;8(3):121-39.\u003c/li\u003e\n \u003cli\u003eTolera FH, Girma E, Mamo A, Babure ZK. Risky sexual behaviors and associated factors among high and preparatory school youth, East Wollega, Ethiopia, 2017: A cross-sectional study design. Journal of Public Health and Epidemiology. 2019 Jan 31;11(1):1-2.\u003c/li\u003e\n \u003cli\u003eMesele J, Alemayehu A, Demise A, Yusuf M, Abubeker F, Ahmed M, Jemal A. Level and determinants of knowledge, attitude, and practice of risky sexual behavior among adolescents in Harar, Ethiopia. SAGE Open Medicine. 2023 Jan;11:20503121221145539.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003eTables 1 to 6 are available in the Supplementary Files section\u003c/p\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Risky sexual behavior, secondary school students, sexual and reproductive health problem","lastPublishedDoi":"10.21203/rs.3.rs-5820398/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5820398/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eIntroduction\u003c/strong\u003e: Ethiopia prioritized adolescent and youth health programmes in recent years; particularly in sexual and reproductive health and youth development. Despite these efforts, significant challenges remain, risky sexual behavior among adolescents poses significant public health challenges, including high rates of unintended pregnancies and sexually transmitted infections.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e: To assess the magnitude of risky sexual behavior and factors associated with it among secondary school students in Mirab Abaya district, Southern Ethiopia, 2024.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethod\u003c/strong\u003e: A school-based cross-sectional study was carried out on 389 students selected by simple random sampling method from September 30 to October 14, 2024. The data were collected using a self-administered structured pretested questionnaire and analyzed using the statistical package for social science version 27. Binary logistic regression analysis was employed to identify the associated variables with the outcome variable. Variables found to have a p-value of \u0026lt;0.25 in the bivariable analysis were passed to multivariable analysis.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResult\u003c/strong\u003e: From 408 students, 389 participated, with a response rate of 95%. The prevalence of risky sexual behavior was 30.10% (95% CI: 25.65%–34.55%). Substance use (AOR = 3.85, 95% CI: 1.44–10.22), watching pornographic movies (AOR = 2.10, 95% CI: 1.64–5.61), neglectful parental monitoring (AOR = 3.71, 95% CI: 1.39–9.86), peer pressure (AOR = 3.46, 95% CI: 1.30–9.88), authoritative parental monitoring (AOR = 0.18, 95% CI: 0.07–0.49). Students’ knowledge (AOR = 2.33, 95% CI: 1.53–6.17) and attitudes (AOR = 2.58, 95% CI: 1.89–6.90) were significantly associated with risky sexual behavior.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion and recommendation\u003c/strong\u003e: The magnitude reported here is significant which demand crucial attention. Educational campaigns should be implemented to address the risks associated with substance use. Efforts should be made to improve the availability of condom, parental engagement in discussions regarding sexuality, and establishment of peer-led health clubs within schools to fostering supportive environments and promoting healthier choices among students.\u003c/p\u003e","manuscriptTitle":"Risky Sexual Behavior and Associated Factors Among Secondary School Students in Mirab Abaya District, Southern Ethiopia, 2024","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-02-05 08:57:14","doi":"10.21203/rs.3.rs-5820398/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"740ad052-65dd-47ab-a1c8-048fdb365cb4","owner":[],"postedDate":"February 5th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-02-05T08:57:15+00:00","versionOfRecord":[],"versionCreatedAt":"2025-02-05 08:57:14","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5820398","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5820398","identity":"rs-5820398","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}