Risky sexual behavior and associated factors among youth in Haramaya Secondary and Preparatory School, East Ethiopia, 2015

World Health Organization (WHO) defines “youths” as age group of 15 to 24 years, and are characterized by significant physiological, psychological and social changes that place their life at high risk. Youth who initiate sexual activity earlier get exposed to risks such as sexually transmitted diseases and unwanted pregnancy, at a time when their developmental status places them at a disadvantage in the assessment and management of these risks. The objective of this research was to assess the prevalence and factors associated with risk of sexual behavior among youths in Haramaya Secondary and Preparatory School. Institutional based cross-sectional study was conducted. Simple random sampling technique was used to select a sample of 394 participants. A structured, pretested and self-administered questionnaire was used to collect data. Collected data was entered and analyzed using SPSS version 20. Crude and adjusted odds ratio with its confidence interval was used as measure of association and statistical significance was declared at P<0.05. Among 363 school youths who completed the questionnaire, 134 (36.9%) were sexually active and more than quarter (25.3%) of the youth had engaged in risky sexual behavior. Living arrangement, substance use, watching pornographic movie, age at sex doubt, peer influence and perceived family control were predictors of risky sexual behavior. This study revealed that risky sexual practice of the study area was relatively high among the respondents. The school, local health bureau and stakeholders should work together to address the identified risky behaviors with particular focus on behaviour change communication.


INTRODUCTION
We are living in a very youthful world, indeed, with almost half of the current global population under the age of 25.There are 1.2 billion young people in the world today, and the next generation of youth (children presently below the are defined as belonging to the age group of 15 to 24 years, while the terminology young people covers the age of 10 to 24 years (International Planned Parenthood Federation (IPPF), 1994), characterized by significant physiological, psychological and social changes that place their life at high risk and making up about 20% of the world's population, of whom 85% live in developing countries (WHO, 1999).
Adolescent is a transition period in life from dependent childhood to self-reliant adulthood and includes the range in which the majority of young people join the labour force.It is the period where young person achieve the highest stage of cognitive and physical development and strive to define their self-identity.A need for independence is also one of the features of this group (Fekadu and Kraft, 2001).
Young adolescents who initiate sexual activity get a "head start" on exposure to risks such as sexually transmitted diseases and unwanted fertility, at a time when their developmental status places them at a disadvantage in the assessment and management of these risks (Keating, 2004).In addition to these direct risks, early onset of sexual activity is associated with other indirect outcomes, such as diminished mental health and increased involvement in other risk behaviors (Resnick et al., 1997).It is not surprising, then, that researchers have devoted considerable attention to the determinants of entry into sexual activity among adolescents (Albert et al., 2003).
Worldwide youth have been observed to have the highest STIs and HIV/AIDS rates since most of them have sexual encounters without protection.Although these youth have a lot of information on STIs and HIV/AIDS from various sources, they fail to translate this knowledge into practice in order to bring about behaviour change (Bekwitt and Martins, 2003).The many cases of STIs and HIV/AIDS as well as unwanted pregnancies witnessed in high schools are clear indicators and definers of what is actually on the ground (Mushoriwa, 2014) The health threats for adolescents today are predominantly behavioral rather than biomedical and more of today's adolescents are involved in health behaviors with potential for serious consequences (Elster and Kznets, 2000).Sexual activities among adolescents have been reported to be increasing worldwide.Several studies in sub-Saharan Africa have also documented high and increasing premarital sexual activities among adolescents (Federal Ministry of Health, 2001).However, viewing adolescents as a specific group with their own needs is a relatively recent practice, especially in developing countries (Sederowitz, 1999).
Studies also suggested that adolescents have limited knowledge about sexual and reproductive health and know little about the natural process of puberty.This lack of knowledge about reproductive health may have grave consequences (HIV/AIDS Prevention and Control Office (HAPCO), 2000).Young people often face enormous Shore and Shunu 85 pressure to engage in sex, especially from peers, exposure to unlicensed erotic video films and the desire for economic gain (Taffa and Johannes, 2002).As a result of this, a significant number of adolescents are involved in sexual activities at an early age (Taffa and Johannes, 2002;Taffa et al., 1999).Since there are limited study with regard to risky sexual behavior in the area in youth as many prior studies focus on adolescents or age group 10-18 years old, the aim of this study was to assess the prevalence and factors associated with risk sexual behavior among youths in Haramaya Secondary and Preparatory School.

MATERIALS AND METHODS
The The town is located 506 km east from Addis Ababa.Its altitude ranges from 1600-2500 m above sea level and located 9° and 24° North, and 42° and 01° East ' .The climate condition of the town is highland and its annual rainfall is about 850 ml.The town is bounded by Awaday in the east, Adelle in the west, Tuji in the north and Gube Chala in the south.Currently, the town has 4 kindergarten, 8 elementary schools, 3 high schools, 2 preparatory schools, 1 TVET college and 1 university.

Study design
A cross-sectional study was carried among Haramaya High and Preparatory School youths enrolled in the year of 2015 in Haramaya town.Haramaya high and preparatory school was selected by lottery method from the three schools in the district and 394 youths were included in the sample.First, the students were stratified first by their grade.In the school, there were 10 grade 9 sections, 8 for grade 10; and 4 each for grades 11 and 12.Ten sections: 3, 3, 2 and 2 from grade 9, 10, 11 and 12 were selected randomly respectively.
The numbers of students from each grade were selected using simple random sampling to obtain the total sample for the study after preparing the sampling frame using list of the names of the students from the class attendances.Sample proportional to size allocated for each grade and random sampling technique was used to draw the required number of students.

Data collection methods and tools
Structured self-administered questionnaires adopted from relevant articles (Mushoriwa, 2014;Elster and Kznets, 2000;Negeri, 2014) and translated to local language.Questionnaire was pre-tested for clarity and consistency prior to the actual data collection.Then, necessary correction was made based on the feedback of the data collectors.
Information on student's risky sexual behavior, socio demographic characteristic of the respondents, factor contributing for the involvement of the respondents in risky sexual activity and another related data was collected.The principal investigators coordinated and supervised the overall activity of the study.

Data processing and analysis
The collected data were entered, cleaned and analyzed using Statistical Package for Social Sciences (SPSS) version 20.Descriptive statistics results including socio-demographic characteristics of the study participants, magnitude of risky sexual behaviors and factors of risky sexual behavior were tabulated using frequency distribution.Univariate analysis was carried out to identify the predictors of risky sexual behavior and then, multivariate logistic regression model was run to control potential confounding variables.Statistical level of significance was set at α<5%.

Data quality assurance
The quality of data was ensured through proper training of data collector and pre test of the questionnaire and close supervision of data collectors.All collected data was checked for completeness, accuracy and consistency by the principal investigator and communicated to the data collectors on the next day.

Limitation of the study
The limitation of this study was that respondents may not give response as required because of the sensitive nature of the sexual behavior.This might under estimate the prevalence of risky sexual behaviors.

Ethical consideration
Ethical Clearance was obtained and formal letter was written by Haramaya University Public Health Department to Haramaya Secondary and Preparatory School explaining objectives of the study and its significance, relevant permission was asked to obtain desirable cooperation and necessary information during data collection.At individual level, the purpose of the study was discussed with all participants prior to their participation in this study.Furthermore, the participants were informed that their participation in the study was voluntary and that they were not obliged to answer any question with which they was uncomfortable and was also free to withdraw their participation from the study at any time they want.Participants were assured that confidentiality would be maintained.

Risky sexual behaviors
The prevalence risky sexual behavior in the High and Preparatory School youth was 25.5%.From 363 youths, 179 (49.9%) of them have had sexual intercourse; of these, 57(46.7) of them had sexual intercourse at the age less than 15 year old.134 (36.9%) of them had sexual intercourse in the last 12 months before the survey.From sexual active youths: 46 (34.3%) of then did not use condom during the last sexual intercourse and 25 (54.3%) reported the reason for not using condom was, it reduces pleasure, 42 (31.3%) of them had more than one sexual partners.From the total participants, 122 (33.6%) of them reported to have watched pornographic movies and 162 (44.6%) of them use substance (Table 2).

Factors associated with risky sexual behavior
Bivariate analysis was carried out to identify predictors of risky sexual behavior and all variables with P<0.3 were selected to be included in multivariate logistic regression.Multivariable logistic regression analysis was done to identify the effect of independent factors after controlling other confounding variables.The overall model to predict the probability of risky sexual behavior was statistically significant (P<0.05).After controlling for effects of potential confounding variables, living arrangement, substance use, watch pornographic movie, age at sex doubt, perceived family control and peer influence were significantly associated with risky sexual behavior.
Accordingly, living arrangement is significantly associated with risky sexual practice.Those who live in rural area were 1.87 [95% CI: 1.03, 3.40] times more likely to practice risky sexual behavior than those who were living.Similarly, substances use is significantly associated with risky sexual practice.Youth who were reported to use substance were 1.93 [95% CI: 1.11, 3.35] times more likely to practice risk sexual behavior than students who did not use substances.
Moreover, watching illicit pornographic movie is significantly associated with risky sexual behavior.Students who have exposure to pornographic movies were 1.96 (95% CI: 1.12, 3.44] times more likely to practice risky sexual behavior than those who did not watch pornographic movies.Besides, age at sexual doubt is strongly associated with risk sexual behavior.Those that initiated sexual intercourse at age less than 15 years, were 3.35 [95% CI: 1.73, 6.52] times higher at odds of practicing risky sexual behavior when compared with those whose age at sexual doubt was 15 years or more. Furthermore, perceived family control is significantly associated with risk sexual behavior.Youths who perceive no or less parental control over their behaviors were 1.91 [95% CI: 1.10, 3.34] times higher at odds of engaging in risky sexual behavior when compared with those who reported perceived parental control.Finally, 1.03, 3.05] times higher at odds of practicing risk sexual behavior when compared with those who perceive their behaviors are not influenced by peer pressure.Other  3).

DISCUSSION
This study attempted to provide insight into the prevalence and risk factors associated with risky sexual behavior among high and preparatory school youth in Haramaya town.It is found that there were several factors that affect youth's sexual behavior.
The finding showed that the magnitude of risky sexual behavior was 25.3% among school youths.This finding was consistent with study conducted in Addis Ababa (Taffa and Johannes, 2002) which reported the 25.3%.But, it was slightly lower than the finding of other study conducted in Addis Ababa (Gizaw et al., 2014) which was 26.7% and Pawe District Benishangul Gumuz Region of Ethiopia (Agajie et al., 2015) which was 37.6%.However, the finding of this study was higher than the prevalence of risky sexual behavior among adolescent in Boditi town, Ethiopia (Daka and Shaweno, 2014) which was 17.9% and western zone of Tigray, Ethiopia (Abel et al., 2014) which was 13.7%.The observed difference could be explained by the access to electronic devices through which youths are easily exposed to pornographic movies and pictures in this area when compared with the two areas.
According to this study, substance use is strongly associated with risk sexual behavior.The odds of engaging in risky sexual behavior is higher among substance user when compared with non-user.This is consistent with several studies (Agajie et al., 2015;Getabalew and Mitsiwat, 2015;Dereje et al., 2015;Jacqueline et al., 2007;Chaveepojnkamjorn and Pichainarong, 2011;Tadesse and Yakob, 2015) and substance use was found to be strongly associated with a wide range of other health risk behaviors.Furthermore, study (Jacqueline et al., 2007) showed that there is strong dose-response relationship between the frequency of substance use and the prevalence of other health risk behaviors.This can be explained by that fact that substance use tended to be the first risk behavior that the youth initiated, and then transitioned to risk sexual behavior (Lori-Ann, 2009) Moreover, watching sexually explicit/pornographic movies was significantly associated with risky sexual behavior when compared with those that did not watch one.This finding is consistent with several study conducted in various parts of Ethiopia (Dereje et al., 2015;Tadesse and Yakob, 2015;Abel and Fiseha, 2014;Oljira et al., 2012).This indicates that exposure to pornography might affect their decision making regarding sex.Besides, the contents of pornographic media may contain inappropriate and unsafe sexual behaviors such as not using condom, sex with causal partner and multiple sexual partnerships that can promote risky behaviors.
In addition, age at sexual doubt was significantly associated with risky sexual behavior.This result is consistent with the study conducted in preparatory schools youth in Addis Ababa (Dereje et al., 2015).Study in U.S.A (de Ravello et al., 2014) also showed that early sexual intercourse before age 13 year increases the likelihood of involvement in other risky sexual behavior.In this study, significant proportion of school youth had their fist sexual intercourse before age 15 years and the longer time of sexual experience was followed by change of partner and others risky behavior.
Furthermore, perceived family control was significantly associated with risky sexual behavior.This finding coincided with study conducted in the Jimma University (Tura et al., 2012).Similarly, study in U.S.A showed that parenting influence many aspects of development, including risky sexual behavior (Biglan et al., 1990).This might be explained by the fact that parental control over adolescents' had minor effect on engaging in sexual intercourse.
Study conducted in San Francisco, U.S.A, showed that adolescents reporting successful parental monitoring (accurately knowing the adolescents' whereabouts and activities outside the home) significantly expressed cognitions which is less favorable for initiating intercourse, while adolescents that reported more unrestricted time were more likely to express cognitions that favored initiating intercourse (John, 2005).Parental supervision and monitoring may be particularly relevant to sexual expression by communicating parents' concern about risky behavior and increasing children's awareness of the costs of such behavior.
The finding of this study showed that perceived peer pressure was the predictor of risky sexual behavior among high school youth.This is similar to study conducted in Ethiopia (Daka and Shaweno, 2014;Abel and Fiseha, 2014;Tura and Dejene, 2012).This might be due to the fact that adolescents are at higher probability of sharing their day to day life experience and they spend majority of their time with their friends, especially with students that does not live with their families.

CONCLUSION AND RECOMMENDATION
In conclusion, the study revealed that risky sexual practice was relatively high among school youth in the study area.Living arrangement, substance use, watching pornographic movie, age at sex doubt, perceived family control and perceived peer pressure were the predictors of risky sexual behavior among youths.The school, and local health bureau and stakeholders should work together to address the identified risky behaviors with particular focus on behaviour change communication.

Table 1 .
Socio-demographic characteristics of students and parents in Haramaya high and preparatory school, Haramaya, 2015.

Table 3 .
Factors associated with risk sexual behaviour among youth in Haramaya high school student, Haramaya, 2015.
*Significant at p<0.05.variables in the model: grade, age in year, sex, religion and living with family are not associated with risk sexual behavior of youths (Table