4.       Background 

World Health Organization (WHO) defines adolescent and youth as people between the ages 10-19 and 15-24 respectively [1]. 

Sexual activity amongst adolescents has been reported to be on the increase worldwide [2]. Similarly, in Ethiopia, adolescents aged 10 to 20 years constitute 25% of the population [3]. Young people are a significant part of the labor force and form the backbone of any country’s economy. The health of young people is thus a key element for social and economic progress [4]. 

Most of the literature showed that most youth have begun to engage in sexual experimentation, including kissing with 97% of adolescents experiencing their first kiss at their early age [5]. 

Youth who begin early sexual activity are more likely to have high risk sex or multiple sexual partners and they have chance of practicing unsafe sex [6]. 

An in school cross-sectional study among sexually experienced Ghanaian in 2012 shows that, 25 %( 28% boys and 23% girls) were sexually experienced [7]. 

In Ethiopia, the sexual and reproductive health of young people has become a major public health concern, particularly with emerging of AIDS pandemics and unsafe abortion [8]. 

Young people often face numerous pressures to engage in sex especially from peers, exposed to unlicensed erotic video films and the desire for economic gain [9]. 

Lack of parental control, substance use, peer pressure campus and outside environment were identified as predisposing factors; males were about three times more likely to ever had sexual intercourse as compared to females [10,11]. 

4.1.              In School Age Risk-Taking Are the Most Serious Threats to Adolescents: 

sexual risk-taking, substance use and illegal behavior. Each of these behaviors provides an interesting lens through which to examine questions about the influence of environmental and individual factors. So, this study is aimed to assess risky sexual behaviors and associated factors among High school students in Dire dawa town, East Ethiopia in 2018.

5.       Methods

5.1.              Study Setting and Participants 

Cross-sectional study design was conducted in Dire Dawa comprehensive & secondary school. This school is the first governmental school that was established in 1963. This school has been a hope for the people of Dire Dawa for over 40 years; still it gives a great service for the people of Dire Dawa and has a significant role in contributing educated human power for the country. 

The school is located at the south-western part of Dire Dawa. It is founded along the right side of the road to Harar on the border of the town. 

In this school, there are a total of 1406 student which are enrolled in 9-12, of this about 803 are male and 603 are female students. The total number of teachers which are involved in the teaching and learning activities are 116, of them 18 are female teachers. The school has a total of 37 sections. This study was conducted from April 27-30, 2018. 

Study participants consist of 276 from all grade &the numbers of students from each grade were selected by 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 was allocated for each grade and random sampling technique was used to draw the required number of students. 

Data was collected using semi structured self-administered questionnaire designed in English language. It was structured as closed ended and open-ended questionnaire and it developed and adapted after review of relevant literatures and arranged according to particular objective it can address. The questionnaire was explained in detail by principal investigators. 

5.2.              Data Collection and Quality Control 

Questionnaire was pre-arranged and consistent supervision was carried out by the principal investigators. Data collection questionnaire were adopted from pre-established known source [12,13] and modified to address the study variables in this study. Daily monitoring of the process and feedback on each day performance at the end of working hours was done. Data completeness was checked during field period.

One week before the actual data collection survey pretest was carried out in another high school on 5% of our sample size to detect on data collection and the necessary modification was made before being applied on the subjects.

5.3.              Data Analysis 

The collected data was checked for its completeness and cleaned by principal investigators. Data was entered and analyzed using SPSS version 20.0, descriptive statistics like frequency distribution, Bi-variant and Multivariable analysis was carried out to calculate the crude odds ratio (OR) and Adjusted odds ratio for testing of the association between independent and dependent variables. Analysis was done according to the objectives of the study. 

5.4.              Inclusion Criteria 

All regular students of grade 9 -12 who present during data collection time were participated in the study. 

5.5.              Exclusion Criteria 

Students those were absent during data collection, not volunteer, critically sick during data collection.

5.6.              Operational Definition 

5.6.1.         Knowledge: Level of educational difference about risky sexual behavior and associated factors. 

5.6.2.         Good Knowledge: those respondents who will be answer correctly >7 of questions about knowledge of risky sexual behaviors. 

5.6.3.         Poor Knowledge: those respondents who will answer correctly <7 of questions about knowledge of risky sexual behaviors. 

5.6.4.         Attitude: Settled way of feeling both negative and positive typically reflected in person’s behavior towards risky sexual related activities. 

5.6.5.         Positive Attitude: those respondents who responds attitude question 3or more by saying YES 

5.6.6.         Negative Attitude: those respondents who responds attitude question less than 3 by saying YES 

5.6.7.         Practice: Experience of respondents toward risky sexual behavior. 

5.6.8.         High Practice: Those who score more than 6 for practice related question 

5.6.9.         Low Practice: those who score less than 6 for practice related question 

5.6.10.      Risky Sexual Behavior: refers to behavior engaging in to unprotected sex without use of condom with non-regular partner or sex with multiple partners’ or sex after use of substances. 

5.6.11.      First Sexual Intercourse: respondents who engaged sex at first time.

6.        Result 

6.1.              Socio-Demography Characteristics              

The response rate of this study was 97.5%. Among 271 respondents 147 (54.2%) were males and, majority 216(79.7%) in age range of 15-19 years. Concerning ethnicity, majority were Oromo 129(47.6%) followed by, Amhara 94(34.7%). Regarding the religion majority of them were Muslim 121(44.6%) followed by Orthodox Christian 105(38.7). Concerning place of residence, majority of them were from urban 206(76%) and Rural 65(24%). Majority of the respondents live with their family 217(80.4%) and mother’s educational status that learned primary school were 100(36%), 75(27.2) were unable to write and read and fathers educational status that learned primary school were 97(35.8%). With regard to monthly income of family, majority 119 (43.9%) earns greater than 3000 (ETB) (Table 1).

6.2.              Knowledge of Risky Sexual Behavior 

Among 271 study participants 193(71.2%) of them were aware of about risky sexual behavior, majority 85(44%) had got information from radio or TV while the least 21(10.9%) they heard from their parents. 

Regarding the risk, 174(64.2%) believed to be sex with multiple partner considered as risky sexual behavior and 97(35.8 %) did not.172(63.5 %) believed to be sex without condom use is risky sexual behavior and 154(56.8%) believed that sex after substance use as risky sexual behavior.149(55%) believed that risky sexual behavior as having sex with commercial sex workers whereas 122 (45%) did not. 141(52%) of them said sex through anal and oral is judged as risky sexual behavior.

Concerning the outcome of risky sexual behavior, majority 204(75.3%) believed that it can leads to unwanted pregnancy and 231(85.2 %) indicated STI including HIV/AIDS as a great impact (Table 2).

6.3.              Attitude Toward Risky Sexual Behavior 

Among the total of 271 study respondents 190(70.1%) have agreed on straight forward questions regarding risky sexual behavior (Table 3).

6.4.              Practice of Risky Sexual Behavior 

From the total of 271 study subjects, majority 199(73.4 %) had sexual feeling to opposite sex. From those who had feeling majority 118(59.3%) are at the age group 15 years and more. 

Out of the sexually active group, 117(58.8) had sexual contact. Majority 72(61.6%) had their first sexual intercourse at the age range of 15-19 years.

The majority of the respondent’s 172 (63.5%) had intimate friends in the last twelve months. Among those who ever had intimate friends, majority 92(53.5%) had sex in the last 12 months. Out of those who had sex in the last 12 months, majority 92(53.5%) had only one intimate friend. 

From those who ever had sexual intercourse, 78(66.7%) have ever used condom and 39(33.3%) have never used. 

From the respondent’s, majority 166(61.3%) had used substance. Out of 166 substance users, majority 82(49.4%) had used khat, followed by alcohol 53(31.9%). 

Out of 48 who enjoyed Night club, majority 23 (47.9) have enjoyed once in a month and the least 10(20.8%) at every weekend. Out of 175 who watched erotic film 84(48%) watched occasionally and the least 24(13.7%) watched every day (Table 4). 

7.       Factors Associated with Risky Sexual Behavior 

7.1.              Bi-Variate Analysis of Risky Sexual Practice 

Bi-variate analysis was carried out to identify predictors of risky sexual behavior and all variables with p<0.2 were selected multi-variate logistic regression. Multi-variate logistic regression analysis was done to identify the effect of independent factors. The overall model to predict the probability of risky sexual behavior was statistically significant (p<0.05). Accordingly, gender is significantly associated with risky sexual behavior. Those males were 2.01[95% CI: 1.25, 3.28] times more likely to practice risky sexual behavior than females. Regarding previous resident of respondent those who lived rural were 2.19[95% CI: 1.23, 3.87] times more than whom resident was urban. Similarly, substances use is significantly associated with risky sexual behavior were 1.94 [95% CI: 1.18, 3.1] than students who did not use substances. 

Moreover, watching erotic movie is significantly associated with risky sexual behavior. Students who have exposure to movies were 1.77[95% CI: 1.083, 2.89] times more likely to practice risky sexual behavior than those who didn’t watch erotic film (Table 5). 

7.2.              Multivariate Analysis of Risky Sexual Practice 

In the bi-variate analysis variables that reached a p-value of less than 0.2 in the bi-variate analysis were included in the multivariable analysis. 

The multivariate binary logistic regression analysis identified that age of the of the students, previous place of residence, Knowledge status of the respondents, Substance Use, Night club enjoyment and sex of respondents had significant association with risky sexual behavior (Table 6).

 8.       Discussion 

In our study, among 271 respondents’ more than half (56.7%) had boy or girls friend which accounts (43.2%) and had sexual intercourse. This finding is almost similar with the study conducted at North East Ethiopia youth ever had sex (51.3%). This difference might be due to sample size and geographical area and Time. 

Regarding first sexual initiation was 12 and 13 years for female and male respectively. The finding is similar with the study conducted at Addis Ababa [13]. The similarity might be because the respondents live in comparable cities and living style of the community. Relating to first sexual intercourse, majority (61.6%) had their first sexual intercourse at age range of 15-19. This finding is also almost similar with the study done in Zambia shows 65% had their first sexual intercourse between the age of 15 and 17. This little difference may be due to cultural difference between the study respondents at the two-study area and media exposure. 

Concerning the reason of starting sexual intercourse (53.8%) started their first sexual intercourse due to desire to experiment, (23.9%) due to peer- influence, (18%) after use of substance like alcohol and khat, and (4.3%) due to need of money. This finding is also similar with the study done in Zambia shows 48% of the first sex done for the desire to experiment 18% due to peer pressure. This revealed almost the same findings even though a little bit lowered. This might be because of the cultural difference between the study respondents at the two study area. 

This study showed that, (46.5%) has two or more sexual partners for the last 12 months. This study is similar with conducted in preparatory school students of Gondar town in 2011, 43.3% had multiple sexual partners. Still there is little difference between the two study areas. This difference might be because of difference in life style, culture and living condition of the respondent. 

In this study, (69.2%) had used condom rarely during sexual contact, (21.8%) had used always and (9%) sometimes. The same study was conducted among undergraduate university students in Ethiopia revealed who had 28% ever had sexual intercourse, about 60% of students had used condom rarely.This discrepancy might be due to because of health education and awareness that have been given at different level and accessibility and distribution of condom. 

Among (61.3%) have used substance, majority (49.1%) have used khat, (31.7%) have used alcohol, (12.6%) have used hashish. The same study conducted among high school students in A. An in 2011, more than half 52.5% of sexually active students (57.4%) were current alcohol drunker, 27% cigarette smokers and 28.7% were chat chewers and 20% were current shisha smokers. This difference might be due to living situation and cultural variation in Addis Ababa city and Dire Dawa city. In addition, in the eastern part of Ethiopia chat is the main economy source of the community and highly accessible. 

Risky sexual behavior is significantly statistical associated with age, previous place of residence, sex, knowledge, night club enjoyment and substance use of study respondents. In other study also most of those factors are considered as risk factors for risky sexual behavior. 

9.       Conclusion 

Majority of the study respondents are knowledgeable about sexual risky behavior. Even though they have knowledge about risky sexual behavior, they started initiation of early sexual intercourse at their early age. The risky sexual behavior is highly prevalent in male than female and they are poorly protecting them self from sexual transiting disease. Multiple sexual partners are considered as risky sexual behavior. Khat chewing and drinking alcohol are pushing the students to practice risky sexual behavior. 

Age, Previous place of residence, knowledge, sex, night club enjoyment and substance use of study respondents are significantly associated with risky sexual behavior.

10.               Acknowledgement 

We would like to thank Haramaya University, school of public health, Chiro general hospital staffs for allowing us to use and provide an internet access. Finally, we would like to thank Dire Dawa secondary and preparatory school staffs and students for their invaluable assistance and participation during our data collection. 

11.   Funding 

There is no organization that fund for this Research. 

12.   Availability Data and Materials 

The datasets used or analyzed during the current study available from the corresponding authors any time in reasonable request. Upon request we are ready for submission of the required data set. 

13.   Authors’ Contribution 

Tariku Derese, Tadele Woldie and Adane Tareke conceived and design the study, perform analysis and interpretation. Alemshet Getachew assists with Design, conception, analysis and interpretation of the data. Tariku Derese also writes up and drafted the manuscript and all the authors read and approved the final manuscript. 

14.   Competing Interests 

Authors declared that there is no competing interest. 

15.   Consent for Publication 

Consent for publication is not necessary because this manuscript didn’t have any personal data like individual details, photo, image and video. 

16.   Ethical Approval and Consent to Participate 

Before data collection, ethical clearance and permission was obtained from Ethical Review Committee of Haramaya University, college of public health and medical sciences, school of public health. The Ethical review committee also had approved the procedure of verbal consent. The written consent is not necessary because Official Support Letter was given for Dire Dawa preparatory school Director and all study participants were informed before data collection about the purpose of the study and their right to refuse. The data was collected after verbal consent is assured from the participant. The investigators made sure that confidentiality of the information was assured in such a way that no disclosure of any information of participant.

Table1: Socio-demographic characteristic of respondents on risky sexual behaviors among Dire Dawa secondary and preparatory school June 2018.

Table 2: Distribution of study participants on Risk sexual behavior awareness among Dire Dawa secondary and preparatory school June 2018.

 Table 3: Distribution of attitudes of study respondent towards risky sexual behavior among Dire Dawa secondary and preparatory school June 2018.

Table 4: Distribution of study participants of sexual practice among Dire Dawa secondary and preparatory school June 2018.

Table 5: Bivariate analysis of Risky sexual practice.

Table 6: Multivariate analysis of Risky sexual practice.

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