Prevalence of Risky Sexual Behavior and Associated Factors Among Secondary School Students in Dire Dawa:

A School-Based Cross-Sectional Study

Abstract

Background: Risky sexual behavior (RSB) among adolescents, including early sexual debut, multiple partners, and inconsistent condom use, poses a major public health challenge in low-income countries like Ethiopia, increasing risks of HIV/AIDS, STIs, and unintended pregnancies. Despite interventions, RSB remains prevalent among Ethiopian secondary students, warranting further research. Studies in Dire Dawa often used small, non-representative samples and inconsistent RSB measures, limiting generalizability. This study aimed to assess the prevalence of risky sexual behavior and its associated factors among secondary school students in Dire Dawa City, Ethiopia.

Methods: A school based cross-sectional study was conducted from November 2024 to January 2025 among 602 secondary school students in Dire Dawa, Ethiopia. Data were collected using structured, self-administered questionnaire adapted from Centers for Disease Control and Prevention (CDC), Youth Risk Behavior Surveillance System (YRBSS), previous related studies and Oslo Social Support Scale (OSSS-3). Multi-stage sampling was used to select participants, and data were analyzed using SPSS version 26. Bivariate and multi-variate logistic regression analyses were performed to identify factors associated with risky sexual behavior, with significance level set at P < 0.05.

Results: The study found that 200 students, representing 33.2%, engaged in risky sexual behavior. Older students had 1.6 times higher odds of risky behavior (AOR=1.63, 95% CI:1.19, 2.24). Social support showed protective effects: moderate support (AOR=0.20, 95% CI:0.07, 0.56) and strong support (AOR=0.03, 95% CI:0.01, 0.09) reduced odds. Family substance uses increased odds 6.5 times (AOR=6.46, 95% CI:2.65, 15.73), peer pressure 5 times (AOR=4.96, 95% CI:1.83, 13.40), and easy post-pill access 7.7 times (AOR=7.67, 95% CI:2.96, 19.89). Good risk perception reduced odds significantly (AOR=0.07, 95% CI:0.03, 0.16).

Conclusion: Risky sexual behavior is prevalent among secondary school in Dire Dawa, Ethiopia, and influenced by combination of individual, familial, and environmental factors. Intervention should focus on strengthening social support system, improving access to sexual health education and services. Additionally, policies should address the easy availability of emergency contraceptive without consultation which may contribute to risky sexual behavior.