# Introduction ccording to World Health Organization (WHO) definition adolescent comprises individuals between the age group of 10-19 years old. 1 United Nations International Children's Emergency Fund (UNICEF) categorizes adolescents in to three stages; 10-13 years old as early adolescents, 14-16 years old as middle adolescents, and 17-19 years old as late adolescents. 2 The World Health Organizations (WHO) has reported that young people aged 15-24 accounted for an estimated 45% of new HIV infections worldwide. 3 Age at marriage is rising in many African societies, especially among the better-educated and urban segments of the population. At the same time, it is believed that age at menarche is declining, and that premarital adolescent sexual activity is increasing. 4 According to Ethiopian Demographic and Health Survey (EDHS) 2011 report, among women age 25-49, 29 percent first had sexual intercourse before age 15. 5 Early sexual debut increases young peoples' risk for infection with HIV and other STIs. Youth who begin early sexual activity are more likely to have highrisk sex or multiple partners and are less likely to use condoms. 6 In Ethiopia, HIV prevalence in the 15-24 age groups is 8.6%.7 the commonest mode of HIV infection is heterosexual contact accounting 87%. 5, 7 Studies conducted so far on pre-marital sexual practices and factors related to it in Ethiopia are few in number and there are no current data on this topic in the study area. # II. # Materials and Methods Institutional based cross sectional study design was conducted among high school and preparatory school students in Alamata town, northern Ethiopia in 2013. A total of 520 sample size was calculated using single population proportion formula then the sample was allocated proportionally for all classes. The procedure involved of three steps. First, in order to select the A (namely, grade 9, 10, 11, and 12) were selected by using simple random sampling (SRS) Second, a probability proportion to sample size (PPs) was used to select the total number of participants to be included in the study from the randomly selected sections. Third, in order to select the study participants, a systematic random sampling method was used by using roster list or names of the students from the registrar office of both schools in every forth interval. Data was collected from March to April, 2013 using self administered questionnaire with seven parts namely, Socio-demographic characteristics; Sexual and Reproductive health knowledge and related questions, communication on Sexuality and HIV/AIDS; Attitudes towards pre-marital sex; related to some risk behaviours of Adolescents; Peer Influence and peer behaviour; and sexual behaviour and practices. Data quality was ensured through pre test was done from other school out of the mail study participants, the questionnaire was translated in to local language-Tigrigna, supervisors and school community were communicated and orientation was given for data collectors and study participants on the purpose of the study. Data cleaning and entry was performed by using EpI Info version 3.5.1 and analyzed by using SPSS version 16. Descriptive analysis was carried out for the dependent and independent variables. Bivariate analysis was done for the independent variables with the dependent variable to select candidate variables (pvalue less than 20%) for multivariate analysis. P value less than 0.05 and 95% confidence interval (CI) for odds ratio was used to judge the significance of association. Administrative and academic staffs were communicated about the study, and they gave their willingness on data collection. Informed consent was obtained from the study subjects after providing the necessary information through the information sheet and the informed consent form which is attached to the front page of the questionnaire and data was collected after getting informed consent from the study participant. # III. # Result a) Socio demographic characteristics of respondents The response rate was 94.8%. From the total respondents, male accounting 264 (53.5%). Among the respondents 472(95.7) were in the age group of 15 to 19 years old. The mean age and standard deviation (SD) for male was 16.7 and 1.48 respectively, and mean age for females was 16.45 and SD of 1.26. (Table 1) One hundred four (21.1%) of adolescent students participated in this study had had premarital sexual practice. From these, Seventy five (72%) were male and 29 (28%) were females. Age at first sexual intercourse is shown in (fig 1). Volume XIV Issue III Version I Year ( ) K Ethical clearance was obtained from Addis Ababa University (AAU), department of nursing and midwifery research committee institutional review board. Permission was granted from officials at different levels in Alamata town through the formal letter obtained from the department's research committee institutional review board. Sixty six (17.2%) of urban residents and 38(34.5%) of rural residents had had sexual practice before marriage. In addition, 24(77.4%) of respondents who didn't attend church or mosque were engaged in premarital sexual practice, compare to 80(17.3%) of those who attend religious. More than one third of respondents (38.5%) who had sexual practice were from illiterate father, 40(31.5%) of respondents who start sexual practice were from illiterate father, while 8(9.4%) of those who start sexual practice were form a father who have educational level of college and above. Similarly, 47(27.5%) of respondents who start sexual practice were from illiterate mother, while 12(17.1%) of respondents who start sexual practice were from a mother with educational status of college level and above. Reasons given by the respondents to start sexual practice include fall in love, had desire, peer pressure, raped was drunk and to get money or gift accounting (figure 2). Regarding the risk behaviors of adolescent's majority, 253(51.3%), of the respondents had never drink alcoholic beverages, while 23.3% drink once or twice a week. Four hundred sixty one (93.5%) had never smoke cigarette in their life, while 21(4.3%) smokes once or twice a week and 3 (0.6%) smokes daily. More than one third (36.3%) of the respondents said that they have a boy/girlfriend at the time of data collection, while 314(63.7%) don't have a boy/girlfriend (Table 2). # Discussion This study revealed that more than one fifth (21.1%) of respondents were involved in premarital sexual practice. When compared with other studies done on a similar topic, the finding of this study is almost similar with studies done in Nekemt and Injibara. 8,9 But the finding of this study is relatively higher than the national level of premarital sex. According to BSS, the proportion of premarital sex among in school youths is 16%. This difference could be due to the study population (this study assessed the prevalence of premarital sex among in school students aged 10 to 19 years old, while the national study included only adolescents who are at the age group of 15 to 19 years old). The other reason could be the number of sample used, the current study assessed adolescents found in two schools, while the national survey included a large number sample with diverse population. According to this study, majority, 75(28.4%) of male respondents and 29(12.7%) of female respondents had had sexual intercourse. showed that males are highly involved in premarital sexual activity than their counterparts. This could be due to the high expectation of virginity before marriage for females than males and a lesser cultural expectation for males to remain virgin until marriage than females in our society, due to low parental control for males than females and the differ -ence in the opportunity costs of becoming sexually active (and the subsequent risks of unintended pregnancy). 10,11 Other similar studies done in eastern Ethiopia, Ambo, Nekemt, Injibara, and Gedeo zone also showed that the proportion of males to engage in premarital sexual practice is relatively higher than females. 8,9,10,12,13 A study done among undergraduate university students in Ethiopia also showed that more proportion of male students ever had sex compared to females. 14 Another study done in Jima University students also showed that male students are three times more as likely as their female encounter parts to experience sexual intercourse. 15 Previous studies done in India, Malaysia and China also found that young boys tend to have premarital sexual activity than young girls. 16 According to the current study, adolescents who are aged 18 and above are more likely to involve in premarital sexual practice than adolescents who are aged below 18 years old. This shows that as the age of adolescents increase, there is higher probability to involve in sexual practice. This result is similar with other studies done in Ambo, Jimma, and Injibara. 9,12,15 Place of residence was another factor found to be associated with premarital sexual practice. According to this study, adolescents who were living in the rural area were more likely to involve in premarital sexual activity than urban residents. This could be because adolescents from rural areas often live away from parental guidance and peoples in urban areas commonly have better sexual and reproductive health access comparing with the rural people. 10,16,17 A study conducted in Nekemt town showed that if adolescents migrate from rural areas to urban areas, then it predisposes them to unnecessary communications and unsupervised relations which lead them to reckless sex.8A study done in Nigeria regarding internal migration and premarital sexual practice also showed that premarital sexual debut is generally higher among migrants than non-migrants. 17 In contrast to the current study, a study done in eastern Ethiopia showed that, adolescents from urban families are more likely to engage in pre-marital sex than those from rural area. The reason for this difference could be attributed to a reason that this study involved only 2 schools, while the study in eastern Ethiopia involved 14 schools with diverse population. Another study done in Lesotho showed that norms of the society discouraging sex before marriage have eroded more in urban areas than in rural areas. Hence urban environment provides a conducive environment for experimenting with sex before marriage. Because of this, never married women living in urban areas are more likely to be sexually experienced than their counterparts residing in rural areas. 18 The difference with the current study could be due to the difference in the socio demographic characteristics and the difference in the study population (the study in Lesotho included women's aged 15-49 years old while the current study included both male and female in school students whose age is 10 to 19 years old). By considering the above different findings and the reasons given, the association between premarital sex and place of residence needs further investigation. Adolescents with positive attitude towards premarital sexual practice were more likely to engage in premarital sex than those who have negative attitude towards premarital sex. This may be because of the reason that, since the acceptance of sexual practice before marriage encourage adolescents to engage in premarital sexual activity. Other studies done in Jima and Jigjiga also showed that students with moderate and positive attitude towards premarital sexual practice are more likely to engage in sexual activity than their traditional minded students. 15,19 A study done in Nigeria also showed that personal attitude in favor of delayed sexual debut were associated with lower sexual debut among both males and females.20A study done in Indonesia also showed that, adolescents who accept premarital sexual intercourse have had premarital sexual intercourse than those who do not accept (8.0% and 0.4 respectively). 16 According to the result of this study, adolescents who use drugs are more likely to involve in premarital sexual practice than non-drug users. This could be because adolescents who abuse drugs are more likely to have poor judgment, which can result in unplanned and unsafe sex. In addition, most of the adolescents involved in substance use are often also involved in sexual practice. 21 A study done in Maharashtra, India on correlates of premarital relationships among unmarried youth also showed that exposure to drugs to be positively associated with rom -antic and sexual relationships for both young women and young men. 22 According to the study done on individual, familial, friends and contextual predictors of early sexual intercourse, substance use was found to be associated with early sexual intercourse. 21 In addition, a study done regarding sexual initiation, substance use, and sexual behavior and knowledge among vocational students in Northern Thailand also showed that use of substances is associated with initiation of sexual intercourse. 23 Similar findings were also seen in a study done in Malaysia, showing that adolescent sexual intercourse is significantly associated with drug use. 11 A study done in Indonesia showed that, in school late adolescents who have a boyfriend or girlfriend were more likely to have premarital sexual intercourse than those who do not have a boy/girlfriend. 16 Similar finding was also observed in this study that, adolescents who have a boy/girlfriend are more likely to involve in premarital sex than those who don't have a boy/girlfriend. This could be due to the pressure from their girl/boyfriend to have sexual practice. In Ethiopia, a study done in Jigjiga and Nekemt town also showed that having a boy/girl friend is one factor which determines to start sexual intercourse. 8,19 Other study done in Malawi also showed that romantic interpersonal relationship was one of the factors that informed sexual decisions of female adolescents. 24 According to the result of this study, adolescents who experience pressure from their friends were found more likely to involve in premarital sexual practice than those adolescents who didn't experience peer pressure from their friends. This could be because; peers play important part in deciding personality and behavior among adolescents. 16 In Ethiopia, according the national HIV/AIDS Behavioral Surveillance Survey (BSS), peer pressure was one of the common reasons given for starting sex. 25 Similar result were also observed in studies done in Injibara, Jimma, and Jigjiga showing that students who had peer influence were more likely to have sexual intercourse than students who do not. 9,15,19 A study done on premarital sexual debut and its associated factors among in school adolescents in eastern Ethiopia also showed that adolescents who were less influenced by external pressure were more protected against pre-marital sexual debut than their counter parts. 10 Another study done in Nigeria regarding adolescent's susceptibility to peer pressure and how it affects pre-marital sexual practice among adolescents, also showed that susceptibility to peer pressure is signif -icantly associated with premarital sexual practice. 26 Another study regarding the reasons for delaying or engaging in early sexual initiation among adolescents in Nigeria, also showed that peer pressure to be associated with early sexual initiation. 27 According to the result of this study, adolescents who watch sex/pornographic movies were more likely to engage in premarital sexual practice than those who don't. This could be because adolescents who watch pornographic movies may develop unrealistic attitudes about sex, which leads them to engage in sexual practice. A study done regarding the age at sexual initiation and factors associated to it among youths in North East Ethiopia showed that watching pornographic materials at age less than 18 years old was found to be associated with sexual initiation. 28 A study done in Jigjiga also showed that students who watched pornographic/sex movies are more likely to engage in sexual activity. 19 Another study done in Jimma also showed that high and medium level of erotic exposure was more than twice as likely as their peer who had low exposure to erotic materials to be sexual experienced. 15 A study done in Injibara town also showed that students who had not seen sex films were less likely to get in to sexual intercourse than those who had seen such film. 9 The result of this study is also similar with a study done in Asian country about premarital sexual intercourse among adolescents. According to the study, pornography viewing was found to be significant factor for premarital sex among boys. 29 In addition a study done in Maharashtra, India, also showed that exposure to pornographic films is positively associated with romantic and sexual relationship. 22 V. # Conclusion A large number of school adolescents were engaged in sexual practice before marriage. Majority of adolescents were males. The risk factors associated with premarital sexual practice were age (>18 years old), previous residence in rural area, having positive attitude towards premarital sexual practice, use of drugs, having a boy/girlfriend, peer pressure and watching sex movies. So, community and/or school health intervenetions are needed to reduce the premarital sexual practice among in school adolescents to prevent sexually related problems by providing due attention for adolescents with above characteristics. 1![Figure 1 : Age during first sex for male and female among Alamata high school and preparatory school adolescent students, northern Ethiopia, March to April 2013](image-2.png "Figure 1 :") 2![Figure 2 : Reason to start first sex among Alamata high school and preparatory school adolescent students, northern Ethiopia, March to April2013](image-3.png "Figure 2 :") 2northern Ethiopia, March to April 2013VariableFrequency PercentageHaveYes17936.3boy/girl friendNo31463.7Peer pressureYes12324.9No37075.1Male friendYes6914sex withNo26754prostituteI don't know15731.8Best friendYes10120.5had sexNo19840.2I don't know19439.4Place to spendReading books/attend religious ceremony33167.1leisure timeNight club153.0Others(Watch films with friends, playing with14729.8friends, helping family at home)WatchYes23247.1sex moviesNo26152.9FrequencyOnce per week11549.6of watching sexTwice per week166.9moviesThree times and more per week3816.4Others *6327.2*= every month, twice a month, every 3 months, twice a year, every 1 yearc) Factors associated with premarital sexual practiceVariables found to have significant associationwith the premarital sexual practice on bivariate andmultivariate analysis are shown in Table 3. 3Volume XIV Issue III Version IPremaritalCrud OR (95% CI) Adjusted OR(95%CI)VariablessexP-valueYes NoAge<18 years old 31313 11>18 years old 73769.7(5.94,15.81)12.05(3.97,36.53)0.000*Previous residence Urban66317 0.39(0.25,0.63)0.23(0.07,0.75)0.014*Rural387211Attitude to prem.Positive86167 6.35(3.7,10.96)3.07(1.19,7.91)0.020*sexNegative18222 11Use of drugsYes18515.93(5.8,44.1)8.30(1.17,58.97)0.034*No85376 11Have boy or girlYes76103 7.5(4.6,12.3)3.33(1.39,7.99)0.007*friendNo28286 11Peer PressureYes754818.3(10.87,31)7.33(2.97,18.09)0.000*No29341 11WatchsexualYes91141 12.3(6.6,22.8)7.98(2.55,24.93)0.000*explicit filmNo13248 11Year( )K IV. © 2014 Global Journals Inc. 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