Sexual Risk Behaviour and associated factors: a cross-sectional study among undergraduates in a lower resource setting
Introduction: Sexual Risk Behaviour (SRB) among undergraduates has emerged as an important public health issue worldwide. Therefore, the study objective is to assess the prevalence of SRB and its associated factors among second-year undergraduates in a lower resource setting. Methods: A descriptive-cross-sectional study was carried out among 1290, second-year undergraduates in Sri Lanka using multi-stage stratified cluster sampling. Four universities were randomly selected out of 10 eligible universities. The cluster size was 30 and 43 clusters were allocated proportionate to the total second-year undergraduate population and three faculties selected. University Health Risk Behaviour (UniHRB) Inventory is a self-administered questionnaire (SAQ) developed, translated and validated in a local setting. SRB was assessed using 18 items, and the minimum score obtained was 0 and the maximum possible score was 78. The minimum threshold score for the presence of SRB was 27 based on expert opinion. A SAQ was developed to assess its associated factors. The factors significantly associated with SRB were identified using appropriate significant tests. All the variables significant p £0.05 in the bivariate analysis were checked for possible effect modification with each other for SRB. In logistic regression analysis forward stepwise logistic regression method was used to identify Adjusted Odds Ratio (AOR) with 95% Confidence Interval (CI). Results: Overall response-rate for the study was 88.1% (n=1136). Prevalence of SRB was 3.5% (95%CI:2.6%-4.7%) and it was more among females (3.9%, 95%CI: 2.5-5.8%) and undergraduates of the Engineering Faculty (5.3%,95%CI:1.8-12.2%). SRB was significantly associated with risky-substance-use (AOR=5.7; 95%CI:1.7-18.4), undue-risk-behavior (AOR=9.0;95%CI:2.6-30.4), being emotionally abused during childhood (AOR=5.9; 95%CI:1.6-20.9), perpetrating physical bullying (AOR=2.2;95%CI 1.5-3.1), discrimination due to religion (AOR=4.1;95%CI:1.2-14.2) and negatively associated with EI (AOR=0.96;95%CI 0.92-0.99). Conclusions: Co-existence and clustering of HRBs were observed, Higher emotional intelligence was significantly negatively associated with SRB.
- Sexual risk behavior, undergraduates, associated factors, lower resource setting
- Bayissa, D., Mebrahtu, G., Bayisa, G., Mekuanint, Y. (2016). Assessment of Early Sexual Initiation and Associated Factors among Ambo University Undergraduate Students, Ambo, Ethiopia. Journal of Reproductive Health and Contracetion, 1(207), 1-6.
- Bori, K., Jelena, M. (2015). Demographic and Socio-Economic Factors Associated with Multiple Health Risk Behaviors among Adolescents in Serbia : A Cross Sectional Study, BMC Public Health, 15 (157), 1–9. https://doi.org/10.1186/s12889-015-1509-8
- Bui, T.C., Markham, C.M., Ross, M.W., Williams, M.L., Beasley, R.P., Tran, L.T., Le, T.N. (2012). Perceived gender inequality, sexual communication self-efficacy, and sexual behavior among female undergraduate students in the Mekong delta of Vietnam, Sexual Health, 9(4), 314–322. https://doi.org/10.1071/sh11067
- Caldeira, K.M., Arria, A.M., Zarate, E.M., Vincent, K.B., Wish, E.D., & O’Grady, K.E. (2009). Prospective associations between alcohol and drug consumption and risky sex among female college students, Journal of Alcohol and Drug Education, 53(2), 71–92.
- Caspi, A., Begg, D., Dickson, N., Harrington, H., Langley, J., Moffitt, T.E., Silva, P.A. (1997). Personality Differences Predict Health-Risk Behaviors in Adulthood : Evidence From a Longitudinal Study, Journal of Personality and Social Psychology, 73(5), 1052–63. https://doi.org/10.1037//0022-35220.127.116.112
- Center for Disease Prevention and Control, (2019). United State, Sexual Risk Behaviors, Available at: https://www.cdc.gov/healthyyouth/sexualbehaviors/index.htm
- Chan, K.L. (2012). Gender Symmetry in the Self-Reporting of Intimate Partner Violence, Journal of Interpersonal Violence, 27(2), 263-286. https://doi.org/10.1177/0886260511416463
- Chanakira, E., O’Cathain, A., Goyder, E.C., & Freeman, J.V. (2014). Factors perceived to influence risky sexual behaviors among university students in the United Kingdom: A qualitative telephone interview study, BMC Public Health, 14(1), 1–7. https://doi.org/10.1186/1471-2458-14-1055
- Chen, Y.Y., Jiun, H.H. (2015). Precollege and In-College Bullying Experiences and Health-Related Quality of Life among College Students, Pediatrics, 135(1), 18–25. https://doi.org/10.1542/peds.2014-1798
- Choi, E.P.H., Wong, J.Y.H., Lo, H.H.M., Wong, W., Chio, J.H.M., Fong, D.Y.T. (2017). Association between using Smartphone Dating Applications and Alcohol and Recreational Drug use in Conjunction with Sexual Activities in College Students, Substance Use and Misuse, 52(4), 422–28. https://doi.org/10.1080/10826084.2016.1233566
- Cohen, S., Kessler, R.C., & Gordon, L.U. (1995). Strategies for measuring stress in studies of psychiatric and physical disorders. In S. Cohen, R. C. Kessler, & L. U. Gordon (Eds.), Measuring stress: A guide for health and social scientists, Oxford University Press, pp. 3–26, New York, NY.
- Cornelius, T.L., Bell, K.M., Kistler, T., Drouin, M. (2020). Consensual sexting among college students: the interplay of coercion and intimate partner aggression in perceived consequences of sexting, International Journal of Environmental Research and Public Health, 17(19), 7141. https://doi.org/10.3390/ijerph17197141
- Dingeta, T., Oljira, L., Assefa, N., (2012). Patterns of sexual risk behavior among undergraduate university students in Ethiopia: a cross-sectional study, Pan African Medical Journal, 12:33.12.
- Espelage, D.L., Basile, K.C., & Hamburger, M.E. (2012). Bullying perpetration and subsequent sexual violence perpetration among middle school students, Journal of Adolescent Health, 50(1), 60–65. https://doi.org/10.1016/j.jadohealth.2011.07.015
- Family Health Bureau (2013). National Youth Health Survey 2012/2013 Sri Lanka, , Ministry of Health, Sri Lanka; http://fhb.health.gov.lk/index.php/en/technical-units/adolecent-health
- Field, A. (2009). Discovering statistics using SPSs (3rd Ed.) SAGE Publications Ltd, London.
- Flores, E., Tschann, J.M., Dimas, J.M., Pasch, L.A., & de Groat, C.L. (2010). Perceived racial/ethnic discrimination, posttraumatic stress symptoms, and health risk behaviors among Mexican American adolescents, Journal of Counseling Psychology, 57(3), 264.
- Gamache Martin, C., Van Ryzin, M.J., & Dishion, T.J. (2016) Profiles of childhood trauma: Betrayal, frequency, and psychological distress in late adolescence, Psychological Trauma: Theory, Research, Practice, and Policy, 8(2), 206.
- Gardner, M., & Steinberg, L. (2005). Peer influence on risk-taking, risk preference, and risky decision making in adolescence and adulthood: An experimental study, Developmental Psychology, 41(4), 625–635. https://doi.org/10.1037/0012-1618.104.22.1685
- Hennekens, C.H., & Buring, J.E. (1987). Epidemiology in Medicine, Little Brown and Company, Boston/Toronto.
- Hong, J.S., Espelage, D.L., Grogan-Kaylor, A., & Allen-Meares, P. (2012). Identifying potential mediators and moderators of the association between child maltreatment and bullying perpetration and victimization in school, Educational Psychology Review, 24(2), 167-186. https://psycnet.apa.org/doi/10.1007/s10648-011-9185-4
- Jackson, C.A., Henderson, M., Frank, J.W., Haw, S.J. (2012). An overview of prevention of multiple risk behavior in adolescence and young adulthood, Journal of Public Health (Oxf.), 34 (Suppl. 1), i31–i40. https://doi.org/10.1093/pubmed/fdr113
- Kebede, D., Alem, A., Mitike, G., Enquselassie, F., Berhane, F., Abebe Y, Ayele, R., Lemma, W., Assefa, T., Gebremichael, T. (2005) Alcohol use and risky sex behavior among in-school and out-of-school youth in Ethiopia, BMC Public Health, 14(5), 109. https://doi.org/10.1186/1471-2458-5-109
- Khalaj, F., Abadi F., John C., and Amir, H.M. (2011) Associations between Family Factors and Premarital Heterosexual Relationships among Female College Students in Tehran, International Perspectives on Sexual and Reproductive Health, 37(1), 30–39. https://doi.org/10.1363/3703011
- Lana, A., Baizan, E.M., Faya-Ornia, G., Lopez, M.L. (2015). Emotional Intelligence and Health Risk Behaviors in Nursing Students, The Journal of Nursing Education, 54(8), 464–467. https://doi.org/10.3928/01484834-20150717-08
- Lazarus, R.S., Folkman, S. (1984) Stress, appraisal, and coping, Springer, New York, NY.
- Matthews, G., Zeidner, M., Roberts, R.D. (2002) Emotional intelligence: science and myth, MIT Press, Cambridge, MA.
- Onwurah, C.C., Makata, N.E. (2020). Relationship between Mesosystem Interaction and the Adolescents Sexual Risk Behaviors in Anambra State, Nigeria, European Journal of Public Health Studies, 2(2), 79-89.
- Perera, U., Abeysena, C. (2018a). Knowledge and Attitudes on Unsafe Abortions among the State University Undergraduates in Western Province, Journal of the College of Community Physicians of Sri Lanka, 24(2), 76–81. https://doi.org/10.4038/jccpsl.v24i2.8149
- Perera, U.A.P., Abeysena, C. (2018b). Prevalence and Associated Factors of Risky Sexual Behaviors among Undergraduate Students in State Universities of Western Province in Sri Lanka: A Descriptive Cross-Sectional Study, Reproductive Health, 15(1), https://doi.org/10.1186/s12978-018-0546-z
- Piña-Watson, B., Cox, K., Neduvelil, A. (2021). Mexican descent college student risky sexual behaviors and alcohol use: The role of general and cultural based coping with discrimination, Journal of American College Health, 69(1), 82–89. https://doi.org/10.1080/07448481.2019.1656214
- Ramiro, L.S., Madrid, B.J., Brown, D.W. (2010). Adverse childhood experiences (ACE) and health-risk behaviors among adults in a developing country setting, Child Abuse and Neglect, 34(11), 842–855. https://doi.org/10.1016/j.chiabu.2010.02.012
- Schutte, N.S., Malouff, J.M., Hall, L.E., Haggerty, D.J., Cooper, J.T., Golden, C.J., & Dormheim, L. (1998). Development and validation of a measure of emotional intelligence, Personality and Individual Differences, 25, 167-177.
- Schutte, N.S., Malouff, J.M., Thorsteinsson, E.B., Bhullar, N., Rooke, S.E. (2007) A Meta-Analytic Investigation of the Relationship between Emotional Intelligence and Health, Personality and Individual Differences, 42(6), 921–33. https://doi.org/10.1016/j.paid.2006.09.003
- Soboka, B., Kejela, G. (2015) Assessment of risky sexual behaviors among Arba Minch University Students, Arba Minch Town, Snnpr, Ethiopia, Journal of Child and Adolescent Behavior, 3(2), 2-7. https://doi.org/10.4172/2375-4494.1000189
- Somaratna, W. (2010). Study on Knowledge and Attitude on HIV/AIDS and current Sexual Practices among first year Agriculture students of university of Ruhuna, (Unpublished Dissertation for Diploma in Reproductive Health), Postgraduate Institute of Medicine, University of Colombo, Sri Lanka
- Ssewanyana, D., Mwangala, P.N., Marsh, V., Jao, I., van Baar, A., Newton, C.R., Abubakar, A. (2018) Young people’s and stakeholders’ perspectives of adolescent sexual risk behavior in Kilifi County, Kenya: A qualitative study, Journal of Health Psychology, 23(2), 188–205. https://doi.org/10.1177/1359105317736783
- Thompson, R., Lewis, T., Neilson, E., English, D., Litrownik, A., Margolis, B., Proctor, L., Dubowitz, H. (2017) Child Maltreatment and Risk Sexual behavior: Indirect effects through trauma symptoms and substance use, Child Maltreatment, 22(1), 69-78. https://doi.org/10.1177/1077559516674595
- Tura, G., Alemseged, F., Dejene, S. (2012). Risky sexual behavior and predisposing factors among students of Jimma University, Ethiopia, Ethiopian Journal of Health Science, 22(3), 170–80.
- Wells, B.E., Kelly, B.C., Golub, S.A., Grov, C., & Parsons, J.T. (2010) Patterns of Alcohol Consumption and Sexual Behavior among Young Adults in Nightclubs Brooke, American Journal of Drug and Alcohol Abuse, 176(3), 139–148. https://doi.org/10.3109/00952990903544836
- World Health Organization. (2005) Department of Mental Health, & Substance Abuse. Alcohol use and sexual risk behavior: a cross-cultural study in eight countries, World Health Organization.
- World Health Organization. (2011) Youth and Health Risks Report from Sixty-Fourth World Health Assembly. Geneva, Switzerland: WHO, (April) 1–7.
- World Health Organization. (2017). Health for World's Adolencents a Second Chance in the Second Decade, www.who.int/adolecents/second-decade
- Yi, S., Te, V., Pengpid, S., Peltzer, K. (2018). Social and behavioral factors associated with risky sexual behaviors among university students in nine ASEAN countries: a multi-country cross-sectional study, SAHARA-J: Journal of Social Aspects of HIV/AIDS, 15(1), 71–79. https://doi.org/10.1080/17290376.2018.1503967