Determinants of Adolescent Sexual Behavior in Sub-Saharan Africa: A Systematic Review of In-School and Out-of-School Adolescents

Abstract

Objectives:

This review aims to identify the main determinants of various sexual behaviors among in-school and out-of-school adolescents in sub-Saharan Africa, using Bronfenbrenner’s ecological system theory as a framework.

Methods:

A systematic review with narrative synthesis was performed of empirical studies about the determinants of sexual behavior among in-school and out-of-school adolescents aged 10 to 19 in sub-Saharan Africa, using quantitative data from Embase, PubMed, PsycInfo, SCOPUS, AJOL, and Google Scholar.

Results:

A total of 132 studies were retrieved, identifying determinants of sexual behaviors such as sexual intercourse, sexual initiation at early age, multipartnership, condom use, contraceptive use, sexual abstinence, or sexual violence. Only four of these 132 studies involved out-of-school adolescents. Determinants of adolescent sexual behavior include demographic characteristics, socio-cognitive factors, problem behaviors, experiences, family relations, peers’ influence, relationships, school dynamics, education system, health system, information system, sociodemographic characteristics, socio-economic characteristics, religion, and societal values and norms.

Conclusion:

To design interventions that address adolescents’ sexual and reproductive health needs, public health policymakers must consider the multifaceted and interconnected determinants of sexual behaviors among in-school and out-of-school adolescents.

Introduction

Sub-Saharan Africa (SSA) has the youngest population in the world, with 32% of the region’s population aged 10–24 years [1]. Investing in their health, education, employment, and civic participation could unlock significant development opportunities for these countries. However, these youth face many challenges particularly in education and sexual health. Of all regions of the world, SSA has the highest rates of education exclusion, with nearly 60% of young people aged 15 to 17 out-of-school [2]. Since adolescents are at high risk of sexually transmitted infections (STIs) and unintended pregnancies, their sexual health is a critical public health issue [3–5]. The World Health Organization (WHO) defines sexual health as “a state of physical, emotional, mental and social wellbeing in relation to sexuality; it is not merely the absence of disease, dysfunction or infirmity” [6]. Sexual health requires a positive and respectful approach to sexuality and sexual relationships, as well as the possibility of having pleasurable and safe sexual experiences, free of coercion, discrimination and violence. For sexual health to be attained and maintained, the sexual rights of every person must be respected, protected and fulfilled. The above definition of sexual health is a working definition, allowing for variations between countries to reflect their health priorities and social norms. It encompasses not only the biomedical aspects of sexual health but also the social and interpersonal dimensions essential to wellbeing.

Sexual health is intrinsically related to sexual behavior, which encompasses how individuals experience and express their sexuality. Sexuality is a natural and important part of being human, influencing nearly every aspect of one’s being, from attitudes and values to feelings and experiences [7]. Sexual behavior is a complex concept for which the literature does not provide a consensual definition. Consequently, it can be operationalized in several ways. Depending on the definition used, it comprises various sexual activities that involve sexual arousal, desire, as well as procreation, sexual risk behavior, sexual orientation, sexual violence, and many other aspects [8]. While the practice of sex education typically approaches sexual behavior primarily in terms of avoiding risky sexual behavior (e.g., early sexual initiation, condom use, multipartnership), education about sexuality can also be approached from a positive perspective. Positive sexuality means that one accepts and respects one’s sexuality and that of other persons without judgment, shame, violence, or discrimination [7]. An increasing number of studies assert that the experience of positive sexuality not only enhances sexual health but also mental health [8].

This ecological approach enables a multilevel analysis of behavioral determinants, from proximal to structural factors.

A large range of studies have been performed to identify the factors that influence specific sexual behaviors among youth in SSA. However, nearly all of these have focused on only a few specific behaviors and/or on a limited number of their determinants, while very few studies have tried to identify the broad range of determinants using an encompassing theoretical model. In addition, most research has been limited to the sexual behavior of in-school adolescents, despite the high rates of educational exclusion among adolescents in SSA countries. The present systematic review aimed to address these limitations by identifying and integrating the main determinants of a variety of sexual behaviors among both in-school and out-of-school adolescents in SSA, using Bronfenbrenner’s ecological system as a theoretical framework. The ultimate purpose was to provide a basis that would enable public health policymakers in SSA to develop more comprehensive and effective sexual health education interventions for adolescents.

Methods

A systematic review was performed of empirical studies that produced quantitative data on the determinants of adolescent sexual behavior in SSA. A systematic review protocol following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines [10] was published in PROSPERO on December 3, 2022 (reference: CRD42022384658).

Search Strategy

To find studies presenting evidence on determinants of in-school and out-of-school adolescent sexual behavior in SSA, the following databases were consulted: Embase, PubMed, PsycInfo, SCOPUS, AJOL, and Google Scholar. Search equations were built using descriptors and keywords related to adolescent, sexual behavior, determinant, and sub-Saharan Africa, organized with Boolean terms. Results were imported into Rayyan, a web-based tool for systematic literature review. After eliminating duplicate references, two independent reviewers (R.K. and S.A.) screened articles based on predefined eligibility criteria in two rounds: first by titles and abstracts, then by full texts. Database searches were performed on April 24, 2023, and on Google Scholar only on April 28, 2023. Reference lists of included studies were scanned to identify additional studies and ensure literature saturation.

Eligibility Criteria

Studies were included in the systematic review if they: (1) were conducted in sub-Saharan countries; (2) focused on in-school or out-of-school adolescents aged 10–19 years (as defined by the United Nations (UN)), whereby the adolescent subpopulation had to be the majority (over 50%); (3) used quantitative methodology; (4) investigated determinants of various sexual behaviors; (5) were published between January 2010 and April 2023 (2010 being 1 year after the publication of the first edition of UNESCO’s International Technical Guide on Adolescent Sexuality Education, a crucial moment in the recognition of adolescents' right to sexuality education); (6) were published in English or French.

Studies were excluded when they: (1) failed to meet one or more of the above inclusion criteria; (2) lacked detail to verify majority of participants were 10–19 years old; (3) did not specify if participants were in-school or out-of-school; (4) did not explicitly address determinants of sexual behavior; (5) used only qualitative data. Conference abstracts, commentaries, and letters that did not contain sufficiently detailed information about the study were also excluded, as were studies for which the full text could not be retrieved, even contacting the corresponding author.

Quality Assessment

To assess the methodological quality and risk of bias of the studies retained for the review, two independent assessors (R.K. and S.A.) scored all articles using the Joanna Briggs Institute (JBI)’s critical appraisal tool for analytical cross-sectional studies [11]. The JBI checklist considers 8 quality criteria: (1) definition of inclusion criteria, (2) description of study subjects and the setting, (3) valid and reliable measurement of the exposure, (4) objective criteria for measuring the condition, (5) identification of confounding factors, (6) strategies for dealing with confounding, (7) valid and reliable measurement of outcomes, and (8) appropriate statistical analysis. To assess the quality of each study, an overall score was calculated expressed as a percentage, with a score of 70%–100% indicating high methodological quality, a score of 50%–69% moderate methodological quality, and a score below 50% poor methodological quality with a high risk of bias. The quality assessment was used for indicative purpose only, meaning that no studies were excluded based on this assessment.

Data Extraction and Synthesis

Data extraction was performed by a single reviewer (R.K.) using a standardized and pretested extraction form developed collaboratively by the research team. This form clearly defined data fields to ensure consistency in recording key study characteristics and findings. In addition, any uncertainties were resolved through discussion with the co-authors.

Due to the heterogeneity of definitions and measurements of sexual behaviors and their determinants across the included studies, a meta-analysis was not feasible. Instead, we conducted a narrative synthesis using a qualitative content analysis approach [12]. To reduce potential subjectivity, key decisions such as grouping different terminologies referring to the same sexual behavior or category of determinant were reviewed and validated in consultation with a second author (SV). For each category of sexual behavior, we listed the identified determinants and retained those most frequently reported across studies. Bronfenbrenner’s ecological model was applied deductively: determinants were categorized according to predefined ecological levels based on their nature and the context in which they were described. When difficulties or overlaps in classification arose, decisions were discussed among co-authors to ensure clarity and coherence in the allocation. Given the strong interconnections between determinants classified under the exosystem and the macrosystem, we decided to merge these categories and report all such determinants under the macrosystem level.

Results

The search strategy produced 6957 records from different databases and reference lists, after removing duplicates. Screening based on titles and abstracts resulted in the exclusion of 6761 records, and another 89 records were excluded after screening the full texts, resulting in a total of 107 records for inclusion. The main reasons for exclusion of study records were a lack of precision regarding the proportion of the adolescent sub-population, not addressing the determinants of sexual behavior, unavailability of a full text, and not focusing on SSA. The reference lists of the 107 eligible studies were scanned to ensure literature saturation. Twenty-five additional studies were identified, giving a final total of 132 studies that met all the inclusion criteria and that were thus included in the content analysis and synthesis (Figure 1).

FIGURE 1

Description of the Included Studies

The 132 studies included for this review covered 28 countries in Sub-Saharan Africa. Six studies contained data from several SSA countries, the other 126 studies had data from one country. Of these, a majority (over 70%) were concerned with one of three countries: Ethiopia (n = 60), Nigeria (n = 21), and South Africa (n = 17). Most studies involved adolescents from secondary or preparatory schools, while one study focused on university adolescent, two on out-of-school adolescents, and two on a mix of in- and out-of-school adolescents. All studies were cross-sectional, employing quantitative data collected via validated and non-validated questionnaires. Among them, 104 investigated determinants of risky sexual behaviors (RSB), and 28 investigated determinants of sexual violence (SV).

Quality Assessment of Included Studies

The overall quality of the included studies was medium to strong, according to the assessment using the JBI critical appraisal tool. More precisely, 45 studies scored above 70% for overall quality, 75 studies scored between 50% and 70%, and 12 studies scored below 50%. The main limitations to quality were a lack of clear information on participant inclusion, a lack of identification of confounding factors, a lack of an explicit strategy for dealing with the effect of confounding factors, and a lack of validation of the questionnaires that were used.

Determinants of Risky Sexual Behaviors

A first series of findings concerns the main determinants of sexual behaviors that can be considered as risky, due to their potential to increase the risk of STIs or unintended pregnancies among adolescents. Risky sexual behavior includes sexual intercourse, premarital sex, early sexual intercourse, having multiple sexual partners, not using contraceptives, and not using condoms. Because of the interconnectedness of these risk behaviors, most studies used measures that considered all these types of RSB together. Of the 104 included studies, 101 involved school-going adolescents, one involved out-of-school adolescents, and two involved both.

Determinants of RSB are factors that can either protect against RSB or increase the probability of RSB. Based on Bronfenbrenner’s ecological systems theory, they can be categorized as related to the adolescent’s ontosystem, microsystem, mesosystem, and macrosystem (Table 1).

At the ontosystem level, determinants include demographic characteristics, socio-cognitive factors, behaviors, and exposure to specific experiences. Findings for several sociodemographic characteristics are ambivalent. Being male [22, 31, 32, 41, 50, 51, 54–66] or female [13, 23–27, 33, 45, 46, 53, 67–69], age [16–18, 21, 22, 33–39, 42, 43, 45, 47, 51, 57, 58, 60, 61, 63–66, 70–78], ethnicity [39, 49, 50], grade level [14, 19, 22, 23, 31, 38, 53, 55, 78, 80–84], and urban residence [31, 43, 50, 53, 85] are identified both as factors increasing and reducing the probability of RSB. Being single [13–15], religious [15–20], and having parents with a high educational level [22–30] are protective factors against RSB. Conversely, rural residence [22, 36, 37, 46–49], living without families [23, 25, 41–43, 50–52], alone [51, 53], or with a single parent [54] increase the probability of RSB. Good knowledge of STIs, HIV, and safe sexual practices is mostly protective [17, 28, 42, 56, 64, 82, 86, 87], except in one study [73]. Self-efficacy in adopting safe sexual behaviors [13, 18, 53, 79], empowerment in safe sexual behaviors [88], a positive attitude toward safe sexual behaviors and abstinence [13, 86, 88], and a high perception of risks associated with RSB [18, 70] are protective factors. Perceived peer pressure generally increase the probability of RSB [16, 23, 26, 36, 38, 41, 43, 47, 48, 50, 55, 56, 58, 61, 62, 67, 82, 83, 89, 90], except in one study [18]. Perceived gender norms [58, 70], perception of social norms associated with the sexual behavior of peers and family [17, 47, 61, 70, 91], a low perception of social norms regarding RSB and abstinence [64, 73, 87, 92], a low perception of risks associated with RSB [21, 79], a low intention to adopt safe sexual behaviors [73], and a positive attitude towards RSB increase the probability of RSB [93]. Behaviors such as substance use [55, 57], [50, 58–61], [31, 32], [22, 65, 66], [13, 23–26], [46], [45, 67, 68], [16, 19, 36, 71, 74, 81, 83, 84], [28–30, 48], [52, 86, 89, 90, 92], [40, 44, 94–98], except in one study [34], pornography use [14, 16, 22, 27–29, 32, 36, 40, 41, 46, 48–51, 67, 68, 80, 82, 90, 98, 99], internet use [33, 89, 95], sexting [99], partying [37, 68, 89, 100], violent behavior [20, 101], and truancy [84] increase the probability of RSB. Experiences of sexual harassment [76, 79], sexual violence [76], domestic violence [23], parental neglect [52], and knowing someone who died of HIV [79] also increase the probability of RSB.

At the microsystems level, family, peers, relationships, and school factors influence RSB. Discussions on sexual and reproductive health (SRH) issues with family are mainly protective against RSB [26, 27, 49, 56, 80, 98], except in one study [47]. Discussions with peers can either increase or reduce the probability of RSB [18, 22, 51, 62, 70, 81]. Good family connectedness [19, 25, 44, 58, 84, 87, 91, 104], parental monitoring [26, 38, 94, 104], family support [44, 63, 65, 105], having living parents [35, 106], close friends [57, 84], being in a stable relationship [85], good school connectedness [19, 44, 66, 78], academic performance [34], and ambitious educational goals [107] are protective factors. Conversely, having sexually active friends [16, 47, 59, 74, 78, 94], polygamous families [42, 54, 75], large household size [83], and dropping out of school [108] increase the probability of RSB.

At the mesosystem level, socio-economic characteristics and social interactions influence RSB. Coming from a low socio-economic family increases the probability of RSB [72], while results for high socio-economic family are ambivalent [51, 102]. Receiving money from family [27, 32, 42, 53, 62, 81], a job [27, 76, 109], or a boyfriend [76] increases the probability of RSB, whereas not receiving money is protective.

Finally, at the macrosystem level, religious schools are protective against RSB [40, 67], while public [99] and mixed schools [35] increase the probability of RSB. The influence of access to information on SRH issues depends on the source [14, 42]. School-based SRH programs [79, 92, 110], health services [105], and awareness campaigns [18, 79] are protective factors against RSB.

Determinants of Sexual Violence Victimization and Perpetration

The second series of findings concerns studies that focus on the determinants of sexual violence among adolescents in SSA, i.e., the risk and protective factors of either victimization or perpetration of SV. The WHO defines sexual violence as “any sexual act, attempt to obtain a sexual act, or other act directed against a person’s sexuality using coercion, by any person regardless of their relationship to the victim, in any setting” [111]. Due to the interrelationship between sexual violence and psychological or physical violence, some studies consider all these types of violence together.

Of the 28 included studies that dealt with sexual violence (Table 2), only one involved out-of-school adolescent girls. Eleven studies focused exclusively on girls who were victims of SV, one on boys who were victims, and three on boys who were perpetrators.

At the ontosystem level, determinants include demographic characteristics, socio-cognitive factors, behaviors, and exposure to specific experiences. The influence of gender on SV victimization is ambivalent [115–118, 140], but being male increases the probability of SV perpetration [115, 116, 125], while being female is protective [125]. Being older [115–117, 125] and in a romantic relationship [117–120, 126] increase the probability of both SV victimization and perpetration. Living with both parents is protective against SV victimization [114], while other living arrangements [39, 112, 113, 122–124] increase SV victimization. Poor knowledge of child rights among girls increases the probability of both SV victimization and perpetration [129]. Perceived gender norms [118, 127], perceived peer pressure to have sex [130], perceived risk of contracting HIV [115], positive attitudes toward male sexual entitlement [131], and tolerance towards SV [130] increase the probability of SV victimization, while generalized self-efficacy is protective. Substance use [107, 122, 126, 128, 130, 132, 135], pornography use [126, 130], previous SV perpetration [115, 125, 133], and experiencing any type of SV [115, 125, 127–129, 132, 136, 137] increase both SV victimization and perpetration. Witnessing domestic violence [119, 120, 128], being bullied [118, 132] and having experienced a breakup [93] increase only SV victimization.

At the microsystems level, family, peers, relationship, and school factors influence SV victimization and perpetration. Polygamous families [118], separated parents [114], parental conflict [118], and fearful parental attachment among girls [130] increase SV victimization. Discussions about SRH issues with family increase SV perpetration among boys [126], while lack of discussion increases SV victimization among girls [122, 123]. Peers’ SV experience [129], low school connectedness [125], low feelings of safety at school [125], and poor school engagement [132] increase both SV victimization and perpetration. Having an older partner [130, 134], schoolwork problems [118], and having repeated a school year [125] increase SV victimization, while never attending school is protective for girls [138].

At the mesosystem level, socio-economic characteristics and social interactions influence SV. Low socio-economic status family [116, 123] and food deprivation [129, 139] increase both SV victimization and perpetration. An unemployed head of household [121] and receiving money from external sources [117] increase SV victimization, while a father working, or retired is protective for girls [112, 114].

Finally, at the macrosystem level, educational system, health system, and societal values and norms influence SV. Attending public school increases SV victimization among girls [120], while private school is protective [113]. Boarding school increases SV perpetration [115]. Financial access to health services is protective against SV victimization [128]. Unequal and sexist gender norms increase both SV victimization and perpetration [129].

Discussion

This study aimed to identify and synthesize the main determinants of in-school and out-of-school adolescent sexual behavior in SSA, focusing on the risk and protective factors for risky sexual behaviors and for victimization or perpetration of sexual violence. The results showed that the sexual behavior of adolescents in SSA is influenced by a multitude of interconnected determinants. Based on Bronfenbrenner’s ecological model, we organized these determinants into four levels and identified key implications for interventions at each.

At the ontosystem level, apart from several demographic characteristics, the main determinants identified include socio-cognitive factors such as knowledge, attitudes and perceived norms. While good knowledge about SRH protects adolescents from RSB and SV, beliefs and emotional factors often override rational decision-making. Interventions should therefore not only ensure access to reliable information from key sources (peers, family, school, media, and professionals [141]), but also address attitudes and perceived norms, particularly those promoting RSB and SV. According to health behavior theories such as Ajzen’s Theory of Planned Behavior (TPB) [142–145], sexual behavior is shaped by behavioral intentions influenced by attitudes, perceived norms, and perceived behavioral control. Our review showed that positive attitudes toward protective sexual practices and abstinence are associated with refraining from RSB, while favorable attitudes towards RSB and SV promote these harmful behaviors. Moreover, limited perceived risk related to sexual behaviors and perceived peer pressure to have sexual intercourse also contribute to RSB and SV, whereas self-efficacy empowers adolescents to adopt protective sexual behaviors. These findings are consistent with the Protection Motivation Theory (PMT) [146], which also emphasizes the role of cognitive appraisal in behavior change. Therefore, interventions should incorporate socio-cognitive approaches, such as the TPB or PMT, to strengthen behavioral intentions toward safer sexual practices. Our review also found that RSB often co-occur with other problem behaviors [147], including substance use, internet and pornography use, sexting, partying, violent behavior, and truancy. Substance use may contribute to RSB through mechanisms like disinhibition [148], while exposure to pornography, particularly when it portrays non-consensual or aggressive acts, can distort adolescents’ perceptions of appropriate sexual behavior [149]. Therefore, integrated interventions should address these co-occurring risk behaviors, which heighten adolescents’ vulnerability to RSB and SV. Experiences of harassment, sexual and domestic violence, or parental neglect increase adolescents’ risk of RSB and SV by contributing to the normalization and potential reproduction of these patterns later in life [150]. These findings highlight the need for individual-level interventions that identify and address adolescents’ traumatic experiences as part of comprehensive RSB and SV prevention strategies in SSA.

At the microsystems level, the review highlights the crucial role of interpersonal relationships with family, peers, partners, and within schools in shaping adolescent sexual behavior. A supportive family environment with present parents, adequate supervision, strong relationships, and open communication on SRH creates a protective environment against RSB and SV. Strengthening parent-child communication and encouraging parental involvement should therefore be central to SRH interventions [151]. Peers also influence adolescent behavior, acting as role models who normalize either risky or protective practices [152]. This influence can be leveraged through peer education strategies that promote safe sexual behaviors [153]. Romantic relationships are another important dimension. Adolescents in relationships are more likely to have early sexual relations and use contraceptives, but large age gaps increase the risk of SV [154]. Relationship stability, exclusivity, communication, mutual respect, and equitable power dynamics play a key role in shaping healthy sexual behavior. Promoting communication, respect, consent, and age-appropriate partnerships helps prevent risky situations and coercion. More broadly, educating adolescents about healthy interpersonal relationships is essential to reducing vulnerability. Finally, school connectedness plays a protective role. Adolescents who are engaged in school and have ambitious educational goals tend to show fewer RSB and SV. Interventions that support school attendance and strengthen students’ connection to school can thus reduce exposure to risky behaviors [155, 156].

At the mesosystem level, socioeconomic factors significantly influence adolescent sexual behavior, particularly when financial insecurity leads youth to seek material support through sexual exchanges. Adolescents from higher socio-economic backgrounds are less likely to engage in RSB and SV, likely due to better access to sexual education and SRH services, and reduced reliance on transactional relationships [157, 158]. In contrast, early financial independence may increase exposure to high-risk environments, such as unsupervised parties involving alcohol. Policies that reduce poverty and promote vocational training, youth employment, and economic empowerment can help reduce economic vulnerability and, in turn, risky behaviors. Interventions should also consider the risks associated with premature financial autonomy, which may facilitate engagement in unsafe practices.

At the macrosystem level, broader structural and cultural factors, including the education and health systems, media, and community norms, significantly shape adolescent sexual behavior. Access to health and social services remains uneven, particularly between urban and rural areas [159]. Likewise, the type of school and the availability of comprehensive sexuality education influence RSB and SV, with well-organized and equipped schools offering a more protective environment [156]. Providing adequate resources and expanding access to comprehensive sexual education in all schools, especially in public and rural settings, should therefore be a policy priority. Media, as a primary source of SRH information for adolescents [141], should be actively engage in promoting safe sexual practices and raising awareness around SV. Ethnic, religious, and social values and norms that characterize a community are also important determinants of adolescent sexual behavior. Religious beliefs promoting abstinence may act as protective factors, particularly when religiosity is strong [160], suggesting that partnerships with religious communities could help promote safer sexual practices. Conversely, traditional gender norms that emphasize male dominance and stereotypical masculinity are associated with increased RSB and SV. Community-based interventions that aim to challenge and deconstruct these norms could therefore contribute to improving adolescent sexual health [161].

While this review aimed to include both in-school and out-of-school adolescents, the overwhelming predominance of studies on in-school youth reflects a major gap in the literature. Only four of the 132 included studies focused on out-of-school adolescents. Yet, the limited available data suggest that this group may face heightened vulnerability due to intersecting socioeconomic, educational, and familial disadvantages, which can increase exposure to RSB and SV. This imbalance limits the generalizability of our findings and highlights a critical evidence gap. More research is needed to identify and understand the specific determinants affecting out-of-school adolescents and to design targeted, inclusive interventions for this population.

Limitations

This study is not without limitations. Most included studies relied on self-reported data, introducing potential social desirability and recall biases that could lead to under- or over-reporting of certain sexual behaviors, especially given the sensitivity of the topic. All studies used cross-sectional designs, limiting the ability to establish causal relationships. A major limitation of the literature is the strong imbalance between studies conducted among in-school and out-of-school adolescents affecting generalizability. Similarly, studies on SV victimization predominantly focused on girls, contributing to gender gaps in the evidence base. Although this review includes studies from various SSA countries, a large proportion of the data comes from a limited number of nations, notably Ethiopia, Nigeria and South Africa. This geographical concentration may limit the regional representativeness of the findings, as sociocultural, educational, and policy contexts vary widely across the continent. Finally, heterogeneity in definitions and measures of sexual behaviors and their determinants precluded the possibility of conducting a meta-analysis.

Conclusion

Despite the limitations, this study provides a comprehensive overview of the determinants of various sexual behaviors among in-school and out-of-school adolescents in SSA, using Bronfenbrenner’s ecological model to identify and structure these determinants. It highlights the crucial role of socio-cognitive factors such as attitudes, perceived social norms, perceived behavioral control, and intention in shaping the adolescents’ sexual behaviors, while also considering risk perception, co-occurring behaviors like substance or pornography use, and experiences of harassment, sexual and domestic violence as key determinants. At the immediate environment level, family dynamics, peer and partner influences, and the school environment are primary determinants, while in the broader environment, community values and norms, socio-economic status, access to SRH services, and education (including comprehensive sexual education) are key influencing factors. Translating these findings into concrete strategies could strengthen both school-based and community-based interventions, contributing to improved adolescents’ SRH outcomes.

High rates of school exclusion in SSA call for inclusive and comprehensive sex education strategies that reach all adolescents, regardless of their schooling status. However, research and policy remain largely focused on school-going adolescents. It is therefore essential to develop targeted interventions addressing the unique challenges faced by out-of-school adolescents.

In conclusion, a holistic approach that integrates individual, interpersonal, socio-cultural, socio-economic, and contextual determinants is essential for designing effective sexual health interventions for adolescents in SSA. By addressing these determinants, public health policymakers will be better equipped to enhance the sexual health and overall wellbeing of adolescents in SSA.

References

• 1.

  UNFPA. State of World Population 2019 (2019). Available online at: https://www.unfpa.org/publications/state-world-population-2019 (Accessed November 29, 2023).180.

  • Google Scholar

• 2.

  UNESCO Institute for Statistics. Education in Africa (2016). Available online at: https://uis.unesco.org/en/topic/education-africa (Accessed November 29, 2023).

  • Google Scholar

• 3.

  Patton GC Coffey C Cappa C Currie D Riley L Gore F et al Health of the World’s Adolescents: A Synthesis of Internationally Comparable Data. Lancet Lond Engl (2012) 379(9826):1665–75. 10.1016/S0140-6736(12)60203-7

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 4.

  Neal S Matthews Z Frost M Fogstad H Camacho AV Laski L . Childbearing in Adolescents Aged 12-15 Years in Low Resource Countries: A Neglected Issue. New Estimates from Demographic and Household Surveys in 42 Countries. Acta Obstet Gynecol Scand (2012) 91(9):1114–8. 10.1111/j.1600-0412.2012.01467.x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 5.

  UNAIDS. In: Danger: UNAIDS Global AIDS Update 2022. Geneva: Joint Nations Programme on HIV/AIDS (2022). Available online at: https://www.unaids.org/en/resources/documents/2022/in-danger-global-aids-update (Accessed January 5, 2024).

  • Google Scholar

• 6.

  World Health Organization. Sexual Health. In: World Health Organization (2006). Available online at: https://www.who.int/health-topics/sexual-health (Accessed November 2, 2022).

  • Google Scholar

• 7.

  The University of Vermont. Positive Sexuality. Available online at: https://legacy.drup2.uvm.edu/health/positive-sexuality (Accessed November 29, 2023).

  • Google Scholar

• 8.

  Anderson RM . Positive Sexuality and its Impact on Overall Well-Being. Bundesgesundheitsblatt - Gesundheitsforschung - Gesundheitsschutz (2013) 56(2):208–14. 10.1007/s00103-012-1607-z

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 9.

  Bronfenbrenner U . Developmental Research, Public Policy, and the Ecology of Childhood. Child Dev (1974) 45(1):1–5. 10.2307/1127743

  • CrossRef
  • Google Scholar

• 10.

  Moher D Shamseer L Clarke M Ghersi D Liberati A Petticrew M et al Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015 Statement. Syst Rev (2015) 4(1):1. 10.1186/2046-4053-4-1

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 11.

  JBI. JBI Critical Appraisal Tools | JBI. Available online at: https://jbi.global/critical-appraisal-tools (Accessed November 30, 2023).

  • Google Scholar

• 12.

  Popay J Roberts H Sowden A Petticrew M Arai L Rodgers M et al Guidance on the Conduct of Narrative Synthesis in Systematic Reviews (2006). p. 92.

  • Google Scholar

• 13.

  Oladepo O Fayemi MM . Perceptions about Sexual Abstinence and Knowledge of HIV/AIDS Prevention Among in-School Adolescents in a Western Nigerian City. BMC Public Health (2011) 11:304. 10.1186/1471-2458-11-304

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 14.

  Debebe D Daka K Daka D . Early Sexual Debut and Associated Factors Among High School Students in Kindo Koyisha District, Wolayta Zone, South Ethiopia. Ethiop J Reprod Health (2022) 14(2). 10.69614/ejrh.v14i2.537

  • CrossRef
  • Google Scholar

• 15.

  Watsi L Tarkang EE . Demographic Determinants of Risky Sexual Behaviours Among Senior High School Students in the Hohoe Municipality, Ghana. PAMJ - Clin Med (2020) 2. 10.11604/pamj-cm.2020.2.81.21304

  • CrossRef
  • Google Scholar

• 16.

  Mulugeta Y Berhane Y . Factors Associated with Pre-Marital Sexual Debut Among Unmarried High School Female Students in Bahir Dar Town, Ethiopia: Cross-Sectional Study. Reprod Health (2014) 11(1):40. 10.1186/1742-4755-11-40

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 17.

  Asubiaro OY Fatusi AO . Differential Effects of Religiosity on Sexual Initiation Among Nigerian In-School Adolescents. Int J Adolesc Med Health (2014) 26(1):93–100. 10.1515/ijamh-2012-0118

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 18.

  Maticka-Tyndale E Tenkorang EY . A Multi-Level Model of Condom Use Among Male and Female Upper Primary School Students in Nyanza, Kenya. Soc Sci Med (2010) 71(3):616–25. 10.1016/j.socscimed.2010.03.049

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 19.

  Handebo S Kebede Y Morankar SN . Does Social Connectedness Influence Risky Sexual Behaviours? Finding from Ethiopian Youths. Int J Adolesc Youth (2018) 23(2):145–58. 10.1080/02673843.2017.1306448

  • CrossRef
  • Google Scholar

• 20.

  Francis JM Myers B Nkosi S Petersen Williams P Carney T Lombard C et al The Prevalence of Religiosity and Association between Religiosity and Alcohol Use, Other Drug Use, and Risky Sexual Behaviours Among Grade 8-10 Learners in Western Cape, South Africa. PLOS ONE (2019) 14(2):e0211322. 10.1371/journal.pone.0211322

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 21.

  Njau B Mwakalo V Mushi D . Correlates of Use of Condoms Among Sexually Active Youth in Southern Highlands, Tanzania. SAGE Open (2013) 3(2):2158244013491406. 10.1177/2158244013491406

  • CrossRef
  • Google Scholar

• 22.

  Taye A Asmare I . Prevalence of Premarital Sexual Practice and Associated Factors Among Adolescents of Jimma Preparatory School Oromia Region, South West Ethiopia. J Nurs Care (2016) 05. 10.4172/2167-1168.1000332

  • CrossRef
  • Google Scholar

• 23.

  Ndagijimana E Biracyaza E Nzayirambaho M . Risky Sexual Behaviors and Their Associated Factors within High School Students from Collège Saint André in Kigali, Rwanda: An Institution-Based Cross-Sectional Study. Front Reprod Health (2023) 5:1029465. 10.3389/frph.2023.1029465

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 24.

  Endazenaw G Abebe M . Assessment of Premarital Sexual Practices and Determinant Factors Among High School Students in West Shoa Zone, Oromia Regional State, Ethiopia. Sci J Public Health (2015) 3(2):229. 10.11648/j.sjph.20150302.21

  • CrossRef
  • Google Scholar

• 25.

  Fentahun N Mamo A . Risky Sexual Behaviors and Associated Factors Among Male and Female Students in Jimma Zone Preparatory Schools, South West Ethiopia: Comparative Study. Ethiop J Health Sci (2014) 24(1):59–68. 10.4314/ejhs.v24i1.8

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 26.

  Fekadu Wakasa B Oljira L Demena M Demissie Regassa L Binu Daga W . Risky Sexual Behavior and Associated Factors Among Sexually Experienced Secondary School Students in Guduru, Ethiopia. Prev Med Rep (2021) 23:101398. 10.1016/j.pmedr.2021.101398

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 27.

  Ayalew A Abreha K Shumey A Berhane K . Magnitude and Predictors of Early Sexual Debut Among High and Preparatory School Students in Northern Ethiopia: A School-Based Crosssectional Study. J Health Educ Res Dev (2015) 03. 10.4172/2380-5439.1000151

  • CrossRef
  • Google Scholar

• 28.

  Abera M Kedir T Rasha D Woiynshet G Shitaye S Agegnehu B et al Risky Sexual Behaviors and Associated Factors Among Preparatory School Students in Arba Minch Town, Southern Ethiopia. J Public Health Epidemiol (2018) 10(12):429–42. 10.5897/jphe2018.1073

  • CrossRef
  • Google Scholar

• 29.

  Hagisso SN Handiso TB . Prevalence of Premarital Sexual Practice and Associated Factors Among Goba Town High School Students, South East-Ethiopia. J Clin Intensive Care Med (2020) 5(1):001–6. 10.29328/journal.jcicm.1001027

  • CrossRef
  • Google Scholar

• 30.

  Meleko A Mitiku K Kebede G Muse M Moloro N . Magnitude of Pre-Marital Sexual Practice and its Associated Factors Among Mizan Preparatory School Students in Mizan Aman Town, South West Ethiopia. J Community Med Health Educ (2017) 07. 10.4172/2161-0711.1000539

  • CrossRef
  • Google Scholar

• 31.

  Biratu B Garoma S Getachew M Desalegn M . Drinking Alcohol Raises the Chance of Premarital Sex by Four Folds Among Secondary School Adolescent Students in Jima Arjo, Southwestern Ethiopia, 2018: A School-Based Cross-Sectional Study. Contracept Reprod Med (2022) 7(1):4. 10.1186/s40834-022-00171-2

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 32.

  Endalew D Gebremichael B MulugetaTesfa AT . Premarital Sexual Practice and Risky Sexual Behaviors Associated with It Among Secondary School Adolescents, South East Ethiopia: A Mixed Design Study. J AIDS Clin Res (2018) 09. 10.4172/2155-6113.1000775

  • CrossRef
  • Google Scholar

• 33.

  Eyeberu A Lami M Bete T Yadeta E Negash A Balcha T et al Risky Sexual Behavior and Associated Factors Among Secondary School Students in Harari Regional State: Multicenter Study. Int J Afr Nurs Sci (2023) 18:100520. 10.1016/j.ijans.2022.100520

  • CrossRef
  • Google Scholar

• 34.

  Amoateng AY Kalule-Sabiti I . Biosocial Correlates of Age at First Sexual Intercourse: The Case of Grade 9 and Grade 11 Pupils in the North West Province of South Africa. J Biosoc Sci (2016) 48(1):20–36. 10.1017/S0021932014000492

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 35.

  Animasahun VJ Sholeye OO Oduwole AD . Promoting the Sexual and Reproductive Health of Adolescent Females in Ijebu-Ode, Southwest, Nigeria: A Study of Sexual Risk-Taking. Int J Adolesc Med Health (2017) 29(6):20160021. 10.1515/ijamh-2016-0021

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 36.

  Kassa GM Woldemariam EB Moges NA . Prevalence of Premarital Sexual Practice and Associated. Glob J Med Res K Interdiscip (2014) 14(3).

  • Google Scholar

• 37.

  Tekletsadik E Shaweno D Daka D . Prevalence, Associated Risk Factors and Consequences of Premarital Sex Among Female Students in Aletawondo High School, Sidama Zone, Ethiopia. J Public Health Epidemiol (2014) 6(7):216–22. 10.5897/JPHE2014.0640

  • CrossRef
  • Google Scholar

• 38.

  Bizu D Aderaw Z Kassa GM . Assessment of Early Sexual Initiation and Associated Factors Among Preparatory School Students of FaggetaLekoma District, Awi Zone, Northwest Ethiopia, 2015. Int J Clin Med (2015) 06(08):521–9. 10.4236/ijcm.2015.68070

  • CrossRef
  • Google Scholar

• 39.

  Kunnuji M . Basic Deprivation and Involvement in Risky Sexual Behaviour Among Out-Of-School Young People in a Lagos Slum. Cult Health Sex (2014) 16(7):727–40. 10.1080/13691058.2014.894206

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 40.

  Arega WL Zewale TA Bogale KA . Premarital Sexual Practice and Associated Factors Among High School Youths in Debretabor Town, South Gondar Zone, North West Ethiopia, 2017. BMC Res Notes (2019) 12(1):314. 10.1186/s13104-019-4348-3

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 41.

  Dadi AF Teklu FG . Risky Sexual Behavior and Associated Factors Among Grade 9-12 Students in Humera Secondary School, Western Zone of Tigray, NW Ethiopia, 2014. Sci J Public Health (2014) 2(5):410. 10.11648/j.sjph.20140205.16

  • CrossRef
  • Google Scholar

• 42.

  Bedru D Maduako KT Alemayehu M Chernet A Darota D . Risky Sexual Behaviors and Associated Factors Among High School Students of Dawuro Zone, South West Ethiopia. Afr J Reprod Health (2022) 26(3):74–83. 10.29063/ajrh2022/v26i3.9

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 43.

  Abate G Tessema F Girma A . Premarital Sexual Practice and Associated Factors Among Preparatory School Students in Jimma Town, Oromia Region, South West Ethiopia. J Biol (2016) 6(15).

  • Google Scholar

• 44.

  Abebe M Tsion A Netsanet F . Living with Parents and Risky Sexual Behaviors Among Preparatory School Students in Jimma Zone, South West Ethiopia. Afr Health Sci (2013) 13(2):498–506. 10.4314/ahs.v13i2.42

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 45.

  Amoo E Adekeye OA Omumu F Akinpelu OO Ajayi MP Olawande T et al Drug Use and High-Risk Sexual Behavior Among School-Going Adolescents in Nigeria. Open Access Maced J Med Sci (2020) 8(E):256–61. 10.3889/oamjms.2020.3290

  • CrossRef
  • Google Scholar

• 46.

  Bizuayehu MH Abyu DM Demessie HF . Assessment of Time of Sexual Initiation and its Associated Factors Among Students in Northwest Ethiopia. Sci J Public Health (2015) 3(1):10. 10.11648/j.sjph.20150301.13

  • CrossRef
  • Google Scholar

• 47.

  Salih NA Metaferia H Reda AA Biadgilign S . Premarital Sexual Activity Among Unmarried Adolescents in Northern Ethiopia: A Cross-Sectional Study. Sex Reprod Healthc Off J Swed Assoc Midwives (2015) 6(1):9–13. 10.1016/j.srhc.2014.06.004

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 48.

  Shore H Shunu A . Risky Sexual Behavior and Associated Factors Among Youth in Haramaya Secondary and Preparatory School, East Ethiopia, 2015. J Public Health Epidemiol (2017) 9(4):84–91. 10.5897/jphe2016.0905

  • CrossRef
  • Google Scholar

• 49.

  Nigussie T Legesse T Abebe L Getachew S Alemayehu D . Magnitude of Risky Sexual Behaviors, Determinants, and Consequences Among High School and Preparatory School Students in Mizan Aman Town, Ethiopia. J Midwifery Reprod Health (2020) 8(1). 10.22038/jmrh.2019.40248.1450

  • CrossRef
  • Google Scholar

• 50.

  Girmay A Marye T Gerensea H . Early Sexual Debut and Associated Factors Among Secondary School Students of Central Zone of Tigray, Northern Ethiopia, 2018. Pan Afr Med J (2019) 34. 10.11604/pamj.2019.34.1.17139

  • CrossRef
  • Google Scholar

• 51.

  Bogale A Seme A . Premarital Sexual Practices and its Predictors Among In-School Youths of Shendi Town, West Gojjam Zone, North Western Ethiopia. Reprod Health (2014) 11(1):49. 10.1186/1742-4755-11-49

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 52.

  Srahbzu M Tirfeneh E . Risky Sexual Behavior and Associated Factors Among Adolescents Aged 15-19 Years at Governmental High Schools in Aksum Town, Tigray, Ethiopia, 2019: An Institution-Based, Cross-Sectional Study. Biomed Res Int (2020) 2020:3719845–8. 10.1155/2020/3719845

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 53.

  Oljira L Berhane Y Worku A . Pre-marital Sexual Debut and its Associated Factors Among In-School Adolescents in Eastern Ethiopia. BMC Public Health (2012) 12(1):375. 10.1186/1471-2458-12-375

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 54.

  Adebayo AM Ajuonu EJ Betiku BO . Family Functionality and Parental Characteristics as Determinants of Sexual Decision-Making of In-School Youths in a Semi-Urban Area of Southwest Nigeria. Int J Adolesc Med Health (2016) 28(4):413–8. 10.1515/ijamh-2015-0029

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 55.

  Gizaw A Jara D Ketema K . Risky Sexual Practice and Associated Factors Among High School Adolescent in Addis Ababa, Ethiopia, 2014. Fam Med Med Sci Res (2014) 3(4). 10.4172/2327-4972.1000141

  • CrossRef
  • Google Scholar

• 56.

  Awotidebe A Phillips J Lens W . Factors Contributing to the Risk of HIV Infection in Rural School-Going Adolescents. Int J Environ Res Public Health (2014) 11(11):11805–21. 10.3390/ijerph111111805

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 57.

  Mulenga D Mazaba-Liwewe ML Babaniyi O Siziya S . Associations of Cigarette Smoking and Close Friendship with Ever Had Sexual Intercourse Among School-Going Adolescents in Mauritania. Int J Child Adolesc Health (2015) 8(3):299–304.

  • Google Scholar

• 58.

  Visser M . Rethinking HIV-Prevention for School-Going Young People Based on Current Behaviour Patterns. SAHARA-J J Soc Asp HIVAIDS (2017) 14(1):64–76. 10.1080/17290376.2017.1376704

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 59.

  Durowade KA Babatunde OA Omokanye LO Elegbede OE Ayodele LM Adewoye KR et al Early Sexual Debut: Prevalence and Risk Factors Among Secondary School Students in Ido-Ekiti, Ekiti State, South-West Nigeria. Afr Health Sci (2017) 17(3):614–22. 10.4314/ahs.v17i3.3

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 60.

  Kugbey N Ayanore MA Amu H Oppong Asante K Adam A . International Note: Analysis of Risk and Protective Factors for Risky Sexual Behaviours Among School‐aged Adolescents. J Adolesc (2018) 68(1):66–9. 10.1016/j.adolescence.2018.06.013

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 61.

  Govender K Cowden RG Asante KO George G Reardon C . Sexual Risk Behavior: A Multi-System Model of Risk and Protective Factors in South African Adolescents. Prev Sci (2019) 20(7):1054–65. 10.1007/s11121-019-01015-3

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 62.

  Behulu GK Anteneh KT Aynalem GL . Premarital Sexual Intercourse and Associated Factors Among Adolescent Students in Debre-Markos Town Secondary and Preparatory Schools, North West Ethiopia, 2017. BMC Res Notes (2019) 12(1):95. 10.1186/s13104-019-4132-4

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 63.

  James PB Osborne A Babawo LS Bah AJ Margao EK . The Use of Condoms and Other Birth Control Methods Among Sexually Active School-Going Adolescents in Nine Sub-Saharan African Countries. BMC Public Health (2022) 22(1):2358. 10.1186/s12889-022-14855-6

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 64.

  Olaoye T Agbede C . Prevalence and Personal Predictors of Risky Sexual Behaviour Among In-School Adolescents in the Ikenne Local Government Area, Ogun State, Nigeria. Int J Adolesc Med Health (2019) 34(3). 10.1515/ijamh-2019-0135

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 65.

  Pengpid S Peltzer K . Sexual Risk Behaviour and its Correlates Among Adolescents in Mozambique: Results from a National School Survey in 2015. Sahara J (2021) 18(1):26–32. 10.1080/17290376.2020.1858947

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 66.

  Basterfield C Reardon C Govender K Litt D . Relationship between Constructions of Masculinity, Health Risk Behaviors and Mental Health Among Adolescent High School Boys in Durban, South Africa. Int J Mens Health (2014) 13(2):101–20. 10.3149/jmh.1302.101

  • CrossRef
  • Google Scholar

• 67.

  Kassahun EA Gelagay AA Muche AA Dessie AA Kassie BA . Factors Associated with Early Sexual Initiation Among Preparatory and High School Youths in Woldia Town, Northeast Ethiopia: A Cross-Sectional Study. BMC Public Health (2019) 19(1):378. 10.1186/s12889-019-6682-8

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 68.

  Girma D Hailu G Ayana M Ketema K . Factors Early Sexual Initiation Among Governmental Preparatory School Students, Addis Ababa, Ethiopia. J Community Med Health Educ (2015) 05. 10.4172/2161-0711.1000333

  • CrossRef
  • Google Scholar

• 69.

  Kalolo A Mazalale J Krumeich A Chenault M . Social Cohesion, Social Trust, Social Participation and Sexual Behaviors of Adolescents in Rural Tanzania. BMC Public Health (2019) 19(1):193. 10.1186/s12889-019-6428-7

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 70.

  Harrison A Smit J Hoffman S Nzama T Leu CS Mantell J et al Gender, Peer and Partner Influences on Adolescent HIV Risk in Rural South Africa. Sex Health (2012) 9(2):178–86. 10.1071/SH10150

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 71.

  Agajie M Belachew T Tilahun T Amentie M . Risky Sexual Behavior and Associated Factors Among High School Youth in Pawe Woreda, Benishangul Gumuz Region. Sci J Clin Med (2015) 4(4):67–75. 10.11648/j.sjcm.20150404.11

  • CrossRef
  • Google Scholar

• 72.

  Ajah L Onubogu E Anozie O Lawani L Iyoke C Onwe E et al Adolescent Reproductive Health Challenges Among Schoolgirls in Southeast Nigeria: Role of Knowledge of Menstrual Pattern and Contraceptive Adherence. Patient Prefer Adherence (2015) 1219:1219–24. 10.2147/PPA.S89258

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 73.

  Eggers SM Mathews C Aarø LE McClinton-Appollis T Bos AER de Vries H . Predicting Primary and Secondary Abstinence Among Adolescent Boys and Girls in the Western Cape, South Africa. AIDS Behav (2017) 21(5):1417–28. 10.1007/s10461-016-1438-2

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 74.

  Alemu MT Dessie Y Gobena T Mazeingia YT Abdu AO . Oral and Anal Sexual Practice and Associated Factors Among Preparatory School Youths in Dire Dawa City Administration, Eastern Ethiopia. PLoS ONE (2018) 13(11):e0206546. 10.1371/journal.pone.0206546

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 75.

  Eyam L Eyam S Ekpeyong B Ndep A Akpan M Ekanem E . Determinants of Risky Sexual Behavior Among Secondary School Adolescents in Cross River State, Nigeria. Niger J Med (2021) 30(6):658–64. 10.4103/njm.njm_126_21

  • CrossRef
  • Google Scholar

• 76.

  Zulaika G Nyothach E van Eijk AM Obor D Mason L Wang D et al Factors Associated with the Prevalence of HIV, HSV-2, Pregnancy, and Reported Sexual Activity Among Adolescent Girls in Rural Western Kenya: A Cross-Sectional Analysis of Baseline Data in a Cluster Randomized Controlled Trial. PLOS Med (2021), 18. 10.1371/journal.pmed.1003756

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 77.

  Gossaye BT Molla M Berhane Y Wesen A Chuko T . Determinants of Risky Sexual Behaviour Among Preparatory School Students in Gurage Zone, SNNPR, Ethiopia (A Cross-Sectional School Based Study). Sci J Public Health (2016) 4(4):330. 10.11648/j.sjph.20160404.20

  • CrossRef
  • Google Scholar

• 78.

  Govender K Naicker SN Meyer‐Weitz A Fanner J Naidoo A Penfold WL . Associations between Perceptions of School Connectedness and Adolescent Health Risk Behaviors in South African High School Learners. J Sch Health (2013) 83(9):614–22. 10.1111/josh.12073

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 79.

  Tenkorang EY Maticka-Tyndale E . Individual- and Community-Level Influences on the Timing of Sexual Debut Among Youth in Nyanza, Kenya. Int Perspect Sex Reprod Health (2014) 40(2):68–78. 10.1363/4006814

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 80.

  Girmay A Mariye T . Risky Sexual Behavior Practice and Associated Factors Among Secondary and Preparatory School Students of Aksum Town, Northern Ethiopia, 2018. BMC Res Notes (2019) 12(1):698. 10.1186/s13104-019-4714-1

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 81.

  Beyene K Hinkosa L Bekele D Demtsu B . Magnitude of Premarital Sexual Practice and Associated Factors Among Adigrat High School Students, Ethiopia, A Cross Sectional Study. Ethiop J Reprod Health (2019) 11(3):10–24. 10.69614/ejrh.v11i3.304

  • CrossRef
  • Google Scholar

• 82.

  Megersa ND Teshome GS . Risky Sexual Behavior and Associated Factors Among Preparatory School Students in Arsi Negelle Town Oromia, Ethiopia. Int J Public Health Sci (2020) 9(3):162–8. 10.11591/ijphs.v9i3.20033

  • CrossRef
  • Google Scholar

• 83.

  Bizuwork MG Hailu A Taderegew MM Bizuwork YG Alebie A Zegeye B . Assessment of Risky Sexual Behaviours and Associated Factors Among Adolescents in Shewa Robit Town, Northeast, Ethiopia: A Cross-Sectional Study. Pan Afr Med J (2022) 41:264. 10.11604/pamj.2022.41.264.25846

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 84.

  Peltzer K . Early Sexual Debut and Associated Factors Among In‐school Adolescents in Eight African Countries. Acta Paediatr (2010) 99(8):1242–7. 10.1111/j.1651-2227.2010.01874.x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 85.

  Tavares CM Schor N França Junior I . Contraceptive Use and Associated Factors Among Adolescents on Santiago Island - Cape Verde - Western Africa. Rev Bras Saúde Materno Infant (2010) 10(2):229–36. 10.1590/S1519-38292010000200010

  • CrossRef
  • Google Scholar

• 86.

  Menna T Ali A Worku A . Prevalence of “HIV/AIDS Related” Parental Death and its Association with Sexual Behavior of Secondary School Youth in Addis Ababa, Ethiopia: A Cross Sectional Study. BMC Public Health (2014) 14(0):1120. 10.1186/1471-2458-14-1120

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 87.

  Yimer B Ashebir W . Parenting Perspective on the Psychosocial Correlates of Adolescent Sexual and Reproductive Health Behavior Among High School Adolescents in Ethiopia. Reprod Health (2019) 16(1):66. 10.1186/s12978-019-0734-5

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 88.

  Kalolo A Kibusi SM . The Influence of Perceived Behaviour Control, Attitude and Empowerment on Reported Condom Use and Intention to Use Condoms Among Adolescents in Rural Tanzania. Reprod Health (2015) 12(1):105. 10.1186/s12978-015-0097-5

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 89.

  Wana GW Arulogun O Roberts A Kebed AS . Predictors of Risky Sexual Behaviour Among Pre-College Students in Adama Town, Ethiopia. Pan Afr Med J (2019) 33:135. 10.11604/pamj.2019.33.135.18068

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 90.

  Solomon MW Nega A Solomon T Hiwot Z . Substance Use and Factors Associated with Risky Sexual Practice in School Youth in Asella Town, South-East Ethiopia, 2017. J Public Health Epidemiol (2018) 10(1):6–15. 10.5897/jphe2016.0962

  • CrossRef
  • Google Scholar

• 91.

  Haftu M Berhe H Tesfay K Gebremeskel M . Older Siblings’ Influence on Sexual Behavior of High School Adolescents in Mekelle, Northern Ethiopia. Adolesc Health Med Ther (2019) 10:67–73. 10.2147/AHMT.S196080

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 92.

  Barchi F Apps H Ntshebe O Ramaphane P . Social and Behavioral Correlates of Adolescent Sexual Experience and Intention to Use Condoms in Northwestern Botswana. Int J Environ Res Public Health (2021) 18(11):5583. 10.3390/ijerph18115583

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 93.

  Idowu A Ayodele AO Omotade PG Anu OS Omolola FF . Risky Sexual Behavior of Senior Secondary School Students in an Urban Community of Oyo State, South West Nigeria. Int Q Community Health Educ (2017) 37(3–4):173–80. 10.1177/0272684X17736154

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 94.

  Azeze GA Gebeyehu NA Wassie AY Mokonnon TM . Factors Associated with Risky Sexual Behaviour Among Secondary and Preparatory Students in Wolaita Sodo Town, Southern Ethiopia; Institution Based Cross-Sectional Study. Afr Health Sci (2021) 21(4):1830–41. 10.4314/ahs.v21i4.41

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 95.

  Kaufman ZA Braunschweig EN Feeney J Dringus S Weiss H Delany-Moretlwe S et al Sexual Risk Behavior, Alcohol Use, and Social Media Use Among Secondary School Students in Informal Settlements in Cape Town and Port Elizabeth, South Africa. AIDS Behav (2014) 18(9):1661–74. 10.1007/s10461-014-0816-x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 96.

  Doku D . Substance Use and Risky Sexual Behaviours Among Sexually Experienced Ghanaian Youth. BMC Public Health (2012) 12:571–7. 10.1186/1471-2458-12-571

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 97.

  Rosenberg M Pettifor A Van Rie A Thirumurthy H Emch M Miller WC et al The Relationship between Alcohol Outlets, HIV Risk Behavior, and HSV-2 Infection Among South African Young Women: A Cross-Sectional Study. PLOS ONE, 10 (2015). 10.1371/journal.pone.0125510

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 98.

  Kasahun AW Yitayal M Girum T Mohammed B . Risky Sexual Behavior and Associated Factors Among High School Students in Gondar City, Northwest Ethiopia. Int J Public Health Sci IJPHS (2017) 6(3):257. 10.11591/ijphs.v6i3.9293

  • CrossRef
  • Google Scholar

• 99.

  Abrha K Worku A Lerebo W Berhane Y . Sexting and High Sexual Risk-Taking Behaviours Among School Youth in Northern Ethiopia: Estimating Using Prevalence Ratio. BMJ Sex Reprod Health (2019) 45:200–6. 10.1136/bmjsrh-2018-200085

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 100.

  Diallo A Diallo Y Magassouba AS Bah IK Sy T . Rapports sexuels chez les élèves de la commune de Matoto à Conakry en Guinée. Pan Afr Med J (2020) 35(0):113. 10.11604/pamj.2020.35.113.20733

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 101.

  Smith AD Chipeta E Stones W Mmari K . Why Do Young People Engage in Dating Relationships during Early Adolescence? An Inter-Generational Qualitative Analysis from Blantyre. Malawi Cult Health Sex (2022) 24(6):842–55. 10.1080/13691058.2021.1889672

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 102.

  Gevers A Jewkes R Mathews C . What Do Young People Think Makes Their Relationships Good? Factors Associated with Assessments of Dating Relationships in South Africa. Cult Health Sex (2013) 15(9):1011–25. 10.1080/13691058.2013.803295

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 103.

  Tavares CM Schor N Valenti VE Kanikadan PYS de Abreu LC . Condom Use at Last Sexual Relationship Among Adolescents of Santiago Island, Cape Verde, - West Africa. Reprod Health (2012) 9(1):29. 10.1186/1742-4755-9-29

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 104.

  Darfour-Oduro SA Grigsby-Toussaint DS . Impact of Social Environment on Sexual Behaviors of Adolescent Girls in 12 Sub-Saharan African Countries: A Cross-Sectional Study. Reprod Health (2022) 19(1):139. 10.1186/s12978-022-01448-0

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 105.

  Agambire R Ansong CA Adusei C . Risky Behaviours Among Adolescents in a Rural Community. A Study Conducted at Kwabre East District, Ashanti Region of Ghana. Cogent Med (2019) 6(1):1673653. 10.1080/2331205x.2019.1673653

  • CrossRef
  • Google Scholar

• 106.

  Pascoe SJS Langhaug LF Durawo J Woelk G Ferrand R Jaffar S et al Increased Risk of HIV-Infection Among School-Attending Orphans in Rural Zimbabwe. AIDS Care (2010) 22(2):206–20. 10.1080/09540120903111528

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 107.

  Price JT Rosenberg NE Vansia D Phanga T Bhushan NL Maseko B et al Predictors of HIV, HIV Risk Perception, and HIV Worry Among Adolescent Girls and Young Women in Lilongwe, Malawi. J Acquir Immune Defic Syndr (1999) 77(1):53–63. 10.1097/qai.0000000000001567

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 108.

  Thirugnanasampanthar SS Embleton L Di Ruggiero E Braitstein P Oduor C Dibaba Wado Y . School Attendance and Sexual and Reproductive Health Outcomes Among Adolescent Girls in Kenya: A Cross-Sectional Analysis. Reprod Health (2023) 20(1):29. 10.1186/s12978-023-01577-0

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 109.

  Jennings L Pettifor A Hamilton E Ritchwood TD Xavier Gómez-Olivé F MacPhail C et al Economic Resources and HIV Preventive Behaviors Among School-Enrolled Young Women in Rural South Africa (HPTN 068). AIDS Behav (2017) 21(3):665–77. 10.1007/s10461-016-1435-5

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 110.

  Massawa O Kazaura M . Use of Modern Contraceptives Among Advanced-Level Secondary School Girls in the Rukwa Region, Tanzania, 2018. Int J Adolesc Med Health (2021) 33(6):449–56. 10.1515/ijamh-2019-0211

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 111.

  World Health Organization. Violence against women (2024). Available online at: https://www.who.int/news-room/fact-sheets/detail/violence-against-women (Accessed December 29, 2024).

  • Google Scholar

• 112.

  Jonas KAWM yan TH chao DL Yu Y Jean-Baptiste KN Basile KK et al Prevalence and Risk Factors Associated with Physical And/or Sexual Abuse Among Female Middle School Students: A Cross- Sectional Study in Kinshasa, DRC. J Interpers Violence (2022) 37(11–12):NP8405–29. 10.1177/0886260520976221

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 113.

  Tenkorang EY . Inconsistent Reports of Sexual Intercourse by Adolescents in Edo State, Nigeria. Sex Res Soc Pol (2021) 18(2):271–80. 10.1007/s13178-020-00455-9

  • CrossRef
  • Google Scholar

• 114.

  Nlewem C Amodu OK . Family Characteristics and Structure as Determinants of Sexual Abuse Among Female Secondary School Students in Nigeria: A Brief Report. J Child Sex Abuse (2017) 26(4):453–64. 10.1080/10538712.2017.1293202

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 115.

  Ybarra ML Bull SS Kiwanuka J Bangsberg DR Korchmaros J . Prevalence Rates of Sexual Coercion Victimization and Perpetration Among Uganda Adolescents. AIDS Care (2012) 24(11):1392–400. 10.1080/09540121.2011.648604

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 116.

  Boafo IM Dagbanu EA Asante KO . Dating Violence and Self-Efficacy for Delayed Sex Among Adolescents in Cape Town, South Africa. Afr J Reprod Health (2014) 18(2):46–57.

  • Pubmed Abstract
  • Google Scholar

• 117.

  Goessmann K Ssenyonga J Mabula N Hermenau K Hecker T . Characterizing the Prevalence and Contributing Factors of Sexual Violence: A Representative Cross-Sectional Study Among School-Going Adolescents in Two East African Countries. Child Abuse Negl (2020) 109:1–12. 10.1016/j.chiabu.2020.104711

  • CrossRef
  • Google Scholar

• 118.

  Quarshie ENB . Boys Should Not Be Overlooked: Sexual Violence Victimization and Associated Factors Among School-Going Adolescents in Urban Ghana. Child Abuse Negl (2021) 120:105227. 10.1016/j.chiabu.2021.105227

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 119.

  Fawole OI Balogun OD Olaleye O . Experience of Gender-Based Violence to Students in Public and Private Secondary Schools in Ilorin, Nigeria. Ghana Med J (2018) 52(2):66–73. 10.4314/gmj.v52i2.1

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 120.

  Tantu T Wolka S Gunta M Teshome M Mohammed H Duko B . Prevalence and Determinants of Gender-Based Violence Among High School Female Students in Wolaita Sodo, Ethiopia: An Institutionally Based Cross-Sectional Study. BMC Public Health (2020) 20(1):540. 10.1186/s12889-020-08593-w

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 121.

  Maguele MS Tlou B Taylor M Khuzwayo N . Risk Factors Associated with High Prevalence of Intimate Partner Violence Amongst School-Going Young Women (Aged 15–24years) in Maputo, Mozambique. PLOS ONE, 15 (2020). 10.1371/journal.pone.0243304

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 122.

  Abera L Aliye A Tadesse K Guta A . Magnitude of Child Sexual Abuse and its Associated Factors Among High School Female Students in Dire Dawa, Eastern Ethiopia: A Cross-Sectional Study. Reprod Health (2021) 18(1):224. 10.1186/s12978-021-01277-7

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 123.

  Mekuria A Nigussie A Abera M . Childhood Sexual Abuse Experiences and its Associated Factors Among Adolescent Female High School Students in Arbaminch Town, Gammo Goffa Zone, Southern Ethiopia: A Mixed Method Study. BMC Int Health Hum Rights (2015) 15(1):21. 10.1186/s12914-015-0059-6

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 124.

  Haile RT Kebeta ND Kassie GM . Prevalence of Sexual Abuse of Male High School Students in Addis Ababa, Ethiopia. BMC Int Health Hum Rights (2013) 13(1):24. 10.1186/1472-698X-13-24

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 125.

  Mason-Jones AJ De Koker P Eggers SM Mathews C Temmerman M Leye E et al Intimate Partner Violence in Early Adolescence: The Role of Gender, Socioeconomic Factors and the School. S Afr Med J (2016) 106(5):60. 10.7196/SAMJ.2016.v106i5.9770

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 126.

  Beyene AS Chojenta C Loxton D . Factors Associated with Gender-Based Violence Perpetration by Male High School Students in Eastern Ethiopia. J Interpers Violence (2022) 37(17–18):NP16421–52. 10.1177/08862605211021978

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 127.

  Rosenman E Sarnquist C Friedberg R Amuyunzu-Nyamongo M Oguda G Otieno D et al Empirical Insights for Improving Sexual Assault Prevention: Evidence from Baseline Data for a Cluster-Randomized Trial of IMPower and Sources of Strength. Violence Women (2020) 26(15–16):1855–75. 10.1177/1077801219886380

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 128.

  Baiocchi M Friedberg R Rosenman E Amuyunzu-Nyamongo M Oguda G Otieno D et al Prevalence and Risk Factors for Sexual Assault Among Class 6 Female Students in Unplanned Settlements of Nairobi, Kenya: Baseline Analysis from the IMPower & Sources of Strength Cluster Randomized Controlled Trial. PLOS ONE, 14 (2019). 10.1371/journal.pone.0213359

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 129.

  Andersson N Paredes-Solís S Milne D Omer K Marokoane N Laetsang D et al Prevalence and Risk Factors for Forced or Coerced Sex Among School-Going Youth: National Cross-Sectional Studies in 10 Southern African Countries in 2003 and 2007. BMJ Open (2012) 2(2):e000754. 10.1136/bmjopen-2011-000754

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 130.

  Bekele AB van Aken MAG Dubas JS . Sexual Violence Victimization Among Female Secondary School Students in Eastern Ethiopia. Violence Vict (2011) 26(5):608–30. 10.1891/0886-6708.26.5.608

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 131.

  Wubs AG Aarø LE Mathews C Onya HE Mbwambo J . Associations between Attitudes toward Violence and Intimate Partner Violence in South Africa and Tanzania. Violence Vict (2013) 28(2):324–40. 10.1891/0886-6708.11-063

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 132.

  Shamu S Gevers A Mahlangu BP Jama Shai PN Chirwa ED Jewkes RK . Prevalence and Risk Factors for Intimate Partner Violence Among Grade 8 Learners in Urban South Africa: Baseline Analysis from the Skhokho Supporting Success Cluster Randomised Controlled Trial. Int Health (2015):ihv068. 10.1093/inthealth/ihv068

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 133.

  Olley BO . Date Fighting and Sexual Risk Behaviours Among Adolescents Attending Public Schools in Ibadan, Nigeria. Gend Behav (2015) 13(1):6515–21.

  • Google Scholar

• 134.

  Tenkorang EY Amo-Adjei J Kumi-Kyereme A Gubhinder K . Determinants of Sexual Violence at Sexual Debut against In-School Adolescents in Ghana. J Fam Violence (2021) 36(7):813–24. 10.1007/s10896-020-00220-x

  • CrossRef
  • Google Scholar

• 135.

  Ogunfowokan AA Olagunju OE Olajubu AO Faremi FA Oloyede AS Sharps PW . Correlates of Self-Report of Rape Among Male School Adolescents in Ile-Ife, Nigeria. J Interpers Violence (2016) 31(4):555–71. 10.1177/0886260514556104

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 136.

  Boakye KE . Reprint of: Juvenile Sexual Offending in Ghana: Prevalence, Risks and Correlates. Child Abuse Negl (2020) 105:104570. 10.1016/j.chiabu.2020.104570

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 137.

  Olofinbiyi BA Awoleke JO Okunola TO Olofinbiyi OR Akintoye OO Adefisan AS . Sexual Assault Among In-School Adolescents in Ekiti State, Nigeria: Prevalence and Predictors. Internet J Gynecol Obstet (2020) 24(1):1–8. 10.5580/IJGO.54928

  • CrossRef
  • Google Scholar

• 138.

  Kunnuji MOPD . Experience of Domestic Violence and Acceptance of Intimate Partner Violence Among Out-Of-School Adolescent Girls in Iwaya Community, Lagos State. J Interpers Violence (2015) 30(4):543–64. 10.1177/0886260514535261

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 139.

  Kunnuji MON Esiet A . Prevalence and Correlates of Sexual Abuse Among Female Out-Of- School Adolescents in Iwaya Community, Lagos State, Nigeria. Afr J Reprod Health (2015) 19(1):82–90.

  • Pubmed Abstract
  • Google Scholar

• 140.

  Manyanga T El-Sayed H Doku DT Randall JR . The Prevalence of Underweight, Overweight, Obesity and Associated Risk Factors Among School-Going Adolescents in Seven African Countries. BMC Public Health (2014) 14(1):887–11. 10.1186/1471-2458-14-887

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 141.

  Bleakley A Hennessy M Fishbein M Jordan A . How Sources of Sexual Information Relate to Adolescents’ Beliefs about Sex. Am J Health Behav (2009) 33(1):37–48. 10.5993/ajhb.33.1.4

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 142.

  Darabi F Kaveh MH Farahani FK Yaseri M Majlessi F Shojaeizadeh D . The Effect of a Theory of Planned Behavior-Based Educational Intervention on Sexual and Reproductive Health in Iranian Adolescent Girls: A Randomized Controlled Trial. J Res Health Sci (2017) 17(4):e00400.

  • Pubmed Abstract
  • Google Scholar

• 143.

  Ajzen I . The Theory of Planned Behavior. Organ Behav Hum Decis Process (1991) 50(2):179–211. 10.1016/0749-5978(91)90020-t

  • CrossRef
  • Google Scholar

• 144.

  Setiowati TA Pamungkasari EP Prasetya H . Application of Theory of Planned Behavior on Sexual Behavior in Female Adolescents. J Health Promot Behav (2019) 4(2):126–36. 10.26911/thejhpb.2019.04.02.05

  • CrossRef
  • Google Scholar

• 145.

  Putri SI Hedo DJPK Apriananda R . The Theory of Planned Behavior on Adolescents Sexual Behavior in Malang, East Java. Int Conf Public Health Proceeding (2021) 6(01):468–78. 10.26911/ICPHpromotion.FP.08.2021.05

  • CrossRef
  • Google Scholar

• 146.

  Rogers R Cacioppo J Petty R . Cognitive and Physiological Processes in Fear Appeals and Attitude Change: A Revised Theory of Protection Motivation. (1983). p. 153–77.

  • Google Scholar

• 147.

  Jessor R . The Origins and Development of Problem Behavior Theory - the Collected Works of Richard Jessor, 1. New York: Springer (2016). Available online at: https://www.scribd.com/document/515895927/The-Origins-and-Development-of-Problem-Behavior-Theory-Jessor-2016 (Accessed December 28, 2024).

  • Google Scholar

• 148.

  Lo TW Tse JWL Cheng CHK Chan GHY . The Association between Substance Abuse and Sexual Misconduct Among Macau Youths. Int J Environ Res Public Health (2019) 16(9):1643. 10.3390/ijerph16091643

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 149.

  Adarsh H Sahoo S . Pornography and its Impact on Adolescent/Teenage Sexuality. J Psychosexual Health (2023) 5(1):35–9. 10.1177/26318318231153984

  • CrossRef
  • Google Scholar

• 150.

  Mncanca M Okeke C . Early Exposure to Domestic Violence and Implications for Early Childhood Education Services. (2019). p. 35–55. 10.4018/978-1-5225-7476-7.ch003

  • CrossRef
  • Google Scholar

• 151.

  Kaestle CE Allen KR Wesche R Grafsky EL . Adolescent Sexual Development: A Family Perspective. J Sex Res (2021) 58(7):874–90. 10.1080/00224499.2021.1924605

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 152.

  Peҫi B . Peer Influence and Adolescent Sexual Behavior Trajectories: Links to Sexual Initation. Eur J Multidiscip Stud (2017) 4(3):96. 10.26417/ejms.v4i3.p96-105

  • CrossRef
  • Google Scholar

• 153.

  Mason-Jones AJ Freeman M Lorenc T Rawal T Bassi S Arora M . Can Peer-Based Interventions Improve Adolescent Sexual and Reproductive Health Outcomes? An Overview of Reviews. J Adolesc Health (2023) 73(1):58–72. 10.1016/j.jadohealth.2023.05.035

  • CrossRef
  • Google Scholar

• 154.

  Volpe EM Hardie TL Cerulli C Sommers MS Morrison-Beedy D . Age Got to Do with it? Partner Age Difference, Power, Intimate Partner Violence, and Sexual Risk in Urban Adolescents. J Interpers Violence (2013) 28(10):2068–87. 10.1177/0886260512471082

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 155.

  Centers for Disease Control and Prevention. School Connectedness: Strategies for Increasing Protective Factors Among Youth. Atlanta, GA: Centers for Disease Control and Prevention (2009). Available online at: https://eric.ed.gov/?id=ED511993 (Accessed October 25, 2024).

  • Google Scholar

• 156.

  Kirby D . The Impact of Schools and School Programs upon Adolescent Sexual Behavior. J Sex Res (2002) 39(1):27–33. 10.1080/00224490209552116

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 157.

  Hallman K . Socio economic Disadvantage and Unsafe Sexual Behaviors Among Young Women and Men in South Africa. New York: Population Council (2004). Available online at: https://knowledgecommons.popcouncil.org/departments_sbsr-pgy/56 (Accessed October 25, 2024).

  • Google Scholar

• 158.

  Lozza E Jarach CM Sesini G Marta E Lugo A Santoro E et al Should I Give Kids Money? The Role of Pocket Money on At-Risk Behaviors in Italian Adolescents. Ann Dellistituto Super Sanità (2023) 59(1):37–42. 10.4415/ANN_23_01_06

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 159.

  Habte A Dessu S Bogale B Lemma L . Disparities in Sexual and Reproductive Health Services Utilization Among Urban and Rural Adolescents in Southern Ethiopia, 2020: A Comparative Cross-Sectional Study. BMC Public Health (2022) 22(1):203. 10.1186/s12889-022-12634-x

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 160.

  Hayward GM . Religiosity and Premarital Sexual Behaviors Among Adolescents: An Analysis of Functional Form. J Sci Study Relig (2019) 58(2):439–58. 10.1111/jssr.12588

  • Pubmed Abstract
  • CrossRef
  • Google Scholar

• 161.

  Malhotra A Amin A Nanda P . Catalyzing Gender Norm Change for Adolescent Sexual and Reproductive Health: Investing in Interventions for Structural Change. J Adolesc Health (2019) 64(4 Suppl. l):S13–S15. 10.1016/j.jadohealth.2019.01.013

  • Pubmed Abstract
  • CrossRef
  • Google Scholar