Factors Associated with Risky Sexual Behavior for Adolescents at Senior High School

• Arisa Harfa Said Lubis
• Anto Anto
• Rusdiyah Rusdiyah

Vol. 4 No. 2: October 2023 | Pages: 65-70

DOI: 10.47679/makein.2023168   Reader: 2899 times PDF Download: 541 times

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Abstract

INTRODUCTION

Adolescence has unique needs for reproductive health and is one of life's most fascinating and complex stages. Adolescents are strong, resourceful, and motivated. They can assist one another through peer-to-peer counseling, education, and outreach and give back to their communities by doing things like volunteering as health care providers' assistants, caring for HIV/AIDS patients, and increasing their peers' access to high-quality reproductive health services in the local area (Natalia et al., 2020).

Risky sexual behavior is a reproductive health problem in today's adolescents. Risky sexual behavior can cause various health problems. Among risky sexual behavior is sexual behavior committed by adolescents outside of legal marriage ties. As a result of sexual intercourse, about 12% were positive for sexually transmitted diseases, and about 27% were HIV positive (Padut et al., 2021). In Indonesia, there are around 4.5% of male youth and around 0.7% of female adolescents aged 15-19 admit to having had risky sexual behavior. At that age, it is feared that they do not yet have adequate life skills, so they are at risk of having unhealthy courtship behavior, including risky sexual behavior (Siregar et al., 2021).

Today's youth face some problems that require attention, namely the earlier age of puberty, the tendency to delay the age of marriage, pre-marital sex, a longer period of risky sexual behavior activity, as well as the risks of early pregnancy and pregnancy outside of marriage. Then coupled with inadequate knowledge about reproductive health and processes, lack of services and guidance on reproductive health, as well as the spread of STDs and HIV/AIDS (Kristianti & Widjayanti, 2021).

The Indonesian Ministry of Health highlighted HIV cases, which are starting to be dominated by young people. The latest data shows that around 51% of new HIV cases detected are in adolescents, in 2021 it is estimated that there will be around 526,841 people living with HIV with an estimated 27 thousand new cases. Data from the Ministry of Health also shows that around 12,533 HIV cases were experienced by children aged 12 and under. Based on data obtained from the Padangsidimpuan City Health Office in 2017, 15 people were infected with HIV/AIDS: 6.67% were aged 15-19 years, 20% were aged (20-24 years), 66.67% aged 25-49 years and 6.67% are over 50 years old, with 2 deaths due to AIDS. In 2018, 10 people were infected with HIV/AIDS: 16.67% aged 20-24 years, and 83.33% aged 25-49 years, with 2 deaths due to AIDS. In 2019 there was an increase where 24 people were infected with HIV: 20.8% aged 20-24 years, 75% aged 25-49 years, and 4.2% aged over 50 years. Based on data obtained from the Padangsidimpuan City Child Protection Commission in 2018 and 2019. In the last two years, there have been 16 cases of risky sexual behavior where the perpetrators and victims were teenagers.

The problems of teenagers today are very complex, this is supported by the increasing behavior of risky sexual behavior among adolescents. The results of a recent study by the Indonesian National Commission for Child Protection show that out of 12 big cities in Indonesia, 97% said they had watched pornographic films, 93.7% said they had kissed, had oral sex or petting and 62.7% of junior high and high school teenagers had not a virgin. Lack of knowledge and understanding of the reproductive system causes trial and error which can put adolescents at risk of contracting STDs, HIV/AIDS, and the risk of unplanned pregnancies leading to abortion which can result in death (Arista, 2015).

Risky sexual behavior committed by adolescents has a major impact on adolescents and their partners. Some of the impacts of risky sexual behavior on adolescents are unwanted pregnancies, early marriage, abortion, venereal sexually transmitted infections (STIs), and HIV/AIDS (Srahbzu & Tirfeneh, 2020). Risky sexual behavior in adolescents if not handled properly can lead to unwanted pregnancies which in turn lead to unsafe abortions, infanticide, STIs and HIV/AIDS, and even death (Do et al., 2020).

risky sexual behavior in adolescents is motivated by a person's behavior. A person's behavior can be influenced by three factors, namely predisposing factors, eanbling factors, and driving factors. Predisposing factors which are factors that facilitate the occurrence of behavior and these factors come from within the individual, for example, the problem of adolescent knowledge about sex that is still lacking. Enabling factors are factors that enable individuals or groups to behave in a certain way, for example, the ease of accessing pornographic VCDs, and porn sites on the internet. Driving factors are factors that strengthen the occurrence of behavior including the role of family and the role of peers (Siregar et al., 2021).

The most dominant factor influencing and being a predictor of sexual behavior in college students is the sexual behavior of close friends, their attitudes toward sexuality, and their level of religiosity (Jahanfar & Pashaei, 2022). As a result of risky sexual behavior among adolescents within the period (2021-2023) at SMA Negeri 5 Padangsidimpuan City based on data obtained from the Counseling Guidance teacher's statement that 2 students were experiencing early marriage. There has been no research focusing on the factors affecting risky sexual behavior at SMA Negeri 5 Padangsidimpuan. In general, it can be concluded that the problem of adolescents in Indonesia is the lack of knowledge about reproductive health due to the absence of an Adolescent Reproductive Health Curriculum in schools. This study was quantitative with a cross-sectional approach and employed 234 students analyzed using chi-square test and logistic regression.

Purpose of Study

Therefore, this study aims to analyze factors related to risky sexual behavior including gander, age, dating status, knowlegde, attitude, parentral roles, peer influence and cource of information in adolescents at SMA Negeri 5 Padangsidimpuan City.

Research Hypothesis

1. There is a relationship between gender and sexual behavior in adolescents.
2. There is a relationship between age and sexual behavior in adolescents.
3. There is a relationship between dating status and sexual behavior in adolescents.
4. There is a relationship between knowledge and sexual behavior in adolescents.
5. There is a relationship between attitudes and sexual behavior in adolescents.
6. There is a relationship between the role of parents and sexual behavior in adolescents.
7. There is a peer influence with sexual behavior in adolescents.
8. There is a relationship between information media and sexual behavior in adolescents.

METHODS

The study was quantitative with a cross-sectional approach, to analyze the relationship between the dependent variable and the independent variable observed at the same period. The population in this study were all students at SMA Negeri 5 Padangsidimpuan City in 2023 totaling 566 people. The sample in this study were some of the students in SMA Negeri 5 Kota Padangsidimpuan as many as 234 students using the proportional random sampling technique and the Slovin formula. Inclusion criteria were active students, and willingness to be respondents as well as those who would need assistance to complete the questionnaire (those with vision or hearing impairments or who were gravely unwell) were excluded from the study.

The questionnaire was developed by modifying the WHO questionnaire in terms of knowledge, attitudes, and behaviors related to adolescent reproductive health (Solehati et al., 2018). The respondents (self-reported) provided the data independently using a questionnaire that tested for the validity and reliability to 25 students from other junior and senior high schools in the Bandung Regency area. Adolescent reproductive health knowledge, attitude, and behaviors obtained Cronbach’s alpha values of 0.87, 0.61, and 0.63, respectively. The validity values were 0.54–0.80, 0.43–0.65, and 0.55–0.82 (Solehati et al., 2022). Data were analyzed using chi-squared and Logistic Regression.

All of the responders, including the teachers, signed the informed consent form. The participants in the study had the option to stop at any point and decline to answer the question. The information was kept secret by the researcher.

The potential limitations of the methods used is biases that may occur with the sampling technique and potential response bias from the questionnaire.

RESULTS AND DISCUSSION

Table 1 shows that of the 234 students who stated that they were female (62.8%) and male (37.2%), middle adolescent age (15-17 years) as much as 65.4% and late youth (18-21 years) as much as 34.6%.

Table 1. Characteristics of Respondents

Variable	n	%
Gender
Male	147	62.8
Female	87	37.2
Age
Middle adolescent age (15-17 years)	153	65.4
Late youth (18-21 years)	81	34.6

Table 2 contains the results of the analysis of the variables studied with risky sexual behavior in adolescents. From the statistical analysis, it shows that gender, dating status, knowledge, attitudes, parental roles, peer influence, and sources of information have a statistically significant relationship with risky sexual behavior in adolescents with p-value (p=0.028; p=0.022; p=0.000; p=0.001; p=0.002; p=0.002 and p=0.004). However, age did not have a statistically significant relationship with risky sexual behavior in adolescents with a p-value of 0.456.

Table 2. The relationship between gender, age, dating status, knowledge, attitudes, parental roles, peer influence, and sources of information with risky sexual behavior in adolescents

Variable	Risky sexual behavior in adolescents		Total	X2 (p-value)
	Risky	No risk
	n (%)	n (%)
Gender
Male	56 (38.1)	91 (61.9)	147	4.854 (0.028*)
Female	46 (52.9)	41 (47.1)	87
Total	102 (43.6)	132 (56.4)	234
Age
Middle adolescent age (15-17 years)	64 (41.8)	89 (58.2)	153	0.557 (0.456)
Late youth (18-21 years)	38 (46.9)	43 (53.1)	81
Total	102 (43.6)	132 (56.4)	234
Dating status
Ever dated	61 (50.8)	59 (49.2)	120	5.256 (0.022*)
Never dated	41 (36.0)	73 (64.0)	114
Total	102 (43.6)	132 (56.4)	234
Knowledge
Sufficient	37 (28.2)	94 (71.8)	131	68.699 (0.000*)
Lack	65 (78.3)	18 (21.7)	83
Total	102 (43.6)	132 (56.4)	234
Attitude
Negative	58 (56.3)	45 (43.7)	103	12.108 (0.001*)
Positive	44 (33.6)	87 (66.4)	131
Total	102 (43.6)	132 (56.4)	234
Parental roles
No exist	56 (54.9)	46 (45.1)	102	9.410 (0.002*)
Exist	46 (34.8)	86 (65.2)	132
Total	102 (43.6)	132 (56.4)	234
Peer influence
Affected	60 (54.1)	51 (45.9)	111	9.404 (0.002*)
Not affected	42 (34.1)	81 (65.9)	123
Total	102 (43.6)	132 (56.4)	234
Sources of information
Smartphone	61 (53.0)	54 (47.0)	115	8.219 (0.004*)
Computer	41 (34.5)	78 (65.5)	119
Total	102 (43.6)	132 (56.4)	234

Table 3. Multivariate Analysis of Factors Associated with Risky Sexual Behavior in Adolescents

Variable	B	Sig	Exp (B)	95%Cl
				Lower	Upper
Gender	-1.970	0.000	0.139	0.047	0.414
Dating status	-21.681	0.999	0.000	0.000	0.000
Knowledge	-2.143	0.000	0.117	0.060	0.229
Attitude	-0.213	0.761	0.808	0.205	3.192
Parental role	1.596	0.147	4.932	0.569	42.715
Peer influence	1.870	0.155	6.488	0.492	85.559
Sources of information	20.305	0.999	6.58558	0.000	.
Constant	4.891	0.000	133.108

Table 3 shows gender (p=0.000), dating status (p=0.999), knowledge (p=0.000), attitude (p=0.761), parental role (p=0.147), peer influence (p =0.155), and sources of information (p=0.999). Of the seven variables most related to risky sexual behavior in adolescents is a source of information with a value of Exp (B) = 6.58558. It is mean students who get information sources either through smartphones or computers 6.58558 times no risky sexual behavior in adolescents.

DISCUSSION

Relationship between gender and sexual behavior in adolescents.

The results of the analysis of the relationship between gender and risky sexual behavior showed that as many as 38.1% of adolescents with female and male had 52.1% risky sexual behavior. The results of the statistical test obtained a p-value=0.028, so it can be concluded that there is a significant relationship between gender and risky sexual behavior in adolescents. This is following the theory stated that the differences between men and women are seen in terms of social, cultural, and anatomical-biological influences. Gender can be divided into two meanings, namely sex and gender. The process of growing a child into a man or becoming a woman, is more often used as the term gender. The term sex is generally used to refer to issues of reproduction and sexual activity (Widyoningsih & Sutarno, 2017). According to Ginting et al. (2021) stated that there is a difference between young men and women in sexual experience. Adolescent boys always show higher sexual figures than girls. Boys perform various sexual behaviors earlier than girls and boys are generally more permissive than girls. Adolescent boys have a stronger sexual drive and are more active in seeking sexual objects, besides that, it is related to norms that are even looser for men than for women in almost all parts of the world, and in connection with that, it is also more likely for men to do more things than women. These results are by research conducted by Padut et al. (2021) where there were 32.4% more male teenagers who had risky sexual behavior than 9.2% of women. Rahayu et al. (2020) stated that biological factors also influence men to have more risky sexual behavior. In men, testosterone levels are related to sexual behavior. The hormone testosterone in men is more than that in women, so men are more likely to engage in sexual behavior. This makes the social position of men considered higher and more profitable than women. The norms that apply are also looser for men, so men tend to be freer and parents are more protective of their daughters.

Relationship between age and sexual behavior in adolescents

The results of the analysis of the relationship between age and risky sexual behavior showed that as many as 41.8% of middle-aged adolescents (15-17 years) had risky sexual behavior, while adolescents with late age (18-21 years) had as much as 46.9%. The statistical test results obtained p-value=0.456, so it can be concluded that there is no significant relationship between age and risky sexual behavior in adolescents. The results of the study are in line with the research of Adawiyah and Winarti (2021) that there is no significant relationship between adolescent age and the initiation of sex in adolescents p-value=0.103. In this study, age was not related to the initiation of risky sexual behavior because the respondents had passed their puberty age with a percentage of 41(53.9%) in late adolescence.

Relationship between dating status and sexual behavior in adolescents.

The results of the analysis of the relationship between dating status and risky sexual behavior showed that as many as 50.8% of adolescents who had ever dated had the opportunity to have risky sexual behavior while adolescents who had never dated had risky sexual behavior of 36.0%. The statistical test results obtained p-value=0.022, so it can be concluded that there is a significant relationship between dating status and risky sexual behavior in adolescents. The results of a study by Atuti and Sulistyowati (2021) stated that there is a positive relationship between perceptions of love in dating and risky sexual behavior among YP Darul Mukminin SMKS students. The correlation coefficient value of 0.037 indicates that the relationship between the two variables is significant and has a positive direction. This shows that the more positive the perception of love in dating students is, the higher risky sexual behavior is and conversely, the more negative the perception of love in dating students is, the lower risky sexual behavior.

Relationship between knowledge and sexual behavior in adolescents.

The results of the analysis of the relationship between knowledge and risky sexual behavior showed that there were as many as 28.2% of adolescents with sufficient knowledge to engage in risky sexual behavior while adolescents with less knowledge had high-risk sexual behavior as much as 78.3%. The statistical test results obtained p-value=0.000, it can be concluded that there is a significant relationship between knowledge and risky sexual behavior in adolescents. Knowledge about risky sexual behavior influences sexual behavior in adolescents. In theory, knowledge and sexual behavior have a positive relationship, where the better the knowledge, the lower the sexual behavior in adolescents (Syah et al., 2022).

Previous studies stated that there is a relationship between knowledge and risky dating behavior in students p-value=0.030 because knowledge is needed to produce a certain behavior when facing a certain situation. Adolescents who have correct knowledge about reproductive health tend to understand dating behavior and alternative ways that can be used to channel sexual urges healthily and responsibly. So risky sexual knowledge is related to risky dating behavior because knowing about risky sexual knowledge encourages these students to carry out risky dating behavior (Meilani et al., 2023).

Relationship between attitude and sexual behavior in adolescents.

The results of the analysis of the relationship between attitudes and risky sexual behavior showed that 56.3% of adolescents with negative attitudes had risky sexual behavior, while 33.6% of adolescents with positive attitudes had risky sexual behavior. The statistical test results obtained p-value=0.001, so it can be concluded that there is a significant relationship between attitudes and risky sexual behavior in adolescents. However, the studies by Khadijah and Winarti (2022) found that there is no significant relationship between attitudes toward risky sexual behavior in adolescents at SMP Negeri 4 Samarinda (p=0.824). Many factors can influence attitudes, including the influence of other people who are considered important by individuals who tend to have attitudes that are in the same direction as the attitudes of people who are considered important. This can be influenced by the peer group which is the main role model for adolescents in line with the growing distance of adolescents from the family environment and other adults.

According to Halu and Dafiq (2021), several factors influence an individual's attitude, first personal experience. the influence of the closest person who is considered to have important influence tends to create a unidirectional attitude to avoid conflict. Third, the mass media influences individual attitudes in responding to an object. Attitude is an evaluation created by an individual towards himself, other people, or the surroundings as a response to a stimulus that causes a reaction to an object. A person who has a positive attitude towards an object will show an agreeable attitude and vice versa, if he shows a negative attitude he will reject it.

Relationship between the role of parents and sexual behavior in adolescents

The results of the analysis of the relationship between the role of parents and risky sexual behavior showed that 54.9% had no role of parents having the opportunity to have risky sexual behavior while there was a role of parents having 34.8% risky sexual behavior. The statistical test results obtained a p-value = 0.002, so it can be concluded that there is a significant relationship between the role of parents and risky sexual behavior in adolescents. The results of this study are not in line with Ginting et al. (2021) which obtained a p-value=0.675. This means that there is no relationship between the role of parents and sexual behavior. Families, where parents treat their children with warmth, openness, and mutual understanding, will produce teenagers who tend to delay sexual behavior until marriage. In addition, adolescents who receive less or no parental supervision tend to engage in risky sexual behavior.

Relationship between peer influence and sexual behavior in adolescents

The results of the analysis of the relationship between peer influence and risky sexual behavior showed that as many as 54.1% of adolescents with peer influence had risky sexual behavior while adolescents with no peer influence had 34.1% risky sexual behavior. The statistical test results obtained a p-value = 0.002, so it can be concluded that there is a significant relationship between peer influence and risky sexual behavior in adolescents. These results are consistent with research conducted by Padut et al. (2021) which states that there is a significant relationship between peer influence and risky sexual behavior in adolescents. In today's modern society, teenagers spend most of their time with their peers. During adolescence, relationships with peers improve drastically, and at the same time relationships with parents decline. The role of peers is closely related to attitudes, speech, interests, appearance, and behavior (Sigalingging & Sianturi, 2019).

Relationship between information sources and sexual behavior in adolescents

The results of the analysis of the relationship between information sources and risky sexual behavior showed that as many as 53.0% of adolescents with smartphone information sources had risky sexual behavior while adolescents with computer information sources had the opportunity to have risky sexual behavior as much as 34.5%. The statistical test results obtained p-value=0.004, so it can be concluded that there is a significant relationship between sources of information and risky sexual behavior in adolescents. This research is in line with previous research which stated that 97.5% of adolescents had sexual intercourse because 17% of them through print media, 25% via the internet, and 12.4% via electronic media. This shows that the percentage of media exposure is quite high in influencing the behavior of a teenager to have risky sexual behavior (Shakti et al., 2022).

LIMITATIONS OF THE STUDY

There are many variable factors regarding adolescent sexual behavior, researchers only took a few variables which made this study unable to discuss in detail regarding risky sexual behavior in adolescents. In the process of data collection, the information provided by respondents through questionnaires sometimes did not show the actual opinions of respondents, this happened because sometimes different thoughts, assumptions, and understandings were different for each respondent, as well as other factors such as the factor of honesty in filling in respondents' opinions on risky sexual behavior that may influence the interpretation of results

CONCLUSION AND RECOMMENDATION

In conclusion of this study, factors associated with risky sexual behavior for adolescents such as gender, dating status, knowledge, attitudes, parental roles, peer influence, and sources of information are related to the risky sexual behavior in adolescents. Meanwhile, age is not related to risky sexual behavior in adolescents. It is recommended that schools can cooperate and communicate with local health authorities to provide information and counseling about health in each new academic year so that students attending school can understand reproductive health related to risky sexual behavior in adolescents to increase appropriate information on students at school. Schools can also provide extracurricular activities that can help students avoid risky sexual behavior in young students of SMA Negeri 5 Padangsidimpuan City.

DECLARATIONS

Consent for publication

Not applicable

Availability of Data and Material (ADM)

The datasets generated and analyzed during the current study are available from the corresponding author on reasonable request.

Competing interests

The authors declare that they have no competing interests.

Funding

This study was fully funded by reserhers self

Copyright and Licenses

Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under an Attribution-ShareAlike 4.0 International (CC BY-SA 4.0) that allows others to share the work with an acknowledgement of the work's authorship and initial publication in this journal.

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