Early Sexual Activity: Prevalence and Correlates Among School Adolescents in Rural Community, Central Thailand Fifth year medical student, Phramongkutklao College of Medicine

Background The prevalence of sexual activity of adolescents in urban areas were relatively higher than rural communities Sexual activity in adolescents remains a major problem worldwide with its negative health outcomes

Average age of first SI throughout world 15 years 16 years 17 years 18 years 19 years 20 years 21 years 22 years 23 years Thailand average 20 years Ref: WHO 2011

Consequences of early sexual activities Teenage pregnancy Criminal abortion STIs Wellings K, Collumbien M, Slaymaker E, Singh S, Hodges Z, Patel D et al. Sexual behaviour in context: a global perspective. The Lancet. 2006;368(9548):1706-1728

Percentage of condom used among Thai students Department of Epidemiology of CDC in Year 2008, Ministry of Public Health

Incidence of STDs from unsafe sex in Thai teenagers (n=x/100,000) Department of Epidemiology of CDC in Year 2007, Ministry of Public Health

Those who already had SI What did they answer?

Associated Factors Individual Factors Individual sexual drive Desire for money as an exchange Environmental Factors Friends Media Couples Family Ref: Prasartwanakit A. Sexual beliefs and patterns among Thai adolescents and youths in education ,Songkla Med J 2009;27(5):369-3807,11

Environmental Factors Ref: Prasartwanakit A. Sexual beliefs and patterns among Thai adolescents and youths in education ,Songkla Med J 2009;27(5):369-3807,11

Objectives To determine the prevalence of sexual activity among secondary school students in Chacheongsao and Sra-kaew provinces To investigate the correlates leading to early sexual activity

Ethical consideration Reviewed and approved by the Institutional Review Board (IRB) of the Royal Thai Army Medical Department

Results

General Characteristic description [N=702]   School A chool B Total n(%) Gender Male 206(43.4) 91(40.1) 297(42.3) Female 269(56.6) 136(59.9) 405(57.7) Secondary school Junior 262(55.2) 113(49.8) 375(53.5) Senior 213(44.9) 114(50.2) 327(46.6) Age (year) mean±sd[min,max] 15.1±1.8[12,20] 15.1±1.8[12,19] Parental status Living together 313(65.9) 152(67) 465(66.2) Another 162(34.1) 75(33) 237(33.7)

General Characteristic description [N=702]   School A School B Total n(%) Resident Home 465(97.9) 221(97.4) 686(97.7) Another 10(2.1) 4(1.7) 14(2) Stay with Parent 351(73.9) 152(67) 503(71.7) 124(26.1) 75(33) 199(28.3) Income(bath) 0-499 110(23.2) 30(13.2) 140(19.9) 500-999 170(35.8) 88(38.8) 258(36.8) ≥1,000 195(41) 109(48) 304(43.3) Grade mean±sd[min,max] 2.7±0.6[1,4] 2.9±0.6[1,4] 2.8±0.6[1,4]

Prevalence of sexual activity in secondary school Total SI = 183 (26.1%) School A 136(29.8%) School B 47(21.7 %) Male 15(18.1%) Female 32(23.9%) Male 59 (30.4%) Female 77(29.4%)

Prevalence of sexual intercourse of school A in each grade by gender

Prevalence of sexual intercourse of school B in each grade by gender

- Average age of first SI among secondary school students (School A and B) was 15 years old. - Average number of sexual partners was 2 persons.

Used to have SI with any sex in early sexual activity (n=183) Male n(%) Female Heterosexual 61(92.4) 88(86.3) Homosexual 4(6.1) 10(9.8) Bisexual 1(1.5) 4(3.9)

Using drugs and substances before sex

Drug and substance types

Contraceptive methods

The usage of condoms in sexual intercourse

Knowledge of the source or condom distribution

Multivariate Analysis of risk factors in early sexual activity among secondary school students in rural area (n=327) No Sexual intercourse Sexual intercourse Adjusted odds ratio p-value    n(%) 95%CI Age* (yr) 15±2[12,18] 16±2[12,20] 1.86 (1.64-2.12) <0.001 Grade* 2.82±10.6[1.00,4.00] 2.70±0.61[1.00,3.80] 0.65 (0.46-0.92) 0.016 Parents status Living together 334(74.7) 113(25.3) 1 Others 156(69) 70(31) 1.57 (1.04-2.36) 0.032 After adjusted for gender, wanted to have homosexual or heterosexual *mean±sd[min,max]

Table**:Multivariate Analysis of risk factors in early sexual activity among secondary school students in rural area (n=327) No Sexual intercourse Sexual intercourse Adjusted Odds ratio p-value n(%) 95%CI    Seeing sexual intercourse of adult no 456(74.3) 158(25.7) 1 yes 15(44.1) 19(55.9) 2.35 (1.27-4.35) 0.007 Early sexual intercourse of close friends No 283(73.9) 100(26.1) 23(38.3) 37(61.7) 3.28 (1.74-6.19) <0.001 Close friends substance abuse 294(71) 120(29) Yes 12(41.4) 17(58.6) 3.04 (1.27-7.28) 0.013

Discussion Literatures Review Our Research Study Prevalence of early SI = 9.3% Average age of first SI = 20 years Some researches, indicating friends and substance use can both cause higher or lower prevalence of early sexual activity Prevalence of early SI = 26.1% Average age of first SI = 15 years Correlates such as age, academic achievement, parental status, media, friends, and substance use shows an effect on having early sexual activity.

Conclusion Prevalence of early sexual activity among secondary school students in a rural community is almost 3 times higher than generalization of students in Thailand Average age of first sexual activity is now lower than before.

Conclusion Associated factors for early sexual intercourse Age Academic achievement Parental status Pornography Illegal drugs Pressure from friends who already had early sexual activity

Conclusion There are still sexually active students reported having multiple sex partners Half of the participants reported a regular use of condoms

Limitation Social desirability bias Self-report questionnaire might cause recall bias, attribution, exaggeration Cross-sectional study can not determine temporal sequence between exposure and outcome

Recommendation Interventions emphasising on the reduction of peer delinquency and substance use ought to be developed and implemented thereafter

Recommendation Planning the education program and public policy for the solution of consequences of early sexual activity – teenage pregnancies, criminal abortions, and sexually-transmitted infections.

Thank you for your attention adiós