Ethiotime1
Study setting and period
An institution based cross-sectional study was conducted on March 7, 2016 in Woldia, northeast Ethiopia. Woldia is found 520 km from Addis Ababa, the capital of Ethiopia. According to the 2016 Woldia town administrative report, the estimated population was 75,446, of which 50.6% were males [21]. In the town, there was one preparatory and three high schools with a total of with a total of 4671 students. There were 87 sections, of these 59 sections were in high schools.
Sample size and sampling procedures
All regular preparatory and high school students in the town during the study were included. The required sample size was calculated using the single population proportion formula by considering a 95% confidence interval (CI), 3% margin of error(d), and the proportion(p) of early sexual debut 19% from the previous study in Shire-Endasellassie town, Tigray region [22]. Considering a 10% non-response rate, the final sample was 723 students. The simple random sampling technique with proportional allocation to each grade level was applied to reach participants. Thus, 269, 177, 143 and 129 students were selected from grade 9, 10, 11, and 12, respectively.
Data collection tool and techniques
The data were collected using a structured self-administered questionnaire (Additional file 1). The questionnaire was first prepared in English and translated to Amharic (the local language) and back-translated into English by language experts to ensure an accurate translation. Ten data collectors were selected from Woldia University 4th year Midwifery students. Interviewers received 2 days intensive training prior to data collection. The questionnaire was pretested on 37 students in Kobo preparatory and high school out of the study area. The purpose and objectives of the study were clearly explained to participants before data collection. No personal identifiers were used on data collection forms, and teachers were requested to leave the classroom. To maintain privacy, seats were arranged far apart and copies were collected on the ballot.
Measurements
Age at sexual initiation
The age at which students had penetrative sexual intercourse from the first time.
Early sexual initiation
Having sexual practice before the age of 18 years.
Sexually active
Students who claimed to have engaged in sexual activity at least once prior to the study.
Peer pressure
Pressure from friends to have sexual intercourse.
Pornographic materials
Refers to newspapers, magazines, books, photographs, movies, the internet intended to sexually arouse the viewer.
Religious participation
Student participation in religious programs.
Assessment of wealth index and parental monitoring
Household wealth index adopted and developed from EDHS 2011 [23] was assessed using Principal Component Analysis (PCA) by considering the numbers and kinds of goods ranging from television to car, agricultural land ownership, quantity of cereal products, livestock and housing condition, such as flooring materials, household cooking material and place. Firstly, variables were coded between 0 and 1; then, the variables were entered and analyzed using PCA. Variables which had communality values greater than 0.5 were considered to produce factor scores. Next, the produced factor scores were computed to produce common factor scores. Finally, common factor scores were summed and categorized into quintile as lowest, second, middle, fourth, and highest. Similarly, paternal monitoring was assessed using a four-item Likert scale which was adapted and developed from previous studies [24, 25]. The items used to assess parental monitoring were ‘How often do your parents try to know who are your friends’, ‘Do your parents know where you are outside of home or school’ and ‘Do your parents know with whom you are outside home or school’. The responses ranged from ‘never’ (coded as 1) to ‘always’ (coded as 4). Finally, via PCA, it was classified as ‘poor’ and ‘good’ parental monitoring.
Assessment of school connectedness and knowledge of HIV/AIDS
Student school connectedness was assessed using a five-item Likert scale adopted and developed from a previous study [26], such as ‘Do you feel close to people who are at school’, ‘Do you feel happy to be at this school’, ‘Do you feel as if you are a part of this school’, ‘Do school teachers treat students fairly at this school’, and ‘Do you feel safe being at this school’. The responses ranged from ‘strongly disagree’ (coded 1) to ‘strongly agree’ (coded as 5). Using PCA, the scale was classified into quantiles as poor and good school connectedness. In addition, knowledge of students on HIV/AIDS was assessed based on the transmission and prevention methods of HIV/AIDS which was adopted from EDHS 2011 [23], and the questions included condom use, number of sexual partners, awareness on healthy-looking person may have HIV/AIDS, and rejection of the two most common local misconceptions about HIV/AIDS that (HIV/AIDS can be transmitted by mosquito bite and supernatural means). Using PCA, the scale was ranked into ‘poor’ and ‘good’ knowledge.
Data processing and analysis
After the data collection, the data were checked for completeness, coded manually, and entered into EpiData version 3.1 and then exported to SPSS version 20 for analysis. Descriptive analysis was carried out and presented using texts, tables, and graphs. Bivariate and multivariable logistic regression analysis were done to identify factors associated with early sexual initiation. Variables in the bivariate logistic regression with p-value less than 0.2 were fitted into the multivariable logistic regression to control the possible effects of confounders. The enter method was employed. Odds Ratios with their corresponding 95% confidence intervals (CI) was calculated to see the presence and the strength of associations. Model fitness was checked by the Hosmer-Lemeshow goodness of-fit test. In the multivariable analysis, variables with p-value < 0.05 were considered as statistically significant.
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