{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:58:42Z","timestamp":1781650722137,"version":"3.54.5"},"reference-count":27,"publisher":"Springer Science and Business Media LLC","issue":"1","license":[{"start":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T00:00:00Z","timestamp":1776816000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,6,4]],"date-time":"2026-06-04T00:00:00Z","timestamp":1780531200000},"content-version":"vor","delay-in-days":43,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["BMC Public Health"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Unsafe sexual practices among adolescents represent a significant public health challenge due to their association with increased risk of sexually transmitted infections, including HIV, and unintended pregnancies. The burden remains substantial, contributing to adverse health outcomes, educational disruption and long-term socio-economic consequences. Multiple factors like inadequate sexual health knowledge, limited access to youth-friendly services, low utilisation of preventive methods, and social and behavioural determinants such as peer pressure, substance use, early sexual initiation and weak parental communication further exacerbate the problem.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>An institution-based cross-sectional survey using a self-administered questionnaire was administered to 621 students who were selected using the systematic sampling technique. Unsafe sexual practice was measured using the self-reported behavioural indicators, including inconsistent condom use, multiple sexual partners, and early sexual initiation. The Health Belief Model (HBM) was used to assess psychosocial determinants of these behaviours. The HBM constructs (perceived susceptibility, perceived severity, perceived benefits, perceived barriers, self-efficacy, and cues to action) were measured using validated Likert-scale items. Composite scores were generated for each construct and analyzed to determine their association with unsafe sexual practices. Corresponding p-values and adjusted odds ratios with 95% confidence intervals have been added to improve clarity and statistical interpretation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      The prevalence of unsafe sexual practices was 36.6% [95% CI: 32.8%\u201340.4%]. The study found that male sex (AOR\u2009=\u20092.38; 95% C.I.: 1.61\u20133.51,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001), age less than 18 years (AOR\u2009=\u20090.65, 95% C.I.: 0.43\u20130.97,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.038), low perceived norms for abstinence [AOR\u2009=\u20090.6, 95% C.I.: 0.41\u20130.89,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.013], low perceived norms for consistent condom use [AOR\u2009=\u20092.05, 95% C.I.: 1.39\u20133.03,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001], low perceived self-efficacy for condom use [AOR\u2009=\u20090.59, 95% C.I.: 0.40\u20130.86,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.007], watching sex films [AOR\u2009=\u20091.5, 95% C.I.: 1.01\u20132.20,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009=\u20090.047], chewing khat [AOR\u2009=\u20092.5, 95% C.I.: 1.57\u20134.07,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001], and drinking alcohol [AOR\u2009=\u20092.93, 95% C.I: 1.86\u20134.62,\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001] were significantly associated with unsafe sexual practice among adolescents.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>The study revealed that about two in five students engage in unsafe sexual practices, influenced by socio-demographic and behavioural factors, highlighting the need for collaboration between key stakeholders to mitigate risks and consequences.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1186\/s12889-026-27466-2","type":"journal-article","created":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T01:34:29Z","timestamp":1776821669000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Unsafe sexual practice and associated factors among adolescents in secondary schools in Gambella town, Ethiopia: a health belief model"],"prefix":"10.1186","volume":"26","author":[{"given":"Tariku","family":"Frissa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9526-839X","authenticated-orcid":false,"given":"Asrat","family":"Zewdie","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6145-2914","authenticated-orcid":false,"given":"Dereje Oljira","family":"Donacho","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benti","family":"Negero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,22]]},"reference":[{"issue":"1","key":"27466_CR1","doi-asserted-by":"publisher","first-page":"S12","DOI":"10.1016\/j.jadohealth.2021.03.019","volume":"72","author":"L Carvajal-Velez","year":"2023","unstructured":"Carvajal-Velez L, Requejo JH, Ahs JW, Idele P, Adewuya A, Cappa C, et al. Increasing data and understanding of adolescent mental health worldwide: UNICEF\u2019s measurement of mental health among adolescents at the population level initiative. J Adolesc Heal. 2023;72(1):S12\u20134.","journal-title":"J Adolesc Heal"},{"issue":"1","key":"27466_CR2","doi-asserted-by":"publisher","first-page":"1126","DOI":"10.1186\/1471-2458-13-1126","volume":"13","author":"V Sychareun","year":"2013","unstructured":"Sychareun V, Thomsen S, Chaleunvong K, Faxelid E. Risk perceptions of STIs\/HIV and sexual risk behaviours among sexually experienced adolescents in the Northern part of Lao PDR. BMC Public Health. 2013;13(1):1126.","journal-title":"BMC Public Health"},{"key":"27466_CR3","unstructured":"Organization WH. The adolescent health indicators recommended by the Global Action for Measurement of Adolescent Health: Guidance for monitoring adolescent health at country, regional and global levels. World Health Organization; 2024."},{"issue":"1","key":"27466_CR4","doi-asserted-by":"publisher","first-page":"e002231","DOI":"10.1136\/bmjgh-2019-002231","volume":"5","author":"DY Melesse","year":"2020","unstructured":"Melesse DY, Mutua MK, Choudhury A, Wado YD, Faye CM, Neal S, et al. Adolescent sexual and reproductive health in sub-Saharan Africa: who is left behind? BMJ Glob Heal. 2020;5(1):e002231.","journal-title":"BMJ Glob Heal"},{"key":"27466_CR5","doi-asserted-by":"crossref","unstructured":"CharbitY, Omrane M. Introduction: The Vulnerability of Adolescence in Sub-Saharan Africa. Gender Inequalities and Vulnerability of sub-Saharan Adolescents: The Case of Benin. Springer; 2023. pp. 1\u201341. https:\/\/link.springer.com\/chapter\/10.1007\/978-3-031-38096-9_1","DOI":"10.1007\/978-3-031-38096-9_1"},{"issue":"1","key":"27466_CR6","doi-asserted-by":"publisher","first-page":"113","DOI":"10.1186\/s12978-017-0376-4","volume":"14","author":"AA Muche","year":"2017","unstructured":"Muche AA, Kassa GM, Berhe AK, Fekadu GA. Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis. Reprod Health. 2017;14(1):113.","journal-title":"Reprod Health"},{"issue":"1","key":"27466_CR7","doi-asserted-by":"publisher","first-page":"59","DOI":"10.4314\/ejhs.v24i1.8","volume":"24","author":"N Fentahun","year":"2014","unstructured":"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\u201368.","journal-title":"Ethiop J Health Sci"},{"issue":"11","key":"27466_CR8","doi-asserted-by":"publisher","first-page":"731","DOI":"10.1055\/s-0040-1713411","volume":"42","author":"EPT Arruda","year":"2020","unstructured":"Arruda EPT, Brito LGO, Prandini TR, Lerri MR, Dos Reis RM, Barcelos TMR, et al. Sexual practices during adolescence. Rev Bras Ginecol e Obs Gynecol Obstet. 2020;42(11):731\u20138.","journal-title":"Rev Bras Ginecol e Obs Gynecol Obstet"},{"key":"27466_CR9","first-page":"1","volume":"3","author":"M Conner","year":"2015","unstructured":"Conner M, Norman P. Predicting and changing health behaviour: A social cognition approach. Predict Chang Heal Behav Res Pract Soc Cogn Model. 2015;3:1\u201329.","journal-title":"Predict Chang Heal Behav Res Pract Soc Cogn Model"},{"issue":"9","key":"27466_CR10","doi-asserted-by":"publisher","first-page":"1196","DOI":"10.1177\/1049732309344206","volume":"19","author":"TM Downing-Matibag","year":"2009","unstructured":"Downing-Matibag TM, Geisinger B. Hooking up and sexual risk taking among college students: A health belief model perspective. Qual Health Res. 2009;19(9):1196\u2013209.","journal-title":"Qual Health Res"},{"key":"27466_CR11","unstructured":"Joseph K. Input Factors That Improve Education Quality In Gambella Town Secondary School Of Gambella. Ambo University; 2022."},{"issue":"1","key":"27466_CR12","doi-asserted-by":"publisher","first-page":"698","DOI":"10.1186\/s13104-019-4714-1","volume":"12","author":"A Girmay","year":"2019","unstructured":"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.","journal-title":"BMC Res Notes"},{"issue":"12","key":"27466_CR13","doi-asserted-by":"publisher","first-page":"429","DOI":"10.5897\/JPHE2018.1073","volume":"10","author":"A Mersha","year":"2018","unstructured":"Mersha A, Teji K, Darghawth R, Gebretsadik W, Shibiru S, Bante A, et al. Risky sexual behaviors and associated factors among preparatory school students in Arba Minch town, Southern Ethiopia. J Public Heal Epidemiol. 2018;10(12):429\u201342.","journal-title":"J Public Heal Epidemiol"},{"key":"27466_CR14","doi-asserted-by":"publisher","unstructured":"MazengiaF, Worku A. Age at sexual initiation and factors associated with it among youths in North East Ethiopia. Ethiop J Heal Dev. 2009;23(2). https:\/\/doi.org\/10.4314\/ejhd.v23i2.53234.","DOI":"10.4314\/ejhd.v23i2.53234"},{"issue":"1","key":"27466_CR15","doi-asserted-by":"publisher","first-page":"9","DOI":"10.1016\/j.srhc.2014.06.004","volume":"6","author":"NA Salih","year":"2015","unstructured":"Salih NA, Metaferia H, Reda AA, Biadgilign S. Premarital sexual activity among unmarried adolescents in northern Ethiopia: a cross-sectional study. Sex Reprod Healthc. 2015;6(1):9\u201313.","journal-title":"Sex Reprod Healthc"},{"issue":"1","key":"27466_CR16","first-page":"763051","volume":"2013","author":"Z Alamrew","year":"2013","unstructured":"Alamrew Z, Bedimo M, Azage M. Risky sexual practices and associated factors for HIV\/AIDS infection among private college students in Bahir Dar City, Northwest Ethiopia. Int Sch Res Not. 2013;2013(1):763051.","journal-title":"Int Sch Res Not"},{"key":"27466_CR17","doi-asserted-by":"publisher","first-page":"1029465","DOI":"10.3389\/frph.2023.1029465","volume":"5","author":"E Ndagijimana","year":"2023","unstructured":"Ndagijimana E, Biracyaza E, Nzayirambaho M. Risky sexual behaviors and their associated factors within high school students from Coll\u00e8ge Saint Andr\u00e9 in Kigali, Rwanda: An institution-based cross-sectional study. Front Reprod Heal. 2023;5:1029465.","journal-title":"Front Reprod Heal"},{"issue":"2","key":"27466_CR18","first-page":"12","volume":"6","author":"M Abay","year":"2019","unstructured":"Abay M, Endgashet S, Etana B, Nguse K. Magnitude of premarital sex and associated factors among preparatory school students in Alamata town, North Ethiopia, 2014. Res Rev AJ Heal Prof. 2019;6(2):12\u201320.","journal-title":"Res Rev AJ Heal Prof"},{"issue":"1","key":"27466_CR19","doi-asserted-by":"publisher","first-page":"301","DOI":"10.1186\/1471-2458-14-301","volume":"14","author":"EL Negeri","year":"2014","unstructured":"Negeri EL. Assessment of risky sexual behaviors and risk perception among youths in Western Ethiopia: the influences of family and peers: a comparative cross-sectional study. BMC Public Health. 2014;14(1):301.","journal-title":"BMC Public Health"},{"key":"27466_CR20","doi-asserted-by":"crossref","unstructured":"Muche AA, Kassa GM, Berhe AK, Fekadu GA. Prevalence and determinants of risky sexual practice in Ethiopia: Systematic review and Meta-analysis. 2017.","DOI":"10.1186\/s12978-017-0376-4"},{"issue":"1","key":"27466_CR21","doi-asserted-by":"publisher","first-page":"1467","DOI":"10.4314\/ahs.v19i1.20","volume":"19","author":"L Odeigah","year":"2019","unstructured":"Odeigah L, Rasaki SO, Ajibola AF, Hafsat AA, Sule AG, Musah Y. High risk sexual behavior among adolescent senior secondary school students in Nigeria. Afr Health Sci. 2019;19(1):1467\u201377.","journal-title":"Afr Health Sci"},{"issue":"1","key":"27466_CR22","doi-asserted-by":"publisher","first-page":"3719845","DOI":"10.1155\/2020\/3719845","volume":"2020","author":"M Srahbzu","year":"2020","unstructured":"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\u2010Based, Cross\u2010Sectional Study. Biomed Res Int. 2020;2020(1):3719845.","journal-title":"Biomed Res Int"},{"issue":"1","key":"27466_CR23","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1186\/s12978-022-01407-9","volume":"19","author":"CO Odimegwu","year":"2022","unstructured":"Odimegwu CO, Ugwu NH. A multilevel mixed effect analysis of neighbourhood and individual level determinants of risky sexual behaviour among young people in South Africa. Reprod Health. 2022;19(1):119.","journal-title":"Reprod Health"},{"key":"27466_CR24","doi-asserted-by":"crossref","unstructured":"Kasahun AW, Yitayal M, Girum T, Mohammed B. Risky sexual behavior and associated factors among high school students in Gondar City, Northwest Ethiopia. 2017.","DOI":"10.11591\/ijphs.v6i3.9293"},{"issue":"4","key":"27466_CR25","doi-asserted-by":"publisher","first-page":"41","DOI":"10.11648\/j.ijhpebs.20170304.12","volume":"3","author":"H Amare","year":"2017","unstructured":"Amare H, Azage M, Negash M, Getachew A, Desale A, Abebe N. Risky sexual behavior and associated factors among adolescent students in Tana Haik high school, Bahir Dar, Northern Ethiopia. Int J HIV\/AIDS Prev Educ Behav Sci. 2017;3(4):41\u20137.","journal-title":"Int J HIV\/AIDS Prev Educ Behav Sci"},{"key":"27466_CR26","doi-asserted-by":"publisher","first-page":"955371","DOI":"10.3389\/fpsyt.2022.955371","volume":"13","author":"T Bete","year":"2022","unstructured":"Bete T, Lami M, Negash A, Eyeberu A, Birhanu A, Berhanu B, et al. Current alcohol, tobacco, and khat use and associated factors among adults living in Harari regional state, eastern Ethiopia: a community-based cross-sectional study. Front Psychiatry. 2022;13:955371.","journal-title":"Front Psychiatry"},{"issue":"6","key":"27466_CR27","doi-asserted-by":"publisher","first-page":"779","DOI":"10.1080\/09540120120076968","volume":"13","author":"MS Selvan","year":"2001","unstructured":"Selvan MS, Ross MW, Kapadia AS, Mathai R, Hira S. Study of perceived norms, beliefs and intended sexual behaviour among higher secondary school students in India. AIDS Care. 2001;13(6):779\u201388.","journal-title":"AIDS Care"}],"container-title":["BMC Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/article\/10.1186\/s12889-026-27466-2","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-27466-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1186\/s12889-026-27466-2.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:31:24Z","timestamp":1781649084000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1186\/s12889-026-27466-2"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,22]]},"references-count":27,"journal-issue":{"issue":"1","published-online":{"date-parts":[[2026,12]]}},"alternative-id":["27466"],"URL":"https:\/\/doi.org\/10.1186\/s12889-026-27466-2","relation":{},"ISSN":["1471-2458"],"issn-type":[{"value":"1471-2458","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,22]]},"assertion":[{"value":"23 April 2024","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"22 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The study was conducted in accordance with the Declaration of Helsinki, and the protocol was approved by the Ethical Review Committee of College of Health Science of Mattu University. A connecting letter with Ref.no. RPG\/325\/15 written on June 14, 2023 was taken from Mattu University to Gambella town administration and health office. Each study participant was informed about the study\u2019s purpose, data collection methods, anticipated benefit, and risk, and informed consent was obtained prior to data collection. In case of minors (participants under the age of 16), informed consent to participate in this study was obtained from the parents or legal guardian\/next of kin and assent was obtained from the participants. Privacy and confidentiality were maintained throughout the data collection, analysis, and result dissemination processes.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors declare no competing interests.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"1797"}}