Premarital sexual intercourse among adolescents in an Asian country: multilevel ecological factors.

Objective: The goal was to assess personal and environmental factors associated with premarital sex among adolescents.

Methods: We conducted a case-control study. Between 2006 and 2008, we recruited 500 adolescents who reported having engaged in voluntary sex for most recent sex. Five hundred control subjects were matched for age, gender, and ethnicity.

Results: Independently significant factors for premarital sex among boys were pornography viewing (adjusted odds ratio [OR]: 5.82 [95% confidence interval [CI]: 2.34-14.43]), lack of confidence to resist peer pressure (OR: 3.84 [95% CI: 2.27-6.50]), perception that more than one half of their friends had engaged in sex (OR: 3.37 [95% CI: 1.92-5.92]), permissiveness regarding premarital sex (OR: 3.41 [95% CI: 2.10-5.55]), involvement in gang activities (OR: 3.45 [95% CI: 1.66-7.15]), drinking (OR: 1.77 [95% CI: 1.07-2.94]), smoking (OR: 1.91 [95% CI: 1.14-3.20]), and living in low-cost housing (OR: 3.25 [95% CI: 1.64-6.43]). For girls, additional factors were previous sexual abuse (OR: 7.81 [95% CI: 2.50-24.41]) and dropping out of school (OR: 2.72 [95% CI: 1.32-5.61]), and stronger associations were found for lack of confidence to resist peer pressure (OR: 5.56 [95% CI: 2.94-10.53]) and permissiveness regarding premarital sex (OR: 6.25 [95% CI: 3.30-11.83]). Exposure to persons with HIV/AIDS or sexually transmitted infections in the media was negatively associated with sex for boys (OR: 0.27 [95% CI: 0.16-0.45]) and girls (OR: 0.24 [95% CI: 0.13-0.47]).

Conclusion: Sex education programs for adolescents must address social, media, and pornographic influences and incorporate skills to negotiate sexual abstinence.