Unsafe sexual practice and associated factors among adolescents in secondary schools in Gambella town, Ethiopia: a health belief model

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. 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. The prevalence of unsafe sexual practices was 36.6% [95% CI: 32.8%–40.4%]. The study found that male sex (AOR = 2.38; 95% C.I.: 1.61–3.51, p < 0.001), age less than 18 years (AOR = 0.65, 95% C.I.: 0.43–0.97, p = 0.038), low perceived norms for abstinence [AOR = 0.6, 95% C.I.: 0.41–0.89, p = 0.013], low perceived norms for consistent condom use [AOR = 2.05, 95% C.I.: 1.39–3.03, p < 0.001], low perceived self-efficacy for condom use [AOR = 0.59, 95% C.I.: 0.40–0.86, p = 0.007], watching sex films [AOR = 1.5, 95% C.I.: 1.01–2.20, p = 0.047], chewing khat [AOR = 2.5, 95% C.I.: 1.57–4.07, p < 0.001], and drinking alcohol [AOR = 2.93, 95% C.I: 1.86–4.62, p < 0.001] were significantly associated with unsafe sexual practice among adolescents. 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.