Factors Associated with Sexual Intercourse, Condom-Use, and Perceived Peer Behaviors Among Adolescents in Malaysia: A School-Based Cross-Sectional Study
High-risk sexual behavior among young adults is concerning to clinicians, public health practitioners and policy makers because it is associated with unintended health outcomes including transmission of sexually transmitted infections (STIs) and unintended pregnancy.This paper analyzes how knowledge of HIV, experience with dating behavior, and perception of peer behavior factors are associated with having sexual intercourse and use of condoms among adolescent students in Malaysia. National data from school-age adolescents who completed the Malaysian HIV/AIDS Knowledge, Attitude and Practice survey were used. Chi-square analysis and multivariate logistic regression analyses were performed. Having sexual intercourse was associated with urbaneness (p<0.001); correctly answered all UNGASS indicator (p=0.011); and perception of peer behavior having had sex (p=0.001). Condom use among those who had sexual experience was associated with males (p=0.013), believing condoms prevent HIV and STIs (p<0.002), and having friends who report having had sex (p=0.034).Equitable and effective sexual education program must be developed to promote the health of adolescents. Practical education about how condoms may prevent the transmission of STIs and HIV should be promoted.
Ahmadian, M., Hamsan, H. H., Abdullah, H., Samah, A. A., & Noor, A. M. (2014). Risky sexual behavior among rural female adolescents in Malaysia: a limited role of protective factors. Glob J Health Sci, 6(3), 165-174. doi:10.5539/gjhs.v6n3p165
Anwar, M., Sulaiman, S. A., Ahmadi, K., & Khan, T. M. (2010). Awareness of school students on sexually transmitted infections (STIs) and their sexual behavior: a cross-sectional study conducted in Pulau Pinang, Malaysia. BMC Public Health, 10(1), 47.
Awaluddin, S. M., Ahmad, N. A., Mohd. Saleh, N., Aris, T., Mohd Kasim, N., Muhammad Sapri, N. A., & Nik Abdul Rashid, N. R. (2015). Prevalence of sexual activity in older Malaysian adolescents and associated factors. Journal of Public Health Aspects, 2(1). doi:10.7243/2055-7205-2-1
Barnes, G. M., Hoffman, J. H., Welte, J. W., Farrell, M. P., & Dintcheff, B. A. (2007). Adolescents’ time use: Effects on substance use, delinquency and sexual activity. Journal of Youth and Adolescence, 36(5), 697-710.
Bewick, V., Cheek, L., & Ball, J. (2005). Statistics review 14: Logistic regression. Critical Care, 9(1), 112-118. doi:10.1186/cc3045
Beyrer, C., Sullivan, P. S., Sanchez, J., Dowdy, D., Altman, D., Trapence, G., . . . Mayer, K. H. (2012). A call to action for comprehensive HIV services for men who have sex with men. The Lancet, 380(9839), 424-438. doi:https://doi.org/10.1016/S0140-6736(12)61022-8
Bowling, A. (2014). Questionnaire Design Research methods in health: investigating health and health services (4th ed., pp. 290-324). Maidenhead, GB: McGraw Hill: Open University Press.
Chandra-Mouli, V., McCarraher, D. R., Phillips, S. J., Williamson, N. E., & Hainsworth, G. (2014). Contraception for adolescents in low and middle income countries: needs, barriers, and access. Reproductive Health, 11(1), 1. doi:10.1186/1742-4755-11-1
Chiao, C., & Yi, C.-C. (2011). Adolescent premarital sex and health outcomes among Taiwanese youth: perception of best friends' sexual behavior and the contextual effect. AIDS Care, 23(9), 1083-1092. doi:10.1080/09540121.2011.555737
Diclemente, R. J. (1991). Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: the influence of perceived peer norms and sexual communication on incarcerated adolescents' consistent use of condoms. J Adolesc Health, 12(5), 385-390.
Fadzilah Kamaludin, S. N., Tan Huey Ning, Mohd Nasir Abdul Aziz, Shaari Ngadiman, Asiah Ayob. (2011). The Knowledge, Attitude and Practice in HIV/AIDS and Sexually Transmitted Infections Related Risk Behaviour of Secondary School Children in Malaysia. . Research Proposal. Institute for Public Health, Ministry of Health Malaysia. Kuala Lumpur.
Farid, N. D., Rus, S. C., Dahlui, M., Al-Sadat, N., & Aziz, N. A. (2014). Predictors of sexual risk behaviour among adolescents from welfare institutions in Malaysia: a cross sectional study. BMC Public Health, 14 Suppl 3, S9. doi:10.1186/1471-2458-14-s3-s9
Gambadauro, P., Carli, V., Hadlaczky, G., Sarchiapone, M., Apter, A., Balazs, J., . . . Wasserman, D. (2018). Correlates of sexual initiation among European adolescents. PLOS ONE, 13(2), e0191451. doi:10.1371/journal.pone.0191451
Ghafari, M., Shamsuddin, K., & Amiri, M. (2014). Barriers to Utilization of Health Services: Perception of Postsecondary School Malaysian Urban Youth. International Journal of Preventive Medicine, 5(7), 805-806.
Holzner, B. M., & Oetomo, D. (2004). Youth, Sexuality and Sex Education Messages in Indonesia: Issues of Desire and Control. Reproductive Health Matters, 12(23), 40-49. doi:10.1016/S0968-8080(04)23122-6
Jaafar, J. A. S., Wibowo, I., & Afiatin, T. (2006). The Relationship Between Religiosity, Youth Culture, and Premarital Sex among Malaysian and Indonesian Adolescents. Asia Pacific Journal of Social Work and Development, 16(2), 5-18. doi:10.1080/21650993.2006.9755999
Lee, L. K., Chen, P. C., Lee, K. K., & Kaur, J. (2006). Premarital sexual intercourse among adolescents in Malaysia: a cross-sectional Malaysian school survey. Singapore Med J, 47(6), 476-481.
Malaysia, M. o. H. (2016). Global AIDS Response Progress Report 2016: Malaysia 2016 Country Responses to HIV/AIDS. Retrieved from Putrajaya http://www.moh.gov.my/images/gallery/Report/Malaysia GARPR 2016_Final.pdf
Marston, C., & King, E. (2006). Factors that shape young people's sexual behaviour: a systematic review. The Lancet, 368(9547), 1581-1586. doi:https://doi.org/10.1016/S0140-6736(06)69662-1
Mohd, A. M., Adibah, H., & Haliza, G. (2015). A review of teenage pregnancy research in Malaysia. The Medical journal of Malaysia, 70(4), 214-219.
Mustapa, M. C., Ismail, K. H., Mohamad, M. S., & Ibrahim, F. (2015). Knowledge on Sexuality and Reproductive Health of Malaysian Adolescents – A Short Review. Procedia - Social and Behavioral Sciences, 211(Supplement C), 221-225. doi:https://doi.org/10.1016/j.sbspro.2015.11.088
Najimudeen, M., & Sachchithanantham, K. (2017). An insight into low contraceptive prevalence in Malaysia and its probable consequences. International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 3(3), 493-496.
Ohene, S., & Akoto, I. (2008). Factors associated with sexually transmitted infections among young ghanaian women. Ghana Med J, 42(3), 96-100.
Okonkwo, P. I., Fatusi, A. O., & Ilika, A. L. (2005). Perception of peers' behaviour regarding sexual health decision making among female undergraduates in Anambra State, Nigeria. African health sciences, 5(2), 107-113.
Omar, K., Hasim, S., Muhammad, N. A., Jaffar, A., Hashim, S. M., & Siraj, H. H. (2010). Adolescent pregnancy outcomes and risk factors in Malaysia. International Journal of Gynecology & Obstetrics, 111(3), 220-223. doi:10.1016/j.ijgo.2010.06.023
Pong, S.-L. (1996). School participation of children from single-mother families in Malaysia. Comparative Education Review, 40(3), 231-249.
Region, W. W. P. (2007). Sexual and Reproductive Health of Adolescents and Youths in Malaysia. Retrieved from Manila, Philippines: http://www.wpro.who.int/publications/docs/ASRHmalaysia.pdf
Rehnström Loi, U., Gemzell-Danielsson, K., Faxelid, E., & Klingberg-Allvin, M. (2015). Health care providers’ perceptions of and attitudes towards induced abortions in sub-Saharan Africa and Southeast Asia: a systematic literature review of qualitative and quantitative data. BMC Public Health, 15(1), 139. doi:10.1186/s12889-015-1502-2
Romer, D., Black, M., Ricardo, I., Feigelman, S., Kaljee, L., Galbraith, J., . . . Stanton, B. (1994). Social influences on the sexual behavior of youth at risk for HIV exposure. Am J Public Health, 84(6), 977-985.
Saewyc, E., Skay, C., Richens, K., Reis, E., Poon, C., & Murphy, A. (2006). Sexual Orientation, Sexual Abuse, and HIV-Risk Behaviors Among Adolescents in the Pacific Northwest. American Journal of Public Health, 96(6), 1104-1110. doi:10.2105/AJPH.2005.065870
Society, C. P. (2008). Adolescent sexual orientation. Paediatrics & Child Health, 13(7), 619-623.
Susanto, T., Rahmawati, I., Wuryaningsih, E. W., Saito, R., Syahrul, Kimura, R., . . . Sugama, J. (2016). Prevalence of factors related to active reproductive health behavior: a cross-sectional study Indonesian adolescent. Epidemiology and Health, 38, e2016041. doi:10.4178/epih.e2016041
Thanavanh, B., Harun-Or-Rashid, M., Kasuya, H., & Sakamoto, J. (2013). Knowledge, attitudes and practices regarding HIV/AIDS among male high school students in Lao People's Democratic Republic. J Int AIDS Soc, 16, 17387. doi:10.7448/ias.16.1.17387
Zulkifli, S., Low, W., & Yusof, K. (1995). Sexual activities of Malaysian adolescents. The Medical journal of Malaysia, 50(1), 4-10.
Zulkifli, S. N., & Low, W.-Y. (2000). Sexual practices in Malaysia: determinants of sexual intercourse among unmarried youths. Journal of Adolescent Health, 27(4), 276-280. doi:https://doi.org/10.1016/S1054-139X(00)00099-9