Background: World Health Organization (WHO) reported that unsafe sex is ranked second among the top ten risk factors to health in terms of the burden of disease they cause. HIV/AIDS is the reason unsafe sex ranks so high. Studies have also shown that the number of adolescents who have premarital sex is increasing. Unsafe sex can increase the risk of sexual transmitted disease, unwanted pregnancy, and suicide in adolescents. The study aimed to determine the associations between attitude, subjective norm, perceived behavior control, equal gender relation, and media exposure, on safe sexual behavior among female adolescents in Karanganyar, Central Java, using Theory Planned Behavior.
Subjects and Method: This was a cross-sectional study conducted in 25 senior high schools in Karanganyar, Central Java, from December 2017 to January 2018. The 25 schools were selected by stratified random sampling, composing of urban and rural schools. A total sample of 200 female adolescents was chosen from by stratified random sampling, resulting in 8 female adolescents from each of the 25 senior high schools. The dependent variable was safe sexual behavior. The independent variables were attitude, subjective norm, perceived behavior control, equal gender relation, and media exposure on safe sexual behavior. The data was collected using questionnaire and analyzed by multilevel analysis. The contextual effect of school, which distinguished rural and urban schools, on safe sex behavior was measured by intra-class correlation (ICC).
Results: Safe sex behavior in female adolescents increased with positive attitude (b= 0.41; 95% CI= 0.14 to 0.69; p= 0.004), positive subjective norm (b=0.23; 95% Cl= 0.21 to 0.43; p= 0.031), strong perceived behavior control (b= 0.69; 95% Cl= 0.44 to 0.96 ; p<0.001), equal gender relation (b= 0.41; 95% Cl= 0.18 to 0.63; p<0.001), and exposure to media on safe sex behavior (b= 0.17; 95% Cl= -0.02 to 0.36; p= 0.085). The intra-class correlation (ICC)= 5.55%, indicating negligible contextual effect of schools.
Conclusion: Safe sex behavior in female adolescents increases with positive attitude, positive subjective norm, strong perceived behavior control, equal gender relation, and exposure to media on safe sex behavior. The contextual effect of schools is negligible.
Keywords: safe sexual behavior, female adolescents, urban-rural, school, multilevel analysis