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Published online June 29, 2009
PEDIATRICS Vol. 124 No. 1 July 2009, pp. e44-e52 (doi:10.1542/peds.2008-2954)
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ARTICLE

Premarital Sexual Intercourse Among Adolescents in an Asian Country: Multilevel Ecological Factors

Mee-Lian Wong, MBBS, MPH, MDa, Roy Kum-Wah Chan, MBBS, MRCP, FRCPa,b, David Koh, MBBS, MSc, PhDa, Hiok-Hee Tan, MBBS, MRCP, FRCPb, Fong-Seng Lim, MBBS, MMedc, Shanta Emmanuel, MBBS, MPHd, George Bishop, MS, PhDe

a Department of Epidemiology and Public Health, Yong Loo Lin School of Medicine
e Department of Psychology, Faculty of Arts and Social Sciences, National University of Singapore, Singapore
b Department of Sexually Transmitted Infection Control, National Skin Centre, Ministry of Health, Singapore
c National Health Group Polyclinics, Singapore
d Research and Epidemiology Department, Singapore General Hospital, Singapore

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.

Key Words: premarital sexual intercourse • adolescents • pornography • sexual abuse • media

Abbreviations: STI—sexually transmitted infection • CI—confidence interval • OR—odds ratio

Accepted Mar 6, 2009.


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