WHO defines risky sexual behavior as one that increases the likelihood of adverse sexual and reproductive health, such as unwanted pregnancies, unsafe abortion and STIs, including HIV/AIDS. Using different substance can result in unprotected sexual intercourse with the same sex or commercial sex workers. The risky sexual practices include: changing sexual partners frequently, having multiple sexual partners, having sex without a condom, using unreliable methods of birth control or birth control inconsistently, engaging in sex with older partners and consumption of alcohol and illicit drug [1].

Many adolescents engage in risky sexual behaviors that can result in unintended health outcomes. Sexual risky behaviors place adolescents at risk for infection, STDs, and unwanted pregnancy. Reducing sexual risky behaviors and related health problems among youth, school and other youth serving organizations can help adolescents people adapt lifelong attitudes and behaviors that support their health and wellbeing including behavior that reduce their risk for HIV/AIDS, other STDs and unwanted pregnancies [2].

Quantitative and qualitative result of studies revealed that substantial number of girls and boys in many developing countries engage in sexual intercourse before their 15^th years of age [3].

According to one national finding, majority predisposing factors for increment of sexual activity among adolescents are fall in menarche age, increased premarital sex, deterioration of traditional norms and values that discourage premarital sex, media that transmit new ideas through movies and music ,and a different books that influence adolescents, attitude and behavior worldwide. According to the family planning guidance association of Ethiopia, about 72% of boys and 71% of girls have had their first sexual contact with in the age range of 15- 17 years while 13% of them started sexual activity between 10 and 14 years of age.

Studies have shown that parental communication is one of the most important factors in reducing risky sexual behavior emphasis should be made to increase the religions values and increase parental communication so that both would have synergistic on students [4,5].

The problems of risky sexual behaviors in Ethiopia are believed to be similar that that of other developing countries. But to dates, there are few studies on adolescent students in our country indicating the current magnitude of risky sexual behaviors. Adolescents who are influential agents for future fate of a country and potential source for development of the nation are being exposed to various health problems. Protecting those groups from risky sexual behaviors is a crucial and has a significant contribution for the development of the nation. In order to design appropriate preventive strategies it is an advisable fact to clearly and systematically understand the risky sexual behaviors from high school environment.

The finding of this study will help for policy makers, health planners, Jimma university community high school and other concerned bodies that work on the students to use as basic information and to fill the gaps that result in risky sexual behaviors. So, this study would be able to dig out the level of knowledge, attitude and practice towards risky sexual behaviors of adolescents.

An institutional based quantitative descriptive cross sectional study design was conducted on adolescents of Jimma university community high school from 16/02/2015 to 17/02/2015. The single population formula was used to calculate a sample size, by using that 50% of students have knowledge, attitude and practice about risky sexual behavior to obtain maximum sample size at 95% certainty and a maximum discrepancy of ± 5% between the sample and the population. Total calculated sample size was proportionally allocated to each grade, and Systematic random sampling technique was used for selecting participants from each grade.

Data was collected by using structured, pre-tested, self-administered questionnaire. The questionnaire has four parts:-Socio demographic information, Knowledge about risky sexual behaviors, Attitude on risky sexual behaviors and Practice on risky sexual behaviors.

The collected data was checked and rechecked for its completeness, consistency and accuracy by principal investigator. After the data was checked for its completeness it was analyzed for frequency and percentage. Cross tabulation was performed on variables to compare & explore relationships. Statistical calculation was made by chi square.

Ethical clearance letter was obtained from nursing department and forwarded to the director of the school and formal permission was obtained. Then the director signed on the letter and informed to the home room teachers and class representatives. Because the confidentiality is important the name of the respondents was not taken during data collection and confidentiality of data was kept. The purpose of data collection was explained for respondents and privacy was kept.

Socio-demographic characteristics

From sampled 252 students, 229 were participated in the study making a response rate 90%. About 146 (62.27%) were females with ratio of 1:1.76 male to female. Majority of the respondents 213 (93.01%) were in age range of 15-19 (Table 1).

Table 1: Socio-demographic characteristics of Jimma University community high school students, Jimma town, Oromia region, south west, Ethiopia, April, 2015.

Knowledge regarding risky sexual behavior

Majority of the study participants 169 (73.8%) knew about risky sexual behavior. From the respondents, 114 (49.78%),108 (47.16%),and 59 (25.76%) defined risky sexual behavior as having sex before marriage, sexual practice with multiple partners and unusual sexual practice like anal &oral sex respectively (Table 2).

Table 2: Knowledge of risky sexual behavior among Jimma university community high school students ,Jimma town, Oromia region, South west,Ethiopia, April,2015.

Attitude towards risky sexual behaviors

About 211 (92.14%) of the respondents reported that as they agree on substance use (like cigarette, alcohol, hashish) expose to risky sexual behaviors, 197 (86.03%) and 193 (84.28%) believed that there is risk of HIV/AIDs by sexual contact with young girls/boys and it is possible girls remain virgin until marriage respectively (Table 3).

Table 3: Attitude towards risky sexual behavior among Jimma university community high school students, Jimma town, Oromia region, Southwest Ethiopia, and March, 2015.

Practices regarding risky sexual behaviors

Eighty four (36.68%) of the study participants reported that they had boy/girlfriend during the study. From the study respondents those who had boy/girlfriends, their boy /girlfriend 51 (60.71%) were in age range of 15-19 and 8 (9.53 %) in >=25 years of age; occupation of the majority respondents’ boy/girlfriend was student 60 (71.43%), only 1 (1.19%) accounts others (Table 4).

Table 4: Participants of the study who had boy/girlfriend during the study period among Jimma university community high school students Jimma town, Oromia region, South west Ethiopia, April, 2015.

Among the respondents those who had sex for the first time about 2/3 (50/75=66.67%) found in age range of 15-19 followed by10-14 years of age 15 (20%) and<10 years 10 (13.33%).

Nearly 1/3 (32.75%) of the respondents reported that had practice sexual intercourse of them 44 (58.67%) were females with higher prevalence among males 31/83 ( 37.35%) as compared to females 44/146 (30.14%).

Above a quarter 62 (27.07%) of the study participants had sex in 3 months prior to the study from those 26 (41.94%) had sex in hotel followed by forest 20 (32.26%) and 5 (8.06%) had in the others places other than the mentioned.

Among those, 28 (45.16%) had sex with their boy/girls’ friend 8 (12.9%) with the others (their husbands/wives); regarding to the reasons for sex, 30 (48.39%) had sex for sexual initiation because of age and 3 (4.84%) did sex for financial gain (Table 5).

Table 5: The study respondents who had sex in previous 3 months prior to the study among study participants Jimma university community high school students, Jimma town, Oromia region, south west Ethiopia, April, 2015.

From those who had not practiced sexual intercourse until the study (154): the majority 101 (65.58%) had their future plan of abstinence and 2 (1.3%) be faithful & using condom (B&C) (Figure 1).

Figure 1: Future plan of the study respondents those who had not sex in Jimma university community high school students, Jimma town, Oromia region, south west Ethiopia, April, 2015.

The study revealed that about 169 (73.8%) knew at least one risky sexual behavior. It is lower than the study conducted in Yirgalem (79.2%) and Bophuthatswana (82.17%) [6]. The possible explanation for this disparity could be due to difference in knowledge of risky sexual behavior , sample size, study population , cultural and background difference (latter case).

According to the result of the study about 195 (85.15%) knew risks/consequences of risky sexual behaviors that help them to protect themselves from the risk. It is lower than study in Yirgalem about 95.6% [7] knew consequences of risky sexual behavior. The difference might be due to curiosity of sexual activity and more information is from their peers of the same sex who themselves lack adequate information about reproductive health [8].

Moreover, 44.98% had information about sexual matter from friends. This is consistent with the study in Nigeria, in Anambra state 47.2%) [7]. This indicates that their friends have chance of influencing and shaping their peers positively/negatively about issue of sexual matter.

About 167 (72.93%) had information about sexual matter from media, 80 (34.93%) and 79 (34.5) got information about sexual matter from parents and magazines respectively. Similar finding was noted study in Zambia in girls about 31% used magazines. In contrast, the more difference in communication with parents than Zambia (7%) [9]. The difference could be due to an increased parental communication about sexual matter in this study area, more than 9/10th of respondents fathers’ and mothers’ were literate that increases free discussion between children and family, and more than 9/10th of the study respondents were residing with their family and nature of the study area (it includes participants from urban). However, parental provision of information about sexual matter is lower than in United States America that was 59% [10] this disparity might be because of difference in culture and background, USA is developed state that parental communication might be increased. It is similar finding according to study in developing countries that adolescents do not communicate sexual matter with parents [8].

According to the result of the study about 176 (76.86%) had good knowledge about risky sexual behaviors. This is higher than finding of study in Bophuthatswana (70.19%) [6]. This difference might be due to the difference on cut point, the nature of questions that respondents were asked, and study population from different cultural and sociodemographic background from Ethiopia and Bophuthatswana.

The result of the study has shown that about 125 (54.59%) had positive attitude towards risky sexual behavior that helps them to protect from the risk. This is similar finding with study conducted in Iran (52.37%) [11]. This slight difference might be due to variation in cut point used, study respondents, difference in cultural and socodemographic background.

The result revealed that about 193 (84.28%) of the respondents agreed that girls should remain virgin until marriage and 164 (71.62%) agreed as it is possible to talk about sexual matter with parents. In contrast, it was higher finding than study in Yirgalem (55.7%) by 28.58%and by 29.28% in Iran (55%) [11]. This difference could be because of increased parental communication about sexual matter in my study area as compared to findings in developing countries, an increased source of information about sexual matter from teachers in class room (51.53%) in my study, difference in attitude towards virginity from different study area, study subjects.

The result also has shown that about 211 (92.14%) agreed substances like chat, alcohol, and cigarette use expose to risky sexual behaviors. This is higher than finding in Yirgalem (82.3%) and in Iran (75.21%) [11]. This difference might be due to difference in positive attitude towards consequence of using substance, place of residence (94.76% )of the respondents were living in family house in which they might be supervised), and study population from different study area.

The study has shown that out of those who knew homosexuality about 126 (67.34%) believed that homosexuality behavior brings risk (harmful).In contrast; it is lower as compared to the study conducted in Iran (76%) [11]. This could be because of Iran is one of the Islamic world in which such behaviors are not socially or legally not accepted such behaviors even carry the death penalty, watching pornographic videos , study population from different culture and background.

Also the result revealed that among who knew masturbation about 59 (41.26%) did not agree as it is form of sexual expression and it is slightly lower as compared to study in Iran (53%) [11] for the possible reasons: watching pornographic videos that initiate sexual need ,study population from different cultural and socio-demographic background.

The result also revealed about 75 (32.75%) had sex at least once prior to the study. It is higher than study done in Agaro (25%). Moreover, the prevalence of premarital sex in the study area was 32.75%. It is higher as compared to national finding (19%) [12]. These might be due to romantic and pornographic films, location of school (in the university), increased sharing of information among friends about sexual matter that enhances curiosity of sexual issues.

About 14 (22.58%) and 28 (45.16%) had sex with fellow class students and boy/girlfriend respectively. The adolescents who had sex with classmate were lower as compared to study in Nigera, Abia State, among sexually active adolescents: about 35.8% with classmate/ playmate [13]; the adolescents who had sex with boy/girlfriends higher than in the same study area (25.9%) [13]. This could be because of increased trust with their friends and it was only about short period (it is only about 3 months prior to the study in this study).

The reasons given for sex in 3 months prior to the in the study area were: sexual initiation because of age (48.39%) peer pressure (14.52%) and financial gain (4.84%).This is different from the study in Nigeria in, Anambra, peer pressure (50%), monetary gain (27.5%) [7]. This difference might be due to difference in interest and satisfaction of the study subjects of different culture and background, and level of peer influence on sexual matter

The result also verified that, about 2/3 (66.67%) started their first sexual intercourse when they were in age 15-19years. This is higher finding as compared to study in Nekemt (57%) [14] had first sexual intercourse in an age 15-17 and it is the similar finding of study in Zambia among adults aged 15 and above have high level of sexual activity[9]and also agrees with finding of family guidance association of Ethiopia about 72% of boys and 71% of girls have had their first sexual contact with a an age range of 15-17 years [5]. As the result of the study depicted, about 44 (58.67%) were females among sexually experienced participants and this is the similar finding in Burkina faso and Ghana among adolescents of 15-19 [15]. This is because of girls attain secondary sexual characteristics before male that initiate early sexual activity as compared to male.

According to finding of the study, about 62 (27.07%) had sex in 3 months prior to the study of them 35 (56.45%) did not use condom when they had the last sex. It is lower as compared to study in Gonder (67.1%) did not use condom[12]. This might be because of increased attitudes of study subjects towards condom than study respondents in Gonder. In contrast, this higher than study conducted in Agaro high school students about 45.6% of them never use condom at all. Also the same finding was recorded as study in Agaro , class room survey in USA among 15-24, about 33.7% had sexual intercourse during previous 3 months prior to the study , and of those about 39.7% [16] did not use condom the last time they had sex .

This could be because of inclusion of study participants who are more older than adolescents that are more mature in USA , (adolescents have less cognitive maturity than adults [4], misconception that condom reduces sexual pleasure and gives less protection for HIV/AIDS, access and availability of condom, and attitude of society towards condom using.

As the result of the study depicted, among the sexually active adolescents about 33 (58.93%) had sex with multiple partners. This is slightly higher than study in Gonder, about 53.3% [12] had two or more sexual partners this might be due to difference in study area and subjects, not knowing consequence of having multiple sexual partners in thisstudy.

According finding of the study about 58 (77.33%) had penetrative vaginal sexual intercourse, 9 (12%) oral and 8 (10.67%) anal this is similar finding with study in Nigeria in Osogbo, Osun State, vaginal penetrative, oral and anal sex contributed 78.1 % 13.3% and 12.4% of the sexual preferences of the sexually active adolescents respectively [17]. This indicates that adolescents act in a similar way to search their curiosity of different methods of sexual intercourse.

The finding revealed that about 36 (15.72%) practiced masturbation. This is comparable finding with study conducted in Nigeria, Anambra state, among adolescents was 16.7% [7]. This similarity shows that adolescents share similar attribute of sexual practice [18-25]. (Table 6-9)

Table 6: Association of overall level of knowledge with sex,age,grade,ethnicity,marital status, religion ,place of residence and educational status of father and mother in Jimma university community high school students, Jimma town, Oromia region, south west Ethiopia, April, 2015
There was association between overall level of knowledge of RSB and place of residence with chi-square( 20.4) and p value (0.000); Relationship was established between knowledge and educational status of father with chi-square (12.5) and p value (.000), and also between and educational status of mother with chi-square (22.7)and p value (0.000).

Table 7: Association of overall level of attitude with sex,age,grade,ethnicity,marital status, religion ,place of residence and educational status of father and mother in Jimma university community high school students, Jimma town, Oromia region, south west Ethiopia, April, 2015.

Table 8: Association of practice of homosexuality with sex,age,grade,ethnicity,marital status, religion ,place of residence and educational status of father and mother in Jimma university community high school students, Jimma town, Oromia region, south west Ethiopia, April, 2015.

Table 9: Association of practice of masturbation with sex, age, grade, ethinicity, marital of residence and educational status of father and mother in Jimma university community high school students, Jimma town, Oromia region, south west Ethiopia,April, 2015.

There was high practice of sexual activity, high prevalence of premarital sex, low utilization of condom and contraceptives and only around half of the participants thought as condom as it prevents HIV/ AIDS that increases short and long term consequences risks of sexual behavior.

The authors declare that they have no competing interests

All authors participated in the design and analysis of the study. LE searched the databases, and wrote the first and second draft of the article. BF reviewed proposal development activities and each drafts of the result article. All authors revised the manuscript and approved the final version.

First and foremost we would like to greatly thank the almighty God, the foundation of knowledge and wisdom for enabling us to achieve this task.

We also would like to thank Jimma University College of health science for providing us with the fund to conduct this thesis. We extend our thanks to Jimma University ICT Department that provided us with the access for internet service.

Lastly, but not least, we offer our regards to all who helped us throughout this thesis work including Coworkers, study participants, school directors and teachers of the school for their coordination during data collection.