This difference in results may at least partially reflect differences in the age range of participants 13 to 15 years old in Pontianak and 12 to 19 years old in Malaysia ; age is associated with the development of sexual maturity and its effect on sexual behavior, although these studies were conducted in similar sociocultural backgrounds. Regarding the activities defined as active RH behavior, the percentage of respondents who reported touching This may indicate that adolescents develop sexual behavior according to the stage of their sexual development.
Unexpectedly, intercourse was not reported in this study. These discrepancies may be explained by the fact that the participants mostly lived in a rural area, with limited access to information, corresponding to a slow influence of Western culture on RH behavior. The results of this study indicated that the prevalence of active RH behavior was the lowest in the Indonesian context. However, it is likely to increase in association with modernization and Westernization [ 3 ], leading to more access to information on RH in Indonesia [ 23 ].
Thus, our findings suggest the importance of health-promotion strategies for youth to prevent active RH behavior in Indonesia. Four factors were related to active RH behavior among boys: smoking, access to information on development, the type of relationship envisioned before marriage, and attitudes about RH. In this study, smoking was related with active RH behavior among boys, which is consistent with a previous study in Malaysia [ 20 ]. This finding might be explained by the fact that adolescents attracted to new and challenging risky experiences, and that life problems during puberty associated with behavioral problems are also associated with adolescent smoking.
Cigarette smoking may lead to behavioral problems, which in turn may influence adolescents to engage in RH behavior. This may provide insight into the main challenges in developing and implementing health education in Indonesia among adolescents, in particular the need to prevent smoking and its potential influence on RH behavior. We also found that the absence of access to information on development was related to active RH behavior among boys. This finding is consistent with previous studies reporting that sources of information [ 26 ] are associated with RH behavior.
This might be explained by the fact that boys are in need of information on the physical, psychological, and emotional phases of growth and development in order to adapt to changes during puberty. These results emphasize the importance of providing sources of correct information and promoting knowledge and understanding of RH issues among adolescents in Indonesia in order to encourage positive attitudes regarding sexual topics, based on the social and cultural context of Indonesia.
Our findings that envisioning pacaran and nikah siri as types of relationships before marriage were related with active RH behavior in boys are similar to those of a previous study in Indonesia [ 27 , 28 ]. This indicates that puberty and RH maturation may cause sexual urges in adolescents who begin to experiment with sexuality through pacaran. This relationship was found among adolescents who were drawn to express feelings through active RH behavior, although this is traditionally the period in which individuals transition towards the age of marriage in Indonesia [ 29 ].
These patterns may illustrate a limited degree of RH self-awareness regarding gender and social norms during puberty. This suggests that the age of marriage should be increased to prevent premarital sexual activity among adolescents in Indonesia. Moreover, we found that attitudes towards RH were associated with a greater likelihood of active RH behavior among boys.
These findings are consistent with previous studies in India [ 30 ]. This may be associated with the acceptance of certain gender roles, since adolescent RH behavior develops in accordance with gender and environmental norms.
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This suggests that Indonesian adolescents need sex education programs to improve their knowledge, attitudes, and behaviors, as well as to encourage the formation of positive attitudes regarding gender and RH norms. In this study, access to information on development and substance abuse, as well as attitudes on RH, were found to be associated with active RH behavior in girls. In particular, the absence of access to information on development was related to active RH behavior among girls.
The explanation for these findings may be similar to that proposed for boys. Therefore, the provision of more accessible to information on development may help adolescents to develop more positive RH behavior. Changes in regulations relating to access to adolescent health information through mass media and the internet may also help to increase healthy RH behavior. Our findings showed that girls who did not have adequate access to information on substance abuse were more likely to engage in active RH behavior, which is similar to the findings of previous studies that pubertal timing may also be associated with an elevated risk of substance abuse [ 31 , 32 ].
This may be explained by the fact that girls show an earlier onset of puberty and by the complexity of woman secondary sexual development, which may cause complex range of challenges for girls.
Therefore, girls need focused access to substance abuse information through educational programs. These findings suggest that it would be desirable to develop infrastructure for the communication of information and socialization regarding the danger of substance abuse during puberty through channels that adolescents may access through school health programs, and family.
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In addition, attitudes on RH were associated with active RH behavior among girls. These findings are consistent with previous studies for the same reason that was proposed regarding the findings among boys. In this study, logistic regression analysis showed interactions between independent variables as factors associated with active RH behavior in both boys and girls. Among boys, it was unclear whether current smoking may have been related to active RH behavior based on access to information on development or vice versa.
These findings are similar to those of previous studies that found that smoking and information sources [ 20 ] were associated with RH [ 33 ]. In contrast, among girls, it was not clear whether access to information on development was related to active RH behavior as mediated by attitudes to RH or vice versa. This findings are similar to those of previous studies reporting that access to information [ 25 ] and pubertal development [ 33 ] were related to attitudes regarding gender and norms.
This may be explained by the availability of resources for the development of adolescent health, and these findings suggest the need to provide health education about the dangers of smoking during adolescent development to minimize risky behavior and encourage positive, balanced attitudes regarding gender and RH norms during puberty based on the social and cultural context of Indonesia. The finding of the current study that intercourse active sexual behavior was not reported may reflect the fact that sexuality and adolescent RH are sensitive issues in Indonesian culture and society, which may have influenced our data collection.
However, in this study, in order to maximize the accuracy of the responses, participants were first asked to respond to questions about their sociodemographic characteristics, communication patterns, information about RH, and competency of RH, and only then were participants encouraged to complete the questionnaire about sexual development, society and culture, spirituality, and RH behavior in a private room.
This suggests that future qualitative research could assess the phenomenon of intercourse among adolescents with appropiate cultural sensitivity in the Indonesian context. This study has limitations, including the cross-sectional nature of the study design, which resulted in associations being found among the variables, rather than causal conclusions. In this study, the CIs were very wide, which casts doubt upon the certainty of the effects, and the fact that further information is needed reflects the sample size.
Furthermore, this is a limitation regarding the measured prevalence of active RH behavior in this study, which may be different from what has been found in other studies, based on definitions of RH behavior and sample size. The current study showed that access to information on development and negative attitudes towards RH were factors associated with active RH behavior in both boys and girls.
Meanwhile, current smoking habit and envisioning pacaran before marriage were associated with active RH behavior in boys, whereas access to information on substance abuse was an additional factor associated with active RH behavior in girls. Thus, the study results suggest that health-promotion programs on sexual health and RH could be designed to provide accurate information grounded in the social, environmental, and religious aspects of the Indonesian context, focusing the content of sex education on concerns regarding adolescent development in order to prevent the development of negative attitudes regarding RH.
Health promotion programs should be designed to focus on smoking and preventing relationships before marriage for boys and the provision of information on substance abuse for girls in the Indonesian context.
The authors have no conflicts of interest to declare for this study. National Center for Biotechnology Information , U. Journal List Epidemiol Health v. Epidemiol Health. Published online Sep Author information Article notes Copyright and License information Disclaimer.
Received Jul 9; Accepted Sep This article has been cited by other articles in PMC. METHODS A cross-sectional study was conducted among 1, of students who were selected through a multi-stage random sampling technique. Setting and sample This study was conducted in 31 districts of East Java in Indonesia from November to February Ethical considerations The study was approved by the ethical committee review board of Indonesia no. Instruments We used questionnaires to collect the data. Open in a separate window. Figure 1. Table 1. Variables investigated in the current study.
Independent variables Competency of RH behavior refers to perceptions of sex, gender, and RH norms; knowledge of and attitudes towards RH; and knowledge of human immunodeficiency virus HIV [ 14 ]. Dependent variables RH behavior was a variable used to measure the activities of adolescents [ 17 ]. Data collection After obtaining consent forms, the investigators distributed a questionnaire to the eligible students.
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Data analysis Descriptive statistics frequencies were used to calculate the prevalence of RH behavior both boys and girls separately. Table 2. RH, reproductive health; CI, confidence interval. Table 3.
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RH, reproductive health; HIV, human immunodeficiency virus. Table 4. Factors related factors to active reproductive health behavior among girls The factors significantly associated with active RH behavior among girls are presented in Table 3. Factors related to active reproductive health behavior among boys Four factors were related to active RH behavior among boys: smoking, access to information on development, the type of relationship envisioned before marriage, and attitudes about RH.
Factors related to active reproductive health behavior among girls In this study, access to information on development and substance abuse, as well as attitudes on RH, were found to be associated with active RH behavior in girls. Footnotes The authors have no conflicts of interest to declare for this study. Beyond sexual desire and curiosity: sexuality among senior high school students in Papua and West Papua Provinces Indonesia and implications for HIV prevention. Cult Health Sex.
Do primary students understand how pregnancy can occur?
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