2. 1. Study area, design and period
Institutional based cross sectional study was conducted among youths in secondary schools of Nekemte town, East Wollega zone, Oromia regional state, Western Ethiopia from December 1–15 2020. Nekemte town is located at 331 km away to west of Addis Ababa the capital city of Ethiopia. Based on Town Health Office report, the projected total population of the town was 131,154 and the estimated number of 15–24 age youth accounts for 25,914. The town has 12 secondary schools, 3 private, and 2 missionary and 7 governmental schools. The total number of students in these school was 9940, out of these 5364 female students and 4576 male students was attending their education during data collection.
2.2. Participants
The source population was all students in secondary schools of Nekemte town, study population was students among selected schools in Nekemte town, and student participated in the study among selected schools were study unit. All regular students in the selected schools who were attending their class during data collection time were included in the study where, Students those absent -from the class during data collection time, Students with hearing, speaking or visual impairment, and non regular students such as evening and weekend program and older than 24 years old were excluded from the study.
2.3. Sample size Determination and sampling procedure.
The sample size was estimated using a single Population proportion formula. Considering the expected prevalence of sexually explicit materials among ambo university students of 52% (1). With a marginal error of 5%, non response rate of 15%, and 95% confidence interval.
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Where n = is sample size, Z∂/ 2 = Critical value at 95% confidence level which is 1.96, P = proportion of previous study, D = marginal error between sample and population which is 0.05.
By considering non response rate of 15% and 1.5 design effect, the final calculated sample was 660.
A multi-stage sampling technique was employed to select study participants in this study. Nekemte town has 12 secondary schools (both public and private schools). The first four schools were selected among all twelve secondary school in Nekemte town by using simple random sampling technique. Then total sample size was proportionally allocated to total number of students corresponds to each of the four selected Schools. Based on this Nekemte preparatory school, Biftu Nekemte secondary school, ASK secondary school, and Onesmosnesib secondary school has been assigned with 397, 239, 14, and 10 samples respectively. All sections of grade 11and grade 12 of all selected school identified and the number of students in each class is also identified. Again the probability proportional to sample size allocation was done based on the number of students in grade 11 and 12 of those selected schools. Simple random sampling method was employed to select the respondent using students roll number as sampling frame and computer generated random numbers to pick the respondents for interview.
2.4. Variables of the Study
Dependent variable
Exposure to Sexually explicit materials
Independent variables
Socio economic and demographic characteristics (Age, Sex, Religion, Ethnicity, family education, family occupation status, getting pocket money), Environmental factors (peer influence, media); Behavioral factor (sexual behavior, alcohol consumption, khat chewing)
2.5. Operational definition
Sexually Explicit Materials
Any pictorial materials (video, newspapers, magazines, books, Photographs, films) displaying direct physical simulation of naked genitals. Typically intend to arouse the viewer and depict sexual activities(13).
Exposure to sexually explicit material
Is exposure to at least one of the sexually explicit materials visually (by watching or reading) in a self reported frequency ranging from 'sometimes' to 'often' frequently (13).
Infrequent watching of sexually explicit materials
Reading/watching sexually explicit texts /movies in a self-reported frequency ranging from never to rarely (once or Twice) life time(13).
Early sexual initiation
- Initiation of sexual intercourse before the age of 18 years.
Risky sexual behaviors- At least having one behavior of: Early sexual intercourse (before 18 years), anal sex, oral sex, unsafe sex, multiple sexual partner sex with commercial sex workers(1).
Unsafe sex – Sexual intercourse without or with occasional use of condom.
Consistent condom use: - condom use reported to be always at every sexual contact.
Attend religion frequently
-Going to religious institution for worshiping at least ones a week(14).
Substance use:- Taking any of the three commonly used psychoactive substances:- alcohol, cigarette, and/or khat in the past ,in life time/last twelve months (15).
2.6. Data collection instruments and procedures
Structured self administered questionnaire was prepared by reviewing literatures and adapted from previous related studies(16). The questionnaire has different sections: socio-demographic characteristics of the students, history of exposure to sexually explicit materials, and sexual behavior sections.
Data collection was facilitated by four BSc nurses and one supervisor. Self administered questionnaire to be filled by the students was prepared and all necessary information and orientation was presented to the students and the facilitator was stayed with respondents until all questions filled and responded. To increase the confidentiality of the information the big envelop was used as ballot to collect the filled questionnaire and the students themselves inserted the questionnaire into the ballot. The sitting arrangement of the students was one student per desk. The facilitators were followed over all activity. Then the collected data provided to supervisor to be checked for completeness and reached the principal investigator on the day of data collection.
2.7. Data processing and analysis
The collected data was checked for completeness and consistencies. Unique code to each questionnaire was given. Then data was entered into Epi data version 4.6.0.0. The entered data were cleaned prior to data analysis. Any errors were corrected by referring to the original data using the code number of the questionnaire and exported to SPSS version 20 statistical software for analysis. Frequencies, graphs and summary statistics (mean, standard deviation, percentage) were used to describe the study population in relation to relevant variables. Independent variables that were statistically significant with p-value < 0.25 at bivariate analysis were included in multivariate logistic regression model for dependant variable to control for potential confounder. The strength of association was interpreted using the adjusted odds ratio with 95% CI. And p-value of < 0.05 were considered to be statistically significant. Finally results were presented in the form of narration, table and charts. Hosmer and Lemeshow's goodness-of-fit test was used to test for model fitness. The independent variables were tested for multicollinearity using the Variance Inflation Factor (VIF) and variables indicating above the tolerable value of greater than 10 were excluded as the presence of multicollinearity
2.8. Data quality assurance
The questionnaire was prepared by reviewing literature and adapted from previous study. The questionnaire was first prepared in English language and then translated to the regional working languages Afaan Oromo by using expert in the language and again translated back to English by another person to check its consistent meaning with the previous one. One day training was given for facilitator as well as for supervisor and orientation was given for the study participant. Also the questionnaire was reviewed for completeness, accuracy, and consistency by supervisor. Pre test was conducted by selecting ten percent (10%) students sample from Nekemte preparatory students among grade 10 students and cheeked for accuracy of the response, the time was estimated and adjustment made to the questionnaire before actual data collection carried out. During data collection each filled questionnaire was checked immediately for completeness by facilitators, and then reviewed by supervisor and principal investigator.