Vulnerability and life style factors among university students in Ethiopia: Assessing risky sexual behavior, exposure to violence and patterns of substance use and alcohol consumption
Belihu, Wudinesh Belete LU
(2025)
In Lund University, Faculty of Medicine Doctoral Dissertation Series
- Abstract
- Background: University students are at a transitional stage in life characterized by increased independence, autonomous decision-making, reduced parental supervision, and heightened susceptibility to peer pressure.
These dynamics expose them to various risks, including risky sexual behaviors, violence, and use of substances and alcohol. These risky behaviors often result in serious negative consequences, such as sexually transmitted infections (STIs) including HIV, unintended pregnancies, unsafe abortions, and psychosocial problems. Despite the significance of these issues, comprehensive studies targeting both male and female university students remain limited in Ethiopia. Therefore, the aim of this thesis was to explore the prevalence... (More) - Background: University students are at a transitional stage in life characterized by increased independence, autonomous decision-making, reduced parental supervision, and heightened susceptibility to peer pressure.
These dynamics expose them to various risks, including risky sexual behaviors, violence, and use of substances and alcohol. These risky behaviors often result in serious negative consequences, such as sexually transmitted infections (STIs) including HIV, unintended pregnancies, unsafe abortions, and psychosocial problems. Despite the significance of these issues, comprehensive studies targeting both male and female university students remain limited in Ethiopia. Therefore, the aim of this thesis was to explore the prevalence of and factors associated with risky sexual behavior, exposure to violence, and patterns of substance and alcohol use among university students in Ethiopia. The findings will inform the development of strategic and targeted interventions aimed at preventing and managing risky sexual behavior, violence exposure, and risky behaviors in the university context.
Methods: All three papers are derived from a cross-sectional study conducted among 2,988 students from six randomly selected universities in Ethiopia. Data were collected using a structured and selfadministered questionnaire. For papers I and II, descriptive statistics were used to summarize the data,
while bivariable and multivariable logistic regression analyses were conducted to identify factors associated with the outcome variables. For paper III, latent class analysis (LCA) was employed to identify subgroups of students based on their substance and alcohol use behavior, and multinomial logistic
regression was used to identify factors associated with class membership.
Results: Paper I revealed that 19.5% of students who had sexual intercourse in the last 12 months engaged in risky sexual behavior (RSB). Of these, 29.9% had multiple sexual partners, and 69.3% did not consistently use condoms with new partners. Older age, early sexual debut, and experiences of emotional violence were significantly associated with RSB. Paper II showed that 17.6% of students reported exposure to any type of violence in the past year (17.9% among males and 16.5% among females). Factors significantly associated with violence exposure included older age, being in a relationship, rural residence, frequent alcohol use, khat chewing, and other drug use in the past 12 months. Paper III identified four distinct substance and alcohol use patterns through LCA: non-users (36.7%), alcohol consumers (29.9%), substance users (22.7%), and both alcohol and substance users (10.8%). Prior residence (urban/rural), average monthly expenditure, and age at sexual debut were significantly associated with class membership.
Conclusion: Risky sexual behavior, exposure to violence, and substance and alcohol use are public health concerns among university students in Ethiopia. These issues are driven by a complex interplay of individual, behavioral, social, and environmental factors. Therefore, it is essential for universities and
relevant stakeholders to design and implement targeted interventions aimed at prevention and response to these challenges within the university student population. (Less)
Please use this url to cite or link to this publication:
https://lup.lub.lu.se/record/4664e752-daa0-4e3f-9d9b-58e4d4de22d1
- author
- Belihu, Wudinesh Belete
LU
- supervisor
- opponent
-
- Professor Lindgren, Helena, Sophiahemmet University, Sweden
- organization
- publishing date
- 2025
- type
- Thesis
- publication status
- published
- subject
- keywords
- Risky sexual behavior, violence, substance, alcohol, university students, Ethiopia
- in
- Lund University, Faculty of Medicine Doctoral Dissertation Series
- issue
- 2025:100
- pages
- 96 pages
- publisher
- Lund University, Faculty of Medicine
- defense location
- Agardh föreläsningssal, CRC, Jan Waldenströms gata 35, Skånes Universitetssjukhus i Malmö
- defense date
- 2025-09-26 13:00:00
- ISSN
- 1652-8220
- ISBN
- 978-91-8021-753-8
- language
- English
- LU publication?
- yes
- id
- 4664e752-daa0-4e3f-9d9b-58e4d4de22d1
- date added to LUP
- 2025-08-29 14:46:07
- date last changed
- 2025-09-08 13:14:03
@phdthesis{4664e752-daa0-4e3f-9d9b-58e4d4de22d1,
abstract = {{Background: University students are at a transitional stage in life characterized by increased independence, autonomous decision-making, reduced parental supervision, and heightened susceptibility to peer pressure.<br/>These dynamics expose them to various risks, including risky sexual behaviors, violence, and use of substances and alcohol. These risky behaviors often result in serious negative consequences, such as sexually transmitted infections (STIs) including HIV, unintended pregnancies, unsafe abortions, and psychosocial problems. Despite the significance of these issues, comprehensive studies targeting both male and female university students remain limited in Ethiopia. Therefore, the aim of this thesis was to explore the prevalence of and factors associated with risky sexual behavior, exposure to violence, and patterns of substance and alcohol use among university students in Ethiopia. The findings will inform the development of strategic and targeted interventions aimed at preventing and managing risky sexual behavior, violence exposure, and risky behaviors in the university context.<br/><br/>Methods: All three papers are derived from a cross-sectional study conducted among 2,988 students from six randomly selected universities in Ethiopia. Data were collected using a structured and selfadministered questionnaire. For papers I and II, descriptive statistics were used to summarize the data,<br/>while bivariable and multivariable logistic regression analyses were conducted to identify factors associated with the outcome variables. For paper III, latent class analysis (LCA) was employed to identify subgroups of students based on their substance and alcohol use behavior, and multinomial logistic<br/>regression was used to identify factors associated with class membership.<br/><br/>Results: Paper I revealed that 19.5% of students who had sexual intercourse in the last 12 months engaged in risky sexual behavior (RSB). Of these, 29.9% had multiple sexual partners, and 69.3% did not consistently use condoms with new partners. Older age, early sexual debut, and experiences of emotional violence were significantly associated with RSB. Paper II showed that 17.6% of students reported exposure to any type of violence in the past year (17.9% among males and 16.5% among females). Factors significantly associated with violence exposure included older age, being in a relationship, rural residence, frequent alcohol use, khat chewing, and other drug use in the past 12 months. Paper III identified four distinct substance and alcohol use patterns through LCA: non-users (36.7%), alcohol consumers (29.9%), substance users (22.7%), and both alcohol and substance users (10.8%). Prior residence (urban/rural), average monthly expenditure, and age at sexual debut were significantly associated with class membership.<br/><br/>Conclusion: Risky sexual behavior, exposure to violence, and substance and alcohol use are public health concerns among university students in Ethiopia. These issues are driven by a complex interplay of individual, behavioral, social, and environmental factors. Therefore, it is essential for universities and<br/>relevant stakeholders to design and implement targeted interventions aimed at prevention and response to these challenges within the university student population.}},
author = {{Belihu, Wudinesh Belete}},
isbn = {{978-91-8021-753-8}},
issn = {{1652-8220}},
keywords = {{Risky sexual behavior, violence, substance, alcohol, university students, Ethiopia}},
language = {{eng}},
number = {{2025:100}},
publisher = {{Lund University, Faculty of Medicine}},
school = {{Lund University}},
series = {{Lund University, Faculty of Medicine Doctoral Dissertation Series}},
title = {{Vulnerability and life style factors among university students in Ethiopia: Assessing risky sexual behavior, exposure to violence and patterns of substance use and alcohol consumption}},
url = {{https://lup.lub.lu.se/search/files/226570223/Thesis_Wudinesh_BB_LUCRIS_without_papers.pdf}},
year = {{2025}},
}