Original Article Singapore Med J 2006; 47(6) : 476 Premarital sexual intercourse among adolescents in Malaysia: a crosssectional Malaysian school survey Lee L K, Chen P C Y, Lee K K, Kaur J ABSTRACT Introduction: Sexual intercourse among Malaysian adolescents is a major concern, especially with the worry of HIV/AIDS. This study was done to determine the prevalence of sexual intercourse among secondary school students aged 12 to 19 years in Negeri Sembilan, Malaysia.
Methods: This is a cross-sectional school survey conducted on 4,500 adolescent students based on a structured questionnaire. Data were collected using the selfadministered questionnaire (translated version of the Youth Risk Behaviour Surveillance in Bahasa Malaysia). Results: The study showed that 5. 4 percent of the total sample were reported to have had sexual intercourse. The proportion among male students who had had sex was higher (8. 3 percent) compared with female students (2. 9 percent). The mean age at ? rst sexual intercourse was 15 years.
One percent of students reported that they had been pregnant or had made someone else pregnant. Adolescent sexual intercourse was signi? cantly associated with (1) sociodemographical factors (age, gender); (2) environmental factors (staying with parents); and (3) substance use (alcohol use, cigarette smoking, drug use), even after adjustment for demographical factors. The survey showed that 20. 8 percent of respondents had taken alcohol, 14. 0 percent had smoked cigarettes, 2. 5 percent had tried marijuana, 1. 2 percent had tried ecstasy pills, 2. percent had tried glue snif? ng, 0. 7 percent had tried heroin, and 0. 7 percent had intravenous drugs. Conclusion: Prevalence of sexual intercourse among Malaysian adolescents was relatively low compared to developed countries. However, certain groups of adolescents tend to be at higher risk of engaging in sexual intercourse. This problem should be addressed early by targeting these groups of high-risk adolescents. Keywords: behaviour, abuse adolescents, premarital sex sexual intercourse, substance Singapore Med J 2006; 47(6):476-481
Department of Community Medicine International Medical University Plaza Komanwel Bukit Jalil Kuala Lumpur 57000 Malaysia Lee L K, MD, MPH Senior Lecturer Chen P C Y, MD, MPH Professor Clinical Sciences Section Kaur J, MSc Senior Lecturer Seremban Specialist Hospital Seremban 70200 Malaysia Lee K K, MD, MRCOG Consultant Obstetrician and Gynaecdogist Correspondence to: Dr Lee Lai Kah Tel: (60) 3 8656 7228 Fax: (60) 3 8656 7229 Email: laikah_lee@ imu. edu. my INTRODUCTION The topic on sexuality has largely remained a taboo subject in Malaysia.
Despite this, there are increasing numbers of sexual activities reported among Malaysian youth(1-3). Due to sensitivity of this issue, adolescents receive inadequate education, guidance and services on reproductive health appointments (4). With their limited knowledge about their bodies and their sexuality, adolescents find themselves vulnerable to sexually transmitted diseases and infections, including HIV/AIDS, unplanned early childbearing and unsafe abortions. In the USA, sexual behaviour differed by ethnicity, age, and urban/rural location(5).
In Thailand and the Philippines, family structure was associated with premarital sex: youths living with one parent have higher rate of sexual activity than those living with both parents(6). For many adolescents, experimenting with tobacco, alcohol, sex, and drugs are rites of passage. Associations between sexual activity and substance use have been a consistent research finding. In Kenya, the single most important predictor of sexual activity among adolescent women was the use of alcohol, drugs, or tobacco(7). Studies from the USA also reported similar findings(8,9).
The purpose of this study is to describe the prevalence of premarital sexual intercourse and the determinants of sexual intercourse among Malaysian secondary school students. Data on premarital sex in Malaysia with its multi-ethnic background and rapid modernisation is interesting because data from Western countries may not be applicable to this country. This study hopes to provide updated information on premarital sex Singapore Med J 2006; 47(6) : 477 among the adolescents in Malaysia, and specifically in Negeri Sembilan.
METHODS This is a cross-sectional descriptive study that was carried out from June 2001 to August 2001. The study was conducted in seven districts (Seremban, Port Dickson, Kuala Pilah, Jempol, Jelebu, Tampin and Rembau) in Negeri Sembilan (purposeful sampling of one of the states in Malaysia). Sampling of schools was done using strati? ed random sampling. Schools were divided, based on their districts and locality, into either urban or rural. Six schools were chosen randomly from the urban areas and eight schools from the rural areas.
Urban areas were de? ned as gazetted areas with their adjoining built-up areas that had a combined population of 10,000 or more at the time of the year 2000 census. Other areas with populations less than 10,000 people were considered rural areas. The study population consisted of students (aged 12-19 years) in form 1 to form 6 (form here refers to the grades of schools according to the age of the students). Two classes were randomly chosen from each form to be the study sample, resulting in a sample of 4,500 secondary school students.
Response rate was calculated based on the number of questionnaires distributed and the number of questionnaires collected back at the end of the session. Data were collected using the supervised selfadministered questionnaire. The questionnaire was established with reference to the Youth Risk Behaviour Surveillance conducted in the USA(10). It had been translated into Bahasa Malaysia and retranslated back to English to ensure accuracy of translation into Bahasa Malaysia. The questionnaires were pretested in one of the schools in Negeri Sembilan, before they were used in the ? eld, to ensure clarity of questions.
Ambiguous questions were revised before the questionnaire was ? nalised and printed. Consent was sought from the State Education Department, school management and all study participants. To ensure maximal response, students were assured that the information gathered would be treated con? dentially by strongly emphasising the anonymity of questionnaire responses. To maximise con? dentiality of answers, teachers were not present during the survey and no discussions were permitted throughout the survey. Background information about the respondents includes age, gender, education level, ethnic group and religion.
Questions related to sexual behaviour include (a) “Have you ever had sexual intercourse? ”, (b) “How old were you when you had sexual intercourse for the ? rst time? ” and (c) “Have you ever been pregnant or ever made a girl pregnant? ” Questions related to smoking and alcohol include “During the past 30 days, on how many days did you smoke cigarettes? ”, “During the past 30 days, on how many days have you had at least one drink of alcohol? ” and “During the past 30 days, on how many days did you have ? ve or more drinks of alcohol in a row and within a few hours? ”.
Substance use was based on responses to the questions on each substance: “During your life, how many times have you used marijuana, used ecstasy pills, sniffed glue, used heroin, or used a needle to inject an illegal drug? ” Analysis was done on factors that were possibly related to the adolescents? sexual behaviour. Statistical signi? cance of differences between 2 groups was tested using ? test. Factors related to the adolescents? sexual activity were analysed using multiple logistic regression. The statistical analysis was performed using Statistical Package for Social Sciences (SPSS) version 11. (Chicago, IL, USA). However, owing to some missing answers to certain survey questions, the denominator used in percentage computation varies according to the responses obtained for the survey question. RESULTS Response rate was 100% as all the 4,500 questionnaires distributed were collected back. Levels on non-response to questions on sexual intercourse were quite low – less than 1% (n=35). Of the total sample (4,500 adolescents), 53. 6% of the respondents were female, 46. 4% were male (Table I). The mean age was 15. 3 years of age (median 15). In terms of ethnic group distribution, there were 51. % Malay, 29. 2% Chinese, 17. 1% Indian and 1. 8% from other ethnic groups (mainly indigenous people) (Table I), which re? ect the ethnic breakdown of the population in Malaysia. More of the adolescents (51. 7%) were from the urban areas as compared to rural areas (48. 3%) (Table I), which is in proportion to the urban/rural population in Negeri Sembilan. 5. 4% of the total sample were reported to have had sexual intercourse (Table I). The proportion among males who had had sex was 8. 3% compared with 2. 9% of females, and the difference was statistically signi? cant (p
