Submitted:
26 November 2024
Posted:
27 November 2024
You are already at the latest version
Abstract
Sexual development is a natural part of adolescence and can be influenced by various factors. This study involved 3,296 Polish adolescents aged 15–17 who participated in the international Health Behaviour in School-aged Children (HBSC) survey in 2018. The main dependent variable was the declared age of sexual initiation. The study examined the determinants of this age by investigating the relationship with gender and 15 factors related to lifestyle and functioning within the family, school, and social environment. The Cox proportional hazard model (aligned with censored data) revealed that frequent use of psychoactive substances is the main predictor of the age of sexual initiation (HR=5.20; 95% CI: 3.66-7.38), with even moderate use having an impact (HR=2.81; 95% CI: 2.04-3.86). Gender was not found to significantly influence the age of initiation, but the determinants did vary by gender. For boys, high physical activity and intensive socializing with peers are important factors. For girls, a positive self-assessment of appearance is more strongly associated with earlier initiation, while good academic performance and family support have a delaying effect. Effective intervention programs should consider these diverse determinants since they profoundly shape adolescents’ decisions about sexual activity and their ensuing psychological experiences.
Keywords:
1. Introduction
2. Materials and Methods
Sample
Research Tool
Lifestyle Questions
Questions on Family and Neighbourhood
Questions on Other Factors
Statistical Analysis
3. Results
Prevalence and Age of Sexual Debut
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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| Sample | Sexual debut | Age of debut | Log-rank chi-sq (p) |
|||||
|---|---|---|---|---|---|---|---|---|
| N | % | Debut N |
Censored N |
Censored % | Mean | SE | ||
| Gender | ||||||||
| Boys | 1525 | 46.2 | 404 | 1121 | 73.5 | 17.37 | 0.049 | 19.641 |
| Girls | 1774 | 53.8 | 359 | 1415 | 79.8 | 17.68 | 0.038 | (<0.001) |
| Grade | ||||||||
| 9 | 1760 | 53.3 | 222 | 1538 | 87.4 | 16.94 | 0.080 | 0.198 |
| K11 | 1539 | 46.7 | 541 | 998 | 64.8 | 17.54 | 0.039 | (0.656) |
| Lifetime experience with substance use | ||||||||
| Never or rarely | 1030 | 31.2 | 51 | 979 | 95.0 | 18.23 | 0.037 | 396.729 |
| Moderate frequency | 1640 | 49.7 | 373 | 1267 | 77.3 | 17.60 | 0.042 | (<0.001) |
| Excessive use | 629 | 19.1 | 339 | 290 | 46.1 | 16.58 | 0.069 | |
| Lifetime experience with getting drunk | ||||||||
| Never | 1750 | 53.1 | 165 | 1585 | 90.6 | 18.03 | 0.035 | 297.688 |
| 1-3 times | 994 | 30.1 | 303 | 691 | 69.5 | 17.39 | 0.055 | (<0.001) |
| 4 times or more | 555 | 16.8 | 295 | 260 | 46.8 | 16.74 | 0.079 | |
| MVPA | ||||||||
| 0-4 days | 2187 | 66.3 | 471 | 1716 | 78.5 | 17.65 | 0.035 | 42.046 |
| 5-6 days | 741 | 22.5 | 171 | 570 | 76.9 | 17.46 | 0.069 | (<0.001) |
| 7 days | 371 | 11.2 | 121 | 250 | 67.4 | 16.88 | 0.103 | |
| Unstructured activity with friends | ||||||||
| Rarely or never | 714 | 21.7 | 149 | 565 | 79.1 | 17.58 | 0.067 | 35.536 |
| Sometimes | 2228 | 67.5 | 491 | 1737 | 78.0 | 17.61 | 0.035 | (<0.001) |
| Often | 357 | 10.8 | 123 | 234 | 65.5 | 16.95 | 0.102 | |
| Organized leisure activity | ||||||||
| 0 | 1367 | 41.4 | 308 | 1059 | 77.5 | 17.64 | 0.044 | 11.033 |
| 1 | 1060 | 32.1 | 246 | 814 | 76.8 | 17.54 | 0.053 | (0.004) |
| 2+ | 872 | 26.5 | 209 | 663 | 76.0 | 17.30 | 0.066 | |
| Social self-efficacy | ||||||||
| Low | 783 | 23.7 | 170 | 613 | 78.3 | 17.58 | 0.064 | 33.827 |
| Average | 1771 | 53.7 | 360 | 1411 | 79.7 | 17.65 | 0.040 | (<0.001) |
| High | 745 | 22.6 | 233 | 512 | 68.7 | 17.25 | 0.066 | |
| Academic achievement | ||||||||
| Poor | 637 | 19.3 | 211 | 426 | 66.9 | 17.19 | 0.072 | 38.090 |
| Average | 1782 | 54.0 | 415 | 1367 | 76.7 | 17.55 | 0.040 | (<0.001) |
| Good or very good | 880 | 26.7 | 137 | 743 | 84. | 17.77 | 0.058 | |
| Sample | Sexual debut | Age of debut | Log-rank chi-sq (p) |
|||||
|---|---|---|---|---|---|---|---|---|
| N | % | Debut N |
Censored N |
Censored % | Mean | SD | ||
| Self-rated health | ||||||||
| excellent | 519 | 15.7 | 152 | 367 | 70.7 | 17.25 | 0.086 | 20.104 |
| Good | 2047 | 62.1 | 421 | 1626 | 79.4 | 17.64 | 0.037 | (<0.001) |
| fair or poor | 733 | 22.2 | 190 | 543 | 74.1 | 17.47 | 0.066 | |
| Self-rated appearance | ||||||||
| Poor | 430 | 13.0 | 82 | 348 | 80.9 | 17.60 | 0.082 | 51.894 |
| Average | 1222 | 37.1 | 218 | 1004 | 82.2 | 17.77 | 0.045 | (<0.001) |
| Good | 1647 | 49.9 | 463 | 1184 | 71.9 | 17.33 | 0.045 | |
| Family support | ||||||||
| Low | 791 | 24.0 | 230 | 561 | 70.9 | 17.28 | 0.068 | 20.999 |
| Average | 1780 | 53.9 | 378 | 1402 | 78.8 | 17.62 | 0.040 | (<0.001) |
| High | 728 | 22.1 | 155 | 573 | 78.7 | 17.51 | 0.059 | |
| Family social position | ||||||||
| Low | 711 | 21.6 | 162 | 549 | 77.2 | 17.56 | 0.066 | 28.174 |
| Average | 1953 | 59.2 | 418 | 1535 | 78.6 | 17.64 | 0.037 | (<0.001) |
| High | 635 | 19.2 | 182 | 452 | 71.2 | 17.16 | 0.078 | |
| Family structure | ||||||||
| Intact | 2509 | 76.1 | 553 | 1956 | 78.0 | 17.59 | 0.034 | |
| Step-parent | 181 | 5.5 | 52 | 129 | 71.3 | 17.21 | 0.126 | 7.491 |
| Single parent | 525 | 15.9 | 133 | 392 | 74.7 | 17.43 | 0.080 | (0.058) |
| Other | 84 | 2.5 | 25 | 59 | 70.2 | 17.03 | 0.226 | |
| Family affluence | ||||||||
| Low | 909 | 27.9 | 204 | 705 | 77.6 | 17.60 | 0.056 | 2.378 |
| Average | 1580 | 48.5 | 367 | 1213 | 76.8 | 17.53 | 0.044 | (0.304) |
| High | 770 | 23.6 | 182 | 588 | 76.4 | 17.49 | 0.064 | |
| Place of living | ||||||||
| Rural areas | 1346 | 40.9 | 300 | 1046 | 77.7 | 17.57 | 0.048 | 2.351 |
| Small towns | 1105 | 33.6 | 268 | 837 | 75.7 | 17.54 | 0.051 | (0.309) |
| Large cities | 839 | 25.5 | 192 | 647 | 77.1 | 17.33 | 0.057 | |
| Neighbourhood SES | ||||||||
| Low | 203 | 6.2 | 60 | 143 | 70.4 | 17.11 | 0.131 | 13.758 |
| Average | 2441 | 74.1 | 526 | 1915 | 78.5 | 17.62 | 0.034 | (0.001) |
| High | 649 | 19.7 | 176 | 473 | 72.9 | 17.30 | 0.072 | |
| Factor | Categories | B | SE | p | HR | 95% CI for HR | |
|---|---|---|---|---|---|---|---|
| lower bound | upper bound | ||||||
| Lifetime experience with substance use |
never or rarely* | <0.001 | |||||
| moderate use | 1.033 | 0.162 | 0.000 | 2.81 | 2.04 | 3.86 | |
| excessive use | 1.648 | 0.179 | 0.000 | 5.20 | 3.66 | 7.38 | |
| Lifetime experience with getting drunk | Never* | <0.001 | |||||
| 1-3 times | 0.381 | 0.108 | 0.000 | 1.46 | 1.18 | 1.81 | |
| 4 times or more | 0.579 | 0.123 | 0.000 | 1.78 | 1.40 | 2.27 | |
| Family support |
Low* | <0.001 | |||||
| Average | -0.348 | 0.090 | 0.000 | 0.71 | 0.59 | 0.84 | |
| High | -0.451 | 0.115 | 0.000 | 0.64 | 0.51 | 0.80 | |
| MVPA |
0-4 days * | 0.002 | |||||
| 5-6 days | 0.088 | 0.092 | 0.337 | 1.09 | 0.91 | 1.31 | |
| 7 days | 0.384 | 0.107 | 0.000 | 1.47 | 1.19 | 1.81 | |
| Academic achievement |
Poor* | 0.001 | |||||
| Average | -0.139 | 0.088 | 0.113 | 0.87 | 0.73 | 1.03 | |
| good or very good | -0.416 | 0.115 | 0.000 | 0.66 | 0.53 | 0.83 | |
| Unstructured activity with friends |
rarely or never* | 0.001 | |||||
| Sometimes | -0.104 | 0.096 | 0.283 | 0.90 | 0.75 | 1.09 | |
| Often | 0.278 | 0.126 | 0.027 | 1.32 | 1.03 | 1.69 | |
| Organized leisure activity | 0* | ||||||
| 1 | 0.083 | 0.089 | 0.352 | 1.09 | 0.91 | 1.29 | |
| 2+ | 0.258 | 0.094 | 0.006 | 1.29 | 1.08 | 1.56 | |
| Self-rated health |
excellent * | 0.022 | |||||
| Good | -0.254 | 0.098 | 0.010 | 0.78 | 0.64 | 0.94 | |
| fair or poor | -0.108 | 0.120 | 0.370 | 0.90 | 0.71 | 1.14 | |
| Self-rated appearance | Poor* | 0.021 | |||||
| Average | -0.041 | 0.133 | 0.756 | 0.96 | 0.74 | 1.25 | |
| Good | 0.355 | 0.130 | 0.006 | 1.43 | 1.11 | 1.84 | |
| Family social position |
Low* | <0.001 | |||||
| Average | 0.002 | 0.098 | 0.986 | 1.00 | 0.83 | 1.21 | |
| High | 0.428 | 0.117 | 0.000 | 1.53 | 1.22 | 1.93 | |
| Social self-efficacy |
Low* | <0.001 | |||||
| Average | -0.127 | 0.098 | 0.193 | 0.88 | 0.73 | 1.07 | |
| High | 0.195 | 0.109 | 0.073 | 1.22 | 0.98 | 1.50 | |
| Factor | Categories | Boys | Girls | ||||||
|---|---|---|---|---|---|---|---|---|---|
| rank | HR | 95% CI | p | rank | HR | 95% CI | p | ||
| Lifetime experience with substance use |
never or rarely* | 0.000 | 0.000 | ||||||
| moderate use | 1 | 2.51 | 1.68-3.73 | 0.000 | 1 | 3.42 | 2.01-5.84 | 0.000 | |
| excessive use | 4.30 | 2.73-6.75 | 0.000 | 7.05 | 3.97-12.50 | 0.000 | |||
| Lifetime experience with getting drunk |
Never* | 0.003 | 0.001 | ||||||
| 1-3 times | 7 | 1.38 | 1.03-1.84 | 0.030 | 2 | 1.67 | 1.22-2.30 | 0.002 | |
| 4 times or more | 1.77 | 1.27-2.46 | 0.001 | 2.01 | 1.40-2.87 | 0.000 | |||
| Family support |
Low* | 0.007 | 0.002 | ||||||
| Average | 6 | 0.66 | 0.51-0.86 | 0.002 | 4 | 0.76 | 0.60-0.96 | 0.021 | |
| High | 0.71 | 0.52-0.97 | 0.029 | 0.55 | 0.40-0.78 | 0.001 | |||
| MVPA |
0-4 days* | 0.005 | |||||||
| 5-6 days | 3 | 1.03 | 0.81-1.31 | 0.813 | - | - | - | - | |
| 7 days | 1.51 | 1.16-1.96 | 0.002 | ||||||
| Academic achievement |
Poor* | 0.020 | |||||||
| Average | - | - | - | - | 5 | 0.98 | 0.76-1.26 | 0.874 | |
| good or very good | 0.64 | 0.45-0.91 | 0.013 | ||||||
| Unstructured activity with friends |
rarely or never* | 0.028 | 0.017 | ||||||
| Sometimes | 8 | 0.929 | 0.74-1.17 | 0.531 | 6 | 0.90 | 0.61-1.31 | 0.566 | |
| Often | 1.390 | 1.00-1.99 | 0.049 | 1.34 | 0.87-2.08 | 0.186 | |||
| Organized leisure activity | 0* | 0.005 | |||||||
| 1 | 5 | 1.12 | 0.87-1.45 | 0.365 | - | - | - | - | |
| 2+ | 1.51 | 1.17-1.95 | 0.002 | ||||||
| Self-rated health |
Excellent* | 0.002 | |||||||
| Good | 4 | 0.65 | 0.52-0.82 | 0.000 | - | - | - | - | |
| fair or poor | 0.71 | 0.53-0.97 | 0.032 | ||||||
| Self-rated appearance | Poor* | 0.000 | |||||||
| Average | - | - | - | - | 3 | 1.06 | 0.76-1.49 | 0.736 | |
| Good | 1.72 | 1.24-2.38 | 0.001 | ||||||
| Family social position |
Low* | 0.000 | |||||||
| Average | 2 | 1.20 | 0.90-1.61 | 0.211 | - | - | - | - | |
| High | 1.80 | 1.30-2.49 | 0.000 | ||||||
| Social self-efficacy |
Low* | 0.030 | 0.046 | ||||||
| Average | 9 | 0.84 | 0.64-1.09 | 0.386 | 7 | 0.92 | 0.69-1.21 | 0.538 | |
| High | 1.14 | 0.85-1.52 | 0.188 | 1.25 | 0.91-1.72 | 0.162 | |||
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