- Open Access
Drinking alcohol raises the chance of premarital sex by four folds among secondary school adolescent students in Jima Arjo, Southwestern Ethiopia, 2018: a school-based cross-sectional study
Contraception and Reproductive Medicine volume 7, Article number: 4 (2022)
Premarital sexual practice is sexual intercourse performed before formal marriage. Pre-marital sexual practice increases adolescents’ risk for having multiple sexual partners, (sexually transmitted disease) STDs, and unintended pregnancy.
The study aimed to assess the prevalence of premarital sexual practice and associated factors among secondary school (9–12 grade) students in the Jima Arjo district.
Institutional-based cross-sectional study design was conducted among adolescent students from May 1st to 15th using a pre-tested and structured questionnaire. A systematic random sampling technique was employed to select study participants. The collected data was cleaned and entered into(statistical package for social science) SPSS version 20. Factors associated with the pre-marital sexual practice were identified by multiple logistic regression analyses.
The over all premarital sexual practice in this study area was 24.4%. Being alcoholdrinker(AOR[95%CI] = 3.78[1.49,22.08]),havingaboy/girlfriend(AOR[95%CI] = 5.07[3.74,26.47]), (being male) (AOR[95%CI] = 2.9[1.78,37.8]); urban residence (AOR[95%CI] = 6.44 [1.95,25.84]).
The study revealed that a significant proportion of adolescent students in this study area practiced premarital sex. Being male sex, urban residence, using alcohol use and having a boy/girlfriend significantly affect premarital sexual practice. Therefore, school and community-based sexual health education, and communication need to be intensified to reduce premarital sex and further health consequences.
World Health Organization (WHO) defines adolescent people as those between the ages of 10 to 19 years . Adolescence is the period of transition from childhood to adulthood at which young people experience significant physiological, psychological, and social changes following puberty; but do not immediately assume the roles and responsibilities of adulthood [2, 3].
These segments of the population account for one-fifth of the total world population and the majority(84%) of them are living in low and middle-income countries . Ethiopia is one of the top ten countries with the greatest number of young populations .
Premarital sex is sexual intercourse performed between couples before marriage . Globally sexual activities among adolescents have been reported to be increasing and Sub-Saharan Africa too . In Ethiopia, the proportion of adolescents engaged in pre-marital sex ranges from 15 to 65% based on evidence from a study conducted in different parts of the country [7,8,9,10,11,12].
Evidence suggested that premarital sexual intercourse with multiple sexual partners has major problems on subsequent marital sexual satisfaction related to physiological and emotional characteristics which could result in divorce [13, 14].
Adolescent living in single-parent or with stepparents initiates sexual activity earlier than those in two-parent families whereas, feelings of closeness and connectedness to parents, parental disapproval of sex, and positive peer influences have been shown to delay sexual activity .
Abstinence from sex before marriage, delay of a sexual debut, and condom use are the major strategies used to reduce the spread of HIV infection in Ethiopia. However, school-based studies revealed that the prevalence of the premarital sexual practice and unprotected sexual practice is yet a common threat among school adolescents. Study on school adolescent premarital sex is not commonly conducted at periphery(district) level . And also adolescents receive inadequate education, guidance, and services on reproductive health and this may lead them to practice premarital sex .
Early sexual initiation before marriage could be the reason to have multiple sexual partners which increase the chance of acquiring and transmitting sexually transmitted disease including HIV/AIDS . Because consistent condom use is less among young people practicing sex at their early age . Not only this but also unintended pregnancy is a serious problem of teenagers or adolescents practicing unsafe sex where 60% of adolescents’ pregnancy is unwanted or unintended resulted from unprotected sexual intercourse in Ethiopia [13, 18]. This could be the reason for not declining AIDS-related death and new HIV infections among adolescents . Therefore this study was very important to identify the magnitude of premarital sex and associated factors among school adolescents in this study area.
Study area and period
The study was conducted in Jima Arjo district high school (9-12th grade) students, East Wollega Zone, Western Ethiopia from 1st to 15th of May 2018 GC. Jima Arjo district is one of the seventeenth districts of East Wollega Zone located at 379 Km to the west of Addis Ababa in the western part of Ethiopia and 48 km from Nekemte town, the capital city, of East Wollega Zone. The district has an estimated total population of 114,175 of which 55,946 were males and 58,229 were females. There were 3676 high school students (1903 males and 1773 females). The district has three public high schools, twenty Health posts, four Health Centers, one public hospital, and twelve private clinics.
The institutional-based quantitative cross-sectional study design was conducted among Jima Arjo District secondary school students. The Source population of this study was all 9th -12th grade secondary school students attending regular class in the 2018 GC academic year, in the Jima Arjo district and the study population was selected students from 9th -12th -grade secondary school students attending regular class during the study period.
All students aged 15 to 19 years, and attending regular class at the time of data collection were included. Those sick and unable to respond to the questionnaire were excluded from the study.
Sample size determination
The required sample size was calculated by single population proportion formula using the following assumptions: the proportion of premarital sex among Jima school adolescents (25%) ; 95% confidence level, 5% precision between a sample and population parameter, and 10% possible none response rate.
Z = the z-score associated with selected degree of confidence interval at 95% confidence Interval is 1.96.
P = estimated percentage based on past study, 25% (0.25),d = margin of error 5%(0.05).
n = sample size.
Computed with the above formula n = 288 and 10% non respondense rate given a total sample size of 317.
First, the three high schools, Arjo, Gombo, and H/kumba were included in the study. Then students were classified according to their schools. Then stratified based on their grades (9th, 10th, 11th, and 12th). And sample was proportionally allocated to the size of each grade and. Finally, a simple random sampling technique was employed to select the participants using their roster as a sampling frame and their Id. The number was used to select individuals participants using a computer-generated random number.
Data collection tool and procedures
The structured self-administered questionnaire was used to collect information from secondary school students in the Jima Arjo district. It was prepared in English and translated to Afan Oromo (the local Language) by an expert of both languages and was translated back to English to ensure its consistency. Pretest was done at Getema secondary school and a necessary amendment was taken before using the tool for actual data collection. Four data collectors were involved in data collection, and they were trained on how to approach respondents, the contents of the tool, and the objectives of the study. In addition, to the principal investigator, two supervisors were assigned to assist data collectors to check for completeness and consistency of a questionnaire.
An individuals who are between the ages of 10–19 years old.
Premarital sexual practice
Sexual intercourse performed before formal marriage.
Age of sexual debut
The age at which the first sexual initiation occurred.
Early sexual debut
Defined as having sexual intercourse before the age of 18 years.
Variables of the study
Premarital sexual practise.
Socio-demographic variables: (Age, sex, residence, grade level, Living arrangement, parental education, and marital status of parents.
Socio-economic factors: family monthly income and Pocket money of students.
Sexual history and reasons to start sexual practice: Having (boy/girlfriends), fall in love, sexual desire, peer pressure, money/Gift, Watching Pornographic film/sex movies, and rape.
Substance abuse: (alcohol consumption, chewing khat, smoking cigarette, and shisha).
Data processing and analysis
After data collection, data were checked manually for completeness and consistency. It was sorted, entered, cleaned, and processed by SPSS version 20. Descriptive statistics were done to compute frequency; percentage, mean and median based on the type of data. Binary logistic regression was conducted and COR, with 95% CI was estimated to select the candidate variables for the final model. Then, variables with a p-value of < 0.25 at binary logistic regression were taken into a multivariable logistic regression to control confounding. Hosmer-Lemeshow goodness-of-fit with stepwise (backward elimination) logistic regression was used to test for model fitness. AOR with 95% CI was estimated to assess the presence of association at multivariable logistic regression. Finally, variables with a p-value of < 0.05 were considered as statistically significant predictors of the outcome variable.
Data Quality management
The quality of data was assured by properly designed and pre-tested questionnaires, trained data collectors, and supervisors for data collection procedures. The Instrument was pretested on 5% of the respondents at Getema high school and amendment was taken accordingly. Every day, the collected questionnaires were reviewed and checked for completeness by the supervisors and principal investigator. The necessary feedback was offered to data collectors before the actual procedure. Data quality was also ensured by coding, cleaning, and double-entry of at least 5% of the questionnaires.
Socio-demographic characteristics of adolescent students in Jima Arjo district
A total of 312 students participated in the study, making a response rate of (98.4%). Among the respondents, 170 (54.5%) were males in sex, and their ages ranged from 14 to 19 years with a mean age of 17.29 (± SD1.10) years. Most of them, 238 (76.3%) were grade 9th − 10th. The majority of the participants, 280 (89.7%), were Oromo and the remaining 32 (10.3%) were Amara.
By religion, 161(51.6%) were Protestant, 41(45.2%) were Orthodox and the rest 10(3.2%) were Muslims. The majority of them, 190(60.9%) were rural and 122 (39.1%) urban residents (Table 1).
Premarital sex and other sexual characteristics of adolescent students in Jima Arjo district
Among all adolescent students who took part in the study, 213(68.3%) had no boy/girlfriends the rest 99 (31.7%) had boy/girlfriends. Seventy-six (24.35%) of them responded that they experienced premarital sexual intercourse; 44(14.10%) males and 32(10.25%) females respectively.
The minimum age at the first sexual practice of participants was 13 and the maximum age was 19 years. The main reasons reported by respondents for the sexual debut were falling in love(39.4%) followed by peer pressure(11.8%) (Fig. 1). The majority of those who experienced premarital sexual intercourse 59(77.6%) had 1 sexual partner,17(22%) have > 2 partners. The majority of the respondents had boy/girlfriends 45 (59.2%) (Table 2).
Substance use and other sexual behaviors of adolescent students in Jima Arjo district
About twenty-six percent of the respondents, 80(25.6%) reported that they use a substance like alcohol, khat, and cigarette/shisha. Fifty-one (16.3%) of them use alcohol, 17(5.4%) use Khat, 12(3.8%) smoke cigarettes or shisha.
Among the study participants who have experienced premarital sex(76 students), a larger proportion, 67(88.2%) of them had sexual intercourse 12 months before the survey.
Concerning the total number of partners, they have had in the past 12 months; 51(76.1%) of them had sex with only one partner, 13(19.4%) had sex with two partners and the rest 3(4.4%) had had sex with over two partners.
The majority, 47(61.8%) of the respondents in this study area did not use a condom during their last sexual intercourse. The main reason mentioned by respondents for not using a condom was: didn’t know how to use 14(29.6%), ashamed to ask partner 13(27.6%), ashamed to buy condom 6(12.7%), trust their partner 5(10.6%), decreased their sexual satisfaction 3(6.3%) and the rest 3(6.3%) of them were not using a condom because the condom was not easily available(Table 3).
Factors associated with premarital sexual practice among adolescent students
Socio-demographic variables, sex of the respondents, Ethnic group of the respondents, the residence of the respondents, Grade level of the respondents, parent marital status of the respondents, and from the socioeconomic variables monthly income of family and pocket money of the respondents were evaluated using logistic regression against the premarital sexual practice.
In the final multivariate logistic regression model; sex, residence, substance use/alcohol use, and having a girl/boyfriend were statistically significant to affect respondents premarital sexual practice. Male adolescents were more likely to be involved in premarital sexual experience than females (AOR [95%CI] = 2.9[1.78,37.8]). Urban residents were more likely to involve in premarital sex than rural (AOR[95%CI] = 6.44[1.95,25.84]). Students of grade 9th had 93% lesser odds of practicing premarital sex compared to grade 12th-grade students (AOR[95%CI] = 0.07[0.01,0.81]). Adolescents who drink alcohol were about four times more likely to practice premarital sex compared to respondents who did not use alcohol (AOR[95%CI] = 3.78[1.49,22.08]). Respondents who had a boy/girlfriend were 5.08 times more likely to practice premarital sex compared to their counterparts (AOR [95%CI] = 5.07[3.74,26.47]).
But Ethnicity, Parent marital status, having pocket money, Parent monthly income, cigarette/hashish use did not show statically significant association with premarital sexual intercourse among high school adolescent students in the Jimma Arjo district (Table 4).
In this study, 24.4% of the adolescent students had premarital sex. This is in line with the finding from a study conducted in Jima preparatory adolescent and Agaro high school adolescent students which revealed premarital sex of 25% each [9, 20]. But lower than a study in Sebeta secondary school (9–12 grade) adolescent students, 28.4% , southeast Ethiopia(31.2%) , southwest Ethiopia (43.8%) , and northwest Ethiopia(60.2%) . This could be due to participants of Jima Arjo are less susceptible to the effect of globalization because they are far from the capital Addis Ababa and they may have less access to sexually explicit materials like pornographic films which could lead them to practice premarital sex. Another possible explanation could be because northwest Ethiopia, Debra tabor town, was a zonal town having higher education institutions like Debra Tabor University which could increase the number of young populations with increased demand for sexual practice. The finding from southwest Ethiopia has a different study setting from this study which was conducted in Rift Valley University.
Premarital sex in this study area was higher than that of Nekemte town (21.4%) , Alamat 21.1% , Ambo high school adolescent student19.4% , North Gojjam 19% , and Sidama zone 18% . This might be due to the variation of study area or study period(2010–2016), which shows changing and improving trend in reporting premarital sex or globalization which tend to increase access to social media ann other sexually explicit material which could have a role in increasing chance of premarital sex in this study area.
In the multivariable logistic regression model, Sex of the respondent has an association with premarital sexual practice. Males were about three times more likely to practice premarital sex than females. The finding of this study was in line with Gedeo zone high school adolescents , Nekemte town high school adolescent students , Ashendi town west Gojjam , Ambo high school adolescents students , Balegoba , Wollega University .
The residence of the respondents was also associated with premarital sexual practice. The adolescent students from urban were 6.44 times more likely to be engaged in pre-marital sexual practice than their counterparts. This finding is consistent with the study conducted in Alamata high school adolescent students , Jimma town school adolescent students , and Eastern Ethiopia . This could be due to liberal lifestyles in urban areas compared to cultural conservatism in rural areas, and may also be attributed to the easiness of reporting pre-marital sex by urban adolescents. The urban environment provides a conducive environment for experimenting with sex before marriage and adolescent students in urban get access to sexually explicit materials which could increase the chance of practicing premarital sex [12, 24, 26].
The grade level or educational level of the student had an association with the prevalence of premarital sexual practice which is consistent with the study conducted in Sebeta high school adolescents  and in Eastern Ethiopia . The most likely explanation might be; as the grade level of grade increase chance of departure from parents increase, parental control gets weaken, which leads them to engage in premarital sexual practice.
Also, as their grade level increase, age increase, which in turn increase premarital sex .The adolescent student who uses alcohol was about four times more likely to practice premarital sex. This was consistent with a study conducted in Jimma town school adolescents , North East Ethiopia high school adolescent students , West Shewa Zone school adolescent students , Mada Walabu university , Jimma zone school adolescent . The reason might be, drinking alcohol decrease self-control and predispose to risky sexual behavior such as unplanned, unprotected sexual intercourse including premarital sex.
Adolescents who have a boy/girlfriends were about 5 times more likely to involve in premarital sexual practices than those who do not have a boy/girlfriend and consistent with a study done in Alamata high school adolescent students , Nekemte high school adolescent students , and Jigjiga University students . This could be because of the pressure from their girl/boyfriend to have a sexual practice which is the second common reason (11.8%) why adolescents practiced premarital sex.
The study has different limitations. First; the study used a cross-sectional study design that cannot establish trends and causality between premarital sex and risk factors. Second, the data was collected using a self-administered questionnaire which may be subjected to recall bias and under-reporting of premarital sex among respondents because of social desirability bias. Finally, the study was school-based which might have missed the adolescent not attending the school. Despite the limitations, this study has valuable finding which encourages the family, community, teachers and other stakeholders to give attention for their adolescent students.
The study revealed that a significant proportion of adolescent students in this study area practiced premarital sex. Being male in sex, urban residence, having boy/girlfriends, and drinking alcohol were found to affect adolescent students’ premarital sexual practice. Therefore, families, the community, and the School should closely communicate with adolescent students about their sexuality and problem behaviors putting them at risk of premarital sex or further health consequences. Those stakeholders should be transparent and provide adolescent students with health education, and communication-related to sexual and reproductive health in collaboration with local health professionals. Further qualitative research should be conducted to explore the concern of key informants and adolescents on premarital sex and its associated factors.
Availability of data and materials
The corresponding author can make the required data and material whenever needed.
Acquired Immuno Deficiency Syndrome
Adjusted Odds Ratio
Crude Odds Ratio
Human Immunodeficiency Virus
Risky Sexual Behaviour
Sexually Transmitted Disease
World Health Organization
UNDO/UNFPA/WHO. Special Program of Research Development and Research Training in Human Reproductive Health (HRP), Progress in Reproductive Health Research.World Bank. No 64, 2003.
UNPF/WHO. Strengthening the Provision of Adolescent - Friendly Health Service to meet the health and development needs of adolescents in Africa. A consensus statement, Harare, Zimbabwe, 17–21, Oct.2000.
Anna C. Bocar, Noeme C Perez, Students’ perception towards premarital sex, Ozamiz City, Philippines, 2013.
Dessalegn W. - An assessment of premarital sexual practice and factors contributing to premarital sex among high school adolescents in Nekemte town, E/wollega zone, Oromia regional state. 2006.
United Nations, Department of Economic and Social Affairs, Population Division. World Population Prospects: The 2010 Revision, Volume I: Comprehensive Tables. ST/ESA/SER; 2011.
Tomas B. Asfew N & Anteneh K: Prevalence of premarital sexual practice and associated factors among undergraduate health science students of Madawalabu University, Bale Goba:, Pan African Medical Journal,2015.
Tekletsadik E, Shaweno D, Daka D. “Prevalence, associated risk factors and consequences of premarital sex among female students in Aletawondo High School, Sidama Zone, Ethiopia.“ J Public Health Epidemiol 6.7 (2014): 216–22.
Bogale A, Seme A. Premarital sexual practices and its predictors among in-school youths of shendi town, west Gojjam zone, North Western Ethiopia. Reprod Health. 2014;11:49. https://doi.org/10.1186/1742-4755-11-49.
Taye A, Asmare I. Prevalence of Premarital Sexual Practice and Associated Factors among Adolescents of Jimma Preparatory School Oromia Region, South West Ethiopia,2016. J Nurs Care 5: 332. https://doi.org/10.4172/2167-1168.1000332.
Hagisso SN, Handiso TB. Prevalence of premarital sexual practice and associated factors among Goba town high school students, South East-Ethiopia. J Clin Intensive Care Med. 2020;5:001–6. https://doi.org/10.29328/journal.jcicm.1001027.
Meleko A, Mitiku K, Kebede G, Muse M, Moloro N. Magnitude of Pre-marital Sexual Practice and its Associated Factors among Mizan Preparatory School Students in Mizan Aman Town, South West Ethiopia. J Community Med Health Educ. 2017;7:539. https://doi.org/10.4172/2161-0711.1000539.
Arega, et al. Premarital sexual practice and associated factors among high school youths in Debretabor town, South Gondar Zone, North West Ethiopia, 2017. BMC Res Notes. 2019;12:314. https://doi.org/10.1186/s13104-019-4348-3.
Christensen S. “The Effects of Premarital Sexual Promiscuity on Subsequent MaritalSexualSatisfaction“(2004). ThesesandDissertations.138.https://scholarsarchive.byu.edu/etd/138.
Helen M, Alvare, Saying Yes before Saying I Do: Premarital Sex and Cohabitation as a Piece of the Divorce Puzzle, vol.18,2012.
Barbara S, Ann, k. and Monica G. what has happened to premarital sexual Behavior as the age of marriage has risen? Brief no. 26 September 2007; accessed from: https://www.popcouncil.org/uploads/pdfs/TABriefs/PGY_Brief26_SexualInitiation.pdf.
Behulu GK, Anteneh KT, Aynalem GL. Premarital sexual intercourse and associated factors among adolescent students in Debre-Markos town secondary and preparatory schools, northwest Ethiopia, 2017. BMC Res Notes. 2019;12:95. https://doi.org/10.1186/s13104-019-4132-4.
Manlove J, Ryan S, Franzetta K. Risk and protective factors associated with the transition to a first sexual relationship with an older partner. J Adolesc Health. 2007;40:135–43.
Getabalew E, Mitsiwat A. Assessment of Premarital Sexual Practices and Determinant Factors among High School Students in West Shoa Zone, Oromia Regional State, Ethiopia. Sci J Public Health Vol. 2015;3(2):229–36. https://doi.org/10.11648/j.sjph.20150302.21.
Idele, et al. epidemiology of HIV and AIDS among adolescents. J Acquir Immune Defic Syndr Volume 66, Supplement 2, July 1, 2014.
Girma B, Assefa D, Tushunie K. Determinants of condom use among Agaro high school students using behavioral models. [Ethiop J Health Dev. 2004;18(1):25–30].
Getachew MK, Emebet BW&, Nurilign AM. Prevalence of Premarital Sexual Practice and Associated Factors among Alamata High School and Preparatory School Adolescents, Northern Ethiopia. Global Journal of Medical Research: Interdisciplinary Volume 14 Issue 3 Version 1.0 the Year 2014.
Abdissa B, Addisie M, Seifu W. Premarital Sexual Practices, Consequences and Associated Factors among Regular Undergraduate Female Students in Ambo University, Oromia Regional State, Central Ethiopia, 2015. Health Sci J. 2017;11:1.
Teferra TB, Erena AN, Kebede A. Prevalence of premarital sexual practice and associated factors among undergraduate health science students of Madawalabu University, Bale Goba, South East Ethiopia: an institution-based cross-sectional study. Pan Afr Med J. 2015 Mar;6:20:209. https://doi.org/10.11604/pamj.2015.20.209.4525. PMID: 26113940; PMCID: PMC4470411.
Regassa T, Chala D, Adeba E. Premarital Sex in the Last Twelve Months and Its Predictors among Students of Wollega University, Ethiopia. Ethiop J Health Sci. 2016;26(4):351–8. https://doi.org/10.4314/ejhs.v26i4.7.
Abay M, Endgashet S, Etana B, et al. Magnitude of Premarital Sex and Associated Factors among Preparatory School Students in Alamata Town, North Ethiopia, 2014. Res Reviews: J Health Professions. 2016;6(2):12–20p.
Oljira L, Berhane Y, Worku A. Pre-marital sexual debut and its associated factors among in-school adolescents in eastern Ethiopia. BMC Public Health. 2012;12:375. https://doi.org/10.1186/1471-2458-12-375.
Endalew D, Gebremichael B, Tesfa M, Asmamaw T. Premarital Sexual Practice and Risky Sexual Behaviors Associated with it among Secondary School Adolescents, South East Ethiopia: A Mixed Design Study. J AIDS Clin Res. 2018;9:775. https://doi.org/10.4172/2155-6113.1000775.
Gebretsadik AM, Babbel NF. Family Environment and Sexual Behaviours in Jimma Zone, South West Ethiopia. Sci J Public Health. 2014;2(6):539–45. https://doi.org/10.11648/j.sjph.20140206.17.
Alelign T. Sexual experience and their correlates among Jigjiga University students. [Mph thesis]. Addis Ababa University; May 2011.
The authors like to acknowledge Wollega University, Institute of Health Sciences, School of post-graduate studies, and their library for giving us support. In addition, we would like to thank the study participants, data collectors, and supervisors.
Ethics approval and consent to participate
Ethical clearance was obtained from Wollega University, School of graduate studies Ethical Review committee. Permission for conducting the study was secured from the Jima Arjo town Health office. Written consent was obtained from the teachers for those younger than 18 years and from study participants after they had briefed about the objectives and the aim of the research. Confidentiality of the information gathered was assured to the interviewee.
Consent for publication
The authors declare that they have no conflicts of interest regarding the publication of the paper.
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
About this article
Cite this article
Biratu, B., Garoma, S., Getachew, M. et al. Drinking alcohol raises the chance of premarital sex by four folds among secondary school adolescent students in Jima Arjo, Southwestern Ethiopia, 2018: a school-based cross-sectional study. Contracept Reprod Med 7, 4 (2022). https://doi.org/10.1186/s40834-022-00171-2
- Premarital sex
- Drinking alcohol