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University students are known to have risky sexual behaviours (RSBs). The severity of the RSB is influenced by many factors, including the family environment, exposure to adverse childhood events (ACEs), and the use of addictive substances. However, there is limited information about the influence of ACEs and the family environment of these students in low-and medium-income countries (LMICs). Therefore, a pilot study was conducted among university students from a LMIC, Uganda. Methods The present study comprised a cross-sectional online survey among Ugandan students at a public university (N = 316; 75% male; 52.2% aged between 18–22 years). The survey included questions relating to socio-demographic information, family environmental information, the Sexual Risk Survey (SRS), and the Adverse Childhood Experiences-International Questionnaire (ACE-IQ). Results Over half (53.8%) reported having had sexual intercourse. Males reported over two times higher mean total SRS score compared to females (χ2 = 4.06, p = 0.044). Approximately one-sixth of the sample had drunk alcohol or used illicit psychoactive substances in the past six months (16.1%). Among four regression analysis models, sociodemographic variables predicted the highest variance (13%), followed by family environment variables (10%), and both psychoactive substance use history (past six months) and ACEs individually explained approximately 5% variance in total SRS score, with the final model predicting 33% of the variance in RSB. Conclusions The present study demonstrated a gender disparity with males involved in more RSB than females, as has been reported in most previous RSB studies. Family environment, sociodemographic factors, substance use, and ACEs all appear to contribute to RSB among university students. These findings will benefit other researchers exploring factors associated with RSB among university students and will help develop interventions to reduce RSB to protect students from unwanted pregnancies, sexually transmitted diseases, and HIV/AIDS.
The present pilot study was a cross-sectional online survey conducted among students of Mbarara University of Science and Technology (MUST), a public university in Southwestern Uganda. Data were collected from April 3 to May 23, 2021, using Google Forms. The survey link was shared on online platforms like WhatsApp groups and personal student emails to students in the university’s six faculties (i.e., Medicine; Computing and Informatics; Business and Management Sciences; Science; Applied Sciences and Technology; and Interdisciplinary Studies), and its two institutions (i.e., Tropical Forest Conservation; and Maternal New-born and Child Health). MUST had over 4,269 undergraduate students enrolled in the academic year 2019/2020, and all were eligible to participate in the study. A total of 316 students participated in the study. The data were collected during the second year of the COVID-19 pandemic when students had just started returning to in-person teaching, and most of the restrictions concerning COVID-19 prevention, such as spatial distancing, had been relaxed. The participants were enrolled using a snowball convenience sampling technique where students who were approached could forward the survey link to other students in the university. To avoid physical contact and to include as many eligible students as possible, snowball convenience sampling was employed to enable efficient recruitment of university students during the COVID-19 pandemic as has been employed in previous studies conducted inside or outside Uganda [31–34]. The online survey link was circulated on the different faculty and student social media platforms like end-to-end encrypted WhatsApp groups and students’ personal emails. The survey tool was designed to only allow a single response from each student participant. Potential participants received a message requesting them to participate and to share the survey link with their fellow students at MUST. The survey was in English (the language of all teaching in Ugandan universities). Questions were pretested among the students before the commencement of the study to ensure that they were all well understood. The online survey tool included a participant information page, which provided participants with information to understand the intentions of the study, and an informed consent page which all participants completed before responding and participating in the study. As there were no mandatory questions to respond to, participants were free to leave questions unanswered if they were not comfortable and/or sure with the response. However, all participants responded to the questions except one question about the number of sexual partners. In addition, the survey included a sociodemographic questionnaire, family environment questions, the Adverse Childhood Experiences-International Questionnaire (ACE-IQ), and the Sexual Risk Survey (SRS). Given that participants responded to the tool items at their time of convenience, participants were advised to use a calendar of the past six months to accurately remember their past sexual experiences and to minimize memory recall bias (i.e., enhance accurate recall). Sociodemographic data collected included relevant personal information regarding basic participant characteristics; participant’s age (in years), gender (female, male), marital status (single, separated/divorced, married/cohabiting), and the region of the country of origin (Central, Western, Eastern, and Northern Uganda). A single question (i.e., “In the past six months have you used alcohol or illicit drugs?”) with a binary response (yes/no) was used to assess recent substance use history. Those with a ‘yes’ response selected the substances used (i.e., alcohol and/or illicit drugs). Family environment data collected included information on the family type (i.e., nuclear family, extended family, step-parent family, grandparent family, and single parent family); the number of family members; the number of children; primary care provider (i.e., parent, step-parent, uncle/aunt, sibling, guardian, grandparent, NGO, and self-sponsored); birth position in the family; parent’s highest level of education; having a family member with mental illness, or who abuses drugs/substance, or with a criminal record; and whether a parent died before 18 years of age. The 23-item SRS [3] was used to assess sexual risk behaviour among college students over a period of six months prior to the study. It comprises five subscales of risky sexual behaviours: sexual risk-taking with uncommitted partners (e.g., “How many times have you had sex with someone you don’t know well or just met?”), risky sex acts (e.g., “How many times have you or your partner used alcohol or drugs before or during sex?”), impulsive sexual behaviours (e.g., “How many times have you had an unexpected and unanticipated sexual experience?”), intent to engage in risky sexual behaviours (e.g., “How many times have you gone out to bars/parties/ social events with the intent of ‘‘hooking up” and having sex with someone?”) and risky anal sex acts (e.g., “How many times have you had anal sex without a condom?”) [35], for details, see S1 Table. Raw response frequencies were recorded and converted into ordinal categories which assign weights to the level of sexual risk-taking, ranging from 0 to 4, employing a method used by the scale developers [35]. This approach addresses the skewness of frequency data commonly used in sexual risk assessment studies. The total sexual risk score is calculated as a sum of all raw items’ responses, with total scores ranging from 0 to 92. Higher scores indicate higher sexual risk riskiness. The SRS has shown very good psychometric properties [3], although the Cronbach alpha was 0.69 in the present study. However, the Cronbach alphas for the five subscales were good to excellent: risk-taking with uncommitted partners (α = 0.92), risky sex acts (α = 0.75), impulsive sexual behaviours (α = 0.83), intent to engage in risky sexual behaviours (α = 0.82), and risky anal sex acts (α = 0.82). The 29-item ACE-IQ [36] was used to assess 13 childhood adversities. Items (e.g., “During the first 18 years of your life, did someone actually have oral, anal, or vaginal intercourse with you when you did not want them to?”) are responded to on a binary (yes/no) scale. Consequently, total scores range from 0 to 13, where a higher score indicates greater childhood adversity. In previous sub-Saharan African studies, the ACE-IQ has demonstrated good psychometric properties among adolescents and young adults [37–39]. The Cronbach alpha of the ACE-QI in the present study was 0.82. The present study received formal ethical approval from Mbarara University of Science and Technology research ethics committee (MUSTREC#04/01-21). Participants were informed about the sensitive nature of the questions on the SRS and the ACE-IQ due to the potential of some questions to give rise to distressing and negative emotions. Consequently, participants did not have to respond to such questions and were free to end the survey at any point with absolutely no penalty whatsoever. Data confidentiality and anonymity were emphasized. Participation was voluntary, and participants provided informed consent. The survey included a detailed consent form that informed the participants about the study, the risks, and the benefits. All participants were adults who provided their written informed consent to participate in the study; these were automatically granted entry to the study survey. A link to the departmental psychiatry team was provided within the survey, and participants could access the link for help and support if they needed it. Data were imported into STATA Version.15 statistical software, where data were cleaned and analysed. Descriptive statistics are presented in percentages, frequencies, medians, ranges and interquartile ranges. The total score on the SRS and its subscales were analysed as continuous variables. Gender differences in sexual risk-taking and behaviours were assessed by Wilcoxon rank-sum (total scores of SRS and all SRS subscales) and chi-square tests (age at which sexual intercourse first occurred and the number of sexual partners). The Gaussian assumption was used to test for normality of continuous data and was confirmed with Shapiro-Wilks’s test and histograms. Hierarchical Poisson regression was used to determine the predictors of RSBs, and four models were generated. All statistics were calculated at a 95% level of confidence and 5% statistical error.
