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Background  More adolescents in Ethiopia are in school today than ever, but few studies have assessed the sexual behaviour of these learners. Thus, this study tried to assess pre-marital sexual debut and factors associated with it among in-school adolescents in Eastern Ethiopia.    Methods  A cross-sectional school-based study was conducted using a facilitator guided selfadministered questionnaire. Respondents were students attending regular school classes in fourteen high schools. The proportion of adolescents involved in pre-marital sexual debut and the mean age at sexual debut was computed. Factors associated with pre-marital sexual debut were assessed using bivariate and multivariable logistic regression.    Results  About one in four, 686 (24.8%) never married in-school adolescent respondents reported pre-marital sexual debut of these 28.8% were males and 14.7% were females ( p  < 0.001). Pre-marital sexual debut was more common among adolescents who had their parents in urban areas (Adjusted OR and [95% CI] =1.42 [1.17–1.73]), who received higher pocket money per month (Adjusted OR and [95% CI] = 1.56 [1.19–2.04]), who perceived low self-educational rank (Adjusted OR and [95% CI] =1.89 [1.07–3.34]) and who lived in rented houses (Adjusted OR and [95% CI] =1.32 [1.03–1.70]). The females and those who were less influenced by external pressure were more protected against pre-marital sexual debut (Adjusted OR and [95% CI] = 0.44 [0.35–0.56; 0.62 [0.52–0.74, respectively]) than their counterparts.    Conclusion  A significant proportion of in-school adolescents were engaged in sexual relationship. Thus, public health interventions should consider the broader determinants of premarital sexual debut, including the ecological factors in which the behavior occurs.

Pre-marital sexual debut and its associated factors among in-school adolescents in eastern Ethiopia