Level of Sexual Health Knowledge and Sexual Behaviors Among Sri Lankan Schooling Adolescents: A Cross-Sectional Analytical Study of Selected Urban and Rural Areas in the Kandy District

IntroductionSexual health problems are prominent among Sri Lankan youth. This study aims to assess sexual health knowledge and behavior and identify associated socio-demographic factors in a sample of schooling adolescents. MethodsA sample of 1690 youth aged 14 to 18 years from urban and rural areas of Kandy district was surveyed in 2022 using a multistage cluster random sampling method. A self-administered questionnaire was used and analyzed using SPSS version 25. Sexual health knowledge >= 60% was classified as a "good" level, and the level of sexual behavior was classified using the Youth Risk Behavior Survey criteria classification. Chi-square tests and regression modeling (P < 0.05) were used. ResultsOut of 1675 respondents (response rate 99.1%), overall 73.4% had "good level" of sexual health knowledge, and 30.6% had an "at-risk" level of sexual behavior. Rural adolescents had "poor" sexual health knowledge, while urban counterparts showed higher levels of "at-risk" behavior. Urban residence (OR 0.34, P < 0.001) and older age (17-18) (OR 0.20, P < 0.001) were negatively associated with poor sexual health knowledge. Urban residence (OR = 1.87, P = 0.004) was positively associated with at-risk behavior, while older age (OR 0.15, P = 0.008) was negatively associated. ConclusionDespite adequate sexual health knowledge, risky sexual behavior persists, indicating the need for targeted interventions tailored to specific age groups. Policy ImplicationsThese findings suggest that increasing adolescent sexual and reproductive health knowledge, reducing the risk of unwanted and teenage pregnancies, reducing STDs, promoting safe choices, effective communication with parents/health care providers about sexual health issues, reducing sexual violence and abuse, maintaining mental wellbeing, respecting one's consent, and building gender equality can all contribute to the development of a safe and healthy nation.