Leisure-time sedentary behavior, alcohol consumption and sexual intercourse among adolescents aged 12-15 years in 19 countries from Africa, the Americas, and Asia

Background: The association between sedentary behavior and sexual behavior has not been investigated among adolescents, while the influential factors in this association are largely unknown. Aim: To (i) investigate the association between leisure-time sedentary behavior and sexual intercourse, and (ii) test for mediation by alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms, in a large global sample of young adolescents. Methods: Data were analyzed from 34674 adolescents aged 12-15 years participating in the Global School-based Student Health Survey. Participants reported the number of hours spent in leisure-time sedentary behavior on a typical day (8). Data on alcohol consumption, drug use, physical activity, bullying victimization, parental support/monitoring, loneliness, and depressive symptoms were considered as potential mediators. Outcome: Participants reported whether or not they had sexual intercourse in the past 12 months (yes/no). Results: The prevalence of past 12-month sexual intercourse was 11.9%, while the prevalence of 8 hours per day of leisure-time sedentary behavior were 26.7%, 35.6%, 21.4%, 11.5%, and 4.9%, respectively. There was a dose-dependent relationship between sedentary behavior and odds of reporting sexual intercourse: compared with 8 hours/day of sedentary behavior were 1.12 (0.94-1.33), 1.22 (1.01-1.48), 1.34 (1.08-1.66), and 1.76 (1.37-2.27), respectively. There was no significant interaction by sex. The largest proportion of the association between sedentary behavior and sexual intercourse was explained by alcohol use (% mediated 21.2%), with other factors explaining an additional 11.2%. Clinical Translation: Interventions to reduce leisure-time sedentary and/or alcohol consumption may contribute to a reduction in the proportion of adolescents engaging in sexual intercourse at a young age. Strengths and Limitations: The strength of this study is the large, representative sample of adolescents from 19 countries. However, the cross-sectional design means causality or temporal associations could not be established. Conclusions: In young adolescents, leisure-time sedentary behavior is positively associated with odds of having sexual intercourse in both boys and girls, in a dose-dependent manner. Alcohol consumption appears to be a key mediator of this relationship