Individual and Community-Level Determinants of Premarital Sexual Practice Among the Youth Population (15–24 Years) of Ethiopia: A Mixed-Effect Analysis

Evidence indicates a higher prevalence of unprotected premarital sexual practices among youths in Sub-Saharan Africa. In Ethiopia, existing studies on predictors of premarital practices have been geographically limited and overlooked community-level variables. Thus, this study aimed to identify individual and community-level predictors of premarital sexual practices among Ethiopian youth. Data were obtained from the official Demographic and Health Survey program database. This study included 7,388 weighted youths. Multilevel multivariable logistic regression analysis identified predictors of premarital practices. Akaike’s information criteria guided model selection. Adjusted odds ratios (AOR) and 95% confidence intervals assessed predictor significance. The pooled prevalence of premarital sexual practice was 9.36% [95% CI (8.72%, 9.99%)]. Significant factors included being male [AOR: 1.60; 95% CI (1.21, 2.13)], belonging to the 20–24 age group [AOR: 3.48; 95% CI (2.62, 4.61)], being employed [AOR: 1.39; 95% CI (1.05, 1.84)], mobile phone ownership [AOR: 1.58; 95% CI (1.16, 2.14)], internet use [AOR: 1.74; 95% CI (1.19, 2.52)], khat chewing [AOR: 3.16; 95% CI (1.81, 5.51)], alcohol consumption [AOR: 2.56; 95% CI (1.65, 3.96)], tested for HIV [AOR: 2.90; 95% CI (2.19, 3.84)], and belonging to small peripheral regions [AOR: 1.91; 95% CI (1.18, 3.08)]. Nearly ten percent of Ethiopian youths participate in premarital sexual activity. Interventions are crucial to improve sexual and reproductive health services, educate on the consequences of premarital sex, substance use, and responsible mobile/internet usage. Strengthening healthcare service provision, particularly in remote areas, is vital to address premarital sexual activity among Ethiopian youths effectively.