Sexual activity among school-going adolescents in Himachal Pradesh, India: what are the risky and protective factors?

Early and risky sexual behaviours among adolescents contribute to adverse health outcomes, yet evidence from school-based settings in India, particularly from methodologically robust samples, remains limited. Previous research in India has documented sexual attitudes and behaviours in specific contexts; however, to our knowledge, no study has examined both risk and protective factors using a large, systematically sampled cohort at the state level. This study investigated sexual activity among school-going adolescents and examined associated risk and protective factors to inform targeted interventions. A school-based cross-sectional survey was conducted during December 2023 in 204 government schools across Himachal Pradesh, India among 7,563 adolescents aged 13–17 years using a self-administered questionnaire adapted from the Global School-based Student Health Survey in India. Descriptive statistics and multivariate logistic regression were performed to assess predictors of ever having sex, early sexual debut, and non-use of contraception. Overall, 6% of adolescents reported ever having sexual intercourse; of these, 62.4% initiated intercourse before age 14. Fewer than half used contraception. Being a boy, parental employment in unskilled/semi-skilled jobs, substance use, poor mental health, and experiencing bullying were significantly associated with sexual activity. Younger adolescents from larger families had higher odds of early sexual debut. Non-use of contraception was associated with being boy, older age, larger families, experiencing bullying, and mental health problems. The findings underscore the need to strengthen comprehensive, age-appropriate sexual and reproductive health interventions in schools to address early and risky sexual behaviours. Although elements of comprehensive sexuality education are delivered through existing platforms, a structured and systematic approach is lacking. Leveraging ongoing initiatives such as Rashtriya Kishor Swasthya Karyakram and the Ayushman Bharat School Health Programme provides a practical opportunity to institutionalize and scale up integrated delivery within the school system.