Abstract
<title>Abstract</title> <p>Background Early sexual debut is a major public health concern associated with increased risks of sexually transmitted infections and unintended pregnancies. With the rapid expansion of digital media, adolescents and young adults (AYAs) may experience shifts in sexual knowledge and behaviors. However, empirical evidence on the relationship between media exposure and early sexual debut in sub-Saharan Africa (SSA) remains limited. This study assessed the prevalence of early sexual debut and examined the associations between digital access, sociodemographic characteristics, and early sexual debut among adolescents and young adults (AYAs) in Sub-Saharan Africa (SSA). Methods A multi-country cross-sectional study was conducted among 3,728 AYAs aged 15–24 years with lifetime sexual experience, sampled from Health and Demographic Surveillance System (HDSS) households and school rosters to ensure proportional representation. Data on sociodemographic characteristics, digital access, and sexual behaviors were collected using structured questionnaires and analyzed using SPSS version 28. Descriptive statistics and binary logistic regression were used to identify factors associated with early sexual debut. Results Among AYAs aged 15–24 years with lifetime sexual experience, the prevalence of early sexual debut was 7.4% (95% CI: 6.6%–8.3%). Initial analysis suggested a protective association between WhatsApp or Telegram ownership and early sexual debut, but this was not significant after adjustment. In multivariable analysis, AYAs in Ghana (aOR = 4.422, 95% CI: 2.047–9.552, p < .001), Nigeria (aOR = 5.608, 95% CI: 2.000–15.721, p = .001), Tanzania (aOR = 3.631, 95% CI: 1.740–7.578, p = .001), and Uganda (aOR = 2.087, 95% CI: 1.034–4.212, p = .040) had significantly higher odds of early sexual debut compared to Burkina Faso. Adolescents aged 15–19 years (aOR = 4.393, 95% CI: 3.311–5.827, p < .001) and males (aOR = 2.910, 95% CI: 2.175–3.894, p < .001) were more likely to report early sexual debut. Not living with a male guardian was associated with reduced odds (aOR = 0.430, 95% CI: 0.284–0.652, p < .001), whereas perceived low household socioeconomic status increased the likelihood (aOR = 1.909, 95% CI: 1.308–2.786, p = .001). Conclusion Early sexual debut among AYAs is influenced by country-specific and sociodemographic factors, with heightened vulnerability among younger adolescents, males, and socioeconomically disadvantaged groups. Context-specific interventions addressing structural determinants, household dynamics, and the cautious use of digital platforms are essential to delay sexual initiation in SSA.</p>