Hrev_master Healthcare in Low-resource Settings 2025; volume 13(s1):13408 Cybersex activity, self-control, and premarital sexual behaviors among adolescents Puji Hastuti,1 Adellia Eka Kartikasari,2 Taufan Agung Prasetya,1 Astrida Budiarti1 1Department of Nursing, Sekolah Tinggi Ilmu Kesehatan Hang Tuah, Surabaya; 2Department of Social Affairs, Sekolah Tinggi Ilmu Kesehatan Hang Tuah, Surabaya, Indonesia Abstract Rapidly growing internet use among adolescents had positive and negative effects. It offers benefits, such as facilitating commu- nication, but it also has negative impacts, including premarital sexual behaviors. The purpose of this study was to determine the relationship between cybersex activity and premarital sexual behaviors, as well as the association between self-control and pre- marital sexual behaviors in adolescents. The research employed a descriptive-analytic approach with a cross-sectional design, and the total sample consisted of 147 adolescents. The independent variables were cybersex activity and self-control, while the depen- dent variable was premarital sexual behaviors. The instruments used were the Internet Sex Screening Test (ISST), the Self-Control Scale (SCS), and the Adolescent Sexual Activity Index (ASCI). Data were analyzed using the Spearman correlation test. The majority of students involved in cybersex activities were at-risk users: 43.5% (64 respondents) had low self-control, and 27.2% (40 respondents) reported having early sexual activity. Additionally, there was a significant relationship between cyber- sex activity and premarital sexual behaviors (p=0.001) and between self-control and premarital sexual behaviors (p=0.001). These findings underscore the necessity of promoting positive internet usage among adolescents to mitigate cybersex activity, as it correlates with premarital sexual behaviors. Parents can encou- rage adolescents to have good self-control to avoid premarital sexual behaviors. Further, educators and policymakers can use these findings to develop programs that teach teenagers responsi- ble internet use, enhance their self-control, and promote safe onli- ne behavior. Additionally, they can incorporate lessons and esta- blish rules that support healthy internet habits. Introduction The rapid growth of internet use has had both positive and negative effects. It offers many benefits, such as making commu- nication easier, building social networks, and providing quick access to information.1 However, it also presents negative effects, especially for adolescents, including involvement in cybersex acti- vities.2 Cybersex activities refer to sexual behaviors conducted online, such as engaging in sexual conversations, sharing sexual images or videos, and seeking sexual satisfaction through social media.3 These activities can lead to negative outcomes such as addiction, sexual crimes, and premarital sexual behaviors.4 Premarital sexual behavior includes various actions such as sexual intercourse, kissing, and petting.5,6 These behaviors pose significant risks to adolescents, including Sexually Transmitted Diseases (STDs), early pregnancies, and negative social and psy- chological impacts.5 According to the Indonesian Health Demographic Survey in 2018, many adolescents engage in these behaviors while dating, with 33% reporting hugging, 50% kissing, 22% petting, and 8% engaging in sexual intercourse.6 Internet use among adolescents in Indonesia has significantly increased. From 2021 to 2022, internet usage reached 77.02%, with the Java region contributing the highest percentage at 43.92%. Among these users, adolescents aged 13 to 18 years accounted for 99.16% of the total internet users.7 A survey of young people aged 18-23 years revealed that 29% of respondents engaged in cybersex behaviors, with 75.6% of them being unmar- ried adolescents. Additionally, global statistics show that, in deve- loping countries, 11.3% of boys and 7.7% of girls have engaged in premarital sexual behavior, highlighting the need for local and cul- Correspondence: Puji Hastuti, Nursing Department, Sekolah Tinggi Ilmu Kesehatan Hang Tuah, Surabaya, Indonesia. E-mail: pujihastutishtsby@gmail.com Key words: adolescents; cybersex; premarital sexual behavior; self-control. Contributions: PH, conceptualization, data curation, formal analysis, methodology, validation, visualization, writing-original draft, review & editing; AEK, conceptualization, investigation, methodology, validation, and writing-original draft, review & editing; TAP, AB, conceptualization, methodology, formal analysis, validation, and writing-original draft, review & editing. Conflict of interest: the authors declare no potential conflict of interest. Ethics approval and consent to participate: this study was approved by the Stikes Hang Tuah Surabaya with number PE/27/VI/2023/KEP/SHT. Informed consent was obtained from the participants involved in this study. Consent for publication: not applicable. Availability of data and materials: all data generated or analyzed during this study are included in this published article. Acknowledgments: we would like to thank Stikes Hang Tuah Surabaya, Indonesia, for their valuable support. Received: 21 November 2024 Accepted: 5 March 2025. Early access: 4 April 2025. This work is licensed under a Creative Commons Attribution 4.0 License (by-nc 4.0). ©Copyright: the Author(s), 2025 Licensee PAGEPress, Italy Healthcare in Low-resource Settings 2025; 13(s1):13408 doi:10.4081/hls.2025.13408 Publisher's note: all claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organi- zations, or those of the publisher, the editors and the reviewers. Any prod- uct that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher. [Healthcare in Low-resource Settings 2025;13(s1):13408] [page 95] turally relevant strategies to address this issue.8,9 Self-control is a critical factor in preventing the negative outcomes of internet use,10,11 particularly in reducing the likelihood of engaging in cybersex activities and premarital sexual behavior. Self-control refers to an individual’s ability to regulate their impulses, emo- tions, and actions.12 Adolescents with low self-control are more likely to engage in risky behaviors, including premarital sexual activities. Conversely, strong self-control acts as a protective fac- tor, helping adolescents avoid behaviors such as dating, kissing, petting, and sexual intercourse.13,14 Cybersex activities, premarital sexual behavior, and self-con- trol are interconnected. Cybersex activities may influence adole- scents to engage in premarital sexual behaviors driven by curiosity, peer pressure, or social motives.15 Meanwhile, self-control plays a vital role in breaking this connection by enabling adolescents to resist these impulses and make healthier decisions.10,11 Adolescents who lack self-control are at higher risk of experiencing premarital sexual behavior and severe consequences such as unwanted pre- gnancies, abortions, STDs, HIV, depression, substance abuse, and even suicidal tendencies.16 Given the increasing prevalence of internet use and its associa- ted risks, attention must be directed toward preventing cybersex activities and premarital sexual behavior among adolescents, parti- cularly in Indonesia. Despite the increasing prevalence of internet use among adolescents and its associated risks, there is limited research focusing on the specific relationships between cybersex activities, self-control, and premarital sexual behavior, particularly in the context of Indonesia. While previous studies have explored premarital sexual behaviors and internet usage trends, they often lack a comprehensive examination of how cybersex activities and self-control influence these behaviors. This study aims to explore the relationship between cybersex activity and premarital sexual behavior, as well as the relationship between self-control and pre- marital sexual behavior. By highlighting the protective role of self- control, this study seeks to emphasize its importance in the context of adolescent sexual health and inform strategies tailored to Indonesia’s youth population. Materials and Methods Study design This study employed a descriptive-analytic design with a cross-sectional approach. The design was chosen to examine the relationships between cybersex activity, self-control, and premari- tal sexual behavior among adolescents by collecting data at a sin- gle point in time. Sample size and sampling technique The sample in this study consisted of 147 senior high school students from Surabaya, Indonesia. The sample was selected using the cluster simple random sampling technique. First, the total clas- ses in this school were divided into clusters. A random selection of classes was made, and all eligible students within the selected clas- ses were invited to participate. Inclusion criteria included students who were willing to participate and adolescents in grade 12. The exclusion criteria in this study were adolescents who withdrew in the middle of the study, did not complete the questionnaire, and students who were absent or ill during data collection. Data collection The data was collected using Google Form links by providing barcodes for students in each class. We explained to the respon- dents the purpose and objectives of the study, as well as the proce- dures and assessments to be carried out. Respondents had the right to withdraw if they were unwilling to answer the questionnaire. The researchers ensured the confidentiality of the respondents’ data. Respondents who agreed to participate in the study were given a reward in the form of a tumbler. Variables and instruments Variables in this study were cybersex activity, self-control, and premarital sexual behavior. The instruments used in the study were the Internet Sex Screening Test (ISST) questionnaire to collect data related to cybersex activity. The questionnaire consists of 25 items, each assigned a score for favorable responses (1-15, 17, 18, 20): 4=always, 3=often, 2=seldom, and 1=never. For unfavorable items (16 and 19), the scoring is as follows: 1=always, 2=often, 3=sel- dom, and 4=never. Total score was categorized by recreational users (20-39), risk users (40-59), and compulsive users (60-80). The Cronbach’s alpha of this questionnaire was 0.86, and the con- vergent validity is adequate with p<0.05 and r=0.621.17 The Self- Control Scale (SCS) was utilized to collect data related to self-con- trol; it comprises 24 items, with a score for each favorable item (1, 17, 24, 5, 25, 13, 22, 26, 27): 4=always, 3=often, 2=seldom, and 1=never. For unfavorable items, the scoring is as follows: 1=always, 2=often, 3=seldom, and 4=never. The total score was categorized into low (36-71), moderate (72-107), and high (108- 144). The Cronbach’s alpha of this questionnaire was 0.91, and the convergent validity is adequate with p<0.05 and r=0.731.18 The Adolescent Sexual Activity Index (ASAI) was used to collect data related to sexual behavior. It had 13 items, with the following scores: 1=yes, 0=never. The total score was categorized into less risk (0-3), risk engaging in sexual intercourse (4-5), sexual inter- course (6), sexual beginnings (7), and sexually active (8-10). The Cronbach’s alpha of this questionnaire was 0.91, and the conver- gent validity is adequate with p<0.05 and r=0.537.19 Study analysis We analyzed the data using the SPSS software to determine the frequency distribution. The Spearman test was employed to assess the relationship between variables, with a significance level set at p<0.05. Ethical clearance This study was approved by the Ethical Clearance Committee of Stikes Hang Tuah Surabaya (No: PE/27/VI/2023/KEP/SHT). All procedures adhered to ethical guidelines, and informed consent was obtained from all participants before data collection. The study ensured participant confidentiality and voluntary participa- tion throughout the research process. Results Table 1 shows the respondents’ characteristics and descriptive variables. Regarding gender, 55.1% were male (81 respondents), and 44.9% were female (66 respondents). In terms of dating status, 67.3% (99 respondents) were in a relationship, while 32.7% (48 respondents) were not. Concerning parental attitudes, 61.9% (91 respondents) reported that their parents permitted dating during Special issue Pathways of Change [page 96] [Healthcare in Low-resource Settings 2025;13(s1):13408] school years, while 38.1% (56 respondents) did not. The frequency distribution of cybersex activity among respondents was catego- rized as at-risk users, accounting for 43.5% (64 respondents); recreational users, making up 37.4% (51 respondents); and com- pulsive users, comprising 19.0% (32 respondents). The frequency distribution of self-control indicated that 42.9% of respondents were categorized as low (63 respondents), 40.1% as medium (59 respondents), and 17.0% as high (25 respondents). The frequency distribution of premarital sexual behavior among adolescents indicated the following: 27.2% (40 respondents) reported having engaged in early sexual intercourse, 25.9% (38 respondents) experienced less risky sexual behavior, 19.0% (28 respondents) engaged in sexual intercourse, 15.6% (23 respondents) were identified as engaging in risky sexual behavior, and 12.2% (18 respondents) were classified as sexually active. Table 2 presents the cross-tabulation of cybersex activity and premarital sexual behavior. The results indicated a significant rela- tionship between cybersex activity and premarital sexual behavior in adolescents, with a p=0.00 and a correlation coefficient of 0.586. Table 3 shows a significant relationship between self-control and premarital sexual behavior in adolescents, with a p=0.00 and a cor- relation coefficient of -0.673. Discussion This study provides important insights into the relationships between cybersex activity, self-control, and premarital sexual behavior among adolescents. The findings revealed that most respondents engaged in at-risk cybersex activities, exhibited low self-control, and were at risk of premarital sexual behavior. These results highlight the critical role of online behaviors and self-regu- lation in shaping adolescent sexual decision-making, aligning with prior studies that identify similar risk factors for premarital sexual behavior.13,20-24 The study found a significant relationship between cybersex activity and premarital sexual behavior among adolescents. The majority of respondents were male and 17 years old, a develop- mental phase marked by increased curiosity regarding sexual activities due to puberty, which can incite sexual desires. Furthermore, the majority of respondents engaged in compulsive online sexual behaviors, with at-risk users being more likely to participate in premarital sexual activities. The findings of this study align with previous research, which indicates a positive cor- relation between cybersex activities and premarital sexual behav- ior categories.25,26 Thus, the higher the level of engagement in cybersex, the greater the likelihood of involvement in premarital sexual behavior. This study also identified a significant relationship between self-control and premarital sexual behavior. The findings indicate that men are usually more open to discussing sexual topics and tend to exhibit lower levels of self-control. Most respondents in the study reported low self-control and began dating at the age of 15. The present study showed that self-control can be developed to prevent risky sexual behaviors in adolescents.27 Self-control is strongly influenced by parenting,26,28 as parents play a vital role in instilling values and guiding their adolescents toward responsible decision-making.29 Through proper guidance, parents help adole- scents develop the ability to regulate their behavior effectively. Furthermore, previous studies have shown that poor self-control in individuals or parents can lead to negative behaviors.30 Self-control is also closely tied to emotional regulation, as individuals with strong self-control are better equipped to manage their emotions.11 In romantic relationships, adolescents often experience psycholo- gical and physiological reactions that evoke feelings of comfort and love. Without adequate self-control, these emotions may lead to premature sexual activity. Therefore, self-control is a crucial factor in managing and reducing the likelihood of engaging in pre- marital sexual behaviors.13,31,32 This study has some limitations that should be considered. The respondents were only adolescents in senior high school; therefore, the findings may not represent all young individuals in Indonesia. Special issue Pathways of Change Table 1. Characteristics of respondents and descriptive variables. Characteristic Frequency (N) Percentage (%) Gender Male 81 55.1 Female 66 44.9 Total 147 100.0 Dating or not Yes 99 67.3 No 48 32.7 Total 147 100.0 Parental response in terms of dating Allow 91 61.9 Not allow 56 38.1 Total 147 100.0 Cybersex activity Recreational users 51 34.7 At-Risk users 64 43.5 Compulsive users 32 21.8 Total 147 100.0 Self-control Low 63 42.9 Moderate 59 40.1 High 25 17.0 Total 147 100.0 Sexual activity Less risk 38 25.9 Risk engaging in sexual behaviours 23 15.6 Sexual intercourse 28 19.0 Early sexual intercourse 40 27.2 Sexual active 18 12.2 Total 147 100.0 Table 2. Relationship between cybersex activity and premarital sexual behaviors. Sexual activity Cybersex activity Correlation coefficient 0.586* Sig. (2-tailed) 0.001 N 147 *p<0.05. Table 3. Relationship between self-control and premarital sexual behaviors. Sexual activity Self-control Correlation coefficient -0.673* Sig. (2-tailed) 0.001 N 147 *p=<0.05. [Healthcare in Low-resource Settings 2025;13(s1):13408] [page 97] However, the study revealed that premarital sexual behavior among adolescents is influenced by cybersex activities and levels of self-control. Conclusions Premarital sexual behavior among adolescents is common. The study found that cybersex activities among adolescents categorized as at risk were linked to low levels of self-control among students. Additionally, there is a connection between cybersex activities and sexual behavior, as well as a connection between self-control and sexual behavior in adolescents. These findings emphasize the importance of encouraging adolescents to use social media in a positive way. Parents and schools can encourage adolescents to develop self-control through counseling, helping them avoid pre- marital sexual behavior. 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