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Research Paper
Perspectives of parents, teachers, and community leaders on adolescent sexual behavior across ecological contexts in Cambodia: a qualitative study
Youngran Yang1orcid, Gloria Park2orcid
Journal of Korean Academy of Nursing 2026;56(1):108-122.
DOI: https://doi.org/10.4040/jkan.25146
Published online: February 25, 2026

1College of NursingㆍResearch Institute of Nursing Science, Jeonbuk National University, Jeonju, South Korea

2St. David’s School of Nursing, Texas State University, Round Rock, TX, USA

Corresponding author: Youngran Yang College of Nursing · Research Institute of Nursing Science, Jeonbuk National University, 567 Baekje-daero, Deokjin-gu, Jeonju 54896, South Korea E-mail: youngran13@jbnu.ac.kr
• Received: October 31, 2025   • Revised: January 24, 2026   • Accepted: January 24, 2026

© 2026 Korean Society of Nursing Science

This is an Open Access article distributed under the terms of the Creative Commons Attribution NoDerivs License (http://creativecommons.org/licenses/by-nd/4.0) If the original work is properly cited and retained without any modification or reproduction, it can be used and re-distributed in any format and medium.

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  • Purpose
    This study investigated the perspectives of parents, teachers, and community leaders regarding adolescents’ sexual behavior in Cambodia.
  • Methods
    Grounded in the ‘ecological framework of adolescent health,’ this study employed a descriptive qualitative approach to explore the perspectives of key stakeholders, including 12 parents, eight teachers, and four community leaders. Drawing on in-depth, semi-structured individual and focus group interviews, the study examined risk and protective factors related to risky sexual behavior across family, school, community, social, cultural, and policy contexts. Data collection was conducted from December 5, 2022 to January 31, 2023.
  • Results
    The integrated thematic analysis revealed six main themes. Parents positioned themselves as anxious protectors but struggled with limited opportunities for open conversation; teachers acted as observe-and-warn mediators, constrained by institutional authority, curricular boundaries, and rapidly shifting youth culture; and community leaders interpreted emerging trends through the lens of social change, eroding traditions, and weakening collective governance. Across groups, participants acknowledged the limitations of unilateral action and advocated for multilevel, collaborative solutions that bridge families, schools, and broader communities.
  • Conclusion
    The study concluded that adolescent sexual behaviors should be understood from diverse perspectives. This finding highlights the need for culturally appropriate and sensitive measures supported by multisectoral systems operating at the family, school, community, civil society (e.g., non-governmental organizations), and national levels.
  • Key words: Adolescent; Cambodia; Qualitative research; Sexual behavior
Risky sexual behavior (RSB) in adolescents is a significant global concern because of its serious consequences, such as human immunodeficiency virus (HIV) infection, sexually transmitted infections (STIs), and teen pregnancies [1]. Globally, over one million STIs are acquired daily by people aged 15–49 years, with approximately half occurring among youth aged 15–24 [2,3]. In 2024 alone, 370,000 young people aged 15–24 were newly infected with HIV worldwide [4]. Additionally, approximately 21 million girls aged 15–19 years worldwide have become pregnant, most of whom are unintended. These statistics highlight the urgent need for effective strategies to decrease RSB and its consequences in adolescents [5].
RSB includes unprotected sexual activity, inconsistent use of condoms, having high-risk partners, and multiple sexual partners [6]. Such behaviors are often influenced by various factors, including alcohol consumption [7], exposure to pornography [8], depression [9], peer pressure [10], and low self-esteem [11]. Adolescents engaged in RSB are more likely to experience not only physical health risks, such as HIV, STIs, and unintended pregnancy, but also adverse psychological consequences, including mental health problems, depression, anxiety [12], and poor quality of life [13]. Therefore, prevention of RSB before marriage or first childbirth remains the most effective strategy for reducing the life-threatening consequences of HIV/STIs and improving maternal-child health outcomes.
The ‘ecological framework of adolescent health’ is designed to understand adolescent behaviors from the perspectives of individual, school, family, neighborhood, and macro-level factors [14]. In this study, adolescent sexual behavior was examined within this framework, shaped by factors operating at the individual, interpersonal, institutional, community, and policy levels. For example, parents and families traditionally influence adolescent sexual decisions. Two meta-analyses found that open parent-adolescent communication about sexual topics and parental monitoring and supervision are linked to safer sex behavior and delayed sexual debut among adolescents [15,16]. The school environment also serves as a significant protective factor. Adolescents’ sense of belonging to school and relationships with teachers are associated with reduced sexual risk behaviors [17], and school-based sex education is effective in changing knowledge, attitudes, and practices associated with RSB [4,18]. Community norms, collective efficacy, social support, and disadvantaged neighborhoods, such as poverty and residential instability, are associated with adolescent RSB [19,20].
Cambodia has a high percentage of young people, with a median age of 27.1 years; 28.6% of the population is aged 0–14, and the 15–64 age group accounts for 65.3% [21]. The country requires healthy young people to enter the workforce to form a foundation for its economic development. However, limited accessibility to information and health services, coupled with traditional societal sexual norms, has contributed to adverse sexual health trends among young people [22]. For example, the age of first sexual intercourse among the young population is very early: 16% of women aged 25–49 had their first sexual intercourse by the age of 18 [23]. Teenage pregnancy is a key concern, as approximately one in eight girls has their first child at the age of 15–19 years [24]. The prevalence of STIs among women aged 15–49 years is 18%, and young adults aged 15–24 account for approximately 44% of new HIV infections [25]. Despite the efforts of the Cambodian Ministry of Health through the National Strategy for Reproductive and Sexual Health 2017–2020, extended to 2023 [26], sexual health among Cambodian adolescents remains far from improvement.
In Cambodian society, where cultural expectations, family values, and community norms strongly shape sexual decision-making [20], these stakeholders may serve as gatekeepers of information and role models for adolescents. Therefore, this study aimed to explore the perspectives of parents, teachers, and community leaders who can closely observe, interact with, and influence adolescents’ behavior within the Cambodian cultural and societal context. These findings can inform the development of contextually relevant programs to reduce RSB among adolescents and improve sexual and reproductive health (SRH) outcomes and school performance, further contributing to the country’s potential social and economic development.
1. Study design
A qualitative research method was used to understand the participants’ in-depth perspectives regarding adolescent sexual behavior. The qualitative research method is most suitable for understanding human and social phenomena from an insider’s perspective in specific contexts and situations [27].
2. Conceptual framework
This study is based on the ‘ecological framework of adolescent health’ [14]. The framework emphasizes that adolescent health behaviors are determined through interactions among individual characteristics, family and peer relationships, school environments, community contexts, and broader social, cultural, and policy structures, not solely by individual choice [14]. Within this framework, the current study conceptualized adolescent sexual behavior as a product of multiple levels of social process. It examined how parents, teachers, and community leaders perceive, interpret, and respond to adolescents’ sexual behavior.
3. Participant and recruitment
The participants, selected as key stakeholders in adolescent sexuality, included parents, teachers, and community leaders. These groups were chosen because of a distinct social position through which adolescent sexual behaviors are observed, interpreted, and responded to within the family, school, and community contexts. Parents and teachers interact directly with adolescents in their roles as caregivers and educators, while community leaders encounter adolescent behavior in everyday community life. The eligibility criteria differed slightly depending on the participant group. Parents and teachers were eligible if they had taught or had adolescents between grades 7 and 12. Community leaders were defined as individuals holding formal positions of authority within the community (e.g., village chiefs, religious leaders) who had long-standing involvement in local governance and regular contact with families and adolescents. Analytically, this group was treated as providing situated, interpretive accounts of community norms and governance practices, rather than as statistically representative of all possible community leadership perspectives in Cambodia. Across all groups, participants were required to be willing to share thoughts, opinions, and experiences on the study topics.
Participants were recruited through school visits and community networks. The recruitment sites were the Phnom Penh and Kampong Cham provinces, representing both urban and rural residences. The recruitment team visited several locations within the community, including schools and villages, after obtaining permission from the principals and village leaders. The research team confirmed eligibility and provided potential participants with an overview of the study. They then arranged a mutually convenient time and location for interviews. Snowball referrals were further employed by asking participants to recommend peers or neighbors within their social networks who might be eligible to participate in the study.
4. Data collection
The data were collected with the support of MRTS Consulting, Ltd. (MRTS), a local professional research agency officially registered with the Ministry of Commerce and with over 15 years of experience in both qualitative and quantitative research. For professional and rigorous data collection, the principal investigator organized a comprehensive training workshop for all research staff and interviewers. The training session addressed the study’s aims, detailed interview questions and guides, and effective interview techniques, including rapport-building, active listening, probing, and summarizing responses. Before the interview, all researchers, interviewers, and transcribers involved in the study signed confidentiality agreements to protect participants’ information and identities. The data collection process was conducted in sequential phases. Pilot testing was carried out from December 5 to December 8, 2022. The interviewer training workshop was held on December 15, 2022. Participant recruitment took place from December 16, 2022, to January 17, 2023. Parent focus group interviews (two groups) were conducted on December 20, 2022 in Phnom Penh and January 10, 2023 in Kampong Cham. Individual interviews with teachers were conducted between December 20, 2022, and January 26, 2023, while individual interviews with community leaders were conducted from December 20, 2022, to January 10, 2023. Transcription and initial data organization were completed by January 31, 2023.
The study team developed semi-structured, open-ended questions to explore participants’ perspectives on adolescent sexual behavior within the Cambodian social context. Table 1 presents the semi-structured interview questions, including common questions for all participants as well as group-specific questions tailored to parents, teachers, and community leaders. The development of the interview guide drew on previous empirical studies related to adolescent sexuality and was informed each level and key elements of the ecological framework of adolescent health [14]. In interview questions, multiple subdomains were used to operationalize core concepts across the family, school, and community contexts within each ecological level. At the family level, parents were asked questions in terms of expectations, support, connectedness, behavioral regulation, and parental monitoring. At the school level, items addressed safety, social connections, opportunities, expectations, and institutional support. At the community level, questions focused on community assets, gender norms, safety, and perceived community risks. The interview guide was further refined through a pilot study conducted with five Cambodian adults in Phnom Penh to enhance clarity and cultural relevance. Prior to field deployment, all interviewers participated in a training workshop, during which the interview questions were reviewed and practiced to ensure conceptual understanding, cultural appropriateness, and smooth interaction between the interviewer and participant.
All in-depth individual interviews with the four community leaders and eight teachers were conducted in private settings chosen by the participants to ensure confidentiality, with only the interviewer and participant present. They were given the option of being interviewed face-to-face or via Zoom (Zoom Video Communications Inc., version 5.13). Teacher interviews were conducted primarily using Zoom, while all four community leaders were interviewed face-to-face. For the online interviews, verbal consent was obtained prior to recording, and a signed consent form was collected after the interviews. In-depth interviews lasted between 40 and 60 minutes, with shorter durations noted for community leaders, who were more cautious about sharing their views.
Focus group interviews (FGIs) among parents (two groups, six parents per group) were conducted in person at the MRTS office in Phnom Penh and in a café meeting room in Kampong Cham. FGIs lasted approximately 90–120 minutes; female participants tended to be less verbally expressive than male participants when discussing sensitive topics. All interviewers had extensive prior experience in conducting qualitative research.
All interviews and FGIs were audio-recorded with the participants’ permission and subsequently transcribed verbatim into English for analysis. A small incentive was provided upon completion as a token of appreciation for participation. Participants completed simple questionnaires in written form, asking about their gender, age, position, and years of service, before the interviews.
5. Data management
All interviews were conducted in Khmer and subsequently transcribed directly into English. Transcriptional and translational analyses were performed. A simplified and natural spoken English style was used during transcription to preserve the accuracy and authenticity of participants’ narratives. Quality control was implemented by reviewing more than 20% of the completed transcripts to ensure fidelity of translation, completeness of responses, and appropriateness of grammar and vocabulary. In cases where culturally specific Khmer terms related to sensitive topics were translated into English, the transcriber provided explanatory summaries to convey the intended meaning while preserving the core messages expressed by participants. When questions arose regarding specific sections of the transcripts, the team cross-checked the original audio, consulted the interviewers, and, when necessary, conducted follow-up calls with participants to ensure the accuracy and completeness of the data.
6. Data analysis
Transcripts translated into English were analyzed using inductive content analysis and qualitative research procedures [28]. Two scholars with extensive experience in qualitative research in nursing, as well as many years of research and residential engagement in Cambodia or comparable multicultural settings, were involved in the data analysis. This background enables a culturally informed interpretation of participants’ narratives.
Initially, the primary investigator read all transcripts multiple times to achieve immersion in the data and to obtain an overall sense of participants’ perspectives on adolescent sexual behavior. Open coding was conducted at the sentence and paragraph levels, with codes generated inductively to reflect participants’ own language and meanings. The coded data were then systematically compared across groups to examine similarities, differences, and points of convergence related to adolescent sexual behavior. A preliminary codebook was then developed based on the initial coding. The codebook included code labels, definitions, and exemplar quotations. An illustrative example of this coding process, including the linkage between open coding, code labels, definitions, and examples of quotations, is provided in Supplementary Table 1. Through regular research team meetings, the codebook was reviewed and refined. Coding discrepancies were discussed until a consensus was achieved. As analysis progressed, codes were merged, revised, or expanded to reflect emerging patterns. During the later stages of analysis, the ecological framework of adolescent health [14] and integrated thematic analysis were used as an interpretive lens to organize and contextualize the inductively derived codes and to synthesize findings across participant groups, allowing shared themes to be identified while preserving group-specific nuances. This allowed themes to be examined across individual, family, school, and community levels without constraining the inductive nature of the analysis. In addition, to minimize potential researcher bias, the research team engaged in reflexive analysis by bracketing prior assumptions derived from previous research experiences on Cambodian adolescents’ sexual behavior and focusing on what the data revealed in the present study.
The collaborative and reflexive process strengthened the credibility and dependability of the findings. Although formal member checking was not conducted, analytic credibility was enhanced through iterative researcher triangulation, consensus-based coding, and reflexive team discussions throughout the analytic process.
7. Data saturation
Data collection and analysis proceeded concurrently, and thematic saturation was considered achieved when no substantively new codes or perspectives emerged from the final interviews [29]. The final sample consisted of 24 participants, including 12 parents, eight teachers, and four community leaders. Across the parent and teacher groups, saturation was reached after repeated interviews yielded recurrent patterns without additional thematic expansion. Although only four community leaders participated and reached relatively early, their long-standing engagement in community affairs and sustained exposure to adolescent behavior (mean 18.8 years of service) yielded information-rich narratives. We interpret saturation in this group as saturation of core patterns within this specific sample rather than exhaustive coverage of the diversity of community leadership perspectives nationally.
8. Strategies to promote scientific rigor
A standardized guide was created and used for each interview, contributing to discovering the subject matter as accurately as possible using a variety of sources such as discussion materials, informal conversations, and field notes. When the content of the analysis was unclear, the research team listened carefully to the conversation and considered the atmosphere, emotions, and content that participants wanted to convey. This study adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) guidelines for comprehensive reporting.
9. Ethical consideration
This study was approved by the Institutional Review Board (IRB) of Jeonbuk National University (JBNU IRB No. 2022-01-017-002). Written informed consent was obtained from all participants prior to data collection. Participants were informed of their right to withdraw from the study at any time without penalty, and all data were de-identified to ensure confidentiality during analysis and reporting.
1. Characteristics of participants
The mean age of the parents in the FGIs (six mothers and six fathers) was 40.3 years, and each had one or two children attending middle or high school. Community leaders (two males and two females) had worked for 6–38 years, with a mean duration of 18.8 years. All participants had completed college-level education, with a mean age of 50.1 years. The teachers (four males and four females) had teaching experience ranging from 1 to 17 years, with a mean of 9.8 years, and taught subjects including biology, physics, mathematics, and Khmer literature. Participants’ residences were evenly split between urban (Phnom Penh) and rural (Kampong Cham) areas at a ratio of 1:1.
2. Integrated thematic analysis overview
Thematic qualitative analysis identified six integrated themes. Table 2 represents the stakeholder perceptions and responses to adolescent sexual behaviors, capturing how different stakeholder groups (parents, teachers, and community leaders) perceive risks, responsibilities, and limitations within their roles.

1) Theme 1. Acceleration of sexual behavior

There is a shared perception of acceleration in adolescents’ sexual behavior, largely driven by exposure to sexualized content from social media platforms (e.g., YouTube, Facebook, and TikTok), peer pressure, and pleasure-seeking activities (e.g., alcohol consumption, drug use, and nightclub attendance). Teachers report that internet pornography and 18+ movies, early dating, curiosity and boldness to engage in sexual activity, and the influence of a “modern” peer culture also contribute to the acceleration. Parents and community leaders attributed these trends to the combined effects of alcohol consumption, provocative attire, and the influence of foreign cultures, particularly those from Europe, Japan, and Thailand. Peer groups serve as both motivators and facilitators, fostering curiosity and imitation, and, in some cases, direct pressure to engage in sexual activities, thereby normalizing early relationship initiation at schools. As teachers explained, “They frequently use Facebook and TikTok. Several types of sexual content are available. It makes them want to try” (Teacher, IDI7), and “Young people nowadays dare to do something they are told not to do. They started dating since 5th or 6th grade. There is more exposure to different images and cultures now, which triggers their willingness to try sexual intercourse” (Teacher, IDI5). Similarly, a community leader observed, “They use drugs. They hang out at nightclubs. They get drunk, so they can’t control themselves. They end up doing it (sex)” (Community leader, IDI3). Another community leader noted, “They grow up faster now. They are easily convinced by their friends. There are sexy posters in restaurants. They end up doing it” (Community leader, IDI4). “It’s from neighboring countries and Europe. They see it on their mobile phones” (Community leader, IDI1). One parent shared that “What concerns me the most is doing drugs; having sexual partners which can be very risky” (Parent, FGI1). Another parent stated, “We can see many pictures and videos of girls wearing sexy bikinis everywhere on social media. This is really thought provoking not only for young but also 90-year-old people” (Parent, FGI2).

2) Theme 2. Loss of parental control

A weakening of parents’ ability to monitor, communicate with, and regulate adolescents’ sexual behavior due to work-related absence, communication barriers, and declining authority within rapidly changing family and social environments heightens adolescents’ vulnerability to early sexual activity. Both teachers and parents alike described significant challenges in maintaining open and effective communication on sensitive topics such as sex and contraception. Community leaders reflected on times of stricter parental authority, now perceived as “lost.” All groups noted a sense of diminished control over child discipline during rapid societal change. Shifts in family structure, economic pressures, and changing community norms further undermine parents’ capacity to guide or monitor their children, driving adolescents to rely heavily on peers, media, and other informal sources. As teachers explained, “I try to explain, but it’s not easy. Students don’t want to listen to teachers, especially about these topics” (Teacher, IDI3), and “Most parents don’t normally talk about sex with their kids. They only talk about it when they are married” (Teacher, IDI6). The parents admitted, “We’re working; we don’t know where our children go after school” (Parent, FGD2), “It’s really hard to control. If they are obedient, it’ fine. If not, it’s very hard” (Parent, FGD1), and community leaders reflected, “Simply returning to the past is unrealistic, but I feel a loss of control” and “In the past, parents were very strict. Nowadays, we can advise them, but we can’t really control what they do anymore” (Community leader, IDI1), “Parents work far away, some go to factories. No one controls the children. They follow friends instead” (Community leader, IDI3).

3) Theme 3. Academic disruption and sex education gaps

Across all participants, early sexual activity was perceived as disruptive not only to academic achievement but also to adolescents’ broader life trajectories, including prospects for higher education, employment, and marriage. Teachers emphasize classroom distractions, absenteeism, and the increased risk of school dropout, warning that such behaviors can have long-term consequences. Parents express concern over the loss of family honor and potential damage to a young person’s future “good name,” while community leaders highlight broader social ramifications and potential harm to the community’s reputation.
Across all participants, there was also a strong perception of a deficit in comprehensive sex education. While biology classes provide some reproductive health content, teachers are constrained by curriculum limitations and a personal reluctance to address sensitive topics. Consequently, students often turn to peers, social media, and the Internet for information, where they encounter confusion, myths, and potentially harmful practices such as misusing emergency contraception, misunderstanding disease prevention, or believing that hygiene alone can prevent pregnancy. For example, some students believed that a partner’s perceived health and honesty eliminated the need for condom use. Participants, particularly teachers, suggested strategies for disseminating accurate information. These included running short educational videos through government channels on Facebook, YouTube, and Telegram; developing youth health apps; organizing face-to-face workshops on safe sex practices; encouraging blood tests after sexual activity; teaching students how to purchase condoms comfortably; engaging them in constructive activities to reduce exposure to social media; and displaying health messages on billboards along the streets. Shame and cultural taboos further inhibit open discussions at home and in schools. As one teacher noted, “Most of them learn about these things from friends or the internet—not from us or their families” (Teacher, IDI7), adding, “They share wrong information in group chat—sometimes very dangerous myths” (Teacher, IDI7), Similarly, one community leader remarked, “There is no proper education, so mistakes are common” (Community leader, IDI4), and “They don’t know much about condoms or the risks of having sex. They hear things by word of mouth, not from proper education” (Community leader, IDI4). Parents shared the same way that “We don’t talk specifically on sex with them. We just provide general advice” (Parent, FGD2).

4) Theme 4. Moral/social concerns

In this theme, moral and social concerns refer to culturally embedded norms and values through which Cambodian society defines and regulates acceptable adolescent behavior. Moral anxieties, framed in terms of right and wrong, shame, and societal propriety, inform adult perspectives, sometimes leading to prescriptive or punitive advice. As teachers observed, “They are distracted from study, which can affect their whole life” (Teacher, IDI7), and “They are not in the mood of studying anymore, so they end up quitting school” (Teacher, IDI5). Similarly, parents group stated, “Having sex too early can affect their health. The girl can become pregnant... it affects her uterus. It does not look good for society” (Parent FGD1) and “For Cambodian culture, it’s not right to do that. It’s morally wrong to have sex before marriage” (Parent, FGD2), while community leaders noted, “We worry about how it affects our community’s image” (Community leader, IDI2), and “The first one is related to pregnancy. Secondly, it’s related to sexually transmitted diseases (STDs) infection. Last but not least, it’s related to family or parents’ reputation that Cambodian people care most” (Community leader, IDI1).

5) Theme 5. Gendered risks and double standards

Across all groups, there is a consistent view that girls are more likely to bear unfair consequences of early sexual activity, including pregnancy, STDs, and social stigma. Teachers and parents describe metaphors such as “stained white paper” to emphasize women’s vulnerability and the lasting impact of sexual behavior at an early age. Girls’ early sexual activity also affects their families’ reputation if it becomes known in the community. Parents stated, “If a daughter makes one mistake, the whole family loses face, and she has to quit school” (Parent, FGI1) and “Girls face more risk because it can damage her vagina, especially damaging hymen” (Parent, FGI2). However, boys’ sexual behavior is often overlooked, excused, or trivialized. Community leaders link persistent double standards to broader social changes and cultural tensions. As community leaders remarked, “Who would have to bear the pregnancy? It’s the girls… for boys, they just go wash themselves and it’s done” (Community leader, IDI4), and “Girls are the ones who can get pregnant, and that is what damages their reputation, while boys can usually keep it hidden” (Community leader, IDI2). Similarly, one teacher observed, “For girls, one mistake stays forever; for boys, nobody cares” (Teacher, IDI6). Another highlighted, “Daughters are linked to family honor, but sons are not” (Teacher, IDI7).

6) Theme 6. Prevention strategies and multi-sectoral cooperation

Prevention strategies for adolescents’ sexual behavior were commonly addressed by the participants: self-restraint, hygiene (e.g., use of feminine washes and cleanliness after sex), using condoms, and enforcing curfews. Teachers stressed that effective prevention requires cooperation among parents, schools, and local authorities. All participants stated that responsibility and collaboration are essential and foster a supportive environment to protect adolescents from the consequences of RSBs. Within this context, collective responsibility referred to the shared obligation of families, schools, and the community to jointly guide and support adolescents. Community leaders called for a revival of collective responsibility and suggested measures such as providing adolescents with advice, implementing a youth forum, conducting door-to-door conversations, and initiating multi-sectoral interventions by non-governmental organizations (NGOs), teachers, parents, and local authorities. As one parent advised, “We should advise them to protect themselves… They have to keep good hygiene and use feminine wash as well. They can use birth control pills” (Parent, FGD1). Another parent stated that “I want them to take good care of themselves and they should focus on their studies rather than love” (Parent, FGD2). A teacher similarly emphasized, “If parents, teachers, and community work together, maybe we can protect young people better” (Teacher, IDI1), while community leaders affirmed, “It must be a shared job, parents, teachers, community working together” (Community leader, IDI12), and “There are parents, school, teachers, community. We can share this information via their parents when we organize some community activity” (Community leader, IDI3).
3. Integrated narrative summary
Across all three groups, there was a strong convergence of core concerns: media-and peer-driven acceleration of sexual behavior, heightened risks for girls, disruption of schooling and future opportunities, and a substantial gap between the realities of adolescent lives and adults’ abilities to supervise and control. Group-specific nuances reflect distinctive features of each group.
This study makes a distinct theoretical contribution by advancing an empirically grounded, interactional ecological account of adolescent sexual behavior in Cambodia, in which family, school, community, social, cultural, and policy processes are shown to be mutually constitutive rather than merely additive. Whereas prior research has typically examined parental monitoring, peer influence, or individual risk factors in relative isolation, the current analysis demonstrates how stakeholders actively stitch together moral, relational, and institutional logics across levels when making sense of adolescent sexuality.
Building on the stakeholder perceptions and responses identified in the Results (Table 2), Table 3 organizes the themes into an ecological-level matrix that maps the findings within the family, school, community, social, cultural, and policy contexts to operationalize the ‘ecological framework for adolescent health.’ Table 3 clarifies how empirically grounded perceptions were subsequently situated into ecological levels to inform a more structured theoretical interpretation. As such, the ecological framework functioned primarily as an interpretive lens rather than a fully sampled multi-level design, a point revisited in this discussion.
At the family level of the ecological framework, which emphasizes monitoring and connectedness of parents, loss of parental control refers to the weakening of the traditional influence over children in a rapidly changing society. Many rural adolescents migrate to urban areas for education or employment, leaving them without parental supervision. Peer culture, mass media, and the internet tend to exert greater influence than parents or the local community [22]. A systematic review supported this finding, stating that living apart from one’s parents is associated with RSB among adolescents [30]. Parent-child communication about sex is often taboo and inadequate, contributing to the weakening of parental control. Cambodian adolescents report a notably low average score of 11.7 out of 35 on the Parental Sexuality Communication Scale [31]. Most adolescents (94.1%) in Lao PDR believe that discussing SRH issues with their parents is important [32]. However, fewer than a quarter (21.3%) actually reported having such discussions with their parents [32]. In both Vietnam and Lao PDR, sexuality-related conversations between parents and children are often viewed as cultural taboos and often experienced as embarrassing by adolescents [32,33]. Parents and teachers in this study framed sexuality as a topic requiring moral control rather than open dialogue, while community leaders emphasized maintaining social order and reputation. Viewed through an ecological lens, this multilevel pattern helps explain why positive attitudes toward communication about sexuality do not translate into practice in Cambodia.
At the school level of the ecological framework, which encompasses institutional opportunities and support for adolescent health, schools in Cambodia were perceived as having limited capacity to protect adolescents regarding sexual health. Adolescents’ RSBs were perceived by participants as hindering their academic achievement, leading to school dropout, and damaging the reputations of their families and communities. These concerns reflect how sexual behavior is embedded within the educational and social functions of schools.
Within the school ecological context, the absence and inadequacy of sex education have been identified as key factors contributing to the development of RSB among Cambodian adolescents. In this study, teachers, parents, and the community expressed concerns about the lack of systematic sex education for adolescents, and many acknowledged that they themselves did not receive adequate knowledge. School sex education is often briefly covered as part of the science curriculum, and its content tends to be limited to topics such as genital structure, pubertal changes, and STI prevention [22]. This also reflects the limitations of school-based sex and parenting education, which the participants in this study described as focusing primarily on hygiene, abstinence, and simple prescriptions. In contrast, Comprehensive Sexuality Education (CSE) provides a scientifically grounded, curriculum-based, and culturally appropriate approach that integrates relationship skills, communication, sexual self-determination, and gender equality within a human rights framework to support healthy adolescent decision-making [34]. A recent systematic review reported that CSE programs significantly increased adolescents’ knowledge, skills, attitudes, and self-efficacy regarding condom use [35]. These findings suggest that it is necessary to translate policy supports into protective environments for adolescents at the school level. Therefore, strengthening sex education through multi-faceted collaborations among schools, families, and communities is emerging as a critical task in Cambodia across ecological levels.
At the community level of the ecological framework, adolescent sexual behavior was primarily interpreted as a threat to family honor and community image. The participants expressed significant moral and social concerns. Cambodian adolescents perceive teenage pregnancy as stigmatizing their families by violating traditional moral norms against premarital sex [20,22]. Southeast Asian countries, including Indonesia, Lao PDR, and Malaysia, share a similar culture where pregnant adolescent girls face social stigma [36]. This study makes a unique contribution by demonstrating how such consequences are not only experienced by adolescents but are also actively constructed and reinforced through the moral and reputational discourses of parents, teachers, and community leaders.
At the social level of the ecological framework, macro-social forces such as digital media, peer culture, and globalization were perceived as key drivers of the accelerating sexual behavior among adolescents in Cambodia. Participants noted that the influx of Western culture, particularly through the Internet and social media, altered adolescents’ attitudes and behaviors. This is echoed by Cambodian adolescents themselves, who reported that pornography stimulates, intrigues, and convinces boys to have sex [22], and increases sexting, the sending and receiving of sexual messages, videos, and images [37]. This aligns with findings from Vietnamese adolescents having a high rate of sexually explicit internet material use (84.1%) [38], and engaging in sexting behaviors (43.9%) [39]. Parents and teachers also cited the influence of peer groups on adolescents accelerated sexual behaviors. A recent meta-analysis on the influence of peer pressure on sexual behavior in African adolescents found that peer pressure increased premarital sexual practice by 13.62 times [40], while positive peer influence played a constructive role in shaping sexual abstinence [41]. The Positive Youth Development model, which helps adolescents develop into healthy and well-integrated adults, provides strategies for the responsible use of digital technologies while avoiding pornography, sexting, and cyberbullying [42]. Adopting this model to develop intervention programs may be beneficial for Cambodia.
At the cultural level, deeply rooted gender norms and sexual double standards were found to shape how adolescent sexuality is interpreted, particularly for girls. The traditional norm, Chbab Srey, requires virtuous Khmer women to be chaste, obey their husbands, and maintain premarital chastity [43]. A qualitative study found that some Cambodian adolescent girls still believe that men are “subjects of desire satisfaction” and women are “obligated to their families and husbands” [20]. Although sexual self-determination is recognized by the United Nations, the participants in this study viewed adolescents’ sexual self-determination as immature and morally deviant [43]. Cambodia remains a patriarchal and male-oriented society, so SRH education and empowerment must be equally balanced for both men and women [44]. For example, schools can provide gender equality and mutual respect education, and community leaders can discuss contemporary interpretations of the traditional norms of Chbab Srey to foster social norms that advocate for the rights of female adolescents [20]. In short, recognizing the gender double standard inherent in adolescent sexual behavior and working to mitigate it should be central to future intervention strategies.
Last, at the policy level of the ecological framework, participants emphasized the need for coordinated, multi-sectoral action to address adolescent sexual behavior through aligned efforts across families, schools, communities, health systems, and national institutions [14,30], yet this level is only indirectly represented through their accounts rather than through interviews with policy-makers, health providers, or NGO staff. This study contributes by detailing how different community actors assign responsibility and envision collaboration in practice. Parental education and local campaigns can be implemented at the home and community levels. Workshops and educational materials can be distributed to parents, and public discourse on adolescent sexual health can be facilitated through collaboration with community and religious leaders. Given that rural adults in Cambodia use Facebook extensively, case-based educational materials tailored to local contexts can be developed into videos and shared on Facebook and YouTube. During public discourse, villages should actively communicate with youth and select individuals to invite for public lectures. In the health and welfare sector, youth-friendly services should be expanded to ensure convenient access for adolescents. Adolescents with limited access to SRH services are at higher risk of engaging in RSBs [44]. Therefore, health authorities should establish policies such as teen-specific counseling centers, anonymous STI screening, and affordable and confidential contraception. Recent initiatives by NGOs, such as SMS (Short Message Service)-based sex education programs, online campaigns, and game-based sexual education [44], exemplify this approach, and government-level expansion is under consideration. Additionally, gendered risks and double standards, identified within the cultural context, should be addressed through policy-level interventions, including protective laws and national policies that support female students regarding pregnancy, school attainment, and access to sexual health services.
One limitation of this study is that it did not include national government officials or NGOs as stakeholders to directly get insight into certain macro-level influences, such as national policy implementation and service delivery. Consequently, the ecological matrix should be read as a stakeholder-derived interpretation of policy influences, not as a comprehensive mapping of structural and institutional processes. Future research could gain a broader perspective by including officials working in ministries of education and youth affairs, as well as NGO staff working to promote adolescent sexual health.
This interpretation is also completed by the relationality of the research team, which includes scholars trained in nursing and public health who have extensive research experience in Cambodia but are not themselves adolescents or caregivers in the study communities. Our decision to employ the ecological framework focused on multi-level determinants of adolescent sexual behavior. Furthermore, conducting interviews through Khmer–English translation and working with a small, highly experienced group of community leaders likely amplified particular moral and reputational discourses. Rather than viewing these features solely as limitations, we regard them as constitutive of the analytic lens through which the data were interpreted and as important boundaries on the transferability of the findings.
Taken together, our use of the ecological framework enabled a layered interpretation of adolescent sexual behavior across family, school, community, and cultural domains, while also revealing gaps at the structural and service-delivery levels that our sampling frame could not fully capture. This partial alignment underscores the value of applying a comprehensive ecological model within a descriptive qualitative design focused on community stakeholders.
This study provides an in-depth ecological understanding of adolescent sexual behavior in Cambodia based on the perspectives of parents, teachers, and community leaders. The final six themes identified reflect processes through which rapid social change, weakened parental and school-based sex education, community moral pressures, gendered cultural norms, and limited safe adolescent sexual decision-making occur. This study also found that the interactive mechanism across family, school, community, social, cultural, and policy contexts influences adolescents’ engagement in RSBs. These findings underscore the need for coordinated, multi-sectoral strategies within a coherent ecological response. Reflecting the sociocultural context, which places a high value on social image and gender norms for adolescents, providing a safe environment for communication and strengthening comprehensive sexuality education are important. This study provides both a theoretical basis and guidance for developing more effective, context-sensitive, and culturally acceptable programs for adolescent sexual health in Cambodia.

Conflicts of Interest

No potential conflict of interest relevant to this article was reported.

Acknowledgements

Generative AI (ChatGPT, OpenAI) was used during manuscript preparation to improve language quality. No AI tool was used to generate original data, conduct analyses, or make scientific decisions. The authors are responsible for all content in this manuscript.

Funding

This work was supported by the Ministry of Education of the Republic of Korea and the National Research Foundation of Korea (NRF-2020S1A5A2A03047080).

Data Sharing Statement

Please contact the corresponding author for data availability.

Supplementary Data

Supplementary data to this article can be found online at https://doi.org/10.4040/jkan.25146.

Supplementary Table 1. Example of the coding process (Theme 1)

jkan-25146-Supplementary-Table-1.pdf

Author Contributions

Conceptualization or/and Methodology: YY. Data curation or/and Analysis: GP, YY. Funding acquisition: YY. Investigation: YY. Project administration or/and Supervision: YY. Resources or/and Software: YY. Validation: GP, YY. Visualization: YY. Writing: original draft or/and Review & Editing: GP, YY. Final approval of the manuscript: all authors.

Table 1.
Interview questions
Level Subdomain Questions
Ecological framework of adolescent health
 For parents
  Family Expectations • What are the expectations that you have for your child?
• What are your expectations of your child in terms of sexual behavior?
Supports • What support do you provide to your child?
• What support do you provide to your child to develop healthy sexual behavior?
Connectedness • How much do you communicate with your child about sex?
Behavioral regulation • What rules do you have regarding your child’s behavior?
Monitoring • How do you monitor your child’s behavior?
In general • Who should educate teenage boys and girls on issues relating to sex?
• Whose duty is it in particular to check the behavior or conduct of adolescents between 13 and 18 years in Cambodia?
• What should parents do if they realize that their under-aged children have engaged in sexual activity?
• In reality, do parents talk to their children about sex, and if they do, how do they do it in Cambodia?
 For teachers
  School Safety • How safe is your school in preventing students from risky sexual behavior?
• How important is school safety to your students?
Connections • What role do teacher–student relationships play in fostering healthy sexual behavior?
Opportunities • What opportunities does your school provide to students to have healthy sexual behavior?
Expectations • What expectations do you have for your students regarding sexual behavior?
Support • How do you support your students to have healthy sexual behavior?
 For community leaders
  Community Community assets • What resources does your community have to prevent adolescents and young adults from engaging in risky sexual behavior?
Gender norms • How do male and female adolescents differ in terms of gender roles in sexual relationships?
Safety • How safe is your community for adolescents?
• How important is community safety to adolescents?
Community risks • How does your community help prevent adolescents from engaging in risky sexual behavior?
Additional questions for all participants
 Risk factors of RSB • What would you say about the sexual behavior of adolescents in Cambodia?
• What cultural beliefs and attitudes influence adolescents and young adults in their decisions regarding sexual behavior?
• What are the sex-related problems among adolescents in your community or country?
• How would you define risky sexual behavior?
• In your expert opinion, what are the causes of early sexual activity?
• In your expert opinion, what factors contribute to adolescents engaging in sexual activity without condom use?
• In your expert opinion, what causes adolescents and young adults to have multiple sexual partners simultaneously?
 Protective factors of RSB • What factors can prevent adolescents and young adults from engaging in sexual activity before the age of 16 years?
• What factors can prevent adolescents from engaging in sexual activity without a condom?
• What factors can prevent adolescents from having multiple sexual partners at the same time?
• What factors within your community or country help adolescents resist pressure to engage in sexual activity?
• What are the factors within your community/country that influence condom use among sexually active adolescents?
• What factors within your community/country help adolescents have a single sexual partner?
 Acceptable intervention models • What do you think is your role in preventing risky sexual behavior among adolescents in your community/country?
• In your expert opinion, what kind of programs would be acceptable to you to prevent risky sexual behavior in your community or country?

RSB, risky sexual behavior.

Table 2.
Integrated themes of adolescent sexual behavior across stakeholders
Theme Definition Stakeholder
Parents Teachers Community leaders
Acceleration of sexual behavior A rapid shift toward earlier and more frequent sexual interest and behavior among adolescents driven by digital exposure, peer culture, and pleasure-seeking environments • Observe children’s exposure to sexualized images on Facebook, TikTok, and YouTube • Observe early dating and online sexual exposure among students • Attribute early sexual behavior to modernization and foreign cultural influence
• Worry about alcohol, drugs, and peer influence accelerating risky behavior • Report influence of internet pornography and 18+ content • Highlight nightlife, alcohol, and drug use as key drivers
• Describe growing curiosity and early romantic involvement • Note increased boldness and willingness to experiment • Note weakening of traditional social restraints
Loss of parental control A weakening of parents’ ability to monitor, communicate with, and regulate adolescents’ sexual behavior due to work-related absence, communication barriers, and declining authority within rapidly changing family and social environments • Supervise children less due to long working hours and migration • Observe students lacking parental supervision • Recall stronger parental authority in the past
• Experience high discomfort and taboos around discussing sex • Notice poor parent–child communication about sex and relationships • Perceive a decline in parental power and discipline
• Rely on warnings and moral instruction rather than dialogue • See adolescents relying on peers and media instead of parents • Link weakened control to urbanization, migration, and social change
• Report a limited capacity to monitor adolescents’ relationships and media use • Encounter behavioral issues that parents fail to regulate • Recognize parents’ limited capacity to guide adolescents
Academic disruption and sex education gaps Early sexual involvement is perceived to disrupt academic engagement and longer-term life trajectories (e.g., higher education, employment, marriage). At the same time, limited school-based sexuality education leaves adolescents to rely on peers and digital media, increasing exposure to misinformation and unsafe practices. • Worry that early sexual activity harms children’s future, family honor, and reputation • Observe classroom distraction, absenteeism, and risk of school dropout linked to early sexual activity • Observe classroom distraction, absenteeism, and risk of school dropout linked to early sexual activity
• Avoid talking directly about sex and provide only general or moral advice • Report that students rely on friends, social media, and online sources for sexual information • Report that students rely on friends, social media, and online sources for sexual information
• Feel unprepared to explain contraception, STIs, or relationships • Feel constrained by curriculum limits and personal discomfort in teaching sexuality • Feel constrained by curriculum limits and personal discomfort in teaching sexuality
• Recognize that children learn about sex from peers and the internet rather than from parents • Recognize widespread misinformation and dangerous myths among students • Recognize widespread misinformation and dangerous myths among students
Moral and social concerns Culturally embedded norms and values through which Cambodian society defines and regulates acceptable adolescent sexual behavior, emphasizing shame, propriety, family honor, and social reputation • View premarital sex as morally wrong in Cambodian culture • See sexual involvement as distracting students from studying • Worry about how adolescent sex affects the community’s public image
• Fear pregnancy will damage a girl’s body and future • Link relationships and sex to school dropout and life failure • Emphasize pregnancy, STDs, and family shame
• Worry about shame and how society judges the family • Frame sexuality through future-oriented moral consequences • See sexuality as a threat to moral and social order
Gendered risks and double standards Socially and culturally constructed norms that assign disproportionate sexual, moral, and reputational consequences to girls while excusing or minimizing boys’ sexual behavior • Believe girls suffer greater physical and moral harm from sex • See girls’ sexuality as involving lasting stigma • See girls’ sexuality as leaving lasting stigma
• Fear pregnancy, loss of virginity, and damage to family reputation • Note that boys’ behavior is socially tolerated • Note that boys’ behavior is socially tolerated
• See daughters’ mistakes as destroying both their future and the family’s honor • Recognize that daughters are linked to family honor, not sons • Recognize that daughters are linked to family honor, not sons
• Emphasize self-protection through hygiene, contraception, and discouraging early relationships • Stress coordinated efforts between parents, schools, and authorities to protect adolescents • Advocate collective action through community meetings, youth forums, and multi-sectoral initiatives
Prevention strategies and multi-sectoral cooperation A shared, multi-level responsibility among families, schools, and community institutions to protect adolescents through coordinated guidance, education, and social support • Advise adolescents to protect themselves through hygiene and contraception • Believe prevention cannot be handled by schools alone • Call for revival of shared responsibility across sectors
• Encourage focus on studies rather than romantic relationships • Emphasize cooperation between parents, teachers, and community authorities • Promote youth forums, community meetings, and information sharing
• Emphasize practical and moral guidance at home • See coordinated action as essential for adolescent protection • Support collaboration with NGOs, schools, and families

NGOs, non-governmental organizations; STDs, sexually transmitted diseases; STIs, sexually transmitted infections.

Table 3.
An ecological-level matrix of integrated themes in adolescent sexual behavior
Theme Ecological level Situation within ecological level
Loss of parental control Family Families are increasingly strained by migration, long working hours, and urban living, reducing parents’ physical presence and emotional capacity to supervise, communicate, and enforce norms around adolescent behavior.
Academic disruption and sex education gaps School Schools operate within a constrained educational system where sexuality is marginally addressed in biology curricula, leaving teachers ill-equipped to provide comprehensive guidance and students to rely on peers and digital media for sexual information.
Moral and social concerns Community Communities are situated within a cultural framework that strongly values family honor, social reputation, and moral conformity, making adolescent sexual behavior a collective concern linked to shame, stigma, and social order.
Acceleration of sexual behavior Social Adolescents are embedded in a rapidly digitalized and globalized social environment characterized by constant exposure to sexualized media, nightlife culture, and peer-oriented leisure spaces, which normalize early romantic and sexual experimentation.
Gendered risks and double standards Cultural Cultural norms continue to position girls as moral and reproductive bearers of family and social honor, while boys’ sexual behavior is more socially tolerated, producing persistent gendered inequalities in sexual consequences.
Prevention strategies and multi-sectoral cooperation Policy Adolescent sexual behavior is increasingly viewed as a shared social responsibility requiring coordinated action among families, schools, community leaders, and public or non-governmental institutions to compensate for weakening informal controls.

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        Perspectives of parents, teachers, and community leaders on adolescent sexual behavior across ecological contexts in Cambodia: a qualitative study
        J Korean Acad Nurs. 2026;56(1):108-122.   Published online February 25, 2026
        DOI: https://doi.org/10.4040/jkan.25146
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      Perspectives of parents, teachers, and community leaders on adolescent sexual behavior across ecological contexts in Cambodia: a qualitative study
      Perspectives of parents, teachers, and community leaders on adolescent sexual behavior across ecological contexts in Cambodia: a qualitative study
      Level Subdomain Questions
      Ecological framework of adolescent health
       For parents
        Family Expectations • What are the expectations that you have for your child?
      • What are your expectations of your child in terms of sexual behavior?
      Supports • What support do you provide to your child?
      • What support do you provide to your child to develop healthy sexual behavior?
      Connectedness • How much do you communicate with your child about sex?
      Behavioral regulation • What rules do you have regarding your child’s behavior?
      Monitoring • How do you monitor your child’s behavior?
      In general • Who should educate teenage boys and girls on issues relating to sex?
      • Whose duty is it in particular to check the behavior or conduct of adolescents between 13 and 18 years in Cambodia?
      • What should parents do if they realize that their under-aged children have engaged in sexual activity?
      • In reality, do parents talk to their children about sex, and if they do, how do they do it in Cambodia?
       For teachers
        School Safety • How safe is your school in preventing students from risky sexual behavior?
      • How important is school safety to your students?
      Connections • What role do teacher–student relationships play in fostering healthy sexual behavior?
      Opportunities • What opportunities does your school provide to students to have healthy sexual behavior?
      Expectations • What expectations do you have for your students regarding sexual behavior?
      Support • How do you support your students to have healthy sexual behavior?
       For community leaders
        Community Community assets • What resources does your community have to prevent adolescents and young adults from engaging in risky sexual behavior?
      Gender norms • How do male and female adolescents differ in terms of gender roles in sexual relationships?
      Safety • How safe is your community for adolescents?
      • How important is community safety to adolescents?
      Community risks • How does your community help prevent adolescents from engaging in risky sexual behavior?
      Additional questions for all participants
       Risk factors of RSB • What would you say about the sexual behavior of adolescents in Cambodia?
      • What cultural beliefs and attitudes influence adolescents and young adults in their decisions regarding sexual behavior?
      • What are the sex-related problems among adolescents in your community or country?
      • How would you define risky sexual behavior?
      • In your expert opinion, what are the causes of early sexual activity?
      • In your expert opinion, what factors contribute to adolescents engaging in sexual activity without condom use?
      • In your expert opinion, what causes adolescents and young adults to have multiple sexual partners simultaneously?
       Protective factors of RSB • What factors can prevent adolescents and young adults from engaging in sexual activity before the age of 16 years?
      • What factors can prevent adolescents from engaging in sexual activity without a condom?
      • What factors can prevent adolescents from having multiple sexual partners at the same time?
      • What factors within your community or country help adolescents resist pressure to engage in sexual activity?
      • What are the factors within your community/country that influence condom use among sexually active adolescents?
      • What factors within your community/country help adolescents have a single sexual partner?
       Acceptable intervention models • What do you think is your role in preventing risky sexual behavior among adolescents in your community/country?
      • In your expert opinion, what kind of programs would be acceptable to you to prevent risky sexual behavior in your community or country?
      Theme Definition Stakeholder
      Parents Teachers Community leaders
      Acceleration of sexual behavior A rapid shift toward earlier and more frequent sexual interest and behavior among adolescents driven by digital exposure, peer culture, and pleasure-seeking environments • Observe children’s exposure to sexualized images on Facebook, TikTok, and YouTube • Observe early dating and online sexual exposure among students • Attribute early sexual behavior to modernization and foreign cultural influence
      • Worry about alcohol, drugs, and peer influence accelerating risky behavior • Report influence of internet pornography and 18+ content • Highlight nightlife, alcohol, and drug use as key drivers
      • Describe growing curiosity and early romantic involvement • Note increased boldness and willingness to experiment • Note weakening of traditional social restraints
      Loss of parental control A weakening of parents’ ability to monitor, communicate with, and regulate adolescents’ sexual behavior due to work-related absence, communication barriers, and declining authority within rapidly changing family and social environments • Supervise children less due to long working hours and migration • Observe students lacking parental supervision • Recall stronger parental authority in the past
      • Experience high discomfort and taboos around discussing sex • Notice poor parent–child communication about sex and relationships • Perceive a decline in parental power and discipline
      • Rely on warnings and moral instruction rather than dialogue • See adolescents relying on peers and media instead of parents • Link weakened control to urbanization, migration, and social change
      • Report a limited capacity to monitor adolescents’ relationships and media use • Encounter behavioral issues that parents fail to regulate • Recognize parents’ limited capacity to guide adolescents
      Academic disruption and sex education gaps Early sexual involvement is perceived to disrupt academic engagement and longer-term life trajectories (e.g., higher education, employment, marriage). At the same time, limited school-based sexuality education leaves adolescents to rely on peers and digital media, increasing exposure to misinformation and unsafe practices. • Worry that early sexual activity harms children’s future, family honor, and reputation • Observe classroom distraction, absenteeism, and risk of school dropout linked to early sexual activity • Observe classroom distraction, absenteeism, and risk of school dropout linked to early sexual activity
      • Avoid talking directly about sex and provide only general or moral advice • Report that students rely on friends, social media, and online sources for sexual information • Report that students rely on friends, social media, and online sources for sexual information
      • Feel unprepared to explain contraception, STIs, or relationships • Feel constrained by curriculum limits and personal discomfort in teaching sexuality • Feel constrained by curriculum limits and personal discomfort in teaching sexuality
      • Recognize that children learn about sex from peers and the internet rather than from parents • Recognize widespread misinformation and dangerous myths among students • Recognize widespread misinformation and dangerous myths among students
      Moral and social concerns Culturally embedded norms and values through which Cambodian society defines and regulates acceptable adolescent sexual behavior, emphasizing shame, propriety, family honor, and social reputation • View premarital sex as morally wrong in Cambodian culture • See sexual involvement as distracting students from studying • Worry about how adolescent sex affects the community’s public image
      • Fear pregnancy will damage a girl’s body and future • Link relationships and sex to school dropout and life failure • Emphasize pregnancy, STDs, and family shame
      • Worry about shame and how society judges the family • Frame sexuality through future-oriented moral consequences • See sexuality as a threat to moral and social order
      Gendered risks and double standards Socially and culturally constructed norms that assign disproportionate sexual, moral, and reputational consequences to girls while excusing or minimizing boys’ sexual behavior • Believe girls suffer greater physical and moral harm from sex • See girls’ sexuality as involving lasting stigma • See girls’ sexuality as leaving lasting stigma
      • Fear pregnancy, loss of virginity, and damage to family reputation • Note that boys’ behavior is socially tolerated • Note that boys’ behavior is socially tolerated
      • See daughters’ mistakes as destroying both their future and the family’s honor • Recognize that daughters are linked to family honor, not sons • Recognize that daughters are linked to family honor, not sons
      • Emphasize self-protection through hygiene, contraception, and discouraging early relationships • Stress coordinated efforts between parents, schools, and authorities to protect adolescents • Advocate collective action through community meetings, youth forums, and multi-sectoral initiatives
      Prevention strategies and multi-sectoral cooperation A shared, multi-level responsibility among families, schools, and community institutions to protect adolescents through coordinated guidance, education, and social support • Advise adolescents to protect themselves through hygiene and contraception • Believe prevention cannot be handled by schools alone • Call for revival of shared responsibility across sectors
      • Encourage focus on studies rather than romantic relationships • Emphasize cooperation between parents, teachers, and community authorities • Promote youth forums, community meetings, and information sharing
      • Emphasize practical and moral guidance at home • See coordinated action as essential for adolescent protection • Support collaboration with NGOs, schools, and families
      Theme Ecological level Situation within ecological level
      Loss of parental control Family Families are increasingly strained by migration, long working hours, and urban living, reducing parents’ physical presence and emotional capacity to supervise, communicate, and enforce norms around adolescent behavior.
      Academic disruption and sex education gaps School Schools operate within a constrained educational system where sexuality is marginally addressed in biology curricula, leaving teachers ill-equipped to provide comprehensive guidance and students to rely on peers and digital media for sexual information.
      Moral and social concerns Community Communities are situated within a cultural framework that strongly values family honor, social reputation, and moral conformity, making adolescent sexual behavior a collective concern linked to shame, stigma, and social order.
      Acceleration of sexual behavior Social Adolescents are embedded in a rapidly digitalized and globalized social environment characterized by constant exposure to sexualized media, nightlife culture, and peer-oriented leisure spaces, which normalize early romantic and sexual experimentation.
      Gendered risks and double standards Cultural Cultural norms continue to position girls as moral and reproductive bearers of family and social honor, while boys’ sexual behavior is more socially tolerated, producing persistent gendered inequalities in sexual consequences.
      Prevention strategies and multi-sectoral cooperation Policy Adolescent sexual behavior is increasingly viewed as a shared social responsibility requiring coordinated action among families, schools, community leaders, and public or non-governmental institutions to compensate for weakening informal controls.
      Table 1. Interview questions

      RSB, risky sexual behavior.

      Table 2. Integrated themes of adolescent sexual behavior across stakeholders

      NGOs, non-governmental organizations; STDs, sexually transmitted diseases; STIs, sexually transmitted infections.

      Table 3. An ecological-level matrix of integrated themes in adolescent sexual behavior

      Table 1.

      Table 2.

      Table 3.

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