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Citation: Belihu WB, Herder T, Amogne MD,
Sundewall J, Palmieri J, Agardh A (2025)
Exposure to violence and associated factors
among university students in Ethiopia: A cross-
sectional study. PLoS ONE 20(3): e0319792.
https://doi.org/10.1371/journal.pone.0319792
Editor: Jessica Leight, IFPRI: International
Food Policy Research Institute, UNITED
STATES OF AMERICA
Received: September 13, 2024
Accepted: February 7, 2025
Published: March 18, 2025
Copyright: © 2025 Belihu et al. This is an open
access article distributed under the terms of
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which permits unrestricted use, distribution,
and reproduction in any medium, provided the
original author and source are credited.
Data availability statement: The data is owned
by the Ethiopian Public Health Institute National
Data Management Center (EPHI NDMC). It can
be made accessible upon request, via web link
below. https://rtds.ephi.gov.et/public/
Funding: The author(s) received no specific
funding for this work.
RESEARCH ARTICLE
Exposure to violence and associated factors
among university students in Ethiopia: A
cross-sectional study
Wudinesh Belete Belihu 1,2*, Tobias Herder1, Minilik Demissie Amogne1,2,
Jesper Sundewall1, Jack Palmieri 1, Anette Agardh1
1 Social Medicine and Global Health, Malmö, Sweden, 2 Infectious Disease Research Directorate,
Ethiopian Public Health Institute, Addis Ababa, Ethiopia
* wudinesh_belete.belihu@med.lu.se, beletewudinesh@gmail.com
Abstract
Background
Violence is a major public health concern with a signicant impact on the health and
well-being of individuals, families, and communities. Living in a new environment without
parental control and experimenting with new lifestyles may increase the risk of violence
among university students. Therefore, this study aimed to assess exposure to violence
and its associated factors among university students in Ethiopia.
Method
A cross-sectional study was conducted among 2988 university students from six ran-
domly selected universities in Ethiopia. A two-stage stratied sampling method was used
to recruit the study participants. A self-administered questionnaire was utilized to collect
information regarding exposure to emotional, physical, and sexual violence. Bivariable
and multivariable logistic regression analyses were used to identify factors associated with
violence exposure in the last 12 months.
Results
The prevalence of exposure to any type of violence in the last 12 months was 17.6%
(n = 525) (17.9% among males, 16.5% among females). The adjusted odds ratio (AOR) of
violence was 2.9 times higher (95% CI 1.6-5.0) among students older than 25 years than
those aged 18-20 years. Those students who were in a relationship had 1.4 times higher
odds of violence (95% CI 1.0-2.0) than those who were not in a relationship. In addition,
those students who were from rural residences before coming to the university had 1.4
times higher odds of violence (95% CI 1.1-1.8) than those from urban residences. The
odds of violence among those who consumed alcohol once a week or more in the past
month were 2.2 times higher (95% CI 1.3-3.6) than those who did not consume alcohol.
Furthermore, the likelihood of violence was 1.6 times higher (95% CI 1.0-2.4) among those
who chewed khat and 2 times higher (95% CI 1.3-3.1) among those who used other drugs
in the last 12 months.
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
Conclusion
Exposure to violence is a challenge for both male and female university students in
Ethiopia. Several socio-demographic and behavioral factors were signicantly associated
with exposure to violence. Therefore, it is crucial for universities and stakeholders to raise
awareness about contributing factors to minimize violence, regardless of gender.
Background
Globally, violence remains a pervasive issue, manifesting in forms as varied as armed conflict,
terrorism, domestic violence, and crime, impacting millions of lives and destabilizing societ-
ies. Both men and women across the world are victims of violence. For example, according to
the estimates based on the WHO global database from 161 countries on the prevalence of vio-
lence against women, more than one in four (27%) ever-partnered women aged 15–49 years
has experienced physical and/or sexual intimate partner violence since the age of 15 years and
one in seven (13%) experienced this violence in the past year before the survey [1].
Violence is a public health issue due to its widespread prevalence and adverse short and
long-term impacts on physical, mental, sexual, and reproductive health. Additionally, it entails
significant social and economic costs for victims, their families, and societies, including inter-
generational cycles of violence, lower academic performance and reduced productivity [2–4].
Violence is frequently categorized into four types, physical, sexual, psychological violence, and
violence involving deprivation or neglect [5]. According to the 2016 Ethiopian Demographic
and Health Survey (EDHS), among women aged 15-49, the prevalence of physical violence
ever and in the past 12 months was 23% and 15%, respectively; the prevalence of sexual vio-
lence ever and in the past 12 months was 10% and 7%, respectively [6]. Although both men
and women are victims of violence, limited information is available concerning men’s expo-
sure to violence in Ethiopia or neighboring countries.
University students can be particularly at risk for exposure to violence. For many young
adults, university study is the first time that they are away from parental control, which can
increase their exposure to behaviors associated with experiences of violence, such as alcohol
consumption [7–9] and drug use [10–12]. Furthermore, university is a time of self-discovery
and exploration of new things, such as being in relationships and having sex. While students
are often independent and make their own decisions, they are also subject to power imbal-
ances by peers and teachers, which might increase their exposure to violence. It is difficult to
get a clear picture of campus violence due to underreporting of incidents and the use of incon-
sistent survey methods across studies [13]. Exposure to emotional and physical violence in the
past six months among university students in the US and Canada was 17% and 16% among
males and females, respectively [14]. Another study among university students in Italy showed
that experience of psychological and physical violence among peers/at school was higher
among males than females (21.5% vs. 9.7%) [15]. Exposure to violence is also prevalent among
university students in African countries. A study on sexual coercion, interpersonal violence,
and mental health among university students in southwestern Uganda showed that 31.1% of
the respondents had experienced some form of sexual coercion in their lifetime; 27.8% and
9.6% of the respondents had been exposed to perceived threats/threats of violence and actual
physical violence, respectively, during the past year [16]. Furthermore, a study on the preva-
lence of sexual violence among female university students in Ethiopia showed that 9.8% and
1.6% of students had been victims of completed rape in their lifetime and after joining the
university, respectively [17]. A similar study among female university students in Ethiopia
Competing interests: No authors have compet-
ing interests.
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
revealed a 15.3% lifetime prevalence of rape and a prevalence of 8% and 2.3% since joining the
university and in the current academic year, respectively [18].
Theoretical framework
It has been argued that a combination of individual, institutional, community, public policy
and societal factors, as well as group processes contribute to exposure to violence in higher
education across countries [13]. One way of understanding these vulnerabilities further would
be to view them from the perspectives of developmental ecology. According to Bronfenbren-
ner’s ecological model of human development, youth violent behavior should be viewed as a
result of interactions within various environmental systems rather than in isolation [19]. The
model comprises five subsystems, the micro-, meso-, exo-, macro- and chronosystems. The
microsystem includes immediate relationships like family, school/university, and peers, the
mesosystem includes interactions between various aspects of the microsystem, and the exo-
system encompasses external influences such as policies and institutions that indirectly affect
individuals. The lack of curriculum and policy to prevent or manage exposure to violence,
is a general problem in Ethiopia, not least for university students, and can be seen as part of
the exosystem in the human deveopment model. Furthermore, university students may be
influenced by the macrosystem, which involves broader cultural beliefs and ideologies and the
chronosystem, accounting for changes over time [20].
Factors such as individual characteristics (age, gender) and behaviors (substance use)
interact with these systems to increase vulnerability to violence among youth, particu-
larly among university students who may face unique risks due to their social networks
and environmental contexts. A study by Heise of violence among women that adopted
an integrated ecological framework, supported by findings from international and cross-
cultural research, described factors contributing to violence at different levels of the social
ecology [21]. These factors involve determinatnats at the individual level, such as having
witnessed marital violence as a child and having been abused as a child, the microsystem
level, including male dominance in the family, the exosystem level, including low socio-
economic status and delinquent peer association, and the macrosystem level, including
masculinity norms linked to aggression and dominance, rigid gender roles, and acceptance
of interpersonal violence [21]. Another longitudinal study of the development of serious
delinquent behavior among adolescent boys showed the relationships between microsys-
tem influences of parenting and peer deviance, macrosystem influences of community
structural characteristics and neighborhood social organization, and individual involve-
ment in violence [22]. Thus, interpersonal violence may have multiple determinants exist-
ing on interacting levels.
Previous studies conducted in Ethiopia, South Africa, India, and Turkey showed that fac-
tors significantly associated with violence exposure among university students were age [23],
childhood rural residence [24], being a second-year student [25], being married or living with
a male partner [25–27], having a father with no formal education [25], alcohol consumption
[24,25], substance/drug use [28], and not being able to freely discuss issues with their families
[25].
In Ethiopia, political instability might contribute to young people’s exposure to violence,
with universities often serving as focal points for its escalation. These institutions, charac-
terized by diverse student populations and political discourse, create environments where
tensions frequently lead to both the experience and initiation of violent acts. Previous studies
of violence among university students in Ethiopia have only targeted one specific university
and have focused solely on women/girls, often with an emphasis on gender-based violence
[24–26,29]. Further knowledge is needed concerning the prevalence and factors associated
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
with exposure to violence among both male and female university students. Therefore, this
study aimed to determine the prevalence of exposure to violence and associated factors among
male and female university students in Ethiopia. A better understanding of the dynamics of
violence and the factors associated with exposure to violence among university students is
necessary to improve prevention and intervention strategies in the university context.
Methods
Study design and setting
A cross-sectional study was conducted at six randomly selected public universities in Ethiopia:
Hawasa, Dire Dawa, Bahir Dar, Ambo, Addis Ababa, and Adama University, located in different
regions and city administrations. Bahir Dar and Hawassa Universities are located in scenic areas
with cultural attractions, 552 km northwest and 278 km south of Addis Ababa, respectively. Dire
Dawa and Adama Universities, about 515 km and 79 km east of Addis Ababa, are located in a
region known for its industrial activities. Ambo University, 114 km west of Addis Ababa, is situ-
ated in an agricultural hub. Addis Ababa University is the oldest university, located in the capital
city of Ethiopia.The data collection period was between August 2021 and February 2022.
Study population
The study participants were undergraduate university students in their second and third year
of study. First-year students were excluded since they were new to the university and their
exposure to violence during their 12 months at the university may not have been fully estab-
lished. Fourth- and fifth-year students were excluded because they had mostly completed their
coursework and left the university campus for their apprenticeship.
Sample size and sampling procedures
A single population proportion was used to determine the sample size. For each university,
the calculated sample size was 493, considering a 45.4% prevalence of sexual violence among
female university students [18], a 95% CI, a design effect of 1.2, and a non-response rate of
10%. The aggregated sample size for the six universities was 2958. However, all students from
the selected departments who were willing to take part in the study were included, yielding a
final sample of 2988.
To recruit study participants, a two-stage stratified sampling technique was used. First, uni-
versities were stratified into first- and second-generation universities to assess whether the risk of
exposure to violence differed by the university’s year of establishment. First-generation universi-
ties (i.e., Addis Ababa, Bahir Dar, and Hawassa) are older institutions located in larger towns and
have more established environments such as nightclubs and bars, compared to second-generation
universities (i.e., Dire Dawa, Ambo, and Adama). Access to venues such as nightclubs and bars
might increase the opportunities for the students to engage in risky behavior. During the study
period, there were nine first-generation and twelve second-generation universities in Ethiopia,
from each of which three universities were randomly selected using the lottery method.
Secondly, on average, 19 departments were randomly selected from each university. This
was based on the assumption that there would be no difference between departments in terms
of students’ likelihood of exposure to violence. Information about the lists of departments
was obtained from the registrar of each university before data collection began. During class
sessions, students were informed about the study and asked to participate voluntarily. Writ-
ten consent was collected from those who agreed to participate, and they then completed a
self-administered questionnaire in the classroom.
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
Data collection tools
The questionnaire included background characteristics, alcohol and drug use, and exposure
to emotional, physical, and sexual violence. The questionnaire was adapted from the Ethio-
pian Demographic and Health Survey questionnaire [30,31], the World Health Organization
(WHO) alcohol consumption indicator book [32], and previous similar studies [17,24–26,33].
The questionnaire was developed in English and translated into Amharic and Oromifa by
professional language translators. A pretest was done on 296 students (10% of the total sample
size). Feedback from the pre-test results was incorporated into the final version of the ques-
tionnaire. Data collection coordinators were trained on data collection procedures, and the
principal investigator closely monitored and supervised the data collection process.
Variables: Definitions and assessment
Violence (dependent variable). According to the World Health Organization (WHO),
violence is the intentional use of physical force or power, threatened or actual, against oneself,
another person, or against a group or community that either results in or has a high likelihood
of resulting in injury, death, psychological harm, maldevelopment, or deprivation [34].
For this study, exposure to violence was assessed in terms of experience of emotional, phys-
ical, and sexual violence within the time frames “ever” and “during the last 12 months”. For
the regression analyses, exposure to violence was defined as exposure to at least one type of
violence at least once during the last 12 months. Emotional violence was assessed by the ques-
tion, “Have you been exposed to any of the following threats or threats of violence (ever and
in the past 12 months) that were so dangerous or serious that they scared you?” The response
options were (Someone) “Said or did something to humiliate you in front of others”, “Threat-
ened to hurt or harm you or someone close to you”, “Insulted you or made you feel bad about
yourself”, “Other, specify” and “No”. Those who answered affirmatively to at least one of the
options except “No” were considered to have experienced emotional violence. Physical vio-
lence was assessed by the question, “Have you been a victim of any of the following physical
violence at any time (ever and during the past 12 months)?”, where the response choices were
(Someone) “Pushed you, shook you, or threw something at you”, “Slapped you”, “Twisted your
arm or pulled your hair”, “Punched you with his/her fist or with something that could hurt
you”, “Kicked you, dragged you, or beat you up”, “Tried to choke you or burn you on pur-
pose”, “Threatened or attacked you with a knife, gun, or any other weapon”, “Other, specify”,
and “No”. Those who responded affirmatively to at least one of the options except “No” were
considered to have experienced physical violence. Experience of sexual violence was assessed
by the question “Have you ever been and during the past 12 months raped or forced to have
sex against your will?” where the choices were “Yes” and “No”. Those who replied “Yes” were
considered to have experienced sexual violence. Participants were also asked about the fre-
quency of physical and sexual violence using an open-ended question, “In the past 12 months,
how many times has someone physically hurt you/ raped you or forced you to have sex against
your will?”. Regarding the perpetrator, information was obtained by the questions: “The last
time this has happened, what was your relationship to the perpetrator? If it was more than one
person, what was your relationship to the person who initiated the violence the most recent
time this happened?”, where the response options were “Boyfriend/girlfriend”, “Teacher/lec-
turer”, “Other student/classmate”, “Husband/ wife”, “Family member”, “Person unknown to
me/ stranger” and “Other (specify)”.
Sociodemographic characteristics (independent variables). Information about age was
obtained by an open-ended question that was grouped into three categories for the purpose
of analysis: 18–20 years, 21–24 years, and older than 25 years. Relationship status was
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
dichotomized as “in a relationship” and “not in a relationship.” “In a relationship” was defined
as having a boyfriend or girlfriend, being married, or living together.
Residence was dichotomized as urban vs. rural, according to the Ethiopian Central Statis-
tical Authority, which classifies a locality as urban residence if it has at least 2000 inhabitants,
includes all administrative capitals of regions, zones, and woredas, or has at least 1000 people
who are primarily engaged in non-agricultural activities and/or is declared urban by the
administrative official. All areas not classified as urban were designated as rural residences
[35].
Living status on campus was assessed by asking participants, “Where do you live?” The
response options were “on campus” (living on university premises) and “off campus” (living
outside the university premises). Participants were also asked about their living conditions
during secondary school in the form of the question, “Did you mostly live at home or away
from home while attending secondary school?” The response options were “at home” and
“away from home.” Other demographic information collected included sex, religion, year of
study, and faculty of study.
Alcohol consumption. Regarding alcohol consumption, participants were asked
whether they had ever experienced alcohol induced blackout, with the following response
options: “I do not drink alcohol”, “I don’t remember”, “No”, I didn’t consume so much
alcohol,” “Yes, before the past 12 months,” and “Yes, in the past 12 months.” Those who
affirmed having this type of excessive consumption before the past 12 months and during
the past 12 months are hereafter referred to as having excessive alcohol consumption and
those who affirmed that they did not drink alcohol or did not consume excessive amounts
of alcohol were considered as not having excessive alcohol consumption. Additionally,
those who responded, “I don’t remember” were considered as missing. Participants were
also asked about the frequency of their alcohol consumption in the past month, with the
following response options: “I do not drink alcohol,” “Less often than once every two
weeks,” “Once every two weeks or more,” “Once a week or more,” “Every day,” and “Other”.
Those who drank every day and once a week or more were considered as drinking once a
week or more. Those who drank once every two weeks or more and less often than once
every two weeks were considered drinking less often than once a week. Furthermore, those
who replied “other” without text were considered as missing. Participants were also asked
about heavy episodic drinking (HED), defined as those who ever consumed five or more
(for men) or four or more (for women) standard drinks of alcohol on at least one occasion
in the past 30 days [36]. Thus, participants were asked, “Have you ever consumed four/five
or more standard drinks of alcohol on at least one occasion?”, with the response options
“Never”, “Yes, before the last 12 months” “Yes, in the last 12 months”, “Yes, in the last one
month” and “Yes, in the last one week”. For the current analysis, those who responded “Yes,
in the last one month” and “Yes, in the last one week” were considered as “Yes” (HED) and
the rest of the options were considered as “No”.
Substance use. Substance use was assessed by asking participants, “Have you used any
substances/drugs/ intoxicants other than alcohol in the past 12 months?” The response
options were “Khat”, “Ganja (Atsefaris)”, “Cocaine”, “Inhaling solvents such as benzine or
glue”, “Marijuana (cannabis)”, “Never used”, and “Other, specify.” For the analysis, those who
chose any of the options were categorized as “Yes”. Those who reported using substances other
than khat, i.e., ganja (atsefaris), hashish, inhaling solvents, marijuana, and cannabis were
considered as having “used any other drugs”. Khat (Catha edulis) is a flowering stimulant
plant containing the alkaloid cathinone, which causes excitement and euphoria [37]. Ganja
is a colloquial term used to refer to cannabis, particularly the dried flowers and leaves of the
Cannabis sativa plant [38]. The frequency of substance or drug use was asked in the form of
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
“How often have you used the drugs or intoxicants during the past month?” The response
options were, “Less often than once every two weeks”, “Once a week or more”, “Once every
two weeks or more”, “Every day”, “I do not use drugs or intoxicants”, and “Other specify”.
Those who used drugs or intoxicants every day and once a week or more were considered as
if they used once a week or more. In addition, those who used drugs or intoxicants once every
two weeks or more and less often than once every two weeks were considered if they used less
often than once a week. Furthermore, those who replied “other” without text were considered
as missing. The frequency of substance or drug use includes all types of substances or drugs.
Data analysis
The data were entered twice using EpiInfo version 7.2.2.12 by two independent data clerks in
order to validate the consistency of the data and then exported to SPSS Version 26 for anal-
ysis. Data from all six universities were aggregated into a single dataset for the final analysis.
Descriptive statistics, such as frequency and percentages, were used to summarize the data.
Bivariable and multivariable logistic regression analyses were performed to identify factors
associated with exposure to violence in the last 12 months. Crude and adjusted odds ratios
with 95% confidence intervals (CIs) were used to measure the strength of the association. A
p-value ≤ 0.25 was used to select potential variables for the final multivariable analysis. A
higher p-value was initially used to keep important variables in the model selection process
[39]. A correlation analysis was also conducted to assess multicollinearity and no correlation
was found between the variables. Associations with a p-value less than 0.05 were considered
statistically significant. Cases with missing values for a particular variable were excluded from
those analyses.
Ethical considerations
Ethical approval was granted by the Scientific and Ethical Research Office (SERO) of the Ethi-
opian Public Health Institute (reference number EPHI 6.13/609). Written informed consent
was obtained from each study participant prior to administering the questionnaire during
their class sessions. The participants were informed that participation was voluntary and that
they could withdraw at any point in the study process. No personally identifiable information
was collected, and confidentiality of the information was maintained.
Inclusivity in global research
Additional information regarding the ethical, cultural, and scientific considerations specific to
inclusivity in global research is included in the Supporting Information (S1 Checklist).
Results
Socio-demographic characteristics of the participants
Table 1 presents the socio-demographic distribution of the study participants by gender.
Out of 3165 students in selected departments, 2988 participated in the study. The major-
ity of participants (65.1%) were male. The largest proportion of students were aged between
21-24 years (68.7%), 80.5% were not in relationships, more than half (56.5%) were Orthodox
Christian, and about three-fourths (73.3%) were from urban residences. In addition, about
half of the participants (50.4%) were from first-generation universities and about one-fourth
(26.0%) were from the Faculty of Business and Economics. The majority (92.8%) of the
students were living on campus and half (48.9%) of them were in their second year of studies
(Table 1).
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
Table 2 shows the distribution of alcohol consumption and substance use among the study par-
ticipants. Regarding alcohol consumption, 9.3% of the students had ever had alcohol induced black-
out. Only 4.8% of participants reported their alcohol consumption as weekly or more often in the
past month. Of the study participants, 5.9% were classified as having had HED in the past month.
Concerning substance/drug/intoxicant use, 10.8% of respondents had ever used khat and
7.0% of them used khat in the last 12 months. Further, 8.7% and 6.8% of them used other
Table 1. Socio-demographic characteristics by gender among undergraduate students at six universities in Ethiopia, 2022 (N = 2988).
Variable Total
n (%)
Male
n (%)
Female
n (%)
Age (n = 2758)
18 - 20 years 770 (27.9) 395 (51.3) 375 (48.7)
21 - 24 years 1894 (68.7) 1330 (70.2) 564 (29.8)
>25 years 94 (3.4) 81 (86.2) 13 (13.8)
Sex (n = 2911)
Female 1016 (34.9)
Male 1895 (65.1)
Relationship status (n = 2774)
In relationship 542 (19.5) 305 (56.3) 237 (43.7)
Not in relationship 2232 (80.5) 1492 (66.8) 740 (33.2)
Religion (n = 2851)
Orthodox Christian 1609 (56.4) 1011 (62.8) 598 (37.2)
Catholic 33 (1.2) 22 (66.7) 11 (33.3)
Protestant 731 (25.6) 492 (67.3) 239 (32.7)
Muslim 433 (15.2) 290 (67.0) 143 (33.0)
Other 45 (1.6) 37 (82.2) 8 (17.8)
Residence before coming to the university (n = 2794)
Urban 2044 (73.2) 1272 (62.2) 772 (37.8)
Rural 750 (26.8) 552 (73.6) 198 (26.4)
Living conditions while attending secondary school (n = 2829)
At home 2188 (77.3) 1347 (61.6) 841 (38.4)
Away from home 641 (22.7) 493 (76.9) 148 (23.1)
Generation of the university (n = 2911)
First generation 1467 (50.4) 978 (66.7) 489 (33.3)
Second generation 1444 (49.6) 917 (63.5) 527 (36.5)
Faculty (n = 2890)
Faculty of Natural and Computational Science 521 (18.0) 351 (67.4) 170 (32.6)
Faculty of Medicine 48 (1.7) 30 (62.5) 18 (37.5)
Faculty of Social and Human Science 619 (21.4) 367 (59.3) 252 (40.7)
Faculty of Law 224 (7.7) 136 (60.7) 88 (39.3)
Faculty of Business and Economics 751 (26.0) 491 (65.4) 260 (34.6)
Faculty of Institute of Technology 727 (25.2) 510 (70.2) 217 (29.8)
Year of study (n = 2911)
Second-year student 1424 (48.9) 877 (61.6) 547 (38.4)
Third-year student 1487 (51.1) 1018 (68.5) 469 (31.5)
Living status on campus (n = 2777)
On campus 2578 (92.8) 1726 (67.0) 852 (33.0)
Off-campus 199 (7.2) 92 (46.2) 107 (53.8)
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
drugs ever and in the last 12 months, respectively. Regarding the frequency of drug use in the
past month, 5.2% of them used once a week or more. The majority of substance/drug/intoxi-
cant users were men as shown in Table 2.
Exposure to violence
The prevalence of exposure to any type of violence ever was 24.9% (n = 742), while the prev-
alence of exposure to violence in the last 12 months was 17.6% (n = 525). The prevalence of
exposure to emotional, physical and sexual violence in the last 12 months was 17.8% (n = 508),
12.3% (n = 349) and 3.3% (n = 87), respectively.
The prevalence of exposure to at least one type of violence ever among males and females
was 25.5% (n = 482) and 23.6% (n = 240), respectively, whereas the prevalence of exposure
to violence among males and females in the last 12 months was 17.9% (n = 340) and 16.5%
(n = 168), respectively (Fig 1).
Regarding the frequency of violence experience, 41.9% of the students experienced physical
violence more than once and 13% of the students experienced sexual violence more than once.
Table 3 shows the proportion of students who experienced different forms of violence and
the type of perpetrator who had initiated the violence on the most recent occasion.
Table 2. Alcohol consumption and substance use by gender among undergraduate students at six universities in Ethiopia, 2022 (N = 2988).
Variable Total
n (%)
Male
n (%)
Female
n (%)
Alcohol induced blackout (n = 2624)
Ye s 245 (9.3) 172 (70.2) 73 (29.8)
No 2379 (90.7) 1549 (65.1) 830 (34.9)
Frequency of alcohol drinking in the last month (n = 2477)
Once a week or more 120 (4.8) 87 (72.5) 33 (27.5)
Less often than once a week 344 (13.9) 256 (74.4) 88 (25.6)
Did not drink alcohol 2013 (81.3) 1279 (63.5) 734 (36.5)
Heavy episodic drinking in the last month (n = 2740)
Ye s 161 (5.9) 112 (69.6%) 49 (30.4)
No 2579 (94.1) 1665 (64.6) 914 (35.4)
Ever chewing khat (n = 2654)
Ye s 286 (10.8) 224 (78.3) 62 (21.7)
No 2368 (89.2) 1514 (63.9) 854 (36.1)
Chewing khat in the last 12 months (n = 2794)
Ye s 195 (7.0) 152 (77.9) 43 (22.1)
No 2599 (93.0) 1668 (64.2) 931 (35.8)
Ever used any other drugs (n = 2654)
Ye s 230 (8.7) 157 (68.3) 73 (31.7)
No 2424 (91.3) 1581 (65.2) 843 (34.8)
Used any other drugs in the last 12 months (n = 2795)
Ye s 189 (6.8) 126 (66.7) 63 (33.3)
No 2606 (93.2) 1695 (65.0) 911 (35.0)
Frequency of all types of substance use in the last month (n = 2703)
Once a week or more 140 (5.2) 111 (79.3) 29 (20.7)
Less often than once a week 166 (6.1) 122 (73.5) 44 (26.5)
Did not use substance or drug 2397 (88.7) 1534 (64.0) 863 (36.0)
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
Intimate partners (boyfriends/girlfriends) were the most common perpetrators of emo-
tional violence (27.7%) and sexual violence (39.3%). With regard to physical violence, other
students/classmates were the most frequent perpetrators (25.5%).
Factors associated with violence as shown by bivariable and multivariable
logistic regression analysis
Table 4 shows the results of the bivariable and multivariable logistic regression analyses for
factors contributing to violence in the last 12 months.
The bivariable regression analysis showed that being older than 25 years, being in a
relationship, being from a rural residence before coming to the university, studying at first-
generation universities, drinking alcohol once a week or more and less often than once a week
in the past month, having HED in the past month, chewing khat and using other drugs in the
last 12 months were significantly associated with violence (p-value < 0.05). In addition to the
aforementioned variables, the variables aged between 21-24 years, being Orthodox Christian,
being a third-year student, and living off-campus were selected for multivariable regression
analysis (p-value < 0.25) (Table 4).
In multivariable logistic regression analysis, when all variables were mutually adjusted for
one another, the adjusted odds of experience of violence were 2.9 times higher (95% CI 1.6-5.0)
among students older than 25 years compared to those aged 18-20 years. Students who were in
a relationship had 1.4 times higher likelihood of violence (95% CI 1.0-2.0) than those who were
not in a relationship. In addition, students who were from rural residences before coming to the
university had 1.4 times higher odds of violence (95% CI 1.1-1.8) as compared to those from
urban residences. Students studying at first-generation universities had 1.4 times higher (95% CI
1.1-1.8) odds of violence than students at second-generation universities. The odds of violence
were 2.2 times higher (95% CI 1.3-3.6) among those who consumed alcohol once a week or
more compared to those who did not drink alcohol in the past month. Furthermore, the odds of
violence were 1.6 times higher (95% CI 1.0-2.4) among those who had chewed khat and 2 times
higher (95% CI 1.3-3.1) among those who used other drugs (Table 4).
Discussion
To our knowledge, this is the first study that examines exposure to violence both among male
and female university students in Ethiopia and presents data from six universities. The overall
Fig 1. Exposure to different types of violence by gender, 2022.
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
prevalence of exposure to at least one type of violence (emotional or/and physical or/and sexual
violence) ever was 24.9%, whereas the prevalence in the last 12 months was 17.6%, with sim-
ilar exposure prevalence among males and females, 17.9% and 16.5%, respectively. The odds
of exposure to violence in the last 12 months were higher among students older than 25 years,
those who were in a relationship, those with rural residence before coming to the university,
those who consumed alcohol more frequently, and those who used khat and other drugs in the
last 12 months.
The current study shows that exposure to any form of violence was common among both
male and female university students. This might be due to university students experiencing
difficulties in adjusting to a new environment, managing newfound independence and experi-
menting with different risky lifestyles such as excessive consumption of alcohol and substance
use. Comparing the prevalence of exposure to violence across studies can be difficult due to
various types of methodological differences, including sampling and definitions of violence.
Furthermore, previous studies in Ethiopia have largely concentrated on gender-based
violence, primarily focusing on women and girls, thus making it difficult to compare the prev-
alence of violence among males and females in the current study with any other locally con-
ducted studies. Nevertheless, the prevalence of violence among males and females in the last
12 months in this study was similar to the prevalence obtained in a study conducted among
university students in the US and Canada, showing 17% and 16% among males and females,
respectively [14]. Even though their setting is different from our study, the study was similar
in terms of study design, study population, and age. The overall prevalence of experience of
violence at two universities in Mexico was 25.7% and 31.9% [40] which is higher than the
current study, most likely because violence was measured as the sum of four types of violence
(verbal, psychological, sexual, and physical violence), whereas in our study, those who experi-
enced at least one type of violence were considered as having violence exposure.
In this study, the prevalence of emotional violence (17.8%) was lower, while the prevalence
of physical violence (12.3%) in the last 12 months was higher compared to results from a study
conducted among university students in southwestern Uganda, which found a prevalence
of 27.8% and 9.6%, respectively [16]. This might be due to methodological differences. The
study in Uganda included the entire undergraduate class of the university and used a different
formulation with regard to the violence questions. Our study used questions with different
categorical options, whereas the Ugandan study used response options in the form of “yes” or
“no”. Furthermore, a study on violence against dating partners by male and female university
Table 3. Perpetrators and different types of violence experienced by undergraduate university students in Ethiopia, stratified by gender of respondent, 2022.
Perpetrators Emotional violence (n = 623) Physical violence (n = 399) Sexual violence (n = 143)
Male Female Male Female Male Female
N % N % N % N % N % N %
Boyfriend/girlfriend 130 31.3 41 19.7 73 25.9 28 23.9 40 43.0 17 34.0
Teacher/lecturer 65 15.7 34 16.3 42 14.9 13 11.1 22 23.7 7 14.0
Other student/ classmate 102 24.6 42 20.2 82 29.1 23 19.7 8 8.6 11 22.0
Husband/wife 23 5.5 16 7.7 5 1.8 3 2.6 2 2.2 3 6.0
Family member 33 7.9 26 12.5 28 9.9 18 15.4 11 11.8 8 16.0
Person unknown to me/ stranger 40 9.6 34 16.3 36 12.8 25 21.4 3 3.2 3 6.0
Other 22 5.3 15 7.2 16 5.7 7 6.0 7 7.5 1 2.0
Note: Cases with missing data were not included in the analysis
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
Table 4. Bivariable and multivariable logistic regression analysis of factors associated with exposure to violence among undergraduate university students in
Ethiopia, 2022 (N = 2988).
Variables COR (95% CI) p-value AOR (95% CI) p-value
Age
18 - 20 years 1 1
21 - 24 years 1.2 (1.0-1.5) 0.119*1.1 (0.8-1.5) 0.422
>25 years 2.9 (1.8-4.6) <0.001*2.9 (1.6-5.0) <0.001**
Sex
Female 0.9 (0.7-1.1) 0.341
Male 1
Relationship status
In relationship 1.6 (1.3-2.0) <0.001*1.4 (1.0-2.0) 0.002**
Not in relationship 1 1
Religion
Orthodox Christian 1 1
Catholic 2.4 (1.1-4.9) 0.022*1.9 (0.7-5.6) 0. 228
Protestant 1.0 (0.8-1.3) 0.987 0.9 (0.7-1.2) 0.528
Muslim 1.0 (0.7-1.3) 0.814 1.0 (0.7-1.5) 0.813
Other 1.0 (0.5-2.1) 0.940 1.1 (0.4-2.8) 0.844
Residence before coming to the university
Rural 1.4 (1.1-1.7) 0.003*1.4 (1.1-1.8) 0.015**
Urban 1 1
Generation of the university
First 1.3 (1.0-1.5) 0.016*1.4 (1.1-1.8) 0.006**
Second 1 1
Year of study
Second-year student 1 1
Third-year student 1.2 (1.0-1.4) 0.156*1.0 (0.8-1.3) 0.821
Living status on campus
In campus 1 1
Out of campus 0.7 (0.5-1.1) 0.081*0.6 (0.4-1.1) 0.111
Frequency of alcohol drinking in the last month
Once a week or more 2.8 (1.9-4.2) <0.001*2.2 (1.3-3.6) 0.002**
Less often than once a week 1.8 (1.3-2.3) <0.001*1.4 (1.0-2.1) 0.050
Did not drink alcohol 1 1
Heavy episodic drinking in the past one month
Ye s 2.0 (1.4-2.8) <0.001*1.0 (0.6-1.7) 0.975
No 1 1
Chewing khat in the last 12 months
Ye s 1.8 (1.3-2.5) <0.001*1.6 (1.0-2.4) 0.039**
No 1 1
Used any other drugs in the last 12 months
Ye s 2.9 (2.2-4.0) <0.001*2.0 (1.3-3.1) 0.001**
No 1 1
*P-value < 0.25;
**P-value < 0.05; COR = Crude Odds Ratio; AOR = Adjusted Odds Ratio; CI = Confidence interval; 1 = Reference category.
Note: P-value < 0.25 was used as the cut-off point for inclusion in the multivariable analysis.
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
students worldwide showed that 7% had been physically injured by a partner (range = 2% to
20%) in the past 12 months [41]. The finding of the current study falls within this range. The
experience of physical violence within a relationship could be due to the power imbalance,
jealousy or possessiveness in a relationship, as shown in a studies of jealousy and intimate
partner violence among university students in Ecuador [42] and young adults in the US [43].
Unexpectedly, the prevalence of sexual violence was higher among males than females
in the current study. This might be due to the fact that sexual violence is a very sensitive
issue in Ethiopia, where strict social norms and cultural factors play a significant role. Thus,
female students may underreport incidents of sexual violence due to stigma, fear of not being
believed, or concern about potential consequences. According to the EDHS, among women
aged 15 to 49 years who experienced either physical or sexual violence or both, 66% have
never disclosed their exposure to anyone [6]. Similarly, a systematic review and meta-analysis
of female domestic violence disclosure in Ethiopia showed a pooled prevalence of 36.2% [44].
The reasons for not disclosing were considering violence as normal or not serious, shame,
embarrassment, and fear of disclosure related consequences [44]. An internet-based study of
undergraduate females in New York City and Miami, Florida showed that among participants
who reported sexual victimization, 25% had not previously disclosed it because of shame,
minimization of experience, fear of consequences, and privacy [45]. Furthermore, a study
among adult female sexual assault survivors in the United States revealed that the reasons for
not telling people were fear of negative social reactions, lack of perceived available support,
fear of burdening others, and family and social norms expectations [46]. In this study, the
prevalence of sexual violence among females was lower compared to findings from a study
conducted among female university students in Wolaita Sodo [18], and a systematic and
meta-analysis conducted among female university students in Ethiopia [47,48]. This could
be due to the difference in the operational definition of sexual violence, as the other studies
included attempted rape, and also variations in study design, with the systematic review and
meta-analysis encompassing all types of observational studies. The ecological model can help
us understand the importance of exploring how factors such gender and gender norms could
affect vulnarabilities to, and behaviors associated with, violence [49,50]. Our study showed
no significant gender differences in overall exposure to violence, which is similar to a study
among university students in southwestern Uganda [16]. However, a study conducted among
university students in Italy showed that ever experienced psychological and physical violence
among peers/school was reported significantly more often by males than by females (21.5%
vs. 9.7%) [15]. Another study among university students in Finland showed that men reported
more emotional and physical violence than women [51], which is similar to the current study.
This might be due to the societal norms and expectations around masculinity that encourage
confrontation among men [52,53]. In addition, the current findings of a higher prevalence of
emotional violence among male students vs. female students could be due to male students
in Ethiopia engaging in risky behaviors such as alcohol consumption [7,54,55] and drug use
[10,12,56].
In the microsystem described by Bronfenbrenner’s immediate relationships with family,
peers and teachers can play a role in contributing to violent behaviors [20]. In our study, most
of the perpetrators of emotional violence were boyfriends/girlfriends, which is in line with
a study among university students in the US and Canada [14] which found that nearly half
of the students experienced violence from intimate partners or persons whom the students
were dating or with whom they were in an ongoing romantic relationship. However, phys-
ical violence perpetrators were other students/classmates and also boyfriends/girlfriends,
albeit to a lesser extent, which is similar to the aforementioned study [14]. Furthermore, the
perpetrators of sexual violence were boyfriends/girlfriends and also teachers/lecturers, albeit
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
to a lesser extent, which is in line with a study conducted on sexual violence among female
university students in Ethiopia [57]. The patterns of perpetrator characteristics shown here
could be linked to experiences of childhood abuse and growing up with domestic violence,
factors which have previously been shown to be significantly associated with intimate part-
ner violence in a multi-country population-based study among women [58]. The relevance
of childhood abuse experiences would also be suggested by Bronfenbrenner’s model where
children who experience violence at home may develop unhealthy coping mechanisms and
encounter difficulties in establishing and maintaining healthy relationships [19]. Similarly, the
authority held by lecturers or teachers can lead to situations where students may be vulnerable
to manipulation or abuse [59,60].
Another individual factor contributing to violence exposure is age. In the current study,
students who were older than 25 years had higher odds of having experienced violence in the
last 12 months. This finding is in line with a study on exposure to emotional violence among
university students in Turkey [23], which showed that the level of exposure to emotional vio-
lence increased as age increased. Another study on the effect of sex and age on experiences of
violence during the past year among adolescents aged 13 to 24 years in five countries (Cambo-
dia, Haiti, Kenya, Malawi, and Tanzania) [61] revealed that the risk of sexual violence and also
intimate partner violence increased with age. This could be due to older students being more
prone to alcohol or substance use than their younger counterparts [62–64], which can impair
their judgment and elevate the likelihood of encountering violent situations. A study con-
ducted on the magnitude of and trends in alcohol-related mortality and morbidity among U.S.
college students revealed that excessive alcohol consumption increased with age and alcohol
consumption was associated with violence experience among the students [65].
Bronfenbrenner’s ecological model suggests that immediate social environments such as
family dynamics, peer influences, and intimate relationships play a crucial role in shaping
an individual’s behavior [20,21]. These could significantly affect the likelihood of experienc-
ing or perpetrating violence where negative interactions in a relationship can create a cycle
of conflict and aggression, reinforcing patterns of violent behavior over time. In the current
analysis, students who were in a relationship had higher odds of violence. Romantic partners
could spend a long time together, which can create opportunities for conflicts and disagree-
ments that can escalate into violence. Additionally, dependency in romantic relationships can
make individuals more vulnerable to manipulation and abuse. Being in a relationship was
previously found to be significantly associated with sexual violence among female university
students in Ethiopia [18,57]. This factor was also significantly associated with gender-based
violence (GBV) among female students in Ethiopia [25,26], at public universities in South
Africa [27] and among male and female university students in the US and Canada [14]. Being
in a relationship would de facto increase the risk of experiencing intimate partner violence,
including emotional, physical, or sexual violence by a partner.
Another factor significantly associated with violence was having a rural residence prior to
attending the university. This is similar to a study conducted on sexual violence among female
students at Bahir Dar private college [66] in Ethiopia, which revealed that rural residence was
significantly associated with exposure to different types of violence in the academic setting.
This could be due to students from rural residences being exposed to forms of violence such as
teasing and bullying, potentially because they are perceived as different or outsiders. A study
conducted on structural family factors and bullying at school among adolescents in China
showed that being from a rural residence was associated with bullying at school [67]. Fur-
thermore, the influence of rural residence is supported by Bronfenbrenner’s ecological model,
suggesting that broader social systems indirectly influence an individual’s development, such
as the community and neighborhood in which they live [68].
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
In the absence of parental oversight, students may feel a newfound sense of freedom and
independence, which could result in experimenting with risky behaviors such as drink-
ing alcohol and substance use. Additionally, the influence of peers plays a significant role;
students may be encouraged or feel compelled to partake in these behaviors to fit in or gain
acceptance within their social circles. Students often engage in these risky behaviors in social
settings, such as parties or gatherings, where the dynamics of the group can intensify these
actions. The collective influence of peers can amplify tendencies toward excessive drinking
or drug use [69–71]. This is also in line with Bronfenbrenner’s ecological model where peer
pressure can influence individuals’ behaviors [20,21]. Such an environment can also heighten
aggressive behavior and consequently, this can escalate into violent incidents.
In the current study, the odds of violence were higher among those who consumed alcohol
more frequently. The effects of alcohol include a reduction in cognitive and physical functions
that impair self-control, with the consequent effect of reducing the ability to resolve conflicts
peacefully [72]. Studies in Ethiopia on sexual violence and GBV among female college/uni-
versity students [24,25,18] revealed that those students who habitually drank alcohol were
more likely to be victims of violence. A research review of alcohol consumption among college
students showed that those students who binge drink frequently (three or more times in two
weeks) were at particularly high risk of negative alcohol-related outcomes [73]. Being a college
or university student may involve a special risk for young adults, as increased availability of
alcohol and acceptance of drinking on college campuses may lead to increases in unwanted
consequences, including physical and sexual assaults [74].
Furthermore, in the current study, those who used khat and other drugs had higher odds
of exposure to violence. Studies conducted among female college and university students in
Ethiopia showed that khat was significantly associated with GBV [17,24,57]. A study on vio-
lence among college students in India found a significant association between substance use
and violence [28]. In addition, physical violence was significantly associated with illicit drug
use in the past 30 days in a study conducted in the US [75]. Moreover, consumption of alcohol
or other drugs was significantly associated with experiences of harassment among students
in a study in Spain [76]. Both alcohol and substance use can impair cognitive function and
decision-making abilities, lower inhibitions, and increase aggression, which potentially leads
to greater exposure to violence. Furthermore, there is a complex causal relationship between
violence and alcohol and drug use, where these substances are often used as coping mecha-
nisms after traumatic events, such as experiences of violence [77,78]. Additionally, being in
environments like bars can increase vulnerability, as the presence of intoxicated individuals
can heighten the likelihood of violence, even if one does not drink to the extent of losing
judgment. Therefore, universities could create a comprehensive approach to reduce violence
related to risky behaviors, such as implementing comprehensive education programs about
the risks and consequences of alcohol and drug use, offering accessible counseling services
that provide support for students struggling with substance use [79,80], and working with
local businesses to limit the availability of alcohol and substances near campus [81,82]. A
comprehensive approach would be in line with Bronfenbrenner’s ecological model, indicating
the need to address multiple contributing factors across individual, relational, community,
and societal levels that contribute to violence. This holistic perspective could inform the devel-
opment of effective prevention and intervention strategies tailored to university students.
Methodological considerations
While this study is a comprehensive exploration of violence among university students in
Ethiopia, the findings might be specific to the studied population, and caution is needed when
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PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
generalizing to university students broadly or students in other countries because of differ-
ences in culture and socioeconomic background.
Self-administration of the questionnaire may have led to incomplete, inaccurate, under-
reported, or overreported data. To mitigate these issues, participants were provided with ori-
entation on how to complete the questionnaire before it was administered. Social desirability
bias may have been present due to the sensitive nature of some questions, but the anonymity
of study participation, where students placed their completed questionnaires in a designated
box and the use of external data collection coordinators helped to reduce this source of bias.
This study examines violence exposure among both male and female participants but does
not assess the gender of the perpetrators. Although there were some missing data points in the
responses to the questionnaire, no systematic pattern was observed, and the distribution of
missing data was considered to be random.
Conclusion
Exposure to violence is a prevalent challenge among female and male university students in
Ethiopia. Socio-demographic and behavioral factors such as the use of alcohol and substances
were significantly associated with exposure to violence. Universities, together with stakehold-
ers such as the Ministry of Science and Higher Education, Ministry of Health, students, and
partners that work on violence need to strengthen/develop awareness raising activities target-
ing violence prevention mechanisms and its associated factors, regardless of gender.
Supporting information
S1 File. Checklist.
(PDF)
Acknowledgments
We would like to express gratitude to the study participants and coordinators.
Author contributions
Conceptualization: Wudinesh Belete Belihu, Tobias Herder, Minilik Demissie Amogne,
Anette Agardh.
Data curation: Wudinesh Belete Belihu, Anette Agardh.
Formal analysis: Wudinesh Belete Belihu, Tobias Herder, Minilik Demissie Amogne, Jesper
Sundewall, Anette Agardh.
Methodology: Wudinesh Belete Belihu, Tobias Herder, Minilik Demissie Amogne, Jesper
Sundewall, Jack Palmieri, Anette Agardh.
Supervision: Wudinesh Belete Belihu, Anette Agardh.
Writing – original draft: Wudinesh Belete Belihu.
Writing – review & editing: Wudinesh Belete Belihu, Tobias Herder, Minilik Demissie
Amogne, Jesper Sundewall, Jack Palmieri, Anette Agardh.
References
1. Sardinha L, Maheu-Giroux M, Stöckl H, Meyer SR, García-Moreno C. Global, regional, and national
prevalence estimates of physical or sexual, or both, intimate partner violence against women in 2018.
Lancet [Internet]. 2022;399(10327):803–13. Available from: https://linkinghub.elsevier.com/retrieve/pii/
S0140673621026647 PMID: 35182472
PLOS ONE | https://doi.org/10.1371/journal.pone.0319792 March 18, 2025 17 / 21
PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
2. World Health Organization. Violence against women [Internet]; 2024 [cited 2024 Jul 7]. Available from:
https://www.who.int/news-room/fact-sheets/detail/violence-against-women
3. World Health Organization. Injuries and violence [Internet]; 2024 [cited 2024 Jul 7]. Available from:
https://www.who.int/news-room/fact-sheets/detail/injuries-and-violence
4. Brewer N, Thomas KA, Higdon J. Intimate partner violence, health, sexuality, and academic perfor-
mance among a national sample of undergraduates. J Am Coll Health [Internet]. 2018;66(7):683–92.
https://doi.org/10.1080/07448481.2018.1454929 PMID: 29565765
5. Rutherford A, Zwi AB, Grove NJ, Butchart A. Violence: a glossary. J Epidemiol Community Health.
2007;61(8):676–80. https://doi.org/10.1136/jech.2005.043711 PMID: 17630364
6. Central Statistical Agency. Ethiopia demographic and health related survey [Internet]; 2016. Available
from: https://dhsprogram.com/pubs/pdf/FR328/FR328.pdf
7. Boltana G, Kacharo MM, Abebe A, Baza D. Alcohol consumption and associated factors among
undergraduate regular students in Wolaita Sodo University, Southern Ethiopia, 2021: a cross-
sectional study. Pan Afr Med J [Internet]. 2023;45:179. Available from: https://www.panafri-
can-med-journal.com//content/article/45/179/full PMID: 37954438
8. Lemma A, Salelew E, Demilew D, Tesfaye W, Shumet S, Kerebih H. Alcohol use disorder and asso-
ciated factors among University of Gondar undergraduate students: a cross-sectional study. J Subst
Abuse Treat [Internet]. 2021;129:108373. https://doi.org/10.1016/j.jsat.2021.108373 PMID: 34080544
9. Amare T, Getinet W. Alcohol use and associated factors among high school, college and univer-
sity students in Ethiopia, systematic review, and meta-analysis, 2018. J Ment Health [Internet].
2020;29(4):455–63. https://doi.org/10.1080/09638237.2019.1677871 PMID: 31718345
10 . Roba HS, Gebremichael B, Adem HA, Beyene AS. Current substances use among stu-
dents in ethiopia: a systematic review and meta-analysis of 20-years evidence. Subst
Abuse [Internet]. 2021;15:11782218211050352. Available from: http://journals.sagepub.com/
doi/10.1177/11782218211050352 PMID: 34671181
11. Yosef T, Getachew D, Shifera N. Psychoactive substance use among undergraduate students of
Mizan-Tepi University in Southwest Ethiopia. Cogent Psychology [Internet]. 2023;10(1). https://doi.org/
10.1080/23311908.2023.2230021
12. Shegute T, Wasihun Y. Prevalence of substance use in university students, Ethiopia.
Subst Abuse. 2021;1511782218211003558. Available from: http://journals.sagepub.com/
doi/10.1177/11782218211003558 PMID: 33854324
13. Langford L. Preventing violence and promoting safety in higher education settings: overview of a
comprehensive approach [Internet]. Available from: https://les.eric.ed.gov/fulltext/ED537696.pdf
14. Saewyc EM, Brown D, Plane M, Mundt MP, Zakletskaia L, Wiegel J, et al. Gender differences in vio-
lence exposure among university students attending campus health clinics in the United States and
Canada. J Adolesc Health [Internet]. 2009;45(6):587–94. Available from: https://linkinghub.elsevier.
com/retrieve/pii/S1054139X09001414 PMID: 19931831
15. Romito P, Grassi M. Does violence affect one gender more than the other? The mental health impact
of violence among male and female university students. Soc Sci Med [Internet]. 2007;65(6):1222–34.
Available from: https://linkinghub.elsevier.com/retrieve/pii/S0277953607002808 PMID: 17576030
16. Agardh A, Tumwine G, Asamoah BO, Cantor-Graae E. The invisible suffering: sexual coercion,
interpersonal violence, and mental health--a cross-sectional study among university students in
south-western Uganda. PLoS One. 2012;7(12):e51424. Available from: https://dx.plos.org/10.1371/
journal.pone.0051424 PMID: 23240021
1 7. Hassen S, Mohammed B. Sexual violence and associated factors among female students at Debre
Berhan University, Ethiopia. Cureus [Internet]. 2021;13(7):1–14. Available from: https://www.cureus.
com/articles/36811-sexual-violence-and-associated-factors-among-female-students-at-debre-ber-
han-university-ethiopia
18. Adinew YM, Hagos MA. Sexual violence against female university students in Ethiopia. BMC Int
Health Hum Rights [Internet]. 2017;17(1):19. Available from: http://bmcinthealthhumrights.biomedcen-
tral.com/articles/10.1186/s12914-017-0127-1 PMID: 28738807
19. Bronfenbrenner U. Toward an experimental ecology of human development. Am Psychol.
1977;32(7):513–31. https://doi.org/10.1037/0003-066x.32.7.513
20. Bronfenbrenner U. Ecological models of human development. Int Encycl Educ. 1994;3:37–43.
21. Heise LL. Violence against women: an integrated, ecological framework. Violence Against Women.
1998;4(3):262–90. https://doi.org/10.1177/1077801298004003002 PMID: 12296014
PLOS ONE | https://doi.org/10.1371/journal.pone.0319792 March 18, 2025 18 / 21
PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
22. Tolan PH, Gorman-Smith D, Henry DB. The developmental ecology of urban males’ youth violence.
Dev Psychol. 2003;39(2):274–91. https://doi.org/10.1037//0012-1649.39.2.274 PMID: 12661886
23. Eskici M, Saatcioglu Tinkir N. Exposure to emotional violence: relationship between uni-
versity students according to their demographic characteristics. Pedagogical Res
[Internet]. 2019;4(1). Available from: http://www.pedagogicalresearch.com/article/
exposure-to-emotional-violence-relationship-between-university-students-according-to-their-5731
24. Arnold D, Gelaye B, Goshu M, Berhane Y, Williams MA. Prevalence and risk factors of
gender-based violence among female college students in Awassa, Ethiopia. Violence Vict [Internet].
2008;23(6):787–800. Available from: http://connect.springerpub.com/lookup/doi/10.1891/0886-
6708.23.6.787 PMID: 19069568
25. Workye H, Mekonnen Z, Wedaje W, Sitot A. Prevalence and predictors of gender-based violence
among Wolkite University female students, southwest Ethiopia, 2021: Cross-sectional study.
Front Reprod Health [Internet]. 2023;5(February):1–9. Available from: https://www.frontiersin.org/
articles/10.3389/frph.2023.978808/full
26. Abubeker F, Dessie Y, Assefa N, Geleto A, Adorjan K, Abdeta T. Prevalence and associated factors
of gender-based violence among female students attending private colleges in Harar Town, Eastern
Ethiopia. Inquiry. 2021;58:469580211047197. Available from: https://www.ajol.info/index.php/gmj/arti-
cle/download/174618/164010 PMID: 34689639
2 7. Mutinta G. Gender-based violence among female students and implicatons for health intervention
programmes in public universities in Eastern Cape, South Africa. Cogent Soc Sci [Internet]. 2022;8(1).
Available from: https://www.tandfonline.com/doi/full/10.1080/23311886.2022.2079212
28. Masthi NRR, Manasa AR. An exploratory study on violence among the college students in Urban
Bengaluru, Karnataka, India. Indian J Public Health [Internet]. 2019;63(4):380–2. Available from:
https://journals.lww.com/10.4103/ijph.IJPH_230_18 PMID: 32189662
29. Tantu T, Wolka S, Gunta M, Teshome M, Mohammed H, Duko B. Prevalence and determinants of
gender-based violence among high school female students in Wolaita Sodo, Ethiopia: an institution-
ally based cross-sectional study. BMC Public Health. 2020;20(1):540. Available from: https://bmcpubli-
chealth.biomedcentral.com/track/pdf/10.1186/s12889-020-09064-y.pdf PMID: 32316941
30. Measure DHS. Demographic and health surveys model woman’s questionnaire. 2019;(1):1–70. Avail-
able from: https://dhsprogram.com/pubs/pdf/DHSQ7/DHS7-Womans-QRE-EN-17Dec2018-DHSQ7.pdf
31. ICF. Demographic and health survey model man’s questionnaire [Internet]; 2019 [cited 2019 Sep 3].
Available from: https://dhsprogram.com/publications/publication-dhsq7-dhs-questionnaires-and-manu-
als.cfm
32. World Health Organization. Indicator code book global information system on alcohol and health.
2014;122.
33. Sivertsen B, Nielsen MB, Madsen IEH, Knapstad M, Lønning KJ, Hysing M. Sexual harassment
and assault among university students in Norway: a cross-sectional prevalence study. BMJ Open.
2019;9(6):e026993. Available from: https://bmjopen.bmj.com/content/bmjopen/9/6/e026993.full.pdf
PMID: 31182445
34. World Health Organization. The Violence Prevention Alliance (VPA) approach: denition and typology
of violence [Internet]; 2023. Available from: https://www.who.int/groups/violence-prevention-alliance/
approach#:~:text=%22theintentionaluseofphysical,%2Cmaldevelopment%2Cordeprivation.%22
35. Central Statistical Agency. Inventory of official national-level statistical denitions for rural/urban areas;
1994.
36. Wechsler H, Dowdall GW, Davenport A, Rimm EB. A gender-specic measure of binge drinking
among college students. Am J Public Health. 1995;85(7):982–5. https://doi.org/10.2105/ajph.85.7.982
PMID: 7604925
3 7. Alcohol and Drug Foundation. What is Khat? [Internet]; 2023 [cited 2023 Apr 1]. Available from: https://
adf.org.au/drug-facts/khat/
38. World Health Organization. Alcohol, drugs and addictive behaviours unit [Internet]; 2024 [cited
2024 May 30]. Available from: https://www.who.int/teams/mental-health-and-substance-use/
alcohol-drugs-and-addictive-behaviours/drugs-psychoactive/cannabis
39. Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. Third ed. John Wiley and Sons;
2013.
40. Gijon-Cruz A, Reyes-Morales RG, Garcia-Ramirez BA, Bautista-Martinez JL, Esteva-Duran N. Mod-
eling violence among and against university students in a Mexican medium-sized city. Chin Bus Rev
[Internet]. 2020;19(6):226–39. Available from: https://www.davidpublisher.com/Public/uploads/Contrib-
ute/5ff3d7598f86a.pdf
PLOS ONE | https://doi.org/10.1371/journal.pone.0319792 March 18, 2025 19 / 21
PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
41. Straus MA. Prevalence of violence against dating partners by male and female university students
worldwide. Violence Against Women [Internet]. 2004;10(7):790–811. Available from: http://journals.
sagepub.com/doi/10.1177/1077801204265552
42. Guillen Verdesoto X, Ochoa Balarezo J, Delucchi G, Leon Mayer E, Folino J. Jealousy and inti-
mate partner violence in students of the University of Cuenca, Ecuador. Cienc Psicol [Internet].
2021;15(1):1–16. Available from: https://doi.org/10.22235/cp.v15i1.2353
43. Kaufman-Parks AM, Longmore MA, Giordano PC, Manning WD. Inducing jealousy and intimate part-
ner violence among young adults. J Soc Pers Relat [Internet]. 2019;36(9):2802–23. Available from:
http://journals.sagepub.com/doi/10.1177/0265407518802451 PMID: 37235138
44. Bifftu BB, Dachew BA, Tiruneh BT, Gezie LD, Guracho YD. Domestic violence related disclosure
among women and girls in Ethiopia: a systematic review and meta-analysis. Reprod Health [Internet].
2019;16(1):184. Available from: https://reproductive-health-journal.biomedcentral.com/articles/10.1186/
s12978-019-0845-z PMID: 31870388
45. Carson KW, Babad S, Brown EJ, Brumbaugh CC, Castillo BK, Nikulina V. Why women are not talking
about it: reasons for nondisclosure of sexual victimization and associated symptoms of posttraumatic
stress disorder and depression. Violence Against Women [Internet]. 2020;26(3–4):271–95. Available
from: http://journals.sagepub.com/doi/10.1177/1077801219832913 PMID: 30870113
46. Ullman SE, O’Callaghan E, Shepp V, Harris C. Reasons for and experiences of sexual assault non-
disclosure in a diverse community sample. J Fam Violence [Internet]. 2020;35(8):839–51. Available
from: http://link.springer.com/10.1007/s10896-020-00141-9 PMID: 33746358
4 7. Kefale B, Yalew M, Damtie Y, Arefaynie M, Adane B. Predictors of sexual violence among female stu-
dents in higher education institutions in Ethiopia: a systematic review and meta-analysis. PLoS One.
2021;16(2):e0247386. Available from: https://bmcpublichealth.biomedcentral.com/track/pdf/10.1186/
s12889-020-08593-w.pdf PMID: 33606841
48. Mekonnen BD, Wubneh CA. Sexual violence against female students in ethiopia: a systematic review
and meta-analysis. Sex Cult [Internet]. 2021;26(2):776–91. Available from: https://doi.org/10.1007/
s12119-021-09899-6
49. El Zaatari W, Maalouf I. How the Bronfenbrenner bio-ecological system theory explains the develop-
ment of students’ sense of belonging to school?. SAGE Open. 2022;12(4):1–18.
50. Krishnan V. Early child development: a conceptual model. Child Council Annual Conference;
2010:7–9.
51. Björklund K, Häkkänen-Nyholm H, Huttunen T, Kunttu K. Violence victimization among Finnish univer-
sity students: prevalence, symptoms and healthcare usage. Soc Sci Med [Internet]. 2010;70(9):1416–
22. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0277953610000365 PMID: 20171000
52. Barker G, Ricardo C. Young men and the construction of masculinity in sub-Saharan Africa: Implica-
tions for HIV/AIDS, conict and violence. Soc Dev Pap Con Prev Reconstr [Internet]. 2005;(26):1–81.
Available from: http://www-wds.worldbank.org/external/default/WDSContentServer/WDSP/IB/2005/06/
23/000012009_20050623134235/Rendered/PDF/327120rev0PAPER0AFR0young0men0WP26.pdf
53. Jewkes R, Flood M, Lang J. From work with men and boys to changes of social norms and reduc-
tion of inequities in gender relations: a conceptual shift in prevention of violence against women
and girls. Lancet [Internet]. 2015;385(9977):1580–9. Available from: http://dx.doi.org/10.1016/S0140-
6736(14)61683-4 PMID: 25467578
54. Ali T, Worku T. Current alcohol consumption and associated factors among school ado-
lescents and youths in Ethiopia: a systematic review and meta-analysis. SAGE Open
Med [Internet]. 2020;8:2050312120974154. Available from: http://journals.sagepub.com/
doi/10.1177/2050312120974154 PMID: 33282302
55. Chekole Y, Mekonnen Abate S. Prevalence of alcohol use and associated factors among Dilla Univer-
sity students, Dilla Town, Southern Ethiopia: a cross-sectional study. SSRN Electron J. 2020;2020.
Available from: https://www.ssrn.com/abstract=3578802
56. Gebremariam TB, Mruts KB, Neway TK. Substance use and associated factors among Debre Berhan
University students, Central Ethiopia. Subst Abuse Treat Prev Policy [Internet]. 2018;13(1):13. Avail-
able from: https://substanceabusepolicy.biomedcentral.com/articles/10.1186/s13011-018-0150-9 PMID:
29622021
5 7. Bekele T, Kaso M, Gebremariam A, Deressa W. Sexual violence and associated factors among
female students of Madawalabu University in Ethiopia. Epidemiol Open Access [Internet].
2015;05(02). Available from: https://www.omicsonline.org/open-access/sexual-violence-and-asso-
ciated-factors-among-female-students-of-madawalabu-university-in-ethiopia-2161-1165-1000190.
php?aid=54859
PLOS ONE | https://doi.org/10.1371/journal.pone.0319792 March 18, 2025 20 / 21
PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
58. Abramsky T, Watts CH, Garcia-Moreno C, Devries K, Kiss L, Ellsberg M, et al. What factors are asso-
ciated with recent intimate partner violence? ndings from the WHO multi-country study on women’s
health and domestic violence. BMC Public Health. 2011;11:109. Available from: http://bmcpublichealth.
biomedcentral.com/articles/10.1186/1471-2458-11-109 PMID: 21324186
59. Young SL, Wiley KK. Erased: why faculty sexual misconduct is prevalent and how we could prevent it.
J Public Aff Educ [Internet]. 2021;27(3):276–300. Available from: https://doi.org/10.1080/15236803.202
1.1877983
60. Silva CH, E. AAUW Educational Foundation. The grants register 2019 [Internet]. London: Palgrave
Macmillan UK; 2019. p. 3–3. Available from: http://link.springer.com/10.1007/978-1-349-95810-8_3
61. Stark L, Seff I, Hoover A, Gordon R, Ligiero D, Massetti G. Sex and age effects in past-year experi-
ences of violence amongst adolescents in ve countries. PLoS One [Internet]. 2019;14(7):e0219073.
Available from: https://dx.plos.org/10.1371/journal.pone.0219073 PMID: 31283760
62. Svenson LW, Jarvis GK, Campbell RL. Gender and age differences in the drinking behaviors of
university students. Psychol Rep. 1994;75(1 Pt 2):395–402. https://doi.org/10.2466/pr0.1994.75.1.395
PMID: 7809314
63. Htet H, Saw YM, Saw TN, Htun NMM, Lay Mon K, Cho SM, et al. Prevalence of alcohol consumption
and its risk factors among university students: a cross-sectional study across six universities in Myan-
mar. PLoS One [Internet]. 2020;15(2):e0229329. Available from: https://dx.plos.org/10.1371/journal.
pone.0229329 PMID: 32084226
64. Arria AM, Caldeira KM, Allen HK, Bugbee BA, Vincent KB, O’Grady KE. Prevalence and incidence of
drug use among college students: an 8-year longitudinal analysis. Am J Drug Alcohol Abuse [Inter-
net]. 2017;43(6):711–8. Available from: https://www.tandfonline.com/doi/full/10.1080/00952990.2017.13
10219 PMID: 28402711
65. Hingson R, Zha W, Weitzman E. Magnitude of and trends in alcohol-related mortality and morbidity
among U. S. college students ages 18-24. J Stud Alcohol Drugs. 2009;16(16):1998–2005.
66. Shimekaw B, Megabiaw B, Alamrew Z. Prevalence and associated factors of sexual violence
among private college female students in Bahir Dar city, North Western Ethiopia. Health [Inter-
net]. 2013;05(06):1069–75. Available from: http://www.scirp.org/journal/doi.aspx?DOI=10.4236/
health.2013.56143
6 7. Wang H, Wang Y, Wang G, Wilson A, Jin T, Zhu L, et al. Structural family factors and bullying at
school: a large scale investigation based on a Chinese adolescent sample. BMC Public Health [Inter-
net]. 2021;21(1):2249. Available from: https://bmcpublichealth.biomedcentral.com/articles/10.1186/
s12889-021-12367-3 PMID: 34895204
68. Bronfenbrenner U. Ecology of the family as a context for human development: Research perspectives.
Dev Psychol. 1986;22(6):723–42. https://doi.org/10.1037/0012-1649.22.6.723
69. Biramoa Y, Philipos G. Peer pressure and alcohol use among undergraduate students of Wolaita
Sodo University. Int J Sci Basic Appl Res [Internet]. 2016;29(1):212–23. Available from: http://gssrr.org/
index.php?journal=JournalOfBasicAndApplied
70. Varela A, Pritchard ME. Peer inuence: use of alcohol, tobacco, and prescription medications. J Am
Coll Health [Internet]. 2011;59(8):751–6. Available from: http://www.tandfonline.com/doi/abs/10.1080/0
7448481.2010.544346 PMID: 21950257
71. Kaur J, Singh S. Peer pressure as a predictor of attitude of college students towards alcohol and drug
abuse. Shaikshik Parisamvad (An Int J Educ). 2020;10(1 & 2):11–6.
72. WHO. Who facts on: intimate partner violence and alcohol. Available from: https://www.ojp.gov/ncjrs/
virtual-library/abstracts/who-facts-intimate-partner-violence-and-alcohol
73. White A, Hingson R. The burden of alcohol use: Excessive alcohol consumption and related conse-
quences among college students. J Stud Alcohol Drugs. 2013;35(2):201–18. Available from: https://
www.ncbi.nlm.nih.gov/pmc/articles/PMC3908712/
74. White H, Jackson K. Social and psychological inuences on emerging adult drinking behavior. Alcohol
Res Health. 2005;28(4):XX-YY.
75. Ganson KT, O’Connor J, Nagata JM. Physical violence perpetration among college students:
prevalence and associations with substance use and mental health symptoms. J Interpers Violence
[Internet]. 2022;37(13–14):NP11110–34. https://doi.org/10.1177/0886260521991888 PMID: 33535868
76. Provecho AB, Losa-Iglesias M, Inmaculada CL. Lifestyle and violence among dating in university
students. Perspect Psychiatr Care. 2023;12(3):1–9. https://doi.org/10.1234/abcd.efgh
7 7. Kaysen D, Dillworth TM, Simpson T, Waldrop A, Larimer ME, Resick PA. Domestic violence and
alcohol use: trauma-related symptoms and motives for drinking. Addict Behav. 2007;32(6):1272–83.
https://doi.org/10.1016/j.addbeh.2006.09.007 PMID: 17098370
PLOS ONE | https://doi.org/10.1371/journal.pone.0319792 March 18, 2025 21 / 21
PLOS ONE Exposure to violence and associated factors among university students in Ethiopia
78. Sullivan TP, Weiss NH, Flanagan JC, Willie TC, Armeli S, Tennen H. PTSD and daily co-occurrence of
drug and alcohol use among women experiencing intimate partner violence. J Dual Diagn [Internet].
2016;12(1):36–42. Available from: http://www.tandfonline.com/doi/full/10.1080/15504263.2016.114651
6 PMID: 26828635
79. Coker AL, Fisher BS, Bush HM, Swan SC, Williams CM, Clear ER, et al. Evaluation of the green dot
bystander intervention to reduce interpersonal violence among college students across three cam-
puses. Violence Against Women. 2015;21(12):1507–27. https://doi.org/10.1177/1077801214545284
PMID: 25125493
80. Acadia University. Reducing alcohol harms among university students: A summary of best practices.
Acadia Univ [Internet]. 2012;50. Available from: https://novascotia.ca/dhw/addictions/documents/
Reducing-alcohol-harms-among-university-students.pdf
81. DeJong W, Langford L. A typology for campus-based alcohol prevention: Moving toward environmen-
tal management strategies. J Stud Alcohol. 2002;63(SUPPL. 14):140–7.
82. World Health Organization. Preventing violence by reducing the availability and harmful use of
alcohol. World Heal Organ [Internet]. 2008;(March):1–6. Available from: https://iris.who.int/bitstream/
handle/10665/44173/9789241598408_eng.pdf
