Background: The very low level of economic development, widespread poverty, very poorrnand inadequate health services, etc., make the consequences of youth sexuality much morernserious in the Ethiopia than those of the developed countries. It is crucial to understandrndeterminants and the surrounding context of early sexual initiation in a broader context forrndesigning and implementing effective interventions targeting youth.rnObjectives: The aim of this study therefore is to examine the median age and various paths ofrnthe commencement of first sex for rural and urban youthsrnMethods: A comparative cross sectional study was conducted between, March 1st -15th inrnDessie town and Dessie Zuria Woreda. To draw a total sample of size 1294 (647 urban andrn647 rural) a multistage cluster sampling was used. Then, households were selected byrnrandom walk method. All youths in the selected households were the study subjects. Torncollect quantitative data semi-structured, pretested questionnaire & for qualitative FGD wasrnutilized. Eight Trained data collectors and two supervisors collected the data. After datarnhave bean cleaned & coded entered and analyzed using EPI INFO version 2000 and SPSSrnfor Windows version 15.0. Univariate and multivariate analysis were used.rnResult: About half, 51.3% of the surveyed youths nearly in equal proportion between ruralrnand urban have ever had sex. The Mean & median age of sexual initiation were 16.8 yearsrn(SD= 2.25) and 17 years respectively (Range 8-24 years). Rural youths initiate sex at lowerrnage mean and median (16.49+2.11) and 16.00 than their urban counterparts mean andrnmedian (17.18+2.32) and 17.00 respectively the hzard was significant (AHR [95% CI] =1.45rn(1.19, 2.55). Multivariate analysis show that female by gender OR [95%CI]=1.56(1.11,2.19),rnchew Khat (adj. OR [CI] = 2.05 [1.05â€“3.96]),who drink alcohol (adj OR [CI] = 2.05 [1.05â€“rn3.96),who viewed pornographic materials < 18 years Adj OR= 24.133 (3.28, 177.80) andrnless connected with parents adj. 0R=2.30(1.35, 3.91)were more likely to have early sexualrninitiation. Nearly two third of the sexual initiations were unprotected and some occur withrnhigher risk groups. Half of the sexually active youths have >2 sexual partner in there liferntime. Furthermore, 14% out of which had sex with a non-regular (causal) sexual partner.rnAttributed to their early and unprotected sexual initiation a significant number of adolescentsrnface the untoward complication of early sexual initiation. Of the sexually active youths 13%rn9rnreport STI 45% of female were pregnant at least once in there sexual life time. Logisticrnanalysis to see the impact of early sexual initiation showed that early initiators were morernlikely to be exposed to STIs & multiple partnership than late initiators [adj OR 95%CI]rn=2.08(1.17, 3.72) and [adj OR (95%CI) = 2.33(1.61, 3.37)] respectively.rnConclusion and Recommendation: Early sexual initiation was prevalent and mostlyrnunexpected and unprotected. Those who initiate early were more likely to have badrnreproductive outcomes and risky behaviours like multiple partnership, STIs, unwantedrnpregnancy and probably HIV. In all aspects the problem prevails in rural youths than urban.rnDelaying sexual debate is the pillar of HIV & other STIs prevention among youths. This canrnbe achieved through starting well designed sexual education programs at earlier life.rnStrengthening the norm of virginity is should be advocated & equally ways to accessrncondoms and other contraceptives specially to rural youths should be sought.