Applied Research
Risky Sexual Behavior of Senior Secondary School Students in an Urban Community of Oyo State, South West Nigeria
International Quarterly of Community Health Education 0(0) 1–8 ! The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0272684X17736154 journals.sagepub.com/home/qch
Ajibola Idowu1, Aremu O. Ayodele1, Popoola G. Omotade2, Olowookere S. Anu3, and Fehintola F. Omolola3
Abstract Background: Young people worldwide are now at increased risk of unsafe sexual behavior; it is thus imperative to understand the determinants of such practices among them. Study objective: To assess factors associated with Risky Sexual Behavior (RSB) among secondary school students in Nigeria. Methodology: This cross-sectional study was conducted using multistage sampling technique among 375 secondary school students in Ogbomoso, Nigeria. A pretested questionnaire was used for data collection; chi-square test and binary logistic regression analysis were done. Result: Overall, 23.0% of the respondents had at least one RSB; students not in steady relationships were 5 times more likely to have RSB (OR ¼ 4.50, 95% CI [2.66, 7.71]). Also, respondents who had positive attitude toward RSB had 24% increased odds of RSB practice compared with those with negative attitude (OR ¼ 23.75, 95%CI [2.48, 22.78]). Conclusion: The burden of RSB is high among secondary school students in South West Nigeria. There is urgent need for reprogramming of sex education for the Nigerian secondary school students. Keywords sexual debut, risky sexual behavior, young people, youths, adolescents
Introduction The progressively increasing rate of sexual activities among youths and adolescents in the past few decades has become a public health concern worldwide.1 Young people are now at increased risk of unsafe sexual behavior and its attendant reproductive health problems such as unwanted pregnancies and sexually transmitted infections. Risky Sexual Behaviors (RSBs) are lifestyle-related factors that increase one’s risk of contracting sexually transmitted infections and experiencing unwanted pregnancies.2 Such factors include early sexual debut, having multiple sexual partners, having sex while under the influence of alcohol or drugs, and having unprotected sex.2 Each year, approximately 1 million young women aged 15 to 19 years become pregnant; the vast majority of these pregnancies are unplanned.3 Moreover, 30% of abortion-related deaths occur among young people.3 In America, young people (aged 13–15 years) accounted for an estimated 22% of all HIV cases in 2014.4 RSB is also a major challenge in African countries. For example, not less than 32.3% of male and 43.5% of female college students in Ethiopia was reported having RSB in 2014.5 In Nigeria,
researchers have shown that RSB is a humungous problem among youths. In Oshogbo, Nigeria, Adenike et al.6 reported that 31.5% of the secondary school students surveyed had experienced their sexual debuts by age 15. Alex-Hart et al.7 reported that 42.9% of secondary school students in Port Harcourt, Nigeria, were sexually active, and only 19.8% of them used condom in their last sexual encounter. Iyaniwura et al.8 also reported that 35.1% of respondents in Ogun State
1
Department of Community Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria 2 Department of Community Health, College of Health Sciences, University of Ilorin, Kwara State, Nigeria 3 Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria This study was done at the Bowen University Teaching Hospital, Ogbomoso, Nigeria. Corresponding Author: Ajibola Idowu, Department of Community Medicine, Bowen University Teaching Hospital, PO Box 15, Ogbomoso, Nigeria. Email: [email protected]
2
International Quarterly of Community Health Education 0(0)
experienced early sexual debut. Alex-Heart et al.7 also revealed that 42.9% of secondary school students in Port Harcourt, South South Nigeria, had experienced sex at least once in their lifetime; the mean age of sexual debut was 13 years. Since the world is home to 1.8 billion young people between the ages of 10 and 24 years,8 about 1 in 7 new HIV infections occur in adolescence;9 it is thus imperative to pay crucial attention to sexual and reproductive needs of this group of people. This study aimed at providing baseline information for planning cost-effective sexual and reproductive health program for young people in Nigeria. The following were our research questions: What are the common RSB among senior secondary school students in Ogbomoso? and what are the factors associated with practice of RSB among senior secondary school students in Ogbomoso? The specific objectives were to assess the prevalence and predictors of RSB among senior secondary school students of Ogbomoso, South West Nigeria. The Health Belief Model was used as the conceptual framework for this research. The model tries to explains how adolescents and young people view or perceive sex and how best to design sexual education program to help them.
Methodology Study Location
where n ¼ minimum sample size Za ¼ standard relative deviate at 95% confidence level ¼1.96 p ¼ proportion of respondents who had at least one of the risky sexual behavior. Based on findings from similar studies in Nigeria, 34% of our respondents were expected to have had their sexual debuts prior to the survey thus having RSB.6 q¼1p d ¼ level of precision/margin of error ¼ 5%. Thus, n ¼ 1.962 0.34 0.66/0.0025 ¼ 345 A response rate of 90% (0.9) was envisaged among the respondents. Therefore, N ¼ 345/0.9 ¼ 383. Thus, a minimum sample size of 383 was estimated for the study, but 400 questionnaires were administered.
Inclusion Criteria Students in senior classes who gave their assents/consents to participate in the study and whose school authority gave us permission were recruited into the study.
Exclusion Criteria
The study was conducted among students in selected public schools in Ogbomoso North Local Government Area of Oyo State, South West Nigeria. The Local Government Area has 10 public secondary schools.10
Study Design Cross-sectional study design was employed.
Sample Size Calculation The required sample size was calculated using Leslie Kish sample size formula for estimating single proportion. n ¼ Z2 pq=d2
Name of school Anglican Grammar school Adeniran Grammar School Nurudeen Grammar school Ori-Oke Grammar School Total
Students with significant physical or mental handicap, who could affect their ability to respond validly to the study instrument, were excluded from the study.
Sampling Technique Multistage sampling method was used to select eligible respondents over a period of 2 months (October and November 2016). In the first stage, four coeducational public secondary schools were selected by balloting from the list of 10 government secondary schools within the Local Government Area. The number of respondents selected per school was proportionate to their population sizes using the formula: Number of students in a school divided by total number of students in the four selected schools, multiplied by 400. Proportionate sampling of respondents per school
Number of SS1 students
Numbers of SS2 students
Total number of students in the school
158 149 153 173 633
149 99 77 69 394
1,050 702 679 700 3,131
Formula for calculation 1,050/3,131 400 702/3,131 400 679/3,131 400 700/3,131 400
Number of students selected 134 90 87 89 400
Idowu et al. Stage 2 involved selection of classes from each level of SSS1 and SSS2; all the school visited had more than one classes per class level. Two of such classes were selected by balloting. Stage 3 involved selecting eligible respondents from the selected classes; a proportionate sample was taken from the selected classes based on their sizes and already determined number of respondents allotted to the school. Respondents from selected classes were selected using systematic sampling technique; the sampling interval was calculated based on the number of students in the class and the number of respondents to be selected from the class. The maleto-female ratio in each class was also considered during the selection such that a fair proportion of both sexes were selected. The first participant was selected by balloting.
Data Collection Method and Instrument Data were collected between September and October 2016 using a facilitated self-administered questionnaire with several questions adapted from the Youth Risk Behavior Surveillance System questionnaire developed by the Centers for Disease Control and Prevention.11 Questions were asked on respondents’ sociodemographic characteristics as well as their practices of RSB. Ten medical students of the Bowen University Teaching Hospital were trained on how to administer questionnaire to youths and adolescents and assisted in data collection. Eligible respondents from selected schools were gathered in halls provided by the respective schools; this was done in order not to disrupt the lecture schedule of the students. The purpose of the study was reiterated as this has been explained in the consent/assent form given to them a day before the survey. Questionnaires were distributed, and the research assistants moved round the hall to facilitate the questionnaire completion process. Spaces were created between the respondents, and they were encouraged to give their honest and independent answers. One major challenges faced was participants’ reluctance in answering some questions relating to their sex lives. They were therefore ensured of confidentiality.
Pretesting The instrument was pretested among 50 male and female students from a secondary school in Ogbomoso South Local Government Area. The school was a coeducational public school, similar to the schools used for the main study. The exercise helped in assessing appropriateness of the questions in eliciting desired responses. Ambiguous questions were rephrased or removed in line with study objectives.
Ethical Consideration Approval for the study was obtained from the Ethical Review Committee of the Bowen University Teaching Hospital, Ogbomoso and permission obtained from authorities of the
3 participating schools. Written assents/consents were also obtained from study participants. Participation was entirely voluntary, and confidentiality was ensured; codes rather than participants’ names were used as personal identifiers, and the data were stored in a computer that was accessible only to the principal investigator.
Measures Knowledge on RSB Respondents were asked five questions based on what they think should constitute RSB. Correct answer to each of the questions attracted 2 points; thus, the respondents were rated over 10; those who scored at least 5 points were classified as having good knowledge, while those who scored less than 5 points were categorized as having poor knowledge.
Attitude Toward RSB Six statements were positively phrased and used to assess respondents’ attitude toward RSB; the response to each question was rated using Likert scale ranging from strongly agree to indifferent. Each respondent was rated over 30 points; those who scored less than 15 points were categorized as having positive attitudes to RSB practice.
Risky Sexual Behavior Participants who had practiced at least one of the following behavior were classified as having RSB; sexual debut before age 14 (early sexual debut), having multiple sexual partners, having sex while under the influence of alcohol or drugs, and having unprotected sex (without using condoms or other family planning methods).
Social Class Respondents’ parents were classified into three social classes based on the work of Oyedeji12 carried out in Nigeria. This classification made use of a scoring system that combined father’s occupational type with mother’s educational levels.
Statistical Analysis Data were edited on the field daily and entered into Statistical Package for Social Sciences (SPSS Version 21) for analyses. Data were presented using appropriate tables and charts. Bivariate and multivariate analyses were carried out through the use of chi-square test and stepwise binary logistic regression. Variables were selected for the logistic regression based on extant literature on possible determinants of RSB among young people and based on whether they were statistically significant at the bivariate level. The level of statistical significance was set at p < .05, and 95% confidence interval
4
International Quarterly of Community Health Education 0(0)
was obtained to assess the determinants of RSB among our study participants.
Table 1. Respondents’ Sociodemographic Variable.
Results
Age (years) 10–13 14–16 17–19 20 Sex Male Female Family type Monogamous Polygamous Marital status Never married Married Religion Christianity Islam Class SS1 SS2 Socioeconomic status Low Middle High Ethnicity Yoruba Igbo Hausa Others Number of children 1 2–4 5 Living situation Live with father only Live with mother only Live with both parents Others Educational sponsorship Father only Mother only Both parents Others
Four hundred questionnaires were administered, but 375 of them were satisfactorily completed; some students did not answer questions about their lifestyles and sexuality, and thus, the response rate was 94%. Table 1 shows the demographic characteristics of the respondents. More than half (57.9%) of them were 14 to 16 years old. Similarly, 52.8% of the participants were males, while 81.9% of them were from monogamous settings. Only eight (2.8%) of the respondents were married, while 60% of them practiced Christianity. Students in SS2 class constituted the largest proportion (52.3%). Majority (92.5%) of the respondents were from Yoruba ethnic group, while 55.2% of them belonged to middle social class. While 51.2% were from homes with family sizes of 2 to 4 children, 70.44% and 69.9% of them lived with both parents and had their education jointly sponsored by them. In Table 2, less than half (41%) of the respondents had good knowledge of RSB; more than three quarter of them (81%) had negative attitude toward it. Majority of the respondents experienced their first menstrual flow/wet dreams at the age of 13 years. A quarter (25.9%) of the students said they had intimate relationship with opposite sex, but 76.5% of them declined ever having sex. Forty-one percent of the students had their sexual debuts before the age of 14 years; the sex was coercive in 5.7% of the cases, but more than three quarter (79.5%) of them had feelings of no regret after the debuts. Meanwhile, pregnancy resulted from 12.4% of the respondents who had ever had sex; more than half (58%) of such pregnancies were aborted. Not less than 65.9% of the sexually active respondents had sex without using condom in their last sexual experiences; 5.6% had more than one sexual partner, and 39.8% of them used substances to enhance their sexual performances at one time or the other. Alcohol was the commonest substance used, reported by 60% of the respondents (Figure 1). Not less than 43.2% of the sexually active respondents failed to use any family planning methods during their last sexual activities. However, condom was the commonest family method used among those who practiced contraception, used by 60% of them (Figure 2) In Table 3, 23% of the respondents had RSB; the proportion (27.4%) of respondents with RSB was significantly higher among those in SS1 class compared with those in SS2 class (p ¼ .037). Likewise, the proportion (54%) was significantly higher among those who were not in a steady relationship (p < .001) and respondents with positive attitude to RSB (81.2%, p < .001). At the multivariate level (Table 4), those two variables remained statistically significant. Respondents with positive attitudes were 24 times more likely to engage in RSB compared
Variable
Frequency
Percent
10 217 136 12
2.7 57.9 36.3 3.2
198 177
52.8 47.2
307 68
81.9 18.1
367 8
97.9 2.1
225 150
60.0 40.0
179 196
47.7 52.3
28 207 140
7.5 55.2 37.3
347 6 14 8
92.5 1.6 3.7 2.1
9 192 174
2.4 51.2 46.4
18 47 264 46
4.8 12.5 70.4 12.3
43 49 262 21
11.5 13.1 69.9 5.6
with those with negative attitude (OR ¼ 23.75, 95% CI [2.78, 22.78]). Similarly, respondents who were not in steady relationships and were engaging in sexual activities were 5 times more likely to have RSB (OR ¼ 4.50, 95% CI [2.66, 7.71]).
Idowu et al.
5
Table 2. Respondents’ Knowledge, Attitude, and Practice of RSB. Variable Age (years) at menarche/first wet dream
Risky Sexual Behavior of Senior Secondary School Students in an Urban Community of Oyo State, South West Nigeria
International Quarterly of Community Health Education 0(0) 1–8 ! The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav DOI: 10.1177/0272684X17736154 journals.sagepub.com/home/qch
Ajibola Idowu1, Aremu O. Ayodele1, Popoola G. Omotade2, Olowookere S. Anu3, and Fehintola F. Omolola3
Abstract Background: Young people worldwide are now at increased risk of unsafe sexual behavior; it is thus imperative to understand the determinants of such practices among them. Study objective: To assess factors associated with Risky Sexual Behavior (RSB) among secondary school students in Nigeria. Methodology: This cross-sectional study was conducted using multistage sampling technique among 375 secondary school students in Ogbomoso, Nigeria. A pretested questionnaire was used for data collection; chi-square test and binary logistic regression analysis were done. Result: Overall, 23.0% of the respondents had at least one RSB; students not in steady relationships were 5 times more likely to have RSB (OR ¼ 4.50, 95% CI [2.66, 7.71]). Also, respondents who had positive attitude toward RSB had 24% increased odds of RSB practice compared with those with negative attitude (OR ¼ 23.75, 95%CI [2.48, 22.78]). Conclusion: The burden of RSB is high among secondary school students in South West Nigeria. There is urgent need for reprogramming of sex education for the Nigerian secondary school students. Keywords sexual debut, risky sexual behavior, young people, youths, adolescents
Introduction The progressively increasing rate of sexual activities among youths and adolescents in the past few decades has become a public health concern worldwide.1 Young people are now at increased risk of unsafe sexual behavior and its attendant reproductive health problems such as unwanted pregnancies and sexually transmitted infections. Risky Sexual Behaviors (RSBs) are lifestyle-related factors that increase one’s risk of contracting sexually transmitted infections and experiencing unwanted pregnancies.2 Such factors include early sexual debut, having multiple sexual partners, having sex while under the influence of alcohol or drugs, and having unprotected sex.2 Each year, approximately 1 million young women aged 15 to 19 years become pregnant; the vast majority of these pregnancies are unplanned.3 Moreover, 30% of abortion-related deaths occur among young people.3 In America, young people (aged 13–15 years) accounted for an estimated 22% of all HIV cases in 2014.4 RSB is also a major challenge in African countries. For example, not less than 32.3% of male and 43.5% of female college students in Ethiopia was reported having RSB in 2014.5 In Nigeria,
researchers have shown that RSB is a humungous problem among youths. In Oshogbo, Nigeria, Adenike et al.6 reported that 31.5% of the secondary school students surveyed had experienced their sexual debuts by age 15. Alex-Hart et al.7 reported that 42.9% of secondary school students in Port Harcourt, Nigeria, were sexually active, and only 19.8% of them used condom in their last sexual encounter. Iyaniwura et al.8 also reported that 35.1% of respondents in Ogun State
1
Department of Community Medicine, Bowen University Teaching Hospital, Ogbomoso, Oyo State, Nigeria 2 Department of Community Health, College of Health Sciences, University of Ilorin, Kwara State, Nigeria 3 Department of Community Health, College of Health Sciences, Obafemi Awolowo University, Ile-Ife, Nigeria This study was done at the Bowen University Teaching Hospital, Ogbomoso, Nigeria. Corresponding Author: Ajibola Idowu, Department of Community Medicine, Bowen University Teaching Hospital, PO Box 15, Ogbomoso, Nigeria. Email: [email protected]
2
International Quarterly of Community Health Education 0(0)
experienced early sexual debut. Alex-Heart et al.7 also revealed that 42.9% of secondary school students in Port Harcourt, South South Nigeria, had experienced sex at least once in their lifetime; the mean age of sexual debut was 13 years. Since the world is home to 1.8 billion young people between the ages of 10 and 24 years,8 about 1 in 7 new HIV infections occur in adolescence;9 it is thus imperative to pay crucial attention to sexual and reproductive needs of this group of people. This study aimed at providing baseline information for planning cost-effective sexual and reproductive health program for young people in Nigeria. The following were our research questions: What are the common RSB among senior secondary school students in Ogbomoso? and what are the factors associated with practice of RSB among senior secondary school students in Ogbomoso? The specific objectives were to assess the prevalence and predictors of RSB among senior secondary school students of Ogbomoso, South West Nigeria. The Health Belief Model was used as the conceptual framework for this research. The model tries to explains how adolescents and young people view or perceive sex and how best to design sexual education program to help them.
Methodology Study Location
where n ¼ minimum sample size Za ¼ standard relative deviate at 95% confidence level ¼1.96 p ¼ proportion of respondents who had at least one of the risky sexual behavior. Based on findings from similar studies in Nigeria, 34% of our respondents were expected to have had their sexual debuts prior to the survey thus having RSB.6 q¼1p d ¼ level of precision/margin of error ¼ 5%. Thus, n ¼ 1.962 0.34 0.66/0.0025 ¼ 345 A response rate of 90% (0.9) was envisaged among the respondents. Therefore, N ¼ 345/0.9 ¼ 383. Thus, a minimum sample size of 383 was estimated for the study, but 400 questionnaires were administered.
Inclusion Criteria Students in senior classes who gave their assents/consents to participate in the study and whose school authority gave us permission were recruited into the study.
Exclusion Criteria
The study was conducted among students in selected public schools in Ogbomoso North Local Government Area of Oyo State, South West Nigeria. The Local Government Area has 10 public secondary schools.10
Study Design Cross-sectional study design was employed.
Sample Size Calculation The required sample size was calculated using Leslie Kish sample size formula for estimating single proportion. n ¼ Z2 pq=d2
Name of school Anglican Grammar school Adeniran Grammar School Nurudeen Grammar school Ori-Oke Grammar School Total
Students with significant physical or mental handicap, who could affect their ability to respond validly to the study instrument, were excluded from the study.
Sampling Technique Multistage sampling method was used to select eligible respondents over a period of 2 months (October and November 2016). In the first stage, four coeducational public secondary schools were selected by balloting from the list of 10 government secondary schools within the Local Government Area. The number of respondents selected per school was proportionate to their population sizes using the formula: Number of students in a school divided by total number of students in the four selected schools, multiplied by 400. Proportionate sampling of respondents per school
Number of SS1 students
Numbers of SS2 students
Total number of students in the school
158 149 153 173 633
149 99 77 69 394
1,050 702 679 700 3,131
Formula for calculation 1,050/3,131 400 702/3,131 400 679/3,131 400 700/3,131 400
Number of students selected 134 90 87 89 400
Idowu et al. Stage 2 involved selection of classes from each level of SSS1 and SSS2; all the school visited had more than one classes per class level. Two of such classes were selected by balloting. Stage 3 involved selecting eligible respondents from the selected classes; a proportionate sample was taken from the selected classes based on their sizes and already determined number of respondents allotted to the school. Respondents from selected classes were selected using systematic sampling technique; the sampling interval was calculated based on the number of students in the class and the number of respondents to be selected from the class. The maleto-female ratio in each class was also considered during the selection such that a fair proportion of both sexes were selected. The first participant was selected by balloting.
Data Collection Method and Instrument Data were collected between September and October 2016 using a facilitated self-administered questionnaire with several questions adapted from the Youth Risk Behavior Surveillance System questionnaire developed by the Centers for Disease Control and Prevention.11 Questions were asked on respondents’ sociodemographic characteristics as well as their practices of RSB. Ten medical students of the Bowen University Teaching Hospital were trained on how to administer questionnaire to youths and adolescents and assisted in data collection. Eligible respondents from selected schools were gathered in halls provided by the respective schools; this was done in order not to disrupt the lecture schedule of the students. The purpose of the study was reiterated as this has been explained in the consent/assent form given to them a day before the survey. Questionnaires were distributed, and the research assistants moved round the hall to facilitate the questionnaire completion process. Spaces were created between the respondents, and they were encouraged to give their honest and independent answers. One major challenges faced was participants’ reluctance in answering some questions relating to their sex lives. They were therefore ensured of confidentiality.
Pretesting The instrument was pretested among 50 male and female students from a secondary school in Ogbomoso South Local Government Area. The school was a coeducational public school, similar to the schools used for the main study. The exercise helped in assessing appropriateness of the questions in eliciting desired responses. Ambiguous questions were rephrased or removed in line with study objectives.
Ethical Consideration Approval for the study was obtained from the Ethical Review Committee of the Bowen University Teaching Hospital, Ogbomoso and permission obtained from authorities of the
3 participating schools. Written assents/consents were also obtained from study participants. Participation was entirely voluntary, and confidentiality was ensured; codes rather than participants’ names were used as personal identifiers, and the data were stored in a computer that was accessible only to the principal investigator.
Measures Knowledge on RSB Respondents were asked five questions based on what they think should constitute RSB. Correct answer to each of the questions attracted 2 points; thus, the respondents were rated over 10; those who scored at least 5 points were classified as having good knowledge, while those who scored less than 5 points were categorized as having poor knowledge.
Attitude Toward RSB Six statements were positively phrased and used to assess respondents’ attitude toward RSB; the response to each question was rated using Likert scale ranging from strongly agree to indifferent. Each respondent was rated over 30 points; those who scored less than 15 points were categorized as having positive attitudes to RSB practice.
Risky Sexual Behavior Participants who had practiced at least one of the following behavior were classified as having RSB; sexual debut before age 14 (early sexual debut), having multiple sexual partners, having sex while under the influence of alcohol or drugs, and having unprotected sex (without using condoms or other family planning methods).
Social Class Respondents’ parents were classified into three social classes based on the work of Oyedeji12 carried out in Nigeria. This classification made use of a scoring system that combined father’s occupational type with mother’s educational levels.
Statistical Analysis Data were edited on the field daily and entered into Statistical Package for Social Sciences (SPSS Version 21) for analyses. Data were presented using appropriate tables and charts. Bivariate and multivariate analyses were carried out through the use of chi-square test and stepwise binary logistic regression. Variables were selected for the logistic regression based on extant literature on possible determinants of RSB among young people and based on whether they were statistically significant at the bivariate level. The level of statistical significance was set at p < .05, and 95% confidence interval
4
International Quarterly of Community Health Education 0(0)
was obtained to assess the determinants of RSB among our study participants.
Table 1. Respondents’ Sociodemographic Variable.
Results
Age (years) 10–13 14–16 17–19 20 Sex Male Female Family type Monogamous Polygamous Marital status Never married Married Religion Christianity Islam Class SS1 SS2 Socioeconomic status Low Middle High Ethnicity Yoruba Igbo Hausa Others Number of children 1 2–4 5 Living situation Live with father only Live with mother only Live with both parents Others Educational sponsorship Father only Mother only Both parents Others
Four hundred questionnaires were administered, but 375 of them were satisfactorily completed; some students did not answer questions about their lifestyles and sexuality, and thus, the response rate was 94%. Table 1 shows the demographic characteristics of the respondents. More than half (57.9%) of them were 14 to 16 years old. Similarly, 52.8% of the participants were males, while 81.9% of them were from monogamous settings. Only eight (2.8%) of the respondents were married, while 60% of them practiced Christianity. Students in SS2 class constituted the largest proportion (52.3%). Majority (92.5%) of the respondents were from Yoruba ethnic group, while 55.2% of them belonged to middle social class. While 51.2% were from homes with family sizes of 2 to 4 children, 70.44% and 69.9% of them lived with both parents and had their education jointly sponsored by them. In Table 2, less than half (41%) of the respondents had good knowledge of RSB; more than three quarter of them (81%) had negative attitude toward it. Majority of the respondents experienced their first menstrual flow/wet dreams at the age of 13 years. A quarter (25.9%) of the students said they had intimate relationship with opposite sex, but 76.5% of them declined ever having sex. Forty-one percent of the students had their sexual debuts before the age of 14 years; the sex was coercive in 5.7% of the cases, but more than three quarter (79.5%) of them had feelings of no regret after the debuts. Meanwhile, pregnancy resulted from 12.4% of the respondents who had ever had sex; more than half (58%) of such pregnancies were aborted. Not less than 65.9% of the sexually active respondents had sex without using condom in their last sexual experiences; 5.6% had more than one sexual partner, and 39.8% of them used substances to enhance their sexual performances at one time or the other. Alcohol was the commonest substance used, reported by 60% of the respondents (Figure 1). Not less than 43.2% of the sexually active respondents failed to use any family planning methods during their last sexual activities. However, condom was the commonest family method used among those who practiced contraception, used by 60% of them (Figure 2) In Table 3, 23% of the respondents had RSB; the proportion (27.4%) of respondents with RSB was significantly higher among those in SS1 class compared with those in SS2 class (p ¼ .037). Likewise, the proportion (54%) was significantly higher among those who were not in a steady relationship (p < .001) and respondents with positive attitude to RSB (81.2%, p < .001). At the multivariate level (Table 4), those two variables remained statistically significant. Respondents with positive attitudes were 24 times more likely to engage in RSB compared
Variable
Frequency
Percent
10 217 136 12
2.7 57.9 36.3 3.2
198 177
52.8 47.2
307 68
81.9 18.1
367 8
97.9 2.1
225 150
60.0 40.0
179 196
47.7 52.3
28 207 140
7.5 55.2 37.3
347 6 14 8
92.5 1.6 3.7 2.1
9 192 174
2.4 51.2 46.4
18 47 264 46
4.8 12.5 70.4 12.3
43 49 262 21
11.5 13.1 69.9 5.6
with those with negative attitude (OR ¼ 23.75, 95% CI [2.78, 22.78]). Similarly, respondents who were not in steady relationships and were engaging in sexual activities were 5 times more likely to have RSB (OR ¼ 4.50, 95% CI [2.66, 7.71]).
Idowu et al.
5
Table 2. Respondents’ Knowledge, Attitude, and Practice of RSB. Variable Age (years) at menarche/first wet dream
