Pattern and predictors of sexual behaviour among adolescents in Ibadan, South West, Nigeria

Background: Adolescents are usually strong and known for vitality but reproductive and sexual issues constitute challenges to their health and well- being. Sexual choices are controlled by interaction of factors surrounding the adolescents’ existence. Aim: The study investigated the pattern and factors affecting sexual behaviour among adolescents in Ibadan, South West, Nigeria. Method: A cross sectional study was conducted among sexually active adolescents at two Family Medicine Practice Clinics after obtaining ethical approval. Data was collected on sexual behaviour, socio demographic and family characteristics using interviewer administered questionnaire. Data was analysed with SPSS version 18 and test of association was done using chi-square and multiple logistic regression at 5% level of signi ﬁ cance. Results: The mean age of sexual debut was 18.82 + 2.804 years, with age of onset being a year earlier among male respondents compared to females. Higher proportion of males (50.9%) had intercourse before age 16 and were involved in sex with multiple partners (71.2%). Females accounted more for inconsistent condom use (67.7%) and transactional sex (73.3%). Predictors of unsafe sexual behaviour were non- tertiary education (OR= 2.05, Con ﬁ dence Interval: 1.096-3.848), lower social class OR: 2.721, Con ﬁ dence Interval: 1.422-5.308 and con ﬂ ict- oriented family types (OR= 1.894 Con ﬁ dence Interval: 1.036-3.462). Conclusion: The ﬁ ndings showed different pattern of sexual behaviour among adolescents. Factors that predicted unsafe sexual practice were low education, poverty and family dysfunction. Ameliorating these factors will reduce risky sex pattern and related morbidities among adolescents’ population.


Introduction
Health related behaviours among young people are infl uenced by factors in which they live, learn and grow up [1]. Sexual attitudes and practices among adolescents are infl uenced by interaction of both personal and proximal factors which include socio-cultural, family structures and functions where they grow [2][3][4][5][6].
Adolescents are at different developmental stages with those in early period struggling with self-identity while the older adolescents from age eighteen years seek for intimacy [7]. Desire for intimacy and its associated odds for sexual involvement increase with age of adolescents [8][9][10][11]. Early exposure to sexual activity is not without risk, particularly the younger aged adolescents 15 -19 years practised more harmful sex as regards inconsistent condom use compared to 20-24 years old adolescents [12].
Sexual behaviours also vary with the gender of adolescents, for instance the average age of sexual debut among males may be earlier than that of females [8,13]. Likewise proportion of sexually active males are more than females [8,9]. However young females are more likely not to use condom and engage transactional sex for gain than their male counterparts [13,14].
The socioeconomic class of a young person infl uences sexual behaviour [14]. For instance, belonging to middle and low socioeconomic strata affect onset of sexual intercourse Religion as an institution that promotes morals and abstinence control sexual practices, religious Latino boys and girls were less likely to report premarital sex, relative to African American and non-Hispanic Whites [18]. Others studies also showed religion offered protection against risky sexual behaviour by delaying early sexual debut and promotion of condom use [14,19,20].
Similarly, families where adolescents dwell and grow have been related to sexual choices [21,22]. Abstinence from sexual intercourse was associated with growing up in supportive families [23]. Good family functioning helps with safe sexual practice such as regular use of condom and maintaining relationship with steady partners among sexually active adolescents [23,24]. In contrast, poor parental support and prominent family confl icts lead to involvement in higher risky sexual behaviour with its resultant consequences [24,25]. This was evidenced in a comparison study where pregnant young females reported higher family confl ict and less of cohesion than those not pregnant [24].
1.2 In addressing the reproductive health issues and in meeting the sustainable development goals' blueprint of reducing global health challenges which remained pervasive among young population in Nigeria, it is important to study the social and family characteristics contexts affecting sexual choices in this environment, thus the study assessed the pattern of sexual behaviour and its predictors among adolescents in Ibadan, Southwest, Nigeria.

Study setting and population
A hospital based cross sectional study was carried out among sexually active adolescents between age 15-24 years, at two Family Medicine Clinics located at two Government Secondary Health Care that were selected from Government Secondary Hospitals in Ibadan Metropolis in Nigeria through computer based simple randomization.

Study participants/process
A total of 1480 respondents were screened for sexual activity using Adolescent Sexual Activity Index an 11 item scale [26]. Respondents with a score of 8 and above were considered sexually active out of which those that gave consents were recruited into the study using consecutive sampling until 370 sexually active respondents required as calculated from previous study [44] were enrolled.
Respondents were selected from each centre based on proportionate allocation from adolescents' record at each centre and the study lasted 4 months.
An interviewer administered-structured questionnaire was used to obtain data from sexually active respondents after obtaining informed consent while maintaining utmost privacy and confi dentiality.

Socio-demographic Characteristics
Questions that answered objectives of the study were asked on bio-data such as age, level of education, family type and characteristics. Economic class was determined using Ogunlesi classifi cation of social class for adolescents [27].

Pattern of sexual behaviour
Sexual behaviour assessment focused on age at fi rst sexual intercourse, number of sexual partners over 12 months, consistency of condom uses and sex in exchange for money, gift or kind. Sexual behaviour was dichotomised into Safe and Unsafe. Risky sex was classifi ed based on sexual debut on or before age 16 years, irregular condom use, transactional sex and multiple sexual partners. Respondents with absence of the aforementioned measures were classifi ed as having safe sex.

Family functioning
Relationship within the family environment was assessed using Family Relationship Index (FRI) [6], a two-point scale which dichotomised quality of family interaction into Support Oriented and Confl ict Oriented families after compilation of respondent raw scores on a standard scale.

Data analysis
Descriptive analysis of socio-demographic characteristics, pattern of sexual behaviour was done using measures like proportions, means. Pattern of sexual behaviour was further disaggregated by gender and was represented by a bar chart.
Chi square was used to test association between sociodemographic, Family type and function with pattern of sexual behaviour. Multiple Logistic regression was used to test predictors of sex behaviour. Statistical level of signifi cance was set at a p value of ≤ 0.05.

Ethical clearance
The study was conducted after ethical clearance was

Predictors of risky sexual behaviour
Multiple logistic regression was carried out to test the independent effect of socio-demographic characteristics and family relationship index on pattern of sexual behaviour among the studied population. The fi ndings indicated that the respondents who had less than tertiary education were 2.053 times more likely to engage in risky sexual behaviour

Discussion
The mean age of sexual debut was 18.82 years in this study, this was close to the mean age recorded in the National Demographic Health Survey [28] and also with the work by Annete, et al. [29] in Uganda which was 18 years, but was much higher than the mean age of 15.4 years reported among American Adolescent Nationals by Aspy, et al. [30]. The observed difference could be attributed to cultural variation between developed and developing countries. The former society compared to the latter allows for early independence which can lead to premature decision making with regards to sexual activity.
Disparity was observed in the age of fi rst sexual intercourse between male and female as was documented in few studies [20,31]. For instance, sexual debut was a year lower among male respondents compared to females. Also, use of condom was poor in this study just as it has been found by other studies [32][33][34][35]. Further analysis on the effects of socio-demographic factors, showed that females accounted for a higher proportion of irregular condom use, consistent with fi ndings of both Wouhabe [35] in Ethiopia and Olasode in Nigeria [36]. Gender  Figure 1: Differential Proportion of Sexual Behaviour Between Gender.   Masculinity had infl uence on number of sexual partners, male respondents accounted for more involvement with multiple partners than females.
Role of age was observed as higher proportion of sexually active adolescents were seen after fi fteen years of age confi rming previous reports that sexual practice increases with age [9,32]. Although, younger adolescents had tendency to practice unsafe sex more than older adolescents in this study and this was in keeping with other studies [38,39]. Early aged adolescents are less likely to make informed decision and are more likely to involve in coercive sex and other associated risks. Early initiators have been shown to lack the ability to negotiate condom use during sexual intercourse [37,40] and have likelihood for multiple sexual partners from serial relationships before marriage [37,39].
Religion is an entity with values that protect against risky sexual behaviour [3,11,20,29], youths who practiced Christianity in this study had reduced engagement in risky sexual activity. Although, Isiugo, et al. observed that religion type had no effect on risky sex behaviour in a National survey [42].
Education as a factor showed that respondents with tertiary education were less involved in unsafe sexual behaviour, similar to other report that education confers an advantage on pattern of sexual activity [16].
Furthermore, the study revealed the importance of family characteristics on pattern of sex behaviour. Polygamy being embedded in confl ict from partner rivalry accounted for higher proportion of youths with risky sexual behaviour [11,41,43,44]. Negative impact leads to pressure exposure from peers and eventual unsafe sexual practice [23,44,45]. Likewise, the quality of family functioning showed that adolescents from support oriented families were less likely to practice risky sex compared to ones from confl ict families. Good family functioning improves bond and communication among family members, an interaction which promotes secured atmosphere to address age related health behaviour such as safe sex [6,18,22,24] Lastly, poor economy in family was associated with the highest percentage of risky sex as found in some studies [16,14,42]. Poverty has been strongly linked with low education, inadequate information on condom use and likelihood of transactional sex for monetary gains [15,32]. Consistent effect of poverty and low education in predicting pattern of sexual practice emphasise their roles in unsafe sexual practice and sex related morbidities and mortalities in low income countries as Nigeria.

Conclusion
The fi ndings showed that the pattern of sexual behaviour among adolescents were at variance of safe and unsafe sexual practice. The paradox observed with high inconsistent use of condoms in this study despite advancement in promoting contraception among young population globally showed a persistent gap in the health of adolescents and young people in Nigeria and Africa at large. Knowing that low level of education, poverty and poor family functioning were identifi ed as predictors of unsafe sexual behaviour in this study. Strategies to improve on education and household fi nances should be effected in order to promote awareness and adoption of safe sexual practice among young population in this environment.
Lastly comprehensive approach to adolescent care must explore family functioning in planning intervention for healthy social integration and safe sexual practice.
In addition, parents should seek help in dealing with family confl icts in order to provide home front that favour healthy sex behaviour. All stakeholders are keys to preventing risky sexual practice and its attendant health burden among young population.

Limitation
The cross-sectional nature of this study limits its ability to establish causal relationship between pattern of sexual activity and identifi ed infl uencing factors.