Risk-taking behaviours among out-of-school female adolescents in Ibadan north local government area, Nigeria

INTRODUCTION

Over 1.6 billion young people between the ages of 10 and 25 live in developing nations which account for 16 percent of the global population.¹ WHO classifies young people as individuals in the age 10-24 years.² In Nigeria young people has a large population with one in every four persons being an adolescent between the age of 10-19 years.³ This young population constitutes a large and important proportion of the Nigerian population, but they are faced with various sexual and reproductive health issues. They engage in risky behaviors that put their health at risk, increase their risk of contracting STIs, HIV/AIDS, and unwanted pregnancy, or hinder their ability to succeed in the future. Examples of these behaviors include unprotected sexual intercourse, having multiple partners, having sex for money, initiating sexual activity at a young age, drinking alcohol, smoking cigarettes, and using drugs.⁴ This impact may manifest as psychologically (unhappiness, loneliness, sorrow, moodiness) or physically (headaches, difficulty sleeping).⁵

A study in Nigeria showed that most respondents (63.9%) had a fair knowledge of sexual reproductive health and consequences of engaging in risky behaviors.⁶ Young girls who engage in sexually risky behavior face long-term consequences, including infertility and higher rates of morbidity and mortality for both mothers and babies. In a study done in Rivers State, 46% of adolescent begin sexual activity at the age of 13, and the median age for first sex was 15.7 years.⁷ The 2023 Demography and Health survey (DHS) revealed that 15% of adolescents between the ages of 15 and 19 are either mothers already or are expecting their first child, this highlights the seriousness of the issue.⁸

According to the health belief model, a person's self-efficacy, beliefs about health issues, and their perceptions of the advantages and disadvantages of taking action, all contribute to their decision to engage in or refrain from engaging in health-promoting behavior. People who believe they are at high risk of contracting STIs or HIV and have received sexual and behavioral change education may find it easier to use a condom or abstain from sexual activity. In contrast, people who believe they are at low risk of HIV and do not have access to sexual and behavioral change information may need more intense external cues.

Though numerous studies on adolescent and young girls' sexual behavior have been conducted, there haven't been many studies conducted on the variety of risky behaviors, particularly substance use in young people and its interrelatedness with sexual behavior. Comprehending these relationships will facilitate the establishment of suitable interventions to tackle them effectively. Also, adolescents in school are the objective of previous studies in sub-Saharan Africa and Nigeria because they are easier to organize than those who are out of school. This study was therefore necessary to identify risky behaviors among out-of-school adolescent girls and young girls. This study examined risk behaviors and knowledge of the negative effects of risky behavior, as well as the factors that encourage female adolescents and young females to engage in risky behavior. Having a better grasp of these variables will aid in creating the right intervention. The purpose of this study is to determine the risk behaviors as well as the factors that lead to these behaviors among out of school female adolescents and young females in Ibadan North Local Government Area.

METHODS

Study design and population

A community-based cross-sectional study was designed, focusing on out-of-school female adolescents and young females. Respondents' self-administered questionnaires were utilized to gather data. The study population consisted of female adolescents and young females between the ages of 10 and 24 who had either completed or not completed their elementary or secondary education and were now pursuing apprenticeships or trades. The study excluded female adolescents who are with mental, hearing, or speech impairments. The study was conducted between June to December, 2019.

Sampling and participant selection

The study's responses were gathered using a multistage sampling technique. Out of the five local government areas (LGAs) in the city of Ibadan, one was chosen at random by balloting. Additionally, four wards were chosen at random from the LGA. The Local Government is made up of over fifty communities. Two communities were chosen at random from each of the four wards that were chosen. Each of these communities serves as a cluster, representing a small scale of the overall population. Three hundred and five (305) out-of-school female adolescents and young females from the eight communities that were chosen were purposefully chosen from their homes, workplaces, and marketplaces until the percentage designated for each community was reached. Adolescents and Young Females between the ages of 10 and 24 who were studying trades, apprentices, office/shop workers, and hawkers made up the responses.

Data collection

A self-administered, semi-structured questionnaire using a quantitative approach was used to gather data. The core elements of the health belief model and the literature review served as a guide for developing the questionnaire's variables. Having several sexual partners, having sex for money, engaging in unprotected sexual activity, perceived risk of HIV/AIDS, attitude toward drug use, and awareness of the consequences of risk behaviors were among the risk practices and influencing factors that were examined.

Data analysis

Data was imported and entered into the Windows version of the Statistical Package for Social Sciences (SPSS) 20 for analysis. Descriptive summary measures, which were represented as mean, median, standard deviation, range for continuous variables, and percentage for categorical variables, were used to summarize the findings. To determine relationships between categorical variables (independent and outcome variables), the chi-square test was used. Additionally, 95% confidence intervals for odds ratios (OR) were computed. Two-tailed tests at the 0.05 level of significance were used for all statistical analyses. Statistical significance was defined as p-values below 0.05.

Ethical consideration

Ethical approval was obtained for the study from Oyo State Ministry of Health, Ibadan. The participants' rights were protected by verbally obtaining informed consent. This was to protect participants’ confidentiality both during and after data collection, no names were included in the questionnaire.

RESULTS

There were total of 305 respondents with the mean age of 18.52±3.3. Majority of respondents, 191 (62.6%) live with both parents, whereas 37 (12.1%) were staying with their sexual partner. Of the respondents, 184 (38.7%) have never worked for pay, while at the moment, 142 (46.2%) are not working for pay. Of those employed, 33.1% are shop assistants, traders make up 12.1%, and apprentices make up 20.7% (Table 1).

Table 2 shows sexual activity of the respondents was reported by 188 (61.6%) of the respondents, among whom 112 (59.6%) were in a continuous sexual relationship with a single person. The mean age at sexual debut was 17.7±2.89 years. Among respondents who were sexually active, 76 (40.4%) had multiple sexual partners in the preceding six months. Majority of sexual activities were for the purpose of pleasure, 119 (63.3%), while 26 (13.8%) were forced intercourse/rape. Also, 23 (12.2%) have had transactional sex. More than half of the 98 respondents (52.1%) who were sexually active had never advised their partners to use condoms to prevent HIV or pregnancy. Additionally, 85 (45.2%) of the respondents reported using condoms, whereas 103 (54.8%) did not. Lack of awareness regarding condom use was the main reasons why people did not use condoms (Table 3).

Of the responders, 119 (39.0%) had previously tasted an alcoholic beverage. Of these, 54 (45.4) currently consume alcohol. Of those, 12.5% have ever consumed alcohol, reasons for drinking alcohol included being sexually active 21 (6.9%), feeling less anxious 13 (4.3%), and becoming mentally dependent 15 (4.9%), and peer pressure, 14 (4.6%). Among those whom their significant other drinks, mothers have the lowest frequency (3.1%) and friends have the largest frequency (56, 19.1%) (Table 4).

Table 5-8 revealed that 26 (8.5%) of respondents had previously smoked cigarettes, while nine (3.0%) of them continue to smoke.

DISCUSSION

Almost two-third (61.6%) of the study participants have had sexual intercourse; this finding is similar to a study conducted among out-of-school female adolescents in Ebonyi State, in which majority of adolescents ages 13-15 years had been sexually initiated.⁹ These results reflect modern trends as adolescents now have more access to pornographic materials greater and social pressures from media. Also, abolishing of traditional and religious norms that frown on premarital sexual activities may be additional reasons and a significant predictor of sexual behavior.¹⁰ Also, being economically dependent on a romantic partner hinders adolescents’ ability to abstain from premarital sex. This corroborates with a study which explains that being in a lowest social class make adolescents practice risky sexual behavior than those from upper class.¹¹

In this study, the mean age of sexual initiation is 17.51 years +2.41. This is similar to a study conducted among out of school adolescent in Ibadan.¹² Adolescents who begin sexual activity early are more likely to have more sexual partners, and therefore are more exposed to the risk of STIs, HIV and AIDS and unwanted pregnancy. More than a third of the respondents who engage in sexual activities have multiple sexual partners ranging between 2-20 in the last 6 months. This may also increase their risk of contracting STIs, including HIV and AIDS. The prevalence of condom use is low as more than half of the sexually active respondents did not use condom the last time, they had sex. This is similar to study conducted among adolescents in Anambra.¹³ A study also showed that knowledge about HIV was lower among adolescent ages 15-17 year. In this study, Reasons for the low utilization of condom was lack of knowledge about condom usage, and a fear of being rejected by sex partners. Condom use is promoted globally as an effective means of reducing sexual risk, more specifically HIV and sexually transmitted infections. Though many of the respondents in this study were aware that a consequence of non-condom usage was HIV transmission but few respondents had knowledge of HIV/AIDs as a negative consequence of substance use. A study in Nigeria also reported that most respondents (63.9%) had a fair knowledge of sexual reproductive health.⁶ Increase knowledge about HIV and STIs transmission and prevention can reduce risky behavior and also delay the onset of sexual intercourse.¹⁴

Alcohol consumption and tobacco smoking were assessed as risk factors for risky sexual behavior. Among the respondents, more than one third reported they had ever drunk alcohol before, and almost three-quarters of these admitted to being drunk before. According to a study conducted among female adolescents, there is an increase in female involvement in alcohol because they belief it facilitates the flushing out of spermatozoa in the urine of a female who just had sexual intercourse.⁹ In this study, peers mostly accounted for acquaintances that consume alcohol. Alcohol consumption has significantly influenced by their friends and not only parental influence.¹⁵

Also in this study, less than a tenth of the respondents admitted to smoking. This prevalence is low and comparable with findings in a study conducted among young adults in Northern Nigeria.¹⁶ The low prevalence of smoking may be due to the disincentivizing message on cigarette advertisements in prime-time adverts supplying information that smokers are liable to die young. The use of other psychoactive drugs such as cocaine, heroin cannabis and others by the respondents was still low as less than 10 percent of respondents use them. This is also similar to study conducted among adolescents in Ibadan, which showed low prevalence of other psychoactive drugs among respondents.¹⁷

More than one third of the respondents in this study identified increased risk of HIV transmission as a consequence of substance use. The implication of this is that they do not consider drug use to reduce a person’s cognitive ability to consider protective sex. This might be because out-of-school female adolescents are outside a formal school system and they miss out of the opportunity for learning in conducive environments. Their level of knowledge on other negative consequences of engaging in risk behavior is thus low.

There was only one limitation for the study, eight communities were studied and the results may not be generalized to out of school female adolescents and young females from all the communities in the local government.

CONCLUSION

This study revealed that most out-of-school adolescents between ages 15-19 are sexually active and also practice risky activities such as drug use and alcohol consumption. Engaging in drug use and alcohol consumption reduces person’s cognitive to consider protective sex. Hence, negotiation of condom-use not considered. Poor knowledge on negative consequences of these behaviors and engaging in risky behaviors can contribute to major health problems and career setbacks. Educational intervention focusing on the negative consequences of taking drugs and alcohol needs to be intensified among adolescents. In addition, adolescents develop better skills for negotiating lower-risk sexual encounters and increase frequency of communications about safer sex if they know the benefits of avoiding risky behaviors outweighs the reasons for non-avoidance. Using a multi-domain interventional approach can help to improve adolescents understanding on the harmful effect of risky behaviors and also reduce risk behaviors to avoid future health problems.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: The study was approved by the Institutional Ethics Committee

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