State and Grade-Level Predictors of Sex Education Knowledge and Attitudes among In-School Adolescents in Nigeria: A Multistate Cross-Sectional Study

State and Grade-Level Predictors of Sex Education Knowledge and Attitudes among In-School Adolescents in Nigeria: A Multistate Cross-Sectional Study | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article State and Grade-Level Predictors of Sex Education Knowledge and Attitudes among In-School Adolescents in Nigeria: A Multistate Cross-Sectional Study Henry Osaro Aisagbonhi, Ukamaka Gladys Okafor, Ifeoluwa Abiodun, and 8 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9164758/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 9 You are reading this latest preprint version Abstract Background: Inconsistent implementation of sexuality education in Nigeria limits equitable knowledge acquisition despite widespread policy support. This study addressed the gap by examining adolescents’ knowledge, attitudes, and structural determinants across multiple states. Methods: A cross-sectional design was employed among 568 secondary school students selected from six public schools across three Nigerian states. Data were collected using structured questionnaires assessing knowledge, attitudes, exposure, and perceived barriers. Multivariable regression analyses identified predictors of outcomes. Results: Support for sexuality education was high (over 95%), with 88.4% reporting prior exposure. Mean knowledge score was 9.08 (SD 1.35), while attitude scores indicated generally favorable perceptions. Knowledge varied significantly by state and local government area, with Ogun State and senior class levels showing higher scores. Attitudes were also higher among students in Ogun, Muslims, and senior classes. Parental involvement showed positive associations with both knowledge (R²=0.113) and attitudes (R²=0.263). Key barriers included poor awareness (62.5%), curriculum exclusion (48.4%), lack of policy enforcement (41.7%), inadequate funding (41.4%), and shortage of trained teachers (33.3%). Conclusion: Findings highlight that positive attitudes alone are insufficient; consistent implementation, teacher preparedness, and parental engagement are critical to improving adolescent sexual and reproductive health outcomes. Clinical trial number - Not applicable Sexuality education Adolescents Knowledge Attitudes Nigeria Figures Figure 1 Figure 2 INTRODUCTION Adolescence represents a critical window for shaping lifelong sexual and reproductive health (SRH) behaviors, yet equitable access to accurate sexuality education remains uneven across many low- and middle-income settings. From a conceptual perspective, comprehensive sexuality education (CSE) is delivered within a socio-ecological model in which attitudes and knowledge are influenced by interacting levels of influence (e.g., family, school systems, community norms, and policy environments), with attitudes toward sexuality education reflecting normative acceptance and knowledge reflecting cognitive acquisition and retention of correct SRH information; therefore, effective CSE is not only about exposure to content but also about structured delivery, pedagogical competence, and reinforcement across various contexts. Empirical evidence consistently shows that well-implemented CSE improves adolescents’ knowledge, decision-making capacity, and protective behaviors. High-quality programs that integrate school-based curricula with parental engagement demonstrate stronger and more sustained outcomes than school-only interventions ( 1 , 2 , 3 ). However, recent global analyses emphasize that policy endorsement alone does not guarantee effective delivery. In many settings, implementation fidelity is undermined by sociocultural resistance, inadequate teacher training, and inconsistent curriculum integration ( 4 , 5 ). Consequently, adolescents may express strong support for sexuality education while still lacking accurate knowledge, particularly when content is selectively delivered or diluted ( 6 ). In sub-Saharan Africa, these challenges are amplified by structural and contextual heterogeneity. Variations in governance, educational infrastructure, and sociocultural norms produce uneven access to sexuality education across regions and school systems ( 7 ). Nigeria exemplifies this complexity. Although national policies formally recognize the importance of adolescent SRH education and have ensured a large scale implementation across the state. However, implementation remains fragmented. Studies indicate that sexuality education is often inconsistently delivered due to teacher discomfort, lack of standardized training, and weak policy enforcement ( 4 , 5 ). Moreover, teacher preparedness has been identified globally as a critical bottleneck limiting effective CSE delivery ( 8 , 9 ). Although attention to adolescent SRH in Nigeria has been growing, several important conceptual and empirical gaps remain: First, much of the existing literature focuses on either knowledge or attitudes in isolation, and not differentiating normative acceptance and cognitive mastery. Second, most studies are based on single-school or single-state samples, limiting the ability to examine how subnational contexts influence educational outcomes. Third, the role of academic progression is insufficiently understood; although developmental theory posits that there are cumulative knowledge gains with advancing grade levels, examination-oriented systems may deprioritize non-core subjects and disrupt expected learning trajectories. Finally, although parental involvement and program exposure are known to be important, the interaction between these and institutional delivery mechanisms is understudied. What these unresolved issues suggest is that there is a critical gap in the literature: multistate, context-sensitive evidence on how structural, institutional, and grade-level factors affect adolescents' knowledge and attitudes toward sexuality education in Nigeria, where such evidence would help policy and programmatic efforts to better understand how access and delivery quality and contextual variability affect outcomes.. This study addresses this gap by providing multistate evidence on adolescents’ knowledge and attitudes toward sex education across Lagos, Ogun, and the Federal Capital Territory. It examines grade-level variation, demographic predictors, and perceived structural barriers to clarify how institutional and contextual factors shape sexuality education outcomes. It was hypothesized that, despite high attitudinal acceptance, knowledge levels would vary significantly across states and class levels, reflecting differences in implementation fidelity and educational context. METHODS Study Design This school-based cross-sectional study was conducted between February and May 2024 to assess adolescents’ knowledge and attitudes toward sex education and identify associated demographic and contextual predictors. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies ( 10 ). Study Setting The study was conducted in Lagos, Ogun, and the Federal Capital Territory (FCT), Abuja, selected to reflect sociocultural and educational diversity. Within each state, one Local Government Area (LGA) and corresponding Local Council Development Areas were included. Lagos has the highest secondary school enrollment, 85.5% literacy, and multiple reproductive health programs ( 11 ). The FCT is highly urbanized with approximately 94% adolescent literacy ( 12 , 13 ). Ogun State, though socioeconomically linked to Lagos, includes semiurban and peri-urban populations with less consistent program coverage ( 11 ). The 2018 Nigeria Demographic and Health Survey reported sexual violence prevalence of 7.0% in Lagos, 3.0% in the FCT, and 1.3% in Ogun ( 11 ). Participants and Eligibility Criteria Participants were male and female adolescents aged 14–20 years enrolled in Senior Secondary School classes (SSS1–SSS3) in selected public schools. Students below SSS1, outside the age range, or without parental consent were excluded. Sample Size Determination Sample size was calculated using Cochran’s formula ( 14 ): n = z²pq/d². Assuming 95% confidence (z = 1.96), 5% margin of error, and a conservative prevalence estimate, the initial sample was 367. After finite population correction for approximately 8,100 students, the minimum sample was 360. To improve power and account for non-response, 590 students were approached of which 568 completed questionnaires were analyzed (96.3% response rate). Sampling Technique A multistage sampling approach was applied. Three states were purposively selected for diversity. Within each state, one LGA and corresponding LCDAs were randomly selected. Public secondary schools were then randomly selected with input from educational authorities. Within schools, students were stratified by class (SSS1–SSS3), and systematic sampling (every third student) was used to achieve proportional representation. Variables and Measurement Outcome Variables Knowledge and attitude toward sex education. Knowledge was assessed using 10 items covering puberty, contraception, sexually transmitted infections, and scope of sex education. Responses were scored as correct [1] or incorrect [0] and summed into a composite score. Attitudes were measured using 9 Likert-scale items [1–5] assessing support for school-based sex education, parental involvement, and perceived benefits. A composite mean score was computed; higher values indicated more favorable attitudes. Behavioral belief items were analyzed separately to enhance construct validity. Independent Variables Age, sex, religion, tribe, class level, family type, and state of residence. Instrument Development, Validity, and Reliability The questionnaire was developed from existing literature and expert input. A pilot study involving 37 students (≈ 10% of estimated sample) in a non-study school informed revisions, including removal of overly explicit items. Content validity was established by public health experts. Reliability testing showed good internal consistency for knowledge (Cronbach’s α = 0.82) and strong reliability for attitude (α = 0.81). The full instrument is provided as Supplementary File 1. Data Collection Procedure Following institutional approvals, trained research assistants administered questionnaires in classrooms. Participants received standardized information on study purpose, confidentiality, and voluntary participation. Completed questionnaires were retrieved immediately to ensure completeness. Ethical Considerations Ethical approval was obtained from the Health Research Ethics Committee of Olabisi Onabanjo University Teaching Hospital (OOUTH/HREC/607/2023AP; 22 June 2023). Additional details are provided in the Declarations section. Data Analysis Data were analyzed using Epi Info 7 and IBM SPSS Statistics version 25. Composite knowledge and attitude scores were treated as continuous variables. Descriptive statistics summarized participant characteristics. Associations between categorical variables were assessed using chi-square tests, while mean differences were examined using one-way ANOVA or Kruskal–Wallis tests as appropriate. Correlation and multiple linear regression analyses identified predictors of outcomes while adjusting for relevant covariates. Statistical significance was set at p < 0.05. During data cleaning, 22 incomplete questionnaires (3.7%) were excluded, leaving 568 for analysis. RESULTS Participant Characteristics Of the 590 students approached across six public secondary schools, 568 provided complete and analyzable responses (response rate: 96.3%), while 22 questionnaires (3.7%) were excluded due to incomplete responses (Table 1 ). Knowledge and Attitudes toward Sex Education Support for sex education was high, with over 95% agreeing it should be taught in schools and 94.5% supporting parental involvement. Overall, 88.4% reported prior exposure to sex education. The mean knowledge score was 9.08 (SD = 1.35; range 0–10), indicating generally high knowledge levels. The mean attitude score toward Sex Education scale was 13.24 (SD = 4.05), reflecting favorable attitudes toward school-based sex education (Table 1 ). Table 1 Frequency - Demography, Attitudes Toward & Knowledge of Sex Education and Barriers. a. Response theme- Demography Total respondents N = 568 (%) State/LGAs (LCDAs) of respondents FCT Abuja/ (Abuja Municipal area council and Kuje area councils.) 193 (91,102) 34.0% Lagos/Alimosho (Igando/Ikotun and Mosan-Okunola LCDAs) 171 (101,70) 30.1% Ogun/Sagamu (Sagamu west and Sagamu South LCDAs) 204 (98,106) 35.9% Age of respondents 14–15 277 48.7% 16–18 272 47.9% > 19 22 3.9% Gender Female 212 37.3% Male 356 62.7% Religion Christian 419 73.8% Muslim 145 25.5% others 4 0.7% Tribe Hausa 15 2.6% Igbo 136 23.9% Yoruba 319 56.2% Others 98 17.3% Class SSS 1 97 17.1% SSS 2 138 24.3% SSS 3 333 58.6% Family Monogamous 405 71.3% Polygamous 163 28.7% Family Socioeconomic status Upper class 147 25.9% Middle class 384 67.6% Lower class 37 6.5% b. Respondents’ attitudes toward and knowledge of sex education Response theme – Attitude toward Sex Education Mean Attitude Score (13.24 ± 4.05) Total respondents N = 568 (Agree) (%) 1. Sex education should be taught in all schools 543 95.6% 2. Sex education programs should be organized in schools 532 93.7% 3. Parents should be involved in teaching their children about sex education 537 94.5% 4. Adolescents should not be denied of sex education 481 84.7% 5. Sex education teaches young people good things and should be approved 517 91.0% 6. Sex education helps adolescents to make decisions about their health 510 89.8% 7. Sex education could help students avoid negative health consequences 511 90.0% 8. Adolescents should have access to private counselling sessions following sex education classes 540 95.1% 9. Sex education can help young people understand healthy and unhealthy relationships. 537 94.6% Response theme – Knowledge of Sex Education Mean knowledge Score (9.08 ± 1.35) Total respondents N = 568 (Agree) (%) 1. Have you had any teaching on sex education before 502 88.4% 2. Sex education is the provision of information about one’s bodily development 513 90.3% 3. Sex education includes information about puberty and reproduction 530 93.3% 4. Sex education includes information on use of contraceptives 435 76.6% 5. Sex education provides information on how best to prevent unwanted pregnancies and sexually transmitted infections (STIs) 533 93.8% 6. Sex education provides information on how to prevent sexually transmitted infections through avoiding sex (abstinence) 530 93.3% 7. Sex education gives young people the right to complete and honest information 496 87.3% 8. Sex education treats sexual development as a normal and natural part of human development 528 93.0% 9. Sex education gives people the right skills and values to make healthy choices on their sexual lives 537 94.5% 10. Information on sex education can be obtained at home, in school or from internet 554 97.54% Factors contributing to poor sex education in schools Freq. N = 568 Yes (%) No (%) Low manpower (low number of teachers) 189 (33.3%) 379 (66.7%) No Government Policy on Sex education 237 (41.7%) 331 (58.3%) Sex education is not in school curriculum 275 (48.4%) 293 (51.6%) Poor awareness on the importance of sex education 355 (62.5%) 213 (37.5%) Lack of funding 235 (41.4%) 333 (58.6%) Lack of general Health education standards are what should be taught in schools 219 (38.56%) 349 (61.4%) The values are presented as frequencies and percentages. The percentages may not total 100% because of rounding. The knowledge items were scored via binary responses (correct = 1, incorrect = 0). The attitude items were measured on a 5−point Likert scale (strongly disagree to strongly agree). Exposure to Sex Education across States Overall awareness of sex education did not differ significantly across states (χ² = 2.789, p = 0.248). However, sources of information varied significantly (χ² = 31.5, p < 0.001), with schools (47.5%) and parents (39.4%) being the primary channels. Classroom exposure to sex education also differed across states (χ² = 9.688, p < 0.001) (Table 2 ). Although reproductive health initiatives existed in all selected schools, some students reported not receiving formal classroom instruction. Table 2 Exposure to Sex Education across States; Associations between response themes and knowledge grades Response theme FCT Abuja N = 193 Lagos N = 171 Ogun N = 204 Total N (%) Df X 2 test Knowledge p-value a. Ever heard of sex education N = 568 2 2.789 0.248 Yes 165 155 183 503 (88.7%) No 28 16 21 65 (11.4%) b. If Yes, the Source of Information N = 503 8 31.5 0.000* Television/radio 4 15 10 29 (5.8%) School 68 73 98 239 (47.5%) Parent 81 63 54 198 (39.4%) Internet 9 4 20 33 (6.6%) All sources above 3 0 1 4 (0.8%) c. Thought sex education in class N = 568 2 9.688 0.007* Yes 170 161 171 502 (88.4%) No 23 10 33 66 (11.6%) The values are presented as frequencies and percentages. χ² = Chi−square test for independence. P values < 0.05 indicate statistically significant variation across states . Factors Associated with Knowledge Scores Knowledge scores differed significantly by local government area (χ² = 43.93, p < 0.001), family type (χ² = 9.27, p = 0.009), and state (χ² = 13.22, p = 0.010). Mean knowledge scores also varied across states (ANOVA F = 17.25, p < 0.001) (Table 3 ). In multivariable linear regression (reference categories: Abuja for state; SSS1 for class), two predictors remained significant. Students in Ogun State had higher knowledge scores than those in Abuja (β = −0.781, 95% CI: −1.115 to − 0.448, p 0.05) (Table 4 ). Factors Associated with Attitude toward Sex Education Mean attitude scores differed significantly across states (ANOVA p < 0.001) (Table 3 ). In adjusted regression analysis using the 9-item attitude scale’ state of residence, religion, and class level were significant predictors. Compared with students in Abuja (reference), those in Ogun had higher attitude scores (β = 2.302, 95% CI: 1.287–3.318, p < 0.001), while no significant difference was observed between Lagos and Abuja (β = 0.517, 95% CI: −0.487–1.521, p = 0.312). Muslim students had higher attitude scores than Christian students (β = 1.248, 95% CI: 0.463–2.032, p = 0.002). SSS3 students had higher attitude scores than SSS1 students (β = −1.342, 95% CI: −2.455 to − 0.229, p = 0.018). The model explained approximately 9% of the variance in attitude scores (R² = 0.09) (Table 4 ). Table 3 Bivariate- Factors Associated with Knowledge and Attitude toward Sex Education Variables Df X 2 Knowledge score a. Associations between the independent variables and knowledge scores of the respondents Age of respondents 14 7.290 0.922 Religion 4 3.505 0.477 Family type 2 9.273 0.009* LGAs 10 43.933 0.000* Gender 2 3.355 0.186 Tribe 6 5.259 0.511 Class 4 7.923 0.094 State 4 13.22 0.010* Means of the knowledge scores across 3 states ANOVA 2 (F test) 17.250 0.000 2 (B test) 101.112 0.000 2 (K.Wallis test) 26.216 0.000 b. Associations between the independent variables and attitude scores of the respondents Age of respondents 7 7.428 0.386 Gender 1 2.973 0.084 2-tailed Tribe 3 6.403 0.093 Religion 2 3.990 0.136 Family type 1 0.046 0.829 2-tailed Family Social-economic status 2 1.197 0.5496 Class 2 1.793 0.407 LGAs 10 43.933 0.000* State 2 16.570 0.000* Means of the Attitude scores across 3 states ANOVA 2 (F test) 10.633 0.000 2 (B test) 22.660 0.000 2 (K.Wallis test) 13.216 0.000 The mean knowledge scores were compared via one−way ANOVA, the Kruskal–Wallis test, and the chi−square test, as appropriate. Higher scores indicate better knowledge. P values are two−tailed. The mean attitude scores were analyzed via one−way ANOVA, Bartlett’s test, and the Kruskal–Wallis test. Higher scores reflect more positive attitudes toward sex education. P values < 0.05 denote significant differences (*). Table 4 Linear regression - predicting the knowledge and attitude score of respondents on sex education on the basis of multiple demographic variables. Variable Coefficient 95% CI (Lower–Upper) Std. Error F test P value a. Knowledge score of respondents on sex education on the basis of multiple demographic variables. Age 0.010 -0.072 to 0.091 0.042 0.054 0.815 Gender (Male/Female) 0.171 -0.054 to 0.395 0.114 2.232 0.135 Religion (Muslim/Christian) 0.002 -0.255 to 0.260 0.131 0.000 0.987 Religion (Others/Christian) -0.969 -2.269 to 0.331 0.662 2.144 0.143 Tribe (Igbo/Hausa) 0.635 -0.097 to 1.367 0.373 2.900 0.089 Tribe (Others/Hausa) 0.348 -0.380 to 1.077 0.387 0.882 0.348 Tribe (Yoruba/Hausa) 0.557 -0.160 to 1.273 0.365 2.376 0.127 Class (SS2/SS1) -0.264 -0.648 to 0.120 0.196 1.819 0.177 Class (SS3/SS1) -0.381 -0.746 to 0.016 0.185 4.208 0.040* Family Type (Polygamous/Monogamous) -0.211 -0.507 to 0.085 0.150 2.504 0.084 State (Lagos/Abuja) -0.131 -0.198 to 0.461 0.168 0.611 0.434 State (Ogun/Abuja) -0.781 -1.115 to 0.448 0.170 21.202 0.000* b. Attitude score of respondents on sex education on the basis of multiple demographic variables. Age -0.059 -0.308 to 0.189 0.127 0.2202 0.639 Gender (Male/Female) 0.484 -0.199 to 1.167 0.348 1.9359 0.164 Religion (Muslim/Christianity) 1.248 0.463 to 2.032 0.399 9.7577 0.001* Religion (Others/Christianity) -1.162 -5.123 to 2.800 2.017 0.3318 0.564 Tribe (Igbo/Hausa) 0.545 -1.687 to 2.776 1.136 0.2297 0.631 Tribe (Others/Hausa) 0.601 -1.620 to 2.822 1.131 0.2828 0.595 Tribe (Yoruba/Hausa) 0.853 -1.330 to 3.037 1.112 0.5890 0.443 Class (SS2/SS1) 0.070 -1.100 to 1.240 0.596 0.0138 0.906 Class (SS3/SS1) -1.342 -2.455 to-0.229 0.566 5.6141 0.018* Family Type (Polygamous/Monogamous) 0.038 -0.681 to 0.757 0.366 0.0110 0.916 State (Lagos/Abuja) 0.517 -0.308 to 0.189 0.511 1.0229 0.312 State (Ogun/Abuja) 2.302 -0.199 to 1.167 0.517 19.8193 0.000* Constant 12.748 0.463 to 2.032 2.303 30.6366 0.000 β = unstandardized regression coefficient; CI = confidence interval. The model controls for age, gender, religion, tribe, class, and state. Negative coefficients indicate lower knowledge compared with the reference category. The reference categories were Abuja (state) and SS1 (class). Positive coefficients indicate more favorable attitudes . P values < 0.05 denote significant differences (*). Perceived Barriers to Effective Sex Education Commonly reported barriers included poor awareness of the importance of sex education (62.5%), exclusion from school curricula (48.4%), absence of government policy (41.7%), inadequate funding (41.4%), and shortage of trained teachers (33.3%) (Table 1 ). Associations with Parental Involvement and Program Exposure Following the correlational analyses in Figs. 1 and 2 respectively, scatter plot analyses demonstrated positive associations between parental involvement and both knowledge (R²=0.113, p < 0.001) (Fig. 1 ) and attitude scores (R²=0.263, p < 0.001). Additionally, reproductive health programs in schools and formal sex education were both strongly associated with better attitude scores (R²=0.320 and 0.283 respectively; both p < 0.001)- (Fig. 2 ). DISCUSSION Our multistate study points out an important distinction in adolescent sexuality education in Nigeria: While attitudinal acceptance of sex education was nearly universal, the translation of this attitudinal acceptance into structured, consistent, and equitable knowledge acquisition was uneven, with high exposure and favorable attitudes alongside institutional inconsistencies, especially in the classroom delivery and integration of the curriculum. Importantly, both knowledge and attitudes were more influenced by contextual and structural factors (such as state of residence, school systems, and parental engagement) than by individual demographic characteristics, further demonstrating the primacy of systems-level determinants of adolescent sexual and reproductive health (SRH) outcomes. The fact that sexuality education is so widely supported is evidence of a generational shift to normative acceptance of SRH discourse even in more conservative contexts; however, knowledge differences across states and local government areas demonstrate that institutionalizing access to correct, organized information is not standardized, implying that exposure alone, particularly through informal or fragmented avenues, is not enough to ensure cognitive mastery ( 15 ). Parental involvement emerges as an important reinforcing factor for knowledge and attitudes, strengthening the notion of dual-channel learning with school-based instruction reinforced by family involvement. In contrast, the lack of association between knowledge and demographic variables (age, gender, and religion) suggests that institutional delivery can overcome individual-level disparities. This pattern is consistent with the theoretical expectation of greater knowledge in older students and those with higher educational attainment, and with previous research that has found that knowledge and exposure to sexual health information tend to increase with age and educational level ( 16 ), although we interpret this pattern cautiously, as previous research has shown that in exam-based systems, where students face performance pressures (e.g., exams, grades), this can lead to less engagement with non-core subjects ( 17 ), which is explained by the fact that external performance pressures (e.g., exams, grades) move student attention towards subjects that are being evaluated, and away from subjects that are not being evaluated (i.e. sexual education), so the gains may be due to selective reinforcement rather than systematic curricular progression. These results are consistent with recent research from around the world and in sub-Saharan Africa that highlights the importance of implementation fidelity over policy presence in determining the efficacy of sexuality education. Keogh and associates. (2018) note that while many low- and middle-income countries have comprehensive sexuality education (CSE) policies, classroom delivery is frequently uneven because of sociocultural resistance and inadequate teacher preparation ( 6 ). Namukonda and associates observed that when curricula are delivered selectively or diluted, positive adolescent attitudes toward SRH education do not always translate into accurate knowledge ( 18 ). This finding of strong parental involvement is consistent with findings by Gavin and associates, which shows that parent-adolescent communication enhances knowledge retention and behavioral outcomes in CSE programs ( 19 ), and aligns with socio-ecological frameworks that emphasize the importance of families in adolescent health education. Also, state-level differences in knowledge and attitudes are consistent with findings by Khosla and associate, which emphasize that subnational governance, cultural norms, and school-level implementation can influence SRH outcomes in the African context ( 20 ). These barriers (curriculum exclusion, inadequate teacher training, and weak policy enforcement) echo the systemic constraints that have been identified in recent literature ( 7 ). Inconsistent delivery of sexuality education has been reported in Nigeria, where teachers feel uncomfortable teaching the content and are not properly trained ( 6 ). Teacher preparedness has also been found to be a significant global bottleneck to effective delivery of CSE ( 8 ). The relatively low explanatory power of the attitude model also implies that other factors, such as peer environment, media exposure, and school climate, influence adolescent attitudes about sex, similar to another previous study by Kanchan M and associates ( 21 ). Crucially, the gap between the availability of reproductive health programs and actual classroom instruction highlights the fact that program availability does not equate to effectiveness ( 19 ). The main factor influencing CSE outcomes is implementation quality rather than program existence ( 22 ). Strength and Limitation One of the strengths of this study is its multistate design, which captures contextual diversity, something single-site studies often cannot do, and permits analysis of subnational variation. The assessment of knowledge, attitudes, and perceived barriers in combination provides a comprehensive view, but the cross-sectional design hinders causal inference about parental involvement, and self-reported data may be subject to social desirability bias, while the lack of qualitative insights into teaching methods limits understanding of classroom dynamics. Implications and future directions Findings such as these underscore the importance of transitioning from policy endorsement to standardized implementation, such as strengthening teacher training, integrating sexuality education into examinable curricula, and establishing accountability mechanisms. Additional research is needed to examine these issues longitudinally and using mixed methods to explore how knowledge and attitudes change over time and the role of peer networks, digital media, and school climate in shaping adolescent SRH outcomes. CONCLUSION This study provides multistate evidence on adolescents’ knowledge and attitudes toward sexuality education in Nigeria. It demonstrates that while acceptance of sexuality education is widespread, meaningful knowledge acquisition depends on consistent institutional delivery, teacher preparedness, and parental engagement. By revealing the dominance of structural over individual determinants, the findings reframe sexuality education as a systems-level responsibility, emphasizing that improving adolescent SRH outcomes requires not only policy presence but coherent implementation across schools, families, and governance structures. Declarations Ethics Approval: This study was approved by the Health Research Ethics Committee of Olabisi Onabanjo University Teaching Hospital (OOUTH/HREC/607/2023AP) on 22 June 2023. The approved protocol included adolescents aged 14–20 years enrolled in senior secondary schools. Permission to conduct the study was obtained from the respective school authorities. The study objectives and procedures were presented to parents during scheduled Parent–Teacher Association meetings prior to data collection. Parental authorization for eligible students (SSS1–SSS3) was granted through formal school-mediated approval processes, and students whose parents declined authorization were excluded from participation. All participants were informed about the purpose of the study, assured of confidentiality, and provided written assent/consent prior to participation. Participation was voluntary, and respondents were free to withdraw at any time without consequence. No identifying information was collected. All study procedures were carried out in accordance with the ethical principles of the 2013 Declaration of Helsinki and relevant Nigerian national research guidelines. Consent to participate: Informed consent was obtained from all participants prior to data collection. For participants below 18 years, parental/guardian consent and participant assent were obtained in accordance with ethical guidelines. Consent to Publish: Not applicable Clinical Trial Number: Not Applicable Acknowledgements: The authors express their gratitude to the participating schools, students, and education officers for their cooperation during data collection. Sources of Funding: This research received no external funding. Competing interests: The authors declare that they have no competing interests. Dual Publication: None of the results/data/figures in our submission have been previously published Authors' contributions HOA conceived the study, designed the methodology, performed the statistical analysis, coordinated data collection, and drafted the manuscript. UGO contributed to study design, data collection, and critical revision of the manuscript. IA contributed to data collection and manuscript review, and manuscript review TWO contributed to data collection and manuscript review, and manuscript review OAS contributed to data collection and manuscript review. EEO contributed to study conceptualization, data collection, and manuscript review. EAA contributed to study conceptualization, data collection, and manuscript review. OAA contributed to study design, data collection, and manuscript review. YOO contributed to data collection and manuscript review. MOO contributed to data collection and manuscript review. EAC contributed to data collection, assisted with drafting the manuscript, and manuscript review. All the authors have read and approved this manuscript for publication, and they have collectively conferred the rights to the corresponding author to make necessary changes required by editorial team of the journal, do the rest of correspondence and act as the guarantor for the manuscript on their behalf. Permission to use third-party material: Not applicable Data Availability- This will be provided upon reasonable request References Kaidbey M, Zhen S, Wong S, Navchaa S, Junjian G. The effectiveness of delivering comprehensive sexuality education through live streaming to schools in Western China. Am J Sexuality Educ. 2023;18(1):115–48. https://doi.org/10.1080/15546128.2022.2064952 . Boonmongkon P, Shrestha M, Samoh N, Kanchawee K, Peerawarunun P, Promnart P, Ojanen T, Guadamuz TE. Comprehensive sexuality education in Thailand? A nationwide assessment of sexuality education implementation in Thai public secondary schools. Sex Health. 2019;16(3):263–73. https://doi.org/10.1071/SH18121 . Sa Z, Tian L, Wang X. Evidence for a comprehensive sexuality education intervention that enhances Chinese adolescents’ sexual knowledge and gender awareness and empowers young women. Sex Roles. 2021;85(5):357–70. https://doi.org/10.1007/s11199-021-01223-8 . Stains M, Vickrey T. 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Reproductive health. 2022;19(1):196. https://doi.org/10.1186/s12978-022-01504-9 . O’Brien H, Hendriks J, Burns S. Teacher training organisations and their preparation of the pre-service teacher to deliver comprehensive sexuality education in the school setting: A systematic literature review. Sex Educ. 2021;21(3):284–303. https://doi.org/10.1080/14681811.2020.1792874 . Oguta PA. Teacher Preparedness and Professional Development in the Competency-Based Education (CBE): An Assessment of Training, Resourcing, and Support in Kenya. https://doi.org/10.5281/zenodo.16164707 von Elm E, Altman DG, Egger M, Pocock SJ, Gøtzsche PC, Vandenbroucke JP. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: Guidelines for reporting observational studies. PLoS Med. 2007;4(10):e296. 10.1371/journal.pmed.0040296 . 2019. Experience of Sexual Violence across States in Nigeria. Nigeria Demographic and Health Survey (NDHS), National Population Commission (NPC) [Nigeria], and ICF, Abuja, Nigeria. and Rockville, MD: NPC and ICF; 2019. Pg. 439, 441 .https://dhsprogram.com/publications/publication-fr359-dhs-final-reports.cfm United Nations Children’s Fund (UNICEF). Situation Analysis of Children in Nigeria. Abuja: UNICEF Nigeria; 2021. https://www.unicef.org/nigeria/reports . World Health Organization (WHO). 2023. Global Accelerated Action for the Health of Adolescents (AA-HA!): Guidance to Support Country Implementation. October 11. https://books.google.com/books?hl=en&lr=&id=VDAJEQAAQBAJ&oi=fnd&pg=PR6&dq=World+Health+Organization+(2023).&ots=nPLsgESGpW&sig=dFZsHSN9kzHHvUqzzAltuHcKdqI Cochran WG. Sampling Techniques. 3rd ed. New York: Wiley; 1977. https://www.academia.edu/download/68847310/COCHRAN_W._Sampling_techniques_compressed.pdf . Conley M. Cognitive strategy instruction for adolescents: What we know about the promise, what we don't know about the potential. Harv Educational Rev. 2008;78(1):84–106. https://doi.org/10.17763/haer.78.1.j612282134673 638 . Asekun-Olarinmoye EO, Asekun-Olarinmoye IO, Adebimpe WO, Omisore AG, Olanrewaju SO. (2011). Effect of mass media and internet on sexual behaviour of undergraduates in Osogbo metropolis, Southwestern Nigeria. Adolescent Health, Medicine and Therapeutics, 2, 15–23. https://doi.org/10.2147/AHMT.S20081 - The study notes that knowledge and exposure to sexual health information tend to increase with age and educational level, supporting the theoretical expectation of higher knowledge in senior classes. Okebukola P. Towards a national strategy for the revitalization of science education in Nigeria. Int J STEM Educ. 2015;2(1):1–12. https://doi.org/10.1186/s40594-015-0024-2 . Namukonda ES, Rosen JG, Simataa MN, Chibuye M, Mbizvo MT, Kangale C. Sexual and reproductive health knowledge, attitudes and service uptake barriers among Zambian in-school adolescents: a mixed methods study. Sex Educ. 2021;21(4):463–79. Gavin LE, Williams JR, Rivera MI, Lachance CR. Programs to strengthen parent–adolescent communication about reproductive health: a systematic review. Am J Prev Med. 2015;49(2):S65–72. https://doi.org/10.1016/j.amepre.2015.03.022 . Khosla R, Tzortziou Brown V. Implementation of sexual and reproductive health education policy in schools in Asia and Africa: A scoping review. Int J Sex Health. 2025;37(2):166–84. https://doi.org/10.1080/19317611.2024.2409129 . Kanchan M. The Attitude-Anxiety Relationship: Influences of Family, Peer Group, and School Environment. Naveen Int J Multidisciplinary Sci (NIJMS). 2025;1(4):150–8. Durlak JA, DuPre EP. Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3):327–50. https://doi.org/10.1007/s10464-008-9165-0 . Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1STUDYQUESTIONNAIRE.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 08 May, 2026 Reviewers agreed at journal 02 May, 2026 Reviewers agreed at journal 29 Apr, 2026 Reviewers agreed at journal 28 Apr, 2026 Reviewers invited by journal 27 Apr, 2026 Editor invited by journal 02 Apr, 2026 Editor assigned by journal 24 Mar, 2026 Submission checks completed at journal 24 Mar, 2026 First submitted to journal 19 Mar, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. 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Foundation","correspondingAuthor":false,"prefix":"","firstName":"Ezioma","middleName":"Anne","lastName":"Chukwu","suffix":""}],"badges":[],"createdAt":"2026-03-19 04:23:34","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9164758/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9164758/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":108638343,"identity":"bf329832-440a-424d-bbd1-d82e403e8b20","added_by":"auto","created_at":"2026-05-06 18:41:35","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":27997,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelational analyses of associations between parental involvement and both knowledge\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-9164758/v1/598dece96ed557e17eb12799.png"},{"id":108638344,"identity":"31985081-dbd1-4c77-8ee5-e7e31ebea751","added_by":"auto","created_at":"2026-05-06 18:41:35","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":107127,"visible":true,"origin":"","legend":"\u003cp\u003ecorrelational analyses of associations between Attitude scores and [1] formal sex education and [2] reproductive health programs in schools, respectively\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9164758/v1/655a1c65f9e47d7502fc8572.png"},{"id":108805736,"identity":"52855820-f586-4389-bf12-db7c1c804045","added_by":"auto","created_at":"2026-05-08 15:26:45","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":664784,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9164758/v1/8d3358dc-f299-42f6-8f0b-fc596682f111.pdf"},{"id":108638342,"identity":"1789e22f-6cd1-4675-bc65-e8eabb4c1e7f","added_by":"auto","created_at":"2026-05-06 18:41:35","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":19834,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1STUDYQUESTIONNAIRE.docx","url":"https://assets-eu.researchsquare.com/files/rs-9164758/v1/3cc19b91d2bcff832dd4590c.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"State and Grade-Level Predictors of Sex Education Knowledge and Attitudes among In-School Adolescents in Nigeria: A Multistate Cross-Sectional Study","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eAdolescence represents a critical window for shaping lifelong sexual and reproductive health (SRH) behaviors, yet equitable access to accurate sexuality education remains uneven across many low- and middle-income settings.\u003c/p\u003e \u003cp\u003eFrom a conceptual perspective, comprehensive sexuality education (CSE) is delivered within a socio-ecological model in which attitudes and knowledge are influenced by interacting levels of influence (e.g., family, school systems, community norms, and policy environments), with attitudes toward sexuality education reflecting normative acceptance and knowledge reflecting cognitive acquisition and retention of correct SRH information; therefore, effective CSE is not only about exposure to content but also about structured delivery, pedagogical competence, and reinforcement across various contexts.\u003c/p\u003e \u003cp\u003eEmpirical evidence consistently shows that well-implemented CSE improves adolescents\u0026rsquo; knowledge, decision-making capacity, and protective behaviors. High-quality programs that integrate school-based curricula with parental engagement demonstrate stronger and more sustained outcomes than school-only interventions (\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e, \u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). However, recent global analyses emphasize that policy endorsement alone does not guarantee effective delivery. In many settings, implementation fidelity is undermined by sociocultural resistance, inadequate teacher training, and inconsistent curriculum integration (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Consequently, adolescents may express strong support for sexuality education while still lacking accurate knowledge, particularly when content is selectively delivered or diluted (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn sub-Saharan Africa, these challenges are amplified by structural and contextual heterogeneity. Variations in governance, educational infrastructure, and sociocultural norms produce uneven access to sexuality education across regions and school systems (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Nigeria exemplifies this complexity. Although national policies formally recognize the importance of adolescent SRH education and have ensured a large scale implementation across the state. However, implementation remains fragmented. Studies indicate that sexuality education is often inconsistently delivered due to teacher discomfort, lack of standardized training, and weak policy enforcement (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Moreover, teacher preparedness has been identified globally as a critical bottleneck limiting effective CSE delivery (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAlthough attention to adolescent SRH in Nigeria has been growing, several important conceptual and empirical gaps remain: First, much of the existing literature focuses on either knowledge or attitudes in isolation, and not differentiating normative acceptance and cognitive mastery. Second, most studies are based on single-school or single-state samples, limiting the ability to examine how subnational contexts influence educational outcomes. Third, the role of academic progression is insufficiently understood; although developmental theory posits that there are cumulative knowledge gains with advancing grade levels, examination-oriented systems may deprioritize non-core subjects and disrupt expected learning trajectories. Finally, although parental involvement and program exposure are known to be important, the interaction between these and institutional delivery mechanisms is understudied.\u003c/p\u003e \u003cp\u003eWhat these unresolved issues suggest is that there is a critical gap in the literature: multistate, context-sensitive evidence on how structural, institutional, and grade-level factors affect adolescents' knowledge and attitudes toward sexuality education in Nigeria, where such evidence would help policy and programmatic efforts to better understand how access and delivery quality and contextual variability affect outcomes..\u003c/p\u003e \u003cp\u003eThis study addresses this gap by providing multistate evidence on adolescents\u0026rsquo; knowledge and attitudes toward sex education across Lagos, Ogun, and the Federal Capital Territory. It examines grade-level variation, demographic predictors, and perceived structural barriers to clarify how institutional and contextual factors shape sexuality education outcomes. It was hypothesized that, despite high attitudinal acceptance, knowledge levels would vary significantly across states and class levels, reflecting differences in implementation fidelity and educational context.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design\u003c/h2\u003e \u003cp\u003eThis school-based cross-sectional study was conducted between February and May 2024 to assess adolescents\u0026rsquo; knowledge and attitudes toward sex education and identify associated demographic and contextual predictors. Reporting followed the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guideline for cross-sectional studies (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Setting\u003c/h3\u003e\n\u003cp\u003eThe study was conducted in Lagos, Ogun, and the Federal Capital Territory (FCT), Abuja, selected to reflect sociocultural and educational diversity. Within each state, one Local Government Area (LGA) and corresponding Local Council Development Areas were included. Lagos has the highest secondary school enrollment, 85.5% literacy, and multiple reproductive health programs (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The FCT is highly urbanized with approximately 94% adolescent literacy (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Ogun State, though socioeconomically linked to Lagos, includes semiurban and peri-urban populations with less consistent program coverage (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The 2018 Nigeria Demographic and Health Survey reported sexual violence prevalence of 7.0% in Lagos, 3.0% in the FCT, and 1.3% in Ogun (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eParticipants and Eligibility Criteria\u003c/h3\u003e\n\u003cp\u003eParticipants were male and female adolescents aged 14\u0026ndash;20 years enrolled in Senior Secondary School classes (SSS1\u0026ndash;SSS3) in selected public schools. Students below SSS1, outside the age range, or without parental consent were excluded.\u003c/p\u003e\n\u003ch3\u003eSample Size Determination\u003c/h3\u003e\n\u003cp\u003eSample size was calculated using Cochran\u0026rsquo;s formula (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e): n\u0026thinsp;=\u0026thinsp;z\u0026sup2;pq/d\u0026sup2;. Assuming 95% confidence (z\u0026thinsp;=\u0026thinsp;1.96), 5% margin of error, and a conservative prevalence estimate, the initial sample was 367. After finite population correction for approximately 8,100 students, the minimum sample was 360. To improve power and account for non-response, 590 students were approached of which 568 completed questionnaires were analyzed (96.3% response rate).\u003c/p\u003e\n\u003ch3\u003eSampling Technique\u003c/h3\u003e\n\u003cp\u003eA multistage sampling approach was applied. Three states were purposively selected for diversity. Within each state, one LGA and corresponding LCDAs were randomly selected. Public secondary schools were then randomly selected with input from educational authorities. Within schools, students were stratified by class (SSS1\u0026ndash;SSS3), and systematic sampling (every third student) was used to achieve proportional representation.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eVariables and Measurement\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eOutcome Variables\u003c/strong\u003e \u003cp\u003eKnowledge and attitude toward sex education.\u003c/p\u003e \u003c/p\u003e \u003cp\u003eKnowledge was assessed using 10 items covering puberty, contraception, sexually transmitted infections, and scope of sex education. Responses were scored as correct [1] or incorrect [0] and summed into a composite score.\u003c/p\u003e \u003cp\u003eAttitudes were measured using 9 Likert-scale items [1\u0026ndash;5] assessing support for school-based sex education, parental involvement, and perceived benefits. A composite mean score was computed; higher values indicated more favorable attitudes. Behavioral belief items were analyzed separately to enhance construct validity.\u003c/p\u003e \u003cp\u003e \u003cstrong\u003eIndependent Variables\u003c/strong\u003e \u003cp\u003eAge, sex, religion, tribe, class level, family type, and state of residence.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eInstrument Development, Validity, and Reliability\u003c/h3\u003e\n\u003cp\u003eThe questionnaire was developed from existing literature and expert input. A pilot study involving 37 students (\u0026asymp;\u0026thinsp;10% of estimated sample) in a non-study school informed revisions, including removal of overly explicit items. Content validity was established by public health experts. Reliability testing showed good internal consistency for knowledge (Cronbach\u0026rsquo;s α\u0026thinsp;=\u0026thinsp;0.82) and strong reliability for attitude (α\u0026thinsp;=\u0026thinsp;0.81). The full instrument is provided as Supplementary File 1.\u003c/p\u003e\n\u003ch3\u003eData Collection Procedure\u003c/h3\u003e\n\u003cp\u003eFollowing institutional approvals, trained research assistants administered questionnaires in classrooms. Participants received standardized information on study purpose, confidentiality, and voluntary participation. Completed questionnaires were retrieved immediately to ensure completeness.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eEthical Considerations\u003c/h2\u003e \u003cp\u003e \u003cstrong\u003eEthical approval\u003c/strong\u003e \u003cp\u003e was obtained from the Health Research Ethics Committee of Olabisi Onabanjo University Teaching Hospital (OOUTH/HREC/607/2023AP; 22 June 2023). Additional details are provided in the Declarations section.\u003c/p\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eData Analysis\u003c/h2\u003e \u003cp\u003eData were analyzed using Epi Info 7 and IBM SPSS Statistics version 25. Composite knowledge and attitude scores were treated as continuous variables. Descriptive statistics summarized participant characteristics. Associations between categorical variables were assessed using chi-square tests, while mean differences were examined using one-way ANOVA or Kruskal\u0026ndash;Wallis tests as appropriate. Correlation and multiple linear regression analyses identified predictors of outcomes while adjusting for relevant covariates. Statistical significance was set at p\u0026thinsp;\u0026lt;\u0026thinsp;0.05. During data cleaning, 22 incomplete questionnaires (3.7%) were excluded, leaving 568 for analysis.\u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eParticipant Characteristics\u003c/h2\u003e \u003cp\u003eOf the 590 students approached across six public secondary schools, 568 provided complete and analyzable responses (response rate: 96.3%), while 22 questionnaires (3.7%) were excluded due to incomplete responses (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eKnowledge and Attitudes toward Sex Education\u003c/h2\u003e \u003cp\u003eSupport for sex education was high, with over 95% agreeing it should be taught in schools and 94.5% supporting parental involvement. Overall, 88.4% reported prior exposure to sex education. The mean knowledge score was 9.08 (SD\u0026thinsp;=\u0026thinsp;1.35; range 0\u0026ndash;10), indicating generally high knowledge levels. The mean attitude score toward Sex Education scale was 13.24 (SD\u0026thinsp;=\u0026thinsp;4.05), reflecting favorable attitudes toward school-based sex education (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eFrequency - Demography, Attitudes Toward \u0026amp; Knowledge of Sex Education and Barriers.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003ea. Response theme- Demography\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eTotal respondents\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;568\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState/LGAs (LCDAs) of respondents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFCT Abuja/ (Abuja Municipal area council and Kuje area councils.)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e193 (91,102)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e34.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLagos/Alimosho (Igando/Ikotun and Mosan-Okunola LCDAs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e171 (101,70)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOgun/Sagamu (Sagamu west and Sagamu South LCDAs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e204 (98,106)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e35.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of respondents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e14\u0026ndash;15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e277\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e48.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e16\u0026ndash;18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e272\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e47.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u0026gt;\u0026thinsp;19\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e3.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFemale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e212\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e37.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMale\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e356\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e62.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eChristian\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e419\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e73.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMuslim\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eothers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHausa\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eIgbo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e23.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYoruba\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e319\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e56.2%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSS 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e97\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e17.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSS 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e24.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSSS 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e333\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e58.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMonogamous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e405\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e71.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePolygamous\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e163\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e28.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Socioeconomic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUpper class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e147\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e25.9%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e384\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e67.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLower class\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e37\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e6.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eb. Respondents\u0026rsquo; attitudes toward and knowledge of sex education\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResponse theme \u0026ndash; Attitude toward Sex Education\u003c/p\u003e \u003cp\u003eMean Attitude Score (13.24\u0026thinsp;\u0026plusmn;\u0026thinsp;4.05)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal respondents\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;568 (Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e\u003cb\u003e(%)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Sex education should be taught in all schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e543\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Sex education programs should be organized in schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e532\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Parents should be involved in teaching their children about sex education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Adolescents should not be denied of sex education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e481\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e84.7%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Sex education teaches young people good things and should be approved\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e91.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Sex education helps adolescents to make decisions about their health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e510\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e89.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Sex education could help students avoid negative health consequences\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Adolescents should have access to private counselling sessions following sex education classes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e540\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e95.1%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Sex education can help young people understand healthy and unhealthy relationships.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResponse theme \u0026ndash; Knowledge of Sex Education\u003c/p\u003e \u003cp\u003eMean knowledge Score (9.08\u0026thinsp;\u0026plusmn;\u0026thinsp;1.35)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e\u003cb\u003eTotal respondents\u003c/b\u003e\u003c/p\u003e \u003cp\u003e\u003cb\u003eN\u0026thinsp;=\u0026thinsp;568 (Agree)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e(%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1. Have you had any teaching on sex education before\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e502\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e88.4%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e2. Sex education is the provision of information about one\u0026rsquo;s bodily development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e513\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e90.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e3. Sex education includes information about puberty and reproduction\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e4. Sex education includes information on use of contraceptives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e435\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e76.6%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e5. Sex education provides information on how best to prevent unwanted pregnancies and sexually transmitted infections (STIs)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e533\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.8%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6. Sex education provides information on how to prevent sexually transmitted infections through avoiding sex (abstinence)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e530\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e7. Sex education gives young people the right to complete and honest information\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e496\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e87.3%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e8. Sex education treats sexual development as a normal and natural part of human development\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e528\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e93.0%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e9. Sex education gives people the right skills and values to make healthy choices on their sexual lives\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e537\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e94.5%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e10. Information on sex education can be obtained at home, in school or from internet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003e554\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e97.54%\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c2\" namest=\"c1\"\u003e \u003cp\u003eFactors contributing to poor sex education in schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c5\" namest=\"c3\"\u003e \u003cp\u003e\u003cb\u003eFreq.\u0026nbsp;N\u0026thinsp;=\u0026thinsp;568\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003eYes (%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003eNo (%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow manpower (low number of teachers)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e189 (33.3%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e379 (66.7%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo Government Policy on Sex education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e237 (41.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e331 (58.3%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex education is not in school curriculum\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e275 (48.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e293 (51.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePoor awareness on the importance of sex education\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e355 (62.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e213 (37.5%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of funding\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e235 (41.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e333 (58.6%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLack of general Health education standards are what should be taught in schools\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c3\" namest=\"c2\"\u003e \u003cp\u003e219 (38.56%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c5\" namest=\"c4\"\u003e \u003cp\u003e349 (61.4%)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cem\u003eThe values are presented as frequencies and percentages. The percentages may not total 100% because of rounding. The knowledge items were scored via binary responses (correct = 1, incorrect = 0). The attitude items were measured on a 5\u0026minus;point Likert scale (strongly disagree to strongly agree).\u003c/em\u003e \u003c/sub\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003eExposure to Sex Education across States\u003c/h2\u003e \u003cp\u003eOverall awareness of sex education did not differ significantly across states (χ\u0026sup2; = 2.789, p\u0026thinsp;=\u0026thinsp;0.248). However, sources of information varied significantly (χ\u0026sup2; = 31.5, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), with schools (47.5%) and parents (39.4%) being the primary channels. Classroom exposure to sex education also differed across states (χ\u0026sup2; = 9.688, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e). Although reproductive health initiatives existed in all selected schools, some students reported not receiving formal classroom instruction.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eExposure to Sex Education across States; Associations between response themes and knowledge grades\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"8\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eResponse theme\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eFCT Abuja\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;193\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eLagos\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;171\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eOgun\u003c/p\u003e \u003cp\u003eN\u0026thinsp;=\u0026thinsp;204\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eTotal N (%)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eKnowledge\u003c/p\u003e \u003cp\u003ep-value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ea. Ever heard of sex education N\u0026thinsp;=\u0026thinsp;568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e2.789\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.248\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e165\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e155\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e503 (88.7%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e65 (11.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003eb. If Yes, the Source of Information N\u0026thinsp;=\u0026thinsp;503\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e31.5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTelevision/radio\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e29 (5.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSchool\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e68\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e73\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e98\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e239 (47.5%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eParent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e81\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e63\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e54\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e198 (39.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eInternet\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e33 (6.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAll sources above\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4 (0.8%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c5\" namest=\"c1\"\u003e \u003cp\u003ec. Thought sex education in class N\u0026thinsp;=\u0026thinsp;568\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e9.688\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e\u003cb\u003e0.007*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e161\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e502 (88.4%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e23\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e33\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e66 (11.6%)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csub\u003eThe values are presented as frequencies and percentages. χ\u0026sup2; = Chi\u0026minus;square test for independence. P values \u0026lt; 0.05 indicate statistically significant variation across states\u003c/sub\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Knowledge Scores\u003c/h2\u003e \u003cp\u003eKnowledge scores differed significantly by local government area (χ\u0026sup2; = 43.93, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), family type (χ\u0026sup2; = 9.27, p\u0026thinsp;=\u0026thinsp;0.009), and state (χ\u0026sup2; = 13.22, p\u0026thinsp;=\u0026thinsp;0.010). Mean knowledge scores also varied across states (ANOVA F\u0026thinsp;=\u0026thinsp;17.25, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eIn multivariable linear regression (reference categories: Abuja for state; SSS1 for class), two predictors remained significant. Students in Ogun State had higher knowledge scores than those in Abuja (β = \u0026minus;0.781, 95% CI: \u0026minus;1.115 to \u0026minus;\u0026thinsp;0.448, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and SSS3 students had higher scores than SSS1 students (β = \u0026minus;0.381, 95% CI: \u0026minus;0.746 to \u0026minus;\u0026thinsp;0.016, p\u0026thinsp;=\u0026thinsp;0.041). Age, gender, religion, and tribe were not significant predictors (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eFactors Associated with Attitude toward Sex Education\u003c/h2\u003e \u003cp\u003eMean attitude scores differed significantly across states (ANOVA p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e). In adjusted regression analysis using the 9-item attitude scale\u0026rsquo; state of residence, religion, and class level were significant predictors. Compared with students in Abuja (reference), those in Ogun had higher attitude scores (β\u0026thinsp;=\u0026thinsp;2.302, 95% CI: 1.287\u0026ndash;3.318, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), while no significant difference was observed between Lagos and Abuja (β\u0026thinsp;=\u0026thinsp;0.517, 95% CI: \u0026minus;0.487\u0026ndash;1.521, p\u0026thinsp;=\u0026thinsp;0.312). Muslim students had higher attitude scores than Christian students (β\u0026thinsp;=\u0026thinsp;1.248, 95% CI: 0.463\u0026ndash;2.032, p\u0026thinsp;=\u0026thinsp;0.002). SSS3 students had higher attitude scores than SSS1 students (β = \u0026minus;1.342, 95% CI: \u0026minus;2.455 to \u0026minus;\u0026thinsp;0.229, p\u0026thinsp;=\u0026thinsp;0.018). The model explained approximately 9% of the variance in attitude scores (R\u0026sup2; = 0.09) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eBivariate- Factors Associated with Knowledge and Attitude toward Sex Education\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariables\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eDf\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eX\u003csup\u003e2\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eKnowledge score\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003ea. Associations between the independent variables and knowledge scores of the respondents\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of respondents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.290\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.922\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.505\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.477\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.009*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLGAs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.355\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.186\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5.259\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.923\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.094\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.22\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.010*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMeans of the knowledge scores across 3 states\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eANOVA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(F test) 17.250\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(B test) 101.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(K.Wallis test) 26.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c4\" namest=\"c1\"\u003e \u003cp\u003eb. Associations between the independent variables and attitude scores of the respondents\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge of respondents\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7.428\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.386\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2.973\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.084 2-tailed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6.403\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.093\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.136\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.046\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.829 2-tailed\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Social-economic status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.197\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.5496\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.793\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.407\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLGAs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e43.933\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e16.570\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eMeans of the Attitude scores across 3 states\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003eANOVA\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(F test) 10.633\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(B test) 22.660\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e(K.Wallis test) 13.216\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csub\u003eThe mean knowledge scores were compared via one\u0026minus;way ANOVA, the Kruskal\u0026ndash;Wallis test, and the chi\u0026minus;square test, as appropriate. Higher scores indicate better knowledge. P values are two\u0026minus;tailed. The mean attitude scores were analyzed via one\u0026minus;way ANOVA, Bartlett\u0026rsquo;s test, and the Kruskal\u0026ndash;Wallis test. Higher scores reflect more positive attitudes toward sex education. P values \u0026lt; 0.05 denote significant differences \u003cb\u003e(*).\u003c/b\u003e\u003c/sub\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eLinear regression - predicting the knowledge and attitude score of respondents on sex education on the basis of multiple demographic variables.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"6\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eVariable\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eCoefficient\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e95% CI (Lower\u0026ndash;Upper)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eStd. Error\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eF test\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eP value\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003ea. Knowledge score of respondents on sex education on the basis of multiple demographic variables.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.010\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.072 to 0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.054\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.815\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.054 to 0.395\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.232\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.135\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion (Muslim/Christian)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.255 to 0.260\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.987\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion (Others/Christian)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.969\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.269 to 0.331\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.662\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.144\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.143\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe (Igbo/Hausa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.635\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.097 to 1.367\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.373\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.900\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.089\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe (Others/Hausa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.380 to 1.077\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.387\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.882\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe (Yoruba/Hausa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.557\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.160 to 1.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.365\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.376\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass (SS2/SS1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.264\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.648 to 0.120\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.819\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass (SS3/SS1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.381\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.746 to 0.016\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.185\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e4.208\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.040*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Type (Polygamous/Monogamous)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.211\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.507 to 0.085\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.150\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e2.504\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState (Lagos/Abuja)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.198 to 0.461\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.168\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.611\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.434\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState (Ogun/Abuja)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.781\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.115 to 0.448\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.170\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e21.202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c6\" namest=\"c1\"\u003e \u003cp\u003eb. Attitude score of respondents on sex education on the basis of multiple demographic variables.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.059\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.308 to 0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.127\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2202\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.639\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eGender (Male/Female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.484\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.199 to 1.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.348\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.9359\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.164\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion (Muslim/Christianity)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.248\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.463 to 2.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.399\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e9.7577\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.001*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReligion (Others/Christianity)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.162\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-5.123 to 2.800\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.3318\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.564\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe (Igbo/Hausa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.545\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.687 to 2.776\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.136\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2297\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.631\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe (Others/Hausa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.601\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.620 to 2.822\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.131\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.2828\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.595\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTribe (Yoruba/Hausa)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.853\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.330 to 3.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1.112\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.5890\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.443\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass (SS2/SS1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.070\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-1.100 to 1.240\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0138\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.906\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eClass (SS3/SS1)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-1.342\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-2.455 to-0.229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.566\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e5.6141\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.018*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eFamily Type (Polygamous/Monogamous)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.038\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.681 to 0.757\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.0110\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.916\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState (Lagos/Abuja)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.308 to 0.189\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.511\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1.0229\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.312\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eState (Ogun/Abuja)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.302\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.199 to 1.167\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.517\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e19.8193\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.000*\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eConstant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12.748\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.463 to 2.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e2.303\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e30.6366\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003csub\u003e \u003cem\u003eβ = unstandardized regression coefficient; CI = confidence interval. The model controls for age, gender, religion, tribe, class, and state. Negative coefficients indicate lower knowledge compared with the reference category. The reference categories were Abuja (state) and SS1 (class). Positive coefficients indicate more favorable attitudes\u003c/em\u003e. P values \u0026lt; 0.05 denote significant differences \u003cb\u003e(*).\u003c/b\u003e\u003c/sub\u003e \u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec19\" class=\"Section2\"\u003e \u003ch2\u003ePerceived Barriers to Effective Sex Education\u003c/h2\u003e \u003cp\u003eCommonly reported barriers included poor awareness of the importance of sex education (62.5%), exclusion from school curricula (48.4%), absence of government policy (41.7%), inadequate funding (41.4%), and shortage of trained teachers (33.3%) (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eAssociations with Parental Involvement and Program Exposure\u003c/h2\u003e \u003cp\u003eFollowing the correlational analyses in Figs.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e and \u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e respectively, scatter plot analyses demonstrated positive associations between parental involvement and both knowledge (R\u0026sup2;=0.113, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001) (Fig.\u0026nbsp;\u003cspan refid=\"Fig1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) and attitude scores (R\u0026sup2;=0.263, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). Additionally, reproductive health programs in schools and formal sex education were both strongly associated with better attitude scores (R\u0026sup2;=0.320 and 0.283 respectively; both p\u0026thinsp;\u0026lt;\u0026thinsp;0.001)- (Fig.\u0026nbsp;\u003cspan refid=\"Fig2\" class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003cp\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eOur multistate study points out an important distinction in adolescent sexuality education in Nigeria: While attitudinal acceptance of sex education was nearly universal, the translation of this attitudinal acceptance into structured, consistent, and equitable knowledge acquisition was uneven, with high exposure and favorable attitudes alongside institutional inconsistencies, especially in the classroom delivery and integration of the curriculum. Importantly, both knowledge and attitudes were more influenced by contextual and structural factors (such as state of residence, school systems, and parental engagement) than by individual demographic characteristics, further demonstrating the primacy of systems-level determinants of adolescent sexual and reproductive health (SRH) outcomes.\u003c/p\u003e \u003cp\u003eThe fact that sexuality education is so widely supported is evidence of a generational shift to normative acceptance of SRH discourse even in more conservative contexts; however, knowledge differences across states and local government areas demonstrate that institutionalizing access to correct, organized information is not standardized, implying that exposure alone, particularly through informal or fragmented avenues, is not enough to ensure cognitive mastery (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eParental involvement emerges as an important reinforcing factor for knowledge and attitudes, strengthening the notion of dual-channel learning with school-based instruction reinforced by family involvement. In contrast, the lack of association between knowledge and demographic variables (age, gender, and religion) suggests that institutional delivery can overcome individual-level disparities. This pattern is consistent with the theoretical expectation of greater knowledge in older students and those with higher educational attainment, and with previous research that has found that knowledge and exposure to sexual health information tend to increase with age and educational level (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e), although we interpret this pattern cautiously, as previous research has shown that in exam-based systems, where students face performance pressures (e.g., exams, grades), this can lead to less engagement with non-core subjects (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e), which is explained by the fact that external performance pressures (e.g., exams, grades) move student attention towards subjects that are being evaluated, and away from subjects that are not being evaluated (i.e. sexual education), so the gains may be due to selective reinforcement rather than systematic curricular progression.\u003c/p\u003e \u003cp\u003eThese results are consistent with recent research from around the world and in sub-Saharan Africa that highlights the importance of implementation fidelity over policy presence in determining the efficacy of sexuality education. Keogh and associates. (2018) note that while many low- and middle-income countries have comprehensive sexuality education (CSE) policies, classroom delivery is frequently uneven because of sociocultural resistance and inadequate teacher preparation (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Namukonda and associates observed that when curricula are delivered selectively or diluted, positive adolescent attitudes toward SRH education do not always translate into accurate knowledge (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThis finding of strong parental involvement is consistent with findings by Gavin and associates, which shows that parent-adolescent communication enhances knowledge retention and behavioral outcomes in CSE programs (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e), and aligns with socio-ecological frameworks that emphasize the importance of families in adolescent health education. Also, state-level differences in knowledge and attitudes are consistent with findings by Khosla and associate, which emphasize that subnational governance, cultural norms, and school-level implementation can influence SRH outcomes in the African context (\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThese barriers (curriculum exclusion, inadequate teacher training, and weak policy enforcement) echo the systemic constraints that have been identified in recent literature (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e). Inconsistent delivery of sexuality education has been reported in Nigeria, where teachers feel uncomfortable teaching the content and are not properly trained (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). Teacher preparedness has also been found to be a significant global bottleneck to effective delivery of CSE (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). The relatively low explanatory power of the attitude model also implies that other factors, such as peer environment, media exposure, and school climate, influence adolescent attitudes about sex, similar to another previous study by Kanchan M and associates (\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eCrucially, the gap between the availability of reproductive health programs and actual classroom instruction highlights the fact that program availability does not equate to effectiveness (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The main factor influencing CSE outcomes is implementation quality rather than program existence (\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec22\" class=\"Section2\"\u003e \u003ch2\u003eStrength and Limitation\u003c/h2\u003e \u003cp\u003eOne of the strengths of this study is its multistate design, which captures contextual diversity, something single-site studies often cannot do, and permits analysis of subnational variation. The assessment of knowledge, attitudes, and perceived barriers in combination provides a comprehensive view, but the cross-sectional design hinders causal inference about parental involvement, and self-reported data may be subject to social desirability bias, while the lack of qualitative insights into teaching methods limits understanding of classroom dynamics.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec23\" class=\"Section2\"\u003e \u003ch2\u003eImplications and future directions\u003c/h2\u003e \u003cp\u003eFindings such as these underscore the importance of transitioning from policy endorsement to standardized implementation, such as strengthening teacher training, integrating sexuality education into examinable curricula, and establishing accountability mechanisms. Additional research is needed to examine these issues longitudinally and using mixed methods to explore how knowledge and attitudes change over time and the role of peer networks, digital media, and school climate in shaping adolescent SRH outcomes.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eThis study provides multistate evidence on adolescents\u0026rsquo; knowledge and attitudes toward sexuality education in Nigeria. It demonstrates that while acceptance of sexuality education is widespread, meaningful knowledge acquisition depends on consistent institutional delivery, teacher preparedness, and parental engagement. By revealing the dominance of structural over individual determinants, the findings reframe sexuality education as a systems-level responsibility, emphasizing that improving adolescent SRH outcomes requires not only policy presence but coherent implementation across schools, families, and governance structures.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics Approval:\u0026nbsp;\u003c/strong\u003eThis study was approved by the Health Research Ethics Committee of Olabisi Onabanjo University Teaching Hospital (OOUTH/HREC/607/2023AP) on 22 June 2023. The approved protocol included adolescents aged 14–20 years enrolled in senior secondary schools. Permission to conduct the study was obtained from the respective school authorities. The study objectives and procedures were presented to parents during scheduled Parent–Teacher Association meetings prior to data collection. Parental authorization for eligible students (SSS1–SSS3) was granted through formal school-mediated approval processes, and students whose parents declined authorization were excluded from participation.\u003c/p\u003e\n\u003cp\u003eAll participants were informed about the purpose of the study, assured of confidentiality, and provided written assent/consent prior to participation. Participation was voluntary, and respondents were free to withdraw at any time without consequence. No identifying information was collected.\u003c/p\u003e\n\u003cp\u003eAll study procedures were carried out in accordance with the ethical principles of the 2013 Declaration of Helsinki and relevant Nigerian national research guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to participate:\u003c/strong\u003e Informed consent was obtained from all participants prior to data collection. For participants below 18 years, parental/guardian consent and participant assent were obtained in accordance with ethical guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent to Publish:\u003c/strong\u003e Not applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical Trial Number:\u0026nbsp;\u003c/strong\u003eNot Applicable\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e The authors express their gratitude to the participating schools, students, and education officers for their cooperation during data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eSources of Funding:\u0026nbsp;\u003c/strong\u003eThis research received no external funding.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u003c/strong\u003e The authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eDual Publication:\u0026nbsp;\u003c/strong\u003eNone of the results/data/figures in our submission have been previously published\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors' contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHOA conceived the study, designed the methodology, performed the statistical analysis, coordinated data collection, and drafted the manuscript.\u003cbr\u003e\u0026nbsp;UGO contributed to study design, data collection, and critical revision of the manuscript.\u003cbr\u003e\u0026nbsp;IA contributed to data collection and manuscript review, and manuscript review\u003cbr\u003e\u0026nbsp;TWO contributed to data collection and manuscript review, and manuscript review\u003cbr\u003e\u0026nbsp;OAS contributed to data collection and manuscript review.\u003cbr\u003e\u0026nbsp;EEO contributed to study conceptualization, data collection, and manuscript review.\u003cbr\u003e\u0026nbsp;EAA contributed to study conceptualization, data collection, and manuscript review.\u003cbr\u003e\u0026nbsp;OAA contributed to study design, data collection, and manuscript review.\u003cbr\u003e\u0026nbsp;YOO contributed to data collection and manuscript review.\u003cbr\u003e\u0026nbsp;MOO contributed to data collection and manuscript review.\u003cbr\u003e\u0026nbsp;EAC contributed to data collection, assisted with drafting the manuscript, and manuscript review.\u003c/p\u003e\n\u003cp\u003eAll the authors have read and approved this manuscript for publication, and they have collectively conferred the rights to the corresponding author to make necessary changes required by editorial team of the journal, do the rest of correspondence and act as the guarantor for the manuscript on their behalf.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003ePermission to use third-party material: Not applicable\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability-\u0026nbsp;\u003c/strong\u003eThis will be provided upon reasonable request\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eKaidbey M, Zhen S, Wong S, Navchaa S, Junjian G. 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Adolescent Health, Medicine and Therapeutics, 2, 15\u0026ndash;23. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.2147/AHMT.S20081\u003c/span\u003e\u003cspan address=\"https://doi.org/10.2147/AHMT.S20081\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e - The study notes that knowledge and exposure to sexual health information tend to increase with age and educational level, supporting the theoretical expectation of higher knowledge in senior classes.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOkebukola P. Towards a national strategy for the revitalization of science education in Nigeria. Int J STEM Educ. 2015;2(1):1\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s40594-015-0024-2\u003c/span\u003e\u003cspan address=\"10.1186/s40594-015-0024-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eNamukonda ES, Rosen JG, Simataa MN, Chibuye M, Mbizvo MT, Kangale C. Sexual and reproductive health knowledge, attitudes and service uptake barriers among Zambian in-school adolescents: a mixed methods study. Sex Educ. 2021;21(4):463\u0026ndash;79.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGavin LE, Williams JR, Rivera MI, Lachance CR. Programs to strengthen parent\u0026ndash;adolescent communication about reproductive health: a systematic review. Am J Prev Med. 2015;49(2):S65\u0026ndash;72. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1016/j.amepre.2015.03.022\u003c/span\u003e\u003cspan address=\"10.1016/j.amepre.2015.03.022\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKhosla R, Tzortziou Brown V. Implementation of sexual and reproductive health education policy in schools in Asia and Africa: A scoping review. Int J Sex Health. 2025;37(2):166\u0026ndash;84. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1080/19317611.2024.2409129\u003c/span\u003e\u003cspan address=\"10.1080/19317611.2024.2409129\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eKanchan M. The Attitude-Anxiety Relationship: Influences of Family, Peer Group, and School Environment. Naveen Int J Multidisciplinary Sci (NIJMS). 2025;1(4):150\u0026ndash;8.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDurlak JA, DuPre EP. Implementation matters: A review of research on the influence of implementation on program outcomes and the factors affecting implementation. Am J Community Psychol. 2008;41(3):327\u0026ndash;50. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1007/s10464-008-9165-0\u003c/span\u003e\u003cspan address=\"10.1007/s10464-008-9165-0\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Sexuality education, Adolescents, Knowledge, Attitudes, Nigeria","lastPublishedDoi":"10.21203/rs.3.rs-9164758/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9164758/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eBackground:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eInconsistent implementation of sexuality education in Nigeria limits equitable knowledge acquisition despite widespread policy support. This study addressed the gap by examining adolescents’ knowledge, attitudes, and structural determinants across multiple states.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eA cross-sectional design was employed among 568 secondary school students selected from six public schools across three Nigerian states. Data were collected using structured questionnaires assessing knowledge, attitudes, exposure, and perceived barriers. Multivariable regression analyses identified predictors of outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eSupport for sexuality education was high (over 95%), with 88.4% reporting prior exposure. Mean knowledge score was 9.08 (SD 1.35), while attitude scores indicated generally favorable perceptions. Knowledge varied significantly by state and local government area, with Ogun State and senior class levels showing higher scores. Attitudes were also higher among students in Ogun, Muslims, and senior classes. Parental involvement showed positive associations with both knowledge (R²=0.113) and attitudes (R²=0.263). Key barriers included poor awareness (62.5%), curriculum exclusion (48.4%), lack of policy enforcement (41.7%), inadequate funding (41.4%), and shortage of trained teachers (33.3%).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eFindings highlight that positive attitudes alone are insufficient; consistent implementation, teacher preparedness, and parental engagement are critical to improving adolescent sexual and reproductive health outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eClinical trial number\u003c/strong\u003e- Not applicable\u003c/p\u003e","manuscriptTitle":"State and Grade-Level Predictors of Sex Education Knowledge and Attitudes among In-School Adolescents in Nigeria: A Multistate Cross-Sectional Study","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-06 18:41:31","doi":"10.21203/rs.3.rs-9164758/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-05-08T12:49:21+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"269662737764891073298801456923475412608","date":"2026-05-02T12:07:23+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"327817009316581930348656236709973912130","date":"2026-04-29T12:37:42+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"31520810518681693862755385728391630041","date":"2026-04-28T06:47:51+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-04-27T11:38:17+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-02T08:19:08+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-03-24T11:11:19+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-03-24T11:11:09+00:00","index":"","fulltext":""},{"type":"submitted","content":"Discover Public Health","date":"2026-03-19T04:19:18+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"discover-public-health","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"","sideBox":"Learn more about [Discover Public Health](https://link.springer.com/journal/12982)","snPcode":"12982","submissionUrl":"https://submission.springernature.com/new-submission/12982/3","title":"Discover Public Health","twitterHandle":"","acdcEnabled":true,"dfaEnabled":true,"editorialSystem":"stoa","reportingPortfolio":"Discover Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"8f852ad8-6210-4e8a-9ec4-ecff732a5d42","owner":[],"postedDate":"May 6th, 2026","published":true,"recentEditorialEvents":[{"type":"editorInvitedReview","content":"","date":"2026-05-08T12:49:21+00:00","index":60,"fulltext":""},{"type":"reviewerAgreed","content":"269662737764891073298801456923475412608","date":"2026-05-02T12:07:23+00:00","index":58,"fulltext":""},{"type":"reviewerAgreed","content":"327817009316581930348656236709973912130","date":"2026-04-29T12:37:42+00:00","index":39,"fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-06T18:41:31+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-06 18:41:31","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9164758","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9164758","identity":"rs-9164758","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}