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Nigerian secondary school adolescents ’ perspective on abstinence-only sexual education as an effective tool for promotion of sexual health

The success of any type of sexual education programme depends on the knowledge and preparedness for practice by adolescents. A recent study has found that an ‘abstinence-only’ sexual education programme is effective in reducing sexual activity among adolescents. Knowledge of abstinence-only sexual education and preparedness for practice as an effective tool for promotion of sexual health among Nigerian secondary school adolescents was studied. An analytic descriptive survey design was used for the study. The research population comprised of all public secondary schools in three southern geopolitical zones of the Niger Delta Region of Nigeria. A multistage sampling technique was used to select 2020 senior secondary school (SS1-SS3) students as sample for the study. A partially self-designed and partially adapted questionnaire from an 'abstinence-only versus comprehensive sex education' debate, from debatepedia (http://wiki.idebate.org/), entitled 'Questionnaire on Nigerian Secondary School Adolescents’ Perspective on Abstinence-Only Sexual Education (QNSSAPAOSE)' was used in eliciting information from respondents. Hypotheses were formulated and tested. Frequency counts, percentage and Pearson Product Moment Correlation were used in analysing data. A greater proportion of secondary school adolescents in this study lacked knowledge of sexual education. About 80% of the respondents could not define sexual education. The general perspective on abstinence-only sexual education was negative, as revealed by the larger number of respondents who demonstrated unwillingness to practice abstinence-only sexual education. Specifically, of those who responded in favour of abstinence-only sexual education, the youngest group of adolescents (11-13 years) and the male respondents were more likely to accept this type of education than the other groups. Poor knowledge of sexual education could be responsible for unwillingness to practice abstinence-only sexual education. Sexual education should, therefore, be introduced into the secondary school curriculum and taught by well-prepared teachers to enable an informed decision on practice. 1


Introduction
Sexual education is a lifelong process of acquiring information on sex and forming attitudes, values and beliefs. It involves sexual development, sexual and reproductive health, interpersonal relationships, affection and intimacy 1 . Abstinence-only sexual education teaches the adolescents to abstain from premarital sexual intercourse because of the advantages it offers. Such advantages include prevention of unintended pregnancies and prevention of contracting HIV/AIDS and other sexually transmitted infections. According to the Federal Law of the United States of America (USA), every school-aged child should not engage in sexual activity 2,3 . The USA Federal law further advocates sexual activity within the confines of monogamous marital relationship to guard against adverse psychological and physical effects associated with premarital sexual activity. Bearing children outside marriage has serious effects on the child, the mother and the society as a whole [3][4][5][6] . The Federal Law of United States of America also posited that, abstaining from sexual activity outside marriage allows for maturity and understanding of self 3,7 .
However, numerous studies oppose abstinence-only in favour of comprehensive sexual education as being capable of preventing sexually transmitted diseases, including HIV/AIDS and unintended pregnancies. Studies further disclose that it is comprehensive sexual education and not abstinence-only that will delay first sexual activity 2,3,[8][9][10][11][12][13][14] . Abstinence-only sexual education lacks strong evidence of effectiveness because of faulty designs 3,15,16a . Abstinenceonly sexual education does not positively affect the sexual behaviour of adolescents, lacks the message of sexually transmitted infections to its recipients and the positive effect in a few cases does not last for a long time 16b,17 .
According to Bruckner and Bearman 18 and a study by the Alan Guttmacher Institute 19 those that embrace abstinence-only sexual education still have sex before they get married. The authors further posited that adolescents also resort to anal and oral sex as alternatives to vaginal sexual intercourse. There is no difference between adolescents that accept abstinence-only sexual education and those who do not in terms of number of sexual partners and ages of first sexual intercourse 17 . Abstinence-only sexual education does not reduce the scourge of HIV/AIDS 16b . Bennett and Assefi saw the failure to provide adolescents with information about contraception as a serious weakness of abstinence only sexual-education 20 .
The proponents of abstinence-only sexual education frown at the role of comprehensive sexual education in emphasising so much on the reliability of contraceptives while de-emphasising their failure rates and the possibility of contracting new sexually transmitted diseases including HIV/AIDS 21 . They further frowned at the double message of comprehensive sexual education such as encouraging the delay of first sexual intercourse and promoting the use of contraceptives 22 . On the other hand, the proponents of abstinenceonly sexual education are accused of overemphasising the failure rate of condoms. They are also blamed for stressing the possibility of contracting sexually transmitted infections to the extent of falsifying information to establish the negative aspect of comprehensive sexual education 1,23,24 . Studies further reveal that sexual educators do not stress enough on sexual intercourse or bring in sensitive issues such as homosexuality and abortions. The adolescents posited that the basic message is that they should not have sex 19,[25][26][27] . The proponents of comprehensive sexual education attributed the ineffectiveness of condoms and contraceptives to poor-quality research 28 .
Abstinence-only sexual education studies are criticised for exaggerations of findings. Such exaggerations include over-blowing the prevalent rate of HIV/AIDS and other sexually transmitted infections and failure rates of condom. They are also blamed for withholding information on the positive aspects of sexual relationships, while magnifying the emotional risks and pitfalls associated with premarital sexual activity 1,24 . Many adolescents may not buy into abstinence-only sexual education because they want to align with the modern life style in industrial societies where people marry later in life, while some do not marry at all. The modern life-style is also characterised by a high rate of broken marriages, predisposing an individual to having many sexual partners 1 . According to some studies the age of first marriage has risen to 30 years, with a fifth of such marriages ending in divorce within a period of five years 29 . Conversely the age at first sexual intercourse has dropped to 16 years with very few people having their husbands as their first sexual partners 30,31 . The data on adolescents' sexual behaviour in the developing world with a high prevalence of HIV/AIDS suggests unacceptability of abstinence-only sexual education. Some countries do not accept abstinence-only sexual education even in the face of the high prevalence of HIV/AIDS. Some countries expect sexual educators to encourage adolescents to delay their first sexual experience while also providing education on contraception and sexual health services 32 . In some countries, the requirements for teaching any type of sexual education are clearly outlined for the sexual educators 33 .
Most studies reveal comprehensive sexual education as the preference of parents and adolescents 34-36 . Studies advocate comprehensive sexual education for unmarried sexually active adolescents 3 . Studies also recommend abstinence-only sexual education with information on contraception and risk-reduction behaviour for the few sexually inactive adolescents. These align with the position of Collins and Priya that parents and adolescents prefer comprehensive sexual education to abstinence-only sexual education 37 . It can be deduced from the position of the proponents of comprehensive sexual education that abstinence-only sexual education denies adolescents the necessary information necessary to empower them for premarital sexual activity. Most studies revealed that the opinion of adults differs on the type of sexual education to teach adolescents. Most of the adults feel 7 th to 9 th graders should be taught 'abstinence only' while some advocate the teaching of contraception use 38 . Most studies also show that a greater percentage of adolescents prefer sexual orientation that will teach them about the use of contraception and sexually transmitted infections than abstinence-only sexual education 39 . Most studies reported the positive outcome of abstinence-only sexual education ranging from reduced sexual activity, pregnancies, abortions to more successful deliveries 40 . In line with this, John and Jemmott disclosed the success of abstinence-only sexual education in reducing sexual activity among youths 41 . In support of the findings of this new study, Rector submitted that out of 15 scientific evaluations of abstinence-only sexual education, 11 of them demonstrated its effectiveness in reducing adolescent sexual activity 42 .
A survey of the National Campaign to Prevent Teen Pregnancy in 2001 showed that 93% of abstinence sexual education came from the society 43 . Studies showed that proponents of abstinence-only sexual education frown seriously at sex before marriage. They considered it not right and immoral. They concluded that this is the only 100% effective method to prevent teenage pregnancy and sexually transmitted diseases 4 . They further reminded that condoms cannot provide 100% protection against unplanned pregnancy and sexually transmitted infections and also that premarital sex can lead to life threatening health problems such as abortion and its associated complications 5 . They feel burdened that sexual, contraceptive and HIV information can provoke early sexual initiation among the adolescents 5 . Abstinence-only sexual education has positively produced a corresponding decrease in teenage pregnancy 4 . Studies have demonstrated that religion acts as a deterrent to early sexual activity 5 . In line with this, many adolescents submitted that morals, values and religious beliefs significantly influence the decision to have sex or not.
In deciding whether or not to have sex, the Organization of Concerned Women for America also decried the outcome of sex without love or responsibility supported by public policies. This results in the breakdown of nuclear families, increases crime, poverty, teen births and AIDS which in turn negatively affects the health of the general public. This only shows lack of values 5 .

Statement of the problem
Adolescents are the future and so they require proper guidance that will propel them into responsible productive adults useful to themselves and their nations. Adolescence is a remarkable period characterised by the quest for experimentations with drugs, alcohol and sexual activity saddled with numerous life threatening adverse effects. The Nigerian Association for the Promotion of Adolescent Health and Development, (NAPAHD) found that, a hospital based research study revealed that 80% of patients with abortion complications in hospitals are adolescents. Studies in Nigeria have also shown that most female adolescents by the age of 15 have already had their first sexual intercourse 6,45 . The same applies to male adolescents. In Nigeria, complicated abortion, sexually transmitted infections and HIV/AIDS, sexual coercion, unplanned and unwanted sexual activity and unwanted pregnancies and babies, drop outs from schools and homelessness abound and are very common features with the adolescents 6 . This ugly situation can be attributed to ignorance of sexual information and the implications of premarital sexual activities. Most Nigerian adolescents do not receive correct sexual information while some are ignorant. They also might not be aware that engaging in premarital sexual activities can terminate their educational career, hold back their potentials and also affect the nation negatively 6 . The intense outcome associated with adolescent sexual activity necessitates the search for a positive way out and thus, the main objective of this study.

Purpose of the study
According to Focus on the Family group, sex should be avoided the same way as the use of guns, tobacco, alcohol and drink-driving 46 . They sternly condemn the advocacy for the use of condoms against unwanted pregnancies and sexually transmitted diseases in favour of abstinence-only sexual education 47 . Previous studies document the advantages of abstinence-only sexual education in reducing adolescent sexual activities and the associated health problems. This study investigated the perspective of secondary school adolescents in Nigeria on abstinence-only sexual education as an effective tool for promoting adolescent sexual health. The findings will help in planning informed corresponding intervention programmes which will hopefully yield positive results in Nigeria as other countries documented in previous studies. Adolescents all over the world face the common problem of media pressure and hormonal surges, which is natural.

Material and methods
An analytic descriptive survey design was used for the study. The research population comprised of all public secondary schools in three southern geopolitical zones of the Niger Delta Region of Nigeria. The States were Rivers, Akwa Ibom and Cross River. A multistage sampling technique was used for selecting 2020 senior secondary school (SS1-SS3) male and female students from the three states. Proportionate sampling technique was used in selecting the number of participating schools from the metropolis of each state. Five schools were selected from each of Cross River and Akwa Ibom States. Ten schools were selected from Rivers State. Respondents from each school were also selected proportionately. A total of 702 respondents were drawn from Akwa Ibom State, 510 from Cross River State and 808 from Rivers State. Participants were within the age range of 10-19 years. A questionnaire entitled Questionnaire on Nigerian Secondary School Adolescents Perspective on Abstinence-Only Sexual Education (QNSSAPAOSE) was used in eliciting information from respondents. The test/re-test reliability method was used to establish the internal consistency of the instrument. The instrument had a reliability coefficient of 0.75 established with Pearson Product Moment Correlation Coefficient (r). The instrument was divided into sections A and B. Section 'A' sought information on respondents' demographic characteristics. Section 'B' sought information on respondents' perspectives on Abstinence-Only sexual education. Questions were closed and open ended. The YES/NO questions attracted two points for positive responses and one point for negative responses. Questionnaires were administered with the aid of ten trained research assistants. Questionnaires were administered and collected on the spot to enhance a high return rate. Completion of the questionnaire was voluntary. Out of a total of 2020 questionnaires sent out, 2013 were returned and 13 questionnaires were not usable yielding a usable number of 2000 questionnaires. The return rate, therefore, was 99.1% (2000/2020). Hypotheses were formulated and tested. Frequency counts, percentage, Standard Deviation and Pearson Product Moment Correlation were used in analysing data. Approval of individual school management was obtained prior to execution of this study in their schools. Participants' consent was also obtained. Participation was voluntary and anonymity was also assured and maintained.
Three research questions and six hypotheses were formulated in this study. Each one of them is addressed as follows: What are the perspectives of adolescents on the advantages of abstinence-only sexual education? Seven positive statements representing the advantages of abstinenceonly sexual education were made ( Table 2). The general perspective of Nigerian secondary adolescents on the advantages of abstinence-only sexual education was negative. A greater number of the respondents did not agree with the statements highlighting the advantages of abstinence-only sexual education. However, taking into consideration the number of respondents from each age group that agreed with the statements highlighting the advantages of abstinence-only sexual education, it was found that the youngest age group (11-13 years) of adolescents ranked first. This implies that this group had the highest number of positive respondents in line with their total number when compared with the young (17-19 years) and younger (14-16 years) groups. Age group 11-13 years therefore demonstrated the likelihood of accepting abstinence-only sexual education.   What are the perspectives of adolescents on the disadvantages of abstinence-only sexual education?
The same number of statements was also made on the disadvantages of abstinence-only sexual education (Table 3). Generally, more respondents agreed with five while disagreeing with the last two of the seven statements highlighting disadvantages of abstinence-only sexual education. Of the total number of respondents that disagreed with the statements of disadvantages, the young adolescents (17-19 years) ranked first followed by the younger ones (14-16 years). More of the young adolescents out of their total number disagreed with the statements   of disadvantages when compared with the responses of the other two groups. This might be a factor of a better understanding than the younger age groups. Moreover, the problem might not be with the type of sexual education but mostly the willingness to practice.
What are the perspectives of adolescents on the acceptance of abstinence-only sexual education?
The general perspective of the respondents to five statements representing the acceptance of abstinence-only sexual education was negative. More respondents were against abstinence-only sexual education demonstrating a negative perspective on the acceptance of abstinence-only sexual education (Table 4). For instance 1686 out of the total respondents of 2000 objected to wanting a strong abstinenceonly message. The youngest adolescent group (11-13 years) had the highest number of respondents out of their total number of those in favour of abstinence-only sexual education. For instance, more of them when compared with other age groups wanted sex to be saved until marriage. More of them (11-13 years) also wanted a strong abstinence message and education. This indicates that the youngest group of adolescents were more likely to accept abstinence-only sexual education than other age groups.
Is there any significant relationship between age and perspective on abstinence-only sexual education? A significant relationship existed between age and the students' perspective on abstinence-only sexual education. (r = 0.123**, N=2000, P < 0.01) ( Table 7). Young age specifically had an influence on the respondents' perspective on abstinence-only sexual education in this study. Null hypothesis is rejected.
Is there any significant relationship between religion and perspective on abstinence-only sexual education? Respondents belonged to different religious organisations but only 31 out of the total respondents of 2000 were pagans (Table 6). A greater proportion were Christians which numbered up to 1877 out of 2000 total number of respondents. Muslims were 86 while traditional worshippers were only 6. According to the total number of each age group, the highest number of Christians came from age group 14-16 years followed by age group 17-19. Age group 11-13 years which has demonstrated the likelihood of accepting abstinence-only sexual education had the least number of Christians relatively.
A significant negative relationship existed between religion and perspective on abstinence-only sexual education. (r=-0.122**, N=2000, P < 0.01) ( Table 12). Religion had negatively influenced perspective on abstinence-only sexual education in the study. Null hypothesis is rejected.
Is there any significant relationship between gender and perspective on abstinence-only sexual education? A greater number of male and female adolescents demonstrated a negative perspective to the advantages of abstinence-only sexual education. This is deduced from their responses to the statements reflecting the advantages of abstinence-only sexual education. Out of the total number according to gender that responded in favour of the advantages of abstinence-only sexual education, more females were in favour of three statements while more males were in favour of four statements.    There is no significant relationship between age and their perspective on abstinence-only sexual More male and female respondents disagreed with five of the statements reflecting the disadvantages of abstinence-only sexual education and agreed with two of the statements. Out of the total number of those that did not agree with the disadvantages of abstinence-only sexual education, more males responded to four of the statements while more females responded to three of the statements.
An outright negative perspective on the acceptance of abstinenceonly sexual education was demonstrated by both male and female adolescents. A greater number of male and female respondents reacted negatively to statements which were in favour of abstinence-only sexual education.
More females responded in favour of acceptance of abstinenceonly sexual education in two statements out of five. More males responded to three of the statements. Specifically, more males than females advocated for sex to be saved until marriage and also wanted a strong abstinence message and education. This study found that boys are more likely to accept abstinence-only sexual education than females. This finding might be connected with the larger number of males among age 11-13 year group of adolescents with a likelihood to accepting abstinence-only sexual education than other older adolescents. (Table 16).
There was no significant relationship between gender and perspective of the adolescents on abstinence-only sexual education. (r = 0.051, N=2000, P <0.05) (Table 11). Gender had no influence on perspective of abstinence-only sexual education in the study. Null hypothesis is therefore retained.
Was there any joint effect of independent variables (age, gender, religion, ethnicity and parent's occupation) on perspective of abstinence-only sexual education? A significant joint effect existed between the independent variables (age, gender, religion, ethnicity and parent's occupation) and perspective on abstinence-only sexual education (F (5, 1994) = 13.085; R = 0.178, R 2 = 0.032, Adj. R 2 = 0.029; P < 0.05) ( Table 13). About 3% of the variation was jointly accounted for by the independent variables. The null hypothesis is therefore rejected.
Would there be any significant relationship between perspective of abstinence-only sexual education and age, gender, religion, ethnicity and parent's occupation? A positive significant relationship existed between perspective on abstinence-only sexual education and age, a negative significant relationship between perspective of abstinence-only sexual education and religion but no relationship between perspective of abstinence-only sexual education and gender, ethnicity and parents' occupation (Table 15).

Discussion
Young age is an important factor in the success of abstinence-only sexual education. According to Massey, three significant periods exist where values are learnt. They are the imprint period, modelling period and socialisation period 48 .
During the imprint and modelling periods, children learn through instructions and modelling. During these periods, the behaviour of children is formed from instructions given to them and examples before them. Therefore, if abstinence-only sexual education is taught between the imprinting to modelling period, it might produce positive results in adolescent lives. During the period of socialisation which starts from 13-21 years, a child is already exposed to different types of views and influences. Introducing abstinence-only sexual education might not be successful at this stage because for several reasons. Probably, most of the adolescents would have become sexually active by this age. Secondly, they might have a conviction already for sexual intercourse outside the confines of marriage as an ideal way of life. It is possible to accept instructions at a younger age. Those within the age range of 11-13 years were 8.8% (N=176) of the total population and they were the youngest group in this study. Most of them would have constituted the population in senior secondary one. The largest number of respondents was within the age bracket of 14-19 years. They might have established their beliefs about premarital sex and are probably sexually active already. This could be an explanation for the larger number of respondents that opposed abstinence-only sexual education.
The major finding of this study shows that Nigerian secondary school adolescents generally have a negative perspective towards abstinence-only sexual education. Out of a total population of 2000 respondents, abstinence-only sexual education was accepted by only 314 respondents and rejected by 1686. Those that had the tendency to accept abstinence-only sexual education were within the age bracket of 11-13 years and are the youngest group of adolescents The highest number of those that advocated for sex to be saved until marriage and also wanted abstinence-only sexual message and education belonged to the youngest group of adolescents. A greater number of respondents that were not in favour of abstinence-only sexual education belong to the 14-19 years age bracket and are the older adolescents. These are the ones within the age of socialisation already. With their exposure to different views about premarital sex, it is likely that most of them are already sexually active and have already taken a position for premarital sex. The message of abstinence-only sexual education at this stage might not be accepted with ease.
Religion had a negative significant influence on the adolescents' perspective on abstinence-only sexual education. Previous studies revealed that almost no religion supported premarital sexual activities. The studies of Concerned Women for America, demonstrated that religion acts as a deterrent to early sexual activity 5 . Many adolescents in previous studies posited that morals, values and religious beliefs significantly influence the decision of whether to have sex [3][4][5] . Probably, those that accepted abstinence-only sexual education would have been influenced by their religious beliefs. This also implies that teaching of religious values could be a useful tool for inculcating the values of sexual intercourse within the confines of marriage. Fortunately 93.9% (N=1877) of the total respondents were Christians 4.3% (N=86) were Muslims and 1.6% (N=31) belonged to traditional religion. Only 0.3% (N=6) were pagans. Christianity should therefore teach abstinence-only sexual education effectively with positive results.
Male and female Nigerian secondary school adolescents generally have a negative perspective towards abstinence-only sexual education. Out     of the number that favoured abstinence-only sexual education, more females than males were in favour of some statements and in other statements more males than females were in agreement. Surprisingly, more males than females advocated for sex to be saved until marriage and also wanted abstinence-only sexual message and education. One would have expected a more positive response from the females than the males because a greater proportion of the respondents in this study were females 64.9% (N=1298) of the total respondents. c. This finding is also sad because it is the females that suffer most from the adverse effects of premarital sexual activities. They are the ones that drop out from schools in the advent of pregnancy. They suffer the adverse effects of early pregnancy and child birth or abortion so one would have expected more females than males to advocate for sex to be saved until marriage. At the other hand more males than females advocating for sex to be saved until marriage and also wanting strong abstinence message and education might not be unconnected with the high number of males among the 11-13 years adolescents (Table 16). This study has revealed age 11-13 years as the group with a more likelihood of accepting abstinence-only sexual education than the other two groups of adolescents.
Ethnicity did not make any significant contribution to perspective of adolescents on abstinence-only sexual education. This shows that adolescents are all the same anywhere and everywhere. This study also revealed that about 80% of the total respondents could not define sexual education. Probably most of the responses would have been informed by ignorance.

Conclusion
Abstinence-only sexual education can work with a timely and early introduction in the lives of adolescents. The findings of this study reveal the need to teach abstinence-only sexual education at an early age as what is right and obtainable by parents who are the first contacts, in religious organisations by the Sunday school teachers and then teachers in school for possible positive results. This will also form part of the values and belief system of the child which might not be easily compromised. It is very important to teach abstinence-only sexual education as an ideal standard of life before a child gets to the age of socialisation of 13-21 years. Teaching abstinence-only sexual education after a child might have been exposed to different views about sex might not yield a good result as revealed by the findings of this study. This can be attributed to the difficulties associated with changing of values and beliefs or habits when once they are formed.

Translations to health education practice
Knowing the perspective of adolescents on abstinence-only sexual education is the key to knowing the right intervention programme to design and the approach to adopt for the implementation of such programme. This study reveals that abstinence-only sexual education will not work for majority of the respondents because it is not acceptable to them. For instance, only 314 out of 2000 respondents agreed with statements reflecting acceptance of abstinence-only sexual education while 1686 respondents disagreed. A very important finding of this study is that abstinence-only sexual education might only impact positively on those within the imprint and modelling periods of development. This include those within the age range of 11-13 years. The earlier abstinenceonly sexual education is introduced in life, the more promising the result. Those within the age bracket of 14-19 years seem to have formed their opinion already from different socialisation processes. This finding suggests the need for a second study only for those within the imprint and modelling period. The intervention programme based on the findings of this study recommends a two-dimensional approach. Comprehensive sexual education for the older age group (14-19 years) and abstinence only for the younger ones (11-13 years).
The implications of this study are directed specifically to parents who are the primary caretakers of the children. They have the first contact with the children during the early years. The religious organisations and the school health educators are also very important role players. Findings from this study suggest the introduction of different programming strategies aimed at teaching abstinence-only sexual education as a way of life within the early ages. This promises positive results capable of safeguarding adolescents especially the females from the numerous life threatening adverse effects associated with premarital sexual activities.
Parents must have a sound knowledge of sexual education so that they can serve as effective teachers to the children. This is the reason it is very good also to empower today's adolescents with the knowledge of sexual education and the benefits as future parents.
Preparing the adolescents of today to become knowledgeable parents of tomorrow can assist in creating a subsequent future of reduced cases of teenage pregnancies, deliveries, abortions and sexually transmitted infections. Whatever is wrong today can be corrected through adequately prepared adolescents who are the future of any nation.
Religious organisations should never relent in teaching the morals and values of abstinence-only sexual education early enough to the children right from their Sunday school classes. School health professionals should design appropriate programmes to internalise the need for abstinence-only sexual education in adolescents. The health educators should devise ways of identifying the children with the right foundations already and continue to build on them. They should also identify those with negative beliefs and design some remedial programmes for them to reduce the negative influence on other adolescents through the process of socialisation. It can be seen from this study that many problems faced by adolescents as a result of pre-marital sexual activity are avoidable.

Author contributions
Obonganyie P Inyang trained research assistants who helped in administering the questionnaire. She coordinated the administration, retrieval and sorting to separate useful copies of questionnaires from those not useful. The title of the work was conceived by Mfrekemfon P Inyang. She planned the research, reviewed the work, did the analysis and wrote the article.

Competing interests
No relevant competing interests were disclosed.

Grant information
The author(s) declared that no grants were involved in supporting this work. This study is not an intervention study so it could not have shown if abstinence-only sexual education could change attitude. It is always necessary to clarify needs before following up with appropriate intervention. The intent for a follow up intervention study has been indicated. The aspect of religion has been earlier addressed. The statement is a recommendation to educate the adolescents with the knowledge of what is right or wrong early in life. Numerous studies have proven the transforming power of information. It has also been established that most of the wrong-doings of adolescence are either due to wrong information or outright ignorance.
Thanks. Dr. M. P. Inyang There are no competing interests.
, University of Port-Harcourt, Rivers State, Nigeria Mfrekemfon Inyang I appreciate the referee's observation. We did not address measures of efficacy of abstinence in our study. This is why this study suggested a second study for those within the age range of 11-13years who demonstrated potential receptivity to abstinence-sexual education. This can be found under translations to health education practice. Measures of efficacy of abstinence is going to be specifically added.
: The conclusion of the study says that based on the potential receptivity of the young ones to Conclusion abstinence-only sexual education, then it can work with a timely and early introduction in the lives of young adolescents that will grow up with it. This requires teaching abstinence-only sexual education at an early age as what is right and obtainable by parents who are the first contacts. Children learn through instructions and modelling during the imprint and modelling periods which spans between 11-13years (Massey, 2011). This means working on the potential found in this study to develop along that line. It is not concluded that abstinence-only sexual education will be more or less effective than no education or alternative education messages in shaping student sexual practices.
: Respondents were asked for religions they were actively involved with. Data analysis showed Religion Christianity as the dominating religion. This explains the emphasis put on Christianity to teach abstinence-sexual health education. However, this was not surprising since Christianity is the dominating religion in the study area.
There are no competing interests.

Competing Interests:
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