Predictors of Adolescent Parent Communication and Safe Sexual Behaviour among In-School Adolescents

Adolescents in communicating about their sexual and reproductive health (SRH) issues are faced with the obstacles created by expected social norms and taboos related to sexuality and gender. This study aims to determine the relationship between adolescent-parent communication and its relationship with safe sex behaviour among adolescents. The study was a descriptive cross-sectional. Data was collected from 400 adolescents in Ife-East local government using a pre-tested semi-structured questionnaire. We used a multistage sampling technique to select the required study subjects. We carried out simple frequencies and chi-square. Fifty –five percent (55.3%) of the respondents were females, while 44.8% are males. The mean age (±SD) of the participants was 15.50 ±1.55years. Of the respondents, only 37% had good knowledge of sexual and reproductive health issues, while 63% had poor knowledge of sexual and reproductive health issues. The predictors of adolescent parent communication among respondents are private schools (OR=2.546, P = 0.005, CI=1.327-4.885), Female sex (OR=12.128, P<0.001, CI=11.590 – 25.534), family size (OR=14.772, P= 0.003, CI=13.037 –20.015) and good knowledge of sexual and reproductive health issues (OR=19.521, P= 0.007, CI=19.521 –29.078). There is a statistically significant relationship between adolescent parent communication and safe sexual behaviour (X2=152.998, P <0.001, df = 1). The findings of our study revealed that adolescents were not communicating much with parents about sexual and reproductive health issues; and that there is an association between adolescent parent communication and safe sexual behaviour.


Introduction
There are more than one billion adolescents all over the world. About 70% of them live in resource-poor countries (Department of Economic and Social Affairs (DESA, 2010). Studies have shown that adolescents have a limited understanding of various physiological changes that take place in them (Farzaneh, Lori, & Karima, 2008;Jejeebhoy, 2006;Seme & Wirtu, 2008). This lack of knowledge about pubertal changes may harm this group of people. In the past, researchers noticed that many adolescents who survived all childhood health challenges enjoyed a period of relatively low morbidity and mortality. However, due to civilization, urbanization, and lifestyle changes, adolescents' health is presently at stake (Berhane, Berhane, & Fantahun, 2005;Shiferaw, Getahun, & Asres, 2014). The greatest threat to adolescents' wellbeing is sexually transmitted infections and other reproductive health challenges (Berhane et al., 2005).
Across the globe, between 2.5 and 3 million adolescents acquire sexually transmitted infections (STIs) annually (Fanta, Lemma, Sagaro, & Meskele, 2016). This fact implies that in the developed countries, approximately one out of every ten adolescents acquire STIs annually. More than one million pregnancies occur among adolescents each year, out of which sixty percent are unwanted due to unprotected sexual intercourse (Yesus & Fantahun, 2010).
Sixteen million girls aged 15-19 give birth annually. This proportion is about 11% of all deliveries globally (Morris & Rushwan, 2015); 95% of these deliveries occur in developing countries (Morris & Rushwan, 2015). Significant differences arise across regions; for example, the proportion of births from teenage pregnancy to all deliveries range between approximately 2% in China to 18% in Latin America and the Caribbean, to more than 50% in Sub-Saharan Africa (WHO (Organization, 2004). Teenage pregnancy is a significant problem. In low-middle income countries (LMICs), about ten percent of teenagers become mothers before 16, with the highest rates in Sub-Saharan Africa and Southeast Asia (WHO (Organization, 2004).
In communicating about sexual and reproductive health (SRH) issues, adolescents tend to face obstacles created by expected societal norms and beliefs regarding sexuality and gender (Kusheta, Bancha, Habtu, Helamo, & Yohannes, 2019;Motsomi, Makanjee, Basera, & Nyasulu, 2016). These obstacles lead to a culture of silence, especially for the girls, in expressing their worries, discussing, and accessing information about SRH (Motsomi et al., 2016). Similarly, because of religious and cultural beliefs, parents tend to avoid discussion about sexual issues with adolescents. Parents believe they are too young for such discussion. This belief, in turn, hinders adolescent-parent communication on sexual health issues by creating an unfavorable environment for discussion (Kusheta et al., 2019;Motsomi et al., 2016).
Adolescents need their parents to spend time with them and show a genuine interest in them. Although adolescents often find it difficult to discuss sexuality with their parents, they tend to imbibe healthy sexual behavior when their parents engage in a robust discussion on SRH issues (DeVore & Ginsburg, 2005). Researches have also shown positive parenting practices involve discussion on sex-related topics, such as abstinence, contraception, and combatting HIV and other sexually transmitted infections (STIs) (DeVore & Ginsburg, 2005;Guilamo-Ramos & Bouris, 2008).
In Nigeria, surveys have not adequately explored the predictors of Adolescent-parent communication on sexual and reproductive health (SRH) challenges. Titiloye and colleagues employed mixed methods to estimate SRH discussion between adolescents and their parents. This method is limited in depth of information about triggers of parent-child communication and does not look into the predictors of adolescent-parent communication SRH issues (Titiloye & Ajuwon, 2017). Izugbara used qualitative methods to explore how and why these discussions happen. He conducted the study in rural areas alone, limiting its transferability to non-rural settings (Izugbara, 2008). These studies were selective in scope, coverage, and assessment of adolescents' SRH issues. This present study conducted more comprehensive research on adolescent-parent communication predictors on SRH issues and its association with adopting safe sex behaviors.

Methodology
We carried it out in Ife East local government (LGA) of Osun State, Nigeria, between August and October 2019. Geographically, Ile-Ife lies on latitude 7˚28'N and 7˚45'N and longitude 4˚30'E and 4˚34'E. The city experiences two distinct seasons, the rainy season spanning between April and October and the dry season between November and March. The average rainfall is about 1,000-1,250mm, with the highest temperature hovering over 28.3˚ Ife East LGA lies between latitude 70 20 "N and longitude 40 33 "E. We classified urban settlement with a total population of about 221,340, a mixture of Yoruba, Igbo, Hausa, and other tribes (Commission, 2009). The Local Government Area has 84 senior secondary schools.

Study Design
The study employed a descriptive cross-sectional design.

Target and Study Population
The study population is adolescents (10-19years) in selected schools.

Sample Size
We determined the sample size with the formula for estimating single proportions described by Armitage & Berry and cited in Gahlinger & Abramson). P is assumed prevalence of 87% (Fanta et al., 2016). Considering 10% non-response rate n= 350+35= 385. We rounded this number up to 400 for robust sampling.

Sampling Technique
We selected the respondents using the multi-stage sampling technique. The researcher obtained a list of all secondary schools in the study area, which had already been classified as public and private schools from the Ife East Local inspector of Education office. Stage 1: Six public and private senior secondary schools were selected by balloting from 84 senior secondary schools within the LGA. We evenly distribute the sample size over the six schools chosen to know the number of respondents per school, giving a total number of 67 respondents per school. Stage 2: Schools selected had more than an arm, from which we selected two arms of each class using a simple random sampling technique by balloting. Stage 3: Eligible respondents from the arms chosen were selected from the class register using simple random sampling.

Inclusion and Exclusion Criteria
Inclusion criteria are Students that are in session during data administration. Students who are seriously sick at the time of data collection were excluded from the study. Students writing their senior secondary school certificate examination. Single-Sex Secondary School.

Data Collection Methods
The adolescent-parent questionnaire was adopted from previous studies for data collection. The question has three sections: A. Socio-demographic status, B. Knowledge on major selected aspects of SRH, C. Level of communication on SRH, and Safe sexual behavior questionnaire. We developed the safe sexual behavior scale according to Dilorio et al. (DiIorio, Parsons, Lehr, Adame, & Carlone, 1992). It contains 27 items, which responses never have, sometimes, almost all the times, and always. We scored the items by awarding 1 for never and 4 for always, giving a score range of 27-108. A score of 78 and below indicates a lower level of safer sex behavior and scores greater than 78 indicate a higher level of safer sex behavior. The questionnaire was pre-tested among secondary school adolescents in Ife Central Local Government Area to ensure its reliability and content validity, and we made necessary changes after that.

Data Analysis
Each questionnaire was cross-checked daily on the field to ensure accurate data collection before data entry. The statistician analyzed the data using Statistical Package for the Social Sciences (SPSS) soft wear package version 20.0.
We generated frequencies and percentages for socio-demographic factors, including mean (standard deviation) for the age. The statistician generated statistical indices (chi-square, p-value, and degree of freedom) for the association between socio-demographic factors and adolescent-parent communication on SRH.
He also generated statistical indices for a statistical association between adolescent-parent communication on SRH and safe sexual behavior. We presented the data using tables. We used the Chi-square test to compare categorical variables and set statistical significance at p<0.05.
We generated Multivariate analysis using binary logistic regression for statistically significant socio-demographic factors and safe sexual behaviors.

Ethical Consideration
We sought ethical approval from the institute's ethical and research committee of public health OAU, Ile-Ife. We gave all participants verbal and written information about the study and the right to withdraw at any time without suffering any form of disadvantage. We then obtained their verbal consent. The researcher also assured them of confidentiality of their identities and information.

Results
Table 1 reveal s that fifty-five percent (55.3%) of the respondents were females, while 44.8% are males. The respondents' mean age was 15.50 ±1.55 years. Also, half of the students (52.5%) were in SS 1. Most of the respondents (90.3%) belonged to the Yoruba ethnic group, and the majority of them (87.8%) were Christians by religion. Seventy -six percent (77.5%) of the respondents were living with both parents. Less than half (46.5%) of their parents were living together. The respondents' mean family size was 4.74±1.56. Forty percent (40.0%) of the respondents' mothers were secondary school certificate holders, and 23.8% of respondents' mothers were small-scale merchant and private employees each. Thirty-three (33.0%) of the respondents' fathers were postgraduate degree holders, and 39.0% of respondents' fathers were government employees.        Table 5 shows a statistically significant relationship between adolescent parent communication and safe sexual behavior (X² = 152.998, P < 0.001, df = 1).  Table 6 reveals the predictors of adolescent parent communication among respondents. Respondents in private schools were three times more likely to discuss sexual and reproductive health issues with their parents than their public school counterparts (OR=2.546, P = 0.005, CI=1.327-4.885). Female respondents are 12 times more likely to discuss sexual and reproductive health issues with their parents than males (OR=12.128, P<0.001, CI=11.590 -25.534). Respondents with family size 1-4 were 15times likely to discuss sexual and reproductive health issues with their parents compared with their counterparts from family size ≥5 (OR=14.772, P= 0.003, CI=13.037 -20.015 ). Respondents with good knowledge were 19 times more likely to discuss sexual and reproductive health issues with their parents than their counterparts with poor knowledge (OR=19.521, P= 0.007, CI=19.521 -29.078).

Discussion
Adolescent sexuality is a significant point of discussion at different health fora over the past decade. Previous studies established the fact that Adolescent-parent communication is central to safe sexual practice among adolescents.
We also found a statistically significant association between adolescent-parent communication and safe sexual behavior. This study revealed that 84.0% of adolescents who practice safe sexual behavior discussed SRH issues with their parents.  (Birhanu, Bisetegn, & Woldeyohannes, 2014), and Harar, East Ethiopia (Yadeta, Bedane, & Tura, 2014). Cultural differences and changes in associated interventions concerning sexual and reproductive health problems among the study settings may account for this variation.
The predictors of adolescent-parent communication in this study include small family size and good knowledge of sexual and reproductive health issues. Our survey revealed that there is an association between sex and adolescent parent communication. This result is comparable to previous reports, which showed that female sex is a predictor of adolescent-parent communication SRH. This finding might be because girls tend to spend more time at home with their parents; and that parents usually focus more on the girls regarding abstinence and pregnancy avoidance (Ayehu et al., 2016;Kumi-Kyereme, Awusabo-Asare, Biddlecom, & Tanle, 2007;Motsomi et al., 2016).
This study showed that good knowledge of SRH issues is a predictor of adolescent parent communication. This finding is similar to previous survey reports, which showed that knowing sexual and reproductive health issues(SRH) is a strong predictor of adolescent parent communication on SRH issues (Fanta et al., 2016;Melaku, Berhane, Kinsman, & Reda, 2014). This finding may be because students who know SRH issues were eager to initiate a discussion with their parents on SRH issues.

Conclusion
This study revealed that the prevalence of adolescent-parent communication is low in our setting even though it plays a central role in enhancing safe sexual behavior in adolescents. The study also identified good knowledge of SRH issues as a predictor of adolescent-parent communication on sexuality.

Recommendation
Parents should engage both male and female adolescents equally during the discussion on Reproductive Health issues. Responsible agencies like the district health office, town administrative office, and others should provide parents with the necessary information, education, communication material, and communication skills on Reproductive Health-related issues. There should be transparency at home and in the community to enhance open discussion among family members, especially adolescents. We should furnish adolescents with accurate RH information in various ways, such as participating in different health clubs both in and outside school. Policymakers should introduce comprehensive family life education programs into the school curriculum. Advocacy should target homes, churches, mosques, and health facilities regarding adolescent-friendly SRH services.

Limitation of the Study
We base Adolescent-parent communication on sexual and reproductive health issues on self-report from the adolescents, and the study did not explore factors from the parent's perspective.