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Patterns and Preventive Strategies for Health Risk Behaviours

Among in-School Adolescents in Ado Ekiti, Ekiti State, Nigeria

Oladiran Isdaiah Olagunju

, Olowa Jesutofunmi Elizabeth

, OjoAbel Adeniji

, Alangs Manasseh

Stephen

, Adeniran Bukunmi Felicia

1,2,4,5

School of Community Health, Obafemi Awolowo University Teaching Hospitals Complex

(OAUTHC), Ile-Ife, Osun State, Nigeria

Department of Community Health, College of Community Health Sciences, Wesley University, Ondo

State.

*Corresponding Author

DOI:

https://doi.org/10.51583/IJLTEMAS.2026.150600249

Received: 12 July 2026; Accepted: 17 July 2026; Published: 01 August 2026

ABSTRACT

Background: Health risk behaviours acquired during adolescence are a leading driver of preventable morbidity

and mortality among young people worldwide, yet context-specific evidence to guide school-based prevention

remains scarce in many Nigerian settings, including Ado Ekiti, Ekiti State. This study examined the prevalence

and patterns of health risk behaviours, awareness of and attitudes toward preventive strategies, associated

factors, and the perceived effectiveness of existing interventions among in-school adolescents in Ado Ekiti.

Methods: A descriptive cross-sectional survey was conducted among 248 in-school adolescents aged 10-19

years, selected from public and private secondary schools in Ado Ekiti through multi-stage sampling

combining purposive school selection with systematic random selection of students. Data were collected using

a structured, self-administered questionnaire and analysed with SPSS version 27 using descriptive statistics,

chi-square tests, Pearson correlation, and independent-samples t-tests, with significance set at p < 0.05.

Results: Nearly half of respondents (49.2%) had engaged in at least one health risk behaviour, most commonly

unhealthy dietary practices (55.6%) and physical inactivity (46.8%), and 29.8% reported two or more

concurrent behaviours. Only 25.8% demonstrated adequate awareness of preventive strategies, although 64.5%

held positive attitudes toward prevention. Health risk behaviours were significantly associated with age,

gender, school type, and socioeconomic status (p < 0.05). They were significantly and inversely correlated

with awareness (r = -0.412), attitude (r = -0.387), and perceived effectiveness of existing strategies (r = -

0.356), all p < 0.001.

Conclusion: Health risk behaviours cluster at high prevalence among in-school adolescents in Ado Ekiti and

are shaped by an interconnected set of individual, interpersonal, and contextual determinants that existing

school-based interventions have not adequately addressed. Comprehensive, skills-based, peer-led, and family-

inclusive prevention strategies are urgently required.

Keywords: adolescents; health risk behaviours; preventive strategies; school health; Nigeria

INTRODUCTION

Adolescence, defined by the World Health Organisation as the period between ages 10 and 19 years, is a

developmental stage of rapid physical, psychological, and social transition during which health-related habits

are formed that persist and often compound across the life course (Sawyer et al., 2020). Health risk behaviours

acquired during this period, spanning substance use, risky sexual activity, physical inactivity, unhealthy dietary

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practice, violence, and cyberbullying, collectively account for a disproportionate share of the global adolescent

disease burden, contributing to an estimated 1.19 million adolescent deaths in 2019 through road traffic injury,

suicide, interpersonal violence, and HIV/AIDS, causes that are substantially preventable (WHO, 2021). Sub-

Saharan Africa, home to a rapidly expanding adolescent population projected to exceed 300 million by 2030,

carries a growing share of this burden, with systematic reviews documenting early sexual debut, multiple

partnerships, unprotected intercourse, and rising substance use across the region (Kabiru et al., 2025;

Ssewanyana et al., 2020).

Nigeria, with approximately 40 million adolescents constituting a fifth of its population, exemplifies these

patterns at national scale. Recent syntheses estimate that behavioural disorders affect 15.1% of Nigerian

adolescents and emotional disorders 11.4%, translating to several million young people whose mental health

needs go largely unmet (MedRxiv, 2025), while a comparable school-based study in neighbouring Ijesa-Land,

Osun State, found that 48.6% of in-school adolescents had engaged in at least one health risk behaviour,

including sexual intercourse (22.9%), alcohol use (19.7%), and illicit drug use (9.4%), with risk behaviours

clustering significantly within individuals (Omisore et al., 2024; Naing et al., 2022).

Despite the scale of this problem nationally, and despite Ekiti State's substantial investment in education

infrastructure and comparatively high school enrolment, Ado Ekiti, the state capital, has no published, context-

specific data describing the prevalence, patterns, or determinants of health risk behaviours among its in-school

adolescent population, nor rigorous evidence on whether the health education programmes, counselling

services, and community campaigns that nominally exist in its schools are known to, valued by, or effective for

the adolescents they are intended to serve. Consequently, policymakers, school administrators, and health

providers in Ekiti State are currently designing and resourcing adolescent health interventions without a local

evidence base, relying instead on data extrapolated from other states and national averages that may not

accurately reflect the specific behavioural patterns, awareness gaps, and structural determinants operating in

Ado Ekiti's schools (Dorcas et al., 2024; Omisore et al., 2024).

Beyond this immediate evidence gap, the study is justified on scientific, policy, and practical grounds.

Scientifically, it extends the still-limited empirical literature on adolescent health risk behaviour in sub-

Saharan Africa to a state capital that has not previously been studied, complementing rather than duplicating

the Ijesa-Land findings of Omisore et al. (2024) and testing the applicability of established behavioural

frameworks, the Health Belief Model, Social Cognitive Theory, and the Theory of Planned Behaviour, in a

new Nigerian setting. At the policy level, the study speaks directly to Nigeria's National Adolescent Health

Policy and to Sustainable Development Goal 3, both of which call for coordinated, evidence-based, multi-

sectoral action on adolescent health (United Nations, 2015; UNESCO, 2020), and offers Ekiti State's education

and health authorities empirical grounds on which to redesign and resource school health programming rather

than continuing to rely on generic, non-contextualised guidance. At the practical level, the findings have direct

application for school administrators seeking to strengthen pastoral care and health education, for health

providers aiming to improve linkages between schools and adolescent-friendly services, and for families

seeking evidence on which protective strategies, such as parental supervision and communication, are most

strongly associated with reduced risk-behaviour engagement in their own community context

(National Bureau

of Statistics. 2021). Despite the substantial and well-documented burden of interconnected health risk

behaviours among Nigerian adolescents and their established contribution to preventable morbidity and

mortality, there is a striking absence of rigorous, context-specific empirical data on the prevalence, patterns,

awareness, attitudes, and determinants of these behaviours among in-school adolescents in Ado Ekiti, Ekiti

State, a gap that leaves policymakers, educators, and health-service providers without the local evidence

required to design, target, and evaluate effective school-based preventive interventions.

This study therefore examined patterns and preventive strategies for health risk behaviours among in-school

adolescents in Ado Ekiti, with five specific objectives: to identify the prevalent health risk behaviours; to

assess adolescents' awareness of, and attitudes toward, preventive strategies; to determine the factors

associated with health risk behaviour engagement; and to examine the perceived effectiveness of existing

preventive strategies. By generating rigorous, locally grounded evidence, the study aims to support the design

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of evidence-based, culturally appropriate interventions in Ado Ekiti and comparable Nigerian settings, in direct

support of Sustainable Development Goal 3 and Nigeria's National Adolescent Health Policy commitments

(United Nations, 2015; UNESCO, 2020).

LITERATURE REVIEW

Empirical evidence across sub-Saharan Africa consistently documents high and clustering rates of adolescent

health risk behaviour. In the most directly comparable Nigerian study, Omisore et al. (2024) found that 48.6%

of in-school adolescents in Ijesa-Land, Osun State, had engaged in at least one health risk behaviour, with male

adolescents significantly more likely than females to report multiple concurrent behaviours, and with strong

statistical associations between different behaviour types, indicating a common underlying vulnerability rather

than independent, unrelated risks. This clustering pattern has been replicated across the region: Ssewanyana et

al. (2020), synthesising evidence from multiple sub-Saharan African countries, reported early sexual debut

before age 15, inconsistent condom use, and rising alcohol and cannabis use as recurring features of adolescent

risk profiles, while Kabiru et al. (2025) further identified adverse childhood experiences, low self-efficacy, and

limited access to positive developmental opportunities as shared upstream determinants linking otherwise

distinct risk behaviours.

At the national level, Dorcas et al. (2024) documented persistent gaps in Nigerian adolescents' access to youth-

friendly sexual and reproductive health services, attributing low service uptake to provider stigma, breaches of

confidentiality, and policies requiring parental consent, while the Center for Policy Impact in Health (2024)

estimated that 13% of Nigerian adolescents, some 166 million young people globally and several million

nationally, live with a diagnosable mental health condition without accessing appropriate care, a burden

closely intertwined with substance use and risk-taking behaviour. A national meta-analysis (MedRxiv, 2025)

placed the best-available prevalence of any adolescent mental health disorder in Nigeria at 15.1%, with

behavioural disorders as the single largest contributor, figures broadly consistent with international low- and

middle-income-country estimates of 10% to 16% (MedRxiv, 2025).

Three behavioural theories inform the conceptual basis of this study. The Health Belief Model (Rosenstock et

al., 2020) posits that health-protective behaviour depends on perceived susceptibility and severity of a threat

weighed against perceived benefits and barriers to action, and on the presence of internal or external cues to

action, a construct directly relevant to the low awareness of preventive resources documented in comparable

Nigerian school settings. Social Cognitive Theory (Bandura, 2021) emphasises observational learning and self-

efficacy, explaining how adolescents model behaviour observed among peers who appear to be rewarded with

social status or acceptance, and why skills-based interventions that build self-efficacy tend to outperform

purely informational ones. The Theory of Planned Behaviour (Ajzen, 2020) further accounts for the well-

documented attitude-behaviour gap in adolescent health research, whereby positive attitudes toward prevention

do not reliably translate into protective practice because behavioural intention is also shaped by subjective

norms and perceived behavioural control, both of which are heavily influenced by peer context.

Evidence on intervention effectiveness converges on a consistent conclusion: skills-based, interactive, and

peer-delivered prevention models produce more sustained behavioural change than didactic, knowledge-only

health education (Kabiru et al., 2025; UNESCO, 2020), yet Ssewanyana et al. (2020) caution that even

theoretically sound programmes frequently fail in low-resource settings owing to weak implementation

fidelity, inadequate teacher or facilitator training, and poor alignment with adolescents' actual needs and

preferences, a gap between programme existence and programme effectiveness that this study directly

investigates in the Ado Ekiti context.

METHODS

Study Design and Setting

This study employed a descriptive cross-sectional survey design, an approach widely used to assess the

prevalence, patterns, and correlates of health behaviours within a defined population at a single point in time.

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The study was conducted in Ado Ekiti, the capital of Ekiti State in southwestern Nigeria (approximately

7.6333°N, 5.2167°E), a predominantly Yoruba, Christian-majority city that serves as the state's administrative,

educational, and commercial hub and hosts numerous public and private secondary schools.

Study Population and Sample Size

The study population comprised in-school adolescents aged 10-19 years enrolled in public and private

secondary schools in Ado Ekiti who were present on the day of data collection and provided informed consent

or assent (with parental consent additionally required for participants under 18 years).

The minimum sample size was determined using Cochran's formula, n₀ = Z²p(1-p)/d², based on a prevalence of

21.1% drawn from a recent comparable Nigerian study, a 95% confidence level (Z = 1.96), and a precision of

5% (d = 0.05), yielding a minimum required sample of 256 students. Of 256 questionnaires administered, 248

were retrieved complete and usable, a response rate of 96.9%.

Sampling Technique

A multi-stage sampling technique was used. In Stage 1, secondary schools meeting eligibility criteria

(minimum enrolment of 200 students, offering both junior and senior secondary classes, and located within

Ado Ekiti metropolis) were purposively selected and stratified by school type (public/private) and gender

composition. In Stage 2, classes within each selected school were randomly selected across all grade levels. In

Stage 3, individual students were selected from class registers using systematic random sampling, with a

sampling interval calculated by dividing class size by the desired sample per class and a randomly selected

starting point.

Research Instrument and Data Analysis

Data were collected using a structured, self-administered questionnaire comprising sections on socio-

demographic characteristics, prevalence and patterns of health risk behaviours (substance use, sexual

behaviour, physical activity, dietary practice, violence, and cyberbullying), awareness of preventive strategies,

attitudes toward prevention (5-point Likert scale), factors associated with risk behaviour, and perceived

effectiveness of existing strategies.

Instrument reliability was established through test-retest administration among 30 adolescents two weeks apart,

with acceptable Pearson correlation coefficients (r >= 0.70). Data were analysed in SPSS version 27 using

descriptive statistics (frequencies, percentages, means, and standard deviations) and inferential statistics (chi-

square tests of independence, Pearson correlation, and independent-samples t-tests), with statistical

significance set at p < 0.05.

Ethical Considerations

Ethical approval was obtained from the Ekiti State Ministry of Health and Human Services Health Research

Ethics Committee (Approval Number: EKHREC/EA/U/169). Written parental or guardian consent and

adolescent assent were obtained prior to participation; participation was voluntary with the right to withdraw at

any stage, and confidentiality was maintained through anonymised coding, secure data storage, and aggregate

reporting of findings.

RESULTS

A total of 256 questionnaires were administered, and 248 were retrieved complete and usable, giving a

response rate of 96.9%.

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Socio-Demographic Characteristics

Table 1 Socio-Demographic Characteristics of Respondents (N = 248)

Variable

Category

Frequency (n)

Percentage (%)

Age (years)

12-14 years

31.5

15-17 years

126

50.8

18-19 years

17.7

Sex

Male

128

51.6

Female

120

48.4

Class level

JSS 1-3

29.8

SSS 1

21.0

SSS 2

27.4

SSS 3

21.8

School type

Public

152

61.3

Private

38.7

Religion

Christianity

184

74.2

Islam

21.0

Traditional/Other

4.8

Living arrangement

Both parents

142

57.3

Single parent

25.8

Guardian/relative

15.3

Alone

1.6

Parent/guardian education

No formal education

7.3

Primary

13.7

Secondary

102

41.1

Tertiary

37.9

Family socioeconomic status

Low income

35.5

Middle income

126

50.8

High income

8.9

Do not know

4.8

Source: Field survey, 2026.

Table 1 shows that the majority of respondents (50.8%) were aged 15-17 years and males constituted a slight

majority (51.6%). Most attended public schools (61.3%) and lived with both parents (57.3%). Christianity was

the predominant religion (74.2%), and half of respondents (50.8%) self-assessed as middle income.

Prevalence and Patterns of Health Risk Behaviours

Table 2 Perceived Prevalence of Health Risk Behaviours Among Respondents (N = 248)

Statement

SA (%)

A (%)

U (%)

D (%)

SD (%)

Mean

Alcohol consumption is common among

students in my school.

22.2

28.6

14.1

20.6

14.5

3.24

1.38

Cigarette/tobacco smoking is practised by

some students in my school.

16.5

24.2

11.7

28.6

19.0

2.91

1.41

Drug use (marijuana, codeine, tramadol) is

prevalent among adolescents in my school.

18.1

26.6

13.3

25.4

16.5

3.05

1.40

Sexual activity (including unprotected sex)

occurs among students of my age group.

20.6

22.2

17.3

23.0

16.9

3.07

1.42

Physical fighting or violence is common

among students in my school.

24.6

30.2

12.5

19.4

13.3

3.33

1.38

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Unhealthy eating habits are common among

students in my school.

35.9

38.3

11.3

10.1

4.4

3.91

1.10

Many students in my school do not engage in

regular physical activity.

30.2

35.5

14.9

13.3

6.0

3.71

1.18

Cyberbullying or online harassment occurs

among students in my school.

19.0

25.0

18.5

22.2

15.3

3.10

1.38

As shown in Table 2, unhealthy eating habits recorded the highest mean agreement score (mean = 3.91, SD =

1.10), followed by physical inactivity (mean = 3.71), physical fighting (mean = 3.33), and alcohol

consumption (mean = 3.24).

Table 3 Overall Prevalence of Engagement in Health Risk Behaviours (N = 248)

Health Risk Behaviour

Frequency (n)

Percentage (%)

Alcohol consumption

21.8

Tobacco/cigarette smoking

11.3

Illicit drug use

12.1

Sexual activity (ever)

24.2

Physical fighting/violence

27.4

Unhealthy dietary practices

138

55.6

Physical inactivity

116

46.8

Cyberbullying (perpetration)

12.9

At least one health risk behaviour

122

49.2

Two or more concurrent health risk

behaviours

29.8

Source: Field survey, 2026.

Table 3 shows that 49.2% of respondents had engaged in at least one health risk behaviour and 29.8% reported

two or more concurrent behaviours, with unhealthy dietary practices (55.6%) and physical inactivity (46.8%)

the most prevalent individual behaviours, figures broadly consistent with the 48.6% overall prevalence

reported by Omisore et al. (2024) in neighbouring Osun State.

Awareness of Preventive Strategies

Table 4 Awareness of Preventive Strategies (N = 248)

Statement

SA (%)

A (%)

U (%)

D (%)

SD (%)

Mean

I am aware that my school has a health

education programme addressing risk

behaviours.

20.2

30.6

18.5

19.4

11.3

3.29

1.30

I know where to access counselling

services or a school counsellor if I need

help.

16.5

28.2

14.5

24.6

16.1

3.04

1.37

I have received information about the

dangers of substance use at school.

28.6

37.5

13.7

12.5

7.7

3.67

1.20

I am aware of safe sex education and

availability of contraceptive information in

my community.

14.1

22.2

17.7

27.4

18.5

2.86

1.35

I know about the existence of peer

education programmes designed to reduce

health risk behaviours.

12.5

20.6

19.0

29.8

18.1

2.80

1.31

I am aware of community or government

initiatives aimed at reducing health risk

behaviours among adolescents.

11.3

21.0

20.2

30.2

17.3

2.79

1.29

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Source: Field survey, 2026.

Table 4 shows that respondents reported the highest awareness of having received information about the

dangers of substance use (mean = 3.67), while awareness of safe sex education (mean = 2.86), peer education

programmes (mean = 2.80), and community/government initiatives (mean = 2.79) was comparatively low.

Table 5 Summary of Awareness Level Classification (N = 248)

Level of Awareness

Score Range

Frequency (n)

Percentage (%)

Adequate (>=70%)

21-30

25.8

Moderate (50-69%)

15-20

112

45.2

Inadequate (<50%)

6-14

29.0

Total

248

100.0

Source: Field survey, 2026.

As summarised in Table 5, only 25.8% of respondents demonstrated adequate awareness of preventive

strategies, while 29.0% had inadequate awareness.

Attitudes Toward Preventive Strategies

Table 6 Attitudes Toward Preventive Strategies (N = 248)

Statement

(%)

A (%)

U (%)

D (%)

(%)

Mean

I believe it is important to follow health

guidelines provided by my school to avoid

risky behaviours.

38.7

40.3

10.1

6.9

4.0

4.03

1.00

I am willing to participate in health education

sessions offered at my school.

34.3

42.3

12.1

7.3

4.0

3.96

1.02

I feel that peer pressure is a major reason why

adolescents engage in health risk behaviours.

40.7

38.3

10.9

6.5

3.6

4.06

1.00

I believe that school-based counselling can

effectively reduce health risk behaviours

among adolescents.

29.4

38.7

18.1

9.3

4.4

3.79

1.08

I think adolescents who engage in health risk

behaviours should be supported rather than

punished.

31.5

35.9

16.9

10.9

4.8

3.79

1.13

I would actively discourage my peers from

engaging in health risk behaviours such as

drug use or unprotected sex.

35.9

38.7

14.5

7.3

3.6

3.96

1.04

Source: Field survey, 2026.

Table 6 shows that respondents most strongly endorsed the belief that peer pressure drives health risk

behaviours (mean = 4.06) and the importance of following school health guidelines (mean = 4.03).

Table 7 Summary of Attitude Classification (N = 248)

Attitude Category

Score Range

Frequency (n)

Percentage (%)

Positive (>=70% favourable)

21-30

160

64.5

Neutral (50-69%)

15-20

27.4

Negative (<50%)

6-14

8.1

Total

248

100.0

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Table 7 shows that 64.5% of respondents held positive attitudes toward preventive strategies, 27.4% neutral

attitudes, and only 8.1% negative attitudes.

Factors Associated With Health Risk Behaviours

Table 8 Factors Associated With Health Risk Behaviours (N = 248)

Statement

(%)

A (%)

U (%)

D (%)

(%)

Mean

Peer pressure from friends is a major

factor influencing adolescents to engage

in health risk behaviours.

42.3

38.3

9.3

6.0

4.0

4.09

1.02

Lack of parental supervision increases the

likelihood of health risk behaviours

among adolescents.

36.7

38.3

12.1

8.5

4.4

3.94

1.07

Poverty or low family income contributes

to health risk behaviours among

adolescents in my community.

30.2

36.7

16.1

11.7

5.2

3.75

1.13

Exposure to social media content

promoting alcohol, drugs, or sexual

activity influences adolescent risk

behaviours.

38.7

37.9

10.9

8.1

4.4

3.98

1.06

Emotional problems such as stress,

anxiety, or depression push adolescents

towards health risk behaviours.

34.3

39.1

14.1

8.5

4.0

3.91

1.05

A poor school environment contributes to

health risk behaviours.

28.6

36.3

18.1

12.1

4.8

3.72

1.13

Source: Field survey, 2026.

Table 8 shows that peer pressure was the most strongly rated associated factor (mean = 4.09), followed by

exposure to social media content promoting risk behaviours (mean = 3.98), lack of parental supervision (mean

= 3.94), and emotional problems (mean = 3.91); all items recorded means above 3.5.

Table 9 Chi-Square Analysis of Socio-Demographic Variables and Health Risk Behaviours (N = 248)

Variable

Chi-square (χ²)

p-value

Decision

Age

14.32

0.006

Reject H0

Gender

18.74

0.000

Reject H0

School type

9.48

0.009

Reject H0

Living arrangement

11.25

0.081

Retain H0

Parent/guardian education

10.62

0.101

Retain H0

Socioeconomic status

16.93

0.010

Reject H0

Source: Field survey, 2026.

Chi-square analysis (Table 9) revealed statistically significant associations between health risk behaviour

engagement and age (χ2 = 14.32, df = 4, p = 0.006), gender (χ2 = 18.74, df = 2, p < 0.001), school type (χ2 =

9.48, df = 2, p = 0.009), and socioeconomic status (χ2 = 16.93, df = 6, p = 0.010); associations with living

arrangement and parental education were not statistically significant.

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Table 10 Correlation Between Awareness, Attitudes, and Health Risk Behaviour Engagement (N = 248)

Variable Pair

Statistic

p-value

Decision

Awareness score vs HRB engagement

r = -0.412

0.000

Reject H0 (2)

Attitude score vs HRB engagement

r = -0.387

0.000

Reject H0 (3)

Public vs private school HRB rates

t = 2.63, df = 246

0.009

Reject H0 (4)

Perceived prevention effectiveness vs HRB engagement

r = -0.356

0.000

Reject H0 (5)

Source: Field survey, 2026.

Table 10 shows statistically significant negative correlations between health risk behaviour engagement and

both awareness score (r = -0.412, p < 0.001) and attitude score (r = -0.387, p < 0.001); an independent-samples

t-test showed significantly higher risk behaviour prevalence among public-school than private-school students

(t = 2.63, df = 246, p = 0.009); and perceived effectiveness of existing prevention strategies was significantly

and negatively correlated with risk behaviour engagement (r = -0.356, p < 0.001).

Existing Preventive Strategies and Perceived Effectiveness

Table 11 Existing Preventive Strategies and Perceived Effectiveness (N = 248)

Statement

(%)

A (%)

U (%)

D (%)

(%)

Mean

The health education programmes currently

available in my school are effective in

reducing risk behaviours.

18.5

28.6

22.2

19.8

10.9

3.24

1.26

The school counselling services in my school

are accessible and helpful to students who

engage in risk behaviours.

14.5

24.6

21.0

24.2

15.7

2.98

1.30

Parental involvement and family-based

interventions are effective strategies for

reducing health risk behaviours.

35.9

41.1

12.5

6.9

3.6

3.99

1.02

Government and community-based health

campaigns have had a positive impact on

reducing risk behaviours among adolescents

in Ado Ekiti.

16.1

26.6

24.2

21.0

12.1

3.14

1.25

Source: Field survey, 2026.

Table 11 shows that parental involvement and family-based interventions were rated the most effective

preventive strategy (mean = 3.99), followed by school health education programs (mean = 3.24) and

government/community campaigns (mean = 3.14). In contrast, school counselling services were rated lowest

(mean = 2.98).

DISCUSSION

The finding that 49.2% of in-school adolescents in Ado Ekiti had engaged in at least one health risk behaviour,

with 29.8% reporting two or more concurrent behaviours (Table 3), closely mirrors the 48.6% prevalence

reported by Omisore et al. (2024) in the culturally and geographically proximate Ijesa-Land, Osun State,

reinforcing the external validity of the present findings and confirming that risk-behaviour clustering, rather

than isolated single-behaviour engagement, is the dominant pattern among adolescents in this part of

southwestern Nigeria. That unhealthy dietary practice (55.6%) and physical inactivity (46.8%) emerged as the

most prevalent behaviours (Tables 2 and 3) is consistent with global evidence that nutrition- and activity-

related risk has intensified in urbanising low- and middle-income settings, driven by greater availability of

energy-dense foods and declining opportunities for structured activity (Dorcas et al., 2024). Reported rates of

alcohol use (21.8%) and sexual activity (24.2%) are broadly comparable to, though likely conservative relative

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to, the true magnitude of these behaviours, given the well-documented tendency of adolescents to under-report

socially sensitive conduct in self-report surveys (Omisore et al., 2024; UNESCO, 2020).

The gap between generally positive attitudes toward prevention (64.5%; Table 7) and comparatively low

behavioural protection (49.2% engagement in at least one risk behaviour; Table 3) illustrates the attitude-

behaviour discordance central to the Theory of Planned Behaviour, whereby favourable attitudes do not

reliably convert into protective action once they are outweighed by subjective peer norms and low perceived

behavioural control (Ajzen, 2020). This interpretation is directly supported by Table 8, in which peer pressure

was rated the strongest associated factor (mean = 4.09), and by the chi-square and correlation results in Tables

9 and 10, which confirm that awareness and attitude scores were significantly, and negatively, associated with

actual risk-behaviour engagement (r = -0.412 and r = -0.387 respectively). Consistent with Social Cognitive

Theory's emphasis on observational learning and self-efficacy (Bandura, 2021), the strong rating given to

social media exposure (mean = 3.98) as a contributing factor in Table 8 further reflects the growing influence

of digital environments on adolescent risk norms in urban Nigeria (Centre for Policy Impact in Health, 2024;

Charan, J., & Biswas, T. (2013)).

Only 25.8% of respondents demonstrated adequate awareness of preventive strategies (Table 5), with

particularly low awareness of safe sex education, peer education programmes, and community initiatives

(Table 4). Interpreted through the Health Belief Model, this low awareness directly undermines the 'cues to

action' construct that prompts protective behaviour, meaning that even adolescents with adequate risk

perception may fail to engage services they do not know exist (Rosenstock et al., 2020). This pattern is

corroborated by the perceived-effectiveness results in Table 11, in which school counselling services, the

resource most dependent on adolescents actively seeking them out, were rated the least effective strategy

(mean = 2.98). In contrast, parental involvement, which does not require adolescent-initiated help-seeking, was

rated most effective (mean = 3.99), consistent with the protective role of supportive family environments

documented by Ssewanyana et al. (2020) and Kabiru et al. (2025).

The significant associations between health risk behaviour and age, gender, school type, and socioeconomic

status (Table 9) align with Omisore et al.'s (2024) finding that male and older adolescents report

disproportionately higher risk engagement, and the significantly higher risk-behaviour prevalence among

public- relative to private-school students (Table 10) plausibly reflects differences in resource availability,

class sizes, and access to structured extracurricular and counselling support between the two school types.

Taken together, the results across Tables 2 through 11 indicate that existing preventive strategies in Ado Ekiti

schools, being predominantly informational and reliant on adolescent-initiated engagement, have not

adequately closed the gap between programme existence and programme effectiveness previously documented

in comparable Nigerian and sub-Saharan African settings (Ssewanyana et al., 2020; UNESCO, 2020).

Limitations

This study is limited by its cross-sectional design, which precludes causal inference, and by its reliance on self-

reported data on sensitive behaviours, which is subject to social desirability bias and likely underestimates true

prevalence. Findings are also specific to in-school adolescents in Ado Ekiti and may not generalise to out-of-

school youth or to rural areas of Ekiti State.

CONCLUSION

This study found that health risk behaviours are highly prevalent and frequently co-occur among in-school

adolescents in Ado Ekiti, that awareness of available preventive resources is inadequate for most respondents

despite generally positive attitudes toward prevention, and that existing school-based strategies, particularly

counselling services, are not perceived as effective, with family-based approaches rated most favourably.

These findings, drawn directly from Tables 1 through 11, indicate that achieving meaningful reductions in

adolescent health risk behaviour in Ado Ekiti will require prevention strategies that move beyond purely

informational, adolescent-initiated models toward comprehensive, skills-based, peer-led, and family-inclusive

approaches.

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RECOMMENDATIONS

Based on these findings, four recommendations are proposed.

To the Government

 Given the significant association between social media exposure and risk-behaviour engagement, a

digital and social media literacy component should be formally integrated into the adolescent health

curriculum, and government-led community campaigns strengthened to close the awareness gaps this

study identified.

To schools

 Schools in Ekiti State should replace purely didactic health education with comprehensive, skills-based

curricula that build the self-efficacy and refusal skills adolescents need to resist peer pressure, the

factor most strongly associated with risk-behaviour engagement in this study.

 Structured, adequately resourced peer education programmes should be established and formally

evaluated in all secondary schools, given both the demonstrated protective association between

awareness and reduced risk behaviour and the currently low awareness of such programmes.

 School counselling services, rated least effective by respondents, should be restructured to be more

accessible, confidential, and proactive rather than dependent on adolescent-initiated help-seeking,

alongside targeted parental engagement programmes that build on the strong protective effect of family

involvement identified in this study.

Contribution to Knowledge and Implications for Public Health

This study provides the first published, population-level evidence on the prevalence, patterns, determinants,

and preventive-strategy landscape of health risk behaviours among in-school adolescents in Ado Ekiti, filling a

geographic evidence gap that neither national datasets nor studies from neighbouring states have addressed,

and offering education and health authorities in Ekiti State the local evidence base needed to design, target, and

evaluate school health programmes. For the wider public, the findings underscore that adolescent health risk

behaviours are rarely isolated choices but cluster together and are driven by shared, addressable social factors,

chiefly peer influence, social media exposure, and family supervision, meaning that parents, teachers, and

community members each hold a genuine, evidence-supported role in prevention rather than this responsibility

resting on health services alone. The consistently stronger protective effect of family involvement relative to

formal counselling services, in particular, offers a practical, low-cost message for households: sustained

parental engagement and open communication about these issues measurably reduce adolescent risk, a finding

with direct relevance beyond Ado Ekiti to comparable urban Nigerian communities.

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