PATTERNS OF AND PREVENTION STRATEGIES FOR HEALTH RISK BEHAVIOURS AMONG IN- SCHOOL ADOLESCENTS IN JIGAWA STATE NIGERIA

Abstract

The patterns of and prevention strategies for health risk behaviours among in-school adolescents in Jigawa State was investigated as a basis for formulating health risk behaviour prevention strategies. The study utilized descriptive survey design. The population of the study consisted of

159,586 in-school adolescents in Jigawa state secondary Schools. A sample of 3,192 students

representing  2  per  cent  of  the  population  participated  in  the  study.  Multi-stage  sampling procedure was adopted to draw the sample from the population. Three instruments were used for data   collection.   These   were   a   55-item   In-School   Adolescent   Health   Risk   Behaviours Questionnaire referred to as ISAHRBQ which was adapted from the 2013- National Youth Risk Behaviour Survey Questionaire–YRBSQ-2013, the 12-item researcher developed In-School Adolescent Health Risk Behaviour Focus Group Discussion Guide referred to as ISAHRBFGDG and In-School Adolescent Health Risk Behaviour Prevention Strategies Evaluation Questionnaire (ISAHRBPSEQ).Spearman Brown Prophecy Formula was employed to establish the reliability index of the ISAHRBQ and ISAHRBPSEQ.  The reliability coefficients of 0.80 for ISAHRBQ and 0.94 for ISAHRBPSEQ were determined through Spearman Brown Prophecy statistic. Data from the 2886 copies of the returned ISAHRBQ and 28 copies for ISAHRBPSEQ were analyzed. Research questions one to eleven and thirteen were analyzed using mean and standard deviations, while research question 12 was analyzed using frequency and percentages. The null hypotheses two and four were tested using t-test statistics while hypotheses one, three and five were tested using Analysis of Variance (ANOVA), and hypothesis six was tested using Chi-square, all at .05 level  of  significance.  The  findings  of  the  study  indicated  that  in-school  adolescents  never exhibited health risk behaviours (HRBs) like substance use (1.05 ±  0.30), unsafe sex (1.01±

0.18), violence (1.48 ±  0.65) and suicidal (1.16 ±  0.35) behaviours. While healthy nutrition (2.07

±   0.89)  and  bullying  (2.28  ± 1.13)  behaviours  were  rarely  exhibited.  The  Findings  further revealed that there were significant differences (p > 0.05) in the mean score rating of in- school adolescents regarding all the HRBs according to age. There were significant differences(p > 0.05) in the mean scores  of in- school adolescents regarding sexual, physical activity, nutritional, violent and suicidal behaviours according to gender. There were significant differences (p > 0.05) in the mean scores of in- school adolescents regarding all the HRBs according to class. There were significant differences (p > 0.05) in the mean scores of in- school adolescents regarding substance use, sexual, physical activity, violent and suicidal behaviours according to location. There were significant  differences  (p  >  0.05) in the mean scores  of  in- school adolescents regarding all the HRBs according to school type. In-school adolescents significantly differed (p >

0.05) in their HRBs according to temporal variations. There were no significant differences (p >

0.05) in the mean score rating regarding substance use behaviours of in- school adolescents according to gender. There was no significant difference (p > 0.05) in the mean scores of in- school adolescents regarding nutritional behaviours according to location. Recommendation such as implementation of Health Risk Behaviour Prevention strategies in Jigawa State schools was made.

Background to the Study

CHAPTER ONE Introduction

Health risk behaviours among adolescents is a  major health concern globally. This is because these behaviours are associated with serious life-threatening consequences among adolescents in both developed and developing nations, including Nigeria. The impact of health risk behaviours (HRBs) on health is of such magnitude that it has become one of the priorities of national and international health organizations, Rutter and Quine, in Baban & Cracium (2007). These  organizations  have  been  initiating  programmes with a  view to  curbing  this  menace globally.

The global estimates of some identified risk behaviours of significance to warrant global concern include, suicide with a prevalence of 7.4 per 100,000 (Wasserman, Cheng, & Jiang,

2005), 185 million drug abusers and 2 billion alcohol users globally (WHO, 2002). According to Onifade, Somoye, Ogunwobi, Ogunwale, Akinhanmi and Adamson (2011), Nigeria has the highest one-year prevalence rate of Cannabis use (14.3%) in Africa. Although, data on drug abuse in Nigeria are sparse, some existing studies show 290 drug abusers in Enugu (Igwe, Ngozi, Ejiofor, Emechebe, & Ibe, 2009), 7.8 per cent in a study in Sokoto, 47 per cent in Ilorin (Oshodi, Aina & Onajole, 2010) and that 149 drug related arrests were made by National Drugs Law Enforcement Agency (NDLEA) between 2011-2012 in Jigawa State (Akubo, 2012). Regarding risky sex practices, 34 million people are infected with HIV/AIDS globally, with 22.9 million in Sub–Saharan Africa and 3.3 million in Nigeria (Avert International, 2010). Death as a result of physical inactivity (WHO, 2013) and unhealthy nutrition accounts for 3.2 million and 1.7 million death yearly respectifully (World Heart Federation, 2013). The aforementioned statistics are some indicators to the growing global health challenges, which mostly occur through health risk behaviours of adolescent.

Health is a state, condition or level of functional efficiency of an individual. World Health Organization, WHO (1946) defined health as a state of complete physical, mental and social wellbeing and not merely the absence of disease or infirmity. According to American Nurses Association, health is a dynamic state of wellbeing in which the development and behavioural potentials of an individual is realized to the fullest extent possible (Davies &

Janosik, 1991). Pender (1996) defined health as positive dynamic state not merely the absence of disease. Flora and Lang (1982) asserted that health can be seen as a dynamic state, or condition of the body that has qualitative and quantitative measurable aspects, that are influenced by both internal and external environment of an individual. In this study, health refers to the dynamic measurable state, condition or quality of individuals’ wellbeing. The influence of internal and external environments brings about changes in individual’s health behaviour.

Behaviour refers to the responses of an organism to its environmental stimuli (both internal and external) (Nwachukwu, 1992). DeClemente, Hansen and Ponton (1997) asserted that problems of behaviour and risk- taking are part of normal adolescent development. They mentioned that behaviour can be positive or negative. Risk taking (exploratory behaviour) that is developmentally  constructive,  such  as  exercise,  is  considered  positive  behaviour  while pathogenic behaviours refer to those behaviours that are negative, and are capable of causing harm to the body, such as HIV infection caused by unprotected sex. Ronald and Seymour (2007) defined behaviour as the actions or reactions of an object or organism to its environment. In this study, behaviour refers to the reactions of in-school adolescents within and around them in relation to their health.  When behaviour relates to health it is referred to as health behaviour.

Health behaviours could be regarded as the way a living human being acts. Springer, Selwyn, and Kidder, (2006) perceived health behaviour as acceptable actions that positively influence the knowledge, attitude and practice of an individual in taking decisions regarding his or her health. Glanz, Rimer and Viswanath (2008) referred to health behaviour as the action of individual, group or organizations as well as their determinants, correlates and consequences, including social change, policy development and implementation, and improved coping skills that  enhance quality of life.Health behaviour as used  in this  study,  refers to    actions that positively or negatively   influence the practice and attitude of in-school adolescents in taking decisions regarding their physical, social and mental health. Actions that negatively influence individuals’ attitude could expose them to many risks.

Risk can be seen as a natural phenomenon that can sometimes be taken by an individual including  adolescents  out  of  volitional  intentions.  Risk  is  the  probability that  a  particular outcome will occur following a particular exposure (Burt, 1998). Risk is conceptualized as a potential negative impact to an asset or other valuables arising from present process or future events (Llona, 2006). Risk is often referred to as the probable occurrence of danger, hazard or

loss. In this study, risk refers to potential negative actions by in- school adolescents that may damage or harm their health. Therefore, when risk relates to behaviour, it is referred to as risk behaviour.

Risk behaviour is a volitional health compromising action that may lead to morbidity and mortality. Risk behaviour is defined as ‘voluntary or involuntary actions that threaten self- esteem, health and increase the likelihood of illness, injury, and premature death (Linda & Allan,

1996).  Risk  behaviour  can  be  healthy  and  unhealthy.  Healthy  risk  behaviours  are  those behaviours that  positively affect,  improve or  maitain ones health. These include travelling, participation in sports, making new friends among others, while unhealthy risk  behaviours refers to those actions or practices which can negatively impact on our health. These behaviours include unsafe sex, substance abuse, suicide and violent behaviours (Ponton, 1997). Richter (2010) opined that risk behaviour refers to any behaviour that can compromise psychosocial aspect of successful adolescent development. According to Samuel and Andrew (2010), risk behaviour refers to any form of action that has basic or obvious potentials for inflicting danger or harm to the person carrying out the behaviour or to others. In this study, risk behaviour refers to any form of action by in- school adolescents to situations or persons within and around the environment  that  have  a  potential  source  of  harm  to  them  and  those  around  them.  Risk behaviours that relates to health is referred to as health risk behaviours.

Health risk behaviour (HRBs) is defined as voluntary involvement in established patterns of acting or functioning that could harm the health of  adolescents  and retard their potentials for responsible adulthood ( Lindbergh, Boggers, & Williams,2000). Springer, Selwyn and Kelder (2006) refers to health risk behaviour as overall term used to describe unfavourable or harmful health actions of people. Health risk behaviour involves actions and related attitudes and perceptions that contribute to people’s propensity to engage in activities that have been deemed by experts to be hazardous or dangerous to health (Lupton, 2007).  In this study, HRBs refer to actions that could have a potential harm to the health of in- school adolescents and those around them. Health-risk behaviours contribute to the leading causes of morbidity and mortality among youth and adults (Center for Disease Control – CDC, 2009). They are often established during childhood and adolescence which may extend into adulthood, and they are interrelated and preventable (Eaton, Kann, Kinchen, Shanklin, Flint, Hawkins, Harris, Lowry, McManus, Chyen, Whittle, Lim and Wechsler, (2012). Health risk behaviours are many.

Brener, Kann, Kinchen, Grunbaum, Whalen, Eaton, Hawkins, Ross (2004) reported that Center for Disease Control – CDC in 1992  developed the Youth Risk Behaviour Surveillance System (YRBSS) to monitor priority health-risk behaviors that contribute substantially to the leading causes of death, disability and social problems among youth and adults in the United States. Brener et-al (2004) added that YRBSS monitors the following six categories of priority health-risk behaviours among youth and young adults:  Behaviours that contribute to substance abuse,  unsafe  sexual  behaviours  that  contribute  to  unintended  pregnancy  and  sexually transmitted infections (STIs), including Human Immunodeficiency Virus (HIV) infection; unhealthy dietary behaviours, physical inactivity violence and suicide. The present study will focus on the six HRBs that have been categorized by YRBSS (substance abuse, unsafe sexual behaviour, unhealthy nutrition, physical inactivity, violence and suicide). Studies by Rutter and Quine, in Baban and Cracium, (2007); Buddy, (2011) have revealed that adolescents engage in various HRBs in many countries. In–school adolescents in Jigawa State may not be an exception because of some reasons such as; insecurity challenges in the northern part of Nigeria that involves violence, political crises, poverty, pornographic media that can influence unsafe sex and the influence of substance use and abuse during festive periods to mention few among others.

Substance abuse can be defined as a pattern of harmful use of any substance for mood- altering purposes. Substance abuse refers to the excessive use of a substance that may eventually lead to some form of addiction (WHO, 1992). Igwe, Ngozi, Ejiofor, Emechebe and Ibe (2009) asserted that abuse of substances by young people has been a significant public health concern for more than two decades. Illegal as well as legal drugs can be abused. Alcohol, prescription and over-the-counter drugs, inhalants and solvents, and even coffee and cigarettes, can all be used in harmful doses (Buddy, 2011). It might be possible that in-school adolescents in Jigawa state may be indulging in one form of substance use or the other. Gill (2002) reported that alcohol drinking was measured by some studies as quantity per week or one to five times in the last six months; he added that one drink is equivalent to one UK unit of beer. According to Gill, many studies used weekly benchmarks of 14 units for female and 21 units for male to monitor drinking behaviour. In this study substance abuse refers to the excessive use of illicit and licit substances by in-school adolescents that can modify body functions and is capable of causing potential harm to their health.

Unsafe sex or risky sex is another health risk behaviour that contributes to adolescent’s mortality and morbidity. Majority of the reproductive health and sexuality problems in Nigeria could be associated with risky sexual behaviours. Ariba (2001) observed that unsafe or risky sexual behaviours lead to many preventable reproductive health problems such as unwanted pregnancy, STIs and AIDS. Schwartz, Forthum, Rvert, Zamboanga, Umana-Taylor, Filton, Kim,

……….. Hudson (2010) identified such unsafe sexual behaviours as unprotected sex, oral sex, anal sex, casual sex and sex while intoxicated. It is through these unsafe sexual behaviours that diseases like sexually transmitted infections (STIs) and HIV/AIDS are spread. Phillip (2010) asserted that sexual behaviour is a crucial aspect of relationships that has proven to have great consequences that may include STIs, HIV/AIDS, or a single parent family. In this study, unsafe sex or risky sex refers to unprotected and inappropriate sexual behaviour carried out by in-school adolescents that seem to have potential harm to their reproductive and general health. In–school adolescents in Jigawa State may engage in unsafe sex because of the influence of pornographic media, poverty and parties organzed during festive periods like Sallah and Christmas that bring male and female closer to each other.

Unhealthy nutrition is another health risk behaviour that leads to morbidity and mortality. Eating habit has a substantial impact on individual’s health which is one of the leading causes of health problems such as coronary heart diseases, cancers, diabetes and kidney diseases (Okafor,

2009). Phillip (2010) explained that food is needed to provide energy for movement and warmth for our bodies. The authors rated that food is needed to build, maintain, and repair the body, and good health starts with eating right, which means eating enough of the right kind of foods. Poor dietary habits can lead to deficient or excess intake of nutrients in relations to the body’s requirement (Lucas & Gilles, 2008), which according to California Department of Public Health- CDPH (2012) leads to the risk and/or incidence of health problems among adolescents, such as obesity and diabetes. In-school adolescents may fall victims of unhealthy nutrition due to the fact that poverty is in the increase in the state because of joblessness coupled with high cost of fuel price, for these reason adolescents who are dependents on their parents may not have the chance of choosing what to eat. Stang and Story (2005) revealed that the recommended minimum number  of servings  per  food  for  adolescents  include  grains  six  servings,  vegetables three servings, fruits two , milk two and meat two servings per day.  In this study, unhealthy nutrition

is used to refer to the poor dietary and eating habits by in- school adolescents which may result to deficient or excess intake of nutrients that may lead to potential harm to their health.

Physical  inactivity,   which   has   been   linked   to   many   health   problems   such  as cardiovascular diseases, stress, overweight and obesity among others (Lee, Shiroma, Lobelo, Puska, Blair & Katzmarzyk, 2012), is another health risk behaviour. Strong evidence shows that physical inactivity increases the risk of many adverse health conditions, including major non- communicable diseases such as coronary heart disease, type 2 diabetes, breast and colon cancers, and  shortening  of  life  expectancy  (Lee,  Shiroma,  Lobelo,  Puska,  Blair  &  Katzmarzyk,

2012).National Institute of Health-NIH (2004) states that physically inactive youths with low levels of cardiovascular fitness, high percentage of body fat, and large amounts of visceral adipose tissue have unfavorable cardiovascular risk profiles. Physical inactivity is defined as an insufficient or non participation in physical activities/exercises (WHO, 2013). In this study, physical inactivity is regarded as inadequate or lack of participation in physical activities or exercises by in-school adolescents. This situation could  be  measured in terms of intensity, frequency or regularity and quantity of activity or exercise. Lack of adequate sports facilities and religious affiliation in Jigawa State may influence in-school adolescent’s physical inactivity in the state. Department of Health and Human Services (2008) revealed that the recommended guidelines for physical activity for children and adolescents include participation in at least 60 minutes of moderate to vigorous intensity physical activity daily for at least three days a week.

There is a great concern about the incidence of violent behaviour among children and adolescents. National Center for Injury Prevention and Control (2004) defined violence as threat or actual physical force or power initiated by individual that result in, or has a high likelihood of resulting in physical or psychological injury or death.This complex and troubling issue needs to be  carefully  understood  by  parents,  teachers,  and  other  adults.  These  behaviours  include explosive temper  tantrums, physical aggression, fighting,  threats or attempts to  hurt  others (including homicidal thoughts), use of weapons, cruelty toward animals, fire setting, destruction of property and vandalism (Academy of Child and  Adolescent Psychiatry – ACAP, 2012). Experience shows that, in Nigeria violent behaviours are common, and are mostly political and religious in nature, especially in the past two decades. Violent behaviour is used in this study to refer to aggressive action to self, other people or to property by in-school adolescents who may cause harm or damage to life and property. Experience show that adolescents in Jigawa State

involve themselves  in  violent  behaviours during political party’s  elections,  bullying  fellow students and the current insecurity in the neighboring states that involves violence may influence in-school adolescents’ involvement in violent behaviours. This may result to suicidal behahiours.

Suicidal behaviour ranges in degree from merely thinking about ending one‘s life (suicide ideation)  through developing a plan to commit suicide, or attempting to kill oneself and finally carrying out the act of completed suicide (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002). Krug, Dahlberg, Mercy, Zwi, and Lozano, (2002) asserted that suicidal behaviour has a large number of underlying causes. The factors that place individuals at risk for suicide are individual‘s life history, demographic factors, such as age and sex. Other factors include psychiatric, biological, social and environmental conditions. In this study, suicidal behaviour refers to any thought, plan or act of taking one’s life by in- school adolescents. Current insecurity in the northern part of Nigeria is compounded by the already serious economic hardship could make the life of in- school adolescents stressful, depressive and  hopeless. This stuations may influence suicidal thought  and  suicide  among  in-school  adolescents  in  Jigawa  State.  Adolescent  Suicide Assessment Protocol- ASAP-20 provides a guideline and scoring range from 0-3 for violent, suicidal, sexual and substance use behaviours. 0 score is regarded as “No” or “Never”, 1 as “Mild”, 2 as “Moderate” and 3 as “Severe” risk behaviour (Fremouw,Strunk, Tyner & Musick,

2008).

The aforementioned risk behaviours may occur or prevail across all age groups including adolescents. According to Lotrean, Laza, Ionut and Vries (2010) the leading causes of mortality and morbidity among people could be traced to several preventable health risk behaviours that are often initiated during adolescence and which may extend into adulthood.  These health risk behaviours can manifest in different patterns.

According to Ryan, Sponseller, Stuart, and Fisher (2008), pattern is the distribution, occurrence and characteristics of things, substance and events in an environment. Pridemore, Andrew, and Spivak (2003) and Avendo (2005) classified pattern into three forms as spatial, temporal and demographic. They described demographic pattern as the distribution of things, events or substances based on variables such as age, gender, level of education, marital status, occupation, socio-economic status (SES), health status and race. In this study, pattern refers to the exhibition or practise of HRBs by in-school adolescents that relates to their temporal, spatial and demographic characteristics or variations.

Demography is the study of human population, its structures, distributions, processes and dynamics (Klauke, 2000). It is concerned with the study of the distributions of human population such as, changes in the number of births, deaths, diseases by sex, age and socio-economic status (SES) in the community. When this is applied to health risk behaviours it means the distribution of HRBs among in- school adolescents according to age, gender, class and school type. Demographic pattern of health risk behaviours in the present study refers to the distribution of HRBs among in-school adolescents according sex, age, class and school-type. Suicide as one of the health risk behaviours was viewed by Pridemore, Andrew, and Spivak (2003) as the occurrence of suicide according to the different demographic groups including age, sex, marital status, occupation socioeconomic status and health status. This research work, therefore aimed to examine demographic variations such as age, gender, class and school type in relation to health risk behaviours of in-school adolescents. The determination of health risk behaviours based on these variables is necessary because persons of different characteristics who take part in various health risk behaviours would be targeted by directing strategies to reduce the occurrence of such behaviours in them.

Health risk behaviours can occur at different times or periods which are described as temporal pattern of occurrence. Pridemore,  Andrew and  Spivak (2003)  described temporal pattern as the time, days and months or seasons a particular event occurs. Hence, temporal pattern of health risk behaviours refers to the time, period or seasons in-school adolescents engage in health risk behaviours. Such periods include public holidays like Sallah, Christmas, Easter, New Year and Weekends or Weekdays. In this study, temporal pattern or variations refers to the time or period in which adolescents engage in various HRBs. Determining the time or period adolescents in the study area engage in particular health risk behaviour will be helpful in tackling these risky behaviours. For example, Nigeria Drug Enforcemnt Agency (NDLEA) monitor drug users and arrests them based on the time they usually congregate to perpetrate the

act.

Health risk behaviours among in-school adolescents could occur at  certain locations otherwise described as spatial pattern of occurrence.   Pridemore, Andrew, and Spivak (2003) described spatial pattern as involving location, which could be urban or rural areas. They also described spatial pattern based on geographical region in a particular country which could be divided into economic and administrative regions, or a result of the mixture of structural and

cultural forces, which may be the socio economic development in the west or eastern part of a country. Office of Management and Budget-OMB (2003) stated that spatial patterns could be based on country type, which reflects different level of urbanicity and metropolitan area such as urban, sub- urban or rural areas.  Avendo (2005) described spatial pattern as space, location or distribution of objects or events in a setting. The author further added that in a particular setting, objects can be used to answer questions about location and distribution of point of objects that could be arranged randomly, clustered or evenly distributed. In this study, spatial pattern refers to the occurrence of health risk behaviours according to geographical location of urban or rural area of adolescents. For example, unsafe sex as one of the health risk behaviours may be practised more by adolescents in rural than in urban schools or vice- versa.

Adolescents as defined by WHO are regarded as the young ones within the age range of

10 – 19 years (WHO, 1998; WHO, 2003). Accordind to Kaplan (2004) adolescents are young people between the ages of 10 – 24 years. Samuel (2006) described adolescent as a person or individual transiting from childhood who is capable of begetting an offspring because of his sexual maturity. He added that as adolescents advanced in life, they become more prepared and competent  to  shoulder  responsibilities  in  the  society,  and  claim  autonomy that  should  be respected to some extent. Adolescence as defined by Morhason, Oladokun, Enakpene, Fabamwo, Obisesan and Ojengbede (2008) is a transition period from childhood to adulthood involving multi-dimensional changes that are characterized by experimenting with new ways of behaving and risk – taking. Because of this developmental process of adolescents’ experimentation and risk- taking they tend to engage in various HRBs that might compromise their health (Terzian, Kristine, Andrews & Moore, 2011). Majority of adolescents are students in secondary schools or other educational institutions.

Student,  according Midrange  (2006)  is  a  learner  who  is  enrolled  in  an educational institution. According to Runchey (2009), students can be those who are within the age level of

11-18 years of lower and upper secondary school. In this study, in-school adolescent refer to individuals within the age range of 10 – 19 years who are currently undergoing secondary school education who are regarded as in- school adolescents. Therefore, the two terms (students and in- school adolescents) are used interchangeably in this study.   The study targeted in-school adolescents because they are believed to be engaging in HRBs (SANYRBS 2003, Eaton et. al.,

2012).Similarly, a South African National Youth Risk Behaviour Survey – (SANYRBS 2003)

found that adolescent’s life has drastically changed in the 21st century with an increase in health compromising behaviours such as suicide, violence, substance abuse, unhealthy eating, unsafe sex and physical inactivity.Sychareum, Thomsen, and Faxelid (2011), and Terzian, Kristine, Andrews and Moore (2011) also revealed that such risky behaviours might cause a threat to adolescents health later in life. Mungrulker, Whiteman, and Posner (2001) asserted that by the year 2010 there could be more adolescents (ages 10-19) alive in the world than ever before, who will constitute about 20 per cent of the world’s population with about 85 per cent of them in developing countries (Morhason et–al, 2008) and about 30 per cent of the total population in Nigeria (Muyibi, Ajayi, Irabor, Ladipo, 2010). Therefore, considering the above proportion of adolescents in the world, and in developing countries including  b Nigeria, attention should be given to this population group in order to protect them from the challenges posed by HRBs.

Studies have been calling for urgent attention on prevention of adolescents from health risk behaviours (Salami, 1997; Odejide, 2006), and according to SANYRBS (2003) and Eaton Kann, Kinchen, Shanklin,  Ross,  Hawkins, Harris,  Lowry,  McManus, Chyen,   Lim,Whittle, Brener, Wechsler (2010) most of these risky behaviours are preventable.  The researcher used in-school adolescents as subjects in this study for some obvious reasons: Adolescents are challenging targets for research aimed at understanding how health risk behaviours are formed, how they differ by ethnicity, gender, and environment. Adolescents are also seen as a window of opportunity for the development of health promoting or enhancing behavours and on the other hand they are vulnerable to various health risk behavious (Mistery, Maccarthy, Yancy, Lu & Patel, 2009). Studies  by Obot, (2000); UNICEF, (2002) and WHO (2004) have revealed that adolescents are found to be involved in various health risk behaviours like substance abuse which can lead to several social, economic and health problems.

Adolescents display sexual behaviours and developmental characteristics, many  of them manage  this  transformation  successfully  while  others  experience  major  stress  and  find themselves engaging in behaviours (e.g. sexual experimentation, exploration and promiscuity etc.) that place their well-being at risk (Esere,2008). Moreover, adolescents are said to be leaders of tomorrow who are the backbone of any nation’s economy. Therefore, adolescents should not be allowed to be destroyed by these preventable health risk behaviours that are capable of leading to morbidity and mortality. This study investigated HRBs among in – school adolescents because   studies (Center for Disease Control-CDC,2009; Eaton et al, 2012) show that they

engage in various HRBs, and these risk behaviours may be as a result of influence by peer group

(Prinstein, Boergers & spirito,2001) which is rampant among the youth.

Those  Adolescents  who  spend  more  time  in  school,  which  is  a  good  setting  for prevention  of  health  risk  behaviours,  are  less  likely  to  engage  in  health  compromising behaviours. Studies show, that the use of school curricular to promote protective attitudes and skills have met with some success in reducing and preventing health risk behaviours (Patton, Bond, Carlin, Thomas, Butler, Glover, Catalano & Bowes, 2006). From the foregoing assertions, it is evident that health risk behaviour among adolescents who are connected to school can be prevented.

To prevent, literally means to keep something from happening. According to Starfield, Hyde, Gervas and Heath (2008) prevention refers to the action to reduce the onset or eliminate the causes, complications or occurrences of diseases. The term prevention is reserved for those planned actions that occur before the initial onset of a problem (Center for Substance Abuse Prevention –CSAP (2011). CSAP further operationalized prevention as the promotion of constructive  lifestyles  and  norms  that  discourage  drug  use.  In  the  context  of  this  study, prevention refers to the promotion of positive lifestyles that  inhibits health risk behaviours among in- school adolescents. Prevention has been divided into three sub- categories. Frish and Frish (1998) categorize prevention as primary prevention – which focuses on whole population interventions,  secondary prevention –  which  focuses on  individuals  with  recognizable risk factors and tertiary prevention – which focuses on high risk persons with detectable indicators of a particular risk behaviour. Weissberg, Kumpfer, and Seligman (2003) and Starfield, Hyde, Gervas and Health (2008)   categorized prevention into universal preventive interventions that target the general population that has no  identified individual risk factors, selective preventive interventions which focuses on individuals or population subgroups who have biological, psychological, or social risk factors and indicated preventive interventions that target high-risk individuals with detectable symptoms or biological markers predictive of mental disorder. Therefore, when formulating prevention strategy for HRBs, the researcher considered the three prevention strategies in order to cover all in-school adolescents.This is because the strategies focuses on the whole population regardless of each student’s risk behaviour status. CSAP also added that prevention can be achieved through the application of multiple strategies.

Strategy refers to a complex web of thoughts, ideas and plans that provides general guidance for specific actions in pursuit of particular ends (Nickolas, 2012). Strategy, according to National Institute for Policy and Strategic Study –NIPSS (2008), refers to skilful formulation, coordination and application of objectives, using appropriate ways and means to promote and defend national interest. Strategy, in the context of the present study, refers to a plan of action designed to prevent health risk behaviours among in- school adolescents. Terzian, Kristine, Andrews and  Moore (2011) opined that  preventing adolescent risk  behaviours is  important because one risk behaviour can lead to another risk behaviour. The authors in effect, suggest the need for multi-behaviour prevention programmes for HRBs among in- school adolescents.

There is a serious lack of comprehensive documented data on frequent adolescent’s health risk behaviours in developing nations including Nigeria (United Nations Children Fund,

2002).  Although data on health risk behaviour of adolescents are sparse in Africa, the available data show a higher prevalence and diverse patterns of adolescent health risk behaviours in sub- sahara Africa, including Nigeria (Hawkins, 1994). The available data from studies on drug abuse in Nigeria show incidence of drug abuse in some parts of Nigeria as follows: Enugu (Igwe, Ngozi, Ejiofor, Emechebe,& Ibe,2009),   Sokoto and Ilorin   (Oshodi,Aina & Onajole,2010). Many drug related arrests were made by National Drugs Law Enforcement Agency (NDLEA) in

2011-2012 in Jigawa State (Akubo, 2012). Again, Jigawa State is one of the northern states which is currently in a serious political and religious crisis involving violence, suicide and vandalization which may be master minded by adolescents. Considering these happenings, in- school adolescents may not be excempted from these health risk behaviour in Jigawa State. Though literature or statistics regarding the status of HRBs in the state is limited, experience by the researcher shows that in-school adolescents in the state may not be unconnected with one form of health risk- taking behaviour or the other. For example, from the researchers experience there were disciplinary cases in secondary schools that  involved substance abuse, violence, sexual harassment and bullying among in-school adolescents in the state. The magnitude and occurances of these behaviours in the state was therefore the focus of this study. This needs to be established by the present study in order to fill part of this gap.

In order to give the present study a theoretical basis, theories and models were reviewed. These theories and models are Health Belief Model-HBM, Problem behaviour theory – PBT and Theory of Reasoned Action.

The Health Belief Model – HBM (Rosenstock, 1974) assumes that the likelihood of a person engaging in a specific health behaviour is a function of several beliefs. HBM is based on the core assumptions that a person will take a health related action if that person feels that a negative  health condition can  be  avoided,  and  has  a  positive expectation that  by taking  a recommended health action he will avoid a negative health condition, and believes that he can successfully take a recommended health action. For example, in-school adolescents may take part in exercise if they have the belief and expectation that exercise will prevent cardiovascular diseases.

Problem behaviour theory – PBT (Jessor & Jessor, 1977; Jessor, 1991) is a widely used theory  to  explain  behaviour  outcomes  in  adolescence.  The  ultimate  premise  of  Problem behaviour theory is that all behaviours arise out of the structure and interaction of three systems of psychosocial components. These components include the perceived-environment system, the personality system, and the behaviour system. The most recent reformulation and extension of problem-behaviour theory re-organizes the main constructs of the theory into protective factors and risk factors (Costa, 2008). Taking part in a health compromising behaviour, according to this theory, depends to a large extent on the constructs of the theory; protective factors and risk factors (Costa, 2008).

The Theory of Reasoned Action (TRA) developed by Ajzen and Fishbein (1980) is a model for the prediction of behavioural intention, based on the premise that humans are rational and that the behaviours being explored are under volitional control. The components of TRA are three general constructs: behavioural intention, attitude, and subjective norm. TRA suggests that a  person’s behavioural intention  depends  on  the  person’s attitude  about  the  behaviour  and subjective norms. A person’s attitude combined with subjective norms, forms his behavioural intention. This may help to find out if the problem is there or not increasing or is decreasing. This may also help in coming up with prevention strategies to reduce its prevalence.

Jigawa State secondary schools are of three types: exclusively boy’s schools (EBS), exclusively girls school (EGS) and mixed schools (MXS). These three types of schools were used in this study in order to make a wider coverage of in- school adolescents based on school type and gender. However, given the researcher’s account (based on experience) of some HRBs being perpetrated among in-school adolescents, the urge may be to suspect a high prevalence of HRBs among in-school adolescents. It would be wrong, however, to conclude that these HRBs

are perpetrated by in-school adolescents in Jigawa state without carrying out empirical study of the prevalence of HRBs. Reviewed literature revealed that the prevalence and patterns of HRBs among adolescents in many countries in the world exist. This information cannot be used against in-school adolescents in Jigawa state because; to the best knowledge of the researcher no study was conducted on the pattern of HRBs among in – school adolescents in Jigawa State.  This omission justifies the present study which aimed at  identifying patterns of and prevention strategies for HRBs among in-school adolescents in Jigawa state.

Statement of the Problem

Adolescents are expected to be healthy and run a healthy life through out their life, this is why programmes and frameworks (such as National Adolescent Health Strategy Frameworks) have  been  initiated  by  governmental  and  non-  governmental  organizations  to  protect  and promote their health in different parts of the world including Nigeria. Unfortunately, adolescents continue to engage themselves in several unhealthy risk-taking and behaviours that are perceived as harmful to health, especially by in-school adolescents whose risk- taking is part of their developmental process.  Moreso, study  in  USA  (Grunbaun,  Kann,  Kichen,  Williams,  Ross, Lowry, and Kolbe, 2001) on National Youth Risk Behaviour Survellance System revealed that high school students engaged in behaviours such as substance abuse, unsafe sexual behaviour, unhealthy eating, physical inactivity, violence and suicide known as health risk behaviours.

Health Risk behaviours as observed by the researcher were found among in-school adolescents in Jigawa state. From experience, the researcher observed that in–school adolescents in Jigawa State were engaging in unsafe sex because they interact with commercial sex workers as they participate in Okada operations, and most of these Okada operatives were found in groups  at  joints  where  substances are  abused.  According  to  the  Jigawa  state  development framework the human development report of the United Nations – 2007 put the jigawa state poverty level at 90.9%, and illiteracy level at 81.3%. The world bank also repoted that  Jigawa state is one of the poorest (77.5%) State in Nigeria. The poverty and illiteracy is high in the area these could influence unhealthy choice of food. Violence and suicide in the neighbouring states may also influence in-school adolescents HRBs in Jigawa state. In- school adolescents were physically inactive due to a serious lack of sports facilities and motivation in the state. However, the patterns and prevention strategies for the health risk behaviours among in- school adolescents in Jigawa state are not yet known.

Regrettably, studies have been conducted in the area of patterns of and prevention strategies for HRBs among in–school adolescents in different parts of the world, including some parts of Nigeria. To the best knowledge of the researcher; no such study has been conducted in Jigawa state. Empirical study on patterns of HRBs of in–school adolescents in Jigawa State is seriously neglected, hence the gap. This gap justifies the present study, and poses a question of what are the patterns of HRBs of in–school adolescents in Jigawa State. Understanding the specific pattern of health risk behaviour of in-school adolescents would stimulate prevention strategies which were population specific. Based on the above, the researcher considered it appropriate to find out the patterns of HRBs among in-school adolescents in Jigawa State for the purpose of coming up with prevention strategies that will promote adolescents health status. This is the thrust of the present study.

Purpose of the Study

The  purpose  of the  present  study was  to  identify  the  patterns  of and  prevention strategies  for  health risk  behaviours (HRBs) among  in-school adolescents  in  Jigawa State, Nigeria. Specifically, the study was to:

1.  determine substance use behaviours among in- school adolescents in Jigawa State

2.  determine unsafe sexual behaviours among in- school adolescents in Jigawa State

3.  determine unhealthy nutritional behaviours among in- school adolescents in Jigawa State

4.  determine physical inactivity behaviours among in- school adolescents in Jigawa State

5.    determine violent behaviours among in- school adolescents in Jigawa State

6.  determine suicidal behaviours among in- school adolescents in Jigawa State

7.  determine HRBs among  in- school adolescents in Jigawa State according to age

8.  determine HRBs among  in- school adolescents in Jigawa State according to gender

9.  determine HRBs among  in- school adolescents in Jigawa State according to class

10. determine HRBs among  in- school adolescents in Jigawa State according to school type

11. determine spatial pattern (urban & rural locations) of HRBs among in- school adolescents in Jigawa State

12. determine  temporal  pattern  (morning,afternoon,night,weekends &  festive  period)  of

HRBs among in- school adolescents in Jigawa State and

13. formulate prevention strategies against HRBs among in-school adolescents in Jigawa

State

Research Questions

The following research questions were posed to guide the present study.

1.  What are the substance use behaviours among in- school adolescents in Jigawa State?

2.  What are the unsafe sexual behaviours among in- school adolescents in Jigawa State?

3.  What are the unhealthy nutritional behaviours among in- school adolescents in Jigawa

State?

4.  What are the physical inactivity behaviours among in- school adolescents in Jigawa

State?

5.  What are the violent behaviours among in- school adolescents in Jigawa State?

6.  What are the suicidal behaviours among in- school adolescents in Jigawa State?

7.  What are the HRBs among in- school adolescents in Jigawa State according to age?

8.  What are the HRBs among in- school adolescents in Jigawa State according to gender?

9.  What are the HRBs among in- school adolescents in Jigawa State according to class?

10. What are the HRBs among in- school adolescents in Jigawa State according to school type?

11. What  are  the  spatial patterns (urban &  rural locations)  of HRBs among  in-  school adolescents in Jigawa State?

12. What are the temporal patterns (morning, afternoon, night, weekends & festive period) of

HRBs among in- school adolescents in Jigawa State?

13. What prevention strategies can be formulated against HRBs of in-school adolescents in

Jigawa State?

Hypotheses

The following hypotheses were postulated and tested at .05 level of significance

1.  There is no significant difference in the mean response scores regarding HRBs of in- school adolescents in Jigawa State according to age.

2.  There is no significant difference in the mean response scores regarding HRBs of in- school adolescents in Jigawa State according to gender.

3.  There is no significant difference in the mean response scores regarding HRBs of in- school adolescents in Jigawa State according to class.

4.  There is no significant difference in the mean response scores regarding HRBs of in- school adolescents in Jigawa State according to location (urban & rural).

5.  There is no significant difference in the mean response scores regarding HRBs of in- school adolescents in Jigawa State according to school type.

6.  There is no significant difference in the mean response scores regarding HRBs of in- school adolescents in Jigawa State according to temporal pattern (morning, afternoon, night, weekends, and festive periods).

Significance of the Study

The present study would be useful in several ways, because its results provided data on the pattern of and prevention strategies for health risk behaviours among in-school adolescents in Jigawa State. The result of this study would be beneficial to health educators, school authorities, Ministry of education (MOE), National Orientation Agency, NGOs, students and parents.

The findings on HRBs of in-school adolescents (like substance abuse) would be useful to health educators, who are teaching health topics in the schools. This would help them to know about the types of substance abused by students. The teachers can use this knowledge to sensitize the in- school adolescents on the dangers of HRBs such as substance abuse and its effects to their health. This would create awareness among in-school adolescents that would also help them in making informed decisions on matters affecting their health. This in turn would lead to the proper maintenance and promotion of their health status by adopting drugs free life.

The findings on unsafe sex would benefit school authorities and MOE. This information would  be  useful  to  the  authorities  in  planning  health  education  programmes  that  will  be beneficial to  in-  school adolescent’s reproductive health.This  information will  be  useful  in developing school health policies, to promote adolescents health.

The finding on demographic pattern of HRBs among in–school adolescents would be useful to National Orientation Agency (NOA). NOA would be able to identify HRBs perpetrated based on in–school adolescents’ age, sex and level of education with a view of helping these adolescents  to  reduce  or  prevent  these  risky  behaviours  through  public  enlightenment, workshops, seminars and conferences. Health educators will also find these findings useful in selecting appropriate topics based on their demographic variations that will suit the in–school adolescents. Brainstorming these adolescents through classroom interaction would raise their understanding of the danger of HRBs which in turn will enhance their health.

The findings on the temporal patterns of in – school adolescents HRBs in Jigawa State will be useful to the school authorities. The data generated will help the school authorities to know the time and period in–school adolescents participate in various HRBs. This will enable them to plan surveillance.   The school authorities can organize programmes at this particular time in order to divert the attention of the in–school adolescents who participate in HRBs to other useful activities.

The findings on spatial pattern of in-school adolescents HRBs in Jigawa state would be beneficial to NOA and NGOS. The data generated on the spatial pattern will give an insight on the location (rural / urban) where various HRBs occur most; this will convince them on where to focus their attention. These agencies and organizations by means of organizing enlightenment campaign, workshops and seminars in the location HRBs occur most will help in the reduction and prevention of such HRBs among in– school adolescents in the area. These activities will help in – school adolescents to develop awareness and coping skills that will help them stop or refuse risky behaviours.

Data generated on the differences in the demographic pattern of in–school adolescents HRBs will be utilized by health educators, school authorities, NOA and NGOS to be able to establish  what  age,  sex  and  level  of  education  should  be  stressed  in  the  enlightenment campaigns, health talks, lectures, radio and TV jingles and drama for the most vulnerable groups. These activities will help the in–school adolescents develop awareness on healthy behaviours and refrain from various HRBs that are damaging to health. Counsellors will also benefit from these findings by helping adolescents based on their age, sex, level of education and the type of HRBs they participate in.

The findings generated on the differences in temporal pattern of HRBs among in–school adolescents will be useful to school authorities and NGOS in demystifying the differences in the period HRBs mostly occur among in–school adolescents, so as to mount programmes based on these differences in order to  target  the appropriate group at  the right  time. By scheduling programmes such as quiz, gardening, sport competitions and staging drama that will cover the period or time of in–school adolescents HRBs, these adolescents will be occupied by these programmes.

The finding on the differences on spatial pattern of HRBs of in-school adolescents will be useful to NGOs and MOE and health educators. The data generated revealed the differences on the spatial pattern, and this will enable them to know the particular location HRBs occur so as to mount  prevention strategies.  These  strategies  will  help  the  in–school adolescents  to  avoid unhealthy behaviours and develop positive healthy behaviours.

The  result  of HRBs  prevention strategies  will  be  useful  to  governmental and  non- governmental organization in the formulation of policies and programmes for in–school adolescents. The findings on the prevention strategies of HRBs will be useful to health educators, parents and researchers. The Health educators and  researchers will use this  information to publish works and design appropriate programmes against HRBs. The data generated will add to the pool of existing knowledge and serve as a reference material for health educators, counsellors and other agencies when organizing workshops and seminars.

Finally, findings of the study would help to verify the theories of reasoned action, health belief  model  and  problem  behaviour  theory  thereby  bringing  out  their  usefulness  and applicability in influencing adolescents’ behaviour positively. Knowledge on the protective and risk  factors as explained  by the  problem behaviour theory would be  useful to  programme designers who would use this knowledge in designing prevention strategies to reduce or prevent a particular HRB among in–school adolescents.

Scope of the Study

The study covered all in-school adolescents in government owned secondary schools in Jigawa state, Nigeria. These are schools under the management of Jigawa State Ministry of Education, the body with sole power to enforce the implementation of the findings of this study. Other schools owned by individuals and organizations are few in number than the state government owned schools, and they do not operate in rural areas, access to students in private schools may be denied by some proprietors as such they were  excluded from the study. The study covered the nine education zones situated at Gumel, Hadejia, Ringim, Kazaure, Kafin Hausa, Jahun, Dutse, Birninkudu and Birniwa zonal offices respectively.

The study covered HRBs such as, substance abuse, unsafe sexual behaviour, unhealthy nutrition, physical inactivity, violence and suicide among in-school adolescents in Jigawa state. This study investigated the demographic patterns of age, gender, class and school type, temporal pattern (morning, afternoon, night, weekends and festive periods) and the spatial pattern (urban and rural). Finally, prevention strategies were formulated for in- school adolescent health risk behaviours mentioned above. All of the in-school adolescents in the area of study constituted the population for the study.

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