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

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

Sexual education is a lifelong process of acquiring information on sex and forming attitudes, values and beliefs. It involves sexual development, sexual and reproductive health, interpersonal relationships, affection and intimacy 1 . Abstinence-only sexual education teaches the adolescents to abstain from premarital sexual intercourse because of the advantages it offers. Such advantages include prevention of unintended pregnancies and prevention of contracting HIV/AIDS and other sexually transmitted infections. According to the Federal Law of the United States of America (USA), every school-aged child should not engage in sexual activity 2,3 . The USA Federal law further advocates sexual activity within the confines of monogamous marital relationship to guard against adverse psychological and physical effects associated with premarital sexual activity. Bearing children outside marriage has serious effects on the child, the mother and the society as a whole [3][4][5][6] . The Federal Law of United States of America also posited that, abstaining from sexual activity outside marriage allows for maturity and understanding of self 3,7 .
Studies disclose that it is comprehensive sexual education and not abstinence-only that will delay first sexual activity 2,3,[8][9][10][11][12][13][14] . Abstinenceonly sexual education lacks strong evidence of effectiveness because of faulty designs 3,15,16a . Abstinence-only sexual education does not positively affect the sexual behaviour of adolescents, lacks the message of sexually transmitted infections to its recipients and the positive effect in a few cases does not last for a long time 16b,17 .
According to Bruckner and Bearman 18 and a study by the Alan Guttmacher Institute 19 those that embrace abstinence-only sexual education still have sex before they get married. There is no difference between adolescents that accept abstinence-only sexual education and those who do not in terms of number of sexual partners and ages of first sexual intercourse 17 . Abstinence-only sexual education does not reduce the scourge of HIV/AIDS 16b . Bennett and Assefi saw the failure to provide adolescents with information about contraception as a serious weakness of abstinence only sexual-education 20 .
The proponents of abstinence-only sexual education frown at the role of comprehensive sexual education in emphasising so much on the reliability of contraceptives while de-emphasising their failure rates and the possibility of contracting new sexually transmitted diseases including HIV/AIDS 21 . They further frowned at the double message of comprehensive sexual education such as encouraging the delay of first sexual intercourse and promoting the use of contraceptives 22 . They are also blamed for stressing the possibility of contracting sexually transmitted infections to the extent of falsifying information to establish the negative aspect of comprehensive sexual education 1,23,24 . Studies further reveal that sexual educators do not stress enough on sexual intercourse or bring in sensitive issues such as homosexuality and abortions. The adolescents posited that the basic message is that they should not have sex 19,25-27 . The proponents of comprehensive sexual education attributed the ineffectiveness of condoms and contraceptives to poor-quality research 28 .
Abstinence-only sexual health education is also blamed for withholding information on the positive aspects of sexual relationships, while magnifying the emotional risks and pitfalls associated with premarital sexual activity 1,24 . Modern lifestyle is characterised by a high rate of broken marriages, predisposing an individual to having many sexual partners 1 . According to some studies the age of first marriage has risen to 30 years, with a fifth of such marriages ending in divorce within a period of five years 29 . Conversely the age at first sexual intercourse has dropped to 16 years with very few people having their husbands as their first sexual partners 30,31 . The data on adolescents' sexual behaviour in the developing world with a high prevalence of HIV/AIDS suggests unacceptability of abstinence-only sexual education. Some countries do not accept abstinence-only sexual education even in the face of the high prevalence of HIV/AIDS. Some countries expect sexual educators to encourage adolescents to delay their first sexual experience while also providing education on contraception and sexual health services 32 . In some countries, the requirements for teaching any type of sexual education are clearly outlined for the sexual educators 33 .
Most studies reveal comprehensive sexual education as the preference of parents and adolescents [34][35][36] . Studies advocate comprehensive sexual education for unmarried sexually active adolescents 3 . Studies also recommend abstinence-only sexual education with information on contraception and risk-reduction behaviour for the few sexually inactive adolescents. These align with the position of Collins and Priya that parents and adolescents prefer comprehensive sexual education to abstinence-only sexual education 37 . Most studies revealed that the opinion of adults differs on the type of sexual education to teach adolescents. Most of the adults feel 7 th to 9 th graders should be taught 'abstinence only' while some advocate the teaching of contraception use 38 . Most studies also show that a greater percentage of adolescents prefer sexual orientation that will teach them about the use of contraception and sexually transmitted infections than abstinence-only sexual education 39 . Other studies reported the positive outcome of abstinence-only sexual education ranging from reduced sexual activity, pregnancies, abortions to more successful deliveries 40 . In line with this, John and Jemmott disclosed the success of abstinence-only sexual education in reducing sexual activity among youths 41 . In support of the findings of this new study, Rector submitted that out of 15 scientific evaluations of abstinence-only sexual education, 11 of them demonstrated its effectiveness in reducing adolescent sexual activity 42 .

Amendments from Version 1
We appreciate immensely the efforts of the reviewers of our original manuscript. Their various suggestions have been incorporated accordingly to produce a second version of our work. All pointed out areas such as measures of efficacy of abstinence-only sexual education which were not addressed by the study are put up as suggestions for a follow up study. Conclusion and other areas pointed out have been amended accordingly to rule out any form of confusion. Comparison by religion is ruled out since Christianity is the dominant religion. Some aspects of the work without any negative effect on the entire work are removed to shorten the manuscript to avoid a possible loss of interest by some readers. Some text descriptions are removed where tables are self explanatory. Efforts are made to clarify that this work only examines the perspectives on abstinence-only sexual education which was found by previous studies as an effective for promotion of sexual health.

REVISED
A survey of the National Campaign to Prevent Teen Pregnancy in 2001 showed that 93% of abstinence sexual education came from the society 43 . They concluded that abstinence-only sexual education is the only 100% effective method to prevent teenage pregnancy and sexually transmitted diseases 4 . They further reminded that condoms cannot provide 100% protection against unplanned pregnancy and sexually transmitted infections and also that premarital sex can lead to life threatening health problems such as abortion and its associated complications 5 . They feel burdened that sexual, contraceptive and HIV information can provoke early sexual initiation among the adolescents 5 . Abstinence-only sexual education has positively produced a corresponding decrease in teenage pregnancy 4 . Studies have demonstrated that religion acts as a deterrent to early sexual activity 5 . In line with this, many adolescents submitted that morals, values and religious beliefs significantly influence the decision to have sex or not.
In deciding whether or not to have sex, the Organization of Concerned Women for America also decried the outcome of sex without love or responsibility supported by public policies. This results in the breakdown of nuclear families, increases crime, poverty, teen births and AIDS which in turn negatively affects the health of the general public. This only shows lack of values 5 .

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

Purpose of the study
According to Focus on the Family group, sex should be avoided the same way as the use of guns, tobacco, alcohol and drink-driving 46 . They sternly condemn the advocacy for the use of condoms against unwanted pregnancies and sexually transmitted diseases in favour of abstinence-only sexual education 47 . Previous studies document the advantages of abstinence-only sexual education in reducing adolescent sexual activities and the associated health problems. This study investigated the perspective of secondary school adolescents in Nigeria on abstinence-only sexual education as an effective tool for promoting adolescent sexual health. The findings will help in planning informed corresponding intervention programmes.

Material and methods
An analytic descriptive survey design was used for the study. Participants' consent was also obtained. Participation was voluntary and anonymity was also assured and maintained.

Results
All of the participants in this study were adolescents between the ages of 10 and 19 years (Table 1).
Three research questions and six hypotheses were formulated in this study. Each one of them is addressed as follows: What are the perspectives of adolescents on the advantages of abstinence-only sexual education? Seven positive statements representing the advantages of abstinenceonly sexual education were made ( Table 2). The general perspective of Nigerian secondary adolescents on the advantages of abstinence-only sexual education was negative. A greater number of the respondents did not agree with the statements highlighting the advantages of abstinence-only sexual education. However, taking into consideration the number of respondents from each age group that agreed with the statements highlighting the advantages of abstinence-only sexual education, it was found that the youngest age group (11-13 years) of  adolescents ranked first. This implies that this group had the highest number of positive respondents in line with their total number when compared with the young (17-19 years) and younger (14-16 years) groups. Age group 11-13 years therefore demonstrated the likelihood of accepting abstinence-only sexual education.
What are the perspectives of adolescents on the disadvantages of abstinence-only sexual education?
The same number of statements was also made on the disadvantages of abstinence-only sexual education (Table 3). Generally, more respondents agreed with five while disagreeing with the last two of the seven statements highlighting disadvantages of abstinenceonly sexual education. Of the total number of respondents that disagreed with the statements of disadvantages, the young adolescents (17-19 years) ranked first followed by the younger ones (14-16 years). More of the young adolescents out of their total number disagreed with the statements of disadvantages when compared with the responses of the other two groups. This might be a factor of a better understanding than the younger age groups. Moreover, the problem might not be with the type of sexual education but mostly the willingness to practice.
What are the perspectives of adolescents on the acceptance of abstinence-only sexual education?
The general perspective of the respondents to five statements representing the acceptance of abstinence-only sexual education was negative. More respondents were against abstinence-only sexual education demonstrating a negative perspective on the acceptance of abstinence-only sexual education (Table 4). For instance 1686 out of the total respondents of 2000 objected to wanting a strong abstinenceonly message. The youngest adolescent group (11-13 years) had the highest number of respondents out of their total number of those in favour of abstinence-only sexual education. For instance, more of them when compared with other age groups wanted sex to be saved until marriage. More of them (11-13 years) also wanted a strong abstinence message and education. This indicates that the youngest group of adolescents were more likely to accept abstinence-only sexual education than other age groups.
Is there any significant relationship between age and perspective on abstinence-only sexual education? A significant relationship existed between age and the students' perspective on abstinence-only sexual education. (r = 0.123**, N = 2000, P < 0.01) ( Table 7). Young age specifically had an influence on the respondents' perspective on abstinence-only sexual education in this study. Null hypothesis is rejected.
Is there any significant relationship between religion and perspective on abstinence-only sexual education? Respondents belonged to different religious organisations but only 31 out of the total respondents of 2000 were pagans (Table 6). A greater proportion were Christians which numbered up to 1877  Gender and perspective on abstinence-only sexual education? A greater number of male and female adolescents demonstrated a negative perspective to the advantages of abstinence-only sexual education. This is deduced from their responses to the statements reflecting the advantages of abstinence-only sexual education. Out of the total number according to gender that responded in favour of the advantages of abstinence-only sexual education, more females were in favour of three statements while more males were in favour of four statements.
More male and female respondents disagreed with five of the statements reflecting the disadvantages of abstinence-only sexual education and agreed with two of the statements. Out of the total number of those that did not agree with the disadvantages of abstinenceonly sexual education, more males responded to four of the statements while more females responded to three of the statements.
An outright negative perspective on the acceptance of abstinenceonly sexual education was demonstrated by both male and female adolescents. A greater number of male and female respondents reacted negatively to statements which were in favour of abstinenceonly sexual education.
More females responded in favour of acceptance of abstinenceonly sexual education in two statements out of five. More males responded to three of the statements. Specifically, more males than females advocated for sex to be saved until marriage and also wanted a strong abstinence message and education. This study found that boys are more likely to accept abstinence-only sexual     education than females. This finding might be connected with the larger number of males among age 11-13 years group of adolescents with a likelihood to accepting abstinence-only sexual education than other older adolescents (Table 16).
There was no significant relationship between gender and perspective of the adolescents on abstinence-only sexual education. (r = 0.051, N = 2000, P < 0.05) (Table 11). Gender had no influence on perspective of abstinence-only sexual education in the study. Null hypothesis is therefore retained.
Was there any joint effect of independent variables (age, gender, religion, ethnicity and parent's occupation) on perspective of abstinence-only sexual education? A significant joint effect existed between the independent variables (age, gender, religion, ethnicity and parent's occupation) and perspective on abstinence-only sexual education (F (5, 1994) = 13.085; R = 0.178, R 2 = 0.032, Adj. R 2 = 0.029; P < 0.05) ( Table 13). About 3% of the variation was jointly accounted for by the independent variables. The null hypothesis is therefore rejected.
Would there be any significant relationship between perspective of abstinence-only sexual education and age, gender, religion, ethnicity and parent's occupation? A positive significant relationship existed between perspective on abstinence-only sexual education and age, a negative significant relationship between perspective of abstinence-only sexual education and religion but no relationship between perspective of abstinenceonly sexual education and gender, ethnicity and parents' occupation (Table 15).

Discussion
Young age is an important factor in the success of abstinence-only sexual education. According to Massey, three significant periods exist where values are learnt. They are the imprint period, modelling period and socialisation period 48 .
During the imprint and modelling periods, children learn through instructions and modelling. During these periods, the behaviour of children is formed from instructions given to them and examples before them. Therefore, if abstinence-only sexual education is taught between the imprinting to modelling period, it might produce positive results in adolescent lives. During the period of socialisation which starts from 13-21 years, a child is already exposed to different types of views and influences. Introducing abstinence-only sexual education might not be successful at this stage because for several reasons. Probably, most of the adolescents would have become sexually active by this age. Secondly, they might have a conviction already for sexual intercourse outside the confines of marriage as an ideal way of life. It is possible to accept instructions at a younger age. Those within the age range of 11-13 years were 8.8% (N = 176) of the total population and they were the youngest group in this study. Most of them would have constituted the population in senior secondary one. The largest number of respondents was within the age bracket of 14-19 years. They might have established their beliefs about premarital sex and are probably sexually active already. This could be an explanation for the larger number of respondents that opposed abstinence-only sexual education.
The major finding of this study shows that Nigerian secondary school adolescents generally have a negative perspective towards abstinence-only sexual education. Out of a total population of 2000 respondents, abstinence-only sexual education was accepted by only 314 respondents and rejected by 1686. Those that had the tendency to accept abstinence-only sexual education were within the age bracket of 11-13 years and are the youngest group of adolescents. The highest number of those that advocated for sex to be saved until marriage and also wanted abstinence-only sexual message and education belonged to the youngest group of adolescents. A greater number of respondents that were not in favour of abstinence-only sexual education belong to the 14-19 years age bracket and are the older adolescents. These are the ones within the age of socialisation already. With their exposure to different views about premarital sex, it is likely that most of them are already sexually active and have already taken a position for premarital sex. The message of abstinence-only sexual education at this stage might not be accepted with ease.

Null hypothesis 3:
There is no significant relationship between religion and their perspective on abstinence-only sexual education.  Null hypothesis 4: There will be no joint effect of independent variables (age, gender, religion, ethnicity and parent's occupation) on perspective of abstinence-only sexuality education.
Religion had a negative significant influence on the adolescents' perspective on abstinence-only sexual education with the highest number of respondents being christians. Previous studies revealed that almost no religion supported premarital sexual activities. The studies of Concerned Women for America, demonstrated that religion acts as a deterrent to early sexual activity 5 . Many adolescents in previous studies posited that morals, values and religious beliefs significantly influence the decision of whether to have sex [3][4][5] . Probably, those that accepted abstinence-only sexual education would have been influenced by their religious beliefs. This also implies that teaching of religious values could be a useful tool for inculcating the values of sexual intercourse within the confines of marriage. Fortunately 93.9% (N = 1877) of the total respondents were Christians 4.3% (N = 86) were Muslims and 1.6% (N = 31) belonged to traditional religion. Only 0.3% (N = 6) were pagans. Christianity should therefore teach abstinence-only sexual education period.
A greater number of male and female Nigerian secondary school adolescents generally have a negative perspective towards abstinenceonly sexual education. Out of the number that favoured abstinence-only sexual education, more females than males were in favour of some statements period, in other statements more males than females were in agreement. Surprisingly, more males than females advocated for sex to be saved until marriage and also wanted abstinenceonly sexual message and education. One would have expected a more positive response from the females than the males because a greater proportion of the respondents in this study were females 64.9% (N = 1298) of the total respondents. This finding is also sad because it is the females that suffer most from the adverse effects of premarital sexual activities. They are the ones that drop out from schools in the advent of pregnancy. They suffer the adverse effects of early pregnancy and child birth or abortion so one would have expected more females than males to advocate for sex to be saved until marriage. At the other hand more males than females advocating for sex to be saved until marriage and also wanting strong abstinence message and education might not be unconnected with the high number of males among the 11-13 years adolescents (Table 16). This study has revealed age 11-13 years as the group with a more likelihood of accepting abstinence-only sexual education than the other two groups of adolescents.
Ethnicity did not make any significant contribution to perspective of adolescents on abstinence-only sexual education. This shows that adolescents are all the same anywhere and everywhere. This study also revealed that about 80% of the total respondents could not define sexual education. Probably most of the responses would have been informed by ignorance.

Conclusion
This study therefore concludes that young adolescents within the age bracket of 11-13 years demonstrated the likelihood of being more receptive to abstinence-only sexual education. This finding suggests the need to teach abstinence-only sexual education at an early age by parents who are the first contacts, in religious organizations by sunday school teachers and then by teachers in schools where abstinence-only sexual education is preferred. This will in turn form a part of the values and belief system of the child which might not be easily compromised.

Translations to health education practice
Knowing the perspective of adolescents on abstinence-only sexual education is the key to knowing the right intervention programme to design and the approach to adopt for the implementation of such programme. This study reveals that abstinence-only sexual education will not work for majority of the respondents because it is not acceptable to them. For instance, only 314 out of 2000 respondents agreed with statements reflecting acceptance of abstinence-only sexual education while 1686 respondents disagreed. A very important finding of this study is that abstinence-only sexual education might only impact positively on those within the imprint and modelling periods of development. This includes those within the age range of 11-13 years. Those within the age bracket of 14-19 years seem to have formed their opinion already from different socialisation processes. This finding suggests the need for a second study only for those within the imprint and modelling period. A new study should address the efficacy of abstinence-only sexual education and the willingness by the young adolescents to practice messages of abstinence-only sexual education. The intervention programme based on the findings of this study recommends a two-dimensional approach. Comprehensive sexual education for the older age group (14-19 years) and abstinence only for the younger ones (11-13 years).
The implications of this study are directed specifically to parents who are the primary caretakers of the children. They have the first contact with the children during the early years. The religious organisations and the school health educators are also very important role players. Findings from this study suggest the introduction of different programming strategies aimed at teaching abstinenceonly sexual education as a way of life within the early ages. This might help in safeguarding adolescents especially the females from Religious organisations should never relent in teaching the morals and values of abstinence-only sexual education to the youngest group of adolescents with the likelihood to accept. This should be commenced early enough right from their Sunday school classes with negative beliefs and design some remedial programmes for them to reduce the negative influence on other adolescents through the process of socialisation. It can be seen from this study that many problems faced by adolescents as a result of pre-marital sexual activity are avoidable.

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

Competing interests
No relevant competing interests were disclosed.

Grant information
The author(s) declared that no grants were involved in supporting this work. the numerous life threatening adverse effects associated with premarital sexual activities.

References
Parents must have a sound knowledge of sexual education so that they can serve as effective teachers to the children. This is the reason it is very good also to empower today's adolescents with the knowledge of sexual education and the benefits as future parents. Preparing the adolescents of today to become knowledgeable parents of tomorrow might assist in creating a subsequent future of reduced cases of teenage pregnancies, deliveries, abortions and sexually transmitted infections. Whatever is wrong today can be corrected through adequately prepared adolescents who are the future of any nation.
The authors submitted a manuscript in which they assessed the perspectives of Nigerian secondary school students on abstinence-only sexual education. They applied a questionnaire to obtain the information. The sample size is correct and the analysis of the data is well conducted. However, my specific comments are that the title does not reflect what the authors did, as the authors did not evaluate the efficacy of abstinence-only sexual education; in fact, there is no evidence of whether the abstinence-only sexual education changes the attitudes of the students. Furthermore, the comments on religion are inappropriate because most of the interviewed students practiced only one religion.
In my opinion, the following statement is strongly speculative and inappropriate because the authors did not obtain any evidence for it: "Preparing the adolescents of today to become knowledgeable parents of tomorrow can assist in creating a subsequent future of reduced cases of teenage pregnancies, deliveries, abortions and sexually transmitted infections. Whatever is wrong today can be corrected through adequately prepared adolescents who are the future of any nation." I have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
No competing interests were disclosed.

Competing Interests:
Author Response 04 Jun 2013 , University of Port-Harcourt, Nigeria, Nigeria

Mfrekemfon Inyang
Much thanks to the referee for the comments. In this study the authors only looked at the Nigerian secondary school adolescents' perspective on abstinence-only sexual education. The purpose of this study is also clearly stated. The authors have not indicated anywhere in the study of evaluating the efficacy of abstinence-only sexual education, but only intend to do that in a follow up study. This study is not an intervention study so it could not have shown if abstinence-only sexual education could change attitude. It is always necessary to clarify needs before following up with appropriate intervention. The intent for a follow up intervention study has been indicated. The aspect of religion has been earlier addressed. The statement is a recommendation to educate the adolescents with the knowledge of what is right or wrong early in life. Numerous studies have proven the transforming power of information. It has also been established that most of the wrong-doings of adolescence are either due to wrong information or outright ignorance. The title gives the impression that it refers to the entire population; however, it is true only for the The title gives the impression that it refers to the entire population; however, it is true only for the youngest group -further clarification is needed. The majority of individuals in this study are Christian, so comparison by religion does not appear to be adequate. The authors need to emphasise this and may describe such findings in a single statement. The manuscript is too long, as is the introduction. It should be shortened to ensure the reader does not lose interest. Several text descriptions should be omitted as tables are self explanatory, e.g. table 1. Furthermore, it should be mentioned that the data only refers to a particular group of the population.
I have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
No competing interests were disclosed. The authors examined secondary school student perspectives on abstinence-only sexual education through the use of a questionnaire. The sample size is robust, the statistical methods are appropriate, and overall the paper is well written. Unfortunately, the title of the paper is misleading. Specifically, the authors only examined student perspectives and there were no measures of efficacy of abstinence-only sexual education. The data suggests only that students of the youngest age group are more likely to be receptive to abstinence-only sexual education but no evidence is presented on whether the students would or in fact do incorporate these messages into their lives. The authors also suggest that the data shows that there is a significant relationship between religion and student perspective; however, the numbers of students in other religions than Christianity is too small to make meaningful conclusions. Moreover, it is unclear if the students simply identify with a particular religion or actively participate in the religion. Finally, the conclusions reached and the implications for health education practice are overstated. The most that can be concluded from this study is that young adolescents are potentially more receptive to most that can be concluded from this study is that young adolescents are potentially more receptive to abstinence-only sexual education. It cannot be concluded that abstinence-only sexual education will be more or less effective than no education or alternative education messages in shaping student sexual practices.
I have read this submission. I believe that I have an appropriate level of expertise to confirm that it is of an acceptable scientific standard, however I have significant reservations, as outlined above.
No competing interests were disclosed. Competing Interests:

Version 1
Author Response 29 Apr 2013 , University of Port-Harcourt, Nigeria, Nigeria Mfrekemfon Inyang I appreciate the referee's observation. We did not address measures of efficacy of abstinence in our study. This is why this study suggested a second study for those within the age range of 11-13years who demonstrated potential receptivity to abstinence-sexual education. This can be found under translations to health education practice. Measures of efficacy of abstinence is going to be specifically added.
: The conclusion of the study says that based on the potential receptivity of the young ones to Conclusion abstinence-only sexual education, then it can work with a timely and early introduction in the lives of young adolescents that will grow up with it. This requires teaching abstinence-only sexual education at an early age as what is right and obtainable by parents who are the first contacts. Children learn through instructions and modelling during the imprint and modelling periods which spans between 11-13years (Massey, 2011). This means working on the potential found in this study to develop along that line. It is not concluded that abstinence-only sexual education will be more or less effective than no education or alternative education messages in shaping student sexual practices.
: Respondents were asked for religions they were actively involved with. Data analysis showed Religion Christianity as the dominating religion. This explains the emphasis put on Christianity to teach abstinence-sexual health education. However, this was not surprising since Christianity is the dominating religion in the study area.
There are no competing interests. Competing Interests: