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Influence of Family Expressiveness and Moral

Emphasis on The Sexual Behaviour of Adolescents
Attending the Ekiti State University Teaching Hospital
(EKSUTH), Nigeria
Agbesanwa Tosin Anthony1, Obimakinde Abimbola Magaret2, Aina Felix Olukayode1, Agboola Segun
Matthew3, Ibrahim Azeez Oyemomi3
1
Department of Family Medicine, Ekiti State University Teaching Hospital. Ado Ekiti.
2
Department of Family Medicine, UCH, Ibadan.
3
Department of Family Medicine, Federal Teaching Hospital, Ido Ekiti
Corresponding Author: Dr. Agbesanwa Tosin Anthony
tosinagbesanwa@yahoo.com
ABSTRACT
Background: Adolescents are sexual beings. Some may experience challenges with their sexuality. This includes
unhealthy sexual behaviours with its attendant negative outcome. Awareness of family influence will help parents
create an atmosphere which will guard against this. Some studies have highlighted the effect of the family structure
on adolescent sexuality; however, little has been done on the impact of family members’ emotional expressivity and
moral emphasis on adolescents’ sexual behaviour. Aim: To assess the influence of family members’ emotional
expressivity and moral emphasis on adolescents’ sexual behaviour. Methods: This was a descriptive cross-sectional
study, on 321 adolescents selected by consecutive sampling technique. The data collection was by means of structured
interviewer administered questionnaire. Result: The mean age of the respondents was 15.9 ± 2.6 years. Majority of
the exposed adolescents studied had initiated sex by age 14 years (X2 = 6.312, P = 0.012). There was significant
association between respondents’ poor score on perceived family expressiveness and coital experience (X2 = 5.526,
P = 0.019). Poor scores in perceived moral religious emphasis was observed to have statistically significant association
with coital experience (X2 = 9.597, P = 0.002). Conclusion: Family Physicians should initiate adolescents’ family
therapy on the benefits of encouraging open communication and adherence to religious values as these have protective
influence against risky sexual behaviours among adolescents. The benefits of delayed sexual debut should be
emphasized to adolescents at the earliest encounter.
Keywords: Family expressiveness, moral emphasis, family environment, adolescent, sexual behaviour
To Cite This Article: Agbesanwa Tosin Anthony, Obimakinde Abimbola Magaret, Aina Felix Olukayode, Agboola Segun Matthew, Ibrahim Azeez
Oyemomi. Influence of Family Expressiveness and Moral Emphasis on The Sexual Behaviour of Adolescents Attending the Ekiti State University
Teaching Hospital (EKSUTH), Nigeria. International Annals of Medicine. 2019;3(1). https://doi.org/10.24087/IAM.2019.3.1.634
International Annals of Medicine
Vol1;3(1);2019
1. INTRODUCTION children in an atmosphere of minimal conflict ensures

parents are able to provide adequate monitoring and
It has been observed that when adolescents are supervision which have been linked with later sexual
supported and engaged positively by their families, debut, fewer sexual partners, and increased condom
they thrive well as individuals and contribute use [11]. The dual effects of high control and strong
significantly to the society at large [1]. Generally, support by parents may lead to a reduction in the
adolescents learn to share intimacy, establish and likelihood of early intercourse or indulgence in risky
maintain satisfying relationship without feeling sexual behaviours like unprotected intercourse [10].
inhibited [2,3]. They often perceive independence as
something to experiment with and the tendency to 2. METHODS
risky sexual behaviour become prominent as they take
on new responsibilities in life. Consequently, the This study was a descriptive cross-sectional study, on
family environmental influences especially parental three hundred and twenty-one (321) adolescents
interaction has a great impact on the sexuality of the selected by consecutive sampling technique. They
growing adolescent [4]. were recruited over a period of 4 months spanning
The influence of parents in shaping the lives of their March to June 2015. Sample size was calculated using
children from birth to adulthood is overwhelming [5]. the formula; n = (Zα)2 p q / d2, where p =28.3% (the
Some parents get confused and agitated at their proportion of the target population estimated to have
adolescents’ prepubescent changes however they need had sexual intercourse according to a previous study
to understand this phase of development is important (12)). A minimum sample size aforementioned was
to be able to relate and help these adolescents navigate arrived at.
to healthy adulthood [5,6]. Highly rated personal All assenting adolescent patients aged 10-19 years
factors, family structure and function have been noted were recruited, after parental permission were
to have a positive role in delay of sexual initiation [5]. obtained. Adolescents who were critically ill and those
It is however worth noting that adolescents living with that were married were excluded. Married adolescents
single parent have been reported to get sexually were excluded because the effect of their own family
exposed early when compared with their peers in dynamics on sexuality may be different from what
families where parents are married [7]. In some operates when they were with their parents. A
families, there may not be problem at this stage but in structured interviewer administered questionnaire was
others conflicts may ensue, nevertheless effective used for data collection and patients who met the
parental role in helping adolescents navigate this stage inclusion criteria and consented to participate in the
of their life is pertinent [8]. One of the factors that can study were recruited. The survey was conducted using
aid development of healthy sexuality in adolescence is standardised interviewer-administered questionnaires.
education. The first school an adolescent is exposed to The questionnaire evaluated for sociodemographic
is the teaching from the parents within the family details of the adolescent and contains 2 instruments
environment. This exposure makes them learn over which included an extract of the Family Environment
time within the context of the family, the acceptable Scale (FES) which was used to assess the adolescents’
ways of living thus explaining why this paper is family environment and the CDC guide to taking
germane. Inspite of adolescents ’innate tendency of sexual history in adolescents. [7,13] The 4 subscales
conflicts with parental authority, lessons learned from of the FES used to assess the adolescents’ family
parents have a strong influence over adolescents’ life environment assessed the level of family cohesion,
when they mix with peers in the absence of parental expressiveness, moral-religious emphasis and control.
control [5]. The family environment is made up of the The response format to the questions of the each of the
circumstances and the social climate condition within 4 subscale is a two point one (true or false), and total
families, where behaviours are first acquired in response is summed individually as a score of 9 each
childhood and soon become established as they turn for the four domains of the adolescents’ family
into adolescents [9]. This strongly influence the ways environment. The CDC guide to taking sexual history
and manners an adolescent behaves [9]. Family type, (13) was included in the questionnaire to assess the
socioeconomic level of the household and previous status of the adolescents’ sexual health. (13) This tool
family transitions has been reported to account for the asked questions about the adolescents’ sexual
differences in the sexual behaviours of adolescent experiences, sexual partners, sexual practices,
[10]. Warm relationships between parents and their
Vol1;3(1);2019
protection from sexually transmitted infections (STIs), All data collected were sorted, coded and analysed
past history of STIs and prevention of pregnancy. using the Statistical Package for Social Sciences
In assessing the adolescents’ pertinent Family (SPSS) software; version 17. Frequency tables and
environment, the respondents’ perception about his or charts were generated for relevant variables. Means,
her family’s level of cohesiveness, expressiveness, medians, standard deviations, proportions and
control and moral-religious emphasis was sought percentages were also determined as applicable.
using the 4 FES subscales [7]. A response that Means and Standard Deviations (SD) were calculated
reflected a positive perceived family’s cohesion, for continuous variables while categorical variables
expressiveness, moral-religious emphasis and control were summarized using proportions. Chi-square
was scored 1. A negative perceived interpretation of statistics was used to find the level of significance
the aforementioned domains was scored 0. A score of between categorical variables.
5 and above (out of a total possible score of 9 for each The approval of the Ethical Review Committee of
of the 4 subscale) was graded as good score while any Ekiti State University Teaching Hospital, Ado Ekiti
score below 5 was rated as poor. was obtained before the commencement of the study.
3. RESULTS
350
304 (94.7 %) 302 (94.1 %) Good
300 Poor
246 (76.6 %)
Number of Respondents
250
199 (62.0 %)
200
150
122 (38.0 %)
100
75 (23.4 %)
50
17 (5.3 %) 19 (5.9 %)
0
Cohesion Expressiveness Moral-Religious Control
emphasis
FES subscale
Figure 1: Clustered bar chart showing the distribution respondents by family environment characteristics (N =
321).
Table 1: Sociodemographic characteristics

Variable Frequency N=321 Percentage (%)
Age (years)
10-14 89 27.7
15-19 232 72.3
Mean ± SD 15.9 ± 2.6
Median (IQR) 16.0 (14.0-18.0)
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Gender
Male 118 36.8
Female 203 63.2
Educational level
Primary/JSS 60 18.7
SSS 142 44.2
Tertiary 119 37.1
Family type
Monogamous 280 87.2
Polygamous 41 12.8
Socioeconomic status
High 213 66.4
Middle 55 17.1
Low 53 16.5
Parents’ marital status
Married 274 85.4
Unmarried 47 14.6
Table 2: Relationship between sexual experience and perceived family environment

FES scale Sexual experience (Yes) Sexual experience (No) ꭓ2 df P value
Cohesion
Poor 4 (23.5) 13 (76.5) 0.641 1 0.423
Good 49 (16.1) 255 (83.9)
Expressiveness
Poor 19 (25.3) 56 (74.7) 5.526 1 0.019*
Good 34 (13,8) 212 (86.2)
Moral- Religious Emphasis
Poor 8(42.1) 11(67.9)
Good 45 (14.9) 257 (85.1) 9.597 1 0.002*
Control
Poor 24 (19.7) 98 (80.3) 1.472 1 0.232
Good 29 (14.6) 170 (85.4)
Table 3: Relationship between respondents’ socio-demographic characteristics and age at sexual debut
Variable Age at sexual debut Age at sexual debut X2 df P value
(years) n (%) 10-14 (years) n (%) 15-19
Age (years)
10 – 14 10 (100) 0 (0) 18.782 1 <0.001*
15 - 19 11 (25.6) 32 (74.4)
Gender 9 (69.2)
Male 12 (30.0) 4 (30.8) 6.312 1 0.012
Female 28 (70.0)
Current educational level
Primary / JSS 8 (100.0) 0 (0.0) 14.585 2 0.001
SSS 5 (25.0) 15 (75.0)
Tertiary 8 (32.0) 17 (68.0)
Religion 27 (60.0)
Christianity 18 (40.0) 5 (62.5) 0.018 1 1.000
Islam 3 (37.5)
Ethnicity
Yoruba 18 (41.9) 25 (58.1) 0.477 1 0.722
Non-Yoruba 3 (30.0) 7 (70.0)
Vol1;3(1);2019
Family type
Monogamous 18 (45.0) 22 (55.0) 1.971 1 0.160
Polygamous 3 (23.1) 10 (76.9)
Socioeconomic status
High 11 (47.8) 12 (52.2) 2.528 2 0.283
Middle 1 (14.3) 6 (85.7)
Low 9 (39.1) 14 (60.9)
Parents' status
Married 16 (40.0) 24 (60.0) 0.010 1 0.922
Not married 5 (38.5) 8 (61.5)
Table 4: Relationship between perceived family environment and age at sexual debut
FES subscale Sexual debut (years), Sexual debut (years), n X2 df P value
n (%) 10-14 (%) 15-19
Cohesion
Poor 0 (0.0) 4 (100) 2.839 1 0.143
Good 21 (42.9) 28 (57.1)
Expressiveness
Poor 7 (36.8) 12 (63.2) 0.096 1 0.757
Good 14 (41.2) 20 (58.8)
Moral/Religious Emphasis
Poor 4 (50) 4 (50)
Good 17 (37.8) 28 (62.2) 0.424 1 0.068
Control
Poor 12 (50) 12 (50) 1.974 1 0.160
Good 9 (31) 20 (69)
Table 5: Relationship between family spirituality and sexual behavior

Variable Moral Religious- Moral Religious- X2 df P Value
Emphasis. Poor Emphasis. Good
Age at Sexual Debut
10 – 14 4 (50.0) 17 (37.8) 0.424 1 0.698*
15 - 19 4 (50.0) 28 (62.2)
Sexual Orientation
Heterosexual 6 (75.0) 41 (91.1) 4.357 2 0.113
Homosexual 2 (25.0) 2 (4.4)
Bisexual 0 (0.0) 2 (4.4)
Number of sexual partners in
the past 2 months
One 7 (87.5) 34 (75.6) 0.770 3 0.857
Two 0 (0.0) 1 (2.2)
Three or more 0 (0.0) 2 (4.4)
None 1 (12.5) 8 (17.8)
Number of sexual partners in
the past 1 year
One 7 (87.5) 24 (53.3) 4.472 3 0.215
Two 0 (0.0) 9 (20.0)
Three or more 0 (0.0) 8 (17.8)
None 1 (12.5) 4 (8.9)
Sexual partner had sex with
others
Yes 3 (37.5) 16 (35.6) 0.902 2 0.637
No 4 (50.0) 27 (60.0)
Unsure 1 (12.5) 2 (4.4)
Vagina sex
Yes 6 (75.0) 44 (97.8) 6.599 1 0.056
No 2 (25.0) 1 (2.2)
Condom use with vagina sex
Yes 4 (66.7) 29 (65.9) 0.001 1 1.000
No 2 (33.3) 15 (34.1)
Vol1;3(1);2019
Anal sex
Yes 1 (12.5) 7 (15.6) 0.049 1 1.000
No 7 (87.5) 38 (84.4)
Condom use with anal sex
Yes 0 (0.0) 3 (42.9) 0.686 1 1.000
No 1 (100.0) 4 (57.1)
Oral sex
Yes 5 (62.5) 13 (28.9) 3.421 1 0.104
No 3 (37.5) 32 (71.1)
4. DISCUSSION sex in the 10 to 14 years’ age group than the older age
group (P value <0.0001) (Table 3). The male
In this study over 75% of the respondents had a good adolescents were more likely to initiate sex earlier
score in perception rating of their family environment when compared to their female counterpart (P value =
except in perceived family control where as 38% 0.012). This is in keeping with other studies on factors
reported a poor score (Figure 1). The implication of affecting adolescent sex initiation [15,16]. It has been
these is that in comparing all the family environment reported that the male gender, black race and fewer
domain used, adolescents responded that control is positive connections to their parents predisposes
perceived in a more reduced intensity when compared adolescent to initiating sex [16]. It has equally been
to other family environment scale. This may be noted that the different perception about virginity also
because of the tendency of adolescents to live an play a role in males initiating sex earlier than females
independent life [2]. Adolescents perception of family [17] While adolescent females see their virginity as a
cohesion and moral religious emphasis was over 94% source of pride, their male counterparts perceive its
while perceived family expressiveness was 76.6% loss as a positive aspect of their sexuality [17].
(Figure 1). This finding may be as a result of increased In support of the findings that lower educational level
interest placed on religious matter and heightened (Table 3) was statistically associated with early sexual
adherence to traditional family setting in the area of initiation (P = 0.001), another study on sexual
study. Over 87% of the family type studied are behaviour of adolescents in sub Saharan Africa has
monogamous in nature (Table 1). The findings of noted that those least educated initiate sex earlier [15].
parental involvement in adolescent life is similar to the This educational level coincides with the adolescents
study conducted by Payne et all where both parents are in the early adolescence period [2] Adolescents in this
involved in the adolescent lives though it was age group rarely get exposed to sex education from
observed that the mothers’ involvement is higher than their parents perhaps because of the underestimation
that of the fathers [14]. Inspite of this parental of adolescent in this age group as being sexually
involvement, the perceived family environment which inactive. It has been reported that the closer the
were statistically associated with adolescents’ sexual mother–child relationship, the more likely mothers
experience were family expressiveness and moral were to underestimate the sexual activity of their
religious emphasis. In this study, table 2 revealed that children [18]. In addition, discussions about sex are
a larger proportion of respondents (25.3%) who had often seen as a taboo to some parents [2]. Peer
poor score in perceived family expressiveness were influence is a dominant psychosocial issue during
sexually experienced compared with those with good adolescence, especially in relation to the behaviour
score (X2 = 5.526, P = 0.019). Similarly, a larger that will be embraced [2]. It has been stated however
proportion of those respondents (42.1%) with poor that the environment the adolescent is raised has an
score in moral religious emphasis were sexually impact on whether he or she will initiate sex early or
experienced compared with those who had a good not [6,18]. Perceived family expressiveness (Table 2)
score (X2 = 9.597, P = 0.017). Among the sexually was significantly associated with sexual experience of
exposed, a larger proportion of respondents had poor adolescents in the area of study (X2 = 5.526, P =
score in their perceived family cohesion (23.5%) and 0.019) but had no association with age of sexual debut.
control (19.7%), however these two variables were not This association with sexual experience is in tandem
statistically associated with sexual experience. with studies that reported similar positive association
In this study, it was observed that adolescents who between family expressiveness and sexual experience,
were sexually experienced were more likely to initiate where it was shown that increased maternal sexual
Vol1;3(1);2019
discussion, which is enhance by good level of family exposed was small (4.4%), yet it is worth noting that
express-ability, is protective against risky sexual they had good score in their perceived family
behaviours [4,6]. Likewise, a study revealed that the religiosity (Table 5). The reason for this might be
longer a father is absent (in years) from the household because norms and values are personally internalised
the higher the odds of engaging in sexual intercourse before they have positive effect on the behavioural
for adolescents, though this was only statistically tendencies. In addition to this, the unlimited access to
associated with girls [16]. In addition, it was noted that differing religious and behavioural norms via the
when daughters feel comfortable communicating with social media may also make an adolescent have
their mothers about sex, they are less likely to engage knowledge of religious ways without behavioural
in sex over the following year [4]. However, effect. It was observed that though there was no
Ankomma et al in Nigeria reported that there was no significant association between oral sex and moral
direct link between parent-child sexual discussion and religious emphasis, a larger proportion of those
adolescents’ risky sexual behaviours [11]. engaged in oral sex had poor score in moral religious
In this study the type of religion practiced had no emphasis. Parental religiosity has been reported to
significant association with age of sexual initiation positively influence adolescent risky sexual [20].
among those studied, but poor score in the The limitations of this study include the fact that this
respondents’ score of perceived family moral religious was a clinic-based study, and as such the
emphasis which summarised family spirituality and characteristics of the respondents might not be a
attachment to religious institution was positively representative of the general population. In addition,
associated with sexual experience (X2 = 9.597, P = the data collection was by interviewer-administered
0.002) (Table 2). This shows that family spirituality questionnaire, and as such some of the responses may
and attachment to religious institution had protective not be as accurate as when absolute anonymity was
influence on adolescents’ sexual behaviour. Personal guaranteed. It is recommended that Family Physicians
values and beliefs have been posited to be of real should routinely take sexual history as part of
impact in helping adolescents to remain abstinent, adolescent’s evaluation to afford them the opportunity
though they will still think and experience similar to counsel and educate those who are not exposed on
thoughts, feelings and desires that other sexually the benefits of delayed sex initiation and safer sex for
active peers have [19]. Haglund and Fehring in USA those already exposed to prevent consequences of
reported that adolescents who view religion as very unhealthy sexual exposure.
important to them, had frequent religious service
attendance and a high religious attitude on sexuality 5. CONCLUSION
were less likely to have sex than those who acted and
This study has demonstrated that while parents may be
opined otherwise [20]. Deviant behaviours have also
involved in the lives of their adolescent, it is only
been said to be prevented by norms and beliefs formed
family expressiveness and moral-religious emphasis
from attachment to religious institution and activities
that has a significant effect in protecting these wards
[20]. It was observed that while there was an
from unhealthy sexual behaviour. It also revealed that
association between family religiosity and sexual
parents should start paying attention to their
experience, the number of sexual partners in the space
adolescents as early as possible and not to assume that
of two months and one year has no association with
they are not having issues of sex that needed to be
the family religiosity (Table 3) This might be because
clarified. Age of initiation was also observed to have
the level of family religiosity may not be the same as
been as low as ages 10 to 14 years. It is important that
adolescent adherence to and internalisation of the
parents should start discussing sexual issues as soon as
teaching of the faith. Though the proportion of
their adolescent reaches the age of 10 years.
respondents who were bisexual among those sexually
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January, 2019 2019; Vol3; Issue 1 http://iamresearcher.

Influence of Family Expressiveness and Moral

1. INTRODUCTION children in an atmosphere of minimal conflict ensures

Table 1: Sociodemographic characteristics

Table 2: Relationship between sexual experience and perceived family environment

Table 5: Relationship between family spirituality and sexual behavior

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