State and grade-level differences in knowledge and attitudes towards sexuality education among in-school adolescents in Nigeria

Background Inconsistent implementation of sexuality education in Nigeria limits equitable knowledge acquisition despite widespread policy support. This study addressed the gap by examining adolescents’ knowledge, attitudes, and structural determinants across multiple states. Methods A cross-sectional design was employed among 568 secondary school students selected from six public schools across three Nigerian states. Data were collected using structured questionnaires assessing knowledge, attitudes, exposure, and perceived barriers. Multivariable regression analyses identified predictors of outcomes. Results Support for sexuality education was high (over 95%), with 88.4% reporting prior exposure. The mean knowledge score was 9.08 (SD 1.35) on a scale ranging from 0 to 10. The mean composite attitude score was 13.24 (SD 4.05) on a scale ranging from 9 to 45, with lower scores indicating more favorable attitudes; overall, respondents demonstrated generally positive attitudes toward sexuality education. Knowledge scores were significantly associated with state of residence and class level, with students in Ogun State and those in SSS3 demonstrating significantly different and higher knowledge scores, respectively, in the adjusted analysis. Attitude scores differed significantly by state, with students in Ogun State recording higher attitude scores than those in Abuja, while religion and class level were not significant predictors in the adjusted analysis. Parental involvement showed positive associations with both knowledge (R² = 0.113) and attitudes (R² = 0.263). Key barriers included poor awareness (62.5%), curriculum exclusion (48.4%), lack of policy enforcement (41.7%), inadequate funding (41.4%), and shortage of trained teachers (33.3%). Conclusion Findings highlight that positive attitudes alone may not necessarily translate into higher knowledge levels. Consistent implementation, teacher preparedness, and parental engagement were associated with more favorable sexuality education outcomes and therefore represent important considerations for policy and programme development.