Determinants of Risky Sexual Practices and Access to Sexual and Reproductive Health Services Among Adolescents in Urban and Rural Areas of Enugu State, Nigeria

Background Adolescent substance use and risky sexual behaviors are not only challenges but also urgent public health crises in Nigeria. This study aimed to determine the prevalence of these behaviors, identify their determinants, and assess the availability and accessibility of sexual and reproductive health (SRH) services among in-school adolescents in urban and rural areas of Enugu State. Methods A cross-sectional mixed-methods study was conducted among 880 in-school adolescents (440 urban, 440 rural) aged 10–19 years, selected through multistage sampling. A self-administered questionnaire collected quantitative data, while qualitative data were gathered through eight Focus Group Discussions (FGDs) with 80 participants. Descriptive statistics, logistic regression, and chi-square tests were used for data analysis. Results The findings revealed a high prevalence of substance use: alcohol (73.2%), cigarettes (39.5%), marijuana (32.0%), tramadol (25.1%), and methamphetamine (9.2%). Urban adolescents reported higher use of alcohol and cigarettes, whereas marijuana, tramadol, and methamphetamine were more common in rural areas. Nearly half (47.7%) of the adolescents were sexually active, with 93% of them using substances such as alcohol and marijuana before sex. Peer influence (OR = 4.23) and parental substance use (OR = 2.80) were significant determinants. Risky sexual behaviors, including unprotected sex (68.4%) and multiple sexual partners (34.2%), were prevalent. Knowledge of and access to SRH services were limited, with major barriers including fear of stigmatization (67.8%) and negative attitudes from service providers (54.3%). Conclusion The study highlights the complex and interconnected issues of adolescent substance abuse and risky sexual behaviors in Enugu State. It calls for comprehensive, multi-faceted interventions targeting adolescents, parents, peers, and communities to address these challenges and to improve access to adolescent-friendly SRH services.