Psychometric properties of an instrument to measure perception of aphrodisiac use among undergraduates in a Southwestern Nigerian University

doi:10.21203/rs.3.rs-1974694/v1

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Psychometric properties of an instrument to measure perception of aphrodisiac use among undergraduates in a Southwestern Nigerian University

https://doi.org/10.21203/rs.3.rs-1974694/v1

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A tool to measure perception of aphrodisiac use by university institution undergraduates was developed and validated. The study was hinged on several theories that could explain potential to use aphrodisiac among the youths.

A cross-sectionally designed study that evolved from qualitative and quantitative processes deployed a pretested instrument adapted from literature reviews and expert judgement on 919 students of University of Ibadan sampled through multi-stage method. Exploratory factor analysis was deployed on Polychoric correlation matrix of the items using R-statistical packages. Further model fit analysis was conducted using Confirmatory factor analysis on the items and factors derived from EFA. Mean Z-scores of factors were computed against socio-demographics and symptoms of aphrodisiac use among respondents that have ever used it.

Two succession of factor analyses and a structural equation modeling suggested that a first-order model is good fit for experimental data (TLI = 0.931; CFI = 0.948; SRMR = 0.047; RMSEA = 0.083). The four-factor solution to the model included: prolonged sexual performance, use without erectile dysfunction or medical advice, treatment of erectile dysfunction and recreational purposes with an internal consistency that ranged from 0.62–0.92. The validation with socio-demographics and symptoms of aphrodisiac use indicated that: Male respondents, those older than 20years, the married, those from poorly educated parent and sufferers of all identified symptoms had statistically significant differences with poor perception of aphrodisiac use’ domains.

This validated instrument is good for assessment of perception of aphrodisiac use among students in tertiary institution albeit with caution. A version of the scale that is broadened with highly refined items and tested for high internal validity is suggested for future studies.

Aphrodisiacs are substances that increase sexual desire (Wallen et al., 2004). They can also be defined as any foods or drugs that arouse sexual instinct, induce venereal desire, and increase pleasure and performance (Yakubu et al., 2007). There are certain animal and plants-based drugs, foods and drinks substances including certain human behaviours which have reputation for making sex more attainable and pleasurable (Sandroni, 2001, Standard Practice in Sexual Medicine, 2002). However, few of these were subjected to pharmacological processes which include clinical trials protocols for approval or recognized in significant research (Bhagavathula et al, 2016; Fiaveh, 2020).

The main indication for use of aphrodisiac drugs is erectile dysfunction (Taberner, 1985) however, the qualities and benefits of sexual pleasures of enhanced libido and erection have prompted their indiscriminate and excessive use (Manortey et al, 2018). A study reported that most of the users are between 15 and 30 years old (Makwana et al., 2013). There is a rising demand and use of aphrodisiacs among young people without any medical indications (Makwana et al., 2013; Dandekar et al., 2013; Lampiao et al., 2015). Young people have high desire to explore and increase sexual performance and anecdotal evidence has shown that males are more vulnerable to using recreational aphrodisiacs (Yiana et al, 2018).

Improper use of aphrodisiac drugs can bring potentially often preventable cause of health hazards that range from disease conditions to death more so evidences are mounting about commonness of adverse reactions to medicines in recent times. Abuse of aphrodisiacs for recreational purpose by young adults with or without knowledge of its debilitating health implications are often done through self-medication (Manortey et al, 2018). SM which is the selection and use of medicines by individuals to treat self-recognized illnesses or symptoms without consultation of health care professional was reported in a study among Ghanian men. Majority were reported to be using sex-enhancing medications without any medical reason (Amidu et al 2010). This act was further substantiated with the fact that about 75% Ghanaians men hold the conviction that intravaginal ejaculatory latency of 7 – 25 min is adequate as against the 3 - 7 minutes sex therapist recommend (Amidu et al, 2010).

For young adults, the dependency on aphrodisiac for elongating sexual pleasures may have started out of curiosity and experimentation however, it ultimately advance to addiction and other serious risky behaviours such as substance use and engagement in multiple sexual relationships (Akre et al, 2015). According to a survey of US college students, lifetime and past year prevalence of nonmedical prescription benzodiazepine use was 8% and 5% respectively. Risky factors found among the students included higher rates of substance use and bisexual activities (McCabe, et al, 2005). In Nigeria, the use of drugs for non-medical purposes by youth is not uncommon, however the rate at which these leaders of tomorrow embrace these drugs for various reasons has been described as alarming (Oshinowo et al, 2019).

Young people who persistently abuse aphrodisiacs and other substances are liable to experience array of problems, including academic difficulties, health-related problems (including mental health and sexual and reproductive), poor peer relationships, and involvement with the juvenile justice system (Fatoye, 2003; Danquah et al, 2011). These health challenges are definitely with huge burden of concern to an already saturated public health system in Sub-Saharan Africa (Ahmed et al, 2017; Manortey et al, 2018).

Studies that endeavor to understand perceptive rationale for use of aphrodisiac among young adults are rare in Nigeria. Such studies will provide knowledge necessary for prompt and adequate public health intervention for experts with capabilities to discourage the continuation and dependency on non-medical use of aphrodisiacs and other related substances among this category of individuals.

Thus, this study was aimed at determining the psychometric properties of an instrument developed to assess the perception to use of aphrodisiacs among tertiary education students in University of Ibadan. Findings derived from this study can assure of precision and trust in the outcome of evaluation such a tool is applied on in future studies.

Study Design

This study was a cross sectional study design with a mixed methods approach, aimed at assessing the perception and use of aphrodisiacs among undergraduates in the University of Ibadan, Nigeria. The qualitative component was purposely to generate relevant information for the qualitative questionnaire design and provide more in-depth information on respondents’ perception of aphrodisiac use.

Description of the Study Area

The study was carried out in the University of Ibadan, Ibadan, Oyo State, Nigeria. The University of Ibadan situated in Ibadan North Local Government Area is the oldest Nigerian university established in 1948 as an external College of University of London. It’s thirteen faculties currently holds about 35,000 students. The university’s undergraduate halls of residence accommodate over 8,000 female and male students.

Study Population

Pharmacists and drug peddlers within Ibadan North LGA constituted key informants interview participants while undergraduates in the University of Ibadan comprised the respondents of the Focus Group Discussion in the qualitative aspect of the data collection. The quantitative component of the study consisted of male and female undergraduate students who were aged between16 years and above enrolled into courses at the University of Ibadan. Eligibility criteria for participation was being a male or female undergraduate student of University of Ibadan and being aged 16 years and above while those who were not student of the university and those below sixteen years of age were excluded from the study.

Sample determination and sampling technique

The minimum sample size of 410 male and female students of University of Ibadan was estimated using Leslie Kish sample size formula for determining single proportion for descriptive studies. Multistage sampling technique involving the use of simple random technique by balloting was deplored for data collection at each required stage of recruitment protocol. At stage one, a total of four halls comprising of two male halls out six and two out of three females’ halls of residence were selected. Five blocks were selected from the halls of interest making a total of 20 blocks in the second phase of the multistage sampling process. At least 20 rooms were selected from each of the selected blocks at the third stage of recruitment processes. Finally, at least one respondent was recruited from each selected room that comprised the blocks of interest.

Study Instrument/Methods

Focus Group Discussion (FGD) and Key Informant Interview (KII) were conducted for the qualitative data collection using FGD and KII guides, respectively. The qualitative survey provided the opportunity for in-depth exploration of respondents’ perception to use of aphrodisiac and the factors associated with use. This exercise also helped in generating information for quantitative questionnaire design.

Qualitative Data Collection-FGD

The FGD sessions were conducted in English language among male and female university undergraduate youths aged 16 – 24 years. Each participant consent was obtained at the beginning of each FGD session after ensuring they understood the objectives and purposes of the study. All FGD sessions were tape recorded with the permission of the participants. The anonymity of participants in the FGD sessions was also protected in the report as each was represented by letter “R” which denotes a particular but unidentified respondent. Four FGD sessions were conducted; two in the male halls of residence and two in the female. A total of thirty consenting discussants were purposively selected from the halls of residence to participate in the discussion. Each discussion lasted for 40-50 minutes. An open-ended interview protocol was used to guide the discussion. The FGD sessions were facilitated by a trained facilitator while two research assistants participated as note taker and observer. More FGD sessions were not conducted because data saturation was reached.

KII sessions

The KII sessions were conducted in English language and each participant’s consent was obtained verbally on tape at the beginning of the interview. Five KII sessions were conducted in Ibadan North LGA. The KII consisted of five key informants; three pharmacists and two drug peddlers. The Key Informants were purposively selected. All KII sessions were tape recorded with the permission of the participants. The anonymity of participants in the KII sessions was also protected in the report. An open-ended interview protocol was used to guide the discussion by a trained facilitator.

Quantitative Instrument and its validity

Information that emerged from the FGD and KII combined with relevant literature findings from study objectives guided the development of the instrument. Also, contributions made by academic, community and reproductive health experts in the Department of Community Health during proposal presentation helped in fine tuning the final questionnaire for quantitative data collection. The experts’ comments and corrections were revised to further enhance quality of the instrument.

Forty-two questionnaires were pre-tested among undergraduates at Lead City University, Ibadan, which were not part of the study population but were similar to the main study subjects by characteristics and socio-demography. The pre-test excluded respondents who were not present on campus as at the time of collecting data. The outcome of the pretest was used to revise ambiguous questions and adding of information found useful for improving the quality of the questionnaire.

A total of fifteen items were developed to measure perception of use of aphrodisiac substances. From this list, those that poorly perceived aphrodisiac use were rightly assigned likert score that ranged from 1-5 based on strongly agree to strongly disagree scale. Those that favour good perception were reversely coded. This was aimed at ensuring scores from each domains of aphrodisiac perception use and total scores reflected final categorization of good and poor perception.

Reliability test

Measures of internal validity was applied on the items of perception to use aphrodisiac in SPSS. Cronbach’s alpha reliability coefficient of the questionnaire was computed which yielded an overall maximum value of 0.78 if no item was deleted and values greater than 0.7 for each of the items.

Analysis of Qualitative Data

Data from the FGD and KII sessions were transcribed and descriptively analysed using the thematic framework approach for qualitative analysis. The FGD and KII sessions provided additional information that was used to modify the quantitative questionnaire prior to pretest and main data collection.

Factor reduction analysis

Polychoric correlation used in analyzing ordinal and nominal likert scale was used (Holgado et al, 2009). The assumption behind polychoric correlation coefficient is that pairs of ordinal scores are generated by latent bivariate normally distributed random variables. Measuring the association between ordinal variables entails the estimation of the product moment correlation between the corresponding normally distributed variables. The polychoric correlation matrix was estimated using the two-stage procedure described in Lee et al (1989) and implemented in R statistical packages (R Core Team, 2013). Note that since the matrix was estimated in a pairwise fashion it was possible to be non-positive definite. Furthermore, an exploratory factor analysis was then performed on the estimated polychoric correlation in R.

Construct validity was further assessed by confirmatory factor analysis. Here the latent items of the scales must prove their relatedness with their respective unobserved constructs according to acceptable goodness of fit measures. The measurement parameters are: CFI; TLI ; SRMR and RMSEA. CFI analyses the change in fit between the hypothesized model and the multidimensional model (Kline et al, 2011; Wang, 2012) which ranges between 0 and 1. TLI indicates the total co-variation in the model and ranges between 0 and 1. The values of TLI and CFI greater than 0.90 imply a good fit to the data. RMSEA is based on analysis of residuals and its expected value for a good model data fit is one with less than 0.08 (Kline et al, 2011; Wang, 2012). The value of RMSEA shows sensitivity to degree of freedom and complexity of the proposed model (Kline et al, 2011; Wang, 2012). Standardized Root Mean Square Residual (SRMR) is an index of the average of standardized residuals between the observed and the hypothesized covariance. It indicates a good fit when it produces a value less than 0.05 (Kline et al, 2011)

Internal consistency reliability measures the extent to which all items within a scale are indeed capturing the same construct. Cronbach's alpha coefficients greater than 0.80 indicate high levels of internal consistency, while values that range between 0.70 to 0.61 suggest acceptable internal consistencies (Cronbach, 1951). This was tested in SPSS statistical packages IBM version 20.0.

Ceiling and floor effects for the created multi-item scales were examined by estimating the responses falling into the highest and lowest possible perception scores (i.e. strongly agree and strongly disagree) expressed in percentages. These are measures of the sensitivity of the tool. Finally, means of weighted scale scores of perception to use of aphrodisiac’s domains were computed and compared with aspects relating all students’ socio-demographic characteristics, medical and psychological symptoms of those who had used aphrodisiac substances in past sexual activities.

Majority of the respondents were less than twenty-five years of age (84.4%) with 58.4% of females 96.3% singles while 41.3% earn monthly income of less than or excatly 20,000 Naira. The largest percentage of the subjects where from Yoruba ethnic background (73.6%) and either of all respondents parent mostly had tertiary education (fathers=59.8%; mothers=54.2%).

Initial polychoric correlation was analysed (Table 2, Fig 2) where items C15i, C15ii, and C15iii significantly correlated with one another having values that ranged between 0.66-0.73; items C16i and C16ii had a correlation value of 0.89; items C15iv and C16iii with a value of 0.51 moderately correlated with each and lastly, all items of C17 subtypes significantly correlated with one another in values that ranged from -0.55 to 0.97.

The KMO measure was 0.89 and Bartlett's test was statistically significant (p < 0.01). Factor analysis performed with maximum likelihood for extracting factors yielded four factors from its minimum residual solution that rotated on its default oblimin transformation. These factors explain 66.31% of the variance in the original 15 variables. The first batch of factor analysis on perception of use of aphrodisiac produced items C17v, C17vii, C17viii, C17vi, C17iv, C17ii, C17iii which constitute “prolonged sexual performance”, questions C15ii, C15i, C15iii and C17i made up the scale “erectile dysfunction or by medical advice use”, questions C16i and C16ii made up the scale “for recreational purpose” and questions C15iv and C16iii aggregated for “To treat erectile dysfunction”. The reliability test for the factors indicated excellent improvement when items C17i and C17iii were removed from the items of factors that connote aphrodisiac for “erectile dysfunction or by medical advice” and “prolonged sexual performance”. Based on this outcome, a second round of factor analysis without the deleted items still suggested a four-factor solution with KMO measure of 0.89. The factors and their respective Cronbach alpha values are Recreational purpose, α=0.62; Aphrodisiac use without medical condition or medical advice, α= 0.84; To treat erectile dysfunction = 0.91 and Prolonged and improved sexual performance = 0.84. Table 4.

A four-dimensional model derived from the exploratory factor analysis of thirteen items was subjected to confirmatory analysis. All the CFA goodness of fit indices were within acceptable values except Root Mean Square Error of Approximation that was just within marginal range (TLI=0.931; CFI=0.948; SRMR=0.047; RMSEA=0.083). Table 2.

Respondents’ perceptions of aphrodisiac use scores were converted to domain Z scores and assessed against respondents’ socio-demographic characteristics. Male students, those of Ibo ethnic group and having mothers with primary educational significantly all had poor perception of the domain of aphrodisiac use for prolonged sexual performance’s Z score. (-0.03±0.02; -0.01±1.00, p<0.05; -0.01±1.00). p<0.05. Table 5.

In terms of age, those older than 20 years and male respondents had statistically significant weak differences in perception of use of aphrodisiac for condition of erectile dysfunction or by medical advice (-0.06±1.01, p<0.05; -0.11±1.01, p<0.05).

Poor Z mean score of perception of aphrodisiac use for treating erectile dysfunction statistically varied among the married, of Ibo tribe, educational status of respondents’ parents. Values decreased in a proportional manner to educational status of either parent. (-0.11±1.20, p<0.05; -0.40±1.20, p<0.05; -0.50±1.14, p<0.05, -1.0±1.10). Table 5.

Significant statistical differences were also found between poor perception of recreational purpose use of aphrodisiac and the males, Ibos, mothers with primary education as well as in those earning above 20,000 monthly. (-0.10±1.03; -0.20±1.10: -0.10±1.00: -0.21±1.02)

The physical and psychological symptoms of using aphrodisiacs were computed against the Z scores of factors derived from perception of its use. Table 6. Sex addiction, sustained erection and loss of sexual performance self-confidence’s symptoms all significantly varied with unsatisfactory Z mean measures of perception of aphrodisiac use without a medical condition or by medical advice. (-0.61±0.66; -0.06±0.95; -0.66±0.69) p<0.05. Weak standardized mean scores of perceptions of aphrodisiac use for recreational purpose statistically differed among respondents who had symptoms of sustained erection, body weakness, self-esteem and the perverts (-0.47±1.01; -0.57±0.80; -0.62±0.92; -0.56±0.92) p<0.05.

The main objective of this study was to develop and validate a scale to measure perception of aphrodisiac use from university undergraduates. A four-factor structure for 13 out of the 15 items was evident, based on a principal components exploratory factor analysis with an oblimin rotation of the scale’s polychoric correlation matrix.

The fitted model for Perception of Aphrodisiac Use among University Undergraduates proposed four-factor structure, involving Prolonged and improved sexual performance (6 items; 0.915), Without medical condition or medical advice (3 items; 0.847), To treat erectile dysfunction (2 items; 0.627), Recreational purpose (2 items; 0.918) factors. These indicates good internal consistency except a questionable factor 3. However, each of the factors could probably be made robust by further refining of items for the purpose of clarity to the target audience. The two items under factor 3 implied the same meaning indicating need to delete one of them and to substitute it with one or more combinations of new items that could align to and elicit same construct.

The four-factor and 13 items scale that was extracted through EFA was validated by CFA to establish a relationship between the exogenous variables (items of perception of aphrodisiac use) and the endogenous latent constructs vis-a-viz acceptable goodness of fit measures. The first and only cfa done as suggested by the EFA produced the fit to the model. Perception in psychology is one of the key attributes of attitude which forms human habit. All components that made up attitude were transactions with one’s physical and social surroundings and that the direction of influence flowed either direction ways—our attitudes are influenced by the social world and our social world is influenced by our attitudes. With respect to the outcome of the psychometrics validation of this study, a theoretical framework has been established as different items on perception of realities of aphrodisiacs aggregated into four constructs that could influence its habitual use. Thus, future studies can examine these domains with respect to use of aphrodisiac substances particularly among youths in institution of higher learning.

This study aimed to also assessed the validity of the perception of aphrodisiac use among tertiary education students by their socio-demographic characteristics and symptoms from its use. This is to determine factors that could influence perception of aphrodisiac use among young adults when the validated instrument is applied. The observed differences in mean scores of the perception of aphrodisiac use among the subjects further underscore the need to use the domains described for comparison of each subgroup of independent variables. With regards to socio-demographic characteristics of respondents, being a male and of Ibo ethnic background presented poorly in all constructs of perception of aphrodisiac use except in respective perception of “aphrodisiac use for treating erectile dysfunction and use of aphrodisiac for condition of erectile dysfunction or by medical advice”. The differed findings with the male sex transcend cultural and socioeconomic status since several qualitative and quantitative studies focusing on factors predisposing perception and use of aphrodisiacs established this natural phenomenon (Amoah et al, 2022; Yiana et al, 2018). Universally, the male and men gender have propensity for aiming to achieve sexual satisfaction characterized by prolonged pleasure to prove their phallic capabilities to themselves and to the opposite sex.

The marked variations between the married, young adults and those from non to early educated parents’ with poor perceptions of use of aphrodisiac for condition of erectile dysfunction or by medical advice and treating erectile dysfunction are realistic associations. For the married, undesirable sexual experience is one of the underlying problems causing marital crisis that could prompt preference for aphrodisiac substances to ameliorate the condition (Oniye et al, 2016; Sanni, 2021). Studies by Oniye et al (2016) and Sanni have investigated the use and pattern of aphrodisiacs by couples to correct sexual dysfunction. The fact that individuals above 20 years significantly differed with the specified constructs of aphrodisiac perception use have been evidenced in previous studies (Prins et al, 2002; Dandekar et al, 2013). The demand for and dependency on aphrodisiac for sexual pleasure or medical reason is higher among this group (Dandekar et al, 2013). The indication for mothers’ lowered educational status and the identified domains of aphrodisiac perception among the population of interest could be considered in future assessment of the scale. Although, studies have yet to evaluate this area, it would be interesting to investigate how parental higher level of education influences young adults’ perception of aphrodisiac use and its medical implications. The significant variation of the higher monthly earning of the students with construct of perception of use of aphrodisiac for recreational purposes should be explored in future use of the scale. This could help in understanding how financial wherewithal could shift the perception of aphrodisiac use among undergraduate student.

The scale was able to differentiate between subgroups of physical and psychological symptoms of using aphrodisiac suggesting a good construct validity of this instrument designed to measure the multi-domain perception of aphrodisiac use. Those who have sex addiction, priapism, lack of sexual performance self-confidence, body weakness, self-esteem and perversion from using aphrodisiacs significantly had worse scores of perception of aphrodisiac use without a medical condition or by medical advice and for recreational purposes.

Several studies have linked abuse of aphrodisiac substances to venereal diseases, psychological health conditions and simple to life threatening non-communicable diseases such as heart failure and kidney problems (Ajao et al, 2019, Yidana et al, 2019; Danquah et al, 2011). Manortey et al (2015) reported that despite health regulatory bodies’ issuance of public awareness on concerns for abuse of unregistered sex enhancing products, purchase remains high amidst menacing side effects. This report corroborated our study’s findings and it all implied that having health problems associated with use of aphrodisiac and the knowledge thereof are not important to having right perception to use of aphrodisiac. Based on this premise, it would be worthwhile, for future use of this scale to assess the significance of health outcomes of aphrodisiac users against the underlying perception to its use.

This study used EFA on polychoric correlation matrix to validate a scale on perception of aphrodisiac use among tertiary institution students followed by confirmatory factor analysis. All the domains that emerged from the analysis statistically, reflect the stimuli, cognitive, translation, behaviour and performance components of perception to aphrodisiac use. The four-factor generated model showed a good fit, indicating that sexual elongation pleasure, use of aphrodisiac substances without erectile dysfunction, treatment of erectile dysfunction and Recreational purpose are adequate components to measure the perception of aphrodisiac use among university undergraduates. The resulted 13 items showed valid factors loadings and high values of internal consistency and reliability reinforced through CFA procedures. There are evidences of statistically significant differences between groups of certain socio-demographic characteristics and symptoms of aphrodisiac with domains of perception of aphrodisiac use.

A number of limitations of the study can be spotlighted. The findings of this study cannot yet be fully generalized due to the wording and interpretation of specific items that aggregated to some factors and the restriction to student population of just one university. Nevertheless, research efforts should be extended to detail and thorough exercise on the scales’ items development and testing in a variety of tertiary educational institutions in order to enhance its robustness and flexibility for generalizability purposes. Another limitation of the research obtains from the slight number of items derived from the statistical outcomes of the data, offering limited or no options for future researchers if item erasure is warranted in their adjusted studies.

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Characteristics	N	%
Age group
16-24	775	84.3
25-40	144	15.7
Gender
Male	537	58.4
Female	382	41.6
Marital status
Single	885	96.3
Married	34	3.7
Ethnicity
Yoruba	676	73.6
Ibo	72	7.8
Hausa	117	12.7
Others	39	4.2
Missing	15	1.6
Father's educational level
No formal education	100	10.9
Primary	64	7.0
Secondary	156	17.0
Tertiary	550	59.8
Missing	49	5.3
Mother's educational level
No formal education	96	10.4
Primary	90	9.8
Secondary	175	19.0
Tertiary	498	54.2
Missing	60	6.5
Average monthly income
≤20,000	380	41.3
>20,000	121	13.2
Missing	418	45.5

Table 1: Socio-demographic characteristics of respondents

Table 2: Fit indices for multidimensional model of perception aphrodisiac use

Indices	Model fit values
X²	64.098
Degree of freedom	32
P	<0.001
RMSEA	0.083
90%CI	0.076-0.091
P	0.391
CFI	0.948
TLI	0.931
SRMR	0.047

	C15i	C15ii	C15iii	C15iv	C16i	C16ii	C16iii	C17i	C17ii	C17iii	C17iv	C17v	C17vi	C17vii	C17viii
C15i	1.00	0.94	0.90	-0.56	0.76	0.75	0.44	0.55	0.74	-0.69	0.58	0.56	0.59	0.58	0.52
C15ii	0.94	1.00	0.95	-0.67	0.73	0.73	0.53	0.48	0.71	-0.69	0.58	0.57	0.58	0.59	0.53
C15iii	0.90	0.95	1.00	-0.73	0.72	0.73	0.58	0.42	0.69	-0.69	0.60	0.60	0.60	0.60	0.56
C15iv	-0.56	-0.67	-0.73	1.00	-0.61	-0.65	-0.88	-0.38	-0.65	0.74	-0.72	-0.72	-0.67	-0.69	-0.68
C16i	0.76	0.73	0.72	-0.61	1.00	0.99	0.64	0.42	0.68	-0.67	0.60	0.58	0.61	0.61	0.57
C16ii	0.75	0.73	0.73	-0.65	0.99	1.00	0.67	0.40	0.68	-0.68	0.62	0.60	0.63	0.63	0.59
C16iii	0.44	0.53	0.58	-0.88	0.64	0.67	1.00	0.31	0.57	-0.77	0.69	0.68	0.59	0.61	0.63
C17i	0.55	0.48	0.42	-0.38	0.42	0.40	0.31	1.00	0.50	-0.55	0.29	0.23	0.26	0.23	0.16
C17ii	0.74	0.71	0.69	-0.65	0.68	0.68	0.57	0.50	1.00	-0.91	0.90	0.87	0.88	0.88	0.84
C17iii	-0.69	-0.69	-0.69	0.74	-0.67	-0.68	-0.77	-0.55	-0.91	1.00	-0.92	-0.91	-0.86	-0.86	-0.85
C17iv	0.58	0.58	0.60	-0.72	0.60	0.62	0.69	0.29	0.90	-0.92	1.00	0.98	0.94	0.94	0.94
C17v	0.56	0.57	0.60	-0.72	0.58	0.60	0.68	0.23	0.87	-0.91	0.98	1.00	0.95	0.96	0.96
C17vi	0.59	0.58	0.60	-0.67	0.61	0.63	0.59	0.26	0.88	-0.86	0.94	0.95	1.00	0.97	0.95
C17vii	0.58	0.59	0.60	-0.69	0.61	0.63	0.61	0.23	0.88	-0.86	0.94	0.96	0.97	1.00	0.97
C17viii	0.52	0.53	0.56	-0.68	0.57	0.59	0.63	0.16	0.84	-0.85	0.94	0.96	0.95	0.97	1.00

Table 2: Polychoric correlation matrix of perception of use of aphrodisiac among university undergraduates

Reliability	Factor ID	Factor Description	Item	ML2	ML3	ML1	ML4	h2	u2	com
Alpha=0.847 (3 items)	Factor 2	Without medical condition or medical advice	C15i. Aphrodisiacs should be used by sexually active adolescents/youths without erectile dysfunction	0.06	0.75	0.13	0.14	0.72	0.28	1.20
Alpha=0.847 (3 items)	Factor 2	Without medical condition or medical advice	C15ii. Aphrodisiacs should be used by sexually active adults without erectile dysfunction	-0.01	0.90	-0.02	-0.03	0.79	0.21	1.00
Alpha=0.847 (3 items)	Factor 2	Without medical condition or medical advice	C15iii. Aphrodisiacs should be used by sexually active elderly without erectile dysfunction	0.01	0.78	0.00	-0.13	0.67	0.33	1.10
Alpha=0.627 (2 items)	Factor 3	To treat erectile dysfunction	C15iv. Aphrodisiacs should be used by people with erectile dysfunction	-0.06	-0.19	0.14	0.61	0.44	0.56	1.30
Alpha=0.918 (2 items)	Factor 4	Recreational purpose	C16i. Aphrodisiacs should be used for recreational purpose for male	0.00	0.01	0.98	0.00	0.96	0.04	1.00
Alpha=0.918 (2 items)	Factor 4	Recreational purpose	C16ii. Aphrodisiacs should be used for recreational purpose for female	0.02	0.04	0.86	-0.06	0.83	0.17	1.00
Alpha=0.627 (2 items)	Factor 3	To treat erectile dysfunction	C16iii. Aphrodisiacs should be used for erectile dysfunction	-0.05	0.03	-0.21	0.74	0.68	0.32	1.20
Alpha=0.915 (6 items)	Factor 1	Prolonged and improved sexual performance	C17ii. Aphrodisiacs should be used for gratification of sexual partner	0.58	0.23	0.09	0.11	0.57	0.43	1.40
Alpha=0.915 (6 items)	Factor 1	Prolonged and improved sexual performance	C17iv. Aphrodisiacs should be used to improve sexual performance	0.82	0.00	-0.01	-0.10	0.72	0.28	1.00
Alpha=0.915 (6 items)	Factor 1	Prolonged and improved sexual performance	C17v.Aphrodisiacs should be used to prolong/enhance erection	0.88	-0.01	-0.06	-0.11	0.79	0.21	1.00
Alpha=0.915 (6 items)	Factor 1	Prolonged and improved sexual performance	C17vi. Aphrodisiacs should be used to boost self esteem	0.84	0.01	0.04	0.09	0.72	0.28	1.00
Alpha=0.915 (6 items)	Factor 1	Prolonged and improved sexual performance	C17vii. Aphrodisiacs should be used for self-satisfaction	0.87	0.01	0.05	0.07	0.77	0.23	1.00
Alpha=0.915 (6 items)	Factor 1	Prolonged and improved sexual performance	C17viii. Aphrodisiacs should be used for prolonged sexual intercourse	0.86	-0.05	0.00	-0.02	0.70	0.30	1.00

Table 3: Standardized loadings (pattern matrix) based on correlation matrix and reliability of factors generated from items of aphrodisiac perception use substances among young university students.

Characteristics		F1		F2		F3		F4
Age group	N (% )	Mean±SD	p-value	Mean±SD	p-value	Mean±SD	p-value	Mean±SD	p-value
<OR=20	385 (41.9)	0.04±0.98	0.37	0.09±0.98	<0.05	0.03±1.00	0.43	0.03±1.00	0.38
>20	534 (58.1)	-0.03±0.02		-0.06±1.01		-0.02±1.00		-0.03±1.00
Gender
Male	537 (58.40)	-0.11±1.02	<0.05	-0.11±1.01	<0.05	0.03±1.00	0.22	-0.10±1.03	<0.05
Female	382 (41.6)	0.20±1.00		0.12±1.10		-0.4±1.10		0.11±1.04
Marital status
Single	885 (96.3)	-0.01±1.00	0.38	0.00±1.00	0.80	0.02±1.00	<0.05	-0.00±1.00	0.81
Married	34 (3.7)	0.20±1.10		-0.04±1.20		-0.11±1.20		0.04±1.01
Ethnicity
Yoruba	676 (73.6)	-0.01±1.00	<0.05	-0.01±1.00	0.06	0.10±1.04	<0.05	-0.02±1.00	<0.05
Ibo	72 (7.8)	-0.20±1.20		-0.20±1.00		-0.40±1.20		-0.20±1.10
Hausa	117 (12.7)	-0.01±1.00		0.10±1.14		-0.10±1.10		0.10±1.10
Others	54 (5.90)	0.40±1.00		0.30±1.03		-0.40±1.10		0.40±1.00
Father's educational level
No formal education	100 (11.5)	-0.03±1.10	0.30	-0.1±1.10	0.57	-0.40±1.10	<0.05	0.20±1.03	0.57
Primary	64 (7.4)	0.24±1.10		-0.10±1.00		-0.50±1.14		0.11±1.00
Secondary	156 (17.9)	0.10±1.04		0.10±1.00		0.02±1.00		0.03±1.02
Tertiary	550 (63.2)	0.01±1.00		0.10±1.00		0.10±1.00		0.01±1.0
Mother's educational level
No formal education	96 (11.2)	0.30±1.12	<0.05	0.10±1.10	0.08	-1.0±1.10	<0.05	0.32±1.02	<0.05
Primary	90 (10.5)	-0.20±1.02		-0.22±1.00		-0.24±1.10		-0.10±1.00
Secondary	175 (20.4)	0.10±1.04		0.02±1.00		-0.01±1.00		0.04±1.01
Tertiary	498 (58.0)	-0.01±1.00		0.10±1.00	0.14±1.00	0.01±1.00
Average monthly income
≤20,000	380 (75.8)	-0.10±1.00	0.25	-0.01±1.00	0.32	0.05±1.00	0.43	0.01±1.00	<0.05
>20,000	121 (24.2)	-0.20±1.00		-0.11±1.04		0.13±1.05		-0.21±1.02

Table 4: Mean Z scores of perception of aphrodisiac use domain according to socio-demographic characteristics

Characteristics		F1		F2		F3		F4
Sexual addiction	N (% )	Mean±SD	p-value	Mean±SD	p-value	Mean±SD	p-value	Mean±SD	p-value
Yes	69 (57.0)	-0.35±0.89	0.34	-0.61±0.66	<0.05	-0.11±0.86	0.32	-0.33±1.00	0.37
No	52 (43.0)	-0.19±0.89		-0.04±1.09		0.07±1.07		-0.17±0.95
Priapism
Yes	59 (48.8)	-0.58±0.81	1.40	-0.58±0.81	0.01	-0.06±0.95	0.76	-0.47±1.01	<0.05
No	62 (51.2)	-0.17±0.96		-0.17±0.96		0.01±0.96		-0.06±0.89
Loss of self-confidence
Yes	56 (46.3)	-0.37±0.94	0.30	-0.57±0.86	0.02	-0.01±0.91	0.62	-0.13±0.90	0.13
No	65 (53.7)	-0.20±0.84		-0.19±0.92		-0.13±0.90		-1.13±0.90
Aphrodisiac dependent
Yes	52 (43.0)	-0.35±0.98	0.45	-0.53±0.96	0.09	-0.01±1.01	0.68	-0.46±0.98	0.52
No	69 (57.0)	-0.23±0.81		-0.25±0.86		-0.07±0.92		-0.11±0.93
Causes you weakness
Yes	45 (37.2)	-0.26±0.94	0.89	-0.66±0.69	<0.05	-0.53±0.93	0.88	-0.57±0.80	<0.05
No	76 (62.8)	-0.29±0.86		0.20±0.1.00		-0.03±0.98		-0.08±1.02
Loss of self-esteem
Yes	43 (35.5)	-0.33±0.97	0.64	-0.54±0.93	0.11	1.49±0.92	0.13	-0.62±0.92	<0.05
No	78 (64.5)	-0.25±0.85		-0.27±0.89		-0.12±0.97		-0.07±0.95
Perversion
Yes	50 (41.3)	-0.36±0.97	0.50	-0.46±0.92	0.51	-0.09±1.00	0.49	-0.56±0.92	<0.05
No	71 (58.7)	-0.25±0.83		-0.35±0.86		-0.06±0.96		-0.10±95

Table 5: Mean Z scores of perception of aphrodisiac use domain according to symptoms of aphrodisiac use

No competing interests reported.

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Psychometric properties of an instrument to measure perception of aphrodisiac use among undergraduates in a Southwestern Nigerian University

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