Sexual intercourse and high-risk sexual behaviours among a national sample of urban adolescents in China

Matching actions to needs: shifting policy responses to the changing health needs of Chinese children and adolescents

China is home to the second largest population of children and adolescents in the world. Yet demographic shifts mean that the government must manage the challenge of fewer children with the needs of an ageing population, while considering the delicate tension between economic growth and environmental sustainability. We mapped the health problems and risks of contemporary school-aged children and adolescents in China against current national health policies. We involved multidisciplinary experts, including young people, with the aim of identifying actionable strategies and specific recommendations to promote child and adolescent health and wellbeing. Notwithstanding major improvements in their health over the past few decades, contemporary Chinese children and adolescents face distinct social challenges, including high academic pressures and youth unemployment, and new health concerns including obesity, mental health issues, and sexually transmitted infections. Inequality by gender, geography, and ethnicity remains a feature of health risks and outcomes. We identified a mismatch between current health determinants, risks and outcomes, and government policies. To promote the health of children and adolescents in China, we recommend a set of strategies that target government-led initiatives across the health, education, and community sectors, which aim to build supportive and responsive families, safe communities, and engaging and respectful learning environments. TRANSLATION: For the Chinese translation of the abstract see Supplementary Materials section.

Demographic Characteristics and Hot-Spot Areas of Recent Infections Among New HIV Diagnoses in Sichuan, China, Between 2018 and 2020

Background

Sichuan Province is severely affected by the HIV epidemic in China. Little is known about the characteristics of recent infections among new HIV diagnoses, which is critical to prevention strategies, evaluation of the HIV epidemic and health resource allocation. Meanwhile, individuals at primary stages of infection are related to the hot-spot areas of ongoing transmission in new HIV diagnoses, which is also rarely known.

Objective

This article aimed to report the proportion of recent infections among new HIV diagnoses, and to reveal demographic characteristics associated with HIV recent infections, and finally, to indicate the hot-spot areas of ongoing transmission in Sichuan province between 2018 and 2020.

Methods

Limiting Antigen (LAg)-Avidity assay was performed to detect recent infection within new HIV diagnoses reported in odd months between 2018 and 2020. Results were reclassified according to the data on CD4 cell count, antiretroviral treatment and the existence of an AIDS-defining illness. Logistic regression was used to determine characteristics associated with HIV recent infections. The spatial analysis was conducted with ArcGIS 10.7 to figure hot-spot areas of HIV recent infections.

Results

42,089 newly diagnosed HIV-1 cases were tested using the LAg-Avidity EIA. In total, 5848 (13.89%) of those were classified as HIV recent infections. Female, age between 18-25 years and men who had sex with men were related to higher proportion of HIV recent infections. Logistic regression revealed that MSM aged between 18-25 years were more likely to be classified as recent infection. Spatial analysis demonstrated significant clustering in Chengdu, Yibin, Luzhou city between 2018 and 2020. Hot spots were mainly clustered in the center of Sichuan in 2018, but gradually spread to southwest and northwest between 2019 and 2020.

Conclusion

Enhanced preventive measures among relevant risk groups and areas where the potential HIV-1 transmission is ongoing is urgently needed to curb further spread.

Long-Term Forecast of HIV/AIDS Epidemic in China with Fear Effect and 90-90-90 Strategies

We formulate a compartmental model considering behavioral changes of susceptible individuals due to fear to assess the transmission dynamics of HIV/AIDS in mainland China. Stability and uniform persistence are analyzed. Markov chain Monte Carlo simulations and Latin hypercube sampling are used to estimate the basic reproduction number and its sensitivity to parameter variations. The estimated mean reproduction number is 1.2138 (95% CI 1.0834-1.3442). The basic reproduction numbers of aware susceptible individuals and high-risk susceptible individuals are [Formula: see text] (95% CI [Formula: see text]-[Formula: see text]) and 1.2138 (95% CI 1.0834-1.3442), respectively. Global sensitivity analysis shows that preventive measures are more effective than post-infection measures in eliminating the epidemic. We incorporate 90-90-90 strategies to predict the new HIV/AIDS cases in China in the next few decades, and the results show that it takes at least 26 years to achieve the goal of zero new HIV/AIDS cases.

Comparison of Health Literacy Assessment Tools among Beijing School-Aged Children

Health literacy is a broad and multidimensional construct, making its measurement and conclusions inconsistent. This study aims to compare the patterning of health literacy using different assessment tools and examine their impact on children's developmental outcomes. A cross-sectional study was conducted with 650 students in Years 7-9 from four secondary schools in Beijing. Health literacy was measured by the eight-item health literacy assessment tool (HLAT, score range 0-37), the six-item Newest Vital Sign (NVS, score range 0-6), and the 16-item Health Literacy Survey (HLS, score range 0-16). Based on Manganello's health literacy framework, information on upstream factors (e.g., gender, ethnicity, socioeconomic status) and developmental outcomes (e.g., health-promoting behaviours, health service use, global health status) was collected. Overall, the average scores for health literacy were 26.34 ± 5.89, 3.64 ± 1.64, and 13.72 ± 2.94, respectively, for HLAT, NVS, and HLS. The distribution of health literacy varied by socio-demographics and individual characteristics except for gender, no matter which health literacy assessment tool was used. The magnitude of associations between health literacy, its upstream factors and developmental outcomes was greater when using three-domain instruments (HLAT and HLS) than using single-domain instruments (NVS). The approach to health literacy measurement will influence the conclusion. Using multidimensional assessment tools may better capture a child's health literacy and contribute to the maximum efficiency and effectiveness of school-based health literacy interventions.

Association between condom use and perspectives on contraceptive responsibility in different sexual relationships among sexually active college students in China: A cross-sectional study

China has increasing incidence of unplanned pregnancies among college students these years. Increasing students' sense of responsibility to protect sexual partners may help reduce the rate of unplanned pregnancies.A self-administered questionnaire was distributed to students from 3 colleges in Sichuan, China. Among them, 559 of male students and 267 of female students were included in this study. The questionnaire collected participants' characteristics, usage of condom, and investigated male and female students' perceptions of who should be responsible for contraception use.We found that relationship status was closely related to students perceiving responsibility for reproductive health and condom using. Male students who were in casual relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other male students (P < .001). Female students who were in steady relationships during their most recent sexual encounter and shared responsibility for contraception were more likely to use condoms than other female students (P = .007). The multivariate analysis revealed condom use was associated with greater odds of sharing responsibility for contraceptive use in different types of sexual relationships.Improving students' attitudes toward responsibility for contraception may increase condom use among students at risk for unplanned pregnancies. Programs providing targeted health education and services may help reduce the rate of unplanned pregnancies among students in China.

A systematic review on identifying risk factors associated with early sexual debut and coerced sex among adolescents and young people in communities

AIMS AND OBJECTIVES

To review literature on identifying the risk factors associated with early sexual coerced debut with the aim to facilitate the healthcare workers' planning of relevant health services to improve intervention strategies for delaying of early coerced sexual debut or forced sexual debut (CSD/FSD) in the communities.

BACKGROUND

Identifying the risk factors associated with coercion at first sex is crucial for developing appropriate sexual and reproductive health information and health promotion in response. However, current knowledge about the risk factors associated with coercion, sexual debut (SD) and delayed SD among young people is limited. Health information programmes are important during adolescence, when young people are developing their values and beliefs about sexual activity and sexual norms. However, little is known about those risk factors on initiation of early sexual debut to plan relevant interventions that can delay SD and prevent CSD/FSD in this population.

DESIGN

A systematic review.

METHODS

An extensive literature search using MEDLINE (PubMed), Nursing Journals (PubMed), Web of Science, PsychINFO and CINAHL.

RESULTS

The search generated 39 published studies that met our inclusion and exclusion criteria. Thirty-two articles passed the quality appraisal and were selected. This review identified six domains of risk factors, categorised as: (1) the individual domain, (2) the family domain, (3) the partner/peer domain, (4) the school domain, (5) the community domain and (6) the cultural domain. These factors highlight the influences on sexual decision-making among adolescents and young people and the timing of their first sexual intercourse.

CONCLUSION

It is important to use the outcome of this review's categorisation of identified risk factors to facilitate the healthcare workers and plan relevant sexual and reproductive health programmes more accessible to adolescents, especially young females and their parents. There is a need to evaluate the impact of these programmes that can delay SD and prevent CSD/FSD in this population.

RELEVANCE TO CLINICAL PRACTICE

The results of this study could provide guidance on the planning of effective interventions for delaying of early CSD/FSD in the communities.

A Peer-Led, Social Media-Delivered, Safer Sex Intervention for Chinese College Students: Randomized Controlled Trial

Background

The peer-led, social media-delivered intervention is an emerging method in sexual health promotion. However, no research has yet investigated its effectiveness as compared with other online channels or in an Asian population.

Objective

The objective of this study is to compare a peer-led, social media-delivered, safer sex intervention with a sexual health website. Both conditions target Chinese college students in Hong Kong.

Methods

A randomized controlled trial was conducted with a peer-led, safer sex Facebook group as the intervention and an existing online sexual health website as the control. The intervention materials were developed with peer input and followed the information-motivation-behavioral skills model; the intervention was moderated by peer educators. The participants filled out the online questionnaires before and after the 6-week intervention period. Outcome evaluations included safer sex attitudes, behavioral skills, and behaviors, while process evaluation focused on online experience, online-visiting frequency, and online engagement. The effect of online-visiting frequency and online engagement on outcome variables was investigated.

Results

Of 196 eligible participants—100 in the control group and 96 in the intervention group—who joined the study, 2 (1.0%) control participants joined the Facebook group and 24 of the remaining 194 participants (12.4%) were lost to follow-up. For the process evaluation, participants in the intervention group reported more satisfying online experiences (P<.001) and a higher level of online-visiting frequency (P<.001). They also had more positive comments when compared with the control group. For outcome evaluation, within-group analysis showed significant improvement in condom use attitude (P=.02) and behavioral skills (P<.001) in the intervention group, but not in the control group. No significant between-group difference was found. After adjusting for demographic data, increased online-visiting frequency was associated with better contraceptive use behavioral intention (P=.05), better behavioral skills (P=.02), and more frequent condom use (P=.04).

Conclusions

A peer-led, social media-delivered, safer sex intervention was found to be feasible and effective in improving attitudes toward condom use and behavioral skills, but was not significantly more effective than a website. Future research may focus on the long-term effectiveness and cost-effectiveness of this popular method, as well as the potential cultural differences of using social media between different countries.

Trial Registration

Chinese Clinical Trial Registry (ChiCTR): ChiCTR-IOR-16009495; http://www.chictr.org.cn/showprojen.aspx?proj=16234 (Archived by WebCite at http://www.webcitation.org/6s0Fc2L9T)

Comparison of Sexual Knowledge, Attitude, and Behavior between Female Chinese College Students from Urban Areas and Rural Areas: A Hidden Challenge for HIV/AIDS Control in China

Currently, research in sexual behavior and awareness in female Chinese college students (FCCSs) is limited, particularly regarding the difference and the influencing factors between students from rural areas and urban areas. To fill the gap in available data, a cross-sectional study using anonymous questionnaires was conducted among 3193 female students from six universities located in Beijing, Shanghai, and Guangzhou, China, from February to June, 2013. Of the 2669 respondents, 20.6% and 20.9% of the students from urban and rural areas, respectively, reported being sexually experienced. The proportion of students who received safe-sex education prior to entering university from rural areas (22.4%, 134/598) was lower (P < 0.0001) than the proportion from urban areas (41.8%, 865/2071). Sexual behavior has become increasingly common among FCCSs, including high-risk sexual behavior such as unprotected commercial sex. However, knowledge concerning human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) transmission and the risks is insufficient, particularly for those from rural areas, which is a challenge for HIV/AIDS control in China. The Chinese government should establish more specific HIV/AIDS prevention policies for Chinese young women, strengthen sex education, and continue to perform relevant research.

The HIV/AIDS epidemic among young people in China between 2005 and 2012: results of a spatial temporal analysis

OBJECTIVES

Despite a recent increase in the HIV/AIDS epidemic among young people in China, youth-specific HIV data are limited.

METHODS

In total, 56 621 individuals with HIV/AIDS, aged 15-24 years, registered in the Case Reporting System of China between 2005 and 2012 and having complete spatial information were included in the present analysis. Spatial autocorrelation (general and local) and space-time scanning were performed using the ArcGIS 10.2 and SaTScan 9.3 software, respectively.

RESULTS

During 2005-2012, the number of reported HIV/AIDS cases and the proportion of HIV cases increased while the proportion of AIDS cases decreased. Sexual contact became the predominant route of transmission in later years. Spatial analysis showed marked geographical variations in HIV infection among young people throughout China during 2005-2012. The number of new hotspots increased over time. They were mainly localized to southeastern coastal areas, southwestern frontier provinces or autonomous regions (of Guangxi, Yunnan and Sichuan) and Beijing municipality. Later these hotspots disappeared and new hotspots were found in the northeast of the country. Significant clusters of HIV-positive cases were identified in three different time periods, which indicated high HIV transmission among young Chinese people in the recent past. The risk of HIV infection was highest in the first cluster (2009-2012; this cluster was the largest in size) covering the provinces of Guizhou and Yunnan, the Chongqing municipality, Guangxi, and the province of Sichuan. The second cluster (2010-2012) was mostly located in Shanghai, South Jiangsu, Zhejiang and South Anhui, while the third cluster (2010-2012) was located in Beijing and Tianjin.

CONCLUSIONS

Target-specific comprehensive behavioural interventions are urgently needed to contain the HIV epidemic among young people.

Knowledge and Behavioural Factors Associated with Gender Gap in Acquiring HIV Among Youth in Uganda

Background

The increasing prevalence of HIV in Uganda during the last decade (7.5% in 2004-05 to 8.3% in 2011 among women and 5.0% in 2004-05 to 6.1% among men in 2011 of 15 to 49 years) clearly shows that women are disproportionately affected by HIV epidemic. Hence, we assessed the prevalence of HIV and focused on differences in risky sexual behaviour and knowledge of HIV among Ugandan youth.

Design and Methods

Uganda AIDS Indicator Survey 2011 data was used. The total samples of men and women (15 to 24 years), interviewed and tested for HIV, were 3450 and 4504 respectively. The analysis of risky sexual behaviour was based on 1941 men and 3127 women who had ever had sex and were tested for HIV. Pearson’s Chi-square test and multivariate logistic regression analysis were used.

Results

Findings showed that young women were almost two times more vulnerable than young men in acquiring HIV (OR=1.762, P<0.001). Women who had first sex under age 15 (7.3%), had more than 2 sexual partners (9.2%) and did not use condom during last sex (6.4%) were more HIV-positive. Higher risk was found among women (6.3%) than men (2.2%). Significantly (P<0.01) less percentage (81.3%) of women as compared to men (83.8%) perceived that the probability of HIV transmission may be reduced by correct and consistent use of the condom during sex.

Conclusions

Hence, there is an urgent need for effective strategies and programmes to raise awareness on sexual health and risky behaviour, particularly targeting the youth, which will reduce the gender gap in risky sexual behaviour and new transmission of HIV in Uganda.

The sexuality education and attitudes of college students in China

Purpose

– The purpose of this paper is to examine the type and quality of sexuality education received by college students in Hangzhou, China. Their attitudes towards sex and sexuality were also explored. To set the broader context the regulations and laws governing the provision of sexuality education in China have also been examined.

Design/methodology/approach

– A cross-sectional survey of 132 college students was conducted in Hangzhou, China in 2013. The aim was to explore their experience of and attitudes towards their sexuality education.

Findings

– Most respondents lacked formal sexuality education. Neither schools nor parents were reported to be the major providers of sexuality education. The students reported that their main sources of knowledge and information relating to sex were their fellow schoolmates and the internet. Participants reported insufficient or inaccurate sexual knowledge as a key factor in their participation in unprotected sex. Attitudes towards premarital sex and cohabitation, and homosexual relationships were reported to be more open and tolerant than those of the older generation.

Originality/value

– The data from this study suggest that reluctance amongst parents and schools to provide formal and comprehensive sexuality education has resulted in unsatisfactory sexuality education in Hangzhou. The lack of sexuality education among college students may have had an influence on their unsafe sexual behaviours which is potentially damaging to both their physical and psychological health. Implications for improving the quality of sexuality education for young people in China are discussed.

The increase of sexually transmitted infections calls for simultaneous preventive intervention for more effectively containing HIV epidemics in China

OBJECTIVE

To identify the priority public health challenges with respect to the development of multipurpose prevention technologies in China.

DESIGN

Review of published literature, databases of state and local disease control agencies and unpublished data relating to HIV and other sexually transmitted infections (STIs).

SETTING

China.

POPULATION

General and migrant populations.

METHODS

Review of published data, government reports and databases of China Disease Control agencies, and our unpublished studies.

MAIN OUTCOME MEASURES

Reported STI incidence, particularly HIV, syphilis, chlamydia and genital herpes, and the migrant population with respect to disease transmission.

RESULTS

We found that the reported STI incidence increases along with that of HIV and showed significant geographic overlap with HIV. Economic migrant workers may facilitate the spread of STIs, including HIV.

CONCLUSIONS

To more effectively contain the HIV epidemic, it is imperative to develop preventive measures to simultaneously target HIV and other STIs. We recommend that the development of multipurpose prevention technologies in China should target HIV and STIs.

Factors influencing adolescent girls' decision in initiation for human papillomavirus vaccination: a cross-sectional study in Hong Kong

BACKGROUND

Cervical cancer is one of the common cancers among women worldwide. Despite HPV vaccination being one of the effective preventive measures, it is not included in government vaccination programme in Hong Kong. This study aimed to assess the knowledge of and attitude towards cervical cancer prevention among Chinese adolescent girls in Hong Kong, and to identify factors influencing the initiation of HPV vaccination.

METHODS

This was a cross-sectional study conducted in Hong Kong during the period of October 2010 to November 2010. A self-administered questionnaire was used, with 1,416 girls from 8 secondary schools completing the questionnaire. Knowledge scores were composited and initiation of HPV vaccination was staged based on stage of change. Analyses were conducted to identify the association of initiation of HPV vaccination with participant's personal and family factors as well as their knowledge and attitude towards cervical cancer prevention.

RESULTS

The uptake rate of HPV vaccination was low (7%) with 58% respondents in pre-contemplation and contemplation stage. The survey identified a significant gap in knowledge on cervical cancer prevention. The main channels of information were from media and very few from schools or parents. However, 70% expressed their wishes to have more information on cancer prevention, and 78% stated that they were willing to change their lifestyles if they knew the ways of prevention. Multivariate analysis identified three independent significant factors for initiation of vaccination (action and intention): perceived cancer as terrifying disease, school should provide more information on cancer prevention, and comments from relatives and friends having received the vaccine. The cost of vaccination and socio-economic background were not found to be significant.

CONCLUSIONS

Public education on cervical cancer needs to be well penetrated into the community for more sharing among friends and relatives. School as setting to provide source of information would facilitate uptake rate of HPV vaccine as students have expressed their wishes that school should provide more information on prevention of cancer. School and community education on cancer prevention would help adolescents to have better understanding of the seriousness of cancer.

Sexual coercion and health-risk behaviors among urban Chinese high school students

Objective

To determine the association between health-risk behaviors and a history of sexual coercion among urban Chinese high school students.

Design

A cross-sectional study was performed among 109,754 high school students who participated in the 2005 Chinese Youth Risk Behavior Survey. Data were analyzed for 5,215 students who had experienced sexual intercourse (1,483 girls, 3,732 boys). Multivariate logistic regression was used to determine the relationship between sexual coercion and the related covariates, and data were stratified by gender.

Results

Of those students who had had sexual intercourse, 40.9% of the females and 29.6% of the males experienced sexual coercion (p<0.01). When analyses controlled for demographic characteristics, in the study sample, that is, students who had sexual intercourse, drug use (odds ratios [OR], 2.44), attempted suicide (OR, 2.30), physical abuse (OR, 1.74), binge drinking (OR, 1.62), verbal abuse (OR, 1.29), experience of being drunk (OR, 0.68), and smoking of cigarettes (OR, 0.52) were related to a history of sexual coercion. Patterns of health-risk behaviors also differed among female and male students who had experienced sexual coercion.

Conclusions

Sexual coercion is associated with health-risk behaviors. Initiatives to reduce the harm associated with sexual coercion among high school students are needed.

Condom use at sexual debut among Chinese youth

Chinese youth represent a high-risk group for sexually transmitted infections and unintended pregnancies, but there is little understanding of their sexual behaviours. Using nationally representative data, this study examines the social and demographic correlates of condom use by Chinese youth at sexual debut. It also examines the relationship context of condom use at sexual debut. The results indicate that condom use at sexual debut is very low in China, confirming that youth are a high-risk group. The results demonstrate that age and educational attainment are the primary indicators of condom use. Early sexual debut associates with a greater risk of unsafe sex at sexual debut and higher educational attainment increases the likelihood of self-protecting behaviours. The likelihood of self-protection also increases when sexual partners plan their sexual debut or discuss contraception beforehand. The results suggest that interventions are needed to provide youth with better knowledge about self-protection.

Predictors of consistent condom use based on the Information-Motivation-Behavior Skill (IMB) model among senior high school students in three coastal cities in China

BACKGROUND

High prevalence of risky sexual behaviors and lack of information, skills and preventive support mean that, adolescents face high risks of HIV/AIDS. This study applied the information-motivation-behavioral skills (IMB) model to examine the predictors of consistent condom use among senior high school students from three coastal cities in China and clarify the relationships between the model constructs.

METHODS

A cross-sectional study was conducted to assess HIV/AIDS related information, motivation, behavioral skills and preventive behaviors among senior high school students in three coastal cities in China. Structural equation modelling (SEM) was used to assess the IMB model.

RESULTS

Of the 12313 participants, 4.5% (95% CI: 4.2-5.0) reported having had premarital sex and among them 25.0% (95% CI: 21.2-29.1) reported having used a condom in their sexual debut. Only about one-ninth of participants reported consistent condom use. The final IMB model provided acceptable fit to the data (CFI = 0.981, RMSEA = 0.014). Consistent condom use was significantly predicted by motivation (β = 0.175, P < 0.01) and behavioral skills (β = 0.778, P < 0.01). Information indirectly predicted consistent condom use, and was mediated by behavioral skills (β = 0.269, P < 0.05).

CONCLUSIONS

The results highlight the importance of conducting HIV/AIDS preventive health promotion among senior high school students in China. The IMB model could predict consistent condom use and suggests that future interventions should focus on improving motivation and behavioral skills.

Early sexual debut and condom nonuse among adolescents in South Korea

BACKGROUND

The purpose of this study was to investigate the factors related to sexual debut among adolescents, and to examine the association between subject characteristics and condom nonuse among those who experienced sexual intercourse in South Korea.

METHODS

Data were obtained from the 2009 Korean Youth Risk Behaviour Survey, a nationally representative sample. Logistic regression analysis was conducted to investigate the factors related to sexual debut, associations of condom nonuse and subject characteristics.

RESULTS

Among male adolescents, age, early age at first emission, low academic achievement, living with a step-parent, perceived low level of household income, frequent drinking and smoking, and depressive feelings were associated with early sexual debut. Attending a coeducational school, living with a single biological parent and step-parent, risky health behaviour such as drinking and smoking, and depressive feelings were related risks factors for early sexual debut among female students. Factors associated with condom nonuse included early sexual debut (less than 16 years of age) (odds ratio (OR)=1.79, 95% confidence interval (CI)=1.32-2.43) and frequent smoking behaviour (OR=1.49, 95% CI=1.08-2.05) for males and early sexual debut (OR=4.37, 95% CI=1.02-18.68) and frequent drinking (OR=2.05, 95% CI=1.12-3.75) for females.

CONCLUSIONS

Appropriate interventions should be implemented for adolescents in Korea to delay sexual debut and educate them on the proper use of condoms.

A blind area of family planning services in China: unintended pregnancy among unmarried graduate students

BACKGROUND

Status of premarital sex, unintended pregnancy and associated factors among Chinese graduate students remain unclear. And unmarried graduate students' needs of family planning services seem to be ignored. In the present study, we ascertained the prevalence rate of premarital sex and unintended pregnancy, as well as estimated the possible factors associated with unintended pregnancy among unmarried Chinese graduate students, and evaluated their reproductive health needs.

METHODS

We obtained the representative sample of graduate students using a multistage, stratified, cluster design, and collected data using a questionnaire.

RESULTS

We obtained 11936 responders. Premarital sexual intercourse was acknowledged by 24.2% of responders; unintended pregnancy was acknowledged by 4.8% of responders (19.8% of students active in premarital sex); and abortion was acknowledged by 4.6% of responders (96.7% of pregnant students). In multivariate analysis, the identified risk factors for unintended pregnancy among both genders that were active in premarital sex were: (1) having no steady lover [for males: odds ratio (OR), 1.96, 95% confidence interval (CI), 1.41-2.70; for females: OR, 2.65; 95%CI, 1.56-4.84]; (2) younger age at the first sexual intercourse (for males: OR, 1.62, 95% CI, 1.22-2.15; for females: OR, 2.57; 95% CI, 1.64-4.02); (3) lack of condom use at the first sex (for males: OR, 1.13, 95% CI, 1.09-1.37; for females: OR, 2.81; 95% CI, 1.81-4.39); (4) unaware of the conditions of conception (for males: OR, 1.69, 95% CI, 1.31-2.19; for females: OR, 1.75; 95% CI, 1.16-2.65); and (5) unaware that abortion endangers women's future pregnancy (for males: OR, 2.98, 95% CI, 2.15-4.14; for females: OR, 2.34; 95% CI, 1.23-4.46). Medical graduates were not less likely to have unintended pregnancy than nonmedical graduates for both genders.

CONCLUSIONS

The avoidable risk of being unintended pregnancy among graduate students in China indicates that an urgent need to take action on how to delay the age of first sex, promote condom use at first sex, and acquire accurate contraceptive information, as well as improve skills to use reliable contraception among graduate students.

Sexual behaviours and associated risks in Chinese young people: a meta-analysis

Background The earlier and unprotected sexual behaviour of young Chinese, and the consequences of these actions, have become a health concern, posing a challenge to traditional Chinese concepts. The aim of the present study was to investigate changes in sexual behaviour and associated risks among adolescents and young people in mainland China over the past three decades. Methods: A meta-analysis was undertaken to comprehensively review the sexual behaviour of Chinese young people (aged from 10 to 24 years) over the past 30 years. Relevant data published from 1979 to 2009 in the Chinese literature database were identified and retrieved. Analysis was performed based on set criteria. Results: Seventy-five studies were identified that were published after 1990. Overall, the estimated prevalence of sexual intercourse among young people was 12.6%, with an average age at sexual debut of 19.4 years. The rate of condom use at sexual debut was 37.2%; 53.6% of young people reported not using a condom during the most recent act of sexual intercourse. The rates of unintentional pregnancy and abortion among the sexually active were 15.1% and 10.8%, respectively. Reviewing the data according to decades revealed that the number of young people engaging in sexual intercourse decreased from 14.3% in 1990–1999 to 11.8% in 2000–2009. However, these rates are higher than the prevalence of sexual activity reported before 1990, which, according to sporadic studies, did not exceeded 1%. Conclusions: There have been increases in sexual activity and high-risk sexual behaviour in Chinese young people in the decades since the adoption of the open door policy in China, particularly since the mid-1990s. High-risk sexual behaviours have contributed to certain adverse consequences in adolescents and young people, such as unwanted pregnancy and sexually transmissible infection. Thus, efficacious intervention strategies need to be developed and implemented.

Rates and Methods of Contraception Among Korean Adolescents from 2007 to 2009

PURPOSE

This study was done to explore the rates and methods of contraception among Korean adolescents from 2007 to 2009.

METHODS

The study was a descriptive study. The data were taken from a web-based survey on risk behavior of Korean youth that was conducted between 2007 and 2009 by the Korea Centers for Disease Control and Prevention.

RESULTS

Among adolescents, 4.7% in 2007, 4.6% in 2008, and 4.7% in 2009 reported having had sexual intercourse. In those who had sexual experiences, less than 30% reported consistent use of contraception, whereas more than 45% report no contraceptive use at all. A condom was the most frequently used contraceptive method and its use has increased continuously among contraceptive users. Some of the adolescents were, nevertheless, using unreliable methods such as withdrawal or the rhythm method.

CONCLUSION

The results of this study indicate that most adolescents are not using contraception consistently and some were relying on unreliable contraceptive methods. Efforts to raise awareness about consistent and correct contraceptive use and the importance of dual protection are essential.