1
|
Zhou H, Zhang H, Xiao AY, Yu L, Tang K. Effects of an Animation-Based Comprehensive Sexuality Education Package: A 2-Year Repeated Intervention Study. HEALTH EDUCATION & BEHAVIOR 2024:10901981241236415. [PMID: 38634397 DOI: 10.1177/10901981241236415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2024]
Abstract
BACKGROUND Preadolescents, who are in a transitional phase of development, may experience higher exposure to heterosexual interactions while facing higher risks regarding misinformation in sexual knowledge and unsafe engagement in sexual activities. There is a deficiency in the availability of qualified educators and age-appropriate teaching materials for sexuality education in China. METHODS We implemented an animation-based comprehensive sexuality education package among preadolescents aged 9 to 12 years from eight schools in Anhui, China. The first round of intervention included 1,835 participants, lasting 2 months from September to November 2020. A total of 374 participants, accounting for 52% of the intervention group, received a second round of intervention in September 2021. Participants completed immediate follow-up assessment and 1-year follow-up assessment to assess changes in their sexual knowledge, attitudes, and other outcomes. Propensity score matching and difference-in-difference analysis were performed to determine the short- and long-term impacts. RESULTS Significant improvements were observed for both sexual knowledge and sexual attitudes in the immediate follow-up. There was no significant effect on pornography-seeking behavior or awareness of experiencing sexual abuse. After 1 year, the effect was sustained for sexual knowledge, but slightly declined for sexual attitudes. The second intervention significantly improved sexual knowledge; however, no significant change in sexual attitudes, pornography-seeking behavior, or awareness of experiencing sexual abuse was observed. CONCLUSIONS Our comprehensive sexuality education package was effective in improving sexual knowledge both immediately and 1 year after the intervention. Repeated intervention can be an effective strategy for promoting preadolescent health development regarding comprehensive sexuality education.
Collapse
Affiliation(s)
- Hui Zhou
- Tsinghua University, Beijing, China
- Harvard University, Boston, MA, USA
| | | | | | - Lei Yu
- Jinan Vocational College of Nursing, Shandong, China
| | - Kun Tang
- Tsinghua University, Beijing, China
| |
Collapse
|
2
|
Zheng H, Cai Y, Liu L, Peng B. The effect of childhood sexual abuse on depressive symptoms in female college students: a serial mediation model. Front Psychol 2024; 15:1306122. [PMID: 38414881 PMCID: PMC10897053 DOI: 10.3389/fpsyg.2024.1306122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Accepted: 01/30/2024] [Indexed: 02/29/2024] Open
Abstract
Objective Childhood sexual abuse (CSA) can have a negative impact on women's psychological, emotional and social functioning. The purpose of this study was to explore the relationship between CSA and depressive symptoms in female college students, as well as the mediating roles of negative core schema and experiential avoidance. Methods 515 female college students responded to the Sexual Abuse subscale of the Childhood Trauma Questionnaire, the Depression subscale of the Depression Anxiety Stress Scale, the Brief Core Schema Scales, and the Acceptance and Action Questionnaire - II. The structural equation modeling was used for the mediation analysis. Results There was a significant positive correlation between CSA and depressive symptoms in female college students. The theoretical model was well fitted, χ2/df = 3.422, RMSEA = 0.069, CFI = 0.929, TLI = 0.919. The negative core schema played a mediating role between CSA and depressive symptoms. Experiential avoidance played a mediating role between CSA and depressive symptoms. The negative core schema and experiential avoidance played a serial mediating role between CSA and depressive symptoms. Conclusion These results deepen our understanding of the relationship between CSA and depressive symptoms in female college students, and provide theoretical guidance for the prevention of depression in female college students. Attention should be paid to female college students who have experienced CSA, to eliminate the adverse influence of negative core schema on these students. Meanwhile, we should teach female college students to accept themselves as they are, and thereby reduce their use of experiential avoidance strategies.
Collapse
Affiliation(s)
- Haopeng Zheng
- College of Marxism, Hunan Normal University, Changsha, China
| | - Yan Cai
- School of Marxism, Guangxi University, Nanning, China
| | - Lei Liu
- Public Administration School, Guangzhou University, Guangzhou, China
| | - Biao Peng
- School of Marxism, Guizhou Medical University, Guiyang, China
| |
Collapse
|
3
|
Rong Z, Jing H, Lin Y, Rongzhe C, Maoxu L, Xin L, Ping Z. Sex differences in the association of childhood sexual abuse severity with premarital sex among Chinese college students in Luzhou, China. BMC Public Health 2024; 24:290. [PMID: 38267877 PMCID: PMC10809740 DOI: 10.1186/s12889-024-17767-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Accepted: 01/13/2024] [Indexed: 01/26/2024] Open
Abstract
PURPOSE The adverse health consequences of premarital sex and childhood sexual abuse (CSA) are both global public health problems. Based on a random sample of college students from a Chinese city, this study investigated the relationship between CSA severity and premarital sex among students, focusing on sex differences. METHODS A total of 2722 college students from 4 schools in Luzhou were recruited by multistage random sampling. Self-administered questionnaires were used to measure CSA experiences and premarital sex. Binary logistic regression analyses were conducted to analyse the relationship between CSA and premarital sex. RESULTS The prevalence of CSA was 9.39%, and that of mild, moderate and severe CSA was 4.04%, 2.90% and 2.46%, respectively. The premarital sex reporting rate was 22.42%. After adjusting for confounding variables, CSA was positively associated with premarital sex. Notably, a cumulative effect of CSA on premarital sex was observed among students. Further stratification analyses showed that males who experienced CSA had a higher premarital sex rate than females, and this sex difference was also observed among students with different CSA severities. CONCLUSION CSA and its severity were associated with premarital sex among college students. Furthermore, this association was stronger for males than females. Therefore, it is important to emphasize CSA prevention, especially for boys. These findings can promote understanding of the effects of CSA on premarital sex, and CSA prevention and intervention strategies should consider CSA severity and sex differences.
Collapse
Affiliation(s)
- Zhang Rong
- School of Public Health, Southwest Medical University, 646000, Luzhou, China
| | - He Jing
- School of Clinical Medicine, Southwest Medical University, 646000, Luzhou, China
| | - Yang Lin
- School of Clinical Medicine, Southwest Medical University, 646000, Luzhou, China
| | - Cao Rongzhe
- School of Clinical Medicine, Southwest Medical University, 646000, Luzhou, China
| | - Liao Maoxu
- Information and Education Technology Center, Southwest Medical University, 646000, Luzhou, China
| | - Lin Xin
- School of Nursing, Southwest Medical University, 646000, Luzhou, China
| | - Zhou Ping
- Department of Radiology, The Affiliated Hospital, Southwest Medical University, No. 25, TaiPing Street, Jiangyang District, 646000, Luzhou, China.
| |
Collapse
|
4
|
Sun J, Wang J, Li H. Are adverse childhood experiences associated with trajectories of healthy aging? Evidence from China. SSM Popul Health 2023; 24:101501. [PMID: 37692835 PMCID: PMC10492199 DOI: 10.1016/j.ssmph.2023.101501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 08/21/2023] [Accepted: 08/25/2023] [Indexed: 09/12/2023] Open
Abstract
Adverse childhood experiences (ACEs) have life-course impact and may be associated with healthy aging. This study aimed to explore the association between ACEs and healthy aging trajectories among middle- and older-aged adults in China. The data were obtained from the China Health and Retirement Longitudinal Study from 2011 to 2018. A total of 8906 respondents were enrolled in the analysis. Through latent growth mixture model, five categories of healthy aging trajectories which defined as 'stable type with high starting point', 'stable type at the middle level', 'stable type with low starting point', 'rapid descending type with high starting point', and 'stable descending type with medium starting point' were identified. Based on multinomial logistic regression, ACEs were significantly associated with healthy aging trajectories (stable type at the middle level/stable type with high starting point: relative risk reduction [RRR] = 1.19; P < 0.01; 95% CI = 1.16-1.23; stable type with low starting point/stable type with high starting point: RRR = 1.35; P < 0.01; 95%CI = 1.21-1.51; rapid descending type with high starting point/stable type with high starting point: RRR = 1.09; P < 0.1; 95% CI = 0.99-1.19; and stable descending type with medium starting point/stable type with high starting point: RRR = 1.30; P < 0.01; 95% CI = 1.23-1.38). When treating ACEs as a categorical variable, the healthy aging trajectory of the rapid descending type with a high starting point was not affected by any ACE groups. Further analysis of the relationship between each ACE and the trajectories of healthy aging reveals that parental disability, household mental illness, domestic violence, physical abuse, unsafe neighbourhood and bullying had significant impacts on almost every developmental trajectory of unhealthy aging. The government should promote the realisation of healthy aging from the perspective of the entire population and life cycle, intervene early in life, avoid the occurrence of ACEs as much as possible, and minimize the harm done by ACEs as much as possible.
Collapse
Affiliation(s)
- Ju Sun
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Jingru Wang
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| | - Haomiao Li
- School of Political Science and Public Administration, Wuhan University, Wuhan, China
| |
Collapse
|
5
|
Li J, Jin Y, Xu S, Luo X, Wilson A, Li H, Wang X, Sun X, Wang Y. Anxiety and Depression Symptoms among Youth Survivors of Childhood Sexual Abuse: A Network Analysis. BMC Psychol 2023; 11:278. [PMID: 37717011 PMCID: PMC10504753 DOI: 10.1186/s40359-023-01275-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 08/08/2023] [Indexed: 09/18/2023] Open
Abstract
BACKGROUND Previous studies have frequently reported a high prevalence of co-occurring anxiety and depression among people who experienced stressful events in childhood. However, few have noted the symptomatic relationship of this comorbidity among childhood sexual abuse (CSA) survivors. Therefore, this study's objectives were as follows: (1) to examine the relationship across symptoms between anxiety and depression among CSA survivors; (2) to compare differences between male and female network structures among CSA survivors. METHODS A total of 63 Universities and Colleges in Jilin Province, China, covered 96,218 participants in this study, a sub-set data of which met the criteria of CSA was analyzed with the network analysis. The Childhood Trauma Questionnaire-Short Form (CTQ-SF), measured CSA. Anxiety was measured by the seven-item Generalized Anxiety Disorder Scale (GAD-7), and depression was measured by the Patient Health Questionnaire (PHQ-9). The sex difference between anxiety and depression among CSA survivors was compared. RESULTS 3,479 college students reported the experience of CSA (CTQ-SF total scores ≥ 8), with a prevalence of 3.62% (95% CI: 3.50-3.73%). Among CSA survivors, control worry, sad mood, and energy were central and bridge symptoms of the anxiety and depression network. Meanwhile, male CSA survivors appeared to have a stronger correlation between guilt and suicide, but female CSA survivors seemed to have a stronger correlation between control worry and suicide. Moreover, the edge of control worry-relax-afraid was stronger in the male network, while the edge of restless-relax was stronger in the female network. CONCLUSION Control worry, sad mood, and energy are crucial to offer targeted treatment and to relieve anxiety and depression symptoms for CSA survivors. Guilt needs more attention for male CSA survivors, while control worry remains more important for female CSA survivors to reduce suicidal ideation and suicide attempts.
Collapse
Affiliation(s)
- Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China.
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China.
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China.
| | - Xianyu Luo
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Amanda Wilson
- Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
| | - Hui Li
- School of Public Health, Jilin University, Changchun, China
| | - Xiaofeng Wang
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Xi Sun
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China; School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China.
| |
Collapse
|
6
|
Stea TH, Steigen AM, Dangmann CR, Granrud MD, Bonsaksen T. Associations between exposure to sexual abuse, substance use, adverse health outcomes, and use of youth health services among Norwegian adolescents. BMC Public Health 2023; 23:1330. [PMID: 37434128 DOI: 10.1186/s12889-023-16261-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/07/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND A strong association between sexual abuse and adverse health outcomes has been reported among adolescents. The present study aimed to provide more information about adverse health outcomes associated with sexual abuse and substance use, and to examine the use of youth health services among Norwegian adolescents. METHODS National representative cross-sectional study among 16-19-year-old Norwegian adolescents (n = 9784). Multivariable regression analyses, adjusted for socioeconomic status and age, were used to examine the association between exposure to sexual abuse, substance use and health risk factors, and the use of youth health services. RESULTS Adolescents exposed to sexual abuse had higher odds of depressive symptoms (males: OR:3.8; 95% CI:2.5-5.8, females: 2.9;2.4-3.5), daily headache (males: 5.3;2.8-10.1, females:1.9; 1.5-2.4), high medication use (males: 3.2;1.7-6.0, females: 2.0;1.6-2.6), self-harm (males: 3.8;2.4-6.0, females:3.2; 2.6-3.9), suicidal thoughts (males: 3.3; 2.2-5.0, females:3.0; 2.5-3.6) and suicide attempts (males: 9.5;5.6-16.0, females:3.6;2.7-4.9). Furthermore, exposure to sexual abuse was associated with higher odds of using school health services (males: 3.9;2.6-5.9, females: 1.6;1.3-1.9) and health services for youth (males: 4.8;3.1-7.6, females: 2.1;1.7-2.5). In general, substance use was associated with increased odds of adverse health related outcomes and use of youth health services, but the strength of the relationships varied according to sex. Finally, results indicated a significant interaction between sexual abuse and smoking that was associated with increased odds of having suicidal thoughts for males (2.6;1.1-6.5) but a decreased odds of having suicidal thoughts and have conducted suicide attempts once or more for females (0.6;0.4-1.0 and 0.5;0.3-0.9, respectively). CONCLUSIONS The present study confirmed a strong relationship between exposure to sexual abuse and health risks, especially among males. Moreover, males exposed to sexual abuse were much more likely to use youth health services compared to sexually abused females. Substance use was also associated with adverse health outcomes and use of youth health services, and interactions between sexual abuse and smoking seemed to influence risk of suicidal thoughts and attempts differently according to sex. Results from this study increase knowledge about possible health related effects of sexual abuse which should be used to identify victims and provide targeted treatment by youth health services.
Collapse
Affiliation(s)
- T H Stea
- Department of Health and Nursing Science, University of Agder, Kristiansand, Norway.
| | - A M Steigen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
| | - C R Dangmann
- Department of Social Sciences and Guidance, Faculty of Social and Health Science, Inland Norway University of Applied Sciences, Elverum, Norway
| | - M D Granrud
- Department of Social Sciences and Guidance, Faculty of Social and Health Science, Inland Norway University of Applied Sciences, Elverum, Norway
| | - T Bonsaksen
- Department of Health and Nursing Sciences, Inland Norway University of Applied Sciences, Elverum, Norway
- Department of Health, Faculty of Health Studies, VID Specialized University, Stavanger, Norway
| |
Collapse
|
7
|
Jin Y, Xu S, Luo X, Wang Y, Li J, Liang B, Li H, Wang X, Sun X, Wang Y. A network approach to the symptom-level associations between smoking and posttraumatic stress disorder (PTSD) among young adults exposed to childhood sexual abuse. J Glob Health 2023; 13:04037. [PMID: 37350563 PMCID: PMC10288921 DOI: 10.7189/jogh.13.04037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023] Open
Abstract
Background Previous empirical literature has examined the associations between childhood sexual abuse (CSA) exposure, posttraumatic stress disorder (PTSD), and smoking. However, few studies examined symptom-level associations between smoking and PTSD among CSA victims. Thus, the aims of this study were 1) to explore symptom-level associations between smoking and PTSD among combustible cigarette (CC) and electronic cigarette (EC) users exposed to CSA and 2) to compare the differences manifested in two network structures between EC and CC users with CSA experiences. Methods This cross-sectional study covers all 63 universities and colleges in Jilin province, China, from October 26 to November 18, 2021. A total of 117 769 students participated in this study, while 3479 young adults were exposed to CSA (3.62%, 95% CI = 3.50%-3.73%). Childhood sexual abuse, PTSD, and smoking symptoms were measured using the Childhood Trauma Questionnaire-Short Form (CTQ-SF), 10-item Trauma Screening Questionnaire (TSQ-10), and the 6-item Fagerstrom Test for Nicotine Dependence (FTND-6), respectively. In addition, network analysis was applied to analyse psychopathological symptoms between EC and CC users with CSA experiences. Both the edges and centralities were computed, and the network properties were compared among the two groups. Results Four symptoms of PTSD (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were both central and bridge symptoms between PTSD and smoking among EC and CC users with CSA experiences. Moreover, compared with CC users with CSA, there were significantly stronger associations between "nightmares" - "difficulty with restrictions" and "irritability / anger" - "more during wake up" among young EC users with CSA. Conclusions The four symptoms (i.e. emotional cue reactivity, hypervigilance, nightmares, and difficulty concentrating) were keystones for treatments or interventions targeting these CSA victims with PTSD and smoking symptoms. Increasing efforts should be taken to restrict morning smoking among EC users with CSA. In addition, target interventions and strategies founded on these core symptoms and associations should be implemented to relieve the comorbid PTSD and smoking in EC and CC users with CSA experiences.
Collapse
Affiliation(s)
- Yu Jin
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Shicun Xu
- Northeast Asian Research Center, Jilin University, Changchun, China
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
- China Center for Aging Studies and Social-Economic Development, Jilin University, Changchun, China
| | - Xianyu Luo
- College of Education for the Future, Beijing Normal University, Beijing, China
| | - Yinzhe Wang
- Vanke School of Public Health, Tsinghua University, Beijing, China
| | - Jiaqi Li
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China, South China Normal University, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Beixiang Liang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China, South China Normal University, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| | - Hui Li
- School of Public Health, Jilin University, Changchun, China
| | - Xiaofeng Wang
- Northeast Asian Research Center, Jilin University, Changchun, China
| | - Xi Sun
- Department of Population, Resources, and Environment, Northeast Asian Studies College, Jilin University, Changchun, China
| | - Yuanyuan Wang
- Key Laboratory of Brain, Cognition and Education Sciences, Ministry of Education, China, South China Normal University, Guangzhou, China
- School of Psychology, Center for Studies of Psychological Application, and Guangdong Key Laboratory of Mental Health and Cognitive Science, South China Normal University, Guangzhou, China
| |
Collapse
|