| [BACKGROUND] In the recent decades, more and more unmarried adolescents and youth in China were in the high risk of unwanted pregnancy, induced abortion and STDs along with the increase of premarital sexual behavior. As a result, exploration and implementation of effective provision model of education and health care and scale up to promote youth reproductive health by helping them to have safe and responsible sexual behavior has become a hot point of social concern. In the intervention area, program based on health promotion theory has drawn more and more attention, because such program can result in long time behavioral change and increase health of youth in large scale. A program based on health promotion theory with five strategic contents (building healthy public policy, creating supportive environments; strengthening community action; developing personal skills; reorienting health services) was evaluated in this study to elucidate its effects on related policy, Cognition, attitudes, skills and behaviors of target population (adolescents in vocational school), and provision and utilization of youth friendly services.[OBJECTIVES] The objective of the study was to evaluate the effect of Adolescent Reproductive Health Promotion Program on the establishment of supportive environment, the effect of life skills training on adolescent's sex-related cognition, attitudes and behaviors, and the quality and utilization of youth friendly service initiated by the program.[METHODS] 1. Data related to effect of the health promotion program on the suppotive environment was collected by documentation (dated from 2000.5 to 2004.3) review and in-depth interview (2004.9-2004.12). Data and information for building supportive enviornment and changes occurred before and after the program were analyzed. 2. Three vocational schools in one district of Shanghai were selected as research site to evaluate the effect of life skills training on students' related cognition , attitudes, skills and behaviors, two as interventional group and the other as control group. The intervention lasted for two semesters (2003-2004) Two intervention models were applied in two interventional groups respectively. In intervention group one, intervention model is life skills training facilitated by the psychology teacher plus peer education activities; in intervention group two, the intervention model is life skills training only facilitated by the teachers in chief of the class. There was no special educational program in the control school except normal education activities as usual. The subjects were grade two students in the three study schools. The intervention lasted for one academic year. Baseline, interim and post-intervention surveys (2003.5-2004.5) were conducted by computer-based questionnaire survey. The effect of the intervention on students' cognition, attitudes and behaviors, and the difference of the effect of two intervention models were analyzed by comparing the change from baseline to post-intervention among different groups. 3. Nine adolescents friendly services centers was selected as research sites to evaluate quality and utilization of the service (dated from 2003.7-2003.6). Statistical methods used in the study included t-test, Chi-square test, correlation analysis, logistic regression, GLM and GEE.[RESULTS]1. The effect of the Adolescent Reproductive Health Promotion Program on the building supportive environmentThe program helped policy makers to realize the seriousness of reproductive health problem of adolescents and the significance of reproductive health education and service provision. It also removed the worry of people at district level in the pilot institures and attracted more and more organizations to join in the program. Attitude of teachers and parents toward sexual education were also changed by the program. During the program period, eight city level documents and 57 of district level documents for promoting adolescent reproductive health were issued. The total of 7.08 million RMB was input into the program by local government during May, 2000 to April, 2003. The ratio of money given by government to by the program was 1.8, 2.4 and 6.6 respectively in the pilot, development and widely extension period. The program also increased the cooperation of related departments, such as education, health and research departments. Twenty-eight training workships were held and 840 trainers were trained. Among them 5 workshops were in city level and 135 trainers participated in the training. The program has extent to 39 sub-districts, 11 towns, 111 schools and 141 companies in 19 districts of Shanghai. The network of Youth friendly service was established, the contents of service was expanded and the service quality was improved continuously.2. The effect of life skills training on the cognition , attitudes, skills and behaviors of students in vocational schoolsThe total of 1,612 students were surveyed at baseline, 623 in intervention group one, 472 in intervention group 2, and 517 in the control group. At post-intervention survey, the number of students in each school was 576, 447, and 486 respectively, and the total number was 1,023. The intervention effectively increased students' knowledge, the mean of increase score was 10.41 and 12.85 respectively in two intervention groups. The intervention also effectively improved perceived risk of students (OR was 2.43 in intervention group one and 3.61 in intervention group two), perceived self-efficacy in contraceptive use (OR was 1.03 in intervention group one and 1.05 in intervention group two), perceived self-efficacy in making a decision of responsible sex (OR was 1.09 in intervention group one and 1.05 in intervention group two). In addition the first intervention model decreased the perceived barrier for contraceptive use (OR was 0.67) and peer pressure (OR was 0.96), made more conservative attitude toward premarital sexual behavior (OR was 0.96), and attitude toward AIDs patients more friendly (OR was 2.16) as well as postponed sex initiation of girls (OR was 0.25). The second intervention model increased the perceived benefit of learning condom (OR was 1.03) and decreased feeling of shame and worries after masturbation (OR was 0.22).3. Quality and utilization of youth friendly servicesThe comprehensive quality score ranged between 0.6～0.8 among nine service centers, most centers were of high level. The scores of different sub-terms varied among different centers. Centers in school have high scores in facility characteristic of youth friendly servicess, peer education, user participation. City level centers have higher scores in most iterms than centers out of school. Totally 3,162 counseling cases were recorded in nine centers, among them 2,248 were provided by city level centers. The most welcomed and utilized counseling way was through web-site (2,079), followd by face-to-face counseling and telephone counseling. The utilization of web-site counseling increased during the study year. The number of girls who used sevices was two time of that of boys. Of all counseling services users, youth aged 15 years of older accounted for the most majority. The counseling topic was very wide. In centers outside of school, the frequently asked questions included pregnancy/contraception (36.3%), unsafe sexual behavior (18.7%) and physical development (19.6%). In centers in school, the most questions frequently asked included study pressure (32.3 % ), physical development (20.5%) and communication with parents (13.7%).[CONCLUTION] 1. The project has successfully improved establishment of the supportive environment for adolescent reproductive health education and services; 2. Life skills training program had positive effect on students' cognition, attitudes, skills and behaviors; 3.The impact of life skills training facilitated by psychologic teacher plus peer education was larger than that facilitated by teacher in chief of the class; 4.Youth friendly services came into being but still in the progress of exploration, counseling services were not fully utilized yet.
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