A Study On The Early Intervention Model Of The Formation Of Adolescents' Sexual Health Behavior

ObjectiveTo establish an early intervention model for adolescents'sexual health behavior that fits Chinese situations, with young people's needs for knowledge on sexual health as the starting point, and building up healthy sexual behavior as the goal.MethodsA combination of quantitative and qualitative methods was used to determine the systematic research design about adolescents'sexual health behavior from both theoretical and empirical perspectives. First, literature review, focus group discussions and nominal group discussions were conducted to create indicators that monitoring adolescents'sexual health behavior. Then adolescents'current sexual health behavior was investigated with cluster random sampling method. Mathematic model on adolescents'sexual health behavior was established using logistic regression, factor analysis and structural equation modeling. Finally, a randomized controlled trial was adopted to develop the on-site intervention and evaluation of intervention effects.Results(1) Baseline survey: Respondents have certain knowledge on adolescence, but not on human reproductive functions, sexually transmitted diseases and HIV/AIDS. The 7th graders'knowledge level was lower than the 8th graders and 9th graders. Boys'sex-related knowledge was better than girls'; but girls had more rational attitude toward sex issues than boys. Fourteen percent of respondents had been in romantic relationships. With the increase of grade level, the proportion of being in a romantic relationship increased as well. Among the respondents, 13.1% had masturbation experience, and 1.3% had sexual intercourse before. That proportion of those who had sexual intercourse among boys (1.7%) was higher than that among girls (0.9%). Their knowledge on sexual health about sex mainly came from schools, classmates/friends and parents.(2) Multivariate logistic regression indicated that factors influencing adolescents'sexual behavior (heterosexual relations, masturbation, and sexual intercourse) included family environment, family education, school education, media, peers, self-malfunctions (absence from school, tobacco, alcohol, and drug use), academic performance, and knowledge on sexual health.Exploratory factor analysis found 5 potential factors in the structural equation model:①negative tendencies, which controlled malfunctioned behavior;②society, which controlled school education, peers, and media;③family, which controlled family education, family environment and academic performance;④individuals tendencies, which controlled knowledge on and attitudes toward sex;⑤sexual behavior, which controlled masturbation, heterosexual relations, and sexual intercourse. According to fitting the ecology theory by observing data, the structural equation model suggested the effects of individual and environment factors on the formation of adolescents'sexual health behavior. The effects of family, community, malfunctioned behavior and individual tendencies on adolescents'sexual health behavior are not independent; instead, they coordinate with each other. Family, community, malfunctioned behavior and individual tendencies have a direct effect on adolescents'sexual health behavior. At the same time, family and community influence adolescents'sexual health behavior indirectly through malfunctioned behavior and individual tendencies.(3) Evaluation of the intervention effects: Respondents'scores on knowledge about sex improved significantly in the intervention group, with a trend benefit sexual health. Parents'scores on knowledge about sex also improved significantly. Their requests for skills on how to educate children about adolescence reproductive health increased significantly. The intervention among teachers changed their attitude towards sexual education among middle school students; their worries about sexual education were eliminated; and their awareness to prevent adolescents'risky sexual behavior was increased.Conclusions(1) It is important to fully understand adolescents'current sexual health status and factors that influence it in establishing effective intervention strategies.(2) Intervention models should be based on adolescents'sexual health behavior theory and focus on the controllable factors, so that they could achieve desirable effects and good intervention methods.(3) Resources from communities, schools, and families should be fully used, and sexual health education and evaluation of intervention effects should be paid attention to. And errands need to be corrected as soon as possible.(4) Sexual education for adolescents should be people-oriented, personality-based education, and aim at building personality. Its development needs the concerted efforts of the whole community. It should be a school-oriented, community involved, and family-cooperated systematic multivariate project.InnovationThis study combined quantitative and qualitative research methods. It explored the inherent mechanism influencing the formation of adolescents'sexual health behavior. At the same time, it applied "digital public health" to study public health issues. It is important in practice to improve the controllability of public health issues.