The Study Of Sex-related Behaviors Pattern And Its Imfluencing Factors Of Unmarried Adolescents And Youth In Three Asian Cities

Background:In recent years, sexual maturity was gradually in advance, age of the first sex gradually declined, and age of marriage was postponed among adolescent. And with reform and opening up and economic development, many changes have taken place in premarital sex attitude of people. Premarital sex of adolescents ceaselessly increase, and thus lead to unwanted pregnancy, induced abortion and STD/AIDS infection, a Series of threats to adolescent health problems continue to emerge. At present, although there are many researches on youth sexual behavior, but lack of in-depth researches of adolescent reproductive health behaviors pattern and comprehensive analysis of its multi-systerm factors.Objectives:To explore behaviors pattern of adolesecent reproductive health and systematicly analyse its imfluencing factors among 3 Asian cities, Hanoi, Shanghai and Taipei using data from reproductive health survey conducted among 15-24 youths and adolescents living in the 3 cities, and provide references for future adolescent reproductive health interventions.Methods:The study is a cross-sectional survey conducted among 15-24 adolescents from urban and rural areas of the 3 cities influenced by Confucian culture.3 cities are at different stages of modernization and economic development levels (Hanoi:low, Shang: medium, Taipei:high). The primary sampling units (PSU) were selected and confirmed through multiple-stage cluster sampling, while the specific sampling methods were different in these cities according to different districts divisions and population density. All of the residential dwellings in the PSU were given a random number. The survey was conducted according to the sequence of the random numbers and was finished until the quote of each PSU was met. CASI (computer assistant self-interview) coupled by face-to-face interview was adopted in the questionnaire survey established by software Sawtooth. The general informations of the questionnaire were filled in interviewer, while the sensitive informations were filled out by adolescents themselves. Informations on subjects’backgrounds, reproductive health related knowledge, attitudes and behaviors, and its multi-system (individual, family, peer, school and media) factors were collected in the survey which took about 40-50 minutes. Before formal investigation started, interviewers from 3 cities were trained and 4 pilot studies were taken, then the questionnaire was revised and finally confirmed. Data from 16.544 unmarried youths and adolescents were analyzed with software SAS 9.1. Statistical methods include t test, ANOVA, chi-square, correlation analysis, canonical correlation analysis, lineral regression model, unconditioned logistic regression and COX regression etc. SEM (structural equation model) was built by software AMOS 17.0 and Multilevel Statistical Model was built by software MLwiN2.22.Results:1、General information:6,204,6,023 and 4,327 unmarried youths and adolescents from Hanoi, Shanghai and Taipei were included in the analysis sample, respectively. Over the half of respondents was student, and about half of them was above high school level, and over 70% of respondents lived in urban. The average age of them was 19.4.2、Reproductive health related knowledge, attitude and sex behavior:Adolescents among three cities obtained the reproductive health related knowledge mainly through the media and the school, followed by peer and family way. The proportion of Taipei adolescents getting the knowledge from various approaches was the highest, secondly Hanoi, the lowest is Shanghai. Reproductive health comprehensive knowledge score (hundred-mark system) of was 51.5 points in Hanoi,51.6 points in Shanghai and 59.8 points in Taipei among male adolescents, and was 50.0 points,50.9 points and 62.8 points respectively among female. The proportion of open premarital sex was 70.9%, 85.1% and 91.8% respectively among male of the 3 cities, and 36.9%,63.5% and 83.3% respectively among female. The proportion of condom use was 65.8%,71.1% and 88.6% respectively among male, and 73.5%,82.2% and 70.3% respectively among female. The proportion of agree with abortion was 71.5%,80.4% and 68.5% respectively among male, and 73.5%,82.2% and 70.3% respectively among female. The incidence of sexual behavior among male was 6.6%,16.8% and 34.9% respectively in three cities, and was 2.2%,8.7% and 27.5% respectively for female.3、Sex development-related behaviors pattern (SRBP):There are many similarities and differences on sex development-related behaviors pattern between Hanoi, Shanghai and Taipei. The main similarities are as follow:First, the incidences of SRB gradually decreased with the increase of behavior intimate degree. Second, the occurrence probabilities of SRB also decreased with the increase of behavior intimate degree. Third, it took 4 years or less for most adolescents from dating to intercourse, the average time is about 2 years. Fourth, the proportion of time interval from kiss to fondle of female is bigger than that of male, but that proportion from fondle to intercourse is smaller than that of male. The main differences are as follow:First, the proportions of intercourse among the three cities show clear ladder results, Taipei is the highest, followed by Shanghai, Hanoi is lowest. Second, the occurrence probabilities of SRB are significantly different between the three cities. Third, the development speed of Taipei adolescents from kiss to fondle is the lowest, followed by Shanghai, Hanoi is the fastest, but it is just the reverse from fondle to intercourse. Fourth, in term of proportion of the time interval from kiss to fondle, Taipei, Shanghai and Hanoi decline successively and accordingly, but that proportion is successively elevated in the three cities according to the time interval from fondle to intercourse.In term of sequence of SRB, dating is as the beginning, kiss, fondle and intercourse successively occur in turn. The proportion of behaviors revise is lower than 4%. The age of first intercourse of adolescent is 18 to 19 in three cities. The median ages of first intercourse of Hanoi and Shanghai youths are more than 24 years old. The median age of first intercourse is about 22 years old for men and 23 years old for women in Taipei, earlier than in Hanoi and Shanghai. The average age gap is less than 3 years between adolescents and their dating objects who are mostly their lovers (over 80%). The time interval from date to intercourse is from 3 months to 1 year for most adolescent. The first intercourse of 20%-30% women was in case of involuntary occurrence. The rate of cohabitation for male is 0.9%,5.0% and 11.5% respectively in 3 cities,0.4%,2.1% and 7.5% for female. The number of sex parterner is less than 5. Sex frequency within 3 months is less than 4 times. Canonical correlation analysis shows that the effects of individual, peer and media system factors on SRBP are big, while ones of school and family system is relatively minor.4、Influence of each system factors on sexual behavior:Sex behavior of adolescent is not only affected by the individual system factors, but also by the living environment of family, peer, school, media and other system factors. Individual system variables: age, gender, education,’student or not’and risky behaviors; Family system variables: family support score and family sex-information score; Peer system variables:peer sex information score and peer sex pressure; Media system variables:Internet sex-information contacts,’the time of watching TV/video or surfing on the internet’ and’whether or not to read pornographic book/magazine or to watch pornographic video’.5、Analysis of SEM and Multilevel Statistical Model:There are seven latent variables in the Structural Equation Model including sex source, peer pressure, pornographic information, risky behaviors, sexual knowledge, sexual attitude and sexual behavior. For adolescents of three cities and considering the total effects of these latent variables on the sexual behavior, peer pressure (Hanoi:0.29, Shanghai: 0.26, Taipei:0.21) and risky behaviors (Hanoi:leel, Shanghai:0.29, Taipei:0.49) are relatively greater. Among Hanoi female, the first two of latent variables was peer pressure (0.51) and risky behaviors (0.32), for the Shanghai female, the first two are peer pressure (0.27) and pornographic information (0.23), for Taipei female, the first two are peer pressure (0.71) and sexual attitude (0.35). Multilevel Statistical Model suggests that incidence difference of adolescent sexual behavior among the three cities due to different survey points (24.7%), contraception variation due to different survey points (9.5%). Sexual individual-level factors include age (OR=1.38), gender (OR=1.14), education degree (OR=0.70),’student or not’(OR=1.39), risky behaviors score (OR=1.58), peer pressure (OR=3.20), peer sex-information (OR=1.07), school sex-information score (OR=0.92),’whether or not see pornographic video/publications’ (OR=3.79). Contraception individual-level factors include gender (OR=0.72), education level (OR=1.69), family economic status (OR=1.22), multiple sex partners (OR=0.69) and the contraceptive attitude (OR=1.90).6、Adolescent contraceptive pattern:There are many similarities and differences on contraceptive prevalence, frequency, methods, knowledge, desired getting place, not-always-use reason and impact factors between 3 cities’adolescents. Contraceptive prevalences at last sex are 56.4%,42.4% and 65.7% respectively for male,58.8%, 49.4% and 67.6% respectively for female. The proportions of always using contraception are 35.0%,25.4% and 49.3% respectively for male,54.0%,31.9% and 54.7% respectively for female. The first three choices of contraceptive methods were same in three cities, and were condom, withdraw and safe period. Condom-use rates are 67.8%,54.5% and 64.3% respectively. The awareness rates of contraceptive pill and condom are higher than those of other contraceptive methods among adolescents. The awareness rate of condom in Hanoi and Taipei is over 95%, and is over 85% in Shanghai. Hanoi adolescents are mostly willing to go to the adolescent/student health care center to get contraceptives. And the store or pharmacy is the most wanted place to get contraceptives for Shanghai and Taipei adolescents.’Temporarily happen, no ready’and’Don’t want to use contraceptives’are the main reasons for adolescents to not always use the contraceptives. The result of logistic regression shows that gender, education level and contraceptive attitude are associated with adolescent contraceptive choice among three cities. Multiple sex partners and family economic status are associated with alolescent contraceptive choice in Shanghai.7> The status of unmarried pregnancy and abortion:Pregancy rates of unmarried female were 8.8%,13.7% and 15.5% respectively in the three cities, unmarried male to make partner pregnancy rates were 4.9%,19.3% and 8.9% respectively. Most of those were unwanted pregnancy (80%). Unmarried cohabitation and multiple sex partners are the most impact factors. Objects who made adolescents pregnancy were their lovers (over 80%). Most outcomes of their pregnancies were abortions.Conclusions:a. Adolescents of the three cities currently and generally lack of sex and reproductive health knowledge. Attitude toward premarital sex in Taipei is the most open, followed by Shanghai, Hanoi is the lowest. b. There are many similarities and differences on SRRP and its influences between Hanoi, Shanghai and Taipei. c. Adolescent sexual behavior is affected by individual, family, peer, school and media influences of various systems. Among of those systems, the effects of individual, peer and media are relatively larger, d. There are some similarities and differences on adolescent contraceptive patterns between the three cities. The status and situation of unmarried pregnancy and abortion is worrying, e. SEM and Multilevel Statistical Model should be more extensively applied in the research field of adolescent sex and reproductive health.