Latent Heterogeneity of Online Sexual Experiences and Associations With Sexual Risk Behaviors and Behavioral Health Outcomes in Chinese Young Adults: Cross-Sectional Study.

BACKGROUND: Online sexual experiences (OSEs) are becoming increasingly common in young adults, but existing papers have reported only on specific types of OSEs and have not shown the heterogeneous nature of the repertoire of OSEs. The use patterns of OSEs remain unclear, and the relationships of OSEs with sexual risk behaviors and behavioral health outcomes have not been evaluated. OBJECTIVE: This study aimed to examine the latent heterogeneity of OSEs in young adults and the associations with sexual risk behaviors and behavioral health outcomes. METHODS: The 2021 Youth Sexuality Study of the Hong Kong Family Planning Association phone interviewed a random sample of 1205 young adults in Hong Kong in 2022 (male sex: 613/1205, 50.9%; mean age 23.0 years, SD 2.86 years) on lifetime OSEs, demographic and family characteristics, Patient Health Questionnaire-4 (PHQ-4) scores, sex-related factors (sexual orientation, sex knowledge, and sexual risk behaviors), and behavioral health outcomes (sexually transmitted infections [STIs], drug use, and suicidal ideation) in the past year. Sample heterogeneity of OSEs was analyzed via latent class analysis with substantive checking of the class profiles. Structural equation modeling was used to examine the direct and indirect associations between the OSE class and behavioral health outcomes via sexual risk behaviors and PHQ-4 scores. RESULTS: The data supported 3 latent classes of OSEs with measurement invariance by sex. In this study, 33.1% (398/1205), 56.0% (675/1205), and 10.9% (132/1205) of the sample were in the abstinent class (minimal OSEs), normative class (occasional OSEs), and active class (substantive OSEs), respectively. Male participants showed a lower prevalence of the abstinent class (131/613, 21.4% versus 263/592, 44.4%) and a higher prevalence of the active class (104/613, 17.0% versus 28/592, 4.7%) than female participants. The normative class showed significantly higher sex knowledge than the other 2 classes. The active class was associated with male sex, nonheterosexual status, higher sex desire and PHQ-4 scores, and more sexual risk behaviors than the other 2 classes. Compared with the nonactive (abstinent and normative) classes, the active class was indirectly associated with higher rates of STIs (absolute difference in percentage points [Δ]=4.8%; P=.03) and drug use (Δ=7.6%; P=.001) via sexual risk behaviors, and with higher rates of suicidal ideation (Δ=2.5%; P=.007) via PHQ-4 scores. CONCLUSIONS: This study provided the first results on the 3 (abstinent, normative, and active) latent classes of OSEs with distinct profiles in OSEs, demographic and family characteristics, PHQ-4 scores, sex-related factors, and behavioral health outcomes. The active class showed indirect associations with higher rates of STIs and drug use via sexual risk behaviors and higher rates of suicidal ideation via PHQ-4 scores than the other 2 classes. These results have implications for the formulation and evaluation of targeted interventions to help young adults.

Sexual knowledge, sexuality education and related factors among secondary vocational school students / 中国学校卫生

Objective@#To understand sexual and reproductive health knowledge, access to sexuality education and associated factors among secondary vocational school students in Shanghai Municipality and Shaanxi Province, so as to provide a scientific basis for conducting sexuality educaiton in vocational schools.@*Methods@#A crosssectional survey was conducted among 3 180 students in grades 1-3 selected by cluster sampling during April to June 2021 in six secondary vocational schools from three cities of Shanghai and Shaanxi (Shangluo, Ankang, Baoji). Participants were investigated through online questionnaire survey, inlcuding demographic characteristics, household information, sexual health at home and school, knowledge on sexual and reproductive health. Both t test and Chisquare test were used for group comparisons, and multivariate ordial Logistic regression was used to explore possible risk factors for sexual and reproductive health score in quartiles. @*Results@#Respondents average score was (51.36±21.61), with the highest score on sexual harassment/sexual abuse (66.45±42.27) and the lowest score on reproduction and physiology (47.67±31.94) and contraception (43.85±26.81). Although significant differences were observed between two study sites, the primary source of knowledge in both sites was schools/teachers, followed by the Internet or friends; the main theme of school sexuality education was puberty development and health care (more than 80%); the most frequently reported topic between respondents and their parents in both sites was interpersonal relationships (more than 55%), and there were significant differences in the reporting rates of secondary vocational school students between the two regions(χ2=28.56，32.02，P<0.05). The results of multivariable Logistic regression analysis showed that residential area, gender, grade, registered residence, number of sexual related topics communicated with parents, number of subjects received from school sexuality education, and reported information sources from classmates/friends, books/magazines/newspapers, internet and communities were related to knowledge level of respondents (OR=1.62, 0.72, 1.20, 1.58, 2.09, 1.17, 1.18, 1.66, 1.62, 1.69, 1.22, P<0.05).@*Conclusions@#Vocational students of Shanghai and Shaanxi have poor sexual and reproductive health knowledge and limited access to school and family sexuality education. It is necessary to strengthen sexuality education for secondary vocational school students.

The status and gender differences of sex knowledge,attitude and behaviors among college students in Guangdong Provine / 重庆医学

Objective To provide evidence for college students'sex education by analysis they status and gender identity of col-lege students'sex knowledge,attitude and behaviors in Guangdong province.Methods By investigating 928 college students of 12 colleges.Results Sex knowledge:Students'awareness of sexual knowledge is low average accuracy rate of question was 37.34%;sex attitude:for sex is a basic human need,love can be sexual,sexual fantasy dreams,masturbation,premarital sex and behavioral aspects of these ideas,the overall degree of recognition is (67.35%,35.24%,56.90%,52.26%,58.04%),boys and girls were sig-nificant differences in acceptance levels(χ2 =7.89,χ2 =48.46,χ2 =189.30,χ2 =32.44,χ2 =27.35,all P <0.01);sex knowledge:students'awareness of sexual knowledge is low;sex behaviors:college Students'heterosexual sex and homosexual sex rates were 8.08% and 1.51%,the incidence of male heterosexual sex is far higher than girls (χ2 = 52.08,P <0.01),there is no significant difference in homosexual acts(χ2 =4.82,P <0.01),condom use rate is low,often use rate was 29.03%,girls was significantly low-er than boys(χ2 = 12.08,P < 0.01 ),they have weak sense of self-protection.Conclusion there are many problems in college students'sex behaviors,attitude and knowledge,and there is need for further strengthening and guidance;we should pay attention to gender differences in education.

Young Men's Shame about Their Desire for other Men Predicts Risky Sex and Moderates the Knowledge - Self-Efficacy Link.

BACKGROUND: Nationally, HIV incidence is rising rapidly among young (18-24 years old) men who have sex with men (YMSM). Knowledge of safer sex generally enhances self-efficacy for safer sex, an important predictor of safer-sex behaviors. Recent findings suggest that a strong negative social emotion (i.e., shame) increases YMSM's sexual risk-taking. Unchangeable shame (e.g., desire for other men) might undermine (moderate) the link between knowledge and self-efficacy or between self-efficacy and unprotected anal intercourse (UAI): this may be less likely for changeable shame (e.g., shame about risky sexual behavior). AIM: To test the hypotheses that shame (i.e., sexual desire shame), but not shame about behavior (i.e., sexual behavior shame), will be positively related to UAI and will moderate the relationship between knowledge and self-efficacy and/or self-efficacy and UAI among YMSM. METHOD: In an online national study, 1177 young adult (18-24 years old) MSM reported one or more acts of UAI in the past 90 days with a casual partner. Eligible MSM filled out a survey in which they provided information about their knowledge of safer sex, self-efficacy for safer sex, reported levels of shame, and reported past 90-day UAI. RESULTS: Sexual desire shame was negatively correlated with knowledge and self-efficacy and positively correlated with UAI, the pattern reversed for sexual behavior shame. Sexual desire shame significantly lowered the knowledge to self-efficacy and the self-efficacy to UAI links. Sexual behavior shame also reduced the link from knowledge to self-efficacy, but not the self-efficacy to UAI link. CONCLUSION: The present study shows that there are different types of shame that may produce different effects with different implications for health behavior. Sexual desire shame may better reflect an emotion that is activated prior to risky behavior (e.g., when men reflect upon or feel desire for another man). Sexual behavior shame, on the other hand, better reflects what has already happened, thus, those higher in knowledge, efficacy, and therefore, safer sex are least likely to experience shame behavior.

The Effects of Sex Education Using Multimedia Program on Knowledge and Attitude about Sex of Middle School Boys / 아동간호학회지

PURPOSE: The purpose of this study was to identify the effects of sex education using multimedia program on knowledge and attitude about sex. METHOD: The subjects of this study were 282 middle school boys in seoul. The data were collected from the 4th of Jun. to 30th of Jun. 2001. This program consisted of 6 subtopics and provided 3 sessions for each class. The per-test was given before the therapy to measure variables and the post-test was performed after intervention. The data were analyzed by the SAS program using t-test. RESULT: The results of this study are as follows. After intervention, the level of knowledge and attitude were increased significantly. CONCLUSION: The sex education using multimedia program is effective in helping middle school boys improve their healthy attitudes and thoughts toward sex.

The needs for sex knowledge in the late schooler / 아동간호학회지

The goal of this research was to provide the basic data of sexual education for late schooler by finding out what they want to know about sex, or to see, if any, its relevancy between female and male students and between each grade. The sample for this research was a total of 453 students in 4th, 5th and 6th grade from 12 different classes at two elementary schools which were located in C city and in B province. The children were requested to write down three points on what they want to know or to learn most about sex, and their answers were put through two analytical stages in order to classify and to examine. The followings are the conclusions from the data. 1. The female cluster took 44.2% out of the whole sample, and there were 151 students per each grade. The specific girl ratios for each grade were 42.4%, 50.3% and 39.7% respectively. 2. It was noted that a total of 1,195 questions were gathered from the students writings, 45% of the questions was raised by the female students. The 4th grade students raised 432questions (43.8% by the girl) while the 5th. and the 6th grade students raised 387 (53.2% by the girl) and 376 questions (42.3% by the girl) respectively. The average number of questions per students was 2.6 while the female students raised 2.8 questions which was more than the average 2.5 questions by male students. It was the 4th grade female student cluster, which raised the most question (3.0) while the 6th grade male students raised the least question (2.4) in average. 3. The questions raised by the children could be divided into seven categories of the knowledge need on sex. They were Reproduction (310 questions, 25.9%), Sexual Culture (230, 19.2%), Concept of sex (125, 18.0%), Changes of Puberty (172, 14.4%), Sexual Health (119, 10.0%), Anatomy and Physiology of Reproductive System (78, 6.5%) and Sexual Tendency and behavior (71, 5.9%). 4.'Reproduction'was the most frequently raised questions not only by both sex groups but also by the 5th grade students. Both sexes in the 4th grade showed the highest interest in Sexual Culture while it was Changes in Puberty for the both sexes in the 6th grade. The knowledge need on sex of the children indicated what they understand sexuality. They apprehended sex as sex, gender and sexuality in an inclusive way. They showed a major interest in the biological sex and the sexual activities. It seems that the children managed to understand clearly the meaning of gender, furthermore, they even pointed out that the streotyped sex role, patrimonial system and the sexual discrimination were unreasonable. The students possessed not only the least but also the most negative understanding in regard of sexuality. Two suggestions were made from the above conclusions for the practical sex education as well as its research. 1. For the practice: The sex education for the elementary upper grade school student should be relevant with their cognitive characteristics, also it should be more specific on the reproductive organs of both sexes, the actual scenes of the pregnancy and child delivery procedures. The gender concept should be added to the biological sex education, which will lead them to understand the unreasonableness of today's male-superior phenomenon and correct them. It is also necessary to develop educational programs for this age group so as to help them to understand sex in the sense of sexuality as well. 2. For the research: It is not easy to draw out a through conclusion since this study was carried out as one-time data collection. Yet it is undeniably helpful for the sex education if we can understand what the children want to know about sex, how much they know about it by conducting deep-interview researches through a small number of sample.

Needs for Sex Knowledge in Adolescents / 아동간호학회지

The purpose of this article was to get hold of adolescent's needs for sex knowledge and to reveal their understanding of sex. These results may be applied to the sex education and counselling for adolescent. The participants of study were 267 students (females, 144 ; males, 123) who were the first and second grade form 1 middle and 2 high schools. They were asked to describe 3 questions that they wanted to know or to learn about sex. Their questions about sex were total 779(girls, subtotal 456, mean 3.2: boys, subtotal 323, mean, 2.6). These questions categorized to 9 items by content analysis. The items were 'sexual drive, behavior and tendency(229, 29.4%)', 'anatomy and physiology of reproductive system(140, 18.0%)', 'reproduction(131, 16.8%)', 'concept of sex(31, 4.0%)', 'acquaintance between the other sexes(17, 2.2%)', and 'the others(9, 1.2%)' in order of frequency. The most frequent item that the student want to know or learn about sex was 'sexual drive, behavior and tendency' except girls of sophomore in middle school. There were several features in participants' needs for sex knowledge as respects of the understanding of sex-biological sex, gender, and sexuality. The prominent feature in knowledge need of biological sex was that the participants had the interests according to their biological sex. They had the negative attitude to the phenomenons(ex, menstruation and pregnancy, phimosiectomy, etc) that they experienced or would experience due to their biological sex. A part of them asked the questions based the misconceptions and used the slangs or 'XX', ect. to name the male or female genitalia. The male students wanted to know the female genitalia. The participants' understanding of gender reflected the sexism of our society, but they didn't accept and had doubts about the dual, hierarchical structure of that. The students, especially female seemed to be powerless to the harms of the sexual violence. Girls had much interest in their appearances and complained to our sexual culture that women comforted and served men. The participants had the dual perspective that the sexuality as respects of physiologic phenomenon was considered as natural but that as related to heterosexuals was as negative. And they deemed that men's sexual drive was stronger than women's and was difficult or was not able to be inhibited. They had much interests in homosexuality but reflected the negative attitude to that in our society. Adolescent felt wonder why the expressions of sexuality of adult were permitted but theirs were not. Lastly, a part of boys substituted querying the sexuality of animals for asking that of human. Maybe it was because of the embarrassment to talk about human's sexuality directly. The teenaged participants understood that the sex had not only the biological meanings but also the sociocultural meanings. They regarded the sex as natural and wanted to know it, but they had conceptions that it was difficult and embarrass to talk about it openly and directly.