Sexual knowledge, sexuality education and related factors among secondary vocational school students
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摘要:
目的 了解上海和陕西中职生的性与生殖健康知识、性教育状况及相关因素，为中职校开展性教育提供科学依据。 方法 2021年4—6月，采用方便与整群抽样相结合的方法在上海市和陕西省3座城市(商洛、安康和宝鸡)共选取6所中职学校一至三年级3 180名中职生进行调查。采用自行设计的调查问卷进行线上调查，调查内容包括个人特征、家庭背景、家庭及学校性教育现况、青少年的性与生殖健康(SRH)知识及来源。采用t检验和χ2检验进行组间比较，对SRH知识总分按四分位数进行分组拟合多分类有序Logistic回归模型分析。 结果 中职生性与生殖健康知识总均分为(51.36±21.61)，在不同维度的知识得分中，以性骚扰/性侵害知识得分(66.45±42.27)较高，生殖生理(47.67±31.94)和避孕知识得分(43.85±26.81)较低。两地中职生最主要的知识来源是学校/老师、网络、同学或朋友。学校性教育主题以青春期发育与保健为主(占比超过80%)，与父母讨论SRH最多的话题是人际关系(占比超过55%)，且两地中职生的报告率差异均有统计学意义(χ2值分别为28.56，32.02，P值均 < 0.05)。多因素Logistic回归分析结果显示，居住地区、性别、年级、户籍、与父母讨论的SRH话题数量、接受学校SRH教育主题数量、从同学/朋友交流过SRH信息、从书籍/杂志/报纸获取过SRH信息、从网络和社区获取过SRH信息与中职生性知识水平均有关(OR值分别为1.62，0.72，1.20，1.58，2.09，1.17，1.18，1.66，1.62，1.69，1.22，P值均 < 0.05)。 结论 上海和陕西中职生的性与生殖健康知识水平普遍偏低。应加强学校老师和家长的培训，提高其性教育意识和性教育能力，推动中职生性教育的开展。 Abstract: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(χ2=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. -
Key words:
- Sex /
- Knowledge /
- Health education /
- Regression analysis /
- Students
1) 利益冲突声明 所有作者声明无利益冲突。 -
表 1 两地区中职生基本特征分布比较
Table 1. Comparison of basic characteristics distribution of secondary vocational school students in two regions
地区 人数 性别 年级 本地户籍 父母婚姻状况 与父母居住 男生 女生 一 二 三 是 否 不知道 在婚 其他 是 否 上海 1 580 739(46.77) 841(53.23) 503(31.84) 505(31.96) 572(36.20) 1 188(75.19) 376(23.80) 16(1.01) 1 231(77.91) 349(22.09) 1 243(78.67) 337(21.33) 陕西 1 600 818(51.12) 782(48.88) 644(40.25) 550(34.38) 406(25.37) 1 377(86.06) 191(11.94) 32(2.00) 1 397(87.31) 203(12.69) 1 192(74.50) 408(25.50) χ2值 6.03 47.30 79.59 48.98 7.71 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 地区 人数 家庭经济状况 父母关系 父亲受教育程度a 母亲受教育程度a 好 一般 差 好 一般 差 初中及以下 高中/
职校/中专大专及以上 初中及以下 高中/
职校/中专大专及以上 上海 1 580 515(32.59) 928(58.73) 137(8.67) 1 085(68.67) 364(23.04) 131(8.29) 436(33.98) 452(35.23) 395(30.79) 503(38.84) 424(32.74) 368(28.42) 陕西 1 600 313(19.56) 1 087(67.94) 200(12.50) 1 158(72.38) 335(20.94) 107(6.69) 1 047(78.72) 214(16.09) 69(5.19) 1 115(84.53) 150(11.37) 54(4.09) χ2值 73.48 5.87 565.17 595.75 P值 < 0.01 0.05 < 0.01 < 0.01 注： ()内数字为构成比/%；a表示数据存在缺失值。 
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表 2 中职生SRH知识总分及各维度得分比较(x±s)
Table 2. Comparison of SRH knowledge scores and dimensions of secondary vocational students(x±s)
组别 选项 人数 统计值 SRH总分 生殖生理 性病/艾滋病 避孕 性骚扰/性侵害 性别 男 1 557 48.80±22.32 43.62±32.85 55.56±24.47 42.70±28.07 58.12±44.27 女 1 623 53.82±20.62 51.56±30.54 59.97±22.49 44.96±25.50 74.43±38.62 t值 -6.59 -7.06 -5.29 -2.38 -11.08 P值 < 0.01 < 0.01 < 0.01 0.02 < 0.01 地区 上海 1 580 55.20±21.07 50.97±32.11 60.53±22.85 49.36±26.43 68.54±41.78 陕西 1 600 47.58±21.07 44.41±31.44 55.13±23.98 38.41±26.06 64.38±42.66 t值 10.10 5.82 6.50 11.77 2.78 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 合计 3 180 51.36±21.61 47.67±31.94 57.81±23.58 43.85±26.81 66.45±42.27
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表 3 不同组别中职生SRH知识来源报告率比较
Table 3. Comparison of the reporting rate of SRH knowledge source among different groups of secondary vocational school students
组别 选项 人数 统计值 父母 学校/老师 兄弟/
姐妹/亲戚同学/朋友 书籍/
杂志/报纸电视/广播 专业机构/
人员等网络 社区 其他 性别 男 1 557 327(21.00) 846(54.34) 289(18.56) 729(46.82) 546(35.07) 485(31.15) 344(22.09) 893(57.35) 287(18.43) 25(1.61) 女 1 623 676(41.65) 1 136(69.99) 285(17.56) 727(44.79) 597(36.78) 562(34.63) 412(25.39) 879(54.16) 404(24.89) 20(1.23) χ2值 156.92 82.98 0.54 1.32 1.02 4.35 4.75 3.29 19.49 0.79 P值 < 0.01 < 0.01 0.46 0.25 0.31 0.04 0.03 0.07 < 0.01 0.37 地区 上海 1 580 564(35.70) 1 027(65.00) 352(22.28) 777(49.18) 601(38.04) 534(33.80) 365(23.10) 927(58.67) 364(23.04) 21(1.33) 陕西 1 600 439(27.44) 955(59.69) 222(13.88) 679(42.44) 542(33.88) 513(32.06) 391(24.44) 845(52.81) 327(20.44) 24(1.50) χ2值 25.11 9.56 37.95 14.55 5.98 1.08 0.78 11.06 3.16 0.17 P值 < 0.01 < 0.01 < 0.01 < 0.01 0.01 0.30 0.38 < 0.01 0.08 0.68 注： ()内数字为报告率/%。
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表 4 不同组别中职生接受过学校SRH教育报告率比较
Table 4. Comparison of the reporting rates of SRH knowledge received through school SRH education among different groups of secondary vocational school students
组别 选项 人数 统计值 青春期发育与保健 价值观与决定 人际关系 性与性行为 生殖与避孕 预防性传播疾病 预防艾滋病 远离毒品 计划未来/
生涯教育其他 都没有 性别 男 1 557 1 271(81.63) 1 037(66.60) 1 015(65.19) 699(44.89) 506(32.50) 967(62.11) 963(61.85) 1 205(77.39) 892(57.29) 7(0.45) 55(3.53) 女 1 623 1 386(85.40) 948(58.41) 1 094(67.41) 679(41.84) 487(30.01) 1 016(62.60) 1 047(64.51) 1 271(78.31) 956(58.90) 11(0.68) 31(1.91) χ2值 8.20 22.74 1.75 3.03 2.30 0.08 2.42 0.39 0.85 0.74 7.95 P值 < 0.01 < 0.01 0.19 0.08 0.13 0.77 0.12 0.53 0.36 0.39 < 0.01 地区 上海 1 580 1 376(87.09) 1 052(66.58) 1 110(70.25) 831(52.59) 616(38.99) 984(62.28) 1 044(66.08) 1 257(79.56) 934(59.11) 2(0.13) 44(2.78) 陕西 1 600 1 281(80.06) 933(58.31) 999(62.44) 547(34.19) 377(23.56) 999(62.44) 966(60.38) 1 219(76.19) 914(57.12) 16(1.00) 42(2.62) χ2值 28.56 23.18 21.74 109.70 88.07 0.01 11.11 5.24 1.29 10.77 0.08 P值 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 0.93 < 0.01 0.02 0.26 < 0.01 0.78 注： ()内数字为报告率/%。
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表 5 不同组别中职生与父母讨论SRH话题报告率比较
Table 5. Comparison of the reporting rates of discussing SRH topics with parents among different groups of secondary vocational school students
组别 选项 人数 统计值 身体发育与保健 自慰/手淫 异性交往/
恋爱性梦/
性幻想男、女生殖系统的结构和功能 性骚扰/
性侵犯/
自我保护怀孕/人工流产/避孕 性病/艾滋病 性别认同/
性取向人际关系 其他 性别 男 1 557 626(40.21) 105(6.74) 515(33.08) 88(5.65) 136(8.73) 148(9.51) 96(6.17) 158(10.15) 208(13.36) 860(55.23) 134(8.61) 女 1 623 931(57.36) 29(1.79) 751(46.27) 54(3.33) 137(8.44) 445(27.42) 204(12.57) 199(12.26) 326(20.09) 993(61.18) 69(4.25) χ2值 93.61 48.38 57.75 10.07 0.09 168.08 38.14 3.56 25.74 11.56 25.22 P值 < 0.01 < 0.01 < 0.01 < 0.01 0.77 < 0.01 < 0.01 0.06 < 0.01 < 0.01 < 0.01 地区 上海 1 580 773(48.92) 100(6.33) 694(43.92) 89(5.63) 163(10.32) 351(22.22) 199(12.59) 200(12.66) 314(19.87) 842(53.29) 94(5.95) 陕西 1 600 784(49.00) 34(2.12) 572(35.75) 53(3.31) 110(6.88) 242(15.12) 101(6.31) 157(9.81) 220(13.75) 1011(63.19) 109(6.81) χ2值 0.00 34.81 22.17 10.03 12.00 26.34 36.72 6.46 21.33 32.02 0.99 P值 0.97 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 < 0.01 0.01 < 0.01 < 0.01 0.32 注： ()内数字为报告率/%。
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表 6 中职生SRH知识水平的多因素Logistic回归分析(n=3 180)
Table 6. Multivariate Logistic regression analysis of SRH knowledge levels among secondary vocational school students(n=3 180)
自变量 选项 OR值(95%CI) P值 地区 陕西 1.00 上海 1.62(1.41~1.86) < 0.01 性别 女 1.00 男 0.72(0.63~0.82) < 0.01 年级 一 1.00 二 1.20(1.03~1.41) 0.02 三 1.58(1.34~1.85) < 0.01 本地户籍 否 1.00 是 2.09(1.21~3.62) < 0.01 家庭经济状况 好 1.00 一般 1.08(0.93~1.27) 0.31 差 1.30(1.01~1.66) 0.04 父母婚姻状况 其他 1.00 在婚 0.89(0.72~1.09) 0.25 父母间关系 好 1.00 一般 1.07(0.91~1.26) 0.43 差 1.12(0.85~1.48) 0.41 与父母居住 否 1.00 是 0.98(0.81~1.18) 0.82 知识来源 父母 1.17(1.12~1.22) < 0.01 学校/老师 1.18(1.15~1.21) < 0.01 兄弟姐妹/亲戚 0.87(0.72~1.05) 0.16 同学/朋友 1.66(1.44~1.91) < 0.01 书籍/杂志/报纸 1.62(1.38~1.89) < 0.01 电视/广播 1.01(0.86~1.18) 0.95 专业机构人员等 1.18(0.99~1.40) 0.07 网络 1.69(1.47~1.95) < 0.01 社区 1.22(1.02~1.45) 0.03 其他 0.68(0.36~1.23) 0.23 注：知识来源各组均以回答“否”为参照。
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