Psych Paper
angie1981
teen_sex_and_china.pdf
Review
Teenage sexual attitudes and behaviour in China: a literature review
Juping Yu PhD MSc PGCE University of Glamorgan, Mid Glamorgan, UK
Accepted for publication 15 October 2011
Correspondence Juping Yu Genomics Policy Unit Faculty of Health, Sport and Science University of Glamorgan Glyntaf Campus, Pontypridd Mid Glamorgan CF37 1DL UK E-mail: [email protected]
What is known about the topic
• Social norms surrounding sex, love and marriage have changed among Chinese people.
• The negative consequences of early sexual intercourse have become issues of health and social concern in many countries.
• The prevalence of sexually trans- mitted infections (STIs) ⁄ HIV has increased in recent years in China.
What this paper adds
• Young people reported poor sexual knowledge, and the media became their main sources of information.
• Despite the reported liberal attitudes to sexual behaviour, only a small number of respondents had lost their virginity or been involved in pregnancies.
• There is a need to develop more comprehensive sex education programmes and make sexual and reproductive health services available to teenagers and unmarried young people.
Abstract China is the most populated of any country in the world. Social norms
and values pertaining to love and marriage have changed considerably
since the launch of its open-door policy and economic reforms of the
1980s. Attitudes to sex have become more open, while the negative con-
sequences of early sexual intercourse have become issues of health and
social concern. The aim of this study is to provide an overview of the
teenage sexual attitudes and behaviour in contemporary China. A litera-
ture review was conducted between 2000 and 2010, using both English (Medline, CINAHL, PsycINFO, ASSIA) and Chinese language databases
(China National Knowledge Infrastructure, Wanfang database). Thirty-
six studies were included and reviewed. It was found that young people
reported poor sexual knowledge, especially in relation to reproductive
matters and sexually transmitted infections. The media, such as televi-
sion, magazines and the Internet, were seen as their main sources of
information on sex. Despite the frequently reported liberal attitudes to
sexual behaviour, only a small number of young people had already lost their virginity or been involved in pregnancies. Young men were more
likely than young women to report having had sex, while respondents at
vocational high schools were less likely to remain virgins than those at
common ⁄ key high schools. Although the prevalence of sexual inter- course among Chinese teenagers was still lower than that reported in
studies conducted in most western countries, the findings do reflect
some changes in sexual values and behaviour of young people within
the country. They also suggest the need to develop more comprehensive sex education programmes in co-operation with young people, schools,
health organisations, families and communities and to make sexual and
reproductive health services accessible to teenagers and unmarried
young people throughout China.
Keywords: attitudes, China, literature review, sex education, sexual behav-
iour, teenagers
Introduction
Situated in East Asia, China is the most populated of
any country in the world, with an area of 9.6 million
km2 and a population of 1.3 billion people made up of
56 ethnic groups (China Ethnic Museum 2005, China-
pop 2009). The Chinese mainland is administratively
divided into 22 provinces, five autonomous regions and four municipalities (Beijing, Tianjin, Shanghai and
Chongqing).
ª 2012 Blackwell Publishing Ltd 561
Health and Social Care in the Community (2012) 20(6), 561–582 doi: 10.1111/j.1365-2524.2011.01054.x
Since the launch of its open-door policy and eco- nomic reforms of the 1980s, China has experienced
great changes under the multiple influences of rapid
modernisation, economic development and exposure to
western culture. Social norms surrounding love, mar-
riage and family have changed considerably among
Chinese people with attitudes to sexual expression
becoming more open (Zhang et al. 1999, Gao et al. 2001). Like many other countries, the adverse conse- quences of early sexual intercourse, such as unwanted
pregnancies and STIs, have become the focus of health
and social concerns.
In China, teenage births are still socially and cultur-
ally unacceptable with most teenage pregnancies being
aborted (Gao et al. 2001, Hu 2009). The prevalence of STIs ⁄ HIV has also increased dramatically in recent years (WHO 2004, Zhang et al. 2004a, Wang et al. 2009a). There were an estimated 740 000 people living with HIV in
2009, and heterosexual transmission became the domi-
nant route, accounting for 44% of all new infections that
occurred during the same year (Ministry of Health of the
People’s Republic of China 2010). In 2007, 50 000 new
patients were diagnosed in the country, of which 33%
were people in their 20s and 40% in their 30s (Chinese
State Council AIDS Working Committee Office & UNA- IDS China 2007).
Although there is serious concern regarding the sex-
ual health of young people in China, research in this area
is still of very limited extent, most being conducted with
university students with little attention being paid to
teenagers and the rural poor (Higgins & Sun 2007, Ma
et al. 2009, Yan et al. 2009). Drawing evidence from cur- rent literature, this study aims to provide an overview of the teenage sexual values and behaviour in contempo-
rary China, with discussions on the provision of sex edu-
cation and sexual health services.
Methods
The key principles of conducting systematic reviews were followed (Centre for Reviews and Dissemination
2008). A literature search was undertaken for the period
of 2000–2010 to review the most current evidence. The
keywords including ‘China’, ‘Chinese’, ‘sex*’, ‘sexual
attitude*’, ‘sexual behaviour’, ‘sex education’, ‘teenage*’,
‘adolescen*’ and ‘young people’ were used in various
combinations to search English language databases
(Medline, CINAHL, PsycINFO, ASSIA). Chinese lan- guage databases (China National Knowledge Infrastruc-
ture, Wanfang database) were searched using keywords
in Chinese, including ‘qing shao nian’ (teenager, adoles-
cent or young people), ‘xing tai du’ (sexual attitudes),
‘xing xing wei’ (sexual behaviour) and ‘xing jiao yu’ (sex
education). The inclusion criteria were as follows:
d Sample: primarily 13- to 19-year-olds in mainland China.
d Language: Chinese or English. d Types of study: primary research.
The review excluded studies conducted in Hong
Kong and Taiwan or studies where a separate break-
down of results for teenage group was unavailable.
A flow diagram of the selection process is shown in
Figure 1. Thirty-six studies were included. Predeter-
mined measures of methodological quality of these stud-
ies were not applied, because this review focused on
providing an overview of research in this area; however, study characteristics were discussed. The data extracted
included bibliographies, study settings, samples, data
collection and key findings. A narrative analysis was car-
ried out because the studies included were too diverse to
carry out meta-analysis or meta-ethnography (Centre for
Reviews and Dissemination 2008).
Results
Study characteristics
Most studies were carried out in large cities and more
developed areas, such as Beijing, Shanghai, Guangzhou
Title search
Abstract search
Full-text search
Reference list search of the papers included
4198 records identified through database searching
709 in Chinese; 3489 in English
480 remaining 191 in Chinese; 289 in English
391 remaining 142 in Chinese; 249 in English
68 remaining 63 in Chinese; 5 in English
323 excluded • Irrelevant age group (124) • No results for teenage group (108) • Studies conducted in Hong Kong,
Taiwan & elsewhere (69) • Review/discussion papers (22)
3718 irrelevant titles excluded
34 excluded • Irrelevant age group (20) • Studies conducted outside China
(11) • Full text unavailable (3)
34 remaining 33 in Chinese; 1 in English
89 duplicates removed
2 additional papers identified
36 included in the review 35 in Chinese; 1 in English
Figure 1 Flow diagram of the selection process.
J. Yu
562 ª 2012 Blackwell Publishing Ltd
and Shenzhen. Seven studies were conducted with pri- marily 13- to 16-year-olds at junior high schools
(Table 1), 14 with mainly 16- to 19-year-olds at
senior ⁄ vocational high schools (Table 2) and 15 with mostly 13- to 19-year-olds at both junior and senior high
schools or other settings (Table 3).
In most cases, questionnaires were completed at
school in the presence of teachers ⁄ researchers, which might have increased self-response bias. There was little information on informed consent; however, the response
rates were high, ranging from 82.6–100%. It was reported
in two studies that some respondents declined to answer
some questions on their sexual behaviour (Gong et al. 2007, Xue et al. 2008), while such information was unavailable in others.
All but one study applied a quantitative method
using questionnaires to collect data. In the only qualita- tive study, the data were collected by in-depth inter-
views with 60 participants and were presented in a
quantitative format (Jia et al. 2007a). Only a few studies used a large random sample of respondents across
regions (e.g. Sun et al. 2001, Nie et al. 2007, Song et al. 2008), while most studies used a convenience sample.
Sexual knowledge
Knowledge was assessed in terms of the individual’s
understanding of reproductive matters, contraception,
HIV ⁄ AIDS and other STIs. With regard to knowledge of reproductive matters, in
a survey of 1846 first-year vocational high school pupils in Shanghai, 84% felt that they were lacking in such
knowledge, with the mean score being 33.5 of 100 (Chen
et al. 2009). In a study of senior ⁄ vocational high school respondents in Beijing, 20% did not know when a
woman’s fertile period occurs (Zhou et al. 2005), while 39% of junior high school respondents in Wuhan, the
capital city of Hubei province, were unable to answer
any questions on the female reproductive system (Peng et al. 2004).
A poor understanding of contraception was reported
repeatedly. Peng et al. (2004) found that only 2% of female junior high school respondents correctly answered all
questions on contraception, while 46% were unable to
answer any such questions (Peng et al. 2004). Similarly, in Shaanxi province, 59% of senior high school respondents
were unaware of any contraceptive method (Wang et al. 2009b), and in Shenzhen, a southern coastal city, out of
the questions asked on condom use, 65% were answered
correctly (Liang et al. 2006). In a study of 591 teenagers seeking abortions in Shanghai, 52% had never heard of
emergency contraception (Xu & Cheng 2008).
Knowledge of STIs was also examined. In a small
study of 192 high school pupils in Guangdong province,
only 23% were able to correctly answer at least 70% of the questions on HIV ⁄ AIDS (Liu et al. 2004). Among junior high school respondents in Wuhan, between 22%
and 55% were unable to correctly answer any STI ques-
tions (Peng et al. 2004, Wu et al. 2007). Conversely, out of the questions asked on basic knowledge of HIV ⁄ AIDS, between 55% and 76% were answered correctly by high
school respondents in Shenzhen and Chongqing munici-
pality (Jia et al. 2007b,c, Tang et al. 2008). In some studies, respondents appeared to be more aware of HIV trans-
mission routes (i.e. unsafe sex and contaminated needles)
than routes via which HIV is not transmitted (i.e. hand-
shaking and sneezing) (Sun et al. 2001, Liu et al. 2007, Zhi 2008).
It is difficult to make direct comparison across these
studies owing to differing samples and measurement
tools used to assess sexual knowledge. However, these findings do provide some evidence to suggest young
people had insufficient sexual knowledge.
How teenagers learned about sex
Most teenagers reported having received information on sex from the media. Among senior high school respon-
dents in Beijing, newspapers ⁄ magazines (56%) and tele- vision ⁄ radio (53%) were reported as their main sources of information on reproductive matters (Zhou et al. 2005). Similarly, films, television, the Internet, newspa-
pers, medical magazines and pamphlets were seen by
high school pupils as their main sources of information
on STIs ⁄ AIDS throughout the regions of China (Liang & Jiang 2006, Liang et al. 2006, Zhi 2008, Wang et al. 2009b).
The family was also regarded as a source of informa-
tion by junior high school pupils in Wuhan and Shenz-
hen (Peng et al. 2004, Gong et al. 2007). Although it was still limited, young people, especially girls, did receive
some sex education at home (Peng et al. 2004, Song et al. 2004, Zhao et al. 2005, Liang & Jiang 2006, Gong et al. 2007, Nie et al. 2007, Tang et al. 2008).
The role of schools varied. Among senior high school
respondents in Xinjiang autonomous region, 67%
reported having learnt about HIV ⁄ AIDS at school (Wang et al. 2009c). Schools (60%), books ⁄ television (51%), peers (42%) and the Internet (29%) were reported as the main
sources by high school respondents in Chongqing (Tang
et al. 2008). Schools, together with medical magazines and peers, were also referred to by young people from other areas of China (Li et al. 2002, Yu et al. 2003, Gong et al. 2007, Liu et al. 2007).
However, 76% of junior high school respondents in
Wuhan reported that their schools had provided no
information about reproductive matters (Peng et al. 2004). Among senior high school pupils in Henan prov-
ince, 49% of city respondents and only 35% of rural
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 563
T a b
le 1
S u m
m a ry
o f
s tu
d ie
s c o n d u c te
d w
it h
ju n io
r h ig
h s c h o o l p u p ils
(n =
7 ):
in fo
rm a ti o n
is p ro
v id
e d
w h e re
a v a ila
b le
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt it u d e s
S e x u a l b e h a v io
u r
G o n g
e t
a l.
(2 0 0 7 )
S h e n z h e n
c it y
G u a n g d o n g
p ro
v in
c e
N =
1 6 6 6
4 ju
n io
r h ig
h s c h o o ls
Y e a r
2 p u p ils
1 2 – 1 6
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
9 4 .1
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
2 0 0 6
M a in
s o u rc
e s
o f
s e x u a l k n o w
le d g e :
s c h o o ls
(6 3 %
), p e e rs
(5 3 %
),
b o o k s
⁄m a g a z in
e s
(4 0 %
) a n d
fa m
ily (3
4 %
)
5 9 %
o f
m a le
s a n d
3 8 %
fe m
a le
s w
is h e d
to h a v e
a
d a te
.
A tt
it u d e s
to te
e n a g e
s e x :
2 1 %
o f
m a le
s a n d
1 2 %
o f
fe m
a le
s in
fa v o u r,
P <
0 .0
1
4 2 %
o f
m a le
s a n d
5 9 %
o f
fe m
a le
s a g a in
s t,
P <
0 .0
1
R e s p o n d e n ts
w h o
h a d
h a d
s e x :
2 .1
% o f
m a le
s
0 .9
% o f
fe m
a le
s
P <
0 .0
1
R e s p o n d e n ts
w h o
d id
n o t
w a n t
to a n s w
e r
th is
q u e s ti o n :
5 5 %
o f
m a le
s
7 4 %
o f
fe m
a le
s
J ia
e t
a l.
(2 0 0 7 b )
S h e n z h e n
c it y
G u a n g d o n g
p ro
v in
c e
N =
3 5 2 8
1 0
ju n io
r h ig
h s c h o o ls
Y e a r
1 – 3
p u p ils
1 0 – 1 9
y e a rs
(M =
1 4 .0
9 ±
1 .1
6 )
R a n d o m
c lu
s te
r
s a m
p le
R e s p o n s e
ra te
: 9 9 .4
%
V a lid
re s p o n s e s :
9 8 .6
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
P e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
a ll
re s p o n d e n ts
to q u e s ti o n s
o n :
H IV
⁄A ID
S (5
5 %
)
H IV
tr a n s m
is s io
n ro
u te
s (e
.g .
u n s a fe
s e x ,
c o n ta
m in
a te
d
n e e d le
s a n d
b re
a s t
m ilk
) (7
7 %
)
H IV
n o n -t
ra n s m
is s io
n ro
u te
s (e
.g .
h a n d s h a k in
g a n d
s n e e z in
g )
(6 8 %
)
H IV
p re
v e n ti o n
(6 1 %
)
R e s p o n d e n ts
in fa
v o u r
o f
te e n a g e
d a ti n g :
2 4 %
A tt it u d e s
to
e x tr
a ⁄p
re m
a ri ta
l s e x :
2 0 %
in fa
v o u r
3 5 %
n e u tr
a l
1 7 .5
% h a d
d a te
d .
1 .1
% h a d
h a d
s e x :
0 .4
% o f
Y e a r
1 p u p ils
0 .8
% o f
Y e a r
2 p u p ils
2 .4
% o f
Y e a r
3 p u p ils
P <
0 .0
0 1
P e n g
e t
a l.
(2 0 0 4 )
W u h a n
c it y
H u b e i p ro
v in
c e
N =
1 3 4 1
3 ju
n io
r h ig
h s c h o o ls
Y e a r
1 – 2
fe m
a le
p u p ils
1 1 .9
– 1 3 .8
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
7 5 .8
% re
p o rt
e d
h a v in
g re
c e iv
e d
n o
e d u c a ti o n
o n
re p ro
d u c ti v e
m a tt
e rs
a t
s c h o o l.
S e x u a l k n o w
le d g e
m e a n
s c o re
(o u t
o f
1 0 0 ):
4 7
R e s p o n d e n ts
u n a b le
to c o rr
e c tl y
a n s w
e r
a n y
q u e s ti o n s
o n :
F e m
a le
re p ro
d u c ti v e
s y s te
m
(3 9 %
)
C o n tr
a c e p ti o n
a n d
m e th
o d s
(4 6 %
)
S T
Is (5
5 %
)
O n ly
2 %
o f
re s p o n d e n ts
c o rr
e c tl y
a n s w
e re
d a ll
q u e s ti o n s
o n
c o n tr
a c e p ti o n
a n d
c o n tr
a c e p ti v e
m e th
o d .
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
s e x :
b o o k s
⁄m a g a z in
e s
(5 3 %
), s c h o o ls
(3 7 %
), fa
m ily
(3 4 %
), ra
d io
⁄T V
(3 1 %
) a n d
p e e rs
(3 0 %
)
A tt
it u d e s
to p re
m a ri ta
l s e x :
3 8 %
a g a in
s t
3 8 %
n o t
e n c o u ra
g in
g
o th
e rs
to h a v e
s e x
b e fo
re m
a rr
ia g e
8 %
n e u tr
a l
1 6 %
in fa
v o u r
J. Yu
564 ª 2012 Blackwell Publishing Ltd
T a b
le 1
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
W u
e t
a l.
(2 0 0 7 )
W u h a n
c it y
H u b e i p ro
v in
c e
N =
2 9 8 7
3 ju
n io
r h ig
h s c h o o ls
Y e a r
1 – 3
p u p ils
M e a n
a g e :
1 3 .1
C lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 6 .8
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
R e s p o n d e n ts
u n a b le
to c o rr
e c tl y
a n s w
e r
a n y
q u e s ti o n s
o n :
C o n tr
a c e p ti v e
m e th
o d s
(1 5 %
)
S T
Is (2
2 %
)
M a in
s o u rc
e s
o f
s e x u a l k n o w
le d g e :
te a c h e rs
, p e e rs
⁄f ri e n d s
a n d
p a re
n ts
A tt
it u d e s
to te
e n a g e
d a ti n g :
4 7 %
a g a in
s t
1 3 %
in fa
v o u r
R e s p o n d e n ts
w is
h in
g to
h a v e
a d a te
: 6 6 %
R e s p o n d e n ts
in fa
v o u r
o f
te e n a g e
s e x :
7 4 %
1 4 %
h a d
d a te
d .
1 .3
% h a d
h a d
s e x :
1 .7
% o f
m a le
s
0 .9
% o f
fe m
a le
s
X u
e t
a l.
(2 0 0 7 )
B e iji
n g
m u n ic
ip a lit
y
N =
6 4 7
3 ju
n io
r h ig
h s c h o o ls
M e a n
a g e :
1 4 .3
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
9 9 .2
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
M a in
s o u rc
e s
o f
s e x u a l k n o w
le d g e :
te a c h e rs
(6 9 %
),
n e w
s p a p e rs
⁄m a g a z in
e s
(3 8 %
),
fa m
ily (3
4 %
) a n d
T V
(3 1 %
)
A tt
it u d e s
to te
e n a g e
s e x :
5 0 %
a g a in
s t
2 3 %
n e u tr
a l
4 %
in fa
v o u r
2 %
(1 3
⁄6 4 7 )
h a d
h a d
s e x .
Y a n g
& Y
u (2
0 0 0 )
D a lia
n c it y
L ia
o n in
g p ro
v in
c e
N =
3 5 4
4 ju
n io
r h ig
h s c h o o ls
Y e a r
1 – 2
p u p ils
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
9 7 %
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
s e x :
b o o k s
⁄m a g a z in
e s
(6 5 %
), s c h o o ls
(2 0 %
) a n d
fa m
ily (1
5 %
)
7 8 %
re p o rt
e d
s e x
e d u c a ti o n
w a s
in s u ffi
c ie
n t
a t
th e ir
s c h o o l.
R e s p o n d e n ts
a g a in
s t:
T e e n a g e
d a ti n g :
4 7 %
P re
m a ri ta
l s e x :
6 7 %
1 .1
% (4
⁄3 5 4 )
h a d
h a d
s e x .
Z h o u
& Y
e (2
0 0 0 )
A la
rg e
u n d is
c lo
s e d
c it y
N =
1 0 3 6
1 0
ju n io
r h ig
h s c h o o ls
Y e a r
1 p u p ils
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
8 8 .5
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
1 9 9 8
1 .1
% (1
1 ⁄1
0 3 6 )
h a d
h a d
s e x .
S T
I, s e x u a lly
tr a n s m
it te
d in
fe c ti o n .
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 565
T a b
le 2
S u m
m a ry
o f
s tu
d ie
s c o n d u c te
d w
it h
s e n io
r ⁄v
o c a ti o n a l h ig
h s c h o o l p u p ils
(n =
1 4 ):
in fo
rm a ti o n
is p ro
v id
e d
w h e re
a v a ila
b le
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
C h e n
e t
a l.
(2 0 0 9 )
S h a n g h a i m
u n ic
ip a lit
y
N =
1 8 4 6
3 v o c a ti o n a l h ig
h
s c h o o ls
Y e a r
1 p u p ils
C lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 9 .5
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
2 0 0 5
S e x u a l a n d
re p ro
d u c ti v e
h e a lt h
m e a n
s c o re
s (o
u t
o f
1 0 0 ):
F e m
a le
s (3
5 )
v s .
m a le
s (3
2 )
T h o s e
h a v in
g h a d
s e x
e d u c a ti o n
(3 9 )
v s .
th o s e
h a v in
g n o t
h a d
(3 0 ),
P <
0 .0
0 1 )
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
m a s s
m e d ia
(4 4 %
), s c h o o ls
(2 3 %
) a n d
p a re
n ts
(1 1 %
)
4 6 %
h a d
h a d
s e x
e d u c a ti o n
a t
ju n io
r h ig
h s c h o o l (6
0 %
o f
fe m
a le
s v s .
3 7 %
o f
m a le
s ,
P <
0 .0
0 0 1 ).
R e s p o n d e n ts
w h o
c o n s id
e re
d
s c h o o l s e x
e d u c a ti o n :
N o t
u s e fu
l (3
0 %
)
U s e fu
l (1
2 %
)
A v e ra
g e
(5 8 %
)
8 4 %
re p o rt
e d
th e y
w e re
la c k in
g
in s e x u a l k n o w
le d g e ,
a n d
6 5 %
th o u g h t
it im
p o rt
a n t
to p ro
v id
e
s e x
e d u c a ti o n
a t
s c h o o l.
R e s p o n d e n ts
in fa
v o u r
o f:
T e e n a g e
d a ti n g :
5 4 %
M a le
p re
m a ri ta
l s e x :
5 3 %
(6 0 %
o f
m a le
s v s .
4 3 %
o f
fe m
a le
s ,
P <
0 .0
0 0 1 )
F e m
a le
p re
m a ri ta
l s e x :
4 8 %
(5 3 %
o f
m a le
s v s .
4 0 %
o f
fe m
a le
s ,
P <
0 .0
0 0 1 )
J ia
e t
a l.
(2 0 0 7 c )
S h e n z h e n
c it y
G u a n g d o n g
p ro
v in
c e
N =
1 1 1 5
5 s e n io
r h ig
h s c h o o ls
Y e a r
1 – 2
p u p ils
1 3 – 2 1
y e a rs
(M =
1 6 .4
3 ±
0 .9
)
R e s p o n s e
ra te
: 9 8 .4
%
V a lid
re s p o n s e s :
9 8 .5
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
P e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
a ll
re s p o n d e n ts
to
q u e s ti o n s
o n :
H IV
⁄A ID
S (7
0 %
)
H IV
tr a n s m
is s io
n ro
u te
s (8
2 %
)
H IV
n o n -t
ra n s m
is s io
n ro
u te
s
(8 1 %
)
H IV
p re
v e n ti o n
(7 6 %
)
4 6 %
h a d
d a te
d :
4 0 %
o f
Y e a r
1 p u p ils
v s .
5 1 %
o f
Y e a r
2 p u p ils
, v
2 =
1 2 .8
8 ,
P <
0 .0
0 1
6 %
h a d
h a d
s e x :
8 .5
% o f
m a le
s v s .
3 .1
%
o f
fe m
a le
s , v
2 =
1 3 .8
6 ,
P <
0 .0
0 1
3 .7
% o f
Y e a r
1 p u p ils
v s .
8 .4
% o f
Y e a r
2
p u p ils
, v
2 =
1 0 .6
5 ,
P <
0 .0
0 1
J. Yu
566 ª 2012 Blackwell Publishing Ltd
T a b
le 2
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
J ia
e t
a l.
(2 0 0 7 a )
T a n g s h a n
c it y
H e b e i p ro
v in
c e
N =
6 0
1 s e n io
r h ig
h s c h o o l
Y e a r
1 – 3
p u p ils
1 5 – 1 9
y e a rs
R a n d o m
s a m
p le
In -d
e p th
fa c e -t
o -f
a c e
in te
rv ie
w s
(a n o n y m
o u s ,
c o n fi d e n ti a l)
3 5 %
h a d
n o t
re c e iv
e d
s e x
e d u c a ti o n
a t
s c h o o l.
7 5 %
b e lie
v e d
it n e c e s s a ry
to
h a v e
s e x
e d u c a ti o n .
3 0 %
b e lie
v e d
it n e c e s s a ry
to
p ro
v id
e e d u c a ti o n
a n d
s e rv
ic e s
a b o u t
c o n tr
a c e p ti o n .
P re
fe rr
e d
s o u rc
e s
o f
in fo
rm a ti o n
o n
s e x :
s c h o o ls
(6 2 %
), h o s p it a ls
(3 3 %
) a n d
n e w
s p a p e rs
⁄ m
a g a z in
e s
(3 0 %
)
R e s p o n d e n ts
a g a in
s t
te e n a g e
s e x :
7 0 %
L i e t
a l.
(2 0 0 2 )
X ix
ia n g
c o u n ty
S h a a n x i p ro
v in
c e
N =
5 4 4
1 s e n io
r a n d
1
v o c a ti o n a l h ig
h
s c h o o ls
Y e a r
1 – 2
p u p ils
M e a n
a g e :
1 6 .6
± 0 .9
6
fo r
m a le
s ,
1 6 .5
7 ±
0 .9
7 fo
r
fe m
a le
s
C lu
s te
r s a m
p le
R e s p o n s e
ra te
: 1 0 0 %
V a lid
re s p o n s e s :
9 9 .6
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
M e a n
s c o re
s o n
k n o w
le d g e
o f
re p ro
d u c ti v e
h e a lt h
a n d
S T
Is ⁄A
ID S
(o u t
o f
3 0 ):
M a le
s :
1 2 .9
6 ±
4 .4
0
F e m
a le
s :
9 .9
1 ±
4 .4
0
P <
0 .0
0 1
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
m e d ic
a l b o o k s
⁄m a g a z in
e s
(7 7 %
), s c h o o ls
(7 0 %
) a n d
T V
⁄fi lm
(3 5 %
)
R e s p o n d e n ts
a g a in
s t:
P re
m a ri ta
l s e x :
4 6 %
o f
m a le
s v s .
5 7 %
o f
fe m
a le
s ,
P <
0 .0
0 1
T e e n a g e
s e x :
7 9 %
o f
m a le
s v s .
9 3 %
o f
fe m
a le
s ,
P <
0 .0
0 1
R e s p o n d e n ts
w h o
h a d
h a d
s e x :
4 .5
% o f
m a le
s (n
= 1 5 )
2 .4
% o f
fe m
a le
s (n
= 4 )
L ia
n g
e t
a l.
(2 0 0 6 )
S h e n z h e n
c it y
G u a n g d o n g
p ro
v in
c e
N =
1 0 7 0
1 s e n io
r a n d
1
v o c a ti o n a l h ig
h
s c h o o ls
Y e a r
1 – 3
p u p ils
1 6 – 1 9
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
9 6 .2
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
a n d
fo c u s
g ro
u p s
2 0 0 3
P e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
a ll
re s p o n d e n ts
to
q u e s ti o n s
o n :
H IV
⁄A ID
S (5
0 %
)
R e p ro
d u c ti v e
tr a c t
in fe
c ti o n s
(1 8 – 5 1 %
)
C o n d o m
u s e
(6 5 %
)
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
S T
Is :
n e w
s p a p e rs
⁄m a g a z in
e s
⁄ b o o k s
(8 3 %
), p a m
p h le
ts (6
3 %
),
T V
(4 0 %
) a n d
fr ie
n d s
(4 0 %
)
R e s p o n d e n ts
w h o
h a d
h a d
s e x :
4 .4
% o f
m a le
s
2 %
o f
fe m
a le
s
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 567
T a b
le 2
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
L ia
n g
e t
a l.
(2 0 0 8 )
4 c it ie
s
H u n a n
p ro
v in
c e
N =
7 6 2 3
S e n io
r h ig
h s c h o o ls
Y e a r
1 – 3
p u p ils
1 5 – 1 9
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
4 9 %
re p o rt
e d
h a v in
g h a d
s e x
e d u c a ti o n
a t
s c h o o l:
4 2 %
o f
m a le
s v s .
5 5 %
o f
fe m
a le
s ,
v 2
= 1 3 4 .1
2 9 ,
P <
0 .0
1
4 7 %
h a d
re c e iv
e d
H IV
⁄A ID
S
e d u c a ti o n
a t
s c h o o l.
3 0 %
h a d
d a te
d :
3 3 %
o f
m a le
s v s .
2 7 %
o f
fe m
a le
s , v
2 =
2 4 .6
3 9 ,
P <
0 .0
1
3 .4
% h a d
h a d
s e x :
5 .2
% o f
m a le
s v s .
1 .8
%
o f
fe m
a le
s ,
v 2
= 6 8 .5
8 1 ,
P <
0 .0
1
2 .6
% o f
Y e a r
1 p u p ils
,
3 .1
% o f
Y e a r
2 p u p ils
v s .
5 %
o f
Y e a r
3
p u p ils
, v
2 =
2 0 .4
3 ,
P <
0 .0
1
L ia
n g
e t
a l.
(2 0 0 9 )
R u ra
l a re
a s
in H
e n a n
p ro
v in
c e
N =
5 0 1 1
S e n io
r h ig
h s c h o o ls
Y e a r
1 – 3
p u p ils
1 5 – 2 0
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 6
3 5 %
h a d
re c e iv
e d
s e x
e d u c a ti o n
a t
s c h o o l:
3 0 %
o f
m a le
s v s .
4 0 %
o f
fe m
a le
s , v
2 =
5 4 .6
4 3 ,
P <
0 .0
1
4 0 %
h a d
h a d
H IV
⁄A ID
S
e d u c a ti o n :
4 1 %
o f
m a le
s v s .
3 8 %
o f
fe m
a le
s , v
2 =
4 .1
8 3 ,
P <
0 .0
5
3 0 %
h a d
d a te
d :
3 2 %
o f
m a le
s v s .
2 7 %
o f
fe m
a le
s , v
2 =
1 2 .0
0 8 ,
P <
0 .0
1
3 .6
% h a d
h a d
s e x :
5 .6
%
o f
m a le
s v s .
1 .5
% o f
fe m
a le
s , v
2 =
6 0 .8
3 9 ,
P <
0 .0
1
N ie
e t
a l.
(2 0 0 7 )
5 c it ie
s
G u a n g d o n g
p ro
v in
c e
N =
1 0
0 1 6
K e y
⁄c o m
m o n
s e n io
r
a n d
v o c a ti o n a l h ig
h
s c h o o ls
R a n d o m
s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
2 0 0 5
R e s p o n d e n ts
w h o
h a d
h a d
s e x
e d u c a ti o n :
7 5 %
8 4 %
o f
fe m
a le
s v s .
6 7 %
o f
m a le
s , v
2 =
3 8 9 .1
2 ,
P <
0 .0
0 1
7 7 %
o f
k e y
s c h o o l p u p ils
, 7 6 %
o f
c o m
m o n
s c h o o l p u p ils
v s .
7 2 %
o f
v o c a ti o n a l s c h o o l
p u p ils
, v
2 =
3 0 .1
0 9 ,
P <
0 .0
0 1
3 6 %
h a d
d a te
d :
3 8 %
o f
m a le
s v s .
3 5 %
o f
fe m
a le
s , v
2 =
8 .5
8 6 ,
P =
0 .0
0 3
4 3 %
o f
v o c a ti o n a l
p u p ils
, 3 5 %
o f
c o m
m o n
s c h o o l p u p ils
a n d
3 2 %
o f
k e y
s c h o o l p u p ils
,
v 2
= 8 7 .2
4 9 ,
P <
0 .0
0 1
5 .9
% h a d
h a d
s e x :
8 .7
% o f
m a le
s v s .
3 .3
%
o f
fe m
a le
s , v
2 =
1 2 8 .1
7 6 ,
P <
0 .0
0 1
3 .1
% o f
k e y
s c h o o l
p u p ils
, 4 .8
% o f
c o m
m o n
s c h o o l p u p ils
v s .
1 0 .1
% o f
v o c a ti o n a l
p u p ils
, v
2 =
1 5 8 .8
3 3 ,
P <
0 .0
0 1
J. Yu
568 ª 2012 Blackwell Publishing Ltd
T a b
le 2
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
S o n g
e t
a l.
(2 0 0 6 )
B e iji
n g
m u n ic
ip a lit
y
N =
6 2 8
3 c o m
m o n
a n d
1
v o c a ti o n a l h ig
h
s c h o o ls
C lu
s te
r s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
O u t
o f
th e
q u e s ti o n s
a s k e d
o n
re p ro
d u c ti v e
m a tt
e rs
, th
e
p e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
:
C o m
m o n
h ig
h s c h o o l p u p ils
:
7 9 %
V o c a ti o n a l p u p ils
: 6 6 %
P <
0 .0
5
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
s e x :
T h e
In te
rn e t
(5 2 %
fo r
m a le
s
v s .
2 4 %
fo r
fe m
a le
s ,
P <
0 .0
1 )
V id
e o s
(3 6 %
fo r
m a le
s v s .
1 2 %
fo r
fe m
a le
s ,
P <
0 .0
1 )
B o o k s
⁄m a g a z in
e s
(2 4 %
fo r
m a le
s v s .
2 5 %
fo r
fe m
a le
s )
R e s p o n d e n ts
in fa
v o u r
o f
p re
m a ri ta
l s e x :
C o m
m o n
s c h o o l p u p ils
:
5 6 %
V o c a ti o n a l p u p ils
: 7 6 %
R e s p o n d e n ts
b e lie
v in
g
p re
m a ri ta
l s e x
c o u ld
s tr
e n g th
e n
re la
ti o n s h ip
s :
C o m
m o n
s c h o o l p u p ils
:
2 8 %
V o c a ti o n a l p u p ils
: 4 2 %
R e s p o n d e n ts
w h o
h a d
h a d
s e x :
1 0 .4
% (2
1 ⁄2
0 2 )
o f
v o c a ti o n a l p u p ils
4 %
(1 7
⁄4 2 6 )
o f
c o m
m o n
s c h o o l p u p ils
P <
0 .0
1
S o n g
e t
a l.
(2 0 0 8 )
1 8
p ro
v in
c e s
N =
1 1 0
9 5 4
K e y
⁄c o m
m o n
s e n io
r
a n d
v o c a ti o n a l h ig
h
s c h o o ls
Y e a r
1 – 3
p u p ils
M e a n
a g e :
1 6 .9
± 1 .1
4
fo r
m a le
s ,
1 6 .8
± 1 .1
0
fo r
fe m
a le
s
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
9 9 .4
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
4 .4
% h a d
h a d
s e x :
6 .9
% o f
m a le
s v s .
2 .1
%
o f
fe m
a le
s ,
P <
0 .0
1
3 .8
% o f
Y e a r
1 p u p ils
,
4 .5
% o f
Y e a r
2 p u p ils
v s .
5 .3
% o f
Y e a r
3
p u p ils
, P
< 0 .0
1
4 .6
% o f
k e y
s c h o o l
p u p ils
, 6 .1
% o f
c o m
m o n
s c h o o l p u p ils
v s .
1 0 .7
% o f
v o c a ti o n a l
p u p ils
, P
< 0 .0
1
S u n
e t
a l.
(2 0 0 4 )
C h e n g d u
c it y
S ic
h u a n
p ro
v in
c e
N =
5 2 6
1 v o c a ti o n a l h ig
h s c h o o l
Y e a r
2 p u p ils
1 6 – 1 9
y e a rs
(M =
1 7 .0
7 )
V a lid
re s p o n s e s :
9 4 .4
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 1
M e a n
s c o re
s o n
k n o w
le d g e
o f:
R e p ro
d u c ti v e
m a tt
e rs
: 4 .3
8
(o u t
o f
7 )
S T
Is :
1 1 .7
1 (o
u t
o f
2 2 )
A tt
it u d e s
to te
e n a g e
d a ti n g :
5 %
a g a in
s t
7 1 %
n e u tr
a l
2 5 %
in fa
v o u r
A tt
it u d e s
to te
e n a g e
s e x :
1 9 %
a g a in
s t
7 0 %
n e u tr
a l
1 1 %
in fa
v o u r
1 3 .9
% h a d
h a d
s e x :
2 2 .9
% o f
m a le
s
9 .4
% fe
m a le
s
P <
0 .0
0 1
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 569
T a b
le 2
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt it u d e s
S e x u a l b e h a v io
u r
W a n g
e t
a l.
(2 0 0 9 c )
1 4
c it ie
s
X in
jia n g
a u to
n o m
y
re g io
n
N =
9 1 3 8
1 4
k e y ,
9 c o m
m o n
s e n io
r a n d
5
v o c a ti o n a l h ig
h
s c h o o ls
Y e a r
1 – 3
p u p ils
1 5 – 1 9
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
V a lid
re s p o n s e s :
9 6 .6
%
Q u e s ti o n n a ir e
2 0 0 8
6 7 %
re p o rt
e d
h a v in
g h a d
H IV
⁄A ID
S e d u c a ti o n .
R e s p o n d e n ts
w h o
w e re
a w
a re
o f
A ID
S c a u s e d
b y
H IV
v ir u s :
5 8 %
Y e a r
3 p u p ils
s c o re
d b e tt
e r
th a n
Y e a r
1 a n d
2 p u p ils
(6 3 %
, 6 1 %
a n d
6 2 %
,
v 2
= 2 9 0 .5
4 ,
P <
0 .0
1 )
K e y
s c h o o l p u p ils
s c o re
d
b e tt
e r
th a n
c o m
m o n
a n d
v o c a ti o n a l s c h o o l p u p ils
(6 4 %
, 6 0 %
a n d
3 8 %
,
v 2
= 2 6 7 .0
5 ,
P <
0 .0
1 ).
4 .8
% h a d
h a d
s e x :
7 .2
% o f
m a le
s v s .
2 .7
%
o f
fe m
a le
s , v
2 =
2 5 .7
9 ,
P <
0 .0
1
6 %
o f
Y e a r
3 p u p ils
,
4 .8
% o f
Y e a r
2 p u p ils
v s .
3 .8
% o f
Y e a r
1 p u p ils
,
v 2
= 2 5 .7
9 ,
P <
0 .0
1
8 .7
% o f
v o c a ti o n a l
p u p ils
, 4 .2
% o f
k e y
h ig
h s c h o o l p u p ils
v s .
3 %
o f
c o m
m o n
h ig
h
s c h o o l p u p ils
, v
2 =
2 7 .2
6 ,
P <
0 .0
1
W a n g
e t
a l.
(2 0 0 9 b )
4 c o u n ti e s
S h a a n x i p ro
v in
c e
N =
9 4 0
3 k e y
a n d
2 c o m
m o n
s e n io
r h ig
h s c h o o ls
Y e a r
1 – 3
p u p ils
R a n d o m
c lu
s te
r
s a m
p le
M e d ia
n a g e :
1 7
y e a rs
4 1 .8
% fr
o m
c it ie
s a n d
to w
n s ;
5 8 .2
% fr
o m
ru ra
l a re
a s
V a lid
re s p o n s e :
9 2 .3
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 8
O u t
o f
th e
q u e s ti o n s
a s k e d
o n
H IV
tr a n s m
is s io
n ro
u te
s ,
8 7 %
w e re
a n s w
e re
d c o rr
e c tl y .
5 9 %
d id
n o t
k n o w
o f
a n y
c o n tr
a c e p ti v e
m e th
o d .
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
b o o k s
⁄m a g a z in
e s
(5 1 %
), p e e rs
(4 0 %
) a n d
s c h o o ls
(2 3 %
)
4 2 %
re p o rt
e d
h a v in
g re
c e iv
e d
n o
s e x
e d u c a ti o n ,
a n d
7 0 %
b e lie
v e d
it n e c e s s a ry
.
R e s p o n d e n ts
in fa
v o u r
o f
p re
m a ri ta
l s e x :
6 4 %
4 4 %
h a d
d a te
d :
4 6 %
o f
m a le
s
4 0 %
o f
fe m
a le
s
P <
0 .0
5
Z h o u
e t
a l.
(2 0 0 5 )
B e iji
n g
m u n ic
ip a lit
y
N =
6 5 8
K e y
⁄c o m
m o n
s e n io
r
a n d
v o c a ti o n a l h ig
h
s c h o o ls
M e a n
a g e :
1 6 .8
y e a rs
R a n d o m
c lu
s te
r
s a m
p le
R e s p o n s e
ra te
: 1 0 0 %
V a lid
re s p o n s e s :
9 7 .3
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 %
d id
n o t
k n o w
w h e n
a
w o m
a n ’s
fe rt
ile p e ri o d
o c c u rs
.
8 6 %
b e lie
v e d
s e x
e d u c a ti o n
n e c e s s a ry
.
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
re p ro
d u c ti v e
h e a lt h :
n e w
s p a p e rs
⁄m a g a z in
e s
(5 6 %
),
ra d io
⁄T V
(5 3 %
), p e e rs
⁄f ri e n d s
(3 8 %
), te
a c h e rs
(3 3 %
) a n d
th e
In te
rn e t
(3 1 %
)
T o p ic
s m
o s tl y
w a n te
d :
p s y c h o lo
g ic
a l a s p e c ts
o f
s e x
(6 2 %
), S
T I
p re
v e n ti o n
(5 4 %
)
a n d
s e x u a l m
o ra
lit y
(3 8 %
)
A tt
it u d e s
to te
e n a g e
s e x :
5 4 %
a g a in
s t
3 4 %
in fa
v o u r
9 %
n o t
s u re
3 .2
% h a d
h a d
s e x :
5 .4
% o f
m a le
s
0 .9
% o f
fe m
a le
s
P <
0 .0
5
S T
I, s e x u a lly
tr a n s m
it te
d in
fe c ti o n .
J. Yu
570 ª 2012 Blackwell Publishing Ltd
T a b
le 3
S u m
m a ry
o f
s tu
d ie
s c o n d u c te
d w
it h
b o th
ju n io
r a n d
s e n io
r h ig
h s c h o o l p u p ils
a n d
o th
e rs
(n =
1 5 ):
in fo
rm a ti o n
is p ro
v id
e d
w h e re
a v a ila
b le
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
L i (2
0 0 0 )
G u a n g z h o u
c it y
G u a n g d o n g
p ro
v in
c e
N =
4 8 5 8
2 c o m
m o n
a n d
2 k e y
h ig
h
s c h o o ls
1 2 – 2 0
y e a rs
C lu
s te
r s a m
p le
V a lid
re s p o n s e s :
8 2 .6
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
1 9 9 4
1 6 .6
% h a d
h a d
s e x :
2 3 .5
% (4
7 5
⁄2 0 2 5 )
o f
m a le
s
1 1 .7
% (3
3 0
⁄2 8 3 3 )
o f
fe m
a le
s
P <
0 .0
1
4 9 %
u s e d
a c o n d o m
a t
fi rs
t
s e x .
L ia
n g
& J ia
n g
(2 0 0 6 )
G u a n g z h o u
c it y
G u a n g d o n g
p ro
v in
c e
N =
2 5 6 2
3 h ig
h s c h o o ls
Y e a r
2 – 3
ju n io
rs a n d
Y e a r
2 – 3
s e n io
rs
R e s p o n s e
ra te
: 1 0 0 %
V a lid
re s p o n s e s :
9 9 .7
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
M e a n
s c o re
s o n
k n o w
le d g e
o f
H IV
⁄A ID
S (o
u t
o f
6 ):
Y e a r
2 ju
n io
rs (3
.3 2
± 1 .2
1 )
v s .
Y e a r
3 ju
n io
rs (4
.6 5
± 1 .3
3 ),
P <
0 .0
1
Y e a r
2 s e n io
rs (4
.1 0
± 1 .2
8 )
v s .
Y e a r
3 s e n io
rs
(4 .9
8 ±
2 .6
1 ),
P <
0 .0
1 )
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
s c h o o ls
(4 6 %
), m
a s s
m e d ia
(4 3 %
) a n d
fa m
ily (8
% )
R e s p o n d e n ts
in fa
v o u r:
P re
m a ri ta
l s e x :
4 8 %
o f
m a le
s v s .
2 9 %
o f
fe m
a le
s , v
2 =
9 9 .9
8 ,
P <
0 .0
1
E x tr
a m
a ri ta
l s e x :
2 6 %
o f
m a le
s v s .
8 %
o f
fe m
a le
s , v
2 =
9 1 .8
8 ,
P <
0 .0
0 1
4 .9
% h a d
h a d
s e x .
1 1
⁄1 3 2 0
fe m
a le
s h a d
h a d
a n
a b o rt
io n .
2 .6
% h a d
h a d
m u lt ip
le
s e x u a l p a rt
n e rs
.
L iu
e t
a l.
(2 0 0 4 )
1 to
w n
G u a n g d o n g
p ro
v in
c e
N =
1 9 2
1 ju
n io
r a n d
1 s e n io
r h ig
h
s c h o o ls
Y e a r
2 ju
n io
rs a n d
Y e a r
2
s e n io
rs
1 3 – 1 9
y e a rs
(M =
1 4 .2
4
fo r
ju n io
rs ,
1 6 .8
3 fo
r
s e n io
rs )
R a n d o m
c lu
s te
r s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 3
R e s p o n d e n ts
w h o
c o rr
e c tl y
a n s w
e re
d a t
le a s t
7 0 %
o f
th e
q u e s ti o n s
o n :
H IV
⁄A ID
S :
2 3 %
(3 2 %
o f
s e n io
rs v s .
1 5 %
o f
ju n io
rs
v 2
= 7 .4
, P
< 0 .0
5 ;
3 2 %
o f
m a le
s v s .
1 4 %
o f
fe m
a le
s ,
v 2
= 8 .6
1 ,
P <
0 .0
5 )
H IV
tr a n s m
is s io
n ro
u te
s :
4 3 %
H IV
p re
v e n ti o n :
2 5 %
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
ra d io
⁄T V
(9 0 %
), s c h o o ls
(8 0 %
)
a n d
m a g a z in
e s
(6 8 %
)
R e s p o n d e n ts
a g a in
s t
e a rl y
d a ti n g :
3 0 %
A tt
it u d e s
to p re
m a ri ta
l s e x :
4 6 %
a g a in
s t
4 0 %
o f
ju n io
rs v s .
7 0 %
o f
s e n io
rs in
fa v o u r,
P <
0 .0
5
A tt
it u d e s
to o n e -n
ig h t
s ta
n d s :
7 9 %
a g a in
s t
1 4 %
o f
ju n io
rs v s .
2 9 %
o f
s e n io
rs in
fa v o u r,
P <
0 .0
5
1 7 .7
% h a d
h a d
s e x :
2 6 .1
% o f
s e n io
rs
1 0 %
o f
ju n io
rs
v 2
= 8 .5
1 ,
P <
0 .0
1
3 5 %
(1 2
⁄3 4 )
u s e d
a c o n d o m
in la
s t
s e x u a l in
te rc
o u rs
e .
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 571
T a b
le 3
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt it u d e s
S e x u a l b e h a v io
u r
L iu
e t
a l.
(2 0 0 7 )
X in
z h o u
c it y
S h a n x i p ro
v in
c e
N =
4 5 0
1 h ig
h s c h o o l
Y e a r
1 – 2
ju n io
rs a n d
Y e a r
1 – 2
s e n io
rs
C lu
s te
r s a m
p le
R e s p o n s e
ra te
a n d
v a lid
re s p o n s e s :
1 0 0 %
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
R e s p o n d e n ts
w h o
c o rr
e c tl y
a n s w
e re
d m
o re
th a n
6 0 %
o f
q u e s ti o n s
o n :
H IV
⁄A ID
S :
6 6 %
(5 6 %
o f
ju n io
rs v s .
7 8 %
o f
s e n io
rs ,
v 2
= 2 2 .8
6 ,
P <
0 .0
1 )
H IV
tr a n s m
is s io
n ro
u te
s :
8 9 %
N o n -t
ra n s m
is s io
n ro
u te
s :
3 0 %
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
m a s s
m e d ia
⁄p e e rs
(7 0 %
),
p a re
n ts
(1 6 %
) a n d
te a c h e rs
(1 0 %
)
S o n g
e t
a l.
(2 0 0 4 )
D a lia
n c it y
L ia
o n in
g p ro
v in
c e
N =
9 2 0
P ri m
a ry
s c h o o ls
a n d
h ig
h
s c h o o ls
Y e a r
6 p ri m
a ry
p u p ils
,
Y e a r
2 ju
n io
rs a n d
Y e a r
2
s e n io
rs
M e a n
a g e :
1 5 .5
1 y e a rs
R a n d o m
c lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 5 .8
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 2
5 0 %
w e re
u n a b le
to c o rr
e c tl y
a n s w
e r
a ll
q u e s ti o n s
o n
s e x u a l
m a tt e rs
, w
it h
o ld
e r
re s p o n d e n ts
h a v in
g b e tt
e r
k n o w
le d g e
th a n
y o u n g e r
o n e s
(P <
0 .0
0 1 ).
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
m a s s
m e d ia
(4 2 %
), s c h o o ls
(3 4 %
) a n d
m e d ic
a l b o o k s
(2 5 %
)
R e s p o n d e n ts
in fa
v o u r
o f
te e n a g e
s e x :
8 %
2 %
o f
p ri m
a ry
p u p ils
5 %
o f
ju n io
rs
1 2 %
o f
s e n io
rs
R e s p o n d e n ts
a g a in
s t
te e n a g e
p re
g n a n c y :
9 0 %
8 6 %
h a d
h a d
h u g s ,
k is
s e s ,
c u d d lin
g o r
s e x u a l
in te
rc o u rs
e :
9 7 %
o f
p ri m
a ry
p u p ils
8 6 %
o f
ju n io
rs
8 4 %
o f
s e n io
rs
S u n
e t
a l.
(2 0 0 1 )
B e iji
n g ,
T ia
n jin
,
S h e n z h e n ,
S h e n y a n g
c it ie
s a n d
Y u n n a n
p ro
v in
c e
N =
1 6
5 8 0
4 0
c o m
m o n
h ig
h s c h o o ls
Y e a r
1 ju
n io
rs a n d
Y e a r
1
s e n io
rs
R a n d o m
c lu
s te
r s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
1 9 9 9
P e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
a ll
re s p o n d e n ts
to
q u e s ti o n s
o n :
H IV
tr a n s m
is s io
n ro
u te
s :
7 3 %
(7 1 %
fr o m
ju n io
rs v s .
7 5 %
fr o m
s e n io
rs ,
P <
0 .0
1 )
H IV
n o n -t
ra n s m
is s io
n ro
u te
s :
4 5 %
(4 2 %
fr o m
ju n io
rs v s .
4 7 %
fr o m
s e n io
rs ,
P <
0 .0
1 )
H IV
p re
v e n ti o n :
7 7 %
(8 0 %
fr o m
ju n io
rs v s .
7 4 %
fr o m
s e n io
rs ,
P <
0 .0
1 )
R e s p o n d e n ts
w h o
h a d
d is
c u s s e d
H IV
⁄A ID
S w
it h :
F a m
ily m
e m
b e rs
: 4 5 %
F ri e n d s :
6 5 %
R e s p o n d e n ts
a g a in
s t
p re
m a ri ta
l s e x :
6 1 %
6 0 %
o f
ju n io
rs v s .
6 3 %
o f
s e n io
rs ,
P <
0 .0
1
5 3 %
o f
ju n io
r m
a le
s v s .
6 6 %
o f
ju n io
r fe
m a le
s ,
P <
0 .0
1
5 2 %
o f
s e n io
r m
a le
s v s .
7 2 %
o f
s e n io
r fe
m a le
s ,
P <
0 .0
1
3 %
h a d
d ia
g n o s e d
w it h
a S
T I:
2 .8
% o f
ju n io
rs v s .
3 .1
% o f
s e n io
rs ,
P <
0 .0
1
A m
o n g
ju n io
rs :
3 .7
% o f
m a le
s v s .
1 .9
% ,
P <
0 .0
1
A m
o n g
s e n io
rs :
4 .6
% o f
m a le
s v s .
1 .7
% o f
fe m
a le
s ,
P <
0 .0
1
J. Yu
572 ª 2012 Blackwell Publishing Ltd
T a b
le 3
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
T a n g
e t
a l.
(2 0 0 8 )
C h o n g q in
g
m u n ic
ip a lit
y
N =
6 6 5
2 h ig
h s c h o o ls
Y e a r
1 – 3
ju n io
rs a n d
Y e a r
1 – 3
s e n io
rs
1 2 – 1 9
y e a rs
(M =
1 5 .5
)
C lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 7 .8
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 7
O u t
o f
th e
S T
I ⁄A
ID S
q u e s ti o n s
a s k e d ,
7 5 %
w e re
a n s w
e re
d
c o rr
e c tl y .
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
s e x :
s c h o o ls
(6 0 %
),
m a g a z in
e s
⁄T V
(5 1 %
), p e e rs
(4 2 %
) a n d
th e
In te
rn e t
(2 9 %
)
6 9 %
b e lie
v e d
it n e c e s s a ry
to
h a v e
s e x
e d u c a ti o n
a t
s c h o o l.
A tt
it u d e s
to c u rr
e n t
s c h o o l s e x
e d u c a ti o n :
S a ti s fi e d
(2 6 %
)
U n s a ti s fi e d
(3 5 %
)
U n c e rt
a in
(4 2 %
)
R e s p o n d e n ts
in fa
v o u r
o f:
E a rl y
d a ti n g :
4 7 %
T e e n a g e
s e x :
3 1 %
O n e -n
ig h t
s ta
n d s :
1 7 %
8 .6
% h a d
h a d
s e x :
1 4 .5
% o f
m a le
s
3 .1
% o f
fe m
a le
s
v 2
= 2 6 .2
3 ,
P <
0 .0
0 0 1
6 8 .8
% h a d
u s e d
a c o n d o m
.
T u
e t
a l.
(2 0 0 7 )
S h a n g h a i
m u n ic
ip a lit
y
N =
3 0 6 9
7 ju
n io
r a n d
4 s e n io
r h ig
h
s c h o o ls
Y e a r
1 ju
n io
rs a n d
Y e a r
1
s e n io
rs
M e a n
a g e :
1 4 .6
6 ±
0 .4
1 fo
r
ju n io
rs ,
1 7 .6
± 0 .3
8 fo
r
s e n io
rs
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 4
M e a n
s c o re
s o n
k n o w
le d g e
o f
re p ro
d u c ti v e
m a tt
e rs
a n d
H IV
⁄A ID
S (o
u t
o f
1 0 0 ):
J u n io
rs (3
3 .8
5 )
v s .
s e n io
rs
(5 5 .0
8 ),
P <
0 .0
0 1
M a le
ju n io
rs (3
1 .2
2 )
v s .
fe m
a le
ju n io
rs (3
6 .4
0 ),
P <
0 .0
0 1
M a le
s e n io
rs (5
5 .2
4 )
v s .
fe m
a le
s e n io
rs (5
4 .9
7 ),
P <
0 .0
0 1
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
F o r
ju n io
rs :
te a c h e rs
(6 3 %
),
p a re
n ts
(5 4 %
) a n d
T V
⁄r a d io
⁄n e w
s p a p e rs
(3 1 %
)
F o r
s e n io
rs :
T V
⁄r a d io
⁄ n e w
s p a p e rs
(6 0 %
), te
a c h e rs
(4 4 %
) a n d
m a g a z in
e s
(4 1 %
)
R e s p o n d e n ts
a g a in
s t
te e n a g e
d a ti n g :
J u n io
rs :
8 0 %
S e n io
rs :
5 1 %
P <
0 .0
1
R e s p o n d e n ts
in fa
v o u r
o f
o r
w it h
n e u tr
a l a tt
it u d e s
to : M a le
p re
m a ri ta
l s e x :
5 6 %
o f
ju n io
rs v s .
8 2 %
o f
s e n io
rs ,
P <
0 .0
0 1
F e m
a le
p re
m a ri ta
l s e x :
5 4 %
o f
ju n io
rs v s .
7 8 %
o f
s e n io
rs ,
P <
0 .0
0 1
R e s p o n d e n ts
w h o
h a d
d a te
d :
5 .2
% o f
ju n io
rs
2 1 .9
% o f
s e n io
rs
P <
0 .0
0 1
1 5
ju n io
rs a n d
3 s e n io
rs h a d
h a d
s e x .
X u
& C
h e n g
(2 0 0 8 )
S h a n g h a i
m u n ic
ip a lit
y
N =
5 9 1
6 h o s p it a ls
P re
g n a n t
te e n a g e rs
s e e k in
g a b o rt
io n s
1 3 .5
– 1 9
y e a rs
(M =
1 7 .8
6 ±
0 .9
9 )
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
H o s p it a l
2 0 0 5
4 8 %
h a d
h e a rd
o f
e m
e rg
e n c y
c o n tr
a c e p ti o n .
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
p e e rs
⁄b o y fr
ie n d s
(6 0 %
) a n d
m a g a z in
e s
⁄n e w
s p a p e rs
(2 1 %
)
M a in
re a s o n s
fo r
n o t
u s in
g
c o n tr
a c e p ti o n :
N o t
k n o w
in g
(5 7 %
)
T h in
k in
g n o t
a t
ri s k
(3 5 %
)
A ll
p re
g n a n c ie
s w
e re
u n in
te n d e d .
4 9 %
h a d
n e v e r
u s e d
a n y
c o n tr
a c e p ti o n .
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 573
T a b
le 3
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
X u e
e t
a l.
(2 0 0 8 )
W e n z h o u
c it y
Z h e jia
n g
p ro
v in
c e
N =
4 6 5
5 ju
n io
r a n d
3 s e n io
r h ig
h
s c h o o ls
Y e a r
1 – 3
ju n io
rs a n d
Y e a r
1 s e n io
rs
1 1 – 1 8
y e a rs
(M =
1 5 .4
0 ±
1 .2
8 )
R a n d o m
c lu
s te
r s a m
p le
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 7
P e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
a ll
re s p o n d e n ts
to
H IV
⁄A ID
S q u e s ti o n s :
7 5 %
7 8 %
fr o m
fe m
a le
s v s .
7 2 %
fr o m
m a le
s , v
2 =
1 9 .5
1 4 ,
P <
0 .0
1
8 2 %
fr o m
s e n io
rs v s .
7 3 %
fr o m
ju n io
rs , v
2 =
2 8 .1
7 1 ,
P <
0 .0
1
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
te a c h e rs
(6 6 %
), p e e rs
(4 8 %
)
a n d
p a re
n ts
⁄g u a rd
ia n s
(3 3 %
)
1 .7
% h a d
h a d
s e x
(6 %
o f
n o n -r
e s p o n s e s ).
6 .3
% h a d
h a d
m u lt ip
le s e x u a l
p a rt
n e rs
(2 5 %
o f
n o n -
re s p o n s e s ).
1 2 .5
% u s e d
n o
c o n d o m
in
th e ir
la te
s t
s e x u a l
in te
rc o u rs
e (3
7 .5
% o f
n o n -
re s p o n s e s ).
1 2 .5
% h a d
b e e n
p re
g n a n t
o r
m a d e
s o m
e o n e
p re
g n a n t
(3 7 .5
% o f
n o n -r
e s p o n s e s ).
Y u
e t
a l.
(2 0 0 3 )
S h a n g h a i
m u n ic
ip a lit
y
N =
8 0 6
3 to
w n s
7 5 %
a t
ju n io
r, s e n io
r a n d
v o c a ti o n a l h ig
h s c h o o ls
1 5 – 1 8
y e a rs
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
2 0 0 0
6 9 %
h a d
n e v e r
h e a rd
o f
a n y th
in g
a b o u t
c o n tr
a c e p ti o n .
7 3 %
h a d
n e v e r
a s k e d
p a re
n ts
fo r
in fo
rm a ti o n
o n
s e x
(9 3 %
o f
m a le
s v s .
5 4 %
o f
fe m
a le
s ,
P <
0 .0
0 1 ).
M a in
s o u rc
e s
o f
in fo
rm a ti o n
o n
s e x :
s c h o o ls
, m
e d ic
a l b o o k s
⁄ m
a g a z in
e s
a n d
p e e rs
6 2 %
h a d
h a d
s e x
e d u c a ti o n
a t
s c h o o l.
8 1 %
c o n s id
e re
d it
n e c e s s a ry
.
R e s p o n d e n ts
in fa
v o u r
o f
te e n a g e
s e x :
5 0 %
2 5 .8
% h a d
d a te
d :
3 4 .1
% o f
m a le
s
1 8 .1
% o f
fe m
a le
s
P <
0 .0
0 1
3 3
re s p o n d e n ts
h a d
h a d
s e x :
2 4
m a le
s v s .
9 fe
m a le
s ,
P <
0 .0
0 1
8 1 .8
% u s e d
n o
c o n tr
a c e p ti o n
a t
fi rs
t s e x .
T h e
y o u n g e s t
a g e
a t
fi rs
t s e x
w a s
1 1 .
Z h a n g
e t
a l.
(2 0 0 4 b )
B e in
g m
u n ic
ip a lit
y
N =
1 3 6 1
1 k e y ,
2 c o m
m o n
a n d
1
v o c a ti o n a l h ig
h s c h o o ls
Y e a r
2 ju
n io
rs
Y e a r
1 – 3
s e n io
rs
M e a n
a g e :
1 3 .7
y e a rs
fo r
ju n io
rs ,
1 6 .8
y e a rs
fo r
s e n io
rs
R a n d o m
c lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 5 .2
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
M e a n
s c o re
s o n
re p ro
d u c ti v e
q u e s ti o n s
(o u t
o f
5 ):
2 .3
7 fo
r ju
n io
rs
3 .3
5 fo
r s e n io
rs
P <
0 .0
1
R e s p o n d e n ts
a g a in
s t
te e n a g e
d a ti n g :
7 1 %
A tt
it u d e s
to te
e n a g e
s e x :
7 4 %
o f
ju n io
rs v s .
5 4 %
o f
s e n io
rs a g a in
s t,
P <
0 .0
1
1 5 %
o f
ju n io
rs v s .
3 4 %
o f
s e n io
rs in
fa v o u r,
P <
0 .0
1
7 %
o f
ju n io
rs v s .
9 %
o f
s e n io
rs u n c e rt
a in
,
P >
0 .0
5
2 .1
% h a d
h a d
s e x :
0 .9
% (6
⁄6 4 7 )
o f
ju n io
rs
3 .2
% (2
1 ⁄6
4 9 )
o f
s e n io
rs
v 2
= 8 .4
6 ,
P =
0 .0
4
J. Yu
574 ª 2012 Blackwell Publishing Ltd
T a b
le 3
C o n ti n u e d
R e fe
re n c e s
a n d
s e tt
in g
S a m
p le
a n d
re s p o n s e
ra te
⁄ v a lid
re s p o n s e s
D a ta
c o lle
c ti o n :
m e th
o d ,
lo c a ti o n
a n d
y e a r
K e y
fi n d in
g s
S e x u a l k n o w
le d g e
a n d
m a in
s o u rc
e s
S e x u a l a tt
it u d e s
S e x u a l b e h a v io
u r
Z h a o
e t
a l.
(2 0 0 5 )
R u ra
l a re
a s
in
Z h e jia
n g ,
S h a n x i
a n d
Q in
g h a i
p ro
v in
c e s
N =
2 9 4 4
4 h ig
h s c h o o ls
1 5 – 1 9
y e a rs
(M =
1 6 .8
8 ±
1 .1
9 )
R a n d o m
c lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 0 .6
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 3
M e a n
s c o re
s o n
k n o w
le d g e
o f
S T
Is ⁄A
ID S
a n d
c o n tr
a c e p ti o n
(o u t
o f
1 0 ):
M a le
s :
4 .4
6 ±
3 .0
4
F e m
a le
s :
3 .7
7 ±
3 0 .1
P <
0 .0
5
In fo
rm a ti o n
n e e d s :
re la
ti o n s h ip
s
(5 9 %
), a d o le
s c e n t
p s y c h o lo
g y
(5 1 %
) a n d
S T
I ⁄A
ID S
p re
v e n ti o n
(4 9 %
)
P re
fe rr
e d
s o u rc
e s :
s c h o o ls
(6 2 %
), h o s p it a ls
(3 3 %
) a n d
te le
p h o n e
c o u n s e lli
n g
(2 4 %
)
A tt
it u d e s
to p re
m a ri ta
l s e x
7 6 %
a g a in
s t
1 6 %
n e u tr
a l
9 %
in fa
v o u r
4 .6
% (1
3 5
⁄2 9 4 4 )
h a d
h a d
s e x :
6 %
o f
m a le
s
3 .1
% o f
fe m
a le
s
P <
0 .0
5
2 8 .9
% (3
9 ⁄1
3 5 )
h a d
u s e d
c o n tr
a c e p ti o n .
Z h i (2
0 0 8 )
A c o u n ty
in
H e n a n
p ro
v in
c e
N =
3 6 1 1
2 ju
n io
r a n d
2 s e n io
r h ig
h
s c h o o ls
1 0 – 2 5
y e a rs
V a lid
re s p o n s e s :
9 9 .8
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 5
P e rc
e n ta
g e
o f
c o rr
e c t
a n s w
e rs
fr o m
a ll
re s p o n d e n ts
to
q u e s ti o n s
o n :
H IV
⁄A ID
S :
3 1 %
H IV
tr a n s m
is s io
n ro
u te
s :
7 7 %
H IV
n o n -t
ra n s m
is s io
n ro
u te
s :
6 1 %
M a in
s o u rc
e s
o f
in fo
rm a ti o n :
T V
(8 6 %
), m
a g a z in
e s
(7 5 %
),
a d v e rt
is e m
e n ts
(7 0 %
) a n d
te a c h e rs
(4 3 %
)
R e s p o n d e n ts
a g a in
s t
p re
m a ri ta
l s e x :
6 5 %
5 5 %
o f
m a le
s v s .
7 7 %
o f
fe m
a le
s ,
P <
0 .0
5
7 3 %
o f
ju n io
rs v s .
5 7 %
o f
s e n io
rs ,
P <
0 .0
5
0 .6
% h a d
h a d
s e x .
Z h u
e t
a l.
(2 0 0 9 )
G u a n g z h o u
c it y
(u rb
a n
a n d
s u b u rb
s )
G u a n g d o n g
p ro
v in
c e
N =
5 9 6 6
9 h ig
h s c h o o ls
Y e a r
1 – 3
ju n io
rs a n d
Y e a r
1 – 3
s e n io
rs
1 1 – 2 2
y e a rs
(M =
1 5 .9
4 ±
1 .8
8 )
C lu
s te
r s a m
p le
V a lid
re s p o n s e s :
9 9 .4
%
Q u e s ti o n n a ir e
(s e lf -c
o m
p le
te d ,
a n o n y m
o u s )
S c h o o l
2 0 0 4
1 .3
% h a d
h a d
fo rc
e d
s e x .
4 .5
% h a d
h a d
s e x
v o lu
n ta
ri ly
:
6 .7
% o f
m a le
s v s .
2 .4
% o f
fe m
a le
s , v
2 =
5 3 .2
9 4 ,
P <
0 .0
0 1
3 .7
% o f
ju n io
rs v s .
5 .3
% o f
s e n io
rs , v
2 =
7 .5
8 1 ,
P <
0 .0
0 6
5 9 .7
% h a d
h a d
m u lt ip
le s e x u a l
p a rt
n e rs
: 6 3 .1
% o f
m a le
s v s .
4 4 .7
%
o f
fe m
a le
s , v
2 =
4 .0
8 7 ,
P <
0 .0
4
5 1 .2
% h a d
u s e d
a c o n d o m
.
2 1 .3
% h a d
b e e n
p re
g n a n t
o r
m a d e
s o m
e o n e
p re
g n a n t.
2 3 .3
% h a d
s e x
b e fo
re a g e
1 1 :
3 1 .3
% (2
5 ⁄8
0 )
o f
ju n io
rs v s .
1 8 .5
%
(2 4
⁄1 3 0 )
o f
s e n io
rs ,
P <
0 .0
5
S T
I, s e x u a lly
tr a n s m
it te
d in
fe c ti o n .
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 575
respondents did report having received some sex educa- tion at school (Liang et al. 2008, 2009). The figures reported by others varied from 42% in Shaanxi province
to 46% in Shanghai and 75% in Guangdong province
(Nie et al. 2007, Chen et al. 2009, Wang et al. 2009b). In terms of HIV ⁄ AIDS education, among senior ⁄ vocational high school respondents, 40% in rural areas of Henan
province and 67% in Xinjiang autonomous region said
that this was provided by their schools (Wang et al. 2009c).
It is uncertain whether the observed differences
across these studies reflected regional variations in sex
education policy or were as a result of response bias.
Among respondents who did receive sex education at
school, only 12% in Shanghai and 23% in Chongqing
thought it useful or satisfactory (Tang et al. 2008, Chen et al. 2009). However, the important role of school in pro- viding education on this subject was highlighted by most
respondents in some studies (Tang et al. 2008, Chen et al. 2009, Wang et al. 2009b). Similar findings were reported in a qualitative study although most respondents were
not sure about the need for advice on contraception (Jia
et al. 2007a). Even so, this need was clearly identified by 73% of respondents in Beijing where the main areas that
respondents wanted schools to cover were psycho-sexual topics (62%), STI prevention (54%) and sexual morality
(38%) (Zhou et al. 2005). Similar results were also reported by Zhao et al. (2005).
Sexual values and attitudes
The reported attitudes to premarital sex varied. In junior
high school, respondents believing no sex before mar-
riage ranged from 38% in Wuhan to 67% in Dalian (Yang
& Yu 2000, Peng et al. 2004). The same view was expressed by 64% of senior high school respondents in
Shaanxi province (Wang et al. 2009b) and by between 46% of high school respondents in Guangdong province
(Liu et al. 2004) and 76% in rural areas of Zhejiang, Shanxi and Qinghai provinces (Zhao et al. 2005). Liberal attitudes were reported by some respondents. For exam-
ple, 16% of junior high school respondents in Wuhan
believed it was okay to have sex before marriage (Peng
et al. 2004). This view was reported by 66% of senior ⁄ vocational high school respondents in Beijing, and 35% believed premarital sex could make a relation-
ship more stable (Song et al. 2006). However, only 9% of rural respondents were in favour of premarital sex (Zhao
et al. 2005). A direct comparison of values between rural and city respondents is impossible as this topic was not
examined in other studies of young people in rural
areas.
With regard to attitudes to teenage sex, junior high
school respondents who reported against it varied from
50% in Beijing to 74% in Wuhan (Wu et al. 2007, Xu et al. 2007), while among senior high school respondents, the
figures were from 19% in Chengdu to 86% in Shaanxi
province (Li et al. 2002, Sun et al. 2004). Respondents who reported in favour of teenage sex seemed generally
low, ranging from 4% of junior to 34% of senior high
school respondents (Zhou et al. 2005, Xu et al. 2007). The figure rose to 50% in a study by Yu et al. (2003), which might be explained by variations in the sample, 75% of which were at school and the rest were either in employ-
ment or unemployed.
Attitudes to other behaviours were also reported.
Dating while still at school was supported by 3% of
junior respondents in Beijing to 54% of senior respon-
dents in Shanghai, while some juniors in Shenzhen and
Wuhan wished to go on a date (Gong et al. 2007, Wu et al. 2007, Chen et al. 2009). Respondents who agreed with one-night stands was 17% in Chongqing and 29%
in Guangdong, while as high as 26% of respondents in
Guangzhou also accepted extramarital sex (Liu et al. 2004, Liang & Jiang 2006, Tang et al. 2008).
Sexual behaviour
In most studies of junior high school pupils, only a small
proportion reported having already lost their virginity.
This was as low as 1%, as reported in two early studies
carried out in northern cities, Dalian and Beijing (Yang &
Yu 2000, Zhou & Ye 2000). Similarly, in Wuhan, 1% of
females and 2% of males were found to have had sex,
and the figure was 2% in Beijing and Shenzhen (Gong et al. 2007, Wu et al. 2007, Xu et al. 2007).
Among respondents attending senior ⁄ vocational high schools, in Beijing, 3% had lost their virginity and 4% in
the rural areas of Henan province (Zhou et al. 2005, Liang et al. 2009). Similarly, in Shaanxi province, 5% of males and 2% of females had had sex (Li et al. 2002), while the prevalence was as high as 14% in Chengdu
(Sun et al. 2004). In studies of both junior and senior high school
pupils, the prevalence of sexual intercourse varied from
1% in Henan to 2% in Beijing and 18% in Guangdong
province (Liu et al. 2004, Zhang et al. 2004b, Zhi 2008). The high proportion reported by Liu et al. (2004) and Sun et al. (2004) might be explained by their samples in terms of size and characteristics, response bias and
respondents’ age group or may alternatively reflect the behavioural changes seen in teenagers.
Contraceptive use, pregnancies, abortions and multi-
ple sexual partners were also reported. In rural areas
across three provinces, only 29% of respondents who
had lost their virginity had ever used contraception
(Zhao et al. 2005). It is unclear whether accessibility to contraception in rural areas had affected their contracep-
J. Yu
576 ª 2012 Blackwell Publishing Ltd
tive choice, as their use was slightly higher among city respondents. For example, in Guangzhou, the capital of
Guangdong province, although contraceptive use among
high school pupils was still low, about half the respon-
dents reported using a condom at their first sexual inter-
course experience (Li 2000, Zhu et al. 2009). In some studies, between 13% and 21% of respondents who had
had sex reported having been pregnant or having made
a female pregnant (Xue et al. 2008, Zhu et al. 2009). Ele- ven respondents in Liang & Jiang (2006) reported having
had an abortion. Also, the prevalence of multiple sexual
partners among respondents who had already lost their
virginity varied from 3–60% in Guangzhou and 6% in
Wenzhou (Liang & Jiang 2006, Xue et al. 2008, Zhu et al. 2009). It is unclear whether the question was answered
honestly and whether they had sex with multiple part-
ners during the same time period or across different time periods. Three per cent of respondents in Sun et al. (2001) confirmed diagnoses of STIs.
Only in two studies was information on the respon-
dents’ age at first sexual intercourse experience available,
which was age 11 or younger (Yu et al. 2003, Zhu et al. 2009). In Guangzhou, Zhu et al. (2009) found that of respondents who had lost their virginity, 23% occurred
before age 11, and this was more likely to be reported by juniors than by seniors (31% vs. 19%). These findings
might be explained by response bias, as 63 juniors (44%)
and 38 seniors (23%) did not answer this question (Zhu
et al. 2009), or have reflected that the juniors were not mature enough to take the questionnaire seriously.
Key factors associated with sexual knowledge,
attitudes and behaviour
Age differences As might be expected, older respondents appeared to
have a better understanding of sexual matters than those
younger than them. Song et al. (2004) surveyed pupils at primary and high schools in Dalian. Half of the respon-
dents were unable to correctly answer the questions put
to them on sexual matters, but even so, senior respon-
dents did better than their younger counterparts
(P < 0.001). In a study of high school pupils in Shanghai, seniors scored significantly higher than juniors (55 vs. 34,
P < 0.001, Tu et al. 2007). Similar results were found in terms of HIV ⁄ AIDS knowledge (Liu et al. 2004, 2007, Zhao et al. 2005, Liang & Jiang 2006, Jia et al. 2007b,c, Xue et al. 2008, Zhi 2008).
However, older respondents tended to report holding
more permissive attitudes to sex (Liu et al. 2004, Sun et al. 2004, Tu et al. 2007, Wu et al. 2007). As might also be expected, older respondents were more likely to
report having lost their virginity (Li 2000, Liu et al. 2004,
Song et al. 2004, Sun et al. 2004, Jia et al. 2007b,c, Wang et al. 2009c, Zhu et al. 2009).
Gender differences Generally, young men were found to have better sex-
related knowledge than young women, including
knowledge of HIV ⁄ AIDS (Li et al. 2002, Yu et al. 2003, Jia et al. 2007b,c, Wu et al. 2007, Zhi 2008). Even so, in Wenz- hou, out of the HIV ⁄ AIDS questions asked, the percent- age of correct answers from female respondents was significantly higher than that from male respondents
(78% vs. 72%, v2 = 28.171, P < 0.01, Xue et al. 2008). Such differences may indicate that females did have better
knowledge, but its small sample size may also have
influenced findings (n = 465). Males were more likely to report having liberal atti-
tudes to premarital and uncommitted sex (Liu et al. 2004, Liang & Jiang 2006) and to have lost their virginity, as reported by respondents at junior high schools (Jia et al. 2007b, Wu et al. 2007). Consistent results were reported in studies at senior ⁄ vocational high school (Sun et al. 2004, Jia et al. 2007b,c, Nie et al. 2007, Liang et al. 2008, Song et al. 2008) and in studies of high school pupils (Li 2000, Zhao et al. 2005, Tang et al. 2008). Moreover, even among high school pupils in Guangzhou, more males
than females reported having more than one sexual part- ner (63% vs. 45%, v2 = 4.087, P < 0.04, Zhu et al. 2009).
Types of schools When young people reach age 16, following secondary
education at junior level, they follow one of three path-
ways. They can leave school or attend a senior or a voca-
tional high school. Senior high schools are divided into
common or key schools. Only high achievers are eligible
to attend key schools.
In some studies, comparisons were made between pupils attending a variety of different types of school. In
Beijing, respondents at vocational high schools had a
poorer knowledge of reproductive matters than those at
common high schools, but they held more liberal atti-
tudes to premarital sex and were more likely to have
already lost their virginity (P < 0.05, Song et al. 2006). It was also reported in three other studies that respondents
at key schools were significantly more likely to remain virgins than those at common and vocational schools
(P < 0.01, Nie et al. 2007, Song et al. 2008, Wang et al. 2009c).
These variations may be explained as follows. Most
young people attending common and key high schools
aim to go through competitive tests to get into university
and therefore might focus more on academic success
than those attending vocational high schools. Some evi- dence supports the idea of academic inspirations being a
positive influence on the sexual attitudes of higher per-
Teenage sexual attitudes and behaviour in China
ª 2012 Blackwell Publishing Ltd 577
forming students. Song et al. (2008) reported that com- mitment to doing well at school protected respondents
from becoming sexually active. Variations may also be
explained by other factors, such as family relationships,
social economic status and levels of parental education
(Sun et al. 2004, Nie et al. 2007, Song et al. 2008).
Discussion
Teenage sexual attitudes and behaviour in China
These findings provide insight into teenage sexual atti-
tudes and behaviour in contemporary China. Premari-
tal ⁄ teenage sex was supported by some teenagers although its prevalence is lower than that reported in
studies conducted in most western countries. For exam-
ple, only 4% of respondents in a UK national survey disapproved of premarital sex (Wellings et al. 1994). Chinese traditional sexual values are mainly based on
Confucian and Taoist traditions, stressing reproduction
and social stability (Ruan 1991). Sexual intercourse is
solely endorsed within marriage for reproductive pur-
poses, while premarital and extramarital relationships,
homosexuality and masturbation are all disapproved
of. The minimum legal age for marriage is 20 for women and 22 for men in China (National People’s
Congress 1980). Teenage sex, therefore, is deemed to
occur before marriage and is thought culturally unac-
ceptable.
With regard to sexual behaviour, in most studies,
<5% of respondents reported having lost their virginity,
although occasionally the prevalence was higher, espe-
cially among male respondents (Li 2000, Liu et al. 2004, Sun et al. 2004, Tang et al. 2008). This figure still seems low, when compared to countries such as the UK and
the USA. Based on national surveys, over one-quarter of
UK teenagers had become sexually active before age 16
(Wellings et al. 2001, Currie et al. 2008), and an estimated 31% of 15- to 17-year-olds had lost their virginity at this
age in the USA (Abma et al. 2004). These findings have been supported by a recent review on sexual behaviour of Chinese young people in western countries, who were
found to be more likely than their white counterparts to
disapprove of uncommitted sex, be virgins, have lost
their virginity at a later age and have fewer sexual part-
ners (Yu 2010a).
This low prevalence of sexual intercourse may indi-
cate that although many respondents tended to agree
with premarital sex, most of them had not actually engaged in it. It may also be due to their reluctance to
reveal sexual behaviour that may not match the norms
of traditional Chinese culture. Sex is always a sensitive
topic for people, but especially for Chinese people (Ruan
1991). This has been reflected in sex-related research with
Chinese young people living in both China and overseas, who often declined to reveal their sexual behaviour and
were reluctant to take part in such research (Higgins
et al. 2002, Gong et al. 2007, Xue et al. 2008, Yu 2009). Although it is always challenging to conduct research in
this area with young people in any country because of
this reticence, the fact that the reliability of the research
reviewed has been influenced by response bias must be
taken into account. Contraceptive use among Chinese teenagers
appeared to be low. This might be due to a lack of
knowledge about contraception, limited access to contra-
ceptive services or unawareness of the risk of getting
pregnant (e.g. Wu et al. 2002, Peng et al. 2004). Cases of pregnancies and abortions were also reported in some
studies discussed (Li 2000, Liang & Jiang 2006, Xue et al. 2008, Zhu et al. 2009). These findings are consistent with studies of university students in China (e.g. Ma et al. 2008, 2009).
Sexual knowledge and sex education in China
Sexual knowledge was generally insufficient, especially in terms of reproductive health and STIs. Many of the
teenagers in the studies reviewed did not seem to have
received sufficient formal sex education at school, while
the role of school in this regard was deemed crucial. The
media, such as magazines, television and the Internet,
were seen to be the main sources of information on sex.
Consistent results have been reported in studies carried
out in other countries (Lesta et al. 2008, Ngo et al. 2008) and suggest that in China schools have not yet played a
key part.
The Chinese government began to support school sex
education in 1985 after China’s first case of HIV was
identified. It became part of the curriculum offered to
pupils in junior high schools in 1988 (Beijing Education
Bureau 1988); however, in some areas, the policy has still
not been well implemented (Gao et al. 2001). It is com- mon for sex education to be taught in biology classes but
with a narrow focus on biology and psychological devel-
opment (Gao et al. 2001, Aresu 2009). This may only con- sist of reading the reproduction section of textbooks in
the classroom or be self-learnt without any discussion.
The reported cases of unwanted pregnancies and multi-
ple sexual partners call for a more comprehensive sex
education that discusses topics on safe sexual practice, sexual morality, negotiation skills and the psychological
aspects of sex. Also, the reported differences in sexual
attitudes and behaviour between the genders and
between respondents attending different types of schools
suggest that this education should particularly target
adolescent males and young people in vocational and
professional training.
J. Yu
578 ª 2012 Blackwell Publishing Ltd
School sex education has the scope to reach teenagers before they leave school at 16 at a time when most of
them are still sexually inactive. This subject could be one
of the most important tools to equip teenagers with the
knowledge they need to make healthy and informed
choices on their sexual behaviour. A positive impact of
sex education at school on young people’s sexual knowl-
edge and prevalence of sexual intercourse has been
reported in the USA and the UK (e.g. Wight et al. 2002, Stephenson et al. 2004, Tucker et al. 2007, Mueller et al. 2008). Moreover, in a UK national survey, school has
become the most commonly cited source of information
on sexual matters among 16- to 19-year-olds, and the
prevalence of reported STIs was lower among respon-
dents who cited school as their main source than those
who reported parents and friends had taught them most
(Wellings et al. 2001, Macdowall et al. 2006).
Review limitations
This is the first critical review concerning teenage sexual
behaviour in China, but some limitations need to be
acknowledged. Grey literature was not included, which may have omitted some relevant work. The selected stud-
ies for inclusion may be subject to selective bias, mainly
due to a lack of a quality assessment and subjective judge-
ment of the sole reviewer. In future work, such a review
could be strengthened by establishing a team comprising
of members with different expertise, including bilingual
reviewers. Despite these limitations, this review helps
enhance the knowledge base of research in this field and lays valuable foundation for additional work.
Implications for practice and research
Government policy on school sex education needs to be
implemented evenly across the country to ensure equal- ity in education on this subject. However, on its own, the
school cannot sufficiently mitigate excesses in teenage
sexual behaviour, as young people tend to shape their
behaviour within a wide set of social and cultural con-
texts: those of school, family, peers, religion, neighbour-
hood and media (Yu 2010b). Parents may not have the
specific knowledge and skills needed to deal with factual
questions about reproduction and STIs; therefore, these topics need to be taught by trained teachers and health
professionals. However, a harmonious family environ-
ment, open parent–child discussions on values and close
monitoring of their children’s behaviour can help teenag-
ers develop positive values and a healthy sexual behav-
iour (Yu 2008, Wetherill et al. 2010). The media, unsurprisingly enough, are regarded as
the most popular source of information on sexual matters. In China, the Internet is increasingly used to
facilitate sex education and has resulted in some positive effects on sexual knowledge and the attitudes in young
people (Lou et al. 2006). However, how teenagers apply media content is crucial, and the negative inputs, such as
those of online pornography, may be mitigated through
parental guidance, monitoring and communication
(Collins et al. 2003). There is also some evidence to sup- port the positive influence of comprehensive commu-
nity-based programmes on young people’s sexual knowledge and contraceptive use (Lou et al. 2004, Wang et al. 2006, Tu et al. 2008); hence, these programmes could complement school-based education.
Sexual health services need to be universally accessi-
ble, but at present, government-sponsored services, such
as free consultations, health checks and contraceptives,
still focus mainly on married couples. Teenagers and sin-
gle young people may be excluded from such services, while health professionals are often uncertain about pro-
viding them with such services (Tu et al. 2004). If there are barriers stopping young people at school from using
such services, then sexually active individuals will con-
tinue to be vulnerable to unsafe sex.
As with research in general, issues around sampling,
response rate, response bias and confidentiality should
be addressed to enhance research quality in this area. Quantitative research needs to be complemented by
qualitative research to provide young people with the
opportunity to express their views on their own sexual
behaviour, the context and meaning of having sex, and
reasons for sexual engagement or maintaining absti-
nence. Future research also needs to use nationally repre-
sentative samples including teenagers across China both
at school and beyond.
Conclusion
Rapid changes in the sexual values of Chinese teenagers
call for a more comprehensive response to sex education
policy and additional improved sexual and reproductive
health services. It is challenging to develop and imple- ment nationwide programmes that meet the needs of all
young people in such a geographically and socioeco-
nomically diverse country. A relevant and inclusive pol-
icy framework is needed to enable young people,
schools, health organisations, families and communities
to get involved in the development of future pro-
grammes and services that are available to all regions
and also accessible to teenagers and unmarried young people in China.
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