社区性与生殖健康教育和服务项目对青(少)年性相关态度的影响

目的:评价社区性与生殖健康教育和服务对未婚青(少)年性相关态度的影响。方法:在上海市某区两个乡镇开展以社区为基础的持续20个月干预性研究,干预组和对照组分别为15～24岁未婚青(少)年1220名和1007名。干预活动包括发放宣教材料、播放教育录像、组织讲座和小组讨论、提供咨询和避孕服务。通过干预前后的问卷调查对干预项目的效果进行。结果:干预组和对照组对象对绝大多数性相关问题的态度与看法在基线调查时无明显差别。两组总随访率为92％。干预后调查发现,干预组对象对男、女性婚前性行为持赞成态度的比例明显低于对照组,而持理解态度的比例高于对照组;认为婚前性行为对男、女未婚青年“有不良影响”的比例高于对照组。此外,干预组对象的安全性行为和自我保护意识增强。多因素分析结果显示,在调整了其它可能影响对婚前性行为和未婚妊娠态度的因素后,干预仍是影响对象对婚前性行为和未婚妊娠态度的因素之一。结论:以社区为基础开展的未婚青(少)年性与生殖健康教育和服务可在一定程度上改变青(少)年的性观念,使他们对性相关问题持更为积极和理性的态度。

Effect of a Community-based Sex Education and Reproductive Health Service Program on Unmarried Young Peoples' Attitudes Towards Sex-related Issues

Objective To examine the effectiveness of a community-based sex education and reproductive health service program on unmarried young peoples' attitudes towards sex-related issues. Methods :Two towns in Shanghai were selected as the research sites, one as the intervention site and the other as the control. The intervention lasted 20 months and comprised by three main areas of activities, i. e. , building awareness, offering counseling and services for 15～24 aged unmarried young people. In order to test the feasibility and effectiveness of the intervention, base-line survey was conducted in both sites before the implementation of the intervention, and similar survey was conducted in both sites 20 months after the intervention had been initiated. Totally, 1220 unmarried young people from the intervention site, and 1007 from the control site consented to be interviewed, about 92% of whom were re-interviewed at follow-up. Results: At baseline, there were no significant differences of the attitudes towards most of sex-related issues between the intervention and the control groups. After 20 months intervention, the proportion of subjects who hold favorable attitudes to male and female premarital sex in the intervention group was lower than that of the control, i.e. , less subjects in the intervention group thought young people could have premarital sex even "it was based on love" or "they were willing to do so", while the proportion of subjects who thought the premarital sex was understandable in the intervention group was higher than that in the control group. Besides, there were higher proportions of subjects who thought premarital sex "had negative impact on male/female youth", premarital pregnancy "was not good" and induced abortion "does harm to women's health" and "influences women's fertility" in the intervention group than those in the control group. Moreover, subjects' perceptions on safe sex and self-protection from sex risk behavior in the intervention group were improved. Multi-variable analysis indicated that after the factors which might potentially affect the attitudes were adjusted, the intervention was still an influencing factor of the attitude. The subjects who had higher reproductive health score were more understandable to premarital sex and pregnancy; the subjects whose parents were strict were more likely to be against to premarital sex and pregnancy; and non-school students were more likely to approve of premarital pregnancy. Conclusion:A community-based sex education and reproductive health service program could change young people's sex-related attitudes and made young people hold more positive and rational attitudes towards sex-related issues.