Beruflich Dokumente
Kultur Dokumente
Original article
a
Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned Parenthood Research, Shanghai, China
Department of Reproductive Health and Research, Special Program of Research, Development and Research Training in Human Reproduction, World
Health Organization, Geneva, Switzerland
Manuscript received June 20, 2005; manuscript accepted April 4, 2006.
Abstract:
Purpose: To assess the feasibility and effectiveness of sex education conducted through the
Internet.
Methods: Two high schools and four colleges of a university in Shanghai were selected as the
research sites. Half of these were assigned to the intervention group and the other half to the control
group. The interventions consisted of offering sexual and reproductive health knowledge, service
information, counseling and discussion to all grade one students in the intervention group. The
intervention phase lasted for 10 months and was implemented through a special website, with web
pages, online videos, Bulletin Board System (BBS) and expert mailbox. In total, 624 students from
the intervention, and 713 from the control schools and colleges participated in the baseline survey,
and about 97% of them were followed up in postintervention survey to assess changes that can be
attributed to the sex education interventions provided through the Internet.
Results: The median scores of the overall knowledge and of each specific aspect of reproductive health
such as reproduction, contraception, condom, sexually transmitted infections (STIs) and human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) were significantly higher in the
intervention group as compared with those in the control group at postintervention (p .0001), although
no significant differences were found between these two groups in the baseline survey (p .05). Group
by time interaction effects in ordinal logistic regression analysis were found on knowledge score (p
.0001) and in attitude of high school students toward sex-related issues (p .05), suggesting that
interventions increased subjects knowledge significantly and changed high school students attitudes to
being less liberal toward sex. The intervention also had positive influence on students attitudes toward
providing contraceptive service for unmarried people.
Conclusions: Providing sex education to students in Shanghai through the Internet was found
feasible and effective. The Internet-based sex education program increased students reproductive
health knowledge effectively and changed their attitudes toward sex-related issues in terms of being
less liberal toward sex and more favorable to providing services to unmarried young people. The
Internet thus offers an important and hitherto untapped potential for providing sex education to
students and young people in China. 2006 Society for Adolescent Medicine. All rights reserved.
Keywords:
Adolescents; Sex education; Reproductive health knowledge; Attitudes; The Internet-based program; China
*Address correspondence to: Dr. Chao-hua Lou, Department of Epidemiology and Social Science on Reproductive Health, Shanghai Institute of Planned
Parenthood Research, 2140 Xie Tu Road, Shanghai 200032, P.R. China.
E-mail address: chaohual@sippr.stc.sh.cn chaohual@yahoo.com
With rapid modernization, economic development and expanded exposure to media, the attitudes of Chinese adolescents (10 19 years old) and youth (1524 years old) toward
sexuality are becoming much more liberal. Studies show
that an increasing number of young people (10 24 years
old) are having sex before marriage, and the age at sexual
1054-139X/06/$ see front matter 2006 Society for Adolescent Medicine. All rights reserved.
doi:10.1016/j.jadohealth.2006.04.003
721
722
Table 1
Score sheet for attitudes towards sex-related issues
Statement
There is nothing wrong for unmarried boys and girls to have sexual
intercourse if they love each other.
Its all right for boys and girls to have sex with each other provided that
they use contraceptive methods to prevent pregnancy.
One night sex is acceptable.
Most boys who have sex before marriage regret it afterwards.
Most girls who have sex before marriage regret it afterwards.
You would look down on him/her, if your boyfriend/girlfriend has had
sexual intercourse with other people before meeting you.
Girls should remain virgin until they marry.
Boys should remain virgin until they marry.
Points
Agree
Unsure
Disagree
3
1
1
1
2
2
2
2
1
3
3
3
1
1
2
2
3
3
normally distributed data such as knowledge scores, nonparametric statistics, i.e., Wilcoxon-Man-Whitney tests,
were used. The effects of the intervention on reproductive
health knowledge and sex-related attitude were analyzed
using ordinal logistic regression models (the knowledge and
attitude scores, the dependent variables of the models, were
ordered as four categories by quartiles from low to high),
adjusting the potential confounding factors. The effect of
the intervention on sex-related behaviors including hugging,
kissing, petting and sexual intercourse were analyzed using
binary logistic regression models (whether experienced
each such outcome as the dependent variable, measured by
Yes 1, No 0). Data were doubly entered with
EpiInfo 6.04 software (Centers for Disease Control and
Prevention, Atlanta, GA), and then validated by comparing
the consistence between the two entries. Data were analyzed
with SAS 8.01 (SAS Institute, Inc, Carey, NC).
Results
Profiles of participants
Table 2 shows that the sociodemographic background
characteristics of two groups were broadly similar. No statistically significant differences were observed between the
intervention and control groups in type of subjects (high
school or college students), age, having a single room or
not, fathers educational level, familys economic status,
and the degree of monitoring by family. Differences were
observed between the two groups in terms of place that
college students came from, mothers educational level and
parents occupations. Subjects from the intervention group
tended to come from outside of Shanghai, and their mother
would be more likely to have a higher educational level, and
their parents to be farmers than those from the control
group. Gender disparities were also observed (Table 2).
The Internet use of participants at baseline
Two-thirds (68%) of all subjects thought the Internet was
a good way to carry out sex education. A high percentage
(90%) of all subjects had ever surfed the Internet; 88% in
the intervention group and 92% in the control group. More
than one-third (34%) of subjects had browsed reproductive
health knowledge on the Internet, and about 5% of them
browsed this type of website more than once a month. Their
opinions on these websites were: contents were not constructive (44%), pornographic (44%), inappropriate to adolescents/young people (38%) and unscientific (24%). About
one-third of subjects (30%) had visited pornographic websites, and 8% of them browsed these websites more than
once a month. They believed these (pornographic) websites
provided unscientific information(37%), induced youth
to have sex(51%), or induced to commit sex
crimes(26%), wheras 30% believed they were attractive.
723
724
Table 2
Sociodemographic profile of participants at the baseline: intervention and control groups (%)
Characteristics
Type of subject
High school student
College student
Age (years)
15
16
17
18
19
Place subject came fromb
Shanghai
Others
Having a single room or not
Yes
No
Fathers educational level
Junior high or below
Senior high or technical school
Junior college or above
Unknown
Mothers educational level
Junior high or below
Senior high or technical school
Junior college or above
Unknown
Fathers occupation
Workerc
Farmer
Professional personel
Administrative personel
Individual or private enterprise
owner
Mothers occupation
Workerc
Farmer
Professional personel
Administrative personel
Individual or private enterprise
owner
Family economic status
Good
Medium
Bad
Degree of monitoring by family
Severe
Medium
Lenient
Intervention group
pa (inter.-contr.)
Control group
Total
(n 624)
Male
(n 376)
Female
(n 248)
pa
Total
(n 713)
Male
(n 360)
Female
(n 353)
pa
44.6
55.4
40.4
59.6
50.8
49.2
.0107
49.1
50.9
44.2
55.8
54.1
45.9
.0079
.0972
20.7
22.9
2.6
20.2
33.6
17.5
22.1
2.7
21.3
36.4
25.4
24.2
2.4
18.6
29.4
.1114
20.6
27.8
2.00
20.2
29.5
17.5
26.1
1.9
18.9
35.6
23.8
29.5
2.00
21.5
23.2
.0074
.2417
45.4
54.6
45.5
54.5
45.1
54.9
.9354
57.3
42.7
57.2
42.8
57.4
42.6
.9704
.0015
71.8
28.2
73.1
26.9
69.8
30.2
.3585
73.2
26.8
72.8
27.2
73.6
26.4
.7916
.5625
33.2
44.7
20.3
1.8
34.8
43.6
20.0
1.6
30.6
46.4
21.0
2.0
.7356
32.4
47.1
19.0
1.5
36.9
41.9
19.4
1.7
27.8
52.3
18.5
1.4
.0329
.8316
42.5
45.8
10.6
1.1
44.2
42.5
12.2
1.1
39.9
50.8
8.1
1.2
.1489
34.8
53.0
10.4
1.8
40.6
47.5
9.4
2.5
28.9
58.6
11.3
1.1
.0035
.0214
53.4
7.0
7.7
20.7
11.2
54.0
8.2
6.7
19.4
11.7
52.4
5.2
9.3
22.6
10.5
.3744
59.9
3.0
7.5
21.2
8.4
60.3
3.3
8.1
20.3
8.1
59.5
2.6
6.8
22.2
8.8
.8832
.0022
61.6
9.0
9.5
13.3
6.6
53.2
10.9
8.5
12.2
8.0
58.7
6.1
10.9
14.9
4.4
.0610
67.7
4.8
8.1
12.3
7.0
70.6
5.6
8.1
10.6
5.3
64.9
4.0
8.2
14.2
8.8
.1468
.0196
13.0
69.5
17.5
12.5
68.1
19.4
13.7
71.8
14.5
.2845
14.2
70.6
15.2
11.9
69.7
18.3
16.5
71.6
11.9
.0238
.4739
41.3
42.7
15.9
41.2
44.2
14.6
41.3
40.9
17.8
.5164
41.3
41.9
16.8
40.3
42.8
16.9
42.3
40.9
16.8
.8457
.8800
2 test between males and females or between the intervention and control groups.
Only for college students.
c
Including retiree, the jobless, etc.
a
725
Table 3
Participation and evaluation of the intervention activities (%)
Participation and evaluation
Main place for using the Internet
Home
School/college (incl. computer room, library and dormitory)
Internet caf
Others
Number of times browsing the website
5 times per month
14 times per month
1 times per month
Never
Time spent browsing the website at each occasion@
20 minutes
1020 minutes
10 minutes
Benefit of the websiteb
Great
Some
Nothing
Whether contents of the website are appropriate to youth or notb
Very appropriate/appropriate
Inappropriate
Whether layout of the website is good or notb
Very good /good
No so good
Bad
Whether website raised the attention to RHb
Yes
No
Whether encouraged to obtain RH knowledge from other sources by using the websiteb
Yes
No
a
b
Total
(n 603)
Male
(n 357)
Female
(n 245)
pa
35.0
44.1
19.2
1.7
31.0
41.2
26.9
0.9
41.1
48.5
7.4
3.0
.0001
5.7
61.1
26.9
6.3
6.5
59.8
26.4
7.3
4.5
63.3
27.3
4.9
.4484
39.9
43.8
16.3
40.9
43.0
16.1
38.6
45.1
16.3
.8555
13.5
69.8
16.7
12.7
67.0
20.3
14.7
73.7
11.6
.0250
94.7
5.3
92.7
7.3
97.4
2.6
.0145
86.5
8.2
5.3
82.7
9.4
7.9
91.9
6.4
1.7
.0018
53.3
46.7
50.8
49.2
56.7
43.3
.1557
40.6
59.4
42.0
58.0
38.8
61.2
.4334
726
Table 4
Knowledge scores at baseline and postintervention in the intervention and control groups (Median)
Knowledge
Reproduction
Baseline
Postintervention
Contraception
Baseline
Postintervention
Condom
Baseline
Postintervention
STIs
Baseline
Postintervention
HIV/AIDS
Baseline
Postintervention
Total
Baseline
Postintervention
Intervention group
Control group
Total
Male
Female
Total
Male
Female
54.6
81.8*
59.1
81.8*
54.6
81.8*
54.6
63.6
63.6
63.6
54.6
63.6
24.2
48.5*
27.3
51.5*
18.2
42.4*
21.2
30.3
24.2
30.3
21.2
27.3
66.7
88.9*
66.7
88.9*
55.6
77.8*
66.7
66.7
66.7
66.7
55.6
66.7
48.2
70.4*
55.6
77.8*
44.4
63.00*
51.8
55.6
55.6
59.3
44.4
51.8
85.0
90.0*
85.0
90.0*
82.5
90.0*
85.0
85.0
85.0
85.0
85.0
85.0
49.0
63.4*
53.1
71.4*
43.9
64.3*
50.0
55.1
54.1
57.1
45.9
53.1
net. For example, it allows the learner to choose a convenient time and place for learning and to come across a wide
variety of learning styles; it enables the learner to move
through educational materials at a speed that meets individual learning needs and allows participants with varying
degrees of knowledge and skills to access instruction in a
comfortable, nonthreatening maner. These advantages of
the Internet and young peoples high access to this new
learning source make it feasible to carry out sex education
on the Internet. Findings presented in this article provide
evidence that high school and university students made
good use of this educational style and considered the provision of sex education though the Internet highly feasible.
It can be concluded from the study that the Internet
education program increased students reproductive health
knowledge effectively and also had a minor influence on
Table 5
Ordinal logistic regression analysis with reproductive health knowledge of all subjects as outcome variable (Model I) and with attitude of high school
students towards sex-related issues as outcome variable (Model II)
Variables
Model I (Reproductive health knowledge of all subjects)
Group (intervention vs. control)
Time (postintervention vs. baseline)
Group time
Model II (Sex-related attitude of high school students)
Group (intervention vs. control)
Time (postintervention vs. baseline)
Group time
OR
95% CI
1.099
2.383
2.845
.8821.369
1.9142.967
2.0593.930
.4021
.0001
.0001
1.124
1.934
.628
.8121.555
1.3562.758
.398.991
.4818
.0003
.0459
Note: For both models, adjusted gender, type of subjects, place subjects came from, parents education level, parents occupation, family economic status,
having browsed reproductive health knowledge on the Internet or not, having browsed pornographic websites or not, having discussed sex-related issues with
parents or friends or not.
727
728
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