Knowledge level and access barriers related to sexual and reproductive health information among youth with disabilities in China: a cross-sectional study.

BACKGROUND: Youth with disabilities have the same right to sexual and reproductive health (SRH) as their peers without disabilities. However, their needs and rights are often ignored. Little is known about the knowledge, needs and access barriers related to SRH information among youth with different types of disabilities in China. METHODS: A cross-sectional survey was carried out among 473 unmarried youth aged 15-24 with visual, hearing, physical disabilities in both urban and rural areas in China. RESULTS: Out of a maximum possible score of 100, respondent's median score ranged from 30 to 50 for knowledge related to sexual physiology, STIs/HIV/AIDS and contraception. For these three categories of knowledge, respondents with hearing and physical disabilities or from rural areas scored lower than their counterparts with visual disabilities or from urban areas. The multivariate analyses showed that the residential area and education level were strong correlates of knowledge among respondents with visual and hearing disabilities. Other significant correlates were age for respondents with visual impairment and physical impairment, and single child status in the family and father's education level for respondents with hearing impairment. Sources of and barriers and preferences in accessing SRH information differed by type of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of SRH knowledge, followed by the Internet, peers/friends and parents. Unaware of where to get accurate information and feeling embarrassed to seek information were the two most frequently mentioned barriers in accessing SRH information. CONCLUSION: Respondents had poor knowledge of SRH and limited access to SRH information, especially those from rural areas. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities.

Youth with disabilities have the same sexual and reproductive health (SRH) needs as their peers without disabilities and the equal right to attain the highest standard of SRH. However, their SRH needs and rights are often overlooked or neglected. Studies on SRH among unmarried youth with disabilities are very limited in China. This study used data collected from 473 unmarried youths with different types of disabilities from both urban and rural areas in China, to understand their SRH knowledge and its associated factors, as well as barriers and preferences in accessing sexuality-related information. This study demonstrated that unmarried youth with disabilities lacked knowledge of SRH, especially those with hearing or physical disabilities and those from rural areas. In general, residential area and education level were significant correlates of knowledge among respondents. Sources of and barriers and preferences in accessing SRH information varied across types of disabilities, residential areas and gender. In general, school teachers were the primary and most preferred sources of knowledge, followed by the Internet, peers and parents. Unaware of the available sources of accurate information and feeling embarrassed to seek information were the most frequently mentioned barriers in accessing SRH information. The findings of the study highlight the need to reduce the barriers to sexuality education for unmarried youth with different types of disabilities. Efforts should be made to promote school and family-based sexuality education tailored for youth with different types of disabilities and empower them to seek information proactively.

Nonconforming gender expression and insufficient sleep among adolescents during COVID-19 school closure and after school reopening.

BACKGROUND: Gender nonconformity (GNC) (i.e., gender expression that differs from gender role expectations for feminine or masculine appearance and behavior) is an under-researched area of adolescent sleep health. The COVID-19 lockdown offers an opportunity to understand how the effect of GNC on adolescent health outcomes changes between school closure and reopening. METHODS: We conducted a cross-sectional study in Shanghai, China, in 2020. The sample size for analysis was 3,265. The age-specific insufficient sleep was estimated according to National Sleep Foundation's sleep duration recommendations. The self-perceived and self-rated GNC were measured by the two items "On the same scale that goes from 100% as a girl to 100% as a boy, where do you think others see you?" and "On a scale that goes from feeling 100% like a girl to feeling 100% like a boy, where do you see yourself?", and birth sex. In addition, we calculated sex-stratified adjusted odds ratios (AORs) of insufficient sleep for students with high and moderate GNC compared to students with low GNC. Finally, we measured the AORs with self-perceived and self-rated GNC during COVID-19 school closure and reopening. RESULTS: Among 3,265 students in grade 6-12 in the analytic sample, 1,567(48.0%) were assigned female at birth (AFAB), 3,188 (97.6%) Han, and 1,921(58.8%) in grade 6-9. Among AFAB students, high self-perceived GNC was significantly associated with insufficient sleep (AOR,1.65; 95%CI,1.30-2.09) during school closure. Insufficient sleep was associated with high self-rated GNC (AOR,1.73; 95%CI,1.23-2.44) and moderate self-rated GNC (AOR,1.69; 95%CI,1.29-2.22) during school closure. After school reopening, neither self-perceived nor self-rated GNC was associated with insufficient sleep among AFAB students. Among assigned male at birth (AMAB) students, none of the two kinds of GNC was associated with insufficient sleep in the two periods during the COVID-19 pandemic. CONCLUSIONS: This study suggests GNC is only associated with insufficient sleep among AFAB students during school closure. Furthermore, the association is nonsignificant among AMAB students. These findings indicate that GNC-related stigma within the family could be a risk factor for insufficient sleep among AFAB adolescents.

Comparing the Perceptions of Gender Norms among Adolescents with Different Sibling Contexts in Shanghai, China.

Individuals' gender development is influenced by the characteristics of personal and contextual environments. However, the role of sibling contexts in shaping gender norms has rarely been studied among Chinese youth at early adolescence as most of them were the only child. The aim of this paper is to compare perceived gender norms among adolescents aged 10-14 with different sibling configurations, to help inform and tailor guidance for sexual and reproductive health education in the future. We used the Global Early Adolescent Study baseline data collected from Shanghai, China. The sample for analysis was 1615 students. We used univariate analysis and multivariate ordinal logistic regression to compare perceived gender-stereotyped traits and gender role attitudes, stratified by age and sex. The results showed that sibling context was more influential for boys than girls at early adolescence in their gender socialization process. Among boys those who were with mixed-sex siblings scored higher on gender-stereotyped traits (ORonly-childvs. mixed-sex siblings = 0.67, 95% CI: 0.48-0.94, p = 0.019; ORsame-sex siblingsvs. mixed-sex siblings = 0.59, 95% CI: 0.37-0.96, p = 0.033). Younger early adolescents aged 10-12 who were the only child or who had mixed-sex siblings perceived more traditional gender role attitudes than those living with same-sex siblings (ORonly-childvs. same-sex siblings = 1.71, 95% CI: 1.06-2.75, p = 0.028; ORmixed-sex siblingsvs. same-sex siblings = 1.74, 95% CI: 1.03-2.94, p = 0.037). Comprehensive sexuality education with gender and power components being well addressed, both in and out of the family, is needed to provide extra gender-inclusive and gender-egalitarian environments for youth.

Violence Perpetration in Early Adolescence: A Study of Four Urban Communities Worldwide.

PURPOSE: Violence perpetration is common among adolescents worldwide but existing research largely focuses on boys, older adolescents, and partner violence. Our study sought to identify individual, family, and neighborhood/peer factors associated with violence perpetration in a multinational sample of male and female young adolescents. METHODS: We used cross-sectional data from 5,762 adolescents in four sites in the Global Early Adolescent Study: Flanders, Belgium; Kinshasa, Democratic Republic of the Congo; Shanghai, China; and Semarang, Indonesia. Adolescents resided in high-poverty urban areas and were aged 10 to 14 years. Logistic regression examined pooled and stratified associations between independent variables with peer violence perpetration in the past six months. Factors included media viewing habits, gender norms, victimization, agency/empowerment, adversity, depression, familial relationships, neighborhood cohesion, and peer behaviors. RESULTS: Restricted-model analyses found increased odds of violence perpetration associated with high media consumption, pornography viewing, violence or bullying victimization, having drank alcohol, depressive symptoms, adverse childhood experiences, greater behavioral control, greater decision-making, feeling unsafe in the neighborhood/school, peer alcohol/tobacco use, and witnessing peers start a fight. Decreased odds of violence perpetration were associated with more egalitarian views on two gender norms scales, closer parental relationships, neighbors looking out for one another, and greater availability of adult help. DISCUSSION: Among young adolescents, increased odds of violence perpetration were related to a perceived lack of safety and risky peer behaviors. Parental and neighborhood connections were often associated with decreased perpetration. Further research examining the interplay of such factors among young adolescents is needed to inform effective intervention and policy.

Sexual-Related Knowledge, School and Family Sexuality Education and Its Association with Experience of Sexual Intercourse among Vocational Secondary School Students in China.

OBJECTIVES: To investigate the associations between sexual-related knowledge, access to school and family sexuality education, and the experience of sexual intercourse, in order to make recommendations on sexuality education for vocational secondary school students in China. METHODS: A cross-sectional study was conducted among 3180 vocational secondary school students in the Shanghai municipality and the Shaanxi province, China. Data were collected through an online, electronic questionnaire, which included socio-demographics, sexual-related knowledge, sources of information, and sexual-related behaviors. RESULTS: The score on sexual-related knowledge among girls (53.8) is higher than that of boys (48.8), and that of participants from Shanghai (55.2) is higher than their counterparts from Shaanxi (47.6). The proportions of girls (70% and 41.7%, respectively) and participants from Shanghai (65% and 35.7%, respectively) who reported acquiring sexual information from their schools/teachers and parents are higher than that of boys (54.3% and 21.0%, respectively) and their counterparts from Shaanxi (59.7% and 27.4%, respectively). About 6% of participants had experienced sexual intercourse and 10% had watched porn actively. Experience of sexual intercourse was associated with higher sexual-related knowledge scores (OR = 1.01, 95% CI: 1.00-1.02) and active porn watching (OR = 2.63, 95% CI: 1.79-3.84) but was not associated with school and family sexuality education. CONCLUSIONS: Vocational secondary school students had poor sexual knowledge and inadequate school and family sexuality education. School and family-based comprehensive sexuality education should be promoted among vocational secondary school students.

Associations of Gender Dissatisfaction with Adolescent Mental Distress and Sexual Victimization.

Gender dissatisfaction is often linked to adverse health outcomes and is an under-researched area of adolescent health. The aim of our study was to examine the associations of gender dissatisfaction with adolescent mental distress and sexual victimization. We conducted a cross-sectional study in April 2019 using a computerized self-administered questionnaire to collect data on the gender dissatisfaction, mental distress, and sexual victimization among Chinese adolescents. We used multivariate logistic models to estimate sex-stratified adjusted odds ratios (AORs) and 95% confidence intervals (CIs) for the associations of gender dissatisfaction with mental distress and sexual victimization. Our study involved 538 female and 556 male students from grades 7 to 11. Among the female students, gender dissatisfaction was significantly associated with depression (AOR, 2.04, 95%CI, 1.17-3.58), anxiety (AOR, 2.13, 95%CI, 2.00-2.27), suicidal ideation (AOR, 2.36, 95%CI, 2.02-2.76), sexting victimization (AOR, 1.67, 95%CI, 1.11-2.51), and nonphysical sexual harassment (AOR, 1.72, 95%CI, 1.08-2.76). Among the male students, gender dissatisfaction was significantly associated with oral--genital contact (AOR, 5.86, 95%CI, 2.74-12.54), attempted sexual assault (AOR, 9.63, 95%CI, 6.91-13.42), and completed sexual assault (AOR, 14.71, 95%CI, 1.16-187.33). Our findings suggest gender dissatisfaction is associated with adolescent mental distress and sexual victimization, underscoring the importance of implementing comprehensive sexual education with gender perspectives in China.

Parenting Practice Profiling and Its Associated Factors among Secondary Vocational School Students in China.

BACKGROUND: Parenting styles have a tremendous influence on a child's development and behavior. Studies on parenting styles using latent profile analysis have been increasing in recent years. However, there are few such studies conducted in China, especially concerning joint parenting styles (that simultaneously characterize maternal and paternal practices), which are held over the age group of secondary vocational school students. This study aimed to identify the profiles of parenting styles and their associated factors among the parents of secondary vocational school students in China, based on natural samples and not a predetermined model. METHOD: Data were drawn from a cross-sectional study conducted among 3180 students from six secondary vocational schools in Shanghai Municipality and Shaanxi Province. A total of 2392 students who have lived with their parents for most of their lifetime were included in the study. Latent profile analysis was used to identify the profiles of parenting styles of the respondent's parents. Multinominal logistic regression models were used to examine the association between parenting style and demographic characteristics and family background and adolescent outcomes. RESULTS: We identified five latent profiles: "free-range parenting" (27.05%), "behavioral monitoring parenting" (33.65%), "authoritative parenting" (11.75%), "psychological control parenting" (14.38%) and "tiger parenting" (13.17%). The associations between these profiles and adolescent outcomes indicated that these profiles were rational. Participants' gender, grade, residential area, family economic level, parental marital relationship, and parental educational level were predictive factors for parenting styles. CONCLUSIONS: The parenting styles held over secondary vocational school students were somewhat different from Baumrind's parenting style model. A considerable number of students received a parenting style that might predispose them to behavioral and mental health outcomes and merit a tailored intervention using the predictive factors of parenting styles.

The pattern of romantic and sexual related experiences among Chinese young adolescents: an exploration with multi-group latent class analysis.

BACKGROUND: Studies on very young adolescents' romantic and sexual experiences would help inform the context in which early sex arises. However, such studies are scant in China due to sparse data and cultural issues. METHOD: This study used the GEAS baseline data conducted among1776 adolescents in Shanghai. Multi-group latent class analysis was used to explore adolescents' romantic and sexual experiences patterns and subgroups. Multi-nominal logistic regression was performed to identify the factors distinguishing different subgroups subsequently. RESULTS: There were gender differences in the lifetime prevalence for very young adolescents' romantic and sexual-related behaviors. The Multi-group latent class analysis indicated that the participants could be classified into three classes: general group, early romance group, and sex exploratory group. Multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both gender, ever had a romantic relationship, and had more autonomy in deciding where to go than the general group; while male respondents in the sex exploratory group were older, ever had a romantic relationship, believed that boys should be more sexually active and more proactive than girls, had more autonomy on deciding where to go, and perceived less school connection and neighborhood cohesion. Female respondents in the sex exploratory group were older and less empowered in decision-making than the general group. CONCLUSIONS: The result provides a picture of romantic and sexual behavior patterns among both gender of very young adolescents in China. Current sex education needs not only to be culturally appropriate but also to address the harm of gender inequality and stereotypes, as well as to provide accessible and supportive services to help young adolescents personalize their received information and strengthen their skills in communication, decision making, and critical thinking.

Studies on teenagers' romantic and sexual experiences would help to prevent early sex arises before it really takes place. However, such studies are limited, especially in China. The traditional culture thought that youth should not start romance before college. This study used the Global Early Adolescent Study Shanghai site baseline data collected among1776 teenagers to explore their romantic and sexual experiences patterns and identify the influencing factors. There were significant gender differences in teenagers' romantic and sexual-related behaviors. According to the multi-group latent class analysis, we classified the teenagers into three classes: the general group, the early romance group, and the sex exploratory group. The multi-nominal logistic regression showed youth in the early romance group were more likely to had friends of both boys and girls, ever had boyfriend/girlfriend and were freer to go out than the general group; while boys in the sex exploratory group were older, ever had a boyfriend/girlfriend, believed it was normal for boys to be sexually active than girls, had more freedom to go out, and had less perception of care from school adults and neighborhood. Girls in the sex exploratory group were older and less likely to make decisions on their own. Given the result we found, we call for health researchers and educators to conduct sex education programs promoting more equal gender norms and provide services to help young adolescents get right information and strengthen their skills in communication, decision making and critical thinking.

Childhood adversity subtypes and violence victimization and perpetration among early adolescents in Shanghai, China.

BACKGROUND: This cross-sectional study aimed to identify adverse childhood experience (ACE) subtypes using variable- and person-centered approaches and examine the possible sex-differentiated associations with violence involvement as victim, perpetrator, and victim-perpetrator. METHODS: Adolescents aged 10-14 years in three junior high schools in Shanghai, China, were selected using a cluster sampling method in November and December 2017. Participants were surveyed anonymously using a computer-assisted self-interview approach via tablets. Thirteen items modified from the CDC-Kaiser ACE study were used to measure the ACEs. Results show subtypes as neglect, abuse, and household dysfunction by developing cumulative index score from the variable perspective and subgroups identified through the latent class analysis (LCA) from the person perspective. Logistic regression analyses were used to test the association between each ACE subtype and violence victimization and perpetration after adjusting for some demographic characteristics. RESULTS: A total of 1,700 participants were included in the final analysis. Approximately 1,322 (77.76 %) participants reported experiencing at least one ACE. The prevalence of neglect, abuse, and household dysfunction was 64.12 % (n = 1090), 61.29 % (n = 1042), and 18.24 % (n = 310), respectively. Three classes were identified through the LCA: low exposure to all ACEs (n = 854, 50.23 %), high exposure to emotional and physical abuse and neglect (n = 715, 42.06 %), and high exposure to all ACEs (n = 131,7.71 %). After controlling the covariates, experiencing abuse, neglect, and household dysfunction was significantly related to violence victimization (adjusted odds ratio [aOR] = 3.19, 3.29, 2.37, P < 0.001) and victim-perpetrator (aOR = 3.48, 4.41, 5.16, P < 0.001). Adolescent violence perpetration was only found to be associated with being neglected (aOR = 2.37, P = 0.003) and suffering household dysfunction (aOR = 3.25, P < 0.001). LCA revealed the cumulative effects of ACEs on adolescent violence victimization and perpetration. Sex-stratified analysis indicate that girls were more vulnerable to the negative effects of ACEs, with a higher risk of perpetration among girls exposed to distinctive subtypes or multiple ACEs. CONCLUSIONS: ACEs were ubiquitous and significantly associated with an elevated risk of violence victimization and perpetration during early adolescence. Future research should examine whether these associations persist over time and the intermediating mechanism from the perspectives of individual neurodevelopment, cognition and resilience ability, and social support.

The effect of COVID-19 school closures on adolescent sleep duration: an uncontrolled before-after study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic affected almost 1.6 billion students or more than 90% of learners globally. However, the effect of school closures during COVID-19 pandemic on adolescent sleep duration remains unclear. METHODS: We undertook a cross-sectional electronic survey in six junior and senior high schools in Shanghai, China from late June to early July 2020. We evaluated the changes of sleep duration on weekdays by comparing sleep duration hours and insufficient sleep (< 9 h for children aged 6-13 years or < 8 h for teenagers aged 14-17 years) in COVID-19 school closures and after school reopening. We also investigated possible sex differences in the changes of sleep duration. RESULTS: A total of 3265 students completed the survey, the mean age was 14.56 ± 1.99 years, 1567 (47.99%) were girls and 1344 (41.17%) were in grades 10-12. The overall sleep duration decreased from 8.88 h in school closures to 7.77 h after school reopening, and the change (difference: - 1.11 h; 95%CI: - 1.16, - 1.07; P < 0.001) was statistically significant. The prevalence of insufficient sleep increased sharply from 21.10 to 63.98%, and the change (ratio:3.03; 95%CI:2.84, 3.23; P < 0.001) was statistically significant. Besides, the changes were greater in girls than in boys. CONCLUSION: Results of this study revealed that sleep duration was longer and percentage of sufficient sleep was higher during COVID-19 school closures in adolescent students.

Correlations of impulsivity and aggressive behaviours among adolescents in Shanghai, China using bioecological model: cross-sectional data from Global Early Adolescent Study.

OBJECTIVE: To examine the correlations between impulsivity and aggressive behaviours among Chinese adolescents. DESIGN: A school-based cross-sectional study. SETTING: Three primary middle schools located in less developed communities of Shanghai. PARTICIPANTS: 1524 adolescents aged 11-16 years. MEASURES: The impulsivity was measured by Barratt Impulsivity Scale, and the aggressive behaviours were determined by self-reports. Data were collected through computer-assisted self-interview using tablets. Multivariate Firth logistic regression model was conducted to examine correlations between total, attentional, motor, and non-planning impulsivity and aggressive behaviours, respectively. RESULTS: Totally, 7.48% of participants reported aggressive behaviours toward others during the past 6 months. The proportion of aggressors among boys and girls was 10.60% and 4.18%, respectively. Results of the multivariate regression suggested the risk of aggressive behaviours was significantly increased among those with the highest tertile of total impulsivity (adjusted OR (aOR)boys=3.14, 95% CI: 1.48 to 6.65; aORgirls=3.74, 95% CI: 1.10 to 12.76) and motor impulsivity (aORboys=2.91, 95% CI: 1.46 to 5.82; aORgirls=3.57, 95% CI: 1.25 to 10.20.), comparing with those with the lowest tertile, for boys and girls, respectively. Besides, younger age, lower social cohesion and being bullied within 6 months were associated with a higher risk of aggressive behaviours among girls. Less family caring and being bullied within 6 months were associated with the risk among boys. CONCLUSIONS: The present study indicates a positive association between impulsivity and aggressive behaviours, with a more salient correlation between motor impulsivity subtrait and aggressive behaviour among both boys and girls. Furthermore, adolescents' aggressive behaviours were affected by multiple factors from individuals, family, peers and community. Comprehensive intervention strategies such as controlling the aggressor's impulsivity, helping them better channel their anger, creating a better family, school and neighbourhood environment, and providing support and services for victims of violence are needed.

Pornography Use and Perceived Gender Norms Among Young Adolescents in Urban Poor Environments: A Cross-site Study.

PURPOSE: The purpose of the study is to assess the prevalence of pornography use and its association with a range of perceived gender norms among adolescents aged 10-14 years across five urban poor settings globally. METHODS: The study includes 9,250 adolescents aged 10-14 years from Belgium, China, the Democratic Republic of the Congo, Ecuador, and Indonesia, as part of the Global Early Adolescent Study. We examined the percentage of pornography use by sex and site and conducted multivariate logistic regressions to examine the relation between gender norm perceptions and pornography use, adjusting for individual, family, peer, and media exposures. RESULTS: Ever-use of pornography ranged from 14.5% in Ecuador to 33.0% in Belgium and was more common among boys than girls. Overall, boys who perceived greater permissiveness about romantic relations, adolescents who engaged in such relations, and adolescents who assumed that their friends were sexually active had greater pornography exposure. Pornography use did not systematically correlate with unequal gender norms. Such correlations only exist among boys in two Asian sites, where a supportive school environment, more caregiver awareness, and/or neighborhood cohesion were related to less pornography use. CONCLUSIONS: Pornography use is a gendered experience that begins in early adolescence. Although factors of pornography use vary across the social context, the exposure to pornography has become a normative part of adolescent sexuality development. Young people, especially those from where sexuality remains taboo, need the ability to critically process information and avoid potential risks associated with pornographic gendered and sexual stereotypes, calling for comprehensive sexuality education programs to help them build the knowledge and confidence they need.

Co-occurrence subgroups of child sexual abuse, health risk behaviors and their associations among secondary school students in China.

BACKGROUND: Little is known on the co-occurrence and heterogeneity of child sexual abuse (CSA) or health risk behavior (HRB) prevalence nor the associations among the victims. OBJECTIVES: To detect the prevalence and subgroups of adolescents reporting CSAs or HRBs, and to examine the association between the subgroups. METHODS: Participants were secondary school students in a national survey in China (N = 8746). Self-reported CSA and HRB experiences were collected through a computer assisted questionnaire. Prevalence and confidence intervals were calculated. Multigroup latent class analysis (LCA) was used to examine latent subgroups of CSA and HRB. Dual latent class regression analysis was used to examine the association between CSA and HRB classes. RESULTS: A total of 8746 students participated in our study. The prevalence of having ever experienced any of the reported seven CSA items was 12.9%. The preferred LCA model consisted of a three-class CSA latent variable, i.e. "Low CSAs"(95.7% of the total respondents), "Verbal or exhibitionism CSAs"(3.3%), and "high multiple CSAs" (1.1%); and a three-class HRB latent variable, i.e. "Low HRBs"(70.5%), "externalizing HRBs" (20.7%), and "internalizing HRBs" (8.7%). Students in the "Verbal or exhibitionism CSAs" or "high multiple CSAs" classes had higher probabilities of being in "externalizing HRBs" or "internalizing HRBs" classes. The probabilities were higher in "high multiple CSAs" class(male externalizing OR 4.05, 95%CI 1.71-9.57; internalizing OR 11.77, 95%CI 4.76-29.13; female externalizing OR 4.97, 95%CI 1.99-12.44; internalizing OR 9.87, 95%CI 3.71-26.25) than those in "Verbal or exhibitionism CSA"(male externalizing OR 2.51, 95%CI 1.50-4.20; internalizing OR 3.08, 95%CI 1.48-6.40; female externalizing OR 2.53, 95%CI 1.63-3.95; internalizing OR 6.05, 95%CI 3.73-9.80). CONCLUSIONS: Prevalence of CSA items varies. Non-contact CSAs are the most common forms of child sexual abuse among Chinese school students. There are different latent class co-occurrence patterns of CSA items or HRB items among the respondents. CSA experiences are in association with HRB experiences and the associations between latent classes are dose-responded. Multi-victimization has more significantly negative effects. The results could help identify high-risk subgroups and promote more nuanced interventions addressing adverse experiences and risk behaviors among at-risk adolescents.

The Association between Gender Role Attitudes and Alcohol Use among Early Adolescents in Shanghai, China.

BACKGROUND: Adolescent alcohol use was a major social and public health concern given its negative impacts. Previous studies indicated gender role attitudes (GRA) were associated with alcohol use; however, few studies focused on early adolescents (10 to 14 years) and similar researches were not found in China. Objective: This study sought to explore the association between GRA and alcohol use among early adolescents. Methods: A cross-sectional study was conducted among students in grades six to eight across three public secondary schools in Shanghai, China. Data were collected by Computer-Assisted Self-Interview (CASI) questionnaire on mobile tablets. Alcohol use was measured by self-report, and six items with 5-point Likert-type options assessed the attitude toward traditional gender roles. The logistic regression model was adopted to examine the associations between GAR and alcohol use. Results: Totally 1,631 adolescents aged 10 to 14 years with 50.33% of boys included in this study. The mean score of GRA in drinkers was significantly higher than nondrinkers among boys (3.03 vs. 2.78, p < 0.001) but not girls (2.15 vs. 2.18, p = 0.499). After controlling the covariates of age, depression, peers' substance use, social cohesion, etc., we found that more traditional GRA was associated with a higher risk of alcohol use among boys (OR = 1.39, 95%CI: 1.11-1.75), whereas the association was not significant among girls (OR = 0.96, 95%CI: 0.74-1.24). Conclusions: Traditional GRA may increase the risk of alcohol use among early adolescent boys, suggesting that altering traditional GRA among this population group may help to prevent alcohol use.

Associations Between Agency and Sexual and Reproductive Health Communication in Early Adolescence: A Cross-cultural, Cross-sectional Study.

PURPOSE: To assess the extent to which adolescents aged 10-14 have communicated about sexual relationships, pregnancy, and contraception and how agency in the form of voice and decision-making along with an enabling socioecological environment are associated with sexual and reproductive health (SRH) communication. METHODS: Using data from the Global Early Adolescent Study, we included 1,367, 697, and 1,424 adolescents in Kinshasa, Cuenca, and Shanghai, respectively. Patterns of SRH communication and agency levels were described by site and sex. Multivariable logistic regressions assessed odds of SRH communication first in relation to socioecological characteristics and second with levels of agency, after adjustment for social environmental factors. Interaction terms tested sex differences in associations. RESULTS: Experiences of SRH communication ranged from one in ten in Kinshasa to about half in Cuenca. Pregnancy was the most discussed SRH topic. Socioecological factors consistently related to SRH communication included older age and pubertal onset, while others varied by context. In multivariable analyses, voice was linked to all forms of SRH communication in Kinshasa and Cuenca with adjusted odds ratios ranging from 1.6 to 2.2, but not in Shanghai. In Cuenca, decision-making was associated with a 50% and 60% increase in odds of communication about pregnancy and contraception, respectively. In Kinshasa, a stronger association between voice and pregnancy discussions was observed for girls than boys. CONCLUSIONS: Developmental characteristics and voice were linked to communication about SRH among young adolescents across two contexts. Results suggest agency may play a role in shaping antecedents, like communication, to sexual behaviors.

Misconceptions and Beliefs Regarding the Use of Intrauterine Devices for Nulliparous Women Among Chinese Health Care Providers.

STUDY OBJECTIVE: To investigate the knowledge and beliefs regarding the use of intrauterine devices (IUDs) for nulliparous women among Chinese health care providers and assess the potential factors related to their misconceptions and conservative beliefs. DESIGN, SETTING, PARTICIPANT, INTERVENTIONS, AND MAIN OUTCOME MEASURES: A self-administered survey was conducted at 2 Chinese national academic conferences in 2015. The questionnaire data obtained from 103 health care providers were analyzed to examine the providers' knowledge regarding the safety and effectiveness of IUDs and the complications associated with IUD use, as well as their beliefs regarding the suitability of IUDs for nulliparous women. An ordinal logistic regression model was used to evaluate the potential factors related to their beliefs. RESULTS: Misconceptions about the complications associated with IUD use were common among our respondents, and they were least likely to know that IUDs do not increase the risk of developing pelvic inflammatory disease (26/97) or ectopic pregnancy (23/102) (22.5%-26.8%). Only approximately 10% of the providers believed that adolescents (9/94) or unmarried nulliparas (10/95) could be candidates for IUDs. In contrast, they were more likely (37/96, 38.5%) to consider married nulliparous women as appropriate candidates (P < .001). Misconceptions about the complications of IUD use were associated with more conservative beliefs regarding IUD use for nulliparous women (adjusted odds ratio, 1.34; 95% confidence interval, 1.00-1.79). CONCLUSION: The health care providers' insufficient knowledge regarding IUDs contributed to their outdated and conservative beliefs about the suitability of IUDs for nulliparous women. In addition, the difference in the providers' beliefs regarding IUD use for married and unmarried nulliparous women might reflect the stigma associated with premarital sex in Chinese traditional culture.

Young internal migrants' major health issues and health seeking barriers in Shanghai, China: a qualitative study.

BACKGROUND: China is experiencing a sizeable rural-urban flow, which may influence the health of internal migrant youth deeply. Disadvantages in the city are highly likely to contribute to health issues among the young internal migrant population. The current qualitative study is to explore how internal migrant young people view the health issues they face, and the services and opportunities they could seek in their host community. METHODS: Data were collected from 90 internal migrant youth aged between 15 and 19 years old and 20 adult service providers who worked with them in a community of Shanghai, where the population of internal migrants was relatively large. Four types of qualitative research methods were used, including key informant interviews with adults, in-depth interviews with adolescents, a photovoice activity with adolescents and community mapping & focus group discussions with adolescents. Guided by the ecological systems framework and the acculturation theory, thematic analysis was conducted using ATLAS.Ti 7.0 software. RESULTS: While younger migrants had a limited understanding of health, elder migrant youths were more sensitive to societal and political factors related to their health. Mental health and health risk behaviors such as smoking, violence and premarital unsafe sex were thought as major health issues. Internal migrant youths rarely seek health information and services initiatively from formal sources. They believed their health concerns weren't as pressing as the pressure coming from the high cost of living, the experience of being unfairly treated and the lack of opportunities. Participants also cited lack of family and social support, lack of awareness and supportive policies to get access to community and public services as impacting health factors. CONCLUSIONS: The study's findings provide the insight to the social contexts which influence the health experience, health seeking behaviors, and city adaptation of young internal migrants in their host community. This research stresses the importance of understanding social networks and structural barriers faced by migrant youth in vulnerable environments. A multidimensional social support is essential for internal migrant youth facing present and potential health risks.

Attitudes and practices related to intrauterine devices for nulliparous women among Chinese health care providers.

BACKGROUND: Unintended pregnancy and induced abortion among young (unmarried or nulliparous) women have become serious social and health issues in China, which are thought to partly result from low use of long-acting reversible contraception, such as intrauterine devices (IUDs). Considering that providers may play an especially important role in increasing use of this particular method, we investigated Chinese health care providers' attitudes and practices regarding IUDs use for nulliparous women, and further examine the potential factors and reasons contributing to their attitudes and practices. METHODS: We recruited health care providers at two Chinese national academic conferences and surveyed them about knowledge of IUDs, willingness to recommend IUDs to nulliparous women, and their related practices. Modified Poisson regression was used to examine the potential factors related to their attitudes and practices. RESULTS: Approximately a half of respondents reported unwillingness to recommend IUDs to nulliparous women. Providers with more misperceptions about the safety and contraindications were more likely to be unwilling to recommend IUDs to nulliparous women. Moreover, 71.0% of respondents rarely or never recommended or provided IUDs to nulliparous women. Providers' unwillingness to recommend IUDs to nulliparous women was associated with their infrequent practices (aPR=1.43; 95% CI: 1.04, 1.96). In addition to concerns about the side effects or complications, traditional sexual concept against premarital sex was often cited as a reason by Chinese health providers for their negative attitudes towards IUDs use for nulliparous women, a large proportion of whom are unmarried. CONCLUSIONS: Our findings suggest that negative attitudes and infrequent practices regarding IUDs use for nulliparous women are common in Chinese health care providers. Moreover, misperceptions about IUDs, as well as traditional sexual concept, contribute to Chinese health care providers' negative attitudes towards IUDs use for nulliparous women, and may further reduce their provision. Educational interventions are needed to improve providers' accurate knowledge of IUDs and fill the gap between traditional sexual concept and young women's needs of contraceptive services.

Puberty timing associated with obesity and central obesity in Chinese Han girls.

BACKGROUND: There is growing scientific evidence supports a link between increased childhood adiposity and early onset of puberty in girls worldwide in recent decades. However, the data from Chinese girls remain ambiguous. The aims of this study were to estimate the puberty milestones and examine attainment of puberty associated with obesity and central obesity in Chinese Han schoolgirls. METHODS: The cross-sectional school-based study examined 2996 Han schoolgirls aged 9 to 19 years from 6 provinces in China. Trained clinicians assessed  the girls for height, weight, waist circumference, Tanner stages of breast and pubic hair development, and menarcheal status. We classified girls as normal weight, overweight, or obese based on BMI, and as normal weight or central obese based on the waist-height ratio, then estimated and compared median age at a given Tanner stage or greater by weight class using Probit models. RESULTS: The median age at menarche was 12.36 years. The median ages at breast stages(B) 2 through 5 were 10.03, 11.38, 13.39, and 15.79 years, respectively, and at pubic hair stages(PH) 2 through 5 were 11.62, 12.70, 14.38, and 16.92 years, respectively. Girls from urban areas experienced menarche, B3 and B4 stages, and PH3 through PH5 stages earlier. Girls with central obesity and overweight/obesity reached puberty earlier at almost every Tanner stage of breast and pubic hair than normal girls. Girls with obesity developed PH2 and PH3 earlier than their overweight peers. However, we did not find any significant differences between girls with overweight and obesity at all stages of breast development. CONCLUSIONS: Childhood obesity, including both overweight/obesity and central obesity, is associated with earlier attainment of puberty in Chinese Han schoolgirls.