The effectiveness of an online sexuality education module in promoting sexual knowledge and attitude change: a cluster randomized controlled trial.

This study assesses the ability of an online sexuality education (OSE) module ('You and Me') to enhance sexual and reproductive health (SRH) knowledge and attitudes among 10th-grade vocational high school students in China. We conducted a cluster randomized controlled trial, randomizing 29 vocational high schools to (i) receiving the module (intervention) or (ii) not receiving the module (control). Students completed a baseline questionnaire, then completed the module within 8 weeks and then completed a follow-up questionnaire within the following 2 weeks. We assessed the differences in intervention effects using hierarchical linear modeling. No significant differences between intervention and control groups were found for knowledge and attitude scores at baseline among the 2985 students included in the analyses. For the intervention group at follow-up, we observed significant improvements in SRH knowledge scores of approximately 20% for boys and girls although girls responded to the module with larger knowledge gains than boys. At follow-up, intervention group students also had higher SRH attitude scores toward views that are more contemporary than the control group. In addition, girls held more contemporary attitudes than boys. The comprehensive OSE module assessed is effective in improving SRH knowledge, and attitude among Chinese vocational high school students after the module is completed.

Number of children and the prevalence of later-life major depression and insomnia in women and men: findings from a cross-sectional study of 0.5 million Chinese adults.

BACKGROUND: Pregnancy and parenthood have been associated with physical and mental health. Previous literature concerning the impacts of parity on mental health was inconsistent and lack epidemiolocal evidence. China, with growing mental health problems and changing fertility patterns, faces unique challenges. This study aims to examine the relationship between parity and the prevalence of major depression and insomnia among men and women in the Chinese population. METHODS: Baseline data from a Chinese population-based study of 512,891 adults (59.01% women) from 10 areas, aged 30-79 were analyzed. Number of children was based on self-report by the participants. Major depression (MD) was assessed using the Composite International Diagnostic Inventory. Insomnia symptoms were accessed by a questionnaire comparable to that used in the Diagnostic and Statistical Manual of Mental Disorders. Logistic regression was used to assess the relationship between MD/Insomnia and number of children, after stratifications and adjustments. RESULTS: For women, each additional child was associated with a 9% decreased odds of MD (OR: 0.91, 95%CI: 0.88-0.96), with the associations significant for those who lived in urban areas (OR: 0.76, 95%CI: 0.70-0.83), or had a lower education (OR: 0.90, 95%CI: 0.85-0.94), or had lower household income (OR: 0.89, 95%CI: 0.85-0.94), or had ever used alcohol (OR: 0.89, 95%CI: 0.84-0.93). The association between per additional children and MD was not significant in men (OR: 1.02, 95%CI: 0.97-1.07), but a decreased odd of MD with per additional child was found in men who lived in urban areas (OR: 0.81, 95%CI: 0.71-0.96). For women, each additional child was associated with a 4% decreased odds of insomnia (OR: 0.96, 95%CI: 0.95-0.96). Each additional child was also associated with a 2% decreased odds of insomnia in men (OR: 0.98, 95%CI: 0.97-1.00). CONCLUSIONS: MD and insomnia were inversely associated with number of children in women while the association was not overall significant in men. The association was mediated by socioeconomic and lifestyle factors. Future mental health public health programs should address parity and sex differences when designing interventions.

The socioeconomic and lifestyle determinants of contraceptive use among Chinese college students: a cross-sectional study.

BACKGROUND: Chinese youth have become more sexually active over the years, yet their behaviours of contraceptive use are influenced by socioeconomic and lifestyle factors. This study aimed to investigate the socioeconomic and lifestyle determinants of contraceptive use among Chinese college students, and to investigate quantitatively their reasons for choosing different contraceptive methods. METHODS: The study used the data from a cross-sectional survey, which was conducted in 2015 among 17,517 students from 130 colleges and professional schools in mainland China. Chi-square tests were performed to test the differences in the awareness and uses of contraceptives between male and female students. Multivariable logistic regression models were used to analyse the associations between socioeconomic and lifestyle factors and contraceptive uses. RESULTS: Condoms (95%), oral contraceptives (91%) and emergency contraceptives (71%) were the most commonly known contraceptive methods among the sample of Chinese youth that were surveyed. Among male participants, high monthly expenditure (OR = 1.37, 95%CI: 1.07-1.75), light alcohol consumption (OR = 1.47, 95%CI: 1.03-2.11), and high sexual knowledge (OR = 1.96, 95%CI: 1.57-2.45) were positively associated with contraceptive uses, while tobacco use (OR = 0.47, 95%CI: 0.23-0.95) showed a negative association with contraceptive uses. Among female students, suburban residency (OR = 1.38, 95%CI: 1.03-1.83), high level of parental education (OR = 1.96, 95%CI: 1.19-3.22), moderate alcohol consumption (OR = 2.66, 95%CI: 1.05-6.77), and high sexual knowledge (OR = 1.50, 95%CI: 1.18-1.91) were positively associated with contraceptive uses, while tobacco use (OR = 0.60, 95%CI: 0.36-0.99) showed a negative association. CONCLUSIONS: A series of socioeconomic and lifestyle factors were associated with contraceptive choices among Chinese college students. Targeted sexual education programs are in demand to improve the awareness and the use of contraceptives in this population.

Maternal depression and loss of children under the one-child family planning policy in China: a cross-sectional study of 300 000 women.

OBJECTIVES: This study aims to explore the association between maternal depression and the loss of the only child under the family-planning (FP) policy. DESIGN: Cross-sectional data from a Chinese population-based study were analysed. SETTING: Population from 10 (5 rural and 5 urban) areas in China. PARTICIPANTS: Around 300 000 females were included in the study. The FP group was defined as women with one or two live births. Those with no surviving child were classified into the loss-of-only-child group. The non-FP group included women who had more than two live births. Logistic regression was used to assess the relationship between major depressive disorder (MDD) and family types, after stratification and adjustment. OUTCOME: MDD was assessed using the Composite International Diagnostic Inventory. RESULTS: The odds of MDD are 1.42 times higher in the FP group in general (OR=1.42, 95% CI: 1.28 to 1.57), as opposed to the non-FP group. In particular, the odds of MDD are 1.36 times greater in the non-loss-of-only-child group (OR=1.36, 95% CI: 1.21 to 1.51) and 2.80 (OR=2.80, 95% CI: 0.88 to 8.94) times greater in the loss-of-only-child group, compared with the non-FP group. The associations between FP groups and MDD appeared to be stronger in the elderly population, in those who were married, less educated and those with a higher household income. The association was found progressively stronger in those who lost their only child. CONCLUSIONS: People in the FP group, especially those who lost their only child, are more susceptible to MDD than their counterparts in the non-FP group. Mental health programmes should give special care to those who lost their only child and take existing social policies and norms, such as FP policies, into consideration.

Effects of an Internet-Based and Teacher-Facilitated Sexuality Education Package: A Cluster-Randomized Trial.

BACKGROUND: This study aimed to evaluate the effects of an internet-based and teacher-facilitated sexuality education package on the sexual knowledge and attitudes of Chinese adolescents. METHODS: Six middle schools where no sexuality education had been performed with a total of 501 adolescent students (245 males and 256 females) were included in the trial. In total, 14 classes were randomly assigned to the intervention (internet-based sexuality education package) or the control group (classes were conducted as per normal). Students' sexual knowledge and attitudes were assessed at the baseline, at the end of the intervention, and 12 months after the intervention. Generalized linear models were employed to assess the effects of the intervention. RESULTS: Positive effects of the intervention were observed on sexual knowledge (ß = 4.65, 95% CI: 4.12-5.17) and attitudes (ß = 1.25, 95% CI: 1.00-1.50) at the end of the intervention. After 12 months, the effects sustained but the magnitude declined for sexual knowledge (ß = 2.39, 95% CI: 1.85-2.93) and attitudes (ß = 0.49, 95% CI: 0.23-0.75). There were no significant differences between male and female students. CONCLUSIONS: Although further modifications are required, the sexuality education package can increase the accessibility of comprehensive sexuality education to adolescents in rural areas in China.