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.

A latent class approach to understanding patterns of emotional and behavioral problems among early adolescents across four low- and middle-income countries.

Early adolescents (ages 10-14) living in low- and middle-income countries have heightened vulnerability to psychosocial risks, but available evidence from these settings is limited. This study used data from the Global Early Adolescent Study to characterize prototypical patterns of emotional and behavioral problems among 10,437 early adolescents (51% female) living in the Democratic Republic of Congo (DRC), Malawi, Indonesia, and China, and explore the extent to which these patterns varied by country and sex. LCA was used to identify and classify patterns of emotional and behavioral problems separately by country. Within each country, measurement invariance by sex was evaluated. LCA supported a four-class solution in DRC, Malawi, and Indonesia, and a three-class solution in China. Across countries, early adolescents fell into the following subgroups: Well-Adjusted (40-62%), Emotional Problems (14-29%), Behavioral Problems (15-22%; not present in China), and Maladjusted (4-15%). Despite the consistency of these patterns, there were notable contextual differences. Further, tests of measurement invariance indicated that the prevalence and nature of these classes differed by sex. Findings can be used to support the tailoring of interventions targeting psychosocial adjustment, and suggest that such programs may have utility across diverse cross-national settings.

Relationship between body image satisfaction and adverse childhood experiences in adolescents / 中国学校卫生

Objective@#To explore the relationship between body image and adverse childhood experiences (ACEs) in adolescents.@*Methods@#A total of 1 701 adolescents in grade 6-8 in three middle schools in Shanghai were selected by stratified cluster sampling, and were investigated anonymously using computer assisted self interview approach. Information including demographic characteristics, body image satisfaction, and ACEs were collected. The Chi square test and multivariate Logistic regression were used to explore the relationship between adolescent body image satisfaction and types of ACEs.@*Results@#About 60.73% of the respondents were satisfied with their body image, with higher satisfaction among boys(66.16%) than among girls(55.13%)( χ 2= 21.70 ， P <0.01). About 79.19% of the respondents had experienced at least one ACE, and respectively 61.61%, 65.14% and 21.58 % of them had experienced abuse, neglect and family dysfunction. Multivariate Logistic regression analysis indicated that experiencing at least one ACE, abuse, neglect and family dysfunction were all related with low body image satisfaction among girls( OR =0.33- 0.57 , P <0.01), while among boys neglect,having 3 or more than 4 ACEs were found to be associated with body image satisfaction ( OR =0.54-0.64, P <0.05). The cumulative effects of ACEs on adolescent body image were observed.@*Conclusion@#Different types of ACEs are associated with body image in adolescents, ACEs have cumulative effects on adolescent body image, which shows gender differences.Screen of ACEs and improvement of family nurturing environment should be highlighted among adolescents, especially among girls.

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.

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.

A Multi-Country Study of Risk and Protective Factors for Emotional and Behavioral Problems Among Early Adolescents.

PURPOSE: Early adolescence (ages 10-14) is a critical period for psychosocial development, but few studies have focused on risk and protective factors for emergent psychosocial challenges among youth living in low- and middle-income countries. This study explored the contribution of social environmental factors to patterns of emotional and behavioral problems among early adolescents across four low- and middle-income countries. METHODS: Participants were drawn from the Global Early Adolescent Study, and included 10,437 early adolescents from six low-resource urban settings in the Democratic Republic of Congo, Malawi, Indonesia, and China. Multivariate latent class regression was used to examine the associations between distinct patterns of emotional and behavioral problems and risk and protective factors across the family, peer, school, and neighborhood levels. RESULTS: Across countries, childhood adversity, peer bullying behaviors, and a perceived lack of school safety were consistently associated with emotional and behavioral problems. With some contextual variability, peer substance use and a perceived lack of neighborhood safety also emerged as significant risk factors. The magnitude of these associations was generally greatest among a subgroup of early adolescents with co-occurring emotional and behavioral problems. DISCUSSION: The overall consistency of findings across countries is suggestive of the generalizability of risk factors in early adolescence and indicates that interventions bolstering psychosocial adjustment among this age group may have applicability in diverse cross-national settings. Given the significance of peer bullying behaviors and school safety, multicomponent school-based interventions may be an especially applicable approach.

COVID-19 Experiences and Health-Related Implications: Results From a Mixed-Method Longitudinal Study of Urban Poor Adolescents in Shanghai.

PURPOSE: This analysis aimed to investigate gender differences in adolescents' concerns and the health implications of COVID-19. METHODS: We used two rounds of the Global Early Adolescent Study (GEAS) collected in Shanghai in 2018 and 2020. We analyzed data from 621 adolescents, comparing boys' and girls' concerns about COVID-19 and examining trends in general health and mental health by sex between the pre-COVID-19 and COVID-19 periods. Changes in health indicators over time were assessed using generalized estimating equation (GEE) models. RESULTS: Adolescent girls reported more health concerns (52.0% vs. 42.7%) and educational concerns (61.0% vs. 46.3%) than boys, whereas boys expressed more worries about the economic consequences of COVID-19 (32.9% vs. 25.4%). Changes in health-related outcomes during the pandemic compared to the prepandemic era differed by sex and varied by COVID-related experiences. Boys reported improved overall health (OR: 1.54, 95% CI: 1.00, 2.35) in the COVID-19 period relative to the pre-COVID-19 period. Such improvements were only observed among boys who reported no family economic hardships (OR: 2.10, 95% CI: 1.24, 3.58). We found no significant change for girls (OR: 1.14, 95% CI: 0.83, 1.55), regardless of COVID-19 economic impacts. In contrast, girls reported increased anxiety (OR: 1.63, 95% CI: 1.09, 2.45), especially among those who were concerned about their academic performance (OR: 1.85, 95% CI: 1.16, 2.97). Boys experienced no such increase (OR: 0.92, 95% CI: 0.55, 1.54), regardless of their education concerns. DISCUSSION: Adolescents' COVID-19 experiences are highly gendered and result in increased health inequalities, with greater mental health implications for girls.

Association between sexting and mental health among secondary vocational school students / 中国学校卫生

Objective@#To explore the prevalence of sexting among secondary vocational school students and to examine the correlation between sexting and mental health, so as to provide evidence for prevention and intervention on adolescents mental health.@*Methods@#In April 2021, three secondary vocational schools from central urban area, outskirts and outer suburbs in Shanghai, among 1 580 students were selected by cluster sampling.@*Results@#The proportions of students who received and who forwarded others private photos or videos were 11.96% and 2.78%, respectively. The proportion of students who sent others personal photos or videos was 2.54%. And the proportions of boys were higher than those of girls ( χ 2=45.89, 24.09, 6.66, P <0.01). The results of multivariable Logistic analysis showed that compared with those who had never sexted, students who had ever had any sexting were at higher risk of anxiety ( OR=2.40, 95%CI =1.59-3.61), depression( OR=1.86, 95%CI =1.25-2.75), non suicidal self injury intention ( OR=2.34, 95%CI =1.48-3.69) and suicidal intention ( OR=2.96, 95%CI =1.83-4.79)( P < 0.05 ).@*Conclusion@#There is a significant correlation between sexting and mental health among secondary vocational school students. The latent risks of sexting should be included in the curriculum of comprehensive sex education for teenagers to enhance their media literacy and decision making capability, so as to prevent sexual assault or abuse caused by sexting and promote sexual and reproductive health and as well as mental health of adolescents.

Relationship between gender role attitudes and depression among adolescents / 中国学校卫生

Objective@#To explore the relationship between gender role attitudes (GRA) and adolescent depression to provide evidence for the promotion of mental health among adolescents.@*Methods@#A total of 1 549 students from grades 6 to 8 in three public middle schools in Jing an District of Shanghai were selected by stratified cluster sampling. The baseline and follow up surveys were conducted by anonymous electronic questionnaire on mobile tablets from November to December in 2017 and 2018, respectively. The GRA Scale and the Depression Scale were used to collect subjects attitudes towards traditional role assignment and power inequality between men and woman and depression in family and sexual relationships. The multivariate Generalized Estimating Equations (GEE) model was adopted to examine the relationship between GRA and depression.@*Results@#The mean score of the GRA Scale was (2.52±0.83) and (2.29±0.86), while the score of Depression Scale was (15.92±5.08) and (16.48±5.29), in the baseline and follow up survey, respectively ( P <0.05). After controlling the covariates of age, bullied experience, body image, social cohesion, etc., the multivariate GEE model indicated traditional GRA was significantly associated with a higher risk of depression among both boys and girls ( β boys =0.38, β girls =0.41, P <0.05).@*Conclusion@#Traditional GRA may increase the risk of depression in adolescents, suggesting that cultivating a positive and equal GRA among this population group may help to prevent depression.

Grade repetition and bullying victimization in adolescents: A global cross-sectional study of the Program for International Student Assessment (PISA) data from 2018.

BACKGROUND: Grade repetition is practiced worldwide and varies considerably across the globe. Globally, around 32.2 million students repeated a grade at the primary education level in 2010. Although a large body of research has documented grade repetition's academic and non-academic effects, the limited evidence on associations between grade repetition and school bullying is inconsistent and ambiguous. This study aimed to investigate the global association of grade repetition with bullying victimization in a large-scale school-based cross-sectional study. METHODS AND FINDINGS: We used the latest global data from the Program for International Student Assessment (PISA) 2018. PISA 2018 was conducted between March and August 2018 in 80 countries and economies among students aged 15-16 years attending secondary education. The students reported their experiences of repeating a grade at any time point before the survey and of being bullied in the past 12 months. The outcome measures were 6 types of bullying victimization. We accounted for the complex survey design and used multivariate logistic regression models to estimate the odds ratios (ORs) with 95% confidence intervals (CIs) of grade repetition with bullying victimization after adjusting for potential confounders (sex; age group; migrant status; school type; economic, social, and cultural status; and parental emotional support). This study included 465,146 students (234,218 girls and 230,928 boys) with complete data on grade repetition and bullying victimization in 74 countries and economies. The lifetime prevalence of grade repetition was 12.26%, and 30.32% of students experienced bullying at least a few times a month during the past 12 months. Grade repetition was statistically significantly associated with each type of bullying victimization. The OR (95% CI) of overall bullying victimization for grade repeaters compared with their promoted peers was 1.42 (95% CI 1.32-1.52, p < 0.001). The sex-specific analysis produced similar results in both boys and girls. Furthermore, girls who repeated a grade had higher risks of being made fun of, being threatened, having possessions taken away, and being pushed around than boys. The major limitation is that this study only included students attending schools and therefore may be subject to possible selection bias. In addition, the cross-sectional design hinders us from establishing causality between grade repetition and bullying victimization. CONCLUSIONS: In this study, we observed that, globally, both boys and girls who repeat a grade are at increased risk of being bullied compared with promoted peers, but girls may experience higher risks than boys of specific types of bullying associated with repeating a grade. These findings provide evidence for the association of grade repetition with bullying victimization. Sex differences in risk of experiencing some types of bullying suggest that tailored interventions for girls who repeat a grade may be warranted.

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.

Assessing the Spectrum of Gender Norms Perceptions in Early Adolescence: A Cross-Cultural Analysis of the Global Early Adolescent Study.

PURPOSE: There is increasing recognition that gender norms affect adolescent health and well-being. This study explores the consistency of adolescents' gender norm perceptions across different dimensions (roles, traits, relations) and describes how the patterns of these perceptions vary across four culturally different settings. METHODS: The study includes 8,977 adolescents aged 10-14 years from Kinshasa, Shanghai, Cuenca, and Indonesia. Three gender norm scales were examined: sexual double standard, gender stereotypical traits, and stereotypical roles. We investigated patterns of gender norms across dimensions (roles, traits, and relations) and compared results between sites. We also examined how adolescents' individual responses across the scales compared with average responses in their site, to assess the consistency of their gender views. RESULTS: Patterns of gender norms varied across sites, reflected in different levels of endorsement of each gender norms scale, from least equal in Kinshasa to most equal in Shanghai, while greater variation of perspectives across gender dimensions was noted in Cuenca and Indonesia. Moving from a societal to an individual perspective, most adolescents in each site (62%-67%) held both more progressive and less progressive views compared with their average peer depending on the gender dimension. CONCLUSIONS: Our study demonstrates the coexistence of multiple gender worldviews that are assessed and enacted as per adolescents' experiences and social context. Accounting for such complexities is essential for gender-transformative programs, as shifting gender attitudes in one area does not necessarily translate in more gender equitable views across other spheres of life.

The Social Context of Early Adolescents in the Global Early Adolescent Study.

PURPOSE: This paper used data from the Global Early Adolescent Study (GEAS) to provide a descriptive analysis of how early adolescents' social environments vary by sex across diverse cultural settings. METHODS: The analyses were based on baseline data among 10-14-year old adolescents living in disadvantaged urban areas in seven sites: Kinshasa (DRC), Shanghai (China), Cuenca (Ecuador), Lampung, Semarang and Denpasar (Indonesia), and Flanders (Belgium). Except in Kinshasa where face-to face interviews were used, data were collected using self-administered surveys on mobile tablets. Social environments were measured by examining factors within five main domains, including the household and family, school, peers, neighborhoods, and the media. Site-specific descriptive analyses were performed, using Chi square tests and Student T-tests to identify sex-differences in each site. RESULTS: The majority of early adolescents lived in two-parent households, perceived their parents/guardians cared and monitored them, had at least one friend, reported high educational aspirations, and perceived their neighborhoods as safe, socially cohesive, with a high level of social control. Yet, large gender and site differences were also observed. More girls reported same-sex friends and high levels of parental monitoring, while boys were more likely to have mixed-sex friends and spend greater amounts of time with friends. Adolescents in Kinshasa and Semarang watched the most TV per day, while higher proportions of adolescents in Flanders used social media on a daily basis. Significant gender differences in media use were also observed but varied according to site. CONCLUSIONS: Understanding how social contexts differ between boys and girls across sites has relevance for how we might examine gender attitude formations and subsequent health behaviors. Given the increased attention on the importance of early adolescence for shaping gender attitudes and norms, implementing approaches that consider the differences in boys' and girls' lives may hold the most promise for creating sustained and improve change.

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.