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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. Plain language summary: 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. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

OBJECTIVE: To ascertain the perspectives of family-planning service providers in eight sites in China on the provision of sexual and reproductive health services to unmarried young people. METHODS: Data were drawn from a survey of 1927 family-planning workers and 16 focus group discussions conducted in eight sites in China in 1998-99. FINDINGS: Family-planning workers recognized the need to protect the sexual health of unmarried young people and were unambiguous about the need for government agencies to provide information and education on sexual and reproductive health to unmarried young people; however, perceptions about the appropriate age for and content of such education remained conservative. While about 70% of family-planning workers were willing to provide contraceptives to unmarried young people, and about 60% approved government provision of contraceptive services to unmarried young people, only one quarter agreed that the services could be extended to senior high schools. CONCLUSION: Family-planning workers in China are ambivalent about the provision of sexual and reproductive health services to unmarried young people, which potentially poses a significant obstacle to the adoption of safe sex behaviours by young people, as well as to the provision of sexual and reproductive health information and services to young unmarried people in China. Training programmes for family-planning workers are urgently needed to address this issue.

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. [ABSTRACT FROM AUTHOR]

Background: Although there is much literature on adolescent suicide, combined effects of depression and anorexia nervosa on suicide were rarely investigated. The aims of this study are to examine the association between anorexia nervosa and suicidal thoughts and explore the interaction between anorexia nervosa and depression. Methods: This is a cross-sectional study, in the study, a sample of 8,746 Chinese adolescents was selected by multistage stratified method in 2012/2013 from 20 middle schools in 7 provinces across China Mainland. Multilevel logistic model was introduced to explore association between anorexia nervosa and suicidal thoughts. And subgroup analyses were conducted on participants with or without depression. Results: Multilevel logistic model revealed that demographic variables, including academic achievement, were not the predictive risk factors of suicidal thoughts. Those who suffered from worse severity of perceived anorexia nervosa were at increased risk of thinking about suicide. The interaction between depression and anorexia nervosa was significant, however, subgroup analyses showed that the associations were significant only among the adolescents without depression. Conclusions: Our results indicate that all levels of anorexia nervosa serve as predictable indicators of suicidal thoughts in Chinese adolescents, and the effects of anorexia nervosa are modified by depression status. [ABSTRACT FROM AUTHOR]

Objective: Cigarette smoking has been found to be more prevalent among adults and youths with a minority sexual orientation (lesbian, gay, bisexual, LGB) than among the general population, while less is known about smoking among LGB youth in low- and middle-income countries. The goal of the study was to examine cigarette smoking in relation to sexual orientation in a community-based sample of youth in Shanghai, China. Methods: A multi-center cross-sectional survey of 17,016 youth aged 15-24 years was conducted in rural and urban areas of Hanoi, Vietnam; Taipei, Taiwan; and Shanghai, China in 2006. In this article, analysis was restricted to the 6,299 respondents in Shanghai. Assessments included ever smoking, age at first smoking, frequency of smoking, and number of cigarettes smoked daily. Logistic regression was used to estimate the association between sexual orientation and cigarette smoking. Results: Nine percent (594/6,299) of eligible participants considered themselves as LGB youths; 34.2 % ever smoked, 14.81 % initiated smoking before age 13, 15.9 % smoked in the past 30 days, and 14.1 % were moderate or heavy smokers. LGB identity predicted moderate or heavy smoking (OR 2.2, 95 % CI 1.3, 3.9). Male LGB youth smoked more cigarettes daily (OR 2.2, 95 % CI 1.3, 3.9) whilst female LGB youth reported less any prior cigarette use (OR 0.7, 95 % CI 0.5, 1.0). Conclusions: Few meaningful disparities in cigarette smoking were related to sexual orientation, except male LGB youth consumed more cigarettes daily. Prevention and cessation should target this population, especially male LGB youth. [ABSTRACT FROM AUTHOR]

Abstract: Purpose: To evaluate the long-term (48-month) sustainable effect of a set of community-based interventions to promote contraceptive use among sexually active unmarried youth in suburban Shanghai, China. Methods: A nonrandomized community trial with one intervention and one control group was conducted in two comparable towns of a suburban area of Shanghai. The intervention program was developed and implemented to increase knowledge and access to sexual and reproductive health services among unmarried youth aged 15–24 years. Baseline surveys were conducted in both sites before implementation of the intervention, and similar surveys were conducted in both sites 20 months after the launch of the intervention and 28 months after the end of the intervention. Results: Statistically significant differences between the respondents surveyed at baseline in 2000 and at the long-term follow up in 2004 were observed in some age categories and in some educational groups. In the postproject period, there was a major improvement in all indicators in the control group. Among the sub-set of respondents interviewed both in 2000 and 2004 who were exposed to the intervention program, the interventions were associated with a significant increase in the frequency of contraceptive use among participants initiating sexual relations over the period of the intervention (odds ratio [OR] = 6.91), as well as with significant reduction in use ever of the withdrawal method of contraception among all sexually active respondents (OR = .37) compared with the control group during long-term follow-up period. No long-term effects on contraceptive practice were observed among new respondents who were not exposed to the intervention program. Conclusions: Comprehensive community-based interventions appear to have limited long-term effects on contraceptive use among unmarried youth in suburban Shanghai. It is necessary to provide sex and reproductive health education and services to all unmarried young people on a regular basis. [Copyright &y& Elsevier]

Purpose The purpose of the study is to understand the gender socialization process in early adolescence. Methods The study was located in two disadvantaged urban communities in Delhi, India and Shanghai, China and was part of the multicountry (15) Global Early Adolescent Study. Qualitative methodologies were used with boys and girls aged 11–13 years, including 16 group-based timeline exercises and 65 narrative interviews. In addition, 58 parents of participating adolescents were interviewed. Interviews were recorded, transcribed, translated, and uploaded into Atlas.ti for coding and thematic analysis. Results Boys and girls growing up in the same community were directed onto different pathways during their transition from early to late adolescence. Adolescents and parents in both sites identified mothers as the primary actor, socializing adolescents into how to dress and behave and what gender roles to play, although fathers were also mentioned as influential. Opposite-sex interactions were restricted, and violations enforced by physical violence. In Delhi, gender roles and mobility were more strictly enforced for girls than boys. Restrictions on opposite-sex interactions were rigid for both boys and girls in Delhi and Shanghai. Sanctions, including beating, for violating norms about boy-girl relationships were more punitive than those related to dress and demeanor, especially in Delhi. Education and career expectations were notably more equitable in Shanghai. Conclusions Parents teach their children to adhere to inequitable gender norms in both Delhi and Shanghai. However, education and career expectations for boys and girls in the two sites differed. Although gender norms varied by site according to the particular cultural and historical context, similar patterns of gender inequity reflect the underlying patriarchal system in both settings. The tendency of parents to pass on the norms they grew up with is evident, yet these results illustrate the social construction of gender through children's interaction with the social ecology, including evolving political and economic systems. Efforts to bend gender norms toward greater equality can build on these results by empowering children and parents to reflect critically on inequitable gender norms and roles and by mobilizing economic and social support at key turning points in adolescents' lives. [ABSTRACT FROM AUTHOR]

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. 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. 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). 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. [ABSTRACT FROM AUTHOR]