【作者】 吴静；

【导师】 石淑华； 熊光练；

【作者基本信息】 华中科技大学 ， 儿少卫生与妇幼保健， 2007， 博士

【摘要】 研究目的以青少年对性健康知识的需求为出发点,形成良好性健康行为为目标,建立一套适合我国国情的青少年性健康行为早期干预模式。研究方法利用定量与定性相结合的方法,从理论与实证角度确定青少年性健康行为系统研究方案。首先采用文献法、专题小组讨论和选题小组讨论的方法建立青少年性健康行为监测指标;再采取整群随机抽样的方法,对青少年性健康行为进行现况调查;然后运用Logistic回归、因子分析和结构方程分析,建立青少年性健康行为形成的数学模型;最后应用随机对照试验进行现场干预及干预效果的评价。研究结果(1)基线调查:被调查的青少年具备一定的青春期知识,但缺乏对人体生殖功能和性病、艾滋病知识的理解;初一学生的知识水平较初二、初三低;男生的性健康知识优于女生,但对待性相关问题的态度女生较男生理性;调查对象中14.0%谈过恋爱,随着年级的升高有恋爱经历的比例增加;13.1%有手淫行为;1.3%有过性交经历,男生有性交经历的比例(1.7%)高于女生(0.9%)。他们的性知识主要来源于学校、同学/朋友和父母。(2)多元Logistic回归分析发现,影响青少年性行为(异性交往、自慰行为、性交行为)的因素有家庭环境、家庭教育、学校教育、媒体和同伴,还有自身的不良行为(旷课、吸烟、饮酒和吸毒)、学习成绩和性知识等。在因子分析中,结构方程模型共涉及5个潜在因子:①不良倾向,支配不良行为;②社会,支配学校教育、同伴和媒体;③家庭,支配家庭教育、家庭环境和学习成绩;④个体倾向,支配性知识和性态度;⑤性行为,支配自慰行为、异性交往和性交行为。通过拟合生态学理论模型,得到的结构方程模型揭示了个体、环境因素对青少年性健康行为形成的作用:家庭、社会、不良行为及个体倾向并不是相互独立地对青少年性健康行为起作用,而是整合在一起起协同作用。家庭、社会、不良行为及个体倾向对青少年性健康行为产生直接效应,而家庭、社会分别通过不良行为和个体倾向对青少年的性健康行为起间接效应。(3)干预效果评价:干预组学生的各种性知识得分在干预后显著提高,其趋势向有利于性健康的方向发展;干预组家长在干预后的性知识得分也显著提高,他们对孩子进行青春期生殖健康教育技巧的需求明显增加;通过对教师的干预,改变了他们对在中学生中开展性教育的态度,消除了他们开展性教育的顾虑,提高了对青少年危险性行为的预防意识。研究结论(1)青少年性健康现况及其影响因素的基线调查对建立良好的干预措施至关重要。(2)在青少年性健康行为形成的理论模型指导下设计的干预模型,能针对性地控制各种可控因素,从而获得有效的干预方法和途径,并取得良好的效果。(3)充分利用社会、学校和家庭现有的各种资源,重视性健康教育和干预效果的评价,对出现的问题可及时进行正确引导。(4)青少年的性健康教育应以人为本,以人格教育为基础,以人格塑造为目标。它应该是一个以学校为主导,社会参与和家庭配合的多元的全社会共同努力的系统工程。研究创新创新点是在利用定量和定性相结合的研究方法,探索影响青少年性健康行为形成的内在作用机制的同时,应用“数字公共卫生”研究公共卫生问题,对提高公共卫生问题的可控性,具有重要的实践价值。更多还原

【Abstract】 ObjectiveTo establish an early intervention model for adolescents’sexual health behavior that fits Chinese situations, with young people’s needs for knowledge on sexual health as the starting point, and building up healthy sexual behavior as the goal.MethodsA combination of quantitative and qualitative methods was used to determine the systematic research design about adolescents’sexual health behavior from both theoretical and empirical perspectives. First, literature review, focus group discussions and nominal group discussions were conducted to create indicators that monitoring adolescents’sexual health behavior. Then adolescents’current sexual health behavior was investigated with cluster random sampling method. Mathematic model on adolescents’sexual health behavior was established using logistic regression, factor analysis and structural equation modeling. Finally, a randomized controlled trial was adopted to develop the on-site intervention and evaluation of intervention effects.Results(1) Baseline survey: Respondents have certain knowledge on adolescence, but not on human reproductive functions, sexually transmitted diseases and HIV/AIDS. The 7th graders’knowledge level was lower than the 8th graders and 9th graders. Boys’sex-related knowledge was better than girls’; but girls had more rational attitude toward sex issues than boys. Fourteen percent of respondents had been in romantic relationships. With the increase of grade level, the proportion of being in a romantic relationship increased as well. Among the respondents, 13.1% had masturbation experience, and 1.3% had sexual intercourse before. That proportion of those who had sexual intercourse among boys (1.7%) was higher than that among girls (0.9%). Their knowledge on sexual health about sex mainly came from schools, classmates/friends and parents.(2) Multivariate logistic regression indicated that factors influencing adolescents’sexual behavior (heterosexual relations, masturbation, and sexual intercourse) included family environment, family education, school education, media, peers, self-malfunctions (absence from school, tobacco, alcohol, and drug use), academic performance, and knowledge on sexual health.Exploratory factor analysis found 5 potential factors in the structural equation model:①negative tendencies, which controlled malfunctioned behavior;②society, which controlled school education, peers, and media;③family, which controlled family education, family environment and academic performance;④individuals tendencies, which controlled knowledge on and attitudes toward sex;⑤sexual behavior, which controlled masturbation, heterosexual relations, and sexual intercourse. According to fitting the ecology theory by observing data, the structural equation model suggested the effects of individual and environment factors on the formation of adolescents’sexual health behavior. The effects of family, community, malfunctioned behavior and individual tendencies on adolescents’sexual health behavior are not independent; instead, they coordinate with each other. Family, community, malfunctioned behavior and individual tendencies have a direct effect on adolescents’sexual health behavior. At the same time, family and community influence adolescents’sexual health behavior indirectly through malfunctioned behavior and individual tendencies.(3) Evaluation of the intervention effects: Respondents’scores on knowledge about sex improved significantly in the intervention group, with a trend benefit sexual health. Parents’scores on knowledge about sex also improved significantly. Their requests for skills on how to educate children about adolescence reproductive health increased significantly. The intervention among teachers changed their attitude towards sexual education among middle school students; their worries about sexual education were eliminated; and their awareness to prevent adolescents’risky sexual behavior was increased.Conclusions(1) It is important to fully understand adolescents’current sexual health status and factors that influence it in establishing effective intervention strategies.(2) Intervention models should be based on adolescents’sexual health behavior theory and focus on the controllable factors, so that they could achieve desirable effects and good intervention methods.(3) Resources from communities, schools, and families should be fully used, and sexual health education and evaluation of intervention effects should be paid attention to. And errands need to be corrected as soon as possible.(4) Sexual education for adolescents should be people-oriented, personality-based education, and aim at building personality. Its development needs the concerted efforts of the whole community. It should be a school-oriented, community involved, and family-cooperated systematic multivariate project.InnovationThis study combined quantitative and qualitative research methods. It explored the inherent mechanism influencing the formation of adolescents’sexual health behavior. At the same time, it applied "digital public health" to study public health issues. It is important in practice to improve the controllability of public health issues.更多还原