Skip to main content

Advertisement

SpringerLink
Log in

The road not taken: sexuality education and its associations with sexual knowledge and attitudes among senior high school students in rural areas of Western China

  • Original Article
  • Published:
China Population and Development Studies Aims and scope Submit manuscript

Abstract

The poor performance and limited availability of sexuality education programs in rural areas of western China increase the danger of younger cohorts being exposed to sexually transmitted diseases (STDs) and engaging in risky sexual behaviors. A traditionally conservative culture, low levels of economic development and the relative lack of faculty resources all contribute to the weakness of sexuality education efforts. This study uses a sample of 164 boys and 195 girls who were senior high school students aged 15–19 in rural western China in 2017. The study aims to explore sexuality education, and sexual and reproductive behaviors, and to identify associations between sexuality education and sexual knowledge and attitudes among adolescents in rural western China. The results reveal a positive association between courses about reproductive health and lectures about STDs, and sexual knowledge; and a positive association between lectures about STDs and sexual attitudes. Our study also found that access to consulting services provided by governmental organization in the field of family planning and reproductive health helped rural adolescents enhance their sexual knowledge. Making such services available appears to offer a feasible method to develop a comprehensive sexuality education system in western China. The study concludes that an improved school-based sexuality education program strictly implemented as a part of the standard school curriculum is an effective way to increase sexual knowledge and promote de-stigmatized sexual attitudes among adolescents in rural western China.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1

Similar content being viewed by others

Notes

  1. This refers to children who have been left in the care of grandparents or other relatives while their parents migrate to cities to find work.

References

  • Abma, J. C., Martinez, G. M., Mosher, W. D., & Dawson, B. S. (2004). Teenagers in the United States: Sexual activity, contraceptive use, and childbearing, 2002. Vital & Health Statistics, 23(24), 1–48.

    Google Scholar 

  • Ahrold, T. K., & Meston, C. M. (2010). Ethnic differences in sexual attitudes of US college students: Gender, acculturation, and religiosity factors. Archives of Sexual Behavior, 39(1), 190–202.

    Article  Google Scholar 

  • Allen, L. (2011). Young People and Sexuality Education: Rethinking Key Debates. Springer.

  • Allgeier, E. R., & Allgeier, A. R. (1995). Sexual interactions. Sexual Interactions.

  • Anderson, L. A., & Whiston, S. C. (2005). Sexual assault education programs: A meta-analytic examination of their effectiveness. Psychology of Women Quarterly, 29(4), 374–388.

    Article  Google Scholar 

  • Bae, Y. S., & Kim, D. H. (2015). A comparison of the sexual knowledge, attitudes, and behaviors of Korean college students studying in Korea and in the United States. Open Journal of Nursing, 05(11), 1253–1262.

    Article  Google Scholar 

  • Chen, Y.-N., Hong-Xiang, W., Qing-Liang, X.-M., & Wang, Y. X. (2008). Sexual and reproductive health service needs of university/college students: Updates from a survey in Shanghai China. Reproduction & Contraception, 10(4), 607–615.

    Google Scholar 

  • Chi, X., Hawk, S. T., Winter, S., & Meeus, W. (2015). The effect of comprehensive sexual education program on sexual health knowledge and sexual attitude among college students in southwest china. Asia-Pacific Journal of Public Health/Asia-Pacific Academic Consortium for Public Health, 27(2), 2049–2066.

    Article  Google Scholar 

  • David, L. W. P. D., Barbara, R. M. S. W., & Mary, F. R. E. M. (1992). Individual changes in sexual attitudes and behavior within collegeâ level human sexuality courses. Journal of Sex Research, 29(1), 43–59.

    Article  Google Scholar 

  • Diamond, M. (2015). Human sexuality: Mass sex education student and community reaction. Chemical Research in Toxicology, 22(11), 1765–1773.

    Google Scholar 

  • Duan, C., Lu, L., Guo, J., & Wang, Z. P. (2013). Survival and development of left-behind children in rural China: Based on the analysis of sixth census data. Population Journal (in Chinese)

  • Ekstrand, M., Engblom, C., Larsson, M., & Tydén, T. (2011). Sex education in Swedish schools as described by young women. The European Journal of Contraception & Reproductive Health Care, 16(3), 210–224. https://doi.org/10.3109/13625187.2011.561937.

    Article  Google Scholar 

  • Evans, H. (1995). Defining difference: The" scientific" construction of sexuality and gender in the People's Republic of China, Signs. Journal of Women in Culture and Society, 20(2), 357–394.

  • Feigenbaum, R., Weinstein, E., & Rosen, E. (1995). College students' sexual attitudes and behaviors: Implications for sexuality education. Journal of American College Health, 44(3), 112–118.

    Article  Google Scholar 

  • Feng, L., Ding, X., Lu, R., Liu, J., Sy, A., Ouyang, L., et al. (2009). High HIV prevalence detected in 2006 and 2007 among men who have sex with men in China's largest municipality: An alarming epidemic in Chongqing, China. Journal of Acquired Immune Deficiency Syndromes (JAIDS), 52(1), 79–85.

    Article  Google Scholar 

  • Feng, Y., & Wu, Z. R. (2010). Evolution of men who have sex with men community and experienced stigma among men who have sex with men in Chengdu, China. Journal of Acquired Immune Deficiency Syndromes, 53 Suppl 1(1), S98.

  • Fonner, V. A., Armstrong, K. S., Kennedy, C. E., O'Reilly, K. R., & Sweat, M. D. (2014). School based sex education and HIV prevention in low- and middle-income countries: A systematic review and meta-analysis. PLoS ONE, 9(3), e89692. https://doi.org/10.1371/journal.pone.0089692.

    Article  Google Scholar 

  • Forhan, S. E., Gottlieb, S. L., Sternberg, M. R., Xu, F., Datta, S. D., Mcquillan, G. M., et al. (2009). Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics, 124(6), 1505.

    Article  Google Scholar 

  • Gao, Y., Lu, Z. Z., Shi, R., Sun, X. Y., & Cai, Y. (2001). AIDS and sex education for young people in China. Reproduction, Fertility, and Development, 13(7–8), 729–737.

    Article  Google Scholar 

  • Grose, R. G., Grabe, S., & Kohfeldt, D. (2014). Sexual education, gender ideology, and youth sexual empowerment. Journal of Sex Research, 51(7), 742–753.

    Article  Google Scholar 

  • Guo, W., Wu, Z., Qiu, Y., Chen, G., & Zheng, X. (2012). The timing of sexual debut among Chinese youth. International Perspectives on Sexual and Reproductive Health, 38(4), 196–204.

    Article  Google Scholar 

  • Guo, W., Wu, Z., Schimmele, C. M., & Zheng, X. (2014). Condom use at sexual debut among Chinese youth. Journal of Biosocial Science, 46(2), 139–154.

    Article  Google Scholar 

  • Haberland, N., & Rogow, D. (2014). Sexuality education: Emerging trends in evidence and practice. Journal of Adolescent Health, 56(1), S15–S21. https://doi.org/10.1016/j.jadohealth.2014.08.013.

    Article  Google Scholar 

  • Higgins, L. T., & Sun, C. (2007). Gender, social background and sexual attitudes among Chinese students. Culture, Health & Sexuality, 9(1), 31–42.

    Article  Google Scholar 

  • Hou, C., Chen, Y., Yao, S., Chen, H., Ming, Q., & Peng, L. (2012). The adolescent psychosexual health questionnaire in middle school students: Reliability and validity. Chinese Journal of Clinical Psychology, 20(4), 442–444. (in Chinese).

    Google Scholar 

  • Huang, J., Bova, C., Fennie, K. P., Rogers, A., & Williams, A. B. (2005). Knowledge, attitudes, behaviors, and perceptions of risk related to HIV/AIDS among Chinese university students in Hunan China. AIDS Patient Care & STDs, 19(11), 769–777.

    Article  Google Scholar 

  • Huang, H., Ye, X., Cai, Y., Shen, L., Xu, G., Shi, R., et al. (2008). Study on peer-led school-based HIV/AIDS prevention among youths in a medium-sized city in China. International Journal of Std & Aids, 19(5), 342–346.

    Article  Google Scholar 

  • Ip, W. Y., Chau, J. P., Chang, A. M., & Lui, M. H. (2001). Knowledge of and attitudes toward sex among Chinese adolescents. Western Journal of Nursing Research, 23(2), 211–222.

    Article  Google Scholar 

  • Kaljee, L. M., Green, M., Riel, R., Lerdboon, P., Tho, L. H., le Thoa, T. K., et al. (2007). Sexual stigma, sexual behaviors, and abstinence among Vietnamese adolescents: Implications for risk and protective behaviors for HIV, sexually transmitted infections, and unwanted pregnancy. Journal of the Association of Nurses in Aids Care, 18(2), 48–59.

    Article  Google Scholar 

  • Kirby, D. B. (2008). The impact of abstinence and comprehensive sex and STD/HIV education programs on adolescent sexual behavior. Sexuality Research & Social Policy, 5(3), 18. https://doi.org/10.1525/srsp.2008.5.3.18.

    Article  Google Scholar 

  • Kirby, D. B., Laris, B. A., & Rolleri, L. A. (2007). Sex and HIV education programs: Their impact on sexual behaviors of young people throughout the world. Journal of Adolescent Health, 40(3), 206–217. https://doi.org/10.1016/j.jadohealth.2006.11.143.

    Article  Google Scholar 

  • Kohler, P., Manhart, L., & We, (2008). Abstinence-only and comprehensive sex education and the initiation of sexual activity and teen pregnancy. Journal of Adolescent Health, 42(4), 344–351.

    Article  Google Scholar 

  • Li, L., King, M. E., & Winter, S. (2009). Sexuality education in China: The conflict between reality and ideology. Asia Pacific Journal of Education, 29(4), 469–480.

    Article  Google Scholar 

  • Liu, W., & Su, Y. (2014). School-based primary school sexuality education for migrant children in Beijing China. Sex Education, 14(5), 568–581.

    Article  Google Scholar 

  • Luo, Y., & Zheng, Y. (2006). A preliminary study of puberty psychosexual health. Psychological Science, 29(3), 661–664. (in Chinese).

    Google Scholar 

  • Parish, W., Laumann, E., & Mojola, S. (2007). Sexual behavior in China: Trends and comparisons. Population and Development Review, 33(4), 729–756. https://doi.org/10.1111/j.1728-4457.2007.00195.x.

    Article  Google Scholar 

  • Phillips, E., & Quigley, T. (2007). Abstinence-Only Sexual Education vs. Comprehensive Sexual Education, with Emphasis on Knowledge, Attitudes, and Behaviors of Adolescents. Wichita State University Graduate School.

  • Ruan, Y., Chen, K., Hong, K., He, Y., Liu, S., Zhou, F., et al. (2004). Community-based survey of HIV transmission modes among intravenous drug users in Sichuan China. Sexually Transmitted Diseases, 31(10), 623–627.

    Article  Google Scholar 

  • Senn, C. Y., Gee, S. S., & Thake, J. (2011). Emancipatory sexuality education and sexual assault resistance: Does the former enhance the latter? Psychology of Women Quarterly, 35(1), 72–91.

    Article  Google Scholar 

  • Shin, K. R., Park, H., & Cha, C. (2011). Sex education during the school-aged years influences sexual attitudes and sexual health in college: A comparative study from Korea. Nursing & Health Sciences, 13(3), 328–334.

    Google Scholar 

  • Song, Y. (2015). The sexuality education and attitudes of college students in China. Health Education, 115(1), 93–104.

    Article  Google Scholar 

  • Song, E. Y., Pruitt, B. E., Mcnamara, J., & Colwell, B. (2000). A meta-analysis examining effects of school sexuality education programs on adolescents' sexual knowledge, 1960–1997. Journal of School Health, 70(10), 413–416.

    Article  Google Scholar 

  • Stanger-Hall, K. F., & Hall, D. W. (2011). Abstinence-only education and teen pregnancy rates: Why we need comprehensive sex education in the US. PLoS ONE, 6(10), e24658. https://doi.org/10.1371/journal.pone.0024658.

    Article  Google Scholar 

  • Stromquist, N. P. (2007). The Gender Socialization Process in Schools: A Cross-National Comparison.

  • Tang, C. S.-K., Lai, F. D.-M., & Chung, T. K. H. (1997). Assessment of sexual functioning for Chinese college students. Archives of Sexual Behavior, 26(1), 79–90. https://doi.org/10.1023/A:1024525504298.

    Article  Google Scholar 

  • Underhill, K., Operario, D., & Montgomery, P. (2007). Systematic review of abstinence-plus HIV prevention programs in high-income countries. PLoS Medicine, 4(9), e275.

    Article  Google Scholar 

  • Wang, B., Hertog, S., Meier, A., Lou, C., & Gao, E. (2005). The potential of comprehensive sex education in China: Findings from suburban Shanghai. International Family Planning Perspectives, 31(2), 63–72.

    Article  Google Scholar 

  • Wang, B., Meier, A., Shah, I., & Li, X. (2007). The impact of a community-based comprehensive sex education program on Chinese adolescents' sex-related knowledge and attitudes. Journal of HIV/AIDS Prevention in Children & Youth, 7(2), 43–64.

    Article  Google Scholar 

  • Zhang, K., & Beck, E. J. (1999). Changing sexual attitudes and behaviour in China: Implications for the spread of HIV and other sexually transmitted diseases. AIDS Care, 11(5), 581–589. https://doi.org/10.1080/09540129947730.

    Article  Google Scholar 

  • Zhang, D. X., Bi, Y. Y., Maddock, J. E., & Li, S. Y. (2010). Sexual and reproductive health knowledge among female college students in Wuhan China. Asia-Pacific Journal of Public Health, 22(1), 118–126.

    Article  Google Scholar 

  • Zhang, L., Li, X., & Shah, I. H. (2007). Where do Chinese adolescents obtain knowledge of sex? Implications for sex education in China. Health Education, 107(4), 351–363.

    Article  Google Scholar 

Download references

Acknowledgement

Dr. Wei Guo wants to thank former U.S. Poet Laureate Robert Frost, whose many poems dealing with rural life and the everyday lives of ordinary people have always inspired, energized, and motivated him throughout his academic journey.

Funding

This work was supported by the National Natural Science Foundation of China, Grant No. 71921003 and the China Scholarship Council (CSC), Grant No. 201706195028.

Author information

Authors and Affiliations

  1. Department of Social Work and Social Policy, School of Social and Behavioral Sciences, Nanjing University, Nanjing, 210023, Jiangsu, People’s Republic of China

    Wei Guo & Zhenrong Su

  2. The Centre for Asia-Pacific Development Studies, Nanjing University, Nanjing, 210023, Jiangsu, People’s Republic of China

    Wei Guo

  3. Department of Law, College of Political Science and Law, Heze University, Heze, 274015, Shandong, People’s Republic of China

    Lijuan Chen

  4. Institute for Medical Humanities, Peking University, Beijing, 100191, People’s Republic of China

    Jihong Wei

Authors
  1. Wei Guo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Lijuan Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Zhenrong Su
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Jihong Wei
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Guo.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Guo, W., Chen, L., Su, Z. et al. The road not taken: sexuality education and its associations with sexual knowledge and attitudes among senior high school students in rural areas of Western China. China popul. dev. stud. 4, 186–201 (2020). https://doi.org/10.1007/s42379-020-00059-1

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s42379-020-00059-1

Keywords

Search

Navigation