Evaluation Of The Sustainable Effect Of A Community-based Sex And Reproductive Health Education And Services Among Unmarried Young People In Sun-urban Shanghai

[BACKGROUND] Premarital sexual behavior has been increasing during recent years in China. Despite this, contraceptive practice remains limited and irregular. Unprotected sexual activity puts young people at higher risks of unwanted pregnancy, unsafe abortion and STIs. There is an urgent need to explore effective and sustainable model of sex and productive health education and services among adolescents and unmarried young people. Now there has been growing interest within China to explore feasible, acceptable and effective program on sex and reproductive health education and service for adolescents and unmarried young people. However, few studies have been undertaken to evaluate the long-term effects of intervention on knowledge, attitudes and behavior changes.[OBJECTIVES] To evaluate the sustainable effect of a community-based sex education and reproductive health service programme among 15-24 aged adolescents and unmarried young adults in sub-urban area of Shanghai.[ METHODS ] This is an extended study of a completed community-based interventions programme among 15-24 aged adolescents and unmarried young adults in sub-urban areas of Shanghai. Base on the baseline survey and the post-intervention survey of the previous study, a third questionnaire-based survey was conducted by using the same methods as before 28 months after the completion of the interventions at the same two towns. The subjects of the third survey included two parts, one is those who have already involved in the intervention project before (old subjects), and the other is the new comers who reach the age of 15 at the time of the survey in the two towns (new subjects). The sustainable effect of the intervention programme was evaluated by comparisons over time and between the intervention and control groups among subjects in the cohort of the previous study and subjects aged 15-24. Data were analyzed with SAS software 8.02 edition. The statistical methods used in the study included t test, Chi-square test, multiple logistic regression model, multinominal logistic regression model, general linear model, general evaluation equations and weighted least squares linear model.[RESULTS]1. General information. Totally, 2184 unmarried young people were interviewed at baseline survey, including 1178 in the intervention site and 1006 in the control site. In the third survey, a total of 2148 unmarried young people were interviewed , including 711 old subjects (351 in the intervention site and 360 in the control site) and 1437 new subjects (707 in the intervention site and 730 in the control site).2. The intervention had long-term effect on the increase of subjects' knowledge on sex and reproductive health. Among old subjects, the average increased knowledge score on sex physiology, contraceptives, AIDS, STDs and the total knowledge in the intervention group was higher than that of control group both in 2001 and 2004. However, the increased score in 2004 is much lower than that of 2001. After adjusting demographic factors and other possible influence factors, the ratio of increased mean total knowledge score of intervention group and control group in 2001 and 2004 is 3.05 and 1.88 and the difference of the increased score between the two groups in 2001 and 2004 is 25.66 and 13.00. Among subjects in the intervention group in 2001, the more they read the educational material, the more likely they had higher increased score. And subjects who had ever watched the educational videos were more likely to have higher increased score. While in 2004, subjects who had ever received education materials from the community after intervention were more likely to have higher increased score. However, the increased score in 2004 was not related to any of the activities subjects took in the intervention period.Among new subjects, subjects in the intervention group had higher knowledge on sex physiology, AIDS, STDs and the total knowledge than those in the control group. The differences of the knowledge score between the two groups ranged from 3.63 to 8.58. However, subjects in the intervention group had lower knowledge on contraceptives when compared with those in the control group (the differences of the knowledge score between the two group is -2.21). After adjusting demographic factors and other possible influence factors, subjects in intervention group had more knowledge than those in control group (OR: 1.58; 95%CI: 1.22-2.05). Except knowledge on contraceptives, the intervention had effect on the other three kinds of knowledge and the total knowledge (OR ranged from 1.48 to 1.71).3. The intervention had no long-term effect on subjects' attitudes toward premarital sexual behavior. The intervention had positive effect on old subjects' attitudes toward premarital sexual behavior in 2001; Subjects in the intervention group were more likely to understand premarital sexual behavior after the intervention. However, this positive effect was no longer present 28 months after the intervention. And the long-term effect of the intervention was not observed among new subjects.4. The intervention had long-term effect on sexual coercion and multiple partners, but had no long-term effect on premarital sexual behavior. Among those who were sexually experienced, subjects in the intervention group were less likely to be forced by their partner or forced their partner to have sex than those in control group in 2004 (4.88 % vs. 12.50% and 7.32% vs. 12.50% respectively). Multivariate logistic regression analysis indicated that the intervention had effect on being forced to have sex for all subject in 2004 (OR: 0.18; 95%CI: 0.04-0.85) and had effect on both being forced and forced to have sex for new subjects (OR: 0.07 and 0.09; 95%CI: 0.01-0.95 and 0.01-1.01, respectively). Besides, the intervention significantly reduced multiple partners among male subjects in the cohort of the previous study (OR: 0.07; 95%CI: 0.01-0.61).5. The intervention had very limited long-term effect on contraceptive use.Although the intervention had very clear short-term effect on contraceptive use among subjects who initiated sex at the intervention period (OR: 9.18; 95%CI: 2.86-29.46), the long-term effect was only limited to subjects who initiated sex at the intervention period (OR: 4.45; 95%CI: 1.05-18.86). Besides, the intervention significantly reduced the use of withdrawal among old subjects (OR:0.38, 95% CI: 0.17-0.84 ) . Unfortunately, no intervention effect was observed among new subjects in 2004.6. The intervention had sustainable effect on the frequency of unwanted pregnancy among female subjects. Although the proportion of unwanted pregnancy among female old subjects during the last two years between the two groups was not statistically significant, subjects in the intervention group were less likely to have ever had 2 times of pregnancy. However, no intervention effect on unwanted pregnancy and induced abortion was found among male old subjects and new subjects in 2004.