Long-Term Effects Of Different Sex And Reproductive Health(SRH) Education And Service Models Among Vocational High School Students In Shanghai

[OBJECTIVES] To evaluate and compare the long-term (2-years) impact of sexual and reproductive health education and service which was conducted by school teachers and medical professionals respectively in vocational high schools, and to explore the factors that influence the effects of the sexual and reproductive health education and service for vocational high school students.[METHODS] Three vocational schools in Shanghai were selected as study sites, among which two were intervention schools, and the other one acted as control school. The study subject consisted of all of students enrolled in 2005 in these three schools. Two intervention models were adopted in the intervention schools. The intervention, which lasted for two school years, was provided by teachers in the school (model 1) and health professionals out of school (model 2), respectively. The intervention activities in model 1 school contained providing life-planning skill training, delivering lectures, distributing educational booklets, playing video, holding debate and drama competitions and offering counseling. Besides the intervention activities that took in model 1 school, an after-school counseling room was set up nearby the model 2 school during the intervention period. In this counseling room, education and services including group discussions, playing video, counseling and contraceptives and free pregnancy testing would be implemented by the health professionals. Three surveys were conducted before intervention, immediately after intervention and two years post-intervention and data were collected using self-administered anonymous questionnaires. The long-term impact of the intervention was evaluated by comparing subject's sex and reproductive health knowledge, sexual attitudes, skills and practices between the intervention and control schools, and between two intervention schools over time.[RESULTS]1. General information. In total,1837 students (621 in the control school,631 in model 1 school and 585 in model 2 school) were surveyed at baseline and 1617(564 in the control school,542 in model 1 school,511 in model 2 school) and 1458 (522 in the control school,458 in model 1 school,478 in model 2 school) were re-interviewed at the midterm and the final surveys, respectively. The follow up rate was 88.0% at the midterm survey and 79.3% at the final survey. The main reasons of withdrawal were drop-out (55.1%), skipping school (26.5%), on leave (11.0%) and school transfer (7.4%) at the midterm survey, and drop-out (35.1%), change of contact information (35.6%) and refusal (19.5%) at the final survey.2. Both two intervention models had long-term effect on the increase of subjects' sex and reproductive health knowledge.At the final survey, respondents in two intervention schools continued to have high total knowledge scores than those in control school. The increment of total knowledge score in model 1 school was 8.9 points 95%CI (6.8-11.0) higher than that in control school and in model 2 school was 8.3 points 95%CI (6.2-10.4) higher than that in control school after adjusting possible influencing factors. However, there was no significant difference on the increment of total knowledge score between the two intervention groups. Comparing the long-term impact of two different intervention models on each type of knowledge, the model 1 had a better impact on STD and HIV/AIDS knowledge and model 2 had a better impact on contraceptive knowledge.3. Both two intervention models had no long-term impact on subject's sexual attitudes.At the final survey, subjects in three groups tend to disapprove of keeping virginity before marriage and agree premarital intercourse. After adjusting potential influencing factors, both two intervention models had no long-term impact on subject's sexual attitudes.4. The intervention model 2 had long-term effect on the improvement of subject's consciousness of having safe sexual activity.The subject's consciousness score of having safe sexual activity in three groups increased significantly at the final survey than those at baseline. After adjusting potential influencing factors, the increment of subject's consciousness score of having safe sex in model 2 school was 2.7 points higher than that in control school. However, model 1 school had no long-term effect on subject's improvement of the consciousness of having safe sexual activity. At the final survey, subject's self-assessment level in two intervention schools had no significant change compared with baseline, however, subject's self-assessment level in the control school was higher than that at baseline and that in two intervention schools at the final survey. Subject's scores on refusal skills in model 1 school and control school at the final survey was higher than those at baseline and those in model 2 school at the final survey. After adjusting possible impact factors, both two intervention models had no long-term effect on subjects'self-assessment level and refusal skills.5. Both two intervention models had no long-term impact on sexual behaviors, unwanted first intercourse and contraceptive use.The proportion of dating, intimate and sexual behaviors in three groups continued to increase from baseline to final survey, and the proportion of unwanted first intercourse and contraceptive use in the three groups had no obvious changes during this period. No significant long-term effect on sexual behaviors, unwanted first intercourse and contraceptive use was observed in two intervention models after adjusting possible influencing factors.[CONCLUSION] Both two intervention models had positive long-term impact on students' sexual and reproductive health knowledge. The intervention model 2 had long-tem impact on students'consciousness of having safe sexual activity. However, No significant long-term effect on self-assessment level, refusal skills, sexual attitudes and practices was observed in both intervention models.