Department of Social Security, School of Health Policy and Management, Nanjing Medical University, Nanjing, China.
Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, China.
JMIR Public Health Surveill. 2023 Jun 7;9:e45236. doi: 10.2196/45236.
Risky sexual behaviors remain significant public health challenges among adolescents. Nearly 90% of adolescents live in low and middle-income countries (LMICs), but few studies have used standardized methodology to monitor the prevalence and trends of sexual behaviors among adolescents in LMICs.
This study aimed to assess the prevalence of sexual behaviors (ever had sexual intercourse, multiple sexual partners, and condom use) among adolescents aged 12 years to 15 years as well as the trends in prevalence between 2003 and 2017.
For this population-based study, we used recent data from the Global School-based Student Health Survey conducted in 69 LMICs from 2003 to 2017 to assess the recent prevalence of sexual behaviors by using complex analysis and a random effects meta-analyses method. Using the chi-square trend test, we also assessed the trends in the prevalence of sexual behaviors in 17 countries that had conducted ≥1 round of surveys from 2003 to 2017.
We included 145,277 adolescents aged 12 years to 15 years (64,719/145,277, 44.5% boys) from the 69 LMICs that had conducted ≥1 survey and 80,646 adolescents aged 12 years to 15 years (34,725/80,646, 43.1% boys) from the 17 LMICs that had conducted ≥1 round of surveys. The recent global prevalence of ever had sexual intercourse was 6.9% (95% CI 6.2%-7.6%) and was higher among boys (10.0%, 95% CI 9.1%-11.1%) than girls (4.2%, 95% CI 3.7%-4.7%) and among those aged 14 years to 15 years (8.5%, 95% CI 7.7%-9.3%) than those aged 12 years to 13 years (4%, 95% CI 3.4%-4.7%). Among adolescents who had ever had sex, the recent global prevalence of having multiple sexual partners was 52% (95% CI 50.4%-53.6%) and was higher among boys (58%, 95% CI 56.1%-59.9%) than girls (41.4%, 95% CI 38.9%-43.9%) and among those aged 14 years to 15 years (53.5%, 95% CI 51.6%-55.4%) than those aged 12 years to 13 years (49.7%, 95% CI 45.9%-53.5%). Among adolescents who had ever had sex, the recent global prevalence of condom use was 58.1% (95% CI 56.2%-59.9%) and was higher among girls (59.2%, 95% CI 56.4%-61.9%) than boys (57.7%, 95% CI 55.7%-59.7%) and among those aged 14 years to 15 years (59.9%, 95% CI 58.0%-61.8%) than those aged 12 years to 13 years (51.6%, 95% CI 47.5%-55.7%). Between the earliest and latest surveys, the overall prevalence of ever had sexual intercourse (3.1% decrease) and condom use (2.0% decrease) showed downward trends. The overall prevalence of having multiple sexual partners increased by 2.6%.
We provide evidence and important implication for policymakers to develop targeted policy support systems to prevent and reduce risky sexual behaviors among young adolescents in LMICs with a high prevalence of risky sexual behaviors.
在青少年中，危险的性行为仍然是重大的公共卫生挑战。近 90%的青少年生活在中低收入国家（LMICs），但很少有研究使用标准化方法来监测 LMICs 中青少年性行为的流行率和趋势。
本研究旨在评估 12 至 15 岁青少年发生性行为（曾有过性行为、多个性伴侣和使用安全套）的流行率，并评估 2003 年至 2017 年之间流行率的变化趋势。
本基于人群的研究使用了最近来自全球学校学生健康调查（2003 年至 2017 年在 69 个 LMICs 进行）的数据，采用复杂分析和随机效应荟萃分析方法评估性行为的近期流行率。使用卡方趋势检验，我们还评估了在 2003 年至 2017 年期间进行了至少一轮调查的 17 个国家中性行为流行率的变化趋势。
我们纳入了来自进行了至少一轮调查的 69 个 LMICs 的 145277 名 12 至 15 岁青少年（64719/145277，44.5%为男孩），以及来自进行了至少一轮调查的 17 个 LMICs 的 80646 名 12 至 15 岁青少年（34725/80646，43.1%为男孩）。最近全球曾有过性行为的流行率为 6.9%（95%CI 6.2%-7.6%），男孩（10.0%，95%CI 9.1%-11.1%）高于女孩（4.2%，95%CI 3.7%-4.7%），14 岁至 15 岁青少年（8.5%，95%CI 7.7%-9.3%）高于 12 岁至 13 岁青少年（4%，95%CI 3.4%-4.7%）。在曾有过性行为的青少年中，最近全球有多个性伴侣的流行率为 52%（95%CI 50.4%-53.6%），男孩（58%，95%CI 56.1%-59.9%）高于女孩（41.4%，95%CI 38.9%-43.9%），14 岁至 15 岁青少年（53.5%，95%CI 51.6%-55.4%）高于 12 岁至 13 岁青少年（49.7%，95%CI 45.9%-53.5%）。在曾有过性行为的青少年中，最近全球安全套使用的流行率为 58.1%（95%CI 56.2%-59.9%），女孩（59.2%，95%CI 56.4%-61.9%）高于男孩（57.7%，95%CI 55.7%-59.7%），14 岁至 15 岁青少年（59.9%，95%CI 58.0%-61.8%）高于 12 岁至 13 岁青少年（51.6%，95%CI 47.5%-55.7%）。在最早和最新的调查之间，曾有过性行为（下降 3.1%）和使用安全套（下降 2.0%）的整体流行率呈下降趋势。多个性伴侣的整体流行率增加了 2.6%。
我们为政策制定者提供了证据和重要启示，以制定有针对性的政策支持系统，以预防和减少中低收入国家中高风险性行为青少年的危险性行为。
