中国珠海大学生无保护性行为风险评估模型的建立：一项横断面研究。
Development of a risk estimation model for condomless sex among college students in Zhuhai, China: a cross-sectional study.
机构信息
Department of Epidemiology and Biostatistics, School of Public Health, Guangdong Pharmaceutical University, Guangzhou, China.
Zhuhai Center for Disease Control and Prevention, Zhuhai, China.
出版信息
BMC Public Health. 2024 Mar 8;24(1):742. doi: 10.1186/s12889-024-18183-9.
BACKGROUND
Condom use at last intercourse is an effective indicator for human immunodeficiency virus (HIV) prevention. To identify at-risk individuals and improve prevention strategies, this study explored factors associated with condomless sex at last intercourse in the last year and developed a risk estimation model to calculate the individual possibility of condomless sex among college students in Zhuhai, China.
METHODS
A cross-sectional study was conducted among 1430 college students who had sex in the last year from six universities in Zhuhai. The least absolute shrinkage and selection operator (LASSO) and logistic regression were performed to explore the predictors of condomless sex. The nomogram was constructed to calculate the individual possibility of condomless sex. Discrimination and calibration of the nomogram were evaluated using the area under the receiver-operator characteristic curve (AUROC) and the calibration curve.
RESULTS
The proportion of students who had condomless sex at last intercourse was 18.2% (260/1430). Students who had experienced more types of intimate partner violence (aOR, 1.58; 95% CI, 1.31 ~ 1.92) and had anal sex (aOR, 1.75; 95% CI, 1.06 ~ 2.84) were more likely to have condomless sex. Students who had heterosexual intercourse (aOR, 0.37; 95% CI, 0.21 ~ 0.70), used condoms at first sex (aOR, 0.20; 95% CI, 0.14 ~ 0.27), had high attitudes towards condom use (aOR, 0.87; 95% CI, 0.80 ~ 0.95) and self-efficacy for condom use (aOR, 0.84; 95% CI, 0.78 ~ 0.90) were less likely to have condomless sex. The nomogram had high accuracy with an AUROC of 0.83 and good discrimination.
CONCLUSIONS
Intimate partner violence, anal sex, condom use at first sex, attitude towards condom use, and self-efficacy for condom use were associated with condomless sex among college students. The nomogram was an effective and convenient tool for calculating the individualized possibility of condomless sex among college students. It could help to identify individuals at risk and help universities and colleges to formulate appropriate individualized interventions and sexual health education programs.
背景
最后一次性行为使用安全套是预防人类免疫缺陷病毒（HIV）的有效指标。为了识别高危人群并改进预防策略，本研究探讨了过去一年中最后一次性行为中未使用安全套的相关因素，并为中国珠海大学生建立了一个风险估计模型，以计算个人发生无保护性行为的可能性。
方法
对来自珠海六所大学的过去一年中有过性行为的 1430 名大学生进行了横断面研究。采用最小绝对收缩和选择算子（LASSO）和逻辑回归来探讨无保护性行为的预测因素。建立列线图来计算个人发生无保护性行为的可能性。使用受试者工作特征曲线（AUROC）和校准曲线评估列线图的区分度和校准度。
结果
最后一次性行为中未使用安全套的学生比例为 18.2%（260/1430）。经历过更多类型的亲密伴侣暴力（aOR，1.58；95%CI，1.311.92）和肛交（aOR，1.75；95%CI，1.062.84）的学生更有可能发生无保护性行为。发生异性性行为（aOR，0.37；95%CI，0.210.70）、首次性行为使用安全套（aOR，0.20；95%CI，0.140.27）、对安全套使用持积极态度（aOR，0.87；95%CI，0.800.95）和安全套使用自我效能感（aOR，0.84；95%CI，0.780.90）较高的学生发生无保护性行为的可能性较低。列线图具有较高的准确性，AUROC 为 0.83，具有良好的区分度。
结论
亲密伴侣暴力、肛交、首次性行为使用安全套、对安全套使用的态度和安全套使用自我效能感与大学生无保护性行为有关。列线图是一种有效且方便的工具，可用于计算大学生无保护性行为的个体化可能性。它可以帮助识别高危人群，并帮助大学制定适当的个体化干预和性健康教育计划。
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