Methods: We used data from the 2009 Survey of Youth Access to Reproductive Health in China, a nationally representative sample of unmarried youth aged 15-24, obtained through stratified sampling and probability-proportionate-to-size sampling (N=22,288). Six indicators were used to assess patterns of sexual behavior: timing of first sexual encounter, number of past-year partners, sex outside of a relationship, incidence of pregnancy, and contraceptive use at the latest and the first sexual encounters. Latent class analysis (LCA) was conducted to first identify latent classes of sexual behavior and then to examine the associations between substance use, family structure and sexual behavior patterns, controlling for demographic characteristics.
Results: The analytic sample included 21,991 subjects (297 cases were excluded due to missingness on all six indicators). After considering statistical indices, parameter estimates, and conceptual/practical implications, a four-class solution was chosen and labeled Abstinent (Class1, 77%), Safe Sex (Class2, 10%), Low-Risk (Class3, 10%), and High-Risk (Class4, 3%). Safe Sex youth had a high probability of initiating first sex after age 18, having only one partner, engaging in relationship-only sex, never becoming pregnant/causing partners to become pregnant, and using contraception in both the latest and the first sexual encounters. Low-Risk youth were similar to Safe Sex youth except that they had a very low probability of using contraception during the first sexual encounter. High-Risk youth had a high probability of initiating sex before age 18, having multiple partners, engaging in non-relationship sex, having a pregnancy/causing partners to become pregnant, and using contraception in the latest, but not the first, sexual encounter. LCA with covariates showed that smoking was significantly associated with membership in riskier classes (4>2/3>1). Drinking was associated with membership in sexually active classes relative to the Abstinent class (2>1; 3>1; 4>1). Growing up with two biological parents living in the same home was associated with being in Class 1, 2 or 3 relative to the High-Risk class (1>4; 2>4; 3>4).
Conclusions and Implications: This study employs a person-oriented approach and shows that there are qualitatively different patterns of sexual behavior among youth in China. The complexity of sexual behavior needs to be addressed by policymakers and social workers when offering individually-tailored sex education and reproductive health services. Screening on substance use and social support to youth from non-two-biological parent households can be integrated in order to make reproductive health interventions comprehensive and effective.