Objective: To explore the association between mothers reactions to adolescents exposure to intimate shots and pornography use of junior high school students, and to provide references for family communications on sexual topics in similar scenarios. Methods: A total of 1 760 students from grade 6 to 8 in three junior high schools in a certain district of Shanghai were selected by cluster sampling. Self-filled questionnaires on tablets were used to collect data. Results: The proportion of junior high school students who watched pornography was 26.36%(464), and that of boys (29.83%，270/905) was higher than of girls (22.69%，194/855). Most junior high school students believed that mothers reactions to adolescents exposure to intimate shots would be “taking the opportunity to educate teenagers not to do this” (30.54%) or “avoiding adolescents watching intimate shots” (42.24%). The results of multivariable analysis showed that comparing with junior high school students who believed that mothers would “watch together without making any comments ”, students who believed that mothers would “take the opportunity to educate teenagers not to do this”(OR=0.43, 95%CI=0.29-0.64) and “avoid adolescents watching intimate shots”(OR=0.56, 95%CI=0.39-0.80) were at lower risk of viewing pornography (P<0.01). Conclusion There is a significant correlation between junior high school students pornography use and mothers possible reactions to adolescents exposure to intimate shots. Family sex education and parental monitoring should be emphasized, and parents awareness of communicating sexual issues with adolescents should be strengthened.

Objective: To explore the relationship between gender role attitudes (GRA) and adolescent depression to provide evidence for the promotion of mental health among adolescents. Methods: A total of 1 549 students from grades 6 to 8 in three public middle schools in Jing an District of Shanghai were selected by stratified cluster sampling. The baseline and follow up surveys were conducted by anonymous electronic questionnaire on mobile tablets from November to December in 2017 and 2018, respectively. The GRA Scale and the Depression Scale were used to collect subjects attitudes towards traditional role assignment and power inequality between men and woman and depression in family and sexual relationships. The multivariate Generalized Estimating Equations (GEE) model was adopted to examine the relationship between GRA and depression. Results: The mean score of the GRA Scale was (2.52±0.83) and (2.29±0.86), while the score of Depression Scale was (15.92±5.08) and (16.48±5.29), in the baseline and follow up survey, respectively ( P <0.05). After controlling the covariates of age, bullied experience, body image, social cohesion, etc., the multivariate GEE model indicated traditional GRA was significantly associated with a higher risk of depression among both boys and girls ( β boys =0.38, β girls =0.41, P <0.05). Conclusion Traditional GRA may increase the risk of depression in adolescents, suggesting that cultivating a positive and equal GRA among this population group may help to prevent depression.

Objective: To explore the prevalence of sexting among secondary vocational school students and to examine the correlation between sexting and mental health, so as to provide evidence for prevention and intervention on adolescents mental health. Methods: In April 2021, three secondary vocational schools from central urban area, outskirts and outer suburbs in Shanghai, among 1 580 students were selected by cluster sampling. Results: The proportions of students who received and who forwarded others private photos or videos were 11.96% and 2.78%, respectively. The proportion of students who sent others personal photos or videos was 2.54%. And the proportions of boys were higher than those of girls ( χ 2=45.89, 24.09, 6.66, P <0.01). The results of multivariable Logistic analysis showed that compared with those who had never sexted, students who had ever had any sexting were at higher risk of anxiety ( OR=2.40, 95%CI =1.59-3.61), depression( OR=1.86, 95%CI =1.25-2.75), non suicidal self injury intention ( OR=2.34, 95%CI =1.48-3.69) and suicidal intention ( OR=2.96, 95%CI =1.83-4.79)( P < 0.05 ). Conclusion There is a significant correlation between sexting and mental health among secondary vocational school students. The latent risks of sexting should be included in the curriculum of comprehensive sex education for teenagers to enhance their media literacy and decision making capability, so as to prevent sexual assault or abuse caused by sexting and promote sexual and reproductive health and as well as mental health of adolescents.

Objective: To explore the heterosexual romantic expectation in early adolescence(10-14 years)and its influencing factors, and to provide a reference for instructing children of early puberty to establish a positive interpersonal relationship(including heterosexual relationship) and improving their healthy development. Methods: Stratified cluster sampling method was adopted to recruit students of grade 6-8 in three middle schools of Shanghai during November to December, 2017. Students were surveyed anonymously using Computer Assisted Self-Interview approach via the tablets. The collected data included the information on demographic, families, peers, use of the media, community cohesion and heterosexual romantic expectation. The ttest, Chi-square test, ANOVA and multiple linear regression were used to explore the relationships between potential factors and heterosexual romantic expectation. Results: The mean score of heterosexual romantic expectation was 2.55. Score of the boys was higher than that of girls (2.62 vs. 2.47, t=2.65, P<0.05). There was no statistically significant difference between the scores of the ages before 12 years old (10-11: 2.34, 12: 2.28), but a significant increase of the scores along the age after 12 years old(13: 2.69, 14: 3.05). Multiple linear regression suggested that respondents with older age, poorer caregiver-child relationship, higher proportion of friends of the opposite sex, more friends that thought having boyfriends/girlfriends was important, more TV/movie use and lower community cohesion had higher score of heterosexual romantic expectation of early adolescents(P<0.05). Conclusion The early adolescents had relative conservative views on the heterosexual romantic relationships of adolescents of their own age while the boys were more permissive than girls. The heterosexual romantic expectation improved significantly after 12 years and may be influenced by factors of family, peers, media and community.

Objective: To explore the relationship between different roles in campus bullying and depression among adolescents. Methods: Stratified cluster sampling method was used to select adolescents in grade 6-8 from three middle schools of Shanghai during November and December of 2017. Adolescents were surveyed anonymously using computer assisted self-interview approach via the tablets. Information including demographic characteristics, depression, and bullying was collected. The chi-square test and multivariate Logistic regressions were performed to explore the relationship between bullying roles and depression. Results: About 75.74% of the respondents were involved in bullying, including 456(27.65%) bystanders, 559(33.90%) victims, 33(2.00%) perpetrators, and 201 (12.19%) perpetrator-victims. There were 1 022(61.98%) respondents in the low depression group and 627 (38.02%) in the high depression group. Multivariate logistic regression showed that the four sub-groups involved in bullying all had higher level of depression than those uninvolved, with the perpetrator-victims (OR=4.77, 95%CI=3.27-6.96) and the victims (OR=3.66, 95%CI=2.71-4.94) had more depressive symptoms. Conclusion Different roles in campus bullying associates with more depressive symptoms, including perpetrators, victims, perpetrator-victims, and the bystanders.

Objective: To explore the association between adverse childhood experiences (ACEs) and adolescent alcohol use and to provide evidence for prevention and intervention. Methods: A total of 1 550 students from grades 6 to 8 in three public middle schools in a district of Shanghai were selected by stratified cluster sampling method. The baseline and follow up investigation were conducted by anonymous electronic questionnaire in mobile tablet from November to December in 2017 and 2018, respectively. The latent class analysis (LCA) was applied for the classification of ACEs, while the multivariate generalized estimating Equations (GEE) model was adopted to examine the association between ACEs and adolescent alcohol use. Results: The ACEs was divided into 3 classes by LCA: high exposure (8.97%), abuse and neglect (38.97%), low exposure (52.06%). The multivariate GEE model indicates the risk of alcohol drinking among adolescents in high exposure and abuse and neglect classes were significantly higher than their counterparts in low exposure class ( OR=2.65, 95%CI=1.72-4.07; OR=1.50, 95%CI =1.14-1.96, respectively). Conclusion The effect of ACEs on alcohol use may vary across different latent classes. Supportive childhood environment may contribute to decrease the risk of adolescent drinking behavior.

Objective: To evaluate adolescents’ self-esteem and explore its influencing factors in order to provide basic evidence for improving self-esteem level and mental health of adolescents. Methods: A total of 5 709 adolescents of different characteristics from both urban and rural areas in six provinces were investigated anonymously with the method of computer-assisted self-interview (CASI). Self-esteem was evaluated by Self-Esteem Scale (SES, scored 10-40 points). Results: The average score of self-esteem was 28.15,28.40, 28.97 and 27.45 point for junior high students, senior high students, college students and out-of-school adolescents, respectively. The difference of the scores among the four groups was statistically significant(F=27.64, 14.41, P<0.01). More than 80% adolescents felt they were people of worth, were able to do things as most other people, took a positive attitude toward themselves and were satisfied with themselves. About 50% of adolescents thought they were no good at all at times. Less than 20% adolescents thought they had enough respect for themselves. About 11.57% to 22.22% of adolescents felt sad about their own gender, about 37.56% to 61.49% of adolescents often or sometimes felt sad about their body image. The multiple linear regression analysis showed that those who had a good overall feeling of family, satisfied with their own gender, and less worried about their body image tended to have a higher self-esteem scores among 4 groups(P<0.01). Other related influencing factors included parental education level, family economic status, only-child or not, birth place and parental preference for gender of their child. Conclusion Adolescents’ self-esteem was fair, and many factors were associated with it. It is necessary to strengthen the education on gender equality among parents and adolescents and to pay more attention to mental health of the adolescents, who were in rural areas, with poor family atmosphere and economic status.

Objective: To explore the relationship between Adverse childhood experiences(ACEs) and depression in early adolescence, and to provide scientific basis for effectively coping with the impact of ACEs on adolescents’ mental health. Methods: Stratified cluster sampling method was used to select adolescents in grade 6-8 in three middle schools of Shanghai during November and December of 2017. Adolescents were investigated anonymously using computer assisted self-interview approach via the tablets. Information including demographic characteristics, ACEs, and depression was collected. The chi-square test and multivariate logistic regression were used to explore the relationship between ACEs and depression, after controlling potential confounders. Results: Totally 1 629 eligible records were obtained. 65.25% of the respondents had experienced of neglect, followed by those abused(61.26%), and the incidence of family dysfunction was relatively low(20.81%). About 79.01% of the respondents had experienced at least one ACE, and more than half(61.45%) of the respondents had experienced at least two ACEs, and 10.01% of the respondents had experienced five or more ACEs. Multivariate logistic regression analysis showed that abuse and neglect experienced by male and female adolescents was associated with depression severity, with the OR values ranging from 2.62 to 3.60. Family dysfunction was found to be associated with depression only in male adolescents, with the OR of 1.91. The cumulative effect of ACE score on depression was observed. Conclusion Different types of ACEs in early adolescents are associated with depression, and ACEs have cumulative effects on depression severity.

Objective: To explore the gender stereotype in early adolescence and the potential influencing factors. Methods: Stratified cluster sampling method was adopted to recruit students of grade 6-8 in three middle schools of Shanghai during November to December, 2017. Students were surveyed anonymously using Computer Assisted Self-Interview approach regarding geder stereotype and associated factors. Results: Average gender stereotype score was (3.32±0.75), with boys(3.43±0.75)higher than the girls(3.20±0.72)(t=6.37, P<0.05). The "agreement" proportion was highest among gender stereotypes items which reflect personality characteristics such as "it’s important for boy to be strong and determined" "girls should be like a lady" and "girls were expected to be submissive"(60.99%，50.79%，43.95%), and the "agreement" proportion among boys increased with age, while decreased in girls. Boys who had sisters or recent bullying behaviors showed more gender stereotype[β(95%CI)=0.19(0.05-0.33), 0.39(0.12-0.67)]. Girls whose parents allowed to go to opposite sex homes alone had less gender stereotype, however, the gender stereotype became stronger when girls had more female peers[β(95%CI)=-0.22(-0.41--0.03),0.04(0.00-0.07)]. Conclusion The young adolescents, especially boys, show certain level of gender stereotype. The normal heterosexual friendships and safe campus environments would help promote young adolescents to establish equal gender beliefs.

Objective: To understand sexual and reproductive health (SRH) knowledge and access to sexual health information among pupils in higher grades, and to provide the scientific basis for conducting sexual education in family and school. Methods: A total of 1 098 pupils in grade four and five from 4 primary schools in a county, Jiaxing City, Zhejiang Province were selected for an anonymous computer assisted self-interview to get the information, including sexual and reproductive information and its sources, the condition about getting sexual education from school and family, and so on. Results: The percentage of correct answers about boy’s and girl’s puberty changes ranged from 15%~54%, and about reproduction and physiology ranges from 14%~70%. The awareness of private body parts ranged from 59%~98%. About 70%~95% could correctly identify sexual abuse scenes. The average score for knowledge on puberty changes, reproduction and physiology, identification of private body and identification of sexual abuse scenes was 31.89, 38.21, 77.03, and 85.72, with total average score of 58.21. In general, girls and students from urban areas or in grade five had higher knowledge level than boys and students from rural areas or in grade four did (P<0.05). Participants mainly obtained SRH knowledge from their mother(63.02%), father(40.53%) and teachers(27.50%). Girls and students from urban areas or in grade five reported higher proportion in access to information on human development, puberty development and health care, self-protection from parents and school teachers than boys and students from rural areas or in grade four(P<0.05). Conclusion Pupils in higher grades lacked SRH knowledge. It is necessary to raise awareness among school teachers and parents about the importance of providing sexuality education for pupils.