Analysis of the Sexual Behavior Status and Influencing Factors Among Undergraduate first-year students at Overseas Universities in China

Objective This study aims to analyze the status of sexual behavior and its influencing factors among first-year undergraduate students in Chinese overseas Chinese schools, providing scientific evidence for university sexual health education and public health interventions. It also explores sexual behavior patterns and prevention strategies in a multicultural context. Methods A cluster sampling method was employed to conduct a questionnaire survey among the 2023 cohort of freshmen at Huaqiao University (n=4892) in October 2023. The questionnaire covered basic sociodemographic characteristics, knowledge about HIV and monkeypox prevention, and sexual behavior. Chi-square tests and binary logistic regression models were used to analyze the differences in sexual behavior among students with different characteristics and the main influencing factors. Results The study found that the sexual behavior occurrence rate among students was 6.6%. The rate was significantly higher among students from Hong Kong, Macau, and Taiwan compared to those from Mainland China and abroad (P<0.05). Binary logistic regression analysis showed that, compared with Mainland Chinese students, students from Hong Kong, Macau, and Taiwan had a significantly higher occurrence of sexual behavior (OR=3.737, 95%CI: 2.846~4.908). Students with higher knowledge about monkeypox had a higher occurrence of sexual behavior (OR=1.174, 95%CI: 1.060~1.301). Students who were aware of the consequences of homosexual behavior had a significantly lower occurrence of sexual behavior (OR=0.453, 95%CI: 0.346~0.594). Compared with those who opposed homosexual behavior, students with neutral and supportive attitudes toward homosexual behavior had a lower occurrence of sexual behavior (OR=0.377, 95%CI: 0.287~0.496; OR=0.371, 95%CI: 0.218~0.629). Students who received HIV prevention services in the past year had a lower occurrence of sexual behavior (OR=0.294, 95%CI: 0.213~0.405), while those who participated in HIV awareness services in the past year had a higher occurrence of sexual behavior (OR=4.280, 95%CI: 3.140~5.834). Conclusion The occurrence rate of sexual behavior among first-year students in Chinese overseas Chinese schools is relatively low, but significant differences are observed based on region of origin, gender, and knowledge level. The study indicates that sexual health education should focus on students' cultural background, gender roles, and cognitive differences, combining behavioral interventions to enhance the relevance and effectiveness of education and reduce high-risk sexual behaviors.