In this study, we investigated sexual attitudes and behavior among unmarried female factory workers in China. The results revealed that a majority of unmarried female workers in our study disapproved of premarital sex, and only 13.1% of subjects held a favorable attitude towards premarital sex, which is inconsistent with previous studies conducted in China [21, 22]. Significant differences on attitudes toward premarital sexual intercourse and pregnancy were found between the west and the east/center provinces, which may be due to differences in social-economic and cultural backgrounds .
Over the last two decades, China has experienced profound social changes associated with the economic reforms. Dramatic changes also seem to have occurred in cultural beliefs and behaviors, such as beliefs about sex, premarital sexual intercourse and premarital pregnancy . In our study, the self-reported rate of premarital sexual intercourse was 17.0%, and 26.4% of those who experienced sexual intercourse reported becoming pregnancy. A study conducted in China reported that the rate of premarital sexual intercourse in unmarried migrant females was 26.9% , which was higher than in our study. Differences in demographic characteristics may be at least a partial explanation for the study outcomes. In our study, all participants had been away from their home towns for less than one year, and this had been indicated as one of potential risk factors of engaging in premarital sexual intercourse in previous study [25, 26]. Additionally, rates of sexual experience reported by females from the east were higher than that reported by females from the west, although they were similar in some demographic characteristics, such as age, education level, dating status, etc. These findings seem to suggest that different social environment promote different attitudes towards premarital sex which may lead to a different sex-related behavior [27, 28].
This study showed a low level of sexual knowledge scores for females from both the west and the eastern/central provinces of China. A very small proportion of participants correctly answered all questions. This may indicate that health education in China provides little information on sexual issues to unmarried females . This study also highlights the importance of sex education by showing that the higher the educational level of the participants, the better the understanding of sexual knowledge. This confirms that schools are one of the main sources of knowledge and influence, as well as parents and peer groups. While much effort and many resources have been earmarked for sex education in schools, family education seems to have been ignored, although it is one of the most important parts of education .
In our study, the results show that age, education level, current residential type, dating status, sexual-related knowledge, attitudes, and communication with their boyfriend on sex-related issues are associated with premarital sexual intercourse, which are similar to the findings of previous studies [24, 31]. Previous studies have suggested that premarital sexual intercourse is a behavior resulting from the interaction of family, social, personal and environmental factors [32, 33]. Different types of family environments are postulated to be related to premarital sexual intercourse, such as parents' disciplinary style, parents' marital status, communication status, and even the economic level . Other social and environmental risk factors included occupation, laws, morality, and customs . Personal risk factors include physiological drive, sex-related knowledge, attitude and beliefs . The risk factors can also be classified into three categories: predisposing factors, enabling factors and reinforcing factors. Many researches have found that attitudes to sex have an enormous influence on sexual activities [22, 36]. In the present study, current residential type was a prominent factor associated with premarital sex which was consistent with a previous study conducted in China ,
Our study indicated that females who communicate with boyfriends on sex-related issues were more likely to engage in premarital sex, which was inconsistently reported in previous studies. For example, some previous studies demonstrated a prospective relationship between parent-youth communication and premarital sexual behavior . However, Mallika A et al reported that the exposure to alcohol, drugs or pornographic films and having more frequent interaction with peers were positively associated with romantic and sexual relationships for both young women and young men , similar results were also reported by Mee-Lian Wong et al . It should also be noted that the rates of sexual intercourse in this population are far below reported rates for western populations of similar age .
The present study must be interpreted in light of several limitations. First, although the study achieved a relative large sample size, we did not use a random sampling method to select the study population, which might have led to selection bias. Some unmarried female workers who had not experienced premarital sexual intercourse might have been more willing to take part in the present study rather than those who were more experienced. However, this is not likely in view of the association between sexual activity and communication shown in this study.
Second, it is possible that the study population underreported their behaviors since sexual behavior is a sensitive subject and socially unacceptable under Chinese culture . However, by ensuring privacy during the completion of questionnaire and using the anonymous self-administered survey, an attempt was made to minimize this bias .
Third, we did not consider some other factors which may be associated with the occurrence of premarital sexual intercourse, including parents' occupation, education level, and relationship with their parents. This might/could lead to different models predicting premarital sexual intercourse. Therefore, the investigation of these and other factors remains key directions for future research.
Fourth, this study was a cross-sectional design, and determining causality must be inferred and can not be tested in the data. Therefore, the findings should be validated in future longitudinal research.