title: A multi-center survey of age of sexual debut and sexual behavior in Chinese women: suggestions for optimal age of human papillomavirus vaccination in China.
abstract: OBJECTIVE
  Cervical cancer is the second most common cancer among women worldwide, and over 85% of cervical cancers occur in developing countries such as China. Lack of resources for nationwide cervical cancer screening in China makes vaccination against oncogenic strains of HPV particularly important. Knowledge of age at sexual debut and sexual behavior is essential prior to implementation of a national vaccination program.
  
  
  METHODS
  A cross-sectional epidemiologic survey was conducted across 21 urban and rural sites in China to assess age at sexual debut and sexual behavior. 98.6% of the 11,852 recruited women aged 15-59 years were included in the analysis. Data were collected using a short, nurse-administered questionnaire and analyzed using standard descriptive statistics and survival analysis.
  
  
  RESULTS
  In urban areas, more than ten percent of the 15-19 year old age group were already sexually active at the time of interview; this number increased to nearly 44% in the 20-24 year old age group. Chinese young women with an occupation were more likely to be sexually active compared to female students of the same age, irrespective of area of residence. The crude median sexual debut age for the youngest age group was 17 years, earlier than the sexual debut age reported by older cohorts. Younger age cohorts had an earlier menarche age than older cohorts and were more likely to have more sexual partners than older women, and more likely to have partners with more than one female partner.
  
  
  CONCLUSIONS
  There is a trend towards earlier sexual debut and riskier sexual behaviors in younger age groups of Chinese women. These findings suggest that HPV vaccination of women between the ages of 13 and 15 years, before the completion of national compulsory education, is likely to contribute to the prevention of HPV infection and cervical cancer in China.
authors.affiliation: Department of Epidemiology, Cancer Institute of Chinese Academy of Medical Sciences, Peking Union Medical College, 17 South Panjiayuan Lane, PO Box 2258, Beijing 100021, China.
authors.forename: Fang-Hui
authors.initials: FH
authors.lastname: Zhao
authors.forename: Sarah M
authors.initials: SM
authors.lastname: Tiggelaar
authors.forename: Shang-Ying
authors.initials: SY
authors.lastname: Hu
authors.forename: Li-Na
authors.initials: LN
authors.lastname: Xu
authors.forename: Ying
authors.initials: Y
authors.lastname: Hong
authors.forename: Mayinuer
authors.initials: M
authors.lastname: Niyazi
authors.forename: Xiao-Hong
authors.initials: XH
authors.lastname: Gao
authors.forename: Li-Rong
authors.initials: LR
authors.lastname: Ju
authors.forename: Li-Qin
authors.initials: LQ
authors.lastname: Zhang
authors.forename: Xiang-Xian
authors.initials: XX
authors.lastname: Feng
authors.forename: Xian-Zhi
authors.initials: XZ
authors.lastname: Duan
authors.forename: Xiu-Ling
authors.initials: XL
authors.lastname: Song
authors.forename: Jing
authors.initials: J
authors.lastname: Wang
authors.forename: Yun
authors.initials: Y
authors.lastname: Yang
authors.forename: Chang-Qing
authors.initials: CQ
authors.lastname: Li
authors.forename: Jia-Hua
authors.initials: JH
authors.lastname: Liu
authors.forename: Ji-Hong
authors.initials: JH
authors.lastname: Liu
authors.forename: Yu-Bo
authors.initials: YB
authors.lastname: Lu
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhou
authors.forename: Jin-feng
authors.initials: JF
authors.lastname: Liu
authors.forename: Na
authors.initials: N
authors.lastname: Zhao
authors.forename: Johannes E
authors.initials: JE
authors.lastname: Schmidt
authors.forename: You-Lin
authors.initials: YL
authors.lastname: Qiao
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D002681:China; D005260:Female; D006801:Humans; D008875:Middle Aged; D030361:Papillomavirus Infections / Q000517:prevention & control; D053918:Papillomavirus Vaccines / Q000008:administration & dosage*; D012725:Sexual Behavior / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D053918:Papillomavirus Vaccines