|Year : 2017 | Volume
| Issue : 4 | Page : 319-326
Sexual knowledge, attitude, behaviors and sources of influences in Urban college youth: A study from India
Siddharth Dutt, M Manjula
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
|Date of Web Publication||17-Nov-2017|
Department of Clinical Psychology, National Institute of Mental Health and Neurosciences (NIMHANS), Hosurl Road, Bengaluru, Karnataka
Source of Support: None, Conflict of Interest: None
Background: The study was undertaken as there is very less literature related to sources of influence for sexual knowledge and attitude toward sex and sexual behaviors of youth in India. Aim: The objectives of the study were to explore sexual knowledge, attitudes, behaviors and the sources of influence and also to examine the relationship between sexual knowledge, attitude and behaviors in the youth. Method: The sample was selected from colleges using purposive sampling method and from the community using snowball method (n = 300). The tools used were sociodemographic data sheet, Sexual Knowledge and Attitude Questionnaire (SKAQ-II) and Sexual Behavior and Sources of Influence (SBSI) scale. Results: Descriptive statistics and correlation was done to analyze the data. The youth had poor sexual knowledge; there was positive relationship between sexual knowledge and attitudes. Sexual behaviors through media and with self or others were found to be low. Internet was found to be the major source for gathering information and was considered the most reliable source. Conclusion: Indian college youth continue to have poor sexual knowledge. Internet is a major source of information and is considered as the most reliable one among youth. More knowledge about sex is associated with liberal attitude toward sex.
Keywords: Media, Sexual Behavior, Sources of Influence, Urban college youth
|How to cite this article:|
Dutt S, Manjula M. Sexual knowledge, attitude, behaviors and sources of influences in Urban college youth: A study from India. Indian J Soc Psychiatry 2017;33:319-26
|How to cite this URL:|
Dutt S, Manjula M. Sexual knowledge, attitude, behaviors and sources of influences in Urban college youth: A study from India. Indian J Soc Psychiatry [serial online] 2017 [cited 2019 Jul 16];33:319-26. Available from: http://www.indjsp.org/text.asp?2017/33/4/319/218602
| Introduction|| |
Currently, in many societies, unmarried, single youths are sexually more active than commonly realized. Adolescents also maintain sexual relationships, even though cultural values in countries like India do not permit this. Sexual behaviors of adolescents depend on their knowledge about sex, attitudes and sources of influence.
Sexual knowledge refers to the knowledge about sexuality, myths and misconceptions. The studies in this area cover knowledge about reproduction, pregnancy, masturbation, abortion, fertility, methods of contraceptive use and sexually transmitted diseases (STDs) and also gender differences in sexual knowledge., Sexual attitude refers to the attitude one has toward sexuality or sexual behaviors, which could be either liberal or conservative. Sexual knowledge and attitudes are often studied together. In a study exploring knowledge about reproductive health among 6549 married men in five districts of the northern state of Uttar Pradesh, India, it was reported that very few men had basic knowledge in areas pertaining to fertility, maternal health and STDs. Another study by Kumar and Tiwari  assessed the knowledge, attitude and behavior toward premarital sex among 469 youths living in two city slums. It was observed that only 17% of the youth population was aware of safe sex and 22% had the prior knowledge that even -time intercourse may lead to pregnancy. Joshi, in her study on sexual knowledge, attitudes and behaviors in urban youth (17-21 years), found that knowledge about physiology of sexual response, conception and pregnancy was less than that about other areas such as masturbation and contraception. Boys reported more liberal attitudes and more frequent sexual behaviors than girls. Social attitudes clearly favor cultural norms of premarital chastity, particularly for females, thereby leaving limited decision-making power in their sexual relationship.
Studies on sexual behaviors have looked at the kind of practices young adults indulge in such as premarital sex, masturbation, watching pornography and sexual behaviors using mediums such as phone, social networking sites and chatting rooms.,, Sexually active adolescents engage in practices that pose a risk to sexual health. An earlier age of initiation of sexual activity has been associated with less frequent condom use, greater number of sexual partners, elevated rates of STDs and unplanned pregnancies., Often they do not take informed decisions about sexual practices and use of contraceptives, resulting in significant risk of experiencing negative consequences.
Jejeebhoy and Sebastian  noted that a substantial proportion of young people who engage in risky or unwanted sexual activity do not receive prompt or appropriate care and therefore, experience adverse reproductive health outcomes. Contextual factors such as poverty, gender imbalances and lack of education or livelihood opportunities clearly increase the vulnerability of youth. Although young people's knowledge and awareness about sexual and reproductive health is increasing, much of this knowledge remains superficial and ridden with myths, misperceptions and a sense of invulnerability. Many factors that influence the early onset and increase in sexual activities of adolescents in developing countries include early age of sexual maturation, lack of knowledge about sex, declining cultural and religious influences and urbanization. Gender discrimination coupled with the stigma about discussing sex and sexuality issues with young people further contributes to risk-taking behaviors amongst youth, thus influencing their sexual and reproductive health.,
Although peers, books and magazines were the most frequently used sources of information on sex, Internet is gradually taking over all these sources. The Internet and other new media technologies such as digital cameras and cell phones have made sexually explicit materials more accessible to young people than ever before. Media plays a major role in determining whether certain teenagers become sexually active earlier rather than later. Much of the concern over increasing accessibility of explicit sexual content is that young people may develop unrealistic ideas about and/or undesirable patterns of sexual behavior because of the exposure.
The available literature on sexual knowledge and attitudes largely focuses on the knowledge in the context of HIV/AIDS. There are not many studies to report the sexual behaviors of the youth given the background of rapid urbanization and easy access to sexual material. Given the importance of sexual needs, the secrecy prevailing in sexual matters, lack of knowledge and free access to material and partners, there is a danger of involving in risky behaviors. There have not been many studies to find the sources of influence on youths' sexual knowledge and attitude toward sex or sexual behavior. Similarly, there is almost no literature on the influence of media. The study aimed at exploring the current sexual attitudes, knowledge and behaviors among the youth and their sources of influence, and also the relationship between above variables.
| Methods|| |
The ethical clearance for the study was obtained from Institute Ethics Committee of NIMHANS, Bengaluru. The sample consisted of 300 unmarried young adults from colleges in Bengaluru. Two hundred forty-eight of these were considered as completers (male = 129, female = 119). The inclusion criterion for the study was young adults who could understand English language, were in the age range of 18-25 years and consenting to participate in the study.
| Description of Tools|| |
Sociodemographic data sheet was used to collect details such as age, gender, education, occupation and socioeconomic status. A self-administered Sexual Knowledge and Attitude Questionnaire-II (SKAQ-II) was used to assess knowledge and attitudes. The 35-item knowledge part consists of dichotomous scoring with the maximum attainable score of 35. The attitude part has 20 items, scored on a three-point linear scale (0-2), with maximum obtainable total score of 40. Higher the scores, better the knowledge and more liberal the attitude. Its test-retest reliability is 0.43 for attitude and 0.66 for knowledge.
Sexual Behavior and Sources of Influence scale (Appendix 1) [Additional file 1] was developed by the researcher for the present study. The scale was divided into two sections: one for assessing sexual behavior and other for assessing sources of influence and scored on a five-point Likert scale. The sexual behavior section was further divided into three subsections: (a) sexual behaviors through various sources of media; (b) sexual behavior with self and others; and (c) lack of interest in sexual activity. The assignment of “low,” 'moderate,” “high,” and “very high” for the subsection sexual behaviors through media was 6-12, 13-18, 19-24 and 25-30, respectively; for the subsection sexual behaviors with self or others, it was 15-30, 31-45, 46-60 and 61-75, respectively.
| Procedure|| |
The phase of the study involved developing of the sexual behaviors and sources of influence scale, as there were no tools to examine the sexual behaviors and sources of influence in the Indian context. A checklist was prepared by examining surveys done in past to assess sexual behaviors and through three focused group discussions [(one girls group (n = 8) and two boys group (n = 7 and 14)]. The probes for the scale were developed and refined after the FGD and used for the next two. The probes covered normal sexual behaviors, risky sexual behaviors, sources of gathering information and sharing of gathered information. The scale was later given to five mental health professionals with more than 5 years experience for establishing face validity. The tool was assessed for suitability, language, content and domains. Based on the suggestions, the number of items were reduced, combined, added and reorganized. The internal consistency for the items in the three subscales of sexual behaviors was Cronbach's alpha of 0.74 for sexual behaviors through media; 0.90 for sexual behaviors with self and others and 0.60 for aversion to sexuality. Sample from the colleges was obtained after getting permission from college authorities. The study tools were administered in group format after the informed obtaining consent from the participants. Ethical considerations such as confidentiality, anonymity, right to participate and right to withdraw at any point of the study were ensured.
Descriptive statistics such as mean, standard deviation, frequency, percentage and correlation were used. Cronbach's alpha was used to find out the internal consistency of the Sexual Behavior and Sources of Influence scale. Correlation between sociodemographic variables, sexual knowledge, sexual attitude and sexual behaviors was determined.
| Results|| |
The sample comprised of more number of males (n =129, 52%) than females (n = 119, 48%). Average age was 20.5 years. With respect to the courses that they were pursuing, 83 were doing business management, 66 commerce and 99 arts. All of them were from middle and upper middle class socioeconomic status.
Sexual knowledge and sexual attitude
The mean score for sexual knowledge was 16.31 (±5.84), which indicates that the participants had poor knowledge regarding sexuality. The item analysis for most frequently agreed and disagreed items are given in [Table 1].
|Table 1: The most frequently agreed and disagreed items on sexual knowledge and attitude questionnaire (n = 248)|
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The mean score for sexual attitude was 37.99 (±6.11), indicating that the participants had a liberal attitude toward sexuality. The item analysis showed that 61% of them agreed that it is always bad to engage in extramarital sex; 75% agreed that abortion should always be with permission; 55% agreed that virginity should be encouraged in our society and 52% of them disagreed on abortion is not a crime.
Sources of influence
The youth gathered information about sexuality largely from Internet, friends, movies, newspapers, magazines and books compared with getting knowledge from parents and family members. With respect to clarifying doubts, most of them relied on friends, and the least preferred source was parents. They trusted Internet as the most reliable source of information followed by friends and printed material compared with other sources.
Sexual behaviors of the youth
The mean for sexual behaviors through media was 10.02 (±4.37), indicating low level of indulgence in sexual behaviors using media. The mean for sexual behaviors with self and others was 25.79 (±13.55), indicating low level of indulgence. The mean for not interested in sexual behaviors was 5.43 (±2.7), indicating low level of aversion to sexuality. The percentage of youth reporting indulgence in sexual behaviors across various subsections is presented in [Table 2].
|Table 2: Sources of influence and sexual behaviors as reported by participants (n = 248)|
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[Table 3] shows that there is positive correlation between sexual knowledge and sexual attitude, indicating that more the knowledge one has about sexuality, more liberal is his/her attitude towards sexuality. There was significant positive correlation between sexual behaviors through media and sexual behaviors with self and others, indicating that individuals who tend to indulge in sexual behaviors through media are also likely to indulge in sexual behaviors with self and others.
|Table 3 : Relationship between sexual knowledge, attitude and behaviors (n = 248)|
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| Discussion|| |
The participants in the study had poor knowledge regarding sexuality such as masturbation, sexuality in females and children and effects of increased sexual activity. This is inconsistent with the study done by Choi and Ha, who found that although sexual knowledge was low with college students, knowledge with regard to masturbation, induced abortion and contraception was high in their sample. The item analysis indicated that they tend to have good knowledge regarding STDs and condom usage for prevention of STDs [Table 1]. This finding was inconsistent with studies by Bloom et al., who explored the knowledge about reproductive health among males, and a study by Kumar and Tiwari, who reported that only 17% of college students knew about safe sex practices, STDs and maternal health. The reason for the present sample to have better knowledge may be that the youth in the present study were better educated or gathered more knowledge about safe sex practices. It can also be noted that the sample being tech savvy and many of them had relied on the Internet and social networking sites to obtain information would have contributed to clarifying the doubts or attaining knowledge easily without hesitation and feelings of stigma [Table 2].
The participants showed liberal attitude toward sexuality, this could be because of the participants' education level  as well as the urban background. They would have got oriented to these issues through the numerous sex educational programmes conducted in the urban educational set ups. Item analysis of the scale showed that the participants expressed conservative attitude toward premarital and extra marital sexual practices, which could be because of sociocultural factors and family values where there is strict ideology regarding these issues. They expressed liberal attitude over usage of contraceptives and abortion. The finding may be understood in the background of major campaign on prevention of AIDS in recent times, which encourage usage of contraceptives. The campaign majorly happens through mass media to which everybody is exposed often. They expressed neutral attitude toward homosexuality and sexual practices of females, this could be because of increased sensitivity and acceptance about homosexuality leading to a neutral stance.
With respect to sources of information regarding sexual matters, majority of the participants gathered information from Internet; this could be because of easy access to information through Internet. This result is in accordance with the study done by M'Imaita, who found that information accessed through the media by adolescents included pornographic pictures and text, dressing and fashion, sex styles and contraceptive use. The Internet has become an abundant source of both sexual information and pornography which is difficult to regulate.
A large percentage of the youth in the study get the knowledge from friends. This could be because discussing sexual matters openly is a taboo and parents or family members are often hesitant in initiating or discussing about it, youth choose to discuss with friends. This is further corroborated by the fact that very low percentage of them get information from parents and family members [Table 2]. Further, half of the participants get information about sexual matters from the movies. While movies are considered as one of the important sources of information, it can also foster misconceptions, since the content in the movies can be distorted in terms of views on romance and normal adolescent sexuality, sexual performance and stereotypes of male and female sexuality. Similarly, less than half of the participants get information from newspaper, magazine and books. However, Joshi  found that peers, books and magazines were the most frequently used source of sex information. Now that the electronic media is available in various forms, access to Internet is replacing the print media in gathering information.
With regards to sources for clarifying doubts or experiences regarding sexuality, participants found discussing or clarifying among friends as comfortable. This could be because the youth might feel that their peers might also have had similar doubts/experiences, since they are also of the same age and also that they tend to spend lot of time together, thus may be comfortable discussing personal issues. A lower percentage of them found discussing sexual matters with doctors or medical professionals comfortable. This hesitation could be because the professionals often themselves find it uncomfortable and they do not ask about these issues. A very less percentage of them discussed these matters with parents, teachers and other family members, which may be because of taboo associated with talking about sexual matters in our country., Some of them indicated that they feel comfortable discussing with siblings, which may again be because of the same age range.
The sources which the youth consider reliable to provide information about sexuality were Internet, followed by friends, and newspaper, magazines and books, movies, parents and family members.
The findings on sexual behavior of the youth show that the indulgence in sexual behaviors was low. However, the percentages on various kinds of indulgence [Table 2] show that majority of them used Internet, television and reading material to fulfill their sexual desires. About 7-11% indicated that they involve in chatting on the social networking sites, make friends on websites meant for discussion on sexual matters and use SMS/MMS to get sexual satisfaction. Although the percentage is not high, it definitely indicates the trend toward using more of electronic media to obtain sexual gratification. The findings suggest the need to regulate the information in these media to facilitate healthy attitudes, objective knowledge and healthy behaviors.
With respect to sexual behaviors with self or others, average score falls under the category of low level of indulgence. Further analysis of each behavior shows that more than 7-16% of them are involved in various sexual behaviors including masturbation and sexual behaviors with same-sex and opposite-sex partners. Which is similar to a study done by Smith et al. in Australia (8.6% of women and 5.9% of men reported some homosexual sexual experience in their lives). The findings reflect on the fact that the homosexual attraction and orientation may be similar across cultures. The percentages were lower compared with a study done by Kumar and Tiwari, where they found that 23% of the youth slum dwellers in Delhi and 13% of youth slum dwellers in Lucknow had engaged in premarital sex.
It was also found that less than 10% of them indulge in unsafe sexual practices such as indulging in sexual activity with more than one partner and engage in sexual intercourse with commercial sex workers. Also, around 15% of them disclosed that they indulge in safe sex practices, such as using contraceptives or other safe sex precautions. Studies suggest that sexual behavior falls along a continuum: from nonpenetrative activities such as hand holding, kissing and touching to intercourse. For example, a study of low-income college students in Mumbai shows that while 26% of young men and 3% of young women reported penetrative sex, 49 and 13%, respectively, reported other forms of physical intimacy such as kissing and touching. The suggestion that penetrative sexual activity may be preceded by periods of nonpenetrative experience offers a window of opportunity for counselling and safe sex messages. With regards to interest in sexual matters, more than half of the participants indicated that they have engaged in sexual behaviors, that thoughts about sex are not aversive to them and did not lack interest in sexual behaviors.
A positive relationship between sexual attitude and knowledge could be interpreted as more the knowledge a person has regarding sexuality the more liberal attitude he/she has toward it [Table 3]. However, there was no association between knowledge about sex and having a conservative or a liberal attitude and indulgence in sexual behaviors, indicating that these do not mediate sexual behaviors. Positive correlation between sexual behaviors through media and sexual behaviors with self or others indicate that individuals who read literature about sex and watch pornography are more likely to indulge in behaviors such as masturbation or sexual behaviors with others. Media are powerful sources for behavioral “scripts” concerning sexual situations for inexperienced teenagers. The media seems to make sex a harmless sport in which everyone engages, and it can have a major effect on young people's attitudes and behaviors.
The strengths of the study are using sexual behaviors scale which provided comprehensive data on behaviors the youth indulged in and the sources that influenced their behavior. The study also tried to find relationship between sexual knowledge, sexual attitude and sexual behaviors. The limitations of the study are that all the participants belonged to the urban background, thus limiting its scope to the youth from rural setting. Including the rural youth would have given differences due to limitations of settings and the sociocultural background. Another major drawback was that during the group administration of the questionnaires, even though confidentiality and anonymity was assured, the factor of hesitation in answering truthfully and the answers of peers would have influenced the responses. Similarly, the factor of social desirability would have influenced non acknowledgement of certain behaviors/practices. Due to time constraints, only content validity and internal consistency of the tool were established.
| Conclusion|| |
Youth have poor sexual knowledge but have more liberal attitude toward sexuality. The major source for gathering information was the Internet, which is also considered the most reliable source. Youth are more likely to clarify doubts about sexuality through discussions with friends. Having more sexual knowledge was likely to influence a liberal attitude toward sexuality. Individuals who are likely to indulge in sexual behaviors through media are more likely to indulge in sexual behaviors with self and others, indicating the link between influence of media and sexual behaviors.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3]