Factors associated with inadequate-to-problematic sexual health literacy among hill tribe junior high school students in northern Thailand: A school-based study

Background Sexual health literacy (SHL) is an important factor in preventing sexually transmitted infections (STIs) among junior high school students, particularly in middle- to lower-income countries, including Thailand. This study aimed to determine the factors associated with sexual health literacy among hill tribe junior high school students in Chiang Rai Province. Methods A school-based cross-sectional study was conducted to collect data via a validated and structured questionnaire and standard tool for assessing SHL between January and March 2024. The questionnaire was completed by students in private places. Logistic regression was used to determine the associations between variables at the significance level α = 0.05. Results A total of 400 hill tribe junior high school students were recruited: 63.8% were females, the average age was 14.2 years (SD = 1.0), 41.3% were Akha, 22.8% were Hmong, and 18.3% were non-Thai. More than half had inadequate SHL (55.8%), and 29.5% had problematic SHL. Four variables were found to be associated with inadequate-to-problematic SHL. Students who had low-to-moderate knowledge about STIs and prevention were 2.27 times (95% CI: 1.10–4.68) more likely to have inadequate-to-problematic SHL than were those who had the desired level of knowledge. Those who had neutral attitudes regarding STIs and prevention were 2.10 times (95% CI: 1.09–4.05) more likely to have inadequate-to-problematic attitudes toward SHL than positive attitudes. Those who had low levels of perceived family relationships were 3.02 times (95% CI: 1.34–6.82) more likely to have inadequate-to-problematic SHL than were those who had high levels. Those who had low perceptions (AOR = 6.04; 95% CI: 1.98–18.47) and moderate perceptions (AOR = 2.31; 95% CI: 1.23–4.34) of the school policy related to teenage sexual health were more likely to have inadequate-to-problematic SHL than were those who had high perceptions. Conclusions A large proportion of hill tribe junior high school students living in northern Thailand have inadequate-to-problematic levels of SHL. Students who have low-to-moderate knowledge of STI prevention, who have a neutral attitude toward STI prevention, who have low perceived family relationships, and who have low-to-moderate perceptions of the school policy related to teenage sexual health are vulnerable to having inadequate-to-problematic SHL. Modifying the local school curriculum to include sexual health issues is urgently recommended to improve SHL.