Factors associated with inadequate and problematic sexual health literacy among hill tribe junior high school students in northern Thailand

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 SHL among hill tribe junior high school students in Chiang Rai Province. A school-based cross-sectional study was conducted to collect data using a validated and structured questionnaire and standard tool for assessing SHL between January and March 2024. The questionnaire was completed by the students in a private setting. Logistic regression was used to determine the associations between variables at the significance level α = 0.05. A total of 400 hill tribe junior high school students were recruited: 63.8% were females; the average student age was 14.2 years (SD = 1.0); and 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 those who had the desired level of knowledge. Students who exhibited neutral attitudes toward STIs and prevention were 2.10 times (95% CI: 1.09–4.05) more likely to have inadequate-to-problematic SHL than those who exhibited positive attitudes. Students who reported 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 those who reported high levels. Students 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 school policies related to teenage sexual health were more likely to have inadequate-to-problematic SHL than those who had high perceptions. 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 exhibit a neutral attitude toward STI prevention, who report low perceived family relationships, and who have low-to-moderate perceptions of school policies 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.