Objective   To compare differences in current status of sexual health-related knowledge, attitude and behavior and influencing factors of sexual behavior between international and domestic students in Chinese colleges and universities for providing references and evidences to promote education on sexual health in the students.

  Methods   With a self-designed questionnaire, we conducted an online anonymous survey from September through November, 2019. The respondents of the survey were 6 665 Chinese students recruited using stratified cluster sampling in 9 colleges/universities in eastern, central and western China and 1 403 international students sampled conveniently in 96 universities across China. Statistical analyses on collected data were performed with SPSS 21.0 software.

  Results   Valid information were collected from 5 989 Chinese and 1 004 international students. The score for sexual knowledge of the international students was significantly lower than that of Chinese students (5.11 ± 2.20 vs. 5.31 ± 2.17, t = 2.751; P < 0.01). Significantly higher proportion of international students reported positive attitude towards one night stands than that of Chinese students (25.10% vs. 14.59%, χ² = 73.04; P < 0.01); but significantly higher proportion of Chinese students reported positive attitude towards homosexuality than that of international students (53.35% vs. 43.23%, χ² = 73.83; P < 0.01). More international students than Chinese students reported ever having sexual behaviors (20.42% vs. 18.88%) and for the students ever having sexual behaviors, the proportion of with multiple sexual partners was significantly higher among international students than among Chinese students (58.05% vs. 35.46%, χ² = 27.26; P < 0.01). Significantly more international students than Chinese students reported first sexual behaviors at the age of less than 18 years (30.73% vs. 15.12%, χ² = 29.28; P < 0.01). The results of logistic regression analysis showed that the international students of male gender, being seniors, with a high level of living consumption, without religious belief, and with bisexual orientation were more likely to have sexual behavior (all P < 0.01); while, the Chinese students of male gender, being seniors, majoring in liberal arts, with a high level of living consumption, and with homosexual or bisexual orientation were more likely to have sexual behavior (P < 0.01 for all).

  Conclusion   There are disparities in sexual health-related knowledge, attitude and behavior between international students and domestic students of colleges/universities in China, suggesting that targeted education on sexual health should be promoted among student groups of different gender and culture background.