Objective  To examine sexual and reproductive health related knowledge, attitude and behaviors among adolescent students in China and to provide evidences for promoting reproductive health education in schools and universities.

  Methods  We conducted a cross-sectional survey from June to August 2017 among 1 840 students recruited with convenient sampling from 22 senior high schools and 21 universities in 11 provinces and municipalities of China. A self-designed questionnaire was adopted in the study and totally 1 355 participants completed the survey via paper work or using mobile phone application anonymously.

  Results  Of all the participants, 53.28% were scored with a pass mark of ≥ 60 out of 100 for sexual and reproductive health knowledge; only 25.98% (352/1 355) considered that one should not have sex before marriage, indicating an open attitude towards sexual behavior. Among the participants, sexual experience was reported by 8.98% (52/579) of those under the age of 18, 10.85% (83/765) of senior high school students, and 26.61% (157/590) of the college students; the senior high school students reported significantly higher sexual behaviors and calling someone for sex after alcohol drinking during previous one year than the college students (χ² = 7.888 4 and χ² = 10.382 7, both P < 0.05). The proportions of having sexual experiences and browsing pornographic materials were significantly higher among the male participants than among the female participants (χ² = 34.529 2 and χ² = 237.760, both P < 0.001). For all the participants, 36.16% (490), 70.26% (952), and 39.78% (539) did not reported having education program on AIDS, maternity and sexually transmitted diseases, and physical health in the schools.

  Conclusion  Among senior high school and college students in China, sexual and reproductive health knowledge is generally at a low level but the attitude towards sexual behavior is relatively open and sexual behavior tends to be prevalent in younger students, especially among male students; the results suggest that education programs on sexual activity and reproductive health and the accessibility of relevant health services need to be promoted among the students.