Objective  To examine attitudes toward premarital sexual behavior and their correlates among middle school students in Luzhou city of Sichuan province and to provide evidences for developing sexual education programs in the students.

  Methods  We carried out an anonymous questionnaire survey among 2 515 students recruited with stratified cluster random sampling in 8 middle schools in Luzhou city from December 2016 to January 2017.

  Results  Of the students, 9.30% reported positive attitude toward premarital sexual behavior and the ratio of reporting the positive attitude was 15.00% and 4.29% in the boy and girl students, respectively. Multivariate linear regression analysis demonstrated that the students with following characteristics were more likely to report positive attitude toward premarital sexual behavior: being a senior high school student (b = – 4.90, P < 0.001), male gender (b = – 4.65, P < 0.001), residing in urban regions or counties (b = – 4.13, P < 0.001), with maternal education of undergraduate and above (b = – 6.62, P = 0.005), with parents having affirmative or receptive attitude toward premarital sexual behavior (b = – 3.94, P < 0.001), with friends having affirmative or receptive attitude toward premarital sexual behavior (b = – 4.78, P < 0.001), with friends having indifferent or indeterminate attitude toward premarital sexual behavior (b = – 2.37, P = 0.017), experiencing dating or love affairs (b = – 4.98, P < 0.001), and ever reading pornographic materials (b = – 5.55, P < 0.001).

  Conclusion  A part of middle school students in Luzhou city have positive attitude toward premarital sexual behavior and the attitude is influenced by multiple personal, familial and social factors, suggesting that comprehensive interventions need to be promoted to reduce the risk of premarital sexual activity in the students.