Analysis 1.1. Comparison 1 SEMS versus plastic tube (main analysis), Outcome 1 Dysphagia improvement. . . . Analysis 1.2. Comparison 1 SEMS versus plastic tube (main analysis), Outcome 2 Subgroup analysis dysphagia

Background Males account for a significant share of new infections among young people in China. This study aimed to identify the factors associated with risk sexual behaviours, and provide evidence of leverage for effective interventions among male college students. Methods The cross-sectional study was conducted from December 2020 to December 2021 in 16 colleges, located in Sichuan Province, one of the high-risk areas in China. Overall 1640 male college students who reported sexually experienced were analyzed in this study. Multivariable logistic regression analysis was applied to determine factors associated with risk sexual behaviours. Results The average age of included male students was 19.95 ± 1.56. Of them, 27.74% initiated sexual behavior early, and 16.52% did not use condoms at the latest sexual intercourse. Students who were older (age 20-21, AOR=0.43, 95%CI: 0.33-0.55; age≥22, AOR=0.13, 95%CI: 0.08-0.21) (versus age ≤ 19) were less likely to have early sexual debut. The likelihood of engaging in condomless sex at the latest sexual intercourse was lower among male college students who had a senior high school educated mother (vs junior high school and below, AOR=0.47, 95%CI: 0.28-0.80), were knowledgeable about sex and reproductive health (vs unknowledgeable, AOR=0.48, 95%CI: 0.27-0.85), and held a higher level of condom use efficacy confident vs unconfident, AOR=0.50, 95%CI: 0.35-0.71; very confident vs unconfident, AOR=0.26, 95%CI: 0.16-0.42). The odds of condomless sex at the latest sexual intercourse increased among participants reporting perceived risk of HIV infection (vs no, AOR=1.96, 95%CI: 1.27-3.03) and early sexual debut (vs no, AOR=1.61, 95%CI: 1.12-2.32). Conclusion Comprehensive sex education curricula might be an effective approach by emphasizing fundamental sex and reproductive information and empowering students with assertiveness and negotiation skills with regard to condom use during or before college.

Background Limited information is available regarding risky sexual behavior among college students with different sexual orientations. Aim The aim of this study was to examine the gender differences in the association between sexual orientation and risky sexual behavior among Chinese college students with sexual experience. Methods With a self-assessment questionnaire, we conducted a cross-sectional survey among 73,800 students from 25 vocational colleges (3-year colleges) in the Sichuan province of China. Multivariate logistic regression models were used to examine the association between sexual orientation and risky sexual behavior among students with sexual experience. Outcomes The main outcome measures used regarding risky sexual behavior are the following: condom use in the last sexual intercourse, early sexual debut, and having multiple sexual partners. Results 12,711 students with sexual experience were included. Sexual minority students were more likely to have an early sexual debut (For male students, homosexual: OR = 1.88, P < .001; bisexual: OR = 1.96, P < .001; unsure: OR = 1.68, P < .001. For female students, homosexual: OR = 1.87, P < .01; bisexual: OR = 2.07, P < .01; unsure: OR = 1.53, P < .05), and less likely to use condoms in their last sexual intercourse (except for homosexual male students) (For male students, bisexual: OR = 0.65, P < .01; unsure: OR = 0.60, P < .001. For female students, homosexual: OR = 0.21, P < .001; bisexual: OR = 0.54, P < .001; unsure: OR = 0.68, tP < .05). There are gender differences in the association between sexual orientation and having multiple sexual partners. Male sexual minorities were more likely to have multiple sexual partners than heterosexual students (homosexual: OR = 2.06, P < .001; bisexual: OR = 1.66, P < .001; unsure: OR = 1.31, P < .05), while the same result was only observed in bisexual female students (OR = 1.46, P < .01). Clinical Implications Sexual health education professionals should consider the sexual orientation of students when providing counseling services or educational intervention, especially for male students and LGBT ones. Strengths & Limitations We examined gender differences in the association between sexual orientation and risky sexual behavior among college students with sexual experience. However, the ability for the cross-sectional survey to address causality is limited, and will be further tested in cohort studies. Conclusion Gender and sexual orientation affect the likelihood of risky sexual behavior among China's college students, and gender differences in the association between sexual orientation and risky sexual behavior should be noticed.