Sexually Explicit and Violent Media Use among High School Students in Vietnam: Gender-Differentiated Links with Sexual Misconduct Victimization, Perpetration, and Health

Background Research is lacking in lower-income countries on levels and associations of sexually explicit and sexually violent media use (SEM/SVM) with well-being outcomes in high-school students.

We tested theories of gendered aggression and moral incongruence to explain the associations of SEM and SVM use versus non-use with sexual misconduct perpetration/victimization and well-being outcomes among males and females attending three high schools in Ho Chi Minh City, Vietnam.

712 eleventh and twelfth graders were surveyed about their general health, mental health, alcohol use, beliefs about pro-violence peer norms, academic disengagement, sexual misconduct perpetration and victimization, and SEM/SVM use. Unadjusted and adjusted regression models were estimated.

Most (79%) reported any SEM/SVM use (47% SEM only; 32% any SVM). SVM use was higher among boys (39%) than girls (27%). Among boys, users reported poorer adjusted self-rated health (SEM coef=0.43; SVM coef=0.58), higher alcohol use (SEM aOR=2.45; SVM aOR=2.35), and higher sexual misconduct perpetration (SVM aOR=5.31) than non-users. Among girls, SVM users reported higher adjusted sexual misconduct perpetration (aOR=2.81) and sexual violence victimization (aOR=5.99), and SEM users reported higher sexual misconduct victimization (aOR=2.24) than non-users.

Sexualized media use is common among high-school students in Ho Chi Minh City, especially among boys. Gendered aggression theory helps explain the effects of use on violence victimization and perpetration. Moral incongruence theory helps explain poorer health among male users. “No-phone” programs alongside staff, parent, and student outreach about the harms of sexualized media use should be tested to improve high-school students’ well-being in Vietnam. Competing Interest Statement The authors have declared no competing interest. Funding Statement This work was supported by training grant D43TW012188 from the Fogarty International Center of the National Institutes of Health to Emory University (MPIs Kathryn M Yount (contact); Le Minh Giang, Hoang Thi Hai Van). Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: The study received ethical approval from the Institutional Review Board of the University of Medicine and Pharmacy at Ho Chi Minh City (3746/DHYD-HDDD). I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes Footnotes meghan.macaulay{at}emory.edu, kimtu{at}ump.edu.vn Data Availability All data produced in the present study are available upon reasonable request to the corresponding author. https://www.medrxiv.org/content/10.1101/2025.01.28.25321240v1