Abstract: Objective　To analyze the influencing factors of health?related behaviors for schistosomiasis prevention and control among primary and secondary school students in Sichuan Province using a multilevel and multivariate logistic model, so as to provide the theoretical evidence for developing the schistosomiasis prevention and control strategy among primary and secondary school students in Sichuan Province. Methods　A multi?stage sampling was conducted among 63 schistosomiasis?endemic counties (districts) in Sichuan Province. Five endemic townships were sampled from each county (district), and 100 Grade 4 to 6 students in each primary school and 100 Grade 1 to 3 students in each secondary school were sampled from each township as the study subjects. The health?related behaviors for schistosomiasis prevention and control were investigated using a questionnaire survey, and factors affecting infested water contact behaviors were identified using univariate and multilevel logistic analyses. Results　Among the 62 200 questionnaires distributed, there were 59 134 recovered, and 56 510 were qualified. The qualified 56 510 respondents included 22 955 secondary school students and 33 555 primary school students, and 28 297 male students and 28 213 females. A higher proportion of infested water contacts was seen in male students than in females (P < 0.001), and the students living in heavily endemic areas had a higher proportion of infested water contacts than those in mildly endemic areas (P < 0.001). In addition, there was no significant difference in the proportion of infested water contacts between primary and secondary school students (P > 0.05). Multilevel and multivariate logistic analyses revealed a lower proportion of infested water contacts with the increase of knowledge, belief and self?efficacy levels (P < 0.001), and there was a cluster of infested water contacts among students at a county scale (P < 0.001). Conclusions　There is a cluster of infested?water contact behaviors among primary and secondary school students at a county scale in Sichuan Province. Individual and environmental factors should be considered during the formulation of health education strategy and interventions for schistosomiasis among primary and secondary school students.

Key words: Schistosomiasis, Health education, Primary and middle school students, Influencing factor, Multilevel model, Sichuan Province

摘要： 目的　应用多水平多因素logistic模型分析四川省中小学生血吸虫病防治健康相关行为影响因素，为制定四川省中小学生血吸虫病防控策略提供理论依据。方法　采用多阶段抽样法，在四川省63个血吸虫病流行县（市、区）中，每个县（市、区）抽取5个流行乡（镇），每个乡（镇）选择1所小学4～6年级100名学生和1所初中1～3年级100名学生作为调查对象。采用问卷调查的方式对上述对象进行血吸虫病防治健康相关行为调查，采用单因素分析及多水平多因素logistic模型对学生疫水接触行为影响因素进行分析。结果　共发放问卷62 200份，回收问卷59 134份，其中有效问卷56 510份。56 510名调查对象中，初中生22 955名，小学生33 555名；男生28 297名，女生28 213名。男生疫水接触行为比例显著高于女生（P < 0.001），重度流行区学生疫水接触行为比例高于轻度流行区（P < 0.001），初中生与小学生疫水接触行为比例差异无统计学意义（P > 0.05）。多水平多因素logistic分析表明，知识、信念、自我效能水平越高，疫水接触行为比例越低（P < 0.001），且在县级水平上学生疫水接触行为存在一定聚集性（P < 0.001）。结论　四川省中小学生疫水接触行为在县级水平上存在一定聚集性，在制定中小学生血吸虫病健康教育策略及措施时应同时考虑个体、环境的影响。

关键词: 血吸虫病, 健康教育, 中小学生, 影响因素, 多水平模型, 四川省