Background: Evidence in western countries indicates that the media have associations with adolescents’ and young people’ sexual behavior that may be as important as family, school and peers. In this new study of Asian adolescents and young adults in the three cities of Hanoi, Shanghai and Taipei, the associations between exposure to sexual content in the media and adolescents’ and young adults’ sex-related knowledge, attitudes and behaviors are explored in societies with traditional Confucian culture, but at different stages in the process of modernization.

Method: The data are from a questionnaire-based cross-sectional study conducted from 2006 to 2007 where a sample of 17,016 adolescents and young adults aged 15–24 years from Shanghai, Hanoi and Taipei completed face-to-face interviews coupled with computer-assisted self-interviews (CASI) for sensitive questions. For the objectives of this paper, analysis was restricted to the 16,554 unmarried respondents. Exposure to sexual content in the mass media (including the Internet and traditional media), pornographic videos, and a preference for western/Asian movies/videos were the main media influence measures. Sex-related knowledge, premarital sexual permissiveness, and sex-related behaviors were the main outcome measures. The impact of each of four contexts including family, peer, school and media on sex-related knowledge, attitudes and behaviors were assessed using multiple linear regression stratified by gender and city, controlling for age, urban/rural residence, education and economic status. The change in adjusted R2 from the multiple linear regression analysis was adopted to indicate the contribution of family, peer, school and media variables to respondents’ sex-related knowledge, attitudes and behaviors.

Results: The contextual factors, including family, peer, school and media, explained 30–50% of the variance in sex-related knowledge, 8–22% of the variance in premarital sexual permissiveness and 32–41% of the variance in sex-related behaviors. Media variables explained 13–24% of the variance in sexual knowledge, 3–13% in premarital sexual permissiveness and 3–13% in sex-related behaviors, which was comparable to that of family, peer and school variables. These associations differed by city and gender.

Conclusion: Access to and use of mass media and the messages it presents are influential factors on sex-related knowledge, attitudes and behaviors of unmarried Asian adolescents and young adults, and should be considered in future research and intervention programs attempting to improve reproductive health outcomes.