Perceived Realism, Sexual Attitudes, and the Role of SEIM: Implications for Adolescent Sexual Health Policy in Cambodia

Introduction: There is a notable trend of widespread consumption of sexually explicit internet material (SEIM) and increasing sexual experiences among adolescents. However, it remains unclear whether SEIM influences sexual experiences through perceived realism and sexual attitudes. Methods: This study examined the direct and indirect effects of various factors on adolescent sexual experiences. A total of 853 Cambodian adolescents participated in the 2022 survey, which employed a quota sampling method to ensure equal representation of males and females, stratified by urban and rural areas. Data were collected using structured questionnaires, and a parallel mediation analysis was performed using the PROCESS macro (version 3.2.01, Model 4) in SPSS. Results: The percentages of male and female participants were 50.9% and 49.1%, respectively, and the average age of the sample was 16.38 ± 1.40 years. The prevalence of sexual experience was 9.3%, significantly higher among males (13.4%) and in urban areas (17.5%) compared to females (5.0%) and rural areas (1.2%). The SEIM consumption (OR = 2.243, 95% CI = 0.432, 1.184), perceived realism (OR = 1.513, 95% CI = 0.029, 0.798), and positive sexual attitudes (OR = 1.594, 95% CI = 0.423, 0.892) were significantly and independently associated with sexual experience. Additionally, the indirect effect coefficients were significant for perceived realism (OR = 1.292, 95% CI = 0.028, 0.483) and positive sexual attitudes (OR = 1.293, 95% CI = 0.063, 0.537). Conclusions: This study emphasizes the role of perceived realism and positive sexual attitudes as mediators between SEIM and sexual experience. The findings highlight the urgent need for comprehensive adolescent programs that address not only SEIM regulation but also shape realistic perceptions and healthy attitudes toward sexuality. Policy Implications: Policy interventions should prioritize adolescent programs that foster awareness of reality and promote healthy sexual attitudes, tailored to reducing SEIM use, and ultimately decreasing sexual experiences.