Background: At present, high-risk sexual practices and reproductive health problems are increasingly evident among Thai adolescents. School-based sex education is one strategy to address these problems. Despite rapid westernization in Thailand, sexual matters are still culturally taboo. Thus, perspectives of Thais toward adolescents' sexual behaviors and school-based sex education are not well understood. Objectives: 1) To explore the perspective of stakeholders toward adolescents' sexual behaviors and an existing school-based sex education curriculum; and 2) To recommend an appropriate school-based sex education curriculum that takes into account viewpoints at the intrapersonal, interpersonal, organizational, community and policy levels. Methodology: This study is based on the descriptive approach to qualitative research. Data were collected from middle and high school students, parents, teachers, school administrators, community leaders, and provincial government authorities from January 4 to July 28, 2006. A total of 90 individuals participated in 28 in-depth interviews, 12 focus group interviews, and 3 classroom observations. Content analysis was used to analyze study data. Results: Thai adolescents engage in various kinds of sexual behaviors. Media and technology are considered by study participants as the greatest influence on these sexual behaviors. Most Thai adults in this study were accepting of adolescents' sexual behaviors such as having a boyfriend or girlfriend and accessing sexually explicit media but not premarital sex. They were also aware of reproductive health problems among adolescents. However, they perceived these problems as family-level problems. All participants supported school-based sex education yet articulated both benefits and costs. Based on stakeholders' recommendations, the appropriate curriculum should emphasize abstinence-only and also provide education about safe sex practices. Morality and Thai culture should also be taught simultaneously. Current school-based sex education is perceived to need improvement in: curriculum, teachers, and the school environment. Conclusion: School-based sex education is recognized as an appropriate strategy to reduce unhealthy sexual behaviors and to promote reproductive health among Thai adolescents
