Abstract
Background
Aboriginal adolescents are more likely to become pregnant and contract an STI than other Canadian adolescents. This study provides some of the first data on factors associated with these outcomes among Aboriginal adolescents.
Methods
A secondary analysis was conducted using 2003 data from a large cross-sectional survey of British Columbia secondary school students. 445 young women and 360 young men who identified as Aboriginal and reported ever having sex were included in analyses. Associations between self-reported pregnancy and STI and 11 exposure variables were examined using logistic regression.
Results
Of young women, 10.6% reported a pregnancy; 10.5% of young men reported causing a pregnancy. An STI diagnosis was reported by 4.2% of young women and 3.9% of young men. In multivariate analyses for young men, ever having been sexually abused was the strongest consistent risk factor for causing a pregnancy (AOR=4.30, 95% CI 1.64–11.25) and STI diagnosis (AOR=5.58, 95% CI 1.61–19.37). For young women, abuse was associated with increased odds of pregnancy (AOR=10.37, 95% CI 4.04–26.60) but not STI. Among young women, substance use was the strongest consistent risk factor for both pregnancy (AOR=3.36, 95% CI 1.25–9.08) and STI (AOR=5.27, 95% CI 1.50–18.42); for young men, substance use was associated with higher odds of STI (AOR=4.60, 95% CI 1.11–19.14). Factors associated with decreased risk included community, school and family involvement.
Conclusions
Health care professionals, communities and policy-makers must urgently address sexual abuse and substance use. Exploring promotion of school and community involvement and family cohesion may be useful for sexual health interventions with Aboriginal students.
Key words: North American Indians, child sexual abuse, sexually transmitted diseases, adolescent pregnancy, substance abuse
Résumé
Contexte
Une adolescente autochtone est plus susceptible de devenir enceinte et contracter une ITS que toute autre adolescente canadienne. Cette étude présente les premières données sur les facteurs associés à ces résultats chez les adolescentes autochtones.
Méthodes
Une analyse secondaire a été réalisée à l’aide des données recueillies en 2003 dans le cadre d’une importante enquête ponctuelle effectuée auprès d’étudiants de niveau secondaire de la Colombie-Britannique. La population de l’analyse comprenait 445 jeunes femmes et 360 jeunes hommes s’identifiant comme des Autochtones et déclarant qu’ils avaient eu des relations sexuelles. Les associations entre la grossesse autodéclarée et l’ITS et 11 variables d’exposition ont été examinées à l’aide d’une analyse de régression logistique.
Résultats
10,6 % des jeunes femmes ont déclaré une grossesse; 10,5 % des jeunes hommes ont indiqué qu’ils avaient causé une grossesse. Un diagnostic d’ITS a été signalé par 4,2 % des jeunes femmes et par 3,9 % des jeunes hommes. Pour ce qui est des analyses multidimensionnelles sur les jeunes hommes, le fait d’avoir été victime de violence sexuelle constitue le plus important facteur de risque conséquent d’avoir causé une grossesse (AOR=4,30; IC95 %: 1,64–11,25) et du diagnostic d’ITS (AOR=5,58; IC95 %: 1,61–19,37). Chez les jeunes femmes, la violence sexuelle a été associée aux probabilités accrues de grossesse (AOR=10,37; IC95 %: 4,04–26,60), mais non au diagnostic d’ITS. Chez les jeunes femmes, la consommation d’alcool et d’autres drogues a été associée aux probabilités accrues de grossesse (AOR=3,36; IC95 %: 1,25–9,08) et de contracter une ITS (AOR=5,27; IC95 %: 1,50–18,42); chez les jeunes hommes, la consommation d’alcool et d’autres drogues a été associée aux probabilités accrues de contracter une ITS (AOR=4,60; IC95 %: 1,11–19,14). Les facteurs suivants ont été associés à une diminution du risque: participation aux activités communautaires, scolaires et familiales.
Conclusions
Les professionnels de la santé, les collectivités et les décideurs doivent urgemment traiter du problème de violence sexuelle et de consommation d’alcool et d’autres drogues. L’exploration des possibilités de favoriser la participation aux activités scolaires et communautaires et la cohésion familiale pourraient contribuer aux efforts d’intervention sur la santé sexuelle des étudiants autochtones.
Mots clés: sévices sexuels des enfants, maladies transmises sexuellement, grossesse chez l’adolescente, consommation d’alcool et d’autres drogues
References
- 1.Health Canada. A statistical profile on the health of First Nations in Canada. Ottawa, ON: Health Canada; 2002. [Google Scholar]
- 2.British Columbia Provincial Health Officer. The Health and Well-being of Aboriginal People in British Columbia. Victoria, BC: BC Ministry of Health Planning; 2002. [Google Scholar]
- 3.National Center for Health Statistics. Health, United States, 2006 with Chartbook on Trends in the Health of Americans. Hyattsville, MD: NCHS; 2006. [PubMed] [Google Scholar]
- 4.Devries K. Condom Use and Sexual Health Among Canadian Aboriginal Adolescents. London, UK: University of London; 2007. [Google Scholar]
- 5.Walters KL, Simoni JM. Reconceptualizing Native women’s health: An “indi-genist” stress-coping model. Am J Public Health. 2002;92(4):520–24. doi: 10.2105/AJPH.92.4.520. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 6.Liu LL, Slap GB, Kinsman SB, Khalid N. Pregnancy among American Indian adolescents: Reactions and prenatal care. J Adolesc Health. 1994;15(4):336–41. doi: 10.1016/1054-139X(94)90607-6. [DOI] [PubMed] [Google Scholar]
- 7.Saewyc EM. Influential life contexts and environments for out-of-home pregnant adolescents. J Holistic Nurs. 2003;21(4):343–67. doi: 10.1177/0898010103258607. [DOI] [PubMed] [Google Scholar]
- 8.Saewyc EM, Skay CL, Bearinger LH, Blum RW, Resnick MD. Sexual orientation, sexual behaviors, and pregnancy among American Indian adolescents. J Ado-lesc Health. 1998;23(4):238–47. doi: 10.1016/S1054-139X(98)00016-0. [DOI] [PubMed] [Google Scholar]
- 9.Calzavara LM, Burchell AN, Myers T, Bullock SL, Escobar M, Cockerill R. Condom use among Aboriginal people in Ontario, Canada. Int J STD AIDS. 1998;9(5):272–79. doi: 10.1258/0956462981922205. [DOI] [PubMed] [Google Scholar]
- 10.Spittal PM, Craib KJP, Teegee M. The Cedar project: Prevalence and correlates of HIV infection among young Aboriginal people who use drugs in two Canadian cities. Int J Circumpolar Health. 2007;66(3):226–40. doi: 10.3402/ijch.v66i3.18259. [DOI] [PubMed] [Google Scholar]
- 11.Wood E, Montaner JS, Li K, Zhang R, Barney L, Strathdee SA, et al. Am J Public Health. 2008. Burden of HIV infection among Aboriginal injection drug users in Canada. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 12.Green R. Methodology: Survey Methodology for the 2003 AHS III. Vancouver, BC: McCreary Centre Society; 2003. [Google Scholar]
- 13.Blum RW, Harris LJ, Resnick MD, Rosenwinkel K. Technical Report on the Adolescent Health Survey. Minneapolis, MN: Adolescent Health Program, University of Minnesota; 1989. [Google Scholar]
- 14.Sieving RE, Beuhring T, Resnick MD, Bearinger LH, Shew M, Ireland M, et al. Development of adolescent self-report measures from the National Longitudinal Study of Adolescent Health. J Adolesc Health. 2001;28(1):73–81. doi: 10.1016/S1054-139X(00)00155-5. [DOI] [PubMed] [Google Scholar]
- 15.StataCorp. Stata Version 9.0. Texas: StataCorp.; 2004. [Google Scholar]
- 16.BC Ministry of Education. Aboriginal Report — How are we doing? Public Schools Only. Victoria, BC: BC Ministry of Education; 2005. [Google Scholar]
- 17.Clark L, Brasseux C, Richmond D, Getson P, D’Angelo LJ. Are adolescents accurate in self-report of frequencies of sexually transmitted diseases and pregnancies? J Adolesc Health. 1997;21:91–96. doi: 10.1016/S1054-139X(97)00042-6. [DOI] [PubMed] [Google Scholar]
- 18.Harrington K, DiClemente RJ, Wingood GM, Crosby RA, Person S, Oh MK, et al. Validity of self-reported sexually transmitted diseases among African-American female adolescents participating in an HIV/STD prevention trial. Sexually Transmitted Dis. 2001;28(8):468–71. doi: 10.1097/00007435-200108000-00009. [DOI] [PubMed] [Google Scholar]
- 19.Stevens-Simon C, Reichert S. Sexual abuse, adolescent pregnancy, and child abuse. A developmental approach to an intergenerational cycle. Arch Pediatr Adolesc Med. 1994;148(1):23–27. doi: 10.1001/archpedi.1994.02170010025005. [DOI] [PubMed] [Google Scholar]
- 20.Saewyc EM, Magee LL, Pettingell SE. Teenage pregnancy and associated risk behaviors among sexually abused adolescents. Perspectives on Sexual and Reproductive Health. 2004;36(3):98–105. doi: 10.1363/3609804. [DOI] [PubMed] [Google Scholar]
- 21.Anda RF, Chapman DP, Felitti VJ, Edwards V, Williamson DF, Croft JB, et al. Adverse childhood experiences and risk of paternity in teen pregnancy. Obstetrics and Gynecol. 2002;100(1):37–45. doi: 10.1016/s0029-7844(02)02063-x. [DOI] [PubMed] [Google Scholar]
- 22.Hillis SD, Anda RF, Felitti VJ, Nordenberg D, Marchbanks PA. Adverse childhood experiences and sexually transmitted diseases in men and women: A retrospective study. Pediatrics. 2000;106(1):e11–18. doi: 10.1542/peds.106.1.e11. [DOI] [PubMed] [Google Scholar]
- 23.Cooper ML. Alcohol use and risky sexual behavior among college students and youth: Evaluating the evidence. J Studies Alcohol. 2002;14(Suppl.):101–1. doi: 10.15288/jsas.2002.s14.101. [DOI] [PubMed] [Google Scholar]
- 24.Resnick MD, Bearman PS, Blum RW, Bauman KE, Harris KM, Jones J, et al. Protecting adolescents from harm. Findings from the National Longitudinal Study on Adolescent Health. JAMA. 1997;278(10):823–32. doi: 10.1001/jama.1997.03550100049038. [DOI] [PubMed] [Google Scholar]
- 25.van der Woerd KA, Dixon BL, McDiarmid T, Chittenden M, Murphy A. The McCreary Centre Society. Raven’s Children II: Aboriginal Youth Health in BC. Vancouver, BC: The McCreary Centre Society; 2005. [Google Scholar]
- 26.Devries KM, Free C, Morison L, Saewyc EM. Am J Public Health. 2008. Factors associated with sexual behavior of Aboriginal youth: Implications for health promotion. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 27.Campbell C, Williams B, Gilgen D. Is social capital a useful conceptual tool for exploring community level influences on HIV infection? An exploratory case study from South Africa. AIDS Care. 2002;14(1):41–54. doi: 10.1080/09540120220097928. [DOI] [PubMed] [Google Scholar]
- 28.Hellerstadt WL, Peterson-Hickey M, Rhodes KL, Garwick A. Environmental, social and personal correlates of having ever had sexual intercourse among American Indian youths. Am J Public Health. 2006;96(12):2228–34. doi: 10.2105/AJPH.2004.053454. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 29.Crosby RA, DiClemente RJ, Wingood GM, Harrington K, Davies SL, Malow R. Participation by African-American adolescent females in social organizations: Associations with HIV-protective behaviors. Ethnicity & Disease. 2002;12(2):186–92. [PubMed] [Google Scholar]
- 30.DiClemente RJ, Wingood GM, Crosby R, Cobb BK, Harrington K, Davies SL. Parent-adolescent communication and sexual risk behaviors among African American adolescent females. J Pediatrics. 2001;139(3):407–12. doi: 10.1067/mpd.2001.117075. [DOI] [PubMed] [Google Scholar]
- 31.DiClemente RJ, Wingood GM, Crosby R, Sionean C, Cobb BK, Harrington K, et al. Parental monitoring: Association with adolescents’ risk behaviors. Pediatrics. 2001;107(6):1363–68. doi: 10.1542/peds.107.6.1363. [DOI] [PubMed] [Google Scholar]
- 32.Crosby RA, Yarber W, DiClemente RJ, Wingood GM, Meyerson B. HIV-associated histories, perceptions, and practices among low-income African-American women: Does rural residence matter? Am J Public Health. 2002;92(4):655–59. doi: 10.2105/AJPH.92.4.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 33.Statistics Canada. 1996 Census: Sources of income, earnings and total income, and family income. Ottawa: Statistics Canada; 1998. [Google Scholar]
- 34.Santelli JS, Lowry R, Brener ND, Robin L. The association of sexual behaviors with socioeconomic status, family structure, and race/ethnicity among US adolescents. Am J Public Health. 2000;90(10):1582–88. doi: 10.2105/AJPH.90.10.1582. [DOI] [PMC free article] [PubMed] [Google Scholar]