Environmental, social, and personal correlates of having ever had sexual intercourse among American Indian youths

Connectedness as a predictor of sexual and reproductive health outcomes for youth

To review research examining the influence of "connectedness" on adolescent sexual and reproductive health (ASRH). Connectedness, or bonding, refers to the emotional attachment and commitment a child makes to social relationships in the family, peer group, school, community, or culture. A systematic review of behavioral research (1985-2007) was conducted. Inclusion criteria included examination of the association between a connectedness sub-construct and an ASRH outcome, use of multivariate analyses, sample size of >or=100, and publication in a peer-reviewed journal. Results were coded as protective, risk, or no association, and as longitudinal, or cross sectional. Findings from at least two longitudinal studies for a given outcome with consistent associations were considered sufficient evidence for a protective or risk association. Eight connectedness sub-constructs were reviewed: family connectedness (90 studies), parent-adolescent general communication (16 studies), parent-adolescent sexuality communication (58 studies), parental monitoring (61 studies), peer connectedness (nine studies), partner connectedness (12 studies), school connectedness (18 studies), and community connectedness (four studies). There was sufficient evidence to support a protective association with ASRH outcomes for family connectedness, general and sexuality-specific parent-adolescent communication, parental monitoring, partner connectedness, and school connectedness. Sufficient evidence of a risk association was identified for the parent overcontrol sub-construct of parental monitoring. Connectedness can be a protective factor for ASRH outcomes, and efforts to strengthen young people's pro-social relationships are a promising target for approaches to promote ASRH. Further study regarding specific sub-constructs as well as their combined influence is needed.

Factors associated with pregnancy and STI among Aboriginal students in British Columbia

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.

Factors associated with pregnancy and STI among Aboriginal students in British Columbia

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.

Perceived risks of HIV/AIDS and first sexual intercourse among youth in Cape Town, South Africa

The 'Health Belief Model' (HBM) identifies perception of HIV/AIDS risks, recognition of its seriousness, and knowledge about prevention as predictors of safer sexual activity. Using data from the Cape Area Panel Survey (CAPS) and hazard models, this study examines the impact of risk perception, considered the first step in HIV prevention, set within the context of the HBM and socio-economic, familial and school factors, on the timing of first sexual intercourse among youth aged 14-22 in Cape Town, South Africa. Of the HBM components, female youth who perceive their risk as 'very small' and males with higher knowledge, experience their sexual debut later than comparison groups, net of other influences. For both males and females socio-economic and familial factors also influence timing of sexual debut, confirming the need to consider the social embeddedness of this sexual behavior as well as the rational components of decision making when designing prevention programs.

Factors associated with the sexual behavior of Canadian Aboriginal young people and their implications for health promotion

OBJECTIVES

We examined factors associated with having ever had sex, having more than 1 lifetime sexual partner, and condom nonuse at last incident of sexual intercourse among Canadian Aboriginal young people.

METHODS

We conducted a secondary analysis of data from the 2003 British Columbia Adolescent Health Survey, a cross-sectional survey of young people in grades 7 through 12.

RESULTS

Of 1140 young Aboriginal men, 34% had ever had sex; of these, 63% had had more than 1 sexual partner, and 21% had not used a condom at their last incident of sexual intercourse. Of 1336 young Aboriginal women, 35% had ever had sex; of these, 56% had had more than 1 sexual partner, and 41% had not used a condom at their last incident of sexual intercourse. Frequent substance use, having been sexually abused, and having lived on a land reservation were strongly associated with sexual behavior outcomes. Feeling connected to family was strongly associated with increased condom use.

CONCLUSIONS

Sexual behavior change interventions for Aboriginal young people must move beyond the individual and incorporate interpersonal and structural dimensions. Interventions to reduce substance use and sexual abuse and promote feelings of family connectedness in this population should be explored. Young people living on land reserves need special attention.

Sexual health and sexually transmitted infections in the North American Arctic

STI rates reported for the Arctic are much higher than those reported for their southern counterparts.

Our objective was to describe the basic epidemiology of sexually transmitted infections for Arctic and sub-Arctic regions of North America. We summarized published and unpublished rates of chlamydial infection and gonorrhea reported from 2003 through 2006 for Alaska, Canada, and Greenland. In 2006, Alaska reported high rates of chlamydial infection (715 cases/100,000 population) compared with the United States as a whole; northern Canada reported high rates of chlamydial infection (1,693 cases/100,000) and gonorrhea (247 cases/100,000) compared with southern Canada; and Greenland consistently reported the highest rates of chlamydial infection (5,543 cases/100,000) and gonorrhea (1,738 cases/100,000) in the Arctic. Rates were high for both men and women, although the highest incidence of infection was predominantly reported for young women in their early twenties. We propose that community-based participatory research is an appropriate approach to improve sexual health in Arctic communities.

Native Teen Voices: adolescent pregnancy prevention recommendations

PURPOSE

American Indian adolescent pregnancy rates are high, yet little is known about how Native youth view primary pregnancy prevention. The aim was to identify pregnancy prevention strategies from the perspectives of both male and female urban Native youth to inform program development.

METHODS

Native Teen Voices (NTV) was a community-based participatory action research study in Minneapolis and St. Paul, Minnesota. Twenty focus groups were held with 148 Native youth who had never been involved in a pregnancy. Groups were stratified by age (13-15 and 16-18 years) and sex. Participants were asked what they would do to prevent adolescent pregnancy if they were in charge of programs for Native youth. Content analyses were used to identify and categorize the range and types of participants' recommendations within and across the age and sex cohorts.

RESULTS

Participants in all cohorts emphasized the following themes: show the consequences of adolescent pregnancy; enhance and develop more pregnancy prevention programs for Native youth in schools and community-based organizations; improve access to contraceptives; discuss teen pregnancy with Native youth; and use key messages and media to reach Native youth.

CONCLUSIONS

Native youth perceived limited access to comprehensive pregnancy prevention education, community-based programs and contraceptives. They suggested a variety of venues and mechanisms to address gaps in sexual health services and emphasized enhancing school-based resources and involving knowledgeable Native peers and elders in school and community-based adolescent pregnancy prevention initiatives. A few recommendations varied by age and sex, consistent with differences in cognitive and emotional development.