Cognitive and demographic factors that predict self-efficacy to use condoms in vulnerable and marginalized aboriginal youth.(Report)

Abstract: Evidence suggests that Aborignal youth are at higher risk for sexual health problems, including HIV and sexually transmitted infections (STI), than are non-Aboriginal youth. Given that condom use is effective in preventing HIV/STI and that self-efficacy is predictive of condom use, it is noteworthy that there is so little research on self-efficacy to use condoms in Aboriginal youth. This study employed a community action research strategy to examine the relationship between a set of cognitive and demographic variables and self-efficacy to use condoms in a sample of vulnerable and marginalized Aboriginal youth (N = 68). We found that those individuals who reported having sex at a later age and who scored higher on a measure of assertive communication reported higher levels of self-efficacy to use condoms. Suggestions concerning how these results could be incorporated in education programs are discussed.

Introduction

There is now considerable evidence documenting the disparities in health between Aboriginal and non-Aboriginal communities. When compared to other groups, Aboriginal communities have shorter life expectancy, higher rates of diabetes and chronic illness, a greater percentage who smoke, higher rates of obesity, higher rates of infant mortality and higher rates of infectious diseases (see Frohlich, Ross & Richmond, 2006). These disparities exist across the lifespan, and consistent with the evidence concerning differences in overall health between Aboriginal and non-Aboriginal groups, available research also suggests that Aboriginal youth are at higher risk than non-aboriginal youth for sexual health problems (Hampton, Jeffery & McWatters, 2001). For example, Aboriginal youth experience higher rates of HIV infection than non-aboriginal youth (Canadian Aboriginal AIDS Network, 2006) and trends suggest that the number of Aboriginal women with AIDS and HIV is increasing at an alarming rate. Females represent 23 percent of cumulative AIDS cases in Aboriginal populations, compared to 8 percent in the non-Aboriginal population, and 46 percent of new HIV cases in Aboriginal populations are female, compared to 16 percent in the non-Aboriginal population (Gatali & Archibald, 2004).

Among young people in Canada, aboriginal youth have the highest incidence rates of sexually transmitted infections (STI) such as Chlamydia and gonorrhea (Public Health Agency of Canada, 2005). Sheilds, Wong, Mann et al. (2004) found that 13.7 percent of Aboriginal homeless youth tested positive for Chlamydia compared to 6.6 percent of homeless non-Aboriginal youth. Furthermore, mortality rates of cervical cancer (which is preventable if detected by regular PAP smears and follow-up treatment) are five times higher in Aboriginal than non-Aboriginal women (Lanier & Kelly, 1999). Geographical mapping suggests that there are higher rates of abnormal PAP smears in Aboriginal neighborhoods in Regina compared to non-Aboriginal neighborhoods (Smith et al., 2001).

Other demographic issues further compromise sexual health in Aboriginal youth. A survey of community Aboriginal youth who were transient and who did not regularly attend school suggests that they are at higher risk for sexual health problems compared to non-Aboriginal youth or Aboriginal youth who attend school. For example, they are less likely to use contraception, more likely to have sex at a younger age with older partners, and are at higher risk for long term health problems (Hampton et al., 2001). Compared to non-Aboriginal youth, this group is exposed to a greater number of environmental risk factors that include lower awareness of health services, higher rates of sexual violence, and greater reliance on community based health care services.

Safer sex behaviours in Aboriginal populations

Safer sex behaviours include activities that reduce the risk of STIs and the consistent use of condoms is viewed as a very effective low cost means to reduce STI transmission. Several studies and reviews have been conducted that examine various demographic and cognitive factors related to condom use in different populations (e.g., Sheeran, Abraham & Orbell, 1999; Brown, Jara & Braxton, 2005; Burns & Dillon, 2005). However, there is a lack of research with North American Aboriginal populations that has examined: (1) the prevalence of condom use, and (2) cognitive and demographic factors that predict condom use. We could find only two studies that examined this topic. Calzavara et al. (1998) found that 61% of Aboriginal people living on reserve in Ontario reported never using condoms, and 8% used them always (Calzavara et al., 1998). These authors found that condom use in their sample was predicted by whether or not the person had a steady sex partner, but was not related to the number of sex partners, the latter being a measure that reflects risk for the transmission of STI/HIV. They also reported that only 8% of the respondents who stated they used condoms, used them for the prevention of STI.