Trends in sexual health and risk behaviours among adolescent students in British Columbia.(Report)(Survey)

Abstract: Regular monitoring of trends in sexual health and sexual behaviours among adolescents provides strong evidence to guide intervention programs and health policies. Using the province-wide, school-based British Columbia (BC) Adolescent Health Surveys of 1992, 1998, and 2003, this study documented the trends in sexual health and risk behaviours among adolescents in grades 7 to 12 in BC, and explored the associations between sexual behaviours and key risk and protective factors. From 1992 to 2003, the percentage of youth who had ever had sexual intercourse decreased for both males (33.9% to 23.3%) and females (28.6% to 24.3%) and the percentage who used a condom at last intercourse increased for both males (64.4% to 74.9%) and females (52.9% to 64.2%). Among students who had ever had sexual intercourse, the percentage who had first intercourse before age 14 decreased for both sexes. These encouraging results may be related in part to concurrent decreases in the prevalence of sexual abuse or forced intercourse among both male and female adolescents. Protective factors such as feeling connected to family or school were also associated with lower odds of having engaged in risky sexual behaviours. These findings emphasize the importance of including questions about adolescent sexual health behaviours, risk exposures, and protective factors on national and provincial youth health surveys, to monitor trends, inform sexual health promotion strategies and policies, and to document the effectiveness of population-level interventions to foster sexual health among Canadian adolescents.

Introduction

Healthy sexual development is a key developmental task of adolescence, yet to what extent are we tracking either sexual health behaviours or sexual risk behaviours among young people in Canada? In 2001, Maticka-Tyndale called for better, more regularly gathered population-level sexual health data for adolescents, both nationally and provincially, including information about healthy behaviours, not just the vital statistics about outcomes such as births and abortions or sexually transmitted infection (STI) rates. Some of our national surveys of youth have begun including questions related to sexual behaviour, although they may limit that to older adolescents, as does the Health Behaviour of School-Aged Children (Boyce, King, & Roche, 2008), or to a small number of general questions, most commonly whether the teens have ever had sexual intercourse, ever had or caused a pregnancy, and possibly whether they used contraception or condoms at last intercourse. Sexual behaviour questions are a relatively recent addition to national youth surveys, so trends with three or more points of data are not yet available.

Even at the provincial level, very few population-based adolescent surveys ask about sexual behaviour. Some, such as the Student Drug Use Surveys of the Atlantic provinces, have recently included items related to sexual health and risk (Poulin, 2002; Poulin & Elliott, 2007). As with the national surveys, these include a limited number of behavioural items, although the number of questions increased in the 2007 survey compared to 2002.

British Columbia stands out as an exception in sexual health population monitoring of adolescents in Canada. Since 1992, the McCreary Centre Society has conducted the BC Adolescent Health Survey (BC AHS) every 5-6 years throughout the province, and from the beginning, included several questions related to sexual health behaviours, sexual risk behaviours, and sexual health outcomes. At the same time, the BC AHS has included questions about key risk factors for sexual health problems, and a number of protective factors that have been associated with healthy sexual development for adolescents in population-based research in other countries. The BC AHS remains the oldest and largest cluster-stratified population-based provincial adolescent health survey to assess sexual health information for younger and older adolescents in school.

There are frequent media stories sounding the alarm about possible trends in adolescent sexual behaviour, sometimes based on evidence from other countries, rather than Canada; just recently, for example, Maclean's magazine ran a cover story asking if teen pregnancy is now "cool," and suggesting that teen parenthood may be on the rise in Canada after decades of decline (Gulli, 2008). Stories regularly seem to imply young people are beginning sexual activity at younger ages, more casually, and with riskier behaviour than previous generations. In the absence of regular monitoring to document trends in sexual health and risk, these perceptions may lead to policies and practice decisions that are not grounded in evidence. Two recent examples where regular population evidence could provide important support for government decision-making are the law to change the legal age of sexual consent from 14 to 16, and the introduction of the new HPV vaccine, with questions about the age at which it should be offered to girls to ensure most of them receive it before becoming sexually active. Equally important is the need to document the effects of such laws and policies after they have been enacted, to ensure they have had their intended effects. Studies have evaluated two Texas laws requiring parental consent for teen access to contraception and abortion, for example, whose alms were to improve parent-teen communication around sexual health decisions, with a goal of reducing unintended pregnancies, sexually transmitted infections (STIs), and abortions (Franzini et al., 2004; Joyce, Kaestner, & Colman, 2006). Texas does not regularly survey youth about relationships with their parents, so the only way to determine whether the policies had the intended effects was to examine the further outcomes the laws were designed to influence, i.e., births, STIs and abortions. Based on these, the laws did not appear to foster communication, but instead delayed youth from accessing timely sexual and reproductive health care; indeed, the studies documented increased rates of second trimester abortions, teen births, and STIs, with an estimated increase in costs of more than $40 million per year to the state of Texas in added health care for these outcomes.

The purpose of this paper is to provide some of the evidence to help inform policies and practices in Canada, by documenting the trends in sexual health and risk behaviour among adolescents in British Columbia since 1992, as well as the link between sexual health behaviours and key risk and protective factors.