Older male sexual partner as a marker for sexual risk-taking in adolescent females in Nova Scotia.

PURPOSE: To examine age differences between Nova Scotia women aged 15-19 and their male sexual partners, and to determine if those adolescents with older partners were more likely to have engaged in sexual risk-taking behaviours. METHODS: A cross-sectional survey (response rate=91%) administered in May 2003 assessed the following sexual risk behaviours: (a) not using condom/hormonal contraception at last vaginal intercourse; (b) having unplanned vaginal intercourse while using alcohol or drugs; (c) having more than one partner in the previous year; (d) vaginal intercourse before age 15; and (e) ever having anal intercourse. Univariate analysis was carried out to determine associations of sexual risk behaviours with partner age difference. Logistic regression was then used to examine behaviours associated with partner age (p < 0.15) in univariate analysis. RESULTS: Of the young women surveyed, 520 (47.7%) had had vaginal intercourse in the previous year; 515 of these provided information on their last partner's age. Over 10% had partners four or more years older. In multivariate analysis, having a partner > or =4 years older was associated with not using a condom at last intercourse (OR 2.15; 95% Cl 1.10-4.20), having more than one partner in the previous year (OR 21.9; 95% Cl 1.13-4.28) and having unplanned vaginal intercourse while using alcohol or drugs (OR 2.66; 95% Cl 1.34-5.28). CONCLUSIONS: A significant number of female adolescents have older male sexual partners, and such relationships are markers for high-risk sexual behaviours. Partner age is an important consideration for health professionals providing sexual health advice to young women.

Factors associated with PAP testing in adolescents in northern Nova Scotia.

OBJECTIVE: To determine relationships of socio-economic factors and contraceptive behaviours with PAP testing in sexually active women aged 15-19 who had received physician services in northern Nova Scotia in the previous year. METHODS: A cross-sectional survey was completed by adolescents attending four high schools in three counties in northern Nova Scotia. Questions concerned contraceptive behaviours, socio-economic status and health services use, including PAP testing. Associations of socio-economic factors and contraceptive behaviours with receipt of a PAP test in the previous year were examined in women who were sexually active for at least one year, and who also had visited a physician during the previous year. RESULTS: One thousand and ninety adolescent women aged 15-19 completed surveys, with a response rate of 91%. Of the 396 (36.3%) who reported being sexually active and having visited a physician in the previous year, 393 provided information about PAP testing. Of these, 214 (54.5%) reported receiving a PAP test. Factors associated with PAP testing included viewing one's family as advantaged and living in a major town as opposed to a more rural area. Compared with using hormonal contraception, using either condom without other effective contraception or no effective contraception at last intercourse were negatively associated with PAP testing. CONCLUSIONS: These findings suggest that physicians use hormonal contraception as a cue for PAP testing in adolescent women. Guidelines call for regular PAP testing of sexually active adolescents, and efforts to increase adolescent PAP testing should include professional development to increase recognition of sexual activity.

Socio-economic factors and adolescent sexual activity and behaviour in Nova Scotia.

PURPOSE: Little is known about associations of adolescents' socio-economic status (SES) and their sexual activity and risk behaviours. This study examined these associations in Nova Scotia adolescents aged 15-19. METHODS: Students at four high schools in northern Nova Scotia completed surveys examining relationships of family SES factors and: 1) sexual activity (having had vaginal or anal intercourse, intercourse before age 15 (early intercourse)); and 2) risk behaviours (use of contraception/condoms, number of partners and unplanned intercourse after substance use). RESULTS: Of students present when the survey was administered, 2,135 (91%) responded. Almost half (49%) had had vaginal intercourse, and 7% anal intercourse. In univariate analysis for young women, non-intact family structure and lower parental education were associated with having vaginal, anal and early intercourse. Female risk behaviours showed no significant univariate associations with SES. Young men had univariate associations of family structure, lower maternal education and paternal unemployment with early intercourse, and lower paternal education with anal intercourse. Condom use was higher for young men with employed fathers; those living with both parents less often had >1 sexual partner. In multivariate analysis, most SES associations with females' sexual activities held, while most for males did not, and few associations of SES and risk behaviours were seen for females. CONCLUSIONS: Indicators of lower SES are associated with sexual activity in young women. Sexual risk behaviours are not often associated with SES in females, though they are more so in males. These findings have implications for sexual health promotion and health services.

Suicidal behaviours among adolescents in northern Nova Scotia.

OBJECTIVES: To estimate the 12-month prevalence of suicidal behaviours by gender and to investigate the gender-specific factors associated with suicidal behaviours and to describe health service utilization by suicidal adolescents. METHODS: This was a cross-sectional study. The baseline data of the Adolescent Health Study conducted in northern Nova Scotia were used. RESULTS: Female students were more likely to report suicidal behaviours than male students (p < 0.005). There was no gender difference in injurious suicide attempts. Depression was the strongest risk factor for suicidal behaviours in the two genders (p < 0.005). Female students who reported drug use and living in a non-intact family were at higher risk of suicide attempts. Low self-esteem was positively associated with suicidal ideation and suicide planning among male students. Suicidal girls were more likely to seek professional help for emotional disturbance than boys. Family doctors were the most frequently contacted professional by suicidal adolescents. CONCLUSIONS: Some factors associated with suicidal behaviours among adolescents may be gender specific. Suicidal behaviours have been considered a depressive symptom. Most suicidal students, however, had not contacted a health professional for an emotional problem in this population. This presents challenges for prevention of suicidal behaviours among adolescents.

Contraception among young women attending high school in rural Nova Scotia.

OBJECTIVE: To examine contraceptive methods used by rural adolescent women and socio-demographic factors associated with not using effective contraception. METHODS: Students in three Nova Scotia high schools participated in a survey concerning sexual activity, behaviours, and contraception used at last intercourse. Proportions using no effective contraception were examined with respect to socio-demographic variables. RESULTS: The overall response rate was 80%; 46% of 922 young women aged 15-19 had had intercourse in the previous year. Of these, 87% used effective contraception at last intercourse. Average school mark < 80%, and having a father with less than high school education were associated with not using effective contraception. Mother's education and employment, family structure, age of first intercourse and importance of religion were not associated with lack of contraception. INTERPRETATION: Using no, or ineffective, contraception at last intercourse was seen in fewer young women than has been seen in other Canadian studies. In addition to examining use of contraception in rural Canadian adolescents, the study provides evidence concerning factors for consideration in targeted interventions.