Sexual health disparities between street-involved youth and peers in the general population highlight the need for targeted, early intervention among at-risk youth.
Jayaraman, Gayatri C. ; Klar, Salman ; Ivanovic, Jelena 等
Dear Editor:
Sexual and Reproductive Health day was marked on February 12, and
highlighted the burden of sexually transmitted infections among
Canadians. The reported rates of notifiable sexually transmitted
infections (STIs), such as chlamydia and gonorrhea, are highest among
youth 15 to 24 years old. (1-3) This burden impacts youth's sexual
and reproductive health. "Youth," however, are comprised of
diverse groups and it can be challenging to identify where interventions
should be targeted to reduce the prevalence of STIs and prevent STI
transmission. Evidence has indicated that street-involved youth (SY) may
be at higher risk for STIs due to multiple sexual partners, poor rates
of condom use, and socio-economic and sexual vulnerabilities. (4-6)
However, few studies have compared the extent of health-related
disparities between SY and their peers in the general population.
We reviewed data drawn from the Enhanced Street Youth Surveillance
system (E-SYS) (7) Cycle 6 (2009-2011) and compared these results to
data from 15-24 year olds in the general population collected through
the 2009/2010 Canadian Community Health Survey (CCHS). (8) Analyses were
limited to the seven urban centres participating in E-SYS: Vancouver,
Edmonton, Saskatoon, Winnipeg, Toronto, Ottawa and Halifax.
When compared to their peers in the general population (unweighted
n=3354, weighted n=1,651,766), a greater proportion of SY (n=1,246) were
male, 15-19 years old, self-identified as being of Aboriginal origin,
had lower high school completion rates, and reported poor or fair mental
health (Table 1). Of note, more than seven times as many SY reported
sexualities other than straight/heterosexual. With respect to sexual
behaviours, a higher proportion of SY reported having ever had sexual
intercourse (96.8% versus 56.6%), earlier sexual debut (median age = 14
years versus 17 years), a higher number of sexual partners (median
number = 1 in last 3 months versus 1 in last 12 months) and lower levels
of condom use at last intercourse (47.7% versus 70.6%). The proportion
reporting a previous STI diagnosis was almost five times higher among SY
(20.0% versus 4.4%). Furthermore, more SY reported regular binge
drinking, and illicit drug use in the past 12 months (Table 1), both of
which may be associated with higher sexual-risk-taking behaviours.
We recognize several important limitations to these analyses. There
is potential for response bias: under-reporting or over-reporting of
risk behaviours is possible as both surveys were
interviewer-administered. Due to differences in the surveys'
objectives, the methodologies used, including sampling frameworks,
prevented rigorous statistical analyses between the two datasets.
Possible geographic variations and heterogeneities within the SY and
general population could not be explored further due to sample size
restrictions.
Regardless, our findings reinforce previous calls to recognize
disparities in sexual health and related factors between SY and their
peers in the general population. Such information is valuable not only
to inform the allocation of limited resources, but also to prioritize
interventions among SY. The higher rates of sexual activity, earlier age
of sexual debut, and lower rates of condom use in the SY population
underscore the need for targeted and early interventions among SY in the
context of STI prevention and sexual health promotion. In addition,
programs and interventions could benefit from taking into account early
child hood development and incorporating a social determinants of health
approach. Early engagement with at-risk youth is important to preventing
street-involvement and homelessness in the first place.
Acknowledgements
Our thanks to the youth who took part in E-SYS; the E-SYS Study
team and working group; and our database manager, Ania Zycki.
Gayatri C. Jayaraman, MPH, PhD [1], Salman Klar, MPH [1], Jelena
Ivanovic, MSc [2], Lily Fang, MHSc [1]
[1.] Centre for Communicable Diseases and Infection Control,
Infectious Disease Prevention and Control Branch, Public Health Agency
of Canada, Ottawa, ON
[2.] Department of Epidemiology and Community Medicine, University
of Ottawa, Ottawa, ON
REFERENCES
(1.) Public Health Agency of Canada. STI and Hepatitis C
Statistics. Available at: http://www.phac-aspc.gc.ca/sti-
its-surv-epi/surveillance-eng.php (Accessed January 25, 2011).
(2.) Centers for Disease Control and Prevention. Sexually
Transmitted Diseases Surveillance 2010: STDs in Adolescents and Young
Adults. Available at: http://www.cdc.gov/std/stats10/adol.htm (Accessed
January 25, 2011).
(3.) European Centre for Disease Prevention and Control. Sexually
transmitted infections in Europe, 1990-2009. Available at:
http://ecdc.europa.eu/en/
publications/Publications/110526_SUR_STI_in_Europe_1990-2009.pdf
(Accessed January 25, 2011).
(4.) Marshall BD, Kerr T, Shoveller JA, Montaner JSG, Wood E.
Structural factors associated with an increased risk of HIV and sexually
transmitted infection transmission among street-involved youth. BMC
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(5.) Halcon LL, Lifson AR. Prevalence and predictors of sexual
risks among homeless youth. J Youth Adolescence 2004;33(1):71-80.
(6.) Boivin J-F, Roy E, Haley N, Galbaud du Fort G. The health of
street youth: A Canadian perspective. Can J Public Health
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(7.) Public Health Agency of Canada. Street youth in Canada:
Findings from enhanced surveillance of Canadian street youth, 1999-2003.
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(Accessed January 25, 2011).
(8.) Statistics Canada. Canadian Community Health Survey--Annual
Component (CCHS). Available at: http://www.statcan.gc.ca/cgi-bin/imdb/
p2SV.pl7Function=getSurvey&SDDS=3226&
lang=en&db=imdb&adm=8&dis=2 (Accessed May 20, 2011).
Table 1. Demographics, Sexual Behaviours and Substance Use Among
Youth Aged 15-24 Years Who Took Part in Canadian
Community Health Survey 2009/2010 (CCHS) and Enhanced
Street Youth Surveillance (E-SYS) 2009-2010
CCHS 2009/2010 E-SYS Cycle 6
n = 3356 n = 1246
% (95% CI) % (95% CI)
Demographics
Males 51.2 (51.2-51.3) 60.4 (57.6-63.1)
Age 15-19 years 46.2 (46.2-46.3) 48.5 (45.7-51.3)
Aboriginal 3.9 (3.9-3.9) 37.6 (34.9-40.3)
Born in Canada 70.6 (71.5-71.6) 92.5 (91.0-94.0)
High school completion * 92.1 (92.1-92.2) 30.2 (27.3-33.2)
Self-reported fair/poor mental 3.9 (3.8-3.9) 30.6 (28.0-33.2)
health
Sexual Behaviours
Sexuality: "Straight" or 96.6 (96.5-96.6) 74.6 (72.2-77.0)
"Heterosexual"
Ever had intercourse 56.6 (56.5-56.7) 96.8 (95.8-97.7)
([dagger])
Age first intercourse 17 (16-18) 14 (13-16)
(median, IQR ([double
dagger]) in Years)
Number of partners (median, 1 (1-2) 1 (1-3)
IQR) ([section])
Condom use last intercourse 69.7 (69.6-69.8) 44.8 (42.0-47.7)
([parallel])
Ever had an STI ([paragraph]) 4.6 (4.6-4.7) 23.5 (21.0-25.9)
Substance Use
Regular binge drinking ** 13.4 (13.3-13.4) 30.6 (28.0-33.2)
Illicit drug use--past 12 27.1 (27.0-27.2) 93.6 (92.2-94.9)
months
* Among those 18 years and over.
([dagger]) CCHS does not define intercourse; for E-SYS, ever had
intercourse was defined as ever having either vaginal or anal sex.
([double dagger]) IQR = Interquartile range.
([section]) Last 12 months for CCHS; last 3 months for E-SYS.
([parallel]) Asked only of those who indicated having ever had sexual
intercourse.
([paragraph) Self-reported and asked only of those who indicated
having had sexual intercourse in CCHS, but asked of all E-SYS
participants.
** For CCHS, regular binge drinking was defined as having 5 or more
drinks on one occasion in the past 12 months, at least 2 to 3 times
per month; for E-SYS, binge drinking was "drinking to get smashed or
drunk."
