Risk Factors For Sexually Transmitted Diseases in Canada and Provincial Variations
Keywords:STDs, Risk Factors, Inequities, Policy
AbstractAim: To estimate factors associated with having ever had a Sexually Transmitted Disease (STDs) in Canada and explore provincial variation. Methods: The 2009-2010 Canadian Community Health Survey (CCHS) was used to examine demographic and behavioral factors associated with having ever had an STD. Univariate and multivariate analyses were conducted. Also, probit models were employed to estimate the probability of having ever had an STD in Canada. Results: People living in the Territories had the highest probability of having ever been diagnosed with an STD (OR = 2.11, 95% CI (1.76, 2.52)) and residents from Maritime Provinces were least likely to have been diagnosed with an STD (OR = .64, 95 % CI (.55, .74)). Women were more likely to have ever had an STD with an odds ratio of 2.06 (95% CI (1.90, 2.24)). In our study, income, marriage, and education were found to be protective factors. Behavioral factors such as smoking and binge drinking had significant harmful effects on sexual health. Daily smokers were 1.56 times (95% CI (1.43, 1.71)) more likely to have been diagnosed with an STD compared with non-smokers. Similarly, individuals with binge drinking frequency of more than once per week had 2.57 (95% CI (2.15, 3.07)) higher odds of having ever had an STD. Conclusion: Both demographic and behavioral factors influence the likelihood of having ever been diagnosed with an STD in Canada. Women, people with lower income, lower education, or unmarried are more likely to have ever had an STD. Smoking and binge drinking are significantly associated with an increase in the likelihood of ever having an STD in Canada. Appropriate policy interventions could address some of these factors leading to reductions in STD incidence and prevalence in Canada.
Catania JA, Kegeles SM, Coates TJ. Towards an Understanding of Risk Behavior: An AIDS Risk Reduction Model (ARRM). Heal Educ Behav. 1990;17(1):53-72. doi:10.1177/109019819001700107.
Lu W, Zeng G, Luo J, et al. HIV transmission risk among serodiscordant couples: a retrospective study of former plasma donors in Henan, China. J Acquir Immune Defic Syndr. 2010;55(2):232-238. doi:10.1097/QAI.0b013e3181e9b6b7.
Boyer CB, Tschann JM, Shafer M-A. Predictors of risk for sexually transmitted diseases in ninth grade urban high school students. J Adolesc Res. 1999;14(4):448-465. doi:10.1177/0743558499144004.
Da Ros CT, Da Silva Schmitt C. Global epidemiology of sexually transmitted diseases. Asian J Androl. 2008;10(1):110-114. doi:10.1111/j.1745-7262.2008.00367.x.
Gilson, R. J., & Mindel A. Sexually transmitted infections. BMJ. 2001;322(7295):1160-1164.
Coker a L, Richter DL, Valois RF, McKeown RE, Garrison CZ, Vincent ML. Correlates and consequences of early initiation of sexual intercourse. J Sch Health. 1994;64(9):372-377. http://www.ncbi.nlm.nih.gov/pubmed/7877279.
Rosenthal SL, Biro FM, Succop PA, Bernstein DI, Stanberry LR. Impact of demographics, sexual history, and psychological functioning on the acquisition of STDS in adolescents. Adolescence. 1997;32(128):757-769.
Anderson JE, Dahlberg LL. High-risk sexual behavior in the general population. Results from a national survey, 1988-1990. Sex Transm Dis. 1992;19(6):320-325.
Wasserheit JN, Aral SO. The dynamic topology of sexually transmitted disease epidemics: implications for prevention strategies. J Infect Dis. 1996;174 Suppl :S201-S213. doi:10.1093/infdis/174.Supplement_2.S201.
Michelson KN1, Thomas JC, Boyd C JA. Chlamydia trachomatis infection in a rural population: the importance of screening men. Int J STD AIDS. 1999;10(1):32-37. doi:10.1258/0956462991913051.
Public Health Agency of Canada. Report on Sexually Transmitted Infections in Canada.; 2010. http://publications.gc.ca/site/archiveearchived.html?url=http://publications.gc.ca/collections/collection_2013/aspc-phac/HP37-10-2010-eng.pdf.
Weinstock H, Berman S, Cates W. Sexually transmitted diseases among American youth: incidence and prevalence estimates, 2000. Perspect Sex Reprod Health. 2000;36(1):6-10. doi:10.1363/psrh.36.6.04.
Warszawski J ML. Gender difference in persistent at-risk sexual behavior after a diagnosed sexually transmitted disease. Sex Transm Dis. 1998;25(8):437-442.
Padian NS, Shiboski SC, Glass SO, Vittinghoff E. Heterosexual transmission of human immunodeficiency virus (HIV) in northern California: results from a ten-year study. Am J Epidemiol. 1997;146(4):350-357. doi:10.1093/oxfordjournals.aje.a009276.
Tyndall M, Patrick D, Spittal P. Risky sexual behaviours among injection drugs users with high HIV prevalence: implications for STD control. Sex Transm …. 2002;78 Suppl 1:i170-i175. doi:12083439.
Rakwar J, Kidula N, Fonck K, Kirui P, Ndinya-Achola J TM. HIV/STD: the women to blame? Knowledge and attitudes among STD clinic attendees in the second decade of HIV/AIDS. Int J STD AIDS. 1999;10(8):543-547.
Mayer KH, Beyrer C. HIV Epidemiology Update and Transmission Factors: Risks and Risk Contexts--16th International AIDS Conference Epidemiology Plenary. Clin Infect Dis. 2007;44(7):981-987. doi:10.1086/512371.
Whyte ,IV J, Standing T, Madigan E. The relationship between HIV-related knowledge and safe sexual behavior in African American women dwelling in the rural Southeast. JANAC J Assoc Nurses AIDS Care. 2004;15(2):51-58. doi:10.1177/1055329003256415.
Crystal S, Akincigil A, Sambamoorthi U, et al. The diverse older HIV-positive population: a national profile of economic circumstances, social support, and quality of life. J Acquir Immune Defic Syndr. 2003;33 Suppl 2(Suppl 2):S76-S83. doi:10.2215/CJN.10581014.
Kass NE, Munoz A, Chen B, Zucconi SL, Bing EG, Hennessy M. Changes in employment, insurance, and income in relation to HIV status and disease progression. JAIDS J Acquir Immune Defic Syndr. 1994;7(1):86-91. http://journals.lww.com/jaids/abstract/1994/01000/changes_in_employment,_insurance,_and_income_in.14.aspx.
Buttmann N, Nielsen A, Munk C, Liaw KL, Kjaer SK. Sexual risk taking behaviour: prevalence and associated factors. A population-based study of 22,000 Danish men. BMC Public Health. 2011;11:764. doi:10.1186/1471-2458-11-764.
Marshall MM, McCormack MC, Kirk GD. Effect of cigarette smoking on HIV acquisition, progression, and mortality. In: AIDS Education and Prevention. Vol 21. ; 2009:28-39. doi:10.1521/aeap.2009.21.3_supp.28.
Kermode M, Sono CZ, Songput CH, Devine A. Falling through the cracks: a qualitative study of HIV risks among women who use drugs and alcohol in Northeast India. BMC Int Health Hum Rights. 2013;13:9. doi:10.1186/1472-698X-13-9.
Hendershot CS, Magnan RE BA. Associations of marijuana use and sex-related marijuana expectancies with HIV/STD risk behavior in high-risk adolescents. Psychol Addict Behav. 2010;24(3):404-414. doi:10.1037/a0019844.
Citizenship and Immigration Canada.Availabel at : http://www.cic.gc.ca/english/department/partner/pp/pdf/IMEI_Syphilis.pdf. Published 2014.
Ross MW, Williams ML. Sexual behavior and illicit drug use. Annu Rev Sex Res. 2001;12:290-310. http://www.ncbi.nlm.nih.gov/pubmed/19503965.
Wight D, Plummer M RD. The need to promote behaviour change at the cultural level: one factor explaining the limited impact of the MEMA kwa Vijana adolescent sexual health intervention in rural Tanzania. A process evaluation. BMC Public Heal. 2012;14(12):788. doi:10.1186/1471-2458-12-788.