Substance use patterns and unprotected sex among street-involved youth in a Canadian setting: a prospective cohort study
Substance use patterns and unprotected sex among street-involved youth in a Canadian setting: a prospective cohort study
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DOI：
10.1186/s12889-015-2627-z
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发表时间：
2016-01-05
影响因子：
4.5
通讯作者：
DeBeck, Kora
中科院分区：
文献类型：
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作者：
Cheng, Tessa;Johnston, Caitlin;DeBeck, Kora
背景：性传播感染（STI）和意外怀孕率在青少年中很高。虽然药物和酒精使用与无保护的性行为之间的相互关系已得到充分认识，但很少有研究调查街头青年等高风险人群中药物使用模式与无保护的性行为之间的关系。方法：数据来源于风险青年研究（ARYS），这是一个来自加拿大温哥华的街头青年的前瞻性队列。使用广义估计方程（GEE）来检查与无保护的性行为独立相关的物质使用模式，无保护的性行为定义为（阴道或肛门）不使用避孕套的性交。结果：2005年9月至2013年5月期间，1026名青年被招募到ARYS队列中，75% （n = 766）报告在研究期间的某个时间点进行了近期无保护的性行为。在多变量分析中，女性（调整优势比[AOR] = 1.46, 95%可信区间[CI]: 1.18-1.81）、高加索血统（AOR = 1.38, 95% CI: 1.13-1.68）、关系稳定（AOR = 4.64, 95% CI: 3.82-5.65）、有多个性伴侣（AOR = 2.60, 95% CI: 2.18-3.10）和以下物质使用模式均与近期无保护的性行为独立相关：注射或非注射冰毒使用（AOR = 1.21, 95% CI: 1.21）：1.03 ~ 1.43)、注射或非注射可卡因使用（AOR = 1.20, 95% CI: 1.02 ~ 1.41）、大麻使用（AOR = 1.23, 95% CI: 1.02 ~ 1.49）、摇头丸使用（AOR = 1.23, 95% CI: 1.01 ~ 1.48）、酒精使用（AOR = 1.31, 95% CI: 1.11 ~ 1.55）（均p < 0.05）。结论：无保护的性行为在该地区街头青少年中普遍存在，并且与女性性别和广泛的物质使用模式独立相关。除了增加获得以青年为中心的成瘾治疗服务的机会外，还需要循证和性别知情的性健康干预措施。性传播感染检测和与保健专业人员的联系仍然是街头青年的重要优先事项，并应纳入所有保健和社会服务。
Background: Rates of sexually transmitted infections (STI) and unplanned pregnancy are high among youth. While the intersection between drug and alcohol use and unprotected sex is well recognized, few studies have examined the relationship between substance use patterns and unprotected sex among high risk-populations such as street-involved youth.Methods: Data were derived from the At-Risk Youth Study (ARYS), a prospective cohort of street-involved youth from Vancouver, Canada. Generalized estimating equations (GEE) were used to examine substance use patterns that were independently associated with unprotected sex, defined as (vaginal or anal) sexual intercourse without consistent condom use.Results: Between September 2005 and May 2013, 1,026 youth were recruited into the ARYS cohort and 75 % (n = 766) reported engaging in recent unprotected sex at some point during the study period. In a multivariable analysis, female gender (adjusted odds ratio [AOR] = 1.46, 95 % confidence interval [CI]: 1.18-1.81), Caucasian ancestry (AOR = 1.38, 95 % CI: 1.13-1.68), being in a stable relationship (AOR = 4.64, 95 % CI: 3.82-5.65), having multiple sex partners (AOR = 2.60, 95 % CI: 2.18-3.10) and the following substance use patterns were all independently associated with recent unprotected sex: injection or non-injection crystal methamphetamine use (AOR = 1.21, 95 % CI: 1.03-1.43), injection or non-injection cocaine use (AOR = 1.20, 95 % CI: 1.02-1.41), marijuana use (AOR = 1.23, 95 % CI: 1.02-1.49), ecstasy use (AOR = 1.23, 95 % CI: 1.01-1.48) and alcohol use (AOR = 1.31, 95 % CI: 1.11-1.55) (all p < 0.05).Conclusions: Unprotected sex was prevalent among street-involved youth in this setting, and independently associated with female gender and a wide range of substance use patterns. Evidence-based and gender-informed sexual health interventions are needed in addition to increased access to youth-centered addiction treatment services. STI testing and linkages to healthcare professionals remain important priorities for street-involved youth, and should be integrated across all health and social services.