According to results of the BC Adolescent Health Surveys
from 1992 to 2003, youth are taking fewer sexual health risks than youth 5–10 years earlier, and many youth are waiting longer to have sex. The proportion of sexually active female students who have had sex before age 14 has dropped by nearly half since 1992, with a similar decline seen among male students. In addition, the rate of self-reported pregnancies declined. This self-report is data supported by declining birth and abortion rates among BC adolescents (Statistics Canada, 2007
). In contrast, there were no changing trends in sexual activity reported between 2002 and 2006 in the World Health Organizations’s Health Behaviour in School-Aged Children
(HBSC) survey for Canada (Boyce, King, & Roche, 2008
). It should be noted that the HBSC survey only asks sexual behaviour questions of students in grades 9 and 10, there are only two data years rather than the three needed to establish trends, and the sample is not large enough to calculate reliable provincial estimates.
Not only are youth in BC waiting longer to become sexually active, but once active, more youth are practising safer sex. Condom use at last intercourse has increased 16–21% for males and females, respectively, with the majority of adolescents using condoms. Concerns about younger adolescents lacking the maturity to engage in responsible sexual practices may be unfounded, as the youngest females who were sexually active reported the highest prevalence of condom use, and younger males were just as likely as older teens to use condoms at last intercourse. The 2006 HBSC (Boyce et al., 2008
) shows equally high rates of condom use among youth, and a similar pattern of younger girls reporting higher condom use than older girls. Among older teens, other forms of contraception are increasingly adopted. These two contraceptive patterns may be complementary: as youth develop longer term intimate relationships, they may switch to the more reliable hormonal methods for preventing pregnancy, and decrease their reliance on condoms. As with condom use, rates of birth control pills and other effective methods of contraception are significantly higher among sexually active students in 2003 than in 1992.
What helps explain these improvements in sexual health behaviours? Although school-based monitoring surveys seldom have room to include numerous questions about the various influences that could contribute to healthier development for young people, there is one measure the BC AHS assesses that may have played a role. Improvements in sexual health behaviours may be due in part to significant declines in sexual violence which has been associated with sexual health risks (Saewyc, Magee, & Pettingell, 2004
). The rates of teens reporting a history of sexual abuse declined by a third among females, and by half among males. At the same time, the two most recent surveys (1998 and 2003) show unchanged rates of forced intercourse and physical sexual harassment for males, and increasing rates for females. Such preliminary trends in sexual violence are concerning, as they may suggest a turnaround in more serious exposures to sexual violence in future years. Population-level sexual violence prevention initiatives may be an important strategy to continue to improve sexual health among adolescents.
Protective factors in youth’s lives, such as supportive schools and families, and opportunities for community involvement, were also associated with positive sexual health outcomes. We were unable to assess trends in protective factors to date, as most of the measures were only included in the more recent BC AHS. Similar connections between family and school relationships and sexual activity have been documented in other countries, including through longitudinal studies; in Canada, these same relationships were noted for students on the 2006 HBSC (Boyce et al., 2008
). The extent to which young people have increasing opportunities for supportive relationships, friends with healthy attitudes, and positive engagement in their schools and communities, may also help explain improving trends in sexual health, although such trends will need to be assessed in future cohorts.
There is still room for improvement, as more than one in 10 sexually active youth did not use effective contraception at last intercourse, and the decline in condom use as older teens switch to hormonal methods reduces their protection against STIs. As well, the number of sexual partners and rates of alcohol and drug use before sex are unchanged for both males and females. Even so, the trends are encouraging, and should reassure adults and young people alike that media portrayals of increasingly risky adolescent sexual behaviours at ever younger ages are not supported by the evidence, at least among high school students in British Columbia, and possibly in Canada.
Strengths and limitations
As with all studies, there are strengths and limitations to this research that should be taken into account when considering these findings. One of the key strengths is the nature of the large-scale, provincially-representative cluster-stratified sample of youth in public schools in British Columbia; it includes youth from all but the most remote regions of BC, from early adolescence through grade 12. There are groups who may not be represented by these data; however, youth who are not attending school, such as homeless and street-involved youth, may have different rates of sexual experience and risk exposures than the general population of youth in school (Smith, Saewyc, Albert et al., 2007
). At the same time, a recent survey of 762 street-involved youth age 12–18 in nine communities in BC found two-thirds of the youth were attending school, a third of them in mainstream schools and the remainder in alternate education programs (Smith et al., 2007
), which suggests the school-based surveys may be more representative of the general population of high-school aged youth than expected. On the other hand, youth in ESL and special education programs within the public schools, youth in private schools, in alternate education programs, or in custody centres also were not included in this survey. Sub-populations of young people within the BC school population, such as Aboriginal youth, or lesbian, gay and bisexual adolescents, may report different trends in sexual behaviours, and different levels of related risk and protective factors (van der Woerd, Dixon, McDiarmid et al., 2005
; Saewyc et al., 2006
; Devries, Free, Morrison, & Saewyc, in press
; Saewyc, Homma, Skay et al., in press
The trends are reported for cross-sectional cohorts in time, not longitudinal results from the same students; therefore, the links between risk and protective factors can only suggest relationships, not directly identify causes of these trends. Similarly, these data are self-reported; younger students, those with learning disabilities, and those who speak English as a second language may not understand the questions and response options as readily as older, sexually experienced students, and this may contribute to some error in prevalence estimates. Equally, these are results for a single province, and may not represent the behavioural trends among youth in other provinces and territories of Canada. However, this is one of the few recurring large-scale population-based surveys of youth in Canada that includes questions about sexual health, risk exposures such as sexual violence, and protective factors; the co-occurring declining trends in teen births and abortions from vital statistics sources, and the relatively similar patterns in the more limited national survey data, help support the reliability of these results.
Conclusions and recommendations
Adolescent students in British Columbia public schools in 2003 reported better sexual health and healthier sexual behaviours than their peers over the previous decade. Fewer were having sex at young ages, and the majority of those who are sexually active were engaging in responsible behaviours to protect their health and prevent unintended pregnancy. These improving trends may be related to declines in sexual violence, as well as to protective factors in teens’ lives, such as family and school connectedness. Other provinces may wish to consider the regular monitoring of sexual behaviours, risk exposures and protective factors among their adolescent populations, in order to counteract widespread misperceptions of the state of sexual health among young Canadians, and to provide evidence for informing sexual health promotion strategies and appropriate policies.