Challenging the Behavioural Model: Exploring Individual, Interpersonal, and Structural Predictors of Adolescent Dual Protection Use

The optimal model to support adolescent sexual health is the concurrent use of hormonal birth control and condoms. This dual protection approach prioritizes protection against unplanned pregnancy as well as sexually transmitted diseases (STDs) and human immunodeficiency virus (HIV). In order to explore individual, interpersonal and structural factors that influence adolescent protection use, multivariate Chi-squared Automatic Interaction Detector (CHAID) analysis was completed with a national sample of adolescents (n=2320) from the 2002 Canadian Youth, Sexual Health, and HIV/AIDS Study. CHAID is a decision tree method which assesses interactions between significant independent variables to optimize prediction of the dependent variable (i.e. safer-sex protection method). Among adolescent females, the following factors were associated with dual protection use: high condom intentions; having lived with both biological parents; having accessed a medical professional or media as the primary source of HIV/AIDS information; having utilized a medical professional as the primary source of sexual health information; having never had unwanted sex; having not consumed alcohol and/or drugs before sex; frequent sexual activity; having identified a medical professional as the primary source of STD advice; having been tested for STDs; and having supported the importance of talking about condoms with a partner. Among adolescent males, dual protection was associated with: high condom intentions; frequent sexual activity; the belief that both partners are responsible for condom use; having been born in Canada; having noted uncertain or high levels of religiosity; having been older than 14 at first sexual intercourse; having been able to speak with their father about sex; having accessed a medical professional or media as the primary source of HIV/AIDS information; and having reported a peer group that did not use tobacco. The results indicate that structural factors, in concert with individual and interpersonal factors, play a vital role in understanding adolescent safer-sex practices. Policy and practice implications include revisions to sexual health curricula, sexual health service accessibility for all adolescents, and targeted prevention programming for adolescents at highest risk. Further research into the sexual health of male adolescents and the influence of structural factors on sexual health among diverse samples should be prioritized.Ph