Syndemic Factors Associated with Safer Sex Efficacy Among Northern and Indigenous Adolescents in Arctic Canada

Background Syndemic approaches explore the synergistic relationships between social and health inequities. Such approaches are particularly salient for the Northwest Territories, Canada, that experiences national social (food insecurity, intimate partner violence [IPV]) and health (sexually transmitted infections [STI]) disparities. Safer sex efficacy (SSE) includes knowledge, intention, and relationship dynamics that facilitate safer sex negotiation. We examined factors associated with SSE among NWT adolescents. Methods We conducted a cross-sectional survey with a venue-based sample of adolescents aged 13-17 in 17 NWT communities from 2016 to 2017. Summary statistics and statistical comparisons were conducted, followed by crude and adjusted multivariable regression models to assess factors associated with SSE. Results Among participants (n = 610; mean age 14.2 years [SD 1.5]; 49.5% cisgender women, 48.9% cisgender men, 1.6% transgender persons; 73.3% Indigenous), one-quarter (n = 144; 23.6%) reported food insecurity and nearly one-fifth (n = 111; 18.2%) IPV. In adjusted analyses, among young women, food insecurity (beta -1.89[CI -2.98, -0.80], p = 0.001) and IPV (beta -1.31[CI -2.53, -0.09], p = 0.036) were associated with lower SSE, and currently dating was associated with increased SSE (beta 1.17[CI 0.15, 2.19], p = 0.024). Among young men, food insecurity (beta -2.27[CI -3.39, -1.15], p = 0.014) was associated with reduced SSE. Among sexually active participants (n = 115), increased SSE was associated with consistent condom use among young women (beta 1.40[0.19, 2.61], p = 0.024) and men (beta 2.14[0.14, 4.14], p = 0.036). Conclusions Food insecurity and IPV were associated with lower SSE-a protective factor associated with consistent condom use-underscoring the need to address poverty and violence to advance adolescent sexual health in the NWT.