Adolescent sexuality in Canada is not as well documented as adolescent sexuality in the United States; despite the proximity of the two nations, Canada has its own unique culture and generalizations about Canadian adolescent sexuality based on American research can be misleading.[1] Because of this, several surveys and studies have been conducted which acquired information on Canadian adolescent sexuality. Surveys which provide this information include the Canadian Community Health Survey (CCHS), the National Population Health Survey (NPHS) and the National Longitudinal Survey of Children and Youth (NLSCY). According to information drawn from the Canadian Community Health Survey and the National Population Health Survey, in 2005 43% of teens aged 15 to 19 reported that they had had sexual intercourse at least once (down from 47% in 1996–1997).
Canadian data on sexual health is scarce; therefore, trend analysis and international comparisons are limited.[2] Existing data shows that, overall, Canadian adolescents are taking more measures to protect their sexual health. However, challenges such as sexually transmitted infections, homophobia and inadequate sexual health education persist.[3]
Although there is a lack of research on the effects of mass media which is specific to Canadian adolescents, studies have been conducted in similar cultures (such as the United States). The media has a reciprocal relationship with sexual behavior, and the type of influence differs by gender. Since Canada has a unique culture, some research findings may not apply.
Adolescents are exposed to diverse conditions and factors influencing their daily lives. Societal conditions, culture, the neighbourhood, family members, parents and peers interact with the adolescent, and adolescent sexuality is shaped by these factors. Research has not looked at the Canadian adolescent, so findings are inferred from those in other countries and may not represent the diverse Canadian culture. Research needs to be conducted in Canada, to provide an accurate picture of adolescent sexuality in Canada.[4]
Garriguet's (2005) analysis of the National Longitudinal Survey of Children and Youth found that by age 14 or 15, about 13% of Canadian adolescents have had sexual intercourse. Young adolescents in the eastern provinces and Quebec were more likely to report being sexually active than were those in Ontario and the west.[1]
Rotermann's review of the NPHS and CCHS found that in 2005, 43% of nationally surveyed teens aged 15 to 19 reported that they had had sexual intercourse at least once; these numbers were higher in Quebec and increasing between surveys in Nova Scotia. She also found that the number of adolescents who had sexual intercourse before the age of 15 had dropped from 12% in 1996–1997 to 8% in 2005.
In the Canadian Youth, Sexual Health and HIV/AIDS Survey created by Boyce and colleagues,[5] it was found that among students in grades 9 and 11 between 2002 and 2003, 84% to 90% of males and females who had ever had intercourse reported being protected from pregnancy by using a combined oral contraceptive pill, a condom or both the last time they engaged in sexual intercourse.[5] This survey was conducted nationally, representing every province except Nunavut.
In 2005, the percentage of adolescents aged 15 to 19 who reported that they had used a condom the last time they had sex was significantly higher in Prince Edward Island, Nova Scotia and Alberta and significantly lower in Quebec, compared with the national average. Nova Scotia was the only province in which condom use among adolescents increased significantly between 2003 and 2005.
Goldenberg and colleagues' (2005) ethnography identified the mobility of the oil–gas workforce, binge partying, a high level of disposable income and gender–power dynamics as the main social, cultural, and structural factors affecting adolescent sexual behaviour in Fort St. John.
A noteworthy point was that 13% of the young women lacked effective contraception at last intercourse (compared to 11% nationally), which may indicate a need to increase sexual health education in the region.
The National Population Health Survey began its first 12-month cycle of data collection in early June 1994, and continues to do so every other year. This survey is a major part of the effort to improve the information available on health policies and programs in Canada during a period of economic downturn and budgetary pressure on the health-care system.[8]
The survey produces both periodic cross-sectional information to monitor programs and longitudinal data to improve understanding of what determines good health.
In 1991, the National Task Force on Health Information pointed out a number of problems with information on Canada's health system. Responding to these concerns, the Canadian Institute for Health Information (CIHI), Statistics Canada and Health Canada joined in creating a Health Information Roadmap (the mandate eventually resulting in the creation of the Canadian Community Health Survey).
The Canadian Community Health Survey (or CCHS) is a cross-sectional survey collecting information on health status, health-care utilization and health determinants for the population.[9] It draws from a large sample of the Canadian population, and is designed to provide reliable estimates at the regional level.[9] The CCHS was created to accomplish the following objectives:
The National Longitudinal Survey of Children and Youth (NLSCY) is a long-term study of Canadian children which follows their development and well-being from birth to early adulthood. Begun in 1994, it is jointly conducted by Statistics Canada and Human Resources and Skills Development Canada.
The study has been designed to collect information about factors influencing a child's social, emotional and behavioural development, and to monitor the impact of these factors on the child's development over time.[10] The survey covers a comprehensive range of topics, including the health of children; information on their physical development, learning and behaviour and information about their social environment (family, friends, schools and communities).[10]
For many Canadians the first sexual activities occur during adolescence, making it the time frame receiving the most attention from sexual health researchers.[2] Compared to previous generations, the majority of contemporary Canadian adolescents are taking more precautions for their sexual health (by increased contraceptive use and seeking abortion when necessary). Trends resulting from such behaviours are declines in pregnancy and the birth rate. Researchers state that behaviours encouraging sexual health can prevent problems such as sexually transmitted diseases and sexual assault. More importantly, it promotes satisfying relationships and a positive sense of self.[5]
Research on sexually transmitted diseases shows that older infections (such as syphilis) are close to elimination in Canada. Taking their place are diseases such as chlamydia and human papillomavirus (HPV), affecting women more than men. Both male and female adolescents tend to overestimate the prevalence of HIV, and underestimate that of the commoner HPV and chlamydia.[2] Although Canada has fewer sexually active teens than Great Britain, France and Sweden, it has the same rate of teen pregnancy and gonorrhea and a higher rate of chlamydia.[11] The chlamydia rate in Canada is highest among those aged 15 to 24;[2] this indicates a further need for self-protection on the part of Canadian teenagers. In addition, long-term adolescent relationships result in a reduced use of condoms and reliance on other contraceptive methods, increasing the risk of STD.[5] Current levels of STDs are an area of concern among sexual health service providers in Canada.
Several small-scale and regional studies in Canada have found that female and gay adolescents experience forms of sexual abuse such as unwanted sexual comments and sexual harassment. Adolescents who are gay, lesbian or transgender continue to face harassment and violence in their schools. Canadian studies have found that these sexual minorities feel higher levels of distrust among health and social service providers. These adolescents have difficulty accessing available sexual health services due to homophobia on the part of Canadian people and institutions. The victim of sexual abuse typically knows their perpetrator. More importantly, sexual abuse is a predictor of behaviors such as intercourse at a younger age and non-use of condoms.
Perception of peers' sexual attitudes and behaviour can increase the amount of sexual content watched by adolescents; this, in turn, can influence sexual behavior. Believing that one's friends approve of sexual activity and have a high level of non-coital sexual experience predicts heavier viewing of sexual material, relative to other types of television.[15] Collins and colleagues[16] found a relationship between the amount of sexual content in television viewed and sexual behavior in adolescents. Adolescents who viewed one standard deviation more sexual content than average showed sexual behavior similar to adolescents, 9 to 17 months older, who viewed an average amount of sexual programming. Adolescents who viewed the highest level of televised sexual content doubled the likelihood of initiating intercourse within the following year, compared to adolescents who viewed average amounts. However, the inability to control for prior interest in sex before television viewing may affect the accuracy of the results.
Steinberg and Monahan[17] questioned the statistical method in the study by Collins and colleagues. In response Collins, Martino, Elliott and Miu[18] reanalyzed the data with propensity score matching. The effects from the reanalysis were not as large as the original data, but were within range. Collins and colleagues concluded that the association does not prove causality, but is sufficient to warrant caution by parents of adolescents.
Parental mediation of adolescents' television viewing is a significant factor in countering sexual media influence.[19] Restrictive mediation involves implementing rules and limits for the amount, type, and occasions on which television can be viewed. Restrictive mediation is negatively related to adolescents' intention to engage in sexual intercourse in the future. This type of parental limitation was also positively associated with increased expectations of negative health consequences following sexual intercourse. Parental mediation can be a moderating influence on the effects of sexual television, but longitudinal studies are needed to examine the long-term effects. Individual differences also influence the impact of televised sexual content on adolescents' sexual behavior. Adolescents who identify with television characters engaging in sexual behavior are more likely to develop confidence in their own ability to engage in these actions, compared to adolescents who do not identify with these television characters.[20] This relationship is only seen when television characters have a successful outcome in their sexual pursuits. Therefore, in addition to the amount of media exposure, interpersonal variation (such as viewer identification with television characters) plays an important role in determining the influence of television on adolescent sexual behavior.
Brown and colleagues support the previous findings of exposure to sexual content in media accelerating adolescents' sexual activity. In addition to television, they[21] examined the effects of movies, music, and magazines. Adolescents aged 12 to 14 who have more exposure to sexual content in media are more likely to engage in sexual activity two years later, compared to adolescents with lighter exposure to sexual media. In addition, Brown and colleagues found differences in race; the relationship between sexual media and sexual behavior was only seen for Caucasian adolescents. They hypothesized that African-American youth may have already formed expectations about sexual behavior, and are therefore less affected by sexual media. Despite the findings, the lack of internet analysis as a source of sexual content in media is a major limitation.
Adolescents' use of sexually explicit internet material has been studied by Peter and Valkenburg,[22] who found that over one year, adolescents' use of sexually explicit internet material increased cognitive engagement in sexual issues. The frequency of viewing sexually explicit internet material correlates positively with adolescents' interest in sex, time spent thinking about sex and the frequency of distraction by sexual thoughts. This suggests a possible feedback loop, in which viewing sexually explicit websites increases adolescents' thinking about sex (which may, in turn, lead to viewing more sexually explicit websites). Statistics show that more than 50% of adolescents have visited a sexually explicit website.[23] Adolescents who visit sexually explicit websites are more likely to engage in high-risk sexual behaviour such as having multiple partners, substance use during sex and lack of condom use. In addition, adolescents frequently viewing sexually explicit websites have more sexually permissive attitudes and a higher acceptance of casual sex, compared to those who view these websites less frequently. Viewing sexually explicit websites has a positive correlation with adolescents' sexual behaviors and attitudes, but the direction of the relationship has not yet been determined.
Adolescent sexuality is influenced by a range of factors that are related, but not easily clustered together. The sexual behaviour of the adolescent is controlled by their culture and influenced by their family, parents and peers. There are three sexual cultures: restrictive, semi-restrictive and permissive. Depending on their sexual culture, the adolescent learns and is influenced by cultural and societal dynamics. The United States and Canada are semi-restrictive sexual cultures; however, Canada is considered less restrictive than the United States.
Semi-restrictive cultures also disapprove of premarital sex; however, the rules are not as strict. Adults in these cultures tend to ignore promiscuous behaviour until the girl becomes pregnant. If this happens, the couple is expected to marry. The United States and Canada are examples of semi-restrictive cultures. Adolescents know that premarital sex is not desirable; however, they engage in it and parents pretend they do not know about their children's activities.
Permissive cultures expect sexual relations before marriage, and may encourage them. An example of this culture would encourage sexuality from a young age and would be open communication about sex between the children and parents. The people of the Trobriand Island in the South Pacific fit this description.
Societal factors (such as family structure, parental style and monitoring) play a role in the type and timeline of sexual behaviour. The family is an important structure in the adolescent's life; it provides values and beliefs about marriage, love and sex, and is the base of the relationships that they will have in later life. Parental monitoring and communication are essential. Parent-child communication "about sex also was significantly and negatively associated with consistent versus inconsistent condom use".[28] The composition of the household plays a critical role in adolescent sexuality. Adolescents from single-parent households (mostly single mothers) are more likely to engage in premarital sex than adolescents from two-parent households. Coley, Medeiros and Schindler[29] investigated the impact of family on adolescent sexual behaviour, concluding that "regular family activities may buffer adolescents, whereas negative parenting behaviors may increase adolescents' engagement in sexual risk behaviors". Parents are both a source of information about sexual behaviour and models of what is accepted and what is not. The neighbourhood is another societal factor; it has been found that the "neighborhood context may be positively or negatively associated with sexual initiation, depending on gender".[30] The neighbourhood may also reflect higher levels of social control.
Since parents are role models for their children, it is critical to understand parental behaviour in the context of adolescent sexuality. Unsafe parental behaviour (such as smoking) are linked to adolescent engagement in risky behaviour.[31] The fact that a parent smokes increases the likelihood of an adolescent engaging in problem behaviour, including risky sexual behaviour. The idea that risk is reproduced in generations is evident; parental behaviour is mirrored by the adolescent. Kim, Schooler and Sorsoli demonstrated "that adolescents' perceptions of parental caring are an important mechanism in the association between parental television involvement and adolescents' self-esteem, body image and sexuality". Parental involvement is desirable when viewing sexual behaviour on TV; the shared experience enables parents to clarify what is seen. Parents and peers both influence adolescent sexuality.
In adolescence, peers are important because they enable a teenager to form a sense of identity. Peers allow the adolescent to compare themselves socially (either positively or negatively). Since peer acceptance is important, adolescents want to do the same activities their friends are doing. Downward and upward comparison permits the adolescent to see what they need to do to be on the same level as their peers. Brown[32] found that "peer norms have been shown to influence adolescent sexual (behaviour)"; these norms may be pro-social or anti-social. Killoren and colleagues demonstrate that teens with deviant peers will engage in sexual activities earlier (and for reasons that may be understood to be wrong in that society). Cohen, Meade and Prinstein (2003) found that the perception of a best friend's sexual behaviour has a significant impact on the adolescent's own sexual behaviour. In addition, the researchers found that adolescents with a high level of sexual activity were perceived to be popular.[33] Popularity and acceptance is crucial at this stage of life; Bauermeister, Elkington, Brackis-Cott, Dolezal and Mellins[34] established that if "the number of peers believing that sexually-active girls were cool and popular" was high, this perception led to more engagement in sexual intercourse. There are visible gender differences; boys do not seem to be affected as much as girls. "Girls were more likely to report engaging in penetrative sex if a greater number of peers perceived sexually active girls were cool or popular". These differences become the norm for sexual behaviour.