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doi:10.1111/jpc.12450
ORIGINAL ARTICLE
Factors associated with consistent contraception and condom use among Ma¯ori secondary school students in New Zealand Terryann C Clark,1 Sue Crengle,2 Janie Sheridan,3 Deborah Rowe1 and Elizabeth Robinson4 School of Nursing, 2Te Kupenga Hauora Ma¯ori and 3School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, and 4Auckland Uniservices Services, Auckland, New Zealand 1
Aims: The aims of this study are to provide a profile of sexual health behaviours of Ma¯ori youth and to identify factors associated with consistent condom and contraception use. Methods: Multivariable analyses were conducted to determine relationships between consistent contraception and condom use among all 2059 sexually active Ma¯ori participants in the 2007 New Zealand youth health and well-being survey of secondary school students. Results: Forty per cent of Ma¯ori students were currently sexually active; of these, 55.3% always used contraception, and 41.1% always used condoms. Risk factors for not using contraception were less than or equal to three sexual partners (males odds ratio (OR) 0.55, P = 0.04, females OR 0.35, P = 0.04) and regular cigarette use for females (OR 0.52, P = 0.02). Risk factors for not using condoms were 13- to 15-year-old females (OR 1.95, P < 0.01) and females who enjoyed sex (OR 0.52, P = 0.02). Family connection was associated with increased use of condoms among males (OR 1.07, P < 0.01). Conclusions: Reducing sexual risks, increasing opportunities for healthy youth development and family connectedness, alongside access to appropriate services, are required to improve the sexual health of Ma¯ori youth. Key words:
adolescent; behavioural; community; international child health; statistics.
What is already known on this topic? 1 Ma¯ori youth have higher rates of pregnancy and sexually transmitted infections compared with non-Ma¯ori youth. 2 Ma¯ori youth report poorer access to sexual health care. 3 Health professionals are not meeting the sexual health needs of Ma¯ori youth.
What this paper adds 1 Risky health behaviours like cigarette smoking, multiple sexual partners and sensation seeking may be markers of non-condom and contraception use among Ma¯ori females. 2 Good family relationships were associated with consistent condom use among Ma¯ori males. 3 These findings support the necessity for comprehensive psychosocial health assessments that identify risk and protective factors to improve sexual health outcomes for Ma¯ori youth.
Sexual and reproductive well-being is of significant importance to Ma¯ori, the indigenous peoples of New Zealand. The concept of whakapapa (ancestry) requires a profound respect for sexuality, how we treat each other, our partners and our future generations.1,2 Whakapapa also acknowledges the great pleasures that can be derived from sexuality, reproduction and our relationships with each other.3,4 Sexual and reproductive wellbeing is a collective responsibility that should be positively modelled in a supportive environment.5 However, many young Ma¯ori do not have access to the information, services and support they need regarding their sexual and reproductive health.6–9
Ma¯ori youth have significant sexual and reproductive disparities compared with non-Ma¯ori, with higher rates of teen pregnancy, sexually transmitted infections and sexual abuse or coercion compared with their New Zealand peers.7,10–15 Despite this knowledge, there is a relatively little literature about the sexual and reproductive health of Ma¯ori youth and evidencebased strategies to reduce these burdens. Such information provides a fundamental basis for developing effective health strategies. The paper aims to provide a profile of the self-reported sexual and reproductive behaviours of Ma¯ori youth attending secondary schools throughout New Zealand and to identify factors that are associated with consistent condom and contraception use.
Correspondence: Dr Terryann C Clark, School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1145, New Zealand. Fax: +64 9 367 7158; email: [email protected]
Methods
Conflict of interest: None declared. Accepted for publication 7 October 2013.
258
Study design This study utilised data from two datasets, Youth’07, a nationally representative health and well-being survey of 9107 New
Journal of Paediatrics and Child Health 50 (2014) 258–265 © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Ma¯ori sexual health
TC Clark et al.
Zealand secondary school students and Taiohi’07, a health and well-being survey of 677 Wharekura (Ma¯ori language immersion secondary schools) students throughout New Zealand.11,16,17 Youth’07 utilised a two-stage sampling design. One hundred fifteen schools were randomly selected for participation from the 389 eligible secondary schools in New Zealand (schools with fewer than 50 students were excluded). Of the 115 randomly selected schools, 96 schools agreed to participate, resulting in a school response rate of 84%. These schools and students were generally representative of the New Zealand secondary school population.18 Within the participating schools, students were randomly selected for participation in the survey (18% of students where school rolls >166 and 30 students selected where school rolls 50 students, between the ages of 12 and 18 years and have self-identified Ma¯ori ethnicity. Given these criteria, 1702 students from the Youth’07 mainstream survey and 357 students from the Taiohi’07 study gave us a combined sample of 2059 Ma¯ori students. The Youth’07 and Taiohi’07 both utilised an anonymous health and well-being survey that asked students a wide range of issues, including sexual and reproductive health. The 622-item questionnaire survey was administered via multimedia computer-assisted self-administered interview using hand-held internet tablets. The full questionnaire is available on our website http://www.youthresearch.auckland.ac.nz. Further detailed methodology for Youth’07 is available elsewhere.16
Outcome variables The outcomes variables were (i) always using contraception to prevent pregnancy (how often do you or your partner use contraception? (by this, we mean protection against pregnancy) response: always) and (ii) always using condoms to prevent sexually transmitted infections (how often do you use condoms as protection against sexually transmitted disease or infection? response: always).
vation may not reflect individual level socio-economic circumstances, additional variables that ask students about ‘worrying about insufficient food in the household’ and ‘moving home frequently’ were used as proxy individual indicators for socioeconomic disadvantage. Depressive symptoms were measured with the Reynolds Adolescent Depression Scale – Short Form.18 A total score above 28 was utilised to determine the level of symptom endorsement associated with clinical depression. This instrument appears to be an acceptable and valid measuring for assessing depressive symptoms amongst New Zealand youth with a Cronbach’s alpha over 0.9 for all ethnic groups including Ma¯ori students.21 A 10-item wha¯nau/family connection scale (range 11–45 α = 0.84) previously developed identified factors that might theoretically constitute wha¯nau/family connectedness.22,23 An eight-item school connection scale (range 5–35 α = 0.63) was also utilised.22,23
Analysis These analyses involved samples of Ma¯ori students selected with differing sampling techniques. SUDAAN software (Research Triangle Institute, Research Triangle Park, NC, USA)24 was utilised to address the effects of the unequal weighting and stratification for the sampling and clustering of the students and schools in the combined Ma¯ori sample. Logistic regressions were used to explore the relationship between the outcome variables (consistent condom use and consistent contraception use) and hypothesised risk and protective variables among Ma¯ori students. Gender interaction terms were identified for risk and protective variables. Consequently, further analysis was conducted by gender separately. Variables associated with the outcomes at the 0.2 level of significance in bivariate analyses and that were answered by at least 90% of the students were considered for inclusion in multivariable analyses. Multiple logistic models were used to determine the relationship between consistent contraception use/condom use and hypothesised risk and protective factors among Ma¯ori students controlling for independent effects of age and socio-economic variables (NZDep2006, family worrying about insufficient food and moving home frequently). Sensitivity analyses were conducted to determine the effect of omitting variables with large amounts of missing data.
Results
Explanatory variables
Demographics
Where there were variables in the youth health surveys that represented previously identified risk and protective factors, they were considered for inclusion in the models (Tables 3,5).
There were similar numbers of male (50.7%) and female (49.3%) students (Table 1) and proportionately more junior students than senior students. Most students reported living in urban and semi-urban areas and towns where there are more than 1000 residents (82.4%). Almost 50% of Ma¯ori were living in socio-economically deprived areas.15 There were higher proportions of Ma¯ori students living in socio-economically deprived areas compared with their non-Ma¯ori peers.11
Measures and scales Age, gender and ethnicity were determined by self-report. Ethnicity was assessed using the standard questions used by the New Zealand census.19 Participants were assigned to a level of area deprivation by linking their residential meshblock number to the 2006 New Zealand Deprivation Index (NZDep2006).20 The index deciles were categorised into three groups reflecting low deprivation (deciles 1–3), middle levels of deprivation (deciles 4–7) and high deprivation (deciles 8–10). Because geographic depri-
Sexual health behaviours Fifty-six per cent (56.1%) of Ma¯ori youth reported that they had ‘ever had sex’, and 40% reported they were currently sexually active (had sex within the past 3 months) (Table 2).
Journal of Paediatrics and Child Health 50 (2014) 258–265 © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
259
Ma¯ori sexual health
TC Clark et al.
Four per cent (4.2%) of Ma¯ori students reported ‘same’ or ‘both sex’ sexual attractions. More males (80.4%) than females (64.7%) reported enjoying sex and males (14.6%) more frequently reported multiple sexual partners (in the previous 3 months) compared with females (6.8%). Fifty-five per cent (55.3%) of Ma¯ori students report that they used contraception all the time to prevent pregnancy. Females were more likely to talk to their partners about preventing pregnancy (females 76.5%, males 60.8%). Females (18.4%) also more frequently reported getting pregnant than males who reported getting their sexual partner pregnant (12.9%). Forty-one per cent of students reported that they used condoms all of the time to prevent sexually transmitted infections. A higher proportion of Ma¯ori males (46.8%) than females (35.0%) used condoms all the time. Females more frequently talked to their partners about preventing sexually transmitted infections (females 49.5%, males 38.4%). A small proportion of students self-reported ever having a sexually transmitted infection (5.4%).
Table 1 Demographic features of students
Total Age
≤13 14 15 16 ≥17 Geography Urban Rural
Ma¯ori males
Ma¯ori females Total Ma¯ori
n
%
n
%
n
1044 267 261 245 169 102 798 196
50.7 25.6 25.0 23.5 16.2 9.8 80.3 19.7
1015 231 285 227 146 126 808 147
49.3 22.8 28.1 22.4 14.4 12.4 84.6 15.4
2059 100 498 24.2 546 26.5 472 22.9 351 15.3 228 11.10 1606 82.4 343 17.6
n
%
NZDep2006† Low deprivation (1–3) Medium deprivation (4–7) High deprivation (8–10)
363 648 979
%
19.9 34.4 45.8
Access to health care for sexual health issues
†New Zealand Deprivation Index scores based on census areas25 combined to form three categories.
More Ma¯ori females (11.1%) than males (5.4%) reported that they had difficulty accessing health care for contraceptionrelated issues (Table 2). Ten per cent of females and 1.4% of
Table 2 Sexual health behaviours and access to health care by gender n/N
Males % (95% CI)
Females % (95% CI)
Total % (95% CI)
Ever had sex†
992/1731
Currently sexually active‡ (sex within the previous 3 months)
706/1702
Use condoms all the time to prevent sexually transmitted infections‡
383/946
Use contraception all the time to prevent pregnancy‡
432/820
57.6 53.4–61.7 40.6 37.5–43.1 46.8 42.6–50.9 56.7 51.9–61.6 3.7 2.3–5.1 14.58 12.0–17.1 80.4 76.5–84.3 38.4 33.8–43.0 60.8 55.9–65.7 12.9 10.9–15.8 3.7 2.0–5.5 5.4 3.5–7.3 1.4 0.6–2.3
54.6 50.5–58.8 40.0 36.1–43.9 35.0 29.9–40.1 53.9 48.6–59.2 4.7 2.3–5.1 6.8 5.1–8.5 64.7 60.1–69.2 49.5 45.0–54.5 76.5 72.4–80.6 18.4 14.6–22.2 7.2 4.8–9.6 11.1 9.1–13.5 10.0 2.1–7.9
56.1 52.9–59.3 40.3 37.5–43.1 41.1 37.7–44.5 55.3 51.7–58.9 4.2 3.1–5.3 10.7 9.1–12.3 72.8 69.5–76.0 43.8 40.4–47.2 68.5 65.3–71.7 15.5 13.3–17.7 5.4 4.0–6.9 8.3 6.8–9.8 5.7 4.5–6.9
Same/both sex attracted†
73/1686
More than three sexual partners in the previous 3 months‡
201/1702
Enjoy sex‡
694/967
Discussed STIs with partner‡
424/964
Discussed pregnancy with partner‡
651/961
Ever been pregnant or got someone pregnant‡
145/884
Ever had an sexually transmitted infection‡
51/951
Difficulty accessing contraception/sexual health care†
148/1832
Difficulty accessing pregnancy care or a pregnancy test†
109/1832
Difference between males and females (P value) 0.29 0.82
doi:10.1111/jpc.12450
ORIGINAL ARTICLE
Factors associated with consistent contraception and condom use among Ma¯ori secondary school students in New Zealand Terryann C Clark,1 Sue Crengle,2 Janie Sheridan,3 Deborah Rowe1 and Elizabeth Robinson4 School of Nursing, 2Te Kupenga Hauora Ma¯ori and 3School of Pharmacy, Faculty of Medical and Health Sciences, The University of Auckland, and 4Auckland Uniservices Services, Auckland, New Zealand 1
Aims: The aims of this study are to provide a profile of sexual health behaviours of Ma¯ori youth and to identify factors associated with consistent condom and contraception use. Methods: Multivariable analyses were conducted to determine relationships between consistent contraception and condom use among all 2059 sexually active Ma¯ori participants in the 2007 New Zealand youth health and well-being survey of secondary school students. Results: Forty per cent of Ma¯ori students were currently sexually active; of these, 55.3% always used contraception, and 41.1% always used condoms. Risk factors for not using contraception were less than or equal to three sexual partners (males odds ratio (OR) 0.55, P = 0.04, females OR 0.35, P = 0.04) and regular cigarette use for females (OR 0.52, P = 0.02). Risk factors for not using condoms were 13- to 15-year-old females (OR 1.95, P < 0.01) and females who enjoyed sex (OR 0.52, P = 0.02). Family connection was associated with increased use of condoms among males (OR 1.07, P < 0.01). Conclusions: Reducing sexual risks, increasing opportunities for healthy youth development and family connectedness, alongside access to appropriate services, are required to improve the sexual health of Ma¯ori youth. Key words:
adolescent; behavioural; community; international child health; statistics.
What is already known on this topic? 1 Ma¯ori youth have higher rates of pregnancy and sexually transmitted infections compared with non-Ma¯ori youth. 2 Ma¯ori youth report poorer access to sexual health care. 3 Health professionals are not meeting the sexual health needs of Ma¯ori youth.
What this paper adds 1 Risky health behaviours like cigarette smoking, multiple sexual partners and sensation seeking may be markers of non-condom and contraception use among Ma¯ori females. 2 Good family relationships were associated with consistent condom use among Ma¯ori males. 3 These findings support the necessity for comprehensive psychosocial health assessments that identify risk and protective factors to improve sexual health outcomes for Ma¯ori youth.
Sexual and reproductive well-being is of significant importance to Ma¯ori, the indigenous peoples of New Zealand. The concept of whakapapa (ancestry) requires a profound respect for sexuality, how we treat each other, our partners and our future generations.1,2 Whakapapa also acknowledges the great pleasures that can be derived from sexuality, reproduction and our relationships with each other.3,4 Sexual and reproductive wellbeing is a collective responsibility that should be positively modelled in a supportive environment.5 However, many young Ma¯ori do not have access to the information, services and support they need regarding their sexual and reproductive health.6–9
Ma¯ori youth have significant sexual and reproductive disparities compared with non-Ma¯ori, with higher rates of teen pregnancy, sexually transmitted infections and sexual abuse or coercion compared with their New Zealand peers.7,10–15 Despite this knowledge, there is a relatively little literature about the sexual and reproductive health of Ma¯ori youth and evidencebased strategies to reduce these burdens. Such information provides a fundamental basis for developing effective health strategies. The paper aims to provide a profile of the self-reported sexual and reproductive behaviours of Ma¯ori youth attending secondary schools throughout New Zealand and to identify factors that are associated with consistent condom and contraception use.
Correspondence: Dr Terryann C Clark, School of Nursing, Faculty of Medical and Health Sciences, The University of Auckland, Auckland 1145, New Zealand. Fax: +64 9 367 7158; email: [email protected]
Methods
Conflict of interest: None declared. Accepted for publication 7 October 2013.
258
Study design This study utilised data from two datasets, Youth’07, a nationally representative health and well-being survey of 9107 New
Journal of Paediatrics and Child Health 50 (2014) 258–265 © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Ma¯ori sexual health
TC Clark et al.
Zealand secondary school students and Taiohi’07, a health and well-being survey of 677 Wharekura (Ma¯ori language immersion secondary schools) students throughout New Zealand.11,16,17 Youth’07 utilised a two-stage sampling design. One hundred fifteen schools were randomly selected for participation from the 389 eligible secondary schools in New Zealand (schools with fewer than 50 students were excluded). Of the 115 randomly selected schools, 96 schools agreed to participate, resulting in a school response rate of 84%. These schools and students were generally representative of the New Zealand secondary school population.18 Within the participating schools, students were randomly selected for participation in the survey (18% of students where school rolls >166 and 30 students selected where school rolls 50 students, between the ages of 12 and 18 years and have self-identified Ma¯ori ethnicity. Given these criteria, 1702 students from the Youth’07 mainstream survey and 357 students from the Taiohi’07 study gave us a combined sample of 2059 Ma¯ori students. The Youth’07 and Taiohi’07 both utilised an anonymous health and well-being survey that asked students a wide range of issues, including sexual and reproductive health. The 622-item questionnaire survey was administered via multimedia computer-assisted self-administered interview using hand-held internet tablets. The full questionnaire is available on our website http://www.youthresearch.auckland.ac.nz. Further detailed methodology for Youth’07 is available elsewhere.16
Outcome variables The outcomes variables were (i) always using contraception to prevent pregnancy (how often do you or your partner use contraception? (by this, we mean protection against pregnancy) response: always) and (ii) always using condoms to prevent sexually transmitted infections (how often do you use condoms as protection against sexually transmitted disease or infection? response: always).
vation may not reflect individual level socio-economic circumstances, additional variables that ask students about ‘worrying about insufficient food in the household’ and ‘moving home frequently’ were used as proxy individual indicators for socioeconomic disadvantage. Depressive symptoms were measured with the Reynolds Adolescent Depression Scale – Short Form.18 A total score above 28 was utilised to determine the level of symptom endorsement associated with clinical depression. This instrument appears to be an acceptable and valid measuring for assessing depressive symptoms amongst New Zealand youth with a Cronbach’s alpha over 0.9 for all ethnic groups including Ma¯ori students.21 A 10-item wha¯nau/family connection scale (range 11–45 α = 0.84) previously developed identified factors that might theoretically constitute wha¯nau/family connectedness.22,23 An eight-item school connection scale (range 5–35 α = 0.63) was also utilised.22,23
Analysis These analyses involved samples of Ma¯ori students selected with differing sampling techniques. SUDAAN software (Research Triangle Institute, Research Triangle Park, NC, USA)24 was utilised to address the effects of the unequal weighting and stratification for the sampling and clustering of the students and schools in the combined Ma¯ori sample. Logistic regressions were used to explore the relationship between the outcome variables (consistent condom use and consistent contraception use) and hypothesised risk and protective variables among Ma¯ori students. Gender interaction terms were identified for risk and protective variables. Consequently, further analysis was conducted by gender separately. Variables associated with the outcomes at the 0.2 level of significance in bivariate analyses and that were answered by at least 90% of the students were considered for inclusion in multivariable analyses. Multiple logistic models were used to determine the relationship between consistent contraception use/condom use and hypothesised risk and protective factors among Ma¯ori students controlling for independent effects of age and socio-economic variables (NZDep2006, family worrying about insufficient food and moving home frequently). Sensitivity analyses were conducted to determine the effect of omitting variables with large amounts of missing data.
Results
Explanatory variables
Demographics
Where there were variables in the youth health surveys that represented previously identified risk and protective factors, they were considered for inclusion in the models (Tables 3,5).
There were similar numbers of male (50.7%) and female (49.3%) students (Table 1) and proportionately more junior students than senior students. Most students reported living in urban and semi-urban areas and towns where there are more than 1000 residents (82.4%). Almost 50% of Ma¯ori were living in socio-economically deprived areas.15 There were higher proportions of Ma¯ori students living in socio-economically deprived areas compared with their non-Ma¯ori peers.11
Measures and scales Age, gender and ethnicity were determined by self-report. Ethnicity was assessed using the standard questions used by the New Zealand census.19 Participants were assigned to a level of area deprivation by linking their residential meshblock number to the 2006 New Zealand Deprivation Index (NZDep2006).20 The index deciles were categorised into three groups reflecting low deprivation (deciles 1–3), middle levels of deprivation (deciles 4–7) and high deprivation (deciles 8–10). Because geographic depri-
Sexual health behaviours Fifty-six per cent (56.1%) of Ma¯ori youth reported that they had ‘ever had sex’, and 40% reported they were currently sexually active (had sex within the past 3 months) (Table 2).
Journal of Paediatrics and Child Health 50 (2014) 258–265 © 2013 The Authors Journal of Paediatrics and Child Health © 2013 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
259
Ma¯ori sexual health
TC Clark et al.
Four per cent (4.2%) of Ma¯ori students reported ‘same’ or ‘both sex’ sexual attractions. More males (80.4%) than females (64.7%) reported enjoying sex and males (14.6%) more frequently reported multiple sexual partners (in the previous 3 months) compared with females (6.8%). Fifty-five per cent (55.3%) of Ma¯ori students report that they used contraception all the time to prevent pregnancy. Females were more likely to talk to their partners about preventing pregnancy (females 76.5%, males 60.8%). Females (18.4%) also more frequently reported getting pregnant than males who reported getting their sexual partner pregnant (12.9%). Forty-one per cent of students reported that they used condoms all of the time to prevent sexually transmitted infections. A higher proportion of Ma¯ori males (46.8%) than females (35.0%) used condoms all the time. Females more frequently talked to their partners about preventing sexually transmitted infections (females 49.5%, males 38.4%). A small proportion of students self-reported ever having a sexually transmitted infection (5.4%).
Table 1 Demographic features of students
Total Age
≤13 14 15 16 ≥17 Geography Urban Rural
Ma¯ori males
Ma¯ori females Total Ma¯ori
n
%
n
%
n
1044 267 261 245 169 102 798 196
50.7 25.6 25.0 23.5 16.2 9.8 80.3 19.7
1015 231 285 227 146 126 808 147
49.3 22.8 28.1 22.4 14.4 12.4 84.6 15.4
2059 100 498 24.2 546 26.5 472 22.9 351 15.3 228 11.10 1606 82.4 343 17.6
n
%
NZDep2006† Low deprivation (1–3) Medium deprivation (4–7) High deprivation (8–10)
363 648 979
%
19.9 34.4 45.8
Access to health care for sexual health issues
†New Zealand Deprivation Index scores based on census areas25 combined to form three categories.
More Ma¯ori females (11.1%) than males (5.4%) reported that they had difficulty accessing health care for contraceptionrelated issues (Table 2). Ten per cent of females and 1.4% of
Table 2 Sexual health behaviours and access to health care by gender n/N
Males % (95% CI)
Females % (95% CI)
Total % (95% CI)
Ever had sex†
992/1731
Currently sexually active‡ (sex within the previous 3 months)
706/1702
Use condoms all the time to prevent sexually transmitted infections‡
383/946
Use contraception all the time to prevent pregnancy‡
432/820
57.6 53.4–61.7 40.6 37.5–43.1 46.8 42.6–50.9 56.7 51.9–61.6 3.7 2.3–5.1 14.58 12.0–17.1 80.4 76.5–84.3 38.4 33.8–43.0 60.8 55.9–65.7 12.9 10.9–15.8 3.7 2.0–5.5 5.4 3.5–7.3 1.4 0.6–2.3
54.6 50.5–58.8 40.0 36.1–43.9 35.0 29.9–40.1 53.9 48.6–59.2 4.7 2.3–5.1 6.8 5.1–8.5 64.7 60.1–69.2 49.5 45.0–54.5 76.5 72.4–80.6 18.4 14.6–22.2 7.2 4.8–9.6 11.1 9.1–13.5 10.0 2.1–7.9
56.1 52.9–59.3 40.3 37.5–43.1 41.1 37.7–44.5 55.3 51.7–58.9 4.2 3.1–5.3 10.7 9.1–12.3 72.8 69.5–76.0 43.8 40.4–47.2 68.5 65.3–71.7 15.5 13.3–17.7 5.4 4.0–6.9 8.3 6.8–9.8 5.7 4.5–6.9
Same/both sex attracted†
73/1686
More than three sexual partners in the previous 3 months‡
201/1702
Enjoy sex‡
694/967
Discussed STIs with partner‡
424/964
Discussed pregnancy with partner‡
651/961
Ever been pregnant or got someone pregnant‡
145/884
Ever had an sexually transmitted infection‡
51/951
Difficulty accessing contraception/sexual health care†
148/1832
Difficulty accessing pregnancy care or a pregnancy test†
109/1832
Difference between males and females (P value) 0.29 0.82
