Sexually Transmitted Infections: Educational Settings

Background: Sexually transmitted infections (STIs) are a major public health concern in Canada and worldwide. Nearly two-thirds of STIs are seen among youth. Therefore, it is crucial to provide effective STI interventions to youth. Substance use is an important factor for STI acquisition among youth because of high prevalence and its ability to link proximal sexual risk behaviors and distal contextual factors. STI preventive behavioral interventions remain the gold standard due to the limitations in biomedical interventions. Educational institutions are recognized as ideal settings to target youth. Thus, it is essential to assess whether integrating substance use into STI prevention programs at educational settings is worthwhile as well as whether STI preventive interventions at educational settings are effective and how can they be improved. Objectives and Methods: The objectives and methodologies of this thesis include 1) determine the prevalence and association between substance use and STIs among Canadian post-secondary students (descriptive analysis and logistic regression of the ACHA-NCHA II Spring 2016 survey data and 2) assess the efficacy and effectiveness of STI preventive intervention programs at educational settings (a systematic review and meta-analysis). Results: Positive association exists between current cannabis use or other drug use and STIs among Canadian post secondary students. STI preventive interventions at educational institutions in developed countries show effectiveness. Interventions are more effective in promoting knowledge compared to enhancing motivational factors, behavioral skills and behaviors, and for female students. No significant difference in effectiveness is seen based on the type of provider (peer-involved and non-peer-involved) and type of intervention (face-to-face and technology-based). Recommendations: Based on our findings, it is recommended to integrate substance use preventive interventions into STI preventive interventions at Canadian post-secondary institutions. A potential framework for effective STI preventive interventions at educational settings which can possibly be inferred to the Canadian post-secondary institutions is presented based on our results. This thesis will help inform, evaluate and guide STI preventive interventions at educational settings to effectively reduce the burden of STIs among Canadian youth. Future research with more rigorous methodology should be undertaken to provide conclusive evidence

STI Health Disparities: A Systematic Review and Meta-Analysis of the Effectiveness of Preventive Interventions in Educational Settings

The purpose of this systematic review and meta-analysis was to address disparities related to sexual health among students by examining the effectiveness of sexually transmitted infection (STI) preventive interventions in educational settings. PubMed, Medline, Cochrane Library, Public Health Database, and EMBASE databases were used to conduct searches. Information relating to studies, programs, participants, and quantitative outcome variables were extracted. Risk of bias was assessed and meta-analysis was conducted. This systematic review included 16 articles. The outcomes were classified into behavioral and psychosocial categories. The behavioral category included sexual partners, sexual activity, condom use, STI/HIV testing, and alcohol/drug use before sex. The psychosocial category consisted of knowledge, motivational factors, and skills. Interventions had a significantly positive impact on both behavioral (OR, 1.28; 95% CI, 1.17⁻1.39) and psychosocial (OR, 1.92; 95% CI, 1.36⁻2.72) outcomes. Among the psychosocial outcomes, the interventions were most effective at promoting knowledge (OR, 3.17; 95% CI, 2.13⁻4.72), followed by enhancing motivational factors (OR, 1.69; 95% CI, 1.04⁻2.75) and increasing behavioral skills (OR, 1.43; 95% CI, 1.13⁻1.81). The results of this systematic review provide empirical evidence for public health professionals and policy makers regarding planning, implementation, evaluation, and modification of STI preventive intervention programs in educational settings