Exploring factors associated with condom use self-efficacy and condom use among Northern and Indigenous adolescent peer leaders in Northern Canada

Abstract

ABSTRACTSocial and health disparities compromise Northern and Indigenous adolescents’ wellbeing in the Northwest Territories (NWT) where food insecurity, sexually transmitted infections (STI), and depression prevalence are higher than other Canadian regions. Condoms are an accessible STI prevention strategy for adolescents, yet depression and food insecurity may constrain condom use self-efficacy. The potential role of resilience in cultivating condom use self-efficacy is understudied. This study examined factors associated with condom use self-efficacy among Northern and Indigenous adolescents. We examined: (1) resilience as a mediator in the relationship between depression and condom use self-efficacy; (2) if food insecurity influenced the indirect effect of depression on condom use self-efficacy through resilience; and (3) condom use self-efficacy as a mediator of the relationship between resilience and condom use. We conducted a cross-sectional survey in 17 NWT communities with adolescents aged 13–18 who had attended a peer leadership training held by a NWT sexual health organization. We conducted descriptive statistics, followed by ordinary least squares regression to test the mediation models, and a conditional process analysis to examine the moderating role of food insecurity in the relationship between depression, resilience, and condom use self-efficacy. Most participants (n = 86; mean age: 15.77, SD = 2.05) identified as Indigenous (n = 65; 77.4%) and women (n = 70; 82.4%) and reported depressive symptoms (n = 54; 70.1%). Results suggest that resilience mediated the relationship between depression and condom use self-efficacy, and among sexually active participants, resilience mediated the association between condom use self-efficacy and condom use. There was a significant positive interaction effect between resilience and food insecurity on condom use self-efficacy, suggesting that food insecure participants with higher resilience reported higher condom use self-efficacy. Findings can inform strengths-based, resilience focused strategies to advance sexual health among Northern adolescents. These findings underscore the need to address syndemics of poverty, mental health, and sexual health.