Risk Factors Associated with Self‑reported Sexually Transmitted Infections among Postsecondary Students in Canada

Edris Haghir, Claudia Madampage, Razi Mahmood, John Moraros


Background: Despite major public health efforts in addressing the burden of disease caused by sexually transmitted infections (STIs), rates among young adults continue to rise in Canada. The purpose of the study was to examine the prevalence and risk factors associated with acquiring STIs
among postsecondary students in Canada.

Methods: A secondary analysis of the American College Health Association‑National College Health Assessment II‑C Spring 2016 survey data (n = 43,780) was conducted. Sexually active participants (n = 28,831) were examined for their demographics, sexual behavior, alcohol and marijuana use, testing for human immunodefciency virus (HIV), and human papillomavirus vaccination history. These factors were analyzed to help identify their possible association with acquiring an STI using logistic regression and multivariate modeling.

Results: Among the study participants, 3.88% had an STI, with the highest rates observed among females and individuals aged 21–24 years old. Multivariate logistic analysis showed that participants who engaged in anal intercourse within the past 30 days (odds ratio [OR] = 1.634; 95% confdence interval [CI], 1.343–1.988), had four or more sexual partners in the last 12 months (OR = 4.223; 95% CI, 3.595–4.962), used marijuana within the past 30 days (OR = 1.641; 95% CI, 1.387–1.941), and
had ever been tested for HIV (OR = 3.008; 95% CI, 2.607–3.471) had greater odds of acquiring an STI.

Conclusions: The fndings of this study highlight certain high‑risk behaviors that are strongly associated with acquiring an STI among postsecondary students. Thus, efforts to design and deliver relevant educational programming and health promotion initiatives for this particular population are of utmost importance.

Keywords: Behaviors, Canada, risks, sexually transmitted diseases and human immunodefciency virus, students

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Public Health Agency of Canada. Report on Sexually Transmitted

Infections in Canada: 2012. Centre for Communicable Diseases

and Infection Control, Infectious Disease Prevention and Control

Branch, Public Health Agency of Canada; 2015.

World Health Organization. Sexually Transmitted

Infections (STIs) Fact Sheet. WHO; 2016. Available from: http://

www.who.int/mediacentre/factsheets/fs110/en/. [Last accessed on

Mar 31].

Cragg A. Understanding STI and HIV Testing Rates Among

Higher Risk University Students [MSc]. Dalhousie University;

Wasik M, Djuric Kachli M. A review of common sexually

transmitted diseases. Formulary 2009;44:78‑86.

GBD 2015 DALYs and HALE Collaborators. Global, regional,

and national disability‑adjusted life‑years (DALYs) for 315

diseases and injuries and healthy life expectancy (HALE),

‑2015: A systematic analysis for the global burden of

disease study 2015. Lancet 2016;388:1603‑58.

Kingston‑Riechers J. The Economic Cost of HIV/AIDS in

Canada. Edmonton (Alberta): Canadian AIDS Society; 2011.

Cassidy C, Curran J, Steenbeek A, Langille D. University

students’ sexual health knowledge: A Scoping literature review.

Can J Nurs Res 2015;47:18‑38.

Sexually Transmitted Infections‑A Continued Public Health

Concern – The Chief Public Health Officer’s Report on

the State of Public Health in Canada, 2013: Infectious

Disease‑The Never‑Ending Threat – Public Health Agency

of Canada. Available from: http://www.phac‑aspc.gc.ca/

cphorsphc‑respcacsp/2013/sti‑its‑eng.php. [Last accessed on

Mar 25].

Chanakira E, Goyder EC, Freeman JV, O’Cathain A,

Kinghorn G, Jakubovic M, et al. Social and psychosocial factors

associated with high‑risk sexual behaviour among university

students in the United Kingdom: A web‑survey. Int J STD AIDS


Adefuye AS, Abiona TC, Balogun JA, Lukobo‑Durrell M. HIV

sexual risk behaviors and perception of risk among college

students: Implications for planning interventions. BMC Public

Health 2009;9:281.

Abdullah AS, Fielding R, Hedley AJ. Understanding sexual risk

taking behaviour in Hong Kong university students. A health

promotion perspective. Prev Med 2003;37:311‑8.

Milhausen RR, McKay A, Graham CA, Crosby RA, Yarber WL,

Sanders SA. Prevalence and predictors of condom use in a

national sample of Canadian university students. Canadian J

Hum Sex 2013;22:142‑51.

Boyer CB, Shafer MA, Pollack LM, Canchola J, Moncada J,

Schachter J, et al. Sociodemographic markers and behavioral

correlates of sexually transmitted infections in a nonclinical

sample of adolescent and young adult women. J Infect Dis


Chlamydia (Chlamydia Trachomatis) ‑ Report on Sexually

Transmitted Infections in Canada: 2012 ‑ Public Health Agency

of Canada; 2015. Available from: http://www.phac‑aspc.


[Last accessed 2017 Mar 17].

Public Health Agency of Canada. HIV and AIDS in Canada:

Surveillance Report to December 31, 2013. Minister of Public

Works and Government Services Canada; 2014. Available

from: http://www.phac‑aspc.gc.ca/aids‑sida/publication/

survreport/2013/dec/index‑eng.php. [Last accessed on

Mar 31].

Surveillance Manual HPV Vaccine Preventable Diseases CDC;

Available from: https://www.cdc.gov/vaccines/pubs/

surv‑manual/chpt05‑hpv.html. [Last accessed on 2017 Apr 1].

Statistics Canada. Table 1‑ Prevalence of Herpes Simplex Virus

Type 2, by Selected Characteristics, Household Population Aged

to 59, Canada, 2009 to 2011; 2015. Available from: http://


tbl1‑eng.htm. [Last accessed on 2017 Mar 25].

Public Health Agency of Canada. Population‑Specific HIV/AIDS

Status Report: Aboriginal Peoples. Ottawa: Public Health Agency

of Canada; 2010.

Zhan W, Krasnoselskikh TV, Niccolai LM, Golovanov S,

Kozlov AP, Abdala N, et al. Concurrent sexual partnerships

and sexually transmitted diseases in Russia. Sex Transm Dis


Gravata A, Castro R, Borges‑Costa J. Study of the

sociodemographic factors and risky behaviours associated

with the acquisition of sexual transmitted infections by foreign

exchange students in Portugal. Acta Med Port 2016;29:360‑6.

American College Health Association. American College Health

Association‑National College Health Assessment II: Canadian

Reference Group Executive Summary Spring 2016. Hanover,

MD: American College Health Association; 2016.

American College Health Association. American College Health

Association‑National College Health Assessment II: Canadian

Reference Group Data Report Spring 2016. Hanover, MD: American College Health Association; 2016.

National College Health Assessment (NCHA) Wellness

Centre University of Calgary; 2016. Available from: http://

www.ucalgary.ca/wellnesscentre/ncha. [Last accessed on

Mar 20].

About NCHA – Health Promotion‑Ryerson University; 2016.

Available from: http://www.ryerson.ca/healthandwellness/

healthpromotion/About_NCHA/. [Last accessed on

Mar 20].

ACHA‑NCHA Data; 2017. Available from: http://www.

acha‑ncha.org/. [Last accessed on 2017 Mar 20].

Kerr D, Ding K, Burke A, Ott‑Walter K. An alcohol, tobacco, and

other drug use comparison of lesbian, bisexual, and heterosexual

undergraduate women. Subst Use Misuse 2015;50:340‑9.

Smith LM, Kaufman JS, Strumpf EC, Lévesque LE. Effect of

human papillomavirus (HPV) vaccination on clinical indicators

of sexual behaviour among adolescent girls: The Ontario grade 8

HPV vaccine cohort study. CMAJ 2015;187:E74‑81.

Hosmer D, Lemeshow S, Sturdivant R. Applied Logistic

Regression. 3rd ed. Hoboken N.J: Wiley; 2013.

Bursac Z, Gauss CH, Williams DK, Hosmer DW. Purposeful

selection of variables in logistic regression. Source Code Biol

Med 2008;3:17.

Fielder RL, Carey KB, Carey MP. Acceptability of sexually

transmitted infection testing using self‑collected vaginal swabs

among college women. J Am Coll Health 2013;61:46‑53.

Trends in Higher Education. Enrolment. Vol. 1. 1st ed. Ottawa,

ON: The Association of Universities and Colleges of Canada;

Available from: https://www.univcan.ca/wp‑content/


[Last accessed on 2017 Apr 11].

Sonnenberg P, Clifton S, Beddows S, Field N, Soldan K,

Tanton C, et al. Prevalence, risk factors, and uptake of

interventions for sexually transmitted infections in Britain:

Findings from the national surveys of sexual attitudes and

lifestyles (Natsal). Lancet 2013;382:1795‑806.

Centers for Disease Control and Prevention. CDC Fact Sheet:

Ways STDs Impact Women Differently From Men; 2011.

Available from: https://www.cdc.gov/std/health‑disparities/

stds‑women‑042011.pdf. [Last accessed on 2017 Apr 11].

Baldwin JI, Baldwin JD. Heterosexual anal intercourse: An

understudied, high‑risk sexual behavior. Arch Sex Behav


Benson LS, Martins SL, Whitaker AK. Correlates of heterosexual

anal intercourse among women in the 2006‑2010 national survey

of family growth. J Sex Med 2015;12:1746‑52.

Billy JO, Grady WR, Sill ME. Sexual risk‑taking among adult

dating couples in the United States. Perspect Sex Reprod Health


Vasilenko SA, Lanza ST. Predictors of multiple sexual partners

from adolescence through young adulthood. J Adolesc Health


Baskin‑Sommers A, Sommers I. The co‑occurrence of substance

use and high‑risk behaviors. J Adolesc Health 2006;38:609‑11.

Cavazos‑Rehg PA, Krauss MJ, Spitznagel EL, Schootman M,

Cottler LB, Bierut LJ, et al. Number of sexual partners and

associations with initiation and intensity of substance use. AIDS

Behav 2011;15:869‑74.

Santelli JS, Brener ND, Lowry R, Bhatt A, Zabin LS. Multiple

sexual partners among U.S. Adolescents and young adults. Fam

Plann Perspect 1998;30:271‑5.

Cooper ML. Alcohol use and risky sexual behavior among

college students and youth: Evaluating the evidence. J Stud

Alcohol Suppl 2002;14:101‑17.

Yan H, Chen W, Wu H, Bi Y, Zhang M, Li S, et al. Multiple

sex partner behavior in female undergraduate students in china:

A multi‑campus survey. BMC Public Health 2009;9:305.

Paul E, McManus B, Hayes A. “Hookups”: Characteristics and

correlates of college students’ spontaneous and anonymous

sexual experiences. J Sex Res 2000;37:76‑88.

Herold ES, Maticka‑Tyndale E, Mewhinney D. Predicting

intentions to engage in casual sex. J Soc Pers Relationsh


Islam MM, Topp L, Conigrave KM, van Beek I, Maher L,

White A, et al. The reliability of sensitive information provided

by injecting drug users in a clinical setting: Clinician‑administered

versus audio computer‑assisted self‑interviewing (ACASI). AIDS

Care 2012;24:1496‑503.

Phillips AE, Gomez GB, Boily MC, Garnett GP. A systematic

review and meta‑analysis of quantitative interviewing tools to

investigate self‑reported HIV and STI associated behaviours

in low‑ and middle‑income countries. Int J Epidemiol


Graham CA, Catania JA, Brand R, Duong T, Canchola JA.

Recalling sexual behavior: A methodological analysis of memory

recall bias via interview using the diary as the gold standard.

J Sex Res 2003;40:325‑32.