多物质使用与性风险行为：主流和替代教育环境中青少年的横断面比较。
Poly-substance use and sexual risk behaviours: a cross-sectional comparison of adolescents in mainstream and alternative education settings.
机构信息
MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, 200 Renfield Street, Scotland, G2 3AX, UK.
Department of Nursing and Community Health, Glasgow Caledonian University, Cowcaddens Road, Glasgow, Scotland, G4 OBA, UK.
出版信息
BMC Public Health. 2019 May 14;19(1):564. doi: 10.1186/s12889-019-6892-0.
BACKGROUND
Surveys of young people under-represent those in alternative education settings (AES), potentially disguising health inequalities. We present the first quantitative UK evidence of health inequalities between AES and mainstream education school (MES) pupils, assessing whether observed inequalities are attributable to socioeconomic, familial, educational and peer factors.
METHODS
Cross-sectional, self-reported data on individual- and poly-substance use (PSU: combined tobacco, alcohol and cannabis use) and sexual risk-taking from 219 pupils in AES (mean age 15.9 years) were compared with data from 4024 pupils in MES (mean age 15.5 years). Data were collected from 2008 to 2009 as part of the quasi-experimental evaluation of Healthy Respect 2 (HR2).
RESULTS
AES pupils reported higher levels of substance use, including tobacco use, weekly drunkenness, using cannabis at least once a week and engaging in PSU at least once a week. AES pupils also reported higher levels of sexual health risk behaviours than their MES counterparts, including: earlier sexual activity; less protection against sexually transmitted infections (STIs); and having 3+ lifetime sexual partners. In multivariate analyses, inequalities in sexual risk-taking were fully explained after adjusting for higher deprivation, lower parental monitoring, lower parent-child connectedness, school disengagement and heightened intentions towards early parenthood among AES vs MES pupils. However, an increased risk (OR = 1.73, 95% CI 1.15, 2.60) of weekly PSU was found for AES vs MES pupils after adjusting for these factors and the influence of peer behaviours.
CONCLUSION
AES pupils are more likely to engage in health risk behaviours, including PSU and sexual risk-taking, compared with MES pupils. AES pupils are a vulnerable group who may not be easily targeted by conventional population-level public health programmes. Health promotion interventions need to be tailored and contextualised for AES pupils, in particular for sexual health and PSU. These could be included within interventions designed to promote broader outcomes such as mental wellbeing, educational engagement, raise future aspirations and promote resilience.
背景
年轻人的调查结果未能充分反映出另类教育环境（AES）中的人群，这可能掩盖了健康不平等现象。我们首次提供了英国关于 AES 和主流教育学校（MES）学生之间健康不平等的定量证据，评估观察到的不平等现象是否归因于社会经济、家庭、教育和同伴因素。
方法
横断面、自我报告的个体和多物质使用（PSU：包括烟草、酒精和大麻使用）和性风险行为数据来自 219 名 AES 学生（平均年龄 15.9 岁），并与 4024 名 MES 学生（平均年龄 15.5 岁）的数据进行比较。数据于 2008 年至 2009 年作为 Healthy Respect 2（HR2）的准实验评估的一部分收集。
结果
AES 学生报告的物质使用水平较高，包括吸烟、每周醉酒、每周至少使用一次大麻和每周至少进行一次 PSU。AES 学生还报告了比 MES 学生更高水平的性健康风险行为，包括：更早的性行为；较少的性传播感染（STI）保护措施；以及有 3 个以上的终身性伴侣。在多变量分析中，在调整了更高的贫困程度、更低的父母监督、更低的亲子关系、学校脱节和 AES 学生比 MES 学生更早成为父母的意愿后，AES 学生的性风险行为的不平等现象得到了充分解释。然而，在调整了这些因素以及同伴行为的影响后，发现 AES 学生比 MES 学生每周 PSU 的风险更高（OR=1.73，95%CI 1.15，2.60）。
结论
与 MES 学生相比，AES 学生更有可能从事健康风险行为，包括 PSU 和性风险行为。AES 学生是一个弱势群体，可能不容易成为传统的人群层面公共卫生计划的目标。健康促进干预措施需要针对 AES 学生进行调整和定制，特别是针对性健康和 PSU。这些干预措施可以包括在旨在促进更广泛的结果（如心理健康、教育参与、提高未来愿望和促进韧性）的干预措施中。
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