Trend analysis of lifetime sexual activity and condom use self-efficacy in repeated cross-sectional survey data among adolescents in the Northwest Territories, Canada

Background Evidence of declining condom use over time among adolescents across diverse settings underscores the need to understand sexual health indicators among this population. Few studies have examined trends in lifetime sexual activity and condom use self-efficacy over time among adolescents in Arctic or remote settings. This study assessed changes and sociodemographic patterns in these outcomes across 7 years among Northern and Indigenous adolescents in the Northwest Territories, Canada. Methods We conducted repeated cross-sectional surveys among secondary school students aged 13–18 years across 17 Northwest Territories communities from 2018 to 2024. Outcomes included lifetime sexual activity (ever having engaged in vaginal, anal or oral sex) and condom use self-efficacy. Linear and logistic mixed-effects regression models estimated unadjusted and adjusted associations with time, gender, sexual orientation, Indigenous identity, and rural residence, including interaction terms. Results Among n = 2745 participants (mean age 13.68 years, standard deviation 1.49; gender: 45.65% cisgender girls, 50.27% cisgender boys and 4.08% gender diverse), 19.06% identified as lesbian, gay, bisexual or queer (LGBQ), 72.62% as Indigenous and 71.17% lived in rural settings. From 2018 to 2024, condom use self-efficacy decreased (adjusted beta coefficient −0.25; 95% CI: −0.36, −0.15; P < 0.001), and was lower among LGBQ and rural youth. Sexual activity also declined (adjusted beta coefficient −0.01; 95% CI: −0.02, −0.01; P < 0.001), but remained higher among cisgender girls, LGBQ youth, Indigenous adolescents and rural youth. Conclusion Condom use self-efficacy and sexual activity declined over time, with persistent disparities across groups. Findings highlight the need for sustained, culturally grounded, equity-focused sexual health programming for Northwest Territories adolescents.