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Infrequency of sexually transmitted disease screening among sexually experienced U.S. female adolescents.

Article Excerpt
The prevalence of chlamydia infection-which is associated with considerable personal, societal and economic costs--is high among adolescents in the United States. (1) By 18 years of age, 4% of all adolescents are infected with Chlamydia trachomatis, and the prevalence is higher among black, Native American and Hispanic women (13%, 10% and 6%, respectively); the vast majority of these infections are asymptomatic. (2) Despite the absence of symptoms, infection can ascend to the upper genital tract, causing pelvic inflammatory disease, tubal scarring, increased risk of ectopic pregnancy and infertility. (3) Asymptomatic infection can also be transmitted to sexual partners, sustaining high prevalence of infection in sexual networks. Adolescents have high rates of repeat infection, and thus are at particularly high risk of medical complications. (40

Since 1993, the Centers for Disease Control and Prevention (CDC) has recommended that all sexually experienced female adolescents be screened annually for Chlamydia trachomatis. (5) The American Academy of Pediatrics, the American Medical Association (AMA) and the U.S. Preventive Services Task Force have made similar recommendations, (6) and annual chlamydia screening among sexually experienced female adolescents is now a quality of care measure in HEDIS (the Health Plan Employer Data and Information Set, a national set of standardized measures of health plan performance), (7) Despite consensus in professional recommendations, regional research suggests that many sexually experienced female adolescents are not receiving annual screening for chlamydia infection. (8) To our knowledge, there are no published national estimates of the proportion of sexually experienced female adolescents who report receiving annual screening for sexually transmitted diseases (STDs).

Wave 1 of the National Longitudinal Study of Adolescent Health (Add Health), conducted in 1995, provides the opportunity to describe STD testing patterns among a large, nationally representative sample of adolescents approximately 2-3 years after the CDC and AMA began recommending universal annual screening for chlamydia infection among sexually experienced female adolescents. It also provides the opportunity to describe baseline receipt of STD testing services, which can be compared with later testing patterns. Given persisting high rates of curable STDs among adolescents, identifying trends in and patterns of STD testing within this age-group is important.

In this study, we describe the proportion of sexually experienced female adolescents in Wave 1 of Add Health who reported having received testing or treatment for an STD in the past year, and how reported receipt of 5TD-related health care varied by age, race and ethnicity, insurance status and whether participants had had a recent routine physical examination. We also examine what types of clinical sites adolescents reported using for STD care.

METHODS

Study Design

Add Health's sampling design and procedures have been described in detail elsewhere. (9) In summary, respondents were a systematically drawn random sample of adolescents in grades 7-12 from 132 schools in the United States. The sample for this study is restricted to the 3,988 female Wales 1 participants who responded yes to the question "Have you ever had sexual intercourse? When we say sexual intercourse we mean when a male inserts his penis into a female's vagina."

Informed written parental consent and minor assent were required for participation. Adolescents completed a 90 minute in-home interview on a wide range of topics that influence adolescent health and well-being. Interviews were conducted in as private an area as possible and were performed from April to December 1995. Sensitive portions of the interview, including questions concerning sexual activity, were performed through audio computer assisted self-interview. This technique promotes more complete reporting of sensitive topics than lace to face interviews. (10) Whenever possible, parents were also interviewed. All procedures for Add Health were approved by the University of North Carolina Institutional Review Board.

Data and Analysis

Measures of receipt of specific STD services were not avail able. Therefore, the outcome variable, receipt of STD care, was measured by responses to the question "In the past year, have you received testing or treatment lot a sexually transmitted disease or AIDS?"

Most predictor variables were derived from data provided by adolescent participants. Age was calculated from date of birth. Race and ethnicity were measured by self-report. All participants who responded yes to the question "Arc you of Hispanic or Latino origin?"...