Adolescents lack specific knowledge of sexually transmitted diseases (STDs) other than HIV, even if they have received relevant sexuality education.¹ Nearly all adolescents (97%) canvassed in waiting areas at an urban pediatric hospital reported that they had received STD education--primarily from their school (70%), parents (52%) or friends (31%). Although the majority of respondents correctly identified HIV as a major STD (91%), just 2% could name all eight major STDs; 9% and 3% could name the four curable and four incurable ones, respectively. Levels of STD knowledge were only weakly correlated with respondents' age and perception of their STD knowledge.

With the help of adolescent peer sexuality educators, researchers assessed levels of STD knowledge among youth present in waiting areas at a children's hospital in Philadelphia from April 1996 through February 1998. In structured interviews, the peer educators asked respondents to provide demographic information, to state the sources of any STD education received and to rate their level of STD knowledge on a four-point scale. The interviewers also tested if respondents knew the eight main STDs (as defined by the Centers for Disease Control and Prevention), which of these are curable and the most prevalent STD in Philadelphia.

The mean age of the 393 respondents was about 17; roughly two-thirds were females, and four-fifths were black. More than two in five respondents were Medicaid recipients (44%). The vast majority of adolescents said that they had received STD education (97%). The main educational sources were school (cited by 70% of respondents), parents (52%) and friends (31%). Other sources were health professionals (22%), relatives other than parents (21%) and peer educators (12%). Twenty-six percent of respondents rated their level of STD knowledge as "a lot," 56% as "average," 16% as "a little" and 2% as "nothing."

Only 2% of those interviewed identified all eight main STDs, although substantial proportions included HIV (91%), gonorrhea (77%), syphilis (65%), genital herpes (58%) and chlamydia (53%) in their answers. Fewer than one-quarter (15-22%) named tricho-monas, human papillomavirus (HPV) and hep-atitis B virus infections. Only 9% of respondents named all four curable STDs--gonorrhea, chlamydia, trichomoniasis and syphilis--and 3% knew that the other four STDs are incurable; fewer than 1% answered all three questions correctly. Nearly half of the adolescents identified HIV instead of chlamydia as the most prevalent STD in the area (46%).

Respondents named, on average, 4.0 of the eight main STDs, 1.5 of the four curable ones and 1.6 of the four incurable ones. When the researchers scored levels of STD knowledge by subtracting the number of incorrect answers from the number of correctly named STDs, the mean score was 3.5 for identifying the main STDs, 1.3 for the curable ones and 1.2 for the incurable ones. The mean score for main STD knowledge was higher among respondents who were Medicaid recipients than among those who did not know what type of health insurance they had (3.8 vs. 2.8). Adolescents who cited at least two sources of STD education scored higher on this question than did those who cited only one source (3.8 vs. 3.0); the number of sources was correlated with this score (r=0.3). In general, knowledge scores of adolescents aged 12-15 were lower than those of older adolescents, and respondents who rated their STD knowledge as "a lot" scored higher than those who rated their knowledge as "a little." Age and perceived level of STD knowledge were weakly correlated with all three knowledge scores (r=0.2-0.3).

Multiple linear regression analyses showed that older age, higher perceived level of STD knowledge, STD education from a relative and education from "other" sources (e.g., books or TV) predicted a higher score for main STD knowledge. Older age was linked with a higher score for knowledge of curable STDs, whereas older age, higher perceived level of knowledge and black and white race predicted a higher score for knowledge of incurable STDs. The researchers concede, however, that all of these associations were small.

Limitations of the study identified by the researchers include the lack of information about respondents' sexual and STD history, possible inconsistency between peer educators' ratings of responses and bias created by interviewing only youth who were seeking medical help (and thus more likely to know about STDs). Nevertheless, the researchers conclude that levels of STD knowledge among the adolescents interviewed are "unacceptably low" for their age. In particular, although the majority of adolescents identified HIV as an STD, their lack of knowledge about tricho-monas and HPV infections leads the authors to suggest that "current STD education may be overemphasizing HIV infection at the expense of other STDs for which teens are at greater risk."--T. Lane

REFERENCE

1. Clark LR, Jackson M and Allen-Taylor L, Adolescent knowledge about sexually transmitted diseases, Sexually Transmitted Diseases, 2002, 29(8):436-443.