In this journal and elsewhere, much has been written by and for professionals whose work focuses on the problem of sexually transmitted diseases (STDs) among young Americans. No one—not researchers, and certainly not health care professionals and others who work with youth—doubts that the problem is a big one. Just how big, however, is an open question. A pair of articles in this issue of Perspectives on Sexual and Reproductive Health present as solid estimates as available data allow of both the disease burden and the economic burden of STDs among teenagers and young adults in this country.
Using data from case reports, national surveys, literature reviews and the World Health Organization, Hillard Weinstock and colleagues (see article) estimate that 15-24-year-olds, who represent one-quarter of sexually experienced Americans, accounted for half of newly diagnosed STDs—more than nine million cases—in 2000. Three diseases (human papillomavirus, trichomoniasis and chlamydia) represented nine in 10 new STDs in this age-group.
The costs associated with these diseases are as staggering as their incidence. Using data available in the literature, as well as their own calculations, Harrell W. Chesson and coauthors (see article) estimate that the costs associated with a lifetime of treating the STDs newly diagnosed in young people in 2000 (and sequelae of those diseases) will come to $6.5 billion. And this figure, they believe, is conservative. What is more, the total cost of these diseases also includes nonmedical expenses and costs in terms of lost wages attributable to STD-related illness, which have not been quantified.
As both teams of researchers emphasize, given the inadequacies of available data, their estimates are far from the last word. Nevertheless, it is impossible to overemphasize the implications of these figures for policy decisions, outreach and educational efforts aimed at preventing young people from acquiring STDs. For some people, the data will demonstrate just one point: that young, unmarried men and women should not be having sex, and that all efforts should be directed at ensuring that they are not. But "abstinence-only education" is not the answer: Some proportion of youth will choose to be sexually active, and they need to know how to do so safely. The real lesson of the new estimates is the importance of ensuring that young people are properly educated about condom use, of identifying groups at greatest risk of disease and finding effective ways to reach them with prevention messages and services, and of stepping up research into promising new methods of prevention, such as microbicides.
Also in This Issue
•Social and familial networks are key sources of support for many young people navigating the various new roads that open up to them during adolescence. In an analysis of a sample of teenagers in the San Francisco area, Cynthia Harper and colleagues (see article) find that going to a clinic to obtain contraceptives is one activity for which young women look to their networks for support. Virtually all of the teenagers in the sample had told their mother, their partner or a friend that they were going to make the clinic visit; those who had looked to their mother or partner for support had overwhelmingly received it (the question was not asked with regard to friends). The choice to obtain an effective method was associated with mother's and partner's awareness of the clinic visit, and with mother's supportiveness. These results suggest, according to the authors, that counselors and health care providers who understand and respond to the social context in which teenagers make contraceptive decisions may be the best equipped to help them use effective methods.
•Although vasectomy is a fairly popular method of contraception, accounting for 11% of contraceptive use in the United States, information on who chooses vasectomy and why has been limited. Results of a nationwide survey conducted at provider sites, however, permit Mark Barone and coinvestigators (see article) to draw a profile of men obtaining the procedure in 1998-1999. The picture that emerges is of a far more homogeneous group than would be expected from the diversity of the U.S. population: The vast majority of vasectomy recipients were married or cohabiting, non-Hispanic and white, well educated and fairly affluent. Half selected the method because of its effectiveness, and six in 10 were aware that it is a simpler and safer procedure than female sterilization, which is the far more common choice among couples seeking permanent contraception. Noting that government support will be crucial, Barone and colleagues urge providers and program managers to work toward making vasectomy services accessible and affordable to socioeconomically disadvantaged men.