Detention Facilities Offer a Window to Screen Youth at High Risk for STDs
In addition to demographic characteristics, psychological, behavioral and family characteristics are associated with the risk of current chlamydial and gonorrheal infection among incarcerated adolescents.1 According to data from a Southern juvenile detention facility, 21% of teenagers who reported sex in the three months before incarceration tested positive for chlamydia or gonorrhea. Among the overall sample, current STD infection was significantly associated with being female or black, having recently used alcohol before sex, having a greater lifetime number of partners and living in a stepfamily (odds ratios, 1.4–4.2). Predictors of infection differed for females and males.
To study the relationship between incarcerated adolescents' characteristics, beliefs and behaviors, and their risk of STD infection, researchers recruited participants from one juvenile detention facility in a Southern city between April 2002 and May 2003. Male and female adolescents aged 13–18 were approached for study participation within three days of incarceration and were asked to complete a survey about their demographic, psychological behavioral and family characteristics using audio computer-administered self-interview. In addition, the researchers asked for participants' permission to link survey data to urinalysis results of samples given during the booking process. The researchers used bivariate and logistic regression analyses to determine the variables significantly associated with current chlamydial and gonorrheal infection.
During the study period, 1,816 incarcerated adolescents aged 10–18 were screened for STDs; the majority were male and black. Of the 1,789 detainees for whom STD test results were available, 13% tested positive for chlamydia and 3% for gonorrhea. Some 690 adolescents completed the survey and allowed their survey data to be linked to their STD test results. Of this sample, 90% reported being sexual experienced and 65% reported having had sex recently (in the three months before incarceration). The prevalence of STD varied by teenagers' reported sexual activity: Seven percent of adolescents who reported never having had sex tested positive for chlamydia or gonorrhea; the proportion was 13% for those who were sexually experienced but had not had sex recently, and 21% for those who had had recent sex.
In bivariate analysis of the 618 adolescents who reported sexual experience, several variables were significantly associated with current STD infection: gender; age; race; history of sexual abuse, alcohol use or STD; recent use of alcohol before sex; lifetime number of partners; condom use; family structure; parental supervision and monitoring; parental involvement; and parental communication. In multivariate analyses, five variables remained significantly associated with increased odds of chlamydial or gonorrheal infection: being female (odds ratio, 4.2), being black (3.4), having recently used alcohol before sex (2.0), increasing lifetime number of partners (1.4) and living in a stepfamily (2.5).
To further examine the associations between adolescents' characteristics and current STD infection, the researchers conducted separate multivariate analyses for each gender. For females, STD infection was positively associated with being black (3.8), having recently used alcohol before sex (2.8) and increasing lifetime number of partners (2.2); young women who believed that alcohol or drug use enhances sex were less likely than those who did not hold that belief to have an STD (0.9). For males, STD infection was very strongly associated with having a history of STD (22.3); in addition, increasing age and consistent condom use were associated with an elevated risk of STD (1.4 and 3.9, respectively), whereas believing that alcohol or drugs cause loss of control was associated with a reduced risk (0.8). In contrast to females, young men who believed that alcohol or drug use enhances sex were more likely than those who did not hold that belief to have an STD (1.2); however, the finding was only marginally significant.
Given the high STD rates found among the adolescents at the study facility and the increased HIV risk among those infected with an STD, the authors recommend "standard STD screening for all youth admitted to a youth detention facility." They comment that such facilities "offer a window in time when it is possible to test and treat very high-risk youths." Furthermore, in light of their finding that different factors predict STD acquisition among females and males, the authors suggest that "individual-level interventions may be more effective when they are organized for sex-specific groups rather than in gender-neutral interventions."
1. Robertson AA et al., Predictors of infection with chlamydia or gonorrhea in incarcerated adolescents, Sexually Transmitted Diseases, 2005, 32(2):115–122.