Ethnic Differences in STD Rates among Female Adolescents
Buzi, Ruth S., Weinman, Maxine L., Smith, Peggy B., Adolescence
Adolescents in general and minority adolescents in particular have significantly higher rates of sexually transmitted diseases (STDs) than do other groups. According to a study by the Centers for Disease Control and Prevention (1993a), every year three million teens (one out of every eight) are infected with an STD. Approximately 24-30% of gonorrhea cases reported in 1981 through 1991 were among adolescents. Some of the highest rates were for 15- to 19-year-old Black females. Further, adolescents accounted for 10-12% of reported primary and secondary syphilis cases. Syphilis rates for Black female adolescents increased more than 150% from 1986 to 1990, compared with increases of less than 50% for other ethnic groups. In addition, chlamydia rates were significantly higher among Black females than among White females (Centers for Disease Control and Prevention, 1993b). Rates of STD reinfection have also been found to be higher among minorities (Richert et al., 1993). STD reinfections are particularly serious because they increase susceptibility to HIV (Rosenberg & Gollub, 1992).
Number of sexual partners and lack of condom use are considered the most significant factors in STD exposure. As the number of sexual partners increases, the cumulative risk for contracting an STD from an infected partner rises (Millstein, Moscicki, & Broering, 1993). Further, adolescents have been found not to use condoms consistently (Hingson, Strunin, & Berlin, 1990; Kegeles, Adler, & Irwin, 1988). Although rates of condom use are low for all teenagers, rates for Black and Hispanic teens are markedly lower than those for White teens. Data from the 1988 National Survey of Family Growth indicate that among females aged 15-19, 51% of Whites have used condoms as compared with 41% of Hispanics and 35% of Blacks. It has also been found that Black and Hispanic females are less likely than White females to have sexual partners who always use condoms (Catania et al., 1992; Marin & Marin, 1992).
Information about sexual behavior is critical if effective educational programs for high-risk sexually active adolescents are to be implemented. Unfortunately, the relationship between ethnicity and sexual behavior, especially among minority adolescents, has received scant attention. The purpose of the present study was to determine whether ethnicity is a factor in adolescent females' STD infection and reinfection rates.
The sample consisted of 205 female adolescents who sought care at either of two teen health clinics. The clinics, located in public county hospitals in Houston, Texas, provide primary and reproductive health care services, including family planning, STD testing and treatment, pregnancy testing, school physicals, HIV testing and counseling, EPSDT (early periodic screening, detection, and treatment), and health education. Females between the ages of 13 and 20 years who had an STD at the time of the clinic visit (between December 1992 and July 1993) were recruited to participate in the study.
Adolescents were screened for gonorrhea, syphilis, trichomoniasis, chlamydia, pubic lice, herpes, and condyloma. Tests for these infections included VDRL and Gonostat; an enzyme-linked immunosorbent assay (ELISA) tested for HIV antibodies. The Western blot test was used for confirmation.
Adolescents were contacted following positive laboratory results, and informed consent to participate in the study was obtained. They received treatment and were counseled by the nurse and STD educator about safe-sex practices. All were given condoms. HIV testing was performed on consenting adolescents, who also received confidential HIV education and counseling. The adolescents were scheduled to return for test of cure/follow-up within six months of the initial visit.
Data were collected by primary health care providers during the course of clinic visits. A standardized data collection form was used to record demographic information, number of sexual partners, history of STDs, and STDs at time of clinic admission (current infections). …