Sexually transmitted diseases in a health maintenance organization teen clinic: associations of race, partner's age, and marijuana use.

OBJECTIVE: To determine the role of sociodemographic risk markers and behavioral risk factors associated with sexually transmitted diseases (STDs) in sexually experienced youth seeking care at an urban, general health maintenance organization teen clinic. DESIGN: Cross-sectional. PARTICIPANTS: A consecutive, racially and ethnically diverse sample of 285 sexually experienced youth who were preponderantly female (58.6%) and who were aged 16.7 years on average. METHODS: All participants completed a self-report questionnaire and were screened for Chlamydia trachomatis using the ligase chain reaction technique and for Neisseria gonorrhoeae and other STDs using conventional methods. RESULTS: Many of these youth were at high risk for STDs, having a self-reported history of sex with multiple partners (49.1%), sex with a new partner (42.5%), inconsistent use of condoms (71.9%), and frequent substance use (24.5% used marijuana 1-2 times per week or more). Sexually transmitted disease screening revealed that 11.6% of the participants had 1 or more STDs. A logistic regression analysis to determine the best model for predicting STDs indicated that youth who are African American (odds ratio, 3.34; 95% confidence interval, 1.52-7.35), had sexual partners who were 2 or more years older (odds ratio, 2.63, 95% confidence interval, 1.22-5.67), and used marijuana 1 to 2 times or more per week (odds ratio, 2.27; 95% confidence interval, 1.01-5.13) were more likely to have STDs at screening. CONCLUSIONS: A brief sociodemographic and behavioral risk assessment that includes these factors may be useful for clinicians in deciding when to screen for STDs in sexually active youth seeking care for reasons not related to reproductive health.

Cervical secretory immunoglobulin A in adolescent girls.

PURPOSE: To determine whether there are differences in levels of cervical secretory immunoglobulin A (sIgA) between adolescent girls in the secretory and proliferative phases of their menstrual cycle. METHODS: Sexually active adolescent girls (n = 117) at health maintenance organization (HMO) based adolescent medical clinic were recruited into the study. In addition to demographic and clinical data, cervical specimens were collected for sIgA measurement and gonorrhea culture, urine for chlamydia ligase chain reaction, and blood for progesterone levels. Subjects were classified as being in the proliferative phase or secretory phase of the menstrual cycle on the basis of their progesterone levels. RESULTS: The mean age of the subjects was 17.2 years old. There was no difference in the sIgA levels between those in the proliferative phase of their cycle (n = 45; mean sIgA level, 0.0055 mg/mL) and those in the secretory phase (n = 40; mean sIgA level, 0.0032 mg/mL) (p > .10). CONCLUSIONS: The secretory phase of the menstrual cycle does not appear to be associated with higher levels of sIgA in adolescent girls. These results suggest that adolescents with anovulatory cycles, i.e., those who lack a secretory phase, may not be at increased risk for genital tract infections such as chlamydia or gonorrhea.

Associations of sociodemographic, psychosocial, and behavioral factors with sexual risk and sexually transmitted diseases in teen clinic patients.

PURPOSE: To examine the influence of sociodemographic characteristics, sexually transmitted disease (STD)/human immunodeficiency virus knowledge, and psychosocial and behavioral risk factors on sexual risk and STDs in adolescents using constructs from the Information, Motivation, and Behavioral Skills model (IMB). METHODS: A convenience sample of 303 sexually experienced, racially diverse adolescents (mean age 16.7 years, 57.9% female) who were seeking health care at a general health maintenance organization teen clinic were recruited for the study and completed a self-reported questionnaire which assessed sociodemographic, knowledge, and psychosocial factors, risk behaviors, and history of STDs. Multiple regression analyses were used to assess factors associated with sexual risk behavior and STD history. RESULTS: Many of the study participants were at risk for STDs; 43.8% had four or more lifetime sexual partners, 62.8% did not consistently use condoms, 21.1% had a history of pregnancy or impregnation, and 28.2% had a history of STDs. A multiple linear regression model to assess factors associated with sexual risk behavior (a nine-item index) indicate that perceptions of higher STD risk, perceptions that friends engage in risk behaviors, perceptions that friends will not support their STD risk-reduction efforts, knowing someone of a similar age who has had an STD, and having no intention of using condoms in the future are significantly associated with sexual behavioral risk (R(2) =.22, p <.000). A logistic regression model to examine history of STDs reveals that teens who are female, African-American, frequently use marijuana, have an older steady sexual partner, have a history of pregnancy or impregnation, have a greater number of lifetime sexual partners, and perceive that monogamy will not decrease STD risk are significantly more likely to report a history of STDs. CONCLUSIONS: Sociodemographic factors and constructs of the IMB model are associated with adolescents' risk and acquisition of STDs. Teens with such risk profiles should be targeted for risk-reduction intervention.