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54: Failure of behavioral intervention to prevent STDs among inner-city adolescent girls
Abstracts / 38 (2006) 137–163
Purpose: As many teens utilize only urgent care visits each year, these visits are an important opportunity to screen for sexually transmitted infections (STIs). This study looked at whether aspects of doctor communication in the urgent care setting were associated with teens’ reported acceptability of sexual health discussion and urine STI testing. Methods: In this cross-sectional study of 211 adolescents, ages 14-18, attending urgent care visits in two HMO pediatric clinics, participants completed a confidential 22item self-administered survey post urgent care visit. Teens were asked to rate their provider’s communication on a 4-point Likert scale (1⫽strongly disagree, 4⫽strongly agree). Statements included: “The doctor knows how to talk to teens like me”; “The doctor explained that what we talked about alone would be confidential (that is kept between us)”. Teens were also asked to rate their acceptability of talking about sexual health during an urgent care visit and providing a urine sample for STI testing in urgent care visits using the same rating scale. For analysis 1,2⫽unacceptable and 3,4⫽acceptable. Results: The overall reported acceptability of sexual health discussion and urine STI testing was 82% and 79% respectively. Using logistic regression analysis, teens’ reported acceptability of sexual health discussion was significantly associated with doctors explaining confidentiality to teens (OR 2.80, 95% CI 1.21-6.49, p value⫽0.02), and having a doctor who “knows how to talk to teens like me” (OR 7.47, CI 2.12-26.39, p value⫽0.002). Teens’ reported acceptability of urine STI testing was also significantly associated with having a doctor who “knows how to talk to teens like me” (OR 4.35, CI 1.31-14.51, p value⫽0.02) but was not significantly associated with the doctors explanation of confidentiality. These associations did not vary by gender. Conclusions: Sexual history taking and collecting urine samples for testing are components of screening for STIs and were reported as acceptable to most teens in the urgent care setting. Aspects of doctor communication were associated with reported acceptability of sexual heath discussion and urine STI testing, and therefore represent an area that can be targeted for provider education as pediatric practices expand STI screening to urgent care visits. Support: Agency for Healthcare Research and Quality, Centers for Disease Control, National Institute for Child Health and Development, Maternal and Child Health Bureau—Leadership and Education in Adolescent Health Training Grant. 54. FAILURE OF BEHAVIORAL INTERVENTION TO PREVENT STDs AMONG INNER-CITY ADOLESCENT GIRLS Rhonda Cambridge, M.D., Dalan Read, M.D., Amy Suss, M.D. Dept. of Pediatrics, S.U.N.Y. Downstate Medical Center, Brooklyn, New York.
Purpose: There is clear evidence that STDs are prevalent among adolescent girls and has been linked to HIV, PID and
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other health related issues. The goal of this study was to assess the feasibility of a group approach to reducing sexual risk behaviors among Caribbean American (CA) and African American (AA) adolescent girls in our service area. Methods: From 2002-2003, 80 (40 CA and 40 AA) adolescent girls presenting for care at our adolescent medicine clinics were recruited. Participants were between 13-18 years of age, sexually active, and documented to have chlamydia, gonorrhea, and/or trichomonas. All participants completed a standardized interviewer administered questionnaire of sexual concerns and behaviors. The girls were then randomly assigned to either a control group (n⫽35) receiving standard care or a behavioral intervention group (n⫽45) utilizing social cognitive approaches to risk reduction that have been shown to be effective with AA adolescents. Small groups of 4 or 5 girls participated in two sessions spaced over the course of several weeks. The content of these groups included safe sex discussion/ education materials, condom demonstration/negotiation skills, and identification and discussion of personal barriers to safe sex. Efforts were made to maintain participation (e.g. phone calls, cab fare, and financial incentives). A repeat medical clinic visit and identical questionnaire were then administered 6 months post-intervention to both groups. Statistical analyses were performed using ChiSquare and Fisher’s Exact Test. Results: A total of 53 participants completed the study. The rate of STDs among the completers was 0/23 (0 %) for the controls and 7/30 (23 %) for the intervention group (p ⫽ 0.02). Rates of STDs among AA and CA girls in the intervention group were 22% and 23%, respectively. Dropouts were high in both groups. The intervention group had 15/45 (33%) dropouts (i.e. did not complete 6 month follow-up questionnaire) vs. 10/35 (29%) for the control group (p ⫽ 0.81). Drop-outs occurred in 14/40 (35 %) of the CA girls vs. 11/40 (28%) of the AA girls (p ⫽ 0.63). Greater discomfort with the format was reported in qualitative interviews with CA participants. Conclusions: The rate of STDs among the intervention group was higher and despite intense efforts to maintain adolescent girls in the study, there was resistance to completion of group based sexual behavior discussions, particularly among the CA girls. Approaches to behavior change that have been shown to reduce sexual risk behaviors among AA adolescents may not have been the most appropriate or effective venue for risk reduction in the girls of this cohort, particularly those of Caribbean descent. Further study is needed to identify more culturally appropriate and acceptable approaches to STD prevention in this community. 55. PREGNANCY RECURRENCE DURING ADOLESCENCE AFTER MULTIPROFESSIONAL PRENATAL CARE AND POSTPARTUM MOTHERCHILD FOLLOW-UP Amanda Melhado, Maria Jose´ Carvalho Sant’Anna, Veroˆnica Coates. Pediatrics Department, F.C.M.S.C.S.P., Sa˜o Paulo, Brazil.
Purpose: As many teens utilize only urgent care visits each year, these visits are an important opportunity to screen for sexually transmitted infections (STIs). This study looked at whether aspects of doctor communication in the urgent care setting were associated with teens’ reported acceptability of sexual health discussion and urine STI testing. Methods: In this cross-sectional study of 211 adolescents, ages 14-18, attending urgent care visits in two HMO pediatric clinics, participants completed a confidential 22item self-administered survey post urgent care visit. Teens were asked to rate their provider’s communication on a 4-point Likert scale (1⫽strongly disagree, 4⫽strongly agree). Statements included: “The doctor knows how to talk to teens like me”; “The doctor explained that what we talked about alone would be confidential (that is kept between us)”. Teens were also asked to rate their acceptability of talking about sexual health during an urgent care visit and providing a urine sample for STI testing in urgent care visits using the same rating scale. For analysis 1,2⫽unacceptable and 3,4⫽acceptable. Results: The overall reported acceptability of sexual health discussion and urine STI testing was 82% and 79% respectively. Using logistic regression analysis, teens’ reported acceptability of sexual health discussion was significantly associated with doctors explaining confidentiality to teens (OR 2.80, 95% CI 1.21-6.49, p value⫽0.02), and having a doctor who “knows how to talk to teens like me” (OR 7.47, CI 2.12-26.39, p value⫽0.002). Teens’ reported acceptability of urine STI testing was also significantly associated with having a doctor who “knows how to talk to teens like me” (OR 4.35, CI 1.31-14.51, p value⫽0.02) but was not significantly associated with the doctors explanation of confidentiality. These associations did not vary by gender. Conclusions: Sexual history taking and collecting urine samples for testing are components of screening for STIs and were reported as acceptable to most teens in the urgent care setting. Aspects of doctor communication were associated with reported acceptability of sexual heath discussion and urine STI testing, and therefore represent an area that can be targeted for provider education as pediatric practices expand STI screening to urgent care visits. Support: Agency for Healthcare Research and Quality, Centers for Disease Control, National Institute for Child Health and Development, Maternal and Child Health Bureau—Leadership and Education in Adolescent Health Training Grant. 54. FAILURE OF BEHAVIORAL INTERVENTION TO PREVENT STDs AMONG INNER-CITY ADOLESCENT GIRLS Rhonda Cambridge, M.D., Dalan Read, M.D., Amy Suss, M.D. Dept. of Pediatrics, S.U.N.Y. Downstate Medical Center, Brooklyn, New York.
Purpose: There is clear evidence that STDs are prevalent among adolescent girls and has been linked to HIV, PID and
141
other health related issues. The goal of this study was to assess the feasibility of a group approach to reducing sexual risk behaviors among Caribbean American (CA) and African American (AA) adolescent girls in our service area. Methods: From 2002-2003, 80 (40 CA and 40 AA) adolescent girls presenting for care at our adolescent medicine clinics were recruited. Participants were between 13-18 years of age, sexually active, and documented to have chlamydia, gonorrhea, and/or trichomonas. All participants completed a standardized interviewer administered questionnaire of sexual concerns and behaviors. The girls were then randomly assigned to either a control group (n⫽35) receiving standard care or a behavioral intervention group (n⫽45) utilizing social cognitive approaches to risk reduction that have been shown to be effective with AA adolescents. Small groups of 4 or 5 girls participated in two sessions spaced over the course of several weeks. The content of these groups included safe sex discussion/ education materials, condom demonstration/negotiation skills, and identification and discussion of personal barriers to safe sex. Efforts were made to maintain participation (e.g. phone calls, cab fare, and financial incentives). A repeat medical clinic visit and identical questionnaire were then administered 6 months post-intervention to both groups. Statistical analyses were performed using ChiSquare and Fisher’s Exact Test. Results: A total of 53 participants completed the study. The rate of STDs among the completers was 0/23 (0 %) for the controls and 7/30 (23 %) for the intervention group (p ⫽ 0.02). Rates of STDs among AA and CA girls in the intervention group were 22% and 23%, respectively. Dropouts were high in both groups. The intervention group had 15/45 (33%) dropouts (i.e. did not complete 6 month follow-up questionnaire) vs. 10/35 (29%) for the control group (p ⫽ 0.81). Drop-outs occurred in 14/40 (35 %) of the CA girls vs. 11/40 (28%) of the AA girls (p ⫽ 0.63). Greater discomfort with the format was reported in qualitative interviews with CA participants. Conclusions: The rate of STDs among the intervention group was higher and despite intense efforts to maintain adolescent girls in the study, there was resistance to completion of group based sexual behavior discussions, particularly among the CA girls. Approaches to behavior change that have been shown to reduce sexual risk behaviors among AA adolescents may not have been the most appropriate or effective venue for risk reduction in the girls of this cohort, particularly those of Caribbean descent. Further study is needed to identify more culturally appropriate and acceptable approaches to STD prevention in this community. 55. PREGNANCY RECURRENCE DURING ADOLESCENCE AFTER MULTIPROFESSIONAL PRENATAL CARE AND POSTPARTUM MOTHERCHILD FOLLOW-UP Amanda Melhado, Maria Jose´ Carvalho Sant’Anna, Veroˆnica Coates. Pediatrics Department, F.C.M.S.C.S.P., Sa˜o Paulo, Brazil.