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Reasons for Focusing on Chlamydia

Assay Results vs. Self-reported Chlamydial Infections: Does Measurement Discrepancy Vary by Level of Risk Behavior?. Bonita Iritani, 1 Denise Hallfors, 1 Carol A. Ford, 2 Carolyn Tucker Halpern, 2 William C. Miller 2 1 Pacific Institute for Research and Evaluation 2 UNC - Chapel Hill

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Reasons for Focusing on Chlamydia

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  1. Assay Results vs. Self-reported Chlamydial Infections: Does Measurement Discrepancy Vary by Level of Risk Behavior? Bonita Iritani,1 Denise Hallfors,1 Carol A. Ford,2 Carolyn Tucker Halpern,2 William C. Miller2 1Pacific Institute for Research and Evaluation 2UNC - Chapel Hill Funded by NIH-NIDA, Denise Hallfors, PI

  2. Reasons for Focusing on Chlamydia • Most common bacterial STI • Has clear recommendations for screening among females

  3. Sources of Chlamydia Estimates • Estimates of chlamydial infections often based on reported cases, clinic-based studies • Limitations • Not representative of general population • Miss asymptomatic infections • Population-based studies that are conducted typically rely on self-reports

  4. Self-reported Infections • Limitations of self-reports • Miss asymptomatic infections when screening inadequate • Screening recommended for all sexually active females ≤ 25 years • Miss people with poor access to health care • Some respondents may not report accurately (Harrington et al, 2001) • By comparing self-reports with biological test results, could look for infections missing from self-reports

  5. Study Objectives • Use National Longitudinal Study of Adolescent Health (Add Health) • Nationally representative sample of young adults • To assess prevalence of prior chlamydia testing • To compare the prevalence of chlamydial infections identified by self-reports vs. assay results

  6. Data • Add Health http://www.cpc.unc.edu/addhealth/ • Sample for present analyses: • Wave 3 • 2001 – 2002 • 18-26 years old • Nonmissing data for chlamydia self-reports and assay results (N=12,359)

  7. Chlamydia Measures • Tested for Chlamydia (self-report) – past 12 months • Self-report Chlamydia Diagnosis– past 12 months • Biological Test of Chlamydia • Urine samples collected at interview

  8. Ratio of Test/Self-report • Ratio = biological test prevalence/self-report prevalence • If all infections diagnosed and reported, people having an infection over 12 months > people with infection on one day • Ratio > 1 indicates infections missing in self-reports

  9. Measure of Risk Behavior Patterns • In previous work, created a measure of risk behavior patterns • Used cluster analysis • Grouped participants into 16 categories based on patterns of substance use and sexual behavior • Each person assigned to one pattern only

  10. Analyses • Bivariate analyses by • Sex and race-ethnicity • Risk behavior patterns • Weighted percents • Account for the complex sampling design

  11. ResultsPrevalence of Sexual Activity

  12. % Prior Chlamydia Testing past 12 months

  13. Chlamydia Prevalence – By Sex *p<.05 for difference between ratios of males vs. females

  14. Chlamydia Prevalence By Race-ethnicity Among Females

  15. Chlamydia Prevalence By Race-ethnicity Among Females

  16. Chlamydia Prevalence By Race-ethnicity Among Males *p<.05 for difference between ratios of NH Black vs. NH White.

  17. Chlamydia Prevalence By Race-ethnicity Among Males *p<.05 for difference between ratios of NH Black vs. NH White.

  18. Prevalence by Sexual & Substance Use Risk Behavior Pattern

  19. Prevalence by Sexual & Substance Use Risk Behavior Pattern

  20. Conclusions • Prevalence of chlamydia testing is low • Screening guidelines for females not achieved (only 29% of sexually active young women were tested)

  21. Infections Missing from Self-reports • 4% were infected on interview day, but only 3% self-reported infection in entire past 12 months • Infections particularly missing among • males compared to females • NH black males compared to white males • Some lower risk behavior categories

  22. Possible Reasons • Some respondents may not be answering accurately • Many infections are undiagnosed • Due to low levels of chlamydia screening

  23. Acknowledgments • This research was supported by grant R01-DA14496-4 from the National Institute on Drug Abuse, Denise Hallfors, PI. • We thank Martha W. Waller and Jon M. Hussey for consultation. • This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by a grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516-2524 (www.cpc.unc.edu/addhealth/contract.html).

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