Seek new avenues to raise chlamydia screenings among adolescent women
4% prevalence rate reported among U.S. teens
With recent findings that 4% of young women between the ages of 14 and 19 in the United States are infected with chlamydia, public health officials are stepping up efforts to screen more adolescent girls for the sexually transmitted disease (STD).1
Data presented at the 2008 STD Prevention Conference confirm that STDs remain a major health threat for millions of Americans, which underscores the importance of strengthened prevention efforts, says Raul Romaguera, DMD, MPH, the newly appointed national chlamydia screening coordinator at the Centers for Disease Control and Prevention's (CDC) Division of STD Prevention. Specifically, missed opportunities for STD screening are identified as significant obstacles to prevention efforts, he notes.
There is a wide cross-section of providers interested in elevating the importance of chlamydia screening and treatment and increasing screening rates among adolescent and young women. They gathered at the first full meeting of the National Chlamydia Coalition in early June. The coalition was established by the Partnership for Prevention, a national membership organization dedicated to building evidence of sound disease prevention and health promotion policies and practices, in close collaboration with CDC. It is designed to address adherence to recommended clinical practice of annual chlamydia screening for sexually active women younger than age 26, says Romaguera. Steering committee member organizations include Advocates for Youth, American Academy of Pediatrics, American College of Obstetricians and Gynecologists, American Social Health Association, National Black Women's Health Imperative, National Coalition of STD Directors, National Partnership for Women and Families, and Planned Parenthood Federation of America.
The coalition also will focus on educating health care providers on the importance of chlamydia screening and ways to improve screening rates, advocating for increasing access to and use of chlamydia screening and treatment services, and encouraging research to enhance prevention of the disease and its medical and social consequences, says Romaguera.
Look at new venues
The CDC continues to implement and expand innovative screening and prevention strategies, says Romaguera. One example of such innovation is a confidential chlamydia screening program in high school-based health clinics in California.2
Researchers at the California Family Health Council analyzed data from the CDC-funded Educational Partnerships to Increase Chlamydia Screening (EPICS) program at seven such school-based clinics in rural and urban California. The program provides funding, training, and technical assistance to encourage greater chlamydia screening among at-risk teens.
The purpose of the EPICS program is to expand chlamydia screening to harder-to-reach females ages 25 and younger who would not otherwise present for care at traditional clinic-based screening programs, explains Rebecca Braun, MPH, program manager of the Infertility Prevention Project at the Berkeley-based California Family Health Council. Agencies may choose to establish this program in collaboration with educational partners such as high schools and school-based health centers, community colleges, and/or universities where chlamydia screening is not an integral part of reproductive health services, explains Braun. She presented information on the California project at the 2008 National STD Prevention Conference.3
"The populations at risk are those with barriers to accessing health care services," notes Braun. "Such barriers may include lack of affordable health care options, lack of transportation, concerns around confidentiality and cultural competency, or any other factor that limits an individual's ability to receive health care services."
Braun and fellow researchers examined data from 1,321 sexually active adolescent girls who attended the school-based health clinics seeking contraceptive or STD services between July 2006 and June 2007. Overall, almost nine in 10 teens (89.7%) attending the health centers were screened and chlamydia was diagnosed in 6.5% of those screened. This positivity rate is more than double the U.S. Department of Health and Human Services' Healthy People 2010 goal of 3% positivity for adolescents and young adults.3
The 2008 EPICS program in California has expanded to include nine Title X agencies, encompassing a total of 19 school-based health clinics — 16 high schools and three community colleges — throughout California, reports Braun. "Overall, we are optimistic that the data from this study will help health officials focus chlamydia screening and risk-reduction counseling on those most at risk of infection, most notably young black women and older adolescents," she says. "Given the success of this program in reaching at-risk teens and young adults, we recommend that other states consider implementing confidential school-based chlamydia testing and treatment programs as a part of providing comprehensive reproductive health care services."
Internet as a resource?
The American Social Health Association (ASHA) has teamed up with a creative team at Duval Guillaume, a New York City-based advertising agency, to get the word out on the insidious spread of chlamydia. Rather than pass out pamphlets, the health advocacy organization is drawing in young people with the use of an application on a popular Internet social networking site, www.facebook.com.
Duval Guillaume and a team of computer software developers have devised a Facebook application called MorphMonkey in which users are invited to "make a love child" by morphing pictures of their own faces with that of their friends. Facebook users simply download the MorphMonkey application and click the "Make a Love Child" tab. About 25,000 to 30,000 Facebook users have downloaded this free application, reports Fred Wyand, ASHA spokesman.
The humor takes a turn when the user is notified that they have "caught" a chlamydial infection from their friend and are prompted to discover more information on the ASHA web site, www.ashastd.org. Users are allowed to continue making "love children" while having the "disease." However, at the end of eight weeks, they find that they are unable to make any more "children" for two days, as their untreated case of chlamydia has made them "infertile." The MorphMonkey application does absolutely no harm to computers and is not a virus, program officials say. Launched in April during STD Awareness Month, the program ran through the end of June, says Wyand.
"We are reaching out to young people in a way that is a little different, with a little bit of a twist on it," says Wyand. "Not only is Facebook a place that they go, the message is presented in a way that is a little bit fun and interactive."
References
- Forhan SE. Prevalence of sexually transmitted infections and bacterial vaginosis among female adolescents in the United States: Data from the National Health and Nutritional Examination Survey (NHANES) 2003-2004. Presented at the 2008 National STD Prevention Conference. Chicago; March 2008.
- Hampton T. Researchers seek ways to stem STDs. JAMA 2008; 299:1,888-1,889.
- Braun R, Provost J. To Screen or Not to Screen — Maximizing Chlamydia Screening of Adolescent Females in School Based Health Centers in California. Presented at the 2008 National STD Prevention Conference. Chicago; March 2008.
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