HEALTH CARE AND EPIDEMIOLOGY OF STD AMONG YOUNG ADULTS

背景资料：美国的青少年和年轻人有很高的性传播疾病（STD）发病率，这对健康和医疗保健费用产生了巨大的不利影响。拟议的项目将调查卫生保健利用，卫生保健行为和性病流行病学的关系，使用的数据从添加健康，一个全国性的研究20,000美国青少年。第一波和第二波的添加健康在1994-1996年进行，并检查风险行为，与同龄人和父母的关系，与卫生保健系统的互动，以及自我报告的性病。在Add Health的第3波中，原始参与者将重新接受采访并接受常见性病的测试。目的：拟议的研究将侧重于与卫生保健系统的相互作用，特别是接受性病筛查，决定确定性病检测结果，并通过后续获得三个可治愈的性病的完整治疗的因素：沙眼衣原体（Ct），淋病奈瑟菌（GC），如果可能的话，阴道毛滴虫（Tv）。我们亦会制订筛选准则，以指导非临床环境下的性病测试。最后，我们将确定特定的卫生保健相关因素，有助于在某些少数民族人群中的性传播疾病的过度负担。设计和方法：Add Health的第3波将重新联系、采访并获取第1波和第2波参与者的尿液标本。将检测尿液标本的Ct、GC和（如可能）Tv。将向研究受试者提供通过电话获取检测结果的说明，并记录受试者是否致电获取结果。所有测试结果呈阳性的参与者将在测试后1个月重新接受采访，以评估寻求护理的行为。分析：将进行分层和抑制分析。筛查接受，要求测试结果，并寻求医疗保健的积极测试将使用结构方程模型与行为和正常的信念，态度，期望，情绪和自我效能的措施进行研究。逻辑回归分析将用于制定适用于社区环境的筛选标准，并评估种族/族裔相关患病率差异的具体决定因素。重要性：这项研究将确定影响筛查接受，寻求医疗保健和卫生保健利用的年轻人或性病的风险，从而创造更有效的干预措施，以控制性病在美国年轻人的持续流行的基础。

Background: Adolescents and young adults in the United States have high rates of sexually transmitted diseases (STDs) with tremendous adverse consequences on health and health care costs. The proposed project will investigate the relationship of health care utilization, health care behavior, and STD epidemiology using data from Add Health, a national study of 20,000 U.S. adolescents. Waves 1 and 2 of Add health were conducted in 1994-1996 and examined risk behaviors, relationships with peers and parents, interactions with the health care system, and self-reported STDs. In Wave 3 of Add Health, original participants will be re-interviewed and undergo testing for common STDs. Objectives: The proposed study will focus on factors related to interactions with the health care system, specifically acceptance of STD screening, the decision to ascertain STD test results, and follow-through to obtain a complete treatment for three curable STDs: Chlamydia trachomatis (Ct), Neisseria gonorrhea (GC), and, if possible, Trichomonas vaginalis (Tv). We will also develop screening criteria to guide STD testing in non-clinical settings. Finally, we will identify specific health care associated factors that contribute to the excess burden of STDs among certain minority populations. Design and Methods: Wave 3 of Add Health will re-contact, interview, and obtain urine specimens from Wave 1 and 2 participants. Urine specimens will be tested for Ct, GC, and, if possible, Tv. Study participants will be given instructions to obtain the test results by telephone and whether or not participants call for results will be recorded. All participants will positive test results will be re-interviewed 1 month after testing to assess care-seeking behaviors. Analyses: Stratified and repression analyses will be conducted. Screening acceptance, calling for test results, and seeking health care for a positive test will be studied using structural equations modeling with measures of behavioral and normal beliefs, attitudes, expectancies, emotions, and self-efficacy. Logistic regression analysis will be used to develop screening criteria applicable in community settings and to assess specific determinants of race/ethnicity-related differences in prevalence. Significance: This study will identify factors that influence screening acceptance, health care seeking, and health care utilization by young people with or at risk of STDs, thereby creating the basis of more effective interventions to control the continuing epidemic of STDs in young Americans.