HEALTH CARE AND EPIDEMIOLOGY OF STD AMONG YOUNG ADULTS

背景：美国青少年和青壮年的性传播疾病(STDS)发病率很高，对健康和医疗保健成本造成了巨大的不良后果。这项拟议的项目将使用ADD Health的数据来调查卫生保健利用、卫生保健行为和性病流行病学之间的关系。ADD Health是一项全国性的研究，涉及20,000名美国青少年。第一波和第二波ADD健康调查是在1994-1996年进行的，调查了危险行为、与同龄人和父母的关系、与医疗保健系统的互动以及自我报告的性传播疾病。在Add Health的第三波中，最初的参与者将被重新采访并接受常见性病的测试。目的：这项拟议的研究将集中于与卫生保健系统相互作用的相关因素，特别是接受STD筛查，确定STD检测结果的决定，以及对三种可治愈的STD进行全面治疗的后续行动：沙眼衣原体(Ct)、淋病奈瑟菌(GC)，如果可能的话，还有阴道毛滴虫(TV)。我们还将制定筛查标准，以指导非临床环境中的性病检测。最后，我们将确定导致某些少数群体中性病负担过重的具体卫生保健相关因素。设计和方法：Add Health的第三波将重新接触、访谈和获取第一波和第二波参与者的尿样。尿样将进行CT、GC检测，如果可能的话，还会检测TV。研究参与者将被指示通过电话获取测试结果，并将记录参与者是否要求结果。所有检测结果为阳性的参与者将在检测后1个月重新面谈，以评估求医行为。分析：将进行分层和压制分析。对阳性测试的筛选接受、要求测试结果和寻求医疗保健将使用结构方程模型进行研究，其中包括行为和正常信念、态度、期望、情绪和自我效能的测量。将使用Logistic回归分析来制定适用于社区环境的筛查标准，并评估与种族/族裔有关的流行率差异的具体决定因素。意义：这项研究将确定影响有性病或有性病风险的年轻人接受筛查、寻求医疗保健和利用医疗保健的因素，从而为更有效的干预措施奠定基础，以控制美国年轻人性病的持续流行。

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.