Ethnic differences in STD rates among female adolescents.

Buzi, Ruth S. ; Weinman, Maxine L. ; Smith, Peggy B. 等

Adolescents in general and minority adolescents in particular have significantly higher rates of sexually transmitted diseases (STDs) than do other groups. According to a study by the Centers for Disease Control and Prevention (1993a), every year three million teens (one out of every eight) are infected with an STD. Approximately 24-30% of gonorrhea cases reported in 1981 through 1991 were among adolescents. Some of the highest rates were for 15- to 19-year-old Black females. Further, adolescents accounted for 10-12% of reported primary and secondary syphilis cases. Syphilis rates for Black female adolescents increased more than 150% from 1986 to 1990, compared with increases of less than 50% for other ethnic groups. In addition, chlamydia rates were significantly higher among Black females than among White females (Centers for Disease Control and Prevention, 1993b). Rates of STD reinfection have also been found to be higher among minorities (Richert et al., 1993). STD reinfections are particularly serious because they increase susceptibility to HIV (Rosenberg & Gollub, 1992).

Number of sexual partners and lack of condom use are considered the most significant factors in STD exposure. As the number of sexual partners increases, the cumulative risk for contracting an STD from an infected partner rises (Millstein, Moscicki, & Broering, 1993). Further, adolescents have been found not to use condoms consistently (Hingson, Strunin, & Berlin, 1990; Kegeles, Adler, & Irwin, 1988). Although rates of condom use are low for all teenagers, rates for Black and Hispanic teens are markedly lower than those for White teens. Data from the 1988 National Survey of Family Growth indicate that among females aged 15-19, 51% of Whites have used condoms as compared with 41% of Hispanics and 35% of Blacks. It has also been found that Black and Hispanic females are less likely than White females to have sexual partners who always use condoms (Catania et al., 1992; Marin & Marin, 1992).

Information about sexual behavior is critical if effective educational programs for high-risk sexually active adolescents are to be implemented. Unfortunately, the relationship between ethnicity and sexual behavior, especially among minority adolescents, has received scant attention. The purpose of the present study was to determine whether ethnicity is a factor in adolescent females' STD infection and reinfection rates.

METHOD

Subjects

The sample consisted of 205 female adolescents who sought care at either of two teen health clinics. The clinics, located in public county hospitals in Houston, Texas, provide primary and reproductive health care services, including family planning, STD testing and treatment, pregnancy testing, school physicals, HIV testing and counseling, EPSDT (early periodic screening, detection, and treatment), and health education. Females between the ages of 13 and 20 years who had an STD at the time of the clinic visit (between December 1992 and July 1993) were recruited to participate in the study.

Procedure

Adolescents were screened for gonorrhea, syphilis, trichomoniasis, chlamydia, pubic lice, herpes, and condyloma. Tests for these infections included VDRL and Gonostat; an enzyme-linked immunosorbent assay (ELISA) tested for HIV antibodies. The Western blot test was used for confirmation.

Adolescents were contacted following positive laboratory results, and informed consent to participate in the study was obtained. They received treatment and were counseled by the nurse and STD educator about safe-sex practices. All were given condoms. HIV testing was performed on consenting adolescents, who also received confidential HIV education and counseling. The adolescents were scheduled to return for test of cure/follow-up within six months of the initial visit.

Data were collected by primary health care providers during the course of clinic visits. A standardized data collection form was used to record demographic information, number of sexual partners, history of STDs, and STDs at time of clinic admission (current infections). At test of cure/follow-up that took place two weeks to six months after the initial visit, new infections (defined as STDs entirely different from the ones at admission) and reinfections (defined as same STDs as the ones at admission) were also noted.

RESULTS

Sociodemographic Profile

The mean age of the females was 17.32 years (SD = 1.55). One hundred forty-nine (72.7%) were Black, 20 (9.8%) were White, and 36 (17.6%) were Hispanic. One hundred thirty-eight (67.6%) were still in school; however, the dropout rate was highest (16, or 44.4%) and the graduation rate lowest (2, or 5.6%) among Hispanics ([x.sup.2] = 19.51, p = .000). Although 191 (93.2%) were single, Hispanics were overrepresented among married teens, 11 (30.6%) versus 2 (1.3%) Black teens and 1 (5.0%) White teen ([x.sup.2] = 39.00, p = .0000).

Past and Current STDs

There were ethnic differences in past STDs. Seventy-eight (52.3%) Black teens, 9 (45.0%) White teens, and 10 (27.8%) Hispanic teens reported a previous STD ([x.sup.2] = 7.07, p = .03). Interestingly, there were no differences in history of STDs between married and single Hispanic teens, but school status was a significant variable. Of the 10 Hispanic teens who reported a previous STD, 8 were school dropouts and not one was a high school graduate ([x.sup.2] = 7.20, p = .02).

There were significant differences among the ethnic groups in the number of reported lifetime sexual partners. The mean number of partners for White teens was 5.20 (SD = 4.06); for Black teens it was 3.73 (SD = 2.70), while Hispanic teens had 3.05 (SD = 3.07) partners (F = 3.47; df = 2, 201; p = .03).

Some of the teens had more than one current STD: the mean was 1.16 (SD = .39). There were no significant differences across ethnic groups. Neither marital nor school status was related to current STD rates. The most frequent infection was chlamydia (103, 50.2%), followed by trichomoniasis (66, 32.2%), gonorrhea (21, 10.2%), condyloma (21, 10.2%), syphilis (13, 6.3%), herpes (10, 4.9%), and lice (5, 2.4%). There were no cases of HIV infection at the time of admission. Ethnic differences were found only for syphilis: all 13 cases occurred among Black teens ([x.sup.2] = 5.21, p = .07).

New and Reinfection Rates

One hundred forty-three (69.8%) of the teens returned to a clinic within six months; 21 (14.7%) had a new STD. Moreover, 20 of the new infections occurred among Black teens and 1 occurred among White teens ([x.sup.2] = 6.32, p = .04). There were 14 (9.8%) cases of reinfections. Although not statistically significant, 10 of the 14 reinfections occurred among Black teens. The most common new infection/reinfection was chlamydia, followed by trichomoniasis, gonorrhea, condyloma, herpes, and lice. There was one new case of HIV (Black teen) and one new case of syphilis (White teen).

DISCUSSION

The present study examined ethnic differences in past, current, new, and reinfection rates for STDs. Black teens were the most likely and Hispanic teens were the least likely to have had a past STD. All 13 of the current cases of syphilis occurred among Black teens. Of the 21 cases of new infections, 20 occurred among Black teens. These findings are alarming, especially the high incidence of syphilis among Black teens. Syphilis has been associated with high-risk behaviors, such as drug use and increased susceptibility to HIV infection (Inciardi, Lockwood, & Pottieger, 1991).

Among Hispanic teens, the marital rate was lower and the mean number of sexual partners was higher than in previous samples (Smith, Weinman, & Mumford, 1992; Weinman, Smith, & Mumford, 1994). Prior studies conducted at these clinics indicated that the mean number of sexual partners among Hispanic teens was 2.01 (SD = 2.13), compared with 3.05 (SD = 3.07) in this study; and previously 56% had been found to be married as compared with only 30.6% here. It has been suggested that the behavior of Hispanics is changing as a result of exposure to the mainstream culture (Marin, Sabogal, Marin, Otero-Sabogal & Perez-Stable, 1987; Pavich, 1986). Researchers have found that the sexual behaviors of acculturated Hispanic adolescents are similar to those of White and Black youth (Ford & Norris, 1993; Sonenstein, Pleck, & Ku, 1989).

It has been suggested that, among Hispanic women, discussion of sexual matters is generally considered unacceptable, regardless of marital status. Consequently, they may find it difficult to insist on the use of condoms (Land, 1994; Stuntzner-Gibson, 1991; Wingood & DiClemente, 1992). Additionally, it has been suggested that Black female adolescents frequently are economically dependent upon their partner and fear that requiring condom use will jeopardize the relationship. Overall, females often perceive their sexual role as passive, consequently viewing themselves as having little control in the relationship (Peterson & Marin, 1988).

The findings of the present study indicate that adolescents who sought care at two family planning clinics were not homogeneous. There were ethnic differences in sexual behaviors and STDs. More studies are needed among diverse groups of minority adolescents to investigate the interaction of ethnicity, acculturation, and gender roles. Nevertheless, the findings have important implications for primary prevention programs aimed at reducing STDs among adolescents.

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