STDs among highrisk youths: Individual and community level factors Richard Dembo, Ph.D.

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STDs among high-risk youths Individual and
community level factors Richard Dembo, Ph.D.
Steven Belenko, Ph.D. U.S.F. Temple Univ.
Kristina Childs, M.A., U.S.F.Jennifer Wareham,
Ph.D.Wayne State Univ. Consultant Matthew
Rollie, MPH, U.S.F October 2007
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• Acknowledgments
• Funded by National Institute on Drug Abuse, Grant
  No. R01-DA-020346
• Hillsborough County Juvenile Assessment Center
  and ACTS, Inc.
• Hillsborough County Health Department
• Florida Department of Health Bureau of
  Laboratories

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Study Testing Phase During the last half of
2006, tested for Chlamydia and Gonorrhea
infections in 948 male (n506) and female (n442)
arrested juveniles entering the Hillsborough
County (FL), Juvenile Assessment Center (HJAC) (a
centralized intake facility). Some Other Study
Objectives (1) Assessing STD risk behaviors and
drug use (2) Determining prior STD, exposure to
STD testing, and prevention services (3)
Examining factors associated with getting
treatment if infected (4) Examine the relative
influence of individual and community level
factors in their STD status
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This was the first JAC in the U.S. to test newly
arrested youths for STDs and provide access to
treatment.
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Project Details

• Youths entering the HJAC became eligible for a
  non-invasive, urine-based,
• VOLUNTARY STD test.
• Inclusion Criteria
• - Adolescent must be 12 years of age
• - Adolescent consented to provide urine for
• drug analysis according to HJAC SOP
• - Additional consent to have urine also tested
  for
• Chlamydia and Gonorrhea
• A brief set of additional questions about STD
  risk behaviors and previous STD testing and
  prevention experience added to
• the existing HJAC assessment protocol.

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Project Details (contd)

• Urine samples sent to the Tampa Branch of ACTS
  (Florida Dept. of Health) lab.
• Youths consenting to STD test had urine sample
  split
• at the lab (Florida law states that adolescents
  12 years of age do not need parental consent to
  receive STD test).
• Samples were tested for Chlamydia and Gonorrhea.
  
• All youth who tested positive are contacted and
  offered free and confidential treatment by the
  Hillsborough County Health
• Department. (62 of STD positive youths received
  treatment)

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Urine-based Nucleic Acid Amplified Test (GenProbe
APTIMA Combo 2 Assay )

• Chlamydia and Gonorrhea specific DNA is
  multiplied to detectable levels using the
  polymerase chain reaction.
• Convenient, non-invasive, and painless (urethral
  swab was previous technique).
• Extremely sensitive and highly accurate can
  detect
• Chlamydia or Gonorrhea from a single bacterium.

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URINE ANALYSIS DRUG SCREEN

• VOLUNTARILY PROVIDED AS PART OF HJAC PROCESSING
  PROTOCOLTESTED FOR 4 DRUGS MARIJUANA,COCAINE,OPIA
  TES,AMPHETAMINES
• USE OF EMIT PROCEDURE IN TESTING

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Initial JAC entry STD info. stapled to property
bag
Prior to 12 pm, photocopy handwritten JAC entry
log (includes name, demographics, date time of
intake)
JAC Assessment (according to SOP this includes
supplemental questions)
NO
Urine sample obtained for drug testing?
End of Assessment
YES
NO
Youth 12 years old?
YES
1. Read Purple Form Is youth willing to have
urine tested for
GC,CT? (Read Orange form)
NO
Transcribed (yellow) copy of risk assessment
questionnaire
YES

• Complete
• Orange consent form signed
• Yellow contact sheet
• Transcribed (yellow) copy of
• risk assessment questionnaire

Supplemental Forms
Place Supplemental Forms in Bin (including
supplemental questions from JAC assessment)
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Contact Sheet

JAC ID Todays Date /
/ Name _____________________
____________________ Address
_________________________________________ City
________________ State ________________
Zip _____________ Date of Birth
__________________ Gender Male
Female Youth Cell Phone _______________
Youth Home Phone _________________ If female,
is youth pregnant? (Circle one)
YES NO Post HJAC Placement (Circle one)
Diversion
Non-secure
home detention
Secure detention

Date of last HJAC admission?
/
/
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Consent to Drug and STD Testing
by Gender

• Male Female Total
• Number Assessed 759 634 1,393
• Consented to
• Drug Test 82.6 82.6 82.6
• Consented to
• STD Test 70.5 72.7 71.5

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Study and Results

• 924 of the 948 youths (97.5) had geocodable
  addresses
• 19.7 of the females and 10.5 of the males were
  STD positive for Chlamydia or Gonorrhea
• As Table 1 shows (a) the male and female youths
  were similar in age, (b) in regard to
  race/ethnicity, a larger percent of white females
  were represented in the study, than white males,
  (c) a larger percent of females were arrested on
  less serious charges (i.e., diversion eligible),
  than the males, (d) nearly 3/4th of the females
  versus just over half of the males were released
  back to the communitywith more males than
  females were placed in secure detention

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Study and Results(Contd)

• A two-level logistical regression analysis was
  performed to determine the individual level
  (gender, age, race, UA test result for cocaine,
  UA test result for THC) and community level
  factors reflecting disorganization/organization
  (e.g., residential stability, proportion of
  population divorced, without a high school
  education, or below the poverty level) relating
  to the youths STD results.

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Study and Results (Contd)

• Results indicated (a) for individual level
  factors---females, older aged, African American
  youths, and youths arrested on more serious
  charges were significantly more likely, and UA
  cocaine positive youths close to significantly
  more likely, to be STD positive.
• Odds-Ratios indicated African American youths
  were nearly 4 times more likely to be STD
  positive, than other youths youths arrested on
  serious charges were over 2 times more likely to
  be STD positive and UA cocaine positive youths
  were nearly 2 times more likely to be STD
  positive, than cocaine negative youths.

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Study and Results (Contd)

• For the community factors (b) no significant
  relationship was found for any of these factors
  and the youths STD results.
• Findings presented in Tables 2 to 4 Figure 1.
  (Appendix Table 1 gives the detailed results of
  the two-level logistical regression analysis)

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Conclusions/Implications

• STD testing of youths at the front end of the
  juvenile justice system is feasible
• A strong connection exists between individual
  factors reflecting cocaine use, being female,
  being older, African American and having a more
  serious arrest charge, and being STD positive.
• These findings point to a very high risk set of
  youths needing focused STD/HIV risk intervention
  services.

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Conclusions/Implications

• There are no significant indications that
  community level factors, such as those
  reflecting social organization/disorganization
  are related to the youths STD status
• These findings have important public health
  implications in that they point to a need for
  resources to be focused on altering individuals
  decision making and sexual risk behavior

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Conclusions/Implications

• Universal, voluntary STD testing for newly
  arrested youths and treatment for STD positive
  caseswith particular emphasis on youths released
  back to the community-- remains a serious need
  for justice involved youths