School-Wide Screening in Detroit: A Tale of Two Schools

Background: Detroiters age 13-19 make up 42% of CT cases in Michigan despite representing 8% of the population.  In 2010, school-based screening accounted for 6% of publically funded CT tests in Michigan, but over 9% of positives.  In early 2011 the Michigan Department of Community Health partnered with St. John Providence Health System to conduct school-wide screenings in two Detroit area public schools.  The schools serve similar demographic profiles:  > 95% African-American and low income.  Additionally, the schools are geographically just three miles apart. 

Objectives: To assess screening acceptance and CT/GC positivity in Detroit area schools.

Methods: Youth were called from English class.  All received education, completed risk and demographic surveys, signed consent, and had a private opportunity, in a bathroom stall, to decide whether to provide a specimen or not.  Urine samples were provided by 665 youth:  420 in School A, and 245 in School B. 

Results: The proportion of male/female, and age breakdown was similar in both sites.  Infection patterns in the schools mirrored each other, with females testing positive for CT at levels 60% higher than males; and a precipitous increase among females 16 and over. Conversely, significantly different outcomes were observed in other areas.  In School A, just 2% declined testing while in School B, 14% declined.  Overall CT positivity in School A was 10.2%; only 4.9% in School B.

Conclusions: Despite similar populations and close physical proximity, school-wide screening in the sites presented notably different outcomes. Possible reasons include: characteristics of those who declined testing, variation in historical access to STD screening, content and tone of educational component, and impact of peer pressure on screening behavior. 

Implications for Programs, Policy, and Research: Additional analysis is necessary to determine reasons for the difference in screening acceptance and positivity.  Close consideration of the risk and disease history of those who chose not to test may inform future activities.