Assessing the Impact of High School Screening on Births Among Teenaged Mothers

Background: The rate of reported STIs among female adolescents in Philadelphia has been increasing since the mid-1990s – partly due to expanded screening, including the Philadelphia High School STD Screening Program (PHSSSP). During this period, births to teen mothers have remained stable.

Objectives: To evaluate overlap between two outcomes associated with unprotected sex – STDs and births – among adolescent females.

Methods: STD surveillance data were matched to birth certificates for mothers aged 14-17 years at delivery.  Eligible females were born between 1985-1993 and aged 14-17 years at some point during 2003-2010.

Results: Nearly 11% (9,544) of the 89,582 females who were 14-17 years old between 2003-2010 delivered a child in this period. Birth rates were 3 times higher for those with STIs compared to those with no STI reports (23% vs 7%). Females who had an STI reported during adolescence but who never tested in PHSSSP had the highest birth rate (26.1%). Of females who had STIs identified in PHSSSP and outside of high school screening, 16.6% delivered. The birth rate was 13.2% for those who had an STI identified through PHSSSP alone. Females who tested negative in PHSSSP and had no other STI reports had a birth rate of 7.6%. Finally, 7.1% of females had no history of STI testing delivered. The birth rate was 70% higher for females who never participated in PHSSSP. Females who tested positive for an STD during high school screening were 1.6 times as likely to have a teen birth than those who tested negative as part of PHSSSP. 

Conclusions: For female adolescents, birth rates increased as STI risks increased.  However, some of the lowest STI risk females were still having unprotected sex as demonstrated by birth outcomes in this group.

Implications for Programs, Policy, and Research: Comprehensive sexual health education, including condom availability, should be mandatory in Philadelphia high schools.