Participation in School-Wide Screening for STDs and Perception of STD Risk

Background: Administrators of school-wide screenings for chlamydia and gonorrhea have suggested that participants may self-select for testing because they perceive themselves at risk of STD. But whether participants in school-wide screenings for STDs are individuals who perceive themselves at risk of STD has not been ascertained.

Objectives: To determine whether participants in school-wide screenings for chlamydia and gonorrhea are individuals who perceive themselves at risk of STD and to determine factors associated with STD risk perception among high school adolescents.

Methods: During school years 2003-2004 and 2004-2005, 3336 participants in a school-wide screening for chlamydia and gonorrhea in New Orleans were asked in a paper-and-pencil, self-administered survey, to assess their chances of getting infected with an STD on a 5-point Likert type scale.

Results: Overall, 64.5% of all participants in screening (95% CI: 62.9% to 66.2%) thought their chances of getting infected with an STD were none, not very high or medium and 35.5% (95% CI: 33.8% to 37.1%) thought their chances of getting infected with an STD were pretty high or very high. Perception of pretty high or very high risk of STD was independently significantly associated with greater knowledge of STDs (p<0.001) and with a previous infection with chlamydia or gonorrhea or having reported a risky sexual behavior in the past (p=0.04).

Conclusions: If only students who perceived themselves at high risk of STD self-selected for testing, no more than 36% of all students tested would have participated.

Implications for Programs, Policy, and Research: Although the potentials for participation bias in school-wide screenings for chlamydia and gonorrhea due to self-selection of volunteers still remain, currently available data do not support the fact of a self-selection based on adolescents’ perception of being at high risk of STD.