Validity of self-reported sexually transmitted diseases among African American female adolescents participating in an HIV/STD prevention intervention trial.
BACKGROUND
Studies assessing the validity attributed to self-reported measures of sexually transmitted diseases (STDs) clearly are needed, particularly those used for high-risk populations such as female adolescents, in whom STD prevention is a priority.


OBJECTIVE
To determine the accuracy of self-reported STD test results in female adolescents over a relatively brief period ( approximately 28 days).


METHODS
A prospective, randomized, controlled clinical trial of STD/HIV prevention for African American females, ages 14 to 18, was conducted. Study participants were recruited from medical clinics and school health classes in low-income neighborhoods of Birmingham, Alabama, that had high rates of unemployment, substance abuse, violence, STDs, and teenage pregnancy.


RESULTS
Of the 522 adolescents enrolled in the trial, 92% (n = 479) completed baseline STD testing and follow-up surveys. At baseline, 28% had positive test results for at least one disease: 4.8% for Neisseria gonorrhoeae, 17.1% for Chlamydia trachomatis, and 12.3% for Trichomonas vaginalis. Of the adolescents with negative STD test results, 98.8% were accurate in their self-report of STD status, as compared with 68.7% of the adolescents with positive results. Underreporting varied by type of STD. Adolescents who accurately reported their positive STD status were significantly more likely to report their receipt of treatment accurately (P < 0.001).


CONCLUSIONS
The substantial underreporting of STD incidence in this study suggests that reliance on self-reports of STD history may introduce misclassification bias, potentially leading to false conclusions regarding the efficacy of prevention interventions. This observation highlights the importance of using biologic indicators as outcome measures.
Harrington
K F
KF
Departments of Pediatrics, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35233-0009, USA. kharring@uab.edu
DiClemente
R J
RJ
Wingood
G M
GM
Crosby
R A
RA
Person
S
S
Oh
M K
MK
Hook
E W
EW
D000293:Adolescent; D000294:Adolescent Behavior; D001741:Black or African American / Q000706:statistics & numerical data; D000407:Alabama / Q000453:epidemiology; D015982:Bias; D002690:Chlamydia Infections / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D015658:HIV Infections / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D006801:Humans; D011446:Prospective Studies; D015203:Reproducibility of Results; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000208:ethnology / Q000517:prevention & control*; D011795:Surveys and Questionnaires / Q000592:standards*; D014247:Trichomonas Vaginitis / Q000453:epidemiology / Q000208:ethnology / Q000517:prevention & control; D016387:Women's Health