title: Health insurance coverage, health care-seeking behaviors, and genital chlamydial infection prevalence in sexually active young adults.
abstract: BACKGROUND
  Genital chlamydial infection remains prevalent in young adults. Differential access to health care and thus the opportunity for testing, treatment, sexual partner services, and risk reduction counseling may be among the factors contributing to variation in chlamydial prevalence.
  
  
  OBJECTIVE
  We investigated associations of health insurance coverage and health care-seeking behaviors, both indicators of healthcare access, to chlamydial infection in a nationally representative sample of young adults.
  
  
  METHODS
  Weighted logistic regression techniques were used to examine associations between indicators of healthcare access and chlamydial infection as determined using Chlamydia trachomatis ligase chain reaction among a subset of sexually active young adults ages 18 to 27 interviewed at wave III of the National Longitudinal Study of Adolescent Health (N = 9347). Analyses were stratified by gender and controlled for age and race/ethnicity.
  
  
  RESULTS
  Having continuous health insurance coverage in the preceding 12 months was associated with a lower risk of chlamydial infection in both men and women. Usual site of health care was also associated with chlamydial infection. Men who reported emergency rooms as their usual site of care had a higher risk of infection, whereas women who used school clinics had a lower risk compared with those seen in primary care settings. Having seen a provider in the preceding 12 months was associated with a lower risk of chlamydial infection for men only. These associations remained even after adjusting for racial/ethnic differences in health insurance coverage and health care-seeking behaviors.
  
  
  CONCLUSIONS
  Independent of race/ethnicity, indicators of healthcare access are associated with chlamydial infection in young adults. Furthermore, our analyses reveal differences in these associations by gender. Improved healthcare access for young people could help reduce chlamydia-associated reproductive health morbidity potentially through access to chlamydial screening, treatment, sex partner services, and risk reduction counseling.
authors.affiliation: Department of Medicine, University of Alabama at Birmingham, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Geisler
authors.forename: Laura
authors.initials: L
authors.lastname: Chyu
authors.forename: Yasamin
authors.initials: Y
authors.lastname: Kusunoki
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Upchurch
authors.forename: Edward W
authors.initials: EW
authors.lastname: Hook
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services / Q000458:organization & administration / Q000706:statistics & numerical data; D000328:Adult; D000407:Alabama / Q000453:epidemiology; D002690:Chlamydia Infections / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control; D002692:Chlamydia trachomatis; D004636:Emergency Service, Hospital; D005260:Female; D006297:Health Services Accessibility / Q000191:economics*; D006801:Humans; D007348:Insurance, Health / Q000706:statistics & numerical data*; D008297:Male; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D015995:Prevalence; D018570:Risk Assessment; D012307:Risk Factors; D012572:School Health Services; D012725:Sexual Behavior