title: Improving STD testing behavior among high-risk young adults by offering STD testing at a vocational school.
abstract: BACKGROUND
  Chlamydia trachomatis infection (CT) is the most prevalent bacterial STD. Sexually active adolescents and young adults are the main risk group for CT. However, STD testing rates in this group are low since exposed individuals may not feel at risk, owing-at least in part-to the infection's largely asymptomatic nature. Designing new testing environments that are more appealing to young people who are most at risk of acquiring chlamydia can be an important strategy to improve overall testing rates. Here we evaluate the effect of a school-based sexual health program conducted among vocational school students, aiming to obtain better access for counseling and enhance students' STD testing behavior.
  
  
  METHODS
  Adolescents (median age 19 years) attending a large vocational school were provided with sexual health education. Students filled in a questionnaire measuring CT risk and were offered STD testing. Using univariate and multivariate analysis, we assessed differences between men and women in STD-related risk behavior, sexual problems, CT testing behavior and determinants of CT testing behavior.
  
  
  RESULTS
  Of 345 participants, 70% were female. Of the 287 sexually active students, 75% were at high risk for CT; one third of women reported sexual problems. Of sexually active participants, 61% provided a self-administered specimen for STD testing. Independent determinants for testing included STD related symptoms and no condom use. All CT diagnoses were in the high-CT-risk group. In the high-risk group, STD testing showed an increased uptake, from 27% (previous self-reported test) to 65% (current test). CT prevalence was 5.7%.
  
  
  CONCLUSIONS
  Vocational school students are a target population for versatile sexual health prevention. When provided with CT testing facilities and education, self selection mechanisms seemed to increase CT testing rate dramatically in this high-CT-risk population expressing sexual problems. Considering the relative ease of testing and treating large numbers of young adults, offering tests at a vocational school is feasible in reaching adolescents for STD screening. Although cost-effectiveness remains an issue counseling is effective in increasing test rates.
authors.affiliation: Department of Infectious Diseases, South Limburg Public Health Service, Geleen, The Netherlands. laura.spauwen@ggdzl.nl
authors.forename: Laura W L
authors.initials: LW
authors.lastname: Spauwen
authors.forename: Christian J P A
authors.initials: CJ
authors.lastname: Hoebe
authors.forename: Elfi E H G
authors.initials: EE
authors.lastname: Brouwers
authors.forename: Nicole H T M
authors.initials: NH
authors.lastname: Dukers-Muijrers
mesh_terms: D000293:Adolescent; D002690:Chlamydia Infections / Q000175:diagnosis / Q000453:epidemiology; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D005260:Female; D006293:Health Promotion / Q000379:methods; D006801:Humans; D008297:Male; D008403:Mass Screening; D009426:Netherlands / Q000453:epidemiology; D010342:Patient Acceptance of Health Care; D012725:Sexual Behavior / Q000706:statistics & numerical data; D012749:Sexually Transmitted Diseases / Q000175:diagnosis* / Q000453:epidemiology; D011795:Surveys and Questionnaires; D014829:Vocational Education; D055815:Young Adult