Comparison of self-reported and test-identified chlamydial infections among young adults in the United States of America
Bonita J. Iritani A F , Carol A. Ford B C , William C. Miller C D , Denise Dion Hallfors A and Carolyn Tucker Halpern EA Pacific Institute for Research and Evaluation, 1516 E. Franklin St., Ste 200, Chapel Hill, North Carolina 27514, USA.
B Department of Pediatrics, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
C Department of Medicine, School of Medicine, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
D Department of Epidemiology, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
E Department of Maternal and Child Health, School of Public Health, University of North Carolina, Chapel Hill, North Carolina 27599, USA.
F Corresponding author. Email: iritani@pire.org
Sexual Health 3(4) 245-251 https://doi.org/10.1071/SH06040
Submitted: 7 July 2006 Accepted: 21 October 2006 Published: 17 November 2006
Abstract
Background: Many studies rely on respondent reports of prior diagnosed sexually transmissible infections (STIs), but these self reports are likely to under-estimate infection prevalence. The extent of bias from using self-reported STI data, and whether bias varies by sex and race, is largely unknown. This gap is addressed using a large, nationally representative sample. Methods: Cross-sectional analyses of Wave III of the National Longitudinal Study of Adolescent Health. Participants were 18–26 years old (n = 12 359). Estimates of the prevalence of chlamydial infection based on self-reported diagnoses in the past year were compared with actual prevalence based on nucleic acid amplification testing (NAAT) at the time of data collection. Ratios of test-identified prevalence to self-reported diagnosis prevalence were calculated by sex and race/ethnicity groups. Larger ratios indicate greater extent of self reports under-estimating infection prevalence. Results: About 4.2% of the sample had a current NAAT-identified chlamydial infection, but only 3.0% reported having been diagnosed with chlamydia in the past year, yielding a ratio of 1.43. The ratio of test-identified infection prevalence to prevalence identified from self-reported diagnoses was larger among men than women (2.07 versus 1.14, P < 0.05). Among men, the ratio was larger among non-Hispanic blacks (2.40) compared with non-Hispanic whites (1.07, P < 0.05). Conclusions: Use of self-reported diagnoses under-estimates chlamydial infection prevalence, particularly among men, and among non-Hispanic black men. Reliance on self-reported STIs may consequently lead to biased conclusions, particularly for these groups. Use of biological testing for STIs in research studies is recommended.
Acknowledgements
The research was supported by grant R01-DA14496 from the National Institute on Drug Abuse, National Institutes of Health (to Dr Hallfors) (BJI, DDH, CTH), the UNC STD Cooperative Research Center (National Institute of Allergy and Infectious Diseases UO131496, WCM, CAF), and The Robert Wood Johnson Foundation Generalist Physician Faculty Scholar Award Program (CAF). The authors thank Jon Hussey and Martha Waller for providing consultation about variable construction. This research uses data from Add Health, a program project designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris, and funded by grant P01-HD31921 from the National Institute of Child Health and Human Development, with cooperative funding from 17 other agencies. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Persons interested in obtaining data files from Add Health should contact Add Health, Carolina Population Center, 123 W. Franklin Street, Chapel Hill, NC 27516–2524 (http://www.cpc.unc.edu/projects/addhealth/data/contract).
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