California Family Health Council, Inc.

Previous studies suggest that only half of young women receive the recommended screening each year. There are many possible explanations for this discrepancy. Some clients and clinicians may not be aware of the need for annual screening. Additionally, many women face barriers in accessing care such as lack of health insurance, difficulty reaching clinics during business hours, and limited transportation. One innovative approach is to provide chlamydia screening at clinics affiliated with schools, called school-based health centers. These health centers are an optimal setting to reach teens that may otherwise lack access to care.

A new study led by Rebecca Braun in the Clinical and Community Health Programs Division at CFHC examined the effectiveness of a chlamydia screening program in high school-based health centers. The researchers analyzed data from the CDC-funded Educational Partnerships to Increase Chlamydia Screening (EPICS) program, managed by CFHC. The program provides funding, training, and technical assistance to address barriers and increase access to chlamydia screening for adolescents. As part of this program, six Title X Agencies received funding to partner with school-based health centers throughout California.

The researchers examined data from 1768 sexually active adolescent girls who attended school-based health centers seeking reproductive health services between July 2006 and December 2007. Of this sample, 9 in 10 teens were screened, and 7 percent of those tested were diagnosed with chlamydia. This chlamydia rate is more than double the U.S. Department of Health and Human Services’ Healthy People 2010 goal of 3 percent positivity for adolescents and young adults.

Differences in screening rates and chlamydia diagnosis were found between women of color and white women. Young black women and women identifying as “other race” were more likely to be screened than young white women (94.5 percent compared to 87.5 percent). In addition, young black women were six times more likely than young white women to test positive for chlamydia. Asian women were three times more likely to test positive than white women, and women identifying as “other race” were four times more likely to test positive for chlamydia. Older adolescents also had higher chlamydia rates. Compared with 4.7 percent of teens aged 13 to 14, 7.3 percent of 15 to 17 year-olds were infected as were 6.4 percent of 17 to 19 year-olds.

CFHC is optimistic that the data will help California health officials focus screening and risk-reduction counseling on those at highest risk for chlamydia, most notably young black women and older adolescents. Given the success of the EPICS program in reaching high-risk youth, researchers suggest that other states consider implementing confidential school-based chlamydia testing and treatment programs as part of comprehensive reproductive health care services for adolescents.

These findings were presented by Rebecca Braun, MPH, at the 2008 National STD Conference sponsored by Centers for Disease Control and Prevention (CDC). Questions about this study can be directed to Rebecca Braun at (510) 486-0412 ext. 2327 or braunr@cfhc.org.

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