Maria A. Villarroel

Effect of Low Medical Literacy on Health Survey Measurements

Paper self-administered questionnaires (SAQs) are a standard interviewing technique for surveys of sensitive topics. Although SAQs afford respondents greater privacy than face-to-face interviews, they have several limitations. First, they require literate respondents. Second, they require forms literacy—the ability to select consistent responses, implement general survey instructions, and correctly follow branching or skip instructions. Survey respondents may have difficulty following skip instructions if they are not forms literate. This brief report examines the relationship between assessed levels of medical literacy, respondent characteristics, and the quality of measurements made in the 1997/98 Baltimore Sexually Transmitted Disease (STD) and Behavior Survey.

T-ACASI reduces bias in STD measurements: The National STD and Behavior Measurement Experiment:

Background: Although telephone surveys provide an economical method for assessing patterns of diagnosed sexually transmitted diseases (STDs) and STD-related behaviors in populations, the requirement that respondents report such information to human telephone interviewers introduces an opportunity for substantial reporting bias. Telephone computer-assisted self-interviewing (T-ACASI) surveys substitute a computer for human interviewers when asking sensitive questions. Methods: A randomized experiment was embedded in a telephone survey that drew probability samples of the populations of the United States (N = 1543) and Baltimore city (N = 744). Respondents were randomly assigned to have sensitive questions asked either by a T-ACASI computer or by a human telephone interviewer. Results: Respondents interviewed by a T-ACASI computer were more likely to report STD symptoms [dysuria, genital sores, genital discharge, and genital warts; adjusted odds ratios (ORs) = 1.5–2.8] and a diagnosis of gonococcal or chlamydial infection during the past year (adjusted ORs = 3.6 and 6.1). T-ACASI respondents with a main sex partner in the past year were more likely to report that their partner has had an STD (adjusted OR = 2.4). For some measurements, the impact of T-ACASI was strongest among younger and less-educated respondents. When sampling weights were applied to project National STD and Behavior Measurement Experiment results to the populations of the United States and Baltimore, we found that reliance on data obtained by human interviewers would underestimate the annual incidence of chlamydial and gonococcal infections in these populations by factors of 2.4 to 9.7. Conclusions: Compared with human telephone interviewers, T-ACASI surveys obtain increased reporting of STD symptoms, infections, and STD-related behaviors.

Chlamydia trachomatis infection among 15- to 35-year-olds in Baltimore, MD.

Background: Chlamydia trachomatis (Ct) is the most frequently reported infectious disease in the United States. This article reports population and subpopulation prevalence estimates of Ct and correlates of infection among 15- to 35-year-olds in Baltimore, MD. Methods: The Monitoring STIs Survey Program (MSSP) monitored sexually transmitted infection (STI) prevalence among probability samples of residents of Baltimore, a city with high STI rates. MSSP respondents completed telephone audio computer-assisted self-interviews and provided biospecimens for STI testing. Results: Among 2120 Baltimore residents aged 15 to 35 years, the estimated prevalence of chlamydia was 3.9% (95% confidence interval [CI]: 2.8, 5.0). Prevalence was 5.8% (95% CI: 4.1, 7.6) among black MSSP respondents versus 0.7% (95% CI: 0.0, 1.4) among nonblack respondents; all but 4 infections detected were among black respondents. Sexual behaviors and other factors associated with infection were far more prevalent among black than nonblack Baltimore residents. Racial disparities persisted after adjustment for sociodemographic, behavioral, and health factors. Conclusion: The MSSP highlights a higher Ct prevalence among young people in Baltimore than in the United States overall, with notable racial disparities in infection and associated risk behaviors. Public health efforts are needed to improve the diagnosis and treatment of asymptomatic infections in this population.

Epidemiology of Undiagnosed Trichomoniasis in a Probability Sample of Urban Young Adults

T. vaginalis infection (trichomoniasis) is the most common curable sexually transmitted infection (STI) in the U.S. It is associated with increased HIV risk and adverse pregnancy outcomes. Trichomoniasis surveillance data do not exist for either national or local populations. The Monitoring STIs Survey Program (MSSP) collected survey data and specimens which were tested using nucleic acid amplification tests to monitor trichomoniasis and other STIs in 2006–09 among a probability sample of young adults (N = 2,936) in Baltimore, Maryland — an urban area with high rates of reported STIs. The estimated prevalence of trichomoniasis was 7.5% (95% CI 6.3, 9.1) in the overall population and 16.1% (95% CI 13.0, 19.8) among Black women. The overwhelming majority of infected men (98.5%) and women (73.3%) were asymptomatic. Infections were more common in both women (OR = 3.6, 95% CI 1.6, 8.2) and men (OR = 9.0, 95% CI 1.8, 44.3) with concurrent chlamydial infection. Trichomoniasis did not vary significantly by age for either men or women. Women with two or more partners in the past year and women with a history of personal or partner incarceration were more likely to have an infection. Overall, these results suggest that routine T vaginalis screening in populations at elevated risk of infection should be considered.

P3.301 Male Clients of Sex Workers in the United States: Correlates with STI/HIV Risk Behaviors and Urbanization Level

Background Men who have purchased sex from sex workers (“clients”) have been associated with an increased risk of acquiring STIs including HIV and in influencing the spread of infection in the population. To date, only a few reports on behavioural risk correlates and infection history of male clients have been documented in the United States, mainly drawn from populations in central cities and at high-risk for HIV. This study examines STIs/HIV behavioural risks and screening history correlates of male clients in the general population and whether the prevalence of male clients differs by urbanisation level. Methods Data from the 1999–2000 National STD and Behavioral Measurement Study, a cross-sectional telephone-based probability sample of the non-institutionalised population aged 18 to 45 years old, was linked to the National Center Health Statistics Urban Rural Classification Scheme for Counties. The analysis is restricted to men aged 26 to 45 years old (N = 469). F-statistic that accounted for survey design effects and Poisson regression for weighted data were used. Results The overall prevalence of clients was 14.5 (95% CI 11.5–18.1) and did not statistically differ between men residing in central cities of large metropolitan areas (MA) and men residing in large metropolitan suburbs, MAs of less than one million people, or non-metropolitan subdivisions (P = 0.5655). Compared to non-clients, clients had a significantly higher prevalence of an array of other high-risk behaviours in their lifetime and more recently including history of same-sex partners (Adjusted prevalence ratio (Adj.PR) = 2.5, 95% CI, 1.5–4.1), sold sex (Adj.PR = 3.6, 95% CI, 2.2–6.1), multiple partners in the past year (Adj.PR = 2.6, 95% CI, 1.6–4.0), as well as a history of STIs (Adj.PR = 2.5 95% CI 1.5–4.4). Conclusion Male clients are ubiquitous. The risk-taking behaviour of clients in the general population is important to develop more comprehensive prevention measures for STIs/HIV.