Professional Documents
Culture Documents
LIANA R. CLARK, MD, MALAKA JACKSON, MD, AND LYNNE ALLEN-TAYLOR, PHD
The authors thank William C. Holmes, MD, MSCE, and Christine Forke,
BA, for their valuable feedback in the development of the manuscript.
Reprint requests: Liana R. Clark, MD, CraigDalsimer Division of
Adolescent Medicine, The Childrens Hospital of Philadelphia, 324 South
34th Street, Philadelphia, PA 19104. E-mail: clark@email.chop.edu
Received for publication July 31, 2001, revised November 15, 2001, and
accepted November 20, 2001.
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Vol. 29 No. 8
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438
TABLE 1.
CLARK ET AL
August 2002
Variable
Number (%)
Age in years: mean SD
Race: no. (%)
Black
Asian
Male
Female
All
144 (37)
17.15 1.73
247 (63)
16.73 1.75
NS
391*
16.88 1.75
119 (38)
2
198 (62)
0
14 (31)
4 (31)
4 (31)
31 (69)
9 (69)
9 (69)
317
2
NS
White
Latino
Other
45
13
13
question. Chi-square analyses, t tests, and analysis of variance (ANOVA) F tests with a critical value of 0.05 were
used for comparisons of STD knowledge scores between
groups. Post hoc Scheffe tests for multiple comparisons
were completed for the multigroup comparisons that were
significant by ANOVA F tests. To examine the relationship
between age and STD knowledge, as well as the relationship
between knowledge score and self-perception of STD
knowledge, pairwise correlations and linear regression analysis were performed. In addition, a multiple linear regression model including all independent variables to predict
knowledge score was used to determine which variables
best predicted high levels of STD knowledge. Analyses
were conducted using STATA 6 for Windows (Stata Corporation, College Station, TX)4 and SPSS for Windows
(SPSS Incorporated, Chicago, IL).5
Results
Questionnaires were collected from 393 adolescents aged
12 to 21 years; 144 (37%) were male and 247 (63%) were
female (sex data were missing for 2 respondents). The mean
age was 17.2 1.7 years for the males and 16.7 1.8 years
for the females (P NS; Table 1). The majority (81%) of
the respondents were black. Forty-four percent reported
having Medicaid insurance (Table 2).
Almost every respondent reported having been educated
about STDs (97%), and the major sources of this education
were school (70%), parents (52%), friends (31%), doctors/
health professionals (22%), and other relatives (21%). Only
seven respondents (2%) correctly named all eight major
STDs.
Thirty-five respondents (9%) correctly identified the four
curable STDs, and 13 (3%) correctly identified the four
incurable STDs. Only two people (0.5%) correctly identified all eight major STDs, all four curable STDs, and all
four incurable STDs. When asked to name the eight major
STDs, 91% of the respondents included HIV; 77%, gonorrhea; 65%, syphilis; 58%, genital herpes; 53%, chlamydial
infection; 22%, HPV infection; 22%, trichomonas infection;
TABLE 2.
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Vol. 29 No. 8
Variable
No. (%) of
Participants
Mean SD
Range
Sex
Male
144 (37)
3.33 1.87
08
Female
Ethnicity
Black
White
Latino/a
Other
Insurance type
Private
Medicaid
Self-pay
Dont know
Missing data
Stage of
adolescence
(years)
Early (1215)
Middle (16 or 17)
Late (18)
STD knowledge
A lot
Average
A little
Nothing
247(63)
3.60 1.86
18
319 (81)
45 (12)
3.56 1.85
3.38 1.95
18
07
13 (3)
17 (4)
3.15 1.28
3.00 2.19
15
06
122 (31)
172 (44)
7 (2)
50 (13)
42 (11)
3.51 1.74
3.77 1.89
4.57 0.98
2.82 1.88
3.02 1.93
57 (15)
236 (60)
100 (25)
103 (25)
219 (56)
64 (17)
6 (2)
P Value
NS
Range
1.16 1.20
24
P Value
NS
Range
1.08 1.10
34
1.23 1.21
34
1.21 1.14
1.27 1.36
34
34
P Value
NS
1.34 1.48
34
1.34 1.37
0.98 1.50
34
24
1.08 1.44
0.75 1.06
04
03
0.46 1.33
0.63 0.81
22
03
17
08
36 0.05*
08
08
1.21 1.35
1.44 1.43
1.14 1.77
1.10 1.36
0.93 1.22
14
34
14
24
14
1.17 1.15
1.13 1.20
1.71 1.25
1.14 1.16
1.26 1.17
34
34
13
24
24
NS
2.23 1.46
3.59 1.85
4.16 1.71
06
18 0.0001
08
0.27 0.80
1.40 1.43
1.62 1.38
13
34 0.0001
14
0.71 0.94
1.15 1.14
1.49 1.31
33
34
24
0.002
3.88 1.82
3.64 1.87
2.61 1.53
1.83 1.94
07
18 0.001
06
05
1.50 1.47
1.31 1.38
0.83 1.18
0.50 1.23
14
34 0.009
14
12
1.41 1.27
1.19 1.11
0.75 1.17
0.67 0.82
24
24
34
02
0.004
NS
NS
NS
NS
Early scored lower than middle and late; middle scored lower than late.
440
TABLE 3.
CLARK ET AL
August 2002
Sources of STD
Education
No. (%) of
Participants
Mean SD
Range
82 (22)
3.81 1.84
08
Physician
Yes
No
Parent
Yes
298 (78)
3.46 1.87
18
198 (48)
3.81 1.87
08
No
Relative
Yes
182 (52)
3.23 1.81
18
78 (21)
4.37 1.89
08
No
Friend
Yes
302 (79)
3.31 1.80
18
119 (31)
4.12 1.95
08
261 (69)
3.26 1.76
18
45 (12)
3.89 1.84
17
No
Peer Educator
Yes
No
School
Yes
No
Other Training
Yes
No
Other Sources
Yes
No
3.48 1.87
08
267 (70)
3.66 1.91
18
113 (30)
3.22 1.72
07
22 (6)
4.05 1.76
17
358 (94)
3.5 1.87
18
51 (13)
4.08 1.92
07
3.45 1.84
NS
0.003
0.0001
0.0001
NS
335 (88)
329 (87)
P Value
18
0.04
NS
0.03
Curable STD
Knowledge Score
Mean SD
Range
1.43 1.56
24
1.24 1.35
34
1.37 1.41
24
1.18 1.37
34
1.64 1.68
34
1.19 1.30
24
1.64 1.51
34
1.12 1.31
24
1.42 1.76
14
1.26 1.34
34
1.31 1.4
34
1.21 1.37
24
1.50 1.47
14
1.27 1.39
34
1.57 1.22
14
1.23 1.42
34
Incurable STD
Knowledge Score
P Value
NS
NS
0.01
0.0007
NS
NS
NS
NS
Mean SD
Range
1.15 1.16
24
1.20 1.13
34
1.14 1.14
24
1.23 1.13
34
1.45 1.38
24
1.12 1.06
34
1.41 1.26
24
1.00 1.06
34
1.4 1.45
24
1.16 1.09
34
1.22 1.23
34
1.11 0.88
23
1.32 1.25
14
1.18 1.13
34
1.22 0.86
03
1.18 1.18
34
P Value
NS
NS
0.03
0.009
NS
NS
NS
NS
NS not significant.
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CLARK ET AL
male overconfidence or pseudo-confidence in their sexuality knowledge that relates to male sexual socialization.33
The majority of our sample had been educated about
STDs via one or more sources, most often school and
parents. This observation differs from other studies, in
which health professionals, friends, and television were the
more common sources of STD education and information.14,34 Our results showed that those educated by their
parents, other relatives, friends, and school performed better
than those educated by other sources, including physicians.
This may be related to time of exposure to the STD messages. Physicians have much less time with the adolescent
to teach about STDs than do parents, friends, or even school
instructors.
The associations between the independent variables and
our adolescents STD knowledge scores were quite small.
Other unexplored variables seem to be responsible for the
majority of variance in our models predicting STD knowledge. Future work should be done to help identify variables
more highly correlated to adolescent STD knowledge.
There are several limitations to this study. Our method of
knowledge assessment may have more accurately tested
respondent recall of STD information than recognition. Recall assessments tend to be more difficult than those relying
on recognition.35 It is possible that if we had chosen a
recognition assessment, the STD knowledge scores would
have been higher. When teens are weighing the risks and
benefits of having unprotected sex, however, their knowledge component of the decision-making process is based on
recall and not recognition. If they cannot procure STD
knowledge from memory, they will not be able to make an
accurate risk assessment. In addition, we did not obtain any
information about the respondents sexual behaviors and
STD history. As has been seen in other studies,6,32 adolescents who are sexually active and those who have had STDs
appear to be more knowledgeable than those who are not
sexually active. This lack of information may mask other
important correlates of adolescent STD knowledge.
Another potential limitation is our decision to not assess
all SIECUS level 3 knowledge (which would have involved
assessing knowledge about transmission, symptomatology,
diagnostic methods, and curability of STDs). We chose to
assess the simplest area of level 3 knowledge by testing
knowledge of only STD curability. Our finding of limited
curability knowledge suggests that more highly specified
STD informationsuch as about transmission, symptomatology, and diagnostic methodswould not have been
known.
We did not test interrater reliability in our adolescent peer
educators. However, we were very clear (in instructing them
about the assessment questionnaires) about what answers to
consider correct and incorrect. We also did not record the
number or characteristics of adolescents who declined to
participate in this study. Our study sample, then, may differ
August 2002
Vol. 29 No. 8
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