Objectives Adolescents and young adults are at high risk for sexually transmitted infections (STIs). We previously reported an increase in STI testing of adolescents in our ED by obtaining a sexual history using an Audio-enhanced Computer-Assisted Self-Interview (ACASI). We now examine associations among demographics, sexual behaviour, chief complaint and willingness to be tested.
Methods This was a prospective study conducted in a paediatric ED between April and December 2011. After triage, eligible patients between 15 and 21 years presenting with non-life-threatening conditions were asked to participate in the study. Consenting participants used an ACASI to provide their demographic data and answer questions about their sexual history and willingness to be tested. Our primary outcome was the association of demographics, chief complaint and ACASI recommendation with the participant’s willingness to be tested.
Results We approached 1337 patients, of whom 800 (59%) enrolled and completed the ACASI. Eleven who did not answer questions related to their sexual history were excluded from analysis. Of 789 participants, 461 (58.4%) were female and median age was 16.9 years (IQR 16.0–17.8); 509 (64.5%) endorsed a history of anal, oral and/or vaginal intercourse. Disclosing a sexual history and willingness to be tested did not differ significantly by gender. 131 (16.6%) had a chief complaint potentially referable to an STI; among the 658 participants with non-STI-related complaints, 412 (62.6%) were sexually active, many of whom disclosed risky behaviours, including multiple partners (46.4%) and inconsistent condom use (43.7%). The ACASI identified 419 patients as needing immediate STI testing; the majority (81%) did not have a chief complaint potentially related to STIs. 697 (88.3%) participants were willing to receive STI testing. Most (94.6%) of the patients with STI-related complaints were willing to be tested, and 92.1% of patients with a recommendation for immediate testing by the ACASI indicated a willingness to be tested.
Conclusions Adolescents were willing to disclose sexual activity via electronic questionnaires and were willing to receive STI testing, even when their chief complaint was not STI related. The ACASI facilitated identification of adolescent ED patients needing STI testing regardless of chief complaint.
- emergency department
- infectious diseases
- clinical care
- paediatrics, paediatric emergency medicine
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Contributors FAA conceived the study, created the survey instruments, supervised the conduct of the study, data collection, managed the data and did quality control, drafted the manuscript and takes responsibility for the paper as a whole. KBS provided statistical advice. FAA and DMJ obtained research funding. FAA, DBJ, KP and DMJ provided substantial revisions to the survey instruments. FAA and KBS analysed the data. FAA, DBJ, KBS, JMG and DMJ interpreted the data. FAA, DBJ, JMG and DMJ provided substantial revisions to the drafts of the manuscript. All authors contributed to the study methodology, and reviewed and approved the final manuscript as submitted.
Funding Research reported in this publication was supported by a grant from National Institute of Child Health & Human Development (T32HD049338-01A2) and the Washington University Institute of Clinical and Translational Sciences grant (KL2 TR000450) from the National Center for Advancing Translational Sciences (NCATS) of the National Institutes of Health (NIH). The authors also used services provided by the Health Behavior, Communication and Outreach Core, which was supported in part by a National Cancer Institute Cancer Center Support Grant (P30 CA091842).
Disclaimer The content is solely the responsibility of the authors and does not necessarily represent the official view of the NIH.
Competing interests None declared.
Ethics approval Washington University in St. Louis Human Research Protection Office.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement Any parties interested in sharing of unpublished data should contact the first author to see what data are available and if a data sharing agreement can be created between institutions.