Adolescents are at elevated STD risk, and previous data for incarcerated adolescents have consistently indicated high positivity for chlamydia and gonorrhea. However, there has been almost no STD research among youths at their initial entry into the JJS following arrest. Because most arrested youths spend little time in custody and quickly return to the community,27
and are not regularly screened for STDs, it is important to estimate STD risk among the broadest possible juvenile justice population. Our pilot, voluntary screening protocol for arrested youths in Hillsborough County demonstrated a high degree of acceptability of STD testing, and found infection prevalence rates that are comparable to incarcerated youths.
An estimated 13.2% of the youths (10.5% of males and 19.2% of females) were infected, with higher rates among older youths, blacks, those remanded to secure detention, and those testing positive for illegal drugs. The higher STD positivity found among youths remanded to detention may reflect that these youths tend to be higher risk in general for delinquency and drug use (based on the HJAC Detention Risk Assessment), and underscores the need for earlier and broader STD screening for youths entering detention. Many detained youths spend a relatively short time in custody, making screening at admission more important. Factors predicting STD infection were similar to those found in studies of incarcerated adolescents,35
and suggest a need to develop gender-and race-specific risk reduction interventions for delinquent youths. Minority populations are disproportionately represented in the JJS,36
and also have elevated STD risk in the general population: in 2005, 41.6% of chlamydia cases occurred among blacks and 18.1% among Hispanics; 68% of the total reported gonorrhea cases occurred among blacks.32
The high STD risk found among recently arrested youths reflects in part their relatively high rates of drug and sex risk behaviors, compared with nonarrested youths, and previously noted among incarcerated youths.6,8,15,16
Most of the older youths in our cohort were sexually active, and an estimated 45.9% had engaged in 1 or more sexual risk behaviors. Rates of sexual activity and risk in our cohort were substantially higher than those observed in general population studies of adolescents.6,37,38
Although drug use was associated with STD prevalence in bivariate analyses, this relationship was not sustained in multivariate models. Given that only an estimated 13.5% of our cohort had previously been tested for an STD, most adolescent offenders will not be aware of their STD status and thus are putting themselves and their sexual partners at risk. The asymptomatic nature of most bacterial STDs14,30
increases the urgency to expand routine STD testing, and prevention programs, at all
stages of the JJS, but especially right after arrest and as youths enter detention.
Several limitations of our study should be noted. Our protocol only included testing for chlamydia and gonorrhea, in part because of the lack of other FDA approved urine-based STD tests. Had we been able to include prevalence data for other STDs, in particular Trichomonas vaginalis
, overall prevalence would likely have been higher. It is also not known whether the risk factors we identified for chlamydia or gonorrhea are the same for other STDs (although coinfections and substantial overlap in risk factors are likely). In addition, our data from a large southern urban county do not necessarily generalize to adolescent offenders in nonurban settings or other geographic regions. However, existing data from incarcerated youths suggest high STD risk in many different parts of the country. For example, data from CDCs Corrections STD Prevalence Monitoring Project and the Infertility Prevention Project were reported in 2006 from 83 male and 57 female juvenile correctional facilities in more than 20 states.2
The overall chlamydia positivity was 6.4% for males and 14.3% for females, and gonorrhea positivity was 1.3% for males and 5.2% for females.39
A number of risk reduction interventions have been tested with incarcerated high-risk youths23,26
but access is limited and much more research is needed on effective program models.40,41
Moreover, given the brief stays in centralized juvenile justice intake centers such as the HJAC, and competing priorities, lengthy interventions may not be feasible at the initial stages of juvenile justice processing and few, if any, centralized intake centers currently have in place procedures to test newly arrested youths for STDs. Brief interventions to increase in interest and motivation for testing, including computerized interventions,42
may be feasible and should be studied in this setting. Given our findings that a substantial proportion of youths consented to be tested and the high proportion that were positive for chlamydia and gonorrhea, voluntary STD screening for arrested delinquents is feasible, and has the potential to identify many undetected infections and improve health outcomes in this high-risk population, and be part of an overall infertility prevention strategy in this high risk population.43
Because most arrested youths are released back to the community within a short time, enormous potential public health benefits would result from protocols to routinely test and treat recently arrested youths and to expand access to risk reduction and prevention programs.