Stage of Change Behavioral Assessment Tool Fails to Predict the Prevalence of Chlamydia in an Urban Adolescent Health Clinic

Study ObjectiveStrategies to reduce STI among adolescents and young adults have failed to consistently demonstrate effectiveness. A universal approach may not be appropriate because individuals are at different stages with respect to self-management behaviors. Thus, the Stage of Change Transtheoretical Model has been advocated. This study was conducted to determine whether staging could be accomplished in an urban adolescent clinic and whether it provides a tool to predict STI risk.DesignParticipants were interviewed and staged according to a standardized instrument with respect to sexual risk behaviors and contraceptive use.SettingUrban adolescent health clinic.Participants103 females (ages 18–24).InterventionsA physical examination and diagnostic tests for syphilis, HSV, HCV, chlamydia, gonorrhea and HPV were performed.Main Outcome MeasuresStages for behaviors to reduce STI risk and to utilize contraception and STI prevalence.Results78% of the participants were in the three earliest stages of behavior (precontemplative, contemplative, and ready for action) with respect to condom use for STI prevention; conversely only 47% were in early stages with respect to birth control practices. Of the participants tested, 12/81 (15%) had chlamydial infection detected by molecular techniques, whereas no participants had gonorrhoeae. Among the subset tested for HPV DNA, 18/45 (40%) were positive. The diagnostic behavior stage for STI prevention did not correlate with the presence of chlamydia.ConclusionsA staging instrument can be implemented into adolescent health clinic practice, but cannot be used as a risk assessment tool for the presence of chlamydia. Additionally females are more likely to protect themselves against pregnancy than against an STI.