Screening for sexually transmitted infections among economically disadvantaged youth in a national job training program

PURPOSE

To evaluate results of screening for syphilis, gonorrhea, and chlamydia among youth in a federally funded job training program.

METHODS

Data were evaluated from medical records of 12,881 randomly selected students in 54 U.S. job training centers during 1996. The intake medical evaluation includes serologic testing for syphilis. The policy was for females to receive a pelvic examination with gonorrhea and chlamydia testing and for males to be first screened with a urine leukocyte esterase (LE) assay, with follow-up gonorrhea and chlamydia testing for those with positive LE results.

RESULTS

Adjusting for our sampling strategy, among females, an estimated 9.2% had a positive chlamydia test, 2.7% a positive gonorrhea test, and 0.4% had a positive syphilis test. Gonorrhea and chlamydia rates among females were highest in African-American followed by Native American students. Chlamydia infection was most common in younger women < or = 17 years of age. An estimated 0.1% of males had a positive syphilis test, and 4.8% of males a positive urine LE test. Of 103 LE-positive males tested for gonorrhea and chlamydia, only 27 (26%) had a positive test for one of these STDs.

CONCLUSIONS

Our study supports routine screening of adolescents for gonorrhea and chlamydia, including those youth from socioeconomically disadvantaged backgrounds. Because individuals from such backgrounds may not regularly interact with traditional clinical health care systems, screening and treatment should be offered in alternative settings, such as the job training program described in this study.

Tuberculin skin testing among economically disadvantaged youth in a federally funded job training program

Low income, medically underserved communities are at increased risk for tuberculosis. Limited population-based national data are available about tuberculous infection in young people from such backgrounds. To determine the prevalence of a positive tuberculin skin test among economically disadvantaged youth in a federally funded job training program during 1995 and 1996, the authors evaluated data from medical records of 22,565 randomly selected students from over 100 job training centers throughout the United States. An estimated 5.6% of students had a documented positive skin test or history of active tuberculosis. Rates were highest among those who were racial/ethnic minorities, foreign born, and (among foreign-born students) older in age (p < 0.001). Weighted rates (adjusting for sampling) were 1.3% for white, 2.2% for Native American, 4.0% for black, 9.6% for Hispanic, and 40.7% for Asian/Pacific Islander students; rates were 2.4% for US-born and 32.7% for foreign-born students. Differences by geographic region of residence were not significant after adjusting for other demographic factors. Tuberculin screening of socioeconomically disadvantaged youth such as evaluated in this study provides important sentinel surveillance data concerning groups at risk for tuberculous infection and allows recommended public health interventions to be offered.

HIV infection in disadvantaged out-of-school youth: prevalence for U.S. Job Corps entrants, 1990 through 1996

To describe HIV infection prevalence and prevalence trends for disadvantaged out-of-school youth in the United States, we analyzed the HIV prevalence for and demographic characteristics of youth, aged 16 through 21 years, who entered the U.S. Job Corps from January 1990 through December 1996. Job Corps is a federally funded jobs training program for socially and economically disadvantaged out-of-school youth. All 357,443 entrants residing at Job Corps centers during their training were tested for HIV infection; 822 (2.3 per 1000) were HIV-positive. HIV prevalence was higher for women than for men (2.8 per 1000 versus 2.0 per 1000; relative risk [RR]=1.4; 95% confidence interval [CI]=1.2-1.6). Among racial/ethnic groups, prevalence was highest for African Americans (3.8 per 1000). Prevalence was higher for African American women (4.9 per 1000) than for any other gender and racial/ethnic group. From 1990 through 1996, standardized HIV prevalence-stratified by age, race/ethnicity, home region, population of home metropolitan statistical area, and year of entry--declined for women and for men: for women, from 4.1 per 1000 in 1990 to 2.1 per 1000 in 1996 (p=.001); and for men, from 2.8 per 1000 in 1990 to 1.4 per 1000 in 1996 (p=.001). These data suggest that HIV prevalence for disadvantaged out-of-school youth declined from 1990 through 1996. However, considering their youth, prevalence was still high, particularly for women and African Americans, most notably African American women. These data support the need for ongoing HIV prevention programs targeting such youth.

Trends in HIV prevalence among disadvantaged youth. Survey results from a national job training program, 1988 through 1992

OBJECTIVE

To describe trends in the prevalence of human immunodeficiency virus (HIV) among socially and educationally disadvantaged US youth.

DESIGN

Analysis of demographic and geographic trends of HIV infection among Job Corps students from January 1988 through December 1992.

SETTING

The Job Corps is a national training program for disadvantaged and out-of-school youth. POPULATION SCREENED: Youths aged 16 to 21 years who entered the Job Corps residential training centers during the survey period.

MAIN OUTCOME MEASURE

Trends in prevalence of HIV infection among Job Corps students stratified by sex, age, race, and region of the country.

RESULTS

Of the 269,956 Job Corps students screened, 812 (0.3%) tested positive for the antibody to HIV type 1. Seroprevalence of HIV for young men decreased from 3.6 per 1000 in 1988 to 2.2 per 1000 in 1992 (chi 2 test for trend, P < .001). Seroprevalence for young women increased from 2.1 per 1000 in 1988 to 4.2 per 1000 in 1990 (P = .001), with seroprevalence remaining stable from 1990 through 1992. The decreasing trends in HIV prevalence among men and increasing trends among women were primarily due to changes in seroprevalence in African-American students.

CONCLUSIONS

The overall prevalence of HIV infection of three per 1000 is high, given the youth of Job Corps students. The significant rise in HIV rates among female Job Corps students provides evidence of the increasing risk of infection for socioeconomically disadvantaged young women. Reasons for the declining trend in HIV prevalence among male Job Corps students are not clear. Efforts to prevent the spread of HIV infection among adolescents must focus on the group that is hardest to reach--out-of-school and impoverished youth.

Human immunodeficiency virus infection in disadvantaged adolescents. Findings from the US Job Corps

OBJECTIVE--To describe the human immunodeficiency virus (HIV) epidemic among socially and educationally disadvantaged young persons in the United States.

DESIGN

-We analyzed demographic and geographic findings from the screening of Job Corps students for antibody to HIV. SETTING--The Job Corps is a federal training program for disadvantaged, out-of-school youth. POPULATION SCREENED--Residential students aged 16 to 21 years who entered the Job Corps from October 1987 through February 1990. MAIN OUTCOME MEASURE--Rates of observed HIV infection in entering students, stratified by demographic and geographic features. RESULTS--Of 137,209 Job Corps students screened, 488 were HIV seropositive (3.6 per 1000), a seroprevalence rate higher than that among military applicants of the same age. Overall seroprevalence was slightly higher in male (3.7 per 1000) than in female (3.2 per 1000) Job Corps students, but among those students aged 16 and 17 years, seroprevalence was higher among females (2.3 per 1000) than among males (1.5 per 1000) (P less than .05). For students aged 16 to 21 years, seroprevalence increased with year of age: 1.8 per 1000 per year for males and 0.7 per 1000 per year for females. Among those aged 21 years, HIV prevalence was 8.9 per 1000. For black and Hispanic students from large Northeastern cities, seroprevalence increased by 4.3 per 1000 per year of age and reached 24.8 per 1000 (one of 40) in students aged 21 years. However, among students from rural areas and small towns, HIV seroprevalence was disproportionately high in the Southeast. Compared with recently described US patients with the acquired immunodeficiency syndrome, HIV-infected students who entered the Job Corps were much more likely to be female. CONCLUSIONS--These findings show that disadvantaged, out-of-school adolescents are at high risk for HIV infection. The screening results identified surprisingly high seroprevalence in the southeastern United States and demonstrated a marked shift in the HIV epidemic to young women. Controlling the HIV epidemic among teenagers must include interventions that will reach adolescents early and outside of the formal educational system.

Health status of disadvantaged adolescents entering the Job Corps program

The health status of 2,203 disadvantaged young people entering the Job Corps was studied by reviewing the medical information collected during examinations performed upon entering the Job Corps. The study was conducted from February 1980 through January 1981. The sample records were obtained from eight representative Job Corps centers. The Job Corps is a federally funded residential vocational training program for youths between 16 and 22 years of age. During the study period, 100 Job Corps centers were in operation, serving a population of 38,000 corpsmembers. Long-term, chronic physical disease or disability was not prevalent among the applicants. The most common physical defect, affecting 10 percent of the youths examined, was uncorrected defective visual acuity. Obesity, defined as weight for height 20 percent or more over nationally calculated "desirable" weights, was present in 16.6 percent of the female trainees. In contrast, only 9.6 percent of a national sample of females have weights this high. Anemia, probably caused by iron deficiency, was prevalent among both sexes; sexually transmitted diseases were found to be common, especially among the females entering the Job Corps. Findings from this study were used by Job Corps staff to make changes in the health program as well as to provide instruction to its health personnel.

The Job Corps experience with health problems among disadvantaged youth

Health problems in a disadvantaged group of young people were studied by analysis of Job Corps screening and medical termination data obtained during fiscal year 1975. The Job Corps is a federally funded, residential vocational training program. During fiscal year 1975, the program was conducted in 60 centers throughout the United States. Corpsmembers (ages 16-21) come from poverty backgrounds; in 1975, 55 percent were black. Approximately 1 percent of applicants with serious health problems are screened out by a nonprofessional procedure. Comprehensive health services are provided to corpsmembers; however, limited funds and interference with training prevent continuing care for pregnancies and some serious illness and injuries. Corpsmembers with these conditions are terminated from the Job Corps, and arrangements are made for care in their communities. Less than 2 percent of the corpsmembers were terminated for medical reasons during fiscal year 1975. Pregnancy accounted for 359 terminations. Of 44,390 corpsmembers, 457 were terminated for illness or injury. The majority of these terminations were for mental health problems; trauma was the next largest category. During fiscal year 1975, 22 deaths occurred; 21 were from accidents or suicide. The low medical termination rate among these socioeconomically disadvantaged young people suggests that maintenance of relatively good health is possible over a short period through provision of basic health care and health education, which can be provided largely by allied health personnel under professional supervision.

Health care in the nation's capital during 30 mass assemblies

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