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BACKGROUND: Cook County, IL ranks first among US counties for number of gonorrhea cases and ranks second for chlamydia cases. Within Chicago, adolescents aged 13-19 account for 37% of chlamydia and 34% of gonorrhea cases. Sexually Transmitted Infection (STI) risk extends beyond individual behaviors, and population-based testing may be more effective than targeted screening among high risk individuals. Beginning in 2009, the Chicago Department of Public Health and Chicago Public Schools (CPS) began screening students in Chicago high schools. Apart from “regular” high schools, CPS manages several different school types, including Charter (privately-managed and publicly-funded), Special Education, Performance, and Alternative (“last chance”).
METHODS: Schools were selected from high STI morbidity zip codes and approached to participate. School characteristics were collected from CPS. Comprehensive STI education was provided, and free testing and treatment for chlamydia and gonorrhea were offered to students in selected schools. Students who chose to be tested were consented for all procedures, and parental consent was obtained for special education students. Students who tested positive were contacted and treatment was provided. Bivariate and multivariate analyses were conducted on basic student demographics collected at time of test and school characteristics (type of school, rating, and probation status).
RESULTS: Out of 24,348 students educated, 16,178 students self-selected to undergo STI screening. Chlamydia prevalence was 12% for female and 5% for male students. Gonorrhea prevalence was 3% for females and 1% for males. 96% of positive students were treated. By race, non-Hispanic Black students had higher STI prevalence and nearly all (99%) dual infections. STI infection increased with age. Students from “Alternative” high schools had markedly higher STI levels (19%) than the overall average of 9%. In multivariate analysis predicting any STI infection, risk effects were found for "Alternative" high schools (OR 2.29), being NH Black (4.06), being female (OR 3.46), and increasing age (OR 1.23), while being in a special education high school was protective (OR .24). Among non-alternative schools, being a "Charter" high school had an increased STI risk (OR 1.25). Being both NH Black and in a school on probation showed increased risk (OR 1.46). A protective effect was found for the school being rated “good” and on probation (OR .80).
CONCLUSIONS: Providing STI screening and treatment services at adolescents’ point of contact is an effective intervention. Understanding STI risk differences among students from different school types may help tailor STI prevention and screening approaches in urban settings.