Abstract

Background: In United States public schools, students in disciplinary alternative schools report engaging in risky sexual behaviors significantly more frequently than students in regular schools. We sought to determine whether the risk of chlamydia or gonorrhea infection in disciplinary alternative schools is significantly higher relative to the risk of infection in regular schools.

Methods: A matched case-control study was retrospectively designed using data obtained from New Orleans public high school students tested for chlamydia and gonorrhea in a school-based screening between the years 2001 and 2003. Cases were 63 African American students tested at a disciplinary alternative school during the school years 2001-2002 (n = 36) and 2002-2003 (n = 27). Each case was matched to 4 controls by date of birth, sex and race among respectively 3029 and 2216 students contemporaneously tested in regular schools. Mantel-Haenszel procedures for matched-pair analysis were used to estimate odds ratios, confidence intervals (CI) and significance tests.

Results: The odds ratio for chlamydia/gonorrhea infection associated with placement in disciplinary alternative school was 2.09 overall (95% CI 1.01, 4.30; p < 0.05), 1.43 (95% CI 0.50, 4.11; p > 0.40) among females and 3.25 (95% CI 1.18, 8.92; p < 0.025) among males.

Conclusions: Behaviorally troubled adolescents in disciplinary alternative school placement are the highest risk group for sexually transmitted infection ever identified in United States public high schools. These students and the disciplinary alternative schools where they are placed would benefit most from screening. They should be considered first for inclusion in any school-wide chlamydia and gonorrhea screening initiative.

Keywords: Infectious disease epidemiology; Matched case-control study; Risk estimate; Sexually transmitted infection; Adolescents