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The protective value of school enrolment against sexually transmitted disease: a study of high-risk African American adolescent females
  1. Richard A Crosby1,
  2. Ralph J DiClemente2,
  3. Gina M Wingood2,
  4. Laura F Salazar2,
  5. Eve Rose2,
  6. Jessica M Sales2
  1. 1College of Public Health University of Kentucky, Kentucky, USA
  2. 2Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  1. Correspondence to:
 Dr R Crosby
 College of Public Health, 121 Washington Avenue, Lexington, KY 40506-0003, USA; crosby{at}


Objective: To identify whether school enrolment is protective against laboratory-confirmed diagnosis of sexually transmitted diseases (STDs) and against a spectrum of sexual risk factors.

Methods: A cross-sectional study of 715 African-American adolescent females (15–21 years old) was conducted. Data collection included an audio-computer-assisted self-interview lasting about 60 min and a self-collected vaginal swab for nucleic acid amplification testing of Trichomonas vaginalis, Chlamydia trachomatis and Neisseria gonorrhoeae.

Results: In total, 65% were enrolled in school. After adjusting for age and whether adolescents resided with a family member, those not enrolled were twice as likely to test positive for one of the three STDs compared with those enrolled (adjusted OR2; 95% CI 1.38 to 2.91). Similarly, school enrolment was protective against risk factors contributing to STD acquisition. The measures of sexual risk behaviour of 8 of 10, retained significance after adjusting for the covariates, and 2 of the 3 psychosocial mediators retained significance.

Conclusion: This study provides initial evidence suggesting that keeping high-risk African-American adolescent females in school (including forms of school that occur after high-school graduation) may be important from a public health standpoint.

  • A-CASI, audio-computer-assisted self-interview
  • STD, sexually transmitted disease

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  • Funding: This study was supported by a grant from the Center for Mental Health Research on AIDS, National Institute of Mental Health (R01 MH061210) to RJD and GMW.

  • Competing interests: None declared.

  • Study implementation and oversight was conducted by RJD, GMW JM-S and ER. RAC and LFS analysed the data and interpreted the findings. RAC, LFS and RJD conceived the analyses and prepared the manuscript.