Original article
What Are the Consequences of Relying upon Self-Reports of Sexually Transmitted Diseases? Lessons Learned about Recanting in a Longitudinal Study

https://doi.org/10.1016/j.jadohealth.2008.12.024Get rights and content

Abstract

Purpose

Self-reports are the standard measure of STD history used in survey research. We explored to what extent self-reports of ever having an STD are recanted in a follow-up data collection.

Methods

Using the National Survey of Adolescent Males (NSAM), we assessed consistency over time in self-reports of ever having an STD in a sample of young men transitioning from adolescence to young adulthood (aged 15–26 years), a population in which STDs are particularly prevalent.

Results

Approximately 7% of all sexually experienced young men rescinded STD self-reports over time. Thus, self-reports at one point in time likely underestimate true STD history, using earlier self-reports as the criterion. Among men who ever report an STD, 94-98% recant their reports in later waves.

Conclusions

Knowledge of the extent of underreporting can potentially be used to adjust cross-sectional estimates of STDs based on survey self-reports. These study findings move us one step closer to estimating just how much underreporting of STDs in self-reports is.

Section snippets

STD incidence and prevalence among youth

The incidence of STDs among youth is a critical public health concern in the United States. Youth are dramatically disproportionately contributing to new cases of STDs. Youth aged 15–24 years contribute to half of new STD infections each year despite constituting only one-quarter of the sexually experienced population aged 15–44 years [15]. With respect to specific STDs, youths' contribution is even higher: nearly 75% of chlamydia cases and 60% of gonorrhea cases [16]. In 2005, the percent of

Data collection

Data used in this study were obtained in three waves as part of the NSAM. The first wave of data was collected from a nationally representative sample of non-institutionalized, unmarried men ages 15–19 years in 1988 (wave 1). These men were followed up at ages 17–22 in 1990–1991 (wave 2) and at ages 21–26 in 1995 (wave 3). African-American and Hispanic men were oversampled in the original sample, and sampling weights were created to adjust for the oversampling to make results characterize the

Results for the total eligible sample

Of the total sample of 1263 respondents with two-or-more data points, 99 (7.1 %, weighted) rescinded their self-reports of STD history across time (Table 1, column 5; Figure 2, center circle). This total sample includes men who participated in wave 1 and 2 only (13 rescinded their STD status), waves 1 and 3 only (two rescinded), and waves 1, 2, and 3 (84 rescinded). Hereafter we will characterize the three waves as middle adolescence, late adolescence, and early adulthood, respectively.

Recanting from middle to late adolescence

Summary of results

Of the at-risk, sexually experienced sample contributing data for three time points, 7% rescind reports of whether a doctor ever told him he had an STD. From the first to the third wave there was nearly 30% attrition; men who engage in more risk behaviors were more likely to attrit [24]. Hence, these findings may underestimate the gravity of reporting errors. Furthermore, recanting patterns reveal that retracting reports of STD history does not occur at a steady rate over time. We observed that

Acknowledgments

This research was supported by the National Institutes of Health–NICHD: (National Institute of Child Health and Human Development) R01 HD036948. Part of the work reported here was also supported by the Cooperative State Research, Education and Extension Service, U.S. Department of Agriculture, under Project No. ILLU-45-0366 (to J.H.P). We thank Janet Rosenbaum for her insightful comments and suggestions on this manuscript.

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