Chlamydia positivity in women screened in family planning clinics: Racial/ethnic differences and trends in the Northwest U.S., 1997-2006

Academic Article


  • Objectives. We assessed chlamydia trends, individual-level risk factors, and population-level area-based socioeconomic measures (ABSMs) associated with chlamydia infection in women attending U.S. Public Health Service (PHS) Region X Infertility Prevention Project (IPP) family planning (FP) clinics from 1997-2006. We then explored these measures within racial/ethnic subpopulations. Methods. Using data from 667,223 chlamydia tests obtained from women aged 15-24 years screened in 201 FP clinics, we employed a generalized mixed model with logistic link, incorporating clinic and ZIP code as random effects to adjust for risk of chlamydia associated with individual- and population-level (areal) measures for the overall population and for each racial/ethnic subpopulation. Results. Significant racial/ethnic differences in chlamydia persisted after adjusting for individual and aggregate factors. Relatively steep chlamydia gradients were found across racial/ethnic ABSM levels. Compared with white women, infection risk was significantly higher for black (adjusted odds ratio [AOR] 5 1.93), American Indian/Alaska Native (AOR51.62), Asian/Pacific Islander (AOR51.42), and Hispanic (AOR51.28) women. The impact of population-level ABSMs on chlamydia varied across racial/ethnic groups and was generally modest. Among white women, there was a significant 4% relative annual increase in predicted chlamydia during the 10-year period 1997-2006. Chlamydia positivity over time did not change for racial/ethnic minority groups after adjusting for individual- and population-level factors. Conclusions. Racial/ethnic differences in chlamydia persisted over time and were not mitigated by adjustment for aggregate socioeconomic position or areal racial/ethnic measures. Changes in project strategies will be needed to address racial/ethnic disparities for chlamydial infection among young female FP clinic clients. © 2012 Association of Schools of Public Health.
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    Author List

  • Fine D; Thomas KK; Nakatsukasa-Ono W; Marrazzo J
  • Start Page

  • 38
  • End Page

  • 51
  • Volume

  • 127
  • Issue

  • 1