Estimating the effect of geographic location on the relationship among financial resources, testing for chlamydial or HIV infection, and chlamydial infection status among young adults: An investigation of the National Longitudinal Study of Adolescent Hea

Objectives. To assess the influence of geographical region on the relationships (1) between financial resources and testing for chlamydial or HIV infection, and (2) between chlamydial infection testing and status.; Methods. We examined Wave III of the National Longitudinal Study of Adolescent Health, a nationally representative cohort study of adolescents followed into young adulthood until 2002. We defined financial resources as functional income and health insurance status; testing for chlamydial infection or HIV based on self-report; and current chlamydial infection status according to laboratory testing of a urine specimen collected at the end of the interview. Of the young adults who reported ever having experienced vaginal intercourse, we report prevalence estimates of testing and infection, and prevalence odds ratios for associations between financial resources and past chlamydia and HIV testing, and for past chlamydia testing and current infection status.; Results. Of the Wave III participants, 85% (n = 12,334) reported ever having vaginal intercourse by the time of the interview. Reported testing in the past year was low for both HIV (18.8%; 95% CI, 17.6%--20.1%) and chlamydial infection (18.0%; 95% CI, 16.8, 19.4). Young adults living in the South reported the least chlamydia testing and were second only to the Midwest in reported HIV testing. Nationally and regionally, resource-poor young adults (e.g., publicly insured or lacking a functional income) were more likely than the privately insured, uninsured or those with a functional income to report testing. The overall prevalence of chlamydial infection was 4.5% (95%CI, 3.9%--5.3%), but highest in the South (5.5%, 95% CI, 4.4%--7.1%). Participants who reported testing for chlamydial infection in the past year were significantly more likely to have a current chlamydial infection (OR 1.39; 95% CI, 1.06--1.82) than those who did not report testing. This trend was consistent regionally.; Conclusions. Differential STI testing behavior and infection prevalence exist among young adults, a sexually experienced group whose STI risks and needs had been previously unaddressed. To address gaps in policy and practice, clarifying the individual and provider-related factors that result in these differences would enhance our understanding of the variability we identified due to financial resources and geographic region.