Major Finding: Adolescent women who reported being abstinent were just as likely as were those who reported being sexually active to acquire a new chlamydia and/or gonorrhea infection.

Data Source: An observational study of 701 black women aged 14-20 years followed up for 2 years.

Disclosures: Dr. Sales reported that she did not have any relevant conflicts of interest.

Adolescent women's self-reports of abstinence are unreliable, even when assessed with contemporary methods designed to reduce bias in reporting, new data show.

In a large study of black adolescent women who were participants in an HIV-prevention trial, those reporting that they had not had vaginal sex in the past 6 months were just as likely as were those reporting they had to have acquired chlamydia, gonorrhea, or both during that time, according to results reported at the annual meeting of the Society for Adolescent Health and Medicine.

“Marked discordance was observed between adolescents' self-report of abstinence and laboratory-confirmed sexually transmitted diseases [STDs],” commented lead investigator Jessica McDermott Sales, Ph.D. “These findings suggest the need to include biological markers, such as STDs or YcPCRs [Y-chromosome polymerase chain reactions], as objective and quantifiable markers to complement self-reported sexual behavior in evaluating the efficacy of these large-scale STD and HIV prevention or abstinence promotion interventions,” she said.

And, as for clinical care, “given the discrepancies observed, adolescent providers may wish to consider screening adolescents for STDs regardless of self-reported sexual behaviors,” she said, pointing out that self-reported behavior has been the cornerstone of reproductive and sexual health research.

“However, self-report of sexual behaviors is prone to biases,” she said, such as recall bias, whereby recall of past events might be inaccurate, and social desirability bias, whereby respondents might give answers that think will be more socially acceptable.

Researchers have addressed these issues by using shorter follow-up periods, providing cues to enhance reporting of events, and using audio computer-assisted self-interviews (ACASIs), which not only help overcome literacy barriers but also enhance perceived confidentiality.

Dr. Sales and her colleagues studied black girls and women aged 14-20 years who were recruited from health clinics in downtown Atlanta and enrolled in a parent randomized trial of an HIV prevention intervention. All had reported having unprotected vaginal sex in the past 6 months and were neither pregnant nor married.

At baseline and again at follow-up time points of 6, 12, 18, and 24 months, the women completed ACASIs that asked how many times they had had vaginal sex in the past 6 months and whether they had used a condom every time. Also, self-collected vaginal swabs were tested for STDs.

Any woman found to have an STD was given treatment. “Thus, the STDs presented at the follow-up time points were new STD infections,” noted Dr. Sales of the department of behavioral sciences and health education at Emory University, Atlanta.

At each time point, women were classified as abstinent if they reported not having had vaginal sex in the past 6 months, and, among those reporting sex, as consistent condom users if they reported that they had used a condom every time they had sex.

Results were based on 701 women with an average age of 18 years at baseline. Two-thirds attended school. Eighty percent were currently in a relationship, and the mean length of the relationship was 14.4 months.

The percentage of women who reported abstinence was low, ranging from 3% to 5% at each follow-up time point. But 5%-23% of this group, depending on the time point, tested positive for chlamydia, gonorrhea, or both.

In fact, no significant difference was found between the self-reported abstinent group and the self-reported sexually active group in the rate of these new infections at any of the time points.

The findings were essentially the same in an additional analysis comparing a combined group of women who reported abstinence or consistent condom use with women who reported inconsistent condom use.

The explanation for the discordance between self-reported abstinence and STD acquisition is unclear, according to Dr. Sales.

The study used ACASIs, calendars, and other reminders, which should have reduced some sources of reporting bias. Also, the HIV intervention being tested focused on condom use, not abstinence, and all women were sexually active at baseline, so it is unlikely that they felt compelled to misreport abstinence because of the trial. But perceived social acceptability is a possibility.

“Further research is needed to identify factors associated with or strategies to increase the accuracy of self-reported sexual behaviors,” she concluded.

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'Providers may wish to consider screening adolescents for STDs regardless of self-reported sexual behaviors.'

Source DR. SALES

Teen Girls' Self-Reports of Abstinence Unreliable