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August 2007

Chlamydial Screening in Urgent Care Visits: Adolescent-Reported Acceptability Associated With Adolescent Perception of Clinician Communication

Author Affiliations

Author Affiliations: Department of Pediatrics, Division of Adolescent Medicine, University of California, San Francisco, School of Medicine (Drs Miller, Tebb, and Shafer, and Ms Williams), and Department of Epidemiology and Biostatistics, Division of Biostatistics, University of California, San Francisco (Dr Neuhaus).

Arch Pediatr Adolesc Med. 2007;161(8):777-782. doi:10.1001/archpedi.161.8.777

Objective  To examine the association between adolescents' perception of clinician communication and adolescents' reported acceptability of the steps involved in chlamydial screening during urgent care visits.

Design  Cross-sectional survey of adolescents after urgent care visits.

Setting  Four pediatric clinics in a health maintenance organization.

Participants  Three hundred sixty-five adolescents aged 13 to 18 years.

Outcome Measures  Participants' ratings of the acceptability of talking about sexual health and providing a urine sample for chlamydial testing in an urgent care visit.

Results  Most adolescents found sexual health discussions and urine collection for chlamydial screening acceptable in the urgent care setting (84% and 80%, respectively). Acceptability of sexual health discussion was significantly associated with adolescents' perception that the clinician explained confidentiality (adjusted odds ratio [AOR], 2.7; 95% confidence interval [CI], 1.3-5.5), knew “how to talk to teens like me” (AOR, 9.0; 95% CI, 3.5-24.2), and “listened carefully as I explained my concerns” (AOR, 14.3; 95% CI, 4.3-54.9). Acceptability of providing a urine sample for chlamydial testing was associated with the adolescents' perception that the clinician knew “how to talk to teens like me” (AOR, 3.7; 95% CI, 1.5-9.3) and “listened carefully as I explained my concerns” (AOR, 3.6; 95% CI, 1.1-11.5).

Conclusions  Sexual history taking and urine collection are 2 key components of chlamydial screening and were reported as acceptable by the great majority of adolescents in the urgent care setting. Aspects of clinician communication appear to be important target areas for pediatric clinician education in supporting expansion of chlamydial screening to adolescents in urgent care visits.