Online Program

Risk analysis of pelvic inflammatory disease among u.s. military recruits, 2001-2012

Monday, November 4, 2013 : 4:30 p.m. - 4:50 p.m.

Patricia Rohrbeck, MPH, DrPH, CPH, PhD Student, Department of Epidemiology, University of North Texas Health Science Center School of Public Health, Fort Worth, TX
Leslie Clark, PhD, MS, Division of Epidemiology & Analysis, General Dynamics Information Technology, Armed Forces Health Surveillance Center, Silver Spring, MD
Brad Cannell, MPH, Department of Behavioral and Community Health, University of North Texas Health Science Center, Fort Worth, TX
Christine Moranetz, PhD, FAWHP, Associate Dean of Academic Affairs, Department of Public Health Education, University of North Texas Health Science Center, School of Public Health, Fort Worth, TX
BACKGROUND: Asymptomatic Chlamydia trachomatis can lead to pelvic inflammatory disease (PID) which, if untreated, can cause severe damage to the upper reproductive organs. PID can be prevented through Chlamydia screening of at-risk females until age 25. U.S. military services, except for the Army, have implemented Chlamydia screening programs for females entering recruit training. Therefore, females with asymptomatic chlamydial infection not screened during training maybe at risk for PID, even though it is unclear how recruit Chlamydia screening programs impact PID incidence. It was hypothesized that women not screened for chlamydial infection are at higher risk for PID during the 12 months following recruit training compared to women who were screened. METHODS: For this IRB approved retrospective cohort study, the Defense Medical Surveillance System (DMSS) was utilized. Females entering recruit training were followed for 12 months or until a PID diagnosis occurred. The surveillance period was January 1, 2001 to December 21, 2012. Multiple Poisson regression was used to assess the effect of covariates. Hazard analysis was employed to characterize risk over time. RESULTS: Among 304,572 female recruits, there were 5,767 incident diagnoses of PID; 51% occurred among Army servicewomen. Most PID cases (93%) occurred in women <25. The incidence rate was 76% higher in the Army. Risk for Army servicewomen increased after 6 months post-accession. CONCLUSIONS: PID rates were highest in the Army compared to all other services during the first year of active duty. This suggests that recruit Chlamydia screening programs contribute to reducing PID incidence in at-risk females.

Learning Areas:

Advocacy for health and health education
Conduct evaluation related to programs, research, and other areas of practice
Public health or related organizational policy, standards, or other guidelines
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Describe the difference in chlamydia recruit screening policies across U.S. Military Services. Identify incidence rates and incidence rate ratios of PID outcomes among female military recruits by service and year. Evaluate the impact of screening vs. not-screening for chlamydia during recruit training on PID during the following 12 months. Analyze and model the risk for PID among female recruits.

Keyword(s): Epidemiology, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a DrPH in Public Health Practice graduate and PhD in Epidemiology student with ten years of public health practice and research experience in the U.S. Air Force. I previously submitted abstract to APHA, which were accepted for oral and poster presentations.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.