Online Program

Effectiveness of chlamydia screening policies on pelvic inflammatory disease among female u.s. military recruits

Tuesday, November 5, 2013

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: U.S. military services require annual Chlamydia trachomatis screening for active duty women < 26 years, yet only the U.S. Navy, Marines, Coast Guard, and Air Force require additional screening upon entry to recruit training. Hence, Army recruits who were asymptomatic upon entry into military service, may not receive treatment for up to 12 months following accession and maybe at higher risk to develop pelvic inflammatory disease (PID). This presentation will discuss the impact of recruit chlamydia screening policies on PID among U.S. serviceswomen over a ten-year period. 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 <26. 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 12-months follow-up period. This suggests that recruit chlamydia screening programs contribute to reducing PID incidence in an at-risk female military population.

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
Social and behavioral sciences
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): Women's Health, Reproductive Health

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been conducting research with this team for the past several years, am a senior epidemiologist, and a member of the Armed Forces Surveillance Center.
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.