The broad long-term objective of the proposed 3-year project is to decrease the duration of untreated gonococcal and chlamydial infection in urban adolescent and young adult women through promotion of STD screening. Using the Trans Theoretical Model of Change as a conceptual guide, the specific aim of this application is to use a randomized clinical trial design to determine the efficacy of a client-centered, stage-based intervention promoting STD screening in response to high-risk sexual behavior in young sexually active minority women ages 16 to 22 years at an urban reproductive health clinic. In Phase 1, the intervention will be refined and adapted to the clinic setting. Information from preliminary studies (to date and in progress) will be used to complete this process. Two assessment focus groups will be conducted to review the completed intervention components. The components will be packaged into a final version and the health educators trained in motivational counseling. In Phase 2, 430 adolescent and young adult women, 16 to 22 years seeking reproductive health care will be recruited by a research assistant from a single clinic site for a 12-month project. Subjects will then be randomized to one of two conditions: the intervention + standard care (intervention group) or a standard care alone control (control group). Subjects in the intervention group will receive stage-based counseling by a Health Educator at the baseline, 2-week, and 6-month visits. The objective of the intervention is to promote STD screening in response to high-risk sexual behavior. Subjects in the intervention and control groups will receive standard care counseling from clinic staff at baseline, and scheduled 6-month visits and at unscheduled visits between the baseline and 12-month visits. To evaluate the efficacy of the intervention, subjects from both groups will be asked to complete face-to-face assessments at the baseline, 6- and 12-month visits. At all scheduled and unscheduled visits, subjects in both groups will be tested for gonorrhea and chiamydia infection by urine BDProbeTec. The primary outcome measure will be the number of clinic visits in response to high-risk sexual behaviors (scheduled and unscheduled) over 12 months. Secondary outcomes will include progression through the Stages of Change for STH screening, the frequency of consistent condom use during the past 30 days and number of episodes of gonococcal or chlamydial infections over 12 months.
