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The genesis of this study lies in the following observations regarding STDs in the United States:
With approximately 12 million new cases of STDs occurring annually (CDC, DSTD/HIVP, 1993), STDs are some of the most commonly reported diseases in the United States and affect all population groups (CDC, 1994). The scope of the STD epidemic, however, remains underappreciated, and the epidemic is largely hidden and excluded from public discourse.
There is a general lack of public awareness and knowledge regarding STDs. Some STDs are initially asymptomatic but may cause serious health problems years after infection. The lag between initial infection and serious complications contributes to the lack of awareness of the impact of STDs. Surveys show that public awareness and knowledge regarding STDs, even among persons at high risk, is dangerously low (ASHA, 1995; EDK Associates, 1995). However, there has not been a comprehensive national public education campaign for STDs.
STDs can lead to long-term health consequences that are often irreversible and are costly in both human and economic terms. Potential health consequences include serious long-term complications such as cervical and liver cancer and infertility (Holmes and Handsfield, 1994). STDs during pregnancy may result in fetal death or significant physical and developmental disabilities, including mental retardation and blindness (Brunham et al., 1990). In addition, the economic consequences of STDs are substantial (IOM, 1985; Washington et al., 1986; Washington et al., 1987; Washington and Katz, 1991), but neither the health nor economic impact of STDs is widely recognized.
Women are particularly vulnerable to STDs because they are more biologically susceptible to certain sexually transmitted infections than men and because they are more likely to have asymptomatic infections that result in delayed diagnosis and treatment (Aral and Guinan, 1984; Cates, 1990). In addition, women develop more serious sequelae and long-term complications compared to men. The disproportionate impact of STDs on the health of women, however, is not widely understood.
Adolescents and young adults are at greatest risk of acquiring an STD. Every year, approximately 3 million teenagers acquire an STD, and many of them will have long-term health problems as a result (CDC, DSTD/HIVP, 1993). Approximately two-thirds of persons who acquire STDs are under age 25. Despite the fact that high-risk sexual behaviors are usually initiated during adolescence, STD prevention efforts for adolescents in the United States remain unfocused and controversial.
Campaigns to increase public awareness of STDs and behavioral interventions to promote condom use and other healthy behaviors have been implemented with varying success. Obstacles to effective prevention efforts include behavioral impediments, sociocultural taboos, and inadequate, sometimes conflicting,