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Making Policy Recommendations With Limited Data and Resources

2003; Lippincott Williams & Wilkins; Volume: 30; Issue: 4 Linguagem: Inglês

10.1097/00007435-200304000-00019

1537-4521

Charlotte Kent, Jeffrey D. Klausner,

Public Health Policies and Education

To the Editor: Since Cohen et al 1,2 from New Orleans and Burstein et al 3 from Baltimore demonstrated the high prevalence of chlamydia among adolescents screened in their local high schools, there has been interest in implementing similar programs elsewhere. For such a program to be successful, it must be feasible to screen students and the chlamydia prevalence should be sufficient to warrant use of limited chlamydia screening resources. In San Francisco, we piloted a high school screening program and found that it was feasible to screen students, but found a much lower prevalence of infection than was found in New Orleans and Baltimore. 4 Our findings from the pilot were consistent with the overall lower prevalence of chlamydia found in San Francisco, 5 and the lower level of reported sexual activity of our students. 6 Given the need to appropriately target limited resources and the findings of the pilot, we do not offer routine chlamydia screening in the San Francisco high schools. Rather we target higher risk adolescents through routine screening at detention facilities and street-based outreach programs. In her letter in this issue, Dr. Nsuami correctly identifies limitations of our pilot study, including the difficulty of generalizing the findings beyond the sample screened. 7 Dr. Nsuami finds of greater concern, however, that our statement of recommendations for school-based screening in San Francisco goes beyond the scope of the pilot. 7 While we agree that screening recommendations for San Francisco high schools cannot be made solely on data from a pilot study because one cannot generalize to all students from data collected in a minority, public health policy must be practical and take into consideration other data, such as reported cases among adolescents and school-based surveys of sexual behavior, to make the best possible decisions. In many areas that do not have the benefit of school-based clinics (such as are available in Baltimore 3) or the means to ask sexual behavior questions, 1,2 it will be necessary to evaluate screening programs in the context of even greater uncertainty. In such settings, demographic and surveillance data may be used to reasonably guide initial screening efforts, if resources are not available to screen every student. In developing public health programs, making recommendations based on available resources, pilot data, and local epidemiology is a necessity and what most of us consider sound public health. CHARLOTTE K. KENT, MPH JEFFREY D. KLAUSNER, MD, MPH