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Katherine Hsu, MD; Demian Christiansen, MPH; Denise O'Connor, RN, MS; John Bernardo, MD; Karen Hacker, MD, MPH

Arch Pediatr Adolesc Med. 2003;157:1227-1231.

Objective  To examine self-reported risks for tuberculosis (TB) infection relative to recalled receipt of TB risk assessments and skin testing in a cohort of urban adolescents.

Design, Setting, and Participants  Survey of ninth graders and their parents from 3 inner-city public high schools. Students and parents were asked about TB infection risk factors, frequency of routine health maintenance visits, TB risk assessments, and TB skin testing. Students were surveyed in schools and asked to take home surveys for their parents to complete.

Results  Of 578 students (95.4% response rate), 436 (75.4%) claimed at least 1 TB infection risk factor. Although 468 (81.0%) of the students reported having a regular checkup within the past year, only 128 (22.1%) recalled being asked TB risk assessment questions and only 231 (40.0%) recalled undergoing skin testing during the previous year. Parent response rates were low (n = 207; 34.2% response rate), and parents of students attending bilingual classes were overrepresented among responders. There were no significant relationships between self-indicating a risk for TB infection and self-recollection of having undergone TB screening, having had a tuberculin skin test placed, or having had a regular checkup, with the exception that students who responded that they lived with a tuberculin skin test–positive person were 38% less likely to recall having had a tuberculin skin test themselves (n = 21; 95% confidence interval, 24%-50%). The level of agreement between student and parent responses in the 207 survey pairs available for analysis ranged from poor to good ( = 0.07-0.61) on individual questions.

Conclusions  These observations suggest that most at-risk adolescents in this city are not being adequately screened for TB infection. Programs to improve health care provider acceptance of targeted testing principles or to reengage in school-based screening of students with certain risk factors seem necessary.

From the Section of Pediatric Infectious Diseases, Boston University Medical Center (Dr Hsu); the Data Coordinating Center, Boston University School of Public Health (Mr Christiansen); and the Tuberculosis Control Program (Ms O'Connor and Dr Bernardo) and the Division of Child and Adolescent Health (Dr Hacker), Boston Public Health Commission, Boston, Mass. Ms O'Connor is now with the Department of Nursing, Beth-Israel Deaconess Hospital, Boston; and Dr Hacker is now at the Institute for Community Health, Cambridge Health Alliance, Cambridge, Mass.

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