Assessing Spatial Relationships between Race, Inequality, Crime, and Gonorrhea and Chlamydia in the United States

Spatial association between green space and COPD mortality: a township-level ecological study in Chongqing, China

BACKGROUND

There are regional differences in the effect of green space on mortality of Chronic obstructive pulmonary disease (COPD). We conduct an ecological study, using the administrative divisions of Chongqing townships in China as the basic unit, to investigate the association between COPD mortality and green space based on data of 313,013 COPD deaths in Chongqing from 2012 to 2020. Green space is defined by Fractional vegetation cover (FVC), which is further calculated based on the normalised vegetation index (NDVI) from satellite remote sensing imagery maps.

METHODS

After processing the data, the non-linear relationship between green space and COPD mortality is revealed by generalised additive models; the spatial differences between green space and COPD mortality is described by geographically weighted regression models; and finally, the interpretive power and interaction of each factor on the spatial distribution of COPD mortality is examined by a geographic probe.

RESULTS

The results show that the FVC local regression coefficients ranged from - 0.0397 to 0.0478, 63.0% of the regions in Chongqing have a positive correlation between green space and COPD mortality while 37.0% of the regions mainly in the northeast and west have a negative correlation. The interpretive power of the FVC factor on the spatial distribution of COPD mortality is 0.08.

CONCLUSIONS

Green space may be a potential risk factor for increased COPD mortality in some regions of Chongqing. This study is the first to reveal the relationship between COPD mortality and green space in Chongqing at the township scale, providing a basis for public health policy formulation in Chongqing.

Anal and Oral Sex Behaviors Among Young Black Men Who Have Vaginal Sex: Evidence of the Need for Extragenital Testing for Chlamydia and Gonorrhea

BACKGROUND

Unprotected oral and anal sex may result in extragenital sexually transmitted infections. The purposes of this study were to describe sexual behaviors, barrier use, and chlamydia/gonorrhea (Ct/GC) positivity among young Black men who have sex with women, and to examine the potential influence of extragenital infections on genital infections.

METHODS

Young Black men who had vaginal sex were screened for Ct/GC in New Orleans, LA, from August 14, 2019, to February 29, 2020. Audio/computer-assisted self-interviews were used to collect data on demographics and sexual behaviors. χ2 /Fisher exact or t test/Wilcoxon rank tests were used to assess differences in behaviors by Ct/GC positivity.

RESULTS

Among 373 men studied, 619 female partnerships were reported in the past 2 months. Vaginal sex was reported in all partnerships per study protocol, receiving fellatio in 42.7%, performing cunnilingus in 35.7%, and penile-anal sex in 5.9%. Although 31.4% of the men consistently used condoms for vaginal sex with all partners, consistent barrier use was low during cunnilingus (0.5%) and fellatio (5.1%). Urethral infection rates among all men in the sample were 12.6% for Ct and 1.6% for GC. There was no significant difference in Ct/GC rates between those using and not using condoms consistently during vaginal sex ( P = 0.38).

CONCLUSIONS

Unprotected oral sex with female partners was common. The high rate of genital infection among men who used condoms consistently for vaginal sex suggests that oral infections could be serving as a reservoir of genital infection. Testing at all sites of exposure for youth who engage in heterosexual sex is merited.

Creating a path forward: understanding the context of sexual health and sexually transmitted infections in American Indian/Alaska Native populations – a review

This review assessed sexual health and sexually transmitted infection (STI) burden among American Indian/Alaska Native (AI/AN) peoples within the context of current clinical and public health services. We conducted a review of published literature about sexual health and bacterial STIs among AI/AN populations in the United States using Medline (OVID), CINAHL (EbscoHost) and Scopus. Peer-reviewed journals published during 1 January 2005-2 December 2021 were included and supplemented by other publicly available literature. A total of 138 articles from reference lists met inclusion criteria, including 85 peer-review articles and 53 additional references. Results indicate a disproportionate burden of STIs is carried by AI/AN populations compared to non-Hispanic Whites. Risk for STIs in AI/AN people has origins in historical trauma and structural and social determinants of health. STI services are available for AI/AN populations, but many barriers to care exist. Community-based sexual health programming has been successful, but has thus far focused primarily on adolescents and young adults. A myriad of factors contributes to high rates of STIs among AI/AN populations. Longstanding disparities show a clear need to increase the availability of integrated, low-barrier STI prevention and treatment services. Implementation of multi-level (individual, physician, clinic, healthcare organisation, and/or community level), culturally relevant sexual health and STI interventions should be community-based and person-centred, acknowledge social determinants of health, and grounded in deep respect and understanding of AI/AN histories and cultures.

Impact of Check It: A Novel Community-Based Chlamydia Screening and Expedited Treatment Program for Young Black Men

OBJECTIVES

This study aimed to estimate the impact of the Check It program, a novel community-based chlamydia seek, test, and treat program for young Black men who have sex with women, on test positivity rates for chlamydia in young Black women.

METHODS

We used a synthetic control model to compare chlamydia test positivity rates in Orleans Parish (intervention site) with other similar parishes (control sites) in Louisiana. We estimated a model that used all other parishes as potential contributors to a synthetic control for Louisiana as well as a sample limited to the 40 parishes in Louisiana with the largest Black populations.

RESULTS

The Check It program was associated with a 1.69-percentage-point decline in chlamydia positivity in the first full year of operation and a 2.44-percentage-point decline in chlamydia positivity in the second full year of operation compared with control sites with the largest Black populations (P = 0.05). Results were similar when the treatment site was compared with all other sites in Louisiana.

CONCLUSIONS

The Check It program was associated with a significant decline in chlamydia testing positivity rates among women in Orleans Parish compared with control sites. Screening of young Black men who have sex with women can decrease rates in women living in the same community. Future recommendations for chlamydia screening of young men should be considered.

The main factors influencing COVID-19 spread and deaths in Mexico: A comparison between phases I and II

This article investigates the geographical spread of confirmed COVID-19 cases and deaths across municipalities in Mexico. It focuses on the spread dynamics and containment of the virus between Phase I (from March 23 to May 31, 2020) and Phase II (from June 1 to August 22, 2020) of the social distancing measures. It also examines municipal-level factors associated with cumulative COVID-19 cases and deaths to understand the spatial determinants of the pandemic. The analysis of the geographic pattern of the pandemic via spatial scan statistics revealed a fast spread among municipalities. During Phase I, clusters of infections and deaths were mainly located at the country's center, whereas in Phase II, these clusters dispersed to the rest of the country. The regression results from the zero-inflated negative binomial regression analysis suggested that income inequality, the prevalence of obesity and diabetes, and concentration of fine particulate matter (PM 2.5) are strongly positively associated with confirmed cases and deaths regardless of lockdown.

Collateral Damage: A Narrative Review on Epidemics of Substance Use Disorders and Their Relationships to Sexually Transmitted Infections in the United States

ABSTRACT

Associations between substance use disorders and outbreaks of HIV and acute viral hepatitis have received considerable attention, but less research has focused on links between substance use disorders and sexually transmitted infections, apart from alcohol misuse. This narrative review describes the history of this public health crisis in the United States and direct and indirect effects opioids and specific stimulants have on high-risk sexual behaviors. We also review the epidemiology of sexually transmitted infections associated with opioids and stimulants in the United States and discuss opportunities for integrated interventions.

County-Level Social Capital and Bacterial Sexually Transmitted Infections in the United States

BACKGROUND

The association between county-level social capital indices (SCIs) and the 3 most commonly reported sexually transmitted infections (STIs) in the United States is lacking. In this study, we determined and examined the association between 2 recently developed county-level SCIs (ie, Penn State Social Capital Index [PSSCI] vs United States Congress Social Capital Index [USCSCI]) and the 3 most commonly reported bacterial STIs (chlamydia, gonorrhea, and syphilis) using spatial and nonspatial regression techniques.

METHODS

We assembled and analyzed multiyear (2012-2016) cross-sectional data on STIs and 2 SCIs (PSSCI vs USCSCI) on counties in all 48 contiguous states. We explored 2 nonspatial regression models (univariate and multiple generalized linear models) and 3 spatial regression models (spatial lag model, spatial error model, and the spatial autoregressive moving average model) for comparison.

RESULTS

Without exception, all the SCIs were negatively associated with all 3 STI morbidities. A 1-unit increase in the SCIs was associated with at least 9% (P < 0.001) decrease in each STI. Our test of the magnitude of the estimated associations indicated that the USCSCI was at least 2 times higher than the estimates for the PSSCI for all STIs (highest P value = 0.01).

CONCLUSIONS

Overall, our results highlight the potential benefits of applying/incorporating social capital concepts to STI control and prevention efforts. In addition, our results suggest that for the purpose of planning, designing, and implementing effective STI control and prevention interventions/programs, understanding the communities' associational life (as indicated by the factors/data used to develop the USCSCI) may be important.

Geospatial and Temporal Associations between Increases in Opioid Deaths, Socioeconomics, and Rates of Sexually Transmitted Infections in the Northeast United States 2012-2017

With the introduction of fentanyl to illegal markets in 2013 and an overall rise in rates of synthetic opioid use, opioid-related deaths have increased significantly. A similar trend has been observed for sexually transmitted infections, homicides, and poor mental health outcomes. In this paper, we explore the spatiotemporal relationship between opioid death rates and sexually transmitted infection (STI) rates in counties from the Northeast region of the United States between the years 2012–2017. We hypothesized that rates for gonorrhea, chlamydia, and human immunodeficiency virus (HIV) would all be positively associated with opioid death rates and that there would be a similar association between the STI rates and later time periods relative to earlier time periods. A negative binomial mixed-effects regression model was employed to assess these associations. Contrary to the study hypothesis, opioid death rates were not found to be significantly associated with the STI rates after accounting for other demographic and socioeconomic variables, with the exception of opioid deaths and gonorrhea in urban counties. Additionally, the regression demonstrated a significant association between infection rate and time period beyond the included socioeconomic variables and opioid deaths. Overall, this study indicates that declining sexual health outcomes may parallel rising opioid death, though both trends may be explained by similar underlying factors related to time period.

Integrating Individual and Contextual Factors to Explain Disparities in HIV/STI Among Heterosexual African American Youth: A Contemporary Literature Review and Social Ecological Model

Heterosexual African American youth face substantial disparities in sexual health consequences such as HIV and STI. Based on the social ecological framework, the current paper provides a comprehensive, narrative review of the past 14 years of literature examining HIV/STI risk, including risky sexual behavior, among heterosexual African American youth and a conceptual model of risk among this population. The review found that individual psychological and biological factors are insufficient to explain the sexual health disparities faced by this group; instead, structural disadvantage, interpersonal risk, and community dysfunction contribute to the disparity in HIV/STI outcomes directly and indirectly through individual psychological factors. The conceptual model presented suggests that for African American youth, (1) HIV/STI risk commonly begins at the structural level and trickles down to the community, social, and individual levels, (2) risk works in a positive feedback system such that downstream effects compound the influence of structural risks, and (3) contextual and individual risk factors must be considered within the advanced stage of the epidemic facing this population. Despite advanced HIV and STI epidemics among heterosexual African American youth, multisystemic interventions that target structural risk factors and their downstream effects are posited to reduce the disparity among this high-risk population.

Gaps in Sexually Transmitted Infection Screening among Men who Have Sex with Men in PrEP Care in the United States

BACKGROUND

The U.S. Centers for Disease Control and Prevention (CDC) recommends comprehensive sexually transmitted infection (STI) screening every 3-6 months for men who have sex with men (MSM) using HIV preexposure prophylaxis (PrEP). The gaps between these recommendations and clinical practice by region have not been quantified.

METHODS

We used survey data collected from the internet-based ARTnet study between 2017 and 2019 on STI screening among MSM across the U.S., stratified by current, prior, and never PrEP use. Poisson regression models with robust error variance were used to model factors, including residence in the Southeast, associated with consistent ("always" or "sometimes") exposure site-specific STI screening during PrEP care.

RESULTS

Of 3259 HIV-negative MSM, 19% were currently using PrEP, 6% had used PrEP in the past, and 75% had never used PrEP. Among ever PrEP users, 87%, 78%, 57%, and 64% reported consistent screening for STIs by blood sample, urine sample or urethral swab, rectal swab, or pharyngeal swab, respectively, during PrEP care. Compared to PrEP users in all other regions, PrEP users in the Southeast were significantly less likely to be consistently screened for urogenital (adjusted prevalence ratio [aPR], 0.86; 95% confidence interval [CI], 0.76-0.98) and rectal STIs (aPR, 0.76; 95% CI, 0.62-0.93) during PrEP care.

CONCLUSIONS

Substantial gaps exist between CDC recommendations for STI screening during PrEP care and current clinical practice, particularly for rectal and pharyngeal exposure sites that can harbor asymptomatic infections and for MSM in Southeast states where the STI burden is substantial.

Measuring and Visualizing Chlamydia and Gonorrhea Inequality: An Informatics Approach Using Geographical Information Systems

BACKGROUND

Health inequality measurements are vital in understanding disease patterns in identifying high-risk patients and implementing effective intervention programs to treat and manage sexually transmitted diseases.

OBJECTIVES

To measure and identify inequalities among chlamydia and gonorrhea rates using Gini coefficient measurements and spatial visualization mapping from geographical information systems. Additionally, we seek to examine trends of disease rate distribution longitudinally over a ten-year period for an urbanized county.

METHODS

Chlamydia and gonorrhea data from January 2005 to December 2014 were collected from the Indiana Network for Patient Care, a health information exchange system that gathers patient data from electronic health records. The Gini coefficient was used to calculate the magnitude of inequality in disease rates. Spatial visualization mapping and decile categorization of disease rates were conducted to identify locations where high and low rates of disease persisted and to visualize differences in inequality. A multiple comparisons ANOVA test was conducted to determine if Gini coefficient values were statistically different between townships and time periods during the study.

RESULTS

Our analyses show that chlamydia and gonorrhea rates are not evenly distributed. Inequalities in disease rates existed for different areas of the county with higher disease rates occurring near the center of the county. Inequality in gonorrhea rates were higher than chlamydia rates. Disease rates were statistically different when geographical locations or townships were compared to each other (p < 0.0001) but not for different years or time periods (p = 0.5152).

CONCLUSION

The ability to use Gini coefficients combined with spatial visualization techniques presented a valuable opportunity to analyze information from health information systems in investigating health inequalities. Knowledge from this study can benefit and improve health quality, delivery of services, and intervention programs while managing healthcare costs.

Urban Green Space Is Spatially Associated with Cardiovascular Disease Occurrence in Women of Mashhad: a Spatial Analysis of Influential Factors on their Presence in Urban Green Spaces

Chronic diseases have spread around the world. Cardiovascular diseases (CVD), the most important of the chronic diseases and the leading cause of death in women of Mashhad, are impacted by environmental factors. Urban green spaces (UGSs) are important environmental factors playing a critical role in the prevention and control of CVD. Spatial analysis is useful in understanding the application of UGSs in CVD prevention. To identify the spatial distribution of CVD in Mashhad, Moran's index was used and 7539 home addresses of female patients with CVD were imported into ArcMap. Moran's coefficient was estimated to be 0.34, revealing a clustered distribution of CVD. The spatial autocorrelation between CVD and UGSs was analyzed using Moran's I. Moran's I index value was calculated to be - 0.15, and four types of clusters were identified in eight sub-districts of Mashhad municipality. To find the factors influencing the presence in UGSs among women affected by CVD, 607 female patients living in the selected sub-districts were asked to take part in a telephone survey. Data were analyzed using ordinary least squares (OLS) and geographically weighted regression (GWR) at block level (343 statistical blocks in total). Accordingly, the spatial diversity and effects of three variables of income, level of education, and access to UGSs among female patients with CVD were measured. According to OLS results and the standard residual, two clusters were removed. Finally, vulnerable blocks were identified that could be helpful in the development of prevention policies and place-based interventions.

Geographic correlates of primary and secondary syphilis among men who have sex with men in the United States

PURPOSE

Primary and secondary (P&S) syphilis in men who have sex with men (MSM) has been increasing; however, there is a lack of research on geographic factors associated with MSM P&S syphilis.

METHODS

We used multiple data sources to examine associations between social and environmental factors and MSM P&S syphilis rates at the state- and county-level in 2014 and 2015, separately. General linear models were used for state-level analyses, and hurdle models were used for county-level models. Bivariate analyses (P < .25) were used to select variables for adjusted models.

RESULTS

In 2014 and 2015 state models, a higher percentage of impoverished persons (2014 β = 1.24, 95% confidence interval, 0.28-2.20; 2015 β = 1.19; 95% confidence interval, 0.42-1.97) was significantly associated with higher MSM P&S syphilis rates. In the 2015 county model, policies related to sexual orientation (marriage, housing, hate crimes) were significant correlates of MSM P&S syphilis rates (P < .05).

CONCLUSIONS

Our state-level findings that poverty is associated with MSM P&S syphilis are consistent with research at the individual level across different subpopulations and various sexually transmitted diseases. Our findings also suggest that more research is needed to further evaluate potential associations between policies and sexually transmitted diseases. Geographic-level interventions to address these determinants may help curtail the rising syphilis rates and their sequelae in MSM.

Spatiotemporal distribution and determinants of gonorrhea infections in mainland China: a panel data analysis

OBJECTIVES

Gonorrhea remains a major public health concern worldwide. This study aims to explore the spatiotemporal distribution and sociodemographic determinants of gonorrhea rates during 2004-2014 in mainland China.

STUDY DESIGN

Space-time scan statistics and spatial panel regression model.

METHODS

The gonorrhea infection data and sociodemographic data during 2004-2014 at the provincial level in mainland China were extracted from the China Public Health Science Data Center and China Statistical Yearbooks, respectively. The space-time scan statistics were used to identify the high-risk clusters of gonorrhea, and the spatial panel regression model was adopted to examine the sociodemographic determinants.

RESULTS

One most likely and five secondary high-risk clusters of gonorrhea rates were identified, which were mainly located in southern and eastern China. The regions with higher GDP per capita, larger floating population, less access to healthcare, higher male-female ratio, and higher divorce rate were more likely to become high-risk areas of gonorrhea.

CONCLUSIONS

Gonorrhea rates were distributed unevenly through space and time and affected by various sociodemographic variables. The space-time scan statistics and spatial panel regression are viable tools for identifying clusters and examining determinants of gonorrhea rates. The findings provide valuable implications for developing targeted prevention and control programs in public health practice.