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Mangone E, Bell J, Khurana R, Taylor MM. Treatment Completion With Three-Dose Series of Benzathine Penicillin Among People Diagnosed With Late Latent and Unknown Duration Syphilis, Maricopa County, Arizona. Sex Transm Dis 2023; 50:298-303. [PMID: 36693196 PMCID: PMC10826670 DOI: 10.1097/olq.0000000000001775] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
BACKGROUND Syphilis is a public health concern as cases are rising each year. If untreated, syphilis is associated with significant morbidity and risk of vertical transmission during pregnancy. For people with late latent and unknown duration stages, 3 injections of benzathine penicillin G (BPG) at 1-week intervals are recommended. Our study quantified treatment for people diagnosed with late latent and unknown duration syphilis in Maricopa County, Arizona with a secondary analysis of pregnant women to assess completion of 3 injections of BPG in multiple time intervals. METHODS Maricopa County syphilis case data were extracted from the state-run database (PRISM). Records were reviewed for people with late latent and unknown duration syphilis during January 1, 2016, to December 31, 2021. Treatment types and time intervals between treatments were analyzed. RESULTS Of a total of 14,924 people with syphilis reported in Maricopa County, 5372 (36.0%) were staged as late latent or unknown duration syphilis. Completion of 3 BPG injections in the time frame of 7 to 9 days was 42.9% (n = 2302). Completion among pregnant women (n = 406) with 3 injections was 68.7% (n = 279). CONCLUSIONS The completion rate of 3 BPG injections for people with late latent or unknown duration syphilis is low. An unmet need exists to identify barriers to treatment including access to BPG and public health follow-up after the first injection. Prioritized effort is needed to identify and classify patients as having earlier stages of syphilis that require only 1 BPG injection.
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Affiliation(s)
- Elizabeth Mangone
- Department of Medicine, University of Arizona College of Medicine
- Masters in Public Health Program, University of Arizona Mel & Enid Zuckerman College of Public Health
| | - Jonathan Bell
- Maricopa County Department of Public Health, STD Clinic, Phoenix, AZ
| | - Renuka Khurana
- Department of Medicine, University of Arizona College of Medicine
- Maricopa County Department of Public Health, STD Clinic, Phoenix, AZ
| | - Melanie M. Taylor
- Department of Medicine, University of Arizona College of Medicine
- Maricopa County Department of Public Health, STD Clinic, Phoenix, AZ
- Division of HIV Prevention, Centers for Disease Control and Prevention, Atlanta, GA
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Vitale M. The social ecology of COVID-19 prevalence and risk in montreal, QC, Canada. Health Place 2022; 78:102919. [PMID: 36219947 PMCID: PMC9510058 DOI: 10.1016/j.healthplace.2022.102919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 09/12/2022] [Accepted: 09/14/2022] [Indexed: 12/23/2022]
Affiliation(s)
- Michele Vitale
- McGill University, Geo-Social Determinants of Health Research Group, Department of Geography, Burnside Hall 427, 805 Sherbrooke St. W., Montreal, QC H3A 0B9, Canada.
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Ueleres Braga J, Araujo RS, de Souza ASS. The Shortage of Benzathine Penicillin and Its Impact on Congenital Syphilis Incidence: An Ecologic Study in the City of Rio de Janeiro. Clin Infect Dis 2021; 72:e79-e87. [PMID: 33197933 DOI: 10.1093/cid/ciaa1716] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 11/09/2020] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND The Pan American Health Organization indicates that increased incidence of congenital syphilis (CS) can be attributed to the lack of penicillin. This study aimed to analyze the relationship between the benzathine penicillin shortage and the significant increase in the incidence of congenital syphilis in the city of Rio de Janeiro from 2013 to 2017. METHODS We used a mixed ecologic study design (temporal and multiple groups). Analysis units were the neighborhoods (spatial) and quarters (temporal) during those years. The study population consisted of CS patients who were living in the city of Rio de Janeiro. The benzathine penicillin supply measure for use in gestational syphilis considered the ratio between (1) the number of bottles dispensed to health facilities in each neighborhood and (2) the number of bottles necessary to treat pregnant women diagnosed with syphilis and their respective partners residing in each neighborhood. To evaluate the association between shortages and a significant increase in CS incidence, the negative-inflated zero-binomial regression model (longitudinal model) was used. RESULTS During the study period, the incidence rate of CS in Rio de Janeiro neighborhoods was on average 19.6 per 1000 live births. In the simple analysis, shortage was associated with a 2.17-fold increase in the risk of a significant increase in CS incidence. After adjustment for the sufficient minimum set, the strength of association increased to 2.23 (95% confidence interval, 1.15-4.30). CONCLUSIONS We conclude that the benzathine penicillin shortage had an impact on the increase in the incidence of CS in Rio de Janeiro.
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Affiliation(s)
- José Ueleres Braga
- Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil.,Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Rachel Sarmeiro Araujo
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
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Abstract
BACKGROUND In the United States, reported rates of syphilis continue to increase. Co-occurring epidemics of syphilis among men who have sex with men (MSM) and heterosexual populations create challenges for the prioritization of resources and the implementation of context-specific interventions. METHODS State was the unit of analysis and was restricted to the 44 states with the most complete data of sex or sex partners for their reported adult syphilis cases. States were classified as high, medium, or low for reported congenital syphilis (CS) and MSM primary and secondary (P&S) syphilis rates. Average values of a range of ecologic state level variables were examined among the 9 categories created through the cross-tabulation of CS and MSM P&S syphilis rates. Patterns among ecologic factors were assessed across the 9 categories of states' syphilis rates. RESULTS Among the 44 states categorized, 4 states had high rates of both CS and MSM P&S syphilis in 2015, whereas 12 states fell into the medium/medium category and 7 into the low category. Six states had high CS and medium MSM syphilis and 4 states had medium CS but high MSM syphilis. Several area-level factors, including violent crime, poverty, insurance status, household structure and income, showed qualitative patterns with higher rates of CS and MSM P&S syphilis. Higher proportions of urban population were found among states with higher CS rates; no trend was seen with respect to urbanity and MSM P&S syphilis. CONCLUSIONS Several area-level factors were associated with CS and MSM P&S syphilis in similar ways, whereas other ecologic factors functioned differently with respect to the 2 epidemics. Explorations of community and area-level factors may shed light on novel opportunities for population specific prevention of syphilis.
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Marotta P. Assessing Spatial Relationships between Race, Inequality, Crime, and Gonorrhea and Chlamydia in the United States. J Urban Health 2017; 94:683-698. [PMID: 28831708 PMCID: PMC5610128 DOI: 10.1007/s11524-017-0179-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Incidence rates of chlamydia and gonorrhea reached unprecedented levels in 2015 and are concentrated in southern counties of the USA. Using incidence data from the Center for Disease Control, Moran's I analyses assessed the data for statistically significant clusters of chlamydia and gonorrhea at the county level in 46 states of the USA. Lagrange multiplier diagnostics justified selection of the spatial Durbin regression model for chlamydia and the spatial error model for gonorrhea. Rates of chlamydia (Moran's I = .37, p < .001) and gonorrhea (Moran's I = .38, p < .001) were highly clustered particularly in the southern region of the USA. Logged percent in poverty (B = .49, p < .001 and B = .48, p < .001) and racial composition of African-Americans (B = .16, p < .001 and B = .40, p < .001); Native Americans (B = .12, p < .001 and B = .20, p < .001); and Asians (B = .14, p < .001 and B = .09, p < .001) were significantly associated with greater rates of chlamydia and gonorrhea, respectively, after accounting for spatial dependence in the data. Logged rates of rates violent crimes were associated with chlamydia (B = .053, p < .001) and gonorrhea (B = .10, p < .001). Logged rates of drug crimes (.052, p < .001) were only associated with chlamydia. Metropolitan census designation was associated with logged rates of chlamydia (B = .12, p < .001) and gonorrhea (B = .24, p < .001). Spatial heterogeneity in the distribution of rates of chlamydia and gonorrhea provide important insights for strategic public health interventions in the USA and inform the allocation of limited resources for the prevention of chlamydia and gonorrhea.
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Multiplex Competition, Collaboration, and Funding Networks Among Health and Social Organizations: Toward Organization-based HIV Interventions for Young Men Who Have Sex With Men. Med Care 2017; 55:102-110. [PMID: 27676400 DOI: 10.1097/mlr.0000000000000595] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Young men who have sex with men (YMSM) have the highest rates of human immunodeficiency virus (HIV) infection in the United States. Decades into the HIV epidemic, the relationships that YMSM-serving health and social organizations have with one another has not been studied in depth. OBJECTIVES The aim of this study was to examine the competition, collaboration, and funding source structures of multiplex organization networks and the mechanisms that promote fruitful relationships among these organizations. RESEARCH DESIGN The study data collection method was a survey of health and social organizations from 2013-2014 in 2 cities, Chicago, IL and Houston, TX. SUBJECTS Study participants were representatives from 138 health and social organizations. MEASURES Responses to survey questions were used to reconstruct competition, collaboration, and combined competition-collaboration networks. RESULTS While taking into consideration the collaborative relationships among organizations, we provide statistical evidence that organizations of similar type, similar social media use patterns, comparable patterns of funding, and similar network contexts tended to compete with one another. This competition was less likely to be accompanied by any sort of collaboration if the organizations shared common funding sources. CONCLUSIONS Competition that excludes potential collaboration may be detrimental to mobilizing the collective efforts that serve local YMSM communities. System-level interventions may provide promising approaches to scaling-up HIV prevention and treatment efforts so as to encourage organizations to form partnerships with otherwise competing providers.
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Marotta P. Assessing Spatial Relationships Between Rates of Crime and Rates of Gonorrhea and Chlamydia in Chicago, 2012. J Urban Health 2017; 94:276-288. [PMID: 27670280 PMCID: PMC5391332 DOI: 10.1007/s11524-016-0080-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Sexually transmitted infections (STIs) remain serious public health problems particularly in urban environments in the USA. Despite accumulating research into the role of aggregate rates of crime in shaping rates of STIs, few studies account for spatial dependence in the structure of geographical data. Using multiple spatial analysis methodologies, the following study investigated spatial patterns in community area rates of violent, drug, and property crimes and rates of infection of gonorrhea and chlamydia in 77 community areas in Chicago. Moran's I analyses confirmed global spatial dependence and statistically significant clusters of STI. Spatial lag regression analyses found that greater rates of drug crimes were associated with higher rates of chlamydia and gonorrhea after adjusting for percent in poverty and racial composition. Finally, a weighted geographic regression identified regions in the urban environment in which local regression coefficient values diverged from their global estimates. Spatial heterogeneity of STIs suggest that public health interventions must be targeted to specific areas of the urban environment with particular attention to substance use.
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Chang BA, Pearson WS, Owusu-Edusei K. Correlates of county-level nonviral sexually transmitted infection hot spots in the US: application of hot spot analysis and spatial logistic regression. Ann Epidemiol 2017; 27:231-237. [PMID: 28302356 DOI: 10.1016/j.annepidem.2017.02.004] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Revised: 12/28/2016] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
PURPOSE We used a combination of hot spot analysis (HSA) and spatial regression to examine county-level hot spot correlates for the most commonly reported nonviral sexually transmitted infections (STIs) in the 48 contiguous states in the United States (US). METHODS We obtained reported county-level total case rates of chlamydia, gonorrhea, and primary and secondary (P&S) syphilis in all counties in the 48 contiguous states from national surveillance data and computed temporally smoothed rates using 2008-2012 data. Covariates were obtained from county-level multiyear (2008-2012) American Community Surveys from the US census. We conducted HSA to identify hot spot counties for all three STIs. We then applied spatial logistic regression with the spatial error model to determine the association between the identified hot spots and the covariates. RESULTS HSA indicated that ≥84% of hot spots for each STI were in the South. Spatial regression results indicated that, a 10-unit increase in the percentage of Black non-Hispanics was associated with ≈42% (P < 0.01) [≈22% (P < 0.01), for Hispanics] increase in the odds of being a hot spot county for chlamydia and gonorrhea, and ≈27% (P < 0.01) [≈11% (P < 0.01) for Hispanics] for P&S syphilis. Compared with the other regions (West, Midwest, and Northeast), counties in the South were 6.5 (P < 0.01; chlamydia), 9.6 (P < 0.01; gonorrhea), and 4.7 (P < 0.01; P&S syphilis) times more likely to be hot spots. CONCLUSION Our study provides important information on hot spot clusters of nonviral STIs in the entire United States, including associations between hot spot counties and sociodemographic factors.
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Affiliation(s)
- Brian A Chang
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; Icahn School of Medicine at Mount Sinai, New York, NY
| | - William S Pearson
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA
| | - Kwame Owusu-Edusei
- Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA.
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Thach SB, Eng E, Thomas JC. Defining and Assessing Organizational Competence in Serving Communities at Risk for Sexually Transmitted Diseases. Health Promot Pract 2016. [DOI: 10.1177/152483990200300217] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study sought to develop an assessment tool to help health agencies enhance their capacity to provide sexually transmitted disease (STD) care to communities at risk and close the gap of racial disparities in health. Specifically, the study sought to (a) define the organizational competence of agencies serving communities at risk for STDs, and (b) develop a method to assess an agency’s organizational competence. In a rural Southern county, qualitative action research methods including key informant interviews, observation, and document review were used to assess four health agencies’ competence in responding to the needs of high STD-risk communities. Nine dimensions of organizational competence were identified: community participation, assessment of community needs, ensured access to services, community outreach, cultural competence, interagency collaboration, policy development, resource acquisition, and organizational commitment to serve. A competent organization was conceived as one that (a) is committed to serve, (b) works with communities at risk, (c) understands and appropriately responds to their needs, and (d) advocates on their behalf.
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Affiliation(s)
- Sarah Brill Thach
- Community Health Resource Services, Mountain Area Health Education Center, North Carolina
| | - Eugenia Eng
- Department of Health Behavior and Health Education, School of Public Health, University of North Carolina
| | - James C. Thomas
- Department of Epidemiology, School of Public Health, University of North Carolina
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Chesson HW, Owusu-Edusei K, Leichliter JS, Aral SO. Violent crime rates as a proxy for the social determinants of sexually transmissible infection rates: the consistent state-level correlation between violent crime and reported sexually transmissible infections in the United States, 1981-2010. Sex Health 2014; 10:419-23. [PMID: 23987728 DOI: 10.1071/sh13006] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Accepted: 06/04/2013] [Indexed: 11/23/2022]
Abstract
BACKGROUND Numerous social determinants of health are associated with violent crime rates and sexually transmissible infection (STI) rates. This report aims to illustrate the potential usefulness of violent crime rates as a proxy for the social determinants of STI rates. METHODS For each year from 1981 to 2010, we assessed the strength of the association between the violent crime rate and the gonorrhoea (Neisseria gonorrhoeae) rate (number of total reported cases per 100?000) at the state level. Specifically, for each year, we calculated Pearson correlation coefficients (and P-values) between two variables (the violent crime rate and the natural log of the gonorrhoea rate) for all 50 states and Washington, DC. For comparison, we also examined the correlation between gonorrhoea rates, and rates of poverty and unemployment. We repeated the analysis using overall syphilis rates instead of overall gonorrhoea rates. RESULTS The correlation between gonorrhoea and violent crime was significant at the P<0.001 level for every year from 1981 to 2010. Syphilis rates were also consistently correlated with violent crime rates. In contrast, the P-value for the correlation coefficient exceeded 0.05 in 9 of the 30 years for the association between gonorrhoea and poverty, and in 17 of the 30 years for that between gonorrhoea and unemployment. CONCLUSIONS Because violent crime is associated with many social determinants of STIs and because it is consistently associated with STI rates, violent crime rates can be a useful proxy for the social determinants of health in statistical analyses of STI rates.
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Affiliation(s)
- Harrell W Chesson
- Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA
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Frye V, Bonner S, Williams K, Henny K, Bond K, Lucy D, Cupid M, Smith S, Koblin BA. Straight talk: HIV prevention for African-American heterosexual men: theoretical bases and intervention design. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2012; 24:389-407. [PMID: 23016501 PMCID: PMC4722530 DOI: 10.1521/aeap.2012.24.5.389] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/12/2023]
Abstract
In the United States, racial disparities in HIV/AIDS are stark. Although African Americans comprise an estimated 14% of the U.S. population, they made up 52% of new HIV cases among adults and adolescents diagnosed in 2009. Heterosexual transmission is now the second leading cause of HIV in the United States. African Americans made up a full two-thirds of all heterosexually acquired HIV/AIDS cases between 2005 and 2008. Few demonstrated efficacious HIV prevention interventions designed specifically for adult, African-American heterosexual men exist. Here, we describe the process used to design a theory-based HIV prevention intervention to increase condom use, reduce concurrent partnering, and increase HIV testing among heterosexually active African-American men living in high HIV prevalence areas of New York City. The intervention integrated empowerment, social identity, and rational choices theories and focused on four major content areas: HIV/AIDS testing and education; condom skills training; key relational and behavioral turning points; and masculinity and fatherhood.
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Affiliation(s)
- Victoria Frye
- Laboratory of Social and Behavioral Sciences, Lindsley F. Kimball Research Institute, New York Blood Center, USA.
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12
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Chesson HW, Kent CK, Owusu-Edusei K, Leichliter JS, Aral SO. Disparities in sexually transmitted disease rates across the "eight Americas". Sex Transm Dis 2012; 39:458-64. [PMID: 22592832 DOI: 10.1097/olq.0b013e318248e3eb] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND The purpose of this study was to examine rates of 3 bacterial sexually transmitted diseases (STDs; syphilis, gonorrhea, and chlamydia) in 8 subpopulations (known as the "eight Americas") defined by race and a small number of county-level sociodemographic and geographical characteristics. The eight Americas are (1) Asians and Pacific Islanders in specific counties; (2) Northland low-income rural white; (3) Middle America; (4) Low-income whites in Appalachia and Mississippi Valley; (5) Western Native American; (6) Black middle America; (7) Southern low-income rural black; and (8) High-risk urban black. METHODS A list of the counties comprising each of the eight Americas was obtained from the corresponding author of the original eight Americas project, which examined disparities in mortality rates across the eight Americas. Using county-level STD surveillance data, we calculated syphilis, gonorrhea, and chlamydia rates (new cases per 100,000) for each of the eight Americas. RESULTS Reported STD rates varied substantially across the eight Americas. STD rates were generally lowest in Americas 1 and 2 and highest in Americas 6, 7, and 8. CONCLUSIONS Although disparities in STDs across the eight Americas are generally similar to the well-established disparities in STDs across race/ethnicity, the grouping of counties into the eight Americas does offer additional insight into disparities in STDs in the United States. The high STD rates we found for black Middle America are consistent with the assertion that sexual networks and social factors are important drivers of racial disparities in STDs.
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Affiliation(s)
- Harrell W Chesson
- From the Division of STD Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA.
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Evered KT, Evered EÖ. Syphilis and prostitution in the socio-medical geographies of Turkey's early republican provinces. Health Place 2012; 18:528-35. [DOI: 10.1016/j.healthplace.2012.02.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 01/22/2012] [Accepted: 02/07/2012] [Indexed: 11/17/2022]
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Beltran VM, Harrison KM, Hall HI, Dean HD. Collection of social determinant of health measures in U.S. national surveillance systems for HIV, viral hepatitis, STDs, and TB. Public Health Rep 2011; 126 Suppl 3:41-53. [PMID: 21836737 DOI: 10.1177/00333549111260s309] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Challenges exist in the study of social determinants of health (SDH) because of limited comparability of population-based U.S. data on SDH. This limitation is due to differences in disparity or equity measurements, as well as general data quality and availability. We reviewed the current SDH variables collected for HIV, viral hepatitis, sexually transmitted diseases, and tuberculosis at the Centers for Disease Control and Prevention through its population-based surveillance systems and assessed specific system attributes. Results were used to provide recommendations for a core set of SDH variables to collect that are both feasible and useful. We also conducted an environmental literature scan to determine the status of knowledge of SDH as underlying causes of disease and to inform the recommended core set of SDH variables.
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Affiliation(s)
- Victoria M Beltran
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Office of the Director, Office of Health Equity, Atlanta, GA 30333, USA.
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Wesley Y, Turner S, Qaabidh L. Leadership and healthcare disparities. Nurs Manag (Harrow) 2011; 42:40-5. [PMID: 21788793 DOI: 10.1097/01.numa.0000399675.97686.aa] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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16
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Gesink DC, Sullivan AB, Miller WC, Bernstein KT. Sexually transmitted disease core theory: roles of person, place, and time. Am J Epidemiol 2011; 174:81-9. [PMID: 21540320 DOI: 10.1093/aje/kwr035] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The authors' purpose was to expand sexually transmitted disease core theory by examining the roles of person, place, and time in differentiating geographic core areas from outbreak areas. The authors mapped yearly census-tract-level syphilis rates for San Francisco, California, based on new primary and secondary syphilis cases reported to the San Francisco City sexually transmitted disease surveillance program between January 1, 1985, and December 31, 2007. SaTScan software (Information Management Services, Inc., Silver Spring, Maryland) was used to identify geographic clusters of significantly elevated syphilis rates over space and time. The authors graphed epidemic curves for 1) core areas, 2) outbreak areas, 3) neither core nor outbreak areas, and 4) noncore areas, where noncore areas included outbreaks, and stratified these curves according to demographic characteristics. Five clusters of significantly elevated primary and secondary syphilis rates were identified. A 5-year threshold was useful for differentiating core clusters from outbreak clusters. Epidemic curves for core areas, outbreak areas, neither core nor outbreak areas, and noncore areas were perfectly synchronized in phase trends and wavelength over time, even when broken down by demographic characteristics. Between epidemics, the occurrence of syphilis affected all demographic groups equally. During an epidemic, a temporary disparity in syphilis occurrence arose and a homogeneous core group of cases could be defined.
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Affiliation(s)
- Dionne C Gesink
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, 6th Floor, Toronto, Ontario, Canada.
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17
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Fichtenberg CM, Jennings JM, Glass TA, Ellen JM. Neighborhood socioeconomic environment and sexual network position. J Urban Health 2010; 87:225-235. [PMID: 20140533 PMCID: PMC2845836 DOI: 10.1007/s11524-009-9425-9] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2009] [Accepted: 12/11/2009] [Indexed: 11/24/2022]
Abstract
Rates of sexually transmitted infections (STIs) are strongly associated with neighborhood poverty; however, the mechanisms responsible for this association remain unclear. Using a population-based study of sexual networks among urban African American adolescents, we tested the hypothesis that poverty, unemployment, and the sex ratio drive STI rates by affecting sexual network structure. Participants were categorized as being in one of three network positions that had previously been found to be strongly linked to infection with chlamydia and gonorrhea: being in a confirmed dyad (i.e., a monogamous pair), being connected to a larger network through one partner, and being in the center of a larger network. We found that only poverty was statistically significantly associated with sexual network position. Residing in the poorest third of neighborhoods was associated with 85% decreased odds of being in confirmed dyads. There was no association of sexual network position with neighborhood employment. Living in a neighborhood with an unequal number of young men and women appeared to be associated with a higher likelihood of being in a confirmed dyad; however, the differences were not statistically significant. These results suggest that poverty may impact STI rates by shaping sexual network structure, but we did not find any evidence that this association operates through unemployment or the sex ratio.
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Affiliation(s)
- Caroline M Fichtenberg
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
| | - Jacky M Jennings
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Thomas A Glass
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jonathan M Ellen
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.,Department of Pediatrics, Johns Hopkins School of Medicine, Baltimore, MD, USA
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[Social vulnerability is more frequent in victims of interpersonal violence: value of the EPICES score]. Presse Med 2009; 38:881-92. [PMID: 19185448 DOI: 10.1016/j.lpm.2008.10.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/06/2008] [Accepted: 10/27/2008] [Indexed: 10/20/2022] Open
Abstract
OBJECTIVES To evaluate social vulnerability of victims of interpersonal violence having consulted a service of forensic medicine with an individual index of social vulnerability. POPULATION AND METHODS The population of victims of interpersonal violence was composed of 275 subjects having consulted the service of forensic medicine of the CHU of Saint Etienne. The social data were collected by questionnaire. Social vulnerability was measured by an individual index (EPICES) calculated on the basis of 11 weighted questions related to material and social deprivation. This population was compared with a reference population; the reference population was people, aged more than 16, living in the Rhône-Alpes region and examined in 2005 in one of the Health examination Centres (HECs) of the French General Health Insurance System, that is 7553 men and 6002 women. The comparisons between the two populations were made after redressing the population of the HECs on various socio-demographic data of the Rhône-Alpes region. The relations between violence and the variables studied were measured by odds ratios adjusted on age and sex. RESULTS The population of the victims of violence is younger than the reference population (p<0.001). It is characterized by a lower level of education (p<0.001, 15% in the higher education level vs 23%) and the categories Employees and Manual workers are more frequent (p<0.001). The situation with respect to employment is also different between the two populations, unemployment rate is higher (OR=2.25) and the retired are fewer (OR=0.41). Subjects in social vulnerability are more frequent in the victims (57% vs 36%). All these differences persist after adjustment on age and sex. The context in which the aggression took place (family, public area or at work) varies significantly according to social vulnerability. On the other hand, the majority of the other medico-legal characteristics are not different according to the level of social vulnerability. CONCLUSION The population of the victims of interpersonal violence has a socio-economic profile different from the reference population. Social vulnerability is associated with interpersonal violence, in particular with violence in the public and family area.
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Abstract
Social determinants of health play an important role in sexually transmitted disease (STD) transmission and acquisition; consequently, racial and ethnic disparities among social determinants are influences upon disparities in STD rates. In this narrative review, we outline a general model showing the relationship between social determinants and STD outcomes, mediated by epidemiologic context. We then review 4 specific social determinants relevant to STD disparities: segregation, health care, socioeconomics and correctional experiences, followed by 2 facets of the resultant epidemiologic context: core areas and sexual networks. This review shows that disparities exist among the social determinants and that they are related to each other, as well as to core areas, sexual networks, and STD rates. Finally, we discuss the implications of our review for STD prevention and control with particular attention to STD program collaboration and service integration.
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Pulling together: interagency coordination and HIV/STD prevention. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2008; 14:E1-6. [PMID: 18091030 DOI: 10.1097/01.phh.0000303419.06389.17] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Using multiple network comparisons, we determined whether sexually transmitted disease (STD) rates or black-white STD rate differences are related to how HIV prevention agencies interact through exchanges of information, clients, or funds. In 10 North Carolinian counties, we conducted a cross-sectional analysis, using each county's network as the unit of interest. Using data from face-to-face interviews, measures of the density (overall connectedness) and degree centralization (amount of centralized information hubs) were calculated with UCINET. Statistical significance of the associations between county characteristics and STD rates was assessed with exact Wilcoxon rank sum test. Syphilis rates were lower (P = .01) in counties with a high network density, on the basis of exchanges of information or clients. The effect on black-white rate differences was in the same direction but weaker. Where network degree centralization was high, syphilis rates were higher and the black-white rate differences were larger. Gonorrhea rates demonstrated similar but attenuated patterns of association with network characteristics. STD prevention is more effective when all agencies interact with each other (density) but less effective when interactions are predominantly with a few central agencies (degree centralization). The measures of network exchanges employed in this study may be appropriate for future assessment of service provision of funded prevention programs.
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Geanuracos CG, Cunningham SD, Weiss G, Forte D, Reid LMH, Ellen JM. Use of geographic information systems for planning HIV prevention interventions for high-risk youths. Am J Public Health 2007; 97:1974-81. [PMID: 17901452 PMCID: PMC2040351 DOI: 10.2105/ajph.2005.076851] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Geographic information system (GIS) analysis is an emerging tool for public health intervention planning. Connect to Protect, a researcher-community collaboration working in 15 cities to reduce HIV infection among youths, developed GIS databases of local health, crime, and demographic data to evaluate the geographic epidemiology of sexually transmitted infections and HIV risk among adolescents. We describe the process and problems of data acquisition, analysis, and mapping in the development of structural interventions, demonstrating how program planners can use this technology to inform and improve planning decisions. The Connect to Protect project's experience suggests strategies for incorporating public data and GIS technology into the next generation of public health interventions.
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Semaan S, Sternberg M, Zaidi A, Aral SO. Social capital and rates of gonorrhea and syphilis in the United States: Spatial regression analyses of state-level associations. Soc Sci Med 2007; 64:2324-41. [PMID: 17400352 DOI: 10.1016/j.socscimed.2007.02.023] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2006] [Indexed: 10/23/2022]
Abstract
We conducted spatial regression analysis to account for spatial clustering of sexually transmitted diseases (STDs) and to examine the state-level association between social capital (using Putnam's public use data set) and rates of gonorrhea and syphilis. We conducted the analysis for the 48 contiguous states of the United States for 1990, 1995, and 2000 and controlled for the effects of regional variation in STD rates, and for state variation in poverty, income inequality, racial composition, and percentage aged 15-34 years. We compared the results of the spatial regression analysis with those of ordinary least squares (OLS) regression. Controlling for all population-level variables, the percentage of variation explained by the OLS regression and by the spatial regression were similar (mid-90s for gonorrhea and low-70s for syphilis), the standardized parameter estimates were similar, and the spatial lag parameter was not statistically significant. Social capital was not associated with STD rates when state variation in racial composition was included in the regression analysis. In this analysis, states with a higher proportion of residents who were African-American had higher STD rates. When we did not control for racial composition, regression analysis showed that states with higher social capital had lower STD rates. We conjecture that sexual networks and sexual mixing drive the association between social capital and STD rates and highlight important measurement and research questions that need elucidation to understand fully the relationship between social capital and STDs.
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Affiliation(s)
- Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, GA, USA.
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Thomas JC. From slavery to incarceration: social forces affecting the epidemiology of sexually transmitted diseases in the rural South. Sex Transm Dis 2006; 33:S6-10. [PMID: 16794556 DOI: 10.1097/01.olq.0000221025.17158.26] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The high rates of sexually transmitted diseases (STDs) in the southeastern United States have been shaped by historic and contemporary social forces. More than other regions of the country, the South was defined by slavery, an extremely hierarchical relationship between whites and blacks. Emancipation left much of the racial hierarchy intact with whites as farm owners and blacks as hired workers or sharecroppers. Agricultural policies that favored mechanization caused blacks to leave farm work and move into segregated towns, leading to the advent of the rural ghetto. Post-World War II mass migration, mostly by young men, to the industrial north altered the sex ratio and social capital of the southern towns left behind. The cocaine epidemic of the 1990s, followed by the high incarceration rates of the "War on Drugs," disproportionately affected low-income blacks. Each of these forces led to sexual and care-seeking behaviors that favor transmission of STDs.
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Affiliation(s)
- James C Thomas
- Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina 27599-7435, USA.
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Farley TA. Sexually transmitted diseases in the Southeastern United States: location, race, and social context. Sex Transm Dis 2006; 33:S58-64. [PMID: 16432486 DOI: 10.1097/01.olq.0000175378.20009.5a] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Heterosexual transmission of HIV in the United States appears to be following the epidemiologic pattern of bacterial sexually transmitted diseases (STDs) such as syphilis and gonorrhea, disproportionately affecting blacks in the Southeastern region. Nationwide, rates of syphilis and gonorrhea are nearly 30 times higher in blacks than in whites, and this racial disparity underlies most of the regional and county-level differences in rates. The racial disparity cannot be explained by traditional measures of socioeconomic differences, and it cannot be explained by individual-level determinants of sexual behavior, but rather reflects deeper group-level social and environmental factors for which race is a marker. A theoretical model based on previous ecologic studies is proposed to explain the relationship between racial discrimination and elevated rates of STDs in blacks. Key factors in the model include: 1) chronic joblessness, 2) drug and alcohol marketing, 3) social disorganization (or social capital), and 4) male incarceration.
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Affiliation(s)
- Thomas A Farley
- Department of Community Health Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana 70112, USA.
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Adimora AA, Schoenbach VJ, Doherty IA. HIV and African Americans in the southern United States: sexual networks and social context. Sex Transm Dis 2006; 33:S39-45. [PMID: 16794554 DOI: 10.1097/01.olq.0000228298.07826.68] [Citation(s) in RCA: 200] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Heterosexual HIV transmission among African Americans in the rural southern United States has climbed in recent years. Concurrent partnerships and bridge populations have emerged as key elements in the spread of sexually transmitted infections (STIs). GOAL The goal of this study was to examine published empiric data and other literature concerning the extent of these network patterns and their relationship to the socioeconomic context among African Americans in the rural South. STUDY DESIGN The authors conducted a review of public health, medical, and social sciences literature. RESULTS In areas of the rural South with high STI rates, there is extensive concurrency with evidence of dense sexual networks and bridging among the general population, core group members, and other high-risk subpopulations. Qualitative research reveals socioeconomic factors that support these network patterns: low ratio of men to women, economic oppression, racial discrimination, and high incarceration rates of black men. CONCLUSION Concurrency and bridging likely contribute to increased heterosexual HIV transmission among blacks in the South; contextual factors promote these network patterns in this population.
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Affiliation(s)
- Adaora A Adimora
- Department of Medicine, School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7030, USA.
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Lichtenstein B, Bachmann LH. Staff affirmations and client criticisms: staff and client perceptions of quality of care at sexually transmitted disease clinics. Sex Transm Dis 2005; 32:281-5. [PMID: 15849528 DOI: 10.1097/01.olq.0000163597.44078.19] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Public health sexually transmitted disease (STD) clinics play a central role in STD control efforts. This study addressed the perceived quality of client services at two STD clinics in Alabama. GOAL The goal of this study was to evaluate and develop tools for assessment of client satisfaction at STD clinics. STUDY Four focus groups of staff (N=16) and clients (N=15) at the clinics were conducted between June and November 2003. RESULTS Staff and client assessments of respect, privacy protections, and friendliness at the clinics differed in substantial ways. Clients were concerned with visibility, being stigmatized or disrespected, and about a breach of confidentiality. Concerns about being stigmatized focused mainly on nonclinical staff. The staff did not perceive these concerns to be warranted. Quality of medical care was rated high by both groups. CONCLUSION Staff-client interactions are an important element of STD care, and "front desk" actions set the tone at public STD clinics. Nonclinicians should receive training to improve body language and other behaviors to alleviate the stigma concerns of clients who are anxious, fearful, and sometimes distrustful of the health system.
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Affiliation(s)
- Bronwen Lichtenstein
- Department of Criminal Justice and the Institute for Rural Health Research, University of Alabama, Tuscaloosa, Alabama 35487-0320, USA.
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Newton JT, Bower EJ. The social determinants of oral health: new approaches to conceptualizing and researching complex causal networks. Community Dent Oral Epidemiol 2005; 33:25-34. [PMID: 15642044 DOI: 10.1111/j.1600-0528.2004.00190.x] [Citation(s) in RCA: 152] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Oral epidemiological research into the social determinants of oral health has been limited by the absence of a theoretical framework which reflects the complexity of real life social processes and the network of causal pathways between social structure and oral health and disease. In the absence of such a framework, social determinants are treated as isolated risk factors, attributable to the individual, having a direct impact on oral health. There is little sense of how such factors interrelate over time and place and the pathways between the factors and oral health. Features of social life which impact on individuals' oral health but are not reducible to the individual remain under-researched. A conceptual framework informing mainstream epidemiological research into the social determinants of health is applied to oral epidemiology. The framework suggests complex causal pathways between social structure and health via interlinking material, psychosocial and behavioural pathways. Methodological implications for oral epidemiological research informed by the framework, such as the use of multilevel modelling, path analysis and structural equation modelling, combining qualitative and quantitative research methods, and collaborative research, are discussed.
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Affiliation(s)
- J Timothy Newton
- Department of Oral Health Services Research and Dental Public Health, GKT Dental Institute, Caldecot Road, London SE5 9RW, UK.
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Uusküla A, Nygård JF, Kibur-Nygård M. Syphilis as a social disease: experience from the post-communist transition period in Estonia. Int J STD AIDS 2004; 15:662-8. [PMID: 15479502 PMCID: PMC2925675 DOI: 10.1177/095646240401501006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Increased incidence of sexually transmitted diseases (STD) and radical social changes have taken place at the same time in Estonia. Our aim was to study the trends in syphilis incidence, selected sociodemographic factors and health status indicators during the economic transition. Associations were estimated by the ordinary least square regression method for change in and actual values of syphilis and tuberculosis incidence rate (IR), percentage of non-ethnic Estonians and urban population, homicides rate, unemployment rate and, birth rate. The analysis was performed by counties at three different time periods. Syphilis IR significantly correlated with the proportion of non-ethnic Estonians, urban population, tuberculosis IR and birth rate. Change of syphilis IR correlated significantly with concurrent changes in unemployment rate and tuberculosis IR. Our findings support the theory that syphilis is a social disease, thus emphasizing the importance of social factors in the occurrence of STDs.
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Affiliation(s)
- Anneli Uusküla
- Department of Public Health, University of Tartu, Ravila str. 19, Tartu 50411, Estonia.
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Hogben M, Bloom F, McFarlane M, St Lawrence JS, Malotte CK. Factors associated with sexually transmitted disease clinic attendance. Int J Nurs Stud 2004; 41:911-20. [PMID: 15476764 DOI: 10.1016/j.ijnurstu.2004.04.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2004] [Revised: 03/25/2004] [Accepted: 04/20/2004] [Indexed: 11/27/2022]
Abstract
Most people in the United States who are infected with sexually transmitted diseases (STDs) do not attend STD clinics for treatment in spite of the low-cost efficacious treatment. We asked a clinic and a community sample about perceived benefits and problems of attending an STD clinic. Analyses yielded two treatment-oriented and two socially oriented, factors, which were also expressed in qualitative interviews. Further analyses suggested that treatment-oriented factors were more strongly associated with clinic attendance than were social factors, although respondents were more positive about expected quality of treatment than they were about retaining confidentiality. We suggest that implications of the results favor integrating STD care with other health care.
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Affiliation(s)
- Matthew Hogben
- Center for Disease Control and Prevention, Division of STD prevention, Mail Stop E-44, 1600 Clifton Road, Atlanta, GA 30333, USA.
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Abstract
BACKGROUND Although relative measures are commonly used to express health disparities, absolute measures could have more value in public health decision-making. GOAL The goal of this study was to examine how associations between county-level variables and black-white racial disparity in gonorrhea rates varied by the measure of disparity used. STUDY DESIGN We studied correlations of 10 population-level variables with the incidence rate difference (RD) and incidence rate ratio (RR) of gonorrhea in North Carolina (NC) counties. RESULTS Nine of the 10 variables correlated more strongly with the RD than the RR. The RD was highly correlated with incidence rates of gonorrhea among blacks (r >0.99). CONCLUSION Several county-level variables were correlated with absolute, but not with relative, racial disparity in gonorrhea in NC. Disease rates were so disparate that the RD essentially reflected rates in the black population. The RD should be preferentially used in planning and evaluating interventions aimed at eliminating racial disparities in gonorrhea in NC.
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Affiliation(s)
- Julia C Dombrowski
- Public Health Leadership Program, University of North Carolina School of Public Health, Chapel Hill, North Carolina, USA.
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Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures—the public health disparities Geocoding Project (US). Public Health Rep 2003. [DOI: 10.1016/s0033-3549(04)50245-5] [Citation(s) in RCA: 106] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Krieger N, Waterman PD, Chen JT, Soobader MJ, Subramanian SV. Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures--the public health disparities geocoding project (US). Public Health Rep 2003; 118:240-60. [PMID: 12766219 PMCID: PMC1497538 DOI: 10.1093/phr/118.3.240] [Citation(s) in RCA: 163] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To determine which area-based socioeconomic measures, at which level of geography, are suitable for monitoring socioeconomic inequalities in sexually transmitted infections (STIs), tuberculosis (TB), and violence in the United States. METHODS Cross-sectional analysis of public health surveillance data, geocoded and linked to area-based socioeconomic measures generated from 1990 census tract, block group, and ZIP Code data. We included all incident cases among residents of either Massachusetts (MA; 1990 population = 6016425) or Rhode Island (RI; 1990 population = 1003464) for: STIs (MA: 1994-1998, n = 26535 chlamydia, 7464 gonorrhea, 2619 syphilis; RI: 1994-1996, n = 4473 chlamydia, 1256 gonorrhea, 305 syphilis); TB (MA: 1993-1998, n = 1793; RI: 1985-1994, n = 576), and non-fatal weapons related injuries (MA: 1995-1997, n = 6628). RESULTS Analyses indicated that: (a). block group and tract socioeconomic measures performed similarly within and across both states, with results more variable for the ZIP Code level measures; (b). measures of economic deprivation consistently detected the steepest socioeconomic gradients, considered across all outcomes (incidence rate ratios on the order of 10 or higher for syphilis, gonorrhea, and non-fatal intentional weapons-related injuries, and 7 or higher for chlamydia and TB); and (c). results were similar for categories generated by quintiles and by a priori categorical cut-points. CONCLUSIONS Supplementing U.S. public health surveillance systems with census tract or block group area-based socioeconomic measures of economic deprivation could greatly enhance monitoring and analysis of social inequalities in health in the United States.
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Affiliation(s)
- Nancy Krieger
- Department of Health and Social Behavior, Harvard School of Public Health, Boston, MA 02115, USA.
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Faraone SV, Brown CH, Glatt SJ, Tsuang MT. Preventing schizophrenia and psychotic behaviour: definitions and methodological issues. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2002; 47:527-37. [PMID: 12211880 DOI: 10.1177/070674370204700604] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Although schizophrenia onset usually occurs in late adolescence or early adulthood, much research shows that its seeds are planted early in life and that eventual onset occurs at the end of a neurodevelopmental process leading to aberrant brain functioning. This idea, along with the fact that current therapies are far from fully effective, suggests that preventive treatments may be needed to achieve an ideal outcome for schizophrenia patients and those predisposed to the disorder. In this article, we review the methodological challenges that must be overcome before effective preventive interventions can be created. Prevention studies will need to define the target population. This requires the identification of risk factors that will be useful in selecting at-risk people for preventive treatment. We review currently identified risk factors for schizophrenia: genes, psychosocial factors, pregnancy and delivery complications, and viruses. We also review 3 different types of prevention programs: universal, indicated, and selective. For schizophrenia, we distinguish prevention programs that target prodromal cases and those that target the disorder's premorbid precursors. Although those targeting prodromal cases provide a useful framework for early treatment of the disorder, studies of premorbid individuals are needed to design a truly preventive treatment.
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Affiliation(s)
- Stephen V Faraone
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, Massachusetts, USA
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Uusküla A, Kalikova A, Zilmer K, Tammai L, DeHovitz J. The role of injection drug use in the emergence of Human Immunodeficiency Virus infection in Estonia. Int J Infect Dis 2002; 6:23-7. [PMID: 12044297 DOI: 10.1016/s1201-9712(02)90131-1] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE This article reviews the marked increase in human immunodeficiency virus (HIV) among injection drug users (IDU) in Estonia, a former Soviet Union republic bordering the Baltic Sea. HIV infection associated with injecting drug use has been reported worldwide. In Eastern Europe large-scale HIV epidemics have been observed from 1995 onward, after injection drug use (IDU) communities became infected. MATERIALS AND METHODS In Estonia, surveillance of HIV infection is based on the mandatory universal notification of newly identified cases, with the same reporting principles in use throughout the last decades. By legal regulations every sample sent for HIV testing has to be coded (on the testing form) to identify the transmission category it belongs to. HIV testing was introduced in Estonia in 1987; by now over 2 million HIV tests have been performed. RESULTS To date since 1987, 1305 cases of HIV have reported in Estonia. The incidence of HIV infections remained very low until recently, even when a considerable rise occurred in the incidence of sexually transmitted diseases, especially syphilis. Through 1999, only 96 cases of HIV had been reported nationally. Since then however, a dramatic increase has occurred. The cumulative data, including the information recorded on HIV testing forms and clinical records suggest that IDU was a factor in nearly 90% of the new HIV cases reported in year 2000. CONCLUSIONS HIV infection appeared in Estonia much later than in many other parts of the world, so the experience from other countries that have confronted with the challenges of HIV could be of great help and importance for Estonia. The IDU related HIV infection epidemic in Estonia emphasizes an urgent need for preventive measures for IDUs as the target group.
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Affiliation(s)
- Anneli Uusküla
- Clinic of Dermatovenerology, University of Tartu, Estonia.
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Buvé A, Weiss HA, Laga M, Van Dyck E, Musonda R, Zekeng L, Kahindo M, Anagonou S, Morison L, Robinson NJ, Hayes RJ. The epidemiology of gonorrhoea, chlamydial infection and syphilis in four African cities. AIDS 2001; 15 Suppl 4:S79-88. [PMID: 11686469 DOI: 10.1097/00002030-200108004-00009] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES To compare the epidemiology of gonorrhoea, chlamydial infection and syphilis in four cities in sub-Saharan Africa; two with a high prevalence of HIV infection (Kisumu, Kenya and Ndola, Zambia), and two with a relatively low HIV prevalence (Cotonou, Benin and Yaoundé, Cameroon). DESIGN Cross-sectional study, using standardized methods, including a standardized questionnaire and standardized laboratory tests, in four cities in sub-Saharan Africa. METHODS In each city, a random sample of about 2000 adults aged 15-49 years was taken. Consenting men and women were interviewed about their socio-demographic characteristics and their sexual behaviour, and were tested for HIV, syphilis, herpes simplex virus type 2 (HSV-2), gonorrhoea, chlamydial infection, and (women only) Trichomonas vaginalis infection. Risk factor analyses were carried out for chlamydial infection and syphilis seroreactivity. RESULTS The prevalence of gonorrhoea ranged between 0% in men in Kisumu and 2.7% in women in Yaoundé. Men and women in Yaoundé had the highest prevalence of chlamydial infection (5.9 and 9.4%, respectively). In the other cities, the prevalence of chlamydial infection ranged between 1.3% in women in Cotonou and 4.5% in women in Kisumu. In Ndola, the prevalence of syphilis seroreactivity was over 10% in both men and women; it was around 6% in Yaoundé, 3-4% in Kisumu, and 1-2% in Cotonou. Chlamydial infection was associated with rate of partner change for both men and women, and with young age for women. At the population level, the prevalence of chlamydial infection correlated well with reported rates of partner change. Positive syphilis serology was associated with rate of partner change and with HSV-2 infection. The latter association could be due to biological interaction between syphilis and HSV-2 or to residual confounding by sexual behaviour. At the population level, there was no correlation between prevalence of syphilis seroreactivity and reported rates of partner change. CONCLUSION Differences in prevalence of chlamydial infection could be explained by differences in reported sexual behaviour, but the variations in prevalence of syphilis seroreactivity remained unexplained. More research is needed to better understand the epidemiology of sexually transmitted infections in Africa.
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Affiliation(s)
- A Buvé
- Department of Microbiology, Institute of Tropical Medicine, Antwerp, Belgium.
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Affiliation(s)
- S B Thomas
- Center for Minority Health, Graduate School of Public Health, University of Pittsburgh, 125 Parran Hall, 130 Desoto St, Pittsburgh, PA 15261, USA.
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Abstract
In many developed countries, ethnic minority communities bear the brunt of poor sexual health outcomes, with high rates of HIV/AIDS, sexually transmitted infections and their sequelae. Economic disadvantage, social exclusion and racism experienced by these communities all contribute to the observed inequalities. However, culturally prescribed attitudes and behaviours also play an important role. A review of the literature suggests that multifaceted and sustained approaches are needed to improve the sexual health of ethnic minority communities. Chief among these approaches are improving sexually transmitted infection surveillance and research tools; creating collaborative partnerships with communities; targeting high-risk groups and networks; and improving access to, and the utilization of, proven effective interventions.
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Affiliation(s)
- K A Fenton
- Department of Sexually Transmitted Diseases, Royal Free and University College Medical School, and PHLS Communicable Disease Surveillance Centre, London, UK.
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Alam F, Argiriadou AS, Hodgson TA, Kumar N, Porter SR. Primary syphilis remains a cause of oral ulceration. Br Dent J 2000; 189:352-4. [PMID: 11081944 DOI: 10.1038/sj.bdj.4800767] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
After many years the incidence of infective syphilis (infection with Treponema pallidum) is increasing in the United Kingdom. This may reflect changes in sexual attitudes and behaviour, altering trends in HIV disease, and increased foreign travel. Oral disease as a consequence of primary syphilis is rare. The present report details two patients presenting to an oral medicine clinic in London, within a 6-month period in 1999, with oral ulceration as their only clinical manifestation of undiagnosed primary syphilis. The oral aspects of early syphilis and the need for dentists to be aware of changing epidemiological trends in relevant infectious diseases are highlighted.
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Affiliation(s)
- F Alam
- Department of Oral Medicine, Eastman Dental Institute for Oral Health Care Sciences, University College London
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