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Rowlinson E, Hughes JP, Stenger MR, Khosropour CM, Golden MR. Diverging Neisseria gonorrhoeae Morbidity in Non-Hispanic Black and White Females: Application of Group-Based Trajectory Modeling to Trends in County-Level Morbidity 2003-2018. J Urban Health 2023; 100:215-226. [PMID: 36580235 PMCID: PMC9798952 DOI: 10.1007/s11524-022-00702-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/14/2022] [Indexed: 12/30/2022]
Abstract
National trends in gonorrhea rates may obscure informative local variations in morbidity. We used group-based trajectory models to identify groups of counties with similar gonorrhea rate trajectories among non-Hispanic White (NHW) and non-Hispanic Black (NHB) females using county-level data on gonorrhea cases in US females from 2003 to 2018. We assessed models with 1-15 groups and selected final models based on fit statistics and identification of divergent trajectory groups with distinct intercepts and/or slopes. We mapped counties by assigned trajectory group and examined the association of county characteristics with group membership. We identified 7 distinct gonorrhea trajectory groups for NHW females and 9 distinct trajectory groups for NHB females. All identified groups for NHW female morbidity experienced increasing gonorrhea rates with a limited range (11.6-183.3/100,000 NHW females in 2018); trajectories of NHB female morbidity varied widely in rates (146.6-966.0/1000 NHB females in 2018) and included 3 groups of counties that experienced a net decline in gonorrhea rates. Counties with higher NHW female morbidity had lower adult sex ratios, lower health insurance coverage, and lower marital rates among NHW adults. Counties with higher NHB female morbidity were more urban, experienced higher rates of poverty, and had lower rates of marriage among NHB adults. Morbidity patterns did not always follow geographic proximity, which could be explained by variation in social determinants of health. Our results demonstrated a highly heterogenous gonorrhea epidemic among NHW and NHB US females, which should prompt further analysis into the differential drivers of gonorrhea morbidity.
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Affiliation(s)
- Emily Rowlinson
- Department of Epidemiology, University of Washington, WA, 98195, Seattle, USA.
| | - James P Hughes
- Department of Biostatistics, University of Washington, Seattle, Washington, USA
| | - Mark R Stenger
- Division of STD Prevention, Centers for Disease Control and Prevention (CDC), Atlanta, Georgia, USA
| | | | - Matthew R Golden
- Department of Epidemiology, University of Washington, WA, 98195, Seattle, USA
- Public Health- Seattle & King County, HIV/STD Program, Seattle, Washington, USA
- Department of Medicine, Division of Allergy & Infectious Diseases, University of Washington, Seattle, Washington, USA
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Trepka MJ, Dawit R, Fernandez SB, Sheehan DM, Degarege A, PhD TL, Maddox LM, Spencer EC. Social disorganization and new HIV diagnoses, 2013-2017, Florida: Rural-urban differences. J Rural Health 2022; 38:960-969. [PMID: 34861068 PMCID: PMC9163207 DOI: 10.1111/jrh.12636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PURPOSE To compare the role of neighborhood social disorganization factors on human immunodeficiency virus (HIV) diagnosis rates in urban and rural areas in Florida, we conducted an ecologic study of HIV diagnosis rates during 2013-2017 and social disorganization components, including concentrated disadvantage, ethnic heterogeneity, and residential instability. METHODS Indices of social disorganization components were obtained from principal component analyses of American Community Survey variables for 910 postal codes. Rural/urban classification was based on the United States Department of Agriculture Rural Urban Commuting Area codes. Using multivariable linear regression, the relationship between social disorganization indices and HIV diagnosis rates was assessed. FINDINGS The only social disorganization index that was significantly higher in rural than urban areas was concentrated disadvantage. In rural areas, the concentrated disadvantage index was significantly associated with HIV diagnosis rates (P = .007) when controlling for the other social disorganization factors but was no longer significant after additionally controlling for prevalence of people with an HIV diagnosis who were not virally suppressed. In urban areas, even after controlling for prevalence of people with HIV who were not virally suppressed, lower male-to-female population ratios and higher scores of residential instability, concentrated disadvantage, and LatinX/immigrant density indices were associated with higher HIV diagnosis rates (all P < .01). CONCLUSIONS In addition to improving community levels of viral suppression, the community contextual environment, including the rurality of the environment, needs to be considered in strategies to end the HIV epidemic in the United States.
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Affiliation(s)
- Mary Jo Trepka
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Rahel Dawit
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Sofia B. Fernandez
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- School of Social Work, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Diana M. Sheehan
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Research Center in Minority Institutions, Florida International University, 11200 SW 8th St, Miami, Florida, USA
- Center for Research on US Latino HIV/AIDS and Drug Abuse, Florida International University, 11200 SW 8th St, AHC 5, Miami, Florida, USA
| | - Abraham Degarege
- Department of Epidemiology, College of Public Health, University of Nebraska Medical Center, 984395 Nebraska Medical Center, Omaha, Nebraska, USA
| | - Tan Li PhD
- Department of Biostatistics, Robert Stempel College of Public Health and Social Work, Florida International University, 11200 SW 8th St, Miami, Florida, USA
| | - Lorene M. Maddox
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
| | - Emma C. Spencer
- HIV/AIDS Section, Bureau of Communicable Diseases, Florida Department of Health, 4025 Esplande Blvd, Tallahassee, Florida, USA
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Sulyok M, Walker M. Social mobility and gonorrhoea in Germany during 2020. Sex Transm Infect 2022; 98:371-375. [PMID: 34510006 PMCID: PMC8440122 DOI: 10.1136/sextrans-2021-055159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2021] [Accepted: 09/03/2021] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES The incidence of STIs is likely to be related to levels of social activity and mobility. Novel datasets detailing levels of social activity were made widely available during the COVID-19 pandemic. These allow the relationship between activity and STI incidence to be examined. METHODS The correlation between social activities and the reported number of gonorrhoea cases between March and December 2020 in Germany was studied. Regression through Autoregressive Integrated Moving Average (ARIMA) time series modelling identified those activities associated with case numbers. RESULTS ARIMA regression identified a significant association with 'transit' activity within the Apple data and 'parks' within Google. CONCLUSIONS This study illustrates the potential newly available measures of social activity provided for STI research. Reductions in STI incidence are likely to have occurred due to COVID-19 social restrictions. Although other studies report reductions in infectious diseases during this period, few examine the potential social factors mediating this. The results illustrate the continual need for sexual health services throughout the pandemic.
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Affiliation(s)
- Mihály Sulyok
- Department of Pathology, Eberhard Karls University of Tübingen, Tubingen, Germany
- Institute of Tropical Medicine, Eberhard Karls University of Tübingen, Tubingen, Germany
| | - Mark Walker
- Faculty of Development and Society, Sheffield Hallam University, Sheffield, UK
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Abstract
BACKGROUND Gonorrhea is a significant public health concern. The changing epidemiology of gonorrhea in Australia has highlighted the need for detailed examination of surveillance data to determine population groups at greatest risk for infection. METHODS We analyzed deidentified gonorrhea notification data for the years 2012 to 2017, in Adelaide (N = 3680), calculating age-adjusted notification and antibiotic resistance rates. Age, gender, year, sexual orientation, and socioeconomic status were assessed for associations with gonorrhea notifications using negative binomial, log binomial and spatial autoregressive models. Maps were generated to examine spatial localization of gonorrhea rates in Adelaide. RESULTS Gonorrhea notification rates in Adelaide increased annually, with a 153% adjusted increase in rates from 2012 to 2017, localized to specific areas and inversely associated with income levels. The increase in rates in 2016 and 2017 was associated with young heterosexuals from low income areas. Azithromycin-resistant notifications increased significantly in 2016 in young heterosexuals. Reinfections were significantly more likely in men who have sex with men than other population groups. CONCLUSIONS This study demonstrates the changing epidemiology of gonorrhea in Adelaide from a largely men who have sex with men profile toward an increase in young heterosexual gonorrhea. This could be seen as a harbinger for future increases in heterosexually transmitted HIV and other sexually transmitted infections in Australia.
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Götz HM, van Oeffelen LA, Hoebe CJPA, van Benthem BH. Regional differences in chlamydia and gonorrhoeae positivity rate among heterosexual STI clinic visitors in the Netherlands: contribution of client and regional characteristics as assessed by cross-sectional surveillance data. BMJ Open 2019; 9:e022793. [PMID: 30670509 PMCID: PMC6347934 DOI: 10.1136/bmjopen-2018-022793] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVES To assess to what extent triage criteria, client and regional characteristics explain regional differences in Chlamydia trachomatis (Ct) and Neisseria gonorrhoeae (Ng) positivity in sexually transmitted infection (STI) clinics. DESIGN Retrospective cross-sectional study on the Dutch STI surveillance database of all 24 STI clinics. PARTICIPANTS STI clinic visits of heterosexual persons in 2015 with a Ct (n=101 495) and/or Ng test (n=101 081). PRIMARY OUTCOME MEASURE Ct and Ng positivity and 95% CI was assessed for each STI clinic. Two-level logistic regression analyses were performed to calculate the percentage change in regional variance (PCV) after adding triage criteria (model 1), other client characteristics (model 2) and regional characteristics (model 3) to the empty model. The contribution of single characteristics was determined after removing them from model 3. RESULTS Ct positivity was 14.9% and ranged from 12.6% to 20.0% regionally. Ng positivity was 1.7% and ranged from 0.8% to 3.8% regionally. For Ct, the PCV was 11.7% in model 1, 32.2% in model 2% and 59.3% in model 3. Age, notified for Ct (triage), level of education (other characteristics) and regional degree of urbanisation (region) explained variance most. For Ng, the PCV was 38.7% in model 1, 61.2% in model 2% and 69.1% in model 3. Ethnicity (triage), partner in risk group, level of education and neighbourhood (other characteristics) and regional socioeconomic status (SES) explained variance most. A significant part of regional variance remained unexplained. CONCLUSIONS Regional variance was explained by differences in client characteristics, indicating that triage and self-selection influence positivity rates in the surveillance data.Clustering of Ng in low SES regions additionally explained regional variance in Ng; targeted interventions in low SES regions may assist Ng control. Including educational level as triage criterion is recommended. Studies incorporating prevalence data are needed to assess whether regional clustering underlies unexplained regional variance.
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Affiliation(s)
- Hannelore M Götz
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Rotterdam, The Netherlands
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
- Department of Public Health, Erasmus MC-University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Louise Aam van Oeffelen
- Department of Infectious Disease Control, Municipal Public Health Service Rotterdam-Rijnmond, Rotterdam, The Netherlands
| | - Christian J P A Hoebe
- Department of Sexual Health, Infectious Diseases and Environmental Health, Public Health Service South Limburg, Geleen, The Netherlands
- Department of Medical Microbiology, Maastricht University Medical Centre, Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Birgit Hb van Benthem
- Centre for Infectious Disease Control, National Institute for Public Health and the Environment, Rotterdam, The Netherlands
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Cao WT, Li R, Ying JY, Chi XL, Yu XD. Spatiotemporal distribution and determinants of gonorrhea infections in mainland China: a panel data analysis. Public Health 2018; 162:82-90. [PMID: 29990616 DOI: 10.1016/j.puhe.2018.05.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 05/03/2018] [Accepted: 05/15/2018] [Indexed: 10/28/2022]
Abstract
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.
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Affiliation(s)
- Wen-Ting Cao
- School of Earth Sciences, Zhejiang University, Hangzhou 310027, Zhejiang, China.
| | - Rui Li
- School of Earth Sciences, Zhejiang University, Hangzhou 310027, Zhejiang, China.
| | - Ju-Ying Ying
- ZheJiang Economic & Trade Polytechnic, Xiasha, Hangzhou 310018, Zhejiang, China.
| | - Xiao-Li Chi
- Institute of Meteorology, Free University of Berlin, Carl-Heinrich-Becker Weg 6-10, 12165 Berlin, Germany.
| | - Xiao-Dong Yu
- School of Earth Sciences, Zhejiang University, Hangzhou 310027, Zhejiang, China.
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Andreatos N, Grigoras C, Shehadeh F, Pliakos EE, Stoukides G, Port J, Flokas ME, Mylonakis E. The impact of HIV infection and socioeconomic factors on the incidence of gonorrhea: A county-level, US-wide analysis. PLoS One 2017; 12:e0183938. [PMID: 28863154 PMCID: PMC5580927 DOI: 10.1371/journal.pone.0183938] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2017] [Accepted: 08/14/2017] [Indexed: 11/24/2022] Open
Abstract
Background Gonorrhea is the second most commonly reported identifiable disease in the United States (U.S.). Importantly, more than 25% of gonorrheal infections demonstrate antibiotic resistance, leading the Centers for Disease Control and Prevention (CDC) to classify gonorrhea as an “urgent threat”. Methods We examined the association of gonorrhea infection rates with the incidence of HIV and socioeconomic factors. A county-level multivariable model was then constructed. Results Multivariable analysis demonstrated that HIV incidence [Coefficient (Coeff): 1.26, 95% Confidence Interval (CI): 0.86, 1.66, P<0.001] exhibited the most powerful independent association with the incidence of gonorrhea and predicted 40% of the observed variation in gonorrhea infection rates. Sociodemographic factors like county urban ranking (Coeff: 0.12, 95% CI: 0.03, 0.20, P = 0.005), percentage of women (Coeff: 0.41, 95% CI: 0.28, 0.53, P<0.001) and percentage of individuals under the poverty line (Coeff: 0.45, 95% CI: 0.32, 0.57, P<0.001) exerted a secondary impact. A regression model that incorporated these variables predicted 56% of the observed variation in gonorrhea incidence (Pmodel<0.001, R2 model = 0.56). Conclusions Gonorrhea and HIV infection exhibited a powerful correlation thus emphasizing the benefits of comprehensive screening for sexually transmitted infections (STIs) and the value of pre-exposure prophylaxis for HIV among patients visiting an STI clinic. Furthermore, sociodemographic factors also impacted gonorrhea incidence, thus suggesting another possible focus for public health initiatives.
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Affiliation(s)
- Nikolaos Andreatos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Christos Grigoras
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Fadi Shehadeh
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Elina Eleftheria Pliakos
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Georgianna Stoukides
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Jenna Port
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Myrto Eleni Flokas
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
| | - Eleftherios Mylonakis
- Infectious Diseases Division, Warren Alpert Medical School of Brown University, Rhode Island Hospital, Providence, Rhode Island, United States of America
- * E-mail:
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Abstract
Identifying predictors that contribute to geographic disparities in sexually transmitted infections (STIs) is necessary in order to reduce disparities. This study assesses the spatial relationship condom availability and accessibility in order to better identify determinants of geographic disparities in STIs. We conducted a telephone-based audit among potential-condom selling establishments. Descriptive analyses were conducted to detect differences in condom-selling characteristics by stores and by store type. Geocoding, mapping, and spatial analysis were conducted to measure the availability of condoms. A total of 850 potential condom-selling establishments participated in the condom availability and accessibility audit in St. Louis city; 29 % sold condoms. There were several significant geographic clusters of stores identified across the study area. The first consisted of fewer convenience stores and gas stations that sold condoms in the northern section of the city, whereas condoms were less likely to be sold in non-convenience store settings in the southwestern and central parts of the city. Additionally, locations that distributed free condoms clustered significantly in city center. However, there was a dearth of businesses that were neither convenience stores nor gas stations in the northern region of the city, which also had the highest concentration of condoms sold. This initial study was conducted to provide evidence that condom availability and accessibility differ by geographic region, and likely are a determinant of social norms surrounding condom use and ultimately impact STI rates.
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Xiong M, Lan L, Feng T, Zhao G, Wang F, Hong F, Wu X, Zhang C, Wen L, Liu A, Best JM, Tang W. Analysis of the sex ratio of reported gonorrhoea incidence in Shenzhen, China. BMJ Open 2016; 6:e009629. [PMID: 26975933 PMCID: PMC4800114 DOI: 10.1136/bmjopen-2015-009629] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To assess the clinical process of gonorrhoea diagnosis and report in China, and to determine the difference of sex ratio between reported incidence based on reporting data and true diagnosis rate based on reference tests of gonorrhoea. SETTING A total of 26 dermatology and sexually transmitted disease (STD) departments, 34 obstetrics-gynaecology clinics and 28 urology outpatient clinics selected from 34 hospitals of Shenzhen regarded as our study sites. PARTICIPANTS A total of 2754 participants were recruited in this study, and 2534 participants completed the questionnaire survey and provided genital tract secretion specimens. There were 1106 male and 1428 female participants. Eligible participants were patients who presented for outpatient STD care at the selected clinics for the first time in October 2012 were at least 18 years old, and were able to give informed consent. OUTCOME MEASURES Untested rate, true-positive rate, false-negative rate and unreported rate of gonorrhoea, as well as reported gonorrhoea incidence sex ratio and true diagnosis sex ratio were calculated and used to describe the results. RESULTS 2534 participants were enrolled in the study. The untested rate of gonorrhoea among females was significantly higher than that among males (female 88.1%, male 68.3%, p=0.001). The male-to-female sex ratios of untested rate, true-positive rate, false-negative rate and unreported rate were 1:1.3, 1.2:1, 1:1.6 and 1:1.4, respectively. The reported gonorrhoea incidence sex ratio of new diagnosed gonorrhoea was 19.8:1 (male vs female: 87/1106 vs 5/1420), while the true diagnosis sex ratio was 2.5:1 (male vs female: 161/1106 vs 84/1420). These data indicate that the sex ratio of reported gonorrhoea incidence has been overestimated by a factor of 7.9 (19.8/2.5). CONCLUSIONS We found the current reported gonorrhoea incidence and sex ratios to be inaccurate due to underestimations of gonorrhoea incidence, especially among women.
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Affiliation(s)
- Mingzhou Xiong
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
- Department of Epidemiology and Health Statistics, Public Health School of Central South University, Changsha, Hunan, China
| | - Lina Lan
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Tiejian Feng
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Guanglu Zhao
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Feng Wang
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Fuchang Hong
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Xiaobing Wu
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Chunlai Zhang
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Lizhang Wen
- STD Prevention and Control Department, Shenzhen Center for Chronic Disease Control, Shenzhen, Guangdong, China
| | - Aizhong Liu
- Department of Epidemiology and Health Statistics, Public Health School of Central South University, Changsha, Hunan, China
| | | | - Weiming Tang
- Project-China, University of North Carolina, Guangzhou, Guangdong, China
- Department of STI Control, Guangdong Provincial Center for Skin Diseases and STIs control, Guangzhou, Guangdong, China
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Golin CE, Haley DF, Wang J, Hughes JP, Kuo I, Justman J, Adimora AA, Soto-Torres L, O'Leary A, Hodder S. Post-traumatic Stress Disorder Symptoms and Mental Health over Time among Low-Income Women at Increased Risk of HIV in the U.S. J Health Care Poor Underserved 2016; 27:891-910. [PMID: 27180715 PMCID: PMC4970215 DOI: 10.1353/hpu.2016.0093] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Women living in poverty suffer more post-traumatic stress disorder (PTSD) symptoms than do members of the general population; however we know little about factors associated with changes in their PTSD symptoms over time. Using data from HPTN 064, a cohort of women from low-income, high-HIV-prevalence communities across six eastern states (n=1,860), we assessed the prevalence of and changes in PTSD symptoms over 12 months and the effect of potential predictors on symptom acquisition and remission (via the Primary Care-PTSD symptoms scale). Forty-three percent screened positive for PTSD symptoms. Those reporting food insecurity, ongoing abuse, depressive symptoms, or binge drinking were more likely to acquire PTSD symptoms. Those with ongoing abuse or depressive symptoms were less likely to experience PTSD symptom remission. Findings suggest a need to integrate programs to reduce abuse, depression, and economic hardship with those that address sexual health risks among women living in low-income, high-HIV-prevalence neighborhoods.
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Nelson EJ, Shacham E, Boutwell BB, Rosenfeld R, Schootman M, Vaughn M, Lewis R. Childhood lead exposure and sexually transmitted infections: New evidence. ENVIRONMENTAL RESEARCH 2015; 143:131-137. [PMID: 26479187 DOI: 10.1016/j.envres.2015.10.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 10/08/2015] [Accepted: 10/09/2015] [Indexed: 06/05/2023]
Abstract
INTRODUCTION The adverse health effects of lead exposure in children are well documented and include intellectual and behavioral maladies. Childhood lead exposure has also been linked to impulsive behaviors, which, in turn, are associated with a host of negative health outcomes including an increased risk for sexually transmitted infections (STI). The purpose of this study was to assess the association of lead exposure with STI rates across census tracts in St. Louis City, Missouri. METHODS Incident cases of gonorrhea and chlamydia (GC) during 2011 were identified from the Missouri Department of Health and Senior Services and aggregated by census tract. We also geocoded the home address of 59,645 children >72 months in age who had blood lead level tests performed in St. Louis City from 1996 to 2007. Traditional regression and Bayesian spatial models were used to determine the relationship between GC and lead exposure while accounting for confounders (condom and alcohol availability, crime, and an index of concentrated disadvantage). RESULTS Incident GC rates were found to cluster across census tracts (Moran's I=0.13, p=0.006). After accounting for confounders and their spatial dependence, a linear relationship existed between lead exposure and GC incidence across census tracts, with higher GC rates occurring in the northern part of St. Louis City CONCLUSIONS At the census-tract level, higher lead exposure is associated with higher STI rates. Visualizing these patterns through maps may help deliver targeted interventions to reduce geographic disparities in GC rates.
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Affiliation(s)
- Erik J Nelson
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA.
| | - Enbal Shacham
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA
| | - Brian B Boutwell
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA; School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA.
| | - Richard Rosenfeld
- Department of Criminology and Criminal Justice, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 6312, USA.
| | - Mario Schootman
- Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA
| | - Michael Vaughn
- School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA
| | - Roger Lewis
- Department of Environmental and Occupational Health, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA.
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Cooper HLF, Linton S, Haley DF, Kelley ME, Dauria EF, Karnes CC, Ross Z, Hunter-Jones J, Renneker KK, Del Rio C, Adimora A, Wingood G, Rothenberg R, Bonney LE. Changes in Exposure to Neighborhood Characteristics are Associated with Sexual Network Characteristics in a Cohort of Adults Relocating from Public Housing. AIDS Behav 2015; 19:1016-30. [PMID: 25150728 DOI: 10.1007/s10461-014-0883-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Ecologic and cross-sectional multilevel analyses suggest that characteristics of the places where people live influence their vulnerability to HIV and other sexually-transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African-American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater post-relocation improvements in economic disadvantage, violent crime, and male:female sex ratios would experience greater reductions in perceived partner risk and in the odds of having a partner who had another partner (i.e., indirect concurrency). Baseline data were collected from 172 public housing residents before relocations occurred; three waves of post-relocation data were collected every 9 months. Participants who experienced greater improvements in community violence and in economic conditions experienced greater reductions in partner risk. Reduced community violence was associated with reduced indirect concurrency. Structural interventions that decrease exposure to violence and economic disadvantage may reduce vulnerability to HIV/STIs.
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Affiliation(s)
- Hannah L F Cooper
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, 1518 Clifton Road, NE Room 526, Atlanta, GA, 30322, USA,
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Impact of public housing relocations: are changes in neighborhood conditions related to STIs among relocaters? Sex Transm Dis 2015; 41:573-9. [PMID: 25211249 DOI: 10.1097/olq.0000000000000172] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Cross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater postrelocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, and male/female sex ratios) would have reduced the odds of testing positive for an STI over time. METHODS Baseline data were collected in 2009 from 172 public housing residents before relocations occurred; 3 waves of postrelocation data were collected every 9 months thereafter. Polymerase chain reaction methods were used to test participants' urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Individual-level characteristics were assessed via survey. Administrative data described the census tracts where participants lived at each wave (e.g., sex ratios, violent crime rates, and poverty rates). Hypotheses were tested using multilevel models. RESULTS Participants experienced improvements in all tract-level conditions studied and reductions in STIs over time (baseline: 29% tested STI positive; wave 4: 16% tested positive). Analyses identified a borderline statistically significant relationship between moving to tracts with more equitable sex ratios and reduced odds of testing positive for an STI (odds ratio, 0.16; 95% confidence interval, 0.02-1.01). Changes in other neighborhood conditions were not associated with this outcome. DISCUSSION Consonant with past research, our findings suggest that moving to areas with more equitable sex ratios reduces the risk of STI infection. Future research should study the extent to which this relationship is mediated by changes in sexual network dynamics.
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Ford JL, Browning CR. Neighborhoods and infectious disease risk: acquisition of chlamydia during the transition to young adulthood. J Urban Health 2014; 91:136-50. [PMID: 23494850 PMCID: PMC3907631 DOI: 10.1007/s11524-013-9792-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults' acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults' acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1-3 (1994-2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents' interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.
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Affiliation(s)
- Jodi L Ford
- College of Nursing, Ohio State University, 320 Newton Hall/1585 Neil Ave, Columbus, OH, 43210, USA,
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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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Moonesinghe R, Fleming E, Truman BI, Dean HD. Linear and non-linear associations of gonorrhea diagnosis rates with social determinants of health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2012. [PMID: 23202676 PMCID: PMC3499859 DOI: 10.3390/ijerph9093149] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Identifying how social determinants of health (SDH) influence the burden of disease in communities and populations is critically important to determine how to target public health interventions and move toward health equity. A holistic approach to disease prevention involves understanding the combined effects of individual, social, health system, and environmental determinants on geographic area-based disease burden. Using 2006–2008 gonorrhea surveillance data from the National Notifiable Sexually Transmitted Disease Surveillance and SDH variables from the American Community Survey, we calculated the diagnosis rate for each geographic area and analyzed the associations between those rates and the SDH and demographic variables. The estimated product moment correlation (PMC) between gonorrhea rate and SDH variables ranged from 0.11 to 0.83. Proportions of the population that were black, of minority race/ethnicity, and unmarried, were each strongly correlated with gonorrhea diagnosis rates. The population density, female proportion, and proportion below the poverty level were moderately correlated with gonorrhea diagnosis rate. To better understand relationships among SDH, demographic variables, and gonorrhea diagnosis rates, more geographic area-based estimates of additional variables are required. With the availability of more SDH variables and methods that distinguish linear from non-linear associations, geographic area-based analysis of disease incidence and SDH can add value to public health prevention and control programs.
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Affiliation(s)
- Ramal Moonesinghe
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
- Author to whom correspondence should be addressed; ; Tel.: +1-770-488-8203; Fax: +1-770-488-8336
| | - Eleanor Fleming
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
- Centers for Disease Control and Prevention, Division of Applied Sciences, Epidemic Intelligence Service, Scientific Education and Professional Development Program Office, Atlanta, GA 30333, USA
| | - Benedict I. Truman
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
| | - Hazel D. Dean
- Centers for Disease Control and Prevention, National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention, Atlanta, GA 30333, USA; (E.F.); (B.I.T.); (H.D.D.)
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Khalil NJ, Allard R. Examining the association between neighbourhood characteristics and gonorrhea rates among women aged 15 to 24 years in Montreal, Canada. CANADIAN JOURNAL OF PUBLIC HEALTH = REVUE CANADIENNE DE SANTE PUBLIQUE 2012; 103:e390-e394. [PMID: 23617995 PMCID: PMC6974076 DOI: 10.1007/bf03404448] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Revised: 07/24/2012] [Accepted: 07/18/2012] [Indexed: 06/02/2023]
Abstract
OBJECTIVE The reported incidence rate of gonorrhea has more than doubled from 2000 to 2010 in Montréal, increasing in both sexes and all age groups; however, the increase was particularly high in females aged 15 to 24 years. As the reasons for this increase among young women are not fully understood, we wanted to determine whether neighbourhood-level population characteristics were associated with incidence rates in this group, to help target intervention strategies. METHODS Incident gonorrhea cases were female residents of Montréal aged 15 to 24 years who met Québec's gonorrhea surveillance definition, with a notification date from 2002 to 2009. Adjusted incidence rate ratios (IRR) were estimated by negative binomial regression and show the change in the incidence of gonorrhea for each unit increase in neighbourhood-level independent variables, which included material and social deprivation indices (plus the latter's combination and components) and ethnic origin. In the final model, independent variables were normalized to facilitate comparison of their respective IRRs. RESULTS A total of 837 cases were reported (cumulative incidence rate 5.6 per 100,000). Higher proportions of persons of African, Aboriginal and Caribbean ethnicity were associated with higher rates of gonorrhea, even after adjustment for deprivation indices. CONCLUSION Customary methods for gonorrhea surveillance consider individual characteristics of cases as risk factors for disease. However, our results show that gonorrhea is clustered in neighbourhoods that have high proportions of three ethnic origin groups. Findings from this ecological approach suggest that although ethnicity may be strongly correlated with socio-economic status, there are factors in ethnicity that transcend poverty.
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Affiliation(s)
- Nashira J Khalil
- Canadian Field Epidemiology Program, Public Health Agency of Canada, Ottawa, ON.
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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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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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Ford JL, Browning CR. Neighborhood social disorganization and the acquisition of trichomoniasis among young adults in the United States. Am J Public Health 2011; 101:1696-703. [PMID: 21778488 DOI: 10.2105/ajph.2011.300213] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined relationships between neighborhood social disorganization and trichomoniasis among young US adults. METHODS We employed multilevel logistic regression modeling with secondary data from wave III of the National Longitudinal Study of Adolescent Health (2001-2002). The dependent variable-trichomoniasis-was measured via urine testing. The measures for neighborhood social disorganization were derived from the 2000 US Census-racial and ethnic composition, concentrated poverty, and residential instability. The sample comprised 11 370 individuals across 4912 neighborhoods. RESULTS Trichomoniasis was more likely in neighborhoods with higher concentrations of Black residents (adjusted odds ratio [AOR] = 1.16; 95% confidence interval [CI] = 1.03, 1.30). However, this association was mediated by neighborhood concentrated poverty. Furthermore, young adults who lived in neighborhoods with higher concentrations of poverty were significantly more likely to have trichomoniasis (AOR = 1.25; 95% CI = 1.07, 1.46). Neither immigrant concentration nor residential instability was significantly associated with trichomoniasis. CONCLUSIONS These findings strengthen the evidence that neighborhood structural conditions are associated with individual sexually transmitted infection (STI) acquisition. Research is needed to explore the mechanisms through which these conditions influence STI. In addition, STI-prevention programs that include structural interventions targeting neighborhood disadvantage are needed.
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Affiliation(s)
- Jodi L Ford
- College of Nursing, The Ohio State University, Columbus, 43210, USA.
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Sullivan AB, Gesink DC, Brown P, Zhou L, Kaufman JS, Fitch M, Serre ML, Miller WC. Are neighborhood sociocultural factors influencing the spatial pattern of gonorrhea in North Carolina? Ann Epidemiol 2011; 21:245-52. [PMID: 21376271 DOI: 10.1016/j.annepidem.2010.11.015] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/28/2010] [Accepted: 11/21/2010] [Indexed: 12/22/2022]
Abstract
PURPOSE To determine if the spatial pattern of gonorrhea observed for North Carolina was influenced by neighborhood-level sociocultural determinants of health, including race/ethnicity. METHODS A generalized linear mixed model with spatially correlated random effects was fit to measure the influence of socio-cultural factors on the spatial pattern of gonorrhea reported to the North Carolina State Health Department (January 1, 2005 to March 31, 2008). RESULTS Neighborhood gonorrhea rates increased as the percent single mothers increased (25th to 75th neighborhood percentile Relative Rate 1.18, 95% CI 1.12, 1.25), and decreased as socioeconomic status increased (Relative Rate 0.89, 95% CI 0.84, 0.95). Increasing numbers of men in neighborhoods with more women than men did not change the gonorrhea rate, but was associated with decreased rates in neighborhoods with more men than women. Living in the mountains was protective for all race/ethnicities. Rurality was associated with decreased rates for Blacks and increased rates for Native Americans outside the mountains. PURPOSE Neighborhood-level sociocultural factors, primarily those indicative of neighborhood deprivation, explained a significant proportion of the spatial pattern of gonorrhea in both urban and rural communities. Race/ethnicity was an important proxy for social and cultural factors not captured by measures of socioeconomic status.
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Affiliation(s)
- Ashleigh B Sullivan
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Cavanaugh CE, Floyd LJ, Penniman TV, Hulbert A, Gaydos C, Latimer WW. Examining racial/ethnic disparities in sexually transmitted diseases among recent heroin-using and cocaine-using women. J Womens Health (Larchmt) 2011; 20:197-205. [PMID: 21314446 DOI: 10.1089/jwh.2010.2140] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND This study examined racial differences in the prevalence of sexual risk behaviors and their associations with sexually transmitted diseases (STDs) among recent heroin-using and cocaine-using women. METHODS Participants were 214 women (59% black, 41% white) who were recruited during 2002-2010 using targeted sampling to participate in a study in Baltimore, Maryland, and reported using heroin, cocaine, or crack during the previous 6 months. Participants completed self-report questionnaires about their drug use, sexual risk behaviors, and lifetime history of one of six STDs, including gonorrhea, syphilis, chlamydia, genital herpes, genital warts, or trichomoniasis. RESULTS More black women (50%) than white women (28%) reported a lifetime STD. Although there were no racial differences in the lifetime prevalence of sexual risk behaviors assessed, there were racial differences in the sexual behaviors associated with ever having a lifetime STD. Simple logistic regressions revealed that ever having a casual sex partner or anal sex were correlates of having a lifetime STD among black women but not among white women. Multiple logistic regression analyses revealed that ever having a casual sex partner was significantly associated with having a lifetime STD among black women, and ever trading sex for money was significantly associated with having a lifetime STD among white women. CONCLUSIONS Findings are consistent with national studies and elucidate racial disparities in STDs and associated sexual behaviors among recent heroin-using and cocaine-using women. Findings underscore the need to tailor STD prevention interventions differently for black and white recent heroin-using and cocaine-using women.
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Springer YP, Samuel MC, Bolan G. Socioeconomic gradients in sexually transmitted diseases: a geographic information system-based analysis of poverty, race/ethnicity, and gonorrhea rates in California, 2004-2006. Am J Public Health 2010; 100:1060-7. [PMID: 20395580 DOI: 10.2105/ajph.2009.172965] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We quantified the relationship between gonorrheal infection rates in California and a measure of poverty status and investigated how this relationship and the spatial dispersion of cases varied among the 4 dominant racial/ethnic groups in the state. METHODS We geocoded gonorrhea cases reported in California between 2004 and 2006, and estimated the poverty status of each case by using the percentage of residents living below poverty in the census tract of residence. We calculated infection rates for African American, Asian, Hispanic, and White cases in each of 4 poverty strata. We mapped cases to visualize the patterns of spatial dispersion associated with each race/ethnicity-poverty combination. RESULTS There was a strong positive relationship between poverty and infection, but racial/ethnic disparities in infection, driven by a disproportionate level of gonorrhea among African Americans, eclipsed this differential. The degree of spatial aggregation varied substantially among groups and was especially pronounced for African Americans with gonorrhea in the highest poverty category. CONCLUSIONS Prevention efforts should target low-income neighborhood "hot spots" to reach the largest numbers of cases, particularly among African Americans.
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Affiliation(s)
- Yuri P Springer
- Sexually Transmitted Disease Control Branch, California Department of Public Health, Richmond, USA
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