Exploring the Social Determinants of Sexually Transmitted Disease and High-Risk Sexual Behaviors

摘要: EXPLORING THE SOCIAL DETERMINATNS OF SEXUALLY TRANSMITTED DISEASE AND HIGH-RISK SEXUAL BEHAVIORS Abstract 1 – A multi-level assessment of disproportionate population sex ratios and high-risk sexual behaviors among STD clinic patients 2 neighborhood vacancy rates 3 Residential segregation gonorrhea in U.S. metropolitan statistical areas1 areas By River A. Pugsley, MPH dissertation submitted partial fulfillment the requirements for degree Doctor Philosophy at Virginia Commonwealth University. University, 2012 Director: Kate L. Lapane Professor Chair Department Epidemiology Community Health 1: patients1: Low male-to-female a may influence behaviors, such as multiple partners inconsistent condom use, which facilitate transmission STDs. This study used modeling to assess whether were associated with these two individual-level behaviors. All analyses stratified by gender. Interview data collected from (N = 9,203, 48% male) attending participating clinics. Interviews included information on socio-demographics behavior, including number previous months use last sex. The ratio per census tract was obtained Census Bureau. There no association between or either men women. That is, we found evidence that shortage tracts increased engagement behavior. 2: patients2: “broken windows” theory posits physical deterioration, its reduced social cohesion, can lead changes individual Thus individuals living neighborhoods high levels deterioration be more likely engage evaluate extent residential likelihood having partners. data, patient demographics 6,347, 52% clinics Richmond, area 2008-2010. Neighborhood Fifty-one percent 36% women reported months. Men who lived slightly report (53.9%) compared low (49.7%). In models, there (OR 0.98; 95% CI: 0.79, 1.20) (1.18; 0.99, 1.42). measured rates, risk patients. 3: areas3: black populations, often economic disadvantage status, play crucial role observed racial inequities rates. An ecological analysis 2005-2009 average performed across 277 (MSAs). isolation index Gini income inequality proxy measures respectively, derived estimates. We logistic regression produce estimates odds (OR) confidence intervals (CI) index, both independently combination, MSAs. Effect measure modification assessed calculating relative excess due interaction (RERI) indices. Compared MSAs segregation, had (adjusted OR 5.54; 2.29-13.44). Adjustment potential confounders did not noticeably impact relationship gonorrhea, higher predicting 2.47; 1.21-5.03). combined stronger than inequality-based segregation; additivity multiplicative interaction. race equality key component perpetuation other STDs populations