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AJPH First Look, published online ahead of print Apr 29, 2008
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AJPH.2007.120451v1
98/6/1128    most recent
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June 2008, Vol 98, No. 6 | American Journal of Public Health 1128-1136
© 2008 American Public Health Association
DOI: 10.2105/AJPH.2007.120451

RESEARCH AND PRACTICE

Moving Upstream: Ecosocial and Psychosocial Correlates of Sexually Transmitted Infections Among Young Adults in the United States

Anne L. Buffardi, MSW, Kathy K. Thomas, MS, King K. Holmes, MD, PhD and Lisa E. Manhart, PhD, MPH

The authors are with the Center for AIDS and STDs, University of Washington, Seattle.

Correspondence: Requests for reprints should be sent to Lisa E. Manhart, PhD, MPH, UW Center for AIDS and STD, 325 9th Ave, Box 359931, Seattle, WA 98104-2499 (e-mail: lmanhart{at}u.washington.edu).

Objectives. We determined the associations of ecosocial factors and psychosocial factors with having a prevalent sexually transmitted infection (STI), recent STI diagnoses, and sexual risk behaviors.

Methods. Young adults aged 18 to 27 years in the National Longitudinal Study of Adolescent Health (n=14322) provided ecosocial, psychosocial, behavioral, and STI-history data. Urine was tested for Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction and for Trichomonas vaginalis, human papillomavirus, and Mycoplasma genitalium by polymerase chain reaction.

Results. Prevalent STI was associated with housing insecurity (adjusted odds ratio [AOR] = 1.3; 95% confidence interval [CI] = 1.00, 1.72), exposure to crime (AOR=1.4; 95% CI=1.02, 1.80), and having been arrested (AOR=1.4; 95% CI=1.07, 1.84). STI prevalence increased linearly from 4.9% for 0 factors to 14.6% for 4 or more (P< .001, for trend). Nearly all contextual conditions predicted more lifetime partners and earlier sexual debut. Recent STI diagnosis was associated with childhood sexual abuse, gang participation, frequent alcohol use, and depression, adjusted for sexual risk behaviors.

Conclusions. Often present before sexual debut, contextual conditions enhance STI risk by increasing sexual risk behaviors and likelihood of exposure to infection. These findings suggest that upstream conditions such as housing and safety contribute to the burden of STIs and are appropriate targets for future intervention.






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