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

The study's objective was to determine "the associations of ecosocial factors and psychosocial factors with having a prevalent sexually transmitted infection (STI), recent STI diagnoses, and sexual risk behaviors."

Ecosocial, psychosocial, behavior and STI-history data on 14,322 young adults ages 18-27 were drawn from the National Longitudinal Study of Adolescent Health. Chlamydia trachomatis and Neisseria gonorrhoeae were detected in urine by ligase chain reaction, and Trichomonas vaginalis, human papillomavirus, and Mycoplasma genitalium were detected by polymerase chain reaction.

Prevalent STI was associated with housing insecurity (adjusted odds ratio [AOR]=1.3, 95 percent confidence interval [CI]=1.00, 1.72), exposure to crime (AOR=1.4; 95 percent CI=1.02, 1.80), and previous arrest (AOR=1.4; 95 percent CI=1.07, 1.84). STI prevalence increased linearly from 4.9 percent for zero factors to 14.6 percent for four or more (p<.001, for trend). Almost all contextual conditions predicted more lifetime partners and earlier sexual debut. After adjusting for sexual risk behaviors, the authors found that childhood sexual abuse, gang participation, frequent alcohol use, and depression were associated with recent STI diagnosis.

"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," the investigators concluded.

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