Neighborhood Social Disorganization and Acquisition of Sexually Transmitted Infection: A Life Course Approach

Background: Sexually transmitted infections (STIs) remain pervasive among U.S. young adults. Consequently, interest in the role of social contexts in shaping STI outcomes is growing, but few longitudinal studies have been conducted. The purpose of this study was to examine associations between exposure to neighborhood social disorganization during the transition from adolescence to young adulthood and young adults' STI acquisition. Methods: This study employed a longitudinal observational design using secondary data from the National Longitudinal Study of Adolescent Health (AddHealth), waves 1-3 (1994-2002). Neighborhood social disorganization was operationalized as concentrated poverty, residential instability and racial/ethnic heterogeneity. STI outcomes included urinary assay findings for Chlamydia. Multilevel modeling was conducted and focused on the simultaneous contribution of neighborhood exposures during adolescence and young adulthood on STI outcomes. Results: Approximately 6% of young adults had a positive urine test for Chlamydia. Adjusting for numerous individual (e.g. risk behavior) and neighborhood control variables, multilevel findings indicate that exposure to neighborhood concentrated poverty during adolescence was associated with an increased likelihood of a positive urine test for Chlamydia during young adulthood (AOR=1.28, 95% CI=1.11, 1.47) while exposure to neighborhood concentrated poverty during young adulthood had no significant relationship. No significant associations were found between neighborhood racial/ethnic diversity or residential instability during adolescence or young adulthood and young adults' likelihood of having a positive urine test for Chlamydia. Conclusions: Further research is needed to better understand the bio-psychosocial and behavioral pathways through which exposure to neighborhood poverty contributes to acquisition of Chlamydia over the life course.