DESCRIPTION (provided by applicant): Although there are significant and longstanding racial disparities in sexually transmitted infections (STI) among young women, their causal mechanisms are unidentified. Unprotected sex, concurrency, and partner choice are well established risk factors, but they do not account for the differences between racial groups. One factor known to differ significantly by race and correlate strongly with STI risk is incarceration. High rates of incarceration and crime in a community have also been associated with higher STI prevalence in that community. Despite these associations and the dramatic differences in incarceration by race, few researchers have studied both individual- and community-level exposure to incarceration and crime and assessed whether these may partially explain STI disparities among young women. Among young women, incarceration and crime may influence STI risk both directly and indirectly. Interaction with the justice system may directly influence sexual risk behavior or substance use social norms. Following incarceration, an individual may have greater difficulty obtaining social services and gainful employment. Incarceration breaks up existing sexual partnerships and family units, removing and distancing the individual or partner and his/her economic and/or social support. Less direct effects of high incarceration rates in a community may lead to a paucity of eligible males, contributing to women having less power to negotiate condom use or being more tolerant of her partner's concurrency. Ex-offenders may change community social norms and transmit STIs as a result of their own riskier sexual behaviors and increased STI burden. In addition to these direct and indirect effects of incarceration, the confounding individual and community factors which may contribute to the likelihood of incarceration may also contribute to STI acquisition. In short, although the existing literature has repeatedly reported associations between incarceration and STIs, the direct, indirect, and confounding mechanisms have been difficult to tease apart and inadequately addressed to date. By building on relationships with justice system and public health leaders, our interdisciplinary team will link juvenile detention, incarceration, public health and clinical data sources at an individual-level to study incarceration, crime and STIs among young women 14 to 25 years old. The 10-year longitudinal data will help answer whether the association between incarceration and STI is causal or confounding and allow us to investigate further which specific factors of incarceration - timing, duration, indication, and recidivism history - contribute most to STI risk. We will employ geospatial methodologies to examine the effects of community-level incarceration in more depth, using point-level data and different extents of exposure. As different mechanisms may contribute to the spread of various STI differently, we will evaluate Chlamydia, gonorrhea, syphilis, and HIV independently and in combination. Most importantly, we will evaluate how differences in individual- and community-level incarceration and crime may contribute to STI disparities among African American compared to white young women. Specifically, we aim to (1) assess whether the association between incarceration and sexually transmitted infections (STI) is stronger when incarceration precedes first STI;(2) assess whether community incarceration and crime rates are associated with an individual's risk of STI, after accounting for an individual's incarceration history;and (3) assess whether increased risk of STI among minority young women is diminished when accounting for an individual's differential incarceration rate and exposure to community incarceration and crime rates. PUBLIC HEALTH RELEVANCE: As a result of the proposed research, we will better understand the relationship between incarceration, crime and sexually transmitted infection (STI) among young women and whether it contributes to significant racial disparities in STI. With this increased understanding, we will be better able to target resources to individuals and communities in need -during or preceding incarceration, in the community and/or through the justice system. From a public health and health services perspective, this information will aid in guiding policy and individually-targeted action in STI treatment and prevention.
|Effective start/end date||9/22/09 → 6/30/13|
- National Institutes of Health: $199,525.00
- National Institutes of Health: $166,174.00
- Immunology and Microbiology(all)