The Relationship between Neighborhood Factors, Depression, and STD Incidence among African American Adolescents

Background:
Young African American women have been disproportionately affected by STDs in recent decades. Numerous risk factors for STD acquisition have been well documented. Specifically, depressive symptoms, even at moderate levels, are associated with STD prevalence among adolescent girls. Research also suggests that poor neighborhood conditions relate to sexual risk taking and STD acquisition.

Objective:
To explain the association between self-reported neighborhood perceptions, depressive symptoms, and STD incidence in a sample of high risk African American adolescent females enrolled in an HIV prevention intervention.

Method:
African American female adolescents (N=715) aged 15-21 years, recruited from 3 public STD clinics, enrolled and completed baseline assessment prior to randomization. Assessment included an ACASI interview, which included depression (CES-D) and neighborhood quality measures, and a self-collected vaginal swab for gonorrhea, chlamydia, and trichomonas.

Result:
Adolescents from poor quality neighborhoods were more likely to have depressive symptoms in the clinically significant range (57% vs. 48%, Chi square = 5.62, p = .018). Moreover, adolescents with clinically significant levels of depressive symptoms were more likely to test positive for an STD at baseline (32% vs. 25%, Chi square = 3.92, p = .048). However, the association between depressive symptoms and STD incidence was only significant for adolescents residing in non-poor quality neighborhoods. Specifically, adolescents residing in non-poor quality neighborhoods with clinically significant levels of depressive symptoms were more likely to test positive for an STD at baseline than those without significant depressive symptoms (57% vs. 43% respectively, Chi square = 5.67, p = .017).

Conclusion:
Although depressive symptoms were highly prevalent among adolescents residing in each neighborhood type, depression was only significantly associated with STD incidence for adolescents who did not perceive their neighborhood as poor quality.

Implications:
Preventive interventions should consider both mental health and environmental factors as possible barriers to STD prevention.