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Background: The “broken windows” theory posits that physical neighborhood deterioration, and its association with reduced social cohesion and the breakdown of informal community controls, can lead to changes in individual behaviors. Thus individuals living in neighborhoods with high levels of deterioration may be more likely to engage in high-risk sexual behaviors.
Objectives: Evaluate the extent to which physical neighborhood deterioration increases the likelihood of engaging in risky sexual behaviors beyond that attributable to other socio-economic factors alone (both at the individual- and area-level).
Methods: Interview data on individual-level demographics and risk behaviors were captured for patients presenting to STD clinics in the Richmond, Virginia area from 2008-2010 by the Virginia Department of Health (VDH) as part of the STD Surveillance Network (SSuN) project. Area-based data on neighborhood conditions were pulled from the U.S. Census Bureau and the Richmond City Department of Community Development and used to construct a broken windows index. Preliminary analyses included an evaluation of bivariate associations between all study measures and potential confounders. Associations between our broken windows index and high-risk sexual behaviors were then assessed using multi-level logistic regression models.
Results: There were 6,472 interviews from patients residing in Richmond City available for analysis. Thirty-eight percent of patients reported multiple sex partners in the previous 3 months, and 14% reported 3 or more sex partners. Approximately 65% of males and 70% of females reported condom non-use at last sex. These behaviors varied significantly by several of the individual and area-based measures examined, including the broken windows measure.
Conclusions: Increased neighborhood deterioration was associated with increased risk of engagement in high-risk sexual behaviors.
Implications for Programs, Policy, and Research: Unlike many other social determinants of health, “broken windows” is potentially an easier factor to address. Reducing signs of physical disorder in a community may reduce social disorder and influence the behavior of individuals living in that community.