"Clap" for College: Educational Roots of STI Disparities Between Students At Community Colleges Versus 4 Year Colleges

Background:  Health disparities generally follow an educational gradient, but scholars debate whether health disparities are attributable to absolute or relative deprivation. 

Objectives:  This study tests the absolute deprivation hypothesis by evaluating the extent to which socioeconomic STI disparities are attributable to absolute sexual risk behavior.  We use 2 multivariate regressions:  conventional regression and matched sampling regression.  If the results differ substantially, absolute sexual behavior may not fully explain STI disparities.

Methods:  This study compares 2 and 4 year college students using Add Health (n=5042), with pre-college factors measured in 1995 (ages 12--18) and college enrollment and urinalysis STI diagnosis measured in 2001.  Conventional and matched sampling analysis controlled for 15 pre-college factors --- demographics, socioeconomic status, and social support --- and 2 college sexual risk-taking factors (number of partners, condom use frequency).  Matched sampling balanced students at 2 and 4 year colleges on the 17 factors.  Both conventional and matched sampling analyses estimated incidence rate ratios from a Poisson working model.

Results:  Community college students were 39% more likely to test positive for gonorrhea or chlamydia than students at 4 year colleges (IRR 1.39 (1.01, 1.92)), according to conventional regression.  After matching on 15 pre-college and 2 college factors, STI disparities were no longer significant (IRR 1.19 (0.84, 1.68)).  

Conclusions:  Students at community colleges are more vulnerable to sexually transmitted infections than would be expected from their behavior and backgrounds.

Implications for Programs, Policy, and Research:  Community college students already access STI testing at higher rates than 4 year college students.  Three-quarters of STI cases in both groups had never had an STI test before.  STI prevention programs need to target community college students to increase testing and treatment.  Future research will identify the most important mediating factors.