LB.1 Area-Level Community Factors Associated with Chlamydia and Gonorrhea Among Female Adolescents, San Francisco, 2010

Wednesday, March 14, 2012: 4:00 PM
Regency
Juliet Stoltey, MD, University of California, San Francisco, San Francisco Department of Public Health, STD Prevention and Control Services, San Francisco, CA, Kyle Bernstein, PhD, ScM, STD Prevention and Control Services Program, San Francisco Department of Public Health, San Francisco, CA and Susan S. Philip, MD, MPH, STD Prevention and Control Services, San Francisco Department of Public Health, San Francisco, CA

Background: Adolescents bear a disproportionate burden of STDs in San Francisco.  The role of community-level factors that modify this risk is poorly understood.

Objectives: We conducted an area-level ecological analysis by census tract exploring which social determinants were associated with female adolescent chlamydia and gonorrhea rates in San Francisco in 2010.

Methods: Chlamydia and gonorrhea cases reported to the San Francisco Department of Public Health in 2010 were geocoded to census tract, and tract-specific morbidity rates were calculated.  American Community Survey 2005-2009 estimates provided the following tract-specific proportions of households/populations that were: female-headed, vacant, renter-occupied, spending >=30% income on rent, occupied by >1 person per room, receiving public assistance, receiving food stamps, African-American, unemployed, did not complete high school, and below poverty level.  Incarceration estimates, homicides, and graffiti complaints from 2010 were also geocoded.  Multivariable linear regression models explored associations between these community-level factors and STD rates among female adolescents.

Results: Among females under age 25 in San Francisco in 2010, 1,085 chlamydia and 143 gonorrhea cases were geocoded to 176 census tracts.  The tract-specific rate of chlamydia was positively associated with incarceration (p<0.0005), proportion of population that is African-American (p=0.001), proportion of households receiving food stamps (p=0.035), and inversely associated with proportions of population below poverty level (p=0.005) and vacant households (p<0.0005).  Gonorrhea rates were positively associated with incarceration (p<0.0005), proportions unemployed (p=0.009) and receiving food stamps (p<0.0005), and inversely associated with proportions of population below poverty level (p=0.039), less than high school education (p=0.030), vacant households (p=0.013), and female-headed households (p=0.015).

Conclusions: This ecologic analysis suggests an important role of area-level factors.  Further study of the relationship between individual and community-level factors of STDs is warranted.

Implications for Programs, Policy, and Research: Individual-level risk factors alone may not explain the excess risk of STDs that adolescents bear.