Disparities in sexually transmitted infections among young women: Role of individ

描述（由申请人提供）：尽管在年轻女性中性传播感染（STI）存在显著且长期的种族差异，但其因果机制尚未确定。无保护的性行为、并发性行为和伴侣选择是公认的风险因素，但它们不能解释种族之间的差异。一个已知因种族而有显著差异并与性传播感染风险密切相关的因素是监禁。一个社区的高监禁率和犯罪率也与该社区较高的性传播感染流行率有关。尽管存在这些关联以及种族监禁的巨大差异，但很少有研究人员研究了个人和社区对监禁和犯罪的暴露情况，并评估这些是否可以部分解释年轻女性之间的性传播感染差异。在年轻女性中，监禁和犯罪可能直接和间接地影响性传播感染风险。与司法系统的互动可能直接影响性风险行为或物质使用的社会规范。入狱后，个人获得社会服务和有酬工作的难度可能更大。监禁破坏了现有的性伙伴关系和家庭单位，使个人或伴侣与他/她的经济和/或社会支持隔绝。在一个社区中，高监禁率的不太直接的影响可能会导致符合条件的男性数量不足，导致女性在协商使用避孕套的问题上的权力更小，或者对伴侣的性行为更宽容。前罪犯可能会改变社区社会规范并传播性传播感染，因为他们自己的性行为更危险，性传播感染负担增加。除了监禁的这些直接和间接影响外，可能导致监禁可能性的混杂的个人和社区因素也可能导致性传播感染。简而言之，尽管现有文献反复报道了监禁与性传播感染之间的联系，但迄今为止，直接、间接和混淆的机制很难梳理出来，也没有得到充分的解决。通过与司法系统和公共卫生领导人建立关系，我们的跨学科团队将把少年拘留、监禁、公共卫生和个人层面的临床数据来源联系起来，研究14至25岁年轻女性的监禁、犯罪和性传播感染。10年的纵向数据将有助于回答监禁和性传播感染之间的联系是因果关系还是混杂关系，并允许我们进一步调查监禁的具体因素——时间、持续时间、指征和再犯史——对性传播感染风险贡献最大。我们将采用地理空间方法，使用点级数据和不同程度的暴露，更深入地研究社区一级监禁的影响。由于不同的机制可能以不同的方式促进各种性传播感染的传播，我们将分别评估衣原体、淋病、梅毒和艾滋病毒。最重要的是，我们将评估与白人年轻女性相比，个人和社区层面的监禁和犯罪的差异如何导致非裔美国人之间的性传播感染差异。具体来说，我们的目标是(1)评估监禁与性传播感染（STI）之间的关联是否在监禁之前更强；(2)在考虑个人的监禁历史后，评估社区监禁和犯罪率是否与个人的性传播感染风险相关；(3)评估当考虑到个体的不同监禁率、社区监禁率和犯罪率时，少数族裔年轻女性患性传播感染的风险是否会降低。公共卫生相关性：作为拟议研究的结果，我们将更好地了解监禁、犯罪和年轻女性性传播感染（STI）之间的关系，以及它是否会导致性传播感染方面的重大种族差异。随着了解的加深，我们将能够更好地将资源用于有需要的个人和社区——在监禁期间或之前，在社区和/或通过司法系统。从公共卫生和卫生服务的角度来看，这些信息将有助于指导性传播感染治疗和预防方面的政策和针对个人的行动。

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.