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

描述（由申请人提供）：虽然有显着和长期的种族差异性传播感染（STI）的年轻女性，其因果机制是不明。无保护的性行为，并发症和伴侣选择是公认的风险因素，但它们不能解释种族群体之间的差异。已知的一个因种族而显著不同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高犯罪率也与该社区的性传播感染率较高有关。尽管存在这些关联以及种族之间监禁的巨大差异，但很少有研究人员研究个人和社区一级的监禁和犯罪风险，并评估这些风险是否可以部分解释年轻女性之间的性传播感染差异。在年轻妇女中，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会直接影响性风险行为或物质使用的社会规范。在监禁之后，个人可能更难获得社会服务和有酬就业。监禁打破了现有的性伙伴关系和家庭单位，剥夺和疏远了个人或伴侣及其经济和/或社会支持。社区中高监禁率的间接影响可能导致合格男性的缺乏，导致妇女在使用避孕套方面的谈判权力减少，或对其伴侣的性行为更加容忍。前罪犯可能会改变社区的社会规范，并传播性传播感染，因为他们自己的风险更大的性行为和性传播感染的负担增加。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个人和社区因素也可能导致性传播感染的发生。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关联，但迄今为止，直接、间接和混杂的机制很难区分开来，也没有得到充分解决。通过建立与司法系统和公共卫生领导人的关系，我们的跨学科团队将在个人层面上将青少年拘留，监禁，公共卫生和临床数据来源联系起来，以研究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STI之间的关联是因果关系还是混杂因素，并使我们能够进一步调查监禁的具体因素-时间，持续时间，适应症和累犯史-对STI风险的贡献最大。我们将采用地理空间方法，更深入地研究社区一级监禁的影响，使用点级数据和不同程度的暴露。由于不同的机制可能会导致不同的性病传播不同，我们将评估衣原体，淋病，梅毒和艾滋病毒单独和组合。最重要的是，我们将评估如何在个人和社区层面的监禁和犯罪的差异可能会导致非裔美国人之间的STI差异相比，白色年轻女性。具体来说，我们的目标是（1）评估监禁和性传播感染（STI）之间的关联是否更强，当监禁在第一次STI之前;（2）评估社区监禁和犯罪率是否与个人的STI风险相关，在考虑个人的监禁历史后;以及（3）评估当考虑到个人的不同监禁率和社区监禁率和犯罪率时，少数民族年轻妇女中增加的性传播感染风险是否减少。公共卫生相关性：由于拟议的研究，我们将更好地了解监禁，犯罪和性传播感染（STI）之间的关系，以及它是否有助于性传播感染的重大种族差异。随着这种认识的提高，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.