Document Type

Dissertation

Degree

Doctor of Philosophy (PhD)

Department

Public Health

First Advisor's Name

Mary Jo Trepka

First Advisor's Committee Title

Committee chair

Second Advisor's Name

Kristopher P. Fennie

Second Advisor's Committee Title

Committee member

Third Advisor's Name

Gladys Ibañez

Third Advisor's Committee Title

Committee member

Fourth Advisor's Name

Hugh Gladwin

Fourth Advisor's Committee Title

Committee member

Keywords

Residential segregation, Sexual behavior, NSFG, Census, Non-Hispanic blacks, Sexually transmitted infections, Concurrent partnerships, Poverty

Date of Defense

6-7-2017

Abstract

Sexually transmitted infections (STIs) disproportionately impact non-Hispanic blacks in the United States. Racial differences in sexual networks can contribute to these disparities. Racial residential segregation, the separation of racial groups in a residential context, is a community factor known to influence sexual networks and has been associated with negative health outcomes. Our objective was to examine the association between racial residential segregation (henceforth, referred to as segregation), risky sexual behavior, concurrent partnerships, and STI diagnoses among non-Hispanic blacks. Demographic, sexual behavior, and STI diagnosis data for non-Hispanic blacks 15–44 years of age were obtained from the 2006–2010 National Survey of Family Growth. Segregation and community poverty data were obtained from the U.S. Census. Five distinct dimensions measured segregation, each with a representative index. Multilevel logistic regressions were conducted to test how each of the five indices were associated with risky sexual behavior, concurrent partnerships, and STI diagnoses. Risky sexual behavior results showed 16.1% (n=588) of participants engaged in risky sexual behavior. The association was stronger for the absolute centralization (adjusted odds ratio [aOR] 2.07; 95% confidence interval [CI] 2.05 – 2.08) and relative concentration indices (aOR 2.05; 95% CI 2.03 – 2.07). This suggests risky sexual behavior is most strongly associated with segregation in neighborhoods with a high density of non-Hispanic blacks and accumulation of non-Hispanic blacks in an urban core. STI diagnosis results showed 7.4% (n=305) of participants reported a STI diagnosis, and segregation was associated with STI diagnosis. The association was strongest measured with the dissimilarity index (aOR 2.41; 95% CI 2.38 – 2.43) and stronger for males. Concurrent partnerships results showed 15.6% (n=645) of participants reported concurrent partnerships. Multilevel analyses showed segregation to be associated with concurrent partnerships with the association strongest measured with the dissimilarity index. Segregation acted as a risk and a protective factor with risky sexual behavior, concurrent partnerships, and STI diagnosis, depending on the segregation measure. Additional work is needed to understand the mechanisms of how specific segregation dimensions influence risky sexual behaviors and sexually transmitted infections.

Identifier

FIDC001913

Available for download on Wednesday, July 03, 2019

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