College of Nursing, Ohio State University, 320 Newton Hall/1585 Neil Ave, Columbus, OH, 43210, USA,
J Urban Health. 2014 Feb;91(1):136-50. doi: 10.1007/s11524-013-9792-0.
Adolescents and young adults have the highest rates of sexually transmitted infections (STIs) in the USA despite national priority goals targeting their reduction. Research on the role of neighborhoods in shaping STI risk among youth has increased in recent years, but few studies have explored the longitudinal effects of neighborhoods on STI acquisition during the adolescent to young adult transition. The aims of this study were to examine: (1) the longitudinal relationships between the neighborhood context (poverty, residential instability, and racial/ethnic concentration) of exposure during adolescence and young adults' acquisition of chlamydia, and (2) the extent to which sexual risk behaviors and depression over the transition from adolescence to young adulthood mediate the relationship between the neighborhood context of exposure during adolescence and young adults' acquisition of chlamydia. A longitudinal observational design was employed using data from the National Longitudinal Study of Adolescent Health (Add Health), waves 1-3 (1994-2002). The sample was composed of 11,460 young adults aged 18 to 27 years. Neighborhood measures during adolescence were derived from the 1990 US Census appended to adolescents' interview data. Chlamydia infection was measured via urine assay at wave 3 and 4.6 % of the young adults in the sample tested positive for chlamydia. Multilevel logistic regression analyses were conducted adjusting for numerous neighborhood and individual risk factors. Multivariate findings indicated exposure to neighborhood poverty during adolescence increased the likelihood of a positive urine test for chlamydia during young adulthood (AOR = 1.23, 95 % CI = 1.06, 1.42), and the association was not mediated by sexual risk behaviors or depression. Further research is needed to better understand the pathways through which exposure to neighborhood poverty contributes to chlamydia over the life course as are comprehensive STI prevention strategies addressing neighborhood poverty.
青少年和年轻人是美国性传播感染（STI）发病率最高的人群，尽管国家有优先目标针对他们的感染率进行降低。近年来，关于邻里环境在塑造年轻人中的 STI 风险方面的研究有所增加，但很少有研究探讨邻里环境对青少年到成年早期过渡期间 STI 获得的纵向影响。本研究旨在探讨：（1）青少年时期暴露于邻里环境（贫困、居住不稳定和种族/民族集中）的纵向关系与年轻人获得衣原体感染之间的关系，以及（2）从青少年到成年早期的过渡期间，性风险行为和抑郁对暴露于邻里环境与年轻人获得衣原体感染之间关系的中介作用。本研究采用纵向观察设计，使用国家青少年健康纵向研究（Add Health）的 1-3 波数据（1994-2002 年）。样本由 11460 名年龄在 18 至 27 岁的年轻人组成。青少年时期的邻里环境测量值来源于 1990 年美国人口普查附加到青少年访谈数据中。在第 3 波和第 4 波通过尿液检测衣原体感染。在样本中，有 4.6%的年轻人检测出衣原体感染呈阳性。在调整了大量邻里和个体风险因素后，进行了多水平逻辑回归分析。多变量分析结果表明，青少年时期暴露于邻里贫困会增加成年早期衣原体尿液检测呈阳性的可能性（OR = 1.23，95%CI = 1.06，1.42），并且这种关联不受性风险行为或抑郁的影响。需要进一步研究以更好地理解暴露于邻里贫困对整个生命过程中衣原体感染的影响途径，以及解决邻里贫困的全面性传播感染预防策略。
