From the Department of Population Health, New York University School of Medicine, New York NY.
Cofrin Logan Center for Addiction Research and Treatment, Department of Psychology, University of Kansas, Lawrence, KS.
Sex Transm Dis. 2020 Sep;47(9):617-624. doi: 10.1097/OLQ.0000000000001232.
Perceived stress is linked to poor sexual and reproductive health, but its relationship with sexually transmitted infections (STIs) is less clear. The elevated burden of stress and STI among Black women suggests a need to examine racial differences in the associations on additive and multiplicative scales.
Using data from Black and White female participants from wave IV of the National Longitudinal Study of Adolescent to Adult Health (n = 4744), we examined the association of high stress (scores ≥6 on the Perceived Stress Scale-4) with self-reported past-year chlamydia diagnosis, combined curable STI, and lifetime pelvic inflammatory disease using modified Poisson regression with robust variance to estimate prevalence ratios and prevalence differences. Models included a race-stress product-interaction term and adjusted for sociodemographic variables, prior trauma and stressors, and mental health factors.
In unadjusted analyses, stress was associated with STI among Black and White women. Adjusted associations were attenuated among White women; among Black women, stress remained associated with chlamydia (adjusted prevalence ratio, 2.22; 95% confidence interval, 1.30-3.79) and curable STI (adjusted prevalence ratio, 1.59; 95% confidence interval, 1.05-2.40), corresponding to approximately 5 excess cases of each. Among White women, poverty and personality traits were the strongest confounders; among Black women, poverty, trauma, and neurotic personality traits were the strongest confounders for chlamydia, although no factors seemed to confound the association with curable STI.
Stress is independently linked to STI, particularly among Black women. Additional research with longitudinal data is needed to understand the role of stress on STI and address a significant health disparity.
感知压力与性健康和生殖健康不良有关，但与性传播感染（STI）的关系尚不清楚。黑人群体中压力和 STI 的负担加重表明，需要在附加和乘法尺度上检查种族差异的关联。
利用来自青少年到成人健康纵向研究第四波的黑人和白人女性参与者的数据（n=4744），我们使用修正泊松回归模型和稳健方差来评估感知压力量表 4 上得分≥6 的高压力与过去一年衣原体诊断、合并可治愈性 STI 和终身盆腔炎的关联，以估计患病率比和患病率差异。模型包括种族-压力乘积交互项，并调整了社会人口统计学变量、既往创伤和压力源以及心理健康因素。
在未调整的分析中，压力与黑人和白人女性的 STI 相关。在白人女性中，调整后的关联减弱；在黑人女性中，压力与衣原体（调整后的患病率比，2.22；95%置信区间，1.30-3.79）和可治愈性 STI（调整后的患病率比，1.59；95%置信区间，1.05-2.40）仍然相关，这对应于每个增加约 5 例。在白人女性中，贫困和人格特质是最强的混杂因素；在黑人女性中，贫困、创伤和神经质人格特质是衣原体的最强混杂因素，尽管没有因素似乎会混淆与可治愈性 STI 的关联。
压力与 STI 独立相关，尤其是在黑人女性中。需要使用纵向数据进行进一步研究，以了解压力对 STI 的作用，并解决这一重大健康差异。
