{"id":873,"date":"2013-06-19T15:36:03","date_gmt":"2013-06-19T15:36:03","guid":{"rendered":"https:\/\/blogs.bmj.com\/sti\/?p=873"},"modified":"2013-06-17T21:42:50","modified_gmt":"2013-06-17T21:42:50","slug":"how-does-neighbourhood-impact-on-sti-chlamydia-risk","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/sti\/2013\/06\/19\/how-does-neighbourhood-impact-on-sti-chlamydia-risk\/","title":{"rendered":"How does neighbourhood impact on STI (Chlamydia) risk?"},"content":{"rendered":"<p>The influence of neighbourhood on STI (and more particularly Chlamydia) acquisition is widely recognized fact.\u00a0 Biello &amp; Nikkolai argue for UK urban populations that neighbourhood socio-economic status (SES) is more closely correlated with Chlamydia risk than individual SES (<a href=\"http:\/\/sti.bmj.com\/content\/87\/7\/560.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7\">http:\/\/sti.bmj.com\/content\/87\/7\/560.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7<\/a>).\u00a0 In another UK study (Birmingham), Shahmanesh &amp; Ross find residence in neighbourhoods having certain SES characteristics to be\u00a0 strongly predictive of both Chlamydia and Gonorrhoea (<a href=\"http:\/\/sti.bmj.com\/content\/76\/4\/268.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7\">http:\/\/sti.bmj.com\/content\/76\/4\/268.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7<\/a>).<\/p>\n<p>But what is it exactly about these neighbourhoods that places their residents at far greater risk of STI acquisition than other neighbourhoods?\u00a0 Is it, as some sociologists have proposed, the general level of social disorganization that heightens the risk, or is it poverty itself, or maybe the degree of residential instability?\u00a0 Ford &amp; Browning, in a recent study using data on a sample of 11,460 young adults from the US National Longitudinal Study of Adolescent Health, waves 1 and 3 (1994-2002), attempt to establish the pathway whereby neighbourhood influences the risk of acquiring Chlamydia (<a href=\"http:\/\/link.springer.com\/article\/10.1007%2Fs11524-013-9792-0\">http:\/\/link.springer.com\/article\/10.1007%2Fs11524-013-9792-0<\/a>).<\/p>\n<p>The nature of the data allows the researchers to capture the association of Chlamydia acquisition amongst young people in their twenties, not only to various characteristics of their current neighbourhoods (i.e. at wave 3 of the study), but also the characteristics of those neighbourhoods in which they accomplished their transition into adulthood some years before (i.e. at wave 1).\u00a0 The main finding of Ford &amp; Browning is that characteristics of the current\u00a0neighbourhood show no statistically significant correlation with Chlamydia acquisition, but characteristics of neighbourhoods at the time of adolescence \u2013 especially\u00a0 \u201cpoverty\u201d (on different models OR 1.23 &amp; 1.25 respectively) \u2013 do show a correlation.\u00a0 The obvious explanation is that these associations are mediated through individual variables such as sexual behaviour or psychological factors (e.g. depression).\u00a0 Yet multi-variate findingsdid not confirm this mediation.<\/p>\n<p>So what potential mechanisms are there for the influence of neighbourhood on STI acquisition?\u00a0 While stressing the need for further research, the authors point principally to two.\u00a0 The first of these is a \u201cnetwork\u201d explanation.\u00a0 Maybe neighbourhood of residence during adolescence could influence opportunities for future partner selection;\u00a0 young adults who lived in an impoverished neighbourhood during adolescence may have a pool of higher risk sexual partners to choose from compared to their peers from more advantaged neighbourhoods.\u00a0 The other interesting possibility is the influence of chronic stress associated with adverse neighbourhood conditions resulting in impaired immune system function and increased infectious disease risk through increased inflammation and cortisol secretion.<\/p>\n<p>Either way, structural factors that are largely refractory even to the most ambitious public health interventions.\u00a0 I am reminded of Wilkinson and Picket\u2019s argument in <i>The Spirit Level<\/i> (<a href=\"http:\/\/www.amazon.com\/The-Spirit-Level-Equality-Societies\/dp\/1608193411\">http:\/\/www.amazon.com\/The-Spirit-Level-Equality-Societies\/dp\/1608193411<\/a>): the determinants of health outcomes are effectively located at a level that is presumably beyond of the reach of any but the most radical (indeed revolutionary) political interventions.\u00a0 \u201cThe poor you will always with you.\u201d\u00a0 At the same time, sociological explanations of this kind provide justification for careful targeting of public health resources on needy populations and help us counter the &#8220;inverse care&#8221; law.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The influence of neighbourhood on STI (and more particularly Chlamydia) acquisition is widely recognized fact.\u00a0 Biello &amp; Nikkolai argue for UK urban populations that neighbourhood socio-economic status (SES) is more closely correlated with Chlamydia risk than individual SES (http:\/\/sti.bmj.com\/content\/87\/7\/560.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7).\u00a0 In another UK study (Birmingham), Shahmanesh &amp; Ross find residence in neighbourhoods having certain SES characteristics [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/06\/19\/how-does-neighbourhood-impact-on-sti-chlamydia-risk\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":152,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2792,151,2793],"tags":[4376],"class_list":["post-873","post","type-post","status-publish","format-standard","hentry","category-chlamydia","category-epidemiology","category-social-inequality","tag-social-inequality"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.5 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>How does neighbourhood impact on STI (Chlamydia) risk? - Sexually Transmitted Infections<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/sti\/2013\/06\/19\/how-does-neighbourhood-impact-on-sti-chlamydia-risk\/\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"How does neighbourhood impact on STI (Chlamydia) risk? - Sexually Transmitted Infections\" \/>\n<meta property=\"og:description\" content=\"The influence of neighbourhood on STI (and more particularly Chlamydia) acquisition is widely recognized fact.\u00a0 Biello &amp; Nikkolai argue for UK urban populations that neighbourhood socio-economic status (SES) is more closely correlated with Chlamydia risk than individual SES (http:\/\/sti.bmj.com\/content\/87\/7\/560.abstract?sid=88b6a7a5-11c9-472d-bd9a-39664d4142b7).\u00a0 In another UK study (Birmingham), Shahmanesh &amp; Ross find residence in neighbourhoods having certain SES characteristics [...]Read More...\" \/>\n<meta property=\"og:url\" content=\"https:\/\/blogs.bmj.com\/sti\/2013\/06\/19\/how-does-neighbourhood-impact-on-sti-chlamydia-risk\/\" \/>\n<meta property=\"og:site_name\" content=\"Sexually Transmitted Infections\" \/>\n<meta property=\"article:published_time\" 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