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Racial Disparities in STIs Among Adolescents in the USA

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Sexually Transmitted Infections in Adolescence and Young Adulthood

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Abstract

Adolescents, particularly females, young people of color, and those with lower socioeconomic status (SES), are disproportionately affected by sexual transmitted infections (STIs) in the USA. Gender and socioeconomic disparities in STIs are often more easily explained, but several alternative hypotheses have been posited in attempt to explain racial disparities in STIs in the USA. In this chapter, we will present five prominent hypotheses including (1) differences in sexual risk behaviors, (2) differences in STI risk among sexual networks, (3) SES-related inequities disproportionately experienced by minorities that reduce access/care, (4) SES/racial inequities that indirectly increase STIs through a psychosocial/behavioral mechanism, and (5) SES/racial inequities that directly increase STI susceptibility through biological stress regulatory systems. We conclude with considerations for healthcare providers in the context of sexual health services for racial minority adolescents including STI testing and treatment.

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References

  1. Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2015. Atlanta: U.S. Department of Health and Human Services; 2016.

    Google Scholar 

  2. Cuffe KM, Newton-Levinson A, Gift TL, McFarlane M, Leichliter JS. Sexually transmitted infection testing among adolescents and young adults in the United States. J Adolesc Health. 2016;58(5):512–9.

    PubMed  Google Scholar 

  3. Forhan SE, Gottlieb SL, Sternberg MR, Xu F, Datta SD, McQuillan GM, Berman SM, Markowitz LE. Prevalence of sexually transmitted infections among female adolescents aged 14 to 19 in the United States. Pediatrics. 2009;124(6):1505–12. https://doi.org/10.1542/peds.2009-0674.

    Article  PubMed  Google Scholar 

  4. Sales JM, Brown JL, DiClemente RJ, Latham TP, Kottke MJ, Rose E. Age differences in STDs, sexual behaviors, and correlates of risky sexual behavior among sexually experienced adolescent African-American females. J Pediatr Psychol. 2012;37(1):33–42.

    PubMed  Google Scholar 

  5. Shirtcliff E. Biological underpinnings of adolescent development. In: DiClemente R, Santelli JS, Crosby RA, editors. Adolescent health: understanding and preventing risk behaviors. Hoboken: Jossey-Bass; 2009.

    Google Scholar 

  6. Giedd JN. The teen brain: insights from neuroimaging. J Adolesc Health. 2008;42:335–43.

    PubMed  Google Scholar 

  7. Steinberg L. A social neuroscience perspective on adolescent risk-taking. Dev Rev. 2008;28(1):78–106.

    PubMed  PubMed Central  Google Scholar 

  8. Zuckerman M. Sensation seeking: beyond the optimal level of arousal. Hillsdale: Earlbaum; 1979.

    Google Scholar 

  9. Berman SM, Hein K. Adolescents and STDs. In: Holmes KK, Sparling P, Mardh P, editors. Sexually transmitted diseases. New York: McGraw-Hill; 2008. p. 129–42.

    Google Scholar 

  10. Eng TR, Butler WT. The hidden epidemic: confronting sexually transmitted diseases. Washington DC: National Academies Press; 1997.

    Google Scholar 

  11. Venkatesh KK, Cu-Uvin S. Assessing the relationship between cervical ectopy and HIV susceptibility: implications for HIV prevention in women. Am J Reprod Immunol. 2013;69:68–73.

    PubMed  Google Scholar 

  12. Kleppa E, Holmen SD, Lillebø K, Kjetland EF, Gundersen SG, Taylor M, Moodley P, Onsrud M. Cervical ectopy: associations with sexually transmitted infections and HIV. A cross-sectional study of high school students in rural South Africa. Sexually transmitted infections 2014:sextrans-2014-051674.

    Google Scholar 

  13. Hallfors DD, Iritani BJ, Miller WC, Bauer DJ. Sexual and drug behavior patterns and HIV and STD racial disparities: the need for new directions. Am J Public Health. 2007;97:125–32.

    PubMed  PubMed Central  Google Scholar 

  14. Bunnell RE, Dahlberg L, Rolfs R, Ransom R, Gershman K, Farshy C, Newhall WJ, Schmid S, Stone K, St Louis M. High prevalence and incidence of sexually transmitted diseases in urban adolescent females despite moderate risk behaviors. J Infect Dis. 1999;180(5):1624–31.

    CAS  PubMed  Google Scholar 

  15. Adimora AA, Schoenbach VJ, Doherty IA. HIV and African-Americans in the southern United States: sexual networks and social context. Sex Transm Dis. 2006;33:S39–45.

    PubMed  Google Scholar 

  16. Farley TA. Sexually transmitted diseases in the southeastern United States: location, race, and social context. Sex Transm Dis. 2006;33:S58–64.

    PubMed  Google Scholar 

  17. Laumann EO, Youm Y. Racial/ethnic group differences in the prevalence of sexually transmitted diseases in the US: a network explanation. Sex Transm Dis. 1999;26(5):250–61.

    CAS  PubMed  Google Scholar 

  18. Newman LM, Berman SM. Epidemiology of STD disparities in African American communities. Sex Transm Dis. 2008;35(12 Suppl):S4–12.

    PubMed  Google Scholar 

  19. Krieger N, Williams DR, Moss N. Measuring social class in us public health research: concepts, methodologies, and guidelines. Annu Rev Public Health. 1997;18(2):341–78.

    CAS  PubMed  Google Scholar 

  20. Dressler WW, Oths KS, Gravlee CC. Race and ethnicity in public health research: models to explain health disparities. Annu Rev Anthropol. 2005;34:231–52. https://doi.org/10.1146/annurev.anthro.34.081804.120505.

    Article  Google Scholar 

  21. Centers for Disease Control and Prevention. Health disparities and inequalities report – United States 2013. MMWR. 2013;62(Suppl 3):1–189.

    Google Scholar 

  22. Strickland J, Strickland DL. Barriers to preventive health services for minority households in the rural south. J Rural Health. 1996;12(3):206–17.

    CAS  PubMed  Google Scholar 

  23. Hock-Long L, Herceg-Baron R, Cassidy AM, Whittaker PG. Access to adolescent reproductive health services: financial and structural barriers to care. Perspect Sex Reprod Health. 2003;35(3):144.

    PubMed  Google Scholar 

  24. Latkin CA, German D, Vlahov D, Galea S. Neighborhoods and HIV: a social ecological approach to prevention and care. Am Psychol. 2013;68(4):210.

    PubMed  PubMed Central  Google Scholar 

  25. Nguyen TQ, Ford CA, Kaufman JS, Leone PA, Suchindran C, Miller WC. Infrequent chlamydial testing among young adults: financial and regional differences. Sex Transm Dis. 2008;35(8):725.

    PubMed  Google Scholar 

  26. Geisler WM, Chyu L, Kusunoki Y, Upchurch DM, Hook EW 3rd. Health insurance coverage, health care-seeking behaviors, and genital chlamydial infection prevalence in sexually active young adults. Sex Transm Dis. 2006;33(6):389.

    PubMed  Google Scholar 

  27. Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005;191(Suppl 1):S115.

    PubMed  Google Scholar 

  28. Cohen DA, Mason K, Bedimo A, Scribner R, Basolo V, Farley TA. Neighborhood physical conditions and health. Am J Public Health. 2003;93(3):467.

    PubMed  PubMed Central  Google Scholar 

  29. Tilson EC, Sanchez V, Ford CL, et al. Barriers to asymptomatic screening and other STD services for adolescents and young adults: focus group discussions. BMC Public Health. 2004;4(1):21.

    PubMed  PubMed Central  Google Scholar 

  30. Lindberg C, Lewis-Spruill C, Crownover R. Barriers to sexual and reproductive health care: urban male adolescents speak out. Issues Compr Pediatr Nurs. 2006;29(2):73–88.

    PubMed  Google Scholar 

  31. Barrow RY, Berkel C, Brooks LC, Groseclose SL, Johnson DB, Valentine JA. Traditional sexually transmitted disease prevention and control strategies: tailoring for African American communities. Sex Transm Dis. 2008;35(12):S30–9.

    PubMed  PubMed Central  Google Scholar 

  32. Brown ER, Ojeda VD, Wyn R, Levan R. Racial and ethnic disparities in access to health insurance and health care. UCLA Center for Health Policy Research. UCLA: UCLA Center for Health Policy Research; 2000. Retrieved from: https://escholarship.org/uc/item/4sf0p1st

  33. Ozturk OD, McDermott S, Mann JR, Hardin JW, Royer JA, Ouyang L. Disparities in health care utilization by race among teenagers and young adults with muscular dystrophy. Med Care. 2014;52(10 0 3):S32–9. https://doi.org/10.1097/MLR.0000000000000194.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Parrish DD, Kent CK. Access to care issues for African American communities: implications for STD disparities. Sex Transm Dis. 2008;35(12):S19–22.

    PubMed  Google Scholar 

  35. Hogben M, Leichliter JS. Social determinants and sexually transmitted disease disparities. Sex Transm Dis. 2008;35(12):S13–8.

    PubMed  Google Scholar 

  36. Valentine JA. Impact of attitudes and beliefs regarding African American sexual behavior on STD prevention and control in African American communities: unintended consequences. Sex Transm Dis. 2008;35(12):S23–9.

    PubMed  Google Scholar 

  37. Fortenberry JD. Health care seeking behaviors related to sexually transmitted diseases among adolescents. Am J Public Health. 1997;87(3):417–20.

    CAS  PubMed  PubMed Central  Google Scholar 

  38. Fortenberry JD, McFarlane M, Bleakley A, et al. Relationships of stigma and shame to gonorrhea and HIV screening. Am J Public Health. 2002;92(3):378–81.

    PubMed  PubMed Central  Google Scholar 

  39. Seth P, Sales JM, DiClemente RJ, et al. Longitudinal examination of alcohol use: a predictor of risky sexual behavior and trichomonas vaginalis among African-American adolescents. Sex Transm Dis. 2011;38:96–101.

    PubMed  Google Scholar 

  40. Seth P, Patel S, Sales JM, et al. The impact of depressive symptomatology on risky sexual practices and psychosocial mediators of HIV/STI-associated sexual risk behaviors among African-American female adolescents. Psychol Health Med. 2011;16(3):346–56.

    PubMed  PubMed Central  Google Scholar 

  41. Evans GW, Kim P. Childhood poverty, chronic stress, self-regulation, and coping. Child Dev Perspect. 2013;7:43.

    Google Scholar 

  42. Bradley RH, Corwyn RF. Socioeconomic status and child development. Annu Rev Psychol. 2002;53:371.

    PubMed  Google Scholar 

  43. Conger RD, Donnellan MB. An interactionist perspective on the socioeconomic context of human development. Annu Rev Psychol. 2007;58:175.

    PubMed  Google Scholar 

  44. Grant KE, Compas BE, Stuhlmacher AF, Thurm AE, McMahon SD, Halpert JA. Stressors and child and adolescent psychopathology: moving from markers to mechanisms of risk. Psychol Bull. 2003;129:447.

    PubMed  Google Scholar 

  45. Sampson RJ, Raudenbush SW, Earls F. Neighborhoods and violent crime: a multilevel study of collective efficacy. Science. 1997;277:918–24.

    CAS  Google Scholar 

  46. Drake B, Pandey S. Understanding the relationship between neighborhood poverty and specific types of child maltreatment. Child Abuse Negl. 1996;20:1003–18.

    CAS  PubMed  Google Scholar 

  47. Cunradi CB, Caetano R, Clark C, Schafer J. Neighborhood poverty as a predictor of intimate partner violence among White, Black, and Hispanic couples in the United States: a multilevel analysis. Ann Epidemiol. 2000;10:297–308.

    CAS  PubMed  Google Scholar 

  48. Sales JM, Brown JL, Swartzendruber AL, Smearman EL, Brody GH, DiClemente R. Genetic sensitivity to emotional cues, racial discrimination and depressive symptoms among African-American adolescent females. Front Psychol. 2015;6:854.

    PubMed  PubMed Central  Google Scholar 

  49. Sales JM, DiClemente RJ, Brody GH, Philibert RA, Rose E. Interaction between 5-HTTLPR polymorphism and abuse history on adolescent African-American females’ condom use behavior following participation in an HIV prevention intervention. Prev Sci. 2014;15:257.

    PubMed  PubMed Central  Google Scholar 

  50. Sales JM, Salazar LF, Wingood GM, DiClemente RJ, Rose E, Crosby RA. The mediating role of partner communication skills on HIV/STD-associated risk behaviors in young African American females with a history of sexual violence. Arch Pediatr Adolesc Med. 2008;162:432.

    PubMed  Google Scholar 

  51. Sales JM, Smearman EL, Brown JL, Brody GH, Philibert RA, Rose E, DiClemente RJ. Associations between a dopamine D4 receptor gene, alcohol use, and sexual behaviors among female adolescent African Americans. J HIV AIDS Soc Serv. 2015;14:136.

    PubMed  PubMed Central  Google Scholar 

  52. Sales JM, Smearman EL, Swartzendruber A, Brown JL, Brody G, DiClemente RJ. Socioeconomic-related risk and sexually transmitted infection among African-American adolescent females. J Adolesc Health. 2014;55:698.

    PubMed  PubMed Central  Google Scholar 

  53. Swartzendruber A, Brown JL, Sales JM, Murray CC, DiClemente RJ. Sexually transmitted infections, sexual risk behavior, and intimate partner violence among African American adolescent females with a male sex partner recently released from incarceration. J Adolesc Health. 2012;51:156.

    PubMed  PubMed Central  Google Scholar 

  54. Swartzendruber A, Sales JM, Brown JL, Davis TL, DiClemente RJ, Rose E. Predictors of repeat chlamydia trachomatis and/or Neisseria gonorrhoeae infections among African-American adolescent women. Sex Transm Infect. 2013;89:76.

    PubMed  Google Scholar 

  55. Swartzendruber A, Sales JM, Brown JL, Diclemente RJ, Rose ES. Correlates of incident trichomonas vaginalis infections among African American female adolescents. Sex Transm Dis. 2014;41:240.

    PubMed  PubMed Central  Google Scholar 

  56. Swartzendruber A, Sales JM, Brown JL, RJ DC, Rose ES. Comparison of substance use typologies as predictors of sexual risk outcomes in African American adolescent females. Arch Sex Behav. 2016;45(1):63–72.

    PubMed  Google Scholar 

  57. Swartzendruber A, Zenilman JM, Niccolai LM, Kershaw TS, Brown JL, Diclemente RJ, Sales JM. It takes 2: partner attributes associated with sexually transmitted infections among adolescents. Sex Transm Dis. 2013;40:372.

    PubMed  PubMed Central  Google Scholar 

  58. Browning CR, Olinger-Wilbon M. Neighborhood structure, social organization, and number of short-term sexual partnerships. J Marriage Fam. 2003;65:730.

    Google Scholar 

  59. Cubbin C, Brindis CD, Jain S, Santelli J, Braveman P. Neighborhood poverty, aspirations and expectations, and initiation of sex. J Adolesc Health. 2010;47:399.

    PubMed  Google Scholar 

  60. Browning CR, Burrington LA, Leventhal T, Brooks-Gunn J. Neighborhood structural inequality, collective efficacy, and sexual risk behavior among urban youth. J Health Soc Behav. 2008;49:269.

    PubMed  PubMed Central  Google Scholar 

  61. Browning CR, Leventhal T, Brooks-Gunn J. Neighborhood context and racial differences in early adolescent sexual activity. Demography. 2004;41:697.

    PubMed  Google Scholar 

  62. Aneshensel CS, Sucoff CA. The neighborhood context of adolescent mental health. J Health Soc Behav. 1996;37:293.

    CAS  PubMed  Google Scholar 

  63. Dupere V, Leventhal T, Lacourse E. Neighborhood poverty and suicidal thoughts and attempts in late adolescence. Psychol Med. 2009;39:1295.

    CAS  PubMed  Google Scholar 

  64. Ford JL, Rechel M. Parental perceptions of the neighborhood context and adolescent depression. Public Health Nurs. 2012;29:390.

    PubMed  Google Scholar 

  65. Khan MR, Kaufman JS, Pence BW, Gaynes BN, Adimora AA, Weir SS, Miller WC. Depression, sexually transmitted infection, and sexual risk behavior among young adults in the United States. Arch Pediatr Adolesc Med. 2009;163:644.

    PubMed  PubMed Central  Google Scholar 

  66. Brawner BM, Gomes MM, Jemmott LS, Deatrick JA, Coleman CL. Clinical depression and HIV risk-related sexual behaviors among African-American adolescent females: unmasking the numbers. AIDS Care. 2012;24:618.

    CAS  PubMed  PubMed Central  Google Scholar 

  67. Wickrama T, Merten MJ, Wickrama KAS. Early socioeconomic disadvantage and young adult sexual health. Am J Health Behav. 2012;36(6):834–48. https://doi.org/10.5993/AJHB.36.6.10.

    Article  PubMed  Google Scholar 

  68. McEwen BS. Sex, stress and the hippocampus: allostasis, allostatic load and the aging process. Neurobiol Aging. 2002;23:921–39. https://doi.org/10.1016/S0197-4580(02)00027-1.

    Article  CAS  PubMed  Google Scholar 

  69. McEwen BS. The neurobiology of stress: from serendipity to clinical relevance. Brain Res. 2000;886:172–89.

    CAS  PubMed  Google Scholar 

  70. Shonkoff JP, Boyce WT, McEwen BS. Neuroscience, molecular biology, and the childhood roots of health disparities: building a new framework for health promotion and disease prevention. JAMA. 2005;301:2252–9. https://doi.org/10.1001/jama.2009.754.

    Article  Google Scholar 

  71. Seeman TE, McEwen BS, Rowe JW, Singer BH. Allostatic load as a marker of cumulative biological risk: McArthur studies of successful aging. Proc Natl Acad Sci U S A. 2001;98:4770–5.

    CAS  PubMed  PubMed Central  Google Scholar 

  72. Lu MC, Halfon N. Racial and ethnic disparities in birth outcomes: a life-course perspective. Matern Child Health J. 2003;7(1):13–30.

    PubMed  Google Scholar 

  73. Doyle WJ, Gentile DA, Cohen S. Emotional style, nasal cytokines, and illness expression after experimental rhinovirus exposure. Brain Behav Immun. 2006;20:175–81.

    CAS  PubMed  Google Scholar 

  74. Leserman J. Role of depression, stress, and trauma in HIV disease progression. Psychosom Med. 2008;70:539–45.

    PubMed  Google Scholar 

  75. Rai B, Kaur J, Anand SC, Jacobs R. Salivary stress markers, stress, and periodontitis: a pilot study. J Periodontol. 2011;82(2):287–92.

    PubMed  Google Scholar 

  76. Culhane JF, Rauh VA, Goldenberg RL. Stress, bacterial vaginosis, and the role of immune processes. Curr Infect Dis Rep. 2006;8:459–64.

    PubMed  Google Scholar 

  77. Burchell AN, Calzavara LM, Myers T, et al. Stress and increased HIV infection risk among gay and bisexual men. AIDS. 2010;24(11):1757–64. https://doi.org/10.1097/QAD.0b013e32833af7c9.

    Article  PubMed  Google Scholar 

  78. Nansel TR, Riggs MA, Yu KF, et al. The association of psychosocial stress and bacterial vaginosis in a longitudinal cohort. Am J Obstet Gynecol. 2006;194:381–6.

    PubMed  PubMed Central  Google Scholar 

  79. Goldenberg RL, Klebanoff MA, Nugent R, et al. Bacterial colonization of the vagina during pregnancy in four ethnic groups. Vaginal Infections and Prematurity Study Group. Am J Obstet Gynecol. 1996;174:1618–21.

    CAS  PubMed  Google Scholar 

  80. Culhane JF, Rauh V, McCollum KF, Elo IT, Hogan V. Exposure to chronic stress and ethnic differences in rates of bacterial vaginosis among pregnant women. Am J Obstet Gynecol. 2002;187(5):1272–6.

    PubMed  Google Scholar 

  81. Allsworth JE, Peipert JF. Severity of bacterial vaginosis and the risk of sexually transmitted infection. Am J Obstet Gynecol. 2011;205:113–e1.

    PubMed  PubMed Central  Google Scholar 

  82. Culhane JF, Rauh V, McCollum KF, Hogan VK, Agnew K, Wadhwa PD. Maternal stress is associated with bacterial vaginosis in human pregnancy. Matern Child Health J. 2001;5(2):127–34.

    CAS  PubMed  Google Scholar 

  83. Cohen S, Frank E, Doyle WJ, Skoner DP, Rabin BS, Gwaltney JM Jr. Types of stressors that increase susceptibility to the common cold in healthy adults. Health Psychol. 1998;17(3):214–23.

    CAS  PubMed  Google Scholar 

  84. Cohen S, Janicki-Deverts DL, Miller GE. Psychological stress and disease. J Am Med Assoc. 2007;298:1685–7.

    CAS  Google Scholar 

  85. Cohen S, Janicki-Deverts D, Turner RB, Marsland AL, Casselbrant ML, Li-Korotky HS, et al. Childhood socioeconomic status, telomere length, and susceptibility to upper respiratory infection. Brain Behav Immun. 2013;34:31–8.

    CAS  PubMed  Google Scholar 

  86. Cohen S, Tyrrell DA, Smith AP. Psychological stress and susceptibility to the common cold. N Engl J Med. 1991;325(9):606–12.

    CAS  PubMed  Google Scholar 

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Acknowledgments

The first author was supported in part by P30DA027827and through the Emory Center for AIDS Research (P30 AI050409). The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute on Drug Abuse or National Institutes of Health.

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Authors and Affiliations

  1. Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA

    Jessica M. Sales & Anna Newton-Levinson

  2. Department of Epidemiology and Biostatistics, College of Public Health, University of Georgia, Athens, GA, USA

    Andrea L. Swartzendruber

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  1. Jessica M. Sales
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  2. Anna Newton-Levinson
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  3. Andrea L. Swartzendruber
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Correspondence to Jessica M. Sales .

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  1. Hubert Department of Global Health, Rollins School of Public Health Emory University, Atlanta, GA, USA

    Sophia A. Hussen

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Sales, J.M., Newton-Levinson, A., Swartzendruber, A.L. (2020). Racial Disparities in STIs Among Adolescents in the USA. In: Hussen, S. (eds) Sexually Transmitted Infections in Adolescence and Young Adulthood. Springer, Cham. https://doi.org/10.1007/978-3-030-20491-4_3

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