{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T11:04:24Z","timestamp":1785236664959,"version":"3.55.0"},"reference-count":28,"publisher":"Oxford University Press (OUP)","issue":"7","license":[{"start":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T00:00:00Z","timestamp":1689206400000},"content-version":"vor","delay-in-days":12,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Sexually transmitted infections (STIs) are increasing in the United States, and certain populations are more at risk than others. One explanation for this is inequities in underlying social determinants of health (SDOH).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We analyzed chlamydia, gonorrhea, and syphilis cases in Durham County, North Carolina, from 01\/01\/2020 to 12\/31\/2020 by select SDOH at the census tract level. We included 48 variables of interest, including variables related to income, education, transportation, and health insurance. For each variable, we modeled STI incidence at the census tract level using Poisson regression. Wald's chi-square was used to determine which variables were significantly associated with STI incidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Of 24 variables that were statistically associated with STI incidence at the census tract level, 9 were negatively associated and 15 positively associated with STI incidence. Having employer health insurance was most strongly associated with lower-than-expected STI incidence, and having Medicaid insurance, no health insurance, using public transportation, and income below the poverty level were most strongly associated with higher-than-expected STI incidence. Lastly, STI incidence was not associated with race or ethnicity overall across Durham County, except in historically marginalized areas, where we found higher-than-expected STI incidence.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>We found that lacking health insurance, having Medicaid insurance, using public transportation, and income below the poverty level were most strongly associated with higher-than-expected STI incidence. Strategies to combat increasing STIs may include improving access to health insurance, reducing barriers to cost-effective and timely transportation to medical appointments, and raising wages to bring individuals out of poverty.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ofid\/ofad368","type":"journal-article","created":{"date-parts":[[2023,7,13]],"date-time":"2023-07-13T11:24:17Z","timestamp":1689247457000},"source":"Crossref","is-referenced-by-count":8,"title":["Relationship Between Sexually Transmitted Infections and Social Determinants of Health in Durham County, North Carolina, United States"],"prefix":"10.1093","volume":"10","author":[{"given":"Jeffrey D","family":"Jenks","sequence":"first","affiliation":[{"name":"Durham County Department of Public Health , Durham, North Carolina , USA"},{"name":"Division of Infectious Diseases, Department of Medicine, Duke University , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Emma","family":"Nipp","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina Chapel Hill , Chapel Hill, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ananya","family":"Tadikonda","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina Chapel Hill , Chapel Hill, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nishitha","family":"Karumuri","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina Chapel Hill , Chapel Hill, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristie","family":"Morales-Lagunes","sequence":"additional","affiliation":[{"name":"Gillings School of Global Public Health, University of North Carolina Chapel Hill , Chapel Hill, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Savannah","family":"Carrico","sequence":"additional","affiliation":[{"name":"Durham County Department of Public Health , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marissa","family":"Mortiboy","sequence":"additional","affiliation":[{"name":"Durham County Department of Public Health , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John-Paul","family":"Zitta","sequence":"additional","affiliation":[{"name":"Durham County Department of Public Health , Durham, North Carolina , USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2023,7,13]]},"reference":[{"key":"2023072709374401200_ofad368-B1","article-title":"Centers for Disease Control and Prevention. Sexually transmitted disease surveillance 2021"},{"key":"2023072709374401200_ofad368-B2","article-title":"Centers for Disease Control and Prevention. National overview of STDs, 2021"},{"key":"2023072709374401200_ofad368-B3","article-title":"United States Census Bureau. QuickFacts Durham County, North Carolina"},{"key":"2023072709374401200_ofad368-B4","article-title":"Centers for Disease Control and Prevention. Minority health: racism and health"},{"key":"2023072709374401200_ofad368-B5","doi-asserted-by":"crossref","first-page":"2083","DOI":"10.1097\/QAD.0b013e3282e9a64b","article-title":"Explaining disparities in HIV infection among Black and White men who have sex with men: a meta-analysis of HIV risk behaviors","volume":"21","author":"Millett","year":"2007","journal-title":"Aids"},{"key":"2023072709374401200_ofad368-B6","doi-asserted-by":"crossref","first-page":"250","DOI":"10.1097\/00007435-199905000-00003","article-title":"Racial\/ethnic group differences in the prevalence of sexually transmitted diseases in the United States: a network explanation","volume":"26","author":"Laumann","year":"1999","journal-title":"Sex Transm Dis"},{"key":"2023072709374401200_ofad368-B7","doi-asserted-by":"crossref","first-page":"1297","DOI":"10.2105\/AJPH.82.9.1297","article-title":"Subpopulation differentials in STD transmission","volume":"82","author":"Seidman","year":"1992","journal-title":"Am J Public Health"},{"key":"2023072709374401200_ofad368-B8","article-title":"World Health Organization. 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