"Broken windows" and the risk of gonorrhea.
OBJECTIVE
We examined the relationships between neighborhood conditions and gonorrhea.


METHODS
We assessed 55 block groups by rating housing and street conditions. We mapped all cases of gonorrhea between 1994 and 1996 and calculated aggregated case rates by block group. We obtained public school inspection reports and assigned findings to the block groups served by the neighborhood schools. A "broken windows" index measured housing quality, abandoned cars, graffiti, trash, and public school deterioration. Using data from the 1990 census and 1995 updates, we determined the association between "broken windows," demographic characteristics, and gonorrhea rates.


RESULTS
The broken windows index explained more of the variance in gonorrhea rates than did a poverty index measuring income, unemployment, and low education. In high-poverty neighborhoods, block groups with high broken windows scores had significantly higher gonorrhea rates than block groups with low broken windows scores (46.6 per 1000 vs 25.8 per 1000; P < .001).


CONCLUSIONS
The robust association of deteriorated physical conditions of local neighborhoods with gonorrhea rates, independent of poverty, merits an intervention trial to test whether the environment has a causal role in influencing high-risk sexual behaviors.
Cohen
D
D
Louisiana State University Medical Center, New Orleans 70112, USA. dcohen@lsumc.edu
Spear
S
S
Scribner
R
R
Kissinger
P
P
Mason
K
K
Wildgen
J
J
D000704:Analysis of Variance; D015981:Epidemiologic Factors; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology*; D015438:Health Behavior; D006801:Humans; D008145:Louisiana / Q000453:epidemiology; D008297:Male; D011204:Poverty Areas; D012111:Residence Characteristics; D012959:Socioeconomic Factors; D014504:Urban Health