title: County-level sexually transmitted disease detection and control in Texas: do sexually transmitted diseases and family planning clinics matter?
abstract: BACKGROUND
  Sexually transmitted disease (STD) detection and control have traditionally been performed by STD and family planning (FP) clinics. However, the magnitude of their impact (or the lack thereof) has not been examined. We examine the association between having STD and/or FP clinics and county-level STD detection and control in the state of Texas.
  
  
  METHODS
  We used county-level STD (chlamydia, gonorrhea, and primary and secondary syphilis) morbidity data from the National Electronic Telecommunications System for Surveillance for 2000 and 2007. We applied spatial regression techniques to examine the impact of the presence of STD/FP clinic(s) (included as dichotomous variables) on STD detection (i.e., morbidity) and control. We included county-level demographic characteristics as control variables.
  
  
  RESULTS
  Our results indicated that counties with STD or FP clinics were associated with at least 8% (P < 0.05) increase in the transformed chlamydia and gonorrhea rates, 20% (P < 0.01) increase in transformed syphilis rates in 2000, and at least 6% (P < 0.05) increase in transformed gonorrhea and Chlamydia rates in 2007. From 2000 to 2007, the transformed incidence rates of chlamydia declined by 4% (P < 0.10), 8% (P < 0.01) for gonorrhea, and 8% (P < 0.05) for primary and secondary syphilis for the counties that had at least 1 STD or FP clinic.
  
  
  CONCLUSIONS
  The results from this ecological study are associations and do not establish a causal relationship between having an STD/FP clinic and improved STD detection and control. Finer level analyses (such as census block or cities) may be able to provide more detail information.
authors.affiliation: Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA 30333, USA. Kowusuedusei@cdc.gov
authors.forename: Kwame
authors.initials: K
authors.lastname: Owusu-Edusei
authors.forename: Sonal R
authors.initials: SR
authors.lastname: Doshi
mesh_terms: D000293:Adolescent; D000328:Adult; D000554:Ambulatory Care Facilities; D002690:Chlamydia Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003710:Demography; D005193:Family Planning Services; D005260:Female; D006069:Gonorrhea / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006801:Humans; D008297:Male; D015233:Models, Statistical; D012923:Social Class; D013587:Syphilis / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D013781:Texas / Q000453:epidemiology; D055815:Young Adult