title: Impact of public housing relocations: are changes in neighborhood conditions related to STIs among relocaters?
abstract: BACKGROUND
  Cross-sectional and ecologic studies suggest that place characteristics influence sexual behaviors and sexually transmitted infections (STIs). Using data from a predominately substance-misusing cohort of African American adults relocating from US public housing complexes, this multilevel longitudinal study tested the hypothesis that participants who experienced greater postrelocation improvements in neighborhood conditions (i.e., socioeconomic disadvantage, social disorder, STI prevalence, and male/female sex ratios) would have reduced the odds of testing positive for an STI over time.
  
  
  METHODS
  Baseline data were collected in 2009 from 172 public housing residents before relocations occurred; 3 waves of postrelocation data were collected every 9 months thereafter. Polymerase chain reaction methods were used to test participants' urine for Chlamydia trachomatis, Neisseria gonorrhoeae, and Trichomonas vaginalis. Individual-level characteristics were assessed via survey. Administrative data described the census tracts where participants lived at each wave (e.g., sex ratios, violent crime rates, and poverty rates). Hypotheses were tested using multilevel models.
  
  
  RESULTS
  Participants experienced improvements in all tract-level conditions studied and reductions in STIs over time (baseline: 29% tested STI positive; wave 4: 16% tested positive). Analyses identified a borderline statistically significant relationship between moving to tracts with more equitable sex ratios and reduced odds of testing positive for an STI (odds ratio, 0.16; 95% confidence interval, 0.02-1.01). Changes in other neighborhood conditions were not associated with this outcome.
  
  
  CONCLUSIONS
  Consonant with past research, our findings suggest that moving to areas with more equitable sex ratios reduces the risk of STI infection. Future research should study the extent to which this relationship is mediated by changes in sexual network dynamics.
authors.affiliation: From the *Departments of Behavioral Sciences and Health Education and †Biostatistics an Bioinformatics, Rollins School of Public Health at Emory University, Atlanta, GA; ‡ZevRoss Spatial Analysis, Ithaca, NY; §University of North Carolina Schools of Medicine and Gillings School of Global Public Health, Chapel Hill, NC; ¶Division of General Medicine, Emory University School of Medicine, Atlanta, GA; ∥Hubert Department of Global Health, Rollins School of Public Health at Emory University, Atlanta, GA; and **Institute of Public Health, Georgia State University, Atlanta, GA.
authors.forename: Hannah L F
authors.initials: HL
authors.lastname: Cooper
authors.forename: Danielle F
authors.initials: DF
authors.lastname: Haley
authors.forename: Sabriya
authors.initials: S
authors.lastname: Linton
authors.forename: Josalin
authors.initials: J
authors.lastname: Hunter-Jones
authors.forename: Monique
authors.initials: M
authors.lastname: Martin
authors.forename: Mary E
authors.initials: ME
authors.lastname: Kelley
authors.forename: Conny
authors.initials: C
authors.lastname: Karnes
authors.forename: Zev
authors.initials: Z
authors.lastname: Ross
authors.forename: Adaora A
authors.initials: AA
authors.lastname: Adimora
authors.forename: Carlos
authors.initials: C
authors.lastname: del Rio
authors.forename: Richard
authors.initials: R
authors.lastname: Rothenberg
authors.forename: Gina M
authors.initials: GM
authors.lastname: Wingood
authors.forename: Loida Elena
authors.initials: LE
authors.lastname: Bonney
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology / Q000706:statistics & numerical data; D002692:Chlamydia trachomatis / Q000302:isolation & purification; D003430:Cross-Sectional Studies; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D009344:Neisseria gonorrhoeae / Q000302:isolation & purification; D016017:Odds Ratio; D011203:Poverty / Q000706:statistics & numerical data*; D015995:Prevalence; D011638:Public Housing / Q000706:statistics & numerical data*; D012111:Residence Characteristics; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012749:Sexually Transmitted Diseases / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control* / Q000523:psychology; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control*; D014246:Trichomonas vaginalis / Q000302:isolation & purification; D014754:Violence / Q000706:statistics & numerical data*