title: American Indians, substance use, and sexual behavior: do predictors of sexually transmitted infections explain the race gap among young adults?
abstract: BACKGROUND
  In this study, we examined whether substance use and risky sexual behaviors predicted sexually transmitted infections (STIs) among American Indian (AI) and white young adults. Furthermore, we explored whether these factors explained the race disparity in STIs.
  
  
  METHODS
  We conducted a cross-sectional analysis of wave 3 of the National Longitudinal Study of Adolescent Health collected in 2001 to 2002. Young adult participants (aged 18-26 years) provided urine specimens that were tested for chlamydia, gonorrhea, and trichomoniasis infection. Estimates of the association between AI with any STI were adjusted for sexual and other risk behavior correlates using multivariate regression techniques.
  
  
  RESULTS
  Nine percent of AIs (n = 367) and 3.6% of whites (n = 7813) tested positive for an STI. Race differences were found for substance use (injection drug use, 3.1% AI vs. 1.3% white; alcohol use frequency, 2.01% AI vs. 2.5% white; binge drinking frequency, 1.25% AI vs. 1.53% white). Among sexually active respondents, AIs were more likely to have paid for sex (9%) than whites (3%). After adjustment, early sexual initiation (adjusted odds ratio, 1.69; 95% confidence interval, 1.19-2.41), no condom use at last sex (adjusted odds ratio, 1.47; 95% confidence interval, 1.08-2.01), and AI race (adjusted odds ratio, 2.45; 95% confidence interval 1.46-4.11) were significantly associated with having an STI.
  
  
  CONCLUSIONS
  Individual-level sexual and other risk behaviors do not fully explain disparities in STIs among AIs compared with white young adults. Further examination of network and community factors is needed to explain these disparities.
authors.affiliation: From the Montana State University, Bozeman, MT.
authors.forename: David
authors.initials: D
authors.lastname: Eitle
authors.forename: Kaylin
authors.initials: K
authors.lastname: Greene
authors.forename: Tamela McNulty
authors.initials: TM
authors.lastname: Eitle
mesh_terms: D000328:Adult; D001294:Attitude to Health / Q000208:ethnology*; D003430:Cross-Sectional Studies; D005260:Female; D054624:Health Status Disparities; D006801:Humans; D007198:Indians, North American / Q000706:statistics & numerical data*; D008297:Male; D016017:Odds Ratio; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data*; D012747:Sexual Partners / Q000523:psychology; D012749:Sexually Transmitted Diseases / Q000453:epidemiology* / Q000523:psychology; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000453:epidemiology*; D044465:White People / Q000706:statistics & numerical data*