title: Childhood lead exposure and sexually transmitted infections: New evidence.
abstract: BACKGROUND
  The adverse health effects of lead exposure in children are well documented and include intellectual and behavioral maladies. Childhood lead exposure has also been linked to impulsive behaviors, which, in turn, are associated with a host of negative health outcomes including an increased risk for sexually transmitted infections (STI). The purpose of this study was to assess the association of lead exposure with STI rates across census tracts in St. Louis City, Missouri.
  
  
  METHODS
  Incident cases of gonorrhea and chlamydia (GC) during 2011 were identified from the Missouri Department of Health and Senior Services and aggregated by census tract. We also geocoded the home address of 59,645 children >72 months in age who had blood lead level tests performed in St. Louis City from 1996 to 2007. Traditional regression and Bayesian spatial models were used to determine the relationship between GC and lead exposure while accounting for confounders (condom and alcohol availability, crime, and an index of concentrated disadvantage).
  
  
  RESULTS
  Incident GC rates were found to cluster across census tracts (Moran's I=0.13, p=0.006). After accounting for confounders and their spatial dependence, a linear relationship existed between lead exposure and GC incidence across census tracts, with higher GC rates occurring in the northern part of St. Louis City
  
  
  CONCLUSIONS
  At the census-tract level, higher lead exposure is associated with higher STI rates. Visualizing these patterns through maps may help deliver targeted interventions to reduce geographic disparities in GC rates.
authors.affiliation: Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA. Electronic address: nelsonej@slu.edu.
authors.forename: Erik J
authors.initials: EJ
authors.lastname: Nelson
authors.affiliation: Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA.
authors.forename: Enbal
authors.initials: E
authors.lastname: Shacham
authors.affiliation: Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA; School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA. Electronic address: bboutwell@slu.edu.
authors.forename: Brian B
authors.initials: BB
authors.lastname: Boutwell
authors.affiliation: Department of Criminology and Criminal Justice, University of Missouri-St. Louis, One University Blvd., St. Louis, MO 6312, USA. Electronic address: richard_rosenfeld@umsl.edu.
authors.forename: Richard
authors.initials: R
authors.lastname: Rosenfeld
authors.affiliation: Department of Epidemiology, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA.
authors.forename: Mario
authors.initials: M
authors.lastname: Schootman
authors.affiliation: School of Social Work, College for Public Health & Social Justice, Saint Louis University, 3550 Lindell Boulevard, St. Louis, MO 63103-1021, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Vaughn
authors.affiliation: Department of Environmental and Occupational Health, College for Public Health & Social Justice, Saint Louis University, 3545 Lafayette Avenue, St. Louis, MO 63104-1399, USA. Electronic address: lewisrd@slu.edu.
authors.forename: Roger
authors.initials: R
authors.lastname: Lewis
mesh_terms: D019352:Censuses; D002648:Child; D002690:Chlamydia Infections / Q000097:blood / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D003415:Crime / Q000706:statistics & numerical data; D004785:Environmental Pollutants / Q000009:adverse effects / Q000097:blood*; D006069:Gonorrhea / Q000097:blood / Q000453:epidemiology* / Q000523:psychology / Q000635:transmission; D006801:Humans; D007175:Impulsive Behavior / Q000187:drug effects*; D015994:Incidence; D007854:Lead / Q000009:adverse effects / Q000097:blood*; D008923:Missouri / Q000453:epidemiology; D012959:Socioeconomic Factors
chemical_list: D004785:Environmental Pollutants; D007854:Lead
keywords: Chlamydia; Gonorrhea; Impulsive behavior; Lead exposure; Spatial analysis