Moving upstream: Ecosocial and psychosocial correlates of sexually transmitted infections among young adults in the United States

Objectives. We determined the associations of ecosocial factors and psychosocial factors with having a prevalent sexually transmitted infection (STI), recent STI diagnoses, and sexual risk behaviors. Methods. Young adults aged 18 to 27 years in the National Longitudinal Study of Adolescent Health (n = 14322) provided ecosocial, psychosocial, behavioral, and STI-history data. Urine was tested for Chlamydia trachomatis and Neisseria gonorrhoeae by ligase chain reaction and for Trichomonas vaginalis, human papillomavirus, and Mycoplasma genitalium by polymerase chain reaction. Results. Prevalent STI was associated with housing insecurity (adjusted odds ratio [AOR] = 1.3; 95% confidence interval [CI] = 1.00, 1.72), exposure to crime (AOR = 1.4; 95% CI = 1.02,1:80), and having been arrested (AOR = 1.4; 95% Cl = 1.07, 1.84). STI prevalence increased linearly from 4.9% for 0 factors to 14.6% for 4 or more (P <.001, for trend). Nearly all contextual conditions predicted more lifetime partners and earlier sexual debut. Recent STI diagnosis was associated with childhood sexual abuse, gang participation, frequent alcohol use, and depression, adjusted for sexual risk behaviors. Conclusions. Often present before sexual debut, contextual conditions enhance STI risk by increasing sexual risk behaviors and likelihood of exposure to infection. These findings suggest that upstream conditions such as housing and safety contribute to the burden of STIs and are appropriate targets for future intervention.