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Socioeconomic Disparities in Sexually Transmitted Infections Among Young Adults in the United States: Examining the Interaction Between Income and Race/Ethnicity

Harling, Guy MA, MPH*; Subramanian, SV PhD*; Bärnighausen, Till MD/PhD, ScD†‡; Kawachi, Ichiro MD, PhD*

Sexually Transmitted Diseases: July 2013 - Volume 40 - Issue 7 - p 575–581
doi: 10.1097/OLQ.0b013e31829529cf
Original Study

Background There is considerable evidence of racial/ethnic patterning of sexually transmitted infection (STI) risk in the United States. There is also evidence that poorer persons are at increased STI risk. Evidence regarding the interaction of race/ethnicity and income is limited, particularly nationally at the individual level.

Methods We examined the pattern of socioeconomic gradients in STI infection among young people in a nationwide US study and determined how these gradients varied by race/ethnicity. We estimated the cumulative diagnosis prevalence of chlamydia, gonorrhea, or trichomoniasis (via self-report or laboratory confirmation) for young adults (ages, 18–26 years old) Hispanics and non-Hispanic whites, blacks, and others across income quintiles in the Add Health data set. We ran regression models to evaluate these relationships adjusting for individual- and school-level covariates.

Results Sexually transmitted infection diagnosis was independently associated with both racial/ethnic identity and with low income, although the racial/ethnic disparities were much larger than income-based ones. A negative gradient of STI risk with increasing income was present within all racial/ethnic categories, but was stronger for nonwhites.

Conclusions Both economic and racial/ethnic factors should be considered in deciding how to target STI prevention efforts in the United States. Particular focus may be warranted for poor, racial/ethnic minority women.

An analysis of young adults in the nationwide Add Health data set found income to be negatively associated with infection risk for gonorrhea, Chlamydia, and trichomoniasis within racial/ethnic categories. Supplemental Digital Content is available in the article.

From the Departments of *Social and Behavioral Sciences and †Global Health and Population, Harvard School of Public Health, Boston, MA; and ‡Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa

Acknowledgment: This research uses data from Add Health, a program project directed by Kathleen Mullan Harris and designed by J. Richard Udry, Peter S. Bearman, and Kathleen Mullan Harris at the University of North Carolina at Chapel Hill, and funded by Grant P01-HD31921 from the Eunice Kennedy Shriver National Institute of Child Health and Human Development, with cooperative funding from 23 other federal agencies and foundations. Special acknowledgment is due Ronald R. Rindfuss and Barbara Entwisle for assistance in the original design. Information on how to obtain the Add Health data files is available on the Add Health Web site ( No direct support was received from Grant P01-HD31921 for this analysis.

Sources of funding: T.B. is supported by Grant 1R01-HD058482-01 from the National Institutes of Health/National Institute of Child Health and Human Development, by Grant 1R01-MG083539-01 from the National Institute of Mental Health, and by the Wellcome Trust.

Conflicts of interest: The authors declare no conflicts of interest.

Correspondence: Guy Harling, MA, MPH, Department of Social and Behavioral Sciences, Harvard School of Public Health, 677 Huntington Avenue, Boston, MA. E-mail:

Received for publication November 9, 2012, and accepted April 2, 2013.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (

© Copyright 2013 American Sexually Transmitted Diseases Association