Thursday, March 17, 2016

Public Housing Relocations and Partnership Dynamics in Areas with High Prevalences of Sexually Transmitted Infections

We investigated the implications of one structural intervention-public housing relocations-for partnership dynamics among individuals living areas with high sexually transmitted infection (STI) prevalence. High-prevalence areas fuel STI endemicity and are perpetuated by spatially assortative partnerships.

We analyzed 7 waves of data from a cohort of black adults (n = 172) relocating from 7 public housing complexes in Atlanta, Georgia. At each wave, data on whether participants' sexual partners lived in the neighborhood were gathered via survey. Participant addresses were geocoded to census tracts, and measures of tract-level STI prevalence, socioeconomic conditions, and other attributes were created for each wave. "High-prevalence tracts" were tracts in the highest quartile of STI prevalence in Georgia. Descriptive statistics and hierarchical generalized linear models examined trajectories of spatially assortative partnerships and identified predictors of assortativity among participants in high-prevalence tracts.

All 7 tracts containing public housing complexes at baseline were high-prevalence tracts; most participants relocated to high-prevalence tracts. Spatially assortative partnerships had a U-shaped distribution: the mean percent of partners living in participants' neighborhoods at baseline was 54%; this mean declined to 28% at wave 2 and was 45% at wave 7. Participants who experienced greater postrelocation improvements in tract-level socioeconomic conditions had a lower odds of having spatially assortative partnerships (adjusted odds ratio, 1.55; 95% confidence interval [95% CI], 1.06-2.26).

Public housing relocation initiatives may disrupt high-prevalence areas if residents experience significant postrelocation gains in tract-level socioeconomic conditions.

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  • 1From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA; †Division of General Medicine, Emory University School of Medicine, Atlanta, GA; ‡Institute of Public Health at Georgia State University, Atlanta, GA; §ZevRoss Spatial Analysis, Ithaca, New York; 
  • Department of Sociomedical Sciences, Columbia University School of Public Health, New York, NY; and ∥University of North Carolina Schools of Medicine and Gillings School of Global Public Health, Chapel Hill, NC. 
  •  2016 Apr;43(4):222-30. doi: 10.1097/OLQ.0000000000000419.

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