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Determining Profiles of Risk for Sexually Transmitted Infections in Young Adults
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Sexually transmitted infections (STI) disproportionately affect adolescents, young adults, women and racial/ethnic minorities, leading to significant reproductive morbidities. Young minority women in the US are also at increased risk for unintended pregnancies, which coupled with STIs, can lead to serious complications in mothers and infants. Prevention of STIs in young minority women is greatly needed in order to improve reproductive and pregnancy health. However, interventions to reduce STIs in young minority women have had limited effectiveness. Furthermore, screening young women for chlamydia and gonorrhea is recommended but uptake is suboptimal. Syndemic theory hypothesizes that diseases co-occur and interact with other social afflictions to increase the risk of STIs. However, population-based studies on STI syndemics have not been conducted and statistical techniques are limited in determining how risk factors interact. In pregnant women, associations between STIs and perinatal outcomes are inconsistent but few studies have examined the effect of maternal factors such as age in adverse outcomes. This dissertation examined two statistical approaches to measure syndemics in a nationally representative sample of US young adults, and determined sex and race/ethnic specific profiles for STI risk. This dissertation also determined if perinatal outcomes following STIs are influenced by maternal age in minority women. The first study compared composite scoring and latent class analysis (LCA) to identify syndemic profiles in men and women using the National Health and Nutrition Examination Survey from 2011-2014. LCA identified different STI risk profiles that composite scoring alone could not. Women with increased odds of STI (AOR: 2.19 CI 95% 1.2-3.8) exhibited a syndemic of depression, substance use and sexual risk behaviors that composite scoring was unable to uncover. The second study, using the same dataset, applied LCA to determine race/ethnic specific STI risk profiles. Interestingly, Black females displayed more co-occurring risk factors (syndemic), despite lower sexual behavior risks compared to other women. The third study, examined a population of primarily minority pregnant women to determine if associations between Chlamydia trachomatis and perinatal outcomes are influenced by maternal age (a factor that influences screening). In young women (age <25), chlamydia was associated with medically indicated preterm birth (RRadj=2.25 95% CI 1.35-3.77). In older women (age > 25), no associations with preterm birth subtypes were found, but C. trachomatis was marginally associated with term preeclampsia (RRadj=1.49 CI 95%0.91-2.45). Further stratifications by race/ethnicity revealed an increased risk in chlamydia associated medically indicated preterm birth among white women, and preeclampsia among Black women. Modeling syndemics by sex and race identified risk profiles that can be utilized to develop culturally competent, targeted interventions to reduce STIs among minorities. Findings from the prenatal study suggest maternal age could influence outcomes following infection that may inform prenatal STI screening recommendations.
Hill, Ashley Victoria (2019). Determining Profiles of Risk for Sexually Transmitted Infections in Young Adults. Doctoral dissertation, Texas A & M University. Available electronically from