Journal of Urban Health

, Volume 87, Issue 2, pp 225–235 | Cite as

Neighborhood Socioeconomic Environment and Sexual Network Position

  • Caroline M. Fichtenberg
  • Jacky M. Jennings
  • Thomas A. Glass
  • Jonathan M. Ellen


Rates of sexually transmitted infections (STIs) are strongly associated with neighborhood poverty; however, the mechanisms responsible for this association remain unclear. Using a population-based study of sexual networks among urban African American adolescents, we tested the hypothesis that poverty, unemployment, and the sex ratio drive STI rates by affecting sexual network structure. Participants were categorized as being in one of three network positions that had previously been found to be strongly linked to infection with chlamydia and gonorrhea: being in a confirmed dyad (i.e., a monogamous pair), being connected to a larger network through one partner, and being in the center of a larger network. We found that only poverty was statistically significantly associated with sexual network position. Residing in the poorest third of neighborhoods was associated with 85% decreased odds of being in confirmed dyads. There was no association of sexual network position with neighborhood employment. Living in a neighborhood with an unequal number of young men and women appeared to be associated with a higher likelihood of being in a confirmed dyad; however, the differences were not statistically significant. These results suggest that poverty may impact STI rates by shaping sexual network structure, but we did not find any evidence that this association operates through unemployment or the sex ratio.


Sexually transmitted infections Sexual networks African American Socioeconomic status 



C.M. Fichtenberg designed and conducted the analysis and wrote the manuscript; J.M. Jennings and T.A. Glass helped design the analysis and interpret findings; J.M. Ellen conceived and conducted the Bayview Networks Study and helped design the analysis and interpret findings. All co-authors reviewed drafts of the manuscript.


  1. 1.
    Cohen D, Spear S, Scribner R, Kissinger P, Mason K, Wildgen J. “Broken windows” and the risk of gonorrhea. Am J Public Health. 2000; 90(2): 230–236.CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    Ellen JM, Kohn RP, Bolan GA, Shiboski S, Krieger N. Socioeconomic differences in sexually transmitted disease rates among black and white adolescents, San Francisco, 1990 to 1992. Am J Public Health. 1995; 85(11): 1546–1548.CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Rice RJ, Roberts PL, Handsfield HH, Holmes KK. Sociodemographic distribution of gonorrhea incidence: implications for prevention and behavioral research. Am J Public Health. 1991; 81(10): 1252–1258.CrossRefPubMedPubMedCentralGoogle Scholar
  4. 4.
    Rothenberg RB. The geography of gonorrhea. Empirical demonstration of core group transmission. Am J Epidemiol. 1983; 117(6): 688–694.CrossRefPubMedGoogle Scholar
  5. 5.
    Holtgrave DR, Crosby RA. Social capital, poverty, and income inequality as predictors of gonorrhoea, syphilis, chlamydia and AIDS case rates in the United States. Sex Transm Infect. 2003; 79(1): 62–64.CrossRefPubMedPubMedCentralGoogle Scholar
  6. 6.
    Thomas JC, Gaffield ME. Social structure, race, and gonorrhea rates in the southeastern United States. Ethn Dis. 2003; 13(3): 362–368.PubMedGoogle Scholar
  7. 7.
    Kilmarx PH, Zaidi AA, Thomas JC, et al. Sociodemographic factors and the variation in syphilis rates among US counties, 1984 through 1993: an ecological analysis. Am J Public Health. 1997; 87(12): 1937–1943.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Crosby RA, Holtgrave DR, DiClemente RJ, Wingood GM, Gayle JA. Social capital as a predictor of adolescents’ sexual risk behavior: a state-level exploratory study. AIDS Behav. 2003; 7(3): 245–252.CrossRefPubMedGoogle Scholar
  9. 9.
    Massey DS, Denton NA. American Apartheid: Segregation and the making of the underclass. Cambridge: Harvard University Press; 1993.Google Scholar
  10. 10.
    Wilson W. The truly disadvantaged: The inner city, the underclass, and public policy. Chicago: University of Chicago Press; 1987.Google Scholar
  11. 11.
    Wilson W. When work disappears: The world of the new urban poor. New York: Knopf; 1996.Google Scholar
  12. 12.
    Andrinopoulos K, Kerrigan D, Ellen JM. Psycho-social factors that influence sex partner selection among urban male and female African-American adolescents. J Adolesc Health. 2004; 34(2): 125.CrossRefGoogle Scholar
  13. 13.
    Brewster KL. Neighborhood context and the transition to sexual activity among young black women. Demography. 1994; 31(4): 603–614.CrossRefPubMedGoogle Scholar
  14. 14.
    Adimora AA, Schoenbach VJ, Bonas DM, Martinson FE, Donaldson KH, Stancil TR. Concurrent sexual partnerships among women in the United States. Epidemiology. 2002; 13(3): 320–327.CrossRefPubMedGoogle Scholar
  15. 15.
    Adimora A, Schoenbach V. Contextual factors and the Black-White disparity in Heterosexual HIV transmission. Epidemiology. 2002; 13(6): 707–712.CrossRefPubMedGoogle Scholar
  16. 16.
    Ghani AC, Swinton J, Garnett GP. The role of sexual partnership networks in the epidemiology of gonorrhea. Sex Transm Dis. 1997; 24(1): 45–56.CrossRefPubMedGoogle Scholar
  17. 17.
    Fichtenberg CM, Muth SQ, Brown B, Padian NS, Glass TA, Ellen JM. Sexual network position and risk of sexually transmitted infections. Sex Transm Infect. 2009; 85(7): 493–498.CrossRefPubMedGoogle Scholar
  18. 18.
    Krieger N, Chen JT, Waterman PD, Rehkopf DH, Subramanian SV. Race/ethnicity, gender, and monitoring socioeconomic gradients in health: a comparison of area-based socioeconomic measures–the public health disparities geocoding project. Am J Public Health. 2003; 93(10): 1655–1671.CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Krieger N, Waterman PD, Chen JT, Soobader MJ, Subramanian SV. Monitoring socioeconomic inequalities in sexually transmitted infections, tuberculosis, and violence: geocoding and choice of area-based socioeconomic measures—the public health disparities geocoding project (US). Public Health Rep. 2003; 118(3): 240–260.PubMedPubMedCentralGoogle Scholar
  20. 20.
    Chamlin M, Cochran J. Unemployment, economic theory, and property crime: a note on measurement. J Quant Criminol. 2000; 16(4): 443–455.CrossRefGoogle Scholar
  21. 21.
    Laumann EO, Gagnon JH, Michael RT, Michaud JM. The social organization of sexuality: Sexual practices in the United States. Chicago: The University of Chicago Press; 1994.Google Scholar
  22. 22.
    White H. Maximum-likelihood estimation of mis-specified models. Econometrica. 1982; 50: 1–25.CrossRefGoogle Scholar
  23. 23.
    Royall R. Model robust confidence-intervals using maximum-likelihood estimators. Int Stat Rev. 1986; 54: 221–226.CrossRefGoogle Scholar
  24. 24.
    Cubbin C, Santelli J, Brindis CD, Braveman P. Neighborhood context and sexual behaviors among adolescents: findings from the national longitudinal study of adolescent health. Perspect Sex Reprod Health. 2005; 37(3): 125–134.CrossRefPubMedGoogle Scholar
  25. 25.
    Oakes JM. The (mis)estimation of neighborhood effects: causal inference for a practicable social epidemiology. Soc Sci Med. 2004; 58(10): 1929–1952.CrossRefPubMedGoogle Scholar
  26. 26.
    Drumright LN, Gorbach PM, Holmes KK. Do people really know their sex partners? Concurrency, knowledge of partner behavior, and sexually transmitted infections within partnerships. Sex Transm Dis. 2004; 31(7): 437–442.CrossRefPubMedGoogle Scholar
  27. 27.
    Lenoir CD, Adler NE, Borzekowski DL, Tschann JM, Ellen JM. What you don’t know can hurt you: perceptions of sex-partner concurrency and partner-reported behavior. J Adolesc Health. 2006; 38(3): 179–185.CrossRefPubMedGoogle Scholar
  28. 28.
    Stoner BP, Whittington WL, Aral SO, Hughes JP, Handsfield HH, Holmes KK. Avoiding risky sex partners: perception of partners’ risks v partners’ self reported risks. Sex Transm Infect. 2003; 79(3): 197–201.CrossRefPubMedPubMedCentralGoogle Scholar
  29. 29.
    Adimora AA, Schoenbach VJ. Social context, sexual networks, and racial disparities in rates of sexually transmitted infections. J Infect Dis. 2005; 191(Suppl 1): S115–S122.CrossRefPubMedGoogle Scholar
  30. 30.
    Thomas JC, Clark M, Robinson J, Monnett M, Kilmarx PH, Peterman TA. The social ecology of syphilis. Soc Sci Med. 1999; 48(8): 1081–1094.CrossRefPubMedGoogle Scholar

Copyright information

© The New York Academy of Medicine 2010

Authors and Affiliations

  • Caroline M. Fichtenberg
    • 1
  • Jacky M. Jennings
    • 1
    • 2
  • Thomas A. Glass
    • 1
  • Jonathan M. Ellen
    • 1
    • 2
  1. 1.Department of EpidemiologyJohns Hopkins Bloomberg School of Public HealthBaltimoreUSA
  2. 2.Department of PediatricsJohns Hopkins School of MedicineBaltimoreUSA

Personalised recommendations