Direct and indirect associations of neighborhood disorder with drug use and high-risk sexual partners

Abstract

Background: On a macrosocial level, neighborhood characteristics have been found to be associated with the prevalence of HIV and other bloodborne and sexually transmitted infections. The current study used structural equation modeling to examine the relationship between neighborhood social and physical disorder and high-risk sexual partners.

Methods: A cohort (N=838) recruited for an HIV prevention study of drug users (2002-2004) in Baltimore, Maryland, was interviewed about their neighborhood characteristics, drug use, depressive symptoms (using the Centers for Epidemiological Studies Depression Scale), and HIV/sexually transmitted infection risk behaviors of exchanging sex for money or drugs, having multiple sexual partners, and having partners who injected drugs or smoked crack cocaine. Data were analyzed in February 2005.

Results: Model fit statistics from Mplus (Muthen & Muthen, Los Angeles CA, 2004) indicated statistically significant direct associations between neighborhood disorder and psychologic distress, neighborhood disorder and sexual risk behaviors, and neighborhood disorder and drug use. There were also significant indirect associations of neighborhood disorder on sexual risk behaviors.

Conclusions: These results highlight the importance of viewing drug use, chronic stress, depression and hopelessness, and infectious diseases such as HIV and hepatitis C as interlinked epidemics that are fostered by neighborhood social and physical disorder. Neighborhood, network, and community level interventions are needed to address these intertwined public health issues.

Figure 1

Hypothesized structural model for males and females Neighborhood disorder has direct associations with psychological distress (4), drug use (5), and sex risk behaviors (1) Neighborhood disorder has an indirect association with sex risk behavior operating though psychological distress and drug use (4 to 6 to 3) Psychological distress has a direct association with sex risk behaviors (2) Drug use has a direct association with sex risk behaviors (3)

Figure 2

Model 5, structural equation modeling for females Bolded coefficients significant at p<0.05 Coefficients are standardized Coefficient in ( ) represents the direct association with neighborhood disorder Indicators for psychological distress and neighborhood disorder not pictured: 14 indicators for psychological distress, seven indicators for neighborhood disorder

Figure 3

Model 5, structural equation modeling for males Bolded coefficients significant at p<0.05 Coefficients are standardized Coefficient in ( ) represents the direct effect of Neighborhood Disorder Indicators for psychological distress and neighborhood disorder not pictured: 14 indicators for psychological distress, seven indicators for neighborhood disorder