The Effects of Peer Networks on the Status of Gonorrhea and Chlamydia Infections among High School Adolescents in the United States Pubblico

Abstract

Sexually transmitted diseases are the most common reportable infectious disease in the United States. The two most common STDs are chlamydia and gonorrhea. Adolescents ages 15-19 are the most affected by these STDs and have rates higher than the total population. Females and African Americans of this subset also have disproportionate rates.

During adolescence, people engage in their most risky behaviors. Peers become an important source of reinforcement and modeling concerning the individual's attitude and belief system. Since most of their time is spent with their peers, this network provides more influence on their behaviors compared to their family. Thus, examination of an individual‟s social network may provide increased insight into the individual's behavior.

The goal of this thesis is to evaluate the effects of peer networks on the status of gonorrhea and chlamydia infections among high school adolescence in the U.S. using the National Longitudinal Survey of Adolescent Health.

Due to the design of the study, generalized estimating equations (GEE) methods were conducted under the assumption of an exchangeable intra-cluster correlation structure. Models identifying risk factors for positive status infections of gonorrhea and chlamydia were produced. 1985 students were used in the analysis.

Sixty one (2.96%) students were classified as having had gonorrhea or chlamydia. Individual attributes, race and gender, in combination with the peer network levels of drinking, smoking, skipping school, and fighting, are significant in helping predict the status of gonorrhea and chlamydia infections. The odds for getting these STDs, adjusting for gender, drinking, smoking and fighting, is approximately 4 times higher for blacks. Furthermore, females have odds approximately 3 times higher than males when adjusting for all other predictors in the model. The GEE analysis concluded that none of the ego network measures have an individual effect on the acquisition of gonorrhea and chlamydia. However, in the prediction model individuals' gender, race, centrality, and density of their send/receive network are significant. Adjusting for gender, centrality, and send/received density, blacks are 2.54 times higher than non-blacks for a positive STD status.

Public health implications and future directions of research are also discussed.

Table of Contents

Table of Contents

1. Introduction…………………………………………………………………………………….............1

1.1. Problem Statement………………………………………………………………….........2

1.1.1. Problem Statistics……………………………………………………….........3

1.1.2. Problem Among Adolescents………………………………………..........3

1.1.3. Problem by Gender……………………………………………………….........3

1.1.4. Problem by Race/Ethnicity……………………………………………........4

1.2. Purpose Statement…………………………………………………………………..........4

1.3. Objectives…………………………………………………………………………...............4

2. Background/Literature Review……………………………………………………………….........5

2.1. Theory………………………………………………………………………………................5

2.1.1. Social Ecological Framework………………………………………...........5

2.1.2. Bronfenbrener's Ecological Systems Theory……………………..5

2.2. Previous Research...………………………………………………………………….........6

2.3. Antecedents...………………………………………………………………………............6

3. Methods………………………………………………………………………………………..................8

3.1. Study Description………………………………………………………………….............8

3.2. Wave I……………………………………………………………………………….................8

3.3. In-School Survey……………………………………………………………………............8

3.3.1. Recruitment……………………………………………………………….............8

3.3.2. Questionnaire……………………………………………………………............9

3.4. In-home Survey…………………………………………………………………….............9

3.4.1. Recruitment………………………………………………………………............9

3.4.2. Special Samples…………………………………………………………...........9

3.4.3. Saturation………………………………………………………………..............9

3.4.4. Questionnaire……………………………………………………………............10

3.4.5. Weights…………………………………………………………………….............10

3.5. Wave II In-home Survey……………………………………………………………........11

3.5.1. Recruitment………………………………………………………………............11

3.5.2. Questionnaire……………………………………………………………............11

3.5.3 Weights……………………………………………………………………..............11

3.6. Network Analysis…………………………………………………………………..............11

3.6.1. Data Collection………………………………………………………….............11

3.7. Independent Variables………………………………………………………………..........12

3.7.1. Individual-level Network Variables……………………………………......12

In-degree…………………………………………………………………..............12

Out-Degree………………………………………………………………..............12

Bonacich Centrality…………………………………………………….............12


Reach……………………………………………………………………..................13


Reach in Three Steps……………………………………………………...........13

Proximity Prestige………………………………………………………...............13

Influence Domain………………………………………………………................14

3.7.2. Ego Network Variables………………………………………………….............14

Ego Send Network Density………………………………………………...........14

Size of Ego Send Network………………………………………………............15

Ego Send/Receive Network Density…………………………….........15

Size of Ego Send/Received Network…………………………………........15

3.7.3. Ego-Network Behavior/ Attributes Means…………………….....15

Mean Values on Behavior Attributes Measur…………………....16

3.8. Outcome Variables…………………………………………………….................16

3.8.1. Questionnaire Scales………………………………………...............16

3.9. Statistical Analysis…………………………………………………….................18

4. Results……………………………………………………………………………….....................19

Behavior and Attribute Variables……………………………………………….............20

Social Network Measures………………………………………………………................32

5. Discussion…………………………………………………………………………….........................40

5.1. Discussion…………………………………………………………………….....................40

5.2. Implications………………………………………………………………….....................41

5.3. Limitations and Future Directions………………………………………...........41

References…………………………………………………………………………………….......................42

Appendix A: All Tables………...……………………………………………………..................44

About this Master's Thesis

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School	Rollins School of Public Health
Department	Biostatistics and Bioinformatics
Subfield / Discipline	Biostatistics - MPH & MSPH
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health
Parola chiave	gonorrhea chlamydia peer network
Committee Chair / Thesis Advisor	Hertzberg, Vicki S, Emory University
Partnering Agencies	Does not apply (no collaborating organization)

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