An Investigation of the Association between Social Capital and County Level Chlamydia Rates in Georgia Público

Turner, Blair Carlin (2016)

Permanent URL: https://etd.library.emory.edu/concern/etds/8p58pd68v?locale=es
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Abstract

Chlamydia, a sexually transmitted infection, is the most commonly reportable notifiable disease in the United States, with racial and gender disparities. In health research, areas with high social capital often have better health outcomes. However, it is often assumed that all individuals in a geographic area benefit from social capital equally. To understand this relationship, Georgia county chlamydia data from Georgia Department of Public Health as accessed through their online system OASIS and an index of social capital developed by Ruspingha is used to investigate the assumption that the association between social capital and chlamydia is homogenous by race and gender.

This study employs multi-level Poisson regression to test three models, controlling for demographic covariate, county level covariates, and the three-way interaction between social capital, sex, and race, with chlamydia as the outcome variable and county social capital as the exposure.

Results indicate there is a significant three-way interaction between social capital, sex and race, and the assumption that every demographic group in a particular geographic area benefits from social capital equally may not be accurate. The association between social capital and chlamydia was found to be opposite for blacks and whites. For whites, areas with more social capital had lower the rates of disease, and for blacks areas with more social capital yielded higher the rates of disease. This relationship was found to be true for both men and women, but more intense among men. Among black men, the prevalence of chlamydia in counties with very low social capital was half as high compared to the prevalence of chlamydia in areas with very high social capital (PR, 0.47; 95% CI, (0.31, 0.71). The opposite was found among white men, the prevalence of chlamydia in counties with very low social capital was 1.12 times higher than the prevalence of chlamydia in counties with very high social capital (95% CI, (0.85- 1.48).

Table of Contents

Table of Contents

Background 1

Introduction 1

Chlamydia and its Disparities 2

Mechanism for Disparities in STI 2

What is Social Capital? 5

How Social Capital is Measured? 7

Social Capital and Health 9

Social Capital and Sexually Transmitted Infections 11

Methods 13

Data 13

Inclusion/Exclusion Criteria 14

Definition of Exposure 14

Definition of Outcome 15

Additional Covariates 15

Analysis 16

Results 17

Descriptive Analysis 17

Regression Analysis 18

Discussion 20

Study Strengths and Limitations 22

Conclusion 23

Future Directions 23

References 24

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