Scholars have long acknowledged a connection between individual conditions and community factors. Contemporary research in public health and epidemiology, in particular, has demonstrated that the health of the individual and the health of the community are linked. This is particularly important when studying the prevalence and transmission of communicable diseases such as sexually transmitted diseases (STDs). While the importance of multilevel research in public health and other paradigms has been asserted, existing multilevel studies of conditions such as STDs are limited. The present study examines the connection between individual-level attributes and community-level characteristics in explaining the prevalence of STDs among an at-risk sample of juvenile offenders.
Individual Level Factors Associated with STDsMore than twenty years ago, Bell, Farrow, Stamm, Critchlow, and Holmes (1985:33) suggested that "adolescent detainees may be disproportionately important as a core-group of transmitters of STDs." Recent estimates from incarcerated youth indicate this statement remains true (Canterbury et al., 1995;Joesoef, Kahn, & Weinstock, 2006;Kahn et al., 2005;Morris, Baker, Valentine, & Pennisi, 1998;Pack, DiClemente, Hook, & Oh, 2000). In particular, chlamydia and gonorrhea rates among male adolescent detainees have been found to be 152 times greater than the general population in the same age range (Centers for Disease Control and Prevention [CDC], 1996). More recently, the CDC (2006) reported a 6.3 percent median state STD positive rate for females aged 15 to 24 tested at family clinics, whereas the median state positive rate for females tested in juvenile correctional facilities was over twice that (14.2%).These high rates of STD infection among juvenile delinquents highlight the need to address this critical public health concern. Identifying the risk factors associated with sexually transmitted diseases is a first, and much needed, step towards obtaining an in-depth understanding of the high STD prevalence rates among juvenile offenders. Such knowledge NIH Public Access
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NIH-PA Author Manuscriptcan inform the development of interventions to reduce risk behaviors and increase access to STD testing and treatment that target at-risk subgroups of youths.Prior research indicates that risky sexual behavior, including STD infection, among juvenile offenders varies by important individual-level characteristics including race (CDC, 2002), gender (Joesoef et al., 2006;Kahn et al., 2005), age (Teplin, Mericle, McClelland, & Abram, 2003), and drug use (Teplin et al., 2005). Female juvenile offenders consistently have disproportionately higher rates of STDs than their male counterparts (Kahn et al., 2005;Mertz, Voigt, Hutchins, & Levine, 2002). For example, Joesoef et al. (2006) estimate that chlamydia positive rates range from 13.0 percent to 24.7 percent in incarcerated adolescent female populations and from 4.8 percent to 8.1 percent among incarcerated male adolescents;...