Racial Residential Segregation and Risky Sexual Behavior Among Non-Hispanic Blacks, National Survey of Family Growth, 2006 – 2010

Sexually transmitted infections (STIs) including human immunodeficiency virus (HIV) have disproportionately affected the non-Hispanic black population in the United States. A person’s community can affect his or her STI risk by the community’s underlying prevalence of STIs, sexual networks, and social influences on individual behaviors. Racial residential segregation— the separation of racial groups in a residential context across physical environments—is a community factor that has been associated with negative health outcomes. The objective of this study was to examine if non-Hispanic blacks living in highly segregated areas were more likely to have risky sexual behavior. Demographic and sexual risk behavior data from non-Hispanic blacks aged 15 – 44 years participating in the National Survey of Family Growth were linked to Core-Based Statistical Area segregation data from the U.S. Census Bureau. Five dimensions measured racial residential segregation, each covering a different concept of spatial variation. Multilevel logistic regressions were performed to test the effect of each dimension on sexual risk behavior controlling for demographics and community poverty. Of the 3,643 participants, 588 (14.5%) reported risky sexual behavior as defined as two or more partners in the last 12 months and no consistent condom use. Multilevel analysis results show that racial residential segregation was associated with risky sexual behavior with the association being stronger for the centralization [aOR (95% CI)][2.07 (2.05 – 2.08)] and concentration [2.05 (2.03 – 2.07)] dimensions. This suggests concentrations of non-Hispanic blacks and an accumulation of non-Hispanic blacks in an urban core. Findings suggest racial residential segregation is associated with risky sexual behavior in non-Hispanic blacks 15 – 44 years of age with magnitudes varying by dimension. Incorporating additional contextual factors may lead to the development of interventions that promote healthier behaviors and lower rates of HIV and other STIs. highly those non-segregated addition, our as well as the epidemiologic observed, we explored age and gender differences through stratification. We hypothesized that the effects of racial residential segregation would be stronger for younger adults and females due to differences observed in age and gender STI patterns. Methods This study uses individual-level demographic and sexual risk behavior data from the National Survey of Family Growth (NSFG) and data on racial residential segregation and community poverty from the United States (U.S.) Census Bureau. The NSFG is administered by the National Center for Health Statistics (NCHS) and is a continuous health survey of men and women between 15 – 44 years of age living in U.S. households. The 2006 – 2010 survey completed a nationally representative sample from 110 primary sampling units (PSUs) generating 22,682 completed interviews resulting in a final sample size of 3,643 non-Hispanic blacks. PSUs are counties or groups of adjoining counties that represent the eight largest metropolitan areas in the United States (each year) as well as 25 smaller metropolitan and nonmetropolitan areas that change each survey year (Lepkowski, Mosher, Davis, Groves, & Van Hoewyk, 2010). Racial residential segregation indices and poverty values were calculated for core-based statistical areas (CBSAs) by the U.S. Census Bureau, using 2010 data for segregation and 2006 – 2010 data for poverty. “CBSA” is a collective term for both metropolitan and micropolitan statistical areas. Metropolitan and micropolitan areas are composed of at least one urban core with a population of at least 50,000 (metro) or a population between 10,000 and 50,000 (micro) and the surrounding areas that are socioeconomically connected with that urban core. The variable, CBSA, was used to merge NSFG individual data and U.S. Census Bureau community data. CBSA is a restricted variable; therefore, these data were accessed through the NCHS Research Data Center. To limit disclosure risk, the Research Data Center did not provide the researchers the identity of the specific CBSAs. NSFG participants who did not reside in a CBSA were excluded from the study.