Examining Associations Between Neighborhood Condom Availability and Rates of Sexually Transmitted Diseases in San Mateo County, California

BACKGROUND: Condoms remain one of the best ways to protect against sexually transmitted infections (STIs), such as chlamydia (CT) and gonorrhea (GC). Our study aims were to examine the condom retail environment and other area level characteristics in neighborhoods with low/high STI rates, to evaluate associations between condom availability and STI rates in San Mateo County.

METHODS: Condom retail data was compiled from the 2016 Healthy Stores for a Healthy Community survey of county retail establishments licensed to sell tobacco, and from the locations of major retail stores where condoms, but not tobacco, are sold. Condom retail store counts for neighborhoods, defined using census tracts, were classified into three categories (0, 1-2 , 2+ stores). Neighborhood condom retail density was calculated based on counts per 1,000 population and per square mile by census tract. Chlamydia cases reported in 2015 (n=2,376) and gonorrhea cases reported from 2011- 2015 (n=1,725) were mapped and census tract STI rates were calculated. STI rates were dichotomized to a low or high STI rate at the median. We examined associations between condom stores, neighborhood sociodemographic characteristics, and low/high STI rates using descriptive statistics.

RESULTS: Neighborhoods with higher CT and GC rates, compared to neighborhoods with lower CT and GC rates, were more likely to have a larger population, a larger non-White population (68% vs. 43% for both CT and GC) as well as a lower income level (CT: 10% vs. 5%; GC: 9% vs 6%) and lower education than in neighborhoods with lower STI rates. Neighborhoods with higher numbers of condom retail stores also had larger populations, and a higher percentage of residents living below the poverty line (neighborhoods with 0 stores: 5%; 1-2 stores: 7%; 2+stores: 9%). Overall, there was a positive association between number of condom retail stores and STI rates. The mean number of condom retail stores for neighborhoods with a high CT rate was 2.8 (SD: 2.6) compared to 1.1 (SD: 1.2) stores in neighborhoods with a low CT rate (p<0.001). Similarly, the mean number of condom retail stores for neighborhoods with a high GC rate was 2.4 (SD: 2.5) compared to 1.4 (SD: 1.7) stores in neighborhoods with a low GC rate (p=0.006).

CONCLUSIONS: Higher neighborhood disadvantage was associated with higher CT and GC rates. While condom availability was higher in neighborhoods with higher rates of STIs, other factors including financial barriers to purchasing condoms, may impact STI rates.