"Broken windows" and the risk of gonorrhea

Objectives. We examined the relationships between neighborhood conditions a nd gonorrhea. Methods. We assessed 55 block soups by rating housing and street conditions . We mapped all cases of gonorrhea between 1994 and 1996 and calculated agg regated case rates by block group. We obtained public school inspection rep orts and assigned findings to the block groups served by the neighborhood s chools. A "broken windows" index measured housing quality, abandoned cars, graffiti: trash and public school deterioration. Using data from the 1990 c ensus and 1995 updates, we determined the association between "broken windo ws," demographic characteristics, and gonorrhea rates. Results. The broken windows index explained more of the variance in gonorrh ea rates than did a poverty index measuring: income, unemployment, and low education. in high-poverty neighborhoods, block groups with high broken win dows scores had significantly higher gonorrhea rates than block groups with low broken windows scores(46.6 per 1000 vs 25.8 per 1000; P<.001). Conclusions. The robust association of deteriorated physical conditions of local neighborhoods with gonorrhea rates, independent of poverty, merits an intervention trial to test whether the environment has a, causal role in i nfluencing high-risk sexual behaviors.