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Identifying predictors for counties that have exceptionally low STI case rates in the US (2019): a positive deviant
Sungwon Lim1, Betty Bekemeier2, Jillian Pintye3
1Department of Nursing, Dongguk University WISE, Gyeongju, Gyeongbuk, South Korea.
Sexual Health
|December 4, 2025
Summary
Local health departments in small, socially vulnerable counties with direct STI treatment services are key to controlling the US sexually transmitted infections (STIs) epidemic. Identifying these high-performing areas can inform public health strategies.
Area of Science:
- Public Health
- Epidemiology
- Health Services Research
Background:
- The US faces a significant epidemic of sexually transmitted infections (STIs), with rates remaining high despite recent stabilization.
- Local health departments (LHDs) are vital for STI prevention and treatment, yet their effectiveness varies.
- A positive deviance (PD) approach was used to identify US counties with unexpectedly low STI rates.
Purpose of the Study:
- To identify high-performing counties with lower-than-expected sexually transmitted infection (STI) rates using a positive deviance (PD) approach.
- To analyze the characteristics and predictors associated with these high-performing counties.
Main Methods:
- A cross-sectional study design analyzed data from 981 US counties.
- A two-step approach involved multivariate linear regression to identify PD counties and multivariate logistic regression to examine predictors of PD status.
Main Results:
- 187 (19.06%) high-performing counties were identified.
- Smaller counties (<25,000 population) were 6.47 times more likely to be identified as PD counties.
- High social vulnerability (racial/ethnic subgroup, housing, transportation) and LHDs providing direct STI treatment services were associated with high performance.
Conclusions:
- The positive deviance (PD) approach is effective for identifying high-performing local health departments (LHDs) in STI control.
- Further research into the specific interventions in these counties can inform targeted public health strategies.
- Findings can guide resource allocation for more effective STI prevention and treatment nationwide.
Keywords:
bacterial infectionsdiagnostic screening programslocal health departmentspositive deviancepreventive health servicespublic health surveillancesexual healthsocial vulnerability indexMore Related Videos
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