Figure 3-1

Distribution of 15-29-year-old persons in the United States by health insurance coverage, 1993. SOURCE: UCLA Center for Health Policy Research, unpublished data, 1996.

Substance Use

Substance use, especially drugs and alcohol, is associated with STDs at both population and individual levels.1 At the population level, rates of STDs are high in geographic areas where rates of substance use are also high, and rates of substance use and STDs have also been shown to co-vary temporally (Greenberg et al., 1991). At the individual level, persons who use substances are more likely to acquire STDs (Marx et al., 1991; Anderson and Dahlberg, 1992; Shafer et al., 1993). There are several possible reasons for this association. One is that underlying social and individual factors lead both to higher rates of STDs and to greater use of substances. Social factors such as poverty, lack of economic and educational opportunities, and weak community infrastructure may contribute to both outcomes. Individual factors, such as risk-taking and low self-efficacy, could similarly contribute to both outcomes.


Much of the following discussion of substance use and STDs was based on the following paper: Beltrami JF, Wright-DeAgüero LK, Fullilove MT, St. Louis ME, Edlin BR. Substance abuse and the spread of sexually transmitted diseases. Commissioned paper for the IOM Committee on Prevention and Control of STDs.

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