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Abstract
Prior research has found that places and people that are more economically disadvantaged have higher rates and risks, respectively, of sexually transmitted infections (STIs). Economic disadvantages at the level of places and people, however, are themselves influenced by economic policies. To enhance the policy relevance of STI research, we explore, for the first time, the relationship between state-level minimum wage policies and STI rates among women in a cohort of 66 large metropolitan statistical areas (MSAs) in the US spanning 2003–2015. Our annual state-level minimum wage measure was adjusted for inflation and cost of living. STI outcomes (rates of primary and secondary syphilis, gonorrhea and chlamydia per 100,000 women) were obtained from the CDC. We used multivariable hierarchical linear models to test the hypothesis that higher minimum wages would be associated with lower STI rates. We preliminarily explored possible socioeconomic mediators of the minimum wage/STI relationship (e.g., MSA-level rates of poverty, employment, and incarceration). We found that a $1 increase in the price-adjusted minimum wage over time was associated with a 19.7% decrease in syphilis rates among women and with an 8.5% drop in gonorrhea rates among women. The association between minimum wage and chlamydia rates did not meet our cutpoint for substantive significance. Preliminary mediation analyses suggest that MSA-level employment among women may mediate the relationship between minimum wage and gonorrhea. Consistent with an emerging body of research on minimum wage and health, our findings suggest that increasing the minimum wage may have a protective effect on STI rates among women. If other studies support this finding, public health strategies to reduce STIs among women should include advocating for a higher minimum wage.
Highlights
Women in the US continue to bear high burden of sexually transmitted infections (STIs), and recent surveillance data show steady increases in rates of reported cases of primary and secondary syphilis, chlamydia, and gonorrhea among women [1]
Analysis of the intraclass correlation coefficients (ICCs) for each STI suggested that a meaningful proportion of the outcome variance was attributable to differences between metropolitan statistical areas (MSAs) and between states, justifying multilevel analysis
Consistent with other studies in this emerging area that have found that higher minimum wages may be protective [25,26,27], we found that MSAs in states with higher minimum wages have lower rates of two common reportable STIs among women
Summary
Women in the US continue to bear high burden of sexually transmitted infections (STIs), and recent surveillance data show steady increases in rates of reported cases of primary and secondary syphilis, chlamydia, and gonorrhea among women (by 155.6%, 11.1% and 39.4% respectively over 2013–2017) [1]. Research on the determinants of STIs has shifted its focus from individual-level characteristics to upstream structural factors that create population-level vulnerability and resilience to STIs [5, 6]. This line of inquiry has found that several structural factors, including poverty rates and income inequality in geographic areas, help propagate STIs [5, 7,8,9,10]. Empirical evidence suggests that area-level poverty may have population-wide effect by increasing the risk of STI transmission for individuals irrespective of their individual sexual practices or socioeconomic status [17]
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