A multilevel study of neighborhoods,
violence, and collective efficacy by Sampson
et al.15 suggests that the occurrence of crime is
mediated by “collective efficacy,” a measure
of the ability of neighborhoods to maintain
effective informal social controls. Informal
social controls are associated with environments
that have relatively lower rates of
crime.16,17 These social controls may include
such efforts as willingness to intervene to prevent
truancy or to discourage teenagers from
hanging out at street corners, and may include
efforts to reduce litter and graffiti.
Given that STDs occur primarily among
persons between the ages of 15 and 25 years,
the high prevalence of STDs represents a failure
to control and protect our youth. Highrisk
behaviors tend to cluster together and
have been shown to form a continuum.18 For
example, the gateway drug theory postulates
that criminal behavior is at the end of a continuum
that may begin with tobacco or alcohol
use and progress to illicit drug use.19 Sexual
behaviors with casual or anonymous
partners are likely to be part of the continuum
because they are highly associated with substance
use.20–22 It is plausible that conditions
conducive to antisocial behaviors such as
vandalism, truancy, and drug use are also permissive
of high-risk sexual behaviors.
To examine the possible association of
neighborhood conditions with high-risk sexual
behavior, we analyzed the relation between a
measure of community disorder (i.e., “broken
windows”) and gonorrhea rates in New
Orleans neighborhoods.