and asthma, and conditions like obesity and
lower health care–seeking behaviors, indicate
that these problems disproportionately affect
persons in inner-city neighborhoods.36–51
Although it is unclear how the inner-city
physical environment may influence behaviors
that are believed to be causally associated
with disease outcomes, further investigation
of the role of the inner-city physical
environment seems justified. It is plausible
that disorderly environments reflective of
apathy may diminish behaviors that protect
health.
In the past, STDs have been considered
to be caused solely by the behavior of individuals;
however, this study demonstrates
that, independent of individual characteristics
such as race, poverty, and unemployment,
gonorrhea is clustered in neighborhoods that
are physically deteriorated. Prior STD prevention
programs have focused on individual-
level variables but not on neighborhood
conditions. Prevention programs that target
the conditions in which people live may in
the long run have a dramatic impact on STD
rates at the population level.