Research Article
Impacts of Federal Prevention Funding on Reported Gonorrhea and Chlamydia Rates

https://doi.org/10.1016/j.amepre.2018.09.012Get rights and content

Introduction

The Centers for Disease Control and Prevention allocates funds annually to jurisdictions nationwide for sexually transmitted infection prevention activities. The objective of this study was to assess the effectiveness of federal sexually transmitted infection prevention funding for reducing rates of reported sexually transmitted infections.

Methods

In 2017–2018, finite distributed lag regression models were estimated to assess the impact of sexually transmitted infection prevention funding (in 2016 dollars per capita) on reported chlamydia rates from 2000 to 2016 and reported gonorrhea rates from 1981 to 2016. Including lagged funding measures allowed for assessing the impact of funding over time. Controls for state-level socioeconomic factors, such as poverty rates, were included.

Results

Results from the main model indicate that a 1% increase in annual funding would cumulatively decrease chlamydia and gonorrhea rates by 0.17% (p<0.10) and 0.33% (p<0.05), respectively. Results were similar when stratified by sex, with significant decreases in rates of reported chlamydia and gonorrhea in males of 0.33% and 0.34% (both p<0.05) respectively, and in rates of reported gonorrhea in females of 0.32% (p<0.05). The results were generally consistent across alternative model specifications and other robustness tests.

Conclusions

The significant inverse associations between federal sexually transmitted infection prevention funding and rates of reported chlamydia and gonorrhea suggest that federally funded sexually transmitted infection prevention activities have a discernable effect on reducing the burden of sexually transmitted infections. The reported sexually transmitted infection rate in a given year depends more on prevention funding in previous years than on prevention funding in the current year, demonstrating the importance of accounting for lagged funding effects.

Section snippets

INTRODUCTION

Public health funding is critical for managing the burden of notifiable sexually transmitted infections (STIs) in the U.S.1, 2, 3, 4 In recent years, nationwide rates of reported chlamydia and gonorrhea have increased substantially.5 Rates of reported chlamydia and gonorrhea cases in the U.S. in in 2016 were 497.3 and 145.8 per 100,000 population, reflecting a 4.7% and 18.5% increase from 2015 rates, respectively. At the same time, declining budgets of state and local public health departments

Study Sample

National chlamydia and gonorrhea case data reported to CDC for each state and the District of Columbia were examined. Data for gonorrhea were obtained for the years 1981 to 2016, and data for chlamydia were obtained for the years 2000 to 2016. Chlamydia reporting was not required by all U.S. jurisdictions until 2000, so data in prior years may be incomplete. These data also contain information on population, race/ethnicity, sex, and age group. Rates of reported chlamydia and gonorrhea cases

RESULTS

During the sample period, the mean overall reported rate (new cases per 100,000 population) was 178.3 for gonorrhea and 375.3 for chlamydia (Table 1). Average reported gonorrhea case rates were higher for males than for females, but average reported chlamydia case rates were consistently lower for males. Mean state-level STI prevention funding per capita in 2016 dollars was 38 cents, and on average 13% of households were below the federal poverty threshold. The percentages of the population

DISCUSSION

This paper provides an indirect assessment of the impact of federally funded STI prevention activities by examining the association between STI prevention funding and rates of reported STIs. Consistent with previous evidence, a strong association between funding and gonorrhea rates was found, indicating that greater funding in a given year is associated with reductions in gonorrhea rates in the same year and subsequent years, all else equal. This paper further contributes to the field by

CONCLUSIONS

This updated and expanded analysis adds to the existing literature that demonstrates a link between increases in federal STI prevention funds and reductions in rates of reported STIs. The findings here suggest that targeted public health funding may be an effective policy lever to address the burden of gonorrhea and chlamydia in the U.S. Having up-to-date, reliable estimates of the impact of STI prevention funding is essential not only to document program impact, but also to inform resource

ACKNOWLEDGMENTS

The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the U.S. Centers for Disease Control and Prevention.

The authors are federal government employees.

No financial disclosures were reported by the authors of this paper.

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    Healthy People 2020 Midcourse Review

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    • Cited by (8)

    • Availability of Safety-net Sexually Transmitted Disease Clinical Services in the U.S., 2018

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      2022, Sexually Transmitted Diseases

    • Analytic approaches to assess the impact of local spending on sexually transmitted diseases

      2022, Health Services Research

    • The Estimated Direct Lifetime Medical Costs of Sexually Transmitted Infections Acquired in the United States in 2018

      2021, Sexually Transmitted Diseases
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