Identifying predictors that contribute to geographic disparities in sexually transmitted infections (STIs) is necessary in order to reduce disparities. This study assesses the spatial relationship condom availability and accessibility in order to better identify determinants of geographic disparities in STIs. We conducted a telephone-based audit among potential-condom selling establishments. Descriptive analyses were conducted to detect differences in condom-selling characteristics by stores and by store type. Geocoding, mapping, and spatial analysis were conducted to measure the availability of condoms. A total of 850 potential condom-selling establishments participated in the condom availability and accessibility audit in St. Louis city; 29 % sold condoms. There were several significant geographic clusters of stores identified across the study area. The first consisted of fewer convenience stores and gas stations that sold condoms in the northern section of the city, whereas condoms were less likely to be sold in non-convenience store settings in the southwestern and central parts of the city. Additionally, locations that distributed free condoms clustered significantly in city center. However, there was a dearth of businesses that were neither convenience stores nor gas stations in the northern region of the city, which also had the highest concentration of condoms sold. This initial study was conducted to provide evidence that condom availability and accessibility differ by geographic region, and likely are a determinant of social norms surrounding condom use and ultimately impact STI rates.

Background Identifying predictors that contribute to geographical disparities in sexually transmitted infections (STIs) is necessary. This study assesses the spatial relationship between condom availability to locations of STIs in order to better understand these geographical disparities. Objectives We conducted a condom availability audit among potential condom-selling establishments. New gonorrhoea and chlamydia cases in 2011 (n=6034) and HIV infection cases from 2006 to 2011 (n=565) were collected by census tract in St Louis, Missouri. 829 potential condom-selling establishments participated in the condom availability audit in St Louis City; 242 of which sold condoms. Results A negative linear relationship exists between condom vendors and cases of gonorrhoea and chlamydia, after adjusting for concentrated disadvantage and free condom locations. Higher concentrated disadvantage, higher proportions of convenience vendors and free locations were associated with higher rates of HIV. Conclusions This study was conducted to provide evidence that lack of condom availability is associated with STI rates, and likely is an integral component to influencing the subjective norms surrounding condom use and STI rates. Condom distribution interventions may be addressing availability needs and social norms, yet are more likely to be effective when placed in locations with the highest STI rates.

Treatment of acute stroke with thrombolytic therapy has been limited because of the narrow treatment window. Distance from home to hospital may affect arrival time and likelihood of receiving thrombolytic therapy for acute stroke. The present study included stroke subjects seen at Barnes Jewish Hospital in 2006-2007, residing in St Louis City/County, who were at home at the time of the stroke (n = 416). A network distance was calculated by mapping the best route from each subject's home to the hospital on a street network grid. Patients were grouped by distance into quintiles, and the group living the closest (group A, first quintile) was compared with the remainder of the cohort (group B). Outcomes of interest were rate of arrival within 3 hours of stroke onset (timely arrival) and rate of thrombolytic administration. The relative rate (RR) of each outcome was calculated for group A versus group B. A multivariate model of thrombolytic administration was created correcting for potential confounders. There was no difference in timely arrival between groups. The rate of thrombolytic administration was 13/100 for group B and 23/100 for group A, for an RR 0.55 (95% confidence interval [CI], 0.31-0.097) for group B versus group A. In the multivariate model, only National Institutes of Health Stroke Scale score was a significant confounder. The adjusted RR of thrombolytic treatment was 0.59 (95% CI, 0.34-0.99) for group B versus group A. Our data indicate that patients living in close proximity to the hospital are more likely to receive thrombolytic therapy for stroke compared with those living farther away. This finding cannot be explained by earlier arrival time.