Testing gene by community disadvantage moderation of sexual health outcomes among urban women

RESEARCH ARTICLE Testing gene by community disadvantage moderation of sexual health outcomes among urban women Terrinieka W. Powell1, Jill A. Rabinowitz ID2*, Michelle R. Kaufman3, Adam J. Milam2, Kelly Benke2, Danielle Y. Sisto2, George Uhl4, Brion S. Maher2, Nicholas S. Ialongo2 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America, 2 Department of Population, Family and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America, 3 Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States of America, 4 New Mexico VA HealthCare System, Las Vegas, NM, United States of America * Abstract OPEN ACCESS Citation: Powell TW, Rabinowitz JA, Kaufman MR, Milam AJ, Benke K, Sisto DY, et al. (2019) Testing gene by community disadvantage moderation of sexual health outcomes among urban women. PLoS ONE 14(10): e0223311. https://doi.org/ 10.1371/journal.pone.0223311 Editor: Stuart White, Boys Town National Research Hospital, UNITED STATES Received: February 11, 2019 We examined whether the interplay between community disadvantage and a conduct disorder polygenic risk score (CD PRS) was associated with sexual health outcomes among urban women. Participants (N = 511; 75.5% African American) were originally recruited to participate in a school-based intervention and were followed into adulthood. Community disadvantage was calculated using census data when participants were in first grade. At age 20, blood or saliva samples were collected and participants reported on their condom use, sexual partners, and sexually transmitted infections. A CD PRS was created based on a genome-wide association study conducted by Dick et al. [2010]. Higher levels of community disadvantage was associated with greater sexually transmitted infections among women with a higher CD PRS. Implications of the study findings are discussed. Accepted: September 5, 2019 Published: October 3, 2019 Copyright: © 2019 Powell et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: The Johns Hopkins Bloomberg School of Public Health Institutional Review Board prohibited the sharing of genetic information with researchers outside of those named in the original IRB protocol. The phenotypic data in de-identified form is available from Dr. William Eaton (). Funding: This work was funded by the Maternal and Child Health Bureau (T76MC00003; T.P), the National Institute on Drug Abuse (1K01DA04213401A1 – T.P., 1K01DA042138-01A1 (M.K), Introduction Youth are more likely than adults to engage in risky sexual behaviors, including sex without condoms, sex with multiple partners, and substance use in conjunction with sex [1]. These risky behaviors can result in negative consequences including teen pregnancy, reduced educational attainment, and unemployment [2]. Young women residing in disadvantaged neighborhoods are disproportionately at risk for poor sexual health outcomes [3–5]. For example, young women living in socio-economically deprived communities are more likely to use condoms inconsistently and contract sexually transmitted infections (STIs) than those in communities with greater resources [3,6,7]. In resource-poor contexts, women may experience higher levels of poverty and have limited access to reproductive health care services, thus increasing the likelihood that they will have fewer opportunities to engage in consistent safer sex practices [7,8]. However, women living in disadvantaged communities likely display diversity in their sexual risk taking. The factors that contribute to differences in sexual behaviors may be related to individual specific-factors (i.e., genetic variants) that predispose some women towards PLOS ONE | https://doi.org/10.1371/journal.pone.0223311 October 3, 2019 1 / 12 Testing gene by community disadvantage moderation of sexual health outcomes among urban women T32DA007292 (J.A.R), R01DA036525 (B.S.M), DA11796 MH57005 (N.S.I), R01 DA009897 (W.E), R01 MH 4296806 (S.K.), the National Institute of Mental Health (R25MH080665 -T.P.) and the Centers for Disease Control and Prevention (Grant #1-U48-DP-000040 – T.P.). Competing interests: The authors have declared that no competing interests exist. harmful sexual behaviors and their consequences. Identifying these genetic variants may elucidate factors that are associated with heterogeneity in sexual risk taking. Links between conduct disorder and sexual health outcomes Conduct disorder (CD) is defined as a syndrome characterized by a pattern of antisocial behaviors that often infringes on the rights of others and violates social norms [9,10]. CD has been consistently associated with sexual health outcomes among women. For example, women higher in CD phenotypes (e.g., impulsivity, disobedience) are more likely to engage in earlier sexual debut, use contraceptives less frequently, have more sexual partners and STIs, and experience early child-rearing relative to women lower in CD phenotypes [10–12]. Individuals higher in CD symptoms may be higher in impulsivity, sensation seeking, and may be more likely to seek out immediate rewards despite potential negative repercussions [9,13], all of which may predispose these individuals towards sexual risk taking. In studies examining the relationship between CD symptoms and sexual health outcomes, CD symptoms are typically examined phenotypically, or via observations of CD emotional and behavioral characteristics. Genetic variants associated with CD symptoms may also play a role in sexual risk behaviors and may be particularly relevant to consider among women in young adulthood, though research is lacking. Contextual changes (e.g., employment, establishing a residence) and increased independence that are associated with young adulthood may enable women to select environments that allow for the expression of their genetic predispositions [14]. Advances in genomics and the genetics of CD and related traits offer the possibility of clarifying genetic variants associated with sexual health outcomes and may inform prevention and intervention initiatives aimed at reducing these outcomes among women residing in underserved communities. Consistent with relations identified between phenotypic conduct problems and sexual health outcomes [15], higher genetic load for CD may be associated with sexual risk behaviors, though it is unclear whether this is the case based on prior work. Contextual factors related to sexual health outcomes Although higher genetic loading for CD may predispose young women towards risky sexual behaviors, it is likely that this relationship (...truncated)