Fig. 1.

Socioecologic framework for determinants of the vaginal micro-biome. Individual and relational determinants associated with differences in the microbiome have been well-studied, and emerging research may show that community-level factors may shape the composition of the microbiome as well. Societal factors that are posited to influence prevalence of sexually transmitted disease (STD) such as segregation, racism, and other societal-level policies may also be determinants of the microbiome. Research that addresses the role of higher level spheres of influence on the microbiome may identify modifiable risk factors that can be addressed. Modified from Scribner R, Theall KP, Simonsen N, Robinson W; National Institute on Alcohol Abuse and Alcoholism. HIV risk and the alcohol environment. Available at: https://pubs.niaaa.nih.gov/publications/arh333/179-183.htm. Retrieved January 4, 2017.