A cross-sectional path analysis of the social determinants of STI preventive behaviors: application of the WHO framework

Sexually transmitted infections (STIs) remain a major public health concern. Preventive behaviors can reduce their burden, and social determinants of health may influence these behaviors. This cross-sectional study was conducted on 384 women aged 18–45 years attending healthcare centers affiliated with Shahid Beheshti University of Medical Sciences in Tehran in 2025. Participants were selected using a two-stage cluster random sampling method was employed. Data were collected using questionnaires on sexual health literacy, socioeconomic status, sexual violence, cultural attitudes toward sexual behaviors, and STI preventive behaviors. Descriptive statistics, Pearson correlation, and path analysis were used. The mean STI preventive behavior score was 68.5 (range 40–100). Path analysis indicated that higher education (β = 0.094), older age at marriage (β = 0.125), and better sexual health literacy (β = 0.547) were positively associated with preventive behaviors, whereas restrictive cultural attitudes toward sexual behaviors (β = − 0.315) were negatively associated. Preventive behaviors against STIs among women of reproductive age are suboptimal. Interventions targeting education, sexual health literacy, and cultural attitudes are essential to promote these behaviors.