Background: Syndemics, defined as co-occurring epidemics, have received increased attention in public health, yet little is known about their manifestation during adolescence. The objectives of this dissertation are to document substance use, intimate partner violence, and depression as a syndemic for adolescent health, and evaluate individual and dyadic longitudinal changes and the role immigration/culture play for this syndemic.
Methods: Two measures were developed and used throughout: syndemic score is the number of reported factors (substance use, intimate partner violence and/or depression); syndemic severity is the average degree/impact of reported factors. We used immigrant generation (immigrant, first generation, second generation) and separated orientation (acculturation to a foreign country) as moderators of this syndemic.
Chapter 2 explores the burden of syndemic score and severity leading to sexual risk in a nationally representative sample of 2,753 sexually active girls aged 1417. Chapter 3 evaluates score and severity as predictors of sexual risk and the moderating role of immigration in a sample of 772 pregnant Latina adolescents in New York City. Chapter 4 evaluates longitudinal changes in syndemic risk in this same cohort of pregnant Latina adolescents from first trimester of pregnancy through one-year postpartum. We evaluate changes in severity over time and whether score predicts this change. We also examine immigration/cultural factors as moderators of this association. Chapter 5 explores longitudinal dyadic associations of syndemic score and severity between men and women. Using data from 296 pregnant couples, we evaluated changes from pregnancy to one-year postpartum, exploring actor-partner effects for syndemic variables.
Results: In Chapter 2 we found syndemic prevalence differed by race/ethnicity (23.8% of Whites, 13.8% Blacks, 24.9% Latinas, 25.8% Other). Multivariate analyses showed Black (OR=0.72, P=<0.05) and Latina (OR=0.76, P=<0.05) adolescents had a protective effect for drugs/alcohol use at last sexual encounter. Syndemic score and severity were significant predictors for multiple sex partners (OR=1.23, P=<0.01; OR=1.56, P=<0.001), not using a condom at last sexual encounter (OR=1.13, P=<0.05; OR=1.32, P=<0.001), and drug/alcohol use during last sexual encounter (OR=2.03, P=<0.001; OR=1.74, P=<0.001). We document a significant interaction between Black race/ethnicity and both score and severity. Among Black adolescents, greater syndemic score leads to greater odds of having multiple sex partners (OR=2.18, P=0.016), and greater syndemic severity leads to greater odds of having multiple sex partners (OR = 2.10, P=0.017).
In Chapter 3, multivariate analyses showed severity was a significant predictor of multiple sex partners (OR=1.51, P=0.04). Moderation analyses showed severity to be associated with more condom use among immigrants (OR =1.75, P=0.04) and lower condom use (OR =0.07, P=0.011) among individuals with a separated orientation. Higher severity was associated with greater odds of having multiple sex partners (OR=2.69, P=0.01) among immigrants. These findings confirm that a syndemic does exist among high-risk Latina adolescents and is impacted by immigration/cultural factors.
In Chapter 4 we found a linear effect of time for syndemic severity (β=0.0413, P=0.005), and syndemic score predicting severity across time. Moderation analyses indicate both immigrant generation (β lmmig=-0.1136, P=0.0032; β1st_Gen=-0.015, P=0.699) and separated orientation (βNot_ Separ=0.0953, P=0.0287) are associated with syndemic change over time. These findings confirm longitudinal changes in syndemics and moderation by immigration/culture.
In Chapter 5 we found significant actor effects for women's syndemic score (βT1- T2=0.2510, P=<0.001; β T2-T3=0.209, P=0.027) predicting subsequent score; and syndemic severity (βT1-T2=0.166, P=0.012; βT2-T3=0.325, P=0.002) predicting subsequent severity across all time points. Only men's score was associated with subsequent time points (βT1-T2=0.250, P=<0.001; β T2-T3=0.450, P=<0.001). For partner effects, women's score was associated with men's score at all time points (βT1-T2=0.153, P=0.039; β T2-T3=-0.171, P=0.061). Women's score 6-months postpartum impacted men's severity 1-year postpartum (βT2–T3=-0.262, P=0.028); and women's severity 6-months postpartum impacting men's severity 1-year postpartum (βT2-T3=0.345, P=0.001). Finally, women's severity at 6-months postpartum impacting men's score at 1-year postpartum (βT2-T3=0.234, P=0.002). Men's risk behaviors had no partner effects on women.
Conclusion: This dissertation confirms a syndemic of substance use, intimate partner violence, and depression among young minority adolescents. While Latinas showed seemingly lower burden compared to Black adolescents, we identified significant differences in syndemic associations for sexual risk by immigration/cultural factors. Syndemic risk also changed over time, particularly from pregnancy to 1-year postpartum. Longitudinal dyadic analyses show women's syndemic experiences are associated with men's subsequent syndemic experiences. Although men begin with higher score and severity, these differences become non-significant in the postpartum period, suggesting the need for targeted prevention. Future research should continue exploring syndemics within and outside of pregnancy, as well as cultural factors that may moderate these associations. Finally, research should continue evaluating actor-partner effects for syndemics to better understand relationship influences.
|Advisor:||Kershaw, Trace S.|
|School Location:||United States -- Connecticut|
|Source:||DAI-B 78/01(E), Dissertation Abstracts International|
|Subjects:||Public health, Behavioral Sciences, Epidemiology|
|Keywords:||Adolescent Health, Depression, Health Disparities, Intimate Partner Violence, Substance Use|
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