Syndemic Risk Classes and Substance Use Problems among Adults in High-Risk Urban Areas: A Latent Class Analysis.

Charles M Cleland,Stephanie T Lanza,Marya Gwadz,Sara A Vasilenko

doi:10.3389/fpubh.2017.00237

Abstract

Substance use problems tend to co-occur with risk factors that are especially prevalent in urban communities with high rates of poverty. The present study draws on Syndemics Theory to understand profiles of risk and resilience and their associations with substance use problems in a population at risk for adverse outcomes. African-American/Black and Hispanic heterosexual adults (N = 2,853) were recruited by respondent-driven sampling from an urban area with elevated poverty rates, and completed a structured assessment battery covering sociodemographics, syndemic factors (that is, multiple, co-occurring risk factors), and substance use. More than one-third of participants (36%) met criteria for either an alcohol or a drug problem in the past year. Latent class analysis identified profiles of risk and resilience, separately for women and men, which were associated with the probability of a substance use problem. Almost a third of women (27%) and 38% of men had lower risk profiles—patterns of resilience not apparent in other types of analyses. Profiles with more risk and fewer resilience factors were associated with an increased probability of substance use problems, but profiles with fewer risk and more resilience factors had rates of substance use problems that were very similar to the general adult population. Relative to the lowest risk profile, profiles with the most risk and fewest resilience factors were associated with increased odds of a substance use problem for both women [adjusted odds ratio (aOR) = 8.50; 95% CI: 3.85–18.74] and men (aOR = 11.68; 95% CI: 6.91–19.74). Addressing syndemic factors in substance use treatment and prevention may yield improved outcomes.

Highlights

Substance use problems tend to co-occur with other serious risk factors that are especially prevalent in communities with high rates of poverty, and where African-American/Black and Hispanic populations are over-represented in comparison to the general underlying population [1, 2]
The present study did not examine the timing of events, these findings suggest the importance of historical, structural risk factors such as homelessness and incarceration
Latent class analysis revealed a small number of syndemic profiles for women and men in a high-poverty urban area

Summary

Introduction

Substance use problems tend to co-occur with other serious risk factors that are especially prevalent in communities with high rates of poverty, and where African-American/Black and Hispanic populations are over-represented in comparison to the general underlying population [1, 2]. While it is well known that risk factors for adverse health outcomes tend to co-occur [2, 13], little is known about specific patterns of risk and resilience in this large population at high risk for poor outcomes, including regarding the potential associations of risk and protective factors with substance use problems Grounded in this literature, we selected the following potential risk and potentially protective background and psychosocial factors for study: education level, experiences of extreme poverty, employment status, history of homelessness, history of incarceration, health literacy, depression, emotional support, and instrumental support [3,4,5]. Mean scores of 3 or greater indicated higher (coded 1) and mean scores less than 3 indicated low instrumental support (coded 2)

Methods

Results

Discussion

Conclusion