Annals of Behavioral Medicine
Volume 52, Issue 1, 2018, Pages 42-52

Acculturation and syndemic risk: Longitudinal evaluation of risk factors among pregnant latina adolescents in New York City (Article) (Open Access)

Martinez I.* , Kershaw T.S. , Keene D. , Perez-Escamilla R. , Lewis J.B. , Tobin J.N. , Ickovics J.R.
  • a Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, Suite 445-B, Boston, MA 02215, United States
  • b Department of Chronic Disease Epidemiology, Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States
  • c Department of Chronic Disease Epidemiology, Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States
  • d Department of Chronic Disease Epidemiology, Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States
  • e Department of Chronic Disease Epidemiology, Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States
  • f Clinical Directors Network, New York, NY, United States
  • g Department of Chronic Disease Epidemiology, Yale University School of Public Health, Center for Interdisciplinary Research on AIDS, New Haven, CT, United States

Abstract

Background Syndemics are co-occurring epidemics that syn-ergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents. Purpose The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time. Methods In a cohort of 772 pregnant Latina adolescents (ages 14–21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time. Results We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = −0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = −0.1348, P ≤ 0.0001; β1st Gen = −0.1932, P = 0.0005). Both immigrant generation (βImmigrant = −0.1125, P = 0.0035; β1st Gen = −0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum. Conclusion Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy. © The Society of Behavioral Medicine 2017.

Author Keywords

health disparities Depression Substance use Adolescents Intimate partner violence

Index Keywords

immigrant depression longitudinal study health disparity pregnancy complication Pregnancy Complications human immigration comorbidity Longitudinal Studies Substance-Related Disorders Depressive Disorder drug dependence ethnology Hispanic Americans syndemic Young Adult Humans Hispanic Adolescent model New York Acculturation female risk factor substance use Risk Factors pregnancy cultural factor Pregnancy in Adolescence adolescent pregnancy Intimate Partner Violence major clinical study partner violence adult New York City risk reduction puerperium
Link
https://www.scopus.com/inward/record.uri?eid=2-s2.0-85023751620&doi=10.1007%2fs12160-017-9924-y&partnerID=40&md5=2329cdd0beed99179b0c307498fa06ed
DOI: 10.1007/s12160-017-9924-y
ISSN: 08836612
Cited by: 3
Original Language: English