Social Stability Relates Social Conditions to the Syndemic of Sex, Drugs, and Violence

Marik Moen, Danielle German, Carla Storr, Erika Friedmann, Colin Flynn, Meg Johantgen

Research output: Contribution to journalArticlepeer-review


The distribution of violence, sexually transmitted infections, and substance use disorders is not random, but rather the product of disease, behavior, and social conditions that co-occur in synergistic ways (syndemics). Syndemics often disproportionately affect urban communities. Studies of syndemics, however, rarely apply consistent measures of social conditions. Here, the construct of social stability (SS) (housing, legal, residential, income, employment, and relationship stability) was evaluated as a consistent measure of social conditions related to sex, drug, and violence exposures in a new population in a Mid-Atlantic urban center. Lower SS predicted greater likelihood of any and combinations of risk. The magnitude varied based on specification: odds of sex-drug-violence exposure were greater for low vs. high latent SS class (OR = 6.25; 95%CI = 2.46, 15.96) compared with low vs. high SS category (OR = 2.64; 95%CI = 1.29, 5.39). A latent class characterized by residential instability was associated with greater likelihood of risk—a relationship that would have been missed with SS characterized only as an ordinal category. SS reliably captured social conditions associated with sexual, drug, and violence risks, and both quantity and quality of SS matter.

Original languageEnglish (US)
Pages (from-to)395-405
Number of pages11
JournalJournal of Urban Health
Issue number3
StatePublished - Jun 1 2020


  • HIV risk
  • Sexual risk
  • Social determinants of health
  • Social stability
  • Substance use
  • Violence

ASJC Scopus subject areas

  • Health(social science)
  • Urban Studies
  • Public Health, Environmental and Occupational Health


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