TY - JOUR
T1 - Syndemic latent transition analysis in the HPTN 061 cohort
T2 - Prospective interactions between trauma, mental health, social support, and substance use
AU - Turpin, Rodman E.
AU - Dyer, Typhanye V.
AU - Dangerfield, Derek T.
AU - Liu, Hongjie
AU - Mayer, Kenneth H.
N1 - Funding Information:
We acknowledge the University of Maryland, College Park, Department of Epidemiology and Biostatistics, the primary institution for Rodman Turpin, Typhanye, Dyer, and Hongjie Liu. This work was also supported by the University of Maryland Prevention Research Center , cooperative agreement #U48 DP006382 from the Centers for Disease Control and Prevention (CDC). Any interpretations and opinions expressed herein are solely those of the authors and may not reflect those of the CDC. Dr. Derek Dangerfield II also acknowledges his support from the National Institute of Mental Health (K01MH11849).
Funding Information:
We also acknowledge the HIV Prevention Trials Network, funded by the National Institute of Allergy and Infectious Diseases ( UM1AI068619 , UM1AI068613 , UM1AI1068617 ), with co-funding from the National Institute of Mental Health , and the National Institute on Drug Abuse, all components of the U.S. National Institutes of Health . The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
We acknowledge the University of Maryland, College Park, Department of Epidemiology and Biostatistics, the primary institution for Rodman Turpin, Typhanye, Dyer, and Hongjie Liu. This work was also supported by the University of Maryland Prevention Research Center, cooperative agreement #U48 DP006382 from the Centers for Disease Control and Prevention (CDC). Any interpretations and opinions expressed herein are solely those of the authors and may not reflect those of the CDC. Dr. Derek Dangerfield II also acknowledges his support from the National Institute of Mental Health (K01MH11849). We also acknowledge the HIV Prevention Trials Network, funded by the National Institute of Allergy and Infectious Diseases (UM1AI068619, UM1AI068613, UM1AI1068617), with co-funding from the National Institute of Mental Health, and the National Institute on Drug Abuse, all components of the U.S. National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Funding Information:
This research was supported by the University of Maryland Prevention Research Center, cooperative agreement #U48 DP006382 from the Centers for Disease Control and Prevention (CDC). Grants for the original data collection, from which we conducted our secondary data analysis, are also acknowledged.
Publisher Copyright:
© 2020 Elsevier B.V.
PY - 2020/9/1
Y1 - 2020/9/1
N2 - Background: Substance use among Black sexual minority men (BSMM) is a significant public health focus of prevention interventions due to its association with sexual risk behaviors and transmission of HIV. Traumatic experiences and mental health challenges may interact to create a syndemic associated with substance use in this population; this may be moderated by social support however. Methods: Using a multicenter prospective cohort of 1068 BSMM, we conducted a longitudinal syndemic latent transition analysis testing whether baseline and 6-month race and sexuality-targeted violence, intimate partner violence, other traumatic experiences, depression, and internalized homophobia was associated with 12-month substance use. We also tested if social support modified this and was associated with transitions between statuses. Results: Our analysis identified four statuses: A “low-risk” status characterized by the lowest proportions of syndemic factors, and 3 “high-risk” statuses, characterized by higher proportions of syndemic factors. All three high-risk statuses were associated with higher substance use than the low-risk status, with the greatest association observed with “high-risk status C” (aRR = 4.54, 95 % CI 1.98, 10.40). Social support attenuated this association (Interaction aRR = 0.21, 95 % CI 0.05, 0.85) and was associated with lower transition rates from low to high-risk status 6 months later (Transition ratio = 0.45, 95 % CI 0.29, 0.69). Conclusions: Our findings identified a syndemic of trauma, depression, and homophobia among BSMM associated with substance use, but attenuated by social support. Future research into the role of social support and resiliency in substance use prevention and recovery is recommended.
AB - Background: Substance use among Black sexual minority men (BSMM) is a significant public health focus of prevention interventions due to its association with sexual risk behaviors and transmission of HIV. Traumatic experiences and mental health challenges may interact to create a syndemic associated with substance use in this population; this may be moderated by social support however. Methods: Using a multicenter prospective cohort of 1068 BSMM, we conducted a longitudinal syndemic latent transition analysis testing whether baseline and 6-month race and sexuality-targeted violence, intimate partner violence, other traumatic experiences, depression, and internalized homophobia was associated with 12-month substance use. We also tested if social support modified this and was associated with transitions between statuses. Results: Our analysis identified four statuses: A “low-risk” status characterized by the lowest proportions of syndemic factors, and 3 “high-risk” statuses, characterized by higher proportions of syndemic factors. All three high-risk statuses were associated with higher substance use than the low-risk status, with the greatest association observed with “high-risk status C” (aRR = 4.54, 95 % CI 1.98, 10.40). Social support attenuated this association (Interaction aRR = 0.21, 95 % CI 0.05, 0.85) and was associated with lower transition rates from low to high-risk status 6 months later (Transition ratio = 0.45, 95 % CI 0.29, 0.69). Conclusions: Our findings identified a syndemic of trauma, depression, and homophobia among BSMM associated with substance use, but attenuated by social support. Future research into the role of social support and resiliency in substance use prevention and recovery is recommended.
KW - Black
KW - Depression
KW - Homophobia
KW - Latent variable
KW - Men who have sex with men
KW - Substance use
KW - Syndemic
KW - Trauma
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U2 - 10.1016/j.drugalcdep.2020.108106
DO - 10.1016/j.drugalcdep.2020.108106
M3 - Article
C2 - 32652374
AN - SCOPUS:85087403730
VL - 214
JO - Drug and Alcohol Dependence
JF - Drug and Alcohol Dependence
SN - 0376-8716
M1 - 108106
ER -