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


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.

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Authors wish to acknowledge the contributions of participants and research team of the BESURE-HET3 study. The statistical oversight provided by Dr. Gregory Hancock,Professor and EDMS Program Director, University of Maryland (College Park). The folllowing funding sources supported Dr. Moen's dissertation: Maryland Higher Education Commission MHEC: Nurse Educator Doctoral Grant; The Jonas Foundation (Jonas Veteran's Scholarship).

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Correspondence to Marik Moen.

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Moen, M., German, D., Storr, C. et al. Social Stability Relates Social Conditions to the Syndemic of Sex, Drugs, and Violence. J Urban Health 97, 395–405 (2020).

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