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Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City

  • Original Article
  • Published:
Annals of Behavioral Medicine

Abstract

Background

Syndemics are co-occurring epidemics that synergistically 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 (β Immigrant = −0.1348, P ≤ 0.0001; β 1st Gen = −0.1932, P = 0.0005). Both immigrant generation (β Immigrant = −0.1125, P = 0.0035; β 1st 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.

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Acknowledgements

This research is supported by the National Institute of Mental Health of the National Institutes of Health under Award Number P30MH062294. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

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Authors and Affiliations

  1. Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, 401 Park Drive, Suite 445-B, Boston, MA, 02215, USA

    Isabel Martinez PhD

  2. Department of Chronic Disease Epidemiology, Yale University School of Public Health and Center for Interdisciplinary Research on AIDS, New Haven, CT, USA

    Trace S. Kershaw PhD, Danya Keene PhD, Rafael Perez-Escamilla PhD, Jessica B. Lewis MA & Jeannette R. Ickovics PhD

  3. Clinical Directors Network, New York, NY, USA

    Jonathan N. Tobin PhD

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Correspondence to Isabel Martinez PhD.

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Author’s Statement of Conflict of Interest and Adherence to Ethical Standards

The research presented in this manuscript has not been previously published. This research is supported by the National Institute of Mental Health of the National Institutes of Health under Award Number P30MH062294. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The data used in analyses were obtained from the Centering Pregnancy Plus study, which is registered at ClinicalTrials.gov (#NCT00628771). Procedures for this study were approved by the human investigation committees at site (Yale #0408026962). The authors have no conflicts of interest to disclose.

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Martinez, I., Kershaw, T.S., Keene, D. et al. Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City. ann. behav. med. (2017). https://doi.org/10.1007/s12160-017-9924-y

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