Cigarette Smoking as Part of a Syndemic Among Young Men Who Have Sex With Men Ages 13-29 in New York City

Background: The prevalence of cigarette smoking among young men who have sex with men (YMSM) is significantly higher than among their heterosexual peers. We undertook an analysis to examine cigarette smoking in relation to demographic factors and other risk behaviors among 580 YMSM, ages 13-29, in New York City. Methods: Cross-sectional data were collected as part of larger study of risk behaviors using handheld devices and targeted active recruitment strategies across all five boroughs of the city. Results: Multivariate modeling indicates that Asian/Pacific Islander and white YMSM are more likely to report cigarette smoking that other racial and ethnic groups, as are men reporting a middle class socio-economic status. In addition, smoking was found to be significantly related to the use of a variety of illicit substances as well as alcohol, and pharmaceuticals without a prescription during the period of assessment. YMSM who smoke cigarettes reported a significantly greater number of casual sex partners, and a greater number of transactional sex partners than non-smokers. Episodic analysis of sexual behaviors with casual partners indicated that smokers were more likely to engage in illicit drug and alcohol use immediately before or during sex than did non-smokers. Conclusions: These findings are understood as part of a larger syndemic among YMSM, and suggest that smoking prevention and cessation programs should be embedded a part of larger more holistic health and wellness programs targeting YMSM.