Toward theoretically informed substance use prevention among young men who have sex with men

Young men who have sex with men (YMSM) remain at higher risk for substance use and abuse than their heterosexual counterparts, yet recent reviews indicate a paucity of effective, theoretically based drug risk reduction interventions for this population. Informed by Social Action Theory (SAT, Ewart, 1991), which includes individual, social, and contextual determinants of health behavior, the present study sought to understand how changes in a range of psychological, social, and cognitive factors contribute to illicit substance use among YMSM. Data come from the NIDA-funded "Healthy Young Men" study, which longitudinally tracked an ethnically diverse cohort of YMSM ages 18-26. We used latent growth curve modeling to understand the relationships between contextual influences (e.g., history of violence and discrimination experiences), changing individual and social process variables (e.g., health values, self-efficacy, social support), and health protective behavior, psychological distress, and illicit drug use outcomes among 487 YMSM recruited through probability sampling in Los Angeles, California. Experiences of discrimination, violence and homophobia predicted illicit drug use indirectly through their influence on social support, psychological distress, and health values; individual and social process measures also significantly predicted health protective behavior. Our analyses also demonstrate significant intercorrelations between the process variables over time, which indicates that the shared relationship between them ultimately impacts illicit drug use. Results highlight the oscillating relationships between environmental experiences, psychological, social, and cognitive factors, and illicit drug use, underscoring the need for interventions tailored for YMSM to address the complex constellation of factors that contribute to illicit drug use in this population. The inclusion of multiple dimensions (social context, linkages between self-change and interpersonal environments, and macro-social and environmental influences) points to the importance of multidimensional targeting of behavior when constructing substance use prevention interventions for YMSM.