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Exploring a Syndemic: Multiple psychosocial health problems and associations with sexual risk and sexually transmitted infections among African American girls in juvenile detention facilities
African American girls in juvenile detention are disproportionately affected by sexually transmitted infections (STIs) and other psychosocial health problems. Using a syndemic approach, we examine potential effects of multiple psychosocial health problems on sexual risk and STI diagnosis.
In 2011-2012, ACASI surveys were completed by 188 African American girls aged 13-17 years in a Southeast juvenile detention facility who reported lifetime vaginal intercourse. We conducted three sets of logistic regression analyses. First, bivariate analyses assessed associations among seven psychosocial factors (emotional, physical, and sexual abuse; pregnancy coercion; substance abuse; depression; and post-traumatic stress disorder [PTSD]) to examine their interrelationships. Second, a count of psychosocial factors was calculated to examine the potential additive effect of multiple psychosocial factors on outcomes (early sexual debut; unprotected sex; multiple sexual partners; self-reported STI). Third, psychosocial factors were categorized into four domains: psychological abuse (emotional abuse, pregnancy coercion); violence (physical abuse, sexual abuse); substance abuse; and mental health (depression, PTSD) and included as independent associations with each outcome to assess the relative importance of the domains.
First, multiple interrelationships among psychosocial factors were identified. Second, having an increased number of psychosocial health problems increased the odds of all outcomes. Third, experiencing violence increased the odds of having multiple partners; and experiencing psychological abuse increased the odds of reporting an STI diagnosis.
Multiple psychosocial health problems, particularly psychological and violent abuse, are associated with sexual risk and STIs among detained African American girls. Simultaneously addressing multiple health outcomes for this vulnerable population may be of benefit.
Learning Areas:
Assessment of individual and community needs for health educationPlanning of health education strategies, interventions, and programs
Public health or related research
Learning Objectives:
Explain and apply the concept of a syndemic to African American girls detained in the juvenile justice system
Describe the interrelationship between multiple psychosocial factors for African American girls detained in the juvenile justice system
Assess the combined associations of experiencing multiple psychosocial health problems with sexual risk behaviors and STI diagnosis.
Keyword(s): Criminal Justice, Sexual Risk Behavior
Qualified on the content I am responsible for because: Dr. Fasula has over 10 years of experience as a social scientist at CDC, with a specific focus on adolescent sexual and reproductive health. Her work includes addressing sexual health disparities for African American and Hispanic youth and other vulnerable populations.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.