Unequal beginnings: Evidence of a sexual risk syndemic among adolescent girls in the US

background: Research has identified sexual risk syndemics (i.e., the confluence of multiple risk factors) affecting vulnerable populations, yet no studies have evaluated whether a syndemic exists among adolescent minority populations. This study identified whether substance use, violence, and depression are a sexual risk syndemic for adolescent females in the U.S. and whether disparities exist by race/ethnicity.

methods: Using a sample of 2,760 girls ages of 14-17, we measured syndemic extent (i.e., number of behaviors reported) and syndemic degree (i.e., severity across behaviors reported). Logistic regression assessed associations between syndemic factors and sexual risk (multiple partners, condom use, and drugs/alcohol at last sex).

results: Syndemic extent was significantly associated with multiple partners (OR=1.23; P<0.01), no condom use at last sex (OR=1.13; P<0.05), and drugs/alcohol at last sex (OR=2.02; P<0.001). Syndemic degree was also highly associated with multiple partners (OR=1.57; P<0.001), no condom use at last sex (OR=1.33; P<0.001), and drug/alcohol at last sex (OR=1.76;P<0.001). Interactions showed an effect between race/ethnicity and both syndemic extent and syndemic degree for multiple partners. Simple effects were calculated for significant interactions. Syndemic extent produced an odds of 2.18 (P<0.05) for multiple partners and syndemic degree an odds of 2.10 (P<0.05) for multiple partners, both effects among Black adolescents.

conclusions: Findings suggest a sexual risk syndemic is present in adolescence and that disparities exist particularly among Black adolescents. Prevention efforts should target substance use, violence, and depression as factors contributing to sexual risk disparities, particularly as a syndemic rather than focusing on individual behaviors.