Cleland Charles M, Lanza Stephanie T, Vasilenko Sara A, Gwadz Marya
Center for Drug Use and HIV Research, New York University Meyers College of Nursing, New York, NY, United States.
Department of Biobehavioral Health, The Pennsylvania State University, University Park, PA, United States.
Front Public Health. 2017 Sep 7;5:237. doi: 10.3389/fpubh.2017.00237. eCollection 2017.
Substance use problems tend to co-occur with risk factors that are especially prevalent in urban communities with high rates of poverty. The present study draws on Syndemics Theory to understand profiles of risk and resilience and their associations with substance use problems in a population at risk for adverse outcomes. African-American/Black and Hispanic heterosexual adults ( = 2,853) were recruited by respondent-driven sampling from an urban area with elevated poverty rates, and completed a structured assessment battery covering sociodemographics, syndemic factors (that is, multiple, co-occurring risk factors), and substance use. More than one-third of participants (36%) met criteria for either an alcohol or a drug problem in the past year. Latent class analysis identified profiles of risk and resilience, separately for women and men, which were associated with the probability of a substance use problem. Almost a third of women (27%) and 38% of men had lower risk profiles-patterns of resilience not apparent in other types of analyses. Profiles with more risk and fewer resilience factors were associated with an increased probability of substance use problems, but profiles with fewer risk and more resilience factors had rates of substance use problems that were very similar to the general adult population. Relative to the lowest risk profile, profiles with the most risk and fewest resilience factors were associated with increased odds of a substance use problem for both women [adjusted odds ratio (aOR) = 8.50; 95% CI: 3.85-18.74] and men (aOR = 11.68; 95% CI: 6.91-19.74). Addressing syndemic factors in substance use treatment and prevention may yield improved outcomes.
物质使用问题往往与贫困率高的城市社区中特别普遍的风险因素同时出现。本研究借鉴综合征理论来理解风险和恢复力概况及其与面临不良后果风险人群中物质使用问题的关联。通过应答驱动抽样从贫困率较高的城市地区招募了非裔美国人/黑人以及西班牙裔异性恋成年人（n = 2853），他们完成了一项结构化评估，内容涵盖社会人口统计学、综合征因素（即多种同时出现的风险因素）和物质使用情况。超过三分之一的参与者（36%）在过去一年中符合酒精或药物问题的标准。潜在类别分析分别确定了女性和男性的风险和恢复力概况，这些概况与物质使用问题的可能性相关。近三分之一的女性（27%）和38%的男性具有较低风险概况——这种恢复力模式在其他类型的分析中并不明显。风险因素较多而恢复力因素较少的概况与物质使用问题的可能性增加相关，但风险因素较少而恢复力因素较多的概况中物质使用问题的发生率与一般成年人群非常相似。相对于风险最低的概况，风险最高且恢复力因素最少的概况与女性 [调整后的优势比（aOR）= 8.50；95%置信区间：3.85 - 18.74] 和男性（aOR = 11.68；95%置信区间：6.91 - 19.74）物质使用问题的几率增加相关。在物质使用治疗和预防中解决综合征因素可能会产生更好的结果。
