Department of Epidemiology and Biostatistics, School of Public Health, Texas A&M University, College Station, Texas.
Department of Psychiatry, University of Pittsburgh, Pittsburgh, Pennsylvania.
J Adolesc Health. 2019 Mar;64(3):319-326. doi: 10.1016/j.jadohealth.2018.09.006. Epub 2018 Nov 14.
Syndemic theory suggests that the convergence of social, environmental, and ecological factors can interact to exacerbate behavioral health problems and are often intensified by social conditions and disparities. This study used latent class analysis (LCA) to determine gender and racial/ethnic specific classes for sexually transmitted infection (STI) risk.
LCA included 18 measured socioeconomic, depression, substance use, and sexual behavioral variables from 1,664 young adults ages 18-25 in the NHANES. Models were stratified by gender and then by race/ethnicity. Logistic regression determined associations between latent class membership and testing positive for one or more STIs (Chlamydia trachomatis, HIV or herpes simplex virus-II). For each stratified analysis, classes with the lowest probability of reported risk factors in the LCA were the reference groups.
Class 3 in females (highest probability of reporting both socioeconomic and behavioral factors) and class 3 in males (majority behavioral factors) had increased odds of STI (females: OR = 2.7, 95% CI 1.6-4.5; males: OR 2.5, 95% CI 1.3-4.6). By race for females, depression (highest in Hispanics), poverty, and less educated households (highest in blacks and Hispanics) were evident in classes associated with STI. Class 1 black males (majority behavioral factors) had a higher odds of STI compared with low risk white males (OR = 16.4 95% CI 3.7-72.0) However, no other associations were observed among males.
Risk patterns for STI differed by gender and race/ethnicity. Consistent with syndemic theory, effective STI interventions need to address socioeconomic factors and mental health rather than individual behaviors, particularly for minority women.
综合征理论表明，社会、环境和生态因素的融合会相互作用，加剧行为健康问题，并且通常会因社会条件和差异而加剧。本研究使用潜在类别分析（LCA）来确定性传播感染（STI）风险的性别和种族/民族特定类别。
LCA 包括来自 NHANES 中 18 项测量的社会经济、抑郁、物质使用和性行为变量，参与者为 18-25 岁的年轻人。根据性别和种族/民族对模型进行分层。逻辑回归确定潜在类别成员与一项或多项 STI（沙眼衣原体、HIV 或单纯疱疹病毒-II）检测呈阳性之间的关联。对于每个分层分析，LCA 中报告风险因素概率最低的类别为参考组。
女性中的类别 3（报告社会经济和行为因素的概率最高）和男性中的类别 3（主要行为因素）的 STI 可能性增加（女性：OR=2.7，95%CI 1.6-4.5；男性：OR 2.5，95%CI 1.3-4.6）。对于女性，按种族来看，抑郁（西班牙裔最高）、贫困和教育程度较低的家庭（黑人和西班牙裔最高）在与 STI 相关的类别中明显存在。与低风险白人男性相比，黑人男性的类别 1（主要行为因素）的 STI 可能性更高（OR=16.4，95%CI 3.7-72.0）。然而，在男性中没有观察到其他关联。
STI 的风险模式因性别和种族/民族而异。与综合征理论一致，有效的 STI 干预措施需要解决社会经济因素和心理健康问题，而不仅仅是个人行为，特别是针对少数族裔妇女。
