School of Nursing, University of Maryland Baltimore, 655 W. Lombard St. Suite 600, Room 592, Baltimore, MD, 21201, USA.
Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
J Urban Health. 2020 Jun;97(3):395-405. doi: 10.1007/s11524-020-00431-z.
The distribution of violence, sexually transmitted infections, and substance use disorders is not random, but rather the product of disease, behavior, and social conditions that co-occur in synergistic ways (syndemics). Syndemics often disproportionately affect urban communities. Studies of syndemics, however, rarely apply consistent measures of social conditions. Here, the construct of social stability (SS) (housing, legal, residential, income, employment, and relationship stability) was evaluated as a consistent measure of social conditions related to sex, drug, and violence exposures in a new population in a Mid-Atlantic urban center. Lower SS predicted greater likelihood of any and combinations of risk. The magnitude varied based on specification: odds of sex-drug-violence exposure were greater for low vs. high latent SS class (OR = 6.25; 95%CI = 2.46, 15.96) compared with low vs. high SS category (OR = 2.64; 95%CI = 1.29, 5.39). A latent class characterized by residential instability was associated with greater likelihood of risk-a relationship that would have been missed with SS characterized only as an ordinal category. SS reliably captured social conditions associated with sexual, drug, and violence risks, and both quantity and quality of SS matter.
暴力、性传播感染和物质使用障碍的分布并非随机,而是疾病、行为和社会条件共同作用的产物(综合征)。综合征往往不成比例地影响城市社区。然而,综合征的研究很少采用一致的社会条件衡量标准。在这里,社会稳定性 (SS)(住房、法律、居住、收入、就业和关系稳定性)的构建被评估为与性、药物和暴力暴露相关的社会条件的一致衡量标准,这是在大西洋中部城市中心的新人群中进行的。较低的 SS 预测更大的风险暴露可能性和风险组合。基于规范,这种差异的幅度有所不同:与低 SS 类别相比,低 SS 类别的性-药-暴力暴露的可能性更高(OR=6.25;95%CI=2.46,15.96)。与低 SS 类别相比,以居住不稳定为特征的潜在类别与更高的风险可能性相关(OR=2.64;95%CI=1.29,5.39)。与 SS 仅作为有序类别相关相比,仅以 SS 为特征可能会忽略与 SS 特征相关的风险的关系。SS 可靠地捕捉到与性、药物和暴力风险相关的社会条件,并且 SS 的数量和质量都很重要。