Syndemic theory and tobacco use in adolescent gay males

Syndemics of Adolescent Health

Theory

There are several social theories that attempt to explain health risks for defined demographics, such as adolescents. Socioeconomic theory suggests a lower status for an individual increases the risk of morbidity and mortality (Ward, Meyer, Verity, Gill, and Luong, 2011). In contrast to a focus on the individual, social quality theory suggests that social inclusion and empowerment lowers health risks. Syndemic theory, on the other hand, proposes that the morbidity and mortality of a defined demographic is determined by both social and economic factors (reviewed by Bruce, Harper, and AMTNHAI). To assess the value of socioeconomic and social factors in determining the health of adolescents, a study examining syndemic factors in adolescent gay males will be analyzed.

A Case Study in Syndemic Theory

A recent study investigated the syndemic of tobacco use in adolescent and young adult homosexual men in New York City (Storholm, Halkitis, Siconolfi, and Moeller, 2011), a demographic that has historically suffered marginalization in America. Smoking prevalence among this group was previously estimated to be 36.3%, significantly higher that their heterosexual counterparts, but smoking prevalence was found to be higher for those with a single racial background compared to those claiming multiracial backgrounds. In contrast to expectations, 40.5% of young White gay males were found to be using cigarettes compared to 29.9% of those having African-American ancestry. In addition, smoking was more prevalent for gay young men reporting a middle-class economic background than those with coming from lower income families.

Smoking among young gay men in New York City was also found to be positively associated with binge drinking, drug use, and high-risk sexual behavior (Storholm, Halkitis, Siconolfi, and Moeller, 2011). Based on syndemic theory, these behaviors should interact to degrade the overall health of the individual synergistically; however, young gay males in New York City do not uniformly suffer from syndemic health risks based on this study. Minority and lower socioeconomic status seem to provide a protective effect against syndemic factors within this demographic, when compared to their counterparts from higher socioeconomic backgrounds.

Interventions

Socioeconomic theory failed to predict the result of this study, but social quality and syndemic theory appear to have predictive value. Accordingly, social quality theory and syndemic theory would suggest that effective interventions include encouraging young gay adolescents to foster healthy social connections and enter into programs designed to minimize or eliminate syndemic factors, respectively. For example, encouraging participation in community programs that support a healthy lifestyle could be suggested as a way to minimize the amount of time spent in gay bars and nightclubs (Bruce, Harper, and AMTNHAI, 2011). Smoking cessation, drug and alcohol rehab, and sex education classes would be examples of interventions designed to reduce or eliminate syndemic factors (Storholm, Halkitis, Siconolfi, and Moeller, 2011).