Syndemics of complex risk factors in adolescents: findings from the youth risk behavior survey, 2021

npj Mental Health Research · 2026-04-02

Syndemic theory posits that multiple, interconnected health behaviors-such as substance use, anxiety, depression, sexual risk behaviors, and societal or social stressors-interact synergistically within specific populations, particularly in those who face social disadvantage. These health behaviors are not isolated, but are shaped and exacerbated by social, economic, and environmental factors. Using data from the 2021 Youth Risk Behavior Surveillance System (N = 17,232), this cross-sectional study examined how the co-occurrence of substance use, mental health challenges, sexual risk behaviors, and COVID-19 pandemic-related stress creates different risk profiles among adolescents. Latent class analysis (LCA) results identified five distinct profiles of behavioral health risks: Class 1 (Complex high-risk), Class 2 (Moderate risk experimenters), Class 3 (Recent polysubstance use/Covid distress), Class 4 (Low-risk/COVID distress), and Class 5 (Low-risk). COVID distress referred to pandemic-related anxiety or stress. Higher-risk classes were characterized by recent substance use, engagement in condomless sex and having multiple partners, and psychological distress. Females, sexual minority adolescents, older-aged adolescents, and racially/ethnically marginalized groups were disproportionately represented in high-risk classes. The co-occurrence of substance, mental health challenges, and sexual risk behaviors reflects underlying structural and social inequities. By applying a syndemic lens, this study highlights the need for integrated, culturally responsive and contextually appropriate interventions, alongside early prevention and systemic policy changes to promote positive adolescent health.

Correlates of HIV and STI Testing in Rural Southern Substance Using-Men who have Sex with Men: A Behavioral Model for Health Services Use Approach

AIDS and Behavior · 2026-05-05

Is There a Cigarette Catch-Up Effect for Biracial Black Youth?

UNC Libraries · 2025-02-25

Introduction: The catch-up effect is a phenomenon in which the tobacco-use prevalence rates of White individuals are initially greater than the rates of Black individuals, but by the time the youth enter young adulthood, the prevalence rates for Black individuals catch up to or exceed the cigarette-use rates of White individuals. We test the catch-up effect by comparing the cigarette trajectories of monoracial and biracial Black adolescents with the trajectories of White adolecents. Methods: We used longitudinal data from the National Longitudinal Study of Adolescent and Adult Health. Our sample includes 9421 respondents. Study hypotheses are tested using latent growth curve modeling. Results: Findings revealed a catch-up effect for two of four outcomes. The catch-up effect was observed most often for Black individuals. Black and Black-Hispanic individuals showed cigarette smoking patterns consisted of a catch-up effect while Black-American individuals showed smoking patterns consisted of a cross-over effect. Black and Black-American Indian individuals showed a stark contrast to the typical bell-shaped curve with substance use patterns demonstrating upward slope trajectories. Conclusions: Interventions to prevent and reduce tobacco use in these populations are warranted.

The Role of School-Based Victimization in Shaping Suicide Risk and Mental Health Disparities Among Black Adolescents

Journal of Interpersonal Violence · 2025-11-27

Suicidal thoughts and behaviors (STBs) among Black adolescents have historically been lower compared to other racial and ethnic groups. Suicide is the third leading cause of death among Black adolescents aged 5 to 19 years. This study examined the predictors of STBs and associated factors in Black adolescents with respect to school-based victimizations. Data from the 2021 Youth Risk Behavior Survey (YRBS) were utilized in this cross-sectional study and included 2,322 Black high school adolescents. All demographic data, and data for school-based victimization and STBs were self-reported. Logistic regression models were employed to examine the association between school-based victimization and STBs. Female ( OR = 6.136; 95% CI [2.874, 13.098]) and male adolescents ( OR = 10.839; 95% CI [5.305, 22.146]) who felt sad or hopeless had significantly higher odds of suicide ideation. Physical fighting at school significantly reduced the odds of males experiencing ideation ( OR = 0.419; 95% CI [0.192, 0.916]) and planning ( OR = 0.273; 95% CI [0.087, 0.853]). Bullied female adolescents had significantly increased odds of planning suicide ( OR = 2.650; 95% CI [1.338, 5.249]). This study presented an analysis of Black adolescents’ experiences of victimization in school settings and their associations with STBs using one of the largest national adolescent health datasets. Findings of this study have implications for school health policy, practice, and equity. These findings highlight the urgent need to address victimization as a critical step in Black adolescents’ suicide risk. We propose expanding victimization items and future phenomenological studies on school-based victimization of Black adolescents and STBs.

Examining the integrated model of the interpersonal‐psychological theory of suicide and intersectionality theory among Black male adolescents

Suicide and Life-Threatening Behavior · 2024-02-27 · 12 citations

INTRODUCTION: Guided by Opara et al.'s (2022), Integrated Model of the Interpersonal Psychological Theory of Suicide and Intersectionality Theory, the current study examined contextual stressors experienced disparately by Black youth (racial discrimination, poverty, and community violence) as moderators of the association between individual motivating factors for suicidal thoughts and behaviors (perceived burdensomeness, thwarted belongingness, and hopelessness) and active suicidal ideation. METHOD: Participants were 457 Black adolescent boys (mean age = 15.31, SD = 1.26) who completed self-report surveys. RESULTS: As predicted, the association between perceived burdensomeness and active suicidal ideation was significantly moderated by economic stress. In addition, the association between peer belongingness and suicidal ideation was significantly moderated by racial discrimination, but there were no moderating effects for school belongingness. Finally, the association between hopelessness and suicidal ideation was significantly moderated by both racial discrimination and witnessing community violence. CONCLUSION: These findings highlight the need for research, interventions, and policy work devoted to using integrated approaches of individual and socioeconomically relevant patterns of suicidal thoughts and behaviors to support Black youth exposed to various forms of structural oppression.

Grade-Level Differences in the Profiles of Substance Use and Behavioral Health Problems: A Multi-Group Latent Class Analysis

International Journal of Environmental Research and Public Health · 2024-09-10 · 5 citations

We investigated associations between polysubstance use and behavioral problems among adolescents. Because substance use becomes more developmentally normative with age, we examined whether polysubstance use was less likely to co-occur with behavioral problems among older (vs. younger) adolescents. Using data from a nationally representative survey of US high school students, we compared the association between polysubstance use (i.e., use of alcohol, cannabis, tobacco/nicotine, and illicit drugs) and behavioral problems (i.e., suicide attempts, depressive symptoms, poor school performance, and sexual risk behaviors) by grade level. We conducted latent class analysis (LCA) to characterize patterns of polysubstance use, and multi-group LCA to estimate invariance by grade. Among the three latent classes that emerged, classes were distinguished by having low, moderate, and high probabilities for behavior problems and use of substances. Class I comprised 52% of the sample, whereas classes II and III comprised 35% and 12% of the sample, respectively. The multi-group LCA showed that younger adolescents had a higher relative probability of co-occurring problem behaviors and polysubstance use. Findings may be helpful in targeting screening and prevention efforts of high school students by grade. Specifically, our results provide evidence that associations between behavioral problems and alcohol/drug use are weaker in later high school grades, suggesting that substance use may not be a weaker marker of behavioral problems for students in higher grades.

Mode of pandemic school instruction associated with distress among military and non-military-connected students

Journal of Military Veteran and Family Health · 2024-11-01

LAY SUMMARY Because they experience unique risk factors, students from military families may have responded differently to remote school instruction during the COVID-19 pandemic. Results from this study show military-connected students were more distressed during this period than students from civilian families. Both groups appeared to fare better when they attended school in person. However, given their unique needs, military-connected students may benefit from specific resources to manage stressors associated with remote instruction.

Profiles of Suicidal Ideation Among Black Male Adolescents: Examination of Individual and Socioecological Predictors

Journal of Clinical Child & Adolescent Psychology · 2023-07-07 · 7 citations

OBJECTIVE: The current study utilized latent profile analysis to identify distinct profiles of suicidal ideation among Black male adolescents and compared profiles on socioecological determinants of suicide and psychological symptoms. METHOD: A sample of 457 Black male adolescents (mean age = 15.31, SD = 1.26) completed self-report measures of suicidal ideation, racial discrimination, community violence exposure, anxiety symptoms, depressive symptoms, and posttraumatic stress symptoms. RESULTS: Results of the latent profile analysis revealed a three-profile model: a low ideation profile, with low levels of all forms of suicidal ideation; a general death ideation profile with elevated general thoughts of death and dying; and a high, concealed ideation profile with high levels on all suicidal ideation items, except communicating the ideation to others. ANOVAs revealed that levels of psychological symptoms were significantly different for each profile, with the high, concealed ideation profile showing the highest levels. The low ideation profile had significantly lower scores than the two other profiles on community violence exposure, but the other two profiles did not differ significantly from one another. Further, the general death ideation profile had significantly higher scores on racial discrimination than the other two profiles, but the other two profiles did not differ significantly from one another. CONCLUSIONS: The current study supports recent socio-cultural theories of suicidal ideation and behavior in Black youth and highlights the need for increased access to care and services for Black boys who are exposed to socioecological factors that heighten suicidal ideation.

Adolescent Military Stress Measure

PsycTESTS Dataset · 2023-01-01

Development and Validation of the AMSM for Military-Connected Adolescents

Journal of Child and Family Studies · 2023-08-31