Acculturation and Syndemic Risk: Longitudinal Evaluation of Risk Factors Among Pregnant Latina Adolescents in New York City

Abstract

Background: Syndemics are co-occurring epidemics that synergistically contribute to specific risks or health outcomes. Although there is substantial evidence demonstrating their existence, little is known about their change over time in adolescents.

Purpose: The objectives of this paper were to identify longitudinal changes in a syndemic of substance use, intimate partner violence, and depression and determine whether immigration/cultural factors moderate this syndemic over time.

Methods: In a cohort of 772 pregnant Latina adolescents (ages 14-21) in New York City, we examined substance use, intimate partner violence, and depression as a syndemic. We used longitudinal mixed-effect modeling to evaluate whether higher syndemic score predicted higher syndemic severity, from pregnancy through 1 year postpartum. Interaction terms were used to determine whether immigrant generation and separated orientation were significant moderators of change over time.

Results: We found a significant increasing linear effect for syndemic severity over time (β = 0.0413, P = 0.005). Syndemic score significantly predicted syndemic severity (β = -0.1390, P ≤ 0.0001), as did immigrant generation (βImmigrant = -0.1348, P ≤ 0.0001; β1stGen = -0.1932, P = 0.0005). Both immigrant generation (βImmigrant = -0.1125, P = 0.0035; β1stGen = -0.0135, P = 0.7279) and separated orientation (β = 0.0946, P = 0.0299) were significantly associated with change in severity from pregnancy to 1 year postpartum.

Conclusion: Pregnancy provides an opportunity for reducing syndemic risk among Latina adolescents. Future research should explore syndemic changes over time, particularly among high-risk adolescents. Prevention should target syndemic risk reduction in the postpartum period to ensure that risk factors do not increase after pregnancy.

Trial registration: ClinicalTrials.gov NCT00628771.

Figures

Fig. 1

Syndemic score (a number of behaviors reported) and syndemic severity (b average degree of behaviors reported)

Fig. 2

Overall syndemic severity across time

Fig. 3

Syndemic severity over time by immigrant generation

Fig. 4

Syndemic severity over time by separated orientation