title: Attachment style, childhood adversity, and behavioral risk among young men who have sex with men.
abstract: OBJECTIVE
  To examine relationships among childhood adversity, attachment style (one's core beliefs regarding the self and others), and the following risk behaviors and contexts among young men who have sex with men (YMSM): homelessness, daily substance use, participation in sex work, involvement in the criminal justice system, and being out of school or work.
  
  
  METHODS
  Using a targeted sampling approach, we recruited 569 YMSM aged 17-28 years from natural venues in New York City including bars, clubs, parks, and bus stations. Youth completed a structured interview assessing lifetime and current risk and protective contexts and behavior. Data were analyzed using univariate and multivariate statistical methods, including hierarchical logistic regression.
  
  
  RESULTS
  After controlling for demographic characteristics and childhood adversity, YMSM with a fearful attachment style were more likely to have been homeless (OR 2.93, 95% CI 1.65-5.18), to have participated in sex work (OR 2.35, 95% CI 1.44-3.85), to use substances daily (OR 2.79, 95% CI 1.29-6.03), to have been involved in the criminal justice system (OR 2.04, 95% CI 1.38-3.01), and to be out of school/work (OR 2.47, 95% CI 1.47-4.15). Three subgroups were particularly vulnerable: YMSM who identified as heterosexual, or bisexual, and/or transgender.
  
  
  CONCLUSIONS
  A fearful attachment style contributes to some YMSM remaining outside of the protective systems of family, school, and work, and is associated with risky contexts where they are less likely to encounter prosocial peers and adults. Further, it is associated with risk behavior. Although gay-identified youth are generally found to have poor outcomes when compared with the general population of adolescents, in the present report, YMSM who identified as heterosexual were at particular risk. Attachment theory can guide interventions by informing how individuals experience relationships and manage developmental transitions.
authors.affiliation: National Development and Research Institutes, Inc, New York, New York 10010, USA. gwadz@ndri.org
authors.forename: Marya Viorst
authors.initials: MV
authors.lastname: Gwadz
authors.forename: Michael C
authors.initials: MC
authors.lastname: Clatts
authors.forename: Noelle R
authors.initials: NR
authors.lastname: Leonard
authors.forename: Lloyd
authors.initials: L
authors.lastname: Goldsamt
mesh_terms: D000293:Adolescent; D000328:Adult; D002649:Child Abuse / Q000523:psychology* / Q000706:statistics & numerical data; D003415:Crime / Q000706:statistics & numerical data; D005581:Foster Home Care / Q000523:psychology* / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009519:New York City / Q000453:epidemiology; D009769:Object Attachment; D012309:Risk-Taking; D011477:Sex Work / Q000706:statistics & numerical data; D019966:Substance-Related Disorders / Q000453:epidemiology; D014478:Unemployment / Q000706:statistics & numerical data