title: Substance abuse, violence, HIV, and depression: an underlying syndemic factor among Latinas.
abstract: BACKGROUND
  Evidence from the literature suggests that substance abuse, violence, HIV risk, depressive symptoms, and underlying socioeconomic conditions are tied intrinsically to health disparities among Latinas. Although these health and social conditions appear to comprise a syndemic, an underlying phenomenon disproportionately accounting for the burden of disease among marginalized groups, these hypothesized relationships have not been formally tested.
  
  
  OBJECTIVE
  The aim of this study was to assess (a) if substance abuse, violence, HIV risk, and depressive symptoms comprised a syndemic and (b) if this syndemic was related to socioeconomic disadvantage among Latinas.
  
  
  METHODS
  Baseline assessment data from a randomized controlled community trial testing the efficacy of an HIV risk reduction program for adult Latinas (n = 548) were used to measure demographic variables, substance abuse, violence, risk for HIV, and depressive symptoms. Structural equation modeling was used to test a single underlying syndemic factor model and any relation to socioeconomic disadvantage.
  
  
  RESULTS
  The results of this study support the idea that HIV risk, substance abuse, violence, and depressive symptoms comprise a syndemic, χ(27) = 53.26, p < .01 (relative χ = 1.97, comparative fit index = .91, root mean square error of approximation = .04). In addition, in limited accord with theory, this factor was related to 2 measures of socioeconomic disadvantage, percentage of years in the United States (b = 7.55, SE = 1.53, p < .001) and education (b = -1.98, SE = .87, p < .05).
  
  
  CONCLUSIONS
  The results of this study could be used to guide public health programs and policies targeting behavioral health disparity conditions among Latinos and other vulnerable populations. Further study of the influence of gender-role expectations and community-level socioeconomic indicators may provide additional insight into this syndemic.
authors.affiliation: University of Miami School of Nursing and Health Studies, Coral Gables, Florida 33146, USA. rosagonzalez@miami.edu
authors.forename: Rosa Maria
authors.initials: RM
authors.lastname: González-Guarda
authors.forename: Brian E
authors.initials: BE
authors.lastname: McCabe
authors.forename: Aubrey
authors.initials: A
authors.lastname: Florom-Smith
authors.forename: Rosina
authors.initials: R
authors.lastname: Cianelli
authors.forename: Nilda
authors.initials: N
authors.lastname: Peragallo
mesh_terms: D000293:Adolescent; D000328:Adult; D003863:Depression / Q000208:ethnology*; D004522:Educational Status; D005260:Female; D015658:HIV Infections / Q000517:prevention & control*; D015438:Health Behavior; D054624:Health Status Disparities; D006630:Hispanic or Latino; D006801:Humans; D008875:Middle Aged; D015233:Models, Statistical; D009742:Nursing Theory; D012959:Socioeconomic Factors; D019966:Substance-Related Disorders / Q000208:ethnology*; D014481:United States; D014754:Violence / Q000208:ethnology* / Q000706:statistics & numerical data; D055815:Young Adult