자료유형  

 학위논문

Control Number  

0016931117

International Standard Book Number  

9798379963453

Dewey Decimal Classification Number  

610.73

Main Entry-Personal Name  

Garcia, David Ray.

Publication, Distribution, etc. (Imprint  

[S.l.] : New York University., 2022

Publication, Distribution, etc. (Imprint  

Ann Arbor : ProQuest Dissertations & Theses, 2022

Physical Description  

1 online resource(234 p.)

General Note  

Source: Dissertations Abstracts International, Volume: 85-02, Section: B.

General Note  

Advisor: Navarra, Ann-Margaret.

Dissertation Note  

Thesis (Ph.D.)--New York University, 2022.

Restrictions on Access Note  

This item must not be sold to any third party vendors.

Summary, Etc.  

요약Background: The national Youth Risk Behavior Survey (YRBS) is conducted biennially among adolescents in high school to examine multiple health related behaviors, such as substance use, violence, mental health, and sexual behaviors. Data from this survey have shown that adolescent gay, bisexual, and other men who have sex with men (AGBM) report disproportionate risks for substance use, violence, and mental health conditions, compared to heterosexual adolescents. These exposures have the potential to interact with HIV risk behaviors (such as condomless intercourse, an increased number of sexual partners, sex under the influence of drugs or alcohol, an early sexual debut, and not previously testing for HIV) known to be prevalent among AGBM, to form what theorists call a syndemic. However, few secondary data analyses of the YRBS dataset have examined a syndemic of substance use, violence, mental health, and HIV risk behaviors among sexually experienced AGBM. Moreover, there is a pressing need for research directed to identifying protective factors (such as academic achievement and a safe school environment) that reduce risk. This type of evidence is of vital importance, as significant increases in HIV infections have been observed to occur by 15 years of age, with disparities occurring among Black/African American and Hispanic/Latino men.Purpose: The primary aim of this dissertation study was to identify and describe the prevalence of syndemic factors (substance use, violence, and mental health) and HIV risk behavior outcomes (sexual intercourse in the last three months, four or more lifetime sexual partners, condom use at last intercourse, drug or alcohol use before last intercourse, engaging in sexual intercourse before the age of 13 years, and previously testing for HIV) among sexually experienced AGBM participating in the YRBS (years 2015-2019). The secondary aim was to test for associations between syndemic factors and HIV risk behavior outcomes, while controlling for demographic covariates (age, race, ethnicity, and sexual orientation). The third aim was to test for amplification of HIV risk behavior outcomes with each additional exposure to a syndemic factor (i.e. no exposure, one exposure, two or more exposures), while controlling for demographic covariates. The fourth aim was to test for associations between protective factors (academic achievement and a safe school environment) and HIV risk behavior outcomes, controlling for demographic covariates.Methods: Framed by syndemics theory, a secondary data analysis of the national YRBS from years 2015-2019 was conducted, as these timepoints contain the only nationally representative data available that are inclusive of sexual orientation and sexual behavior. Inclusion criteria for the analytic sample (n = 644) were self-report of the following: (1) biological male sex, (2) history of sexual intercourse, and (3) self-identification as gay, bisexual, unsure/no answer, or ever having same sex partners. Univariate analyses were used to obtain descriptive statistics for the demographic covariates and individual (a) syndemic factors, (b) protective factors, and (c) HIV risk behavior outcomes. Bivariate analyses examined independent associations between each HIV risk behavior outcome and (a) demographic covariates, (b) syndemic composite scores, and (c) protective factors. Multivariate logistic regression analyses (α = .05) were used to examine relationships between each HIV risk behavior outcome and (a) syndemic composite scores and (b) protective factors, while controlling for demographic covariates. Count scores were used to examine amplification of each HIV risk behavior outcome in the presence of increasing exposures of (a) syndemic factors and (b) protective factors, while controlling for demographic covariates.Results: There were four key findings. First, among a nationally representative analytic sample of sexually experienced AGBM in high school, the analysis showed that one-half (52%) of AGBM used a condom at last intercourse and 21% had previously tested for HIV. Differences among Black/African American and Hispanic/Latino AGBM were also observed. Adjusted models showed that Black/African American AGBM had a lower likelihood of previously testing for HIV (aOR = 0.06, 95% CI [0.01,0.44], p .01), compared to White AGBM. Hispanic/Latino AGBM were found to have a greater likelihood of reporting four or more lifetime sexual partners (aOR = 3.75, 95% Confidence Interval [CI] [1.49,9.44], p .01), compared to White AGBM, in both the unadjusted and adjusted models. Second, multivariate models identified a syndemic of substance use, intimate partner violence (IPV), and HIV risk behavior outcomes. Specifically, the co-occurrence of substance use and IPV was found to increase the likelihood of three HIV risk behavior outcomes (sexual intercourse before the age of 13 years, having four or more lifetime sexual partners, and using drugs or alcohol before last sexual intercourse). Third, additive risk, marked by increasing odds ratios, was observed to occur between multiple exposures of substance use, violence, and five HIV risk behavior outcomes (sexual intercourse in the last three months, four or more lifetime sexual partners, condom use at last intercourse, drug or alcohol use before last intercourse, and engaging in sexual intercourse before the age of 13 years). Similarly, additive risk was observed to occur between suicidal behaviors and two HIV risk behavior outcomes (sexual intercourse before 13 years and use of alcohol or drugs before last intercourse). Fourth, in the multivariate models examining opportunities for resiliency, protective factors were found to decrease the likelihood of four HIV risk behavior outcomes (sexual intercourse before 13 years, four or more lifetime sexual partners, use of alcohol/drugs before last intercourse, and not using a condom at last intercourse). Additive risk for these same four outcomes was found to be reduced when examining multiple exposures to protective factors.Conclusion: The observed syndemic relationships found between substance use, IPV, and HIV risk behavior outcomes provides important targets for the development of HIV prevention programs in school districts serving Black/African American and Hispanic/Latino ABGM. Study findings also highlight the need for increased access to school-based services such as HIV testing, HIV prevention strategies (condoms and pre-exposure prophylaxis), and linkage with HIV care. Polices directed at providing these school-based services, coupled with investments in a safe school environment and support for the academic success of AGBM also lend to HIV risk reduction. Limitations of the dataset show that future research needs be inclusive of contemporary measures for sex, gender, and experiences with stigma, in order to expand on the syndemic burdens experienced during adolescence.

Subject Added Entry-Topical Term  

Nursing.

Subject Added Entry-Topical Term  

Public health.

Subject Added Entry-Topical Term  

Mental health.

Index Term-Uncontrolled  

Adolescent

Index Term-Uncontrolled  

HIV

Index Term-Uncontrolled  

Secondary data analysis

Index Term-Uncontrolled  

Substance-related disorders

Index Term-Uncontrolled  

Violence

Added Entry-Corporate Name  

New York University College of Nursing

Host Item Entry  

Dissertations Abstracts International. 85-02B.

Host Item Entry  

Dissertation Abstract International

Electronic Location and Access  

로그인을 한후 보실 수 있는 자료입니다.

Control Number  

joongbu:641669