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

Abstract

Second generation Latina adolescents experience increases in severity while immigrant Latinas experience decreases in severity for a syndemic comprised of substance use, intimate partner violence and depression during pregnancy and the postpartum period.

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 ( β _Immigrant = –0.1348, P ≤ 0.0001; β _{1st Gen} = –0.1932, P = 0.0005). Both immigrant generation ( β _Immigrant = –0.1125, P = 0.0035; β _{1st Gen} = –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.