Using a Syndemic Framework and Structural Equation Modeling to Assess the Co-occurrence and Mutual Impact of Violence Experiences and Substance Use Behaviors Among Adolescents.

Adolescents are at particular risk for multiple violence experiences and substance use behaviors. The extent to which the two clusters of experiences correlate with each other remains unclear. The purpose of this study is to assess the co-occurrence and mutual impact of violence experiences and substance use behaviors in adolescents using structural equation modeling (SEM) based on syndemic theory. This study utilized data collected by 2019 Youth Risk Behavior Survey from a nationally representative sample ( N  = 13,677). Bivariate associations and correlations between four forms of violence experiences (weapon threats, sexual violence, dating violence, and bullying) and three types of substance use behaviors (e-cigarette smoking, alcohol drinking, and marijuana use) were examined. Two SEM models were built to measure the correlation between the two clusters of variables. The results showed that 36.8% of adolescents experienced at least one form of violence in the past year (22.0% one form, 8.9% two forms, and 5.9% three or more forms) and 42.4% reported one or more types of substance use in the past month (16.3% one type, 14.0% two types, and 12.1% three types). Youths with multiple violence experiences were three to four times more likely to report substance use, and those using three types of substances were two to six times more likely to report violence victimization. All examined associations and correlations between violence experiences and substance use behaviors were statistically significant. In the final SEM model, the four violence variables indicated a syndemic factor and the three substance use variables indicated another syndemic factor. The two syndemic factors were positively correlated (β = .43, p  < .05), with 19% of variance being explained by each other. Findings in this study highlight the needs for comprehensive prevention efforts to address the co-occurring and mutually reinforced situation between violence experiences and substance use behaviors in the youth population. Targeted intervention programs and mental health services are needed for adolescents with multiple violence experiences and concurrent substance use behaviors.