imageCharles M. Cleland1*, imageStephanie T. Lanza2imageSara A. Vasilenko2 and imageMarya Gwadz1


These findings highlight multiple opportunities for the prevention of, and interventions to ameliorate, substance use problems among H-HRA. These include the importance of education, particularly for H-HRA women, and interventions targeting young women at risk for dropout have shown promise (64). Further, they highlight the primacy of homelessness and incarceration as risk factors for poor outcomes, and at the same time, suggest opportunities for substance use prevention and treatment interventions in shelters and criminal justice settings. While substance use problems are treatable, often there are psychosocial and structural barriers to effective treatment (5961), barriers which may be related to syndemic factors. Women in the Low Resources and Support class and men in the Low Resources and Support classes may benefit from specialized outreach efforts (6566) and wrap-around clinical services (67), particularly because they lack emotional and instrumental support, as well as job training programs to address unemployment. Future research on the optimal and most cost-effective combinations of interventions is needed, particularly for this sub-group of women in the Low Resources and Support class and men in the Low Resources and Support class, more than half of whom experience substance use problems.

The syndemic profiles captured in latent classes have implications for the tailoring of substance use treatment and prevention. Among those with a current problem, addressing syndemic factors as part of treatment, or adapting treatments to work more effectively in the presence of syndemic factors, could improve outcomes of substance use treatment. Integrated care that considers multiple problems simultaneously within a single system may lead to better outcomes than care fragmented across multiple, separate systems. Those in classes at higher risk for substance use problems, but without a current problem, may benefit the most from prevention interventions. This suggests syndemic risk and protective factors need to be assessed in a variety of contexts where people may present—jail, homeless shelters, primary care, and others. Addressing modifiable syndemic factors might improve prevention interventions for substance use problems.


This study reveals numerous risk factors as well as protective factors for at-risk urban youth, predominantly of minority and lower socieconomic class.  What is interesting is that it also identifies and helps to define the protective effects of various other social factors which thus allows prospective interventions to be more efficiently targeted at those with the highest risk of harm.

Dr. Raymond Oenbrink
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