Objectives. To examine linear and nonlinear associations between psychosocial syndemic factors and HIV risk and engagement in HIV prevention care among sexual and gender minority (SGM) youths. Methods. Between February and October 2022, we recruited 17 578 SGM youths aged 13 to 18 years in the United States for an online survey. We examined the relationship of syndemics (i.e., binge drinking, drug use, sexual victimization, and anti-lesbian, gay, bisexual, and transgender discrimination) with sexual behaviors (i.e., sexual initiation, condomless anal or vaginal sex, and number of sexual partners) and HIV prevention care (i.e., HIV testing, preexposure prophylaxis awareness and utilization) using regression. Results. Psychosocial syndemic burden (number of syndemic factors reported) was linearly and cubically associated with engagement in sexual behaviors. Psychosocial syndemic burden was linearly associated with higher HIV testing and preexposure prophylaxis awareness and cubically associated with higher preexposure prophylaxis utilization. Conclusions. Our findings are evidence of synergism across psychosocial syndemic factors regarding HIV risk and engagement in HIV prevention care among SGM youths in the United States. Public Health Implications. Multicomponent interventions may help reduce HIV risk and promote access to HIV prevention services among SGM individuals aged 13 to 18 years. (Am J Public Health. 2024;114(9):892-902. https://doi.org/10.2105/AJPH.2024.307753).

A State of the Art lecture titled \"Syndemics in Women\'s Health: Poverty, Social Exclusion and Clustering of Thrombotic and Haemostasis Disorders\" was presented at the International Society on Thrombosis and Haemostasis (ISTH) Congress in 2023. Syndemics are characterized by the clustering of specific health conditions in vulnerable populations. These populations become vulnerable as a result of large-scale social, political, and economic factors that influence social determinants of health and increase susceptibility to disease. Vulnerable populations at risk of experiencing a syndemic include those who are subjected to social exclusion and gender- or race-based marginalization. Biological sex (assigned at birth based on physical & genetic differences) and gender identity (the personal sense of ones own gender) have been recognized as important determinants of health outcomes in the context of certain syndemic diseases. Potential examples of syndemic biosocial interactions in the field of thrombosis and hemostasis include the effect of social determinants of health in perpetuating the global maternal mortality crisis and the role of poverty and marginalization in influencing thrombosis risk in socially excluded individuals. Initiatives directed at prevention and treatment of syndemic conditions require multilevel interventions directed at the socio-economic as well as the biological determinants of the disease. In the present article, we describe potential syndemic disease interactions in the field of thrombosis and hemostasis, and we summarize some relevant new data relating to the social determinants of health presented during the 2023 ISTH Congress.

The intricate relationship between food systems and health outcomes, known as the food-nutrition-health nexus, intersects with environmental concerns. However, there\'s still a literature gap in evaluating food systems alongside the global syndemic using the complex systems theory, especially concerning vulnerable populations like children. This research aimed to design a system dynamics model to advance a theoretical understanding of the connections between food systems and the global syndemic, particularly focusing on their impacts on children under five years of age. The framework was developed through a literature review and authors\' insights into the relationships between the food, health, and environmental components of the global syndemic among children. The conceptual model presented 17 factors, with 26 connections and 6 feedback loops, categorized into the following 5 groups: environmental, economic, school-related, family-related, and child-related. It delineated and elucidated mechanisms among the components of the global syndemic encompassing being overweight, suffering from undernutrition, and climate change. The findings unveiled potential interactions within food systems and health outcomes. Furthermore, the model integrated elements of the socio-ecological model by incorporating an external layer representing the environment and its natural resources. Consequently, the development of public policies and interventions should encompass environmental considerations to effectively tackle the complex challenges posed by the global syndemic.

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OBJECTIVE: LGBTQ-affirmative cognitive-behavioral therapy (CBT) addresses minority stress to improve sexual minority individuals\' mental and behavioral health. This treatment has never been tested in high-stigma contexts like China using online delivery.
METHODS: Chinese young sexual minority men (n = 120; ages 16-30; HIV-negative; reporting depression and/or anxiety symptoms and past-90-day HIV-transmission-risk behavior), were randomized to receive 10 sessions of culturally adapted asynchronous LGBTQ-affirmative internet-based CBT (ICBT) or weekly assessments only. The primary outcome included HIV-transmission-risk behavior (i.e., past-30-day condomless anal sex). Secondary outcomes included HIV social-cognitive mechanisms (e.g., condom use self-efficacy), mental health (e.g., depression), and behavioral health (e.g., alcohol use), as well as minority stress (e.g., acceptance concerns), and universal (e.g., emotion regulation) mechanisms at baseline and 4- and 8-month follow-up. Moderation analyses examined treatment efficacy as a function of baseline stigma experiences and session completion.
RESULTS: Compared to assessment only, LGBTQ-affirmative ICBT did not yield greater reductions in HIV-transmission-risk behavior or social-cognitive mechanisms. However, LGBTQ-affirmative ICBT yielded greater improvements in depression (d = -0.50, d = -0.63) and anxiety (d = -0.51, d = -0.49) at 4- and 8-month follow-up, respectively; alcohol use (d = -0.40) at 8-month follow-up; and certain minority stress (e.g., internalized stigma) and universal (i.e., emotion dysregulation) mechanisms compared to assessment only. LGBTQ-affirmative ICBT was more efficacious for reducing HIV-transmission-risk behavior for participants with lower internalized stigma (d = 0.42). Greater session completion predicted greater reductions in suicidality and rumination.
CONCLUSIONS: LGBTQ-affirmative ICBT demonstrates preliminary efficacy for Chinese young sexual minority men. Findings can inform future interventions for young sexual minority men in contexts with limited affirmative supports.

The syndemic framework goes beyond the concept of comorbidity and considers how diseases interact within their wider environmental context, along with social and political factors, to mutually exacerbate negative outcomes. The syndemic approach enhances the way mental disorders are understood in terms of their aetiology, treatment and prognosis and therefore influences the direction of clinical practice, policy development and research priorities in the field of psychiatry. Using a syndemic framework to develop mental health policy globally can help address the mental health treatment gap in countries where resources are limited. In Russia, identified syndemics have been of particular relevance to mental disorders and further research using a syndemic framework will continue to build upon the strong background of integrated mental healthcare currently provided.

In the last ten years, multimorbidity in children under the age of five years has become an emerging health issue in developing countries. The study of multimorbidity of anaemia, malaria, and malnutrition (MAMM) among children in Nigeria has not received significant attention. This study aims to investigate what risk factors are associated with the prevalence of multimorbidity among children aged 6 to 59 months in Nigeria. This study used two nationally representative cross-sectional surveys, the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report. A series of multilevel mixed-effect ordered logistic regression models were used to investigate the associations between child/parent/household variables (at level 1), community-related variables (at level 2) and area-related variables (at level 3), and the multimorbidity outcome (no disease, one disease only, two or more diseases). The results show that 48.3% (4917/10,184) of the sample of children aged 6-59 months display two or more of the disease outcomes. Being a female child, the maternal parent having completed higher education, the mother being anaemic, the household wealth quintile being in the richest category, the proportion of community wealth status being high, the region being in the south, and place of residence being rural were among the significant predictors of MAMM (p < 0.05). The prevalence of MAMM found in this study is unacceptably high. If suitable actions are not urgently taken, Nigeria\'s ability to actualise SDG-3 will be in grave danger. Therefore, suitable policies are necessary to pave the way for the creation/development of integrated care models to ameliorate this problem.

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Multimorbidity of malaria, anemia, and malnutrition (MAMM) is a condition in which an individual has two or more of these health conditions, and is becoming an emergent public health concern in sub-Saharan African countries. The independent associations of a child\'s demographic variables and household socioeconomic (HSE) disparities with a child\'s health outcomes have been established in the literature. However, the effects of the intersection of these factors on MAMM, while accounting for other covariates, have not been studied. Therefore, this study aimed to determine how children\'s sex, age, and household socioeconomic status interact to explain the variations in MAMM among children aged 6-59 months in Nigeria. Data from the 2018 Nigeria Demographic and Health Survey and the 2018 National Human Development Report (NHDR) were used. This study included weighted samples of 10,184 children aged 6-59 months in Nigeria. A three-level multilevel mixed effect ordinal logistic regression model was used, such that individual characteristics at level 1 were nested in communities at level 2 and nested in states at level 3. Subsequently, predictive probability charts and average adjusted probability tables were used to interpret the intersectional effects. Five models were created in this scenario. Model 1 is the interaction between the child\'s sex and household wealth status; model 2 is the interaction between the child\'s sex and age; model 3 is the interaction between the child\'s age and household wealth status; model 4 has the three two-way interactions of the child\'s sex, age, and household wealth status; and model 5 includes model 4 and the three-way interactions between a child\'s sex, age, and household wealth quintiles; while accounting for other covariates in each of the models. The prevalence of children with a \'none of the three diseases\' outcome was 17.3% (1767/10,184), while 34.4% (3499/10,184) had \'only one of the diseases\', and 48.3% (4918/10,184) had \'two or more\' MAMMs. However, in the multivariate analyses, model 3 was the best fit compared with other models, so the two-way interaction effects of a child\'s age and household wealth status are significant predictors in the model. Children aged 36-47 months living in the poorest households had a probability of 0.11, 0.18, and 0.32 of existing with MAMM above the probability of children of the same age who live in the middle class, more prosperous, and richest households, respectively, while all other covariates were held constant. Thus, the variation in the prevalence of MAMM in children of different ages differs depending on the household wealth quintile. In other words, in older children, the variations in MAMM become more evident between the richer and the poorer household quintiles. Therefore, it is recommended that policies that are geared toward economic redistribution will help bridge the disparities observed in the prevalence of multiple diseases among children aged 6-59 months in Nigeria.

BACKGROUND: Mental health issues (depression and suicidal ideation) are increasingly common in children and emerge as escalating public health concerns. The syndemics that underline the importance of risk factor clustering provides a framework for intervention, but there is a lack of research on syndemics involving the adverse interactions of children\'s mental health problems. This study therefore examined the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation among children in China.
METHODS: A mental health screening census of students in grades 5-12 was conducted from November 2022 to January 2023 in Nanling County, Anhui Province, China. The prevalence and co-occurrence of vulnerable conditions (unfavorable parental marital status, left-behind experience, bullying victimization, and self-harm behavior), depression, and suicidal ideation and the cumulative and synergistic effects of vulnerable conditions on depression and suicidal ideation were explored.
RESULTS: Nearly a quarter of students (24.8%) reported at least two syndemic conditions. Overall, the prevalence of depression and suicidal ideation were 20.2% and 24.2% respectively. The odds of depression and suicidal ideation were higher for children with one or more vulnerable conditions and were ten times higher for children with three or more vulnerable conditions compared with those without any vulnerable condition. These four vulnerable conditions can increase the odds of depression and suicidal ideation by interacting synergistically with each other.
CONCLUSIONS: Our findings signal the importance of addressing mental health syndemics among children in China by simultaneously considering concurrent vulnerable conditions.