Social ecological model of alcohol use among youth living with HIV

ABSTRACT

The goal of this study was to identify predictors of alcohol use among youth living with HIV (YWH) using a social ecological approach that examines the individual and the context in which they are embedded. The sample consisted of 183 YWH ages 17–24 from five sites within the Adolescent Medicine Trials Network (ATN). Structural equation modeling was used to test the social ecological model of alcohol use in this sample. The model tested predictors at the individual, interpersonal, and environmental level. Results showed that mental health distress (b = 0.21, p < 0.05), social norms of alcohol use (b = 0.29, p < 0.05) and alcohol outlets (b = 0.23, p < 0.05) were associated with alcohol use. Externalizing behaviors were indirectly associated with problematic alcohol use, while social norms of alcohol use mediated this relationship (z = 2.42, p = 0.015). Our findings identified factors across multiple systems related to alcohol use among YWH supporting the social ecological model. Findings suggest treatment for alcohol use behavior would benefit from also addressing the individual by focusing on mental health issues as well. Additionally, at the interpersonal level, considering one’s social norms of drinking in their social network, especially among youth who are more prone to externalizing behaviors, would lower alcohol use. Furthermore, public policy should examine ways to limit the accessibility of alcohol in higher risk environments.

KEYWORDS:

• HIV
• alcohol use
• social ecological framework
• structural equation modeling

Disclosure statement

No potential conflict of interest was reported by the author(s).

Author contributions

All authors take responsibility for the integrity and accuracy of this work, took part in the concept and design, contributed to the acquisition, analysis, or interpretation of data, and drafted of the manuscript and critically reviewed the manuscript for important intellectual content.

Role of the funder/sponsor

The funding sources had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Additional information

Funding

The research project was funded by the National Institute on Alcohol Abuse and Alcoholism (R01AA022891).

Notes on contributors

Veronica Dinaj

Veronica Dinaj, PhD was a postdoctoral fellow in Family Medicine and Public Health Sciences at Wayne State University at the time of analyses and manuscript preparation. She is a developmental psychologist with an emphasis on quantitative methods and analyses.

Bo Wang

Bo Wang, PhD is a Professor in the Department of Population and Quantitative Health Sciences at UMass Chan Medical School. He is a biostatistician and behavioral epidemiologist by training, focused on HIV prevention and implementation science research.

Henna Budhwani

Henna Budhwani, PhD is a Professor at Florida State University College of Nursing, Institute on Digital Health and Innovation). She is an Implementation Scientist and socio-behavioral interventionist with expertise in qualitative and mixed-methods research, digital health interventions, and pragmatic clinical trial design.

Sylvie Naar

Sylvie Naar, PhD is a Distinguished Endowed Professor at the Florida State University College of Medicine’s Department of Behavioral Sciences and Social Medicine and the Director of the Center for Translational Behavioral Science. Dr. Naar is a clinical psychologist and researcher with more than two decades of studies across the spectrum of intervention research.

Karen Kolmodin MacDonell

Karen MacDonell, PhD is an Associate Professor in the Department of Behavioral Sciences and Social Medicine and the Center for Translational Behavioral Science at Florida State University. She was faculty at Wayne State University when this study was conducted. Dr. MacDonell is a developmental psychologist focused on digital behavioral intervention research in vulnerable populations.