Syndemics of psychosocial problems and HIV risk: A systematic review of empirical tests of the disease interaction concept
Open accessAbstract
In the theory of syndemics, diseases co-occur in particular temporal or geographical contexts due to harmful social conditions (disease concentration) and interact at the level of populations and individuals, with mutually enhancing deleterious consequences for health (disease interaction). Empirical tests of the disease interaction concept require rigorous statistical evaluation of interaction on additive and multiplicative scales.
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4 of 26 cited sources checked · 1 supported · 0 flagged · accuracy not yet measured
- Background
The count variable approach has drawn limited criticism in the syndemics literature as overly simplistic.
“The count variable approach has received muted criticism in the syndemics literature for being too “simplistic” (Gebrekristos, 2010; Halkitis et al., 2013).”
Quote in the paperNot yet classified1 of 2 sources checked- cites Gebrekristos, 2010
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Halkitis et al., 2013 source
In the Introduction (“The Present Study”; page unavailable), Halkitis et al. criticize additive syndemic measures for weighing variables equally and relying on simple correlations. The Discussion likewise contrasts prior summation-based studies with its more complex model. These passages support the criticism that the approach is simplistic, but do not establish that criticism across the literature was limited or “muted.” (LLM, conf=0.84)
Experimental — accuracy not yet measured
- Method
When a product term was used, the reviewers checked whether the report gave enough information to interpret interaction on both additive and multiplicative scales.
“If the test involved inclusion of a product term in a regression model, we assessed whether the presentation yielded sufficient information to interpret interaction on an additive and on a multiplicative scale (Knol et al., 2009; Knol & VanderWeele, 2012).”
Quote in the paperNot yet classified1 of 2 sources checked - Background
Depression and substance abuse disorders are common among people at risk for HIV and among people living with HIV, and dual diagnosis interventions are widely considered necessary.
“Both depressive and substance abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis interventions for both primary and secondary HIV prevention is widely acknowledged (Batki, 1990; Fisher & Smith, 2009; Sikkema et al., 2010; Walkup et al., 2008).”
Quote in the paperNot yet classified2 of 3 sources checked- cites Bing et al., 2001 source
The Comment (p. 6) reports high rates of psychiatric disorders and drug dependence among people receiving HIV care, including a 36% positive screen for major depression. The study sampled adults with HIV, so it does not establish prevalence among people at risk of acquiring HIV. The separate claim about dual-diagnosis interventions has its own citations and is not attributed to Bing et al. (LLM, conf=0.87)
Experimental — accuracy not yet measured - cites Riley et al., 2014 source
The Methods describe a cohort of HIV-infected and non–HIV-infected homeless and unstably housed women; the Results (Population Characteristics; page not provided) report major depressive episodes in 66% and substance-related disorders in 85%. This supports high prevalence in that specific group, but not the broader claim about all people at risk for or living with HIV. The dual-diagnosis intervention clause cites other works, not Riley et al. (LLM, conf=0.85)
Experimental — accuracy not yet measured - cites Tsai et al., 2013a
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Finding
The typical included study used a cross-sectional design, took place in the United States, and studied men who have sex with men.
“Most studies were based on a cross-sectional design (32 [80%]), conducted in the U.S. (32 [80%]), and focused on men who have sex with men (21 [53%]).”
Quote in the paperNot yet classified - Finding
Fewer than one-third of studies used an empirical approach that properly assessed whether psychosocial problems interact to amplify HIV risk.
“However, fewer than one in three studies used an empirical specification that appropriately assessed the extent to which psychosocial problems interact to magnify HIV risk.”
Quote in the paperNot yet classified
- Finding
Only Herrick (2011) formally computed additive interaction measures, such as RERI, and found greater-than-additive associations between psychosocial problems and condomless anal intercourse.
“Of the studies included in this review, only Herrick (2011) formally calculated measures of additive interaction -- such as the relative excess risk due to interaction (RERI) (Rothman, 1974) -- and found that psychosocial problems did in fact have greater than additive associations with condomless anal intercourse.”
Quote in the paperNot yet classified0 of 2 sources checked- cites Herrick (2011)
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites Rothman, 1974 source
- Finding
Every included study found a statistically significant link between at least one psychosocial problem and one or more outcomes.
“All studies (40/40 [100%]) reported a statistically significant association between one or more psychosocial problems (sometimes referred to as “syndemic exposures”) and one or more outcome variables.”
Quote in the paperNot yet classified - Finding
Studies using the count variable were more likely than others to describe their results as showing additive associations between psychosocial problems and outcomes.
“Compared to studies that used other specifications (e.g., product term in a multiplicative model), the studies that employed the count variable approach were much more likely to characterize their findings as demonstrating that psychosocial problems had “additive associations” with the outcomes of interest (19/31 [62%] vs. 1/9 [11%]; χ2=7.03, P=0.008).”
Quote in the paperNot yet classified - Finding
Sixteen studies (40%) could have supported fully saturated regression models based on sample size and number of psychosocial problems; their median sample size was 788 versus 577 for those that could not, a non-significant difference.
“Sixteen (40%) studies would have permitted fully saturated regression models according to generally accepted rules of thumb, given their sample sizes and number of psychosocial problems considered. These studies had a median sample size of 788 (interquartile range [IQR], 493–2989), compared to a median sample size of 577 among the studies that would not have permitted fully saturated regression models (IQR, 322–926) (nonparametric test on the equality of medians, χ2=0.94; P=0.33).”
Quote in the paperNot yet classified - Finding
No included study used an experimental or quasi-experimental design, so all carried some risk of bias.
“No studies were based on experimental or quasi-experimental designs, placing all at some risk of bias.”
Quote in the paperNot yet classified - Finding
The most common specification was a sum score counting the total number of psychosocial problems, used by 31 studies (78%).
“The most frequently used specification to test the disease interaction concept was the “syndemic count variable,” i.e., sum score corresponding to the total number of psychosocial problems (31 [78%]).”
Quote in the paperNot yet classified - Finding
The review ultimately analyzed forty records, including thirty-four journal articles, five dissertations, and one conference abstract.
“The final sample included 40 records: 34 journal articles, 5 dissertations (one of which was mapped to a published journal article), and 1 conference abstract (see Appendix).”
Quote in the paperNot yet classified - Finding
Count-variable studies were also more likely to use synergy or interaction language that did not match their statistical models.
“Although no formal tests of interaction were used in these studies, they were also much more likely to include language about “synergy” or “interaction” that was inconsistent with the statistical models used: 14/31 (45%) of these studies employed such language, compared to 0/9 (0%) of the others (χ2=6.25, P=0.01).”
Quote in the paperNot yet classified - Finding
Count-variable studies more often cited Stall et al. (2003) than studies using other specifications.
“The studies that used the count variable approach were more likely to have cited Stall et al. (2003) (27/31 [87%] vs. 5/9 [56%]; χ2=4.34, P=0.04).”
Quote in the paperNot yet classified - Background
Rothman originally proposed causal interaction and defined it as a departure from additivity in risk differences among causal factors.
“The notion of causal interaction is derived from a theoretical concept of causation and was originally proposed by Rothman (1974), who formally defined it as a deviation from additivity of the risk differences of the causal risk factors under investigation.”
Quote in the paperNot yet classified0 of 1 sources checked- cites Rothman (1974) source
- Background
Epidemiologists have urged researchers to stop judging interactions solely from product terms in multiplicative models.
“Regarding studies that employ the product term specification, epidemiologists have called for an end to the practice of assessing interactions based purely on product terms in multiplicative models (Greenland, 2009; Rajaleid, Janszky, & Hallqvist, 2011).”
Quote in the paperNot yet classified0 of 2 sources checked - Background
Singer introduced the term syndemic to highlight the often co-occurring issues of substance abuse, violence, and HIV.
“The term “syndemic” was proposed by Singer (1994) to call attention to these issues, with a special focus on the frequently co-occurring problems of substance abuse, violence, and HIV (Singer, 1996, 2006).”
Quote in the paperNot yet classified0 of 2 sources checked- cites Singer (1994) source
- cites Singer, 1996, 2006
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Background
The paper links its syndemic models to Link and Phelan's fundamental cause framework.
“These simple models are consistent with the fundamental cause concept elaborated by Link and Phelan (1995).”
Quote in the paperNot yet classified0 of 1 sources checked- cites Link and Phelan (1995) source
- Background
Epidemiologic work on disease interaction has a lengthy and contentious history.
“The concept of disease interaction has had a long and controversial history in the epidemiologic literature (Blot & Day, 1979; Greenland, 2009; Kaufman, 2009; Kupper & Hogan, 1978; Rothman, 1974, 1976a; Rothman, Greenland, & Walker, 1980; Saracci, 1980; Siemiatycki & Thomas, 1981; VanderWeele, 2009a; Walter & Holford, 1978).”
Quote in the paperNot yet classified0 of 3 sources checked - Background
Stall and colleagues' early empirical study extended syndemic thinking to HIV risk among U.S. men who have sex with men, but it did not find evidence of interacting epidemics; it did show that psychosocial problems often co-occurred.
“In one of the first empirical studies in this literature, Stall et al. (2003) attempted to extend conceptual thinking about syndemics to understanding HIV risk among men who have sex with men in the U.S. While their analysis did not provide evidence of interacting epidemics, they did show that psychosocial problems were frequently co-occurring and that”
Quote in the paperNot yet classified0 of 1 sources checked- cites Stall et al. (2003) source
- Background
Singer and Clair's later formulation defines a syndemic as intertwined epidemics that reinforce each other through biological disease interactions and are maintained by harmful social conditions and connections.
“As summarized by Singer and Clair (2003) in one of the more recent restatements of the theory, “a syndemic is a set of intertwined and mutually enhancing epidemics involving disease interactions at the biological level that develop and are sustained in a community/population because of harmful social conditions and injurious social connections” (p.429).”
Quote in the paperNot yet classified0 of 1 sources checked- cites Singer and Clair (2003) source
- Method
The review used the accepted guideline that logit or Cox models need roughly 5 to 10 events per covariate to judge whether studies could support fully saturated models with product terms.
“Following the generally accepted rule of thumb that 5–10 events are required per covariate in logit or Cox regression models (Peduzzi et al., 1995; Peduzzi et al., 1996; Vittinghoff & McCulloch, 2007), we assessed whether or not each paper could have supported fully saturated regression models with product terms between all of the psychosocial problems considered.”
Quote in the paperNot yet classified0 of 3 sources checked - Background
There is broad agreement that analyses testing departures from additivity better reflect how depression and substance use causally interact.
“General consensus in the field (Blot & Day, 1979; Kupper & Hogan, 1978; Rothman, 1986; Rothman, Greenland, & Walker, 1980; Saracci, 1980) suggests that an analysis that assesses for departures from additivity would more appropriately reflect the causal structure of the interaction between depression and substance use.”
Quote in the paperNot yet classified0 of 3 sources checked
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The field has largely studied how individual-level outcomes are explained by individual-level covariates.
“The field, however, has largely focused on investigating how individual-level outcomes can be explained by individual-level covariates.14”
From Co-occurring epidemics, syndemics, and population health (2017) · cites this paper as [14]
The Discussion (page unavailable) says the most common approach in the reviewed syndemics studies used a count of psychosocial problems to assess HIV-related outcomes. That supports an individual-level focus in this literature, but the review is limited to psychosocial problems and HIV risk; it does not establish the claim for a broader, unspecified field. (LLM, conf=0.78)
Experimental — accuracy not yet measuredSystematic reviews have shown that most epidemiological studies in the syndemics literature, all using individual-level data, have attempted to document syndemics with the sum score specification.
“Systematic reviews have shown that most epidemiological studies in this literature -- all of which are based on individual-level data -- have attempted to document the existence of syndemics by using the “sum score” specification (Tsai & Burns, 2015; Tsai et al., 2017).”
From Syndemics: a theory in search of data or data in search of a theory? (2018) · cites this paper as Tsai & Burns, 2015
The Results report that 31 of 40 reviewed studies (78%) used a sum score—the total count of psychosocial problems—to test the disease-interaction concept. The review concerns psychosocial problems and HIV risk; the passages do not establish that all epidemiological studies in the broader syndemics literature used individual-level data. (LLM, conf=0.84)
Experimental — accuracy not yet measuredTo date, the field has focused exclusively on investigating how individual-level outcomes can be explained by individual-level covariates.
“To date, the field has focused exclusively on investigating how individual-level outcomes can be explained by individual-level covariates (Tsai & Burns, 2015; Tsai et al., 2017).”
From Syndemics: a theory in search of data or data in search of a theory? (2018) · cites this paper as Tsai & Burns, 2015
Methods §3.3 describes studies modeling HIV outcomes using psychosocial problems as covariates, supporting an individual-level focus in the literature reviewed. But the paper does not establish that the field focused exclusively on individual-level outcomes and covariates; §5.2 also discusses ways to investigate syndemics at the population level. (LLM, conf=0.83)
Experimental — accuracy not yet measuredConventional methods for testing models of synergistic disease interaction or multicomponent intervention effectiveness can face intractable difficulties because full factorial study designs are resource-demanding.
“Unfortunately, use of conventional methods to test models of synergistic disease interaction or the effectiveness of multicomponent interventions can encounter intractable difficulties due to the resource demands of full factorial study designs (Tsai & Burns, 2015; Tsai & Venkataramani, 2016).”
From Syndemics: a theory in search of data or data in search of a theory? (2018) · cites this paper as Tsai & Burns, 2015
The Discussion (page unavailable) says that testing disease interaction with product terms can require large samples and that funding may make large studies infeasible. But it discusses fully saturated regression models, not full factorial study designs, and does not address the effectiveness of multicomponent interventions. It also notes that nearly half the reviewed studies could have supported fully saturated models, so the difficulty is conditional rather than universal. (LLM, conf=0.88)
Experimental — accuracy not yet measuredThe difficulty in operationalizing syndemic theory's central elements has resulted in a divergence of scholarship from the theory's centralizing principles towards a simpler accumulation perspective in which more conditions equate to worse health outcomes.
“The difficulty in operationalizing these central elements has resulted in a divergence of scholarship from the centralizing principles of the theory towards a simpler accumulation perspective in which more conditions equate to worse health outcomes.”
From Recommendations for empirical syndemics analyses: A stepwise methodological guide (2024) · cites this paper as [11]
Split into 2 atoms — 1 confirmed, 1 partially supported, 0 disputed, 0 misattributed, 0 unverifiable. Expand the claim to see per-atom verdicts.
Experimental — accuracy not yet measured
Researchers in the syndemics literature have not successfully accomplished what they set out to achieve.
“Tsai and Burns (2015) and Tsai and Venkataramani (2016) demonstrated that researchers in this literature have not successfully accomplished what they set out to achieve”
From Syndemic theory, methods, and data (2022) · cites this paper as Tsai and Burns (2015)
The Methods (§3.2) say many studies purported to test syndemics theory but did not appropriately test disease interaction; the Discussion (§5) says fewer than one in three used an appropriate specification. That supports a narrower criticism than the citing sentence: the review also says all included studies found associations between psychosocial problems and outcomes, so it does not establish that researchers failed at everything they set out to achieve. Page numbers were not supplied in our copy. (LLM, conf=0.86)
Experimental — accuracy not yet measuredMost studies have used an empirical specification like the sum score of exposures common in childhood adversity research.
“Rather, the overwhelming majority of studies14 have employed an empirical specification similar to that which has predominated in the literature on childhood adversity, i.e., a sum score of exposures.15–18”
From Co-occurring epidemics, syndemics, and population health (2017) · cites this paper as [14]
Summing up the associations across variables being used as proxies for syndemics tends to overlook the central tenet of syndemic theory: interaction.
“A second gap in the literature is occasioned by a major critique of the field -that summing up the associations across variables being used as proxies for syndemics tends to overlook the central tenet of syndemic theory: interaction (Tsai and Burns, 2015; Tsai and Venkataramani, 2016).”
From Syndemic theory, methods, and data (2022) · cites this paper as Tsai and Burns, 2015
Recent reviews conclude that the accumulation/sum score approach currently dominates syndemics studies.
“Recent reviews of syndemics literature [[11], [12], [13], [14]], conclude that this approach currently dominates syndemics studies.”
From Recommendations for empirical syndemics analyses: A stepwise methodological guide (2024) · cites this paper as [11]
Tsai and Burns (2015) showed that the majority of studies claiming to have tested the theory of syndemics had not used appropriate analytical strategies.
“In their systematic review, Tsai and Burns (2015) showed that the majority of studies claiming to have tested the theory of syndemics had not used appropriate analytical strategies.”
From The syndemic of violence victimisation, drug use, frequent alcohol use, and HIV transmission risk behaviour among men who have sex with men: Cross-sectional, population-based study in India (2019) · cites this paper as Tsai and Burns (2015)
None of the empirical studies in the syndemics literature were based on ecological or multilevel data.
“In the systematic review by Tsai and Burns (2015) subsequently updated by Tsai et al. (2017), none of the empirical studies in the syndemics literature were based on ecological or multilevel data.”
From The syndemic of violence victimisation, drug use, frequent alcohol use, and HIV transmission risk behaviour among men who have sex with men: Cross-sectional, population-based study in India (2019) · cites this paper as Tsai and Burns (2015)
The Results section reports that 32 of 40 included studies were cross-sectional, but does not say whether any used ecological or multilevel data. Searches for “ecological,” “multilevel,” and the claim’s phrasing found no passage establishing that none did; the review’s inclusion criteria also cover empirical tests of disease interaction, not every study in the syndemics literature. (LLM, conf=0.73)
Experimental — accuracy not yet measuredThis study represents the largest probability-based study of syndemics among MSM.
“Our study represents the largest probability-based study of syndemics among MSM (Tsai & Burns, 2015).”
From The syndemic of violence victimisation, drug use, frequent alcohol use, and HIV transmission risk behaviour among men who have sex with men: Cross-sectional, population-based study in India (2019) · cites this paper as Tsai & Burns, 2015
The Results (page unavailable) report that 21 reviewed studies focused on men who have sex with men and give a median sample size, but do not identify the largest probability-based study. Searches for “probability-based study of syndemics among MSM” and “probability sample largest sample size” found no comparison that verifies the citing authors’ claim about their own study. (LLM, conf=0.73)
Experimental — accuracy not yet measuredMost syndemic studies of psychosocial conditions and HIV risk have not used analytical approaches that examine whether co-occurring conditions have synergistic effects.
“the majority of studies to date have not used analytical approaches that enable an examination of whether and how the co-occurring psychosocial conditions assert synergistic effects on HIV risk – a fundamental assumption of syndemic theory.”
From Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India (2018) · cites this paper as Tsai and Burns 2015
The most common analytical approach in syndemic studies is an additive count or sum approach that investigates a dose-response relationship.
“The most common analytical approach is an additive (count or sum) approach, wherein the association of the cumulative number of conditions is explored with an HIV behavioral outcome (e.g., unprotected anal intercourse) or prevalent HIV or other sexually transmitted infection, essentially investigating the presence of a dose response.”
From Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India (2018) · cites this paper as Tsai and Burns 2015
The authors' findings support the argument by Tsai and colleagues that synergy cannot be assumed from a cumulative relationship between number of syndemic conditions and sexual risk behaviors, and that formal methods are needed to evaluate synergistic interaction.
“Foremost, our findings provide further support for Tsai and colleagues’ (Tsai and Burns 2015, Tsai and Venkataramani 2016, Tsai, Mendenhall et al. 2017) argument that synergy cannot be assumed based on a cumulative relationship of the number of syndemic conditions and sexual risk behaviors and that additional methods are necessary to formally evaluate the presence of synergistic interaction.”
From Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India (2018) · cites this paper as Tsai and Burns 2015
Tsai and Burns (2015) observed that many syndemic investigations show a dose-response pattern between syndemic conditions and sexual risk or HIV seroconversion.
“This pattern fits with Tsai and Burns’s (2015) observation that there is a pattern of dose-response relationships with syndemic conditions and sexual risk (or HIV seroconversion) in many syndemic investigations.”
From Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India (2018) · cites this paper as Tsai and Burns’s (2015)
Five syndemic conditions were chosen based on their previous associations with HIV risk and their frequent use in the syndemic literature.
“Five syndemic conditions were chosen based on their previous associations with HIV risk and their frequent use in the syndemic literature, including alcohol dependence, illicit drug use, depression, intimate partner violence (IPV), and childhood sexual abuse (CSA) (Tsai and Burns 2015).”
From Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India (2018) · cites this paper as Tsai and Burns 2015
Tsai and Burns (2015) and Tsai and Venkataramani (2016) argue that a linear pattern suggests additive effects but does not support substantial synergistic interactions.
“In contrast, however, Tsai and Burns (2015) and Tsai and Venkataramani (2016) point out that such a linear pattern suggests additive effects, but does not support substantial synergistic interactions.”
From Is there synergy in syndemics? Psychosocial conditions and sexual risk among men who have sex with men in India (2018) · cites this paper as Tsai and Burns (2015)
To the authors' knowledge, no one else has applied syndemics theory to youth living with HIV, who experience similar maladies to gay, bisexual, and other men who have sex with men and are at high risk of transmitting HIV through condomless anal and vaginal sex.
“To our knowledge, no one else has applied syndemics theory to YLWH who suffer from similar maladies to GBMSM including adverse mental health outcomes, severe substance abuse problems, and lack of strong social support networks and who are also at high risk for transmitting HIV due to their engagement in condomless anal and vaginal sex [43].”
From Using syndemics theory to investigate risk and protective factors associated with condomless sex among youth living with HIV in 17 U.S. Cities (2017) · cites this paper as [43]
Most syndemics papers rely on summing the total number of syndemic conditions, which is insufficient to demonstrate disease interaction or synergistic effects.
“The authors note that most papers rely on summing the total number of syndemic conditions of individuals (Tsai & Burns, 2015), a technique that is insufficient to demonstrate disease interaction or synergistic effects (Tsai, 2018; Tsai & Venkataramani, 2016).”
From Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa (2022) · cites this paper as Tsai & Burns, 2015
Syndemic theory holds that synergistic clustering of conditions, not simple summation, influences a population's health burden.
“The theory posits that it is the synergistic clustering of conditions, rather than the simple summation of additional symptoms, that influence the health burden of a specific population (Tsai & Burns, 2015).”
From Gendered syndemic of intimate partner violence, alcohol misuse, and HIV risk among peri-urban, heterosexual men in South Africa (2022) · cites this paper as Tsai & Burns, 2015
Instead of testing disease interaction, specific health outcomes were added to post-hoc analyses when deemed appropriate to examine how some health outcomes may influence others.
“Instead of testing disease interaction [102, 103], we added specific health outcomes to post-hoc analyses when deemed appropriate to examine how some health outcomes may influence others.”
Most studies conducted with the expressed aim of generating empirical support for the theory of syndemics have not operationalized the concept of disease interaction in a way that actually supports the theory's predictions about mutually enhancing epidemics.
“Most studies that have been conducted with the expressed aim of generating empirical support for the theory of syndemics have not operationalized the concept of disease interaction in a way that actually supports the theory’s predictions about mutually enhancing epidemics [11].”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
The issue of statistical imprecision is exacerbated by potential collinearity between the psychosocial and structural problems of interest.
“The issue of statistical imprecision is exacerbated by potential collinearity between the psychosocial and structural problems of interest (which is likely to occur given the very hypothesis motivating research on syndemics, i.e., that these problems frequently co-occur) [11].”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
In 31 of the 40 studies (78%) reviewed by Tsai & Burns, the analysis was based on an ordinal variable created as the sum score X4 = sum of Xi.
“Instead, in 31 of the 40 studies (78%) reviewed, the analysis was based on an ordinal variable created as follows: (3)X4=∑i=13Xi”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
Among the 40 studies included in the systematic review by Tsai & Burns, 27 (68%) demonstrated the co-occurrence of psychosocial and structural problems using Venn diagrams, correlation matrices, or matrices of unadjusted odds ratios.
“Among the 40 studies included in the systematic review by Tsai & Burns [11], 27 (68%) demonstrated the co-occurrence of psychosocial and structural problems using one of these representations.”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
The sum score approach to modeling, which currently dominates the literature, does not generate estimates with clear programmatic implications for public health policy to address syndemics.
“The sum score approach to modeling, which currently dominates the literature [11], does not generate estimates with clear programmatic implications for public health policy to address syndemics.”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
As summarized by Tsai & Burns, most studies in the syndemics literature have not subjected their data to the empirical test described in Eq. (2).
“As summarized by Tsai & Burns [11], most studies in the syndemics literature have not subjected their data to the empirical test described in Eq. (2).”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
Tsai & Burns showed that nearly half of the studies included in their review would have permitted fully saturated regression models given the sample sizes and conventional rules of thumb.
“Tsai & Burns [11] showed that nearly half of the studies included in their review would have permitted fully saturated regression models given the sample sizes and conventional rules of thumb.”
From Syndemics and Health Disparities: A Methodological Note (2016) · cites this paper as [11]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Limitations section lists four after announcing three
MinorThe section says there are three limitations, but subsequently introduces a fourth.
“Interpretation of our findings is subject to three important limitations.”
“Fourth, for the studies that employed a product term in the context of a multiplicative model but nonetheless employed the language of synergy, some of these conclusions may have been correct.”
Count-variable studies cannot all have lacked interaction tests
MinorThe paper reports 31 count-variable studies and 11 studies using product terms among 40 records, so at least two studies must be in both groups. Its statement that no formal interaction tests were used in the count-variable studies conflicts with its description of product terms as tests of interaction.
“Although no formal tests of interaction were used in these studies, they were also much more likely to include language about “synergy” or “interaction” that was inconsistent with the statistical models used: 14/31 (45%) of these studies employed such language, compared to 0/9 (0%) of the others (χ2=6.25, P=0.01).”
“To test the disease interaction concept, 11 (28%) studies used some variation of a product term.”
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BackgroundGrading quality of evidence and strength of recommendations
(2004) · BMJ · doi:10.1136/bmj.328.7454.1490 · Cited by 8,477 · cited 1× · see citing works
“The well-known hierarchy of evidence, in which randomized studies occupy a position of privilege (Atkins et al., 2004; Canadian Task Force on the Periodic Health Examination, 1979; Guyatt et al., 2002; Sackett, 1986), certainly applies to the literature on syndemics.”
BackgroundRegression Models for Categorical and Limited Dependent Variables.
MTW, & Long, J. S. (1997) · Journal of the American Statistical Association · doi:10.2307/2965458 · Cited by 6,889 · see citing works
Lippa, N. C., & Sanderson, S. C. (2013) · Human Heredity · doi:10.1159/000353712 · Cited by 6,093 · see citing works
Social conditions as fundamental causes of disease.
Link, B. G., & Phelan, J. (1995) · Journal of Health and Social Behavior · doi:10.2307/2626958 · Cited by 5,722 · see citing works
Interaction terms in logit and probit models
Ai, C., & Norton, E. C. (2003) · Economics Letters · doi:10.1016/s0165-1765(03)00032-6 · Cited by 5,466 · cited 1× · see citing works
“A uthor M anuscript A uthor M anuscript A uthor M anuscript A uthor M anuscript model, the effect of a risk factor on the outcome cannot be understood without knowing the values of all of the other covariates (Ai & Norton, 2003).”
BackgroundRegression Models for Categorical and Limited Dependent Variables
Calvin, J. A., & Long, J. S. (1998) · Technometrics · doi:10.2307/1271407 · Cited by 5,287 · see citing works
(1967) · Project Euclid (Cornell University) · Cited by 4,720 · see citing works
Relaxing the Rule of Ten Events per Variable in Logistic and Cox Regression
Vittinghoff, E., & McCulloch, C. E. (2007) · American Journal of Epidemiology · doi:10.1093/aje/kwk052 · Cited by 4,359 · cited 2× · see citing works
“…accepted rule of thumb that 5– 10 events are required per covariate in logit or Cox regression models (Peduzzi et al., 1995; Peduzzi et al., 1996; Vittinghoff & McCulloch, 2007), we assessed whether or not each paper could have supported fully saturated regression models with product terms…”
MethodIdentification of Causal Effects Using Instrumental Variables
Angrist, J. D., Imbens, G. W., & Rubin, D. B. (1996) · Journal of the American Statistical Association · doi:10.1080/01621459.1996.10476902 · Cited by 4,230 · see citing works
Selection on observed and unobserved variables: Assessing the effectiveness of Catholic schools
Altonji, J. G., Elder, T. E., & Taber, C. R. (2005) · Journal of Political Economy · doi:10.1086/426036 · Cited by 3,706 · see citing works
Vandenbroucke, J. P., Elm, E. V., Altman, D. G., Gøtzsche, P. C., Mulrow, C. D., Pocock, S. J., Poole, C., Schlesselman, J. J., Egger, M., & initiative, F. T. S. (2007) · Annals of Internal Medicine · doi:10.7326/0003-4819-147-8-200710160-00010-w1 · Cited by 3,543 · see citing works
Social Conditions as Fundamental Causes of Disease
Link, B. G., & Phelan, J. C. (1995) · PubMed · doi:10.13016/rpln-eiwa · Cited by 2,684 · see citing works
Stigma as a fundamental cause of population health inequalities
Hatzenbuehler, M. L., Phelan, J. C., & Link, B. G. (2013) · American Journal of Public Health · doi:10.2105/ajph.2012.301069 · Cited by 2,674 · cited 1× · see citing works
“While we are unaware of studies providing empirical support for this hypothesis in the context of the literature on HIV risk, Hatzenbuehler, Phelan, and Link (2013) offer an illuminating conceptual discussion on fundamental causes of disparities in population health and provide a concrete example…”
Mostly Harmless Econometrics: An Empiricist's Companion
Kmenta, J. (2010) · Business Economics · doi:10.1057/be.2009.37 · Cited by 2,617 · see citing works
An Anthropology of Structural Violence
Farmer, P. E. (2004) · Current Anthropology · doi:10.1086/382250 · Cited by 2,344 · see citing works
Peduzzi, P., Concato, J., Feinstein, A. R., & Holford, T. R. (1995) · Journal of Clinical Epidemiology · doi:10.1016/0895-4356(95)00048-8 · Cited by 2,154 · cited 4× · see citing works
“Following the generally accepted rule of thumb that 5– 10 events are required per covariate in logit or Cox regression models (Peduzzi et al., 1995; Peduzzi et al., 1996; Vittinghoff & McCulloch, 2007), we assessed whether or not each paper could have supported fully saturated regression models…”
BackgroundMethodInfluentialNatural and Quasi- Experiments in Economics
Meyer, B. (1994) · Journal of Business and Economic Statistics · doi:10.2307/1392369 · Cited by 1,806 · see citing works
How to measure comorbiditya critical review of available methods
DEGROOT, V, BECKERMAN, H., LANKHORST, G., & BOUTER, L. (2003) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(02)00585-1 · Cited by 1,757 · cited 1× · see citing works
“In many ways this specification resembles a comorbidity index, without the weighting functions and/or supporting psychometric analyses that typically support such indices (de Groot et al., 2003).”
BackgroundCalculating measures of biological interaction
Andersson, T., Alfredsson, L., Källberg, H., Zdravkovic, S., & Ahlbom, A. (2005) · European Journal of Epidemiology · doi:10.1007/s10654-005-7835-x · Cited by 1,498 · cited 1× · see citing works
“Computation of standard errors for the RERI is straightforward and can be done using many standard software packages (Andersson et al., 2005; Assmann et al., 1996; Kallberg, Ahlbom, & Alfredsson, 2006; Lundberg et al., 1996; Richardson & Kaufman, 2009; VanderWeele & Knol, 2014).”
MethodRecommendations for presenting analyses of effect modification and interaction
Knol, M. J., & VanderWeele, T. J. (2012) · International Journal of Epidemiology · doi:10.1093/ije/dyr218 · Cited by 1,436 · cited 1× · see citing works
“If the test involved inclusion of a product term in a regression model, we assessed whether the presentation yielded sufficient information to interpret interaction on an additive and on a multiplicative scale (Knol et al., 2009; Knol & VanderWeele, 2012).”
MethodRules of Evidence and Clinical Recommendations on the Use of Antithrombotic Agents
Sackett, D. L. (1989) · CHEST Journal · doi:10.1378/chest.95.2_supplement.2s · Cited by 1,369 · see citing works
Bing, E. G., Burnam, M. A., Longshore, D., Fleishman, J. A., Sherbourne, C. D., London, A. S., Turner, B. J., Eggan, F., Beckman, R., Vitiello, B., et al. (2001) · Archives of General Psychiatry · doi:10.1001/archpsyc.58.8.721 · Cited by 1,255 · cited 2× · see citing works
“Both depressive and substance abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diag…”
BackgroundSyndemics and public health: Reconceptualizing disease in bio-social context
Singer, M., & Clair, S. (2003) · Medical Anthropology Quarterly · doi:10.1525/maq.2003.17.4.423 · Cited by 1,140 · cited 4× · see citing works
“…in any of the searchable field descriptions, we also used the Science Citation Index to identify publications citing either Singer (1994) or Singer and Clair (2003), which are his two most highly cited journal articles associated with the theory of syndemics (with 116 and 126 citations,…”
BackgroundMethodInfluentialVanderWeele, T. J., & Knol, M. J. (2014) · Epidemiologic Methods · doi:10.1515/em-2013-0005 · Cited by 1,127 · cited 4× · see citing works
“Computation of standard errors for the RERI is straightforward and can be done using many standard software packages (Andersson et al., 2005; Assmann et al., 1996; Kallberg, Ahlbom, & Alfredsson, 2006; Lundberg et al., 1996; Richardson & Kaufman, 2009; VanderWeele & Knol, 2014).”
BackgroundMethodInfluentialNatural and Quasi-Experiments in Economics
Meyer, B. D. (1995) · Journal of Business & Economic Statistics · doi:10.1080/07350015.1995.10524589 · Cited by 1,100 · see citing works
van den Akker, M., Buntinx, F., Metsemakers, J. F. M., Roos, S., & Knottnerus, J. A. (1998) · Journal of Clinical Epidemiology · doi:10.1016/s0895-4356(97)00306-5 · Cited by 1,022 · cited 1× · see citing works
“…also been highlighted in other literatures that have evolved largely in parallel to the literature on syndemics, including the concepts of multimorbidity (van den Akker, Buntinx, & Knottnerus, 1996; van den Akker et al., 1998) and dual diagnosis (Drake et al., 1991; Lehman, Myers, & Corty, 1989).”
BackgroundSterling, T. D. (1959) · Journal of the American Statistical Association · doi:10.1080/01621459.1959.10501497 · Cited by 964 · cited 1× · see citing works
“…in our review in that all demonstrated statistically significant associations between one or more psychosocial problems and the outcomes of interest, our summary conclusions could have been driven by non-publication of non-statistically significant findings (Rosenthal, 1979; Sterling, 1959).”
ResultInfections and inequalities: the modern plagues
Farmer, P. E. (2001) · Choice Reviews Online · doi:10.5860/choice.38-3356 · Cited by 958 · see citing works
Stall, R., Mills, T. C., Williamson, J., Hart, T., Greenwood, G., Paul, J., Pollack, L., Binson, D., Osmond, D., & Catania, J. A. (2003) · American Journal of Public Health · doi:10.2105/ajph.93.6.939 · Cited by 940 · cited 6× · see citing works
“Some researchers have specified the number of psychosocial problems as a categorical variable (Stall et al., 2003); the extent to which ascending odds ratios across exposure categories can be interpreted as evidence of an “additive” impact on the outcome would again be contingent on the pattern of predicted probabilit…”
BackgroundInfluentialOn Suffering and Structural Violence: A View from Below
Farmer, P. E. (1998) · University of California Press eBooks · doi:10.1525/9780520353695-014 · Cited by 879 · see citing works
Comorbidity or multimorbidity: what's in a name? A review of literature
van den Akker, M., Buntinx, F., & Knottnerus, J. A. (1996) · European Journal of General Practice · doi:10.3109/13814789609162146 · Cited by 857 · see citing works
ROTHMAN, K. J., GREENLAND, S., & WALKER, A. M. (1980) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a113015 · Cited by 851 · cited 2× · see citing works
“As was aptly summarized by Greenland and Rothman (1998): “if the excess case loads produced by each factor are not additive, one must know the levels of all the factors in order to predict the public-health impact of removing or introducing any one of them” (p.341).”
BackgroundMethod“Fundamental Causes” of Social Inequalities in Mortality: A Test of the Theory
Phelan, J. C., Link, B. G., Roux, A. V. D., Kawachi, I. I., & Levin, B. L. (2004) · Journal of Health and Social Behavior · doi:10.1177/002214650404500303 · Cited by 837 · cited 2× · see citing works
“…and disease outcomes, enables some people to leverage their resources to either avoid risk factors or minimize the adverse health impacts of disease, and reproduces health disparities over time through the organic production of new pathways to disease (Link & Phelan, 1995; Phelan et al., 2004).”
BackgroundTanser, F. C., Bärnighausen, T., Grapsa, E., Zaidi, J., & Newell, M. (2013) · Science · doi:10.1126/science.1228160 · Cited by 797 · cited 1× · see citing works
“Large-scale surveillance programs that incorporate both survey and biomarker data collection (Tanser et al., 2013) may provide the most promising settings in which to explore these issues at the population level in more detail.”
BackgroundROTHMAN, K. J. (1976) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112335 · Cited by 776 · see citing works
The Effects of Universal Pre-K on Cognitive Development.
Gormley, W. T., Gayer, T., Phillips, D. A., & Dawson, B. (2005) · Developmental Psychology · doi:10.1037/0012-1649.41.6.872 · Cited by 732 · see citing works
Violence in War and Peace: An Anthology
Strathern, A. J., & Stewart, P. J. (2005) · American Anthropologist · doi:10.1525/aa.2005.107.4.743 · Cited by 683 · see citing works
Mueser, K. T., Drake, R. E., & Wallach, M. A. (1998) · Addictive Behaviors · doi:10.1016/s0306-4603(98)00073-2 · Cited by 616 · see citing works
The epidemiology of dual diagnosis
Kessler, R. C. (2004) · Biological Psychiatry · doi:10.1016/j.biopsych.2004.06.034 · Cited by 588 · cited 1× · see citing works
“However, it is consistent with clinical thinking on the etiology of dual diagnosis and the reciprocal associations between mental and substance use disorders (Kessler, 2004; Mueser, Drake, & Wallach, 1998).”
BackgroundResults on the bias and inconsistency of ordinary least squares for the linear probability model
Horrace, W. C., & Oaxaca, R. L. (2005) · Economics Letters · doi:10.1016/j.econlet.2005.08.024 · Cited by 526 · cited 1× · see citing works
“In addition, any potential bias is lessened as the relative proportion of predicted probabilities lying inside the unit interval increases (Horrace & Oaxaca, 2006).”
BackgroundSterling, T. D. (1959) · Journal of the American Statistical Association · doi:10.2307/2282137 · Cited by 524 · see citing works
AIDS and the health crisis of the U.S. urban poor; the perspective of critical medical anthropology
Singer, M. (1994) · Social Science & Medicine · doi:10.1016/0277-9536(94)90205-4 · Cited by 518 · cited 5× · see citing works
“…the term “syndemic” in any of the searchable field descriptions, we also used the Science Citation Index to identify publications citing either Singer (1994) or Singer and Clair (2003), which are his two most highly cited journal articles associated with the theory of syndemics (with 116…”
BackgroundMethodInfluential(1996) · Free inquiry in creative sociology · Cited by 516 · see citing works
Drake, R. E., Mueser, K. T., Brunette, M. F., & McHugo, G. J. (2004) · Psychiatric Rehabilitation Journal · doi:10.2975/27.2004.360.374 · Cited by 459 · cited 2× · see citing works
“There is widespread consensus in the field that treatment in the setting of dual diagnosis should be coordinated and integrated (Drake et al., 2004; Horsfall et al., 2009), because depression cannot be ameliorated without also reducing substance abuse and vice versa if the two conditions are mutually causal.”
BackgroundOn the distinction between interaction and effect modification
VanderWeele, T. J. (2009) · Epidemiology · doi:10.1097/ede.0b013e3181ba333c · Cited by 450 · see citing works
THE ESTIMATION OF SYNERGY OR ANTAGONISM1
Rothman, K. J. (1976) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112252 · Cited by 335 · cited 3× · see citing works
“These measures include the RERI; the attributable proportion due to interaction (AP), which is a derivative measure of the RERI; and the synergy index (S) (Rothman, 1974, 1976b; Rothman, 1986).”
BackgroundParsons, J. T., Grov, C., & Golub, S. A. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300284 · Cited by 335 · cited 1× · see citing works
“For example, in a reanalysis of data from Parsons, Grov, and Golub (2012) (who themselves had employed the count variable approach), Starks et al. (2014) highlighted these and other psychometric assumptions and used latent factor analysis to demonstrate that the assumption of equal factor loadings…”
MethodWeiner, D. E., Tabatabai, S., Tighiouart, H., Elsayed, E. F., Bansal, N., Griffith, J. L., Salem, D. N., Levey, A. S., & Sarnak, M. J. (2006) · American Journal of Kidney Diseases · doi:10.1053/j.ajkd.2006.05.021 · Cited by 325 · cited 1× · see citing works
“For example, in a study published in the American Journal of Kidney Diseases, Weiner et al. (2006) included a product term in a multivariable Cox proportional hazards regression model.”
BackgroundThe periodic health examination. Canadian Task Force on the Periodic Health Examination.
(1979) · PubMed Central · Cited by 281 · see citing works
Users’ Guides to the Medical Literature: A Manual for Evidence-Based Clinical Practice
Kleinbart, J., & Williams, M. V. (2002) · ACP Journal Club · doi:10.7326/acpjc-2002-136-2-a17 · Cited by 268 · see citing works
Confidence intervals for measures of interaction
Assmann, S. F., Hosmer, D. W., Lemeshow, S., & Mundt, K. A. (1996) · Epidemiology · doi:10.1097/00001648-199605000-00012 · Cited by 262 · cited 1× · see citing works
“Computation of standard errors for the RERI is straightforward and can be done using many standard software packages (Andersson et al., 2005; Assmann et al., 1996; Kallberg, Ahlbom, & Alfredsson, 2006; Lundberg et al., 1996; Richardson & Kaufman, 2009; VanderWeele & Knol, 2014).”
MethodRules of Evidence and Clinical Recommendations on the Use of Antithrombotic Agents
Sackett, D. L. (1986) · CHEST Journal · doi:10.1378/chest.89.2_supplement.2s · Cited by 259 · see citing works
Infections and Inequalities: The Modern Plagues
Kendall, C. (2000) · Medical Anthropology Quarterly · doi:10.1525/maq.2000.14.3.448 · Cited by 257 · see citing works
SYNERGY AND ANTAGONISM IN CAUSE-EFFECT RELATIONSHIPS1
ROTHMAN, K. J. (1974) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a121626 · Cited by 250 · cited 7× · see citing works
“These measures include the RERI; the attributable proportion due to interaction (AP), which is a derivative measure of the RERI; and the synergy index (S) (Rothman, 1974, 1976b; Rothman, 1986).”
BackgroundInfluentialEstimation of the relative excess risk due to interaction and associated confidence bounds
Richardson, D. B., & Kaufman, J. S. (2009) · American Journal of Epidemiology · doi:10.1093/aje/kwn411 · Cited by 240 · see citing works
Horsfall, J. M., Cleary, M. L., Hunt, G. E., & Walter, G. (2009) · Harvard Review of Psychiatry · doi:10.1080/10673220902724599 · Cited by 237 · cited 2× · see citing works
“There is widespread consensus in the field that treatment in the setting of dual diagnosis should be coordinated and integrated (Drake et al., 2004; Horsfall et al., 2009), because depression cannot be ameliorated without also reducing substance abuse and vice versa if the two conditions are mutually causal.”
BackgroundAssessment and Classification of Patients With Psychiatric and Substance Abuse Syndromes
Lehman, A. F., Myers, C. P., & Corty, E. W. (1989) · Psychiatric Services · doi:10.1176/ps.40.10.1019 · Cited by 216 · see citing works
Interactions in epidemiology: relevance, identification, and estimation
Greenland, S. (2009) · Epidemiology · doi:10.1097/ede.0b013e318193e7b5 · Cited by 204 · see citing works
Mimiaga, M. J., O'Cleirigh, C., Biello, K. B., Robertson, A. M., Safren, S. A., Coates, T. J., Koblin, B. A., Chesney, M. A., Donnell, D. J., Stall, R. D., et al. (2015) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000475 · Cited by 201 · cited 1× · see citing works
“For example, a Cox proportional hazards regression model fitted to the data used in Mimiaga et al. (2015), with 259 seroconversions during study follow-up, would have permitted approximately 25–50 covariates under assumptions of differing conservatism (Peduzzi et al., 1995; Peduzzi et al., 1996;…”
MethodMental Health and HIV Risk in Men Who Have Sex With Men
Safren, S. A., Reisner, S. L., Herrick, A. L., Mimiaga, M. J., & Stall, R. D. (2010) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181fbc939 · Cited by 195 · cited 1× · see citing works
“…identified records in which the authors failed to cite Singer’s work if the concept of syndemics was invoked in a searchable field (e.g., Safren et al. (2010)), our search strategy would not have identified records where the authors did not use the term “syndemic” in a searchable field…”
BackgroundMustanski, B., Andrews, R., Herrick, A., Stall, R., & Schnarrs, P. W. (2014) · American Journal of Public Health · doi:10.2105/ajph.2013.301744 · Cited by 184 · cited 2× · see citing works
“(2014) and two other studies included in our review (Halkitis et al., 2013; Mustanski et al., 2014), may suggest ways to improve models in settings where this assumption is unwarranted.”
ResultBiological Models and Statistical Interactions: an Example from Multistage Carcinogenesis
Siemiatycki, J., & Thomas, D. C. (1981) · International Journal of Epidemiology · doi:10.1093/ije/10.4.383 · Cited by 173 · cited 1× · see citing works
“…has had a long and controversial history in the epidemiologic literature (Blot & Day, 1979; Greenland, 2009; Kaufman, 2009; Kupper & Hogan, 1978; Rothman, 1974, 1976a; Rothman, Greenland, & Walker, 1980; Saracci, 1980; Siemiatycki & Thomas, 1981; VanderWeele, 2009a; Walter & Holford, 1978).”
Sufficient cause interactions and statistical interactions
VanderWeele, T. J. (2009) · Epidemiology · doi:10.1097/ede.0b013e31818f69e7 · Cited by 163 · cited 2× · see citing works
“…has had a long and controversial history in the epidemiologic literature (Blot & Day, 1979; Greenland, 2009; Kaufman, 2009; Kupper & Hogan, 1978; Rothman, 1974, 1976a; Rothman, Greenland, & Walker, 1980; Saracci, 1980; Siemiatycki & Thomas, 1981; VanderWeele, 2009a; Walter & Holford, 1978).”
BackgroundThe Impact of Mental Health and Substance Abuse Factors on HIV Prevention and Treatment
Walkup, J., Blank, M. B., Gonzalez, J. S., Safren, S., Schwartz, R., Brown, L., Wilson, I., Knowlton, A., Lombard, F., Grossman, C., et al. (2008) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0b013e3181605b26 · Cited by 150 · cited 2× · see citing works
“, 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis interventions for both primary and secondary HIV prevention is widely acknowledged (Batki, 1990; Fisher & Smith, 2009; Sikkema et al., 2010; Walkup et al., 2008).”
BackgroundHIV and tuberculosis: The construction and management of double stigma
Daftary, A. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.01.027 · Cited by 144 · cited 2× · see citing works
“While qualitative studies exploring psychosocial health problems in sub-Saharan Africa have been informed by the theory of syndemics (Daftary, 2012; Hatcher et al., 2014; Mendenhall & Norris, 2015), only two studies included in our review were conducted in sub-Saharan Africa -- home to more than two-thirds of the 35.”
Background(1996) · PubMed · Cited by 141 · see citing works
Dual diagnosis of major mental illness and substance disorder: An overview
Drake, R. E., McLaughlin, P., Pepper, B., & Minkoff, K. (1991) · New Directions for Mental Health Services · doi:10.1002/yd.23319915003 · Cited by 137 · cited 1× · see citing works
“…also been highlighted in other literatures that have evolved largely in parallel to the literature on syndemics, including the concepts of multimorbidity (van den Akker, Buntinx, & Knottnerus, 1996; van den Akker et al., 1998) and dual diagnosis (Drake et al., 1991; Lehman, Myers, & Corty, 1989).”
BackgroundMeasurement model exploring a syndemic in emerging adult gay and bisexual men
Halkitis, P. N., Moeller, R. W., Siconolfi, D. E., Storholm, E. D., Solomon, T. M., & Bub, K. L. (2013) · AIDS and Behavior · doi:10.1007/s10461-012-0273-3 · Cited by 135 · cited 3× · see citing works
“(2014) and two other studies included in our review (Halkitis et al., 2013; Mustanski et al., 2014), may suggest ways to improve models in settings where this assumption is unwarranted.”
MethodResultSynergism and interaction: are they equivalent?
Blot, W. J., & Day, N. E. (1979) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112793 · Cited by 135 · cited 2× · see citing works
“General consensus in the field (Blot & Day, 1979; Kupper & Hogan, 1978; Rothman, 1986; Rothman, Greenland, & Walker, 1980; Saracci, 1980) suggests that an analysis that assesses for departures from additivity would more appropriately reflect the causal structure of the interaction between…”
BackgroundMental Health Treatment to Reduce HIV Transmission Risk Behavior: A Positive Prevention Model
Sikkema, K. J., Watt, M. H., Drabkin, A. S., Meade, C. S., Hansen, N. B., & Pence, B. W. (2009) · AIDS and Behavior · doi:10.1007/s10461-009-9650-y · Cited by 124 · cited 2× · see citing works
“, 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis interventions for both primary and secondary HIV prevention is widely acknowledged (Batki, 1990; Fisher & Smith, 2009; Sikkema et al., 2010; Walkup et al., 2008).”
BackgroundMaking Prospective Registration of Observational Research a Reality
Dal-Ré, R., Ioannidis, J. P., Bracken, M. B., Buffler, P. A., Chan, A.-W., Franco, E. L., La Vecchia, C., & Weiderpass, E. (2014) · Science Translational Medicine · doi:10.1126/scitranslmed.3007513 · Cited by 123 · cited 2× · see citing works
“…-- based on theoretical models or previously published empirical findings -- about excluding certain product terms from the regression models (thereby reducing the degrees of freedom), and prospectively registering their analysis plans in the interest of transparency (Dal-Re et al., 2014).”
BackgroundTsai, A. (2014) · Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000000210 · Cited by 122 · cited 1× · see citing works
“…highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis interventions for…”
BackgroundSelf-citationWhen One Depends on the Other: Reporting of Interaction in Case-Control and Cohort Studies
Knol, M. J., Egger, M., Scott, P., Geerlings, M. I., & Vandenbroucke, J. P. (2009) · Epidemiology · doi:10.1097/ede.0b013e31818f6651 · Cited by 113 · cited 3× · see citing works
“If the test involved inclusion of a product term in a regression model, we assessed whether the presentation yielded sufficient information to interpret interaction on an additive and on a multiplicative scale (Knol et al., 2009; Knol & VanderWeele, 2012).”
BackgroundMethodADDITIVE, MULTIPLICATIVE, AND OTHER MODELS FOR DISEASE RISKS1
WALTER, S. D., & HOLFORD, T. R. (1978) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112629 · Cited by 110 · cited 2× · see citing works
“Certainly interaction can be positive on one scale but negative on another, or present on one scale but absent on another (Kupper & Hogan, 1978; Walter & Holford, 1978).”
BackgroundHatcher, A. M., Colvin, C. J., Ndlovu, N., & Dworkin, S. L. (2014) · Culture, Health & Sexuality · doi:10.1080/13691058.2014.924558 · Cited by 103 · cited 2× · see citing works
“While qualitative studies exploring psychosocial health problems in sub-Saharan Africa have been informed by the theory of syndemics (Daftary, 2012; Hatcher et al., 2014; Mendenhall & Norris, 2015), only two studies included in our review were conducted in sub-Saharan Africa -- home to more than two-thirds of the 35.”
BackgroundSARACCI, R. (1980) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a113014 · Cited by 98 · cited 4× · see citing works
“General consensus in the field (Blot & Day, 1979; Kupper & Hogan, 1978; Rothman, 1986; Rothman, Greenland, & Walker, 1980; Saracci, 1980) suggests that an analysis that assesses for departures from additivity would more appropriately reflect the causal structure of the interaction between…”
BackgroundInfluentialGuadamuz, T. E., McCarthy, K., Wimonsate, W., Thienkrua, W., Varangrat, A., Chaikummao, S., Sangiamkittikul, A., Stall, R. D., & van Griensven, F. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0826-8 · Cited by 88 · cited 4× · see citing works
“In their discussion, for example, Guadamuz et al. (2014) state that, “While current prevention approaches tend to focus on one health issue, integration and simultaneous implementation of prevention programs for multiple conditions needs serious consideration” (p.2094).”
BackgroundInfluentialInteraction in epidemiologic studies
KUPPER, L. L., & HOGAN, M. D. (1978) · American Journal of Epidemiology · doi:10.1093/oxfordjournals.aje.a112643 · Cited by 77 · cited 3× · see citing works
“General consensus in the field (Blot & Day, 1979; Kupper & Hogan, 1978; Rothman, 1986; Rothman, Greenland, & Walker, 1980; Saracci, 1980) suggests that an analysis that assesses for departures from additivity would more appropriately reflect the causal structure of the interaction between…”
BackgroundTsai, A. C., Karasic, D. H., Hammer, G. P., Charlebois, E. D., Ragland, K., Moss, A. R., Sorensen, J. L., Dilley, J., & Bangsberg, D. R. (2012) · American Journal of Public Health · doi:10.2105/ajph.2011.300422 · Cited by 76 · cited 2× · see citing works
“…abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis…”
BackgroundMethodSelf-citationPersistent household food insecurity, HIV, and maternal stress in Peri-Urban Ghana
García, J., Hromi‐Fiedler, A. J., Mazur, R., Marquis, G. S., Sellen, D., Lartey, A. A., & Pérez‐Escamilla, R. (2013) · BMC Public Health · doi:10.1186/1471-2458-13-215 · Cited by 73 · see citing works
Secondary prevention of HIV infection: the current state of prevention for positives
Fisher, J. D., & Smith, L. R. (2009) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0b013e32832c7ce5 · Cited by 70 · cited 1× · see citing works
“…2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis interventions for both primary and secondary HIV prevention is widely acknowledged (Batki, 1990; Fisher & Smith, 2009; Sikkema et al., 2010; Walkup et al., 2008).”
BackgroundRiley, E. D., Cohen, J., Knight, K. R., Decker, A., Marson, K., & Shumway, M. (2014) · American Journal of Public Health · doi:10.2105/ajph.2014.301958 · Cited by 64 · cited 2× · see citing works
“Both depressive and substance abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diag…”
BackgroundCalculating measures of biological interaction using R
Källberg, H., Ahlbom, A., & Alfredsson, L. S. (2006) · European Journal of Epidemiology · doi:10.1007/s10654-006-9037-6 · Cited by 62 · see citing works
(2006) · Free inquiry in creative sociology · Cited by 60 · see citing works
Tsai, A. C., Weiser, S. D., Dilworth, S. E., Shumway, M., & Riley, E. D. (2015) · American Journal of Epidemiology · doi:10.1093/aje/kwu350 · Cited by 59 · cited 2× · see citing works
“Both depressive and substance abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diag…”
BackgroundSelf-citationPitpitan, E. V., Kalichman, S. C., Eaton, L. A., Cain, D. N., Sikkema, K. J., Watt, M. H., Skinner, D. G., & Pieterse, D. (2012) · Annals of Behavioral Medicine · doi:10.1007/s12160-012-9420-3 · Cited by 58 · cited 1× · see citing works
“Problems with statistical power may be especially severe if the explanatory variables are collinear with each other (Pitpitan et al., 2013) -- which is likely to be the case in this literature, given that collinearity is implied by the concept of disease concentration.”
BackgroundWhen HIV is ordinary and diabetes new: Remaking suffering in a South African Township
Mendenhall, E., & Norris, S. A. (2015) · Global Public Health · doi:10.1080/17441692.2014.998698 · Cited by 52 · cited 1× · see citing works
“…exploring psychosocial health problems in sub-Saharan Africa have been informed by the theory of syndemics (Daftary, 2012; Hatcher et al., 2014; Mendenhall & Norris, 2015), only two studies included in our review were conducted in sub-Saharan Africa -- home to more than two-thirds of the 35.3…”
BackgroundInfluentialWomen, poverty and AIDS: an introduction
Farmer, P., Lindenbaum, S., & Good, M.-J. D. (1993) · Culture, Medicine and Psychiatry · doi:10.1007/bf01379306 · Cited by 49 · see citing works
Starks, T. J., Millar, B. M., Eggleston, J. J., & Parsons, J. T. (2014) · AIDS and Behavior · doi:10.1007/s10461-014-0841-9 · Cited by 46 · cited 2× · see citing works
“Latent factor approaches, such as those employed by Starks et al. (2014) and two other studies included in our review (Halkitis et al., 2013; Mustanski et al., 2014), may suggest ways to improve models in settings where this assumption is unwarranted.”
MethodResultThe HIV epidemic among individuals with mental illness in the United States
Weiser, S. D., Wolfe, W. R., & Bangsberg, D. R. (2004) · Current HIV/AIDS Reports · doi:10.1007/s11904-004-0029-4 · Cited by 45 · see citing works
Drug abuse, psychiatric disorders, and AIDS. Dual and triple diagnosis.
Batki, S. L. (1990) · PubMed Central · Cited by 39 · see citing works
Hilt, B., Langard, S., Lund-Larsen, P. G., & Lien, J. T. (1986) · Scandinavian Journal of Work, Environment & Health · doi:10.5271/sjweh.2106 · Cited by 35 · cited 1× · see citing works
“For example, VanderWeele and Knol (2014) discuss a study on cigarette smoking, asbestos exposure, and lung cancer by Hilt et al. (1986) in which there is evidence of a positive interaction on the additive scale but a negative interaction on the multiplicative scale.”
BackgroundWeiser, S. D., Dilworth, S. E., Neilands, T. B., et al. (2006) · Journal of Urban Health · doi:10.1007/s11524-005-9019-0 · Cited by 34 · cited 2× · see citing works
“Both depressive and substance abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diag…”
BackgroundProtecting Health—The New Research Imperative
Gerberding, J. L. (2005) · JAMA · doi:10.1001/jama.294.11.1403 · Cited by 34 · cited 2× · see citing works
“The previously-cited commentary by Gerberding (2005) is a relevant example of such a record (although it would have been excluded from our analysis due to lack of original data).”
BackgroundMoving from evidence to action
di Censo, A., Ciliska, D. K., Dobbins, M., et al. (2005) · Mosby eBooks · Cited by 33 · see citing works
Kaufman, J. S. (2009) · Epidemiology · doi:10.1097/ede.0b013e318197c0f5 · Cited by 27 · cited 2× · see citing works
“…concept of disease interaction has had a long and controversial history in the epidemiologic literature (Blot & Day, 1979; Greenland, 2009; Kaufman, 2009; Kupper & Hogan, 1978; Rothman, 1974, 1976a; Rothman, Greenland, & Walker, 1980; Saracci, 1980; Siemiatycki & Thomas, 1981;…”
MethodTsai, A. C., Mimiaga, M. J., Dilley, J., Hammer, G. P., Karasic, D. H., Charlebois, E. D., Sorensen, J. L., Safren, S. A., & Bangsberg, D. R. (2013) · AIDS and Behavior · doi:10.1007/s10461-013-0600-3 · Cited by 23 · cited 2× · see citing works
“…abuse disorders are highly prevalent among persons at risk for HIV acquisition and among persons with HIV (Bing et al., 2001; Riley et al., 2014; Tsai et al., 2013a; Tsai, 2014; Tsai et al., 2015; Weiser et al., 2006; Weiser, Wolfe, & Bangsberg, 2004), and the need for effective dual diagnosis…”
BackgroundMethodSelf-citationThe Interplay of Syndemic Production and Serosorting in Drug-Using Gay and Bisexual Men
Moeller, R. W., Halkitis, P. N., & Surrence, K. (2011) · Sexual and Gender Diversity in Social Services · doi:10.1080/10538720.2010.538007 · Cited by 22 · see citing works
A typology of structural approaches to HIV prevention: A commentary on Roberts and Matthews
Tsai, A. C. (2012) · Social Science & Medicine · doi:10.1016/j.socscimed.2012.06.033 · Cited by 19 · cited 1× · see citing works
“Instead, interventions targeting the structural factors conditioning people’s risk for HIV would be needed (Tsai, 2012).”
BackgroundSelf-citationIn defense of “biological interaction”
Rajaleid, K., Janszky, I., & Hallqvist, J. (2011) · Epidemiology · doi:10.1097/ede.0b013e31820932ac · Cited by 6 · see citing works
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Syndemics and the biosocial conception of health
Singer, M., Bulled, N., Ostrach, B., & Mendenhall, E. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30003-x · Cited by 1,491 · see citing works
Global Epidemiology of HIV Infection and Related Syndemics Affecting Transgender People
Poteat, T., Scheim, A. I., Xavier, J. M., Reisner, S. L., & Baral, S. (2016) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001087 · Cited by 391 · see citing works
“The most frequently studied outcome variables were HIV risk behaviors (73%) or HIV infection (23%).(31) No systematic review has yet examined the data on syndemic production of HIV among transgender populations.”
BackgroundCo-occurring epidemics, syndemics, and population health
Tsai, A. C., Mendenhall, E., Trostle, J. A., & Kawachi, I. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30403-8 · Cited by 268 · see citing works
Self-citationSyndemic vulnerability and the right to health
Willen, S. S., Knipper, M., Abadía‐Barrero, C. E., & Davidovitch, N. (2017) · The Lancet · doi:10.1016/s0140-6736(17)30261-1 · Cited by 209 · see citing works
Syndemics: a theory in search of data or data in search of a theory?
Tsai, A. C. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.03.040 · Cited by 185 · see citing works
Self-citationSyndemics and Health Disparities: A Methodological Note
Tsai, A. C., & Venkataramani, A. S. (2016) · AIDS and Behavior · doi:10.1007/s10461-015-1260-2 · Cited by 176 · see citing works
“, that these problems frequently co-occur) [11].”
BackgroundInfluentialSelf-citationAddressing Minority Stress and Mental Health among Men Who Have Sex with Men (MSM) in China
Sun, S., Pachankis, J. E., Li, X., & Operario, D. (2020) · Current HIV/AIDS Reports · doi:10.1007/s11904-019-00479-w · Cited by 169 · see citing works
Whither syndemics?: Trends in syndemics research, a review 2015–2019
Singer, M., Bulled, N., & Ostrach, B. (2020) · Global Public Health · doi:10.1080/17441692.2020.1724317 · Cited by 133 · see citing works
“…of Tsai and colleagues that articulates the challenges of empirically measuring syndemic interactions, particularly the difficulty in proving the synergistic nature of the syndemic arrangement (Tsai, 2018; Tsai & Burns, 2015; Tsai & Venkataramani, 2016; Tsai, Mendenhall, Trostle, & Kawachi, 2017).”
BackgroundTsai, A., Tomlinson, M., Comulada, W., & Rotheram-Borus, M. (2016) · Social Science & Medicine (1967) · doi:10.1016/j.socscimed.2015.12.042 · Cited by 110 · see citing works
Self-citationFriedman, M. R., Coulter, R. W. S., Silvestre, A. J., Stall, R. D., Teplin, L. A., SHOPTAW, S. J., Surkan, P. J., & Plankey, M. W. (2016) · AIDS Care · doi:10.1080/09540121.2016.1211614 · Cited by 129 · see citing works
What constitutes a syndemic? Methods, contexts, and framing from 2019
Mendenhall, E., & Singer, M. (2020) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000628 · Cited by 96 · see citing works
Syndemic theory, methods, and data
Mendenhall, E., Newfield, T., & Tsai, A. C. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2021.114656 · Cited by 95 · see citing works
“…Science & Medicine journal homepage: www.elsevier.com/locate/socscimed https://doi.org/10.1016/j.socscimed.2021.114656 Social Science & Medicine 295 (2022) 114656 (Chakrapani et al., 2020; Stall et al., 2015; Tomori et al., 2018; Tsai and Burns, 2015; Tsai and Venkataramani, 2016).”
InfluentialSelf-citationBoateng, G. O., Workman, C. L., Miller, J. D., Onono, M., Neilands, T. B., & Young, S. L. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113043 · Cited by 90 · see citing works
“Although existing syndemic literature has cogently demonstrated that diseases such as depression concentrate among certain at-risk populations, Tsai and others argue that few studies have clearly demonstrated the exact relationship between examined co-factors (Tsai et al., 2017; Tsai and Burns, 2015; Tsai and Venkatar…”
BackgroundHatcher, A. M., Gibbs, A., McBride, R.-S., Rebombo, D., Khumalo, M., & Christofides, N. J. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112637 · Cited by 90 · see citing works
“The theory posits that it is the synergistic clustering of conditions, rather than the simple summation of additional symptoms, that influence the health burden of a specific population (Tsai and Burns, 2015).”
BackgroundSyndemics and the PrEP Cascade: Results from a Sample of Young Latino Men Who Have Sex with Men
Blashill, A. J., Brady, J. P., Rooney, B. M., Rodríguez-Díaz, C. E., Horvath, K. J., Blumenthal, J. S., Morris, S., Moore, D. J., & Safren, S. A. (2019) · Archives of Sexual Behavior · doi:10.1007/s10508-019-01470-7 · Cited by 90 · see citing works
Pantalone, D. W., Nelson, K. M., Batchelder, A. W., Chiu, C., Gunn, H. A., & Horvath, K. J. (2020) · The Journal of Sex Research · doi:10.1080/00224499.2020.1728514 · Cited by 81 · see citing works
“…and alcohol use – have been vigorously investigated in SMM, and have been shown to have strong associations with HIV risk behaviors, HIV serostatus, and higher healthcare utilization and medical costs in a variety of HIV-negative SMM subgroups (e.g., O’Cleirigh et al., 2018; Tsai & Burns, 2015).”
BackgroundSex Differences in Neurocognitive Function in Adults with HIV: Patterns, Predictors, and Mechanisms
Rubin, L. H., Neigh, G. N., Sundermann, E. E., Xu, Y., Scully, E. P., & Maki, P. M. (2019) · Current Psychiatry Reports · doi:10.1007/s11920-019-1089-x · Cited by 80 · see citing works
Glynn, T. R., Safren, S. A., Carrico, A. W., Mendez, N. A., Duthely, L. M., Dale, S. K., Jones, D. L., Feaster, D. J., & Rodriguez, A. E. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02619-0 · Cited by 79 · see citing works
Using syndemic theory to understand food insecurity and diet-related chronic diseases
Himmelgreen, D., Romero-Daza, N., Heuer, J., Lucas, W., Salinas-Miranda, A. A., & Stoddard, T. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113124 · Cited by 83 · see citing works
Shuper, P. A., Joharchi, N., Bogoch, I. I., Loutfy, M. R., Crouzat, F., El‐Helou, P., Knox, D. C., Woodward, K., & Rehm, J. T. (2020) · BMC Public Health · doi:10.1186/s12889-020-09883-z · Cited by 79 · see citing works
Wei, D., Wang, X., You, X., Luo, X., Hao, C., Gu, J., Peng, S., Yang, X., Hao, Y., Silenzio, V., et al. (2020) · Epidemiology and Psychiatric Sciences · doi:10.1017/s2045796020000487 · Cited by 79 · see citing works
“These psychological problems are conducive to the ‘syndemic’ conditions surrounding human immunodeficiency virus (HIV) transmission risk behaviours and indirectly contribute to the high prevalence of HIV among MSM (Tsai and Burns, 2015; Safren et al., 2010).”
BackgroundSex differences in HIV-associated cognitive impairment
Sundermann, E. E., Heaton, R. K., Pasipanodya, E. C., Moore, R. C., Paolillo, E. W., Rubin, L. H., Ellis, R. J., & Moore, D. J. (2018) · AIDS · doi:10.1097/qad.0000000000002012 · Cited by 72 · see citing works
Quinn, K. G. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112779 · Cited by 70 · see citing works
Gibbs, A., Govender, K., & Jewkes, R. K. (2016) · Global Public Health · doi:10.1080/17441692.2016.1214281 · Cited by 64 · see citing works
“A substantial body of research, particularly in the global north, has used the concept of syndemics to emphasise how mental health challenges create HIV-vulnerability for people (Tsai & Burns, 2015).”
BackgroundSyndemics and clinical science
Mendenhall, E., Kohrt, B. A., Logie, C. H., & Tsai, A. C. (2022) · Nature Medicine · doi:10.1038/s41591-022-01888-y · Cited by 69 · see citing works
Self-citationLeddy, A. M., Zakaras, J. M., Shieh, J., Conroy, A. A., Ofotokun, I., Tien, P. C., & Weiser, S. D. (2021) · PLoS ONE · doi:10.1371/journal.pone.0252338 · Cited by 61 · see citing works
Longitudinal Effects of Syndemics on ART Non-adherence Among Sexual Minority Men
Harkness, A., Bainter, S. A., O’Cleirigh, C. M., Mendez, N. A., Mayer, K. H., & Safren, S. A. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2180-8 · Cited by 59 · see citing works
“Another complex issue that has been raised in the syndemics literature is the possibility of testing interaction terms to elucidate synergistic effects of syndemics on HIV-related outcomes [45].”
Mustanski, B. S., Phillips, G., Ryan, D. T., Swann, G., Kuhns, L. M., & Garofalo, R. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1607-3 · Cited by 57 · see citing works
“This potential issue, coupled with concerns that the additive model does not truly test the ‘‘interactive’’ or ‘‘synergistic’’ epidemics implied in the syndemics literature [75, 76], suggests the need for further study of quantitative approaches that can better test the postulates of a syndemic perspective.”
Syndemics: A Cross-Disciplinary Approach to Complex Epidemic Events Like COVID-19
Singer, M., Bulled, N., Ostrach, B., & Lerman Ginzburg, S. (2021) · Annual Review of Anthropology · doi:10.1146/annurev-anthro-100919-121009 · Cited by 59 · see citing works
A Syndemic Model of Exchange Sex Among HIV-Positive Men Who Have Sex With Men
Walters, S. M., Braksmajer, A., Coston, B. M., Yoon, I. S., Grov, C., Downing, M. J., Teran, R. A., & Hirshfield, S. (2020) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01628-8 · Cited by 54 · see citing works
Tomori, C., McFall, A. M., Solomon, S. S., Srikrishnan, A. K., Anand, S., Balakrishnan, P., Mehta, S. H., & Celentano, D. D. (2018) · Social Science & Medicine · doi:10.1016/j.socscimed.2018.03.032 · Cited by 54 · see citing works
McMahon, J. M., Braksmajer, A., Zhang, C., Leblanc, N. M., Chen, M. J., Aidala, A. A., & Simmons, J. (2019) · AIDS Research and Therapy · doi:10.1186/s12981-019-0248-9 · Cited by 49 · see citing works
Meanley, S., Haberlen, S., Okafor, C. N., Brown, A. L., Brennan‐Ing, M., Ware, D. P., Egan, J. E., Teplin, L. A., Bolan, R., Friedman, M. R., et al. (2020) · The Gerontologist · doi:10.1093/geront/gnaa069 · Cited by 48 · see citing works
HIV-related sexual risk among transgender men who are gay, bisexual, or have sex with men.
Scheim, A. I., Bauer, G. R., & Travers, R. (2017) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000001222 · Cited by 49 · see citing works
Chakrapani, V., Lakshmi, P. V. M., Tsai, A. C., Vijin, P. P., Kumar, P., & Srinivas, V. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2018.100348 · Cited by 49 · see citing works
Self-citationTsuyuki, K., Pitpitan, E. V., Levi‐Minzi, M. A., Urada, L. A., Kurtz, S. P., Stockman, J. K., & Surratt, H. L. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1841-3 · Cited by 48 · see citing works
“Latent variable approaches capture the full structure of syndemic data, and generate a variable that can be interpreted in light of the syndemic theory [15].”
Syndemic Classes, Stigma, and Sexual Risk Among Transgender Women in India
Chakrapani, V., Willie, T. C., Shunmugam, M., & Kershaw, T. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2373-1 · Cited by 47 · see citing works
Stall, R., Coulter, R. W. S., Friedman, M. R., & Plankey, M. W. (2015) · Social Science & Medicine · doi:10.1016/j.socscimed.2015.07.016 · Cited by 48 · see citing works
The Global Syndemic of Obesity, Undernutrition, and Climate Change
Swinburn, B. A., Hovmand, P. S., Waterlander, W. E., & Allender, S. E. (2022) · Wiley eBooks · doi:10.1002/9781119695257.ch31 · Cited by 51 · see citing works
The syndemics of diabetes and depression in Brazil – An epidemiological analysis
Diderichsen, F., & Andersen, I. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2018.11.002 · Cited by 44 · see citing works
“Recent reviews (Tsai & Burns, 2015; Tsai & Venkataramani, 2016; Tsai, Mendenhall, Trostle, & Kawachi, 2017) has pointed out that many studies aiming to demonstrate interactions between diseases and conditions have applied a “sum-score” approach that might illustrate that effects are adding up, but…”
BackgroundSpatial epidemiology: An empirical framework for syndemics research
Shrestha, S., Bauer, C., Hendricks, B. M., & Stopka, T. J. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113352 · Cited by 40 · see citing works
Integrating Intersectional and Syndemic Frameworks for Ending the US HIV Epidemic
Smith, L. R., Patel, V. V., Tsai, A. C., et al. (2022) · American Journal of Public Health · doi:10.2105/ajph.2021.306634 · Cited by 37 · see citing works
Self-citationMerrill, K. G., Campbell, J. C., Decker, M. R., McGready, J., Burke, V. M., Mwansa, J. K., Miti, S., Frimpong, C., Kennedy, C. E., & Denison, J. A. (2020) · AIDS and Behavior · doi:10.1007/s10461-020-02958-3 · Cited by 39 · see citing works
Longitudinal Effects of Syndemics on HIV-Positive Sexual Minority Men’s Sexual Health Behaviors
Harkness, A., Bainter, S. A., O’Cleirigh, C. M., Albright, C. A., Mayer, K. H., & Safren, S. A. (2019) · Archives of Sexual Behavior · doi:10.1007/s10508-018-1329-x · Cited by 38 · see citing works
Quinn, K. G., Spector, A. L., Takahashi, L. M., & Voisin, D. R. (2020) · AIDS and Behavior · doi:10.1007/s10461-020-03040-8 · Cited by 38 · see citing works
Sex Differences in the Patterns and Predictors of Cognitive Function in HIV
Rubin, L. H., Sundermann, E. E., Dastgheyb, R. M., Buchholz, A. S., Pasipanodya, E. C., Heaton, R. K., Grant, I., Ellis, R. J., & Moore, D. J. (2020) · Frontiers in Neurology · doi:10.3389/fneur.2020.551921 · Cited by 38 · see citing works
Kaur, J., Kaur, M., Chakrapani, V., Webster, J. L., Santos, J. A., & Kumar, R. (2020) · PLoS ONE · doi:10.1371/journal.pone.0225892 · Cited by 37 · see citing works
“BMI was calculated as weight (Kg) divided by height (m(2)) [28].”
MethodScheer, J. R., & Pachankis, J. E. (2019) · LGBT Health · doi:10.1089/lgbt.2019.0025 · Cited by 38 · see citing works
“Although the present study extends previous research on the overlapping and potentially synergistic association between syndemic conditions and the relative risk of physical health conditions among SGM individuals, future research should consider using a person-centered approach to uncover the nuances in the associati…”
BackgroundMethodInfluentialCouple Interdependence Impacts Alcohol Use and Adherence to Antiretroviral Therapy in Malawi
Conroy, A. A., McKenna, S. A., & Ruark, A. H. (2018) · AIDS and Behavior · doi:10.1007/s10461-018-2275-2 · Cited by 38 · see citing works
Examining a Syndemics Network Among Young Latino Men Who Have Sex with Men
Lee, J. S., Safren, S. A., Bainter, S. A., Rodríguez-Díaz, C. E., Horvath, K. J., & Blashill, A. J. (2019) · International Journal of Behavioral Medicine · doi:10.1007/s12529-019-09831-1 · Cited by 37 · see citing works
“These researchers suggest that a statistically significant interaction term within a larger additive model would suggest a deviation from additive effects, and may provide statistical evidence of synergy among syndemic indicators [13].”
BackgroundMcCurley, J. L., Gutierrez, A. P., Bravin, J. I., Schneiderman, N., Reina, S. A., Khambaty, T., Castañeda, S. F., Smoller, S., Daviglus, M. L., O’Brien, M. J., et al. (2019) · Annals of Behavioral Medicine · doi:10.1093/abm/kaz009 · Cited by 41 · see citing works
Mapping a Syndemic of Psychosocial Risks During Pregnancy Using Network Analysis
Choi, K. W., Smit, J. A., Coleman, J. N., Mosery, N., Bangsberg, D. R., Safren, S. A., & Psaros, C. (2019) · International Journal of Behavioral Medicine · doi:10.1007/s12529-019-09774-7 · Cited by 33 · see citing works
“To date, many syndemic studies have used relatively basic methods for characterizing the presence of multiple risks [23], often summing them together to produce an index of cumulative risk.”
Chakrapani, V., Kaur, M., Tsai, A. C., Newman, P. A., & Kumar, R. (2020) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.112817 · Cited by 31 · see citing works
Self-citationPantalone, D. W., Valentine, S. E., Woodward, E. N., & O’Cleirigh, C. M. (2017) · Journal of Gay & Lesbian Mental Health · doi:10.1080/19359705.2017.1389794 · Cited by 31 · see citing works
“Future work should attempt to address this syndemics measurement issue (e.g., Tsai & Burns, 2015).”
BackgroundChakrapani, V., Lakshmi, P. V. M., Newman, P. A., Kaur, J., Tsai, A. C., Vijin, P. P., Singh, B., Kumar, P., Rajan, S., & Kumar, R. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000437 · Cited by 32 · see citing works
“Our use of appropriate statistical analyses (interactions on both additive and multiplicative scales) to assess synergy is another strength, given several studies that purportedly assessed syndemics and HIV risk among transgender women did not use such analytic techniques [49], among very few that did [50].”
BackgroundSelf-citationFiliatreau, L. M., Pettifor, A. E., Edwards, J. K., Masilela, N., Twine, R., Gómez-Olivé, F. X., Haberland, N. A., Kabudula, C. W., Lippman, S. A., & Kahn, K. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03198-9 · Cited by 28 · see citing works
Lee, J. S., Bainter, S. A., Carrico, A. W., Glynn, T. R., Rogers, B. G., Albright, C. A., O’Cleirigh, C. M., Mayer, K. H., & Safren, S. A. (2020) · Journal of Behavioral Medicine · doi:10.1007/s10865-020-00148-z · Cited by 30 · see citing works
“As a field of study, there are discrepant findings across studies of syndemic indicators and HIV acquisition risk, and there is a lack of a standard set of syndemic indicators and assessments of such indicators examined across studies (see Tsai & Burns, 2015; Tsai & Venkataramani, 2016).”
BackgroundNöstlinger, C., Reyniers, T., Smekens, T., Apers, H., Laga, M., Wouters, K., & Vuylsteke, B. (2020) · AIDS Care · doi:10.1080/09540121.2020.1739218 · Cited by 25 · see citing works
“Given the vast literature on syndemics among HIV-negative gay and other men having sex with men (Tsai & Burns, 2015), we hypothesise that drug use, depression and sexual risk behaviour would be high in a cohort of PrEP users enrolled in the Belgian PrEP demonstration project.”
BackgroundAlvarado, B., Mueses-Marín, H. F., Galindo, J., & Martínez-Cajas, J. (2020) · Biomédica · doi:10.7705/biomedica.5082 · Cited by 28 · see citing works
“Studies conducted in MSM and transgender women have shown that adverse psychosocial conditions can cluster or coexist (2) and their accumulation (number of exposures as a cumulative count) increases HIV risk and transmission (12).”
BackgroundRoll-out of HIV pre-exposure prophylaxis: a gateway to mental health promotion
Ikeda, D. J., Kidia, K. K., Agins, B., Haberer, J. E., & Tsai, A. C. (2021) · BMJ Global Health · doi:10.1136/bmjgh-2021-007212 · Cited by 26 · see citing works
Self-citationMcDonald, L., Antoine, D. G., Liao, C., Lee, A. E., Wahab, M., & Coleman, J. S. (2017) · Journal of Interpersonal Violence · doi:10.1177/0886260516685708 · Cited by 27 · see citing works
“Some argue for sophisticated modeling to address interaction effects versus an additive effect (Tsai & Burns, 2015); whereas, others agree with methodology similar to ours (Stall, Coulter, Freidman, & Plankey, 2015).”
MethodStoicescu, C., Ameilia, R., Irwanto, I., Praptoraharjo, I., & Mahanani, M. M. (2019) · Journal of Urban Health · doi:10.1007/s11524-019-00352-6 · Cited by 25 · see citing works
“To this end, epidemiologists have argued for an expansion of the assessment of interactions based purely on product terms in multiplicative models of cross-sectional data to also include additive interaction [24, 27, 28].”
BackgroundChandler, C. J., Meunier, É., Eaton, L. A., Andrade, E., Bukowski, L. A., Matthews, D. D., Raymond, H. F., Stall, R. D., & Friedman, M. R. (2020) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01828-2 · Cited by 24 · see citing works
Brewis, A., Wutich, A., Galvin, M., & Lachaud, J. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2020.113031 · Cited by 26 · see citing works
Internet gaming, embodied distress, and psychosocial well-being: A syndemic-syndaimonic continuum
Snodgrass, J. G., Lacy, M. G., & Cole, S. W. (2019) · Social Science & Medicine · doi:10.1016/j.socscimed.2019.112728 · Cited by 25 · see citing works
Jiwatram-Negrón, T., Michalopoulos, L., & El‐Bassel, N. (2018) · Global Social Welfare · doi:10.1007/s40609-018-0112-1 · Cited by 23 · see citing works
Syndemic Profiles and Sexual Minority Men’s HIV-Risk Behavior: A Latent Class Analysis
Scheer, J. R., Clark, K. A., Maiolatesi, A. J., & Pachankis, J. E. (2021) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01850-4 · Cited by 22 · see citing works
Chan, R. C. H., Operario, D., & Mak, W. W. S. (2020) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph17061924 · Cited by 22 · see citing works
“Studies applying the syndemic theory have mostly examined how multiple psychosocial problems work additively to increase the vulnerability to HIV infection in marginalized populations [18].”
BackgroundMethodEthnic disparities in psychotic experiences explained by area-level syndemic effects
Coid, J. W., Rodriguez, R. G., Kallis, C., Zhang, Y., Bhui, K. S., Stavola, B. L. D., Bebbington, P., & Ullrich, S. (2019) · The British Journal of Psychiatry · doi:10.1192/bjp.2019.203 · Cited by 22 · see citing works
Ogunbajo, A., Oke, T., Jin, H., Rashidi, W., Iwuagwu, S., Harper, G. W., Biello, K. B., & Mimiaga, M. J. (2019) · AIDS Care · doi:10.1080/09540121.2019.1678722 · Cited by 22 · see citing works
“Lastly, we are aware of the critique of the “count variable” approach to exploring syndemics of psychosocial problems and HIV risk (Tsai & Burns, 2015) but due to the small sample size we were unable to carryout higher-level modeling to explore syndemic effects.”
BackgroundLau, J. T. F., Wu, X., Wu, A. M. S., Wang, Z. J., & Mo, P. K. H. (2017) · AIDS and Behavior · doi:10.1007/s10461-017-1874-7 · Cited by 22 · see citing works
“It also increased the likelihood of HIV transmissions [6] among PLWH.”
BackgroundRelationship power and sexual violence among HIV-positive women in rural Uganda
Conroy, A. A., Tsai, A. C., Clark, G. M., Boum, Y., Hatcher, A. M., Kawuma, A., Hunt, P. W., Martin, J. N., Bangsberg, D. R., & Weiser, S. D. (2016) · AIDS and Behavior · doi:10.1007/s10461-016-1385-y · Cited by 22 · see citing works
“These co-occurring epidemics of psychosocial problems, often termed syndemics [42], may interact in ways that synergistically worsen health disparities between HIVpositive and negative individuals [43, 44], with the potential to further spread the HIV virus to children and men.”
BackgroundSelf-citationChuang, D.-M., Newman, P. A., Fang, L., & Lai, M. (2021) · AIDS and Behavior · doi:10.1007/s10461-021-03269-x · Cited by 21 · see citing works
“Consistent with previous studies [18, 19, 58], the results from the accumulative and interactive effect analyses showed that there is a much higher relative risk of HIV infection if MU interacts with at least two or more other PHCs.”
ResultWalters, S. M., Kral, A. H., Lamb, S., Goldshear, J. L., Wenger, L. D., & Bluthenthal, R. N. (2021) · Journal of Urban Health · doi:10.1007/s11524-020-00494-y · Cited by 20 · see citing works
Effects of syndemic psychiatric diagnoses on health indicators in men who have sex with men.
Batchelder, A., Choi, K. W., Dale, S. K., Pierre‐Louis, C., Sweek, E. W., Ironson, G. H., Safren, S. A., & O’Cleirigh, C. M. (2019) · Health Psychology · doi:10.1037/hea0000724 · Cited by 22 · see citing works
“…of psychosocial syndemic problems in relation to HIV, few have compared the additive versus interactive, or multiplicative, relationships (Tsai & Burns, 2015), despite being more consistent with syndemic theory’s description of the “synergistic” effects of syndemic problems (Singer,…”
BackgroundResultATN 086/106 Protocol Teams for the Adolescent Medicine Trials Network for HIV/ADS Interventions, van den Berg, J. J., Isabel Fernández, M., Fava, J. L., Operario, D., Rudy, B. J., & Wilson, P. A. (2017) · AIDS and Behavior · doi:10.1007/s10461-016-1550-3 · Cited by 19 · see citing works
“and lack of strong social support networks and who are also at high risk for transmitting HIV due to their engagement in condomless anal and vaginal sex [43].”
Context, COVID-19 and comorbidities: exploring emergent directions in syndemics and HIV research
Logie, C. H., Coelho, M., Kohrt, B., Tsai, A. C., & Mendenhall, E. (2022) · Current Opinion in HIV and AIDS · doi:10.1097/coh.0000000000000722 · Cited by 20 · see citing works
“Although most empirical studies in our review examined social context and mechanisms of action, they did not explicitly assess interactions between health conditions [61]; they instead applied cumulative (or sum score) approaches to documenting comorbidities, similar to the older literature on adverse childhood experi…”
ResultSelf-citationSatyanarayana, S., Rogers, B. G., Bainter, S. A., Christopoulos, K., Fredericksen, R. J., Mathews, W. C., Moore, R. D., Mugavero, M. J., Napravnik, S., Carrico, A. W., et al. (2021) · AIDS Patient Care and STDs · doi:10.1089/apc.2021.0004 · Cited by 19 · see citing works
“68,69 Fourth, a viral suppression threshold of HIV RNA 400 copies/mL is higher than the typical threshold of HIV RNA 200 copies/mL, suggesting that our estimates for the effects of syndemic conditions on viral suppression may be conservative.”
Hotton, A., Perloff, J., Paul, J. L., Parker, C., Ducheny, K., Holloway, T., Johnson, A. K., Garofalo, R., Swartz, J. A., & Kuhns, L. M. (2020) · AIDS and Behavior · doi:10.1007/s10461-020-02874-6 · Cited by 18 · see citing works
“While their co-occurrence has been well established in the literature, the extent to which they operate synergistically remains unclear [43, 44].”
BackgroundChandler, C. J., Bukowski, L. A., Matthews, D. D., Hawk, M. E., Marković, N., Stall, R. D., & Egan, J. E. (2019) · AIDS Care · doi:10.1080/09540121.2019.1659921 · Cited by 19 · see citing works
“A total of four of the most often used psychosocial condition categories among MSM reported in literature were considered to contribute to a syndemic for analysis (Chandler et al., 2019; Tsai & Burns, 2015).”
BackgroundChandler, C. J., Bukowski, L. A., Matthews, D. D., Hawk, M. E., Marković, N., Egan, J. E., & Stall, R. D. (2019) · AIDS and Behavior · doi:10.1007/s10461-019-02458-z · Cited by 19 · see citing works
Bauer, G. R., Flanders, C. E., MacLeod, M. A., & Ross, L. E. (2016) · BMC Public Health · doi:10.1186/s12889-016-3173-z · Cited by 19 · see citing works
“Research on syndemics in public health has not coalesced around a coherent conceptualization and corresponding methodology, and it is unclear that phenomena frequently identified as “syndemics” always differ from classical comorbidity [40], or even simple morbidity; some analysis strategies use a summed variable for p…”
BackgroundJennings, T. L., Gleason, N., Grubbs, J. B., & Kraus, S. W. (2024) · Current Addiction Reports · doi:10.1007/s40429-024-00546-2 · Cited by 20 · see citing works
“Systematic reviews of the syndemic theory literature indicate that the dominant approach to modeling syndemic interactions is the “sum score” specification, which is the sum total of health risks reported by a participant [74].”
Storholm, E. D., Huang, W., Ogunbajo, A., Horvath, K. J., Reback, C. J., Blumenthal, J. S., Moore, D. J., Flynn, R. P., Bolan, R., Corado, K., et al. (2022) · AIDS and Behavior · doi:10.1007/s10461-022-03807-1 · Cited by 15 · see citing works
Chandler, C. J., Adams, B., Eaton, L. A., Meunier, É., Andrade, E., Bukowski, L. A., Stall, R. D., & Friedman, M. R. (2022) · The Journal of Sex Research · doi:10.1080/00224499.2022.2072799 · Cited by 21 · see citing works
“The theory is most often used to explore psychosocial conditions such as issues in mental health, violence, substance use, and risk behavior (Tsai & Burns, 2015).”
MethodTan, S., Cen, P., Fang, T., Yang, X. H., Zhang, Y., Zhu, J., Huang, H., Wang, M., Jiang, L., Mo, J., et al. (2022) · BMC Public Health · doi:10.1186/s12889-022-13231-8 · Cited by 19 · see citing works
Do psychosocial factors mediate sexual minorities’ risky sexual behaviour? A twin study.
Oginni, O. A., Jern, P., Rahman, Q., & Rijsdijk, F. V. (2021) · Health Psychology · doi:10.1037/hea0001129 · Cited by 18 · see citing works
“However, despite recognized associations between psychosocial adversities and risky sexual behavior (Stall et al., 2003; Tsai & Burns, 2015), Oginni et al. (2020) did not include social adversity variables were included in their analytic model.”
Jiang, H., Li, J., Tan, Z., Chen, X., Cheng, W., Gong, X., & Yang, Y. (2019) · Archives of Sexual Behavior · doi:10.1007/s10508-019-01488-x · Cited by 18 · see citing works
Okumu, M., Ombayo, B. K., Small, E., & Ansong, D. (2019) · International Journal of Behavioral Medicine · doi:10.1007/s12529-019-09783-6 · Cited by 18 · see citing works
Maclin, B. J., Wang, Y., Rodriguez-Diaz, C., Donastorg, Y., Perez, M., Gomez, H., Barrington, C., & Kerrigan, D. (2023) · PLOS ONE · doi:10.1371/journal.pone.0291314 · Cited by 18 · see citing works
Hershow, R. B., Trujillo, L., Olansky, E., Lee, K., Agnew-Brune, C. B., Wejnert, C., Adams, M., National HIV Behavioral Surveillance Among Transgender Women Study Group, National HIV Behavioral Surveillance Among Transgender Women Study Group, Barak, N., et al. (2024) · MMWR Supplements · doi:10.15585/mmwr.su7301a3 · Cited by 17 · see citing works
“…analytic approaches have been used in research with men who have sex with men and help identify specific combinations of syndemic conditions that result in increased likelihood of behaviors associated with HIV transmission and help develop tailored intervention responses ( 25 , 27 , 33 , 34 ).”
BackgroundBeames, J. R., Huckvale, K., Fujimoto, H., Maston, K., Batterham, P. J., Calear, A. L., Mackinnon, A. J., Werner‐Seidler, A., & Christensen, H. M. (2023) · Child and Adolescent Psychiatry and Mental Health · doi:10.1186/s13034-023-00583-1 · Cited by 17 · see citing works
“Exploring interactions between these disasters through the lens of syndemic theory is a novel contribution that will advance disaster research and practice [29].”
BackgroundTsai, A. C., Kakuhikire, B., Perkins, J. M., Downey, J., Baguma, C., Satinsky, E. N., Gumisiriza, P., Kananura, J., & Bangsberg, D. R. (2021) · Journal of Global Health · doi:10.7189/jogh.11.04056 · Cited by 17 · see citing works
Self-citationWhat the HIV Pandemic Experience Can Teach the United States About the COVID-19 Response
Strathdee, S. A., Martin, N. K., Pitpitan, E. V., Stockman, J. K., & Smith, D. M. (2020) · JAIDS Journal of Acquired Immune Deficiency Syndromes · doi:10.1097/qai.0000000000002520 · Cited by 16 · see citing works
McDaid, L. M., Flowers, P., Ferlatte, O., McAloney‐Kocaman, K., Gilbert, M., & Frankis, J. S. (2019) · SSM - Population Health · doi:10.1016/j.ssmph.2019.100519 · Cited by 16 · see citing works
Gaspar, M., Marshall, Z., Rodrigues, R., Adam, B. D., Brennan, D. J., Hart, T. A., & Grace, D. (2019) · Sociology of Health & Illness · doi:10.1111/1467-9566.12884 · Cited by 16 · see citing works
Yellin, H., Beckwith, C. G., Kurth, A., et al. (2018) · AIDS Care · doi:10.1080/09540121.2018.1455961 · Cited by 17 · see citing works
“These methods require large sample sizes to achieve adequate statistical power (Tsai & Burns, 2015), and can be misleading when calculated using odds ratios that do not approximate relative risk (Kalilani & Atashili, 2006).”
BackgroundMethodOuafik, M., Buret, L., & Scholtes, B. (2022) · Social Science & Medicine · doi:10.1016/j.socscimed.2022.115162 · Cited by 16 · see citing works
Slagboom, M. N., Reis, R., Tsai, A. C., Büchner, F. L., Dijk, D. J. A. V. D.-V., & Crone, M. R. (2021) · Journal of Global Health · doi:10.7189/jogh.11.04029 · Cited by 17 · see citing works
Self-citationCouture, M.-C., Evans, J. L., Draughon, J. E., Stein, E. S., Sokunny, M., Phou, M., Len, A., Song, N., Sophal, C., Neak, Y., et al. (2020) · Archives of Sexual Behavior · doi:10.1007/s10508-020-01705-y · Cited by 14 · see citing works
- Authors
- Tsai, A. C., & Burns, B. F. O.
- Affiliations
- Harvard University (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Tsai, Alexander C.
- Venue
- Social Science & Medicine
- Publisher
- Elsevier BV
- Published
- 2015-08
- Volume
- 139
- Pages
- 26-35
- ISSN
- 0277-9536 (ISSN-L)
- PMC
- PMC4519429
- OpenAlex
- W1738219260
- Cited by
- 227
- References
- 118
- Citations by year
- 2026: 13 · 2025: 22 · 2024: 25 · 2023: 19 · 2022: 27 · 2021: 24 · 2020: 31 · 2019: 30 · 2018: 13 · 2017: 9 · 2016: 11 · 2015: 2 · 2013: 1
- FWCI
- 1.50
- Type
- journal article
- Language
- en
- Open access
- green
- www.ncbi.nlm.nih.gov
- Locations
- Social Science & Medicine (publishedVersion)
- PubMed (publishedVersion)
- Europe PMC (PubMed Central) (acceptedVersion)
- PubMed Central (acceptedVersion)
- RePEc: Research Papers in Economics (submittedVersion)
- Funders
- Harvard University Center for AIDS Research
- National Institutes of Health (P30AI060354)
- NIH (K23MH096620)
- Topics
- Health Sciences › Medicine › Epidemiology › HIV, Drug Use, Sexual Risk
- Health Sciences › Medicine › Infectious Diseases › HIV/AIDS Research and Interventions
- Social Sciences › General Social Sciences › HIV, TB, and STIs Epidemiology
- Keywords
- syndemic, disease interaction, psychosocial problems, HIV risk, HIV transmission risk behavior, HIV infection, men who have sex with men, mental health, substance abuse, violence, synergistic effect
- MeSH terms
- Cross-Sectional Studies, Humans, Male, Risk-Taking, Social Problems, United States, HIV Infections, Cluster Analysis, Homosexuality, Male
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