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Examining the influence of unmet needs on psychosocial predictors of health behavior in emerging young adult men with intersecting minority identifications
Date
2024
Authors
Journal Title
Journal ISSN
Volume Title
Publisher
University of Delaware
Abstract
Historically, examination of health outcomes has typically been examined within samples of the population in isolation without consideration of a variety of socioeconomic influences on the interplay between human behavior and health outcomes. This is particularly relevant when discussing the emerging young adult population. During a time of developmental instability, health behaviors could irrevocably alter one’s life course through the development of maladaptive coping mechanisms leading to substance use disorders and potential infectious disease transmission. The studies contained within this dissertation examine a vulnerable population who face both intrinsic and extrinsic challenges to optimal health states related to their intersecting identifications as both a racial/ethnic and a sexual minority. ☐ This dissertation aims to examine and describe the impact of the roles of socioeconomic disadvantage, and psychological constructs that could potentially impede emerging young adult sexual minority men (EYASMM) from attaining their presumed desired health states. Through a systematic review of the extant literature (Chapter Two), needs for definition and elucidation of influencing extrinsic factors on behavior are determined and discussed. This systematic review begins as an examination of risk-taking behavior in EYASMM and then discusses three themes gleaned from the literature. The three themes elicited from the literature share a common assertion that the interactions individuals encounter have potentially life-changing repercussions both immediately, and later in the life course. The quantitative research questions posed by the studies contained in this dissertation are answered through secondary data analyses of the Healthy Young Men’s Cohort Study (HYMCS) dataset. The HYMCS is a 14-wave longitudinal study that examines HIV transmission and reduction within the context of economic, and psychosocial barriers to care as well as a variety of health behaviors including substance use, healthy sex practices, pre-exposure prophylaxis (PrEP) usage and adherence as well as HIVrelated behaviors. This study examines individuals ages 16-24 years old who identify as Hispanic/Latinx, Black/ African American/ or Afro-Latinx. Study data were provided to the primary researcher of this dissertation after a publication proposal and exchange of ideas with the primary research team was accepted. This dissertation examines the roles of unmet basic needs on two pathways to explain health behavior. Study Two (Chapter Three) of this dissertation examines the association of unmet basic needs on problematic alcohol use. Further, the researchers of this study inquire if the use of substances to cope mediates the relationship between these two variables. Multivariable regression models determined that there was a statistically significant association between increasing age, Hispanic/Latinx identification, completion of a four-year undergraduate degree or higher, and substance use coping and problematic alcohol use. Despite these assertions, there was no statistically significant association between unmet basic needs and problematic alcohol use. Mediated regression analysis was performed and despite the absence of a direct causal pathway explaining problematic alcohol use as a behavior, an indirect effect was statistically significant providing the researchers with an opportunity for further research. Since this indirect effect does suggest an economic mediation to explain this causal pathway, selection of a different variable or framing of the research question could provide more evidence for the influences of personal socioeconomic considerations for problematic alcohol use interventions. Study Three (Chapter Four) of this dissertation examines the health behavior of condom self-efficacy within a socioeconomic context. Essential to the reduction of HIV and STI transmission, an examination of behaviors reducing this public health crisis is warranted. Using a mean measure of social support from three sources (friends, family, and significant other) to quantify perceived social support, the relationship between social support and condom self-efficacy was established, in alignment with the extant literature. Multivariable regression of demographic covariates yields that the only significant association was that of employment on condom self-efficacy. Moderated regression to determine the degree of influence of unmet needs on the association between social support and condom self-efficacy does not find an influence of the moderating variable. Therefore, condom self-efficacy is determined to be more of a socially mediated behavior than an economically influenced behavior. The studies within this dissertation demonstrate that there is a need for researchers, particularly in nursing, to develop a clear, population-specific definition of financial insecurity that captures those challenges encountered by EYASMM when it comes to health behaviors. In addition, the findings demonstrate a need for policy that embraces financial insecurity as a potential confounder of poor health outcomes in those thought not to be affected by poorer health as a function of age.
Description
"At the request of the author or degree granting institution, this graduate work is not available to view or purchase until March 05 2030"--Proquest citation/abstract page.
Keywords
Condom self-efficacy, Emerging young adult, Health behavior, Problematic alcohol use, Sexual minority men, Social support