Mentored Scientist Award

Heavy alcohol consumption (HAC) is a significant public health concern, particularly among women and sexual and gender minorities. The prevalence of HAC is linked to increased sexual risk behaviors (SRB), such as condomless sex and having multiple partners, thus heightening the risk for HIV. Syndemic theory provides a framework for understanding how co-occurring psychosocial and structural factors interact to influence HAC and SRB. However, gaps remain in understanding how syndemic factors affect HAC and SRB outcomes. Moreover, there is a lack of methodological rigor in syndemic research, including the use of comprehensive mixed methods, longitudinal design, and objective biomarker confirmation. Objective: This study aims to investigate the syndemic factors contributing to HAC and SRB among sexually active adults, leveraging data from the parent NIH-funded “BEATS” study, which uses ecological momentary assessment (EMA) to track these behaviors. By applying a mixed methods longitudinal design and biomarker confirmation, we seek to identify the synergistic effects of multiple co-occurring syndemic conditions on HAC and SRB and explore the processes by which these behaviors unfold. Methods: This “MIXED BARS” study will draw data from the “BEATS” study to assess HAC and SRB over 30 days. Phase 1 of MIXED BARS will analyze the additive and multiplicative interactions of syndemic conditions on HAC (measured by EMA self-report and phosphatidyl ethanol [PEth] biomarkers) and SRB (measured by EMA) over time. Phase 2 will use qualitative interviews to explore the influence of key syndemic factors in the unfolding of HAC and SRB events, guided by syndemic and modified grounded theory frameworks, integrating insights from Phase 1. Impact: The findings will deepen understanding of individual, environmental, and structural syndemic interactions affecting HAC and SRB, informing screening and interventions to prevent HIV transmission. Additionally, by aligning with the National Institute on Alcohol Abuse and Alcoholism’s (NIAAA) emphasis on the intersection of syndemics and HIV prevention in alcohol-impacted populations, this study will generate preliminary data for a K-award application responsive to NIAAA’s priorities.