Smoking Syndemics among a Sample of Men Who Have Sex with Men in Shanghai, China Open Access

Abstract

Fan Yu
Men who have sex with men (MSM) population are considerably at a greater risk for
HIV infection in China. Studies in other countries indicated the prevalence of cigarette
smoking among MSM is significantly higher than among their heterosexual peers.
Western researchers found that MSM, gay, and/or bisexual men tend to experience more
psychosocial problems, and have higher rates of substance use and HIV and other STIs.
They proposed a syndemic theory to study the concurrent psychosocial conditions and
health problems and their effects on HIV and other Sexually Transmitted Infections
(STIs).
Guided by syndemic theory, we analyzed cigarette smoking in relation to
demographics, substance use behaviors and psychosocial conditions among 404 MSM
participants in Shanghai, China. We also aimed to explore the syndemic effects of
substance use and psychosocial problems on sexual risks. Cross-sectional data were
collected as part of larger study examining characteristics of HIV/STIs, sexual risks, and
health issues among MSM. Bivariate logistic modeling suggests that MSM have a higher
prevalence of smoking than general males in China. The smoking level is associated with
alcohol and drug use, depression, intimate partner violence, sexual attitude and gay
identity. Linear regression analyses present that substance use and psychosocial
conditions could significantly predict sexual risks.
These findings are understood as part of a syndemic among MSM, and suggest that
smoking prevention and cessation, as well as other substance abuse interventions should
be integrated with the prevention of sexual risk behaviors for MSM in order for HIV and
STIs prevention efforts to be more effective among MSM.

Table of Contents

i

TABLE OF CONTENTS

INTRODUCTION .................................................................................................................. 1
METHODS ......................................................................................................................... 6
RESULTS .......................................................................................................................... 11
DISCUSSION ..................................................................................................................... 14
REFERENCE ....................................................................................................................... 19
TABLES ............................................................................................................................ 28

ii

LIST OF TABLES

Table 1: Demographic Characteristics of 404 MSM by Cigarette Smoking Status
Recruited by Respondent-Driven Sampling Method in Shanghai Mens Study in Shanghai
China, 2008-2009 .............................................................................................................. 28
Table 2. The Association Between Demographic, Behavioral and Psychosocial Predictors
by Smoker Type among 404 MSM Recruited by Respondent-Driven Sampling Method in
Shanghai Mens Study, in Shanghai, China, 2008-2009 .............................................................. 30
Table 3. Correlation matrix between Sex Risk Behaviors and Factors among 404 MSM
Recruited by Respondent-Driven Sampling Method in Shanghai Mens Study, in Shanghai,
China, 2008-2009 .............................................................................................................. 31
Table 4. Linear Regression on Sex Risk Behaviors among 404 MSM Recruited by
Respondent-Driven Sampling Method in Shanghai Mens Study, in Shanghai, China,
2008-2009. ...................................................................................................................... 32

About this Master's Thesis

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School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Smoking Syndemics Chinese MSM
Committee Chair / Thesis Advisor	Wong, Frank Y, Emory University Sullivan, Patrick S, Emory University
Committee Members	Nehl, Eric J., Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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