# Racial/ethnic disparities in the dose-response relationship between syndemic risk factors and increased gun carrying odds among male high school students in the United States

## TL;DR

This study finds that the more risk factors like substance use and mental health issues a student has, the more likely they are to carry a gun, with bigger risks for Black and Hispanic male teens.

## Contribution

The study introduces a syndemic framework to quantify racial/ethnic disparities in gun carrying among male adolescents.

## Key findings

- Gun carrying odds increased significantly with more syndemic risk factors (e.g., 17 times higher with 4+ risks).
- Black and Hispanic male adolescents showed stronger associations between syndemic risks and gun carrying.
- Results were consistent using both standard and penalized maximum likelihood estimation methods.

## Abstract

Substance use, mental health, and violence are co-occurring risks associated with gun carrying among adolescents. Using a syndemic framework, we examined the co-occurrence and cumulative effect of these risk factors on gun carrying in male adolescents and potential racial/ethnic disparities.

We analyzed 2019–2023 Youth Risk Behavior Survey data with weighted multiple logistic regression models, controlling for age and sexual orientation. A syndemic risk factor variable was created by summing exposures to substance use, mental health, and victimization/violence. Interaction terms were tested, and models were stratified by race/ethnicity. A penalized maximum likelihood estimation (PMLE) regression was also applied to address potential instability due to the rarity of the outcome.

In multiple regression models, a significant dose-response relationship was found between the number of syndemic risk factors and the odds of gun carrying. Compared with male adolescents reporting 0–1 syndemic risk factors, the odds of gun carrying was more than five times higher among those with 2–3 syndemic risk factors (Adjusted Odds Ratio (AOR): 5.1, 95 % CI: 4.0, 6.6) and almost 17 times higher among those with 4+ syndemic risk factors (AOR: 17.3, 95 % CI: 12.9, 23.2). Stratified analyses revealed stronger effects among Black and Hispanic adolescents. Results were similar with PMLE regression.

The odds of gun carrying increased as the number of syndemic risk factors increased, with notable racial/ethnic disparities. Understanding the syndemic risk factors associated with gun carrying and the disparities that exist is crucial for developing targeted prevention interventions.

•Substance use, mental health, and violence co-occur among students who carry guns.•Gun carrying odds increased as the number of syndemic risk factors increased.•Stronger effects were observed among Black and Hispanic male adolescents.•Interventions must address the co-occurring syndemic risk factors of gun carrying.

Substance use, mental health, and violence co-occur among students who carry guns.

Gun carrying odds increased as the number of syndemic risk factors increased.

Stronger effects were observed among Black and Hispanic male adolescents.

Interventions must address the co-occurring syndemic risk factors of gun carrying.