Sexual orientation and co-occurring psychosocial health problems among male college students in the United States

Male sexual minorities (MSM) are theorized to be at increased risk of co-occurring psychosocial health problems (i.e., syndemics). The purpose of this study is to investigate the association between sexual minority status (SMS), defined by both sexual identity and behavior, and the co-occurrence of psychosocial health problems in a national sample of male college students. Methods. We employed secondary analysis of National College Health Assessment (Spring 2009) data, including sexually active males 18-24 years old (N=14,933). We conducted multiple logistic regression analysis to assess associations between SMS and syndemic factors: sexual abuse, intimate partner violence (IPV), drug use, heavy episodic drinking, and depressive symptoms. We then used path analysis to evaluate the meditational role of syndemic factors on the relationship between SMS and recent sexually transmitted infection (STI). Results. This sample was primarily non-Hispanic white (81%), full-time students (97%), and attending public institutions (68%). Sexual abuse, IPV, and depressive symptoms were prevalent among all MSM. Drug use was more prevalent among bisexually-identified MSM. Syndemic factors were more likely to co-occur among gay/bisexual MSM. Co-occurring syndemic factors partially mediated the association between SMS and recent STI for gay and bisexual MSM, but not heterosexually-identified MSM. Conclusion. Syndemic risks are an issue for a subset of male college students and are associated with sexual health. Interventions targeting MSM should be tailored for differences across sexual identities as we found that sexual identity and behavior exerted differential effects on psychosocial health problems and subsequent sexual health risks.