Social ecological model of alcohol use among youth living with HIV

The goal of this study was to identify predictors of alcohol use among youth living with HIV (YWH) using a social ecological approach that examines the individual and the context in which they are embedded. The sample consisted of 183 YWH ages 17–24 from five sites within the Adolescent Medicine Trials Network (ATN). Structural equation modeling was used to test the social ecological model of alcohol use in this sample. The model tested predictors at the individual, interpersonal, and environmental level. Results showed that mental health distress (b = 0.21, p < 0.05), social norms of alcohol use (b = 0.29, p < 0.05) and alcohol outlets (b = 0.23, p < 0.05) were associated with alcohol use. Externalizing behaviors were indirectly associated with problematic alcohol use, while social norms of alcohol use mediated this relationship (z = 2.42, p = 0.015). Our findings identified factors across multiple systems related to alcohol use among YWH supporting the social ecological model. Findings suggest treatment for alcohol use behavior would benefit from also addressing the individual by focusing on mental health issues as well. Additionally, at the interpersonal level, considering one's social norms of drinking in their social network, especially among youth who are more prone to externalizing behaviors, would lower alcohol use. Furthermore, public policy should examine ways to limit the accessibility of alcohol in higher risk environments.