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Syndemic Orientation | Orientaci贸n Sind茅mica

Our Approach

Syndemic Approach Graphic

We take a syndemic approach to our work, which means we look at how multiple health issues鈥攍ike violence, substance use, HIV, and mental health鈥攈appen together in Latino communities in the U.S. These issues don鈥檛 exist in isolation. They develop over time, across generations, and are shaped by the experience of adapting to life in a new country (acculturation).鹿

Unlike traditional public health approaches that focus on one issue at a time, a syndemic perspective helps us understand the deeper, shared causes behind these problems. It also guides us in creating programs and policies that address those root causes.虏

This syndemic鈥攙iolence, substance use, HIV, and mental health鈥攊s driven by long-term stressors. These include acculturative stress, which is the pressure of adjusting to a new culture, and structural challenges like navigating schools that aren鈥檛 welcoming or accessing health care that鈥檚 hard to reach.虏 鲁 These same social factors also increase the risk for other health problems, such as chronic stress and physical illnesses.鈦碘伝鈦

We represent this syndemic visually as branches of one tree, inspired by how community members describe these issues.鈦封伝鹿鈦 The winds in our image symbolize acculturative stress鈥攁n environmental force that shapes the health of Latino communities in the U.S. This idea connects to weathering theory, which explains how constant exposure to stress wears down the body over time.鹿鹿

Yet, despite these challenges, Latino immigrants continue to thrive. Like a tree that grows stronger in a storm, our communities deepen their roots. The SER Familia team builds on this resilience by strengthening what already makes Latino families strong: family and social support, coping skills, cultural pride, and hope in the American Dream. We call this approach 鈥渞oot-focused鈥 syndemic strategies.

  1. Singer, M. C., Erickson, P. I., Badiane, L., Diaz, R., Ortiz, D., Abraham, T., & Nicolaysen, A. M. (2006). Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Social science & medicine, 63(8), 2010-2021.
  2. Gonz谩lez鈥怗uarda, R. M., Florom鈥怱mith, A. L., & Thomas, T. (2011a). A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics. Public health nursing, 28(4), 366-378.
  3. Gonzalez-Guarda, R. M., McCabe, B. E., Nagy, G. A., Stafford, A. M., Matos, L., Lu, M., ... & Cervantes, R. C. (2023). Acculturative stress, resilience, and a syndemic factor among Latinx immigrants. Nursing research, 72(4), 249-258.
  4. Tolstokoraya, Y., Gonzalez-Guarda, R., & Stafford, A. M. (2025). Acculturative Stress, Resiliency Factors, and Depressive Symptoms in Latino/a/e Emerging Adult Immigrants: Differences by College Attendance Status. Hispanic health care international : the official journal of the National Association of Hispanic Nurses, 15404153251383130. Advance online publication.
  5. Gonzalez-Guarda, R. M., Pan, W., Buzelli, P., Mack, B., McCabe, B. E., Stafford, A., ... & Walker, J. K. L. (2024). Trajectories of physiological stress markers over time among Latinx immigrants in the United States: Influences of acculturative stressors and psychosocial resilience. Social Science & Medicine, 362, 117429.
  6. Zhan, C., Nagy, G. A., Wu, J. Q., McCabe, B., Stafford, A. M., & Gonzalez-Guarda, R. M. (2022). Acculturation stress, age at immigration, and employment status as predictors of sleep among Latinx immigrants. Journal of immigrant and minority health, 24(6), 1408-1420.
  7. Gonzalez-Guarda, R. M., Stafford, A. M., Nagy, G. A., Befus, D. R., & Conklin, J. L. (2021). A systematic review of physical health consequences and acculturation stress among Latinx individuals in the United States. Biological Research for Nursing, 23(3), 362-374.
  8. De Santis, J. P., Gonzalez-Guarda, R., Provencio-Vasquez, E., & Deleon, D. A. (2014). The Tangled Branches (Las Ramas Enredadas) Sexual Risk, Substance Abuse, and Intimate Partner Violence Among Hispanic Men Who Have Sex With Men. Journal of Transcultural Nursing, 25(1), 23-32.
  9. Gonzalez-Guarda, R. M., Vasquez, E. P., Urrutia, M. T., Villarruel, A. M., & Peragallo, N. (2011b). Hispanic women鈥檚 experiences with substance abuse, intimate partner violence, and risk for HIV. Journal of Transcultural Nursing, 22(1), 46-54.
  10. Gonzalez-Guarda, R. M., Ortega, J., Vasquez, E. P., & De Santis, J. (2010). La mancha negra: Substance abuse, violence, and sexual risks among Hispanic males. Western Journal of Nursing Research, 32(1), 128-148.
  11. Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity & disease, 207-221.

Nuestro enfoque

Syndemic Approach Graphic

Adoptamos un enfoque sind茅mico en nuestro trabajo, lo que significa que analizamos c贸mo m煤ltiples problemas de salud 鈥攃omo la violencia, el consumo de sustancias, el VIH y la salud mental鈥 se presentan de forma conjunta en las comunidades latinas de Estados Unidos. Estos problemas no existen de forma aislada. Se desarrollan con el tiempo, a lo largo de generaciones, y est谩n influenciados por la experiencia de adaptarse a la vida en un nuevo pa铆s (aculturaci贸n).鹿

A diferencia de los enfoques tradicionales de salud p煤blica que se centran en un solo problema a la vez, una perspectiva sind茅mica nos ayuda a comprender las causas subyacentes y compartidas de estos problemas. Tambi茅n nos gu铆a en la creaci贸n de programas y pol铆ticas que aborden estas causas fundamentales.虏

Esta sindemia 鈥攙iolencia, consumo de sustancias, VIH y salud mental鈥 est谩 impulsada por factores estresantes a largo plazo. Estos incluyen el estr茅s aculturativo, que es la presi贸n de adaptarse a una nueva cultura, y desaf铆os estructurales como lidiar con escuelas poco acogedoras o acceder a atenci贸n m茅dica de dif铆cil acceso.虏 鲁 Estos mismos factores sociales tambi茅n aumentan el riesgo de otros problemas de salud, como el estr茅s cr贸nico y las enfermedades f铆sicas.鈦碘伝鈦

Representamos esta sindemia visualmente como las ramas de un 谩rbol, inspirados en c贸mo los miembros de la comunidad describen estos problemas.鈦封伝鹿鈦 Los vientos en nuestra imagen simbolizan el estr茅s aculturativo, una fuerza ambiental que influye en la salud de las comunidades latinas en Estados Unidos. Esta idea se relaciona con la teor铆a del desgaste, que explica c贸mo la exposici贸n constante al estr茅s debilita el cuerpo con el tiempo.鹿鹿

Sin embargo, a pesar de estos desaf铆os, los inmigrantes latinos contin煤an prosperando. Como un 谩rbol que se fortalece con la tormenta, nuestras comunidades profundizan sus ra铆ces. El equipo de SER Familia se basa en esta resiliencia fortaleciendo lo que ya hace fuertes a las familias latinas: el apoyo familiar y social, las habilidades de afrontamiento, el orgullo cultural y la esperanza en el sue帽o americano. A este enfoque lo llamamos estrategias sind茅micas centradas en las ra铆ces.

  1. Singer, M. C., Erickson, P. I., Badiane, L., Diaz, R., Ortiz, D., Abraham, T., & Nicolaysen, A. M. (2006). Syndemics, sex and the city: understanding sexually transmitted diseases in social and cultural context. Social science & medicine, 63(8), 2010-2021.
  2. Gonz谩lez鈥怗uarda, R. M., Florom鈥怱mith, A. L., & Thomas, T. (2011a). A syndemic model of substance abuse, intimate partner violence, HIV infection, and mental health among Hispanics. Public health nursing, 28(4), 366-378.
  3. Gonzalez-Guarda, R. M., McCabe, B. E., Nagy, G. A., Stafford, A. M., Matos, L., Lu, M., ... & Cervantes, R. C. (2023). Acculturative stress, resilience, and a syndemic factor among Latinx immigrants. Nursing research, 72(4), 249-258.
  4. Tolstokoraya, Y., Gonzalez-Guarda, R., & Stafford, A. M. (2025). Acculturative Stress, Resiliency Factors, and Depressive Symptoms in Latino/a/e Emerging Adult Immigrants: Differences by College Attendance Status. Hispanic health care international : the official journal of the National Association of Hispanic Nurses, 15404153251383130. Advance online publication.
  5. Gonzalez-Guarda, R. M., Pan, W., Buzelli, P., Mack, B., McCabe, B. E., Stafford, A., ... & Walker, J. K. L. (2024). Trajectories of physiological stress markers over time among Latinx immigrants in the United States: Influences of acculturative stressors and psychosocial resilience. Social Science & Medicine, 362, 117429.
  6. Zhan, C., Nagy, G. A., Wu, J. Q., McCabe, B., Stafford, A. M., & Gonzalez-Guarda, R. M. (2022). Acculturation stress, age at immigration, and employment status as predictors of sleep among Latinx immigrants. Journal of immigrant and minority health, 24(6), 1408-1420.
  7. Gonzalez-Guarda, R. M., Stafford, A. M., Nagy, G. A., Befus, D. R., & Conklin, J. L. (2021). A systematic review of physical health consequences and acculturation stress among Latinx individuals in the United States. Biological Research for Nursing, 23(3), 362-374.
  8. De Santis, J. P., Gonzalez-Guarda, R., Provencio-Vasquez, E., & Deleon, D. A. (2014). The Tangled Branches (Las Ramas Enredadas) Sexual Risk, Substance Abuse, and Intimate Partner Violence Among Hispanic Men Who Have Sex With Men. Journal of Transcultural Nursing, 25(1), 23-32.
  9. Gonzalez-Guarda, R. M., Vasquez, E. P., Urrutia, M. T., Villarruel, A. M., & Peragallo, N. (2011b). Hispanic women鈥檚 experiences with substance abuse, intimate partner violence, and risk for HIV. Journal of Transcultural Nursing, 22(1), 46-54.
  10. Gonzalez-Guarda, R. M., Ortega, J., Vasquez, E. P., & De Santis, J. (2010). La mancha negra: Substance abuse, violence, and sexual risks among Hispanic males. Western Journal of Nursing Research, 32(1), 128-148.
  11. Geronimus, A. T. (1992). The weathering hypothesis and the health of African-American women and infants: evidence and speculations. Ethnicity & disease, 207-221.
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