Sexual risk profiles of delinquent and homeless youths

Birth Control Access and Selection among Youths Experiencing Homelessness in the United States: A Review

Youths experiencing homelessness (YEH) become pregnant at five times the general population rate. Education, social, and health care systems struggle to adequately address this young community's sexual and reproductive health needs, yet social workers are well positioned across sectors to address their sexual and reproductive health and well-being. A growing body of literature exists on the factors affecting YEH's access and selection of birth control, prompting the present review that aimed to understand this process and inform better attuned sexual and reproductive health approaches. Using a systematic search and analytic approach, we retrieved 203 articles, of which 23 met inclusion criteria. Key findings emerged across socioecological levels, including barriers and facilitators to condom use; the differential impact on YEH of hormonal birth control side effects; and the devastating effects of economic insecurity leading to sexual exploitation, survival sex, and exposure to violence. Implications include the need for multilevel intervention that addresses youths' knowledge, attitudes, and behavior as well the need to improve social norms and system design to provide better attuned care for YEH.

The Relationship between Survival Sex and Borderline Personality Disorder Symptoms in a High Risk Female Population

Engaging in survival sex and mental illness are overrepresented within homeless populations. This article assesses the relationship between symptoms of borderline personality disorder (BPD) and engaging in survival sex among homeless women. One hundred and fifty-eight homeless women completed surveys on self-reported BPD symptomology and sexual history. Bivariate and multivariate analyses conducted in this study provided insights into the association of experiencing BPD symptoms and engaging in survival sex. Results indicate that some symptoms of BPD are robustly correlated with engaging in survival sex among homeless adult women. Implications for service agencies and others working with at-risk female populations are discussed.

The Least of These

Each year 200,000 youth under the age of 18 are waived to adult criminal court, and African American males are disproportionately overrepresented among youth detained in adult jails. This population of vulnerable youth may be at greater risk for early violent death and HIV infection than youth detained in juvenile settings. The purpose of this study was to examine the social context of HIV risk behavior, substance misuse, and violence among youth offenders detained in adult jail using Elijah Anderson’s Code of the Street as a conceptual framework. Focus groups were conducted with 15 African American male youth (aged 15-17 years) detained at a city jail. Content analysis revealed several themes related to violence and HIV risk, including (1) HIV literacy and condom use, (2) substance use and sex, and (3) violence and the code of the street. These rich, descriptive narratives suggest that youth offenders exposed to chronic violence also engage in HIV risk–related behaviors. Findings may also aid in the development of age- and culturally appropriate interventions for this population while they are detained.

The Association Between Same-Sex Romantic Attractions and Relationships and Running Away Among a Nationally Representative Sample of Adolescents

Sexual minorities are overrepresented among the runaway population, and sexual minority runaways are at greater risk for adverse health outcomes than their heterosexual peers. Our knowledge of this vulnerable population has been restricted by methodological limitations of existing studies. This study used a nationally representative sample of U.S. adolescents to explore the association between same-sex romantic attractions and relationships and run away behavior over a two year period. Results indicated that although the association between sexual orientation and running away appears to be partially attenuated by other risk factors for running away, there remains a significant positive association between same-sex romantic attractions and running away. Furthermore, youth with no romantic or sexual relationships were significantly less likely to report running away compared to youth with only opposite-sex relationships. These associations remained significant even after controlling for other risk factors.

Correlates of engaging in survival sex among homeless youth and young adults

Using a sample of 1,625 homeless youth and young adults aged 10 to 25 from 28 different states in the United States, this study examines the correlates of having engaged in survival sex. Findings suggest that differences exist based on demographic variables (gender, age, race, and sexual orientation), lifetime drug use (inhalants, Valium™, crack cocaine, alcohol, Coricidin™, and morphine), recent drug use (alcohol, ecstasy, heroin, and methamphetamine), mental health variables (suicide attempts, familial history of substance use, and having been in substance abuse treatment), and health variables (sharing needles and having been tested for HIV). In addition to replicating previous findings, this study's findings suggest that African American youth; gay, lesbian, or bisexual youth; and youth who had been tested for HIV were significantly more likely to have engaged in survival sex than White, heterosexual youth, and youth who had not been tested for HIV, respectively. Implications for interventions with youth and suggestions for future research are discussed.

Trajectories of risk behaviors and exiting homelessness among newly homeless adolescents

Using cluster analysis techniques, we identified two distinct clusters of newly homeless adolescents in Los Angeles (n = 261): those who are protected and doing relatively well while out of home with more protective than risk factors, and those who are risky with more risk than protective factors. The objective of this study was to examine the trajectories of human immunodeficiency virus (HIV) risk behaviors and exiting homelessness among protected newly homeless adolescents, compared to those who are classified as risky. HIV risk behavior included unprotected sex, having multiple sex partners and hard drug use. Logistic regression mixed-effects models were used to evaluate the trajectories of HIV risk behaviors and exiting homelessness over time. The adolescents in the protected group reported significantly less unprotected sex ( p = 0.0156), being abstinent or monogamous ( p < 0.0001) and less hard drug use ( p < 0.0001) compared to the adolescents in the risky group. In addition, the protected group reported more "exiting homelessness", compared to the risky group ( p = 0.0007). However, the differences in the level of unprotected sex between the protected and risky groups decreased over time. Our findings confirm the notion that newly homeless adolescents are indeed heterogeneous. Given that the risk behavior profiles of protected group merges to the risky group over time, our findings underscore the need to mount tailored interventions to be designed for the protected group early in the process.

Social network characteristics and risky sexual and drug related behaviors among homeless young adults

Although research finds high rates of risky sexual and drug related behavior among homeless young people, little research had examined how the characteristics of their social networks encourage or constrain risky behaviors. Based on a sample of 145 homeless young adults in the Midwestern United States, results revealed that having used alcohol with at least one of their network members and the presence of more conflict was associated with engaging in a greater number of sexual risk taking behaviors. Correlates of engaging in a greater number of substance use related behaviors included having older peers within the network, having used illicit drugs with at least one network member, and the presence of more conflict. The presence of a family member in one's network, however, was associated with fewer sexual and drug related risk behaviors. Overall, the social network characteristics of youth explained significant, additional variance beyond that of youth's own characteristics and their early family histories.

Sexual health of homeless youth: prevalence and correlates of sexually transmissible infections

BACKGROUND

The study examined risk factors for having ever contracted sexually transmissible infections (STI) among a high-risk sample in midwestern USA.

METHODS

A cross sectional survey was conducted among 428 homeless youth aged 16-19 years. Assessed correlates included child maltreatment, street exposure, sexual histories, street experiences and substance use.

RESULTS

Multivariate analyses revealed that males were 86% less likely to have had STI compared with females (adjusted odds ratio [AOR] = 0.14; 95% confidence interval [CI] = 0.06-0.31). Blacks were almost four times more likely (AOR = 3.71; 95% CI = 1.80-7.63) and other races were over two times more likely (AOR = 2.25; 95% CI = 1.08-4.67) to have had STI compared with whites. For every one unit increase in the number of times youth ran away, there was a 3% increase in the likelihood of ever having had an STI (AOR = 1.03; 95% CI = 1.01-1.06). For every one unit increase in frequency of condom use there was a 61% decrease in the likelihood of an STI (AOR = 1.39; 95% CI = 1.10-1.76). Finally, youth who traded sex were approximately 2.5 times more likely to have had STI compared with youth who did not trade sex (AOR = 2.36; 95% CI = 1.04-5.34). None of the remaining correlates approached multivariate significance.

CONCLUSIONS

The amount of time youth spend on the street, their sexual practices, and their subsistence strategies are important correlates of STI and females and non-whites are particularly vulnerable among this high-risk population.

Predictors of sexually transmitted infection testing among sexually active homeless youth

We examined the association between sexual risk behaviors and sexually transmitted infection (STI) testing in a sample of homeless youth. Of 261 youth interviewed, 50% had been sexually active in the past 3 months. Gender variation in sexual behaviors and risk were found. Boys were more likely than girls to engage in anal sex (46% vs. 15%), to have 3 or more sexual partners (46% vs. 17%) and to engage in anonymous sex (38% vs. 21%). Girls were less likely to use condoms consistently and more likely to engage in sex with a partner suspected of having an STI (20% vs. 4%). In the past 3 months, the STI testing rates were similar for boys and girls (46%). However, girls were more likely to have positive STI results (46% vs. 9%). In a multivariate logistic regression analysis, the only variable that was an independent predictor of STI testing was having either gotten someone or having become pregnant in the past 3 months. High-risk sexual behaviors did not predict STI testing in our sample. Outreach programs are needed that target sexually active homeless youth for early STI testing and treatment.

Prevalence and correlates of survival sex among runaway and homeless youth

OBJECTIVE

This study examined the prevalence and correlates of survival sex among runaway and homeless youths.

METHODS

A nationally representative sample of shelter youths and a multicity sample of street youths were interviewed.

RESULTS

Approximately 28% of street youths and 10% of shelter youths reported having participated in survival sex, which was associated with age, days away from home, victimization, criminal behaviors, substance use, suicide attempts, sexually transmitted disease, and pregnancy.

CONCLUSIONS

Intensive and ongoing services are needed to provide resources and residential assistance to enable runaway and homeless youths to avoid survival sex, which is associated with many problem behaviors.

Amateur tattooing practices and beliefs among high school adolescents

PURPOSE

The objective of this research was to investigate the reasons, experiences, methods, and perceived health consequences of obtaining tattoos among a sample of Western Australian high school adolescents.

METHODS

Information pertaining to levels of health awareness and school social behavior were obtained. Data were gathered in two phases using a questionnaire and follow-up interviews.

RESULTS

Findings revealed that over 13% of participants had acquired tattoos and that the majority had been self-administered with crude implements. Some participants identified possible methods of removal, with a small number having attempted removal, again using crude implements.

CONCLUSIONS

Statistical analyses revealed a number of significant main effects for gender, age, and tattoo status on the dependent variables for health awareness and school social behavior.