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Baiden P, LaBrenz CA, Broni MN, Baiden JF, Adepoju OE. Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study. Psychiatry Res 2024; 334:115823. [PMID: 38430817 DOI: 10.1016/j.psychres.2024.115823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States.
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States
| | - Marisa N Broni
- University of Ghana, School of Public Health, P. O. Box LG 25, Legon, Accra, Ghana
| | - John F Baiden
- East Airport International School, P. O. Box KAPM 57, KIA, Accra, Ghana
| | - Omolola E Adepoju
- University of Houston, Tilman J. Fertitta Family College of Medicine, 5055 Medical Circle, Houston, TX 77204, United States
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2
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Storholm ED, Klein DJ, Pedersen ER, D'Amico EJ, Rodriguez A, Garvey R, Tucker JS. Sociodemographic and Behavioral Risk Correlates of PrEP Interest and Use Among Young Adults Experiencing Homelessness in Los Angeles. AIDS Behav 2024; 28:1216-1226. [PMID: 37698638 PMCID: PMC10927607 DOI: 10.1007/s10461-023-04144-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/19/2023] [Indexed: 09/13/2023]
Abstract
Young adults experiencing homelessness (YAEH) are at elevated risk for HIV compared to their stably housed peers. Preexposure prophylaxis (PrEP) is highly effective at preventing HIV infection, yet YAEH have been largely overlooked in PrEP efforts to date despite YAEH reporting high overall interest in PrEP. We assessed individual, social, and structural variables associated with PrEP interest and use among a sample of 195 YAEH (ages 18-25) recruited from drop-in centers across Los Angeles County who met criteria for HIV risk. In the current sample, though most had heard of PrEP (81.0%), the majority were not interested in taking PrEP (68.2%) and only a minority had used/were using PrEP (11.8%). YAEH who identified as sexual and/or gender minority, reported knowing someone who had used PrEP, or recently accessed sexual health services were more likely to have used and/or reported interest in using PrEP. Those who reported more episodes of heavy drinking were less likely to report having used PrEP. Suggestions are provided for better integrating PrEP-related services into existing behavioral and health service programs for YAEH, as well as leveraging peers and fostering positive social norms to reduce PrEP-related stigma and increase interest and use of PrEP among YAEH.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, United States of America.
- RAND Corporation, Santa Monica, CA, United States of America.
| | - David J Klein
- RAND Corporation, Santa Monica, CA, United States of America
| | - Eric R Pedersen
- Department of Psychiatry, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States of America
| | | | | | - Rick Garvey
- RAND Corporation, Santa Monica, CA, United States of America
| | - Joan S Tucker
- RAND Corporation, Santa Monica, CA, United States of America
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3
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Adedze M, Osei-Yeboah R, Morhe ESK, Ngambouk VP. Exploring Sexual and Reproductive Health Needs and Associated Barriers of Homeless Young Adults in Urban Ghana: A Qualitative Study. SEXUALITY RESEARCH & SOCIAL POLICY : JOURNAL OF NSRC : SR & SP 2022; 19:1006-1019. [PMID: 35602180 PMCID: PMC9103610 DOI: 10.1007/s13178-022-00724-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Homelessness has become a major global and public health challenge, especially in low- and middle-income countries. This phenomenon predisposes young adults to severe psychosocial and health challenges. AIM To explore the sexual and reproductive health needs and behaviours of homeless young adults and challenges in accessing these services. METHODS A semi-structured interview guide was used for data collection from in-depth interviews, focus group discussions, and key informant interviews. Data were collected between 01 June and 31 July 2020 from 30 participants using in-depth interviews, two focus group discussions involving 12 participants, and one key informant interview. Thematic analysis was used to analyse transcripts from the interviews. RESULTS The findings show that certain behavioural patterns associated with homelessness impact the lives of homeless young adults in their sexual and reproductive health (SRH) choices, beliefs, and perspectives. This group faces several challenges in accessing sexual and reproductive health services (SRHS) such as modern contraceptives and abortion care. The high cost, and undesirable and unfriendly attitude of service providers in health facilities pose as barriers to accessing SRHS by homeless young adults. CONCLUSION Sustainable and proactive measures must be put in place to address the identified barriers. Timely delivery of accurate information and educative materials, ensuring affordability, and setting up of accessible and friendly facilities could improve SRHS for this group. SOCIAL AND PUBLIC POLICY IMPLICATIONS This study may inform and support policy guideline development to address homelessness and SRH needs of young adults in urban Ghana.
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Affiliation(s)
- Miranda Adedze
- Department of Global Health, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Richard Osei-Yeboah
- Division of Computational Biology, Integrative Biomedical Sciences Department, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Emmanuel Senanu Komla Morhe
- Department of Obstetrics and Gynaecology, School of Medicine, University of Health and Allied Sciences, Ho, Volta Region Ghana
| | - Vitalis Pemunta Ngambouk
- Section of Epidemiology and Social Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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4
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Abstract
Condoms are a valuable tool in combating the continued spread of sexually transmitted infections (STIs). Despite the fact that condoms are effective and easily accessible, young adults report inconsistent condom use and young adults represent a disproportionately large amount of new STI cases annually. The Behavioural Immune System theory suggests that health behaviours, such as condom use, are impacted by cognitive activation of perceived threat of disease. The advent of the COVID-19 pandemic may then have unforeseen impacts on condom use and the spread of STIs. The present study investigated changes in condom use during the pandemic, and any associations these changes may have had with perceived vulnerability to COVID-19. An Australian sample of 269 students completed a survey asking them to recall their condom use prior to COVID-19, and then their current condom use. Final analyses included a sample of 149 sexually active heterosexual participants. Results revealed a general decline in condom use. Single and coupled participants both reported less frequent condom use, but this decrease was more pronounced among single people. Gender did not moderate these effects. Surprisingly, diminished condom use was not significantly related to perceived threat of COVID-19. Findings of the present study have concerning implications for sexual health and sexual messaging during pandemics.
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5
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Green B, Lee Kim F, Dean D. Substance Use and Treatment Among Youth Experiencing Homelessness: 1992-2017. J Adolesc Health 2020; 67:786-792. [PMID: 32665070 DOI: 10.1016/j.jadohealth.2020.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/20/2020] [Accepted: 04/20/2020] [Indexed: 10/23/2022]
Abstract
PURPOSE This study aimed to describe the patterns in substance use and treatment utilization from admissions to publicly funded treatment programs among youth (aged 12-24 years) experiencing homelessness between the years of 1992 and 2017. METHODS We used the concatenated Substance Abuse and Mental Health Services Administration Treatment Episode Data Set Admissions (total youth admissions, n = 5,153,775; and youth reported being homeless at the time of admission, n = 241,310). Prevalence estimates and binary logistic regression models were used to estimate the odds ratios to identify the differences among youth who reported being homeless or housed at the time of the treatment. RESULTS Homeless youth had higher odds than housed youth to self-refer for treatment; to enroll in treatment for cocaine/crack, heroin, or methamphetamine; and to receive treatment in 24-hour detoxication facilities or long-term residential facilities. Additional differences were identified among youth aged 12-17 years and youth aged 18-24 years and by sex within the homeless youth population. CONCLUSIONS This analysis provides a picture of treatment utilization patterns by youth who are experiencing homelessness and substance use disorder, by exploring differences by housing status among admissions to publicly funded treatment facilities.
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Affiliation(s)
| | | | - David Dean
- Behavioral Health Research and Policy, IBM Watson Health, Bethesda, Maryland
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Tucker JS, D'Amico EJ, Pedersen ER, Rodriguez A, Garvey R. Study protocol for a group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among young adults experiencing homelessness. Addict Sci Clin Pract 2020; 15:26. [PMID: 32723349 PMCID: PMC7390162 DOI: 10.1186/s13722-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/17/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. METHODS/DESIGN In a cluster-cross-over randomized controlled trial, 18-25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. DISCUSSION This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered).
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.,Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, United States
| | - Rick Garvey
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
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7
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Pirani E, Matera C. Who is at risk? Gendered psychological correlates in Italian students’ sexual risk profiles. GENUS 2020. [DOI: 10.1186/s41118-020-00080-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
AbstractRecent research has shown that sexual risk behaviours are rising substantially among Italian youth, but this evidence is still undervalued in public discussion. Adopting a multidimensional perspective for sexual risk and addressing gender differences, the present study investigates if and how some individuals’ psychological characteristics—namely body satisfaction, self-esteem and body sensation-seeking—are associated with unsafe and risky sexual behaviours of Italian emerging adults. We exploited the survey SELFY—Sexual and Emotional LiFe of Youths—conducted in 2017 in Italy. Several key points may be highlighted from our study. First, we identify two clusters characterized by high sexual risk-taking behaviours, which include one third of our sample, a non-negligible proportion. Second, we prove that women are generally less inclined to adopt risk-taking behaviours in sexual life. Third, our findings show that body satisfaction, self-esteem and sensation seeking are differently linked to sexual risk taking among women and men. Body satisfaction is associated with a higher probability of adopting risky and promiscuous sexual behaviours among men, while the relationship is not significant among women. Sensation seeking shows a certain relevance in defining sexual risk profiles, especially for men. Overall, our research suggests that body image and self-worth could be relevant areas of intervention for sexual health programs targeting emerging Italian adults. Notably, communication and education strategies on these issues should be differentiated for women and men.
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Moon SH, Kim HR, Kim M. Predictors for Sexual Intercourse Experience among Runaway Female At-Risk Adolescents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17113913. [PMID: 32492833 PMCID: PMC7311989 DOI: 10.3390/ijerph17113913] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/28/2020] [Accepted: 05/28/2020] [Indexed: 11/16/2022]
Abstract
This study attempted to provide basic data for creating a program to help promote safe sexual behavior among runaway female at-risk adolescents by identifying factors related to the sexual experiences. This study conducted a logistic regression analysis using data regarding 182 female at-risk adolescents, which were sourced from the 2016 survey of Korean adolescents’ contact with media usage and harmful environment. This study showed that adolescents’ age, smoking, and harmful environments are associated with the occurrence of sexual activity among at-risk female adolescents. One significant outcome of this study was the identification of harmful environmental factors and their impact on sexual behavior. Since smoking and sex-related problems among adolescents can act as risk factors for adult sexual health in the future, schools should institute direct and indirect channels for assessing sex-related problems among runaway female at-risk adolescents and establishing proactive and preventive measures for promoting their sexual health. In addition, a social cooperation system should be established in order to assess, and mediate within, the environments around schools in order to minimize adolescents’ exposure to harmful environments.
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Affiliation(s)
- So-Hyun Moon
- Department of Nursing, College of Medicine, Chosun University, Gwangju 61452, Korea;
| | - Hyung-Ran Kim
- Department of Pediatrics, Kwangju Christian Hospital, Gwangju 61661, Korea;
| | - Miok Kim
- Department of Nursing, College of Nursing, Dankook University, Cheonan 31116, Korea
- Correspondence: ; Tel.: +82-41-550-3888
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9
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Kamke K, Widman L, Haskett ME. Safer Sex Communication and Sexual Health Behaviors Among a Representative Statewide Sample of Homeless Adolescents. JOURNAL OF SEX RESEARCH 2020; 57:137-144. [PMID: 30810384 DOI: 10.1080/00224499.2019.1577945] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Homeless adolescents are at substantial risk of human immunodeficiency virus (HIV), other sexually transmitted infections (STIs), and unplanned pregnancy; however, little research has assessed factors, such as safer sex communication, that may protect homeless adolescents against these negative outcomes. Using the 2015 North Carolina Youth Risk Behavior Survey (YRBS; unweighted N = 5,486; ages 12 to 18; 5% homeless), we compared homeless adolescents' primary safer sex communication sources (i.e., health care providers, parents, teachers, peers, religious leaders) to housed adolescents' communication sources and assessed how these sources relate to sexual health behaviors, including condom use, HIV testing, and number of sexual partners. Most homeless adolescents (61%), and 46% of housed adolescents reported having questions about sex. Further, twice as many homeless adolescents communicated primarily with health care providers compared to housed adolescents. Importantly, among homeless adolescents, communicating primarily with health care providers or teachers was related to greater likelihood of condom use and communicating primarily with religious leaders was related to greater likelihood of HIV testing. Parent communication was unrelated to homeless adolescents' sexual health behaviors. Last, communicating primarily with peers was associated with reduced likelihood of HIV testing. Having nonparental adult communication sources, including health care providers, teachers, and religious leaders, may be critical for encouraging safer sex behaviors among homeless adolescents.
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Affiliation(s)
- Kristyn Kamke
- Department of Psychology, North Carolina State University
| | - Laura Widman
- Department of Psychology, North Carolina State University
| | - Mary E Haskett
- Department of Psychology, North Carolina State University
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10
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Knowles A, Rinehart JK, Steinberg L, Frick PJ, Cauffman E. Risky Sexual Behavior among Arrested Adolescent Males: The Role of Future Expectations and Impulse Control. JOURNAL OF RESEARCH ON ADOLESCENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR RESEARCH ON ADOLESCENCE 2020; 30 Suppl 2:562-579. [PMID: 30983069 DOI: 10.1111/jora.12499] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The current study evaluates two predictors of adolescent sexual risk-taking, specifically whether impulse control or future expectations predict condom use and casual sex. We examine whether risky sex occurs among youth who tend to act without thinking about the future, or instead, youth who report low future expectations. We consider these relations longitudinally among a sample of sexually active justice-involved adolescent males (N = 752, M age = 15.58) a group at heightened risk for sexual risk-taking. We found that optimistic expectations for the future predict a higher likelihood of engaging in consistent condom use, whereas high impulse control is related to a lower likelihood of casual sex. Implications for intervention and research on positive sexual health are discussed.
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Affiliation(s)
| | | | | | - Paul J Frick
- Louisiana State University System
- Australian Catholic University
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11
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Santa Maria D, Daundasekara SS, Hernandez DC, Zhang W, Narendorf SC. Sexual risk classes among youth experiencing homelessness: Relation to childhood adversities, current mental symptoms, substance use, and HIV testing. PLoS One 2020; 15:e0227331. [PMID: 31899781 PMCID: PMC6941897 DOI: 10.1371/journal.pone.0227331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/17/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to determine whether there are meaningful subgroups with different types of sexual risk behaviors among youth experiencing homelessness and examine the associations between potential classes and other risk variables. A latent class analysis was used to identify classes of youth according to sexual risk behaviors and sexual assault. A two-class solution was found to be the best fit for the data-Lower and Higher Risk groups. The Higher Risk class had significantly higher levels of synthetic marijuana and alcohol use, mental health diagnoses, and were more likely to have been tested for HIV than the Lower Risk group. Youth were more likely to be in the Higher Risk group if they were cisgender female or lesbian, gay, bisexual, or questioning (LGBQ). Nearly all youth (10/11) who reported having HIV infection were in the Higher Risk group. The Lower Risk group were sexually active but had lower rates of risk behaviors and sexual assault. Youth who were not sexually active had the lowest rates of marijuana and alcohol use as well as HIV testing. Health and social service providers should be aware of the added risks for stress, mental distress, mental health diagnoses, and substance use among youth who also report higher risk sexual behaviors and treat as needed.
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Affiliation(s)
- Diane Santa Maria
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Saumali S. Daundasekara
- Department of Health and Human Performance, University of Houston, Houston, TX, United States of America
| | - Daphne C. Hernandez
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Wei Zhang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Sarah C. Narendorf
- University of Houston, Graduate College of Social Work, Houston, TX, United States of America
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12
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Craddock JB, Barman-Adhikari A, Combs KM, Fulginiti A, Rice E. Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness. AIDS Behav 2020; 24:222-232. [PMID: 31471815 PMCID: PMC6954958 DOI: 10.1007/s10461-019-02646-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.
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Affiliation(s)
- Jaih B Craddock
- University of Maryland School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA.
| | | | | | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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13
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Gauvin G, Labelle R, Daigle M, Breton JJ, Houle J. Coping, Social Support, and Suicide Attempts Among Homeless Adolescents. CRISIS 2019; 40:390-399. [DOI: 10.1027/0227-5910/a000579] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Abstract. Background: Homeless youth are a population at risk for suicidal behavior. Despite growing knowledge about risk factors, protective factors against suicidal behavior among this population are still poorly understood. Aims: To explore differences in coping and social support between homeless adolescents who attempted suicide and those who did not. Method: In total, 76 homeless adolescents from eight different shelters provided information about their suicidal behaviors over the previous year and filled out coping and social support questionnaires. Results: Homeless adolescents who had not attempted suicide perceived more social support (tangible assistance and guidance). Conversely, youth who had attempted suicide reported using more nonproductive strategies of coping (tension reduction, keep to self, and self-blame). Tangible assistance and tension reduction were found to be the strongest predictors. Limitations: As most of these youth were not homeless for a long time, care should be taken in generalizing these results to adolescents with longer histories of homelessness. Conclusion: Productive coping does not seem to constitute a sufficient personal resource to protect homeless adolescents from suicide attempts. Nonproductive coping could, however, be considered a serious risk factor. Consequently, promoting homeless youths' ability to find environmental resources, especially tangible assistance, could be the most valuable approach.
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Affiliation(s)
- Geoffrey Gauvin
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Québec, Canada
| | - Réal Labelle
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Québec, Canada
- Department of Psychiatry, Université de Montréal, Québec, Canada
- Research Centre, Institut universitaire en santé mentale de Montréal, Québec, Canada
| | - Marc Daigle
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Québec, Canada
| | | | - Janie Houle
- Department of Psychology, Université du Québec à Montréal, Québec, Canada
- Centre for Research and Intervention on Suicide, Ethical Issues and End-of-Life Practices, Université du Québec à Montréal, Québec, Canada
- Research Centre, Institut universitaire en santé mentale de Montréal, Québec, Canada
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14
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Goodin A, Elswick A, Fallin-Bennett A. Mental health disparities and high-risk alcohol use among non-heterosexual high school students. Perspect Psychiatr Care 2019; 55:570-575. [PMID: 31066062 DOI: 10.1111/ppc.12394] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 04/14/2019] [Accepted: 04/21/2019] [Indexed: 11/27/2022] Open
Abstract
PURPOSE To examine disparities in mental health and high-risk alcohol use among high school students by sexual orientation, and the impact of having access to an adult with whom to talk. DESIGN AND METHODS Cross-sectional survey, from the 2015 Kentucky Youth Risk Behavior Survey. Logistic regression estimated the relationship between being "non-heterosexual" on mental health (e.g, suicidal ideation/attempt) and alcohol behaviors (e.g, binge drinking), controlling for demographics and "having an adult to talk to." FINDINGS Non-heterosexual students were more likely to report all adverse outcomes and risk was lower among students who report "having an adult to talk to." PRACTICE IMPLICATIONS Psychiatric nurses need to assess sexual minority youth for access to positive adult relationships.
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Affiliation(s)
- Amie Goodin
- Department of Pharmaceutical Outcomes and Policy, University of Florida College of Pharmacy, Gainesville, Florida
| | - Alex Elswick
- Department of Family Science, University of Kentucky, Lexington, Kentucky
| | - Amanda Fallin-Bennett
- University of Kentucky College of Nursing, University of Kentucky, Lexington, Kentucky
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15
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Begun S, Combs KM, Torrie M, Bender K. "It seems kinda like a different language to us": Homeless youths' attitudes and experiences pertaining to condoms and contraceptives. SOCIAL WORK IN HEALTH CARE 2019; 58:237-257. [PMID: 30407128 DOI: 10.1080/00981389.2018.1544961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 06/08/2023]
Abstract
Homeless youth become pregnant or involved in pregnancies at high rates. There are many ways by which unintended pregnancies may be prevented, including the use of condoms and other contraceptives. However, there is a dearth of research regarding contraceptive use among this vulnerable youth population, and especially through lenses that consider homeless youths' diverse gender identities, expressions, and sexualities. This study qualitatively explores homeless youths' attitudes and experiences regarding condom and other contraceptive use. Data were obtained from interviews with 30 youth experiencing homelessness, ages 18-21. Youth reported inconsistent use of condoms and other contraceptives, which youth often attributed to their perceptions of contraceptive inaccessibility and exorbitant cost. Most youth also did not know where to obtain contraceptive information and services, and reported transportation barriers and fear of being stigmatized in health care settings, particularly in relation to their gender identities and sexualities. Findings suggest that reproductive and sexual health information and services are urgently needed by all homeless young people, and from low-barrier, non-judgmental, and empathetic sources.
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Affiliation(s)
- Stephanie Begun
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Katie Massey Combs
- b Graduate School of Social Work , University of Denver , Denver , CO USA
| | - Michaela Torrie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kimberly Bender
- b Graduate School of Social Work , University of Denver , Denver , CO USA
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Milburn NG, Stein JA, Lopez SA, Hilberg AM, Veprinsky A, Arnold EM, Desmond KA, Branson K, Lee A, Bath E, Amani B, Comulada WS. Trauma, Family Factors and the Mental Health of Homeless Adolescents. JOURNAL OF CHILD & ADOLESCENT TRAUMA 2019; 12:37-47. [PMID: 32318178 PMCID: PMC7163862 DOI: 10.1007/s40653-017-0157-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Family factors, such as poor family functioning and trauma, have been associated with negative outcomes for homeless adolescents. Further study is needed to better understand how family factors and trauma jointly relate to mental health problems and externalizing behaviors among homeless adolescents. Structural equation modeling was used to examine the influence of trauma (encompassing traumatic events experienced prior to, and after, becoming homeless) and family factors (poor family functioning and family conflict) on mental health problems and externalizing behaviors (substance use, delinquent behaviors, and sexual risk) among 201 homeless adolescents, ages 12 to 17 years. Trauma, poor family functioning, and family conflict significantly predicted greater mental health problems, delinquent behaviors, high-risk sexual behaviors and substance use. Overall, the findings suggest that family factors appear to be key to understanding mental health problems and externalizing behaviors among homeless adolescents. Implications, limitations and future directions are addressed.
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Affiliation(s)
- Norweeta G. Milburn
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - Judith A. Stein
- Department of Psychology, University of California at Los Angeles, Los Angeles, CA USA
| | - Susana A. Lopez
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - Amanda M. Hilberg
- Department of Psychiatry and Behavioral Sciences, PGSP-Stanford PsyD Consortium, Palo Alto, CA USA
| | - Anna Veprinsky
- Department of Psychology, Old Dominion University, Norfolk, VA USA
| | - Elizabeth Mayfield Arnold
- Department of Psychiatry and Behavioral Medicine, Wake Forest School of Medicine, Winston-Salem, NC USA
| | - Katherine A. Desmond
- Department of Public Policy, University of California at Los Angeles, Los Angeles, CA USA
| | - Katie Branson
- School of Nursing, University of California at Los Angeles, Los Angeles, CA USA
| | - Alex Lee
- School of Social Work, University of Southern California, Los Angeles, CA USA
| | - Eraka Bath
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
| | - Bita Amani
- College of Science and Health, Charles R. Drew University, Los Angeles, CA USA
| | - W. Scott Comulada
- Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, Los Angeles, CA USA
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Abstract
AbstractHomeless girls suffer labour and sexual exploitation, abuse, discrimination and social exclusion at a higher rate than the rest of the population. However, worldwide information on homeless girls and intervention programmes for this group are scarce. This study examined the preliminary efficacy of a brief cognitive behavioural group therapy tailored to Mexican homeless girls. The intervention targeted subjective well-being and these determinants: symptoms of anxiety, symptoms of depression, assertive behaviours and functional emotion regulation skills. Results revealed statistically significant differences in symptoms of anxiety and depression, assertiveness, emotion regulation strategies and subjective well-being with treatment effects that ranged from moderate to large. Symptoms of anxiety and depression, and dysfunctional emotion regulation strategies decreased. Assertive skills, functional emotion regulation strategies, and subjective well-being increased. Outcomes were clinically relevant. At 2-month follow-up, participants showed improvement from pre-treatment on all measures. The current study provides unique findings in terms of a promising preliminary intervention that helps restore homeless girls to a healthier social/emotional developmental path especially in the context of Latin American cities. As a result, the clinical implications of this research highlight the urgent need to design effective interventions based on the observed characteristics and identified needs among homeless girls.
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But Everyone is Doing It (Sort of)! Perceived Sexual Risks in the Social Environment and the Impact on Homeless Youth Engagement in Concurrent Sexual Relationships. AIDS Behav 2018; 22:3508-3518. [PMID: 29725788 DOI: 10.1007/s10461-018-2133-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Although homeless youth are likely to engage in concurrent sexual relationships and doing so can accelerate HIV transmission, the issue of sexual concurrency (i.e., having sexual partnerships that overlap in time) has received scarce attention in this vulnerable population. The literature that exists tends to focus on individuals' characteristics that may be associated with concurrency and overlooks the influence of their social environment. Informed by the risk amplification and abatement model (RAAM), this study explored the association between pro-social and problematic social network connections, and sexual concurrency among homeless youth using drop-in center services (N = 841). Nearly 37% of youth engaged in concurrency. Partially consistent with the RAAM, regression analyses showed that affiliation with more problematic ties (i.e., having more network members who practice concurrency and unprotected sex) was associated with greater sexual concurrency. Programs addressing HIV risk among homeless youth in drop-in centers should consider the role youths' network composition may play in concurrency.
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Narrative Review: Sexually Transmitted Diseases and Homeless Youth-What Do We Know About Sexually Transmitted Disease Prevalence and Risk? Sex Transm Dis 2018; 44:466-476. [PMID: 28703725 DOI: 10.1097/olq.0000000000000633] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Homelessness affects an estimated 1.6 million US youth annually. Compared with housed youth, homeless youth are more likely to engage in high-risk behaviors, including inconsistent condom use, multiple sex partners, survival sex, and alcohol/drug use, putting them at increased sexually transmitted disease (STD) risk. However, there is no national estimate of STD prevalence among this population. METHODS We identified 10 peer-reviewed articles (9 unique studies) reporting STD prevalence among homeless US youth (2000-2015). Descriptive and qualitative analyses identified STD prevalence ranges and risk factors among youth. RESULTS Eight studies reported specific STD prevalence estimates, mainly chlamydia, gonorrhea, and syphilis. Overall STD prevalence among homeless youth ranged from 6% to 32%. STD rates for girls varied from 16.7% to 46%, and from 9% to 13.1% in boys. Most studies were conducted in the Western United States, with no studies from the Southeast or Northeast. Youths who experienced longer periods of homelessness were more likely to engage in high-risk sexual behaviors. Girls had lower rates of condom use and higher rates of STDs; boys were more likely to engage in anal and anonymous sex. Additionally, peer social networks contributed to protective effects on individual sexual risk behavior. CONCLUSIONS Sexually transmitted disease prevalence estimates among homeless youth fluctuated greatly by study. Sexually transmitted disease risk behaviors are associated with unmet survival needs, length of homelessness, and influence of social networks. To promote sexual health and reduce STD rates, we need better estimates of STD prevalence, more geographic diversity of studies, and interventions addressing the behavioral associations identified in our review.
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Hodder RK, Homer S, Freund M, Bowman JA, Lecathelinais C, Colyvas K, Campbell E, Gillham K, Dray J, Wiggers JH. The association between adolescent condom use and individual and environmental resilience protective factors. Aust N Z J Public Health 2018. [PMID: 29528537 DOI: 10.1111/1753-6405.12744] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Individual and environmental resilience protective factors are suggested to be associated with adolescent condom use; however, previous studies have not comprehensively examined such associations. This study aimed to determine the associations between condom use, and numerous individual and environmental resilience protective factors in sexually active Australian adolescents. METHODS Participants were Grade 10 students attending 28 Australian government high schools (n=1,688). An online survey (2011) collected data regarding: sexual intercourse (past year), condom use and 14 individual and environmental resilience protective factors. Multivariable backward stepwise logistic regression models examined associations between student condom use and protective factors (total, subscale). RESULTS Only total environmental protective factors remained in the final total score model; students with higher total environmental protective factors scores were 2.59 times more likely to always use a condom(95%CI:1.80-3.74). Only three of 14 protective factor subscales were associated with a higher likelihood of always using a condom in the final subscale model (individual: goals/aspirations; environmental: community participation, pro-social peers). CONCLUSIONS Total environmental and three protective factor subscales demonstrated prominent associations with consistent use of condoms in sexually active adolescents. Implications for public health: Consideration of particular resilience protective factors in adolescent sexual risk behaviour prevention, such as condom use, is warranted.
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Affiliation(s)
- Rebecca Kate Hodder
- Hunter New England Population Health, Hunter New England Local Health District, New South Wales.,School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Sally Homer
- School of Psychology, The University of Newcastle, New South Wales
| | - Megan Freund
- School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Jennifer A Bowman
- School of Psychology, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | | | - Kim Colyvas
- School of Psychology, The University of Newcastle, New South Wales
| | - Elizabeth Campbell
- Hunter New England Population Health, Hunter New England Local Health District, New South Wales.,School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Karen Gillham
- Hunter New England Population Health, Hunter New England Local Health District, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - Julia Dray
- Hunter New England Population Health, Hunter New England Local Health District, New South Wales.,School of Psychology, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
| | - John H Wiggers
- Hunter New England Population Health, Hunter New England Local Health District, New South Wales.,School of Medicine and Public Health, The University of Newcastle, New South Wales.,Hunter Medical Research Institute, New South Wales
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Fisher S, Zapolski TC, Sheehan C, Barnes-Najor J. Pathway of protection: Ethnic identity, self-esteem, and substance use among multiracial youth. Addict Behav 2017; 72:27-32. [PMID: 28343088 DOI: 10.1016/j.addbeh.2017.03.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 03/08/2017] [Indexed: 10/20/2022]
Abstract
Fifty percent of adolescents have tried an illicit drug and 70% have tried alcohol by the end of high school, with even higher rates among multiracial youth. Ethnic identity is a protective factor against substance use for minority groups. However, little is known about the mechanisms that facilitate its protective effects, and even less is known about this relationship for multiracial youth. The purpose of the present study was to examine the protective effect of ethnic identity on substance use and to determine whether this relationship operated indirectly through self-esteem, a strong predictor of substance use for among adolescent populations. Participants included 468 multiracial youth in grades six through 12 (53% female). The results found that ethnic identity was indeed related to substance use, partially through changes in self-esteem. Findings from this study contribute to our understanding and development of models of risk and protection for an understudied population.
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22
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Barman-Adhikari A, Hsu HT, Begun S, Portillo AP, Rice E. Condomless Sex Among Homeless Youth: The Role of Multidimensional Social Norms and Gender. AIDS Behav 2017; 21:688-702. [PMID: 27885551 DOI: 10.1007/s10461-016-1624-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.
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Affiliation(s)
- Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| | - Stephanie Begun
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA
| | - Andrea Perez Portillo
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO, 80208, USA
| | - Eric Rice
- School of Social Work, University of Southern California, Los Angeles, CA, USA
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23
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Heerde JA, Hemphill SA. Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth: A Systematic Review of Associations With Substance Use. TRAUMA, VIOLENCE & ABUSE 2016; 17:468-489. [PMID: 25985990 DOI: 10.1177/1524838015584371] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The use of substances among youth experiencing homelessness is an important issue in the context of addressing the developing burden of morbidities arising due to illness, injury, physical and mental health concerns, and low rates of health care utilization among this population group. Youth experiencing homelessness report engaging in and being victimized by various forms of sexual behavior. Of interest in this systematic review were published studies investigating substance use in its association with perpetration of sexual offenses, engagement in sexual risk behavior, or experience of sexual victimization among homeless youth. A systematic search of 12 psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "sex crimes," "sexual victimization," "survival sex," "rape," "drugs," and "substance abuse." Twenty-three studies were identified that met the inclusion criteria. No studies statistically examining substance use in its association with perpetrating sexual offenses were located. Findings showed substance use was generally associated with sexual risk behavior or sexual victimization; however, it remains unclear whether substance use precedes or follows these behaviors and experiences. It is possible substances are used by homeless youth as a means of coping with sexual risk behavior and victimization. Implications of the review findings in relation to prevention and intervention approaches aimed to decrease the incidence and severity of health concerns among homeless youth are discussed.
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Affiliation(s)
- Jessica A Heerde
- Learning Sciences Institute Australia, Faculty of Education and Arts, Australian Catholic University, Fitzroy, Victoria, Australia
| | - Sheryl A Hemphill
- Learning Sciences Institute Australia, Faculty of Education and Arts, Australian Catholic University, Fitzroy, Victoria, Australia
- School of Psychology, Faculty of Health Sciences, Australian Catholic University, Fitzroy, Victoria, Australia
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24
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Dombrowski K, Sittner K, Crawford D, Welch-Lazoritz M, Habecker P, Khan B. Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review. Health (London) 2016; 8:1143-1165. [PMID: 28042394 PMCID: PMC5193114 DOI: 10.4236/health.2016.812119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the United States economic recession of 2008-2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.
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Affiliation(s)
- Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Kelley Sittner
- Department of Sociology, Oklahoma State University, Stillwater, USA
| | | | | | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
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25
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Winter VR, O'Neill E, Begun S, Kattari SK, McKay K. MSW student perceptions of sexual health as relevant to the profession: Do social work educational experiences matter? SOCIAL WORK IN HEALTH CARE 2016; 55:614-634. [PMID: 27332145 DOI: 10.1080/00981389.2016.1189476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2015] [Accepted: 05/10/2016] [Indexed: 06/06/2023]
Abstract
Many social work clients are at an increased risk for negative outcomes related to sexual behavior, including unwanted pregnancies and sexually transmitted infections (STIs). However, there is a dearth of literature on social work student experiences with these topics in social work classrooms and their perceptions about the topic's relevance to their practice. The purpose of this study is to explore relationships between experiences with STIs and contraception as topics in social work education and practica experiences on student perceptions toward sexual health as a relevant topic for social work. Among a national sample of MSW students (N = 443), experiences with STIs and contraception as topics in practica was significantly related to perceptions toward sexual health's relevance to social work. Findings and implications are discussed.
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Affiliation(s)
| | - Elizabeth O'Neill
- b School of Social Welfare , University of Kansas , Lawrence , Kansas , USA
| | - Stephanie Begun
- c Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Shanna K Kattari
- c Graduate School of Social Work , University of Denver , Denver , Colorado , USA
| | - Kimberly McKay
- d School of Social Work , Temple University , Philadelphia , Pennsylvania , USA
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Santa Maria D, Narendorf SC, Ha Y, Bezette-Flores N. Exploring Contextual Factors of Youth Homelessness And Sexual Risk Behaviors: A Qualitative Study. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2015; 47:195-201. [PMID: 26575948 DOI: 10.1363/47e6715] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Revised: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 06/05/2023]
Abstract
CONTEXT HIV disproportionately affects homeless youth, and interventions to date have had minimal success in reducing sexual risk behaviors in this population. Few qualitative studies have been conducted to provide insight into the influence of homelessness-related factors on sexual risk behaviors. METHODS A qualitative study with a quantitative component was conducted with a nonprobability sample of 64 homeless youth aged 14-24; participants were recruited from a variety of venues in Houston between October 2013 and March 2014. Thirteen focus group discussions were conducted; thematic analysis was used to identify themes related to HIV risk. RESULTS Participants were predominantly black (75%), sheltered (67%) and aged 18 or older (77%). Youth discussed how the circumstances of their homelessness and the struggle to meet their immediate needs led to behaviors and experiences that put them at risk for HIV. Three themes emerged: Homeless youth frequently engage in risky sexual behavior, sometimes as a way to cope with stress; they often trade sex, either voluntarily or involuntarily, for such necessities as money or a place to sleep; and many experienced childhood sexual victimization or have been victimized since becoming homeless. Youth also described how stress, stigma and self-reliance contributed to their involvement in HIV risk behaviors. CONCLUSIONS HIV prevention methods that target stress and stigma while respecting youths' self-reliance may help reduce sexual risk behaviors. Further research is needed to determine suitable behavioral change techniques to address these potentially modifiable factors.
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27
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Mutumba M, Harper GW. Mental health and support among young key populations: an ecological approach to understanding and intervention. J Int AIDS Soc 2015; 18:19429. [PMID: 25724505 PMCID: PMC4344542 DOI: 10.7448/ias.18.2.19429] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2014] [Revised: 12/11/2014] [Accepted: 01/02/2015] [Indexed: 12/03/2022] Open
Abstract
INTRODUCTION The patterning of the HIV epidemic within young key populations (YKPs) highlights disproportionate burden by mental disorders in these populations. The mental wellbeing of YKPs is closely associated with biological predispositions and psychosocial factors related to YKPs' sexual and gender identities and socio-economic status. The purpose of this paper is to highlight sources of risk and resilience, as well as identify treatment and supports for mental health disorders (MHDs) among YKPs. DISCUSSION This paper utilizes Bronfenbrenner's Bioecological Systems Theory and the Social Stress Model to explore the risk and protective factors for MHDs across YKPs' ecological systems, and identify current gaps in treatment and support for MHDs among these youth. We emphasize the fluidity and intersections across these categorizations which reinforce the vulnerability of these populations, the lack of concrete data to inform mental health interventions among YKPs, and the need to ground YKP interventions and programmes with human rights principles stipulated in the convention on the rights of a child. CONCLUSIONS We put forth recommendations for future research and strategies to address the mental wellbeing of YKPs, including the need for integrated interventions that address the multiplicity of risk factors inherent in the multiple group membership, rather than single-focus interventions whilst addressing the unique needs or challenges of YKPs.
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Affiliation(s)
- Massy Mutumba
- Center for Sexuality and Health Disparities, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Joint Clinical Research Center, Kampala, Uganda;
| | - Gary W Harper
- Center for Sexuality and Health Disparities, Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
- Department of Health Behavior and Health Education, University of Michigan, Ann Arbor, MI, USA
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28
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29
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Kennedy DP, Brown RA, Morrison P, Vie L, Ryan GW, Tucker JS. Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation. BMC Public Health 2015; 15:62. [PMID: 25636862 PMCID: PMC4324882 DOI: 10.1186/s12889-015-1419-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect. Methods To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis. Results We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances. Conclusions Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1419-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David P Kennedy
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Ryan A Brown
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Penelope Morrison
- The RAND-University of Pittsburgh Health Institute, Pittsburgh, PA, USA.
| | - Loryana Vie
- The Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. .,The Department of Psychology, University of California, Riverside, CA, USA.
| | - Gery W Ryan
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Joan S Tucker
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
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Sipsma HL, Ickovics JR, Lin H, Kershaw TS. The impact of future expectations on adolescent sexual risk behavior. J Youth Adolesc 2015; 44:170-83. [PMID: 24357042 PMCID: PMC4065220 DOI: 10.1007/s10964-013-0082-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 12/07/2013] [Indexed: 10/25/2022]
Abstract
Rates of STIs, HIV, and pregnancy remain high among adolescents in the US, and recent approaches to reducing sexual risk have shown limited success. Future expectations, or the extent to which one expects an event to actually occur, may influence sexual risk behavior. This prospective study uses longitudinal data from the National Longitudinal Survey of Youth 1997 (n = 3,205 adolescents; 49.8% female) to examine the impact of previously derived latent classes of future expectations on sexual risk behavior. Cox regression and latent growth models were used to determine the effect of future expectations on age at first biological child, number of sexual partners, and inconsistent contraception use. The results indicate that classes of future expectations were uniquely associated with each outcome. The latent class reporting expectations of drinking and being arrested was consistently associated with the greatest risks of engaging in sexual risk behavior compared with the referent class, which reported expectations of attending school and little engagement in delinquent behaviors. The class reporting expectations of attending school and drinking was associated with having greater numbers of sexual partners and inconsistent contraception use but not with age at first biological child. The third class, defined by expectations of victimization, was not associated with any outcome in adjusted models, despite being associated with being younger at the birth of their first child in the unadjusted analysis. Gender moderated specific associations between latent classes and sexual risk outcomes. Future expectations, conceptualized as a multidimensional construct, may have a unique ability to explain sexual risk behaviors over time. Future strategies should target multiple expectations and use multiple levels of influence to improve individual future expectations prior to high school and throughout the adolescent period.
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Affiliation(s)
- Heather L Sipsma
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, CT, USA,
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Begun S. The paradox of homeless youth pregnancy: a review of challenges and opportunities. SOCIAL WORK IN HEALTH CARE 2015; 54:444-460. [PMID: 25985287 DOI: 10.1080/00981389.2015.1030058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Compared to their housed counterparts, homeless youth become pregnant at exceptionally high rates. Causes of such pregnancies are multifaceted, while a paradoxically high proportion of these pregnancies are intended. This review discusses causes and risk factors associated with homeless youth pregnancies, and notes experiences of pregnancy decision-making discord, challenges encountered during and following pregnancy, and difficulties faced by homeless youth when or if they become parents. Because homeless youth face a wide array of unique risks, future research would benefit from exploring alternative approaches to prevention to reduce pregnancies and improve sexual and reproductive health outcomes among this population.
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Affiliation(s)
- Stephanie Begun
- a Graduate School of Social Work, University of Denver , Denver , Colorado , USA
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Heerde JA, Scholes-Balog KE, Hemphill SA. Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review. ARCHIVES OF SEXUAL BEHAVIOR 2015; 44:181-212. [PMID: 25411128 DOI: 10.1007/s10508-014-0375-2] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Revised: 01/13/2014] [Accepted: 01/13/2014] [Indexed: 05/22/2023]
Abstract
Homeless youth commonly report engaging in sexual risk behaviors. These vulnerable young people also frequently report being sexually victimized. This systematic review collates, summarizes, and appraises published studies of youth investigating relationships between homelessness, perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior. A systematic search of seventeen psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "offend*," "victimization," "crime," "rape," "victim*," and "sex crimes." Thirty-eight studies were identified that met the inclusion criteria. Findings showed homeless youth commonly report being raped and sexually assaulted, fear being sexually victimized, and engage in street prostitution and survival sex. Rates of victimization and sexual risk behavior were generally higher for females. Given the paucity of longitudinal studies and limitations of current studies, it is unclear whether homelessness is prospectively associated with sexual victimization or engagement in sexual risk behavior, and whether such associations vary cross nationally and as a function of time and place. Future prospective research examining the influence of the situational context of homelessness is necessary to develop a better understanding of how homelessness influences the perpetration of sexual offenses, experience of sexual victimization, and engagement in sexual risk behavior among homeless youth.
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Affiliation(s)
- Jessica A Heerde
- School of Psychology, Faculty of Arts and Sciences, Australian Catholic University, 115 Victoria Parade, Fitzroy, VIC, 3065, Australia,
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Rana Y, Brown RA, Kennedy DP, Ryan GW, Stern S, Tucker JS. Understanding Condom Use Decision Making Among Homeless Youth Using Event-Level Data. JOURNAL OF SEX RESEARCH 2014; 52:1064-1074. [PMID: 25396781 PMCID: PMC4689140 DOI: 10.1080/00224499.2014.961185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.
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Affiliation(s)
- Yashodhara Rana
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | - Ryan A. Brown
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | | | - Gery W. Ryan
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | - Stefanie Stern
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | - Joan S. Tucker
- RAND Health, RAND Corporation, Santa Monica, California, USA
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The health diagnoses of homeless adolescents: a systematic review of the literature. J Adolesc 2014; 37:531-42. [PMID: 24931556 DOI: 10.1016/j.adolescence.2014.04.003] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Revised: 03/17/2014] [Accepted: 04/13/2014] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homelessness during adolescence impacts negatively upon young people's physical and mental wellbeing. To be effective, programs aimed at addressing the health needs of this population must include knowledge of both the presenting and underlying acute and chronic conditions that characterise this high risk group of youth. METHODS We undertook a systematic review of the international literature for studies that used validated instruments and techniques to diagnose prevalence rates of physical and mental health disorders in homeless adolescents. RESULTS Twenty-one studies fulfilled the selection criteria. Of these, nine studies examined mental health diagnoses including depression, post-traumatic stress disorder, anxiety and substance abuse disorders. With one exception, the remaining twelve studies all related to sexually transmitted infections. CONCLUSION Homeless adolescents are diagnosed with widely varying rates of mental health disorders and high rates of sexually transmitted infection. Other likely chronic and acute physical conditions appear to be neglected in the published research.
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Dang MT, Miller E. Characteristics of natural mentoring relationships from the perspectives of homeless youth. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2013; 26:246-53. [PMID: 24180604 PMCID: PMC3818248 DOI: 10.1111/jcap.12038] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
PROBLEM Homeless youth experience high risks for poor mental health outcomes. The purpose of this qualitative study was to explore the characteristics of natural mentoring relationships among homeless youth and to identify possible mechanisms that can enhance social support for this population. METHODS Semi-structured interviews were conducted with 23 homeless youth aged 14-21 who had natural mentors. The interviews focused on how youth met their natural mentors, the function of these relationships, and how natural mentoring relationships differed from other relationships in the youth's social networks. FINDINGS Main themes that emerged from the interviews included parental absence, natural mentors as surrogate parents, and social support from mentors. CONCLUSIONS Findings suggest that social supports provided by mentors enhance youth's adaptive functioning and may promote resilience, thus the use of natural mentors may be an important untapped asset in designing interventions to improve outcomes for homeless youth.
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Affiliation(s)
- Michelle T Dang
- School of Nursing, California State University, Sacramento, CA, USA
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Valente AM, Auerswald CL. Gender differences in sexual risk and sexually transmitted infections correlate with gender differences in social networks among San Francisco homeless youth. J Adolesc Health 2013; 53:486-91. [PMID: 23871131 DOI: 10.1016/j.jadohealth.2013.05.016] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2012] [Revised: 05/26/2013] [Accepted: 05/28/2013] [Indexed: 10/26/2022]
Abstract
PURPOSE To explore whether gender differences in sexual risk and sexually transmitted infections (STIs) among homeless youth may be explained in part by gender differences in their social networks. METHODS Our sample includes 258 youth (64% male) recruited in San Francisco from street venues and transitional programs. Participants completed an audio computer-administered self-interview survey regarding their housing status and risk behaviors and an interviewer-administered survey regarding their social networks, and were tested for STIs (chlamydia and gonorrhea). We examined relationships between sexual risk and STI rates and social network characteristics by gender. RESULTS Condom use was lower in young women than in young men, whereas young women were more likely to have an injection drug user (IDU) sex partner and to be diagnosed with an STI. Homeless young men were more likely to have stably housed contacts and same-sex friendships in their social networks than were young women. Stably housed network contacts were associated with increased condom use and decreased STI prevalence in young men. Same-sex friends were associated with increased condom use in young women. No young woman with a family member in her network had an IDU sex partner. Having a network member who had been recently incarcerated was associated with having an IDU sex partner for young women. CONCLUSIONS Homeless young women's networks may place them at greater risk for STIs than young men. Increasing mainstream contacts and same-gender friendships may protect all homeless youth from STIs. Interventions addressing homeless young women's social networks may decrease their gender-disparate STI risk.
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Moura YGD, Sanchez ZM, Opaleye ES, Neiva-Silva L, Koller SH, Noto AR. Drug use among street children and adolescents: what helps? CAD SAUDE PUBLICA 2013; 28:1371-80. [PMID: 22729267 DOI: 10.1590/s0102-311x2012000700015] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2011] [Accepted: 03/19/2012] [Indexed: 08/30/2023] Open
Abstract
The aim of this study was to investigate factors associated to frequent and heavy drug use among street children and adolescents aged 10 to 18 years. A sample of 2,807 street children and adolescents from the 27 Brazilian state capital cities was analyzed. A World Health Organization questionnaire for non-students was adapted for use in Brazil. Data analysis was performed using logistic regression and decision tree models. Factors inversely associated with frequent and heavy drug use were: being age nine to 11 years (OR = 0.1); school attendance (OR = 0.3); daily time (one to five hours) spent on the streets (OR = 0.3 and 0.4); not sleeping on the streets (OR = 0.4); being on the streets for less than one year (OR = 0.4); maintenance of some family bonds (OR = 0.5); presence on the streets of a family member (OR = 0.6); not suffering domestic violence (OR = 0.6); being female (OR = 0.8). All of these variables were significant at the p < 0.05 level. The findings suggest that being younger, having family bonds and engagement in school are important protective factors that affect drug use among this population and should be considered in the formulation of public policies.
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Lau M, Lin H, Flores G. Clusters of markers identify high and low prevalence of adolescent pregnancy in the US. J Pediatr Adolesc Gynecol 2013; 26:40-6. [PMID: 23158753 DOI: 10.1016/j.jpag.2012.09.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2012] [Revised: 09/13/2012] [Accepted: 09/13/2012] [Indexed: 11/20/2022]
Abstract
STUDY OBJECTIVE To identify markers that, when clustered, are associated with the highest and lowest pregnancy prevalence among US adolescent females. DESIGN Secondary database analysis of the National Survey of Family Growth. PARTICIPANTS Adolescent females 15-19 years old. SETTING United States. METHODS Bivariate analyses were performed of the 2002 and 2006-08 cycles to identify markers associated with pregnancy in females 15-19 years old. Recursive partitioning analysis (RPA) was done to identify markers which, when combined, identify adolescent females with the highest and lowest pregnancy prevalence. RESULTS Pregnancy prevalence in 2,528 adolescent females was 14%. In RPA, females who ever HIV tested had a 48% pregnancy prevalence vs 4% in those never tested. The highest pregnancy prevalence (78%) was associated with the combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, and age of sexual debut ≤14 years old. Adolescent females with a combination of ever HIV tested, never lived away from parents before 18 years old, age >17 years old, age of sexual debut at 15-16 years old, and the adolescent's father not having a high-school diploma had a pregnancy prevalence of 75%. CONCLUSIONS Two clusters of markers yield adolescent females with a very high adolescent pregnancy prevalence, at 75%-78%. Pregnancy prevention efforts might be especially effective when targeting combinations of HIV-testing history, never living away from home before 18 years old, adolescent age, age of sexual debut, and paternal educational attainment.
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Affiliation(s)
- May Lau
- Division of General Pediatrics, Department of Pediatrics, University of Texas Southwestern Medical Center, Dallas, TX 75390-9063, USA.
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Tyler KA, Melander LA. Individual and Social Network Sexual Behavior Norms of Homeless Youth at High Risk for HIV Infection. CHILDREN AND YOUTH SERVICES REVIEW 2012; 34:2481-2486. [PMID: 23162182 PMCID: PMC3496415 DOI: 10.1016/j.childyouth.2012.09.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Although previous research shows that homeless youth engage in numerous risky sexual behaviors, little is known about whether or not specific rules govern this conduct within their social networks and how group norms influence subsequent sexual actions. The current study utilizes 19 in-depth interviews with homeless youth to investigate different elements of their sexual behavior. Findings reveal that their decision to have sex generally depends on chemistry and physical appearance whereas a potential partner's risky sexual history and heavy substance use discourages youth from engaging in sex. Both males and females discuss condom usage as it relates to unknown sexual history, availability, pregnancy, and the prevention of sexually transmitted infections (STIs). Sixteen homeless youth indicate that they do not discuss safe sex practices with their partners or social network members.
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Affiliation(s)
| | - Lisa A. Melander
- Kansas State University, Department of Sociology, Anthropology, and Social Work
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Tucker JS, Sussell J, Golinelli D, Zhou A, Kennedy DP, Wenzel SL. Understanding pregnancy-related attitudes and behaviors: a mixed-methods study of homeless youth. PERSPECTIVES ON SEXUAL AND REPRODUCTIVE HEALTH 2012; 44:252-261. [PMID: 23231333 PMCID: PMC3531816 DOI: 10.1363/4425212] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
CONTEXT Pregnancy rates are substantially higher among homeless youth than in the general population of youth, yet little is known about homeless adolescents' and young adults' pregnancy-related attitudes and behaviors. METHODS Pregnancy-related attitudes and behaviors were examined among two samples of sexually active homeless 13-24-year-olds in Los Angeles County. Data from 37 semistructured interviews conducted in March-April 2011 were analyzed using standard qualitative methods. Data from a structured survey with 277 respondents, conducted between October 2008 and August 2009, were analyzed primarily using regression modeling. RESULTS More than half of interview respondents held ambivalent attitudes toward pregnancy, and ambivalent youth reported less contraceptive use than others. The interviews identified several potential influences on pregnancy attitudes: barriers associated with homelessness, readiness to settle down, desire to achieve goals, belief that a child would create something positive in life, and family and partners. In the survey, having positive attitudes toward pregnancy was positively associated with duration of homelessness (odds ratio, 1.6), contact with relatives (1.1) and relationship commitment (1.8); it was negatively associated with frequency of drinking (0.9). Relationship commitment was positively associated with nonuse of an effective contraceptive method at last sex (1.5). CONCLUSIONS Effective and accessible pregnancy prevention and family planning programs for homeless youth are needed. Youths' ambivalence toward pregnancy and feelings of relationship commitment warrant attention as possible areas for programs to address.
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Kennedy DP, Tucker JS, Green HD, Golinelli D, Ewing B. Unprotected sex of homeless youth: results from a multilevel dyadic analysis of individual, social network, and relationship factors. AIDS Behav 2012; 16:2015-32. [PMID: 22610421 DOI: 10.1007/s10461-012-0195-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
Homeless youth have elevated risk of HIV through sexual behavior. This project investigates the multiple levels of influence on unprotected sex among homeless youth, including social network, individual, and partner level influences. Findings are based on analyses of an exploratory, semi-structured interview (n = 40) and a structured personal network interview (n = 240) with randomly selected homeless youth in Los Angeles. Previous social network studies of risky sex by homeless youth have collected limited social network data from non-random samples and have not distinguished sex partner influences from other network influences. The present analyses have identified significant associations with unprotected sex at multiple levels, including individual, partner, and, to a lesser extent, the social network. Analyses also distinguished between youth who did or did not want to use condoms when they had unprotected sex. Implications for social network based HIV risk interventions with homeless youth are discussed.
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Affiliation(s)
- David P Kennedy
- RAND Health, RAND Corporation, 1776 Main Street, Santa Monica, CA 90407, USA.
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42
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Tucker JS, Hu J, Golinelli D, Kennedy DP, Green HD, Wenzel SL. Social network and individual correlates of sexual risk behavior among homeless young men who have sex with men. J Adolesc Health 2012; 51:386-92. [PMID: 22999840 PMCID: PMC3531968 DOI: 10.1016/j.jadohealth.2012.01.015] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2011] [Revised: 01/18/2012] [Accepted: 01/19/2012] [Indexed: 11/17/2022]
Abstract
PURPOSE There is growing interest in network-based interventions to reduce HIV sexual risk behavior among both homeless youth and men who have sex with men. The goal of this study was to better understand the social network and individual correlates of sexual risk behavior among homeless young men who have sex with men (YMSM) to inform these HIV prevention efforts. METHODS A multistage sampling design was used to recruit a probability sample of 121 homeless YMSM (ages: 16-24 years) from shelters, drop-in centers, and street venues in Los Angeles County. Face-to-face interviews were conducted. Because of the different distributions of the three outcome variables, three distinct regression models were needed: ordinal logistic regression for unprotected sex, zero-truncated Poisson regression for number of sex partners, and logistic regression for any sex trade. RESULTS Homeless YMSM were less likely to engage in unprotected sex and had fewer sex partners if their networks included platonic ties to peers who regularly attended school, and had fewer sex partners if most of their network members were not heavy drinkers. Most other aspects of network composition were unrelated to sexual risk behavior. Individual predictors of sexual risk behavior included older age, Hispanic ethnicity, lower education, depressive symptoms, less positive condom attitudes, and sleeping outdoors because of nowhere else to stay. CONCLUSIONS HIV prevention programs for homeless YMSM may warrant a multipronged approach that helps these youth strengthen their ties to prosocial peers, develop more positive condom attitudes, and access needed mental health and housing services.
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Affiliation(s)
- Joan S Tucker
- RAND Health, RAND Corporation, Santa Monica, California 90407-2138, USA.
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Kaestle CE. Selling and buying sex: a longitudinal study of risk and protective factors in adolescence. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2012; 13:314-22. [PMID: 22350114 DOI: 10.1007/s11121-011-0268-8] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Engaging in trading sex is associated with many co-occurring problems, including elevated risk for sexually transmitted infections. Various dimensions of social support from parents, schools, and mentors may be protective against sex trading and may ameliorate the impact of risk factors. This study analyzes data from respondents to Waves I and III of the National Longitudinal Study of Adolescent Health (Add Health) who had not participated in sex trading for money or drugs in Wave I so that risk and protective factors for first initiations of selling or buying sex could be examined longitudinally. About 2% of the study sample began selling sex and about 2% began buying sex between Wave I and Wave III. The respondent's sex, race/ethnicity, history of sexual abuse, shoplifting, marijuana use, and experiences of homelessness or running away were significant predictors of trading sex (p < 0.05). Being happy at school was associated with lower selling of sex, and feeling part of school was associated with lower buying of sex even after controlling for demographics and risk factors (p < 0.05). Results indicate a need for early intervention for youth who experience sexual abuse or running away. Elements of school connectedness have a protective effect on selling and buying sex. Promoting school connectedness may advance public health goals.
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Affiliation(s)
- Christine E Kaestle
- Department of Human Development, Virginia Tech, 315 Wallace Hall 0416, Blacksburg, VA 24061, USA.
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Sipsma HL, Ickovics JR, Lin H, Kershaw TS. Future expectations among adolescents: a latent class analysis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2012; 50:169-81. [PMID: 22193990 PMCID: PMC3528017 DOI: 10.1007/s10464-011-9487-1] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Future expectations have been important predictors of adolescent development and behavior. Its measurement, however, has largely focused on single dimensions and misses potentially important components. This analysis investigates whether an empirically-driven, multidimensional approach to conceptualizing future expectations can substantively contribute to our understanding of adolescent risk behavior. We use data from the National Longitudinal Survey of Youth 1997 to derive subpopulations of adolescents based on their future expectations with latent class analysis. Multinomial regression then determines which covariates from Bronfenbrenner's ecological systems theory are associated with class membership. After modeling these covariates, we examine whether future expectations is associated with delinquency, substance use, and sexual experience. Our analysis suggests the emergence of four distinct classes labeled the Student Expectations, Student/Drinking Expectations, Victim Expectations, and Drinking/Arrest Expectations classes according to their indicator profiles. These classes differ with respect to covariates associated with membership; furthermore, they are all statistically and differentially associated with at least one adolescent risk behavior. This analysis demonstrates the additional benefit derived from using this multidimensional approach for studying future expectations. Further research is needed to investigate its stability and role in predicting adolescent risk behavior over time.
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Affiliation(s)
- Heather L Sipsma
- Department of Health Policy and Administration, School of Public Health, Yale University, 2 Church Street South, New Haven, CT 06519, USA.
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Grangeiro A, Holcman MM, Onaga ET, Alencar HDRD, Placco ALN, Teixeira PR. Prevalência e vulnerabilidade à infecção pelo HIV de moradores de rua em São Paulo, SP. Rev Saude Publica 2012; 46:674-84. [DOI: 10.1590/s0034-89102012005000037] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2011] [Accepted: 03/11/2012] [Indexed: 11/22/2022] Open
Abstract
OBJETIVO: Analisar a prevalência e o perfil de vulnerabilidade ao HIV de moradores de rua. MÉTODOS: Estudo transversal com amostra não probabilística de 1.405 moradores de rua usuários de instituições de acolhimento de São Paulo, SP, de 2006 a 2007. Foi realizado teste anti-HIV e aplicado questionário estruturado. O perfil de vulnerabilidade foi analisado pela frequência do uso do preservativo, considerando mais vulneráveis os que referiram o uso nunca ou às vezes. Foram utilizadas regressões logística e multinomial para estimar as medidas de efeito e intervalos de 95% de confiança. RESULTADOS: Houve predominância do sexo masculino (85,6%), média de 40,9 anos, ter cursado o ensino fundamental (72,0%) e cor não branca (71,5%). A prática homo/bissexual foi referida por 15,7% e a parceria ocasional por 62,0%. O número médio de parcerias em um ano foi de 5,4 e mais da metade (55,7%) referiu uso de drogas na vida, dos quais 25,7% relataram uso frequente. No total, 39,6% mencionaram ter tido uma doença sexualmente transmissível e 38,3% relataram o uso do preservativo em todas as relações sexuais. A prevalência do HIV foi de 4,9% (17,4% dos quais apresentaram também sorologia positiva para sífilis). Pouco mais da metade (55,4%) tinha acesso a ações de prevenção. A maior prevalência do HIV esteve associada a ser mais jovem (OR 18 a 29 anos = 4,0 [IC95% 1,54;10,46]), história de doença sexualmente transmissível (OR = 3,3 [IC95% 1,87;5,73]); prática homossexual (OR = 3,0 [IC95% 1,28;6,92]) e à presença de sífilis (OR = 2,4 [IC95% 1,13;4,93]). O grupo de maior vulnerabilidade foi caracterizado por ser mulher, jovem, ter prática homossexual, número reduzido de parcerias, parceria fixa, uso de drogas e álcool e não ter acesso a ações de prevenção e apoio social. CONCLUSÕES: O impacto da epidemia entre moradores de rua é elevado, refletindo um ciclo que conjuga exclusão, vulnerabilidade social e acesso limitado à prevenção.
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Tucker JS, Ryan GW, Golinelli D, Ewing B, Wenzel SL, Kennedy DP, Green HD, Zhou A. Substance use and other risk factors for unprotected sex: results from an event-based study of homeless youth. AIDS Behav 2012; 16:1699-707. [PMID: 21932093 PMCID: PMC3244544 DOI: 10.1007/s10461-011-0017-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
This study used an event-based approach to understand condom use in a probability sample of 309 homeless youth recruited from service and street sites in Los Angeles County. Condom use was significantly less likely when hard drug use preceded sex, the relationship was serious, the partners talked about "pulling out", or sex occurred in a non-private place (and marginally less likely when heavier drinking preceded sex, or the partnership was monogamous or abusive). Condom use was significantly more likely when the youth held positive condom attitudes or were concerned about pregnancy, the partners talked about condom use, and the partners met up by chance. This study extends previous work by simultaneously examining a broad range of individual, relationship, and contexual factors that may play a role in condom use. Results identify a number of actionable targets for programs aimed at reducing HIV/STI transmission and pregnancy risk among homeless youth.
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Edidin JP, Ganim Z, Hunter SJ, Karnik NS. The mental and physical health of homeless youth: a literature review. Child Psychiatry Hum Dev 2012; 43:354-75. [PMID: 22120422 DOI: 10.1007/s10578-011-0270-1] [Citation(s) in RCA: 186] [Impact Index Per Article: 15.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed.
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Affiliation(s)
- Jennifer P Edidin
- Department of Psychiatry and Behavioral Neuroscience, University of Chicago, Chicago, IL, USA.
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Ssewamala FM, Sperber E, Blake CA, Ilic VP. Increasing Opportunities for Inner-City Youth: The Feasibility of an Economic Empowerment Model in East Harlem and the South Bronx, New York. CHILDREN AND YOUTH SERVICES REVIEW 2012; 34:218-224. [PMID: 22581997 PMCID: PMC3347469 DOI: 10.1016/j.childyouth.2011.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Youth of color are disproportionately likely to grow-up in poor, disadvantaged neighborhoods characterized by high levels of psychosocial stressors and inadequate supportive resources. Poverty and racial minority status correlate with an increased risk of high-school dropout, teen pregnancy, substance abuse, and sexually transmitted infections (STIs). Given these trends, child welfare researchers are developing various interventions to increase the protective resources and social opportunities available to youth of color. This article reports results of a preliminary, qualitative study that investigated the feasibility and acceptability of an economic empowerment intervention in the South Bronx and East Harlem, New York. Using focus groups and brief questionnaires with youth and their parents/guardians (N=24 dyads), we explored attitudes toward youth educational savings accounts, financial planning classes, and mentorship for inner-city youth. Findings indicate a strong interest in an economic empowerment intervention among adolescents and their caregivers in these communities. These findings have implications for the design of larger-scale research programs that aim to improve inner-city youth's socio-economic wellbeing using economic empowerment models.
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Affiliation(s)
- Fred M. Ssewamala
- Associate Professor of Social Work and International Affairs, Columbia University
| | - Elizabeth Sperber
- Ph.D. Student, Columbia University, Graduate School of Arts and Sciences
| | | | - Vilma P. Ilic
- Research Associate, Columbia University School of Social Work
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