Increased substance use and risky sexual behavior among migratory homeless youth: exploring the role of social network composition

Identifying early intervention opportunities for illicit stimulant use: A cross-sectional study of factors associated with illicit stimulant use among young people accessing integrated youth services in British Columbia, Canada

INTRODUCTION

Illicit stimulant (cocaine and/or amphetamine) use among young people aged 12-24 is a public health priority given that substance use initiation tends to peak in this developmental period and significant associated immediate and long-term harms are associated with its use. Young people using stimulants must be engaged in services as early as possible to reduce these harms. To inform early intervention opportunities, this study aimed to identify the risk/protective factors associated with illicit stimulant use among young people.

METHODS

We conducted a cross-sectional study on routinely collected self-reported data among young people accessing integrated youth services in British Columbia (Canada) between April 2018 and January 2022. Data were collected on young peoples' socio-demographic characteristics, and social, behavioral, and health profiles. Variable selection was guided by established risk/protective factors for substance use among young people. The study used multivariable logistic regression to identify risk/protective factors that were independently associated with past 30-day illicit stimulant use.

RESULTS

The analytic sample included n = 5620 young people aged 12-24 and a total of 163 (2.9 %) reported past 30-day illicit cocaine and/or amphetamine use. Demographic characteristics that were independently associated with illicit stimulant use included older age (aOR = 1.27, 95 % CI = 1.17-1.38) and gender identity as man vs woman (aOR = 1.71, 95 % CI = 1.10-2.70). Social and environmental risk factors included recently witnessing or experiencing violence (aOR = 2.32, 95 % CI = 1.47-3.68) and higher past-year crime/violent behaviors score (aOR = 1.39, 95 % CI = 1.13-1.69). Finally, regular alcohol (aOR = 6.90, 95 % CI = 2.36-25.42), regular (aOR = 3.74, 95 % CI = 1.95-7.54) or social (aOR = 3.06, 95 % CI = 1.44-6.60) tobacco use, and lifetime hallucinogen (aOR = 3.24, 95 % CI = 1.8-5.91) and ecstasy/MDMA (aOR = 2.53, 95 % CI = 1.48-4.39) use were also statistically significant risk factors.

CONCLUSIONS

These risk/protective factors support identification of young people who may benefit from further screening, assessment, and treatment for illicit stimulant use. This study also underscores the need to expand early intervention and harm reduction programs that can comprehensively respond to young peoples' stimulant use, health, and social needs.

Problematic substance use and its associated factors among street youth in Bahir Dar city, Ethiopia

BACKGROUND

Problematic substance use is becoming a common problem in marginalized groups such as street youths. However, there is a dearth of studies on the prevalence and factors associated with problematic substance use among street youth in Ethiopia.

OBJECTIVE

The objective of this study was to determine the prevalence of problematic substance use and identify its associated factors among street youth.

METHODS

This community-based cross-sectional study was conducted between June and July 2020. A total of 252 participants were included in this study. Systematic random sampling was used to recruit participants. Cut down, annoyed, guilty feeling, and eye opening-adapted to include drugs (CAGE-AIDs) were used to assess problematic substance use. The data were entered into epidata and exported to SPSS version 25 for analysis. Logistic regression with a 95% confidence interval (CI) was used to show the strength of association. A p-value < 0.5 was statistically significant.

RESULTS

The prevalence of problematic substance use was 55.8%, 95% CI (49-63%). Peer pressure [adjusted odds ratio (AOR) = 3.01, 95% CI: 1.38, 6.59], family conflict [AOR = 5.05, 95% CI: 1.67, 15.25], physical abuse [AOR = 2.56, 95% CI: 1.11, 5.84], and substance use in the family [AOR = 2.85, 95% CI: 1.29, 6.27] were the factors significantly associated with problematic substance use.

CONCLUSION

The prevalence of problematic substance use was high. It was also found that peer pressure, family conflict, substance use in the family, and physical abuse were the factors associated with problematic substance use. Therefore, proper screening and intervention for individuals with problematic substance use are needed, and further research should be conducted for marginalized groups.

Motivational network intervention to reduce substance use and increase supportive connections among formerly homeless emerging adults transitioning to housing: study protocol for a pilot randomized controlled trial

BACKGROUND

Studies indicate high rates of substance use among youth experiencing homelessness (YEH). Further, the social networks of YEH, although multi-dimensional in composition, are largely comprised of other YEH, substance users, and individuals who do not provide the youth with tangible or emotional support. For YEH who have the opportunity to enter a housing program, helping them to reduce their substance use and strengthen their prosocial supportive connections during this critical transition period may increase their stability and reduce their risk of re-entering homelessness. The goal of this study is to pilot test a brief motivational network intervention (MNI), delivered by case managers, to help former YEH who have recently transitioned to a housing program reduce their substance use and strengthen their prosocial supportive connections.

METHODS/DESIGN

Up to 60 residents of housing programs in the Los Angeles area will be randomized to receive four sessions of usual case manager support or four sessions of case manager support + MNI. Each MNI session consists of three parts: (1) identifying two goals that are most important for the resident over the next year (e.g., get or keep a job, finish or stay in school, reduce substance use); (2) a network interview with the resident to capture network data pertaining to their interactions in the past 2 weeks; and (3) a discussion between the case manager and the resident of the resulting network visualizations, conducted in a Motivational Interviewing (MI) style, and what role the resident's network may play in reaching their most important goals over the next year.

DISCUSSION

This study addresses a critical gap by pilot testing a computer-assisted MNI, delivered using MI techniques, that can help case managers work with recent YEH to reduce substance use and increase permanent supportive connections during the critical transitional period from homelessness to housing. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.

Polysubstance use among youth experiencing homelessness: The role of trauma, mental health, and social network composition

BACKGROUND

Substance use is common among youth experiencing homelessness (YEH). However, less is known about the use of multiple substances (polysubstance use), or factors associated with polysubstance use among YEH. The present study sought to identify subgroups of YEH based on their recent polysubstance use behavior, and investigate traumatic experiences, mental health and social network composition as predictors.

METHODS

YEH (N = 1,032; M_age = 21.3) from three drop-in centers in Los Angeles completed an in-person survey and social network interview between October 2011 and June 2013. Latent class analysis (LCA) was used to identify subgroups of youth based on nine types of substance use in the past 30 days; latent class logistic regression was used to identify variables associated with class membership.

RESULTS

Five polysubstance use classes were identified: heavy alcohol and marijuana (33.6 %), illicit drug use (4.9 %), high all polysubstance use (14.9 %), primarily marijuana (18.1 %), and low use (28.5 %). Relative to the low use class, traumatic experiences were associated with membership in every polysubstance use class. Suicide attempts were associated with membership in the high all class (OR = 9.41). Number of substance-using, homeless network members was associated with membership in the heavy alcohol and marijuana use class (OR = 1.35). Number of non-substance-using network members (homeless [OR = 0.29] and housed [OR = 0.73]) was associated with lower odds of membership in the high all class.

CONCLUSIONS

Distinct groups of YEH can be identified by their recent polysubstance use patterns. Traumatic experiences, suicidality, and social network composition are important correlates of polysubstance use among YEH.

Factors Associated With HIV Testing Among Atlanta's Homeless Youth

Homeless youth experience increased risk of contracting HIV, making HIV testing imperative in this population. We analyzed factors associated with HIV testing among homeless youth in Atlanta, Georgia using data from the 2015 Atlanta Youth Count and Needs Assessment. The analysis included 693 homeless youth aged 14-25 years, of whom 88.4% reported ever being tested for HIV, and 74.6% reported being tested within the previous year. Prevalence of ever testing for HIV was significantly higher among youth who reported risk factors for HIV (sexually active, transactional sex, or ever having an STI). Higher prevalence of testing within the last year was significantly associated with experiencing physical abuse or transactional sex. However, reporting ≥ 4 sexual partners or not using condoms were not associated with higher testing. Although testing prevalence among homeless youth was high, homeless youth engaging in certain high risk behaviors could benefit from further promotion of HIV testing.

Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles, USA

Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths' substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross-sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14-29, at three drop-in centres in Los Angeles, CA (N = 1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths' social support networks were identified: (a) high staff emotional and service support; (b) high home-based peer and family emotional, service and instrumental support; (c) moderate street- and home-based peer emotional support; (d) low or no support and (e) high home-based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths' social networks.

Developing a text messaging-based smoking cessation intervention for young smokers experiencing homelessness

Introduction

Cigarette smoking is highly prevalent among young people experiencing homelessness, and many of these smokers are motivated to quit. However, there is a lack of readily available cessation services for this population, which is highly mobile and can be challenging to engage in services.

Aims

We describe the development of a smoking cessation text messaging intervention (TMI) for homeless youth who are interested in quitting smoking.

Methods

Participants were 18–25 years old and recruited from drop-in centers serving homeless youth. Three focus groups (N = 18) were conducted with smokers to refine the TMI content, and a separate sample of smokers (N = 8) provided feedback on the TMI after using it for 1 week. Survey data assessed the TMI's acceptability and feasibility.

Results

Participants generally rated the TMI as helpful and relevant, and nearly all had cell phone plans that included unlimited texting and were able to view TMI content with few difficulties. Qualitative feedback on strengths/limitations of the TMI in terms of content, tone, and delivery parameters was used to finalize the TMI for a future evaluation.

Conclusions

Results suggest that a TMI is a feasible and acceptable option for young people experiencing homelessness who are interested in quitting smoking.

Substance use off and on school grounds: A California statewide comparison between different groups of homeless students and nonhomeless students

About 1.3 million homeless students attend schools across the US, yet little is known about their substance use patterns, especially substance use on school grounds. The objectives of this study were to examine differences in substance use on and off school grounds between nonsheltered homeless, sheltered homeless, and nonhomeless public school students, and to examine the relationship between homelessness and substance use in school. Data were from a statewide representative sample from the California Healthy Kids Survey collected in 2011-2013, (n = 390,028). Bivariate and multivariate analyses were applied. Findings show that compared to nonhomeless students, homeless students, both sheltered and nonsheltered, reported higher rates of age at first time of use under the age of 10, and recent substance use, for an array of substances, indulging alcohol, cigarettes, marijuana and other illegal drugs. Additionally about 50% of nonsheltered homeless students, and 15% of sheltered homeless students reported having used substances in school in the past 30 days. Results from logistic regressions indicate that homelessness is associated with substance use in school. Particularly, nonsheltered homeless students were 17.41, 12.09, 11.36 and 17.59 times more likely to report smoking cigarettes, drinking alcohol, using marijuana and using other illegal drugs (respectively) in school in the past 30 days, compared to nonhomeless students. Sheltered homeless students were also more likely to use substances in school compared to nonhomeless students, but less likely compared to nonsheltered students. Findings highlight the need to develop differentiated school-based responses to each homeless subgroup and have conceptual, scientific and policy implications.

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

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.

Perceived Need and Receipt of Behavioral Health Services at Drop-In Centers among Homeless Youth

OBJECTIVE

Homeless youth are a population in need of housing assistance and case management, as well as services to address behavioral health problems. This study examines youth's perceived need for and receipt of services through drop-in centers.

DATA SOURCE

Surveys of 273 homeless youth.

STUDY DESIGN

Cross-sectional.

EXTRACTION METHODS

Descriptive analyses with bivariate and multivariable regression models.

PRINCIPAL FINDINGS

About one-third to half of the sample met criteria for behavioral health problems, yet half or less of those meeting criteria reported a need for services targeting the problems. Most youth who perceived a need for services received relevant services through a drop-in center, with the exception of care for substance use problems. Youth with behavioral health problems were more likely to perceive a need for services related to housing and case management than those addressing behavioral health problems more directly. Multivariable regression analyses indicated that the factors most strongly associated with perceived need for services were not behavioral health problems, but rather race/ethnicity, traveler status, trouble meeting basic needs, delinquency, abuse/victimization experiences, and trading sex.

CONCLUSIONS

Findings can help to develop outreach and intervention efforts to reach homeless youth and help promote the use of behavioral health services.

Predictors of Retention in an Alcohol and Risky Sex Prevention Program for Homeless Young Adults

Homeless young adults are at risk for alcohol and other drug (AOD) use and risky sexual behavior. Interventions are needed to help these young people reduce their risky behavior, but this population is often difficult to engage and retain in services. We offered a four-session AOD and risky sex reduction program to 100 participants and examined if retention in the program was predicted by a number of factors: demographics, homelessness severity, other service use, AOD behaviors, mental health symptoms, sexual risk behaviors, and readiness to change AOD and condom use. Nearly half (48%) of participants completed all sessions. In bivariate analyses, participants were significantly less likely to be retained in the program if they had slept outdoors in the past month, engaged in more alcohol and marijuana use, experienced more alcohol-related consequences, and received the program in an urban drop-in center (as opposed to a drop-in center near the beach). When controlling for all significant bivariate relationships, only sleeping outdoors and receipt of the program in the urban setting predicted fewer sessions completed. The most endorsed reasons for program non-completion were being too busy to attend and inconvenient day/time of the program. Findings can help outreach staff and researchers better prepare methods to engage higher risk homeless youth and retain them in services. Finding unique ways to help youth overcome barriers related to location of services appears especially necessary, perhaps by bringing services to youth where they temporarily reside or offering meaningful incentives for program attendance.

'Hello, you're not supposed to be here': homeless emerging adults' experiences negotiating food access

OBJECTIVE

We aimed to examine the food-seeking experiences of homeless emerging adults (age 18-24 years) in a US urban context.

DESIGN

The study used a qualitative descriptive design, combining semi-structured interviews with a standardized quantitative measure of food insecurity. Interview data were coded using constant comparative methods to identify patterns across and within interviews. Emerging themes were confirmed and refined through member checking.

SETTING

Buffalo, a mid-sized city in the Northeastern USA.

SUBJECTS

A sample of thirty participants was recruited through community-based methods. Eligibility criteria specified that participants were aged 18-24 years and did not have a stable place to live. The sample was demographically diverse and included participants who were couch-surfing, staying on the streets and/or using shelters.

RESULTS

Participants' food access strategies varied across their living circumstances. Common strategies included purchasing food with cash or benefits (reported by 77 %), using free meal programmes (70 %) and eating at friends' or relatives' homes (47 %). Although 70 % of participants received Supplemental Nutrition Assistance Program benefits, several reported access barriers, including initial denials of eligibility due to being listed on a parent's application even when the participant no longer resided in the household. Participants described a stigma associated with using food pantries and free meal programmes and expressed preference for less institutionalized programmes such as Food Not Bombs.

CONCLUSIONS

Given endemic levels of food insecurity among homeless youth and young adults, policy modifications and service interventions are needed to improve food access for this population.

Recruitment and Retention of Homeless Youth in a Substance Use and HIV-risk Reduction Program

Conducting intervention studies with homeless populations can be difficult, particularly in terms of retaining participants across multiple sessions and locating them for subsequent follow-up assessments. Homeless youth are even more challenging to engage due to substance use, mental health problems, wariness of authority figures, and frequent relocations. This article describes methods used to successfully recruit a sample of 200 homeless youth from two drop-in centers in Los Angeles, engage them in a four-session substance use and sexual risk reduction program (79% of youth attended multiple sessions), and retain 91% of the full sample at a three-month follow-up assessment. Our experience indicates that utilizing structured project materials and having a small dedicated staff are essential to recruitment and retention efforts for intervention studies with homeless youth. Using these and other nontraditional methods are likely necessary to engage this at-risk yet hard-to-reach population.

The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups

The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data ( N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.

Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review

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.

Violence in the Social Networks of Homeless Youths

This study examined social network processes related to interpersonal violence using a sample of 360 homeless youths from Los Angeles. Results indicated that violence is pervasive among homeless youths. Consistent with previous findings, hard drug use and childhood maltreatment experiences were closely related to violence experiences. Social network analyses revealed that having a higher proportion of violence-engaged peers in a youth’s network is associated with increased risk of personal violent behavior as well as having a high k-core number within the larger overall homeless youth network. The findings have important implications for the development of violence prevention programs for homeless youths, particularly the potential for network-based programs.

Sociometric network structure and its association with methamphetamine use norms among homeless youth

Homeless youths' social networks are consistently linked with their substance use. Social networks influence behavior through several mechanisms, especially social norms. This study used sociometric analyses to understand whether social norms of drug use behaviors are clustered in network structures and whether these perceived norms (descriptive and injunctive) influence youths' drug use behaviors. An event-based approach was used to delineate boundaries of the two sociometric networks of homeless youth, one in Los Angeles, CA (n = 160) and the other in Santa Monica, CA (n = 130). Network characteristics included centrality (i.e., popularity) and cohesiveness (location in dense subnetworks). The primary outcome was recent methamphetamine use. Results revealed that both descriptive and injunctive norms influenced methamphetamine use. Network cohesion was found to be associated with perception of both descriptive and injunctive norms in both networks, however in opposite directions. Network interventions therefore might be effective if designed to capitalize on social influence that naturally occurs in cohesive parts of networks.

Social Networking Technology Use and Engagement in HIV-Related Risk and Protective Behaviors Among Homeless Youth

Preliminary studies with homeless youth have found surprisingly pervasive social media use and suggest that youth's online interactions may be associated with their HIV-related risk and protective behaviors. As homeless youth are transient and difficult to engage in place-based services, social media may represent a novel venue for intervention. A critical 1st step in intervention development is gaining greater understanding of how homeless youth use social media, especially as it relates to who they connect to and around what topics. Given the salience of social networking sites in the lives of these otherwise difficult-to-reach adolescents, and their potential to disseminate prevention interventions, this study assessed associations between online social networking technology use and HIV risk behaviors among homeless youth in Los Angeles, California. Homeless youth ages 13 through 24 (N = 1,046) were recruited through 3 drop-in centers and surveyed about their social media use and self-reported HIV-related risk behaviors. Results suggest that social media use is widely prevalent among this population, and the content of these online interactions is associated with whether youth engage in risk or protective behaviors. Implications for interventions and further research are discussed.

Barriers and facilitators to shelter utilization among homeless young adults

Rates of shelter use among homeless youth are low compared to use of other supportive services, yet research on barriers to shelter use has been conducted in limited regions, specifically in West Coast or Midwest cities. Additionally, while studies have generally focused on barriers to shelter use, studies on what might facilitate shelter use are lacking. This study explores barriers and facilitators to shelter use among homeless young adults from a large city in the Southwest region. Focus groups were conducted with a diverse sample of 49 homeless young adults ages 18-24. Drawing on models of health service use, findings were categorized into two domains--attitudinal and access. Themes related to attitudinal barriers include stigma/shame and self-reliance/pride. Attitudinal facilitators include the desire to extricate themselves from street life and turn their lives in a new direction. Access-related themes include barriers such as a lack of shelters and services available to meet the needs of youth, adverse shelter conditions, staff attitudes that are not acceptable to youth, restrictive shelter rules, restrictive definitions of homelessness, and a desire to differentiate themselves from older homeless individuals. Certain characteristics or circumstances (e.g., being pregnant), having supportive others, and shelters' ability to connect them to other services emerged as access facilitators to shelter use. Implications for policymakers, service providers, and future research are discussed.

An Inside Look at Homeless Youths' Social Networks: Perceptions of Substance Use Norms

Substance use among homeless young people is a pervasive problem, and there have been many efforts to understand more about the dynamics of this health compromising behavior. The current study examined perceived substance use norms within homeless youths' social networks utilizing in-depth interviews. The sample included 19 homeless individuals aged 16 to 21. Four elements of substance use within networks emerged: substance use choices, drug use safety issues, encouragement and/or discouragement, and appropriate situations in which substance use is condoned. These findings provide unique insight into the norms associated with drug and alcohol use within homeless youths' social networks.

Understanding Consistent Condom Use Among Homeless Men Who Have Sex with Women and Engage in Multiple Sexual Partnerships: A Path Analysis

Consistent condom use is the main strategy aimed at preventing individuals from acquiring HIV through sexual intercourse. The mechanism of consistent condom use among a high-risk homeless subpopulation-homeless men who have sex with women and also engage in multiple sexual partnerships-remains unclear. This study identified 182 homeless men who engaged in multiple sexual partnerships from a representative sample of homeless men, who self-identified as heterosexual, using meal line services in Downtown Los Angeles' Skid Row area. Information such as participants' condom use psychosocial correlates, sexual risk behaviors, and social network characteristics were collected. Results suggested that condom efficacy is a potential intervening mechanism through which condom attitudes (β = -0.199; p = 0.005) and depression (β = -0.156; p = 0.029) are associated with an individual's consistent condom use. Having more network members with whom participants talked about HIV prevention (β = 0.051; p = 0.006) was also found to be associated with an individual's consistent condom use. HIV prevention programs should focus on increasing their condom efficacy to help reduce HIV risks among this vulnerable homeless subpopulation.

Child Abuse, Street Victimization, and Substance Use Among Homeless Young Adults

Although previous research documents high rates of child abuse, street victimization, and substance use among homeless youth, few studies have investigated these three constructs simultaneously, and thus little is known about how various forms of victimization are uniquely associated with substance use among this population. The purpose of this article is to examine the relationship among child sexual and physical abuse, street victimization, and partner violence with substance use among 172 homeless young adults. Path analysis results revealed that males and those who reported parental drug problems were significantly more likely to have higher rates of substance use. Those who suffered more childhood physical and sexual abuse and those who experienced more types of relationship violence were more likely to report greater frequency of substance use. The intersection of various forms of victimization with substance use may have important implications for service providers working with this population.

Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation

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.

Children Seeking Refuge: A Review of the Escalating Humanitarian Crisis of Child Sexual Abuse and HIV/AIDS in Latin America

Early identification and intervention for victims of child sexual abuse (CSA) is essential to halting the spread of HIV in Latino populations because children who are sexually abused are at an increased risk of contracting HIV. The recent influx of unaccompanied children into the United States exposed histories of victimization, vulnerability to CSA, and suggested an epidemic of CSA in Latin America. CSA has been identified as a contributory event to HIV infection. The aim of our research was to identify factors associated with CSA and Latin Americans. A systematic review and a document search were conducted on factors associated with CSA in Latin America. Victimization was associated with lifelong risk factors for HIV. Males were consistently underrepresented in the published CSA literature and machismo attitudes may contribute to abuses of sexual power by males and contribute to males not reporting or under-reporting victimization.

The Social Networks of Homeless Youth Experiencing Intimate Partner Violence

While there is a growing body of research on intimate partner violence (IPV) experienced by the housed youth population, a limited amount is known about IPV experienced by homeless youth. To our knowledge, no previous studies have examined how homeless youths' experience of IPV is related to their social network, even though the social networks of homeless youth have been shown to be significant indicators of health and mental health. The purpose of this study is to understand the relationship between IPV, gender, and social networks among a sample of 386 homeless youth in Los Angeles, California. Results revealed that one fifth of the sample experienced IPV in the past year. Stratified regression models revealed that IPV was not significantly related to any measure of male social networks; however, females who experienced IPV had more male friends (β = 2.03, SE = 0.89, p < .05) than females who did not experience IPV. Female homeless youth who witnessed family violence during childhood had more male friends (β = 2.75, SE = 1.08, p < .05), but those who experienced sexual abuse during childhood had fewer male friends (β = -2.04, SE = 0.93, p < .05). Although there was no significant difference in the rate of IPV victimization across genders, the context of this abuse appears to be drastically different. The results suggest that females with more male friendships are at greater risk for exposure to IPV. To date, there are few effective youth-targeted IPV prevention programs and none have been shown to be effective with homeless youth. These results provide insight into future program development.

Prescription drug misuse among homeless youth

BACKGROUND

Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth.

METHODS

A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM.

RESULTS

Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM.

CONCLUSIONS

Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.

Health and social harms associated with crystal methamphetamine use among street-involved youth in a Canadian setting

BACKGROUND AND OBJECTIVES

Despite recent increases in crystal methamphetamine use among high-risk populations such as street-involved youth, few prospective studies have examined the health and social outcomes associated with active crystal methamphetamine use.

METHODS

We enrolled 1,019 street-involved youth in Vancouver, Canada, in a prospective cohort known as the at-risk youth study (ARYS). Participants were assessed semi-annually and a generalized estimating equation (GEE) logistic regression was used to identify factors independently associated with active crystal methamphetamine use.

RESULTS

Among 1,019 participants recruited into ARYS between 2005 and 2012 the median follow up duration was 17 months, 320 (31.4%) participants were female and 454 (44.6%) had previously used crystal methamphetamine at baseline. In adjusted GEE analyses, active crystal methamphetamine use was independently associated with Caucasian ethnicity (adjusted odds ratio [AOR] = 1.37; 95% confidence interval [CI]: 1.04-1.81), homelessness (AOR = 1.34; 95% CI: 1.15-1.56), injection drug use (AOR = 3.40; 95% CI: 2.76-4.19), non-fatal overdose (AOR = 1.46; 95%CI: 1.07-2.00), being a victim of violence (AOR = 1.19; 95% CI: 1.02-1.38), involvement in sex work (AOR = 1.39; 95% CI: 1.03-1.86), and drug dealing (AOR = 1.60; 95% CI: 1.35-1.90).

DISCUSSION AND CONCLUSIONS

Prevalence of crystal methamphetamine use was high in this setting and active use was independently associated with a range of serious health and social harms.

SCIENTIFIC SIGNIFICANCE

Evidence-based strategies to prevent and treat crystal methamphetamine use are urgently needed.

Association between prescription drug misuse and injection among runaway and homeless youth

BACKGROUND

The nonmedical use of prescription drugs is the fastest growing drug problem in the United States, disproportionately impacting youth. Furthermore, the population prevalence of injection drug use among youth is also on the rise. This short communication examines the association between current prescription drug misuse (PDM) and injection among runaway and homeless youth.

METHODS

Homeless youth were surveyed between October 2011 and February 2012 at two drop-in service agencies in Los Angeles, CA. Prevalence ratios (PR) and 95% confidence intervals (CI) for the association between current PDM and injection behavior were estimated. The outcome of interest was use of a needle to inject any illegal drug into the body during the past 30 days.

RESULTS

Of 380 homeless youth (median age, 21; IQR, 17-25; 72% male), 84 (22%) reported current PDM and 48 (13%) reported currently injecting. PDM during the past 30 days was associated with a 7.7 (95% CI: 4.4, 13.5) fold increase in the risk of injecting during that same time. Among those reporting current PDM with concurrent heroin, cocaine, and methamphetamine use, the PR with injection was 15.1 (95% CI: 8.5, 26.8).

CONCLUSIONS

Runaway and homeless youth are at increased risk for a myriad of negative outcomes. Our preliminary findings are among the first to show the strong association between current PDM and injection in this population. Our findings provide the basis for additional research to delineate specific patterns of PDM and factors that enable or inhibit transition to injection among homeless and runaway youth.

Injecting risk behavior among traveling young injection drug users: travel partner and city characteristics

Young injection drug users (IDUs), a highly mobile population, engage in high levels of injecting risk behavior, yet little is understood about how such risk behavior may vary by the characteristics of the cities to which they travel, including the existence of a syringe exchange program (SEP), as well as travel partner characteristics. In 2004-2005, we conducted a 6-month prospective study to investigate the risk behavior of 89 young IDUs as they traveled, with detailed information gathered about 350 city visits. In multivariable analyses, travel to larger urban cities with a population of 500,000-1,000,000 was significantly associated with injecting drugs (adjusted odds ratio (AOR) = 3.71; 95 % confidence interval (CI), 1.56-8.82), ancillary equipment sharing (AES; AOR = 7.05; 95 % CI, 2.25-22.06) and receptive needle sharing (RNS; AOR = 5.73; 95 % CI, 1.11-27.95), as compared with visits to smaller cities with populations below 50,000. Region of the country, and the existence of a SEP within the city visited, were not independently associated with injecting drugs, AES, or RNS during city visits. Traveling with more than one injecting partner was associated with injecting drugs during city visits (AOR = 2.77; 95 % CI, 1.46-5.27), when compared with traveling alone. Additionally, both non-daily and daily/almost daily alcohol use during city visits were associated with AES (AOR = 3.37; 95 % CI, 1.42-7.68; AOR = 3.03; 95 % CI, 1.32-6.97, respectively) as compared with no alcohol consumption. Traveling young IDUs are more likely to inject when traveling with other IDUs and to engage in higher risk injection behavior when they are in large cities. Risk behavior occurring in city visits, including equipment sharing and alcohol consumption, suggests further need for focused interventions to reduce risk for viral infection among this population.

Invited commentary: seeking a coherent strategy in our response to homeless and street-involved youth: a historical review and suggested future directions

This invited commentary seeks to encourage a critical dialogue about youth homelessness that might assist in re-energizing a field that seems increasingly stagnant with a research body focused primarily on analyses of risk, hopelessly inadequate policy frameworks in most cities, diminishing funds for services, and decreasing media attention. Reviewing major trends in research and public responses to youth homelessness in the past century, I propose that there exist three major culturally-bound dimensions from which we construct our understanding of and responses to youth homelessness. These dimensions, which are considered in a transactional framework, are the scope of responsibility, the location of moral responsibility, and the amount of agency attributed to the youth. In this review I highlight the manner in which our historically binary and uncritical understanding of these dimensional characterizations of youth homelessness has led to major lapses in the effectiveness of our collective efforts to address this problem. I highlight gaps in the existing body of research literature and provide this framework, arguing that a strategic and cohesive response is vital if we are to move from reiterations of risk and hackneyed calls for prevention strategies to the generation of meaningful solutions.

'It's just a social thing': drug use, friendship and borderwork among marginalized young people

This article joins a growing chorus of researchers who doubt the utility of the concept of peer pressure for explaining young people's initiation to and use of drugs. Drawing on interview data with 45 patrons of a youth drop-in centre in Ottawa, Canada, we argue that drug use is more intricately woven into friendship - affective relationships of trust and intimacy, belonging and sharing - rather than simply part of the unidirectional pressures some young people put on others to fit in to a subculture. Marginalized young people's narratives show that drugs and alcohol furnish them with a relatively inexpensive pastime to share with friends, introducing opportunities for intimacy that are otherwise difficult to attain at the individualistic and isolating margins of neoliberal cities. We demonstrate how young drug users draw boundaries between acceptable and unacceptable relationships to drugs and alcohol, articulating an important sense of belonging to a superior group of drug users. Through this 'borderwork', they solidify the bonds they share with the people with whom they smoke cannabis and drink alcohol.

Understanding pregnancy-related attitudes and behaviors: a mixed-methods study of homeless youth

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.

Are social network correlates of heavy drinking similar among black homeless youth and white homeless youth?

OBJECTIVE

Understanding factors associated with heavy drinking among homeless youth is important for prevention efforts. Social networks are associated with drinking among homeless youth, and studies have called for attention to racial differences in networks that may affect drinking behavior. This study investigates differences in network characteristics by the racial background of homeless youth, and associations of network characteristics with heavy drinking. (Heavy drinking was defined as having five or more drinks of alcohol in a row within a couple of hours on at least one day within the past 30 days.)

METHOD

A probability sample of 235 Black and White homeless youths ages 13-24 were interviewed in Los Angeles County. We used chi-square or one-way analysis of variance tests to examine network differences by race and logistic regressions to identify network correlates of heavy drinking among Black and White homeless youth.

RESULTS

The networks of Black youth included significantly more relatives and students who attend school regularly, whereas the networks of White youth were more likely to include homeless persons, relatives who drink to intoxication, and peers who drink to intoxication. Having peers who drink heavily was significantly associated with heavy drinking only among White youth. For all homeless youth, having more students in the network who regularly attend school was associated with less risk of heavy drinking.

CONCLUSIONS

This study is the first to our knowledge to investigate racial differences in network characteristics and associations of network characteristics with heavy drinking among homeless youth. White homeless youth may benefit from interventions that reduce their ties with peers who drink. Enhancing ties to school-involved peers may be a promising intervention focus for both Black and White homeless youth.

Unprotected sex of homeless youth: results from a multilevel dyadic analysis of individual, social network, and relationship factors

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.