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Petering R, Rice E, Rhoades H. Violence in the Social Networks of Homeless Youths. JOURNAL OF ADOLESCENT RESEARCH 2016. [DOI: 10.1177/0743558415600073] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
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.
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Affiliation(s)
| | - Eric Rice
- University of Southern California, Los Angeles, CA, USA
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Nicholas DB, Newton AS, Calhoun A, Dong K, deJong-Berg MA, Hamilton F, Kilmer C, McLaughlin AM, Shankar J. The Experiences and Perceptions of Street-Involved Youth Regarding Emergency Department Services. QUALITATIVE HEALTH RESEARCH 2016; 26:851-62. [PMID: 25829466 DOI: 10.1177/1049732315577605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
Street-involved (SI) youth comprise a substantial component of the urban homeless population. Despite being significant users of hospital emergency department (ED) services for acute and ongoing health needs, little is known about their experiences of ED care and the factors affecting their ED use. This study used a grounded theory and community-based approach to examine these issues. Focus groups and individual interviews were facilitated with 48 SI youth between ages 15 and 26 years, recruited in hospital or through community agencies serving SI youth in a major Western Canadian city. Results demonstrate that SI youth often perceived suboptimal care and experienced long waiting periods that led to many avoiding or prematurely exiting the ED. Service gaps appeared to have a negative bearing on their care and health outcomes. Findings invite a critical review of ED care processes, structures, and staff interactions in the aim of enhancing ED services to SI youth.
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Affiliation(s)
| | | | | | - Kathryn Dong
- University of Alberta, Edmonton, Alberta, Canada
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Barry PJ, Ensign J, Lippek SH. Embracing street culture: fitting health care into the lives of street youth. J Transcult Nurs 2002; 13:145-52. [PMID: 11951718 DOI: 10.1177/104365960201300208] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
The purpose of this article is to describe a unique model for the provision of comprehensive primary health care for homeless youth in Seattle, Washington. Through the description of our program, we argue for the use of youth-centric instead of youth-friendly programs. This means a change from using the friendly health program as the central focus to having the young people be the starting point and adapting the health service to meet their needs. We describe how our model of care optimizes chances for homeless youth to establish positive connections with caring adults. We also show how homeless youth have their own street culture, which is of primary importance to them and which has a powerful impact on how they use and view health care.
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Huba GJ, Melchior LA, Woods ER, Panter AT, Feudo R, Schneir A, Trevithick L, Wright E, Martinez R, Sturdevant M, Remafedi G, Greenberg B, Tierney S, Wallace M, Goodman E, Tenner A, Marconi K, Brady RE, Singer B. Service use patterns of youth with, and at high risk for, HIV: a care typology. AIDS Patient Care STDS 2000; 14:359-79. [PMID: 10935053 DOI: 10.1089/108729100413239] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
This paper uses confirmatory structural equation models to develop and test a theoretical model for understanding the service utilization history of 4679 youth who received services from 10 national HIV/AIDS demonstration models of youth-appropriate and youth-attractive services funded by the Special Projects of National Significance (SPNS) Program, HIV/AIDS Bureau, Health Resources and Services Administration. Although the projects differ from one another in the areas of emphasis in their service models, each is targeted to youth at high risk for HIV, or those youth who have already contracted HIV. Collectively, the projects represent a comprehensive adolescent HIV service model. This paper examines the characteristics of the services provided to young people ranging from outreach to intensive participation in medical treatment. Major typologies of service utilization are derived empirically through exploratory factor and cluster analysis methods. Confirmatory structural equation modeling methods are used to refine the exploratory results using a derivation and replication strategy and methods of statistical estimation appropriate for non-normally distributed service utilization indicators. The model hypothesizes that youth enter the service system through a general construct of connectedness to a comprehensive service model and through service-specific methods, primarily of outreach or emergency services. Estimates are made of the degree to which a comprehensive service model drives the services as opposed to specific service entry points.
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Affiliation(s)
- G J Huba
- Measurement Group, Culver City, California, USA.
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Ensign J, Gittelsohn J. Health and access to care: perspectives of homeless youth in Baltimore City, U.S.A. Soc Sci Med 1998; 47:2087-99. [PMID: 10075249 DOI: 10.1016/s0277-9536(98)00273-1] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Homeless youth suffer from high rates of health problems, yet little is known about their perceptions of or context for their own health issues. In this study, a combination of qualitative techniques from participatory rural appraisal and rapid assessment procedures was used to investigate the perceptions of health needs of shelter-based youth in Baltimore, MD in the U.S.A. The most common youth-identified health problems included STDs, HIV/AIDS, pregnancy, depression, drug use and injuries. These correlate well with more objective health status data for the same youth. The youth spoke of environmental safety threats of violence and victimization by adults, as well as racism and sexism in their lives. Youth reported that trusted adult figures such as grandmothers are important sources of health advice. Many homeless youth from less than ideal family situations remain in contact with and continue to seek advice from parents and other family members. Health interventions with urban street youth need to acknowledge the primacy of the social context for these youth, as well as the reality of violence as a daily health threat.
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Affiliation(s)
- J Ensign
- Department of Psychosocial and Community Health, University of Washington, Seattle 98195, USA.
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Clements K, Gleghorn A, Garcia D, Katz M, Marx R. A risk profile of street youth in northern California: implications for gender-specific human immunodeficiency virus prevention. J Adolesc Health 1997; 20:343-53. [PMID: 9168381 DOI: 10.1016/s1054-139x(97)00033-5] [Citation(s) in RCA: 83] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To assess human immunodeficiency virus (HIV) risk behaviors of street youth and to determine whether risk behaviors differ by gender or housing status. METHODS Using systematic street-based sampling in four Northern California cities, we recruited 429 street youth (mean age = 19.2 years). Participants completed a structured interview which was used to assess sexual and drug HIV risk behaviors. RESULTS The majority of youth were heterosexual (85%), white (77%), male (68%), and currently without any type of stable housing (75%). Although 60% of the sample had had vaginal sex in the past 30 days, only 44% used a condom the last time they had sex. About one-third (32%) of the sample reported ever injecting drugs, and almost all reported lifetime use of multiple drugs including D-lysergic acid diethylamide (96%), marijuana (90%), alcohol (81%), cocaine (70%), and speed (70%). Compared to males, females were equally likely to use injection and noninjection drugs, but were more likely to be sexually active (P < .001), were more likely to have been diagnosed with a sexually transmitted disease (P = .005), and were less likely to report consistent condom use (P = .003) or intent to use condoms consistently in the future (P = .005). Compared with those with stable housing, youth who were currently without such housing reported higher rates of injection, and other drug use; females without stable housing were less likely to have used condoms the last time they had vaginal intercourse. CONCLUSION The high level of HIV risk behavior in this street-based sample of youth, particularly females and youth without stable housing, suggests an urgent need for gender-specific prevention efforts and an increased range of housing options.
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Affiliation(s)
- K Clements
- San Francisco Department of Public Health, AIDS Office, CA 94102, USA
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Abstract
Although the exact number of homeless adolescents is unknown, it is estimated that this population may exceed 2 million. Literally living on the streets, homeless youth are at risk for a variety of physical, psychosocial, and spiritual health problems. Many engage in "survival sex," exchanging sexual favors for necessities of food, clothing, and shelter. Such risky sexual behaviors make them vulnerable to sexually transmitted diseases, including human immunodeficiency virus (HIV) and acquired immunodeficiency syndrome (AIDS), and unintended pregnancies. Many have serious, diagnosable mental health problems, whereas others suffer various consequences of substance abuse. There is a need for comprehensive and holistic health care services, for which the majority of homeless youth have very limited access. Holistic nursing can provide creative interventions for thus vulnerable population.
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Affiliation(s)
- L Rew
- University of Minnesota, USA
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Bradford MS. Health concerns and prevalence of abuse and sexual activity in adolescents at a runaway shelter. Appl Nurs Res 1995; 8:187-90. [PMID: 8579352 DOI: 10.1016/s0897-1897(95)80417-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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Abstract
PURPOSE Although runaway and homeless adolescents are at high risk for acquiring HIV infection, little is known about which of these youth obtain HIV testing or whether those considered to be at highest risk are being tested. The purpose of our study was to determine demographic characteristics and risk profiles of runaway and homeless adolescents who had obtained an HIV test and compare them to those who had not been tested. METHODS We analyzed data collected by the State of California from a survey of 202 San Francisco Bay area runaway and homeless youth aged 13-18 years conducted in 1990-1991. Adolescents were interviewed about AIDS-related knowledge, attitudes, beliefs, and behaviors, including HIV testing experience. RESULTS Most subjects were 16 years or older (80%), white (61%), sexually active (91%) and heterosexual (82%). Twenty-three percent reported a previous sexually transmitted disease (STD); 27% had used injection drugs. Over half (54%) had been HIV antibody tested. Free/community clinics were the most common site for testing. In a logistic regression model, four variables were independent predictors of having obtained an HIV antibody test: history of an STD (p = 0.01), 5 or more years of sexual activity (p = 0.01), injection drug use (P = 0.04), and age (p = 0.04). CONCLUSIONS Our study demonstrates that many runaway and homeless adolescents have obtained an HIV antibody test and that those with known risk factors are more likely to have been tested. These data support the need for community-based expansion of HIV-related services for homeless youth. The effects of HIV antibody testing on subsequent beliefs and behaviors need further study.
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Affiliation(s)
- E Goodman
- Division of Adolescent Medicine, Children's Hospital, Boston, MA
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Abstract
Relatively little is know about the sexual behaviors of high-risk adolescents, such as delinquent and homeless youths. Having secured data from medical examinations, this study provides sexual risk profiles for a sample of delinquent (N = 245) and homeless (N = 160) youths in San Francisco, California. The study found several indicators of high-risk behaviors, such as high levels of STDs, trading sex for money or drugs, and unprotected sexual relations with multiple partners. The study suggests that communities provide better sex education and medical services to high-risk adolescents through multi-service health clinics, public health clinics, and street outreach.
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Affiliation(s)
- M L Forst
- URSA Institute, San Francisco, CA 94107
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Pinto JA, Ruff AJ, Paiva JV, Antunes CM, Adams IK, Halsey NA, Greco DB. HIV risk behavior and medical status of underprivileged youths in Belo Horizonte, Brazil. J Adolesc Health 1994; 15:179-85. [PMID: 8018693 DOI: 10.1016/1054-139x(94)90547-9] [Citation(s) in RCA: 27] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
METHODS From June 1989 to April 1991, 394 adolescents aged 10-18 years randomly selected upon admission at a state shelter in Belo Horizonte, Brazil underwent health history interview, physical examination, serology for HIV, hepatitis B, and syphilis, and stool examination. Participants were classified as street-based youths (n = 195) or home-based youths (n = 199). The age distribution was similar in both groups, although males were overrepresented among street-based youths (79.5% versus 62.3%). RESULTS Compared with home-based youths, street-based youths reported earlier onset (p = 0.009) and higher rates of sexual activity (odds ratio [OR], 2.1; 95% confidence interval [CI], 1.4-3.3), sexual abuse (OR, 3.7; 95% CI, 1.2-10.1), and sexually transmitted diseases (OR, 2.9; 95% CI, 1.3-6.6). Overall condom use was low in both groups. Street-based youths were 7.8 times more likely to use drugs than home-based youths (95% CI, 4.9-12.7). Inhalants and marijuana were the more commonly used drugs. Intravenous drug use was low. CONCLUSIONS Although chronic malnutrition and multiple parasitosis were common findings in both groups, street-based youths were more likely to present disorders related to trauma and poor hygienic conditions. Antibodies to HIV were detected in four (2%) street-based youths and in none of the home-based youths. This study confirms that street youths are at higher risk for HIV infection than their home-based peers and indicates a need for HIV prevention programs targeting this population.
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Affiliation(s)
- J A Pinto
- Service of Parasitic and Infectious Diseases, School of Medicine, Federal University of Minas Gerais, Belo Horizonte, Brazil
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Abstract
The overall health status of delinquent and homeless youths is of increasing concern. These high-risk youth populations have a variety of health problems, including relatively high levels of substance abuse. This study provides empirical data on the substance use behaviors of a sample of delinquent and homeless youths in San Francisco, California. The data, secured within the context of medical examinations, indicate that both samples use tobacco, alcohol, and illicit drugs at higher rates than the general adolescent population. The study concludes that drug education and prevention programs must be tailored to fit the needs and lifestyles of these two populations, and that the programs should be provided within the broader context of adolescent health care.
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