Substance use predictors of victimization profiles among homeless youth: a latent class analysis

Patterns of Poly-Victimization Among Early Adolescents: A Latent Class and Two-Wave Latent Transition Analysis

Background

Poly-victimization involves more than just counting incidents; it varies in severity and type among adolescents and can change over time.

Objective

The aim is to identify latent classes of poly-victimization among children in early adolescence, investigate transition probabilities between these latent categories, and examine the influencing factors.

Methods

We used stratified cluster random sampling to select 2275 junior high students from five rural middle schools in Shantou and Jieyang, China, and surveyed them in two waves. Latent Class Analysis (LCA) and Latent Transition Analysis (LTA) identified latent classes of poly-victimization, and multi-factor logistic regression examined factors influencing the probability of students transitioning between these latent classes.

Results

LCA identified three categories of poly-victimization: low poly-victimization, group, and high child maltreatment and peer and sibling victimization. The probabilities of remaining in the high child maltreatment and peer and sibling victimization group, transitioning to the transition group, or shifting to the low poly-victimization group were 37.00%, 29.20%, and 33.80%, respectively. Most transition group members remained in the same group, with a conversion probability of 77.10%, followed by transitioning to the low poly-victimization group with a probability of 15.80%. Physically healthy children, compared to those with disabilities or illnesses, were less likely to switch from the low poly-victimization group to the transition group (OR=0.034) or the high child maltreatment and peer and sibling victimization group (OR=0.14). Non-left-behind children, compared to left-behind children, have a higher probability of switching from the high child maltreatment and peer and sibling victimization group to the low poly-victimization group (OR=6.905).

Conclusion

The high child maltreatment and peer and sibling victimization group had similar probabilities of transitioning into other categories. Physical illness or disability, as well as being left behind, are significant risk factors for children transitioning from the low-harm group to the high-harm group.

Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis

BACKGROUND

Substance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics.

METHODS

From June 2016 to July 2017, 1,426 YEH (aged 18-26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership.

RESULTS

Four latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH.

CONCLUSIONS

These findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.

Prevalence and Correlates of Sexual Violence Experienced by Young Adult Black Men Who Have Sex with Men

Men who have sex with men (MSM) experience high prevalence of sexual violence (SV), and SV has well-documented effects on health. Research gaps are especially evident for young Black MSM (YBMSM), who experience significant HIV disparities and syndemics, including multiple forms of violence victimization. We examined lifetime prevalence of SV (having been forced or frightened into sexual activity) in a cross-sectional sample of YBMSM (N = 1732), and tested associations of demographic, psychosocial, and structural factors using multivariable regression. YBMSM were recruited between 2013 and 2015 using modified venue-based time-location sampling (e.g., at bars and clubs) in Dallas and Houston, Texas. Approximately 17% of YBMSM experienced any SV in their lifetimes. SV was associated with high school non-completion (OR 1.78; 95% CI 1.15-2.77), lower psychological resilience (OR 0.84; 95% CI 0.71-0.98), lifetime history of homelessness (OR 5.52; 95% CI 3.80-8.02), recent financial hardship (OR 2.16; 95% CI 1.48-3.14), and recent transactional sex (OR 3.87; 95% CI 2.43-6.15). We also examined differences by age of SV onset (childhood versus adulthood). YBMSM with adolescent/emerging adult-onset SV may have been more ambivalent in reporting lifetime SV experience, compared to men with childhood-onset SV, and correlates differed by age of onset. Childhood-onset SV was associated with high school non-completion, lower levels of psychological resilience, history of homelessness, recent financial hardship, and recent transactional sex. Adolescent/emerging adult-onset SV was associated with greater depressive symptoms, history of homelessness, and recent financial hardship. There is a need for multi-level approaches to SV prevention and treatment, including services and supports that are culturally-relevant and responsive to the needs of YBMSM.

Can Better Emotion Regulation Protect Against Interpersonal Violence in Homeless Youth Social Networks?

Homeless youth experience all types of violence at higher rates than their housed counterparts. This is typically the result of many contributing factors including childhood experiences of trauma, subsistence survival strategies, and exposure to perpetrators while living on the streets. Reducing violence in the lives of homeless youth is imperative and can contribute to a young person's ability to safely and successfully exit the streets and lead a long and productive life in society. However, developing public health and social interventions to reduce violence in adolescent and young adult populations is difficult due to the complex interplay of extrinsic and intrinsic drivers of this phenomenon. Los Angeles area homeless youth (N = 366) were asked questions regarding recent violence experiences, emotion regulation, and their social network. Multivariable logistic regressions tested the overall effect of emotion regulation on violence, controlling for age, gender, race, sexual identity, experience of childhood abuse, and data collection site. In this sample, 56% of youth endorsed fighting in the previous year, and those who reported more difficulties with emotion regulation were significantly more likely to fight. In addition, youth who scored below the mean on difficulties with regulation and belonged to networks characterized by low-difficulty peers were 60% less likely to report fighting. Emotion regulation skills represent a malleable target for intervention that may contribute to reduced propensity for violence in this population. Implications for network-based interventions to improve individual emotion regulation and reduce overall violence among homeless youth and other at-risk populations are discussed.

Health, Homelessness Severity, and Substance Use among Sexual Minority Youth Experiencing Homelessness: A Comparison of Bisexual Versus Gay and Lesbian Youth

Lesbian, gay, bisexual, and questioning (LGBQ) youth are overrepresented among youth experiencing homelessness (YEH), and health disparities among LGBQ youth are well-documented. LGBQ youth are typically aggregated as a single sexual minority group; however, research suggests that bisexual youth may have greater mental health, substance use, and physical health risks relative to their gay and lesbian peers. In a probability sample of LGBQ YEH in Los Angeles County (n = 183), we examined subgroup differences in homelessness severity, depression, physical health, and substance use, focusing on differences between bisexual and gay/lesbian youth due to the small subsample of questioning youth. Indicators of homelessness severity were standalone outcomes, and also were integrated as control variables with gender, age, race/ethnicity, and education in multivariable models. Bisexual youth were more likely to have become unaccompanied homeless persons as minors (OR = 4.35, 95% CI 1.85-10.23), and to have not recently utilized emergency shelters or transitional housing at least once in the past month (OR = 6.41; 95% CI 2.41-17.03). Bisexual youth were more likely to have probable depression (OR = 4.06, 95% CI 1.41-11.68). Among sexual minority YEH, bisexual youth may be at elevated risk for depression, in addition to more severe homelessness.

Influences of victimization and comorbid conditions on substance use disorder outcomes in justice-involved youth: A discrete time survival mixture analysis

To understand how exposure to victimization during adolescence and the presence of comorbid psychological conditions influence substance use treatment entry and substance use disorder diagnosis from 14 to 25 years old among serious juvenile offenders, this study included 1,354 serious juvenile offenders who were prospectively followed over 7 years. Growth mixture modeling was used to assess profiles of early victimization during adolescence (14-17 years). Discrete time survival mixture analysis was used to assess time to treatment entry and substance use disorder diagnosis. Posttraumatic stress disorder (PTSD) and major depressive disorder (MDD) were used as predictors of survival time. Mixture models revealed three profiles of victimization: sustained poly-victimization, moderate/decreasing victimization, and low victimization. Youth in the sustained poly-victimization class were more likely to enter treatment earlier and have a substance use diagnosis earlier than other classes. PTSD was a significant predictor of treatment entry for youth in the sustained poly-victimization class, and MDD was a significant predictor of substance use disorder diagnosis for youth in the moderate/decreasing victimization class. Therefore, substance use prevention programming targeted at youth experiencing poly-victimization in early adolescence-especially those who have PTSD or MDD-is needed.

Childhood Disadvantage, Social and Psychological Stress, and Substance Use Among Homeless Youth: A Life Stress Framework

We used a life stress framework to examine linkages between distal or primary stressors (e.g., child abuse) and proximal or secondary stressors (e.g., street victimization) and their association with substance use among 150 youth experiencing homelessness in the Midwestern United States. Results revealed that numerous primary stressors such as number of times youth ran from home and number of foster care placements were associated with secondary stressors, such as anxiety, total duration of homelessness, and street victimization. Only street physical victimization (e.g., been beaten up since leaving home) was associated with greater substance use. Our findings provide a more holistic picture of both distal and proximal life stressors that these young people experience and reveal the complexity of issues that service providers must acknowledge when working with this population.

Sexual risk classes among youth experiencing homelessness: Relation to childhood adversities, current mental symptoms, substance use, and HIV testing

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.

Social and psychological resources among homeless youth: protection against risk for physical victimization?

This study examines child physical abuse, social and psychological resources, and street physical victimization among 150 homeless youth from the Midwest. Path analyses results show that males have higher self-efficacy than females, while older youth and those who experienced less child physical abuse reported higher self-esteem. Self-efficacy and self-esteem were positively associated with social support as was being younger and having experienced less child physical abuse. Younger respondents reported fewer difficulties obtaining basic necessities, and those who had less trouble finding these necessities experienced less street physical victimization. Females, younger youth, and those who experienced less child physical abuse reported lower rates of physical victimization. Agencies should be aware that many youth experiencing homelessness have trouble obtaining basic necessities, which increases risk for victimization. Moreover, the ability to obtain necessities appears to override the influential role of social support, further affirming the foundational importance of agencies helping youth meet their basic needs.

Violent Poly-Victimization: The Longitudinal Patterns of Physical and Emotional Victimization Throughout Adolescence (11-17 Years)

In this study, we aimed to characterize developmental patterns of poly-victimization in a normative sample of adolescents by applying longitudinal latent class analysis. Using the four most recent waves of data from the Zurich Project on the Social Development of Children and Youths (z-proso), we identified three classes, or separate groups, of youths with distinct patterns of victimization from age 11 to 17. The largest class represented young people who were least likely to be victimized in any way and at any time. The two smaller groups represented different types of poly-victimization-a non-parental and a long-term parental victimization group. Adolescents in the two groups differed both in the number as well as type of victimization that they experienced at different times. Moreover, class membership also had implications for different mental health outcomes.

A comparison of risk factors for various forms of trauma in the lives of lesbian, gay, bisexual and heterosexual homeless youth

Numerous homeless youth experience trauma prior to leaving home and while on the street. Bullying and trading sex (i.e. exchanging sexual favors for survival items such as food) are additional forms of trauma experienced by many homeless youth. Although lesbian, gay, and bisexual (LGB) homeless youth experience higher rates of child abuse compared to their heterosexual counterparts, there is a paucity of research comparing these two groups. As such, we compare whether difficulties finding items of necessity (e.g. food) and different forms of trauma including child sexual abuse, being bullied, trading sex, and street sexual victimization significantly differ for LGB and heterosexual homeless youth. Bivariate results reveal that LGB youth have more trouble finding shelter and are more likely to trade sex compared to heterosexual youth. Logistic regression results show that trading sex is correlated with street sexual victimization. In the second model, we find that being female, experiencing more child sexual abuse, and ever having traded sex are all positively linked with street sexual victimization. LGB youth are over-represented among homeless youth populations and are also more likely to trade sex; therefore, these young people need services that are widely accessible and specific to their needs.

Poly-victimization and trajectories of binge drinking from adolescence to young adulthood among serious juvenile offenders

BACKGROUND

Justice involved youth exposed to multiple forms of victimization (i.e., poly-victimization) may be at risk for long term substance use problems and difficulty in self-regulation, placing them at higher risk of long-term problematic behaviors. This study empirically identifies victimization classifications in a sample of justice involved youth and how long-term binge drinking is related to victimization experiences. We further sought to understand how self-regulatory abilities such as impulse control and emotion regulation effect emergent profiles and binge drinking trajectories.

METHODS

Based on a sample of 1354 justice involved youth from 15 to 25 years old, classes of victimization were extracted. Emergent classes were examined in relationship to their binge drinking trajectories using latent growth models. Finally, self-regulation was examined as a predictor of binge drinking trajectories across emergent classes.

RESULTS

The analyses indicated three classes of victimization: poly-victimized, indirectly victimized, and lowly victimized. Latent growth models revealed that the poly-victimized class had significantly steeper growth in binge drinking as compared to the indirect and low victimized patterns. Impulse and emotional regulation both significantly decelerated binge drinking only for the indirect victimization group.

CONCLUSIONS

Findings highlight the need to focus on poly-victimization in understanding binge drinking trajectories as well as the role impulse control and emotional regulation play among justice involved youth. Findings are discussed through the lens of adolescent development, coping strategies, and early traumatic experiences.

Mental health correlates of victimization classes among homeless youth

Literature reports high rates of street victimization among homeless youth and recognizes psychiatric symptoms associated with such victimization. Few studies have investigated the existence of victimization classes that differ in type and frequency of victimization and how youth in such classes differ in psychiatric profiles. We used latent class analysis (LCA) to examine whether classes of homeless youth, based on both type and frequency of victimization experiences, differ in rates of meeting diagnostic criteria for major depressive episodes and posttraumatic stress disorder (PTSD) in a sample of homeless youth (N=601) from three regions of the United States. Results suggest youth who experience high levels of direct and indirect victimization (high-victimization class) share similarly high rates of depressive episodes and PTSD as youth who experience primarily indirect victimization only (witness class). Rates of meeting criteria for depressive episodes and PTSD were nearly two and three times greater, respectively, among the high victimization and witness classes compared to youth who never or rarely experienced victimization. Findings suggest the need for screening and intervention for homeless youth who report direct and indirect victimization and youth who report indirect victimization only, while prevention efforts may be more relevant for youth who report limited victimization experience.