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Diana P, Esposito S. Epidemiology, risk factors, and prevention strategies of HIV, HPV, and other sexually transmitted infections among cisgender and transgender youth: a narrative review. Front Public Health 2024; 12:1342532. [PMID: 38515602 PMCID: PMC10955097 DOI: 10.3389/fpubh.2024.1342532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Accepted: 02/26/2024] [Indexed: 03/23/2024] Open
Abstract
Adolescents face an increased risk of contracting sexually transmitted infections (STIs) with alarming data especially concerning HIV. Limited data exists for teenagers regarding the influence of their gender identity (GI) and sexual orientation on the risk of STIs. This narrative review aims to analyse the available data to provide a comprehensive overview of STIs incidence and risk factors among adolescents, taking into account the unique circumstances related to various sexual orientations and GIs. Transgender and gender minority (TGM) youth experience more challenges accessing health services compared to cisgender youth. This is often attributed to non-inclusive health environments, barriers to obtaining medical gender affirmation, and an underestimation of sexual risk perception. Literature analysis has revealed that the majority of adolescents, both cisgender and TGM, have limited awareness regarding the risks associated with their sexual behaviors, the most common sexually transmitted diseases, and strategies for prevention, such as PrEP and HPV vaccination. Moreover, a significant portion of pediatricians possess limited knowledge and comfort in addressing various aspects of sexual health, particularly when it involves discussing topics such as sexual orientation, gender identity, and sexual behaviors with sexually active adolescents. This underscores the pressing need for enhanced education for pediatricians, specifically focusing on STIs diagnosis, prevention, and screening.
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Affiliation(s)
| | - Susanna Esposito
- Pediatric Clinic, Pietro Barilla Children’s Hospital, Department of Medicine and Surgery, University Hospital of Parma, Parma, Italy
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Orsi-Hunt R, Clemens EV, Thibodeau H, Belcher C. Young Adults with Lived Foster Care Experience Who Later Experience Houselessness: an Exploratory Latent Class Analysis. INTERNATIONAL JOURNAL ON CHILD MALTREATMENT : RESEARCH, POLICY AND PRACTICE 2023:1-25. [PMID: 37360287 PMCID: PMC10130814 DOI: 10.1007/s42448-023-00160-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/14/2023] [Indexed: 06/28/2023]
Abstract
Young adults with lived experience in out-of-home care during childhood report later experiences of housing instability as common. Existing literature identifies a host of factors compounding an individual's risk of experiencing houselessness, but research has yet to explore constellations of characteristics which describe youth formerly in care who later become unhoused. This exploratory study leverages a public-private data linkage collaborative to integrate and de-identify child welfare data extracted from a Rocky Mountain state's administrative database and houselessness service utilization data from a regional provider in a large metro area of the state. Linkage and sampling yielded a final sample of 285 youth (ages 18 to 24) formerly in foster care who accessed houselessness services between December 2018 and March 2020 and who had signed required consents. A 22-measure latent class analysis identified three characteristic groups: intensive youth corrections involvement and emancipation from the child welfare system (32% of sample); family-based challenges, neglect, and more moderate youth corrections involvement (41% of sample); and youth behavior and substance use challenges along with family reunification before accessing houselessness services (26%). We found that young women and Black, Indigenous, and people of color were disproportionately represented in the sample compared to the state's population of youth in out-of-home care. Youth with long histories of child welfare placement were a majority of the sample. Implications are discussed. Data-sharing barriers must be addressed to facilitate further research aimed at understanding houselessness within this population.
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Affiliation(s)
- Rebecca Orsi-Hunt
- Kempe Center for the Prevention and Treatment of Child Abuse and Neglect, University of Colorado School of Medicine, 13123 E. 16th Ave, Box 390, Aurora, CO 80045 USA
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Phillips G, Davoudpour S, Floresca YB, Felt D, Curry CW, Wang X, Choi J, Kelsey SW, Beach LB. Disparities in HIV Testing, Condom Use, and HIV Education Between Transgender and Not Transgender High School-Aged Youth: Findings From the 2019 Youth Risk Behavior Survey. HEALTH EDUCATION & BEHAVIOR 2023; 50:29-40. [PMID: 36540958 DOI: 10.1177/10901981221142238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Transgender individuals are disproportionately affected by HIV in the United States. Given increased risk of HIV among youth, there is a need to understand HIV risk and protective factors among transgender individuals who are 18 years and younger. Patterns of HIV testing, HIV education, and condom use have known associations with HIV outcomes among youth in general, but are understudied among transgender youth. This study assessed these outcomes by developing a series of sex-stratified multivariable logistic regression models using pooled Youth Risk Behavior Survey data. Results indicate female and male transgender youth as well as males who were not sure they were transgender were more likely have tested for HIV compared with their not transgender peers. Male transgender youth were significantly less likely to have received HIV education compared with not transgender males. Females not sure if they were transgender and male transgender youth were significantly less likely to have used condoms compared with, respectively, not transgender female and not transgender male counterparts. In sum, condom use and HIV education both remain lower among transgender individuals relative to their not-transgender peers. This highlights the need for the promotion of culturally appropriate HIV education and HIV prevention supports among transgender youth.
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Affiliation(s)
| | | | | | - Dylan Felt
- Northwestern University, Chicago IL, USA
| | - Caleb W Curry
- Northwestern University, Chicago IL, USA.,Case Western Reserve University, Cleveland, OH, USA
| | - Xinzi Wang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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4
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Self-Identification of Mental Health Problems Among Young Adults Experiencing Homelessness. Community Ment Health J 2023; 59:844-854. [PMID: 36681751 PMCID: PMC9867546 DOI: 10.1007/s10597-022-01068-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Accepted: 12/05/2022] [Indexed: 01/22/2023]
Abstract
Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify.
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Gibbs KD, Jones JT, LaMark W, Abdulmooti S, Bretz L, Kearney KD, Narendorf SC, Santa Maria DM. Coping during the COVID-19 pandemic among young adults experiencing homelessness and unstable housing: A qualitative study. Public Health Nurs 2023; 40:17-27. [PMID: 36251216 PMCID: PMC9844081 DOI: 10.1111/phn.13136] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Revised: 09/03/2022] [Accepted: 09/06/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Young adults experiencing homelessness (YAEH) experience more stressors compared to housed peers, yet little is known about the impact of the COVID-19 pandemic on these youth. The purpose of this qualitative study was to explore how YAEH perceived the pandemic's impact on their well-being and coping. METHODS YAEH were recruited from those participating in an HIV prevention study. Semi-structured interviews were conducted and analysis was guided by Lazarus and Folkman's transactional theory of stress and coping. RESULTS Four major themes were identified from interviews with 40 youth: (1) ongoing harms, (2) COVID-19 as a stressor, (3) mental health impacts, and (4) coping strategies. Participants described unmet basic needs, emotions of frustration and anxiety, and several coping strategies including substance use. CONCLUSION Many YAEH reported experiencing continued challenges that were compounded by the stressors related to the COVID-19 pandemic. Special considerations are needed to address pandemic-related exacerbations of mental health symptoms and substance use among YAEH.
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Affiliation(s)
- Karen DiValerio Gibbs
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas,Texas Children's HospitalHoustonTexas
| | - Jennifer Torres Jones
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | - Whitney LaMark
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | - Sarah Abdulmooti
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | - Lauren Bretz
- Baylor College of MedicineSection of Adolescent MedicineHoustonTexas
| | - Kelly D. Kearney
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
| | | | - Diane M. Santa Maria
- Cizik School of NursingUniversity of Texas Health Science Center at HoustonHoustonTexas
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Ilyas Y, Hassanbeigi Daryani S, Kiriella D, Pachwicewicz P, Boley RA, Reyes KM, Smith DL, Zalta AK, Schueller SM, Karnik NS, Stiles-Shields C. Geolocation Patterns, Wi-Fi Connectivity Rates, and Psychiatric Symptoms amongst Urban Homeless Youth Using Self-Report and Smartphone Data: Pilot Study (Preprint). JMIR Form Res 2022; 7:e45309. [PMID: 37071457 PMCID: PMC10155082 DOI: 10.2196/45309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/17/2023] [Accepted: 03/06/2023] [Indexed: 03/08/2023] Open
Abstract
BACKGROUND Despite significant research done on youth experiencing homelessness, few studies have examined movement patterns and digital habits in this population. Examining these digital behaviors may provide useful data to design new digital health intervention models for youth experiencing homelessness. Specifically, passive data collection (data collected without extra steps for a user) may provide insights into lived experience and user needs without putting an additional burden on youth experiencing homelessness to inform digital health intervention design. OBJECTIVE The objective of this study was to explore patterns of mobile phone Wi-Fi usage and GPS location movement among youth experiencing homelessness. Additionally, we further examined the relationship between usage and location as correlated with depression and posttraumatic stress disorder (PTSD) symptoms. METHODS A total of 35 adolescent and young adult participants were recruited from the general community of youth experiencing homelessness for a mobile intervention study that included installing a sensor data acquisition app (Purple Robot) for up to 6 months. Of these participants, 19 had sufficient passive data to conduct analyses. At baseline, participants completed self-reported measures for depression (Patient Health Questionnaire-9 [PHQ-9]) and PTSD (PTSD Checklist for DSM-5 [PCL-5]). Behavioral features were developed and extracted from phone location and usage data. RESULTS Almost all participants (18/19, 95%) used private networks for most of their noncellular connectivity. Greater Wi-Fi usage was associated with a higher PCL-5 score (P=.006). Greater location entropy, representing the amount of variability in time spent across identified clusters, was also associated with higher severity in both PCL-5 (P=.007) and PHQ-9 (P=.045) scores. CONCLUSIONS Location and Wi-Fi usage both demonstrated associations with PTSD symptoms, while only location was associated with depression symptom severity. While further research needs to be conducted to establish the consistency of these findings, they suggest that the digital patterns of youth experiencing homelessness offer insights that could be used to tailor digital interventions.
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Affiliation(s)
- Yousaf Ilyas
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | | | - Dona Kiriella
- School of Medicine, City University of New York, New York, NY, United States
| | - Paul Pachwicewicz
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Randy A Boley
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
- Center for Health Equity using Machine Learning and Artificial Intelligence (CHEMA), College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Karen M Reyes
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
| | - Dale L Smith
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
- Center for Health Equity using Machine Learning and Artificial Intelligence (CHEMA), College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Alyson K Zalta
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, CA, United States
| | - Stephen M Schueller
- Department of Psychological Science, School of Social Ecology, University of California Irvine, Irvine, CA, United States
| | - Niranjan S Karnik
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
- Center for Health Equity using Machine Learning and Artificial Intelligence (CHEMA), College of Medicine, University of Illinois Chicago, Chicago, IL, United States
| | - Colleen Stiles-Shields
- Department of Psychiatry and Behavioral Sciences, Rush University Medical Center, Chicago, IL, United States
- Institute for Juvenile Research, Department of Psychiatry, College of Medicine, University of Illinois Chicago, Chicago, IL, United States
- Center for Health Equity using Machine Learning and Artificial Intelligence (CHEMA), College of Medicine, University of Illinois Chicago, Chicago, IL, United States
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Thulien NS, Amiri A, Hwang SW, Kozloff N, Wang A, Akdikmen A, Roglich J, Nisenbaum R. Effect of Portable Rent Subsidies and Mentorship on Socioeconomic Inclusion for Young People Exiting Homelessness: A Community-Based Pilot Randomized Clinical Trial. JAMA Netw Open 2022; 5:e2238670. [PMID: 36301546 PMCID: PMC9614573 DOI: 10.1001/jamanetworkopen.2022.38670] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023] Open
Abstract
IMPORTANCE There have been no published randomized clinical trials with a primary outcome of socioeconomic inclusion for young people who have experienced homelessness. OBJECTIVE To explore whether young people exiting homelessness who received rent subsidies and adult mentorship experienced more socioeconomic inclusion relative to young people who received only rent subsidies. DESIGN, SETTING, AND PARTICIPANTS This was a convergent mixed-methods, unblinded, 2-group, parallel randomized clinical trial with 1:1 allocation embedded within a community-based framework in 3 cities in Ontario, Canada. Participants were enrolled between March 1 and September 30, 2019, and were followed up through March 31, 2022. INTERVENTIONS Participants (n = 24) were randomly assigned adult mentors (n = 13) who had been recruited and screened by community partner agencies. All participants received portable rent subsidies (subsidy not tied to a specific location) for 2 years. MAIN OUTCOMES AND MEASURES Primary quantitative outcomes were self-reported measures of community integration (psychological and physical) and self-esteem-proxy indicators of socioeconomic inclusion. Community integration was measured with the Community Integration Scale, with a score range of 1 to 7 for the physical component and 4 to 20 for the psychological component; higher scores indicate higher integration. Self-esteem was measured with the Rosenberg Self-Esteem Scale, with a score range of 0 to 30; higher scores indicate greater self-esteem. Secondary quantitative outcomes included social connectedness, hopelessness, and academic and vocational participation. All analyses followed the intention-to-treat principle. RESULTS A total of 24 youths (12 women [50.0%]; mean [SD] age, 21.8 [2.2] years [range, 18-26 years]; race and ethnicity: 10 White [41.7%], 8 Black [33.3%], 2 Asian [8.3%], 2 Indigenous [8.3%], and 2 different choice [8.3%]) transitioned out of homelessness and into market-rent housing. All youths in the group that received mentorship and in the group that did not receive mentorship had stable or nonsignificant improvements in all study outcomes at the primary end point of 18 months compared with baseline (mean [SD] Community Integration Scale psychological score: mentorship group, 11.3 [2.6] at baseline and 11.2 [3.9] at 18 months; no-mentorship group, 10.8 [4.1] at baseline and 13.2 [2.9] at 18 months; mean [SD] Rosenberg Self-Esteem Scale score: mentorship group, 16.0 [4.6] at baseline and 18.1 [5.2] at 18 months; no-mentorship group, 16.3 [6.1] at baseline and 19.6 [5.7] at 18 months). However, there were no significant differences between the 2 groups in the Community Integration Scale psychological score (adjusted mean difference, -2.0; 95% CI, -5.0 to 1.0; P = .18) and Rosenberg Self-Esteem Scale score (adjusted mean difference, -1.4; 95% CI, -5.0 to 2.3; P = .44) 18 months after randomization. Ancillary analysis suggested that youths with informal mentors (mentors outside the study) at baseline felt more psychologically integrated at 18 months relative to those with no informal mentors at baseline (adjusted mean difference, 3.6; 95% CI, 0.4-6.8; P = .03). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, COVID-19 pandemic-related restrictions made it challenging for mentors and mentees to connect, which may have affected the findings. Steady socioeconomic outcomes-potentially attributable to portable rent subsidies-are noteworthy, given the socioeconomic inequities this population has faced during the COVID-19 pandemic. The possible benefit of informal mentorship warrants further investigation. This small pilot study was designed with the intention of generating data and hypotheses for a full-scale study; findings should be interpreted with caution. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03779204.
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Affiliation(s)
- Naomi S. Thulien
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Centre for Critical Qualitative Health Research, University of Toronto, Toronto, Ontario, Canada
| | - Alexandra Amiri
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Andrea Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- School of Medicine, Boston University, Boston, Massachusetts
| | - Alex Akdikmen
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
| | - Julia Roglich
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute of St Michael’s Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Damian AJ, Ponce D, Ortiz-Siberon A, Kokan Z, Curran R, Azevedo B, Gonzalez M. Understanding the Health and Health-Related Social Needs of Youth Experiencing Homelessness: A Photovoice Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19169799. [PMID: 36011440 PMCID: PMC9408072 DOI: 10.3390/ijerph19169799] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 08/02/2022] [Accepted: 08/05/2022] [Indexed: 05/16/2023]
Abstract
PURPOSE Homelessness is a major public health problem facing millions of youths across the United States (U.S.), with lesbian gay, bisexual, transgender, questioning (LGBTQ+) youths and youths of color being disproportionately at higher risk. This study obtains an understanding of the health and health-related social needs of youths experiencing homelessness during the coronavirus disease (COVID-19) pandemic. METHODS A total of 14 youths between the ages of 14 and 24 who (a) lived, worked, or attended school in New Britain, Connecticut (CT) and (b) had at least one experience of homelessness or housing insecurity worked with the research team to conduct a needs assessment regarding youth homelessness. Using photovoice, a community-based participatory research method, participants created photo narratives to share their stories and recommendations for community change. The main goals of photovoice are to enable participants to (1) record and represent their everyday realities; (2) promote critical dialogue and knowledge about person and community strengths and concerns; and (3) reach policy makers. RESULTS Most of the participants identified as youths of color, and half of the participants identified as members of the LGBTQ+ community. Three major themes that appeared in the youths' narratives include the following: mental health and substance use challenges, trouble accessing basic human needs, and lack of a social support system. CONCLUSION This study uplifts and empowers a vulnerable population to increase visibility around a major public health challenge from their own lived experiences. Despite the challenges that were voiced, many participants shared a sense of hope and resiliency. The major themes endorsed by the youths has the potential of informing practitioners and policy makers of how to better address the needs of youths experiencing homelessness, particularly those most at risk.
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Affiliation(s)
- April Joy Damian
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
- Correspondence:
| | - Delilah Ponce
- Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD 21205, USA
| | - Angel Ortiz-Siberon
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Zeba Kokan
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Ryan Curran
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Brandon Azevedo
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
| | - Melanie Gonzalez
- Weitzman Institute, Community Health Center, Inc., 19 Grand Str., Middletown, CT 06457, USA
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