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Rahaman M, Das KC. Differentials in self-reported health status and healthcare utilization among homeless women during the antenatal period in urban settings: Does migration status matter? J Migr Health 2024; 10:100246. [PMID: 39169914 PMCID: PMC11338154 DOI: 10.1016/j.jmh.2024.100246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 07/01/2024] [Accepted: 07/13/2024] [Indexed: 08/23/2024] Open
Abstract
Background Limited studies have covered the nexus between homelessness, migration, and maternal health. However, most homeless women are migrants and have high-risk fertility behaviors. Therefore, the present study examines the variation in antenatal health and healthcare behavior among homeless women, focusing on migration status. Methods The present study employed a mixed-methods approach. A cross-sectional quantitative survey using Time and Location sampling (TLS) and face-to-face interviews was carried out for the quantitative component. Further, qualitative data was gathered through in-depth interviews using purposive sampling. Descriptive statistics, bivariate analysis with the Pearson chi-square test, and multivariate logistic models estimated qualitative results. Further, the thematic analysis presented qualitative findings. Results Out of 400 respondents, 76 % were migrants, and 57 % reported poor SRH. The likelihood of poor SRH was 1.07 times higher among migrants than non-migrants. A higher likelihood of poor SRH was found among beggars and ragpickers. Similarly, it was prevalent among the respondents who lived alone, mainly migrants. Almost 80 % of migrants reported experiencing depression. The unmet need for health visits was substantial among the study population (41 %), and it was found to be noteworthy among migrants (51 %). Several individual, socioeconomic, and structural factors were identified as barriers to healthcare utilization. Conclusion Poor antenatal health was substantial among homeless women, mainly migrants. Public and private healthcare visits were inadequate among homeless women who were migrants. Several individual, socioeconomic, and structural factors affected healthcare utilization. The study highlights the urgent need to introduce population-centric programs and policies to promote reproductive health among homeless women.
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Affiliation(s)
- Margubur Rahaman
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
- Research Associate, Govind Ballabh Pant Social Science Institute, Prayagraj, 211019, India
| | - Kailash Chandra Das
- Department of Migration & Urban Studies, International Institute for Population Sciences (IIPS), Mumbai, 400088, India
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Edwards R, Hamilton C, Keeping Burke L, Goudreau A. Support and services available to at-risk mothers and their children in maternity residences: a scoping review protocol. JBI Evid Synth 2024; 22:1161-1169. [PMID: 38044847 DOI: 10.11124/jbies-23-00186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
OBJECTIVE The objective of this scoping review is to identify, categorize, and map the types of support and services available to at-risk mothers and their children in maternity residences. A secondary objective is to identify and map the measures used to evaluate the efficacy of these types of support and services. INTRODUCTION Pregnant and parenting women and their children experiencing complex challenges related to the social determinants of health, including unstable housing and poverty, are at high risk of long-term negative health and socioeconomic outcomes. Maternity residences may provide support and services that improve this population's outcomes; however, there is little understanding of what services are offered and how efficacious they may be. Therefore, it is necessary to provide a comprehensive overview of support and services in maternity residences, and to identify the measures used to evaluate the efficacy of the support and services. This will provide the foundation to evaluate these services and outcomes and inform the development of future maternity residential programs. INCLUSION CRITERIA Studies including pregnant and parenting women and gender-diverse individuals who are housed in, or accessing the services of, maternity residences in politically stable high-income countries due to challenges rooted in the social determinants of health will be considered for inclusion. We define maternity residences as any agency with a residential component offering support/services to this population. METHODS This review will be conducted in accordance with JBI methodology for scoping reviews. The data will be analyzed using a quantitative descriptive analysis approach. The data analysis and discussion will be informed by the Social Determinants of Health, Reproductive Justice, Harm Reduction, and Health in All Policies frameworks.
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Affiliation(s)
- Rosann Edwards
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | - Catherine Hamilton
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | - Lisa Keeping Burke
- Department of Nursing and Health Sciences, University of New Brunswick, Saint John, NB, Canada
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
| | - Alex Goudreau
- The University of New Brunswick (UNB) Saint John Collaboration for Evidence-Informed Healthcare: A JBI Centre of Excellence, Saint John, NB, Canada
- University of New Brunswick Libraries, University of New Brunswick, Saint John, NB, Canada
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Creswell L, Leahy C, McNamee E, Lindow SW, O'Connell MP. Homelessness in pregnancy. Eur J Obstet Gynecol Reprod Biol 2024; 296:239-243. [PMID: 38484615 DOI: 10.1016/j.ejogrb.2024.03.007] [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: 11/08/2023] [Revised: 02/23/2024] [Accepted: 03/06/2024] [Indexed: 04/19/2024]
Abstract
OBJECTIVES To evaluate the association, if any, of homelessness or refuge accommodation on delivery and short term perinatal outcomes in an Irish tertiary maternity hospital. METHODS A retrospective cohort study of 133 singleton pregnancies in women reporting to be homeless or living in refuge at their booking antenatal appointment between 2013 and 2022. Analysis compared sociodemographic characteristics and perinatal outcomes in this cohort to a reference population of 76,858 women with stable living arrangements. RESULTS Women in the homeless/refuge population were statistically more likely to be single (75.2 % vs 39.5 %, p < 0.001), have an unplanned pregnancy (73.7 % vs 27.2 %, p < 0.001), report a history of psychiatric illness (42.9 % vs 22.4 %, p < 0.001), domestic violence (18.8 % vs 0.9 %, p < 0.001) alcohol consumption in pregnancy (3.0 % vs 0.8 %, p < 0.001) or smoking in pregnancy (41.3 % vs 9.7 %, p < 0.001). They were significantly more likely to have a preterm birth (adjusted OR 1.71 (1.01-2.87) p = 0.04). They also had a significantly lower median birth weight compared to the reference population (birthweight 3270 g vs 3420 g, p < 0.001). CONCLUSION Women in the homeless and refuge population are more likely to experience poorer perinatal outcomes compared to women with stable living arrangements.
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Affiliation(s)
| | - C Leahy
- The Coombe Hospital, Dublin, Ireland
| | - E McNamee
- The Coombe Hospital, Dublin, Ireland
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Kachingwe ON, Phillips DR, Jasczynski M, Hillig E, Chavez R, Tellei J, Aparicio EM. 'I told him I'm gonna get it': intimate partner birth control communication among homeless young women. CULTURE, HEALTH & SEXUALITY 2023; 25:159-175. [PMID: 35020565 DOI: 10.1080/13691058.2021.2025431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Homeless youth have disproportionately high rates of unintended pregnancy and STIs. Enhancing communication between sexual partners can improve sexual health outcomes, yet little is known about this topic among homeless youth; therefore, this study aimed to examine how homeless youth communicate with their partners about birth control. In-depth semi-structured interviews regarding intimate partner birth control communication were conducted with 10 homeless young women aged 14-22 years following their completion of a comprehensive sexual health program (Wahine Talk). We transcribed the interviews verbatim and used a structured, inductive analytic approach to identify themes. Analysis identified three themes: Getting the Conversation Started, Conversation Content, and Impact of Conversation. Birth control conversations were prompted by programme participation, birth control side effects, and family members' interest in homeless youth becoming pregnant. Barriers to communication included fear and mistimed conversations (e.g. during the initiation of sex). Homeless young people shared simultaneous desires to delay pregnancy and concerns about side effects of birth control use. Discussions about birth control with their partners may demonstrably improve homeless youth's intimate relationships and family planning efforts. Providers can support homeless young women by helping them plan conversation timing and addressing fear, including the risk of violence.
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Affiliation(s)
- Olivia N Kachingwe
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Michelle Jasczynski
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Emily Hillig
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Rebecca Chavez
- Youth Outreach (YO!) Program, Waikiki Health, Honolulu, HI, USA
| | | | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
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5
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Eapen DJ, Bergh R, Narendorf SC, Santa Maria DM. Pregnancy and parenting support for youth experiencing homelessness. Public Health Nurs 2022; 39:728-735. [PMID: 35084059 DOI: 10.1111/phn.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
This study explored the perceptions and experiences related to pregnancy and parenting support among youth while homeless. This study employed a qualitative descriptive design using data collected from focus group discussions. We assessed the experiences and perceptions of youth related to pregnancy and parenting support. Eighty-one youth participated in eight focus group discussions and were recruited from shelters, drop-in centers, and organizations that serve youth in a large metropolitan areas in the southern United States. Thematic content analyses were used to generate results from the qualitative data. Four main themes emerged: youth encountered barriers to accessing healthcare services at the individual and system levels; pregnancy and parenting are stressful, especially during homelessness; support can help overcome the stresses of parenting; and embracing responsibility or "stepping up" is a positive influence of pregnancy and parenting during homelessness. Youth experiencing homelessness (YEH) face significant challenges to accessing healthcare services and adjusting to the parental role. Interventions for pregnant and parenting youth should be co-designed with and tailored for youth and address the existing health inequities within the healthcare and social service systems.
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Affiliation(s)
- Doncy J Eapen
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | - Rebecca Bergh
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Diane M Santa Maria
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
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Wagner V, Flores-Aranda J, Villela Guilhon AC, Knight S, Bertrand K. How do Past, Present and Future Weigh into Trajectories of Precarity? The Time Perspectives of Young Psychoactive Substance Users Living in Situations of Social Precarity in Montreal. QUALITATIVE HEALTH RESEARCH 2022; 32:195-209. [PMID: 34892988 DOI: 10.1177/10497323211051671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Young psychoactive substance users in social precarity are vulnerable to a range of health and social issues. Time perspective is one aspect to consider in supporting change. This study draws on the views expressed by young adults to portray their subjective experience of time, how this perception evolves and its implications for their substance use and socio-occupational integration trajectories. The sample includes 23 young psychoactive substance users (M = 24.65 years old; 83% male) in social precarity frequenting a community-based harm reduction centre. Thematic analysis of the interviews reveals the past to be synonymous with disappointment and disillusionment, but also a constructive force. Participants expressed their present-day material and human needs as well as their need for recognition and a sense of control over their own destiny. Their limited ability to project into the future was also discussed. Avenues on how support to this population might be adapted are suggested.
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Affiliation(s)
- Vincent Wagner
- 198734Programmes d'études et de recherche en toxicomanie, Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Canada
- 49987Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Canada
| | - Jorge Flores-Aranda
- 198734Programmes d'études et de recherche en toxicomanie, Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Canada
- 49987Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Canada
- 229169École de travail social, Université du Québec à Montréal, Canada
| | - Ana Cecilia Villela Guilhon
- 198734Programmes d'études et de recherche en toxicomanie, Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Canada
| | - Shane Knight
- 198734Programmes d'études et de recherche en toxicomanie, Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Canada
| | - Karine Bertrand
- 198734Programmes d'études et de recherche en toxicomanie, Département des sciences de la santé communautaire, Faculté de médecine et des sciences de la santé, Université de Sherbrooke, Canada
- 49987Institut universitaire sur les dépendances, Direction de l'enseignement universitaire et de la recherche, Centre intégré universitaire de santé et de services sociaux du Centre-Sud-de-l'Ile-de-Montréal, Canada
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Gaudet BA, Liu N, Kayne AN, Jarvill TL, Zemanek C, Downen JM, Cuadrado HM, Smith AB, Greenberg MR, Jacoby JL, Quinones JN. Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Shelter Adolescents. Cureus 2021; 13:e18128. [PMID: 34692338 PMCID: PMC8525671 DOI: 10.7759/cureus.18128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.
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Affiliation(s)
- Brittney A Gaudet
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Nina Liu
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Allison N Kayne
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Taylor L Jarvill
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Cecilia Zemanek
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jeffrey M Downen
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hoonani M Cuadrado
- Department of Community Health and Health Studies, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA.,Street Medicine, Valley Health Partners, Allentown, USA
| | - Amy B Smith
- Department of Education, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Marna R Greenberg
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jessica L Jacoby
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Joanne N Quinones
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
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McGeough C, Walsh A, Clyne B. Barriers and facilitators perceived by women while homeless and pregnant in accessing antenatal and or postnatal healthcare: A qualitative evidence synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1380-1393. [PMID: 32147895 DOI: 10.1111/hsc.12972] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 01/16/2020] [Accepted: 02/19/2020] [Indexed: 06/10/2023]
Abstract
Evidence indicates that homelessness is increasing within Europe and the United States (US), particularly for women. Pregnancy rates among homeless women are exceptionally high compared to their housed counterparts and homeless women engage poorly with antenatal care. The aim of this review is to explore the barriers and facilitators perceived by homeless women, while pregnant, or within six weeks postpartum in accessing antenatal and/or postnatal healthcare. A qualitative systematic review and synthesis was conducted. Key words and search terms were derived using the SPIDER (Sample, Phenomenon of Interest, Design, Evaluation, Research type) framework. Titles and abstracts were screened in accordance with inclusion and exclusion criteria. The methodological quality of included papers was assessed using criteria described by the Critical Appraisal Skills Programme (CASP) with data analysis using thematic synthesis. Two primary linked themes were generated: (a) lack of person-centred care; (b) complexity of survival. At an organisational level, a fragmented health service and accessibility to the health system were barriers, and resulted in poor person-centred care. At a clinical level, attitude & treatment from healthcare providers together with health knowledge all combined to illustrate poor person-centred care as barriers to homeless women accessing antenatal/postnatal healthcare. Sub-themes associated with complexity of survival included: disillusion with life, distrust of services, competing lifestyle demands and support and relationships. The findings of this review highlight that poor engagement may be partly explained by the complex interplay between both the healthcare system (person-centred care) and the individual (complexity of survival). Future services should be delivered in a way that recognises homeless people's complex and diverse needs, and should be reconfigured in order to try to meet them, through decreasing fragmentation of health services and staff training.
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Affiliation(s)
- Christine McGeough
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
- Our Lady of Lourdes Hospital, Royal College of Surgeons Hospital Group, Dublin, Ireland
| | - Aisling Walsh
- Department of Epidemiology and Public Health Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Barbara Clyne
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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Gewirtz O'Brien JR, Edinburgh LD, Barnes AJ, McRee AL. Mental Health Outcomes Among Homeless, Runaway, and Stably Housed Youth. Pediatrics 2020; 145:peds.2019-2674. [PMID: 32152134 DOI: 10.1542/peds.2019-2674] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Runaway youth and homeless youth are at risk for adverse mental health outcomes. These 2 populations are frequently pooled together in both research and interventions yet may have unique health needs. We sought to assess differences in mental health outcomes among these populations. METHODS We conducted a secondary data analysis of ninth- and 11th-graders in the 2016 minnesota Student Survey (n = 68 785). We categorized youth into 4 subgroups based on housing status in the previous year: (1) unaccompanied homeless youth (0.5%), (2) runaway youth (4%), (3) youth who had both run away and been homeless (0.6%), and (4) stably housed youth (95%). We performed multivariable logistic regression to compare 4 mental health outcomes (self-injury, suicidal ideation, suicide attempts, and depressive symptoms) across groups, controlling for demographics and abuse history. RESULTS Unstably housed youth had poorer mental health outcomes when compared with their stably housed peers (P < .05). For example, 11% of homeless youth, 20% of runaways, and 33% of youth who had experienced both had attempted suicide in the previous year compared with 2% of stably housed youth (adjusted odds ratios 2.4, 4.9, and 7.1, respectively). Other outcomes showed a similar pattern. CONCLUSIONS Our findings suggest that runaway and homeless youth represent unique populations with high levels of mental health needs who would benefit from targeted clinical and community interventions. Pediatric clinicians represent one potential point of screening and intervention.
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Affiliation(s)
| | - Laurel D Edinburgh
- Midwest Children's Resource Center, Children's Hospitals and Clinics of Minnesota, St Paul, Minnesota
| | - Andrew J Barnes
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and
| | - Annie-Laurie McRee
- Department of Pediatrics, University of Minnesota, Minneapolis, Minnesota; and
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Craddock JB, Barman-Adhikari A, Combs KM, Fulginiti A, Rice E. Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness. AIDS Behav 2020; 24:222-232. [PMID: 31471815 PMCID: PMC6954958 DOI: 10.1007/s10461-019-02646-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.
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Affiliation(s)
- Jaih B Craddock
- University of Maryland School of Social Work, University of Maryland, Baltimore, Baltimore, MD, USA.
| | | | | | - Anthony Fulginiti
- Graduate School of Social Work, University of Denver, Denver, CO, USA
| | - Eric Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, USA
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Pedersen ER, Ewing BA, D'Amico EJ, Miles JNV, Haas AC, Tucker JS. Predictors of Retention in an Alcohol and Risky Sex Prevention Program for Homeless Young Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:459-467. [PMID: 29352399 PMCID: PMC5947862 DOI: 10.1007/s11121-018-0866-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
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.
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Affiliation(s)
- Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Brett A Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Jeremy N V Miles
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | - Ann C Haas
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
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12
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Cronley C, Hohn K, Nahar S. Reproductive health rights and survival: The voices of mothers experiencing homelessness. Women Health 2017; 58:320-333. [PMID: 28278012 DOI: 10.1080/03630242.2017.1296060] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Women experiencing homelessness report higher rates of reproductive health-related traumas, including unplanned pregnancy, miscarriage, and abortion than their non-homeless peers. Using phenomenological hermeneutic methods, we sought to understand the reproductive health histories of women currently experiencing homelessness (N = 20, 25-61 years old, Mage = 38.33, SDage = 9.33) analyzing data collected between June 2014 and July 2015 in north central Texas. Three key themes highlight the essence of the women's experiences: (1) unexpected pregnancy-pregnancy just happened, (2) loss of reproductive health rights-I was broken, and (3) resilience-giving back and looking forward to good things. Many of the women became mothers through unexpected pregnancies, and overnight found that their lives were transformed irrevocably. Often unexpected pregnancy was the result or cause of a lack of ownership over their reproductive health and led to prolonged health-related traumas. Over time, though, many of the women whom we interviewed re-expressed resilience through social support, housing assistance, and a sense of giving back to society. Results indicate that reproductive health care providers require training to identify the relationship among unexpected pregnancy, reproductive health-related traumas, and housing insecurity. Providers can help preserve women's reproductive health rights through education and empowerment.
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Affiliation(s)
- Courtney Cronley
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
| | - Kris Hohn
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
| | - Shamsun Nahar
- a School of Social Work , The University of Texas at Arlington , Arlington , Texas , USA
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Tucker JS, D'Amico EJ, Ewing BA, Miles JNV, Pedersen ER. A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults. J Subst Abuse Treat 2017; 76:20-27. [PMID: 28340904 DOI: 10.1016/j.jsat.2017.02.008] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/09/2023]
Abstract
Homeless young adults ages 18-25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3month and past 30day alcohol use (ps≤0.05), motivation to change drug use (ps<0.05), and condom use self-efficacy (p=0.05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p<0.05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Brett A Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Jeremy N V Miles
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
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Schmitz RM, Tyler KA. Growing Up Before Their Time: The Early Adultification Experiences of Homeless Young People. CHILDREN AND YOUTH SERVICES REVIEW 2016; 64:15-22. [PMID: 27003952 PMCID: PMC4797323 DOI: 10.1016/j.childyouth.2016.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Affiliation(s)
- Rachel M. Schmitz
- Direct all correspondence to Rachel M. Schmitz, University of Nebraska-Lincoln, Department of Sociology, 711 Oldfather Hall, Lincoln, NE 68588-0324. Phone: (402) 472-3631. Fax: (402) 472-6070.
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