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Brown S, Barman-Adhikari A, Garcia K, Chassman S, Hsu HT, Petering R, Santa Maria D, Narendorf S, Shelton J, Bender K, Ferguson K. Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis. Addict Behav 2024; 150:107929. [PMID: 38056194 DOI: 10.1016/j.addbeh.2023.107929] [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: 05/08/2023] [Revised: 11/16/2023] [Accepted: 11/29/2023] [Indexed: 12/08/2023]
Abstract
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.
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Affiliation(s)
- Samantha Brown
- School of Social Work, Colorado State University, 450 W Pitkin St, Fort Collins, CO 80521, USA.
| | - Anamika Barman-Adhikari
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Kevin Garcia
- School of Social Work, Colorado State University, 450 W Pitkin St, Fort Collins, CO 80521, USA
| | - Stephanie Chassman
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, 729 Clark Hall, Columbia, MO 65211, USA
| | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 1150 South Olive Street, 1503-1, Los Angeles, CA 90015, USA
| | - Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, 6901 Bertner Ave., Ste. 591, Houston, TX 77030, USA
| | - Sarah Narendorf
- Graduate College of Social Work, University of Houston, 3511 Cullen Blvd. #110HA, Houston, TX 77204-4013, USA
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, 2180 Third Ave., New York, NY 10035, USA
| | - Kimberly Bender
- Graduate School of Social Work, University of Denver, 2148 S. High St., Denver, CO 80208, USA.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, 411 N. Central Ave., #865, Phoenix, AZ 85004-0689, USA
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Curtis MG, Reed M, Newman A, Doraivelu K, Patel SA, Crawford ND, Holland DP, Hussen SA. Exploring the Association Between Indicators of Socioeconomic Instability, Survival Sex, and Methamphetamine Use Among Young Adult Black Gay, Bisexual, and Other Men Who Have Sex With Men: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2023; 34:538-547. [PMID: 37738524 PMCID: PMC10592098 DOI: 10.1097/jnc.0000000000000428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/24/2023]
Abstract
ABSTRACT Methamphetamine (Meth) use is a contributor to poor health outcomes among young Black American gay, bisexual, and other men who have sex with men (YB-GBMSM). Emerging research indicates that socioeconomic instability may be a salient antecedent of meth use as men may be encouraged to engage in health-eroding activities, such as survival sex, to care for themselves, and then cope with instability-related stress via use of substances. We examined the degree to which indicators of socioeconomic instability, including homelessness and food insecurity, would directly, and indirectly, predict increases in meth use, via survival sex engagement. Hypotheses were tested using mediated path analysis with data from 100 YB-GBMSM in Atlanta, Georgia. Preliminary analysis results demonstrated positive associations between engaging in survival sex, food insecurity, homelessness, and living with HIV. Findings demonstrated that homelessness and food insecurity were directly associated with increased survival sex engagement but were not directly associated with meth use. Homelessness and food insecurity were indirectly associated with increased severity of meth use, via increased engagement in survival sex. Socioeconomic instability and survival sex engagement may be important intervention targets for future meth use intervention/prevention programming. Integrating programmatic components that address homelessness and food insecurity may decrease YB-GBMSM's need to rely on survival sex to meet their needs and decrease their likelihood of using meth as a result.
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Affiliation(s)
- Michael G. Curtis
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Marcus Reed
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Antonio Newman
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Kamini Doraivelu
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Shivani A. Patel
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Natalie D. Crawford
- Department of Behavioral, Social, and Health Education Sciences, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - David P. Holland
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
| | - Sophia A. Hussen
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
- Department of Medicine, Division of Infectious Diseases, School of Medicine, Emory University, Atlanta, Georgia, USA
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Le D, Kelmis CE, Ferdock AJ, Smith AB, Cuadrado HM, Greenberg MR. Identifying Biopsychosocial Characteristics of Emergency Youth Shelter Residents With Psychiatric Diagnoses. Cureus 2023; 15:e45355. [PMID: 37849570 PMCID: PMC10578194 DOI: 10.7759/cureus.45355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2023] [Accepted: 09/16/2023] [Indexed: 10/19/2023] Open
Abstract
Background In the United States, homelessness is an issue that may affect a significant portion of the adolescent population. There is no consensus on the extent to which this population has been impacted by poor mental health and lack of resources. This study aimed to characterize trends among those who struggle with housing insecurity and mental illness to provide a clearer picture of mental health needs among this population. Methods Data from 641 adolescents who presented to a local adolescent homeless shelter between 2015 and 2021 were utilized to determine if there were significant associations between specific mental illness diagnoses and biopsychosocial characteristics. A chi-square test of independence was performed on demographic and psychosocial variables for categories with a frequency greater than five. For continuous variables, an unpaired t-test was utilized to assess significance (p<0.05). Results Among the study population, 61.3% (369) had at least one psychiatric diagnosis, which is higher than even the most conservative estimates of mental illness among the general public. Having one or more psychiatric diagnoses was significantly associated with suicide attempts, documented aggressive behavior, and tobacco use. Contrary to our initial hypothesis, there were no significant correlations between psychiatric diagnoses and demographic characteristics or drug use other than tobacco. Conclusions Our findings indicate that though the particular reasons for homelessness among adolescents may vary, the prevalence of mental illness among these young individuals was roughly uniformly distributed and vastly above normal levels. Future research must focus on developing interventions to mitigate the effects of mental illness among homeless adolescents, as they are at a vulnerable point in their formative years.
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Affiliation(s)
- Dao Le
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF (University of South Florida) Morsani College of Medicine, Allentown, USA
| | - Caroline E Kelmis
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF (University of South Florida) Morsani College of Medicine, Allentown, USA
| | - Andrew J Ferdock
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF (University of South Florida) Morsani College of Medicine, Allentown, USA
| | - Amy B Smith
- Department of Education, Lehigh Valley Health Network/USF (University of South Florida) Morsani College of Medicine, Allentown, USA
| | - Hoonani M Cuadrado
- Department of Street Medicine, Lehigh Valley Health Network/USF (University of South Florida) Morsani College of Medicine, Allentown, USA
| | - Marna R Greenberg
- Department of Emergency and Hospital Medicine, Lehigh Valley Health Network/USF (University of South Florida) Morsani College of Medicine, Allentown, USA
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Ford JS, Mousa MA, Voong S, Matsumoto CG, Chechi T, Tran N, May L. Risk factors for HIV infection at a large urban emergency department: a cross-sectional study. Sex Transm Infect 2023; 99:404-408. [PMID: 37015802 DOI: 10.1136/sextrans-2022-055513] [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: 04/28/2022] [Accepted: 03/20/2023] [Indexed: 04/06/2023] Open
Abstract
OBJECTIVES In 2019, the US Preventative Services Task Force released updated guidelines recommending HIV screening in all individuals aged 15-64 years and all pregnant females. In the current study, we aimed to identify risk factors for HIV infection in an emergency department (ED) population. METHODS We performed a cross-sectional study that employed a post hoc risk factor analysis of ED patients ≥18 years who were screened for HIV between 27 November 2018 and 26 November 2019, at a single urban, quaternary referral academic hospital. Patients were screened using HIV antigen/antibody testing and diagnoses were confirmed using HIV-1/HIV-2 antibody testing. The outcome of interest was the number of positive HIV tests. Multiple logistic regression models were used to identify risk factors associated with HIV positivity. RESULTS 14 335 adult patients were screened for HIV (mean age: 43±14 years; 52% female). HIV seroprevalence was 0.7%. Independent risk factors for HIV positivity included male sex (adjusted OR (aOR) 3.1 (95% CI 1.7 to 5.6)), unhoused status (aOR 2.9 (95% CI 1.7 to 4.9)), history of illicit drug use (aOR 1.8 (95% CI 1.04 to 3.13)) and Medicare insurance status (aOR 2.2 (95% CI 1.1 to 4.4)). CONCLUSIONS The study ED services a high-risk population with regard to HIV infection. These data support universal screening of ED patients for HIV. Risk factor profiles could improve targeted screening at institutions without universal HIV testing protocols.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Mohammad A Mousa
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Stephanie Voong
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Cynthia G Matsumoto
- Department of Population Health and Accountable Care, University of California Davis Health, Sacramento, CA, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, CA, USA
| | - Larissa May
- Department of Emergency Medicine, University of California Davis Health, Sacramento, CA, USA
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Armoon B, Griffiths MD, Mohammadi R, Ahounbar E. The global distribution and epidemiology of alcohol and drug use among street-involved children and youth: a meta-analysis. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2023; 49:381-398. [PMID: 37310881 DOI: 10.1080/00952990.2023.2201872] [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: 10/04/2022] [Revised: 03/14/2023] [Accepted: 03/28/2023] [Indexed: 06/15/2023]
Abstract
Background: Street-involved children and youth (SICY) who work and live on/of the streets are more likely to inject drugs and engage in psychoactive substance use.Objectives: The present study aimed to identify the prevalence, distribution, sociodemographic determinants, and risk-taking associated with alcohol and drug use among SICY.Methods: Studies published in English related to alcohol and drug use among SICY were searched for from December 1 1985 to July 1 2022, on PubMed, Scopus, Cochrane, and Web of Science.Results: After full-text paper evaluation, 73 studies were included in the meta-analysis. Results indicated that lifetime prevalence rates were 44% (alcohol), 44% (crack), 33% (inhalants), 44% (solvents), 16% (tranquilizer/sedatives), 22% (opioids), and 62% (polysubstance use). The current prevalence rates were 40% (alcohol), 21% (crack), 20% (inhalants), 11% (tranquilizer/sedatives), and 1% (opioids). Also, life-time and current prevalence of alcohol and crack use, current prevalence of tranquilizer/sedative use, and life-time prevalence of polysubstance use were higher among older age groups. Life-time prevalence of tranquilizer/sedative use was lower among older age groups.Conclusions: The high prevalence of using alcohol, crack, and inhalants is a major issue because they are used extensively among different age groups, including minors. Such findings are beneficial for policymakers, health authorities, and professionals in developing programs aimed at minimizing inhalant use and other types of substance use harms among this group. It is important to accurately monitor this risk-exposed population to understand the mechanisms that might help protect them from high-risk substance use.
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Affiliation(s)
- Bahram Armoon
- Social Determinants of Health Research Center, Saveh University of Medical Sciences, Saveh, Iran
| | - Mark D Griffiths
- International Gaming Research Unit, Psychology Department, Nottingham Trent University, Nottingham, UK
| | - Rasool Mohammadi
- Department of Biostatistics and Epidemiology, School of Public Health and Nutrition, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Elaheh Ahounbar
- Orygen, The National Center of Excellence in Youth Mental Health, University of Melbourne, Parkville, VIC, Australia
- Center for Youth Mental Health, Faculty of Medicine, Dentistry and Health Sciences, University of Melbourne, Parkville, Australia
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Smith-Carrier T, Hall J, Belanger L, Hyman I, Oudshoorn A, B J, Lindstrom A. A WISH to be Housed: Exploring the Winter Interim Solution to Homelessness (WISH) Temporary Accommodation Model in London, Canada. Community Ment Health J 2023; 59:307-324. [PMID: 35906436 PMCID: PMC9862215 DOI: 10.1007/s10597-022-01009-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 07/03/2022] [Indexed: 01/25/2023]
Abstract
Temporary housing programs (THPs) aim to serve the homeless population. This article explores the impacts of a THP, the Winter Interim Solution to Homelessness (WISH) in London, Canada, which applied a barrier-free, harm reduction model. Adopting an intersectional lens and interpretive description methodology, we analyzed data collected from WISH residents, utilizing a thematic analytic approach. Identified themes included: (1) "(It's) kinda like a real home" (WISH is unlike other shelters); (2) "It's like a buddy system" (A sense of community was fostered); (3) "It's the same size as a jail cell" (Problems with infrastructure); (4) "To keep us on focus" (Un/supportive staff/volunteers); (5) "I'm not sure what I'm going to do after" (The dearth of permanent housing creates trauma); and (6) "Too much bloody money in too little hands" (Distrust of housing providers). Although WISH was helpful to some residents, the temporary nature of the program limited its long-term impact.
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Affiliation(s)
- Tracy Smith-Carrier
- Canada Research Chair (Tier 2) Advancing the UN Sustainable Development Goals & Associate Professor, School of Humanitarian Studies, Royal Roads University, 2005 Sooke Road, Victoria, BC V9B 5Y2 Canada
| | - Jodi Hall
- School of Nursing, Fanshawe College, London, Canada
| | | | - Ilene Hyman
- Dalla Lana School of Public Health, Ryerson Centre for Immigration and Settlement (RCIS), University of Toronto, Graduate Program in Health, York University Research Affiliate, Adjunct Member, Toronto, Canada
| | - Abe Oudshoorn
- Arthur Labatt Family School of Nursing, Arthur Labatt Family Chair in Nursing Leadership in Health Equity, London, Canada
| | - Julie B
- SafeSpace London, London, Canada
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Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors. PLoS One 2023; 18:e0281107. [PMID: 36877700 PMCID: PMC9987824 DOI: 10.1371/journal.pone.0281107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana. METHODS 305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression. RESULTS Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001). CONCLUSIONS Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.
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Ford JS, Hollywood E, Steuble B, Meng Z, Voong S, Chechi T, Tran N, May L. Risk factors for hepatitis C virus infection at a large urban emergency department. J Viral Hepat 2022; 29:930-937. [PMID: 35789152 DOI: 10.1111/jvh.13730] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 05/23/2022] [Accepted: 06/17/2022] [Indexed: 12/09/2022]
Abstract
In 2020, Centers for Disease Control and Prevention (CDC) released guidelines recommending HCV screening in all adults 18 years and older. In the current study, we aimed to identify risk factors for HCV infection in an ED population. We performed a retrospective analysis of ED patients ≥ 18 years who were screened for HCV between 28 November 2018, and 27 November 2019, at a single urban, quaternary referral academic hospital. An HCV-antibody immunoassay (HCV-Ab) was used for screening; positive results were confirmed by measuring HCV ribonucleic acid (RNA). The outcome of interest was the number of new HCV diagnoses (presence of viremia by HCV RNA testing). Multiple logistic regression models were used to identify risk factors associated with a new HCV diagnosis. 16,722 adult patients were screened for HCV (mean age: 46 ± 15 years; 51% female). HCV seroprevalence was 5%. Independent risk factors for HCV included increasing age [10-year aOR 1.26 (95% CI 1.23, 1.30)], male sex [aOR 1.25 (95% CI 1.03, 1.51)], undomiciled housing status [aOR 2.8 (95% CI 2.3, 3.5)], history of tobacco use [aOR 3.0 (95% CI 2.3, 3.9)], history of illicit drug use [aOR 3.6 (95% CI 2.9, 4.5)], Medicaid insurance status [aOR 4.0 (95% CI 2.9, 5.5)] and Medicare insurance status [aOR 1.6 (95% CI 1.1, 2.2)].The ED services a high-risk population with regards to HCV infection. These data support universal screening of ED patients for HCV. Risk factor profiles could improve targeted screening at institutions without universal testing protocols.
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Affiliation(s)
- James S Ford
- Department of Emergency Medicine, University of California, San Francisco, California, USA
| | - Erika Hollywood
- A.T. Still University School of Osteopathic Medicine in Arizona, Mesa, Arizona, USA
| | - Bradley Steuble
- Touro University of California, College of Osteopathic Medicine, Vallejo, California, USA
| | - Zichun Meng
- Department of Statistics, Graduate Group of Biostatistics, University of California Davis Health, Sacramento, California, USA
| | - Stephanie Voong
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Tasleem Chechi
- Department of Emergency Medicine, University of California, Davis, California, USA
| | - Nam Tran
- Department of Pathology and Laboratory Medicine, University of California Davis Health, Sacramento, California, USA
| | - Larissa May
- Department of Emergency Medicine, University of California, Davis, California, USA
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Scarlett H, Melchior M, Davisse-Paturet C, Aarbaoui TE, Longchamps C, Figueiredo N, Ducarroz S. Substance Use Among Residents of Homeless Shelters During the COVID-19 Pandemic: Findings From France. Int J Public Health 2022; 67:1604684. [PMID: 36090832 PMCID: PMC9452639 DOI: 10.3389/ijph.2022.1604684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2021] [Accepted: 07/26/2022] [Indexed: 12/01/2022] Open
Abstract
Objectives: To record the prevalence and risk factors of substance use amongst homeless persons during the COVID-19 pandemic. Methods: The ECHO study consisted in two independent cross-sectional waves of data collection in the regions of Paris, Lyon, and Strasbourg during the Spring of 2020 (n = 530) and 2021 (n = 319). Factors associated with substance use were explored using generalised logistic regression models. Results: The most prevalent substance used was tobacco (38%–43%), followed by alcohol (26%–34%). The use of both substances positively associated with each other, although risk factors varied depending on the substance. The only factors consistently associated with alcohol and tobacco use were being male, exposure to theft/assault and participants’ region of origin. Whilst the rate of tobacco use was relatively stable between Spring 2020 and 2021, alcohol use was more common in 2021. Conclusion: These findings highlight a high prevalence of substance use amongst homeless persons. People experiencing homelessness face specific challenges in the context of the pandemic, alongside greater vulnerability to illness and low healthcare access, therefore the need to improve prevention and support services for substance abuse within this population is vital.
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Affiliation(s)
- Honor Scarlett
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- *Correspondence: Honor Scarlett, ; Simon Ducarroz,
| | - Maria Melchior
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- CNRS, Institut Convergences Migration, Aubervilliers, France
| | - Camille Davisse-Paturet
- Research on Healthcare Performance RESHAPE, INSERM U1290, Université Claude Bernard Lyon 1, Lyon, France
| | - Tarik El. Aarbaoui
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Cécile Longchamps
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Natasha Figueiredo
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
| | - Simon Ducarroz
- Sorbonne Université, INSERM, Institut Pierre Louis d’Epidémiologie et de Santé Publique, Paris, France
- CNRS, Institut Convergences Migration, Aubervilliers, France
- *Correspondence: Honor Scarlett, ; Simon Ducarroz,
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Kennedy DP, Osilla KC, Tucker JS. Feasibility of a computer-assisted social network motivational interviewing intervention to reduce substance use and increase supportive connections among emerging adults transitioning from homelessness to housing. Addict Sci Clin Pract 2022; 17:26. [PMID: 35505383 PMCID: PMC9066760 DOI: 10.1186/s13722-022-00307-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks may play positive and negative roles in the lives of young adults experiencing homelessness (YEH) who are transitioning into housing. Social networks can influence their alcohol and/or other drug (AOD) use, as well as provide immediate and long-term support necessary for a successful transition. METHODS We adapted a four-session computer-assisted motivational interviewing social network intervention (MI-SNI) for YEH transitioning into housing. We iteratively adapted and beta tested the intervention for delivery by case managers at an organization that provides supportive housing to YEH. We conducted a focus group with agency staff (n = 6), role-play exercises with case managers (n = 3), and semi-structured interviews with residents (n = 6). Interview data were thematically analyzed with open coding. This study presents the first adaptation of an innovative social network-based motivational intervention to reduce AOD use and increase stable, prosocial supportive connections via visualizations of the structure and composition of the individual's social network. RESULTS Participants rated sessions as "moderately" to "very" helpful and "good" quality on average. Participants agreed that the sessions were helpful, understandable, and satisfying and would work for new residents. Themes emerged in four broad categories: (1) Acceptability, (2) Positive benefits, (3) Visualization reactions, and (4) MI-SNI interface reactions. For the acceptability category, three sub-themes emerged: (1) understandability, (2) enjoyability and ease of use, (3) and barriers to acceptability. Five sub-themes emerged about the intervention's likelihood to trigger positive benefits: (1) learning/new insights, (2) enhancement to motivation to change, (3) making AOD changes, (4) building social support, and (5) the intervention's usefulness to some but not others. Five sub-themes also emerged from comments about the social network visualizations: (1) general positive comments, (2) understandability, (3) new insights, (4) triggering changes in social support, and (5) triggering changes in AOD use. When discussing the MI-SNI intervention interface beyond the visualizations, discussions emerged in three thematic categories: (1) discussion of name listing, (2) discussion of screen wording, and (3) the use of a computer interface to deliver the intervention. CONCLUSIONS Results suggest that the MI-SNI is acceptable to YEH and can be feasibly delivered by case managers during case management sessions. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.
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Affiliation(s)
- David P Kennedy
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Karen Chan Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Chassman S, Barman-Adhikari A, Hsu HT, Ferguson KM, Narendorf SC, Maria DS, Shelton J, Petering R, Bender K. Prevalence and Correlates of Illicit Substance Use Among Young Adults Experiencing Homelessness in Seven Cities Across the United States. JOURNAL OF DRUG ISSUES 2022. [DOI: 10.1177/00220426211049355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Young adults experiencing homelessness (YAEH) engage in substantially higher substance use rates than housed young adults. This current study builds on previous research by investigating the prevalence of and salient correlates of illicit substance use across a seven-city sample. Methods This study used the Homeless Youth Risk and Resiliency Survey (HYRRS) dataset, n=1426 Young adults experiencing homelessness to study patterns and correlates of illicit substance use. Results Multivariate logistic regression analyses were used to assess correlates of substance use. Study site, age, gender identity, sexual orientation, history of suicidal ideation, use of specific substances, and trading sex for drugs were associated with five types of illicit substance use (ecstasy, cocaine, crack, methamphetamine, and injection drug use). Conclusion Findings indicate that substance use interventions for YAEH must be multifaceted, addressing illicit and multiple substance use, along with the myriad factors associated with substance use among this at-risk group.
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Affiliation(s)
| | | | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, MO, USA
| | | | - Sarah C. Narendorf
- Graduate College of Social Work, University of Houston, Houston, TX, USA
| | - Diane Santa Maria
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, New York, NY, USA
| | | | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, CO, USA
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12
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Hargrave AS, Kimberg L, Machtinger EL, Kushel MB, Cohen BE. The Association Between Interpersonal Violence and Unstable Housing Among Veterans. Mil Med 2022; 188:usab557. [PMID: 35018446 PMCID: PMC10362995 DOI: 10.1093/milmed/usab557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Despite programs to address housing for Veterans, they continue to be at high risk of unstable housing. Interpersonal violence is also highly prevalent among Veterans and may contribute to unstable housing. Our study aimed to determine whether interpersonal violence was associated with unstable housing among Veterans, and how this association was influenced by common co-occurring conditions such as substance use and mental illness. METHODS Veterans in the Mind Your Heart Study (N = 741) completed survey data on history of interpersonal violence and access to housing in the prior year. Interpersonal violence was defined as experiencing sexual violence, physical violence, or mugging/physical attack using the Brief Trauma Questionnaire. Multivariable models examined associations between interpersonal violence and unstable housing. Primary models were adjusted for age and sex. Potential explanatory factors were added in subsequent models, including marital status, education, income, substance use disorder, PTSD, and other mental illness. RESULTS Veterans who had experienced interpersonal violence had almost twice the odds of unstable housing after adjustment for age and sex (AOR 1.9, 95% CI 1.2-3.0). This association was attenuated in the fully adjusted model including substance use, PTSD, and other mental illness, illustrating the interdependence of these factors (AOR 1.5, 95% CI 0.91-2.5). Subtypes of interpersonal violence were individually associated with increased odds of unstable housing after adjustment for age and sex (physical abuse AOR 1.7, 95% CI 1.2-2.5; mugging/physical attack AOR 1.8, 95% CI 1.2-2.7; sexual violence AOR 1.4, 95% CI 0.89-2.2), but were no longer significant in the fully adjusted model. CONCLUSIONS Previous experiences of interpersonal violence were associated with unstable housing among Veterans. Substance use, PTSD, and other mental illness played an important role in this relationship-highlighting the potential to improve health outcomes through trauma informed approaches that address mental health, substance use, and housing concurrently.
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Affiliation(s)
- Anita S Hargrave
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA 94110, USA
| | - Leigh Kimberg
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA 94110, USA
| | - Edward L Machtinger
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA 94110, USA
| | - Margot B Kushel
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA 94110, USA
- UCSF Center for Vulnerable Populations, San Francisco General Hospital, San Francisco, CA 94110, USA
| | - Beth E Cohen
- Department of Internal Medicine, University of California San Francisco, San Francisco, CA 94110, USA
- Department of Internal Medicine, San Francisco VA Health Care System, San Francisco, CA 94121, USA
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13
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Shegaw M, Fekadu W, Beka M, Menberu M, Yohannes K, Yimer S, Seid M, Necho M, Moges S, Anbesaw T. Problematic substance use and its associated factors among street youth in Bahir Dar city, Ethiopia. Front Psychiatry 2022; 13:930059. [PMID: 35966470 PMCID: PMC9365990 DOI: 10.3389/fpsyt.2022.930059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 07/05/2022] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Problematic substance use is becoming a common problem in marginalized groups such as street youths. However, there is a dearth of studies on the prevalence and factors associated with problematic substance use among street youth in Ethiopia. OBJECTIVE The objective of this study was to determine the prevalence of problematic substance use and identify its associated factors among street youth. METHODS This community-based cross-sectional study was conducted between June and July 2020. A total of 252 participants were included in this study. Systematic random sampling was used to recruit participants. Cut down, annoyed, guilty feeling, and eye opening-adapted to include drugs (CAGE-AIDs) were used to assess problematic substance use. The data were entered into epidata and exported to SPSS version 25 for analysis. Logistic regression with a 95% confidence interval (CI) was used to show the strength of association. A p-value < 0.5 was statistically significant. RESULTS The prevalence of problematic substance use was 55.8%, 95% CI (49-63%). Peer pressure [adjusted odds ratio (AOR) = 3.01, 95% CI: 1.38, 6.59], family conflict [AOR = 5.05, 95% CI: 1.67, 15.25], physical abuse [AOR = 2.56, 95% CI: 1.11, 5.84], and substance use in the family [AOR = 2.85, 95% CI: 1.29, 6.27] were the factors significantly associated with problematic substance use. CONCLUSION The prevalence of problematic substance use was high. It was also found that peer pressure, family conflict, substance use in the family, and physical abuse were the factors associated with problematic substance use. Therefore, proper screening and intervention for individuals with problematic substance use are needed, and further research should be conducted for marginalized groups.
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Affiliation(s)
- Maregu Shegaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Wubalem Fekadu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Michael Beka
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Melake Menberu
- Department of Psychiatry, College of Medicine and Health Science, Bahir Dar University, Bahir Dar, Ethiopia
| | - Kalkidan Yohannes
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Solomon Yimer
- Department of Psychiatry, College of Medicine and Health Science, Dilla University, Dilla, Ethiopia
| | - Mohammed Seid
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Mogesie Necho
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
| | - Solomon Moges
- Department of Psychiatry, College of Medicine and Health Science, Woldia University, Woldia, Ethiopia
| | - Tamrat Anbesaw
- Department of Psychiatry, College of Medicine and Health Science, Wollo University, Dessie, Ethiopia
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14
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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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15
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Flores MW, Granados S, Cook BL. US trends in the association of suicide ideation/behaviors with marijuana use among adolescents ages 12-17 and differences by gender and race/ethnicity. Front Psychiatry 2022; 13:1057784. [PMID: 36684023 PMCID: PMC9849946 DOI: 10.3389/fpsyt.2022.1057784] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Accepted: 12/02/2022] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND In the US over the past decade, there has been a steady increase in marijuana use rates among adolescents, in part due to marijuana legalization laws. It is unknown whether these greater marijuana use rates are associated with rising rates of adolescent suicide ideation and behaviors (plan and attempt) or whether these associations differ by gender or race/ethnicity. OBJECTIVE To determine whether marijuana use is associated with suicide ideation/behaviors among adolescents and if differences exist by gender and race/ethnicity. MATERIALS AND METHODS Using the 2015-2019 National Surveys on Drug Use and Health, we assessed the relationship between marijuana use frequency and suicide ideation/behaviors among adolescents (12-17, n = 73,986). We also examined the association with marijuana use disorder (MUD) and assessed differences by gender and race/ethnicity. Marijuana use frequency in the past year was categorized as no use, non-weekly use, and weekly-plus use. We estimated multivariable logistic regression models, adjusting for sociodemographics, health status, common co-occurring behavioral health disorders, and criminal history. For interpretability, regression coefficients were converted into predicted probabilities using predictive margin methods. RESULTS In primary analyses, adolescents with non-weekly use and weekly-plus use had higher rates of any suicide ideation, 61.5% (+ 10.4 percentage-points; 95% CI: 7.0-13.8%) and 64.5% (+ 13.4 percentage-points; 95% CI: 9.1-17.7%), relative to no use (51.1%). Non-weekly and weekly-plus use was associated with higher rates of any suicide plan 58.2% (+ 11.8 percentage-points; 95% CI: 7.8-16.0%) and 59.0% (+ 12.6 percentage-points; 95% CI: 6.4-18.9%), and any suicide attempt, 42.0% (+ 11.6 percentage-points; 95% CI: 7.0-16.2%) and 47.3% (+ 16.9 percentage-points; 95% CI: 10.9-22.9%) compared to no use (46.4 and 30.4%, respectively). Similar results were found among adolescents with a MUD (all p < 0.05). Positive associations between marijuana use and suicide ideation/behaviors persisted among males and females as well as White, Black, and Latinx adolescents (all p < 0.05). CONCLUSION Between 2015 and 2019, suicide ideation/behaviors increased for adolescents that used marijuana. As marijuana is legalized in more states, public health efforts are needed to curb increases in marijuana use among adolescents and to better understand the causal linkages between marijuana use and suicide ideation/behaviors.
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Affiliation(s)
- Michael William Flores
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Saul Granados
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States
| | - Benjamin Lê Cook
- Health Equity Research Lab, Cambridge Health Alliance, Cambridge, MA, United States.,Department of Psychiatry, Harvard Medical School, Boston, MA, United States
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16
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Johnson ME, Lloyd SL, Bristol SC, Rosel G, Otufowora AA, Epps NN. Runaway History and Past 30-Day Opioid Misuse in Justice-Involved Adolescents. JUVENILE & FAMILY COURT JOURNAL 2021; 72:21-35. [PMID: 34955571 PMCID: PMC8699162 DOI: 10.1111/jfcj.12206] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
This study used a sample from the Florida Department of Juvenile Justice (n= 79,960) to analyze the association between runaway history and past 30-day opioid misuse (OM) among justice involved adolescents. Past 30-day OM was confirmed using a urine analysis. Adolescents who were runaways in their lifetime were twice as likely to misuse opioids, and those who were runaways at the time of arrest were three times as likely to be opioid misusers compared to adolescents who never ran away or been kicked out of a home. These findings emphasize a need for resources that focus on developing strong attachment bonds.
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Affiliation(s)
- Micah E Johnson
- Department of Mental Health Law and Policy in the College of Behavioral and Community Sciences at the University of South Florida
| | | | - Skye C Bristol
- College of Behavioral and Community Sciences at the University of South Florida
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17
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Health Literacy, Self-Perceived Health, and Substance Use Behavior among Young People with Alcohol and Substance Use Disorders. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084337. [PMID: 33921885 PMCID: PMC8073264 DOI: 10.3390/ijerph18084337] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 04/12/2021] [Accepted: 04/13/2021] [Indexed: 11/17/2022]
Abstract
Licit and illicit substance use is one of the major public health issues with severe negative health consequences for individuals and society. Health literacy is essential for improving one's health and navigation in the healthcare system. However, the evidence of health literacy in people with substance use disorders is limited. This study aims to examine health literacy and its socio-demographic, health-related, and substance use-related correlates in young people with alcohol (AUD) and substance use disorders (SUD). In this study, cross-sectional data of young people undergoing addiction treatment for AUD (N = 201, mean age 37.6) and SUD (N = 165, mean age 31.1) were used. Health literacy was assessed using the HLS-EU-Q47. Simple and multiple linear regression was performed to estimate the correlates of health literacy. In total, 37.8% of participants with AUD and 41.8% of SUD had limited health literacy. In participants with AUD, living condition factors, self-perceived health indicators, and frequency of alcohol use showed a significant effect on health literacy. In participants with SUD, financial factors, self-perceived health indicators, and injection sharing showed a significant effect. Increasing health literacy might contribute to improved health outcomes and decreased high-risk substance use-related behavior in people undergoing addiction treatment.
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18
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Tucker JS, Kennedy DP, Osilla KC, Golinelli D. Motivational network intervention to reduce substance use and increase supportive connections among formerly homeless emerging adults transitioning to housing: study protocol for a pilot randomized controlled trial. Addict Sci Clin Pract 2021; 16:18. [PMID: 33726809 PMCID: PMC7968154 DOI: 10.1186/s13722-021-00227-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 03/03/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Studies indicate high rates of substance use among youth experiencing homelessness (YEH). Further, the social networks of YEH, although multi-dimensional in composition, are largely comprised of other YEH, substance users, and individuals who do not provide the youth with tangible or emotional support. For YEH who have the opportunity to enter a housing program, helping them to reduce their substance use and strengthen their prosocial supportive connections during this critical transition period may increase their stability and reduce their risk of re-entering homelessness. The goal of this study is to pilot test a brief motivational network intervention (MNI), delivered by case managers, to help former YEH who have recently transitioned to a housing program reduce their substance use and strengthen their prosocial supportive connections. METHODS/DESIGN Up to 60 residents of housing programs in the Los Angeles area will be randomized to receive four sessions of usual case manager support or four sessions of case manager support + MNI. Each MNI session consists of three parts: (1) identifying two goals that are most important for the resident over the next year (e.g., get or keep a job, finish or stay in school, reduce substance use); (2) a network interview with the resident to capture network data pertaining to their interactions in the past 2 weeks; and (3) a discussion between the case manager and the resident of the resulting network visualizations, conducted in a Motivational Interviewing (MI) style, and what role the resident's network may play in reaching their most important goals over the next year. DISCUSSION This study addresses a critical gap by pilot testing a computer-assisted MNI, delivered using MI techniques, that can help case managers work with recent YEH to reduce substance use and increase permanent supportive connections during the critical transitional period from homelessness to housing. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - David P Kennedy
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407, USA
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19
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Substance Use among Homeless Reproductive Age People in Southern Ethiopia. Int J Reprod Med 2021; 2021:8272986. [PMID: 33816608 PMCID: PMC7987451 DOI: 10.1155/2021/8272986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 02/28/2021] [Accepted: 03/09/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction Substance use by homeless reproductive age people may result to anxiety, involvement of risky sexual behaviors, and increasing the likelihood of unwanted pregnancy and sexually transmitted diseases (STDs). Therefore, this study assessed the magnitude of alcohol use, sexual intercourse after alcohol use, and its associated factors among homeless reproductive age people in southern Ethiopia. Methods Community-based cross-sectional study design was conducted among homeless reproductive age people. The snowball sampling technique was used to recruit 842 participants. Pretested and structured interviewer-administered questionnaire was used to collect the data. Data were entered into Epidata version 3.1 and exported to SPSS version 23 for analysis. Binary logistic regression was used to determine the association of independent variables with the outcome variables. Odds ratio with their 95% confidence interval and P value was used to identify the significant variables. Results More than half 423 (53.2%) of the respondents had taken a drink that contains alcohol in the last one year of the study period. Out of 324 khat chewers, 190 (58.64%) had sex after chewing khat. More than one-thirds, 323(38.4%) homeless people were smoking cigarette during the study period. Factors associated with alcohol use were age 19-25 years (AOR: 0.49; CI: 0.34, 0.72), ≥26 years (AOR: 0.40; CI: 0.25, 0.65), level of education (AOR: 0.61; CI: 0.39, 0.94), place of residence: major urban (AOR: 0.31; CI: 0.18, 0.51), small town (AOR: 0.38; CI: 0.23, 0.63), ever heard about STDs (AOR: 0.14; CI: 0.07, 027), and being a cigarette smoker (AOR: 2.67; CI: 1.94, 3.71). Conclusions In this study, significant percentage of respondents had taken a drink that contains alcohol. Age, level of education, place of residence, ever heard about STDs, and smoking cigarette were variables significantly associated with alcohol use. Awareness creation on the effect and outcome of substance use is recommended.
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20
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Ararso Y, Beharie NN, Scheidell JD, Schatz D, Quinn K, Doran KM, Khan MR. The Joint Effect of Childhood Abuse and Homelessness on Substance Use in Adulthood. Subst Use Misuse 2021; 56:660-667. [PMID: 33678119 DOI: 10.1080/10826084.2021.1887249] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Childhood abuse and homelessness are independently associated with substance use. Though childhood abuse and homelessness are strongly correlated, research on the joint effect of exposure to both traumatic life events on substance use is limited. Objective: To estimate independent and joint effects of childhood abuse and homelessness on substance use risk during emerging adulthood and adulthood. Methods: Using the National Longitudinal Study of Adolescent to Adult Health (N = 12,288), we measured associations between exposure to physical or sexual abuse in childhood, homelessness in childhood or emerging adulthood, or exposure to both traumas and outcomes of binge drinking, marijuana use, cocaine use, methamphetamine use, and prescription opioid misuse during emerging adulthood (Wave III, ages 18-26 years) and adulthood (Wave IV, ages 24-32 years). Results: In adjusted analyses, exposure to childhood abuse alone, homelessness alone, and both childhood abuse and homelessness were significant correlates of most substance use indicators in emerging adulthood. Those jointly exposed to childhood abuse and homelessness had disproportionate risk of substance use, particularly use of cocaine (adjusted odds ratio (AOR)=4.25, 95% confidence interval (CI): 2.70, 6.71) and methamphetamine (AOR = 6.59, 95% CI: 3.87, 11.21). The independent and combined effects of abuse and homelessness generally persisted into adulthood though associations tended to weaken. Conclusions/Importance: Those with exposure to abuse, homelessness, and both adverse outcomes constitute a high-risk population for substance use. Addressing abuse and homelessness should be a component of preventing drug risk for screening, treatment, and prevention efforts.
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Affiliation(s)
- Yonathan Ararso
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | | | - Joy D Scheidell
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Daniel Schatz
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Kelly Quinn
- Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Kelly M Doran
- Ronald O. Perelman Department of Emergency Medicine, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
| | - Maria R Khan
- Division of Comparative Effectiveness and Decision Science, Department of Population Health, New York University Grossman School of Medicine, New York, New York, USA
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21
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Yoshioka-Maxwell A. Social Work in Action: Social Connectedness and Homelessness Amidst a Pandemic: Are the Social Impacts of Quarantine on Homeless Populations Being Adequately Addressed? HAWAI'I JOURNAL OF HEALTH & SOCIAL WELFARE 2020; 79:329-331. [PMID: 33205051 PMCID: PMC7668111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Affiliation(s)
- Amanda Yoshioka-Maxwell
- Department of Social Work, Myron B. Thompson School of Social Work, University of Hawai'i at Mānoa, Honolulu, HI
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22
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Thompson RG, Aivadyan C, Stohl M, Aharonovich E, Hasin DS. Smartphone application plus brief motivational intervention reduces substance use and sexual risk behaviors among homeless young adults: Results from a randomized controlled trial. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2020; 34:641-649. [PMID: 32175752 PMCID: PMC9997652 DOI: 10.1037/adb0000570] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Homeless young adults are more likely than their never-homeless counterparts to abuse substances and engage in sexual risk behaviors. This study evaluated the feasibility and preliminary effectiveness of OnTrack, a smartphone application to self-monitor substance use and sexual risk behaviors, plus a brief motivational intervention (BMI), in reducing substance use and sexual risk among homeless young adults. A randomized controlled pilot trial (N = 60) compared OnTrack + BMI to treatment as usual (TAU) at an inner-city crisis shelter for homeless young adults (aged 18-21 years). Participants were assessed at baseline and 2 weeks, 4 weeks, and 6 weeks after baseline to evaluate substance use and sexual risk behaviors. Kruskal-Wallis tests determined differences between baseline and postintervention assessments. Logistic regression models examined treatment effect on change in outcomes between baseline and postintervention follow-up assessment, controlling for baseline levels. Participants in OnTrack + BMI significantly reduced past 2-week number of drinks (p = .023), times used marijuana (p = .046), times engaged in unprotected sex (p = .012), and times used drugs before sexual activity (p = .019). No reductions of substance use or sexual risk behaviors were found among participants in TAU (all ps > .05). After adjusting for baseline levels of substance use and sexual risk, participants in OnTrack + BMI had significantly lower odds than those in TAU for drinking alcohol (adjusted OR = 0.14; p = .01) and having unprotected sex (adjusted OR = 0.151; p = .032). OnTrack + BMI is feasible and effective in reducing past 2-week alcohol use and unprotected sex among homeless young adults. A larger randomized trial is warranted to replicate and extend present results. (PsycInfo Database Record (c) 2020 APA, all rights reserved).
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Tucker JS, D'Amico EJ, Pedersen ER, Rodriguez A, Garvey R. Study protocol for a group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among young adults experiencing homelessness. Addict Sci Clin Pract 2020; 15:26. [PMID: 32723349 PMCID: PMC7390162 DOI: 10.1186/s13722-020-00201-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 07/17/2020] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND Young people experiencing homelessness have alarmingly high rates of alcohol and other drug (AOD) use, which is associated with sexual risk behaviors such as unprotected sex, trading sex, and sex with multiple casual partners. Few risk reduction programs for this population have been developed and rigorously evaluated, particularly those that address both of these interrelated behaviors, use a collaborative and non-judgmental approach, and are feasible to deliver in settings where homeless young people seek services. This paper describes the protocol of a study evaluating a four-session Motivational Interviewing (MI)-based group risk reduction intervention for this population. The protocol has been shown to be efficacious in pilot work over 3 months with 200 homeless young adults [1]. The current study seeks to refine the intervention protocol and evaluate the program on a larger scale. METHODS/DESIGN In a cluster-cross-over randomized controlled trial, 18-25 year olds will receive the AWARE risk reduction program (n = 200) or standard care (n = 200) at one of three drop-in centers serving homeless youth in the Los Angeles area. We will evaluate intervention effects on primary outcomes of AOD use and sexual risk behavior, as well as secondary outcomes of health-related quality of life and social stability, over a 12-month period. DISCUSSION This project has the potential to fill a significant gap in prevention services by demonstrating that a brief intervention, feasible to deliver within settings where young people experiencing homelessness typically seeks services, can significantly reduce the interrelated problems of AOD use and sexual risk behavior. Trial registration ClinicalTrials.gov Identifier: NCT03735784. Registered November 18, 2018, https://clinicaltrials.gov/ct2/show/record/NCT03735784 (retrospectively registered).
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States.,Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, 250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA, 02116, United States
| | - Rick Garvey
- RAND Corporation, 1776 Main Street, PO Box 2136, Santa Monica, CA, 90407-2138, United States
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Tyler KA, Ray CM. Risk and Protective Factors for Substance Use Among Youth Experiencing Homelessness. CHILDREN AND YOUTH SERVICES REVIEW 2019; 107:104548. [PMID: 31827311 PMCID: PMC6905194 DOI: 10.1016/j.childyouth.2019.104548] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Though research finds that youth experiencing homelessness (YEH) have high rates of substance use, which can lead to numerous long-term negative health effects, less is known about both risk and protective factors for substance use. Moreover, even less is known about whether these factors differ for lesbian, gay and bisexual (LGB) youth compared to non-LGB youth. In the current study, we compared risk and protective factors for binge drinking, marijuana use, and illicit drug use (i.e. substance use) among heterosexual and sexual minority YEH. METHODS The sample included 322 young people experiencing homelessness in the Midwestern United States and who were between 16 and 26 years of age. Almost one-half of our sample were female (N = 146; 45%) and 68 youth (21%) identified as LGB. RESULTS Youth who experienced more child physical abuse, ran away from home more frequently, and those who had a parent(s) with drug problems were more likely to have reported binge drinking in the past 30 days. Additionally, having parents with drug problems was associated with the use of marijuana and illicit drugs. Conversely, having higher parental monitoring while growing up reduced the likelihood of using marijuana and illicit drugs. Tests for interactions revealed that while self-efficacy had no relationship with the probability of binge drinking for heterosexual youth, as self-efficacy increased, the probability of binge drinking declined drastically for sexual minority youth suggesting this protective mechanism operates differently for these two groups of youth. Additionally, tests of interactions showed that the probability of binge drinking among heterosexual and sexual minority youth also varied by child sexual abuse and street sexual victimization. CONCLUSION Study results have implications for service providers who serve YEH.
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Abstract
Globally, suicide is a major public health problem among homeless people. Suicidal ideation and attempt are remarkably higher among homeless people as compared to the general population and they are linked with greater risk of complete suicide. However, no systematic review and meta-analysis has been conducted to report the consolidated magnitude of suicidal ideation and attempt among homeless people. We searched PubMed, Embase, and Scopus to identify pertinent studies on suicidal ideation and attempt among homeless people. A meta-analysis of the studies was conducted using a random effect model. We also conducted a sensitivity analysis and Cochran's Q- and the I2 test was employed to evaluate heterogeneity. Publication bias was assessed by Egger's test and visual inspection of the symmetry in funnel plots. In total, 20 eligible studies with 27,497 homeless people matched the inclusion criteria. Nineteen studies assessed suicidal attempt and thirteen studies assessed suicidal ideation among homeless people. The pooled current and lifetime prevalence of suicidal ideation was 17.83% (95% CI;10.73-28.14) and 41.60% (95% CI; 28.55-55.95), respectively whereas the pooled current and lifetime prevalence of suicidal attempt was 9.16% (95% CI;4.10-19.20) and 28.80% (95% CI; 21.66-37.18), respectively. We found a considerable heterogeneity between the studies, but we found no significant publication bias. The current review revealed a remarkably higher magnitude of suicidal ideation and attempt among homeless people as compared to the estimated prevalence in the general population. The concerned stakeholders need to give attention to address this problem emphasizing more on prevention and treatment strategies as well as utilizing holistic approaches to address the potential predictors of suicide among homeless people including physical, mental, and substance use problems.
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Abstract
Substance use is higher among homeless youth than among the general population. Although substance use has been well studied, little is known about the risk factors associated with specific substances used by homeless youth, particularly in the Houston, Texas, area. Therefore, we conducted this study to examine the rates of lifetime and past-month substance use in a sample of homeless youth in Harris County, Texas, and examine the relations between substance type and race/ethnicity, age, gender identity, sexual orientation, shelter status, stress, and trauma history. Participants were recruited during October and November 2014 as part of the study YouthCount 2.0! and completed a survey to assess demographics, stress, abuse, substance use, and risk behaviors. The sample (N = 416) was predominantly young adult (13-17 years old: 55 and 18-24 years old: 361), African American (54.5%), and male (55.9%). Nearly one quarter identified as lesbian, gay, bisexual, or questioning (n = 102). Over a third of youth had used alcohol (38%) or marijuana (36%) in the past month, and 36% had ever used synthetic marijuana. Bivariate analyses showed that substance use was significantly associated with race/ethnicity, age, gender identity, sexual orientation, shelter status, stress, and trauma scores. Youth in this study had lower rates of alcohol and some substance use than other samples of homeless youth, although use still exceeded national rates for housed youth. Substance use prevention interventions for homeless youth should be trauma informed and include housing navigation and stress management strategies. The most at-risk subgroups included street-dwelling and lesbian, gay, bisexual, or questioning youth.
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Mohaqeqi Kamal SH, Sajadi S, Ghaedamini Harouni G, Basakha M, Noroozi M. Prevalence, risk and protective factors for substance abuse among homeless males living in Tehran. JOURNAL OF SUBSTANCE USE 2018. [DOI: 10.1080/14659891.2018.1552727] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Affiliation(s)
- Seyed Hossein Mohaqeqi Kamal
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Sajad Sajadi
- Social Worker, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | | | - Mehdi Basakha
- Social Welfare Management Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mehdi Noroozi
- Social Determinants of Health Research Center, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
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When structural violences create a context that facilitates sexual assault and intimate partner violence against street-involved young women. WOMENS STUDIES INTERNATIONAL FORUM 2018. [DOI: 10.1016/j.wsif.2018.01.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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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: 5] [Impact Index Per Article: 0.8] [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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Santa Maria D, Padhye N, Yang Y, Gallardo K, Santos GM, Jung J, Businelle M. Drug use patterns and predictors among homeless youth: Results of an ecological momentary assessment. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2017; 44:551-560. [PMID: 29286835 DOI: 10.1080/00952990.2017.1407328] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
BACKGROUND Alcohol and drug use is associated with significant morbidity and mortality and is highly prevalent among homeless youth. Ecological Momentary Assessments (EMA) have been used to examine the effect of urges on drug use, though not among homeless youth. OBJECTIVES We assessed the patterns of drug use and the correlation between real-time contextual factors and drug use using EMA collected daily. We identified predictors of drug use among a sample of homeless youth 18-25 years old in Houston, Texas. METHODS Homeless youth (n = 66, 62% male) were recruited from a drop-in center between September 2015 and May 2016. We used generalized linear mixed models and cross-validation methods to determine the best predictive model of drug use. RESULTS The overall drug use was high: 61% and 32% of participants reported using drugs or alcohol at least one day, respectively. Marijuana and synthetic marijuana use (i.e., Kush, K2, incense packs) were reported most frequently; 86% and 13% of the total drug use EMAs, respectfully. Drug use urge was reported on 26% of days and was the highest on drug use days. Drug use was predicted by discrimination, pornography use, alcohol use, and urges for drugs, alcohol, and to steal. CONCLUSIONS EMA can be used to predict drug use among homeless youth. Drug use treatment among homeless youth should address the role of experiencing discrimination, pornography and alcohol use, and urge management strategies on drug use. Research is needed to determine if EMA informed just-in-time interventions targeting these predictors can reduce use.
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Affiliation(s)
- Diane Santa Maria
- a University of Texas Health Science Center , School of Nursing, Center for Nursing Research , Houston , TX , USA
| | - Nikhil Padhye
- a University of Texas Health Science Center , School of Nursing, Center for Nursing Research , Houston , TX , USA
| | - Yijiong Yang
- b University of Texas Health Science , Center School of Public Health , Houston , TX , USA
| | - Kathryn Gallardo
- b University of Texas Health Science , Center School of Public Health , Houston , TX , USA
| | - Glenn-Milo Santos
- c Department of Community Health Systems, University of California , San Francisco School of Nursing , San Francisco , CA , USA
| | | | - Michael Businelle
- e The University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center , Oklahoma City , OK , USA
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Prince DM, Epstein M, Nurius PS, Gorman-Smith D, Henry DB. Reciprocal Effects of Positive Future Expectations, Threats to Safety, and Risk Behavior Across Adolescence. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2016; 48:54-67. [PMID: 27617781 DOI: 10.1080/15374416.2016.1197835] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
We examined the reciprocal relationships among positive future expectations, expected threats to future safety, depression, and individual substance use and delinquency using 4 waves of data (N = 248-338) from African American and Latino adolescent male participants in the Chicago Youth Development Study. Individual positive future expectations and expected threats to safety were assessed at each wave and modeled as latent constructs. Individual substance use and delinquency were assessed at each wave and represented as ordinal variables ranging from low to high. Categorical autoregressive cross-lagged structural models were used to examine the hypothesized reciprocal relationships between both aspects of future expectations construct and risk behavior across adolescence. Analyses show that future expectations has important effects on youth substance use and involvement in delinquency, both of which in turn decrease positive expectations and increase expectation of threats to future safety across adolescence. Similarly, low positive expectations for the future continued to predict increased substance use and involvement in delinquency. The expected threats to safety construct was significantly correlated with delinquency within time. These effects are observed across adolescence after controlling for youth depression and race. Findings support the reciprocal effects hypothesis of a negative reinforcing cycle in the relationships between future expectations and both substance use and involvement in delinquent behavior across adolescence. The enduring nature of these relationships underscores the importance of future expectation as a potential change mechanism for intervention and prevention efforts to promote healthy development; vulnerable racial and ethnic minority male adolescents may especially benefit from such intervention.
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Affiliation(s)
- Dana M Prince
- a Jack, Joseph, and Morton Mandel School of Applied Social Sciences, Case Western Reserve University
| | - Marina Epstein
- b Social Development Research Group , University of Washington
| | | | | | - David B Henry
- e Institute for Health Research and Policy , University of Illinois at Chicago
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Ching Yin L, Razak Zakaria A. Stress and Depression, Low Religiosity, Social Injustice and Insufficient Rehabilitation Outcomes as Predictors of Frequent Relapse in Drug Dependence. OPEN JOURNAL OF SOCIAL SCIENCES 2016; 04:194-206. [DOI: 10.4236/jss.2016.411016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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Melander LA, Tyler KA, Schmitz RM. An Inside Look at Homeless Youths' Social Networks: Perceptions of Substance Use Norms. JOURNAL OF CHILD & ADOLESCENT SUBSTANCE ABUSE 2015; 25:78-88. [PMID: 26989340 DOI: 10.1080/1067828x.2014.918003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Substance use among homeless young people is a pervasive problem, and there have been many efforts to understand more about the dynamics of this health compromising behavior. The current study examined perceived substance use norms within homeless youths' social networks utilizing in-depth interviews. The sample included 19 homeless individuals aged 16 to 21. Four elements of substance use within networks emerged: substance use choices, drug use safety issues, encouragement and/or discouragement, and appropriate situations in which substance use is condoned. These findings provide unique insight into the norms associated with drug and alcohol use within homeless youths' social networks.
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Affiliation(s)
- Lisa A Melander
- Kansas State University, Department of Sociology, Anthropology, and Social Work
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Nyamathi A, Salem B, Marshall L, Idemundia F, Mata R, Khalilifard F, Farabee D, Leake B. Substance use trends among younger vs. older homeless parolees. J Addict Dis 2015; 33:124-33. [PMID: 24784498 DOI: 10.1080/10550887.2014.909694] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
This cross-sectional study of 540 homeless ex-offenders exiting prisons and jails assessed sociodemographic, childhood, and drug-related differences. Older ex-offenders from prison were more likely to have been married, come from a two-parent family, and used crack, whereas younger ex-offenders from prison were more likely to have used methamphetamine. Older ex-offenders from jail were more likely to be African American, have children, and report a history of crack and injection drug use, whereas younger ex-offenders from jail were more likely to have engaged in binge drinking and be in a gang. Our findings showcase the need to understand unique correlates of younger and older incarcerated populations.
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Rhoades H, Winetrobe H, Rice E. Prescription drug misuse among homeless youth. Drug Alcohol Depend 2014; 138:229-33. [PMID: 24613220 PMCID: PMC4029497 DOI: 10.1016/j.drugalcdep.2014.02.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 02/04/2014] [Accepted: 02/05/2014] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth. METHODS A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM. RESULTS Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM. CONCLUSIONS Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.
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Affiliation(s)
- Harmony Rhoades
- University of Southern California School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015, United States.
| | - Hailey Winetrobe
- University of Southern California School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
| | - Eric Rice
- University of Southern California School of Social Work, 1149 S. Hill St., Suite 360, Los Angeles, CA 90015
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Salem BE, Nyamathi A, Brecht L, Phillips LR, Mentes J, Sarkisian C, Stein JA. Constructing and identifying predictors of frailty among homeless adults—a latent variable structural equations model approach. Arch Gerontol Geriatr 2014; 58:248-56. [PMID: 24505611 PMCID: PMC4005873 DOI: 10.1016/j.archger.2013.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Homeless urbanites are a heterogeneous population with unique health and social service needs. The study examined situational, behavioral, health-related and resource indicators in terms of their direct impact on frailty, hypothesized as a latent variable. Using structural equation modeling (SEM), a model was tested with 150 homeless men and women, ages 40–73, from three homeless day center drop-in sites on Skid Row and one residential drug treatment (RDT) facility that works with homeless parolees and probationers. In bivariate analyses with the latent construct frailty, months homeless (p < 0.01), female gender (p < 0.05), education (p < 0.05), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), health care utilization (p < 0.01), and falls (p < 0.001) were significantly associated with frailty. In the final path model, significant predictors of frailty included educational attainment (p < 0.01), comorbid conditions (p < 0.001), nutrition (p < 0.001), resilience (p < 0.001), and falls (p < 0.01). These findings will serve as a foundation for future nurse-led, community-based initiatives that focus on key predictors of frailty among the homeless and the development of interventions.
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Affiliation(s)
- Benissa E. Salem
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Adeline Nyamathi
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Lynn Brecht
- UCLA School of Nursing, Address: 700 Tiverton Avenue Los Angeles,
CA 90095
| | - Linda R Phillips
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Janet Mentes
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
| | - Catherine Sarkisian
- Geriatric Research Education Clinical Center (GRECC), Address:
11301 Wilshire Blvd. Los Angeles, CA 90073
| | - Judith A. Stein
- University of California, Los Angeles School of Nursing, Address:
700 Tiverton Avenue Los Angeles, CA 90095
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Rhoades H, Wenzel SL. Correlates of prescription drug misuse among heterosexually active homeless men. Subst Abus 2014; 34:143-9. [PMID: 23577908 DOI: 10.1080/08897077.2012.726960] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Prescription drug misuse (PDM) is an emerging epidemic in the United States. This study examines the prevalence and correlates of PDM among homeless men. Homeless men experience higher risk for substance misuse and associated health problems and are particularly vulnerable to PDM and its negative health consequences. METHODS Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles. Interviews assessed demographics, substance use, mental health, and social networks. Logistic regression examined correlates of PDM. RESULTS Twenty-six percent of the study population reported PDM in the past year. PDM was more likely among homeless men suffering from posttraumatic stress disorder (PTSD) (odds ratio [OR] = 2.41, 95% confidence interval [CI]: 1.03-5.61) and among those with more substance-using social network members (OR = 1.07, 95% CI: 1.01-1.14). Decreased PDM was associated with good health (OR = 0.34, 95% CI: 0.16-0.75). CONCLUSIONS The prevalence of PDM is higher among the homeless men in this study than in the general population. Correlates of PDM included PTSD and poor health, suggesting that homeless men may use PDM to self-medicate. PDM was also associated with increased substance-using social network alters. Physical and mental health and social context are important aspects to consider in prevention efforts to reduce PDM among homeless men.
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Affiliation(s)
- Harmony Rhoades
- School of Social Work, University of Southern California, Los Angeles, CA 90015, USA.
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Song A, Wenzel SL. The association of social networks with substance use among homeless men in Los Angeles who have unprotected sex with women. JOURNAL OF SUBSTANCE USE 2014. [DOI: 10.3109/14659891.2013.875075] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Salem BE, Nyamathi A, Phillips LR, Mentes J, Sarkisian C, Brecht L. Development of a frailty framework among vulnerable populations. ANS Adv Nurs Sci 2014; 37:70-81. [PMID: 24469090 PMCID: PMC4162317 DOI: 10.1097/ans.0000000000000013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
Frailty is a public health issue that is experienced by homeless and other vulnerable populations; to date, a frailty framework has not been proposed to guide researchers who study hard-to-reach populations. The Frailty Framework among Vulnerable Populations has been developed from empirical research and consultation with frailty experts in an effort to characterize antecedents, that is, situational, health-related, behavioral, resource, biological, and environmental factors that contribute to physical, psychological, and social frailty domains and impact adverse outcomes. As vulnerable populations continue to age, a greater understanding of frailty will enable the development of nursing interventions.
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Affiliation(s)
| | - Adeline Nyamathi
- Associate Dean for International Research and Scholarly Activities, University of California, Los Angeles School of Nursing
| | | | - Janet Mentes
- University of California, Los Angeles School of Nursing
| | - Catherine Sarkisian
- UCLA Division of Geriatrics, VA Greater Los Angeles Healthcare System, Geriatric Research Education Clinical Center (GRECC)
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Substance use predictors of victimization profiles among homeless youth: a latent class analysis. J Adolesc 2013; 37:155-64. [PMID: 24439621 DOI: 10.1016/j.adolescence.2013.11.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2012] [Revised: 11/11/2013] [Accepted: 11/17/2013] [Indexed: 02/08/2023]
Abstract
Although a substantial body of literature demonstrates high prevalence of street victimization among homeless youth, few studies have investigated the existence of victimization classes that differ on the type and frequency of victimization experienced. Nor do we know how substance use patterns relate to victimization classes. Using latent class analysis (LCA), we examined the existence of victimization classes of homeless youth and investigated substance use predictors of class membership utilizing a large purposive sample (N=601) recruited from homeless youth-serving host agencies in three disparate regions of the U.S. Results of the LCA suggest the presence of three distinct victimization profiles - youth fit into a low-victimization class, a witness class, or a high-victimization class. These three victimization classes demonstrated differences in their substance use, including rates of substance abuse/dependence on alcohol and/or drugs. The presence of distinct victimization profiles suggests the need for screening and referral for differential services.
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Green HD, de la Haye K, Tucker JS, Golinelli D. Shared risk: who engages in substance use with American homeless youth? Addiction 2013; 108:1618-24. [PMID: 23600596 PMCID: PMC3742579 DOI: 10.1111/add.12177] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2012] [Revised: 07/27/2012] [Accepted: 02/28/2013] [Indexed: 11/28/2022]
Abstract
AIMS To identify characteristics of social network members with whom homeless youth engage in drinking and drug use. DESIGN A multi-stage probability sample of homeless youth completed a social network survey. SETTING Forty-one shelters, drop-in centers and known street hangouts in Los Angeles County. PARTICIPANTS A total of 419 homeless youth, aged 13-24 years (mean age = 20.09, standard deviation = 2.80). MEASUREMENTS Respondents described 20 individuals in their networks, including their substance use and demographics, and the characteristics of the relationships they shared, including with whom they drank and used drugs. Dyadic, multi-level regressions identified predictors of shared substance use. FINDINGS Shared drinking was more likely to occur with recent sex partners [odds ratio (OR) = 2.64, confidence interval (CI): 1.67, 4.18], drug users (OR = 4.57, CI: 3.21, 6.49), sexual risk takers (OR = 1.71, CI: 1.25, 2.33), opinion leaders (OR = 1.69, CI: 1.42, 2.00), support providers (OR = 1.41, CI: 1.03, 1.93) and popular people (those with high degree scores in the network) (OR = 1.07, CI: 1.01, 1.14). Shared drug use was more likely to occur with recent sex partners (OR = 2.44, CI: 1.57, 3.80), drinkers (OR = 4.53, CI: 3.05, 6.74), sexual risk takers (OR = 1.51, CI: 1.06, 2.17), opinion leaders (OR = 1.24, CI: 1.03, 1.50), support providers (OR = 1.83, CI: 1.29, 2.60) and popular people (OR = 1.16, CI: 1.08, 1.24). CONCLUSIONS Homeless youth in the United States are more likely to drink or use drugs with those who engage in multiple risk behaviors and who occupy influential social roles (popular, opinion leaders, support providers, sex partners). Understanding these social networks may be helpful in designing interventions to combat substance misuse.
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Abstract
Individuals who are homeless or living in marginal conditions have an elevated burden of infection with HIV. Existing research suggests the HIV/AIDS pandemic in resource-rich settings is increasingly concentrated among members of vulnerable and marginalized populations, including homeless/marginally-housed individuals, who have yet to benefit fully from recent advances in highly-active antiretroviral therapy (HAART). We reviewed the scientific evidence investigating the relationships between inferior housing and the health status, HAART access and adherence and HIV treatment outcomes of people living with HIV/AIDS (PLWHA.) Studies indicate being homeless/marginally-housed is common among PLWHA and associated with poorer levels of HAART access and sub-optimal treatment outcomes. Among homeless/marginally-housed PLWHA, determinants of poorer HAART access/adherence or treatment outcomes include depression, illicit drug use, and medication insurance status. Future research should consider possible social- and structural-level determinants of HAART access and HV treatment outcomes that have been shown to increase vulnerability to HIV infection among homeless/marginally-housed individuals. As evidence indicates homeless/marginally-housed PLWHA with adequate levels of adherence can benefit from HAART at similar rates to housed PLWHA, and given the individual and community benefits of expanding HAART use, interventions to identify HIV-seropositive homeless/marginally-housed individuals, and engage them in HIV care including comprehensive support for HAART adherence are urgently needed.
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Nyamathi A, Salem B, Reback CJ, Shoptaw S, Branson CM, Idemundia FE, Kennedy B, Khalilifard F, Marfisee M, Liu Y. Correlates of hepatitis B virus and HIV knowledge among gay and bisexual homeless young adults in Hollywood. Am J Mens Health 2012; 7:18-26. [PMID: 22879650 DOI: 10.1177/1557988312456068] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Homeless gay and bisexual (G/B) young men have multiple risk factors that increase their risk of contracting hepatitis B virus (HBV) and human immunodeficiency virus (HIV). This study used baseline information from structured instruments to assess correlates of knowledge to HIV and HBV infection from 267 young (18-39 year old) G/B active methamphetamine, cocaine, and crack-using homeless men enrolled in a longitudinal trial. The study is designed to reduce drug use and improve knowledge of hepatitis and HIV/AIDS in a community center in Hollywood, California. Regression modeling revealed that previous hepatitis education delivered to G/B men was associated with higher levels of HIV/AIDS and hepatitis knowledge. Moreover, higher HIV/AIDS knowledge was associated with combining sex and drinking alcohol. Associations with hepatitis B knowledge was found among G/B men who were engaging in sex while under the influence of marijuana, who were receiving support from non-drug users, and who had been homeless in the last 4 months. Although being informed about HIV/AIDS and hepatitis did not preclude risky sexual and drug use behavior, knowledge about the dangers of concurrent sex with substance use is important. As higher levels of knowledge of hepatitis was associated with more moderate drug use, early access to testing and teaching harm reduction strategies remain critical to reduce exposure and infection of HBV and HIV in this population.
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Rhoades H, Wenzel SL, Golinelli D, Tucker JS, Kennedy DP, Green HD, Zhou A. The social context of homeless men's substance use. Drug Alcohol Depend 2011; 118:320-5. [PMID: 21601380 PMCID: PMC3177996 DOI: 10.1016/j.drugalcdep.2011.04.011] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2011] [Revised: 04/11/2011] [Accepted: 04/12/2011] [Indexed: 11/24/2022]
Abstract
BACKGROUND Homeless men may be at particular risk for the negative health effects of substance use. This cross-sectional study investigates the individual and personal network risk factors associated with substance use in this vulnerable population. METHODS Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles, CA. Interviews assessed individual, personal network, and substance use characteristics. Logistic regression examined individual and personal network predictors of the three most prevalent substances. RESULTS In the past 6 months, the three most prevalent substances were marijuana (56%), crack (40%), and alcohol to intoxication (38%). The mental health status of homeless men was associated with substance use, with PTSD more common among those who used crack. Riskier networks (comprised of a larger proportion of drug users) were associated with marijuana use, and normative social ties (family, employed and school/work contacts) were associated with a decreased likelihood of crack use. CONCLUSIONS Mental health problems and riskier personal networks are associated with homeless men's substance use. These findings underscore the importance of interventions that focus on improving mental health, mitigating the drug-using norms of personal networks, and helping men to maintain contact with normative, low-risk alters. Mental health care and peer-based, network interventions to reduce substance use should be a priority for heterosexually active homeless men.
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Affiliation(s)
- Harmony Rhoades
- University of Southern California, School of Social Work, 669 W. 34th Street, Los Angeles, CA 90089-0411, USA.
| | - Suzanne L. Wenzel
- University of Southern California, School of Social Work, 669 W. 34th Street, Los Angeles, CA 90089-0411, USA, RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, USA
| | - Daniela Golinelli
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, USA
| | - Joan S. Tucker
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, USA
| | - David P. Kennedy
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, USA
| | - Harold D. Green
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, USA
| | - Annie Zhou
- RAND Corporation, 1776 Main Street, P.O. Box 2138, Santa Monica, CA 90407, USA
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Lee SJ, Liang LJ, Rotheram-Borus MJ, Milburn NG. Resiliency and survival skills among newly homeless adolescents: Implications for future interventions. VULNERABLE CHILDREN AND YOUTH STUDIES 2011; 6:301-308. [PMID: 22216061 PMCID: PMC3248916 DOI: 10.1080/17450128.2011.626468] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Recent studies on homeless adolescents suggest that the profiles of homeless adolescents are heterogeneous, and that certain clusters of homeless adolescents demonstrated resiliency and positive coping strategies. This study examined the relationship between HIV-related risk factors and resiliency (survival skills) of homeless adolescents over a 2-year period. Those who did not engage in unprotected sex reported significantly higher survival skills scores. Similarly, those who were monogamous during the study period reported significantly higher survival skills scores. However, there was a significant decline in survival skills scores after 6 months, regardless of the HIV-related risk factors. Findings from this study point to the urgent need to identify and target resilient adolescents early on to provide interventions to facilitate the transition to stable living situations before their resiliency deteriorates.
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Affiliation(s)
- Sung-Jae Lee
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, Los Angeles, CA
| | - Li-Jung Liang
- Department of Medicine Statistics Core, University of California, Los Angeles, Los Angeles, CA
| | - Mary Jane Rotheram-Borus
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, Los Angeles, CA
| | - Norweeta G. Milburn
- University of California, Los Angeles, Department of Psychiatry and Biobehavioral Sciences, Semel Institute for Neuroscience and Human Behavior, Center for Community Health, Los Angeles, CA
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Thompson S, Jun J, Bender K, Ferguson KM, Pollio DE. Estrangement factors associated with addiction to alcohol and drugs among homeless youth in three U.S. cities. EVALUATION AND PROGRAM PLANNING 2010; 33:418-427. [PMID: 20299098 DOI: 10.1016/j.evalprogplan.2010.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2009] [Revised: 01/22/2010] [Accepted: 02/21/2010] [Indexed: 05/29/2023]
Abstract
Substance use is highly prevalent among homeless, street-involved young people. Societal estrangement is often associated with substance use, particularly among this population. The current study sought to identify four domains of social estrangement (disaffiliation, human capital, identification with homeless culture, and psychological dysfunction) in relation to alcohol and drug addiction. Homeless young adults were recruited from three disparate urban areas: Los Angeles, CA (n=50), Austin, TX (n=50) and St. Louis, MO (n=46) using comparable research methods and measurement instruments. Findings demonstrated that variables measuring psychological dysfunction and homeless culture predicted alcohol addiction, while institutional disaffiliation and homeless culture predicted drug addiction. Findings affirm distinct patterns of estrangement related to alcohol compared to drug addiction. Understanding these features and the heterogeneity of this population has strong potential for assisting development of programs targeting substance use among this underserved population.
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Affiliation(s)
- Sanna Thompson
- University of Texas at Austin, School of Social Work, 1717 W. 6th Street, Austin, TX 78703, United States.
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