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Kyei-Arthur F, Kyei-Gyamfi S. Alcohol consumption and risky sexual behaviors among fishers in Elmina in Ghana. BMC Public Health 2023; 23:1328. [PMID: 37434125 PMCID: PMC10337065 DOI: 10.1186/s12889-023-16239-w] [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: 01/26/2023] [Accepted: 07/04/2023] [Indexed: 07/13/2023] Open
Abstract
BACKGROUND Alcohol consumption is part of human social behavior and constitutes a routine part of social life in many countries. Prior studies have found over-indulgence of fishers in alcohol in fishing communities. The study uses the Alcohol Myopia Theory (AMT) to analyze and explain the phenomena of fishers engaging in sex after alcohol consumption, and condom use with sexual partner(s) after alcohol consumption. The study investigated alcohol consumption, predictors of alcohol consumption, and the reasons for drinking alcohol among fishers. It also examined fishers' engagement in sex after alcohol consumption, the use of condoms with sexual partners after drinking alcohol, and predictors of the use of condoms with sexual partners after drinking alcohol. METHODS A cross-sectional convergent parallel mixed-method design was used to study 385 fishers in Elmina. Also, two focus group discussions were conducted among male and female fishers. Descriptive statistics were used to analyze the quantitative data, while the qualitative data was analyzed thematically. RESULTS Generally, 59.2% of participants indulged in alcohol consumption. Most male participants (70.6%) indulged in alcohol consumption than female participants (48.5%). Also, 48.5% of participants indulged in binge alcohol consumption, while 38.1% indulged in moderate alcohol consumption. The predictors of alcohol consumption were sex, religion, and type of fishing occupation. Participants identified consuming alcohol to kill loneliness and boredom, to forget family and work-related issues, and to have fun as reasons why fishers consume alcohol. Sixty-four percent of participants have ever engaged in sexual intercourse after consuming alcohol in the past 12 months. However, 70% of participants did not use a condom the last time they had sex after drinking alcohol. Only ethnicity of participants predicted their use of a condom the last time they had sex after drinking alcohol. The primary reasons for the non-use of condoms were do not like using condoms (37.9%), forgetting to use a condom (33.0%), and had sex with a trusted regular partner (15.5%). CONCLUSIONS This study demonstrated that alcohol consumption was prevalent among fishers, especially among male fishers, which contributes to risky sexual behaviors among them as espoused by the AMT. It is recommended that fishers are targeted for alcohol use and risky sexual behavior programs and interventions since alcohol use is prevalent among them and most of them also engage in unprotected sexual intercourse after consuming alcohol.
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Affiliation(s)
- Frank Kyei-Arthur
- Department of Environment and Public Health, University of Environment and Sustainable Development, Somanya, Ghana.
| | - Sylvester Kyei-Gyamfi
- Department of Children, Ministry of Gender, Children and Social Protection, Accra, Ghana
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2
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Brott H, Townley G. Reproductive justice for unhoused women: An integrative review of the literature. JOURNAL OF COMMUNITY PSYCHOLOGY 2023; 51:1935-1960. [PMID: 36525556 DOI: 10.1002/jcop.22980] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Revised: 11/07/2022] [Accepted: 12/02/2022] [Indexed: 06/14/2023]
Abstract
This review examines the reproductive health experiences of unhoused women and youth. Guided by the reproductive justice framework, this review examines barriers to accessing contraception, medical abortion, and prenatal care while homeless. Twenty-one articles were identified through keyword searches in Google Scholar, Ebscohost Academic Search Premier, and PsycINFO. In included articles, barriers were identified at the individual, relational, and contextual levels. Findings from this scoping review illustrate the need to examine multiple levels of analysis when seeking to improve access to family planning services for individuals experiencing homelessness. Included literature suggests an overabundance of research documenting barriers to contraceptive care relative to the literature examining abortion and prenatal care experiences and a scarcity of research examining barriers to reproductive justice among unhoused individuals who do not identify as women.
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Affiliation(s)
- Holly Brott
- Department of Psychology, Portland State University, Portland, Oregon, USA
| | - Greg Townley
- Department of Psychology, Portland State University, Portland, Oregon, USA
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3
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Kachingwe ON, Phillips DR, Jasczynski M, Hillig E, Chavez R, Tellei J, Aparicio EM. 'I told him I'm gonna get it': intimate partner birth control communication among homeless young women. CULTURE, HEALTH & SEXUALITY 2023; 25:159-175. [PMID: 35020565 DOI: 10.1080/13691058.2021.2025431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Accepted: 12/31/2021] [Indexed: 06/14/2023]
Abstract
Homeless youth have disproportionately high rates of unintended pregnancy and STIs. Enhancing communication between sexual partners can improve sexual health outcomes, yet little is known about this topic among homeless youth; therefore, this study aimed to examine how homeless youth communicate with their partners about birth control. In-depth semi-structured interviews regarding intimate partner birth control communication were conducted with 10 homeless young women aged 14-22 years following their completion of a comprehensive sexual health program (Wahine Talk). We transcribed the interviews verbatim and used a structured, inductive analytic approach to identify themes. Analysis identified three themes: Getting the Conversation Started, Conversation Content, and Impact of Conversation. Birth control conversations were prompted by programme participation, birth control side effects, and family members' interest in homeless youth becoming pregnant. Barriers to communication included fear and mistimed conversations (e.g. during the initiation of sex). Homeless young people shared simultaneous desires to delay pregnancy and concerns about side effects of birth control use. Discussions about birth control with their partners may demonstrably improve homeless youth's intimate relationships and family planning efforts. Providers can support homeless young women by helping them plan conversation timing and addressing fear, including the risk of violence.
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Affiliation(s)
- Olivia N Kachingwe
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | | | - Michelle Jasczynski
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Emily Hillig
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Rebecca Chavez
- Youth Outreach (YO!) Program, Waikiki Health, Honolulu, HI, USA
| | | | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
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4
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Moisan C, Bélanger R, Calvin J, Shipaluk L, Fraser S, Morin V, Muckle G. Exploring ambivalence toward pregnancy among young Inuit women. CULTURE, HEALTH & SEXUALITY 2023; 25:94-109. [PMID: 35015967 DOI: 10.1080/13691058.2021.2022211] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Ambivalence toward pregnancy is an important predictor of early pregnancy as documented in diverse Western societies. Inuit women from Nunavik, a northern region of Quebec, Canada, experience a high rate of early pregnancy, yet no study has explored their attitudes toward pregnancy. Grounded in a participatory approach, this study aimed to explore ambivalence toward pregnancy, among other pregnancy-related attitudes, and identify themes underlying ambivalence among young Inuit women from Nunavik. We conducted semi-structured interviews with 15 women aged 16 to 20 years, who became pregnant during the year preceding the interview. We used an inductive approach to analyse the data. Eleven participants were identified as ambivalent toward pregnancy while three were characterised as having a favourable attitude, and one as unfavourable. Four themes related to ambivalence were identified: the value of childbearing/motherhood; the use of contraceptives; the likelihood of becoming pregnant; and the ideal age to become pregnant. A better understanding of young women's attitudes toward pregnancy could contribute to the development of culturally relevant programmes to more effectively support adolescents, pregnant adolescents and young mothers, and to lead to better care.
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Affiliation(s)
- Caroline Moisan
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Center - Université Laval, Quebec City, Canada
- School of Psychology, Université Laval, Quebec City, Canada
| | - Richard Bélanger
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Center - Université Laval, Quebec City, Canada
- Department of Paediatrics, Centre mère-enfant Soleil, CHU de Québec - Université Laval, Quebec City, Canada
| | | | | | - Sarah Fraser
- School of Psychology, Université de Montréal, Montréal, Canada
| | - Véronique Morin
- Nunavik Regional Board of Health and Social Services, Nunavik, Canada
| | - Gina Muckle
- Population Health and Optimal Health Practices Research Branch, CHU de Québec Research Center - Université Laval, Quebec City, Canada
- School of Psychology, Université Laval, Quebec City, Canada
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5
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Henriques E, Schmidt C, Pascoe R, Liss K, Begun S. Counter-Narratives of Structural Oppressions, Stigma and Resistance, and Reproductive and Sexual Health Among Youth Experiencing Homelessness. QUALITATIVE HEALTH RESEARCH 2022; 32:1447-1463. [PMID: 35739061 PMCID: PMC9411701 DOI: 10.1177/10497323221110694] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Youth experiencing homelessness (YEH) face myriad injustices regarding their reproductive and sexual health and rights. Reproductive and sexual health research with YEH often explores condom-use and sexually transmitted infections, potentially contributing to narrow conceptualizations of YEH as "unclean" or in need of disease-screening. A narrative theory perspective was applied to this study, which allowed for the emergence of alternative storylines, or counter-narratives, which attend to manifestations of power and oppression within the lives of marginalized individuals. Qualitative interviews engaged 30 young people (ages 18-21) accessing shelter services. Narrative analyses identified YEHs' documentations of dominant narratives related to structural oppressions, stigma, and numerous dimensions of reproductive and sexual health including how they create, through their resistance, counter-narratives that include their preferred futures. YEH emphasized systemic sources of stigma and outlined their criticisms of the state. Within-group stigma emerged as a noteworthy theme, with YEH showing both empathy and ambivalence towards other YEH, along with internalization of stigmatizing narratives about pregnancy and homelessness. Approaches to service provision that further amplify youths' voices in naming and challenging the many oppressions and stigmas they face should be prioritized. Moreover, policies should be implemented to dismantle the actual root causes of challenges faced by YEH, rather than perpetuating them through measures rooted in interlocking oppressions of discrimination, inequity, and judgment.
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Affiliation(s)
- Emilia Henriques
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Catherine Schmidt
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Rachael Pascoe
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Kira Liss
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
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6
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Moisan C, Bélanger R, Fraser S, Muckle G. Shedding light on attitudes towards pregnancy among Inuit adolescents from Nunavik. Int J Circumpolar Health 2022; 81:2051335. [PMID: 35319351 PMCID: PMC8956303 DOI: 10.1080/22423982.2022.2051335] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Better understanding attitudes toward pregnancy – a potent predictor of adolescent pregnancy – could help explain the high adolescent pregnancy rate in Nunavik, Canada. The objective of this study was to assess the distribution of different attitudes toward pregnancy and the factors associated with high pregnancy likelihood attitudes (HPLA; favourable, indifferent, and ambivalent), focusing on the perceived benefits of childbearing (BOC). T-tests, chi-square tests, and logistics regressions were performed based the answers of 159 Inuit women aged 16 to 20 years from the Qanuilirpitaa? survey. About 43% were ambivalent, 16% favourable, 5% indifferent, and 35% unfavourable toward pregnancy. Bivariate analysis indicate that the HPLA group was more likely to work, to report less frequent positive interactions, and to show a higher BOC score compared to others. Multivariate analysis show that an increased BOC score was associated with HPLA (OR = 1.09, 95% CI = 1.01 − 1.18). Perceiving that a baby would strengthen the relationship with the other parent (OR = 1.65, 95% CI = 1.15 − 2.37) and that it would help to access housing were individually associated with HPLA (OR = 1.45, 95% CI = 1.02 − 2.10). Findings provide evidence to support Inuit adolescents’ reproductive choices.
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Affiliation(s)
- Caroline Moisan
- Population Health and Optimal Health Practices Research Branch, Chu de Québec Research Center - Université Laval, Quebec, Ontario, Canada.,School of Psychology, Université Laval, Quebec, Ontario, Canada
| | - Richard Bélanger
- Population Health and Optimal Health Practices Research Branch, Chu de Québec Research Center - Université Laval, Quebec, Ontario, Canada.,Department of Paediatrics, Centre mère-enfant Soleil, CHU de Québec - Université Laval, Quebec, Ontario, Canada
| | - Sarah Fraser
- School of Psychology, Université de Montréal, Montréal, Ontario, Canada
| | - Gina Muckle
- Population Health and Optimal Health Practices Research Branch, Chu de Québec Research Center - Université Laval, Quebec, Ontario, Canada.,School of Psychology, Université Laval, Quebec, Ontario, Canada
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7
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Eapen DJ, Bergh R, Narendorf SC, Santa Maria DM. Pregnancy and parenting support for youth experiencing homelessness. Public Health Nurs 2022; 39:728-735. [PMID: 35084059 DOI: 10.1111/phn.13055] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 12/23/2021] [Accepted: 01/12/2022] [Indexed: 12/01/2022]
Abstract
This study explored the perceptions and experiences related to pregnancy and parenting support among youth while homeless. This study employed a qualitative descriptive design using data collected from focus group discussions. We assessed the experiences and perceptions of youth related to pregnancy and parenting support. Eighty-one youth participated in eight focus group discussions and were recruited from shelters, drop-in centers, and organizations that serve youth in a large metropolitan areas in the southern United States. Thematic content analyses were used to generate results from the qualitative data. Four main themes emerged: youth encountered barriers to accessing healthcare services at the individual and system levels; pregnancy and parenting are stressful, especially during homelessness; support can help overcome the stresses of parenting; and embracing responsibility or "stepping up" is a positive influence of pregnancy and parenting during homelessness. Youth experiencing homelessness (YEH) face significant challenges to accessing healthcare services and adjusting to the parental role. Interventions for pregnant and parenting youth should be co-designed with and tailored for youth and address the existing health inequities within the healthcare and social service systems.
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Affiliation(s)
- Doncy J Eapen
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | - Rebecca Bergh
- Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
| | | | - Diane M Santa Maria
- Department of Research, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, TX
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8
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Gaudet BA, Liu N, Kayne AN, Jarvill TL, Zemanek C, Downen JM, Cuadrado HM, Smith AB, Greenberg MR, Jacoby JL, Quinones JN. Relationship Between Sexual Activity, Contraceptive Utilization and Biopsychosocial Characteristics Among Homeless Shelter Adolescents. Cureus 2021; 13:e18128. [PMID: 34692338 PMCID: PMC8525671 DOI: 10.7759/cureus.18128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 09/20/2021] [Indexed: 11/30/2022] Open
Abstract
Objective: To determine whether biopsychosocial factors are associated with sexual activity and contraceptive utilization among homeless shelter adolescents. Methods: A retrospective study of 440 adolescents at a shelter in Pennsylvania between February 2015 and September 2019 was conducted. The cohort was evaluated to determine what relationship age, gender identity, substance use, and trauma history have with sexual activity and contraceptive utilization. Results: Sexual activity was significantly related to age (mean 15.8+1.4 years in sexually active vs. 14.7+1.6 years in abstinent youth, p<0.001); remote history of self-harm behavior (relative risk ratio (RR) 1.23 [95% CI 1.03-1.46]; p=0.02), history of aggressive behavior (RR 1.21 [95% CI 1.01-1.46]; p=0.04), history of trauma (RR 1.24 [95% CI 1.04-1.48]; p=0.03), and substance use (RR 2.27 [95%CI 1.86-2.77]; p<0.001). There were 55.7% sexually active females vs. 42.50% males reporting contraception use (p=0.01). After adjustment, older age and substance use remained significantly associated with sexual activity (adjusted odds ratio (AOR) 1.58 [95% CI 1.36-1.83]; p<0.001 and AOR 5.18 [95% CI 3.28-8.18]; p<0.001, respectively). Conclusions: Females self-reported sexual activity using contraception more than males. After adjustment, older age and substance use were associated with sexual activity. By better understanding the impact these factors can have on contraceptive utilization, informed policy and practice interventions can be developed and implemented to help increase safe sex practices in spaces where homeless adolescents access healthcare.
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Affiliation(s)
- Brittney A Gaudet
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Nina Liu
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Allison N Kayne
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Taylor L Jarvill
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Cecilia Zemanek
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jeffrey M Downen
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Hoonani M Cuadrado
- Department of Community Health and Health Studies, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA.,Street Medicine, Valley Health Partners, Allentown, USA
| | - Amy B Smith
- Department of Education, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Marna R Greenberg
- Department of Emergency Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Jessica L Jacoby
- Department of Emergency and Hospital Medicine, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
| | - Joanne N Quinones
- Department of Obstetrics and Gynecology, University of South Florida Morsani College of Medicine/Lehigh Valley Health Network Campus, Allentown, USA
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9
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Aparicio EM, Kachingwe ON, Fleishman J, Novick J. Birth Control Access and Selection among Youths Experiencing Homelessness in the United States: A Review. HEALTH & SOCIAL WORK 2021; 46:171-186. [PMID: 34114598 DOI: 10.1093/hsw/hlab004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2019] [Revised: 10/22/2019] [Accepted: 12/16/2019] [Indexed: 06/12/2023]
Abstract
Youths experiencing homelessness (YEH) become pregnant at five times the general population rate. Education, social, and health care systems struggle to adequately address this young community's sexual and reproductive health needs, yet social workers are well positioned across sectors to address their sexual and reproductive health and well-being. A growing body of literature exists on the factors affecting YEH's access and selection of birth control, prompting the present review that aimed to understand this process and inform better attuned sexual and reproductive health approaches. Using a systematic search and analytic approach, we retrieved 203 articles, of which 23 met inclusion criteria. Key findings emerged across socioecological levels, including barriers and facilitators to condom use; the differential impact on YEH of hormonal birth control side effects; and the devastating effects of economic insecurity leading to sexual exploitation, survival sex, and exposure to violence. Implications include the need for multilevel intervention that addresses youths' knowledge, attitudes, and behavior as well the need to improve social norms and system design to provide better attuned care for YEH.
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Affiliation(s)
- Elizabeth M Aparicio
- assistant professor, Department of Behavioral and Community Health, University of Maryland at College Park
| | - Olivia N Kachingwe
- doctoral candidate, Department of Behavioral and Community Health, University of Maryland at College Park
| | - Jamie Fleishman
- research assistants, Department of Behavioral and Community Health, University of Maryland at College Park
| | - Julia Novick
- research assistants, Department of Behavioral and Community Health, University of Maryland at College Park
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10
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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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11
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Begun S, Weber A, Spring J, Arora SRA, Frey C, Fortin A. "This Research Is Cool": Engaging Youth Experiencing Homelessness in Research on Reproductive and Sexual Health. SOCIAL WORK IN PUBLIC HEALTH 2020; 35:271-281. [PMID: 32631161 DOI: 10.1080/19371918.2020.1791296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Youth experiencing homelessness face myriad barriers and inequities regarding their reproductive and sexual health and rights. Moreover, homeless youth are often characterized as "disaffiliated" and depicted as difficult to engage in research. This study qualitatively explored homeless youths' attitudes, beliefs, and needs regarding reproductive and sexual health, and sought their perspectives on being involved in research on such topics, which are often thought of as "taboo" or sensitive. Youth were enthusiastic about openly discussing such issues, which they deemed as highly relevant to their daily lives. Youth identified that how they were engaged in such research, and having opportunities for longer-term contributions to such efforts, were both important and exciting to them. Future social work and public health research efforts should seek to further disrupt narratives of homeless youth as "disaffiliated" and difficult to engage, and in doing so, develop more creative, participatory, and youth-led opportunities for including this group in reproductive and sexual health research.
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Affiliation(s)
- Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Ariel Weber
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Joshua Spring
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Simran R A Arora
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Cressida Frey
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
| | - Alicia Fortin
- Factor-Inwentash Faculty of Social Work, University of Toronto , Toronto, Ontario, Canada
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12
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Attitudes of Teenage Mothers towards Pregnancy and Childbirth. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17041411. [PMID: 32098226 PMCID: PMC7068586 DOI: 10.3390/ijerph17041411] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/19/2020] [Revised: 02/15/2020] [Accepted: 02/20/2020] [Indexed: 12/04/2022]
Abstract
The problem of early motherhood is still a serious medical and social problem in many countries around the world. The aim of this study was to analyze the attitudes of teenage mothers towards pregnancy and childbirth. A retrospective cross-sectional study was conducted with the use of an original questionnaire containing a test to measure attitudes on a five-point Likert scale and a Life Orientation Test-Revised (LOT-R) to assess dispositional optimism. The study involved 308 teenage mothers between 13 and 19 years of age. Attitudes of teenage mothers towards pregnancy and childbirth were more often positive (90.6%) than negative (9.4%). Sociodemographic features determining the attitudes of teenage mothers towards both their pregnancy and childbirth included their age, marital status, current occupation, and main source of income. The type of attitude adopted by teenage mothers towards pregnancy and childbirth was significantly related to the level of their dispositional optimism.
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13
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Wycoff KL, Matone M. Amplifying the Need for Trauma-Informed Sexual and Reproductive Health Care for At-Risk Adolescents During Times of Social and Political Complexity. J Adolesc Health 2019; 65:181-184. [PMID: 31331541 DOI: 10.1016/j.jadohealth.2019.05.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2019] [Accepted: 05/23/2019] [Indexed: 11/17/2022]
Affiliation(s)
- Kirby L Wycoff
- Division of Adolescent Medicine, Leadership and Education in Adolescecent Health Fellowship Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; College of Education, School Psychology Program, Eastern University, St. Davids Pennsylvania.
| | - Meredith Matone
- PolicyLab, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania; Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
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14
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LaCross A, Smaldone A, Angelson J. Ambivalence Toward Pregnancy as an Indicator for Contraceptive Nonuse: A Systematic Review and Meta‐Analysis. J Midwifery Womens Health 2019; 64:385-394. [DOI: 10.1111/jmwh.12969] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 12/26/2018] [Accepted: 01/02/2019] [Indexed: 11/29/2022]
Affiliation(s)
- Allison LaCross
- Department of Obstetrics and GynecologyNorth Central Bronx Hospital Bronx New York
- Columbia University School of Nursing New York New York
| | - Arlene Smaldone
- Columbia University School of Nursing New York New York
- College of Dental MedicineColumbia University Medical Center New York New York
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Begun S, Combs KM, Torrie M, Bender K. "It seems kinda like a different language to us": Homeless youths' attitudes and experiences pertaining to condoms and contraceptives. SOCIAL WORK IN HEALTH CARE 2019; 58:237-257. [PMID: 30407128 DOI: 10.1080/00981389.2018.1544961] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2017] [Revised: 11/01/2018] [Accepted: 11/02/2018] [Indexed: 06/08/2023]
Abstract
Homeless youth become pregnant or involved in pregnancies at high rates. There are many ways by which unintended pregnancies may be prevented, including the use of condoms and other contraceptives. However, there is a dearth of research regarding contraceptive use among this vulnerable youth population, and especially through lenses that consider homeless youths' diverse gender identities, expressions, and sexualities. This study qualitatively explores homeless youths' attitudes and experiences regarding condom and other contraceptive use. Data were obtained from interviews with 30 youth experiencing homelessness, ages 18-21. Youth reported inconsistent use of condoms and other contraceptives, which youth often attributed to their perceptions of contraceptive inaccessibility and exorbitant cost. Most youth also did not know where to obtain contraceptive information and services, and reported transportation barriers and fear of being stigmatized in health care settings, particularly in relation to their gender identities and sexualities. Findings suggest that reproductive and sexual health information and services are urgently needed by all homeless young people, and from low-barrier, non-judgmental, and empathetic sources.
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Affiliation(s)
- Stephanie Begun
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Katie Massey Combs
- b Graduate School of Social Work , University of Denver , Denver , CO USA
| | - Michaela Torrie
- a Factor-Inwentash Faculty of Social Work , University of Toronto , Toronto , ON , Canada
| | - Kimberly Bender
- b Graduate School of Social Work , University of Denver , Denver , CO USA
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Combs KM, Brown SM, Begun S, Taussig H. Pregnancy Attitudes and Contraceptive Use among Young Adults with Histories of Foster Care. CHILDREN AND YOUTH SERVICES REVIEW 2018; 94:284-289. [PMID: 31105369 PMCID: PMC6519940 DOI: 10.1016/j.childyouth.2018.10.017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
INTRODUCTION This study examined pregnancy attitudes and contraceptive use among young adults with histories of foster care. METHODS 209 female and male young adults, aged 18-22, with histories of foster care were interviewed about their intentions and feelings towards pregnancy. Respondents were then categorized as having pro-pregnancy (i.e., having positive pregnancy intentions and happy feelings about pregnancy), ambivalent (either intentions or happy feelings), or anti-pregnancy (no intentions and unhappy feelings) attitudes. Participants also reported their past-year contraceptive use, and the relationship between pregnancy attitudes and contraceptive use was subsequently explored for the overall sample, and by sex and history of pregnancy using Chi-square tests. RESULTS Only 13.4% of participants had positive pregnancy intentions, though 41.9% reported that they would feel happy with a pregnancy. Over half (55.9%) of participants were anti-pregnancy, a third (32.8%) were ambivalent and 11.3% were pro-pregnancy. Compared to females, males were more likely to have positive pregnancy intentions (18.6% vs. 7.8%, p = .03) and to be pro-pregnancy (16.5% vs. 5.6%, p = .04). No differences in pregnancy attitudes were found as a function of pregnancy history. Consistent contraceptive use was significantly associated with pregnancy attitudes; 22.2% of pro-pregnancy participants reported consistent contraceptive use versus 52.9% of ambivalent and 62.2% of anti-pregnancy participants. DISCUSSION In this exploratory study, few participants held pro-pregnancy attitudes and a high percentage of participants who were anti-pregnancy did not use contraception consistently. Although studies with larger samples examining this topic are needed, professionals should distinguish between young adults' intentions and feelings about pregnancy in an effort to better address contraceptive needs.
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Affiliation(s)
- Katie Massey Combs
- Graduate School of Social Work, University of Denver; 2148
S. High Street, Denver, CO 80208
| | - Samantha M. Brown
- School of Social Work, Colorado State University; 1586
Campus Delivery, Fort Collins, CO 80523
| | - Stephanie Begun
- Factor-Inwentash Faculty of Social Work, University of
Toronto, 246 Bloor Street West, Office 434, Toronto, ON M5S 1V4
| | - Heather Taussig
- Graduate School of Social Work, University of Denver; 2148
S. High Street, Denver, CO 80208
- Kempe Center, University of Colorado School of Medicine.
13123 E 16th Ave., Aurora, CO 80045
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Clark LF, Desai M, Drake P, Okonta V. Is Current Measurement of Contraception Use Hindering Identification of Evidence-Based Pregnancy Prevention for Vulnerable Adolescents? Am J Public Health 2018; 108:S17-S18. [PMID: 29443566 DOI: 10.2105/ajph.2017.304207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Leslie F Clark
- Leslie F. Clark is with the Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Southern California, Los Angeles, and The Community, Health Outcomes, and Intervention Research Program, The Saban Research Institute, Children's Hospital Los Angeles. Mona Desai is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles. Pamela Drake is with ETR Associates, Scotts Valley, CA. Vivian Okonta is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles
| | - Mona Desai
- Leslie F. Clark is with the Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Southern California, Los Angeles, and The Community, Health Outcomes, and Intervention Research Program, The Saban Research Institute, Children's Hospital Los Angeles. Mona Desai is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles. Pamela Drake is with ETR Associates, Scotts Valley, CA. Vivian Okonta is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles
| | - Pamela Drake
- Leslie F. Clark is with the Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Southern California, Los Angeles, and The Community, Health Outcomes, and Intervention Research Program, The Saban Research Institute, Children's Hospital Los Angeles. Mona Desai is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles. Pamela Drake is with ETR Associates, Scotts Valley, CA. Vivian Okonta is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles
| | - Vivian Okonta
- Leslie F. Clark is with the Division of Adolescent and Young Adult Medicine, Department of Pediatrics, University of Southern California, Los Angeles, and The Community, Health Outcomes, and Intervention Research Program, The Saban Research Institute, Children's Hospital Los Angeles. Mona Desai is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles. Pamela Drake is with ETR Associates, Scotts Valley, CA. Vivian Okonta is with the Division of Adolescent and Young Adult Medicine, Children's Hospital Los Angeles
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Tucker JS, D'Amico EJ, Ewing BA, Miles JNV, Pedersen ER. A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults. J Subst Abuse Treat 2017; 76:20-27. [PMID: 28340904 DOI: 10.1016/j.jsat.2017.02.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 01/17/2017] [Accepted: 02/10/2017] [Indexed: 01/09/2023]
Abstract
Homeless young adults ages 18-25 exhibit high rates of alcohol and other drug (AOD) use, and sexual risk behaviors such as unprotected sex. Yet few programs exist for this population that are both effective and can be easily incorporated into settings serving this population. This pilot cluster cross-over randomized controlled trial evaluates AWARE, a voluntary four session group-based motivational interviewing (MI) intervention to reduce AOD use and sexual risk behavior. We evaluated AWARE with 200 homeless young adults using drop-in center services in Los Angeles County (mean age=21.8years; 73% male; 79% heterosexual; 31% non-Hispanic White, 25% African American, 24% Hispanic, 21% multiracial/other). Surveys were completed at baseline and three months after program completion. Retention in the AWARE program was excellent (79% attended multiple sessions) and participants reported high levels of satisfaction with the program. AWARE participants self-reported positive change in their past 3month and past 30day alcohol use (ps≤0.05), motivation to change drug use (ps<0.05), and condom use self-efficacy (p=0.05) compared to the control group. Among those with multiple sex partners, AWARE participants showed a decrease in unprotected sexual events (p<0.05), whereas the control group did not. Results from this pilot evaluation are promising, suggesting that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their alcohol and condom use. Further work is needed to more fully evaluate the efficacy of AWARE on AOD behavior and sexual risk behavior outcomes.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States.
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Brett A Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Jeremy N V Miles
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90407-2138, United States
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Dasari M, Borrero S, Akers AY, Sucato GS, Dick R, Hicks A, Miller E. Barriers to Long-Acting Reversible Contraceptive Uptake Among Homeless Young Women. J Pediatr Adolesc Gynecol 2016. [PMID: 26210293 DOI: 10.1016/j.jpag.2015.07.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY OBJECTIVE To identify barriers to long-acting reversible contraception (LARC) uptake among homeless young women. DESIGN In this mixed methods study surveys and guided interviews were used to explore women's contraceptive and reproductive experiences, interactions with the health care system, and their histories of homelessness. SETTING All surveys and interviews were conducted at a homeless drop-in center or shelter. PARTICIPANTS Fifteen women between 18 and 24 years of age with a past year history of homelessness. INTERVENTIONS None. MAIN OUTCOME MEASURES Perceived barriers to contraceptive use, including knowledge and access barriers and interactions with the health care system around reproductive health. RESULTS Confusion about the possibility of early termination of LARC, and the perception that providers deliberately withhold selective information about contraceptive options to bias contraceptive decision-making, were 2 key new findings. Women also reported interest in visual aids accompanying verbal contraceptive counseling. Pregnancy attitudes and history of reproductive and sexual coercion also influenced contraceptive decision-making and reported interest in LARC methods. CONCLUSION Comprehensive counseling about all contraceptive options, including LARC, are important for targeting the perceived gaps in contraceptive education and care among homeless young women.
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Affiliation(s)
- Mohini Dasari
- University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Sonya Borrero
- Division of General Internal Medicine, University of Pittsburgh School of Medicine and Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Aletha Y Akers
- The Craig Dalsimer Division of Adolescent Medicine, The Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Gina S Sucato
- Adolescent Health, Group Health Cooperative, Seattle Children's Hospital, Seattle, Washington
| | - Rebecca Dick
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Angela Hicks
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Elizabeth Miller
- Division of Adolescent and Young Adult Medicine, Children's Hospital of Pittsburgh, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; Department of Pediatrics, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
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Wachira J, Kamanda A, Embleton L, Naanyu V, Ayuku D, Braitstein P. 'Pregnancy Has Its Advantages': The Voices of Street Connected Children and Youth in Eldoret, Kenya. PLoS One 2016; 11:e0150814. [PMID: 26942724 PMCID: PMC4778759 DOI: 10.1371/journal.pone.0150814] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2015] [Accepted: 02/19/2016] [Indexed: 11/19/2022] Open
Abstract
Objective Little is known about the reproductive health or family planning needs of street-connected children and youth in resource-constrained countries. The study objective was to describe how street-connected children and youth (SCCY) in Eldoret, Kenya, perceive pregnancy. Methods This qualitative study was conducted between August 2013 and February 2014. A total of 65 SCCY aged 11–24 years were purposively sampled from the three referral points: 1) A dedicated study clinic for vulnerable children and youth at Moi Teaching and Referral Hospital (MTRH); 2) Primary locations in which street children reside known as “bases/barracks”; and 3) Street youth community-based organizations. In-depth interviews and focus group discussions were audio recorded, transcribed, and translated into English. Content analysis was performed after thematic coding by 4 independent coders. Results The majority of SCCY interviewed were male (69%) and sexually active (81.5%). None had gone beyond primary level of education. The strong desire for SCCY to go through conventional life experiences including marriage and child bearing was evident. Sub-themes around desired pregnancies included: sense of identity with other SCCY, sense of hope, male ego, lineage, source of income, and avoiding stigmatization. The desire for children was highly gendered with male SCCY more focused on their social status in the street community, while for females it was primarily for survival on the street. Female SCCY generally lacked agency around reproductive health issues and faced gender-based violence. Abortions (either assisted or self-induced), infanticide, and child abandonment were reported. Respondents described a lucrative market for babies born to SCCY and alleged that healthcare workers were known to abduct these babies following hospital deliveries. Conclusion Our findings indicate gender differences in the reasons why SCCY become pregnant and have children. We also noted gender inequalities in reproductive health decisions. SCCY friendly interventions that provide tailored reproductive health services are needed.
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Affiliation(s)
- Juddy Wachira
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- * E-mail:
| | | | - Lonnie Embleton
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
| | - Violet Naanyu
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - David Ayuku
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
| | - Paula Braitstein
- Academic Model Providing Access to Healthcare (AMPATH), Eldoret, Kenya
- College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
- Dalla Lana School of Public Health, University of Toronto, Ontario, Canada
- Indiana University, Fairbanks School of Public Health, Department of Epidemiology, Indianapolis, Indiana, United States of America
- Regenstrief Institute, Inc., Indianapolis, Indiana, United States of America
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21
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Kennedy DP, Brown RA, Morrison P, Vie L, Ryan GW, Tucker JS. Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation. BMC Public Health 2015; 15:62. [PMID: 25636862 PMCID: PMC4324882 DOI: 10.1186/s12889-015-1419-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 01/14/2015] [Indexed: 11/17/2022] Open
Abstract
Background Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect. Methods To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis. Results We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances. Conclusions Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1419-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- David P Kennedy
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Ryan A Brown
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Penelope Morrison
- The RAND-University of Pittsburgh Health Institute, Pittsburgh, PA, USA.
| | - Loryana Vie
- The Department of Psychology, University of Pennsylvania, Philadelphia, PA, USA. .,The Department of Psychology, University of California, Riverside, CA, USA.
| | - Gery W Ryan
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
| | - Joan S Tucker
- RAND Health, RAND Corporation, P.O. Box 2138, 1776 Main Street, Santa Monica, CA, 90407, USA.
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Lau M, Lin H, Flores G. Factors Associated With Being Pleased With a Female Partner Pregnancy Among Sexually Active U.S. Adolescent Males. Am J Mens Health 2015; 10:192-206. [PMID: 25563382 DOI: 10.1177/1557988314563729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Adolescent pregnancy remains a major U.S. public health problem. Little is known about pregnancy attitudes in U.S. adolescent males. The study objective was to identify factors from different domains that are associated with sexually active U.S. adolescent males who would be pleased with a female partner pregnancy (hereafter known as pleased with a pregnancy). The National Survey of Family Growth is a nationally representative survey of those 15 to 44 years old. Bivariate and multivariable analyses were performed of the 2002 and 2006-2010 cycles to examine factors associated with being pleased with a pregnancy among sexually active U.S. males. Among the 1,445 sexually active U.S. adolescent males surveyed, 25% would be pleased with a pregnancy. In bivariate analyses, ever being suspended from school, having sporadic health insurance, age, and ever HIV tested were significantly associated with being pleased with a pregnancy. In final multivariable analyses, sporadic insurance was associated with almost triple the odds, and being older and ever HIV tested with double the odds of being pleased with a pregnancy. Higher educational attainment for both adolescent males and adolescent males' fathers was associated with reduced odds of a being pleased with a pregnancy. One quarter of sexually active U.S. adolescent males would be pleased with a pregnancy. Adolescent males who have been sporadically insured, are older, and ever HIV tested have higher odds of being pleased with a pregnancy. Targeting these adolescent males for more focused pregnancy-prevention counseling may prove useful in reducing adolescent pregnancy rates.
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Affiliation(s)
- May Lau
- University of Texas Southwestern Medical Center, Dallas, TX, USA Children's Medical Center, Dallas, TX, USA
| | - Hua Lin
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Glenn Flores
- University of Texas Southwestern Medical Center, Dallas, TX, USA Children's Medical Center, Dallas, TX, USA
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Begun S. The paradox of homeless youth pregnancy: a review of challenges and opportunities. SOCIAL WORK IN HEALTH CARE 2015; 54:444-460. [PMID: 25985287 DOI: 10.1080/00981389.2015.1030058] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Compared to their housed counterparts, homeless youth become pregnant at exceptionally high rates. Causes of such pregnancies are multifaceted, while a paradoxically high proportion of these pregnancies are intended. This review discusses causes and risk factors associated with homeless youth pregnancies, and notes experiences of pregnancy decision-making discord, challenges encountered during and following pregnancy, and difficulties faced by homeless youth when or if they become parents. Because homeless youth face a wide array of unique risks, future research would benefit from exploring alternative approaches to prevention to reduce pregnancies and improve sexual and reproductive health outcomes among this population.
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Affiliation(s)
- Stephanie Begun
- a Graduate School of Social Work, University of Denver , Denver , Colorado , USA
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Rana Y, Brown RA, Kennedy DP, Ryan GW, Stern S, Tucker JS. Understanding Condom Use Decision Making Among Homeless Youth Using Event-Level Data. JOURNAL OF SEX RESEARCH 2014; 52:1064-1074. [PMID: 25396781 PMCID: PMC4689140 DOI: 10.1080/00224499.2014.961185] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
This is one of the first qualitative event-based studies to understand the various mechanisms through which multiple factors influence condom use decision making among homeless youth. Event-level interviews that explore characteristics of the environment surrounding sexual events were conducted with 29 youth who were asked to describe two recent sexual encounters. In thematic analyses of data across events, reasons that youth gave for engaging in unprotected sex included the expectation of having sex and use of alternative methods of protection against pregnancy. Other nonevent factors that influenced condom use decision making were related to attributes of the partnership (e.g., testing, trust and love, and assessments of risk) and attributes of the youth (e.g., perceptions of diseases, concerns over pregnancy, and discomfort using condoms). Additional event analyses conducted within the same individuals found that decision making was influenced by multiple interacting factors, with different pathways operating for event and nonevent factors. Future interventions should consider taking a multilevel and individualized approach that focuses on event-based determinants of risky sex in this population.
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Affiliation(s)
- Yashodhara Rana
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | - Ryan A. Brown
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | | | - Gery W. Ryan
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | - Stefanie Stern
- RAND Health, RAND Corporation, Santa Monica, California, USA
| | - Joan S. Tucker
- RAND Health, RAND Corporation, Santa Monica, California, USA
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Winetrobe H, Rhoades H, Barman-Adhikari A, Cederbaum J, Rice E, Milburn N. Pregnancy attitudes, contraceptive service utilization, and other factors associated with Los Angeles homeless youths' use of effective contraception and withdrawal. J Pediatr Adolesc Gynecol 2013; 26:314-22. [PMID: 24238265 PMCID: PMC3834348 DOI: 10.1016/j.jpag.2013.06.007] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2012] [Revised: 06/04/2013] [Accepted: 06/09/2013] [Indexed: 11/17/2022]
Abstract
STUDY OBJECTIVE This study aims to understand the associations of contraceptive service utilization (ie, accessing condoms or birth control), pregnancy attitudes, and lifetime pregnancy history among male and female homeless youth in relation to use of effective contraception and withdrawal. DESIGN, SETTING, AND PARTICIPANTS Between October 2011 and February 2012, homeless youth (14-27 years old) from 2 drop-in centers in Los Angeles (N = 380) were recruited and completed a questionnaire. The data in this paper are restricted to those who reported vaginal sex at last sex (N = 283). MAIN OUTCOME MEASURES Analyses examined history of foster care, sexual abuse, exchange sex, pregnancy, lifetime homelessness duration, current living situation, contraceptive service utilization, and pregnancy attitudes in predicting use of effective contraception and withdrawal at last sex. RESULTS Over 62% of females and 43% of males report having ever been pregnant or impregnating someone. There are no gender-based differences in pregnancy attitudes; 21% agree they would like to become pregnant within the year. Additionally, there are no gender-based differences in reported contraceptive use at last vaginal sex. In the multivariable model, high school education, contraceptive service utilization (Relative Risk Ratio [RRR]: 4.0), and anti-pregnancy attitudes (RRR: 1.3) are significant positive predictors of using effective contraception; anti-pregnancy attitudes (RRR: 1.2) and gender (RRR: 0.3) are significantly associated with using withdrawal. CONCLUSIONS Health professionals should acknowledge that some homeless youth desire pregnancy; for those that do not, access to effective contraception is important. Programs must continue to promote pregnancy prevention, and include discussions of healthy pregnancy habits for pregnancy-desiring youth.
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Affiliation(s)
- H Winetrobe
- School of Social Work, University of Southern California, Los Angeles, CA.
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Tucker JS, Ober A, Ryan G, Golinelli D, Ewing B, Wenzel SL. To use or not to use: a stage-based approach to understanding condom use among homeless youth. AIDS Care 2013; 26:567-73. [PMID: 24099462 DOI: 10.1080/09540121.2013.841834] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
This study used a stage-based approach to understand condom use behavior in a representative sample of 309 sexually active homeless youth recruited from shelters, drop-in centers, and street sites in Los Angeles County. Focusing on the youth's most recent sexual event, the three stages of condom use examined were: (1) whether the partners decided prior to the event about using condoms; (2) whether a condom was available at the event; and (3) whether a condom was used at the event. Logistic regression analysis was used to identify attitudinal, relationship, and contextual correlates of each of these three stages. Deciding ahead of time about condom use was associated with being Hispanic, level of education, condom attitudes, and various relationship characteristics (e.g., partner type, monogamy, relationship abuse), with the nature of these associations varying depending on the type of decision (i.e., deciding to use, deciding to not use). Condom availability was more likely to be reported by males, if the event was described as being special in some way, or if the event lacked privacy. Condom use was more likely among youth with more positive condom attitudes and among youth who decide ahead of time to use a condom, but less likely among those in monogamous relationships or when hard drugs were used prior to sex. Whether sexual intercourse is protected or unprotected is the end result of a series of decisions and actions by sexual partners. Results from this study illustrate how condom use can be better understood by unpacking the stages and identifying influential factors at each stage. Each stage may, in and of itself, be an important target for intervention with homeless youth.
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Albright K, Gechter K, Kempe A. Importance of mixed methods in pragmatic trials and dissemination and implementation research. Acad Pediatr 2013; 13:400-7. [PMID: 24011744 DOI: 10.1016/j.acap.2013.06.010] [Citation(s) in RCA: 80] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Revised: 06/21/2013] [Accepted: 06/29/2013] [Indexed: 12/19/2022]
Abstract
With increased attention to the importance of translating research to clinical practice and policy, recent years have seen a proliferation of particular types of research, including pragmatic trials and dissemination and implementation research. Such research seeks to understand how and why interventions function in real-world settings, as opposed to highly controlled settings involving conditions not likely to be repeated outside the research study. Because understanding the context in which interventions are implemented is imperative for effective pragmatic trials and dissemination and implementation research, the use of mixed methods is critical to understanding trial results and the success or failure of implementation efforts. This article discusses a number of dimensions of mixed methods research, utilizing at least one qualitative method and at least one quantitative method, that may be helpful when designing projects or preparing grant proposals. Although the strengths and emphases of qualitative and quantitative approaches differ substantially, methods may be combined in a variety of ways to achieve a deeper level of understanding than can be achieved by one method alone. However, researchers must understand when and how to integrate the data as well as the appropriate order, priority, and purpose of each method. The ability to demonstrate an understanding of the rationale for and benefits of mixed methods research is increasingly important in today's competitive funding environment, and many funding agencies now expect applicants to include mixed methods in proposals. The increasing demand for mixed methods research necessitates broader methodological training and deepened collaboration between medical, clinical, and social scientists. Although a number of challenges to conducting and disseminating mixed methods research remain, the potential for insight generated by such work is substantial.
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Affiliation(s)
- Karen Albright
- Department of Community and Behavioral Health, Colorado School of Public Health; Colorado Health Outcomes Program, University of Colorado Anschutz Medical Campus; Center for Research in Implementation Science and Prevention.
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Wenzel SL, Hsu HT, Zhou A, Tucker JS. Are social network correlates of heavy drinking similar among black homeless youth and white homeless youth? J Stud Alcohol Drugs 2012; 73:885-9. [PMID: 23036205 PMCID: PMC3469042 DOI: 10.15288/jsad.2012.73.885] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE Understanding factors associated with heavy drinking among homeless youth is important for prevention efforts. Social networks are associated with drinking among homeless youth, and studies have called for attention to racial differences in networks that may affect drinking behavior. This study investigates differences in network characteristics by the racial background of homeless youth, and associations of network characteristics with heavy drinking. (Heavy drinking was defined as having five or more drinks of alcohol in a row within a couple of hours on at least one day within the past 30 days.) METHOD A probability sample of 235 Black and White homeless youths ages 13-24 were interviewed in Los Angeles County. We used chi-square or one-way analysis of variance tests to examine network differences by race and logistic regressions to identify network correlates of heavy drinking among Black and White homeless youth. RESULTS The networks of Black youth included significantly more relatives and students who attend school regularly, whereas the networks of White youth were more likely to include homeless persons, relatives who drink to intoxication, and peers who drink to intoxication. Having peers who drink heavily was significantly associated with heavy drinking only among White youth. For all homeless youth, having more students in the network who regularly attend school was associated with less risk of heavy drinking. CONCLUSIONS This study is the first to our knowledge to investigate racial differences in network characteristics and associations of network characteristics with heavy drinking among homeless youth. White homeless youth may benefit from interventions that reduce their ties with peers who drink. Enhancing ties to school-involved peers may be a promising intervention focus for both Black and White homeless youth.
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Affiliation(s)
- Suzanne L. Wenzel
- School of Social Work, University of Southern California, Los Angeles, California,Correspondence may be sent to Suzanne L. Wenzel at the School of Social Work, University of Southern California, 669 West 34th Street, Los Angeles, CA 90089, or via email at:
| | - Hsun-Ta Hsu
- School of Social Work, University of Southern California, Los Angeles, California
| | - Annie Zhou
- RAND Corporation, Santa Monica, California
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