Child-street migration among HIV-affected families in Kenya: a mediation analysis from cross-sectional data

Within Kenya, an estimated quarter of a million children live on the streets, and 1.8 million children are orphaned. In this study, we analyze how HIV contributes to the phenomenon of child-street migration. We interviewed a random community sample of caregiving women (n = 1974) in Meru County, Kenya, using a structured questionnaire in summer 2015. Items included reported HIV prevalence of respondent and her partner, social support, overall health, school enrollment of biologically related children and whether the respondent has a child currently living on the streets. Controlling for alcohol use, education, wealth, age and household size, we found a positive-graded association between the number of partners living with HIV and the probability that a child lives on the street. There was little difference in the odds of a child living on the street between maternally affected and paternally affected households. Lower maternal social support, overall health and school enrollment of biologically related children mediated 14% of the association between HIV-affected households and reporting child-street migration. Street-migration of children is strongly associated with household HIV, but the small percentage of mediated effect presents a greater need to focus on interactions between household and community factors in the context of HIV. Programs and policies responding to these findings will involve targeting parents and children in HIV-affected households, and coordinate care between clinical providers, social service providers and schools.

Youth Homelessness: Prevalence and Associations with Weight in Three Regions

This study investigated the utility of the Youth Risk Behavior Survey (YRBS) to document associations between homeless status and weight while estimating the prevalence of youth homelessness in three regions. A school-based survey, the YRBS includes youths who have been difficult to involve in past research. Analysis of 2011 YRBS data produced population-weighted estimates of youth homelessness prevalence separately for Connecticut, Delaware, and Philadelphia. Public high school students anonymously reported their housing status, height, and weight on the YRBS. Height and weight were converted to body mass index (BMI) percentile-for-age scores. Homelessness was associated with higher BMI percentile scores for youths compared with nonhomeless peers. Associations between BMI percentile and different forms of homelessness (homeless with family, unaccompanied homeless without family) were explored at each site. Estimates of one-month homelessness prevalence ranged from 3.9 percent to 5.9 percent at each site. Homelessness, especially family homelessness, is associated with risk for higher BMI. The YRBS is an informative tool for estimating the prevalence of youth homelessness, expanding on what is known through other, more commonly used methods.

BeLieving in Native Girls: characteristics from a baseline assessment

BeLieving In Native Girls (BLING) is a juvenile delinquency and HIV intervention at a residential boarding school for American Indian/Alaska Native adolescent girls ages 12-20 years. In 2010, 115 participants completed baseline surveys to identify risk and protective factors. Initial findings are discussed regarding a variety of topics, including demographics and general characteristics, academic engagement, home neighborhood characteristics and safety, experience with and perceptions of gang involvement, problem-solving skills, self-esteem, depression, sexual experiences and risk-taking behaviors, substance abuse, and dating violence.

Changelings: transformative perceptions of San José's street children, 1965-1981

Between 1965 and 1981, Costa Ricans changed their perceptions of which characteristics they thought defined appropriate urban childhoods. By 1981, the model of a modern, urban Costa Rican child was that of a child who attended school, did not work on the streets, and played in specifically designated places. Children who did not fit this mold began, in the late 1970s and early 1980s, to be viewed as dangerous to society and as evidencing social pathology. Whereas children who worked on the streets during the 1960s were considered part of the urban landscape, and their childhoods, though difficult, were not perceived as deviant, these same children, two decades later, were viewed as marginal and problematic. To trace this change, this article focuses on the changing perceptions about children on the streets that writers for and public contributors to La Nación, one of the preeminent Costa Rican newspapers, show during the sixteen-year period under analysis.

Health educators' perceptions of a sexual health intervention for homeless adolescents

OBJECTIVE

The purpose of this qualitative descriptive study was to explore the perceptions and experiences of health educators in providing a brief, street-based intervention to homeless adolescents.

METHOD

Qualitative data were collected via e-mail from a purposive sample of 13 male and female health educators who provided the intervention and analyzed using manifest and latent content analysis techniques.

RESULTS

Five categories with two or more subcategories were identified in the data and included how the educators' views changed, how they felt homeless youth were similar to and different from other adolescents, positive aspects and challenges of providing the intervention, and suggestions for future interventionists working with this population.

CONCLUSIONS

The health educators' practice was strengthened over the course of providing the intervention through their positive experiences, changes in their perceptions, some of which were biased, and ability to confront the challenges that accompany working with this vulnerable population.

PRACTICE IMPLICATIONS

Health educators who work with this population should learn about the culture of homeless youth and characteristics of homeless youth that may influence their participation in a sexual health intervention. Moreover, they need to be non-judgmental, practice the intervention, be aware of their biases, and remain flexible.

Six- and twelve-month outcomes among homeless youth accessing therapy and case management services through an urban drop-in center

RESEARCH OBJECTIVE

To evaluate the impact of case management and individual therapy offered through a drop-in center for homeless youth on substance use, mental health, housing, education, employment, and medical care utilization.

STUDY POPULATION

All youth (n=172) between the ages of 14-24 who accessed treatment services through an urban, southwestern drop-in center were included.

DATA SOURCE

Semistructured and self-report questionnaires were administered to youth between October 2002 and April 2005.

STUDY DESIGN

A repeated measures design was utilized. Youth were assessed at baseline, 6 months, and 12 months postbaseline. Hierarchical linear modeling was used to test the hypotheses.

PRINCIPAL FINDINGS

Statistically significant improvements were found in substance abuse, mental health, and percent days housed up to 12 months postbaseline. Decreased alcohol and drug use was associated with an increase in housing. However, most youth did not acquire permanent housing, and education, employment, and medical service utilization did not significantly change over time.

CONCLUSIONS

While treatment offered through drop-in centers for homeless youth can positively impact homeless youth, policy, funding, and service provision need greater focus, collaboration, and support if youth homelessness is to be successfully addressed.

Outcomes of a brief sexual health intervention for homeless youth

Homeless youth face various health challenges. The effectiveness of a short intervention to promote sexual health in 572 homeless 16-23-year-olds (M = 19.467+1.89) was conducted using a quasi-experimental repeated measures design. Data collected at three time points (pre-intervention, immediately post-intervention and follow-up) via laptop computers were analyzed using multivariate general linear mixed models. A significant condition by time interaction was found for self-reported AIDS/STD knowledge; intervention participants had higher scores at first post-test. Females scored significantly higher on cognitive and behavioral outcomes while males reported significantly more sexual risk-taking behaviors. Findings support gender-specific interventions.

Newly homeless youth typically return home

Newly homeless adolescents from Melbourne, Australia (n = 165) and Los Angeles, United States (n = 261) were surveyed and followed for 2 years. Most newly homeless adolescents returned home (70% U.S., 47% Australia) for significant amounts of time (39% U.S., 17% Australia more than 12 months) within 2 years of becoming homeless.

Predictors of running away from family foster care

Running away is a frequent but little studied phenomenon among adolescents in foster care. Repeated running from care often leads to premature discharge and homelessness for youth. This article uses cumulative risk theory in the context of normative adolescent development to investigate predicators of running away from foster care. Results indicate risks stemming from individual, foster home, and child welfare system sources, which offer some insight for prevention and intervention.

Prevalence of hepatitis B, hepatitis C, human immunodeficiency virus, and syphilis among street children residing in southern Tehran, Iran

Street children are among vulnerable people in the world. They are one of the main groups in the society who affect the pattern of health. To determine the prevalence of hepatitis B, hepatitis C, human immunodeficiency viruses (HIV), and syphilis among street children residing in southern Tehran, Iran. In a cross-sectional study, we selected 102 children aged below 15 years from southern Tehran. The selected children had an interview and were examined. From each child a blood sample was taken and tested for anti-HIV (ELISA), anti-HCV (ELISA), HBsAg (ELISA), anti-HBs, anti-HBc (radioimmunoassay [RIA]), rapid plasma reagin (RPR), and fluorescent treponema antibody absorption (FTA-ABS). We studied 39 (38%) boys and 63 (62%) girls, including 79 (77%) Afghan and 16 (16%) Iranian children. The nationality of 8 children could not be identified. The children were negative for syphilis, HIV, and HCV. Nevertheless, 3 of them were positive for HBsAg and 15 were HBsAb positive (>10 MIU/mL). The majority of street children are immigrants. Although these children did not have syphilis, HIV, and HCV, they are at risk of HBV.

The Miami, Florida, Young Men's Survey: HIV prevalence and risk behaviors among urban young men who have sex with men who have ever runaway

Youth in urban areas with a history of running away from home often have special needs. Importantly, risk factors for HIV/AIDS might be associated with such a history. We assessed the association between having a history of running away from home and the occurrence of HIV infection and risk behavior among young men who have sex with men (YMSM), aged 15-22 years. A cross-sectional epidemiologic and behavioral survey was conducted between 1995 and 1996 in Miami, Florida, as part of a national Young Men's Survey. Of 488 YMSM, the prevalence of HIV infection among those with a history of running away from home was 10.5% (adjusted odds ratio=3.4; 95% CI 1.5-7.8). YMSM who had ever run away were more likely to be HIV infected, be out of school, and have ever had vaginal or anal sex with females, been forced to have sex, injected drugs, and used needles for self-tattooing or body piercing. The prevalence of HIV infection and associated risk behaviors among runaways was high, highlighting the ongoing need for prevention and social support services for youth with a history of running away from home.

Parents, teachers, and peers and early adolescent runaway in Hong Kong

Parental monitoring, teacher support, classmate support, and friend relationship presumably affect adolescents' runaway from home. According to social control theory, social control based on conventional social norms would prevent adolescent runaway, but association with friends may erode such control. This expectation appears to hold true in a sample of Grade 7 students in Hong Kong; parental monitoring and classmate support reduced runaway risk whereas friend relationship raised the risk. These findings emerged from a causal model that controlled for a latent predisposition that commonly affected parental monitoring, friend relationship, and runaway risk. Further analysis indicates that the preventive effect of parental monitoring was stronger on adolescents born on the Chinese mainland than in Hong Kong, and the effect of friend relationship was stronger on the Hong Kong born than the mainland born. Conceivably, a socially controlling culture bolsters the preventive effect of social control.

Street and working children of Delhi, India, misusing toluene: an ethnographic exploration

Our qualitative study explored: the perceptions of street children indulging in whitener fluid misuse; the social, economic, and cultural determinants of use; and users' views regarding effective preventive and control strategies. Forty-five in-depth interviews and three focus group discussions were conducted between March and December 2003. A purposive sample of those working children who were using toluene was selected by Snowball sampling. The paper discusses the: determinants of initiation and continued use; drug user social networks; psycho emotional deprivation and frustrations of these children; socio-cultural aspects like work driven need; others' attitudinal response towards them and their work; parental support or the lack of it; and strategies for prevention of this misuse.

Reaching the hard to reach: innovative housing for homeless youth through strategic partnerships

This article features three housing programs designed to target the needs of youth aging out of child welfare. One program combines housing and treatment to move substance-dependent youth off the streets; one combines the resources of Urban Peak, the only licensed homeless and runaway youth shelter in Colorado, with the Denver Department of Human Services to prevent youth in child welfare from discharging to the streets; and one addresses the intense mental health needs of this population. It costs Colorado 53,655 dollars to place a young person in youth corrections for one year and 53,527 dollars for residential treatment. It costs Urban Peak 5378 dollars to move a young person off of the streets. This article describes how data have driven program development and discusses how policy implications and relationships with the public and private sector can leverage additional resources.

Experiences of being homeless or at risk of being homeless among Canadian youths

A qualitative study was undertaken with four groups--immigrants, youths, Aboriginal people, and landlords--in order to explore, compare, and contrast diversity issues among the homeless population and those at risk of homelessness in a larger Canadian city (Calgary, Alberta) with a smaller city (Lethbridge, Alberta), to better understand their and to needs make recommendations for improvement in service delivery and policy formation. This paper focuses on the findings from our sample of youths who shared information on a range of factors that contributed to their being homeless or at risk of being homeless. The youths in this study also shared their positive as well as negative experiences with educators, peers, family members, and social service providers. Canada's homeless include growing numbers of young people, families, women, and members of various ethnic communities, including Aboriginal people and immigrants. Today it is no longer possible to articulate a single silhouette of the homeless, but rather a diversity of profiles is needed. It was in the light of this reality that a study, "Diversity Among the Homeless and Those At Risk," was carried out. It was undertaken with four groups--immigrants, youths, Aboriginal people, and landlords.

Help-seeking and risk-taking behavior among Black street youth: implications for HIV/AIDS prevention and social policy

This article explores and analyzes the help-seeking and risk-taking behavior of Black urban street youth in Washington, DC, USA and Cape Town, South Africa. The target population of 100 youths came from the streets of Washington, DC and Cape Town, South Africa. Structured face-to-face interviews and direct observation of informal and formal settings where youths congregated were used to gather data. Major findings indicate that the majority received high levels of support from families and friends. In terms of formal systems, social and mental health services are viewed as much less accessible or useful. Youths were knowledgeable about HIV/AIDS but did not translate this into safer sexual practices. Implications for health and social policy are outlined.

Social network analysis for health and social interventions among Kenyan scavenging street children

Street children are a high priority for health policy and service planning in Kenya. Poverty, wars, famine and disease have resulted in street children having a persistent presence in African cities and towns. The Maastricht Social Network Analysis (MSNA) was implemented as the core instrument in a battery to measure the health status of the street children. Owing to the absence of census data of street children in Kenya and the difficulty in tracking this mobile population, we implemented a mixed snowball and convenience sampling design to recruit research subjects. Three hundred street and orphanage children, and 100 primary school children as a control group, were included in the study. The MSNA provided a social diagnosis that complements the clinical diagnosis of the health status of the sample. Only one main methodological question is presented: is the MSNA applicable to describe the personal social networks of (1). children and of (2). people living in a Kenyan culture? Qualitative field observations, key informant interviews and focus groups inform the adaptation of the MSNA instrument, and improve its face validity. A case series analysis is presented. The main result is that the street children population consists of distinct subgroups defined by the UNICEF classification as 'on' and 'of' the street and by gender. Street children networks have some notable deficiencies depending on the subgroup. Constant across the groups is the deficiency of service providers in their networks. The conclusion is that the MSNA is a suitable instrument for obtaining a social diagnosis and gathering other useful information that helps in understanding the social and health backgrounds, status and daily experiences of Kenyan scavenging street children. Applying the MSNA protocol was successful in the diagnosis and interpretation of the findings.

Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts

OBJECTIVES

The goal of this study was to identify differences between gay, lesbian, bisexual, and transgender (GLBT) homeless youths and their heterosexual counterparts in terms of physical and mental health difficulties.

METHODS

A sample of 84 GLBT adolescents was matched in regard to age and self-reported gender with 84 heterosexual adolescents. The 2 samples were compared on a variety of psychosocial variables.

RESULTS

GLBT adolescents left home more frequently, were victimized more often, used highly addictive substances more frequently, had higher rates of psychopathology, and had more sexual partners than heterosexual adolescents.

CONCLUSIONS

Homeless youths who identify themselves as members of sexual minority groups are at increased risk for negative outcomes. Recommendations for treatment programs and implications for public health are discussed.

Youth homelessness in San Francisco: a life cycle approach

HIV risk behaviors and seroprevalence are particularly high among street youth. Though many programs have been designed to serve them, street youth have low rates of service utilization. The aim of this street-based, ethnographic project was to study the social and cultural context of street life in this population. Data were collected by participant observation, exploratory interviews and semi-structured interviews. Twenty street youth (15-23 years old; six female), recruited from street sites in San Francisco, participated in the interviews. Field notes and transcriptions were analyzed using an inductive technique for model building. This analysis yielded a proposed model of the life cycle of youth homelessness. In the first on the street stage, youth face an intense psychological feeling of outsiderness, and an urgency to meet basic needs. These stresses either lead to an escape from street life or to a process of acculturation to the street. Initiation to the street is facilitated by street mentors, who provide youth with survival skills. In the stasis stage, youth reach a tenuous equilibrium in which they can meet their basic needs. A strong street ethic allows youth to rationalize significant conflicts and frequent physical suffering. Youth in stasis are repeatedly thrown into disequilibrium, crises that frequently cause them to come into greater contact with mainstream society. After repeated episodes of disequilibrium, some youth extricate themselves from street life, finding a new identity in mainstream society. Otherwise, youth return to the street, in an episode of recidivism. The life cycle model suggests that street youth who are most open to intervention are those who are in transitional states, i.e., those who have just arrived on the street or those who are in crisis (disequilibrium). If this model is validated in a larger population of youth, programs that are aimed at these two stages in the life cycle could potentially effectively complement existing programs, which are usually focused on youth in stasis.

A snapshot of homeless youth in Seattle: their characteristics, behaviors and beliefs about HIV protective strategies

The purpose of this study was to determine how initial HIV prevention efforts for homeless youth were received and to determine areas where homeless youth's beliefs and behaviors continue to put them at risk for HIV infection. Interviews were conducted with 289 Seattle homeless youth. Youth reported using condoms with casual partners during vaginal and anal sex and with clients during oral, anal and vaginal sex. Condoms are often not used during vaginal sex with main partners or during oral sex with casual or main partners. Knowledge of HIV protective strategies differed according to youth's behavioral characteristics with heterosexual youth having the weakest knowledge of HIV protective strategies especially compared with young men who have sex with men. There is room for improvement in youth's knowledge and beliefs about HIV.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons

PURPOSE

To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area of Los Angeles, California; identify demographic and other correlates of utilization; and contextualize the findings with qualitative data.

METHOD

During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless.

RESULTS

Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%), substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles versus all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including rules perceived to be restrictive, and concerns youth had about confidentiality and mandated reporting. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets.

CONCLUSIONS

Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that we understand the perceived barriers to service utilization.

Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons

PURPOSE

To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data.

METHOD

During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless.

RESULTS

Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets.

CONCLUSIONS

Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that barriers to use of these services are eliminated.

Determinants of health and service use patterns in homeless and low-income housed children

OBJECTIVE

Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children.

METHODS

Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes.

RESULTS

Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings.

CONCLUSIONS

Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.

Homeless children

Homeless children are an "invisible" population within our community. A review is provided of the economic, social, medical and dental conditions of these children.

What happened to street kids? An analysis of the Mexican experience

This paper documents some possible reasons of failure of programs for street children in Mexico, and provides background information on demographic and socioeconomic trends that underlay self-employment as well as a historical perspective of the social context of street children. It also describes the strategies used to survive in the streets, trends in drug use/misuse, the felt needs of children and the social responses to this problem. It documents how underlying failure there are unrealistic goals, a fragmented perception of the problem and consequently, a fragmented response to it. It also refers to the great pressure on institutions for results, lack of continuity of the programs and disregard of the perception and felt needs of working children who should benefit from these programs.