The social context of homeless women's alcohol and drug use

Association of childhood abuse with homeless women's social networks

OBJECTIVE

Childhood abuse has been linked to negative sequelae for women later in life including drug and alcohol use and violence as victim or perpetrator and may also affect the development of women's social networks. Childhood abuse is prevalent among at-risk populations of women (such as the homeless) and thus may have a stronger impact on their social networks. We conducted a study to: (a) develop a typology of sheltered homeless women's social networks; (b) determine whether childhood abuse was associated with the social networks of sheltered homeless women; and (c) determine whether those associations remained after accounting for past-year substance abuse and recent intimate partner abuse.

METHODS

A probability sample of 428 homeless women from temporary shelter settings in Los Angeles County completed a personal network survey that provided respondent information as well as information about their network members' demographics and level of interaction with each other. Cluster analyses identified groups of women who shared specific social network characteristics. Multinomial logistic regressions revealed variables associated with group membership.

RESULTS

We identified three groups of women with differing social network characteristics: low-risk networks, densely connected risky networks (dense, risky), and sparsely connected risky networks (sparse, risky). Multinomial logistic regressions indicated that membership in the sparse, risky network group, when compared to the low-risk group, was associated with history of childhood physical abuse (but not sexual or emotional abuse). Recent drug abuse was associated with membership in both risky network groups; however, the association of childhood physical abuse with sparse, risky network group membership remained.

CONCLUSIONS

Although these findings support theories proposing that the experience of childhood abuse can shape women's social networks, they suggest that it may be childhood physical abuse that has the most impact among homeless women.

PRACTICAL IMPLICATIONS

The effects of childhood physical abuse should be more actively investigated in clinical settings, especially those frequented by homeless women, particularly with respect to the formation of social networks in social contexts that may expose these women to greater risks.

"Homelessness and trauma go hand-in-hand": pathways to homelessness among women veterans

BACKGROUND

Veterans comprise a disproportionate fraction of the nation's homeless population, with women veterans up to four times more likely to be homeless than non-veteran women. This paper provides a grounded description of women veterans' pathways into homelessness.

METHODS

Three focus groups were held in Los Angeles, California, with a total of 29 homeless women veterans.

RESULTS

Five predominant "roots" (precipitating experiences) initiated pathways toward homelessness: 1) childhood adversity, 2) trauma and/or substance abuse during military service, 3) post-military abuse, adversity, and/or relationship termination, 4) post-military mental health, substance abuse, and/or medical problems, and 5) unemployment. Contextual factors, which promoted development of homelessness in the setting of primary roots, included women veterans' "survivor instinct," lack of social support and resources, sense of isolation, pronounced sense of independence, and barriers to care. These contextual factors also reinforced persistence of the roots of post-military adversity and mental health and substance abuse problems, serving to maintain cycles of chronic homelessness.

CONCLUSION

Collectively, these multiple, interacting roots and contextual factors form a "web of vulnerability" that is a target for action. Multiple points along the pathways to homelessness represent critical junctures for VA and community-based organizations to engage in prevention or intervention efforts on behalf of women veterans. Considering the multiple, interconnected challenges that these women veterans described, solutions to homelessness should address multiple risk factors, include trauma-informed care that acknowledges women veterans' traumatic experiences, and incorporate holistic responses that can contribute to healing and recovery.

The social context of homeless men's substance use

BACKGROUND

Homeless men may be at particular risk for the negative health effects of substance use. This cross-sectional study investigates the individual and personal network risk factors associated with substance use in this vulnerable population.

METHODS

Participants were a representative probability sample of 305 heterosexually active homeless men interviewed from meal programs in the Skid Row region of Los Angeles, CA. Interviews assessed individual, personal network, and substance use characteristics. Logistic regression examined individual and personal network predictors of the three most prevalent substances.

RESULTS

In the past 6 months, the three most prevalent substances were marijuana (56%), crack (40%), and alcohol to intoxication (38%). The mental health status of homeless men was associated with substance use, with PTSD more common among those who used crack. Riskier networks (comprised of a larger proportion of drug users) were associated with marijuana use, and normative social ties (family, employed and school/work contacts) were associated with a decreased likelihood of crack use.

CONCLUSIONS

Mental health problems and riskier personal networks are associated with homeless men's substance use. These findings underscore the importance of interventions that focus on improving mental health, mitigating the drug-using norms of personal networks, and helping men to maintain contact with normative, low-risk alters. Mental health care and peer-based, network interventions to reduce substance use should be a priority for heterosexually active homeless men.

Social networks of homeless youth in emerging adulthood

Little is known about the social networks of homeless youth in emerging adulthood despite the importance of this information for interventions to reduce health risks. This study examined the composition of social networks, and the risks and supports present within them, in a random sample of 349 homeless youth (33.4% female, 23.9% African American, 17.7% Hispanic) between the ages of 18 and 24. Social network members who were met on the street were among the most likely to be perceived as engaging in risky sex, as well as to engage in substance use with the youth. Youth were more likely to count on relatives and sex partners for support compared to other network members, but they also were more likely to use substances with sex partners and perceived them as engaging in risky sex. Interventions may need to recognize the importance of intimate relationships during the developmental stage of emerging adulthood by enhancing supportive bonds and reducing substance use and risky sex in these relationships.

Predictors of substance abuse treatment need and receipt among homeless women

Many homeless women do not receive needed treatment for substance abuse. This study identified social network and other predisposing factors associated with perceived need for and receipt of substance abuse treatment among 273 homeless women who screened positive for past-year substance abuse. Perceived treatment need was more likely among women with drug-using sex partners, a denser network, and an arrest history but less likely for those with a minor child and a longer history of homelessness. Receiving treatment was more likely among women who received informational support from their sex partners and who had an arrest history but less likely among those who had a more street-based social network, had a minor child, considered themselves homeless, and recently needed mental health treatment. Treatment services researchers should attend more closely to social contextual factors, as well as the more traditional individual factors, to understand access and barriers to treatment.

Addiction research ethics and the Belmont principles: do drug users have a different moral voice?

This study used semi-structured interviews and content analysis to examine moral principles that street drug users apply to three hypothetical addiction research ethical dilemmas. Participants (n = 90) were ethnically diverse, economically disadvantaged drug users recruited in New York City in 2009 . Participants applied a wide range of contextually sensitive moral precepts, including respect, beneficence, justice, relationality, professional obligations, rules, and pragmatic self-interest. Limitations and implications for future research and the responsible conduct of addiction research are discussed.

Personal network correlates of alcohol, cigarette, and marijuana use among homeless youth

BACKGROUND

Youth who are homeless and on their own are among the most marginalized individuals in the United States and face multiple risks, including use of substances. This study investigates how the use of alcohol, cigarettes, and marijuana among homeless youth may be influenced by characteristics of their social networks.

METHODS

Homeless youth aged 13-24 were randomly sampled from 41 service and street sites in Los Angeles County (N=419). Predictors of substance use were examined using linear regression analysis (for average number of drinks and average number of cigarettes per day) and negative binomial regression analysis (for frequency of past month marijuana use).

RESULTS

Youth with more substance users in their networks reported greater alcohol, cigarette, and marijuana consumption regardless of whether these network members provided tangible or emotional support. Marijuana use was more frequent for youth who met more network members through homeless settings, but less frequent among those who met more network members through treatment or AA/NA. Greater alcohol use occurred among youth who met more network members through substance use-related activities. Youth having more adults in positions of responsibility in their networks consumed less alcohol, and those with more school attendees in their networks consumed less alcohol and cigarettes.

CONCLUSIONS

Findings highlight the importance of social context in understanding substance use among homeless youth. Results also support the relevance of network-based interventions to change social context for substance-using youth, in terms of both enhancing pro-social influences and reducing exposure to substance use.

Sampling to reduce respondent burden in personal network studies and its effect on estimates of structural measures

Recently, researchers have been increasingly interested in collecting personal network data. Collecting this type of data is particularly burdensome on the respondents, who need to elicit the names of alters, answer questions about each alter (network composition), and evaluate the strength of possible relationships among the named alters (network structure). In line with McCarty et al.'s (2007) research, we propose reducing respondent burden by randomly sampling a smaller set of alters from those originally elicited. Via simulation, we assess the estimation error we incur when measures of the network structure are computed on a random sample of alters and illustrate the trade-offs between reduction in respondent burden (measured with the amount of interview time saved) and total estimation error incurred. Researchers can use the provided trade-offs figure to make an informed decision regarding the number of alters to sample when in need to reduce respondent burden.