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Baiden P, LaBrenz CA, Broni MN, Baiden JF, Adepoju OE. Prevalence of youth experiencing homelessness and its association with suicidal thoughts and behaviors: Findings from a population-based study. Psychiatry Res 2024; 334:115823. [PMID: 38430817 DOI: 10.1016/j.psychres.2024.115823] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 02/22/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
Although various studies have examined factors associated with suicidal behaviors among youth, few studies have investigated the association between youth experiencing homelessness (YEH) and suicidal thoughts and behaviors (STBs) using a large nationally representative sample. The objectives of this study were to investigate prevalence of YEH and its association with STBs. Data for this study came from the 2021 Youth Risk Behavior Survey. An analytic sample of 17,033 youth aged 14-18 (51.7 % male) was analyzed using binary logistic regression. Of the 17,033 youth examined, 3 % experienced homelessness during the past 30 days, 21.3 % experienced suicidal ideation, 17.3 % made a suicide plan, and 10.9 % attempted suicide during the past 12 months. Controlling for demographic characteristics and feeling sad or hopeless, YEH was associated with 2.48 times higher odds of experiencing suicidal ideation (AOR=2.48, p<.001), 2.46 times higher odds of making a suicide plan (AOR=2.46, p<.001), and 4.38 times higher odds of making a suicide attempt (AOR=4.38, p<.001). The findings of this study highlight the importance of identifying youth who are at risk of experiencing homelessness to ensure early interventions are put in place to prevent suicidal behaviors.
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Affiliation(s)
- Philip Baiden
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States.
| | - Catherine A LaBrenz
- The University of Texas at Arlington, School of Social Work, 501 W. Mitchell St., Box 19129, Arlington, TX 76019, United States
| | - Marisa N Broni
- University of Ghana, School of Public Health, P. O. Box LG 25, Legon, Accra, Ghana
| | - John F Baiden
- East Airport International School, P. O. Box KAPM 57, KIA, Accra, Ghana
| | - Omolola E Adepoju
- University of Houston, Tilman J. Fertitta Family College of Medicine, 5055 Medical Circle, Houston, TX 77204, United States
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Santa Maria D, Lightfoot M, Nyamathi A, Businelle M, Paul M, Quadri Y, Padhye N, Jones J, Calvo Armijo M. A Nurse Case Management HIV Prevention Intervention (Come As You Are) for Youth Experiencing Homelessness: Protocol for a Randomized Wait-list Controlled Trial. JMIR Res Protoc 2021; 10:e26716. [PMID: 34018967 PMCID: PMC8178739 DOI: 10.2196/26716] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 01/29/2021] [Accepted: 04/08/2021] [Indexed: 11/25/2022] Open
Abstract
Background Youth experiencing homelessness are more likely than housed youth to experience premature death, suicide, drug overdose, pregnancy, substance use, and mental illness. Yet while youth experiencing homelessness are 6 to 12 times more likely to become infected with HIV than housed youth, with HIV prevalence as high as 16%, many do not access the prevention services they need. Despite adversities, youth experiencing homelessness are interested in health promotion programs, can be recruited and retained in interventions and research studies, and demonstrate improved outcomes when programs are tailored and relevant to them. Objective The study aims to compare the efficacy of a nurse case management HIV prevention and care intervention, titled Come As You Are, with that of usual care among youth experiencing homelessness aged 16 to 25 years. Methods The study is designed as a 2-armed randomized wait-list controlled trial. Participants (n=450) will be recruited and followed up for 9 months after the intervention for a total study period of 12 months. Come As You Are combines nurse case management with a smartphone-based daily ecological momentary assessment to develop participant-driven HIV prevention behavioral goals that can be monitored in real-time. Youth in the city of Houston, Texas will be recruited from drop-in centers, shelters, street outreach programs, youth-serving organizations, and clinics. Results Institutional review board approval (Committee for the Protection of Human Subjects, University of Texas Health Science Center at Houston) was obtained in November 2018. The first participant was enrolled in November 2019. Data collection is ongoing. To date, 123 participants have consented to participate in the study, 89 have been enrolled, and 15 have completed their final follow-up. Conclusions There is a paucity of HIV prevention research regarding youth experiencing homelessness. Novel and scalable interventions that address the full continuum of behavioral and biomedical HIV prevention are needed. This study will determine whether a personalized and mobile HIV prevention approach can reduce HIV risk among a hard-to-reach, transient population of youth at high risk. International Registered Report Identifier (IRRID) DERR1-10.2196/26716
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Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Marguerita Lightfoot
- Center for AIDS Prevention Studies and UCSF Prevention Research Center, University of California San Francisco, San Francisco, CA, United States
| | - Adey Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, United States
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, United States
| | - Mary Paul
- Baylor College of Medicine, Houston, TX, United States
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Nikhil Padhye
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Jennifer Jones
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
| | - Margarita Calvo Armijo
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States
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Predicting Daily Sheltering Arrangements among Youth Experiencing Homelessness Using Diary Measurements Collected by Ecological Momentary Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186873. [PMID: 32962272 PMCID: PMC7558709 DOI: 10.3390/ijerph17186873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that assessed daily sleeping arrangements. Analyses applied a hypothesis-generating machine learning algorithm (component-wise gradient boosting) to build interpretable models that would select only the best predictors of daily sheltering from a large set of 92 variables while accounting for the correlated nature of the data. Sheltering was examined as a three-category outcome comparing nights spent literally homeless, unstably housed or at a shelter. The final model retained 15 predictors. These predictors included (among others) specific stressors (e.g., not having a place to stay, parenting and hunger), discrimination (by a friend or nonspecified other; due to race or homelessness), being arrested and synthetic cannabinoids use (a.k.a., “kush”). The final model demonstrated success in classifying the categorical outcome. These results have implications for developing just-in-time adaptive interventions for improving the lives of YEH.
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Cutuli JJ, Treglia D, Herbers JE. Adolescent Homelessness and Associated Features: Prevalence and Risk Across Eight States. Child Psychiatry Hum Dev 2020; 51:48-58. [PMID: 31270658 DOI: 10.1007/s10578-019-00909-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive.
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Affiliation(s)
- J J Cutuli
- Department of Psychology, Rutgers University - Camden, 311 N Fifth Street, Rm 308, Camden, NJ, 08243, USA.
| | - Dan Treglia
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Janette E Herbers
- Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, USA
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Santa Maria DM, Breeden K, Drake SA, Narendorf SC, Barman-Adhikari A, Petering R, Hsu HT, Shelton J, Ferguson-Colvin K, Bender K. Gaps in Sexual Assault Health Care Among Homeless Young Adults. Am J Prev Med 2020; 58:191-198. [PMID: 31859174 PMCID: PMC11006393 DOI: 10.1016/j.amepre.2019.09.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Revised: 09/16/2019] [Accepted: 09/17/2019] [Indexed: 01/16/2023]
Abstract
INTRODUCTION Young adults experiencing homelessness are at increased risk for sexual assault. Receiving a post-sexual assault examination has important implications for HIV and unintended pregnancy prevention; yet, utilization is not well understood. In a population at elevated risk for HIV, unintended pregnancy, and sexual violence, identifying barriers and facilitators to post-sexual assault examination is imperative. METHODS As part of a large, multisite study to assess youth experiencing homelessness across 7 cities in the U.S, a cross-sectional survey was conducted between June 2016 and July 2017. Data were analyzed in 2019 to determine the prevalence and correlates of sexual violence and examine the correlates of post-sexual assault examination utilization. RESULTS Respondents (n=1,405), aged 18-26 years, were mainly youth of color (38% black, 17% Latinx) and identified as cisgender male (59%) and lesbian, gay, bisexual, or queer (29%). HIV risks were high: 23% of participants had engaged in trade sex, 32% had experienced sexual assault as a minor, and 39% had experienced sexual exploitation. Young adults reported high rates of sexual assault (22%) and forced sex (24%). Yet, only 29% of participants who were forced to have sex received a post-sexual assault examination. Latinx young adults were more likely than other races/ethnicities to receive post-assault care. Participants frequently said they did not get a post-sexual assault exam because they did not want to involve the legal system and did not think it was important. CONCLUSIONS Interventions are needed to increase use of preventive care after experiencing sexual assault among young adults experiencing homelessness.
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Affiliation(s)
- Diane M Santa Maria
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas.
| | - Khara Breeden
- Texas County Forensic Nurse Examiners, Houston, Texas
| | - Stacy A Drake
- Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas
| | - Sarah C Narendorf
- Graduate College of Social Work, University of Houston, Houston, Texas
| | | | - Robin Petering
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California
| | - Hsun-Ta Hsu
- School of Social Work, University of Missouri, Columbia, Missouri
| | - Jama Shelton
- Silberman School of Social Work at Hunter College, New York, New York
| | | | - Kimberly Bender
- Graduate School of Social Work, University of Denver, Denver, Colorado
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Santa Maria D, Daundasekara SS, Hernandez DC, Zhang W, Narendorf SC. Sexual risk classes among youth experiencing homelessness: Relation to childhood adversities, current mental symptoms, substance use, and HIV testing. PLoS One 2020; 15:e0227331. [PMID: 31899781 PMCID: PMC6941897 DOI: 10.1371/journal.pone.0227331] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2018] [Accepted: 12/17/2019] [Indexed: 12/26/2022] Open
Abstract
The aim of this study was to determine whether there are meaningful subgroups with different types of sexual risk behaviors among youth experiencing homelessness and examine the associations between potential classes and other risk variables. A latent class analysis was used to identify classes of youth according to sexual risk behaviors and sexual assault. A two-class solution was found to be the best fit for the data-Lower and Higher Risk groups. The Higher Risk class had significantly higher levels of synthetic marijuana and alcohol use, mental health diagnoses, and were more likely to have been tested for HIV than the Lower Risk group. Youth were more likely to be in the Higher Risk group if they were cisgender female or lesbian, gay, bisexual, or questioning (LGBQ). Nearly all youth (10/11) who reported having HIV infection were in the Higher Risk group. The Lower Risk group were sexually active but had lower rates of risk behaviors and sexual assault. Youth who were not sexually active had the lowest rates of marijuana and alcohol use as well as HIV testing. Health and social service providers should be aware of the added risks for stress, mental distress, mental health diagnoses, and substance use among youth who also report higher risk sexual behaviors and treat as needed.
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Affiliation(s)
- Diane Santa Maria
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Saumali S. Daundasekara
- Department of Health and Human Performance, University of Houston, Houston, TX, United States of America
| | - Daphne C. Hernandez
- Department of Research, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Wei Zhang
- Department of Biostatistics and Data Science, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, United States of America
| | - Sarah C. Narendorf
- University of Houston, Graduate College of Social Work, Houston, TX, United States of America
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Relations between mental health diagnoses, mental health treatment, and substance use in homeless youth. Drug Alcohol Depend 2017; 175:1-8. [PMID: 28364629 DOI: 10.1016/j.drugalcdep.2017.01.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/04/2016] [Revised: 11/27/2016] [Accepted: 01/16/2017] [Indexed: 11/20/2022]
Abstract
BACKGROUND Youth experiencing homelessness have elevated rates of mental illness and substance use compared to the general population. However, the extent to which underlying mental health issues may contribute to substance use as a way to manage symptoms and whether mental health treatment may reduce risk for substance use is unclear. This paper investigated these relations in a community sample of homeless youth. METHODS Youth ages 13-24 (N=416) were interviewed as part of a community count and survey of homeless youth in Houston, Texas. A path analysis examined relations among lifetime diagnoses of ADHD, bipolar disorder, and depression; past-month marijuana, alcohol, and synthetic marijuana use, and hypothesized mediators of past-year mental health treatment and perceived unmet need for treatment. RESULTS Rates of prior mental disorder diagnoses were high, with extensive comorbidity across the three diagnoses (n=114, 27.3% had all three diagnoses). Relations varied by diagnoses and substances. ADHD was positively related to current marijuana use (β=0.55 (0.16), p<0.001), a relation that mental health treatment did not mediate. Depression was positively related to synthetic marijuana use through unmet need (β=0.25 (0.09), p=0.004) and to alcohol use through unmet need (β=0.20 (0.10), p=0.04) CONCLUSIONS: This study provides new information about relations between prior mental health diagnoses and substance use in homeless youth. Findings support the need to consider prior mental disorder diagnoses in relation to current substance use and to assess for whether youth perceive they have unmet needs for mental health treatment.
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