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Santa Maria D, Paul M, Lightfoot M, Nyamathi A, Quadri Y, Padhye N, Ocampo E, Babayev R, Ramos MW, Malone-Thomas SL, White M, Carrillo A, Jones JT. The Leaky Preexposure Prophylaxis Cascade-Barriers and Facilitators to Preexposure Prophylaxis Uptake and Adherence Among Youth Experiencing Homelessness in the US South: A Mixed Methods Study. J Assoc Nurses AIDS Care 2025; 36:271-283. [PMID: 39718374 PMCID: PMC12017592 DOI: 10.1097/jnc.0000000000000516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2024]
Abstract
ABSTRACT Adherence to preexposure prophylaxis (PrEP) is lower among high-risk populations, including youth experiencing homelessness (YEH). This study determined the feasibility of urine PrEP adherence biomarker testing and examined the barriers and facilitators to PrEP uptake and adherence among YEH. YEH were recruited from a randomized control trial conducted in a large urban setting in southern United States. Interviews ( N = 40) were conducted to identify barriers and facilitators to PrEP uptake and adherence. PrEP urine-based adherence testing feasibility was conducted among those who started on PrEP. Twenty-two participants obtained a prescription and 15 youth completed at least one adherence test. Facilitators and barriers were categorized as individual, interpersonal and community, and structural among PrEP starters and nonstarters. PrEP uptake and adherence were low for eligible YEH. Enriching the understanding of the challenges and facilitators experienced with accessing PrEP for YEH can improve engagement in HIV prevention among YEH.
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Affiliation(s)
| | - Mary Paul
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Marguerita Lightfoot
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Adeline Nyamathi
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Yasmeen Quadri
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Nikhil Padhye
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Eduardo Ocampo
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Roman Babayev
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Melanie Watt Ramos
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Sheryl L. Malone-Thomas
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Margaret White
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Alejandro Carrillo
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - Jennifer Torres Jones
- Diane Santa Maria, DrPH, MSN, BSN, is a Dean and Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Mary Paul, MD, is a Professor, Baylor College of Medicine, Houston, Texas, USA
- Marguerita Lightfoot, PhD, is an Associate Dean for Research, Oregon Health & Science University-Portland State University School of Public Health, Portland, Oregon, USA
- Adeline M. Nyamathi, PhD, ANP, FAAN, is a Distinguished Professor and Founding Dean, Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, California, USA
- Yasmeen Quadri, MD, is an Associate Professor, Baylor College of Medicine, Houston, Texas, USA
- Nikhil Padhye, PhD, is a Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Eduardo Ocampo, MA, is a Patient/PrEP Navigator, Texas Children's Hospital, Houston, Texas, USA
- Roman Babayev, MD, is an Adolescent Medicine Physician, NYU Langone Health, New York City, New York, USA
- Melanie Watt Ramos, MD, is an Adolescent Medicine Fellow, Baylor College of Medicine, Houston, Texas, USA
- Sheryl L. Malone-Thomas, DNP, APRN, FNP-BC, AACRN, is an Assistant Professor, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Margaret White, FNP, is a doctoral student, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Alejandro Carrillo, RN, is a Research Nurse, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
- Jennifer Torres Jones, MPH, is a Sr. Program Manager, Cizik School of Nursing, University of Texas Health Science Center at Houston, Houston, Texas, USA
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Chavez LJ, Kelleher KJ, Bunger A, Feng X, Fitzpatrick M, Ford JL, Mallory AB, Sheftall AH, Yilmazer T, Pizzulo A, Hawke JL, Davenport MA, Slesnick N. Youth experiencing homelessness at risk for suicide: psychosocial risk factors and service use patterns. BMC Public Health 2025; 25:444. [PMID: 39905400 PMCID: PMC11792679 DOI: 10.1186/s12889-024-21212-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 12/26/2024] [Indexed: 02/06/2025] Open
Abstract
OBJECTIVE Young adults experiencing homelessness often suffer from adverse mental health outcomes and suicide is a leading cause of death. The objective of this study is to examine service use and psychosocial risk factors for suicide, in relation to suicide risk assessment, to inform strategies for engaging youth in suicide prevention services. METHODS A cross-sectional analysis of youth enrolled in a supportive housing randomized clinical trial. We categorized suicide risk into three groups (low-, moderate-, and high-risk) based on suicidal ideation and past-year suicide attempt. The service use patterns across these groups are described, as well as other psychosocial risk factors (psychiatric comorbidity, depressive symptoms, substance use, and sleep impairment). RESULTS Among 193 enrolled youth, 126 (65.3%), 32 (16.6%), and 35 (18.1%) were categorized as low-risk, moderate-risk, and high-risk for suicide, respectively. A high proportion of youth reported ever having been diagnosed with a psychiatric disorder (57.5%) and cannabis was the most heavily used substance. However, only a minority of youth received medical care or mental health services in the past 3 months, 40% and 34%, respectively. Even fewer youth received mental/emotional health services in the past 3 months (15%), though use was highest among the high-risk group (34%). CONCLUSION Understanding the needs of youth experiencing homelessness who are at risk for suicide is critical to developing interventions to alleviate their risk for suicide. Given that the use of medical and mental health care is low among this population, more active outreach strategies may be warranted to deliver prevention interventions.
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Affiliation(s)
- Laura J Chavez
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Kelly J Kelleher
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Alicia Bunger
- Division of General Internal Medicine, Department of Internal Medicine, College of Medicine, The Ohio State University, 700 Ackerman Road, Columbus, OH, 43202, USA
| | - Xin Feng
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Margaret Fitzpatrick
- College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, USA
| | - Jodi L Ford
- College of Nursing, The Ohio State University, 1577 Neil Avenue, Columbus, OH, 43210, USA
| | - Allen B Mallory
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Arielle H Sheftall
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Tansel Yilmazer
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Alexis Pizzulo
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
| | - Jesse L Hawke
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Mattina A Davenport
- Center for Child Health Equity and Outcomes Research, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Natasha Slesnick
- College of Education and Human Ecology, Department of Human Sciences, The Ohio State University, 1787 Neil Ave, Columbus, OH, 43210, USA
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Maria DS, Nyamathi A, Lightfoot M, Paul M, Quadri Y, Padhye N, Businelle M, Fernandez-Sanchez H, Jones JT. Results of a Randomized Wait-List Controlled Trial of CAYA: A Nurse Case Management HIV Prevention Intervention for Youth Experiencing Homelessness. AIDS Behav 2025; 29:613-625. [PMID: 39531116 PMCID: PMC11814025 DOI: 10.1007/s10461-024-04544-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/27/2024] [Indexed: 11/16/2024]
Abstract
Youth experiencing homelessness (YEH) face challenges that increase their susceptibility to HIV/STIs. Nurse case management is effective in managing the complex needs of populations experiencing homelessness and reducing HIV risk. A randomized wait-list control study conducted between September 2019 to May 2023 evaluated the CAYA "Come As You Are" intervention. This nurse-led HIV prevention for YEH aged 16-25 years focused on the uptake of HIV prevention methods: pre- and post-HIV exposure prophylaxis (PrEP, nPEP), HIV/STI testing and treatment, sober sex, and condom use. Secondarily, we examined intervention impact on housing stability. Descriptive statistics were calculated by study arm. Multiple imputation (m = 10) was used for missing values and intervention effects were estimated from Bayesian multilevel models with noninformative priors. Participants (N = 450) were 21.1 years old on average, 62% Black, 11% Hispanic, 11% White, and 10% other race and reported being homeless for an average of 3 years. An intervention effect was found for PrEP use, which showed a larger increase from baseline to first follow-up (OR = 3.27; 95% Cr.I.: 1.13 to 10.14). No intervention impact was found for nPEP use, HIV and STI cases, sober sex, or condom use. Sheltering arrangements improved from baseline to the first follow-up in both groups with increase in shelter stability (OR = 3.85; 95% Cr.I.: 1.61 to 10.30) and decreased shelter transiency (OR = 0.29; 95% Cr.I.: 0.14 to 0.60). This study demonstrates that a personalized, nurse-led HIV prevention approach increased uptake of some but not all HIV prevention strategies among YEH. CLINICAL TRIAL REGISTRATION NUMBER: NCT03910218.
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Affiliation(s)
- Diane Santa Maria
- Cizik School of Nursing, Center for Nursing Research, University of Texas Health Science Center at Houston, Houston, TX, USA.
| | - Adeline Nyamathi
- Sue & Bill Gross School of Nursing, University of California Irvine, Irvine, CA, USA
| | - Marguerita Lightfoot
- Oregon Health & Science University-Portland State University School of Public Health, Portland, OR, USA
| | - Mary Paul
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA
| | - Yasmeen Quadri
- Department of Family and Community Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Nikhil Padhye
- Cizik School of Nursing, Center for Nursing Research, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Michael Businelle
- TSET Health Promotion Research Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Higinio Fernandez-Sanchez
- Cizik School of Nursing, Center for Nursing Research, University of Texas Health Science Center at Houston, Houston, TX, USA
| | - Jennifer Torres Jones
- Cizik School of Nursing, Center for Nursing Research, University of Texas Health Science Center at Houston, Houston, TX, USA
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Lachaud J, Yusuf AA, Maelzer F, Perri M, Gogosis E, Ziegler C, Mejia-Lancheros C, Hwang SW. Social isolation and loneliness among people living with experience of homelessness: a scoping review. BMC Public Health 2024; 24:2515. [PMID: 39285399 PMCID: PMC11403937 DOI: 10.1186/s12889-024-19850-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2024] [Accepted: 08/22/2024] [Indexed: 09/20/2024] Open
Abstract
Social isolation and loneliness (SIL) are public health challenges that disproportionally affect individuals who experience structural and socio-economic exclusion. The social and health outcomes of SIL for people with experiences of being unhoused have largely remained unexplored. Yet, there is limited synthesis of literature focused on SIL to appropriately inform policy and targeted social interventions for people with homelessness experience. The aim of this scoping review is to synthesize evidence on SIL among people with lived experience of homelessness and explore how it negatively impacts their wellbeing. We carried out a comprehensive literature search from Medline, Embase, Cochrane Library, PsycINFO, CINAHL, Sociological Abstracts, and Web of Science's Social Sciences Citation Index and Science Citation Index for peer-reviewed studies published between January 1st, 2000 to January 3rd, 2023. Studies went through title, abstract and full-text screening conducted independently by at least two reviewers. Included studies were then analyzed and synthesized to identify the conceptualizations of SIL, measurement tools and approaches, prevalence characterization, and relationship with social and health outcomes. The literature search yielded 5,294 papers after removing duplicate records. Following screening, we retained 27 qualitative studies, 23 quantitative studies and two mixed method studies. SIL was not the primary objective of most of the included articles. The prevalence of SIL among people with homelessness experience varied from 25 to 90% across studies. A range of measurement tools were used to measure SIL making it difficult to compare results across studies. Though the studies reported associations between SIL, health, wellbeing, and substance use, we found substantial gaps in the literature. Most of the quantitative studies were cross-sectional, and only one study used health administrative data to ascertain health outcomes. More studies are needed to better understand SIL among this population and to build evidence for actionable strategies and policies to address its social and health impacts.
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Affiliation(s)
- James Lachaud
- College of Social Work, The Ohio State University, 1947 College Rd, Columbus, OH, 43210, USA.
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada.
| | - Ayan A Yusuf
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Faith Maelzer
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Health Sciences Department, McMaster University, Hamilton, ON, Canada
| | - Melissa Perri
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Evie Gogosis
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
| | - Carolyn Ziegler
- Library Services, Unity Health, Toronto, Toronto, ON, Canada
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Family Child Health Initiative, Institute for Better Health, Trillium, Health Partners, Mississauga, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
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Dorfman M, Goldhammer H, Krebs D, Chavis NS, Psihopaidas D, Moore MP, Downes A, Rebchook G, Cahill S, Mayer KH, Keuroghlian AS. Interventions for Improving HIV Care Continuum Outcomes Among LGBTQ+ Youth in the United States: A Narrative Review. AIDS Patient Care STDS 2024; 38:358-369. [PMID: 39047018 DOI: 10.1089/apc.2024.0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/27/2024] Open
Abstract
Lesbian, gay, bisexual, transgender, queer, and all sexually and gender diverse (LGBTQ+) youth with HIV face multiple barriers to progression along the HIV care continuum. We searched PubMed, PsycInfo, clinicaltrials.gov, and the Adolescent Medicine Trials Network for HIV/AIDS Interventions for interventions focused on improving linkage to care, retention in care, adherence to antiretroviral therapy, or viral suppression (VS) among LGBTQ+ youth with HIV in the United States. Included studies were published in English between January 1, 2017 and December 31, 2022, took place in the United States, and had samples with a minimum age of 12 years, a median or mean age of 24 years or less, and with ≥50% reporting an LGBTQ+ identity. Our search identified 11 interventions that met our criteria, of which only three were designed and tailored exclusively for LGBTQ+ populations. Interventions used a variety of modalities, including remote electronic delivery, in-person delivery, or both. Interventions most commonly aimed to enhance self-efficacy, HIV health knowledge, and medication self-management to facilitate improvements in HIV care continuum outcomes. Only two interventions showed statistically significant improvements in VS. More interventions tailored for LGBTQ+ youth are needed to end the HIV epidemic in the United States.
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Affiliation(s)
- Milo Dorfman
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | | | - Damian Krebs
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
| | - Nicole S Chavis
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Demetrios Psihopaidas
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | - Melanie P Moore
- HIV/AIDS Bureau, Health Resources and Services Administration, Rockville, Maryland, USA
| | | | - Greg Rebchook
- Center for AIDS Prevention Studies, University of California, San Francisco, California, USA
| | - Sean Cahill
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Boston University School of Public Health, Boston, Massachusetts, USA
- Bouve College of Health Sciences, Northeastern University, Boston, Massachusetts, USA
| | - Kenneth H Mayer
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Alex S Keuroghlian
- The Fenway Institute, Fenway Health, Boston, Massachusetts, USA
- Department of Psychiatry, Harvard Medical School, Boston, Massachusetts, USA
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Milburn NG, Rice E, Petry L. Understanding Homelessness Among Young People to Improve Outcomes. Annu Rev Clin Psychol 2024; 20:457-479. [PMID: 38109482 DOI: 10.1146/annurev-clinpsy-080921-081903] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
In the United States, an estimated 4.2 million young people experience homelessness during critical stages in their development-adolescence and emerging adulthood. While research on youth homelessness often emphasizes risk and vulnerability, the field must situate these issues within the developmental trajectories of adolescence and emerging adulthood to effectively prevent and end youth homelessness. This review uses the Risk Amplification and Abatement Model (RAAM) as a conceptual framework for contextualizing the landscape of youth homelessness research in the United States since 2010. An extension of ecological models of risk-taking, RAAM emphasizes both risk and resilience, positing that negative as well as positive socialization processes across interactions with family, peers, social services, and formal institutions affect key housing, health, and behavioral outcomes for youth experiencing homelessness. This review applies RAAM to our understanding of the causes and consequences of youth homelessness, recent interventions, and recommendations for future directions.
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Affiliation(s)
- Norweeta G Milburn
- Department of Psychiatry and Biobehavioral Sciences, Division of Population Behavioral Health, University of California, Los Angeles, California, USA;
| | - Eric Rice
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
- USC Center for Artificial Intelligence in Society, University of Southern California, Los Angeles, California, USA
| | - Laura Petry
- USC Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California, USA
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Misedah-Robinson L, Witte L, Henneke E, Land M, Schick V. An exploration of anxiety and depressive symptoms among sexual and gender minority young adults visiting a drop-in center for youth experiencing homelessness. HEALTH CARE TRANSITIONS 2024; 2:100055. [PMID: 39712590 PMCID: PMC11657165 DOI: 10.1016/j.hctj.2024.100055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 03/05/2024] [Accepted: 03/07/2024] [Indexed: 12/24/2024]
Abstract
Background Research suggests that marginalized young adults, particularly sexual and gender minorities (SGM), face distinctive healthcare transition challenges. SGM often navigate a complex intersection of identities, experiences, and stressors that can contribute to mental health disparities. However, they often lack access to appropriate support and resources tailored to their needs, which can result in increased psychological distress. Drop-in centers are effective mental health interventions for marginalized communities. Therefore, we conducted a study to explore the healthcare access experiences and mental health outcomes of young adult SGM compared to their non-SGM counterparts. Methods We surveyed 151 young adults aged 18-25 who visited two drop-in centers for young adults experiencing homelessness in Houston, Texas, between October and November 2018. Depressive and anxiety symptoms were assessed using Patient Health Questionnaire- 4 (PHQ-4.ther variables included demographics, prior mental health diagnosis, and experiences of homelessness and involvement in justice. Results Transgender and gender-diverse individuals had higher proportions of anxiety symptoms than their cisgender counterparts, while gay and lesbian individuals were more likely to experience depressive symptoms. In general, SGM individuals were three times more likely to report a previous anxiety diagnosis and four times more likely to report a previous depression diagnosis than their non-SGM counterparts. However, we did not find a significant association between having anxiety or depressive symptoms with seeking healthcare, experiences of homelessness, and justice involvement. Conclusion The findings suggest that drop-in centers can provide targeted care for SGM youth with intersecting needs, thus improving their mental health outcomes. Nevertheless, more research is needed to understand further and inform more targeted and effective evidence-based interventions that support SGM young adults across the trajectory of experiences, changing needs, and care coordination over time during this critical and vulnerable transition to adulthood.
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Affiliation(s)
- Lourence Misedah-Robinson
- School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX 77030, USA
- US Department of Veterans Affairs, Houston, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd, Suite 01Y, Houston, TX 77021, USA
| | - Laura Witte
- School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX 77030, USA
- US Department of Veterans Affairs, Houston, Michael E. DeBakey Veterans Affairs Medical Center, 2450 Holcombe Blvd, Suite 01Y, Houston, TX 77021, USA
| | - Elizabeth Henneke
- Lone Star Justice Alliance, 3809 South 1st St., Austin, TX 78704, USA
| | - MaDonna Land
- Tony’s Place, P. O. Box 980935, Houston, TX 77098, USA
| | - Vanessa Schick
- School of Public Health, The University of Texas Health Science Center at Houston, 1200 Pressler St., Houston, TX 77030, USA
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8
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D’Amico EJ, Houck JM, Pedersen ER, Klein DJ, Rodriguez A, Tucker JS. Understanding effects of the group process on drinking outcomes for emerging adults experiencing homelessness. ALCOHOL, CLINICAL & EXPERIMENTAL RESEARCH 2024; 48:556-566. [PMID: 38411540 PMCID: PMC10939735 DOI: 10.1111/acer.15272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 01/06/2024] [Accepted: 01/08/2024] [Indexed: 02/28/2024]
Abstract
BACKGROUND There is little research on group process for motivational interviewing-based group interventions with young people. We examine how change talk, group climate and cohesion, and facilitator empathy among emerging adults experiencing homelessness affect their drinking outcomes. METHODS Data come from a clinical trial at three drop-in centers serving emerging adults experiencing homelessness in Los Angeles County and focus on those who received the intervention (n = 132). Participants completed baseline, 3-, 6-, and 12-month follow-up surveys. They were predominantly male and non-white. Group sessions were digitally recorded and coded for percentage change talk (PCT), group climate and cohesion, and facilitator empathy. RESULTS Because baseline alcohol use was significantly higher at site 1 than sites 2 and 3, we examined associations separately by site. At 6 months, higher PCT was associated with fewer drinks per drinking day for sites 2 and 3, whereas higher PCT was associated with more drinks per drinking day for site 1. There were no effects of PCT at 12 months. Higher group cohesion scores were associated with fewer drinking days at 6 months; higher facilitator empathy was associated with fewer maximum drinks in a day at both 6 and 12 months. Group climate was not associated with drinking outcomes. CONCLUSIONS These findings highlight the importance of measuring multiple factors in the group process to understand outcomes. What is "uttered" during group and what is observed provide different methods to evaluate the group process and allow us to better bridge the gap between research and practice.
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Affiliation(s)
| | - Jon M. Houck
- Mind Research Network, 2425 Ridgecrest Dr. SE, Albuquerque NM 87108
| | - Eric R. Pedersen
- University of Southern California, Department of Psychiatry and Behavioral Sciences, Keck School
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9
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Tucker JS, Rodriguez A, D'Amico EJ, Pedersen ER, Jose R, Klein DJ. Trajectories of alcohol and cannabis use among emerging adults with a history of unstable housing: Associations with functioning over a two-year period. Drug Alcohol Depend 2024; 256:111117. [PMID: 38340400 DOI: 10.1016/j.drugalcdep.2024.111117] [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: 10/23/2023] [Revised: 01/22/2024] [Accepted: 01/28/2024] [Indexed: 02/12/2024]
Abstract
INTRODUCTION Research has documented high rates of alcohol and cannabis use among emerging adults experiencing homelessness. However, little is known about trajectories of use over time or how trajectories are associated with functioning (e.g., risk behaviors, mental and physical health, social functioning, economic well-being). METHODS Data come from a cohort of 18-25 year olds experiencing homelessness who were surveyed 5 times over 24 months. Parallel process growth mixture models were used to model heterogeneity in alcohol and cannabis use across the 5 timepoints, which allowed for the extraction of classes based on both alcohol and cannabis use trajectories. Classes were compared on demographics and functioning at baseline and 24-months. RESULTS Two trajectory classes of alcohol and cannabis use emerged: moderate decreasing cannabis and low stable alcohol use (75% of the sample) and heavy cannabis and alcohol use (25% of the sample). The heavy cannabis and alcohol use class reported a significantly higher likelihood for any non-cannabis drug use at baseline and 24-months, as well as greater depression and physical ailments at 24-months. In addition, at 24-months this class had a marginally higher likelihood of a positive screen for at least moderate anxiety and being recently unhoused. CONCLUSIONS The effects of heavy continued cannabis and alcohol co-use on multiple domains of functioning (e.g., risk behavior, mental and physical health) highlight the importance of a coordinated systems approach that addresses the often complex and interrelated challenges facing emerging adults with a history of homelessness.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA.
| | | | | | - Eric R Pedersen
- University of Southern California, Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, 250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - Rupa Jose
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
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10
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Asmare L, Goshu A, Alemu T, Gebeye E. HIV Preexposure Prophylaxis Practice among Urban Female Sex Workers in Northwest Ethiopia: Using Generalized Structural Equation Modeling. J Int Assoc Provid AIDS Care 2024; 23:23259582241302900. [PMID: 39632570 PMCID: PMC11618946 DOI: 10.1177/23259582241302900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2024] [Revised: 10/10/2024] [Accepted: 11/09/2024] [Indexed: 12/07/2024] Open
Abstract
BACKGROUND Acquired immunodeficiency syndrome, caused by the human immunodeficiency virus, has remained a public health threat for the last decades with significantly high burden. Despite the introduction of various human immunodeficiency virus (HIV) prevention strategies targeting high-risk populations, including preexposure prophylaxis, there remains a notable gap in the literature regarding Pre-Exposure Prophylaxis (PrEP) practice among female sex workers (FSWs) in Ethiopia, particularly using advanced analytical methods like structural equation modeling. This study aimed to assess practice and associated factors of preexposure prophylaxis among urban female sex workers in Northwest Ethiopia. METHODS A cross-sectional study was carried out at organizations of Organizations for Social Service, Health Development, Mehabere Hiwot for Social Development, and African Network for the Prevention and Protection Against Child Abuse and Neglect that serve FSWs. Systematic random sampling technique was employed among 549 FSWs. An interviewer-administered questionnaire was used to collect the data. Generalized structural equation modeling was employed to identify factors associated with PrEP practice. As the mediation of effects was present, the direct, indirect, and total effects were determined. A final model was selected based on the statistical significance of the path coefficient. RESULTS In this study, the practice of preexposure prophylaxis was 28.00% with 95% CI = 25.34% to 32.72%. Thus, female sex workers with an education level of college and above had both direct and indirect positive effects on PrEP practice when mediated by knowledge, knowledge had both direct and indirect effects on PrEP practice when mediated by attitude. Whereas, FSWs who had duration of sex work for 3 to 5 years had only a positive direct effect on PrEP practice compared to those who were living in sex work for less than three years duration. CONCLUSION However, HIV remains a public health problem, and the practice of preexposure prophylaxis in this study was found to be low. FSWs having higher education levels, attitudes, and knowledge demonstrate a significantly positive effect on their likelihood to practice PrEP. They suggested enhancing their health outcomes and reducing the risk of HIV transmission. The result of this study was also significant for communities that are serving in a given organization targeting integrated HIV testing and counseling services among key populations.
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Affiliation(s)
- Lakew Asmare
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Atalay Goshu
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
- Biosecuirity Program, Kirby Institute, Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Tihtna Alemu
- Department of Surgical Nursing, School of Nursing, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Ejigu Gebeye
- Department of Epidemiology and Biostatistics, Institute of Public Health, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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Pedersen ER, DiGuiseppi G, D'Amico EJ, Rodriguez A, Tran DD, Jose R, Tucker JS. Predictors of Housing Trajectories Among Young Adults Experiencing Homelessness in Los Angeles. J Behav Health Serv Res 2024; 51:31-43. [PMID: 37803216 PMCID: PMC10733216 DOI: 10.1007/s11414-023-09863-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2023] [Indexed: 10/08/2023]
Abstract
Experiencing homelessness during young adulthood is associated with negative health outcomes and understanding housing trajectories of young adults experiencing homelessness may aid in the development of evidence-based public health programs designed to serve this at-risk age group. In the present study, the authors examined baseline predictors of 24-month trajectories of housing stability and unsheltered housing among a sample of 271 young adults aged 18 to 25 recruited from drop-in centers in Los Angeles. In multivariate models, the authors found that identifying as multi-racial/other and better friendship quality at baseline were associated with less steep increases in the likelihood of stable housing over time. Being employed at baseline was associated with a less steep decrease in the probability of being unsheltered over time, while illicit drug use days associated with a steeper decrease in the probability of being unsheltered over time. Continued research is needed to establish important factors determining young adults' long-term housing trajectories in the effort to promote greater access and engagement with housing services.
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Affiliation(s)
- Eric R Pedersen
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA.
| | - Graham DiGuiseppi
- School of Social Work, University of Southern California, Los Angeles, CA, 90089, USA
- RAND Corporation, 4570 Fifth Ave #600, Pittsburgh, PA, 15213, USA
| | - Elizabeth J D'Amico
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | | | - Denise D Tran
- Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, University of Southern California, 2250 Alcazar Street, Suite 2200, Los Angeles, CA, 90033, USA
| | - Rupa Jose
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407, USA
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12
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DiGuiseppi G, Pedersen ER, Rodriguez A, D’Amico EJ, Tucker JS. Associations between service use and behavioral health trajectories among young adults experiencing homelessness. CHILDREN AND YOUTH SERVICES REVIEW 2024; 156:107354. [PMID: 38644956 PMCID: PMC11031190 DOI: 10.1016/j.childyouth.2023.107354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Purpose To examine associations of service use (housing, mental health, substance use, education, and employment) with depression and substance use disorder (SUD) trajectories among young adults experiencing homelessness. Method Secondary data come from 276 young adults who participated in an intervention to reduce substance use and sexual risk behaviors. Participants were recruited from three drop-in centers in Los Angeles County from 2018 to 2020, and completed surveys at baseline, 3-, 6-, 12-, and 24-months post-baseline. Latent growth curve models examined trajectories of depression and SUD; service use in the past three months was used to predict growth trajectories. Results More frequent use of mental health services (but not other services) at baseline was associated with greater depression symptoms at baseline, linear declines in depression, and a quadratic increase in depression. Service use at baseline was not associated with likelihood of SUD at baseline or changes in SUD over time. Conclusions Young adults in most need of behavioral services are likely to receive services for mental health, but not SUD. Use of mental health services may reduce depression symptoms over time, but continuing care may be needed to prevent symptom returns. More work is needed to connect young adults with SUD treatment and improve effectiveness of these services.
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Affiliation(s)
- Graham DiGuiseppi
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA 90089, United States
- RAND Corporation, 4570 5th Avenue, Suite 600, Pittsburgh, PA 15213, United States
| | - Eric R. Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences, 250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, United States
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
| | - Anthony Rodriguez
- RAND Corporation, 20 Park Plaza, Suite 920, Boston, MA 02116, United States
| | | | - Joan S. Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA 90401, United States
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Huq MR, Phillips DR, Childers C, Chavez R, Tellei J, Blakely L, Aparicio EM. Opportunities and Challenges to Linkage to Housing in the Context of a Sexual and Reproductive Health Program for Youth Experiencing Homelessness. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2023; 24:241-250. [PMID: 37300799 PMCID: PMC10764445 DOI: 10.1007/s11121-023-01560-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2023] [Indexed: 06/12/2023]
Abstract
Youth homelessness remains a major public health issue in the USA, and youth experiencing homelessness (YEH) are still one of the more understudied and underserved groups. Comprehensive sexual and reproductive health (SRH) programs for YEH are rare. Yet, such programs are potentially effective settings through which to link YEH with housing services. Wahine ("woman") Talk is one such comprehensive program for YEH, and is a multilevel intervention delivered out of a youth drop-in center in Honolulu, Hawai 'i. One of Wahine Talk's core components is addressing basic needs, including providing linkages to housing services. Little research exists on SRH programs' opportunities and challenges to providing linkage to housing for YEH. The current study is an exploratory study asking, "What are opportunities and challenges to linking young women experiencing homelessness to housing services through a comprehensive sexual and reproductive health program?" The study team collected in-depth qualitative data through seven focus groups and 25 individual interviews with Wahine Talk staff and youth participants aged 14-22 years. Multiple team members analyzed the data using template analysis. The analysis revealed that while comprehensive SRH programs may have some opportunities and challenges to linking YEH to housing services that are consistent with traditional housing assistance programs, there are also factors specific to SRH programs. In particular, opportunities would be SRH programs employing a housing staff person and bolstering staff-youth meetings and communication. A challenge specific to SRH programs would be prioritizing youth's reproductive justice (i.e., choice) in lieu of solely prioritizing pregnancy reductions and delays; thus, it is recommended to train staff to prioritize youth's reproductive justice. The findings highlight the importance of SRH programs having staff focused on housing, sufficient opportunities for youth and staff to communicate with each other, and staff trained to prioritize youth's reproductive justice.
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Affiliation(s)
- Maisha R Huq
- Community THRIVES Lab, Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA.
| | | | | | | | - Jacqueline Tellei
- Waikiki Health, Honolulu, HI, USA
- PATH Clinic, Waikiki Health, Honolulu, HI, USA
| | - Lenora Blakely
- Community THRIVES Lab, Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
| | - Elizabeth M Aparicio
- Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, 4200 Valley Drive, 20742, College Park, MD, USA
- Community THRIVES Lab, Department of Behavioral and Community Health, School of Public Health, University of Maryland, College Park, MD, USA
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14
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Passetti L, Smith Ramey J, Hunter B, Godley M. Predicting Response to Services for Homeless Adolescents and Transition Age Youth (TAY) with Substance Use And/Or Mental Health Disorders: Implications for Youth Treatment and Recovery. JOURNAL OF EVIDENCE-BASED SOCIAL WORK (2019) 2023; 20:668-685. [PMID: 37461305 DOI: 10.1080/26408066.2023.2202663] [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: 07/20/2023]
Abstract
PURPOSE This paper examines patterns of response to a multi-disciplinary wrap-around program for homeless adolescents and transition-aged youth with substance use and/or mental health disorders. METHOD A cluster analysis of outcome data from 148 youth was conducted. RESULTS Cluster 1 (n = 67) demonstrated significant decreases in risky behavior (e.g., engaging in unprotected sex, crime, and substance use) and poor interpersonal relationships (e.g. more interaction with family and friends and lower rates of violence) but experienced relatively fewer interactions with family and friends. Cluster 2 (n = 57) demonstrated a significant decrease in poor life functioning (e.g., lower rates of employment/education, better quality of life, and less symptoms of internalizing disorders). Cluster 3 (n = 24) experienced significant increases in risky behavior, poor life functioning, and poor interpersonal relationships. DISCUSSION Clusters 1 and 2 improved over six months of care. Cluster 3 deteriorated despite receiving similar services and used more opioids and stimulants. CONCLUSIONS Peer engagement in programs for this population are important. Recommendations for cluster 3 include targeted outreach, medication assisted treatment, and additional research-supported treatments. Further research is needed to test these interventions over longer periods of time.
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Affiliation(s)
- Lora Passetti
- Lighthouse Institute, Chestnut Health Systems, Normal, Illinois, USA
| | - Jennifer Smith Ramey
- Substance Use/Co-Occurring Disorder Program, Horizon Behavioral Health, Lynchburg, Virginia, USA
| | - Brooke Hunter
- Lighthouse Institute, Chestnut Health Systems, Normal, Illinois, USA
| | - Mark Godley
- Lighthouse Institute, Chestnut Health Systems, Normal, Illinois, USA
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15
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Tucker JS, D'Amico EJ, Rodriguez A, Garvey R, Pedersen ER, Klein DJ. A randomized controlled trial of a brief motivational interviewing-based group intervention for emerging adults experiencing homelessness: 12-Month effects on substance use and sexual risk behavior. JOURNAL OF SUBSTANCE USE AND ADDICTION TREATMENT 2023; 152:209114. [PMID: 37355155 PMCID: PMC10530378 DOI: 10.1016/j.josat.2023.209114] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 06/08/2023] [Accepted: 06/13/2023] [Indexed: 06/26/2023]
Abstract
INTRODUCTION Few brief evidence-based risk reduction programs for emerging adults experiencing homelessness focus on the interrelated problems of substance use and sexual risk behavior. This study examines outcomes from a 12-month evaluation of AWARE, a brief Motivational Interviewing (MI)-based group risk reduction intervention for this population. METHODS In a cluster randomized crossover trial, N = 276 18-25-year-olds received AWARE or usual care at drop-in centers serving homeless youth in Los Angeles County. We evaluated intervention effects on substance use and condomless sex (primary outcomes), as well as drinking consequences and protective strategies, number of casual partners, self-efficacy, and motivation for change (secondary outcomes). RESULTS AWARE participants self-reported reductions in their alcohol use and negative consequences from drinking, and an increase in use of drinking protective strategies. AWARE participants also reported an initial decrease in drug use other than marijuana, followed by a slight uptake later on, as well as an initial increase in importance of cutting down on other drug use followed by a decrease. Control group participants did not show change in these outcomes. Among those who reported casual sex partners at both baseline and 12-month surveys, exploratory analyses indicated that AWARE participants had a 29 % decline in condomless sex with casual partners compared to a 6 % decline for control group participants. CONCLUSIONS Findings build on our pilot work by demonstrating that AWARE has long-term benefits on drinking among emerging adults experiencing homelessness. Further work should seek to strengthen its long-term effectiveness in reducing drug use in this population.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA.
| | | | | | - Rick Garvey
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
| | - Eric R Pedersen
- University of Southern California, Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, 250 Alcazar Street, Suite 2200, Los Angeles, CA 90033, USA
| | - David J Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, USA
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Pedersen ER, D'Amico EJ, Klein DJ, Rodriguez A, Tucker JS. Secondary Outcomes of a Brief Group Alcohol and Risky Sex Intervention for Emerging Adults Experiencing Homelessness. EMERGING ADULTHOOD (PRINT) 2023; 11:704-709. [PMID: 38389804 PMCID: PMC10883596 DOI: 10.1177/21676968231156647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/24/2024]
Abstract
AWARE is a four-session group-based motivational enhancement intervention designed to reduce substance use and sexual risk behavior among emerging adults experiencing homelessness. Expanding on promising intervention effects on substance use and risky sex outcomes, this study explored intervention effects on changes in secondary outcomes from baseline to 12-month post-intervention: depression, physical health (general health ratings, physical symptoms), social functioning (satisfaction, quality of friendships), and housing stability. Among the 240 participants with baseline and 12-month follow-up data, we found small effect sizes generally favoring the intervention over usual care for all outcomes. Findings show promise that addressing substance use and risky sexual behavior through interventions in drop-in centers could benefit emerging adults experiencing homelessness in additional areas of their lives. More work is needed to understand how interventions could be tailored to more directly address these outcomes and sustain changes in the long-term.
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Affiliation(s)
- Eric R Pedersen
- University of Southern California, Keck School of Medicine, Department of Psychiatry and Behavioral Sciences
| | | | - David J Klein
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407
| | | | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA 90407
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17
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Rice ER, DiGuiseppi G, Onasch-Vera L, Casey E, Cooper T, DiBattiste M. A Longitudinal Exploration of How Connections to Staff Facilitate Efficacy and Service Use in Drop-in Centers Serving Youth Experiencing Homelessness. JOURNAL OF PREVENTION (2022) 2023; 44:359-371. [PMID: 36929457 DOI: 10.1007/s10935-023-00728-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/06/2023] [Indexed: 03/18/2023]
Abstract
INTRODUCTION Youth experiencing homelessness (YEH) benefit from a variety of services to meet their immediate and long-term needs. Drop-in centers are a popular service venue used by YEH. However, the mechanisms responsible for engaging youth in drop-in services are not clear. The current study uses longitudinal data to explore the role of positive staff relationships in increasing youths' knowledge and efficacy to access and subsequently use drop-in center services. METHODS 731 youth (Mage = 21.8, SD = 2.2, 25.1% female) accessing services at three drop-in centers in Los Angeles, California participated in the study. Surveys were completed at baseline, 1-month, and 3-months later. Path models examined the direct effect of positive relationships with adult staff on service use at the 3-month follow-up, and the indirect effect of service knowledge (assessed at the 1-month follow-up). RESULTS The direct effect model showed that positive staff relationships at baseline were significantly associated with number of services used at the 3-month follow-up (aIRR = 1.24, 95% CI: 1.00, 1.54). Positive staff relationships were also associated with greater service knowledge at 1-month (b = 0.93, p < 0.001), which in turn was associated with greater service use at 3-months (IRR = 1.15, 95% CI: 1.04, 1.28). The indirect effect of service knowledge was significant (b = 0.13, p = 0.02), suggesting that the association between positive staff relationships and service use was completely mediated by service knowledge. CONCLUSIONS The current study adds to the literature by demonstrating that positive relationships with staff lead to increased service use by increasing youths' knowledge and efficacy to access services. Efforts should be made to develop positive relationships with YEH in order to engage them in essential services needed to exit homelessness.
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Affiliation(s)
- Eric R Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90015, USA.
| | - Graham DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90015, USA
| | - Laura Onasch-Vera
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA, 90015, USA
| | - Erin Casey
- My Friend's Place, 5850 Hollywood Blvd, Los Angeles, CA, 90028, USA
| | - Toni Cooper
- My Friend's Place, 5850 Hollywood Blvd, Los Angeles, CA, 90028, USA
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18
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Caruana T, Mao L, Gray RM, Bryant J. Engagement and outcomes of marginalised young people in an early intervention youth alcohol and other drug program: The Street Universities model. PLoS One 2023; 18:e0286025. [PMID: 37200391 DOI: 10.1371/journal.pone.0286025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 05/06/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND Early intervention alcohol and drug (AOD) programs for disadvantaged young people have the potential to substantially decrease the need for future intervention, however there is little research about how young people use these programs or the substance use and other outcomes of such programs. This paper uses data from an Australian AOD early intervention program, The Street Universities, to: describe young people's participation; examine changes in substance use and wellbeing over 90 days; and assess which young people are most positively impacted. METHODS Data come from a prospective study of new attendees, measuring retention in and attendance patterns in an 'engagement' program focussed on arts and lifestyle activities (n = 95), and a routine service dataset collected from seven years of therapeutic intervention (n = 3,893), measuring substance dependence (SDS), psychological distress (K10) and quality of life (EQoL). RESULTS Analysis reveals that young people were retained in the program at high proportion (63% at six months) and more than half of these returned at a frequency of weekly or more often. Young people participating in the therapeutic component of the program reported significant improvements in all key wellbeing indicators with SDS, K10 and EQoL scores significantly improving (at p < .001). These improvements occurred rapidly, within the first 30 days, and were maintained over the 90 day study period. Moreover, young people with the highest SDS and K10 scores and lowest quality of life at baseline experienced the most positive changes. CONCLUSION Aligning engagement program with therapeutic intervention can provide comprehensive support to disadvantaged young people, producing substantial improvements in AOD use, distress and wellbeing.
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Affiliation(s)
- Theresa Caruana
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Limin Mao
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Rebecca M Gray
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, University of New South Wales, Sydney, NSW, Australia
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19
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Kennedy DP, Osilla KC, Tucker JS. Feasibility of a computer-assisted social network motivational interviewing intervention to reduce substance use and increase supportive connections among emerging adults transitioning from homelessness to housing. Addict Sci Clin Pract 2022; 17:26. [PMID: 35505383 PMCID: PMC9066760 DOI: 10.1186/s13722-022-00307-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 03/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Social networks may play positive and negative roles in the lives of young adults experiencing homelessness (YEH) who are transitioning into housing. Social networks can influence their alcohol and/or other drug (AOD) use, as well as provide immediate and long-term support necessary for a successful transition. METHODS We adapted a four-session computer-assisted motivational interviewing social network intervention (MI-SNI) for YEH transitioning into housing. We iteratively adapted and beta tested the intervention for delivery by case managers at an organization that provides supportive housing to YEH. We conducted a focus group with agency staff (n = 6), role-play exercises with case managers (n = 3), and semi-structured interviews with residents (n = 6). Interview data were thematically analyzed with open coding. This study presents the first adaptation of an innovative social network-based motivational intervention to reduce AOD use and increase stable, prosocial supportive connections via visualizations of the structure and composition of the individual's social network. RESULTS Participants rated sessions as "moderately" to "very" helpful and "good" quality on average. Participants agreed that the sessions were helpful, understandable, and satisfying and would work for new residents. Themes emerged in four broad categories: (1) Acceptability, (2) Positive benefits, (3) Visualization reactions, and (4) MI-SNI interface reactions. For the acceptability category, three sub-themes emerged: (1) understandability, (2) enjoyability and ease of use, (3) and barriers to acceptability. Five sub-themes emerged about the intervention's likelihood to trigger positive benefits: (1) learning/new insights, (2) enhancement to motivation to change, (3) making AOD changes, (4) building social support, and (5) the intervention's usefulness to some but not others. Five sub-themes also emerged from comments about the social network visualizations: (1) general positive comments, (2) understandability, (3) new insights, (4) triggering changes in social support, and (5) triggering changes in AOD use. When discussing the MI-SNI intervention interface beyond the visualizations, discussions emerged in three thematic categories: (1) discussion of name listing, (2) discussion of screen wording, and (3) the use of a computer interface to deliver the intervention. CONCLUSIONS Results suggest that the MI-SNI is acceptable to YEH and can be feasibly delivered by case managers during case management sessions. Trial registration ClinicalTrials.gov Identifier: NCT04637815. Registered November 10, 2020.
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Affiliation(s)
- David P Kennedy
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Karen Chan Osilla
- Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, 401 Quarry Road, Palo Alto, CA, 94305, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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20
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Lal S, Halicki-Asakawa A, Fauvelle A. A Scoping Review on Access and Use of Technology in Youth Experiencing Homelessness: Implications for Healthcare. Front Digit Health 2021; 3:782145. [PMID: 34901927 PMCID: PMC8651704 DOI: 10.3389/fdgth.2021.782145] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2021] [Accepted: 10/28/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Youth are among the fastest growing subset of the homeless population. Youth experiencing homelessness (YEH) face multiple barriers in accessing health information and health care services. As such, they may best be reached through information and communication technologies (ICTs); however, limited efforts have been made to synthesize literature on this topic. In this paper, we review studies on access and use of ICTs among YEH. We also discuss the implications of the review for healthcare. Methods: Using scoping review methodology, we searched four databases (Medline, Embase, PsycInfo, and CINAHL) for studies published between 2005 and 2019, screening 1,927 titles and abstracts. Results: We identified 19 articles reporting on studies with YEH between the ages of 12-30, the majority of which were published in the USA. On average, more than half of the samples owned smartphones, used social media, and accessed the internet weekly to search for housing, employment, health information, and to communicate with family, peers, and health workers; however, many youths faced barriers to sustaining their access to technology. Benefits of using ICTs were connecting with home-based peers, family, and case workers, which was associated with a reduction in substance use, risky sexual health behaviors, and severity of mental health symptoms. Connecting with negative, street-based social ties was identified as the most common risk factor to using ICTs due to its association with engaging in risky sex behaviors and substance abuse. Discussion: This review supports the advancement of research and practice on using ICTs to deliver public health information and health services to YEH, while also considering the health-related risks, benefits, and barriers that YEH face when accessing ICTs.
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Affiliation(s)
- Shalini Lal
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
- Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
- Douglas Mental Health University Institute, Montreal, QC, Canada
| | - Amané Halicki-Asakawa
- Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Amélie Fauvelle
- School of Rehabilitation, University of Montreal, Montreal, QC, Canada
- Youth Mental Health and Technology Lab, Innovation and Evaluation Hub, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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21
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Walsh L, Luthy E, Feng X, Yilmazer T, Ford J, Kelleher K, Chavez L, Slesnick N. Predictors of Treatment Engagement Among Suicidal Youth Experiencing Homelessness. Community Ment Health J 2021; 57:1310-1317. [PMID: 34050857 PMCID: PMC8416804 DOI: 10.1007/s10597-021-00850-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 05/25/2021] [Indexed: 10/21/2022]
Abstract
Homeless youth experience high rates of suicidal ideation and attempts, yet limited research has examined predictors of treatment engagement among this population. Suicidal homeless youth (N = 150) between the ages of 18 and 24 years were recruited from a drop-in center in Columbus, Ohio. Participants were randomly assigned to Cognitive Therapy for Suicide Prevention + treatment as usual through a local drop-in center (CTSP + TAU) (N = 75) or TAU alone (N = 75), and treatment attendance among those assigned to CTSP + TAU was examined in this study. As expected, among youth engaged in CTSP + TAU, those with a history of intimate partner violence (IPV) showed decreased odds of treatment attendance. Additionally, youth randomized into CTSP + TAU with higher acquired capability for suicide (ACS) scores and those identifying as Black were more likely to attend treatment sessions. Findings suggest that effective treatment implementation must consider youth's trauma history, demographics and severity of suicidal ideation and behaviors.
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Affiliation(s)
- Laura Walsh
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA.
| | - Ellison Luthy
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Xin Feng
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Tansel Yilmazer
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
| | - Jodi Ford
- College of Nursing, The Ohio State University, Columbus, OH, USA
| | | | - Laura Chavez
- Nationwide Children's Hospital, Columbus, OH, USA
| | - Natasha Slesnick
- Department of Human Sciences, College of Education and Human Ecology, The Ohio State University, 1787 Neil Ave, 135 Campbell Hall, Columbus, OH, 43210, USA
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22
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Adelian H, Khodabandeh Shahraki S, Miri S, Farokhzadian J. The effect of mindfulness-based stress reduction on resilience of vulnerable women at drop-in centers in the southeast of Iran. BMC WOMENS HEALTH 2021; 21:255. [PMID: 34167523 PMCID: PMC8222952 DOI: 10.1186/s12905-021-01390-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Accepted: 06/07/2021] [Indexed: 11/26/2022]
Abstract
Background Female sex workers and addicted women are among the vulnerable groups who impose high costs on the health system of every society. They are prone to psychological problems such as anxiety, stress, and reduced resilience due to their lifestyles. Since mindfulness-based stress reduction (MBSR) has been applied frequently by many psychotherapists to treat stress and anxiety, the present study investigated the effectiveness of MBSR on resilience of the vulnerable women. Methods The statistical population of this quasi-experimental study consisted of all eligible women who referred to the drop-in centers in Kerman in the southeast of Iran. Followed by random sampling, 63 vulnerable women were randomly assigned into the intervention (n = 30) and control (n = 33) groups. The MBSR intervention was conducted for the intervention group in eight 90-min sessions. Demographic information questionnaire and Connor-Davidson resilience scale were administered to collect data prior to and one month after the MBSR intervention. Results The pre-test resilience score was not significantly different between the intervention (53.40 ± 10.49) and the control (54.5 ± 9.27) groups (t = 0.43, p = 0.66). However, the posttest resilience score in the intervention group (60.66 ± 6.71) was significantly higher than the control group (53.88 ± 7.54) (t = 3.58, P = 0.001). Moreover, a comparison between the pretest and posttest scores revealed a significant decrease in resilience scores of the control group (t = 2.81, p = 0.009). Conclusion Since MBSR intervention increased resilience of the vulnerable women in the intervention group, researchers, managers, counselors, community health nurses, and psychiatric nurses are suggested to implement related interventions to promote the health of women, especially vulnerable ones. Supplementary Information The online version contains supplementary material available at 10.1186/s12905-021-01390-6.
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Affiliation(s)
- Hamideh Adelian
- Health in Disasters and Emergencies Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran.,Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Sedigheh Khodabandeh Shahraki
- Department of Community Health Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Sakineh Miri
- Department of Psychiatric Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran.,Nursing Research Center, Kerman University of Medical Sciences, Kerman, Iran
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23
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Tucker JS, Linnemayr S, Pedersen ER, Shadel WG, Zutshi R, DeYoreo M, Cabreros I. Pilot Randomized Clinical Trial of a Text Messaging-Based Intervention for Smoking Cessation Among Young People Experiencing Homelessness. Nicotine Tob Res 2021; 23:1691-1698. [PMID: 33852730 DOI: 10.1093/ntr/ntab055] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 04/13/2021] [Indexed: 01/20/2023]
Abstract
INTRODUCTION Smoking rates are alarmingly high among young people experiencing homelessness (YEH), yet there are no evidence-based cessation programs for this population. This paper presents results from a pilot evaluation of a text messaging-based smoking cessation treatment, as an adjunct to brief group cessation counseling, to improve abstinence rates among 18-25 year old smokers experiencing homelessness. The goal of this study was to estimate effect sizes for a larger trial and it was not powered to detect group differences. METHODS YEH smokers who had a working cell phone with them at recruitment were randomized to receive a group counseling session, nicotine patches, and written material on quitting (n=37) or a similar program that also included a 6-week automated text messaging intervention (TMI) to provide ongoing support for quitting (n=40). Smoking outcomes were evaluated through a 90-day follow-up. RESULTS 7-day point prevalence abstinence at 90-day follow-up was higher in the TMI condition than standard condition (17.50% vs. 8.11%, respectively; Cohen's h=.37); however, the 90-day continuous abstinence rate was not statistically different from zero in either condition. Reductions in the number of days smoked in the past 30 days from baseline to follow-up were greater in the TMI condition than the standard condition (-14.24 vs. -8.62, respectively; Cohen's d=.49). CONCLUSIONS Adding a 6-week TMI support to a brief group counseling and pharmacotherapy protocol holds promise for smoking reduction and abstinence among YEH smokers. Results indicate that further development and evaluation of the TMI in this population is warranted. IMPLICATIONS This is the first study to evaluate the feasibility of using a text messaging-based intervention (TMI) for behavior change with 18-25 year olds experiencing homelessness, and more specifically, the first to test a TMI to provide ongoing support for smoking cessation. Small to medium effect sizes for the TMI are promising in terms of implementing a TMI using participants' own cell phones, as well as the efficacy of this approach as an adjunct to standard care (brief group counseling and pharmacotherapy) for smoking cessation among young people experiencing homelessness.
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Affiliation(s)
| | | | - Eric R Pedersen
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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The Prevalence and Correlates of Labor and Sex Trafficking in a Community Sample of Youth Experiencing Homelessness in Metro-Atlanta. SOCIAL SCIENCES 2021. [DOI: 10.3390/socsci10020032] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Research suggests that runaway and homeless youth (RHY) in the United States are vulnerable to sex and labor trafficking. In this paper, we report and analyze estimates of sex and labor trafficking collected as part of the Atlanta Youth Count 2018, a community-based field survey of RHY between the ages of 14 and 25 in the metro-Atlanta area. A total of 564 participants were recruited and completed a survey that included questions about their backgrounds as well as the Human Trafficking Screening Tool (HTST). We found that 39.9% experienced some form of trafficking while homeless. While 15.6% of the youth reported commercial sexual exploitation while homeless, coerced labor (29.3%) or fraud (25.2%) were even more common experiences. Women, transgender, and gender nonconforming youth, as well young people who had prior system involvement and those who had been homeless for more than a year were the most likely to report having been trafficked. The significance of these findings for research and policy on RHY and trafficking are discussed.
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25
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Kerman N, Lem M, Witte M, Kim C, Rhoades H. A Multilevel Intervention Framework for Supporting People Experiencing Homelessness with Pets. Animals (Basel) 2020; 10:ani10101869. [PMID: 33066290 PMCID: PMC7602009 DOI: 10.3390/ani10101869] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Approximately one in 10 people experiencing homelessness have pets. Despite pets having psychosocial benefits for their owners, pets can also present challenges for people experiencing homelessness related to meeting their basic needs and obtaining housing. This article proposes a framework of policy, public, and service interventions for improving the health and well-being of pet owners experiencing homelessness. At the policy level, the framework proposes an increase of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. At the service delivery level, direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support this vulnerable group. Abstract Approximately one in 10 people experiencing homelessness have pets. Despite the psychosocial benefits derived from pet ownership, systemic and structural barriers can prevent this group from meeting their basic needs and exiting homelessness. A multilevel framework is proposed for improving the health and well-being of pet owners experiencing homelessness. Informed by a One Health approach, the framework identifies interventions at the policy, public, and direct service delivery levels. Policy interventions are proposed to increase the supply of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. Direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support a group that is often overlooked or unaccommodated in efforts to end homelessness.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | - Michelle Lem
- Community Veterinary Outreach, Carp, ON K0A 1L0, Canada; (M.L.); (M.W.)
| | - Mike Witte
- Community Veterinary Outreach, Carp, ON K0A 1L0, Canada; (M.L.); (M.W.)
| | | | - Harmony Rhoades
- USC Suzanne Dworak-Peck School of Social Work, University of South California, Los Angeles, CA 90089, USA;
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26
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Tucker JS, D'Amico EJ, Pedersen ER, Garvey R, Rodriguez A, Klein DJ. Behavioral Health and Service Usage During the COVID-19 Pandemic Among Emerging Adults Currently or Recently Experiencing Homelessness. J Adolesc Health 2020; 67:603-605. [PMID: 32792255 PMCID: PMC7417157 DOI: 10.1016/j.jadohealth.2020.07.013] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/12/2020] [Accepted: 07/13/2020] [Indexed: 10/26/2022]
Abstract
PURPOSE This study provides information on how the coronavirus disease 2019 (COVID-19) outbreak is affecting emerging adults currently or recently homeless in terms of engagement in protective behaviors, mental health, substance use, and access to services. METHODS Ninety participants in an ongoing clinical trial of a risk reduction program for homeless, aged 18-25 years, were administered items about COVID-19 between April 10 and July 9, 2020. RESULTS Most participants reported engaging in COVID-19 protective behaviors. Past week mental health symptoms were reported by 38%-48% of participants, depending on symptoms. Among those who used substances before the outbreak, 16%-28% reported increased use of alcohol, tobacco, and marijuana. More than half of the participants reported increased difficulty meeting basic needs (e.g., food), and approximately 32%-44% reported more difficulty getting behavioral health services since the outbreak. CONCLUSIONS Innovative strategies are needed to address the increased behavioral health needs of young people experiencing homelessness during events such as the COVID-19 outbreak.
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Affiliation(s)
- Joan S. Tucker
- RAND Corporation, Santa Monica, California,Address correspondence to: Joan S. Tucker, Ph.D., RAND Corporation, 1776 Main Street, Santa Monica, CA 90407
| | | | - Eric R. Pedersen
- RAND Corporation, Santa Monica, California,Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, California
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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: 0.8] [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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Stormon N, Sowa PM, Anderson J, Ford PJ. Facilitating Access to Dental Care for People Experiencing Homelessness. JDR Clin Trans Res 2020; 6:420-429. [PMID: 32853528 DOI: 10.1177/2380084420952350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Fear, lack of information, and lower health literacy are prominent barriers preventing people experiencing homelessness from accessing dental services. Most of this population are eligible for free dental treatment in Australia, yet few access care. This study evaluated 3 models for facilitating access to dental services for people experiencing homelessness. METHODS Three facilitated access models were developed and implemented at 4 community organizations. In model 1, dental appointments were booked on the spot after a screening by dental practitioners. Model 2 also involved dental screenings followed by appointments made via phone call from the service. In model 3, the community organizations referred clients directly to the service where appointments were made via a phone call to the client. The models were trialed with community organizations between 2017 and 2019. For each model, participant demographic information, attendance at subsequent dental appointments, and program operation resource use were collected. Cost-effectiveness was assessed as an incremental cost per additional person attending a dental appointment. RESULTS A total of 76 people participated in model 1, 66 in model 2, and 43 in model 3. Model 1 was the most effective, leading to 84.2 (confidence interval, 75.8-92.7) of every 100 participants attending a dental appointment. Model 2 had a lower effectiveness of 56.1 (44.6-67.6), and model 3 was the least effective, with a mean of 29.3 (15.0-43.6) per 100 participants attending. Incremental cost-effectiveness ratios were $51 per additional person attending a dental appointment for model 3 (compared to no strategy) and $173 per additional person attending for model 1 (compared to model 3). CONCLUSIONS Model 3 was the most cost-effective strategy of increasing access to dental care for people experiencing homelessness. Decision makers who find the effectiveness of model 3 insufficient should look instead to employ model 1 or a combination of these 2 models. The importance of face-to-face engagement to foster trust between the individual and health care practitioner was evident. KNOWLEDGE TRANSFER STATEMENT This study provides a range of models for dental and community services to facilitate access to dental care for people experiencing homelessness. Decision makers should consider the needs of vulnerable populations, alternative model designs, and their cost-effectiveness when implementing models of facilitated access to dental care. Face-to-face engagement between clients and dental practitioners by inclusion of a screening stage appears to be instrumental in overcoming barriers to access clinical care.
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Affiliation(s)
- N Stormon
- School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, Australia
| | - P M Sowa
- Centre for the Business and Economics of Health, University of Queensland, Brisbane, Australia
| | - J Anderson
- Queensland Health, Oral Health Services, Community and Oral Health Directorate, Royal Brisbane & Women's Hospital, Brisbane, Australia
| | - P J Ford
- School of Dentistry, Oral Health Centre, University of Queensland, Brisbane, Australia
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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: 12] [Impact Index Per Article: 2.4] [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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Semborski S, Redline B, Rhoades H, Henwood B. Provider perspectives of housing programs for young adults experiencing homelessness. CHILDREN AND YOUTH SERVICES REVIEW 2020; 112:104898. [PMID: 33041411 PMCID: PMC7543879 DOI: 10.1016/j.childyouth.2020.104898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Qualitative methods were used to investigate the perspectives of service providers working in Permanent Supportive Housing, Transitional Living Programs, and Rapid Rehousing for young adults who have experienced homelessness. The primary aim was to explore how housing models were designed, implemented, and the extent to which there is variability in how providers approach their work with young adults. METHODS Data come from 26 housing service providers purposively sampled from supportive housing providers across the United States between October 2017 and July 2018. Interview transcripts were analyzed using a comparative case summary approach, grouped by program model. RESULTS Three themes emerged from the qualitative analysis related to how specific housing models were developed (Stranded between systems: "No model to follow"), the strategies that providers took to support residents toward independence and self-sufficiency (Working toward independence and self-sufficiency: "No one-sized approach"), and the various roles that individual providers discussed fulfilling in their work with young adults (Shifting roles: "Whatever type of figure is needed"). DISCUSSION While the overarching goals of supportive housing span across housing models, the methods and philosophies of service delivery differ, mirroring the programmatic structure of the model. Results point to a competing philosophies approach to housing as it delivers different philosophically oriented programming models for similar youth through Transitional Living Programs, Permanent Supportive Housing, and Rapid Rehousing models.
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Simpson EK, McDermott CP, Hild LE. Needs of Transitionally Housed Young People to Promote Occupational Participation. Occup Ther Health Care 2020; 34:62-80. [PMID: 32153251 DOI: 10.1080/07380577.2020.1737895] [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: 10/24/2022]
Abstract
This qualitative descriptive study explored what young people who are transitionally housed need to promote occupational participation. Nine young people and four staff members from a transitional living facility participated in interviews and focus groups. Results suggested that the young people need opportunities to practice independent living skills, develop routines to support employment, housing, and education, and receive more individualized support from service providers. Findings also reveal that service providers experience a range of barriers to meeting young people's needs. This study underscores the importance of occupational therapy practitioners being informed of national and regional policies as well as emerging evidence of innovative approaches with populations, communities, and individuals so as to ultimately develop novel, collaborative, occupation-based programs to help young people set goals and transition out of homelessness.
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Affiliation(s)
- Emily K Simpson
- Occupational Therapy Program, Midwestern University, Downers Grove, IL, USA
| | - Callan P McDermott
- Occupational Therapy Program, Midwestern University, Downers Grove, IL, USA
| | - Lauren E Hild
- Occupational Therapy Program, Midwestern University, Downers Grove, IL, USA
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Tucker JS, Pedersen ER, Linnemayr S, Shadel WG, DeYoreo M, Zutshi R. A text message intervention for quitting cigarette smoking among young adults experiencing homelessness: study protocol for a pilot randomized controlled trial. Addict Sci Clin Pract 2020; 15:11. [PMID: 32075695 PMCID: PMC7031942 DOI: 10.1186/s13722-020-00187-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 02/09/2020] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Cigarette smoking is much more prevalent among young people experiencing homelessness than in the general population of adolescents and young adults. Although many young homeless smokers are motivated to quit, there are no empirically-evaluated smoking cessation programs for this population. It is important that any such program address the factors known to be associated with quitting-related outcomes among homeless young people, to provide ongoing support in a way that accommodates the mobility of this population, and does not rely on scarce service provider resources for its delivery. The objective of this project is to develop and pilot test a text messaging-based intervention (TMI), as an adjunct to brief cessation counseling and provision of nicotine patches, to help homeless young people who want to quit smoking. METHODS/DESIGN This pilot study will utilize a cluster cross-over randomized controlled design with up to 80 current smokers who desire to quit and are recruited from three drop-in centers serving young people experiencing homelessness in the Los Angeles area. All participants will be provided with a minimum standard of care: a 30-min group-based smoking cessation counseling session and free nicotine replacement. Half of these smokers will then also receive the TMI, as an adjunct to this standard care, which will provide 6 weeks of ongoing support for quitting. This support includes continued and more intensive education regarding nicotine dependence, quitting smoking, and relapse; does not require additional agency resources; can be available "on demand" to users; and includes features to personalize the quitting experience. This study will investigate whether receiving the TMI adjunct to standard smoking cessation care results in greater reductions in cigarette smoking compared to standard care alone over a 3-month period. DISCUSSION This study has the potential to address an important gap in the clinical research literature on cigarette smoking cessation and provide empirical support for using a TMI to provide ongoing assistance and support for quitting among young smokers experiencing homelessness. Trial registration ClinicalTrials.gov Identifier NCT03874585. Registered March 14, 2019, https://clinicaltrials.gov/ct2/show/record/NCT03874585.
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Affiliation(s)
- Joan S Tucker
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA.
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Sebastian Linnemayr
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - William G Shadel
- RAND Corporation, 4570 Fifth Ave, Ste. #600, Pittsburgh, PA, 15213, USA
| | - Maria DeYoreo
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
| | - Rushil Zutshi
- RAND Corporation, 1776 Main Street, PO Box 2138, Santa Monica, CA, 90407-2138, USA
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Khan BM, Reid N, Brown R, Kozloff N, Stergiopoulos V. Engaging Adults Experiencing Homelessness in Recovery Education: A Qualitative Analysis of Individual and Program Level Enabling Factors. Front Psychiatry 2020; 11:779. [PMID: 32848944 PMCID: PMC7424067 DOI: 10.3389/fpsyt.2020.00779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/22/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Recovery Education Centres (REC) in mental health offer a new model of providing recovery supports through emancipatory adult education and recovery-oriented service principles. Despite the widespread adoption of RECs, there is limited evidence regarding factors enabling engagement and participation, particularly for unique subpopulations or service delivery contexts. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Ontario is the first REC in Canada and one of few worldwide supporting adults transitioning out of homelessness. This research aimed to investigate individual and program level enablers of engagement and participation in a REC for this population. METHODS Qualitative methods were used to explore the experiences of 20 service user participants through semi-structured interviews exploring their experiences of REC participation and perceived key program features. Interviews were conducted between July 2017 and June 2018, six to 14 months following REC enrollment, and analyzed using inductive thematic analysis. RESULTS In contrast to past experiences with health and social services, participants described a welcoming and respectful physical and interpersonal environment with low-barrier seamless access facilitating their engagement and participation. Although the realities of homelessness presented barriers for some, participants described that the involvement of peers, as role models, and the self-directed, strengths, and skills-based curriculum, co-produced and co-delivered by peers and professionals, were instrumental in activating the process of recovery through education. CONCLUSIONS/IMPLICATIONS Findings are consistent with the growing evidence base of the defining features of RECs and suggest this model can be successfully extended to support recovery among adults transitioning out of homelessness. This unique examination of Canada's first REC for adults exiting homelessness can help guide program and policy development to better support this disadvantaged population.
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Affiliation(s)
- Bushra M Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nadine Reid
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rebecca Brown
- Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Santa Maria D, Flash CA, Narendorf S, Barman-Adhikari A, Petering R, Hsu HT, Shelton J, Bender K, Ferguson K. Knowledge and Attitudes About Pre-Exposure Prophylaxis Among Young Adults Experiencing Homelessness in Seven U.S. Cities. J Adolesc Health 2019; 64:574-580. [PMID: 30254009 DOI: 10.1016/j.jadohealth.2018.06.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 06/21/2018] [Accepted: 06/22/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE Evidence suggests that young adults experiencing homelessness (YEH) are at elevated risk of HIV compared to housed youth. Given the limited research on pre-exposure prophylaxis (PrEP) awareness among YEH, this study examined their PrEP knowledge and attitudes. METHODS Data from a cross-sectional survey among YEH (ages 18-26) (n = 1,427) in seven U.S. cities were used to assess their knowledge and attitudes regarding PrEP to inform HIV prevention efforts. RESULTS Participants were primarily male youth of color. The mean age was 20.9years. While 66% felt at risk for HIV, only 14% strongly agreed that they try to protect themselves from getting infected with HIV. Most (84%) were eligible for PrEP based on risk, yet only 29% had knowledge of PrEP. Despite this, 59% reported they were likely/extremely likely to take PrEP. Access to free PrEP (55%), HIV testing (72%), healthcare (68%), and one-on-one (62%), and text messaging support (57%) were rated as very/extremely important for PrEP uptake and adherence. CONCLUSIONS The results of this study suggest missed opportunities to prevent new HIV infections among YEH. Efforts to increase PrEP uptake among this population should consider provider- and system-level interventions to increase PrEP awareness, decrease PrEP-associated healthcare costs, improve access to PrEP providers, and provide in-person and text messaging support.
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Affiliation(s)
- Diane Santa Maria
- Department of Nursing Systems, Cizik School of Nursing, The University of Texas Health Science Center at Houston, Houston, Texas.
| | - Charlene A Flash
- Department of Medicine, Division of Infectious Disease, Baylor College of Medicine and Legacy Community Health, Houston, Texas.
| | - Sarah 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.
| | - Kristin Ferguson
- School of Social Work, Arizona State University, Phoenix, Arizona.
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Straub DM. Pre-Exposure Prophylaxis for Homeless Youth: A Rights-Based Perspective. J Adolesc Health 2019; 64:549-550. [PMID: 31010549 DOI: 10.1016/j.jadohealth.2019.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 02/27/2019] [Indexed: 10/27/2022]
Affiliation(s)
- Diane M Straub
- Department of Pediatrics, University of South Florida College of Medicine, Tampa, Florida
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Bounds DT, Edinburgh LD, Fogg LF, Saeywc EM. A nurse practitioner-led intervention for runaway adolescents who have been sexually assaulted or sexually exploited: Effects on trauma symptoms, suicidality, and self-injury. CHILD ABUSE & NEGLECT 2019; 90:99-107. [PMID: 30772751 DOI: 10.1016/j.chiabu.2019.01.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 01/28/2019] [Accepted: 01/30/2019] [Indexed: 06/09/2023]
Abstract
BACKGROUND Adolescent victims of sexual assault and exploitation suffer significant mental health distress including PTSD, self-harm, suicidal ideation, and attempts. OBJECTIVE This longitudinal observational study investigated the Runaway Intervention Program's influence on trauma responses at 3, 6, and 12 months for adolescents who have run away at least once and have been sexually assaulted or exploited. PARTICIPANTS Runaways (n = 362) received nurse practitioner (NP) home and community visits, intensive case management, and optional empowerment groups. SETTING An urban Midwestern city's hospital-based Children's Advocacy Center. METHODS Trauma responses were measured by the UCLA PTSD-RI index, past 30 days emotional distress scale, and self-harm, suicidal ideation, and suicide attempt questions. Repeated Measures ANOVA assessed trauma response changes over time. Growth curve analyses using intervention doses determined which aspects of the intervention predicted change. RESULTS From program entry to 3 and 6 months, mean values decreased significantly for emotional distress (-0.67, -.91) self-harm (-.30, -.55), suicidal ideation (-.45, -.57), suicide attempts (-.58, -.61), and trauma symptoms (-11.8, -16.2, all p < .001) all maintained at 12 months. In growth curve models, NP visits independently predicted declines in emotional distress (-.038), self-injury (-.020), suicidal ideation (-.025) and attempts (-.032), while empowerment groups predicted trauma symptoms (-.525) and all others except suicide attempts. CONCLUSIONS The program, especially NP community visits and empowerment group elements, decreased trauma responses in runaway youth with a history of sexual assault. Given high rates of PTSD and emotional distress among runaways, the Runaway Intervention Program offers promise for improving mental health outcomes.
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Affiliation(s)
- Dawn T Bounds
- Rush University Medical Center, College of Nursing, 600 S. Paulina St., AAC Suite 1080, Chicago, IL 60612, United States
| | - Laurel D Edinburgh
- Midwest Children's Resource Center, Children's Hospital of Minnesota, 347 N. Smith Ave., St. Paul, MN 55102, United States.
| | - Louis F Fogg
- Rush University Medical Center, College of Nursing, 600 S. Paulina St., AAC Suite 1080, Chicago, IL 60612, United States
| | - Elizabeth M Saeywc
- School of Nursing, University of British Columbia, T201-2211 Westbrook Mall, Vancouver, BC V6T 2B5, Canada
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Parast L, Tucker JS, Pedersen ER, Klein D. Utilization and Perceptions of Drop-in Center Services Among Youth Experiencing Homelessness. J Behav Health Serv Res 2019; 46:234-248. [PMID: 30291586 PMCID: PMC6450788 DOI: 10.1007/s11414-018-9632-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Drop-in centers offer a range of services to assist unaccompanied youth experiencing homelessness, but little is known about their perceptions of drop-in centers or use of different services. A random sample of 273 youth experiencing homelessness in the Los Angeles area who had ever used a drop-in center was surveyed. Most youth heard about local drop-in centers from peers (65.1%). They generally reported positive perceptions of the drop-in center environment, staff, and clients; overall, 57.8% were "very" or "extremely" satisfied with the services they had received. Nearly all youth cited basic services (e.g., food, showers, clothes) as a reason they went to drop-in centers; far fewer reported going to obtain higher-level services (e.g., case management). Perceptions and utilization did not differ by sexual orientation; however, non-white youth were more likely than Whites to use drop-in centers for certain higher-level services. Strategies for engaging youth in drop-in center services are discussed.
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Affiliation(s)
- Layla Parast
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA.
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
| | - David Klein
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90401, USA
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Yarcusko E, Slesnick N, Hatsu I. Food Sources for Homeless Youth: An Evaluation of Food Availability at a Homeless Youth Drop-In Center. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2019; 51:91-95. [PMID: 30279070 DOI: 10.1016/j.jneb.2018.08.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 08/03/2018] [Accepted: 08/15/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE We utilized a validated food inventory questionnaire to assess the types and quality of food available at a homeless youth drop-in center. METHODS Scores for 13 food categories were computed; higher scores indicated a greater availability of foods found in that category. A summative score was computed to assess the presence of obesogenic foods. RESULTS Dry cereal, vegetables, and meat, were the most available foods; 83.3%, 60.9%, and 56.3% of food items in each category, respectively, were available. The food categories with least available items included candy and dairy: 26.6% and 25.4% of items in those categories, respectively. Mean obesogenic food availability score was 31 ± 4.2 (range 23-34), out of a possible score of 71. CONCLUSIONS AND IMPLICATIONS It is possible for a drop-in center to provide healthful foods to homeless youth. Further studies examining the extent to which drop-in centers contribute to the homeless youth food environment are warranted.
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Affiliation(s)
- Emily Yarcusko
- Human Nutrition, Department of Human Sciences, The Ohio State University, Columbus, OH
| | - Natasha Slesnick
- Human Development and Family Science, Department of Human Sciences, The Ohio State University, Columbus, OH
| | - Irene Hatsu
- Human Nutrition, Department of Human Sciences, The Ohio State University, Columbus, OH.
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Dang MT, Amos A, Dangerfield M, Ford B, Kern K, Moon M. A Youth Participatory Project to Address STIs and HIV among Homeless Youth. Compr Child Adolesc Nurs 2018; 42:222-240. [PMID: 29902090 DOI: 10.1080/24694193.2018.1483980] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
The purpose of this study was to conduct a youth participatory action research project to address the disparities in sexually transmitted infection (STI) and HIV rates among homeless youth. Four youth served as co-investigators and cultural informants for the project. The team conducted focus groups (N = 22; ages 16-22) and in-depth interviews (N = 20; ages 18-24) with homeless youth to explore decisions about condomless sex, knowledge of STIs and HIV, health-care access for STI-related services, and perceptions about STI testing. Findings revealed that homeless youth have good general knowledge about STIs, are receptive to STI testing for themselves and their sexual partners, and have heightened concerns about being HIV positive and peers knowing their STI status. Results from the current study could contribute to the development of youth-informed tailored interventions to increase protective sexual behavior, reduce health disparities, and improve access to and the quality of health-care services for homeless youth.
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Affiliation(s)
- Michelle T Dang
- School of Nursing, California State University, Sacramento , Sacramento , California , USA
| | - Aaron Amos
- School of Nursing, California State University, Sacramento , Sacramento , California , USA
| | - Monique Dangerfield
- School of Nursing, California State University, Sacramento , Sacramento , California , USA
| | - Brian Ford
- School of Nursing, California State University, Sacramento , Sacramento , California , USA
| | - Kayla Kern
- School of Nursing, California State University, Sacramento , Sacramento , California , USA
| | - Martha Moon
- School of Nursing, California State University, Sacramento , Sacramento , California , USA
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Pedersen ER, Tucker JS, Klein DJ, Parast L. Perceived Need and Receipt of Behavioral Health Services at Drop-In Centers among Homeless Youth. Health Serv Res 2018; 53:4609-4628. [PMID: 29862501 DOI: 10.1111/1475-6773.12990] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
OBJECTIVE Homeless youth are a population in need of housing assistance and case management, as well as services to address behavioral health problems. This study examines youth's perceived need for and receipt of services through drop-in centers. DATA SOURCE Surveys of 273 homeless youth. STUDY DESIGN Cross-sectional. EXTRACTION METHODS Descriptive analyses with bivariate and multivariable regression models. PRINCIPAL FINDINGS About one-third to half of the sample met criteria for behavioral health problems, yet half or less of those meeting criteria reported a need for services targeting the problems. Most youth who perceived a need for services received relevant services through a drop-in center, with the exception of care for substance use problems. Youth with behavioral health problems were more likely to perceive a need for services related to housing and case management than those addressing behavioral health problems more directly. Multivariable regression analyses indicated that the factors most strongly associated with perceived need for services were not behavioral health problems, but rather race/ethnicity, traveler status, trouble meeting basic needs, delinquency, abuse/victimization experiences, and trading sex. CONCLUSIONS Findings can help to develop outreach and intervention efforts to reach homeless youth and help promote the use of behavioral health services.
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VonHoltz LAH, Frasso R, Golinkoff JM, Lozano AJ, Hanlon A, Dowshen N. Internet and Social Media Access Among Youth Experiencing Homelessness: Mixed-Methods Study. J Med Internet Res 2018; 20:e184. [PMID: 29789281 PMCID: PMC5989062 DOI: 10.2196/jmir.9306] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2017] [Revised: 02/08/2018] [Accepted: 03/22/2018] [Indexed: 11/20/2022] Open
Abstract
Background Youth experiencing homelessness are at a risk for a variety of adverse outcomes. Given the widespread use of the internet and social media, these new technologies may be used to address their needs and for outreach purposes. However, little is known about how this group uses these resources. Objective This study investigated how homeless adolescents use these technologies for general and health-related purposes, whether the scope of their use changes with housing status, and their interest in a website dedicated to youth experiencing homelessness. Methods A convenience sample of youth aged 18 to 21 years was recruited from a youth-specific homeless shelter. All participants completed a 47-item survey, with 10 individuals completing a semistructured interview. Descriptive statistics, exact testing, logistic regression, and generalized estimating equation modeling was performed for quantitative data analysis. Interviews were transcribed verbatim, and NVivo 10 (QSR International) was employed to facilitate double coding and thematic analysis. Results A total of 87 participants completed the survey with a mean age of 19.4 (SD 1.1) years. While experiencing homelessness, 56% (49/87) accessed the internet at least once a day, with 86% (75/87) accessing once a week. Access to a smartphone was associated with a 3.03 greater odds of accessing the internet and was the most frequently used device (66% of participants, 57/87). While experiencing homelessness, subjects reported a 68% decreased odds in internet access frequency (odds ratio [OR] 0.32, P<.001), 75% decreased odds in spending greater amounts of time on the internet (OR 0.25, P<.001), and an 87% decreased odds of social media use (OR 0.13, P=.01). Ten participants completed the semistructured interview. Several themes were identified, including (1) changes in internet behaviors while experiencing homelessness, (2) health status as a major concern and reason for Internet use, and (3) interest in a website dedicated to youth experiencing homelessness. While experiencing homelessness, participants indicated their behaviors were more goal-oriented and less focused on leisure or entertainment activities. Conclusions While homeless youth experience changes in the frequency, amount of time, and specific uses of the internet and social media, study participants were able to access the internet regularly. The internet was used to search health-related topics. Given the importance of smartphones in accessing the internet, mobile-optimized websites may be an effective method for reaching this group.
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Affiliation(s)
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, PA, United States
| | - Jesse M Golinkoff
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Alicia J Lozano
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Alexandra Hanlon
- School of Nursing, University of Pennsylvania, Philadelphia, PA, United States
| | - Nadia Dowshen
- Craig-Dalsimer Division of Adolescent Medicine, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.,Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
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Pedersen ER, Ewing BA, D'Amico EJ, Miles JNV, Haas AC, Tucker JS. Predictors of Retention in an Alcohol and Risky Sex Prevention Program for Homeless Young Adults. PREVENTION SCIENCE : THE OFFICIAL JOURNAL OF THE SOCIETY FOR PREVENTION RESEARCH 2018; 19:459-467. [PMID: 29352399 PMCID: PMC5947862 DOI: 10.1007/s11121-018-0866-9] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Homeless young adults are at risk for alcohol and other drug (AOD) use and risky sexual behavior. Interventions are needed to help these young people reduce their risky behavior, but this population is often difficult to engage and retain in services. We offered a four-session AOD and risky sex reduction program to 100 participants and examined if retention in the program was predicted by a number of factors: demographics, homelessness severity, other service use, AOD behaviors, mental health symptoms, sexual risk behaviors, and readiness to change AOD and condom use. Nearly half (48%) of participants completed all sessions. In bivariate analyses, participants were significantly less likely to be retained in the program if they had slept outdoors in the past month, engaged in more alcohol and marijuana use, experienced more alcohol-related consequences, and received the program in an urban drop-in center (as opposed to a drop-in center near the beach). When controlling for all significant bivariate relationships, only sleeping outdoors and receipt of the program in the urban setting predicted fewer sessions completed. The most endorsed reasons for program non-completion were being too busy to attend and inconvenient day/time of the program. Findings can help outreach staff and researchers better prepare methods to engage higher risk homeless youth and retain them in services. Finding unique ways to help youth overcome barriers related to location of services appears especially necessary, perhaps by bringing services to youth where they temporarily reside or offering meaningful incentives for program attendance.
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Affiliation(s)
- Eric R Pedersen
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA.
| | - Brett A Ewing
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | | | - Jeremy N V Miles
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | - Ann C Haas
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
| | - Joan S Tucker
- RAND Corporation, 1776 Main Street, Santa Monica, CA, 90407-2138, USA
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Leonard NR, Freeman R, Ritchie A, Gwadz MV, Tabac L, Dickson V, Cleland C, Bolas J, Hirsh M. "Coming from the place of walking with the youth -- that feeds everything": A mixed methods case study of a runaway and homeless youth organization. CHILD & ADOLESCENT SOCIAL WORK JOURNAL : C & A 2017; 34:443-459. [PMID: 31579286 PMCID: PMC6774622 DOI: 10.1007/s10560-016-0483-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
Organizations for runaway and homeless youth (RHY) provide essential services to highly vulnerable youth who have a wide variety of basic needs and complex psychosocial challenges. We present a mixed-methods case study of an RHY organization to identify the specific mechanisms and processes by the organization successfully promotes engagement and positive development of the youth they serve. We analyzed the qualitative and quantitative data separately and then integrated these two strands of data. Our findings indicate a consistent convergence of responses across the data sources, in both the qualitative and quantitative strands, that consistently reflect the organization's youth-centered approach. Primary among these policies and practices is the emphasis on building and maintaining empathic relationships with youth, the promotion of youths' autonomy, and an institutional culture of continuous evaluation of how the organization is meeting their mission to provide services that reflect best practices.
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Affiliation(s)
- Noelle R Leonard
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
| | | | - Amanda Ritchie
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
| | - Marya V Gwadz
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
| | | | - Victoria Dickson
- Rory Meyers College of Nursing, New York University, New York, NY
| | - Charles Cleland
- Center for Drug Use and HIV Research, Rory Meyers College of Nursing, New York University, New York, NY
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Lynch J, McCay E, Aiello A, Donald F. Engaging street-involved youth using an evidence-based intervention: A preliminary report of findings. JOURNAL OF CHILD AND ADOLESCENT PSYCHIATRIC NURSING 2017; 30:98-104. [DOI: 10.1111/jcap.12179] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Revised: 08/17/2017] [Accepted: 08/18/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Joanna Lynch
- Daphne Cockwell School of Nursing; Ryerson University; Toronto ON Canada
| | - Elizabeth McCay
- Daphne Cockwell School of Nursing; Ryerson University; Toronto ON Canada
| | - Andria Aiello
- Daphne Cockwell School of Nursing; Ryerson University; Toronto ON Canada
| | - Faith Donald
- Daphne Cockwell School of Nursing; Ryerson University; Toronto ON Canada
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D'Amico EJ, Houck JM, Tucker JS, Ewing BA, Pedersen ER. Group motivational interviewing for homeless young adults: Associations of change talk with substance use and sexual risk behavior. PSYCHOLOGY OF ADDICTIVE BEHAVIORS 2017. [PMID: 28627914 DOI: 10.1037/adb0000288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Homeless young adults exhibit high rates of alcohol and other drug (AOD) use and sexual risk behaviors. This study is a secondary analysis of data collected in a randomized clinical trial of AWARE, a new 4 session group motivational interviewing intervention. AWARE mainly focused on alcohol use and sexual risk behavior given focus group feedback. We used sequential coding to analyze how the group process affected both AOD use and sexual risk behavior at 3-month follow up among homeless young adults by examining facilitator behavior and participant change talk (CT) and sustain talk (ST). We analyzed 57 group session digital recordings of 100 youth (69% male, 74% heterosexual, 28% non-Hispanic white, 23% African American, 26% Hispanic, 23% multiracial/other; mean age 21.75). Outcomes included importance and readiness to change AOD use and risky sexual behavior, AOD use and consequences, number of partners and unprotected sex, and condom self-efficacy. Sequential analysis indicated that facilitator open-ended questions and reflections of CT increased Group CT. Group CT was associated with a lower likelihood of being a heavy drinker 3 months later; Group ST was associated with decreased readiness and confidence to change alcohol use. There were no associations with CT or ST for drug use or risky sexual behavior. Facilitator speech and peer responses were related to CT and ST during the group sessions with this high risk population, which were then associated with individual changes for alcohol use. Further research is needed to explore associations with drug use and sexual risk behavior. (PsycINFO Database Record
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Affiliation(s)
| | - Jon M Houck
- Center on Alcoholism, Substance Abuse, and Addictions, University of New Mexico
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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: 58] [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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