Correlates of substance use severity among homeless youth

Identifying Marijuana Use Behaviors Among Youth Experiencing Homelessness Using a Machine Learning-Based Framework: Development and Evaluation Study

BACKGROUND

Youth experiencing homelessness face substance use problems disproportionately compared to other youth. A study found that 69% of youth experiencing homelessness meet the criteria for dependence on at least 1 substance, compared to 1.8% for all US adolescents. In addition, they experience major structural and social inequalities, which further undermine their ability to receive the care they need.

OBJECTIVE

The goal of this study was to develop a machine learning-based framework that uses the social media content (posts and interactions) of youth experiencing homelessness to predict their substance use behaviors (ie, the probability of using marijuana). With this framework, social workers and care providers can identify and reach out to youth experiencing homelessness who are at a higher risk of substance use.

METHODS

We recruited 133 young people experiencing homelessness at a nonprofit organization located in a city in the western United States. After obtaining their consent, we collected the participants' social media conversations for the past year before they were recruited, and we asked the participants to complete a survey on their demographic information, health conditions, sexual behaviors, and substance use behaviors. Building on the social sharing of emotions theory and social support theory, we identified important features that can potentially predict substance use. Then, we used natural language processing techniques to extract such features from social media conversations and reactions and built a series of machine learning models to predict participants' marijuana use.

RESULTS

We evaluated our models based on their predictive performance as well as their conformity with measures of fairness. Without predictive features from survey information, which may introduce sex and racial biases, our machine learning models can reach an area under the curve of 0.72 and an accuracy of 0.81 using only social media data when predicting marijuana use. We also evaluated the false-positive rate for each sex and age segment.

CONCLUSIONS

We showed that textual interactions among youth experiencing homelessness and their friends on social media can serve as a powerful resource to predict their substance use. The framework we developed allows care providers to allocate resources efficiently to youth experiencing homelessness in the greatest need while costing minimal overhead. It can be extended to analyze and predict other health-related behaviors and conditions observed in this vulnerable community.

In flux: Associations of substance use with instability in housing, employment, and income among young adults experiencing homelessness

Young adults experiencing homelessness (YAEH) are faced with instabilities in many areas of their lives, including their living situation, employment, and income. Little is known about how the experience of instability in these different domains might be associated with substance use. Leveraging data collected on 276 YAEH in Los Angeles County, regression analyses examine associations between three distinct types of instability (housing, employment, income) and participants' self-reported alcohol use, alcohol consequences, non-cannabis drug use, and substance use symptoms. Results indicated that recent instability in income, employment, and secure housing for those with access to it (but not housing in general or non-secure housing) were significantly associated with greater alcohol/drug use or substance use symptoms. Depression was also found to moderate the association between employment instability and alcohol use. Our findings suggest that efforts to reduce instability in income, employment, and secure housing may have positive benefits for substance using YAEH, especially those with depressive symptoms.

Substance use typologies among young people experiencing homelessness in seven cities across the United States: A latent class analysis

BACKGROUND

Substance use and other health-risk risk factors, including mental health, trauma, and sexual-risk behaviors, often co-occur among youth experiencing homelessness (YEH). The present study aimed to identify subgroups of YEH based on polysubstance use and the linkages to sociodemographic and health-risk characteristics.

METHODS

From June 2016 to July 2017, 1,426 YEH (aged 18-26 years) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, sexual risk behaviors, and sociodemographic characteristics. The majority of YEH identified as Black (37.3%), cisgender (92.8%), and heterosexual (69.2%). On average, YEH were 20.9 years (SD = 2.1). This study employed latent class analysis (LCA) to identify subgroups of YEH according to their substance use. Multinomial logistic regression analyses were conducted to identify sociodemographic and health-risk characteristics associated with class-membership.

RESULTS

Four latent classes of YEH substance use were identified: (1) high polysubstance use; (2) moderate stimulant and high marijuana, alcohol, and prescription drug use; (3) high marijuana, alcohol, and prescription drug use; (4) low/moderate marijuana and alcohol use. Multinomial logistic regression models indicated that geographic location, gender, race/ethnicity, mental health, trauma history, and sexual risk behaviors were significant correlates of substance use class membership among YEH.

CONCLUSIONS

These findings offer important implications for the prevention and treatment of substance use among YEH. Screening protocols should consider co-occurring risk factors such as traumatic experiences, sexual risk behaviors, and mental health history as indicators of polysubstance use.

Examining the Role of Duration and Frequency of Homelessness on Health Outcomes Among Unsheltered Young Adults

PURPOSE

We examined the impact of duration and number of homelessness episodes on health outcomes for unsheltered homeless young adults.

METHODS

We analyzed the 2018/2019 Los Angeles County homeless youth demographic surveys. We addressed five summary health outcomes: physical health, mental health, substance use disorder, tri-morbidity, and any condition. Respondents were classified into three homeless trajectory groups: (1) short-term-homeless < 1 year in one episode, (2) episodic-homeless < 1 year and multiple episodes, and (3) long-term-homeless continuously for > 1 year. Weighted bivariate and multivariate logistic regression models tested the relationship between homeless trajectory group and health, with controls for sociodemographic factors and structural exposures.

RESULTS

Mental health and substance use were high among unsheltered young adults compared to national rates. Long-term homeless respondents were significantly more likely than short-term to report a mental health condition (53.3% vs. 39.8%, p < .001), substance use disorder (25.5% vs. 18.3%, p < .001), and physical conditions (26.0% vs. 15.6%, p = .008). Episodic respondents were more likely to report a mental health condition (50.5%, p < .001). In multivariate models, long-term respondents had twice the odds of tri-morbidity (odds ratio [OR] = 2.14, p < .05) and any health condition (OR 2.00, p < .01) as short term and significantly higher odds of a physical health condition (OR = 1.64, p < .05).

DISCUSSION

Youth with longer durations and more frequent episodes of homelessness have substantially poorer health outcomes. The association of longer duration to poorer health persisted in multivariate models. Longer duration of unsheltered homelessness may drive the onset of physical and mental health problems.

Lesbian, Gay, and Bisexual Students Experiencing Homelessness and Substance Use in the School Context: A Statewide Study

PURPOSE

This study explored differences between lesbian, gay, and bisexual (LGB)-housed and homeless students regarding substance use patterns on and off school grounds and the unique contribution of homelessness to substance use in school.

METHODS

Data were from the 2013-2015 California Healthy Kids Survey, a statewide survey of school protective factors and risk behaviors. A representative sample of 9th- and 11th-grade students (N = 20,337) was used. Comparisons between housed (n = 19,456) and homeless (doubled up: n = 715; acute homeless: n = 166) LGB students were conducted. We used chi-square tests to compare rates of lifetime, past-30-day, and in-school substance use and conducted multivariate logistic regression models for each substance use variables.

RESULTS

Chi-square test results indicated significant differences in rates of substance use among students experiencing homelessness (both categories) and housed LGB students. Lesbian, gay, and bisexual students experiencing homelessness were more likely to report substance use off and on school grounds. Results from logistic regression analyses indicated that LGB students who experience homelessness were significantly more likely to report recent and in-school substance use. For example, students experiencing acute homelessness were about 3 times as likely to report heavy episodic drinking (adjusted odds ratio [AOR] = 3.13; 95% confidence interval [CI] = 2.13, 4.26) and more than 5 times as likely to smoke marijuana in school (AOR = 5.38; 95% CI = 3.46, 8.36), compared to housed LGB students.

CONCLUSIONS

LGB students who experience homelessness are at higher risk than housed LGB students of substance use on and off school grounds. Findings highlight the need to provide support in the school context for this subpopulation.

Problematic substance use and its associated factors among street youth in Bahir Dar city, Ethiopia

BACKGROUND

Problematic substance use is becoming a common problem in marginalized groups such as street youths. However, there is a dearth of studies on the prevalence and factors associated with problematic substance use among street youth in Ethiopia.

OBJECTIVE

The objective of this study was to determine the prevalence of problematic substance use and identify its associated factors among street youth.

METHODS

This community-based cross-sectional study was conducted between June and July 2020. A total of 252 participants were included in this study. Systematic random sampling was used to recruit participants. Cut down, annoyed, guilty feeling, and eye opening-adapted to include drugs (CAGE-AIDs) were used to assess problematic substance use. The data were entered into epidata and exported to SPSS version 25 for analysis. Logistic regression with a 95% confidence interval (CI) was used to show the strength of association. A p-value < 0.5 was statistically significant.

RESULTS

The prevalence of problematic substance use was 55.8%, 95% CI (49-63%). Peer pressure [adjusted odds ratio (AOR) = 3.01, 95% CI: 1.38, 6.59], family conflict [AOR = 5.05, 95% CI: 1.67, 15.25], physical abuse [AOR = 2.56, 95% CI: 1.11, 5.84], and substance use in the family [AOR = 2.85, 95% CI: 1.29, 6.27] were the factors significantly associated with problematic substance use.

CONCLUSION

The prevalence of problematic substance use was high. It was also found that peer pressure, family conflict, substance use in the family, and physical abuse were the factors associated with problematic substance use. Therefore, proper screening and intervention for individuals with problematic substance use are needed, and further research should be conducted for marginalized groups.

Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults

This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18–27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.

Housing interventions for emerging adults experiencing homelessness: A scoping review

INTRODUCTION

This review aims to identify and synthesize literature focused on housing interventions for young adults experiencing homelessness.

METHODS

Following a five-stage approach to scoping reviews, a computerized search was conducted between February 4-8, 2019 to include peer-reviewed articles from a total of eight electronic databases: PsychINFO, Google Scholar, PubMed, Web of Science, Social Work Abstracts, Cochrane, Clinicaltrials.gov, and CINAHL. The search was limited to include literature published between January 1, 1987 and December 31, 2018. Search parameters included three domains: homelessness, housing intervention, and age.

RESULTS

Of the initial 7,344 sources identified, 29 articles met the search criteria and were included in the final sample. Housing models discussed in the reviewed literature include Permanent Supportive Housing, Transitional and Independent Housing and Living Programs, the Foyer model, Housing First, and general Supportive Housing. Housing models were discussed in the context of outcome domains including quality of life, education, employment, housing tenure, cost of intervention, systems and service use, HIV, and social network and relationships.

DISCUSSION

Housing interventions for young adults experiencing homelessness remains a relatively new intervention to combat homelessness among younger demographics. While the evidence base continues to grow, there remains a need for quality research to generate empirical evidence in this area, though studies included in this review showed promise for the development of best housing practices with this population.

The TCU Drug Screen 5: Identifying Justice-involved Individuals with Substance Use Disorders

The TCU Drug Screen II, a widely used instrument for identifying substance use problems, was originally developed based on Diagnostic and Statistical Manual of Mental Disorders III-R criteria. In 2013, the American Psychiatric Association revised the criteria and classification scheme for substance use disorders (SUDs) with the publication of the DSM-5. Subsequently, the TCU Drug Screen was modified to reflect the updated DSM-5. The current study examines the concordance of the TCU Drug Screen II and TCU Drug Screen 5 with adult and juvenile justice-involved samples. Both versions were administered to 305 adult male and 310 juvenile male justice-involved clients as part of standard intake procedures. Results revealed a high level of agreement between the two versions; however, the TCU Drug Screen 5 detected significantly more cases of SUDs, the majority of which corresponded to a mild SUD. Results documented appropriate discrimination in meeting diagnostic thresholds among both age groups, with fewer adolescents identified as having a disorder. Overall, the results suggest that the TCU Drug Screen 5 is comparable to the TCU Drug Screen II with the added potential benefit of DSM-5 conformity and severity specifiers.

Incarceration history, social network composition, and substance use among homeless youth in Los Angeles

Background: Homeless youth in the United States have high rates of substance use. Existing research has identified social network composition and street-associated stressors as contributing factors. Incarceration is a highly prevalent stressor for homeless youth. Its effect on youth's social network composition and substance use, however, has been neglected. Aims: This study investigated the direct and indirect associations between incarceration history and substance use (through social networks) among homeless youth in Los Angeles, California. Methods: A sample of 1047 homeless youths were recruited between 2011 and 2013. Computerized self-administrated surveys and social network interviews were conducted to collect youth's sociodemographic characteristics, incarceration history, social network composition, and substance use. Bootstrapping was used to identify the direct and indirect associations between youth's incarceration history and substance use. Results: Incarceration history was positively associated with youth's cannabis, methamphetamine, and injection drug use. The percentage of cannabis-using peers partially mediated the associations between incarceration history and youth's cannabis, cocaine, and heroin use. The percentage of methamphetamine-using peers partially mediated the associations between incarceration history and youth's methamphetamine, cocaine, and injection drug use. The percentage of heroin-using peers partially mediated the association between incarceration history and youth's heroin use. Moreover, the percentage of peers who inject drugs partially mediated the associations between incarceration history and youth's methamphetamine, heroin, and injection drug use. Discussion: Incarceration history should be taken to a more central place in future research and practice with homeless youth in the United States.

Risk Factors for Substance Use Among Youth Experiencing Homelessness

Background

Youth experiencing homelessness are at high risk for frequent substance use. This study examines individual, interpersonal, and contextual factors associated with substance use among such youth, age 13-24.

Methods

Data were collected through computer-assisted structured interviews with participants (N=474) recruited at service agencies in Los Angeles.

Results

Youth had experienced over two years of homelessness on average. Almost a third used substances frequently; significant risk factors included delinquency, sensation seeking, and ongoing homelessness. Time spent in clubs and organizations was protective.

Conclusions

Providing housing and services to curb delinquency may help protect youth from becoming frequent substance users.

Housing Instability and Concurrent Substance use and Mental Health Concerns: An Examination of Canadian Youth

OBJECTIVE

Though previous research has identified the high burden of mental health and addiction (MHA) concerns among precariously housed youth, earlier studies have not examined differences in MHA concerns among housing insecure Canadian youth across sectors. This study examines this issue using the Global Appraisal of Individual Needs Short Screener (GAIN-SS) in a cross-sectoral sample of Canadian youth.

METHOD

A total of 2605 youth ages 12 to 24 seeking services across sectors completed the GAIN-SS and a sociodemographic form. The analyses described demographic variables and sector of presentation, then evaluated internalizing, externalizing, substance use, and crime/violence concerns based on housing status.

RESULTS

While many precariously housed youth presented through the housing/outreach/support sector, 33.6% presented to other sectors. Housing groups endorsed comparably high levels of internalizing and externalizing problems. However, precariously housed youth reported higher rates of problematic substance use (OR = 1.54; 95% CI 1.25, 1.88; p < 0.01) and crime/violence issues (OR = 1.95; 95% CI 1.54, 2.46; p < 0.01). Precariously housed youth were 48% more likely to endorse concurrent disorders (OR = 1.48; 95% CI 1.21, 1.82; p < 0.01), which was largely driven by the high rate of concurrent disorders among precariously housed females.

CONCLUSIONS

Since precariously housed youth with multiple clinical needs presented across sectors, attention must be given to screening for both housing stability and MHA and building stronger cross-sectoral partnerships. The findings should encourage systematic screening, MHA training and capacity building within housing sectors as well as integrated services across all youth-serving organizations.

The age of onset of substance use is related to the coping strategies to deal with treatment in men with substance use disorder

BACKGROUND

The age of onset of substance use (OSU) as well as the coping strategies (CS) influence both the development and the course of Substance Use Disorders (SUD). We aim to examine the differences in the CS applied to deal with treatment in men with SUD, considering whether the age of OSU had begun at age 16 or earlier (OSU ≤ 16) or at 17 years or later (OSU ≥ 17), as well as the associations of the CS with clinical variables were studied.

METHODS

A total of 122 patients with at least three months of abstinence, 60 with OSU≤16 and 62 with OSU≥17, were evaluated through the Coping Strategies Inventory and clinical assessment tools.

RESULTS

The OSU≤16 patients were younger and presented a worse clinical state. Compared to the norms, the SUD patients were less likely to use adaptive CS, although this was more remarkable for the OSU≤16 group. Furthermore, the OSU≤16 patients presented a CS pattern of higher Disengagement, with lesser use of Social Support and higher Problem Avoidance and Social Withdrawal. In the whole SUD sample, the severity of addiction, number of relapses and age of OSU (as a continuous variable) were related to maladaptive coping. Nevertheless, the cut-off age of OSU modulated these results.

CONCLUSIONS

The OSU≤16 was a risk factor for presenting greater clinical severity and a more dysfunctional CS profile to deal with treatment. Thus, the cut-off age considered has allowed us to differentiate SUD patients with more vulnerability to present worse clinical prognosis who may require specific prevention and rehabilitation strategies discussed throughout this work.

Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review

During the United States economic recession of 2008-2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.

Exploring Contextual Factors of Youth Homelessness And Sexual Risk Behaviors: A Qualitative Study

CONTEXT

HIV disproportionately affects homeless youth, and interventions to date have had minimal success in reducing sexual risk behaviors in this population. Few qualitative studies have been conducted to provide insight into the influence of homelessness-related factors on sexual risk behaviors.

METHODS

A qualitative study with a quantitative component was conducted with a nonprobability sample of 64 homeless youth aged 14-24; participants were recruited from a variety of venues in Houston between October 2013 and March 2014. Thirteen focus group discussions were conducted; thematic analysis was used to identify themes related to HIV risk.

RESULTS

Participants were predominantly black (75%), sheltered (67%) and aged 18 or older (77%). Youth discussed how the circumstances of their homelessness and the struggle to meet their immediate needs led to behaviors and experiences that put them at risk for HIV. Three themes emerged: Homeless youth frequently engage in risky sexual behavior, sometimes as a way to cope with stress; they often trade sex, either voluntarily or involuntarily, for such necessities as money or a place to sleep; and many experienced childhood sexual victimization or have been victimized since becoming homeless. Youth also described how stress, stigma and self-reliance contributed to their involvement in HIV risk behaviors.

CONCLUSIONS

HIV prevention methods that target stress and stigma while respecting youths' self-reliance may help reduce sexual risk behaviors. Further research is needed to determine suitable behavioral change techniques to address these potentially modifiable factors.

Prescription drug misuse among homeless youth

BACKGROUND

Prescription drug misuse (PDM) is highly prevalent among youth in the U.S., and can have serious health consequences. Homeless youth are a particularly vulnerable population with high rates of substance use. However, PDM has not been studied in a sample comprised exclusively of homeless youth.

METHODS

A sample of 451 homeless youth recruited from drop-in centers in Los Angeles, CA, provided information on substance use, mental health, service utilization, trauma, and sexual risk behavior. Multivariable logistic regression assessed correlates of past month PDM.

RESULTS

Nearly 50% reported lifetime PDM and 21.6% reported PDM in the past month. The most frequently used prescriptions in the past month were: opioids only (24.5%), sedatives only (23.4%), and stimulants only (10.6%); 14.9% used some combination of these three types of prescription medications. Homeless youth reported that prescriptions were most commonly obtained for free from friends or relatives (24.5%). Foster care involvement was associated with decreased PDM, while hard drug use, suicidal ideation, and unprotected sex were associated with increased PDM.

CONCLUSIONS

Homeless youth report high rates of PDM, and access these medications most frequently from friends and family. PDM among homeless youth clusters with other risk factors, including hard drug use, unprotected sex, and suicidal ideation. Surprisingly, foster care history was associated with decreased PDM. Programs aimed at preventing PDM among homeless youth should recognize the clustering of risk behaviors, assess prescription use/access when providing mental health services, and educate the general public about proper disposal of prescriptions.

Correlates of self-reported incarceration among homeless gay and bisexual stimulant-using young adults

Gay and bisexual (G/B) homeless adults face multiple challenges in life which may place them at high risk for incarceration. Yet, little is known about this understudied population in terms of risk for incarceration. Baseline data collected from a longitudinal study between October 2009 and March 2012 in Hollywood, California, explored correlates of self-reported incarceration among G/B homeless stimulant-using adults (N = 353). Findings revealed older age, less education, having children, as well as a history of injection drug use and being born in the United States were positively associated with incarceration. Moreover, having poor social support and having received hepatitis information were also correlated with a history of incarceration. Our findings help us gain a greater awareness of homeless G/B adults who may be at greater risk for incarceration, which may be used by health care providers to design targeted interventions for this underserved population.

Explaining homeless youths' criminal justice interactions: childhood trauma or surviving life on the streets?

Homeless youth are at increased risk for involvement in the criminal justice system. This study investigated childhood trauma as a risk factor for arrest or jail among a sample of youth seeking services at drop in, shelter, and transitional housing settings, while controlling for more established risk factors including: substance use, peer deviance, and engagement in survival behaviors. Standardized and researcher developed measures collected quantitative data through face-to-face interviews with youth (N = 202). Two sequential logic regression models identified significant predictors of arrest and jail, with a particular interest in the effects of childhood maltreatment. Youth with a history of physical abuse were nearly twice as likely to be arrested and to be jailed compared to non-abused youth, controlling for the significant influence of drug use and survival behaviors. These findings suggest the need for trauma screening and trauma-informed services for homeless youth at risk of illegal behavior.

Predictors of substance abuse treatment participation among homeless adults

The current study focuses on the relationships among a trauma history, a substance use history, chronic homelessness, and the mediating role of recent emotional distress in predicting drug treatment participation among adult homeless people. We explored the predictors of participation in substance abuse treatment because enrolling and retaining clients in substance abuse treatment programs is always a challenge particularly among homeless people. Participants were 853 homeless adults from Los Angeles, California. Using structural equation models, findings indicated that trauma history, substance use history and chronicity of homelessness were associated, and were significant predictors of greater recent emotional distress. The most notable result was that recent emotional distress predicted less participation in current substance abuse treatment (both formal and self-help) whereas a substance use history alone predicted significantly more participation in treatment. Implications concerning treatment engagement and difficulties in obtaining appropriate dual-diagnosis services for homeless mentally distressed individuals are discussed.

Coping and emotion regulation profiles as predictors of nonmedical prescription drug and illicit drug use among high-risk young adults

BACKGROUND

Deficits in the ability to organize, integrate, and modulate emotions, thoughts, and behaviors when dealing with stress have been found to be related to the onset and escalation of substance use among adolescents and young adults. However, limited research has focused on understanding how coping and emotion regulation tendencies might be associated with different patterns of prescription and illicit drug use, particularly among high-risk young adults who may already face additional challenges relative to lower-risk populations.

METHODS

Young adults aged 16-25 years who had misused prescription drugs within the past 90 days were interviewed in Los Angeles and New York. The current study utilized latent profile analysis to empirically derive coping and emotion regulation typologies/profiles that are then used to predict different patterns of substance use (N=560).

RESULTS

Four latent classes/groups were identified: (1) suppressors, (2) others-reliant copers, (3) self-reliant copers and (4) active copers. Distinct patterns of prescription and illicit drug misuse were found among different coping/emotion regulation profiles, including differences in age of initiation of opiates, tranquilizers, and illicit drugs, recent injection drug use, substance use-related problems, and past 90-day use of tranquilizers, heroin, and cocaine. Specifically, suppressors and others-reliant copers evidenced more problematic patterns of substance use compared to active copers.

CONCLUSION

This is among the first studies to show how coping and emotion regulation profiles predict distinct patterns of substance use. Results provide the groundwork for additional investigations that could have significant prevention and clinical implications for substance-using high-risk young adults.

Peer substance use and homelessness predicting substance abuse from adolescence through early adulthood

Adolescents who experience homelessness are at higher risk for abusing substances, and for being exposed to substance-using peers. The current study used a longitudinal design to track substance abuse, affiliation with substance-using peers, and episodes of homelessness among a sample of 223 adolescents who were housed at the baseline data collection and 148 adolescents who were housed at baseline. Participants were interviewed at six waves over 6.5 years, covering an age range from 13 to 25. Many participants experienced a recurrence of homelessness during follow-up, with 64.6 % of the baseline homeless group and 22.6 % of the baseline housed group reporting an additional episode of homelessness. Both alcohol abuse and other drug abuse symptoms showed an increase in adolescence followed by slowing in early adulthood. Recent homelessness and friend alcohol use predicted alcohol abuse symptoms, and the strength of the influence of friend use decreased over time. Recent homelessness and friend drug use predicted other drug abuse symptoms. Duration of the initial episode of adolescent homelessness showed no influence on substance abuse over time, or the effects of other predictors, highlighting the importance of conceptualizing the experience of homelessness as a recent stressor rather than an enduring personal characteristic.

Impact of nursing intervention on improving HIV, hepatitis knowledge and mental health among homeless young adults

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge and HBV and HCV knowledge at 6 months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

Characteristics of homeless youth who use cocaine and methamphetamine

This cross-sectional hepatitis health promotion study (N = 156) was designed to identify correlates of cocaine and methamphetamine use among young, homeless persons living in Los Angeles County. Structured questionnaires were administered at baseline to assess sociodemographic characteristics, drug history, and social support. Unadjusted analysis showed that older age, having a history of incarceration, injection drug use (IDU), 10 or more sexual partners, and sex for money were associated with both cocaine and methamphetamine use. Logistic regression results showed that injection drug users had over seven times greater odds of using each stimulant compared with nonusers of injection drugs; those reporting at least 10 sexual partners and alcohol use in the past 6 months were more likely to use cocaine than their respective counterparts. African Americans were also less likely than Whites to report cocaine use. Understanding of these relationships can guide interventions targeting the multiple challenges faced by this population.

The mental and physical health of homeless youth: a literature review

Youth homelessness is a growing concern in the United States. Despite difficulties studying this population due to inconsistent definitions of what it means to be a youth and homeless, the current body of research indicates that abuse, family breakdown, and disruptive family relationships are common contributing factors to youth homelessness. Moreover, the experience of homelessness appears to have numerous adverse implications and to affect neurocognitive development and academics, as well as mental and physical health. Substance use, sexually transmitted infections, and psychiatric disorders are particularly prevalent in this population. Whereas some of these problems may be short-lived, the chronic stress and deprivation associated with homelessness may have long-term effects on development and functioning. Further, difficulties accessing adequate and developmentally-appropriate health care contribute to more serious health concerns. Suggestions for future research and interventions are discussed.