The relationship between victimization and substance use among homeless and runaway female adolescents

Childhood maltreatment as a predictor of substance use/misuse among youth: A systematic review and meta-analysis

This systematic review and meta-analysis aimed to comprehensively describe whether experiencing a variety of childhood maltreatment types predicts a variety of substance use/misuse types among youth, beyond the narrow scope covered in previous systematic reviews on similar topics. A literature search was conducted in June, 2022 using PubMed, PsycInfo, and Embase. 58 studies (total participant n=170,749) were included. These studies were primarily organized by substance type outcomes including alcohol (n=43), cannabis (n=25), unspecified substances (n=25), and other specific substances (n=10). Results were further stratified by maltreatment type. For specific maltreatment and substance type combinations, the majority of studies indicated that childhood maltreatment was a significant predictor of substance use/misuse in youth. Of the 10 meta-analyses we conducted, significant associations were found for the majority (9/10) of maltreatment and substance type combinations. For instance, unspecified childhood maltreatment increased the probability of youth alcohol use by about four times, which was the highest relative risk found. In conclusion, this study shows that childhood maltreatment is a predictor of youth substance use/misuse.

Understanding Homelessness Among Young People to Improve Outcomes

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.

Prostitution in the shadow of life-long sexual abuse: Arab women's retrospective experiences

The present study uses the life-course and intersectionality perspectives to explore the meaning that aging Arab women attribute to their lived experiences of life-long sexual abuse in the shadow of engaging in prostitution. Interpretive phenomenological analysis was used to analyze the narratives of 10 older Arab women in Israel who were engaged in prostitution. Four themes emerged: experiencing childhood in the shadow of sexual abuse, becoming a prostitute, being entrapped in prostitution, and settling accounts with the native culture. Women aging in prostitution experience a harsh reality of abuse and loss. The present study points to multiple channels of abuse throughout the life course, from childhood until old age.

A state-wide analysis of characteristics and predictors of dual system involvement among child victims of human trafficking

BACKGROUND

The child welfare system is pivotal in identifying and responding to child (younger than age 18) human trafficking victims. Children who have experienced human trafficking-or are at risk of victimization-are increasingly recognized as also being served in the juvenile justice system. Yet little is known about human trafficking victimization among children in the juvenile justice population or among children with child welfare and juvenile justice involvement.

OBJECTIVE

Building on previous research with child welfare-and juvenile justice-involved children, we investigated characteristics and system experiences among children who have experienced a human trafficking abuse allegation in Florida.

PARTICIPANTS AND SETTING

The overall study population included all children born on or after January 1, 1993, who had at least one DCF-documented maltreatment allegation before March 1, 2020. This study examined a total of 12,167 allegations in the first set of analyses and the first human trafficking allegation for each child (N = 9300) in the second set of analyses.

METHODS

Analyses are based on linked administrative data for a cohort of children involved with Florida's Departments of Juvenile Justice (DJJ) and/or Children and Families (DCF). We used descriptive and multivariate logistic regression analyses to document the characteristics of single and dual system-involved children and examine predictors of child welfare, juvenile justice, and dual system involvement.

RESULTS

(1) Nearly half of children with a human trafficking abuse allegation are involved in DCF at the time of the allegation, (2) females who experienced trafficking are more likely to be involved in DCF (with or without DJJ involvement) than involved in no system, (3) Black children with an alleged trafficking incident were more likely than White children to be involved in both systems compared with DCF only, and (4) children who experienced labor trafficking abuse allegations were less likely than those who experienced sex trafficking to be involved with either system.

CONCLUSIONS

This study depicts child victims of sex and labor trafficking who are involved with one or both systems in one state.

Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors

BACKGROUND

Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana.

METHODS

305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression.

RESULTS

Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001).

CONCLUSIONS

Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.

The Associations Between Gang Membership and Domestic Minor Sex Trafficking: Findings From a Nationally Representative Study

Adolescent gang membership has been proposed as a risk factor that creates individual-level vulnerability for domestic minor sex trafficking (DMST) and/or a context in which DMST may occur. This study investigates the gang membership-DMST association using data from The National Longitudinal Study of Adolescent to Adult Health, a nationally representative sample of adolescents in the United States (n = 12,605). Bivariate results found gang-involved minors had 4.39 greater odds of experiencing DMST compared to non-gang-involved peers. Multivariable results found gang membership, violence victimization, delinquency, and certain demographic characteristics to be significantly associated with DMST. These findings emphasize the need to consider the context in an adolescent's life beyond DMST when designing policies and programs, and highlight the need for additional research into the gang membership-DMST association.

"It Made Me so Vulnerable": Victim-blaming and Disbelief of Child Sexual Abuse as Triggers of Social Exclusion Leading Women to Homelessness

Although the association between child sexual abuse (CSA) and homelessness among women is well documented, few studies have investigated this topic from a feminist standpoint, examining the impact of sociocultural factors such as rape culture. Based on a qualitative life course approach, individual interviews were conducted with 21 women who experienced both CSA and homelessness. Participants were between 29 to 60 years old (M = 45 years of age). Analyses revealed that CSA disclosure experiences were characterized by victim-blaming and disbelief. Women's traumatic experiences were further aggravated by these types of reactions. Finally, CSA and negative social reactions to women's disclosures of CSA were perceived as the onset of social exclusion, which lead to their homelessness. This study shows how traumatic CSA experiences and negative social reactions to their disclosure can both contribute to social exclusion and isolation, and to homelessness through the internalization of rape myths. These findings support the importance of focusing on CSA prevention to reduce social exclusion and homelessness.

Runaway History and Past 30-Day Opioid Misuse in Justice-Involved Adolescents

This study used a sample from the Florida Department of Juvenile Justice (n= 79,960) to analyze the association between runaway history and past 30-day opioid misuse (OM) among justice involved adolescents. Past 30-day OM was confirmed using a urine analysis. Adolescents who were runaways in their lifetime were twice as likely to misuse opioids, and those who were runaways at the time of arrest were three times as likely to be opioid misusers compared to adolescents who never ran away or been kicked out of a home. These findings emphasize a need for resources that focus on developing strong attachment bonds.

A Latent Class Analysis of Lifetime Victimization Among Homeless Youth

Homeless youth experience high rates of child physical and sexual abuse, and many are revictimized on the streets. Despite their high rates of victimization, few studies have examined whether specific victimization types (e.g., sexual vs. physical) cluster together and for whom (e.g., sexual minority youth). As such, the purpose of this study was to identify clusters of homeless youth based on their exposure to different forms of child abuse and street victimization, to examine what factors distinguish each cluster, and how unique clusters are related to youths' mental health using data collected at two time points. The sample included 150 youth experiencing homelessness in the Midwest. Latent class analysis was used to identify clusters of youth. Three latent classes emerge: The low exposure class had significantly lower rates of child physical and emotional abuse and threats compared with the medium- and high-exposure groups. The high exposure group had significantly higher rates of child sexual abuse compared with the other groups. Females, sexual minority youth, and those who have lived in more foster care homes were more likely to be in the high exposure group compared with the low and/or medium exposure groups. Multivariate results revealed that those in the medium and high exposure cluster groups had higher rates of Wave 1 depressive symptoms and Wave 1 anxiety compared with youth in the low exposure cluster. Overall, although these young people experience high rates of abuse and victimization both at home and while on the street, there are gradations in these experiences such that certain victimization experiences subgroups are at heightened risk for poor mental health.

Victimization and substance use among adolescents in residential child care

BACKGROUND

Adolescents in Residential Child Care (RCC) report high levels of victimization. This has been linked to mental health problems and a higher risk of substance use and substance use problems. The present study aimed to evaluate the specific impact of different forms of victimization on alcohol and cannabis use problems among adolescents in RCC, attending to sex differences.

METHODS

321 adolescents from 38 residential therapeutic care facilities in Spain participated in the study. Thirty-six different forms of victimization were evaluated, as well as alcohol and cannabis use problems. Impact of polyvictimization and specific forms of victimization on alcohol and cannabis use problems and disorders were calculated using Analysis of Variance (ANOVA) and logistic regression models.

RESULTS

Girls in RCC reported significantly more experiences of victimization. Polyvictimization was associated with alcohol use problems but not cannabis use problems. Property, domestic and community victimization showed the highest predictive role regarding alcohol and cannabis use disorders, with significant interactions with sex and migrant family background.

CONCLUSIONS

Adolescents in RCC reported considerably high levels of victimization and alcohol and cannabis use problems. In this population, property victimization, as well as indirect domestic and community victimization were predictors of further substance use problems, with girls being particularly sensitive to victimization. Migrant family backgrounds can also have an influence on the impact of some victimization forms on substance use. Victimization associated to high-risk environments and families could contribute to explain the high levels of substance use problems in this population.

Mental Health Outcomes Among Homeless, Runaway, and Stably Housed Youth

BACKGROUND AND OBJECTIVES

Runaway youth and homeless youth are at risk for adverse mental health outcomes. These 2 populations are frequently pooled together in both research and interventions yet may have unique health needs. We sought to assess differences in mental health outcomes among these populations.

METHODS

We conducted a secondary data analysis of ninth- and 11th-graders in the 2016 minnesota Student Survey (n = 68 785). We categorized youth into 4 subgroups based on housing status in the previous year: (1) unaccompanied homeless youth (0.5%), (2) runaway youth (4%), (3) youth who had both run away and been homeless (0.6%), and (4) stably housed youth (95%). We performed multivariable logistic regression to compare 4 mental health outcomes (self-injury, suicidal ideation, suicide attempts, and depressive symptoms) across groups, controlling for demographics and abuse history.

RESULTS

Unstably housed youth had poorer mental health outcomes when compared with their stably housed peers (P < .05). For example, 11% of homeless youth, 20% of runaways, and 33% of youth who had experienced both had attempted suicide in the previous year compared with 2% of stably housed youth (adjusted odds ratios 2.4, 4.9, and 7.1, respectively). Other outcomes showed a similar pattern.

CONCLUSIONS

Our findings suggest that runaway and homeless youth represent unique populations with high levels of mental health needs who would benefit from targeted clinical and community interventions. Pediatric clinicians represent one potential point of screening and intervention.

Childhood Disadvantage, Social and Psychological Stress, and Substance Use Among Homeless Youth: A Life Stress Framework

We used a life stress framework to examine linkages between distal or primary stressors (e.g., child abuse) and proximal or secondary stressors (e.g., street victimization) and their association with substance use among 150 youth experiencing homelessness in the Midwestern United States. Results revealed that numerous primary stressors such as number of times youth ran from home and number of foster care placements were associated with secondary stressors, such as anxiety, total duration of homelessness, and street victimization. Only street physical victimization (e.g., been beaten up since leaving home) was associated with greater substance use. Our findings provide a more holistic picture of both distal and proximal life stressors that these young people experience and reveal the complexity of issues that service providers must acknowledge when working with this population.

Exploring the Overlap Between Sexual Victimization and Offending Among Young Women Across Neighborhoods: Does the Type of Force and Type of Offending Matter?

The relationship between victimization and subsequent maladaptive behaviors such as offending is well established. To a lesser degree, a contextual lens has been used to examine how neighborhood characteristics influence the overlap between victimization and offending. The existing literature has yet to explore how the neighborhood context moderates the victim-offender overlap among young women, specifically, or whether the type of force used during sexual victimization or offending matters. This study uses data from The National Longitudinal Study of Adolescent to Adult Health (Add Health) to examine whether concentrated disadvantage moderates the impact of sexual victimization on subsequent offending for women. Results indicate that young women who experience sexual victimization are more likely to engage in general offending regardless of neighborhood type. However, closer examination reveals that, when taking into account the type of force used in sexual victimization (physical or coerced) and the type of offending (violent, property, drug use), the overlap does indeed vary across neighborhoods. Specifically, results indicate that only coerced sexual victimization significantly affects property offending in neighborhoods with high levels of concentrated disadvantage. Related to violent offending, physical sexual victimization has a strong positive impact in less disadvantaged neighborhoods. Finally, coerced sexual victimization is significantly associated with an increased likelihood for drug use, and this relationship is consistent across neighborhoods. The findings suggest that nuances in the nature of victimization and offending need to be taken into account to fully understand the victim-offender overlap across neighborhood context.

Runaway Youth: Caring for the Nation's Largest Segment of Missing Children

The largest segment of missing children in the United States includes runaways, children who run away from home, and thrownaways, children who are told to leave or stay away from home by a household adult. Although estimates vary, as many as 1 in 20 youth run away from home annually. These unaccompanied youth have unique health needs, including high rates of trauma, mental illness, substance use, pregnancy, and sexually transmitted infections. While away, youth who run away are at high risk for additional trauma, victimization, and violence. Runaway and thrownaway youth have high unmet health care needs and limited access to care. Several populations are at particular high risk for runaway episodes, including victims of abuse and neglect; lesbian, gay, bisexual, transgender, and questioning youth; and youth in protective custody. Pediatricians and other health care professionals have a critical role to play in supporting runaway youth, addressing their unique health needs, fostering positive relationships within their families and with other supportive adults, and connecting them with available community resources. This report provides clinical guidance for pediatricians and other health care professionals regarding (1) the identification of adolescents who are at risk for running away or being thrown away and (2) the management of the unique medical, mental health, and social needs of these youth. In partnership with national, state, and local resources, pediatricians can significantly reduce risk and improve long-term outcomes for runaway youth.

Risk and Protective Factors for Substance Use Among Youth Experiencing Homelessness

BACKGROUND

Though research finds that youth experiencing homelessness (YEH) have high rates of substance use, which can lead to numerous long-term negative health effects, less is known about both risk and protective factors for substance use. Moreover, even less is known about whether these factors differ for lesbian, gay and bisexual (LGB) youth compared to non-LGB youth. In the current study, we compared risk and protective factors for binge drinking, marijuana use, and illicit drug use (i.e. substance use) among heterosexual and sexual minority YEH.

METHODS

The sample included 322 young people experiencing homelessness in the Midwestern United States and who were between 16 and 26 years of age. Almost one-half of our sample were female (N = 146; 45%) and 68 youth (21%) identified as LGB.

RESULTS

Youth who experienced more child physical abuse, ran away from home more frequently, and those who had a parent(s) with drug problems were more likely to have reported binge drinking in the past 30 days. Additionally, having parents with drug problems was associated with the use of marijuana and illicit drugs. Conversely, having higher parental monitoring while growing up reduced the likelihood of using marijuana and illicit drugs. Tests for interactions revealed that while self-efficacy had no relationship with the probability of binge drinking for heterosexual youth, as self-efficacy increased, the probability of binge drinking declined drastically for sexual minority youth suggesting this protective mechanism operates differently for these two groups of youth. Additionally, tests of interactions showed that the probability of binge drinking among heterosexual and sexual minority youth also varied by child sexual abuse and street sexual victimization.

CONCLUSION

Study results have implications for service providers who serve YEH.

The Links Between Sexual Abuse Severity, Running Away, and Parental Connectedness Among Youth at a Hospital-Based Child Advocacy Center

PURPOSE

Runaway adolescents often have strained relationships with their parents. Given parental support is an important protective resource for traumatized young people, understanding differences in support within parent-adolescent relationships could aid in designing more effective interventions. We hypothesized (1) runaway adolescents seen at a Child Advocacy Center (CAC) would have poorer parental relationships than adolescents without a history of running away and (2) severity of diagnosed sexual violence would be associated with lower parental connectedness.

METHODS

Data were from 2,042 adolescents aged 10-19 years and their parents evaluated for any reason at our hospital-based CAC from 2008 to 2017. Parent-adolescent relationship scales were completed by adolescents and at least one parent/guardian (usually mothers). Sexual abuse was stratified at four levels, higher levels indicating increasingly severe forms of abuse. T-tests and analyses of variance to tested relationships between supportive and controlling parental behaviors by runaway status, and, among runaways, by the severity of sexual abuse.

RESULTS

Runaway adolescents comprised 58.3% of adolescents seen at the CAC; runaways reported lower parental support and higher parental controlling than patients without a history of running away. Those with the most severe forms of sexual abuse (including sexual exploitation and gang rape) reported the least supportive and most controlling relationships with parents, as did their parents.

CONCLUSIONS

Findings support our clinical observations that polyvictimization of adolescents who have spent significant time as runaways may further strain parent-adolescent relationships. Future clinical research should focus on developing interventions to promote parental connectedness after a runaway episode.

Social and psychological resources among homeless youth: protection against risk for physical victimization?

This study examines child physical abuse, social and psychological resources, and street physical victimization among 150 homeless youth from the Midwest. Path analyses results show that males have higher self-efficacy than females, while older youth and those who experienced less child physical abuse reported higher self-esteem. Self-efficacy and self-esteem were positively associated with social support as was being younger and having experienced less child physical abuse. Younger respondents reported fewer difficulties obtaining basic necessities, and those who had less trouble finding these necessities experienced less street physical victimization. Females, younger youth, and those who experienced less child physical abuse reported lower rates of physical victimization. Agencies should be aware that many youth experiencing homelessness have trouble obtaining basic necessities, which increases risk for victimization. Moreover, the ability to obtain necessities appears to override the influential role of social support, further affirming the foundational importance of agencies helping youth meet their basic needs.

A comparison of risk factors for various forms of trauma in the lives of lesbian, gay, bisexual and heterosexual homeless youth

Numerous homeless youth experience trauma prior to leaving home and while on the street. Bullying and trading sex (i.e. exchanging sexual favors for survival items such as food) are additional forms of trauma experienced by many homeless youth. Although lesbian, gay, and bisexual (LGB) homeless youth experience higher rates of child abuse compared to their heterosexual counterparts, there is a paucity of research comparing these two groups. As such, we compare whether difficulties finding items of necessity (e.g. food) and different forms of trauma including child sexual abuse, being bullied, trading sex, and street sexual victimization significantly differ for LGB and heterosexual homeless youth. Bivariate results reveal that LGB youth have more trouble finding shelter and are more likely to trade sex compared to heterosexual youth. Logistic regression results show that trading sex is correlated with street sexual victimization. In the second model, we find that being female, experiencing more child sexual abuse, and ever having traded sex are all positively linked with street sexual victimization. LGB youth are over-represented among homeless youth populations and are also more likely to trade sex; therefore, these young people need services that are widely accessible and specific to their needs.

Role of Social Environmental Protective Factors on Anxiety and Depressive Symptoms Among Midwestern Homeless Youth

We employ a social stress framework, which examines the influence of multiple stressors (e.g., physical abuse, foster care placement) on an individual's ability to function (e.g., mental well-being), to longitudinally examine the effects of stressful life events on mental health and the role of the social environment in this process among 150 homeless youth. Results revealed that numerous stressors, such as physical abuse and running away from home more frequently, were associated with greater depressive symptoms and elevated anxiety. Having mentors and family and friends from home that youth can rely on resulted in more positive social support, which subsequently lowered the risk for depressive symptoms and anxiety at wave 2.

Understanding the Link between Victimization and Alcohol Use among Homeless Youth Using Ecological Momentary Assessment

Most prior research on victimization and alcohol use among homeless youth is retrospective and thus does not allow researchers to determine the sequencing of these events. We address this gap using ecological momentary assessment via short message service surveying with homeless youth during 30 days. Multilevel binary logistic regression results revealed that experiencing physical or sexual victimization on a specific day was positively associated with youth's drinking alcohol later that day. Because ecological momentary assessment via short message service allows for such specificity, we can link a specific victimization experience with a current drinking episode. Thus, the time ordering of daily events in the current study is a significant improvement over prior research. Understanding the timing between victimization and drinking alcohol is also important for intervention with this underserved population.

Drug use patterns and predictors among homeless youth: Results of an ecological momentary assessment

BACKGROUND

Alcohol and drug use is associated with significant morbidity and mortality and is highly prevalent among homeless youth. Ecological Momentary Assessments (EMA) have been used to examine the effect of urges on drug use, though not among homeless youth.

OBJECTIVES

We assessed the patterns of drug use and the correlation between real-time contextual factors and drug use using EMA collected daily. We identified predictors of drug use among a sample of homeless youth 18-25 years old in Houston, Texas.

METHODS

Homeless youth (n = 66, 62% male) were recruited from a drop-in center between September 2015 and May 2016. We used generalized linear mixed models and cross-validation methods to determine the best predictive model of drug use.

RESULTS

The overall drug use was high: 61% and 32% of participants reported using drugs or alcohol at least one day, respectively. Marijuana and synthetic marijuana use (i.e., Kush, K2, incense packs) were reported most frequently; 86% and 13% of the total drug use EMAs, respectfully. Drug use urge was reported on 26% of days and was the highest on drug use days. Drug use was predicted by discrimination, pornography use, alcohol use, and urges for drugs, alcohol, and to steal.

CONCLUSIONS

EMA can be used to predict drug use among homeless youth. Drug use treatment among homeless youth should address the role of experiencing discrimination, pornography and alcohol use, and urge management strategies on drug use. Research is needed to determine if EMA informed just-in-time interventions targeting these predictors can reduce use.

Sexual Risk Behaviors, Sexual Offenses, and Sexual Victimization Among Homeless Youth: A Systematic Review of Associations With Substance Use

The use of substances among youth experiencing homelessness is an important issue in the context of addressing the developing burden of morbidities arising due to illness, injury, physical and mental health concerns, and low rates of health care utilization among this population group. Youth experiencing homelessness report engaging in and being victimized by various forms of sexual behavior. Of interest in this systematic review were published studies investigating substance use in its association with perpetration of sexual offenses, engagement in sexual risk behavior, or experience of sexual victimization among homeless youth. A systematic search of 12 psychology, health, and social science electronic databases was conducted. Search terms included "homeless*," "youth," "sex crimes," "sexual victimization," "survival sex," "rape," "drugs," and "substance abuse." Twenty-three studies were identified that met the inclusion criteria. No studies statistically examining substance use in its association with perpetrating sexual offenses were located. Findings showed substance use was generally associated with sexual risk behavior or sexual victimization; however, it remains unclear whether substance use precedes or follows these behaviors and experiences. It is possible substances are used by homeless youth as a means of coping with sexual risk behavior and victimization. Implications of the review findings in relation to prevention and intervention approaches aimed to decrease the incidence and severity of health concerns among homeless youth are discussed.

Violence in the Social Networks of Homeless Youths

This study examined social network processes related to interpersonal violence using a sample of 360 homeless youths from Los Angeles. Results indicated that violence is pervasive among homeless youths. Consistent with previous findings, hard drug use and childhood maltreatment experiences were closely related to violence experiences. Social network analyses revealed that having a higher proportion of violence-engaged peers in a youth’s network is associated with increased risk of personal violent behavior as well as having a high k-core number within the larger overall homeless youth network. The findings have important implications for the development of violence prevention programs for homeless youths, particularly the potential for network-based programs.

Multi-Level Risk and Protective Factors for Substance Use Among Zambian Street Youth

BACKGROUND

High rates of substance use have been reported among youth in Zambia. This is particularly concerning given that substance use is one of the biggest risk factors placing young people at risk for HIV infection.

OBJECTIVES

The purpose of the current study is to examine how multi-level risk and protective factors (i.e., community, family, peers, individual) influence alcohol and marijuana use.

METHODS

A total of 250 street youth in Lusaka, Zambia were interviewed in the summer of 2014 about their alcohol and marijuana use and reasons for usage. Data were analyzed using descriptive and multivariate methods.

RESULTS

Youth reported high rates of alcohol use. At the multivariate level, peer and individual level variables (e.g., using alcohol or drugs for coping or for fun) explained the most variance, followed by family level factors. Community level variables explained the least variance in all models. Conclusion/Importance: A better understanding of multi-level risk and protective factors for young people's alcohol and marijuana use could lead to the development of better intervention strategies to reduce this behavior among Zambian street youth.

PTSD, Depression, and Substance Use in Relation to Suicidality Risk among Traumatized Minority Lesbian, Gay, and Bisexual Youth

Youths who are lesbian, gay, or bisexual (LGB) are more likely than heterosexuals to commit suicide. Substance use, PTSD, and depression are independent risk factors for suicidality; however, the extent to which these factors interact to predict suicidality is unclear. The current study examined the association between substance use, PTSD symptoms (PTSS), depressive symptoms, and suicidality in a sample of 68 traumatized minority LGB youths. Participants were recruited from an LGBT community center and completed a packet of questionnaires. Substance use and depressive symptoms were positively associated with prior suicide attempts. A significant three-way interaction revealed that substance use interacted with both PTSS and depressive symptoms to increase the odds of attempted suicide. Results underscore the importance of integrating substance use components into PTSD/depression treatment to reduce suicide risk in LGB youth.

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.

A Heated Debate: Theoretical Perspectives of Sexual Exploitation and Sex Work

The theoretical and often political framework of sexual exploitation and sex work among women is widely and enthusiastically debated among academic and legal scholars alike. The majority of theoretical literature in this area focuses on the macro perspective, while the micro-level perspective as to theory and causation remains sparse. This article provides a comprehensive overview of the philosophical, legal, and political perspectives pertaining to sexual exploitation of women and girls while addressing the subsequent controversies in the field.

Differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified young adults

BACKGROUND

Little is known about differences in alcohol use and alcohol-related problems between transgender- and nontransgender-identified populations. Using data from a large-scale health survey, we compare the drinking patterns and prevalence of alcohol-related problems of transgender-identified individuals to nontransgender-identified males and females. For transgender-identified people, we examine how various forms of victimization relate to heavy episodic drinking (HED).

METHODS

Cross-sectional surveys were completed by 75,192 students aged 18-29 years attending 120 post-secondary educational institutions in the United States from 2011 to 2013. Self-reported measures included alcohol use, alcohol-related problems, victimization, and sociodemographics, including 3 gender-identity groups: transgender-identified individuals; nontransgender-identified males; and nontransgender-identified females.

RESULTS

Compared to transgender-identified individuals, nontransgender-identified males were more likely to report HED in the past 2 weeks (relative risk=1.42; p=0.006); however, nontransgender-identified males and females reported HED on fewer days than transgender-identified people (incidence-rate ratios [IRRs] ranged from 0.28 to 0.43; p-values<0.001). Compared to transgender-identified people, nontransgender-identified males and females had lower odds of past-year alcohol-related sexual assault and suicidal ideation (odds ratios ranged from 0.24 to 0.45; p-values<0.05). Among transgender-identified people, individuals who were sexually assaulted (IRR=3.21, p=0.011) or verbally threatened (IRR=2.42, p=0.021) in the past year had greater HED days than those who did not experience those forms of victimization.

CONCLUSIONS

Compared to transgender-identified people, nontransgender-identified males and females: have fewer HED occasions (despite nontransgender-identified males having greater prevalence of HED); and are at lower risk for alcohol-related sexual assaults and suicidal ideation. Experiences of sexual assault and verbal threats are associated with greater HED occasions for transgender-identified people.

[Implications of psychoactive substances on the health of men deprived of liberty]

OBJECTIVE

To describe the frequency of the use of alcohol and other drugs, as well as different types of victimization in men deprived of liberty in the prisons of Castile-La Mancha (Spain).

MATERIAL AND METHODS

A cross-sectional study was conducted in a sample of men deprived of liberty in four prisons in Castile-La Mancha. An anonymous questionnaire on victimization was distributed among a total of 425 prisoners, with a confidence interval of 95%.

RESULTS

The most commonly reported assaults were verbal, affecting 41.4% of the prisoners (n=176) and the least common were sexual, affecting 7.8% (n=33). The most commonly consumed substance was cannabis, with 40.2% (n=171) of prisoners consuming it in the previous month.

CONCLUSIONS

Victimization and substance use is a reality in prisons, and there is a statistically significant association between the two phenomena. This association should be further studied to design preventive measures and improve prison life.

On the relationships between commercial sexual exploitation/prostitution, substance dependency, and delinquency in youthful offenders

Researchers have consistently linked commercial sexual exploitation (CSE) of youth and involvement in prostitution with substance dependency and delinquency. Yet, important questions remain regarding the directionality and mechanisms driving this association. Utilizing a sample of 114 CSE/prostituted youth participating in the Pathways to Desistance study-a longitudinal investigation of the transition from adolescence to adulthood among serious adolescent offenders-the current study examined key criminal career parameters of CSE/prostitution including age of onset and rate of recurrence. Additionally, structural equation modeling (SEM) was used to explore concurrent associations and causal links between CSE/prostitution and drug involvement. Findings show a general sequential pattern of the ages of onset with substance use and selling drugs occurring prior to CSE/prostitution, evidence that a small group with chronic CSE/prostitution account for the majority of CSE/prostitution occurrences, and high rates of repeated CSE/prostitution. SEM results suggest CSE/prostituted youth persist in drug involvement from year to year but infrequently experience perpetuation of CSE/prostitution from year to year. Concurrent associations between CSE/prostitution and drug involvement were found across the length of the study. Additionally, drug involvement at one year was linked to CSE/prostitution during the subsequent year during early years of the study.

Reducing High Risk Behaviors among Street Living Youth: Outcomes of an Integrated Prevention Intervention

Research efforts to reduce Human Immunodeficiency Virus (HIV) risk behavior among street living youth have shown disappointing outcomes, with few studies reporting reduced risk behaviors. The current study tested the impact of an integrated HIV prevention intervention, and predictors of change, for youth (N=270) between the ages of 14 to 20 years receiving substance use treatment through a drop-in center. Condom use, HIV knowledge, number of sexual partners and behaviors associated with an overall HIV risk index were assessed at baseline, 3, 6 and 12 months post-baseline. Findings suggest that HIV prevention integrated with substance use treatment is associated with increased condom use and reduced sex partners. However, the effects on condom use were short lived and dissipated by 12 months post-baseline. Higher treatment attendance and baseline substance use predicted increased condom use. Although no significant change was observed in the overall HIV risk index, increases in depressive symptoms were associated with increases in the index score, as well as more sexual partners. Future research should determine whether successful intervention requires reinforcement of risk reduction behaviors while youth remain homeless.

Betrayal trauma among homeless adults: associations with revictimization, psychological well-being, and health

Betrayal trauma theory postulates that traumas perpetrated by a caregiver or close other are more detrimental to mental health functioning than are traumatic experiences in which the victim is not affiliated closely with the perpetrator. This study is the first to examine the concept of betrayal among a sample of individuals with a history of homelessness. A total of 95 homeless or formerly homeless adults completed the Brief Betrayal Trauma Survey, the Posttraumatic Stress Disorder Checklist-Civilian Version, the Center for Epidemiologic Studies Depression Scale the Perceived Stress Scale, and a demographics questionnaire assessing participants' histories of homelessness, health, and relationships with their families. Regression analyses were conducted to explore the associations between high betrayal (HB) and low betrayal (LB) trauma exposure, relationship with family, and physical and mental health symptoms. Exposure to HB traumas in childhood and poor family relationships predicted earlier age at first episode of homelessness, and participants who had been exposed to a greater number of traumas during childhood were more likely to be revictimized during adulthood. Trauma exposure as an adult and earlier age of first homeless episode predicted symptoms of posttraumatic stress disorder, while trauma exposure alone predicted symptoms of depression and perceived stress. Number of medical diagnoses was associated with trauma exposure and becoming homeless at an older age. These findings emphasize that even among the most marginalized and multiply victimized individuals in our society, traumas that are characterized by a higher degree of betrayal are associated with more adverse outcomes.

The effect of victimization, mental health, and protective factors on crime and illicit drug use among homeless young adults

Although research has found high rates of child maltreatment, widespread victimization, and other negative outcomes among homeless youth and young adults, resiliency among this population has largely been understudied. Specifically, a gap remains in terms of how protective factors such as self-efficacy, low deviant beliefs, and religiosity operate among homeless youth and young adults. The purpose of this study is to examine the relationship between various forms of victimization, mental health, and protective factors with property and violent crime and illicit drug use among homeless young adults. Results from regression analyses indicate that running away from home more frequently, experiencing more physical victimization on the street, higher levels of self-efficacy, and more deviant beliefs were associated with greater property crime. Significant correlates of violent crime included being male, running away from home more frequently, greater sexual and physical victimization on the street, higher levels of self-efficacy, and more deviant beliefs. Finally, being male, running away more frequently from home, greater child physical abuse and partner victimization, and more deviant beliefs were all associated with greater illicit drug use. Self-efficacy was positively related to both property and violent crime, suggesting that it may not operate for homeless young adults in the same manner as it does for normative populations.

Child maltreatment: promising approaches and new directions

PURPOSE OF REVIEW

This review summarizes the key articles in the field of child maltreatment, addressing abusive head trauma, physical abuse, sexual abuse, and global issues surrounding maltreatment. This topic is salient for both general pediatricians as well as specialists.

RECENT FINDINGS

Many articles this year focus on the importance of making an accurate diagnosis when considering child maltreatment, whether in the form of physical or sexual abuse. There is also a focus on understanding the epidemiology of abuse, as some data show a decrease in numbers, which is felt by many in the field to be a misleading impression.

SUMMARY

An appreciation of the scope of Child Abuse Pediatrics requires an understanding of physical abuse, sexual abuse, and neglect. The authors summarize notable advances in our understanding of these key areas in a review of the year's best literature.