Are social supports always protective? A seven-city study on heavy drinking among sexual and gender minority young adults experiencing homelessness.

PURPOSE: Sexual and gender minority (SGM) young adults are disproportionately impacted by homelessness and heavy drinking (i.e., having five or more drinks of alcohol in a row within a couple of hours). Social support, in general, is protective in reducing individuals' risk of heavy drinking. However, whether and how support from different sources may have different implications on heavy drinking among SGM young adults experiencing homelessness (SGM-YAEH) remains unclear. Informed by the risk amplification and abatement model (RAAM), this study examined the associations between support sources and heavy drinking among SGM-YAEH. METHODS: A purposive sample of SGM-YAEH (N=425) recruited in homeless service agencies from seven major cities in the U.S. completed a self-administered computer-assisted anonymous survey. This survey covered heavy drinking behaviors and social network properties. Logistic regression models were conducted to identify social support sources associated with SGM-YAEH's heavy drinking. RESULTS: Over 40 % of SGM-YAEH were involved in heavy drinking in the past 30 days. Receiving support from street-based peers (OR=1.9; 95 % CI=1.1, 3.2) and home-based peers (OR=1.7; 95 % CI=1.0, 2.8) were each positively associated with SGMYAEH heavy drinking risks. CONCLUSION: This study was not able to identify the protective role social supports may play in reducing SGM-YAEH's heavy drinking. Furthermore, receiving support from network members was correlated with elevated heavy drinking risks among this population. As heavy drinking prevention programs develop interventions: they should use affirming and trauma approaches to promote protective social ties, as research points to its association in reducing alcohol use disparities among SGM-YAEH.

Predicting Intimate Partner Violence Perpetration Among Young Adults Experiencing Homelessness in Seven U.S. Cities Using Interpretable Machine Learning.

Young adults experiencing homelessness (YAEH) are at higher risk for intimate partner violence (IPV) victimization than their housed peers. This is often due to their increased vulnerability to abuse and victimization before and during homelessness, which can result in a cycle of violence in which YAEH also perpetrates IPV. Identifying and addressing factors contributing to IPV perpetration at an early stage can reduce the risk of IPV. Yet to date, research examining YAEH's IPV perpetration is scarce and has largely employed conventional statistical approaches that are limited in modeling this complex phenomenon. To address these gaps, this study used an interpretable machine learning approach to answer the research question: What are the most salient predictors of IPV perpetration among a large sample of YAEH in seven U.S. cities? Participants (N = 1,426) on average were 21 years old (SD = 2.09) and were largely cisgender males (59%) and racially/ethnically diverse (81% were from historically excluded racial/ethnic groups; i.e., African American, Latino/a, American Indian, Asian or Pacific Islander, and mixed race/ethnicity). Over one-quarter (26%) reported IPV victimization, and 20% reported IPV perpetration while homeless. Experiencing IPV victimization while homeless was the most important factor in predicting IPV perpetration. An additional 11 predictors (e.g., faced frequent discrimination) were positively associated with IPV perpetration, whereas 8 predictors (e.g., reported higher scores of mindfulness) were negatively associated. These findings underscore the importance of developing and implementing effective interventions with YAEH that can prevent IPV, particularly those that recognize the positive association between victimization and perpetration experiences.

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.

Transitioning to independent living: Experiences of homeless young adults in rapid rehousing.

Rapid rehousing (RRH) is an intervention that is being adopted nationally to assist adolescents and emerging adults who are homeless. RRH provides short-term rental assistance for independent scattered-site housing, in addition to an array of support services for approximately 12-24 months. The aim of this study is to explore the experiences of young adults (18-23 years old) who had previously been homeless and who were enrolled in RRH programs set in two urban Northeastern cities, and their subsequent preparedness for independent living. Our sample mostly consisted of non-Hispanic Black females, many of whom identified as LGBTQ. Semi-structured interviews (n = 15) were conducted after participants had been in the program for nine months - three months prior to their initial program completion date. Thematic analysis revealed three themes: the importance of tangible support, communication among all parties: staff lead the way, and "I gotta start learning to do it on my own". These domains provided essential assistance for young people to attain their goals and through this process they learned skills to live independently and transition into adulthood. These findings suggest that rapid rehousing programs and service providers should focus on these domains to facilitate successful transition to independent living for this population.

MYPATH: A novel mindfulness and yoga-based peer leader intervention to prevent violence among youth experiencing homelessness.

Young adults experiencing homelessness (YAEH) are at elevated risk for violence victimization and perpetration. However, there are no evidence-based violence prevention interventions for homeless populations. This study is an evaluation of a novel mindfulness-based peer-leader intervention designed to reduce violence and improve mindfulness in YAEH. A social network of YAEH receiving services at a drop-in agency was recruited in Summer 2018 (n = 106) and peer-leaders identified at baseline (n = 12). Peer leaders were trained in mindfulness and yoga skills during a 1-day intensive workshop and seven 1-h weekly follow-up workshops and encouraged to share their knowledge with in-network peers. Postintervention data were collected 2 and 3 months after baseline. Two one-way repeated-measures analyses of variance (ANOVAs) tested differences in means for mindfulness and fighting. ANOVA models showed significant increases in group mean mindfulness F(2, 110) = 3.42, p < 0.05 and significant decreases in group mean violent behavior F(2, 112) = 5.23, p < 0.01 at the network level. Findings indicate a network-based, peer-leader model can be effective for influencing complex, socially conditioned attitudes and behaviors among YAEH. Additional advantages of the peer-leader model include relatively few direct-service person-hours required from providers and convenience to participants able practice skills in their relevant social contexts.

Experiences of discrimination among young adults experiencing homelessness: Relationship to mental health outcomes.

Young adults experiencing homelessness (YAEH) are at high risk for discrimination. Limited research has documented the extent of discrimination experiences and their relationship to mental health outcomes among this group. This study used data from YAEH who completed self-administered surveys across seven U.S. cities (N = 1,426) to examine the rates and correlates of discrimination experiences and their association with psychological distress and suicidal ideation. Chi-square and multivariate logistic regressions were used to examine the relations between perceived discrimination and race, gender identity, sexual orientation, foster care history, criminal justice history, reasons for homelessness, and length of time homeless. Then, logistic regression was used to examine whether discrimination increased the odds of psychological distress and suicidal ideation, controlling for other factors. Three-fourths (75.8%) of the sample (n = 1,055) reported experiencing at least one of the five forms of everyday discrimination experiences at least a few times a year, with the most common reason attributed to their housing situation (46%). Sexual orientation, juvenile justice involvement, and having been homeless for 2 years or more were associated with increased odds of experiencing discrimination. Discrimination was a strong predictor of psychological distress but was significant only at the bivariate level for suicidal ideation. Study results suggest that experiences of discrimination are common among YAEH and that these experiences increase risk for psychological distress. Providers working with YAEH need to validate and acknowledge the impact of these experiences on mental health. And, communities need to work to reduce discrimination experiences by targeting stigma against YAEH. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Graduation practices and outcomes in intensive case management programs for severe mental illness: A systematic review.

OBJECTIVE: Intensive case management (ICM) is important in psychiatric rehabilitation but there is a need to "graduate" clients. The purpose of this research was to review the literature on criteria used and outcomes of graduating clients with severe mental illness from ICM programs. METHOD: A systematic review conducted in 2019 used keyword searches in all major research databases. This search yielded 1,142 articles which were distilled to 20 studies that reported a graduation process from an ICM program (11 studies), and/or reported clinical or psychosocial outcomes after graduation (15 studies). RESULTS: Three main methods have been used to determine graduation: Clinician judgment (n = 8 studies), rating scales (n = 4), or shared decision-making (n = 3). Across studies, graduation rates ranged from 1% to 25% over a 1-year period, 44% to 65% over a 2-year period, and 9% to 29% over a 4-year period. After graduation, 4%-14% of graduates had to be readmitted to ICM but 60% of studies reported positive client outcomes after graduation which included significant reductions in hospitalizations, and improvements in quality of life, unmet needs for care, and family relationships. Only two studies reported negative outcomes after graduation which included hospitalizations, homelessness, incarceration, and treatment drop-out. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: ICM programs can successfully graduate clients to less intensive services, and there are procedures available to guide graduation decisions but no universally agreed-upon method. Additional research is needed to identify optimal methods for graduation for different client populations. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Few Do and To Few: Disclosure of Suicidal Thoughts in Friendship Networks of Young Adults Experiencing Homelessness.

Disclosure of one's suicidal thoughts is a pivotal but under-investigated mechanism for preventing suicide among young adults experiencing homelessness (YAEH). In a sample of 527 YAEH, we adopted a multi-level perspective to assess patterns and correlates of disclosure in their friendship networks. Less than one-third of YAEH disclosed their suicidal thoughts-half of them doing so during a suicidal crisis-and only disclosed to 21% of their friends. Multilevel modeling showed that YAEH who reported a history of unmet mental health needs were more likely to have disclosed to a friend, and friends who were sources of social support were most highly sought out for disclosures. Our findings highlight the need for cultivating safe environments that promote disclosures among YAEH.

A Peer-Led, Artificial Intelligence-Augmented Social Network Intervention to Prevent HIV Among Youth Experiencing Homelessness.

BACKGROUND: Youth experiencing homelessness (YEH) are at elevated risk of HIV/AIDS and disproportionately identify as racial, ethnic, sexual, and gender minorities. We developed a new peer change agent (PCA) HIV prevention intervention with 3 arms: (1) an arm using an artificial intelligence (AI) planning algorithm to select PCAs; (2) a popularity arm, the standard PCA approach, operationalized as highest degree centrality (DC); and (3) an observation-only comparison group. SETTING: A total of 713 YEH were recruited from 3 drop-in centers in Los Angeles, CA. METHODS: Youth consented and completed a baseline survey that collected self-reported data on HIV knowledge, condom use, and social network information. A quasi-experimental pretest/posttest design was used; 472 youth (66.5% retention at 1 month postbaseline) and 415 youth (58.5% retention at 3 months postbaseline) completed follow-up. In each intervention arm (AI and DC), 20% of youth was selected as PCAs and attended a 4-hour initial training, followed by 7 weeks of half-hour follow-up sessions. Youth disseminated messages promoting HIV knowledge and condom use. RESULTS: Using generalized estimating equation models, there was a significant reduction over time (P < 0.001) and a significant time by AI arm interaction (P < 0.001) for condomless anal sex act. There was a significant increase in HIV knowledge over time among PCAs in DC and AI arms. CONCLUSIONS: PCA models that promote HIV knowledge and condom use are efficacious for YEH. Youth are able to serve as a bridge between interventionists and their community. Interventionists should consider working with computer scientists to solve implementation problems.

Understanding the Correlates of Firearm Violence Involvement Among Young Adults Experiencing Homelessness: A 7-City Study.

INTRODUCTION: Young adults experiencing homelessness are vulnerable to firearm violence. This study aims to explore the correlates of firearm violence involvement among this vulnerable population, which may inform firearm violence reduction intervention development. METHODS: Between 2016 and 2017, young adults experiencing homelessness aged 18-26 years (N=1,426) were recruited in 7 U.S. cities. Respondents completed a self-administered computer-assisted anonymous survey regarding their homeless experiences and violence involvement. Separate multivariate logistic regression models were conducted in 2020 to explore the correlates of direct firearm violence victimization, witness of firearm violence, and firearm violence perpetration. RESULTS: A high proportion of young adults experiencing homelessness were involved in firearm violence (witnessing firearm violence: 40%; direct firearm violence victimization: 28%; perpetration: 18%). Stressful experiences, such as childhood trauma and street victimization, were associated with greater odds of firearm violence involvement. Black (OR=2.4, p<0.001) and Latinx (OR=2.0, p<0.05) young adults had greater odds of experiencing direct firearm violence victimization than White young adults. Black (OR=2.0, p<0.01) and Latinx (OR=2.4, p<0.001) young adults were also at greater risk of witnessing firearm violence. Young adults with mental illness had greater odds of being directly victimized by firearm violence (OR=1.7, p<0.01). CONCLUSIONS: Given the inter-related nature of firearm violence involvement and given that risk factors for violence are often embedded in social and structural contexts, multipronged community-based approaches to prevent firearm violence among young adults experiencing homelessness are necessary. Targeted efforts may be indicated to attenuate the risk and promote resilience among subgroups of young adults experiencing homelessness who are disproportionately affected by firearm violence.

The intersection of housing and mental well-being: Examining the needs of formerly homeless young adults transitioning to stable housing.

We examine the challenges formerly homeless young adults (FHYAs) face after they transition out of homelessness. Considering the adversities FHYAs face, it is unclear how transitioning to stable housing may affect their mental well-being or what types of stressors they may experience once housed. This study investigates the social environment young adults encounter in their transition to stable housing and examines trauma and social coping predictors of mental health symptoms in a sample of FHYAs to generate new knowledge for better intervening to meet their needs. Data were obtained from REALYST, a national research collaborative comprised of interdisciplinary researchers investigating young adults' (ages 18-26) experiences with homelessness. Cross-sectional data for 1426 young adults experiencing homelessness were collected from 2016 to 2017 across seven cities in the United States (i.e., Los Angeles, Phoenix, Denver, Houston, San Jose, St. Louis, and New York City). The analytical sub-sample for this study consisted of 173 FHYAs who were housed in their own apartment (via voucher from Housing and Urban Development or another source) or in transitional living programs during their participation in the study. Ordinary Least Squares regression was used to examine the influence of trauma and social coping strategies on indicators of mental well-being. Findings indicated that higher adversity scores and higher mental health help-seeking intentions were positively associated with higher levels of stress, psychological distress, and depression severity. Higher level of social coping was associated with lower levels of depression severity. Logistic regression results showed that young adults with higher adversity scores had higher odds of reporting clinical levels of post-traumatic symptoms. The study implications suggest that FHYAs who transition to stable housing continue to need support navigating and coping with stressful life events; and interventions that help FHYAs develop strong networks of social supports are needed to promote positive mental well-being.

Changes in Physical Assault Among Adults Moving Into Permanent Supportive Housing.

People experiencing homelessness experience high rates of physical assault. While this high risk for victimization is well established, there is no research that examines whether victimization rates change over time as persons transition into permanent supportive housing (PSH). Data are from a longitudinal study of adults moving into PSH in the Los Angeles, CA area. Interviews were conducted prior to or within 5 days of moving in, with follow-up interviews at 3, 6, and 12 months after move-in (n = 370 participants completing all four interviews). Each interview assessed characteristics of past 3-month physical assault. Analyses examined change in rates of assault over time and differences by demographic subgroups. We also present findings on the most common locations and perpetrators of assault. Overall, rates of physical assault decreased after participants entered PSH. Statistically significant differences by subgroups varied by time point. Differences identified include higher rates of physical assault among Latino/a respondents, lower rates among African Americans, and higher rates of physical assault among lesbian, gay, bisexual, and transgender (LGBT) respondents. The most frequent location of assault was outside at baseline, 3- and 6-month time points. Strangers were the most common perpetrator at all time points. Rates of perpetration by neighbors nearly doubled from baseline to the 12-month time point, and inside locations for assault were most common at this time point as well. While PSH is an effective intervention in reducing chronic homelessness, it is important to consider other risks to overall health and well-being, such as physical victimization.

Can Better Emotion Regulation Protect Against Interpersonal Violence in Homeless Youth Social Networks?

Homeless youth experience all types of violence at higher rates than their housed counterparts. This is typically the result of many contributing factors including childhood experiences of trauma, subsistence survival strategies, and exposure to perpetrators while living on the streets. Reducing violence in the lives of homeless youth is imperative and can contribute to a young person's ability to safely and successfully exit the streets and lead a long and productive life in society. However, developing public health and social interventions to reduce violence in adolescent and young adult populations is difficult due to the complex interplay of extrinsic and intrinsic drivers of this phenomenon. Los Angeles area homeless youth (N = 366) were asked questions regarding recent violence experiences, emotion regulation, and their social network. Multivariable logistic regressions tested the overall effect of emotion regulation on violence, controlling for age, gender, race, sexual identity, experience of childhood abuse, and data collection site. In this sample, 56% of youth endorsed fighting in the previous year, and those who reported more difficulties with emotion regulation were significantly more likely to fight. In addition, youth who scored below the mean on difficulties with regulation and belonged to networks characterized by low-difficulty peers were 60% less likely to report fighting. Emotion regulation skills represent a malleable target for intervention that may contribute to reduced propensity for violence in this population. Implications for network-based interventions to improve individual emotion regulation and reduce overall violence among homeless youth and other at-risk populations are discussed.

Firearm Access and Suicidal Crises Among Young Adults Experiencing Homelessness in the United States.

Background: Young adults experiencing homelessness (YAEH) report high rates of suicidal crises. Having access to firearms during suicidal crises elevates risk of death by suicide. Yet, no known information exists about firearm access among YAEH. Aims: We aimed to examine the proportion of participants who had firearm access, as well as the association between past-year suicidal crises and firearm access among participants. Method: We recruited 1,426 YAEH (18-26 years old) from homelessness service settings in seven US cities. Logistic regression analyses were used to examine the association between past-year suicidal crises and firearm access. Results: One third of the sample reported having easy firearm access. YAEH who experienced suicidal ideation and suicide attempts were more likely to report firearm access. Limitations: Results from this cross-sectional study cannot be causally interpreted nor generalized to all YAEH. Conclusion: A substantial segment of YAEH had easy firearm access and it was more common for YAEH with suicidal crises to have firearm access. Reducing firearm access should be part of suicide prevention planning for YAEH in the US but requires comprehensive and innovative solutions.

Firearm Violence Exposure and Suicidal Ideation Among Young Adults Experiencing Homelessness.

PURPOSE: This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH). METHODS: YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months. RESULTS: Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02-2.01) among YAEH. CONCLUSIONS: A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.

Gaps in Sexual Assault Health Care Among Homeless Young Adults.

INTRODUCTION: Young adults experiencing homelessness are at increased risk for sexual assault. Receiving a post-sexual assault examination has important implications for HIV and unintended pregnancy prevention; yet, utilization is not well understood. In a population at elevated risk for HIV, unintended pregnancy, and sexual violence, identifying barriers and facilitators to post-sexual assault examination is imperative. METHODS: As part of a large, multisite study to assess youth experiencing homelessness across 7 cities in the U.S, a cross-sectional survey was conducted between June 2016 and July 2017. Data were analyzed in 2019 to determine the prevalence and correlates of sexual violence and examine the correlates of post-sexual assault examination utilization. RESULTS: Respondents (n=1,405), aged 18-26 years, were mainly youth of color (38% black, 17% Latinx) and identified as cisgender male (59%) and lesbian, gay, bisexual, or queer (29%). HIV risks were high: 23% of participants had engaged in trade sex, 32% had experienced sexual assault as a minor, and 39% had experienced sexual exploitation. Young adults reported high rates of sexual assault (22%) and forced sex (24%). Yet, only 29% of participants who were forced to have sex received a post-sexual assault examination. Latinx young adults were more likely than other races/ethnicities to receive post-assault care. Participants frequently said they did not get a post-sexual assault exam because they did not want to involve the legal system and did not think it was important. CONCLUSIONS: Interventions are needed to increase use of preventive care after experiencing sexual assault among young adults experiencing homelessness.

Prevalence and correlates of nonmedical use of prescription drugs (NMUPD) among Young adults experiencing homelessness in seven cities across the United States.

BACKGROUND: Nonmedical use of prescription drugs (NMUPD) is an urgent public health concern facing the United States. Young adults experiencing homelessness (YEH) are at increased risk of NMUPD; however, community estimates of NMUPD among YEH are sparse. This current study sought to understand patterns and correlates of NMUPD in a geographically heterogeneous sample of YEH recruited from seven cities across the United States. METHODS: From June 2016 to July 2017, 1,426 YEH (aged 18-26) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information on substance use, mental health, trauma, and sexual-risk behaviors. Multivariable logistic regression was utilized to assess demographic, psychological, and behavioral correlates of self-reported past-month NMUPD and NMUPD types (i.e., prescription stimulant, sedative, and opioids). RESULTS: Approximately 20% of participants reported past-month NMUPD. Almost 9% reported misusing prescription opioids, 8.7% misused prescription sedatives, and 6% misused prescription stimulants. Multivariable logistic regressions revealed unmet mental health needs were associated with sedative and stimulant misuse but not opioid misuse. Having suicidal thoughts was associated with opioid misuse but not sedative or stimulant misuse. Although no geographical differences emerged for stimulant and sedative misuse, youth from Denver, Phoenix, and San Jose were more likely to engage in opioid misuse relative to youth in Los Angeles. CONCLUSIONS: These findings indicate that interventions designed to address NMUPD need to be multifaceted, designed to address other risk behaviors correlated with NMUPD, and target unmet mental health needs.

Implications for PrEP Uptake in Young Adults Experiencing Homelessness: A Mixed Methods Study.

Youth experiencing homelessness (YEH) have a high risk of contracting HIV; however, they remain relatively unreached by pre-exposure prophylaxis (PrEP)-based HIV prevention initiatives. We used a cross-sectional mixed-methods study to explore PrEP knowledge, interest, facilitators, and barriers among YEH. Young adults were recruited from agencies serving YEH in Houston, TX (n = 30) and Los Angeles, CA (n = 15) to participate in an electronic self-report survey and a semistructured interview. Survey results indicate that 68.2% of YEH had low or no prior knowledge of PrEP, though 63.7% reported interest in taking PrEP. Qualitative results revealed facilitators of PrEP use, including high PrEP acceptability and awareness, and supportive social networks. Several barriers emerged, including medication-related barriers, adherence, cost, access barriers, low perceived HIV risk, perceived stigma of PrEP use, and low PrEP awareness. Despite high PrEP acceptability, PrEP use among YEH remains low partly due to low PrEP awareness, low perceived HIV risk, and medical mistrust.

Knowledge and Attitudes About Pre-Exposure Prophylaxis Among Young Adults Experiencing Homelessness in Seven U.S. Cities.

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.

Bidirectional Intimate Partner Violence and Drug Use Among Homeless Youth.

Intimate partner violence (IPV) among homeless youth (HY) is common, yet it has continuously been understudied, especially in relation to substance use. As part of a longitudinal study of Los Angeles area HY, drop-in service seeking youth completed a self-administered questionnaire. The presented results are from the third panel of data collection ( N = 238), and the Revised Conflict Tactics Scale (CTS2) was used to assess IPV behavior regarding the participant's most recent intimate relationship. Approximately 38% of participants reported IPV behavior in their most recent relationship, and the majority of this behavior was bidirectional. It was unlikely that a HY was only a victim or only a perpetrator. Multivariable models revealed that bidirectional IPV was related to increased odds of recent methamphetamine; whereas sole perpetration was associated with an increased likelihood of ecstasy use. Specific substance use and IPV are closely related to risk behaviors for HY. Comprehensive interventions should be developed to address both these risk behaviors.