Effects of Community-Wide Teen Pregnancy Prevention Initiatives on Local Teen Birth Rates in the United States: A Synthetic Control Approach.

The impact of community-wide teen pregnancy prevention initiatives (CWIs) on local U.S. birth rates among adolescents aged 15 to 19 years was examined using synthetic control methodology within a quasi-experimental design. CWIs were implemented in 10 U.S. communities from 2010 to 2015. Each initiative implemented evidence-based teen pregnancy prevention interventions at local organizations and enhanced best practices in adolescent reproductive health care at local health centers, while engaging diverse community sectors. The synthetic control method was used to estimate the impact of each CWI on overall and race- and ethnicity-specific teen births relative to rates in synthetic control communities. Additionally, we estimated the overall effect of CWIs across communities by pooling results from the 10 synthetic control case studies using the mean percentile rank. Pooled data across all 10 communities indicated an estimated average of 6.6 fewer births per 1000 teens per year overall during the initiative relative to each community's synthetic control (p = .001). By race and ethnicity, there were an estimated average of 6.4 fewer births per 1000 teens per year among Black teens (p = .03), 10.7 fewer births among Hispanic teens (p = .03), and 4.2 fewer births (p = .10) among White teens. Results from individual communities indicated an intervention effect on overall and/or race/ethnicity-specific teen birth rates in five communities. This study demonstrates the value of synthetic control methods in evaluating community-level outcomes of programmatic efforts. Findings indicate the CWIs had a positive impact on teen birth rates and have the potential to address racial and ethnic disparities in those rates.

Claims for Contraceptive Services and Chlamydia and Gonorrhea Testing Among Insured Adolescent and Young Adult Females in the United States.

Objective: To examine claims for reversible prescription contraceptives and chlamydia and gonorrhea testing among commercially and Medicaid-insured adolescent and young adult (AYA) females in the United States. Methods: Using IBM MarketScan Research Databases, we identified sexually active, nonpregnant AYA (15- to 24-year-old) females enrolled in 2018. We examined claims for reversible prescription contraceptives and chlamydia and gonorrhea testing, using drug names and diagnosis/procedure codes, by age-group in commercially and Medicaid-insured separately and by race/ethnicity in Medicaid-insured. Results: Among 15- to 19-year-old and 20- to 24-year-old females, 67.2% and 67.9% of commercially insured and 57.3% and 54.0% of Medicaid-insured, respectively, had claims for reversible prescription contraceptives in 2018. Across insurance types among both age-groups, the most common claim for contraceptives was prescription for combined oral contraceptives. Among Medicaid-insured 15- to 19-year-olds, claims for contraceptives ranged from 42.6% for Hispanic females to 63.4% for non-Hispanic White females; among Medicaid-insured 20- to 24-year-olds, claims ranged from 50.4% for non-Hispanic Black females to 57.0% for non-Hispanic White females. Approximately half of the commercially and Medicaid-insured females had claims for chlamydia and gonorrhea testing. Non-Hispanic Black females had the highest percentages of claims for chlamydia testing (56.3% among 15- to 19-year-olds and 61.1% among 20- to 24-year-olds) and gonorrhea testing (61.6% among 15- to 19-year-olds and 64.9% among 20- to 24-year-olds). Conclusion: Approximately, two-thirds of commercially insured and more than half of Medicaid-insured, sexually active, nonpregnant AYA females had claims for reversible prescription contraceptives. Race/ethnicity data were available for Medicaid-insured females, and there were differences in claims for contraceptives and chlamydia and gonorrhea testing by race/ethnicity. Half of the AYA females had claims for chlamydia and gonorrhea testing suggesting missed opportunities.

Rural/urban differences in health care utilization and costs by perinatal depression status among commercial enrollees.

PURPOSE: To understand differences in health care utilization and medical expenditures by perinatal depression (PND) status during pregnancy and 1-year postpartum overall and by rural/urban status. METHODS: We estimated differences in health care utilization and medical expenditures by PND status for individuals with an inpatient live-birth delivery in 2017, continuously enrolled in commercial insurance from 3 months before pregnancy through 1-year postpartum (study period), using MarketScan Commercial Claims data. Multivariable regression was used to examine differences by rurality. FINDINGS: Ten percent of commercially insured individuals had claims with PND. A smaller proportion of rural (8.7%) versus urban residents (10.0%) had a depression diagnosis (p < 0.0001). Of those with PND, a smaller proportion of rural (5.5%) versus urban residents (9.6%) had a depression claim 3 months before pregnancy (p < 0.0001). Compared with urban residents, rural residents had greater differences by PND status in total inpatient days (rural: 0.7, 95% confidence interval [CI]: 0.6-0.9 vs. urban: 0.5, 95% CI: 0.5-0.6) and emergency department (ED) visits (rural: 0.7, 95% CI: 0.6-0.9 vs. urban: 0.5, 95% CI: 0.4-0.5), but a smaller difference by PND status in the number of outpatient visits (rural: 9.2, 95% CI: 8.2-10.2 vs. urban: 13.1, 95% CI: 12.7-13.5). Differences in expenditures for inpatient services by PND status differed by rural/urban status (rural: $2654; 95% CI: $1823-$3485 vs. urban: $1786; 95% CI: $1445-$2127). CONCLUSIONS: Commercially insured rural residents had more utilization for inpatient and ED services and less utilization for outpatient services. Rural locations can present barriers to evidence-based care to address PND.

Timing of Postpartum Depressive Symptoms.

Introduction: Postpartum depression is a serious public health problem that can adversely impact mother-child interactions. Few studies have examined depressive symptoms in the later (9-10 months) postpartum period. Methods: We analyzed data from the 2019 Pregnancy Risk Assessment Monitoring System (PRAMS) linked with data from a telephone follow-up survey administered to PRAMS respondents 9 to 10 months postpartum in 7 states (N = 1,954). We estimated the prevalence of postpartum depressive symptoms (PDS) at 9 to 10 months overall and by sociodemographic characteristics, prior depression (before or during pregnancy), PDS at 2 to 6 months, and other mental health characteristics. We used unadjusted prevalence ratios (PRs) to examine associations between those characteristics and PDS at 9 to 10 months. We also examined prevalence and associations with PDS at both time periods. Results: Prevalence of PDS at 9 to 10 months was 7.2%. Of those with PDS at 9 to 10 months, 57.4% had not reported depressive symptoms at 2 to 6 months. Prevalence of PDS at 9 to 10 months was associated with having Medicaid insurance postpartum (PR = 2.34; P = .001), prior depression (PR = 4.03; P <.001), and current postpartum anxiety (PR = 3.58; P <.001). Prevalence of PDS at both time periods was 3.1%. Of those with PDS at both time periods, 68.5% had prior depression. Conclusion: Nearly 3 in 5 women with PDS at 9 to 10 months did not report PDS at 2 to 6 months. Screening for depression throughout the first postpartum year can identify women who are not symptomatic early in the postpartum period but later develop symptoms.

A National Communication Effort Addressing Maternal Mortality in the United States: Implementation of the Hear Her Campaign.

More than 700 women die each year in the United States from complications related to pregnancy, and considerable racial and ethnic disparities continue to exist. Recognizing the urgent maternal warning signs of pregnancy-related complications, getting an accurate and timely diagnosis and quality care can save lives. In August 2020, the Centers for Disease Control and Prevention, Division of Reproductive Health launched a national communication campaign called "Hear Her" to raise awareness of urgent maternal warning signs during pregnancy and in the year after pregnancy and improve communication between pregnant or postpartum people and their support systems and health care providers. Storytelling is a central strategy to the campaign, which features video stories of women's experiences with pregnancy-related conditions to bring voices to the statistics and to help motivate action. These stories and additional campaign resources are disseminated through a website, digital media, organic (free) and paid social media, earned media, public service announcement distribution, and partners, with increased outreach to disproportionately affected communities. Partners in maternal and child health played an important role from campaign development to outreach and message dissemination. In the first year of the campaign, there were >390,000 unique visitors to the Hear Her website and 180 million impressions (number of times that content was displayed to a user) from digital and social media. Digital media allowed the campaign to reach priority audiences at a time when news and social media had a number of other urgent public health messages related to the COVID-19 pandemic.

US county-level estimation for maternal and infant health-related behavior indicators using pregnancy risk assessment monitoring system data, 2016-2018.

BACKGROUND: There is a critical need for maternal and child health data at the local level (for example, county), yet most counties lack sustainable resources or capabilities to collect local-level data. In such case, model-based small area estimation (SAE) could be a feasible approach. SAE for maternal or infant health-related behaviors at small areas has never been conducted or evaluated. METHODS: We applied multilevel regression with post-stratification approach to produce county-level estimates using Pregnancy Risk Assessment Monitoring System (PRAMS) data, 2016-2018 (n = 65,803 from 23 states) for 2 key outcomes, breastfeeding at 8 weeks and infant non-supine sleeping position. RESULTS: Among the 1,471 counties, the median model estimate of breastfeeding at 8 weeks was 59.8% (ranged from 34.9 to 87.4%), and the median of infant non-supine sleeping position was 16.6% (ranged from 10.3 to 39.0%). Strong correlations were found between model estimates and direct estimates for both indicators at the state level. Model estimates for both indicators were close to direct estimates in magnitude for Philadelphia County, Pennsylvania. CONCLUSION: Our findings support this approach being potentially applied to other maternal and infant health and behavioral indicators in PRAMS to facilitate public health decision-making at the local level.

Healthcare Utilization and Costs Associated With Perinatal Depression Among Medicaid Enrollees.

INTRODUCTION: Differences in healthcare utilization and medical expenditures associated with perinatal depression are estimated. METHODS: Using the MarketScan Multi-State Medicaid Database, the analytic cohort included individuals aged 15-44 years who had an inpatient live birth delivery hospitalization between January 1, 2017 and December 31, 2018. Multivariable negative binomial regression models were used to estimate the differences in utilization associated with perinatal depression, and multivariable generalized linear models were used to estimate the differences in expenditures associated with perinatal depression. Analyses were conducted in 2021. RESULTS: The cohort included 330,593 individuals. Nearly 17% had perinatal depression. Compared with individuals without perinatal depression individuals with perinatal depression had a larger number of inpatient admissions (0.19, 95% CI=0.18, 0.20), total inpatient days (0.95, 95% CI=0.92, 0.97), outpatient visits (14.02, 95% CI=13.81, 14.22), emergency department visits (1.70, 95% CI=1.66, 1.74), and weeks of drug therapy covered by a prescription (28.70, 95% CI=28.12, 29.28) and larger total expenditures ($5,078, 95% CI=$4,816, $5,340). Non-Hispanic Black individuals had larger differences in utilization and expenditures for inpatient services and outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. Hispanic individuals had larger differences in utilization for outpatient visits but smaller differences in utilization for pharmaceutical services associated with perinatal depression than non-Hispanic White individuals. CONCLUSIONS: Individuals with perinatal depression had more healthcare utilization and medical expenditures than individuals without perinatal depression, and differences varied by race/ethnicity. The findings highlight the need to ensure comprehensive and equitable mental health care to address perinatal depression.

Implementation of Community­Wide Initiatives Designed to Reduce Teen Pregnancy: Measuring Progress in a 5­Year Project in 10 Communities.

Introduction: Community-wide initiatives (CWI) to prevent teen pregnancy were implemented in 10 communities in the USA. The CWI supported the implementation of evidence-based teen pregnancy interventions (EBIs) and implementation of best practices for adolescent reproductive health care. Implementation was supported through mobilizing communities, educating stakeholders, and strategies to promote health equity. Methods: We assessed indicators of progress of the CWI for the following five project components (data collected from 2010 to 2015): community mobilization, stakeholder education, working with diverse communities, evidence-based interventions, and increasing access to clinical services and the potential contributions of training and technical assistance. Results: Communities engaged multiple stakeholder groups to contribute to planning, community outreach and education, and partnership development and used multiple dissemination methods to share information on adolescent reproductive health needs and teen pregnancy prevention strategies. The amount of training and technical assistance from state- and community-based organizations was associated with increased numbers of youth receiving EBIs and increased provision of contraceptives. The number of health centers implementing best practices for adolescent reproductive health services increased; conducting sexual health assessments, offering hormonal contraception or IUD, and offering quick start of IUDs were associated with increases in long-acting reversible contraception utilization. Conclusions: These findings demonstrate that scaled prevention efforts can occur with adequate support including training and technical assistance and community awareness and engagement in the process. Policy Implications: The findings raise important questions for understanding what factors contribute to successful community-wide implementation of EBIs and health center best practices for contraceptive access and whether these lead to reductions in teen pregnancies in highly impacted communities.

Vital Signs: Prescription Opioid Pain Reliever Use During Pregnancy - 34 U.S. Jurisdictions, 2019.

BACKGROUND: Prescription opioid use during pregnancy has been associated with poor outcomes for mothers and infants. Studies using administrative data have estimated that 14%-22% of women filled a prescription for opioids during pregnancy; however, data on self-reported prescription opioid use during pregnancy are limited. METHODS: CDC analyzed 2019 data from the Pregnancy Risk Assessment Monitoring System (PRAMS) survey in 32 jurisdictions and maternal and infant health surveys in two additional jurisdictions not participating in PRAMS to estimate self-reported prescription opioid pain reliever (prescription opioid) use during pregnancy overall and by maternal characteristics among women with a recent live birth. This study describes source of prescription opioids, reasons for use, want or need to cut down or stop use, and receipt of health care provider counseling on how use during pregnancy can affect an infant. RESULTS: An estimated 6.6% of respondents reported prescription opioid use during pregnancy. Among these women, 21.2% reported misuse (a source other than a health care provider or a reason for use other than pain), 27.1% indicated wanting or needing to cut down or stop using, and 68.1% received counseling from a provider on how prescription opioid use during pregnancy could affect an infant. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: Among respondents reporting opioid use during pregnancy, most indicated receiving prescription opioids from a health care provider and using for pain reasons; however, answers from one in five women indicated misuse. Improved screening for opioid misuse and treatment of opioid use disorder in pregnant patients might prevent adverse outcomes. Implementation of public health strategies (e.g., improving state prescription drug monitoring program use and enhancing provider training) can support delivery of evidence-based care for pregnant women.

Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression - United States, 2018.

INTRODUCTION: Perinatal depression is a complication of pregnancy that can result in adverse maternal and infant outcomes. Screening to identify pregnant and postpartum women with depressive symptoms is recommended to provide diagnosis, treatment, and follow-up care to reduce poor outcomes. METHODS: CDC analyzed 2018 data from the Pregnancy Risk Assessment Monitoring System to describe postpartum depressive symptoms (PDS) among women with a recent live birth and to assess whether health care providers asked women about depression during prenatal and postpartum health care visits, by site and maternal and infant characteristics. RESULTS: Among respondents from 31 sites, the prevalence of PDS was 13.2%, ranging from 9.7% in Illinois to 23.5% in Mississippi. The prevalence of PDS exceeded 20% among women who were aged ≤19 years, were American Indian/Alaska Native, smoked during or after pregnancy, experienced intimate partner violence before or during pregnancy, self-reported depression before or during pregnancy, or whose infant had died since birth. The prevalence of women reporting that a health care provider asked about depression during prenatal care visits was 79.1% overall, ranging from 51.3% in Puerto Rico to 90.7% in Alaska. The prevalence of women reporting that a provider asked about depression during postpartum visits was 87.4% overall, ranging from 50.7% in Puerto Rico to 96.2% in Vermont. CONCLUSIONS AND IMPLICATIONS FOR PUBLIC HEALTH PRACTICE: The prevalence of self-reported PDS varied by site and maternal and infant characteristics. Whether providers asked women about perinatal depression was not consistent across sites. Provision of recommended screenings and appropriate referrals for diagnosis, treatment, and follow-up care can ensure early and effective management of depression to reduce adverse maternal and infant outcomes.

The Teen Access and Quality Initiative: Improving Adolescent Reproductive Health Best Practices in Publicly Funded Health Centers.

Quality adolescent sexual and reproductive health (ASRH) services play an important role in supporting the overall health and well-being of adolescents. Improving access to this care can help reduce unintended pregnancies, sexually transmitted diseases (STDs), and human immunodeficiency virus (HIV) infection and their associated consequences, as well as promote health equity. The Centers for Disease Control and Prevention funded three grantees to implement a clinic-based ASRH quality improvement initiative complimented by activities to strengthen systems to refer and link youth to ASRH services. The purpose of this study is to describe the initiative and baseline assessment results of ASRH best practice implementation in participating health centers. The assessment found common use of the following practices: STD/HIV screening, education on abstinence and the use of dual protection, and activities to increase accessibility (e.g., offering after-school hours and walk-in and same-day appointments). The following practices were used less frequently: provider training for Long-Acting Reversible Contraception (LARC) insertion and removal, LARC availability, same-day provision of all contraceptive methods, and consistent sharing of information about confidentiality and minors' rights with adolescent clients. This study describes the types of training and technical assistance being implemented at each health center and discusses implications for future programming.

Socioecological risk factors associated with teen pregnancy or birth for young men: A scoping review.

INTRODUCTION: Teen pregnancy prevention typically focuses on young women, overlooking the unique prevention needs of young men. Identifying factors associated with teen pregnancy for young men is essential to developing relevant and effective programming. METHODS: We conducted a scoping review of studies with findings on factors associated with pregnancies/birth specific to young men. We searched Scopus, OVID, and PubMed databases for peer-reviewed articles published from 2000 to 2015. We reviewed 1750 articles for inclusion of studies conducted in the United States with a sample size greater than 200 that assessed the effect of factors on teen pregnancy/birth using multivariate, male-specific analyses. Two coders abstracted 48 articles (having established 80% reliability with 10% of the articles). We grouped study variables into factors and used a matrix to summarize findings for each factor. During analysis, 29 articles were excluded for a final sample of 19 articles, each describing a separate study. RESULTS: Study settings included households, healthcare organizations, schools, neighborhoods, and correctional facilities. Factors showing associations with teen pregnancy/birth included: experiencing childhood abuse; engaging in serious or repeated delinquent behaviors; substance abuse; having a teen parent; serious family disruption; not living with either parent; and Hispanic ethnicity. No studies assessed knowledge and attitudes about contraceptive methods, or access and use of clinical services; and few assessed relationship factors (n = 4) or gender and power (n = 1). CONCLUSIONS: Factors related to disadvantaged social contexts were associated with teen pregnancy/birth. Resilience-based research may identify protective factors to support vulnerable families and youth.

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.

Implementing Evidence-Based Teen Pregnancy-Prevention Interventions in a Community-Wide Initiative: Building Capacity and Reaching Youth.

PURPOSE: To describe efforts to implement evidence-based interventions (EBIs) within multicomponent, community-wide initiatives to reduce teen pregnancy. METHODS: During 2011-2014, we collected information about the capacity (i.e., knowledge, confidence, training, and experience) of state and community-based organizations to support implementation of the following: EBIs, number and characteristics of youth served by EBIs, type of EBIs implemented, EBI settings, hours of training, and technical assistance provided. State and community-based organizations reported these data annually; however, training and technical assistance was reported monthly. We used aggregated data from these annual and monthly reports to describe the implementation of EBIs in the community-wide initiative project. RESULTS: From baseline in 2011-2014, state and community-based organizations increased their capacities to support program partners in delivering EBIs. They provided 5,015 hours of technical assistance and training on topics, including ensuring adequate capacity, process and outcome evaluation, program planning, and continuous quality improvement. Program partners increased the number of youth reached by an EBI in targeted communities by 349%, from 4,304 in the first year of implementation in 2012 to 19,344 in 2014. Most youth in 2014 received sexuality education programs (59%), whereas smaller percentages received abstinence-based, youth development, and clinic-based programs. Most youth were reached through schools (72%) and community-based organizations (16%), and smaller numbers were reached in other settings (e.g., faith-based organizations, health centers). CONCLUSIONS: Building and monitoring the capacity of program partners to deliver EBIs through technical assistance and training is important. In addition, partnering with schools leads to reaching more youth.

Stakeholder Education and Community Mobilization Garner Support for Sex Education.

PURPOSE: The University of Texas Health Science Center at San Antonio UT Teen Health (UTTH) implemented a community-wide teen pregnancy prevention (TPP) initiative in south San Antonio. This article describes how UTTH staff educated community stakeholders and mobilized community members to support implementation of evidence-based TPP interventions. METHODS: UTTH educated key stakeholders about the need for TPP efforts, strong local support for such efforts, and the value of evidence-based interventions (EBIs). The process of stakeholder education and partnership development leading to implementation of EBIs was lengthy with, for example, an average of 11 meetings and 13.5 months between the initial meeting and formal approval of EBI implementation among school partners. UTTH also mobilized the community by engaging community members on leadership teams that actively supported the initiative efforts. RESULTS: Partnerships to implement EBIs were developed with 16 middle and high schools across five local school districts, two divisions of the juvenile justice system, and five youth-serving organizations. From 2011 to 2015, more than 12,500 youth (51% female) aged 11 to 19 years received EBIs. Of the total served, 95% were served through partnerships with local schools, 4% by juvenile justice, and 1% by youth-serving organizations. CONCLUSIONS: Engaging and educating members of the community require notable time and resource investments up front; however, once strong partnerships are built, there is an ongoing opportunity to reach youth. In south San Antonio, schools provided the opportunity to reach the largest numbers of youth.

Practical Approaches to Evaluating Progress and Outcomes in Community-Wide Teen Pregnancy Prevention Initiatives.

This paper presents an overview of the key evaluation components for a set of community-wide teen pregnancy prevention initiatives. We first describe the performance measures selected to assess progress toward meeting short-term objectives on the reach and quality of implementation of evidence-based teen pregnancy prevention interventions and adolescent reproductive health services. Next, we describe an evaluation that will compare teen birth rates in intervention communities relative to synthetic control communities. Synthetic controls are developed via a data-driven technique that constructs control communities by combining information from a pool of communities that are similar to the intervention community. Finally, we share lessons learned thus far in the evaluation of the project, with a focus on those lessons that may be valuable for local communities evaluating efforts to reduce teen pregnancy.

Implementation of Community-Wide Teen Pregnancy Prevention Initiatives: Focus on Partnerships.

Seeking to reduce teen pregnancy and births in communities with rates above the national average, the Centers for Disease Control and Prevention, in partnership with the U.S. Department of Health and Human Services Office of Adolescent Health Teen Pregnancy Prevention Program, developed a joint funding opportunity through which grantees worked to implement and test an approach involving community-wide teen pregnancy prevention initiatives. Once these projects had been in the field for 2.5 years, Centers for Disease Control and Prevention staff developed plans for a supplemental issue of the Journal of Adolescent Health to present findings from and lessons learned during implementation of the community-wide initiatives. When the articles included in the supplemental issue are considered together, common themes emerge, particularly those related to initiating, building, and maintaining strong partnerships. Themes seen across articles include the importance of (1) sharing local data with partners to advance initiative implementation, (2) defining partner roles from the beginning of the initiatives, (3) developing teams that include community partners to provide direction to the initiatives, and (4) addressing challenges to maintaining strong partnerships including partner staff turnover and delays in implementation.

Teen Pregnancy Prevention: Implementation of a Multicomponent, Community-Wide Approach.

This article provides an overview and description of implementation activities of the multicomponent, community-wide initiatives of the Teenage Pregnancy Prevention Program initiated in 2010 by the Office of Adolescent Health and the Centers for Disease Control and Prevention. The community-wide initiatives applied the Interactive Systems Framework for dissemination and implementation through training and technical assistance on the key elements of the initiative: implementation of evidence-based teen pregnancy prevention (TPP) interventions; enhancing quality of and access to youth-friendly reproductive health services; educating stakeholders about TPP; working with youth in communities most at risk of teen pregnancy; and mobilizing the community to garner support. Of nearly 12,000 hours of training and technical assistance provided, the majority was for selecting, implementing, and evaluating an evidence-based TPP program. Real-world implementation of a community-wide approach to TPP takes time and effort. This report describes implementation within each of the components and shares lessons learned during planning and implementation phases of the initiative.

Finding shelter: two-year housing trajectories among homeless youth.

PURPOSE: The aim of this study was to (1) identify trajectories of homeless youth remaining sheltered or returning to shelter over a period of 2 years, and (2) to identify predictors of these trajectories. METHOD: A sample of 426 individuals aged 14-24 years receiving services at homeless youth serving agencies completed six assessments over 2 years. Latent class growth analysis was applied to the reports of whether youth had been inconsistently sheltered (i.e., living on the street or in a squat, abandoned building, or automobile) or consistently sheltered (i.e., not living in any of those settings) during the past 3 months. RESULTS: Three trajectories of homeless youth remaining sheltered or returning to shelter were identified: consistently sheltered (approximately 41% of the sample); inconsistently sheltered, short-term (approximately 20%); and inconsistently sheltered, long-term (approximately 39%). Being able to go home and having not left of one's own accord predicted greater likelihood of membership in the short-term versus the long-term inconsistently sheltered trajectory. Younger age, not using drugs other than alcohol or marijuana, less involvement in informal sector activities, being able to go home, and having been homeless for <1 year predicted membership in the consistently sheltered groups versus the long-term inconsistently sheltered groups in the multivariate analyses. CONCLUSIONS: Findings suggest that being able to return home is more important than the degree of individual impairment (e.g., substance use or mental health problems) when determining the likelihood that a homeless youth follows a more or a less chronically homeless pathway.

Protective factors associated with fewer multiple problem behaviors among homeless/runaway youth.

Although homeless youth exhibit numerous problem behaviors, protective factors that can be targeted and modified by prevention programs to decrease the likelihood of involvement in risky behaviors are less apparent. The current study tested a model of protective factors for multiple problem behavior in a sample of 474 homeless youth (42% girls; 83% minority) ages 12 to 24 years. Higher levels of problem solving and planning skills were strongly related to lower levels of multiple problem behaviors in homeless youth, suggesting both the positive impact of preexisting personal assets of these youth and important programmatic targets for further building their resilience and decreasing problem behaviors. Indirect relationships between the background factors of self-esteem and social support and multiple problem behaviors were significantly mediated through protective skills. The model suggests that helping youth enhance their skills in goal setting, decision making, and self-reliant coping could lessen a variety of problem behaviors commonly found among homeless youth.