Self-Identification of Mental Health Problems Among Young Adults Experiencing Homelessness.

Young adults experiencing homelessness (YAEH) have high rates of mental health problems but low rates of mental health service use. This study examined identification of mental health problems among YAEH in seven U.S. cities and its relationship to service use. YAEH that screened positive for depression, psychological distress, or Post Traumatic Stress (n = 892) were asked whether they felt they had a mental health problem. One-third identified as having a mental health problem (35%), with 22% endorsing not sure. Multinomial logistic regression models found that older age, cisgender female or gender-expansive (compared to cisgender male), and LGBQ sexual orientation, were positively associated with self-identification and Hispanic race/ethnicity (compared to White) was negatively associated. Self-identification of a mental health problem was positively associated with use of therapy, medications, and reporting unmet needs. Interventions should target understanding mental health, through psychoeducation that reduces stigma, or should reframe conversations around wellness, reducing the need to self-identify.

Individual and Social Network Correlates of Sexual Health Communication Among Youth Experiencing Homelessness.

Despite the potential for sexual health communication to be leveraged for HIV prevention among youth experiencing homelessness (YEH), there has yet to be a rigorous examination of individual and network or relational characteristics associated with sexual health communication in this group of young people. Cross-sectional survey and social network data from 1014 YEH aged 14-25 recruited in Los Angeles, California, were utilized to assess individual and network or relational characteristics associated with communication regarding condom use and HIV testing among YEH. Results suggest that social networks are key to understanding sexual health communication; YEH's engagement in sexual health communication was significantly related to the composition of their networks. To increase testing and decrease new HIV cases, a prudent strategy would be to train existing social network members (e.g., staff members, home-based peers, or partners) as agents of change in naturally occurring social networks of YEH.

Human Papillomavirus Vaccination Initiation and Completion among Youth Experiencing Homelessness in Seven U.S. Cities.

Little is known about human papillomavirus (HPV) vaccination uptake among youth experiencing homelessness (YEH), who may be at higher risk for HPV than their housed counterparts. We examined the prevalence and associations of HPV vaccination initiation and completion among YEH. Guided by the Behavioral Model for Vulnerable Populations, we analyzed cross-sectional data collected from YEH (N = 1074; ages 18-26) in seven U.S. cities to assess HPV vaccination prevalence and to identify predisposing, enabling, and need factors associated with HPV vaccination status. Due to timing differences in the release of HPV vaccine recommendations, we conducted separate logistic regression analyses for men (n = 673) and women (n = 401). Approximately 19% of men and 37% of women had initiated and completed HPV vaccination. Several factors among men (i.e., older age, Latinx ethnicity, San Jose or St. Louis residence compared with New York City, never having had sex, and not previously being tested for STIs) and women (i.e., lower education level, San Jose or Houston residence compared with New York City, and never having had sex) were associated with lower odds of HPV vaccination initiation, completion, or both. Gay men had higher odds of initiating and completing the vaccination series than their heterosexual counterparts. Our findings reveal that HPV vaccination uptake is low among YEH and that there are vaccination disparities among subgroups of YEH. HPV vaccination strategies and resources that are easy-to-understand, facilitate point-of-care services, and address societal and system-level vaccination barriers encountered by YEH are needed.

On the fringes: How youth experiencing homelessness conceptualize social and economic inequality-A Photovoice study.

This study used Photovoice methods with young adults experiencing homelessness to collaboratively identify issues that are of greatest importance in an open-ended, exploratory, and inductive manner. Participants selected two concepts to focus their inquiry: freedom and prosperity. Within these concepts, participants discussed nature as a source of inspiration, a desire to better themselves and to change their situations, and passion for contributing to social change by exposing economic inequality and raising awareness about homelessness. These findings demonstrate that young people are keenly aware of the structural and macro-level factors that have contributed to their risks of social exclusion and marginalization.

Condomless Sex Among Homeless Youth: The Role of Multidimensional Social Norms and Gender.

Most studies of condomless sex among homeless youth have focused on peer norms, while excluding other potentially pertinent influences. This study explored how different types of relationships contributed to norms about condomless sex and whether such norms were associated with engagement in condomless sex among homeless youth. Additionally, because recent work has noted gender differences in social networks of male and female homeless youth, gender differences in social network norms of condomless sex were also assessed. Egocentric network data were collected from homeless youth accessing services at two drop-in centers in Los Angeles, CA (N = 976). Multivariate analyses (non-stratified and stratified by gender) assessed associations between descriptive, injunctive, and communicative norms and participants' engagement in condomless sex. Multivariate analyses indicated that perception of peer condom use and communication with sexual partners were significantly associated with not engaging in condomless sex. These relationships, however, varied by gender. Implications for interventions are discussed.

Prevalence and covariates of food insecurity among residents of single-room occupancy housing in Chicago, IL, USA.

OBJECTIVE: Emerging evidence suggests that food insecurity is a significant public health concern among people who are homeless or marginally housed. The present study assessed prevalence of food insecurity and its covariates among a group of marginally housed individuals living in single-room occupancy (SRO) dwellings, a population for which there is little extant health or nutrition research. DESIGN: Cross-sectional survey incorporating the Household Food Insecurity Access Scale. SETTING: Ten private SRO residences in the Uptown neighbourhood of Chicago, IL, USA, 2013. SUBJECTS: SRO residents over 18 years of age who were able to communicate verbally in English (n 153). RESULTS: Food insecurity was widespread among SRO residents, with 75 % of the sample considered food insecure and 52 % meeting criteria for severe food insecurity. Bivariate analyses indicated that female gender, eating most meals at a soup kitchen, having a mental health condition, problem drinking, having at least one chronic health condition, and diabetes were all significantly associated with food insecurity. In the multivariate ordered logistic regression model, eating most meals at a soup kitchen remained as the only significant correlate of food insecurity (OR=10·13). CONCLUSIONS: SRO residents and other marginally housed populations face unique food access challenges. Although targeted assistance in the form of food stamps and congregate meal programmes remains critical, efforts to prevent and address food insecurity among homeless and marginally housed individuals should include policy interventions that recognize poverty as the root cause of food insecurity and aim to increase overall income and improve housing conditions.

Social Networking Technology Use and Engagement in HIV-Related Risk and Protective Behaviors Among Homeless Youth.

Preliminary studies with homeless youth have found surprisingly pervasive social media use and suggest that youth's online interactions may be associated with their HIV-related risk and protective behaviors. As homeless youth are transient and difficult to engage in place-based services, social media may represent a novel venue for intervention. A critical 1st step in intervention development is gaining greater understanding of how homeless youth use social media, especially as it relates to who they connect to and around what topics. Given the salience of social networking sites in the lives of these otherwise difficult-to-reach adolescents, and their potential to disseminate prevention interventions, this study assessed associations between online social networking technology use and HIV risk behaviors among homeless youth in Los Angeles, California. Homeless youth ages 13 through 24 (N = 1,046) were recruited through 3 drop-in centers and surveyed about their social media use and self-reported HIV-related risk behaviors. Results suggest that social media use is widely prevalent among this population, and the content of these online interactions is associated with whether youth engage in risk or protective behaviors. Implications for interventions and further research are discussed.

Sociometric network structure and its association with methamphetamine use norms among homeless youth.

Homeless youths' social networks are consistently linked with their substance use. Social networks influence behavior through several mechanisms, especially social norms. This study used sociometric analyses to understand whether social norms of drug use behaviors are clustered in network structures and whether these perceived norms (descriptive and injunctive) influence youths' drug use behaviors. An event-based approach was used to delineate boundaries of the two sociometric networks of homeless youth, one in Los Angeles, CA (n = 160) and the other in Santa Monica, CA (n = 130). Network characteristics included centrality (i.e., popularity) and cohesiveness (location in dense subnetworks). The primary outcome was recent methamphetamine use. Results revealed that both descriptive and injunctive norms influenced methamphetamine use. Network cohesion was found to be associated with perception of both descriptive and injunctive norms in both networks, however in opposite directions. Network interventions therefore might be effective if designed to capitalize on social influence that naturally occurs in cohesive parts of networks.

Network Influences on the Sexual Risk Behaviors of Gay, Bisexual and Other Men Who Have Sex with Men Using Geosocial Networking Applications.

Geosocial networking applications (GSN apps) have become increasingly popular among gay, bisexual and other men who have sex with men (MSM). Our study sought to understand whether inclusion of individuals met via GSN apps in participants' social networks was associated with increased HIV risk behaviors among a probability sample of GSN app using MSM (N = 295) recruited in Los Angeles, California. Approximately 20 % of participants included a GSN app-met individual as one of their top five closest social network members. Those with a GSN app-met network member had more recent (past 30-day) sexual partners (B = 1.21, p < 0.05), were nearly twice as likely to have engaged in unprotected anal intercourse (UAI) with their last sexual partner (AOR = 2.02, p < 0.05), and were nearly four times as likely to have engaged in UAI with their last GSN app-met sexual partner (AOR = 3.98, p < 0.001). Network-based interventions delivered via GSN apps may be useful in preventing the spread of HIV among MSM.

Perceived risk and condom use among adolescents in sub-Saharan Africa: a latent class analysis.

While studies have examined factors associated with condom use behaviors, few have assessed risk perception and condom use among SSA adolescents. This work sought to fill this gap. Data for this study are derived from the National Survey of Adolescents (2004-2005), a survey of 12-19 year olds in Burkina Faso, Ghana, Malawi, and Uganda. Latent class analysis was conducted. Two risk profiles emerged in the data. Percent of adolescents in the high perceived risk sub-groups ranged from 49.6% - 90.8% and moderate risk from 29.1-83.8%. Those in the high perceived risk class were 2.26 to 5.10 times more likely to report condom use. The findings provide additional information about the factors that influence condom use among adolescents in these four countries. Because an individual's development is influenced by his/her settings and systems, expanded views of behavior must be included in prevention efforts.

Internet and Social Media Use as a Resource Among Homeless Youth.

Little is known about internet and social media use among homeless youth. Consistent with typologies prevalent among housed youth, we found that homeless youth were using internet and social media for entertainment, sociability, and instrumental purposes. Using Haythornwaite's (2001) premise that it is important to look at the types of ties accessed in understanding the impact of new media, we found that homeless youth were predominantly using e-mail to reach out to their parents, caseworkers, and potential employers, while, using social media to communicate with their peers. Using the "Social Capital" perspective, we found that youth who were connecting to maintained or bridging social ties were more likely to look for jobs and housing online than youth who did not.

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.

Position-specific HIV risk in a large network of homeless youths.

OBJECTIVES: We examined interconnections among runaway and homeless youths (RHYs) and how aggregated network structure position was associated with HIV risk in this population. METHODS: We collected individual and social network data from 136 RHYs. On the basis of these data, we generated a sociomatrix, accomplished network visualization with a "spring embedder," and examined k-cores. We used multivariate logistic regression models to assess associations between peripheral and nonperipheral network position and recent unprotected sexual intercourse. RESULTS: Small numbers of nominations at the individual level aggregated into a large social network with a visible core, periphery, and small clusters. Female youths were more likely to be in the core, as were youths who had been homeless for 2 years or more. Youths at the periphery were less likely to report unprotected intercourse and had been homeless for a shorter duration. CONCLUSIONS: HIV risk was a function of risk-taking youths' connections with one another and was associated with position in the overall network structure. Social network-based prevention programs, young women's housing and health programs, and housing-first programs for peripheral youths could be effective strategies for preventing HIV among this population.

Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention.

The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future.

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.

Examining sources of Social Support and Depression Prevention Among Pregnant Youth Experiencing Homelessness: Outcomes of a Seven-City Study.

Young adults experiencing homelessness (YAEH) with pregnancy history are at higher depression risk. Receiving social support is protective for depression in pregnancy. This study differentiates social support sources associated with depression by pregnancy history among YAEH.Using a subsample of data collected from YAEH in seven US cities that were collected through REALYST, we conducted stratified logistic regression models (by pregnancy history) to identify support sources associated with depression. Logistic regression analysis including the interaction term (i.e., pregnancy history x support sources) using the full sample was then conducted.A higher proportion with pregnancy history reported depression compared to those without. Support from home-based peers was significantly associated with reduced depression risks among YAEH with pregnancy history, but not among youth without. Home-based supports were less frequently indicated by homeless female youth with pregnancy experience.Home-based social support is protective against major depression for YAEH with pregnancy experience. Findings of this study suggest that interventions addressing depression among YAEH should take their pregnancy history and social support sources into consideration. Specifically, for YAEH with pregnancy history, facilitating supportive social ties with home-based peers may be promising in reducing their depression risks.

Just Research: Advancing Antiracist and Antioppressive Social Work Research.

The Society for Social Work and Research (SSWR) created its Research Capacity and Development Committee in 2017 to build research capacity across the careers of social work scholars. The committee has initiated multiple conferences and webinar sessions that have increasingly focused on antiracist and antioppressive (ARAO) research, including "Mentorship for Antiracist and Inclusive Research" and "Strategies for Supporting Antiracist Pedagogy & Scholarship: Reimagining Institutional Systems & Structures." This commentary integrates themes from these sessions and other discussions among committee members about strategies to advance ARAO research. Although SSWR board members reviewed and approved this submission, it is not an official statement of SSWR or its board of directors.

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).

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.

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.