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.

Gatekeeping beliefs, intent, and behavior among homeless youth.

No research has explored the potential of homeless youth to serve as gatekeepers for suicide prevention purposes. This study described and examined associations between gatekeeping beliefs (i.e. preparedness and efficacy), intent-to-intervene, and gatekeeping behaviors (approach/referral behavior). In a sample of 139 homeless youth (aged 14-24), regression analysis was used to characterize associations between gatekeeper beliefs, intent, and behaviors. On average, participants engaged in gatekeeper behaviors with 1-2 people over the past 3 months. Gatekeeping beliefs and intent were positively associated with behaviors. Gatekeeper training that targets these attributes is a promising prevention strategy for homeless youth, but may require population-specific adaptation.

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.

Understanding Wait Times in Rapid Re-Housing Among Homeless Youth: A Competing Risk Survival Analysis.

Approximately 3.5 million youth experience homelessness in the United States. Assisting youth to exit homelessness as quickly as possible through various housing venues aims to prevent adverse health impacts that prolonged homeless experiences may have on youth. Rapid re-housing (RRH) is a recent, short-term, less costly housing option than permanent supportive housing that provides temporary housing supports and services to counter homelessness. Although previous literature indicates that youth are likely to achieve stable homelessness exits via RRH, the duration of wait times for youth and potential disparities in RRH waiting periods remain unclear. We used administrative data from 16 communities across the United States (N = 10,920) to gain a greater understanding about RRH wait times among homeless youth. In addition, we adopted a competing risk survival analysis to investigate potential disparities (i.e., race and ethnicity, gender, rurality, sexual orientation, and previous homelessness condition) in RRH wait times while taking into consideration the presence of other homelessness exit options (e.g., permanent supportive housing). Study results indicate that RRH is a common homelessness exit for homeless youth and is prioritized for youth assessed as mid-vulnerability, per commonly accepted assessment measures of youth vulnerability. However, youth who received RRH waited, on average, 131 days following their housing eligibility assessment. Furthermore, being a minor (i.e., 17 years old or younger), experiencing homelessness in rural communities, and lower engagement in homeless services (e.g., emergency shelters and transitional living programs) were all associated with lower probability of exiting into RRH over time, taking into account the possibility of other competing homelessness exits. Expansion of the short-term housing supports offered through RRH may be a promising strategy to counter homelessness among youth in a timely manner. However, such an expansion should also address the potential disparities underlying youths' wait time to receive RRH in order to reduce prolonged homelessness experiences within this vulnerable population.

But Everyone is Doing It (Sort of)! Perceived Sexual Risks in the Social Environment and the Impact on Homeless Youth Engagement in Concurrent Sexual Relationships.

Although homeless youth are likely to engage in concurrent sexual relationships and doing so can accelerate HIV transmission, the issue of sexual concurrency (i.e., having sexual partnerships that overlap in time) has received scarce attention in this vulnerable population. The literature that exists tends to focus on individuals' characteristics that may be associated with concurrency and overlooks the influence of their social environment. Informed by the risk amplification and abatement model (RAAM), this study explored the association between pro-social and problematic social network connections, and sexual concurrency among homeless youth using drop-in center services (N = 841). Nearly 37% of youth engaged in concurrency. Partially consistent with the RAAM, regression analyses showed that affiliation with more problematic ties (i.e., having more network members who practice concurrency and unprotected sex) was associated with greater sexual concurrency. Programs addressing HIV risk among homeless youth in drop-in centers should consider the role youths' network composition may play in concurrency.

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.

Pilot Test of an Adapted, Evidence-Based HIV Sexual Risk Reduction Intervention for Homeless Women.

Women experiencing homelessness are at heightened risk for HIV, yet risk reduction interventions specifically designed for this population are lacking. This study reports on a pilot efficacy trial of a brief evidence-based intervention, Sister To Sister (STS), that we specifically adapted for homeless women in the temporary/emergency settings where they typically seek services. Seventy-nine women, recruited from three service sites in Los Angeles County, were assigned to the 40-min adapted STS intervention or an information-only control group. At 30-day follow-up, intervention participants reported significantly greater condom use, intentions to use condoms, and sexual impulse control (as well as marginally higher positive condom beliefs and condom self-efficacy) compared to control participants. Results provide preliminary evidence that HIV risk reduction can be achieved for homeless women through a brief skill-based intervention. A randomized controlled trial employing a longer follow-up period to monitor outcomes will be necessary to determine efficacy of the adapted intervention.

Understanding Consistent Condom Use Among Homeless Men Who Have Sex with Women and Engage in Multiple Sexual Partnerships: A Path Analysis.

Consistent condom use is the main strategy aimed at preventing individuals from acquiring HIV through sexual intercourse. The mechanism of consistent condom use among a high-risk homeless subpopulation-homeless men who have sex with women and also engage in multiple sexual partnerships-remains unclear. This study identified 182 homeless men who engaged in multiple sexual partnerships from a representative sample of homeless men, who self-identified as heterosexual, using meal line services in Downtown Los Angeles' Skid Row area. Information such as participants' condom use psychosocial correlates, sexual risk behaviors, and social network characteristics were collected. Results suggested that condom efficacy is a potential intervening mechanism through which condom attitudes (ß = -0.199; p = 0.005) and depression (ß = -0.156; p = 0.029) are associated with an individual's consistent condom use. Having more network members with whom participants talked about HIV prevention (ß = 0.051; p = 0.006) was also found to be associated with an individual's consistent condom use. HIV prevention programs should focus on increasing their condom efficacy to help reduce HIV risks among this vulnerable homeless subpopulation.

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.

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.

Behavioral health and social normative influence: correlates of concurrent sexual partnering among heterosexually-active homeless men.

Sexual concurrency poses significant HIV/STI transmission risk. The correlates of concurrency have not been examined among homeless men. A representative sample of 305 heterosexually active homeless men utilizing meal programs in the Skid Row area of Los Angeles reported on their mental health, substance use, and social network characteristics. Nearly 40% of men reported concurrency with one of their four most recent sex partners. Results indicated that HIV seropositivity (OR = 4.39, CI: 1.10, 17.46; P = 0.04), PTSD (OR = 2.29, CI: 1.05, 5.01; P = 0.04), hard drug use (OR = 2.45, CI: 1.07, 5.58; P = 0.03), and the perception that network alters engage in risky sex (OR = 3.72, CI: 1.49, 9.30; P = 0.01) were associated with increased odds of concurrency. Programs aimed at reducing HIV/STI transmission in this vulnerable population must take into account the roles that behavioral health and social networks may play in sexual concurrency.

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.

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).

Social Network Change after Moving into Permanent Supportive Housing: Who Stays and Who Goes?

Social relationships are important among persons experiencing homelessness, but there is little research on changes in social networks among persons moving into permanent supportive housing (PSH). Using data collected as part of a longitudinal study of 405 adults (aged 39+) moving into PSH, this study describes network upheaval during this critical time of transition. Interviews conducted prior to and after three months of living in PSH assessed individual-level characteristics (demographics, homelessness history, health and mental health) and included a social network component that assessed network size and composition (demographics, relationship type, social support); interviewers utilized network member characteristics to assess whether network members were new or sustained between baseline and 3 months post-housing. Multilevel logistic regression models assessed what characteristics of network members were associated with being newly-gained or persisting in networks 3 months after moving into PSH. We found that only one-third of social networks were retained during the transition to PSH, and that veterans, African Americans and other persons of racial/ethnic minorities, and those living in scattered-site housing were more likely to experience network disruption. Relatives, romantic partners, and service providers were most likely to be retained after move-in. Some network change was moderated by tie strength, including the retention of street-met persons. Implications are discussed.

Correlates of Housing Sustainability Among Youth Placed Into Permanent Supportive Housing and Rapid Re-Housing: A Survival Analysis.

PURPOSE: Youth experiencing homelessness (YEH) are vulnerable to multiple adverse health outcomes. Connecting YEH with housing is critical to addressing youth homelessness and to preventing long-term negative health consequences among this vulnerable population. Using administrative data, this study aims to explore correlates of YEH's sustainability in two major housing programs: permanent supportive housing (PSH) and rapid re-housing (RRH) programs. METHODS: This study used Homelessness Management Information System administrative data collected from 16 communities across the U.S. between January 1, 2015 and May 1, 2017 (n = 10,902). We conducted Cox proportional hazards survival analyses to explore correlates (e.g., demographics, homeless experiences, and overall vulnerability) of YEH's PSH (n = 577) and RRH (n = 2,883) sustainability separately. RESULTS: For YEH receiving PSH, only individuals' level of vulnerability is associated with greater hazard of exiting PSH. As for RRH sustainability, YEH who were 17 years old or younger, black or Latinx (as compared to white), of higher level of vulnerability, or previously spent most nights couch surfing or in transitional living programs (as compared to on the street) are associated with higher hazard of exiting RRH. CONCLUSIONS: Both PSH and RRH programs should incorporate comprehensive services targeting youth experiencing high vulnerability to prevent them from re-entering homelessness. Future RRH programming should also address housing sustainability disparities faced by racial and ethnic minority YEH, especially when they are disproportionately influenced by homelessness. Finally, RRH programs should incorporate services to foster independent living among younger YEH to sustain their housing status once temporary housing subsidies expire.

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.

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.

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.