Social networks: A hypothesized mediator in the association between incarceration and risk behaviors among women with histories of homelessness | Journal of the Society for Social Work and Research
2015 Objective: Research on women with histories of homelessness shows both higher rates of incarceration and higher rates of HIV-risk behaviors. However, understanding homeless women’s experiences with the criminal justice system is hampered by the dearth of social network research with this population. To fill this gap and in an effort to enhance HIV-risk reduction among women with histories of homelessness, we examine whether incarceration history contributes to HIV-risk behaviors, and explore whether personal networks mediate the potential association between incarceration and HIV-risk behaviors. Method: This study uses a sample of 445 women with histories of homelessness. Women self-reported lifetime experience of incarceration and recent 6-month participation in 3 risk behaviors: multiple sex partnership, sex trade, and crack/cocaine use. Personal network characteristics included number of network members who had risky sexual behaviors and network members who had ever been incarcerated. Path analysis is used to answer whether incarceration is associated with the 3 risk behaviors and if risky personal networks mediate those relationships. Results: Findings indicate that incarceration is directly and indirectly (through personal networks) associated with all 3 risk behaviors. Though limited by the temporal structure of the data, the associations between incarceration, personal networks, and risk behaviors suggest incarceration can be a standalone correlate of HIV risk. Conclusion: This study validates a need to intervene earlier in the criminal justice process and to incorporate personal network composition into interventions for women with histories of homelessness and incarceration.
To use or not to use: A stage-based approach to understanding condom use among homeless youth | AIDS Care
2014 This study used a stage-based approach to understand condom use behavior in a representative sample of 309 sexually active homeless youth recruited from shelters, drop-in centers, and street sites in Los Angeles County. Focusing on the youth's most recent sexual event, the three stages of condom use examined were: (1) whether the partners decided prior to the event about using condoms; (2) whether a condom was available at the event; and (3) whether a condom was used at the event. Logistic regression analysis was used to identify attitudinal, relationship, and contextual correlates of each of these three stages. Deciding ahead of time about condom use was associated with being Hispanic, level of education, condom attitudes, and various relationship characteristics (e.g., partner type, monogamy, relationship abuse), with the nature of these associations varying depending on the type of decision (i.e., deciding to use, deciding to not use). Condom availability was more likely to be reported by males, if the event was described as being special in some way, or if the event lacked privacy. Condom use was more likely among youth with more positive condom attitudes and among youth who decide ahead of time to use a condom, but less likely among those in monogamous relationships or when hard drugs were used prior to sex. Whether sexual intercourse is protected or unprotected is the end result of a series of decisions and actions by sexual partners. Results from this study illustrate how condom use can be better understood by unpacking the stages and identifying influential factors at each stage. Each stage may, in and of itself, be an important target for intervention with homeless youth.
Service integration to reduce homelessness in Los Angeles County: Multiple stakeholder perspectives | Human Services Organization Management, Leadership & Governance,
2014 Homeless people are among the most marginalized individuals in the United States and experience significant rates of morbidity and mortality. Los Angeles County, California, has the highest concentration of homeless individuals in the nation, and although it features the largest health and social services system available to homeless people, it faces significant challenges to provide cost-effective integrated care. Housing and highly coordinated or integrated care represents an efficient and effective way to serve homeless individuals. Based on content analysis of symposium proceedings that included multiple stakeholders who engaged in a daylong structured conversation about challenges and opportunities related to the development of a fully integrated system of care, this manuscript presents insights about the state of service integration in the largest county in the United States. We discuss implications for the health and social services system, including a call for developing an strategic plan to vertically integrate care to address issues of homelessness.
Systematic review of intimate partner violence prevention programs and applicability to homeless youth | Journal of the Society for Social Work and Research
2014 This systematic review explores empirical research published between 2002 and 2012 regarding the effectiveness of prevention programs for intimate partner violence. To assess whether and to what extent programs might be applicable to implementation with a homeless youth population, we categorize studies as being tested with the general youth population or with at-risk youth populations. Quality of the research is assessed by comparing participant selection, study design, assessment instruments, and program outcomes. Applicability to homeless youth is assessed by examining setting, participants, curriculum, duration of intervention, target outcomes, measures and instruments, and results. After retrieving abstracts from various databases using search words that reflected our research questions, we identified 14 studies that met the review inclusion criteria. Of the 14 programs reviewed, 7 were implemented with the general youth population and 7 programs were implemented with “at-risk” youth. Although some programs show sufficient promise to warrant further research (e.g., efficacy and effectiveness trials), whether these programs can be adapted to fit the needs of homeless youth remains unclear. Therefore, preventing intimate partner violence among homeless youth might require efforts to develop a new intervention that not only meets the needs of homeless youth but also meets the needs of those providing services for homeless youth.
