A Snapshot of Substance Abuse Among Homeless and Runaway Youth in Denver, Colorado

We report on results of a one-day survey measuring rates of substance use and HIV risk behaviors among the homeless youth population of Denver, Colorado. On March 15, 2001, staff of Urban Peak, conducted a single-day survey of homeless and runaway youth in the Denver metropolitan region, going to locations known to be frequented by this population. All youth encountered were asked to fill out a brief survey asking about past nine month use of the following substances: alcohol, marijuana, cocaine, methamphetamine, heroin, hallucinogens, ecstasy and ketamine, and HIV risk behaviors. Chi-square analyses of the association of substance used and gender, age, living situation, and ethnicity were conducted. In addition, the use of any club drug was examined. One-hundred-eighty-six homeless or runaway youth were surveyed; 74 percent were between 16 and 25. Rates of use over the last nine months were as follows: alcohol, 69 percent; marijuana, 75 percent; methamphetamine, 18 percent; cocaine, 19 percent; heroin, 12 percent; hallucinogens, 30 percent; ecstasy, 25 percent; and ketamine, 13 percent. Eleven percent reported trading sex for drugs, money, food, or shelter; and 13 percent reported sharing needles. There were significant associations between living situation and use of marijuana, cocaine and hallucinogens. Prevalence rates of club drugs show 75 percent, 77 percent and 77 percent of homeless or runaway youth ihaving used ecstasy, ketamine and hallucinogens one to three times per month over the last nine months, respectively. Prevalence rates of substance use among homeless youth in the Denver metropolitan are similar to rates reported in other larger metropolitan areas. Routine screening for every substance needs to be part of the assessment for all homeless youth. Initial data points to a need for more research exploring protective factors among this population and to better understand the prevalence of club drug use.     

Runaway Youth Utilizing Crisis Shelter Services: Predictors of Presenting Problems

The evidence is clear that the problems of runaway youth are immense, varied, and persistent. Services must be designed to address these problems and the factors associated with them. This study investigated a sample (n=156) of runaway youths admitted to basic shelter services and evaluated the individual and family factors associated with various problem domains, including: family relationships, abuse, mental health, substance use, and educational difficulties. Findings demonstrated that family-oriented issues were the predominant predictors of youth problems. Results point to the need for developing and evaluating new approaches in solving problems of runaway youth that incorporate strengthening family relationships.     

Examining Risk Factors Associated With Family Reunification for Runaway Youth: Does Ethnicity Matter?

This study investigated the likelihood of family reunification across ethnic groups of 14,419 youth using runaway shelter services nationwide. Among White, African American, Hispanic, Native American, and Asian ethnic groups, youths who reported abuse or neglect by their parental figures or had parent(s) who were unemployed were less likely to reunify following a runaway episode. However, completing youth shelter services markedly increased the likelihood of reunification. Implications for cultural sensitivity in service delivery, particularly regarding family issues, are discussed.     

Prevention of HIV Among Adolescents

Adolescents are at risk for HIV primarily through their sexual behavior. A comprehensive prevention strategy includes a national HIV campaign based on social marketing principles; targeted social marketing, intensive skill building, and sexually transmitted disease control programs for youth at high risk; programs targeting institutions (e.g., school health clinics), providers, and parents; and interventions to identify and reduce risk acts among seropositive youth. The U.S. focus for HIV prevention has been single-session educational classes (an ineffective strategy) or intensive multi-session, small-group interventions for youth at high risk (demonstrated to increase condom use by about 30%). There is a need to expand the range, modalities, and dissemination of HIV prevention programs nationally, to recognize (especially by policymakers) limitations of abstinence programs, and to increase early detection of HIV among youth.     

Runaway and Pregnant: Risk Factors Associated with Pregnancy in a National Sample of Runaway/Homeless Female Adolescents

PURPOSE: Homeless youth are at particularly high risk for teen pregnancy; research indicates as many as 20% of homeless young women become pregnant. These pregnant and homeless teens lack financial resources and adequate health care, resulting in increased risk for low-birth-weight babies and high infant mortality. This study investigated individual and family-level predictors of teen pregnancy among a national sample of runaway/homeless youth in order to better understand the needs of this vulnerable population. METHODS: Data from the Runaway/Homeless Youth Management Information System (RHY MIS) provided a national sample of youth seeking services at crisis shelters. A sub-sample of pregnant females and a random sub-sample (matched by age) of nonpregnant females comprised the study sample (N = 951). Chi-square and t tests identified differences between pregnant and nonpregnant runaway females; maximum likelihood logistic regression identified individual and family-level predictors of teen pregnancy. RESULTS: Teen pregnancy was associated with being an ethnic minority, dropping out of school, being away from home for longer periods of time, having a sexually transmitted disease, and feeling abandoned by one's family. Family factors, such as living in a single parent household and experiencing emotional abuse by one's mother, increased the odds of a teen being pregnant. CONCLUSIONS: The complex problems associated with pregnant runaway/homeless teens create challenges for short-term shelter services. Suggestions are made for extending shelter services to include referrals and coordination with teen parenting programs and other systems of care.     

The Clustering of Risk Behaviors Among Caribbean Youth

Objective: To examine the relationships among risk behaviors for Caribbean youth; and to determine the correlations between initiation of sexual activity and other risk behaviors. Methods: The associations between cigarette smoking, alcohol and marijuana use, early initiation of sexual intercourse, involvement in violence and delinquency were examined using odds ratios on data from the Caribbean Youth Health Survey (n = 15,695). Survival analysis was then used to determine the association between initiation of sexual activity and the risk behaviors. Findings: There were statistically significant relationships between all pairs of risk behaviors for both male and female adolescents. Even though more males than females had engaged in each of the behaviors, the strengths of association were higher for females. From survival analysis, initiation of sexual activity was associated with gang involvement and weapon carrying among young adolescents and even more risk behaviors among the older adolescents. Conclusion: Health compromising behaviors cluster among Caribbean youth with associations being stronger for females. Initiating sexual activity was a predictor of other risk behaviors with the likelihood increasing among older adolescents and females.     

Using the Information-Motivation Behavioral Model to Predict Sexual Behavior Among Underserved Minority Youth

BACKGROUND: Testing, refining, and tailoring theoretical approaches that are hypothesized to reduce sexual risk behaviors among adolescent subpopulations is an important task. Relatively little is known about the relationship between components of the information-motivation-behavior (IMB) model and sexual behaviors among underage minority youth. Using the IMB model, this study examines predictors of risky sexual behavior among underserved Hispanic and African-American youth. METHODS: This cross-sectional study was conducted with a sample of 380 youths aged 11–17 years recruited in Los Angeles, California, and utilized latent variable models to examine interrelationships and predictive relations among IMB model variables associated with risky sexual behavior. RESULTS: Sixty percent of the participants aged 15–17 and 1 out of 10 participants aged 11–12 reported prior sexual intercourse. Of the sexually active, more than half reported having unprotected sex and 11% had sexual intercourse with 4 or more partners. Results of the structural equation model indicated that older age and attitudes against sexual activities had significant, direct impacts on risky sexual behaviors. Behavioral refusal skills, positioned as an intervening variable, also significantly predicted less risky sex. Knowledge, attitudes against sexual activities, and perceived peer pressure against sexual behavior predicted sexual refusal skills. Additionally, there were significant indirect effects on risky sexual behavior mediated through behavioral refusal skills. CONCLUSION: A large number of disadvantaged minority urban youth are engaged in risky sexual behaviors. Intervention programs, particularly those targeting preadolescents, should focus on building long-lasting behavioral skills that emphasize the reduction of peer pressure and normative influences on risky sexual behaviors. Components of the IMB model clearly have a role in the design of efficacious interventions.     

四川省未婚校外青少年艾滋病知识现状调查

目的了解四川省9县未婚校外青少年艾滋病相关的知识现状及需求。方法采用横断面设计、固定样本方便抽样法进行抽样,调查员面对面问卷调查方式开展现场调查。结果共调查1180名15—24岁的未婚校外青少年,运用国家艾滋病防治督导与评估框架指标评价艾滋病知识知晓率为69．3％（818／1180）,不同年龄组、不同民族和不同文化程度的校外青少年艾滋病知识知晓率不同,差别有统计学意义（X2=28．81,P〈0．01;x。=53．28,P〈0．01;x。=50．82,P〈0．01）,其中20岁以下年龄组、少数民族和初中以下文化程度的校外青少年艾滋病知识知晓率相对较低。校外青少年艾滋病知识主要来源于电视（81．9％）、报刊书籍（43．6％）和网络（63．1％）;希望获得艾滋病知识的3个主要途径,分别是电视（72．4％）、网络（53．3％）和宣传材料（29．4％）。结论某省校外青少年对于艾滋病知识有一定了解,但差别较大,应针对校外青少年的特点及需求,加强对校外青少年的艾滋病防治知识宣传教育。     

A measure to assess HIV treatment readiness among adolescents and young adults

HIV infections among adolescents and young adults continue to grow and clinical guidelines recommend the immediate start of life-saving antiretroviral therapy (ART). Unfortunately, suboptimal medication adherence among youth is common and can lead to poorer health outcomes as well as onward transmission of HIV to sexual partners. Clinical tools to assess treatment readiness are needed and can assist with adherence intervention strategies for youth. An assessment tool that we previously developed, the HIV Treatment Readiness Measure (HTRM), was administered to 595 HIV-positive youth ages 13–24 recruited from adolescent medicine clinics in the United States. Participants were followed for a minimum of 6 months and had to have at least one viral load test completed to be included in this analysis. The HTRM demonstrated high internal consistency (Chronbach’s alpha = 0.86). For participants currently on ART at study entry, higher overall treatment readiness scores predicted future viral suppression (OR 1.52). Individual scores on three of the measure’s factors (Psychosocial Issues, Connection with Care, and HIV Medication Beliefs) were also significant predictors of viral suppression. For those participants not on ART at study entry, the HIV Medication Beliefs factor significantly predicted who would eventually start ART (OR 2.26) but overall treatment readiness scores did not predict viral suppression in that group.     

艾滋病预防青年同伴教育项目

介绍了云南省红十字会和澳大利亚红十字会合作开展的艾滋病预防青年同伴教育项目的几个阶段，并着重介绍了项目的拓展阶段：即与不同的国际、国内组织共同合作或单独开展艾滋病预防项目的情况及成就。     

Youth health outcomes from the Connect-to-Protect coalitions to prevent adolescent HIV infections

We assessed the relationships among HIV-related social and behavioral outcomes resulting from an adolescent-focused HIV structural change initiative in eight urban sites operating Connect-to-Protect coalitions. Over a 4-year period, annual cross-sectional panels of adolescents (N = 2248) completed an audio-computer-assisted interview, providing data on satisfaction with their communities as adolescent-supportive environments, internalized HIV stigma, lifetime HIV-testing, lifetime sexual risk-taking and number of sexual partners in the prior year. We used structural equation modeling to estimate hypothesized links between time since coalition mobilization to our social and behavioral outcomes. Over the 4 years, adolescents perceived their communities to become more supportive (p < .05). Positive perceptions of community support were associated with lower lifetime HIV sexual risk (p < .05). The effect of time on risk behavior was mediated by perceptions of community support. Stigma was unchanged over time. Stigma had damaging effects on risk behavior, effects which were also mediated by perceptions of community support. Special efforts are needed to address the deleterious effect of HIV stigma on high-risk urban adolescents.     

Trajectories of risk behaviors and exiting homelessness among newly homeless adolescents

Using cluster analysis techniques, we identified two distinct clusters of newly homeless adolescents in Los Angeles (n = 261): those who are protected and doing relatively well while out of home with more protective than risk factors, and those who are risky with more risk than protective factors. The objective of this study was to examine the trajectories of human immunodeficiency virus (HIV) risk behaviors and exiting homelessness among protected newly homeless adolescents, compared to those who are classified as risky. HIV risk behavior included unprotected sex, having multiple sex partners and hard drug use. Logistic regression mixed-effects models were used to evaluate the trajectories of HIV risk behaviors and exiting homelessness over time. The adolescents in the protected group reported significantly less unprotected sex ( p = 0.0156), being abstinent or monogamous ( p < 0.0001) and less hard drug use ( p < 0.0001) compared to the adolescents in the risky group. In addition, the protected group reported more “exiting homelessness”, compared to the risky group ( p = 0.0007). However, the differences in the level of unprotected sex between the protected and risky groups decreased over time. Our findings confirm the notion that newly homeless adolescents are indeed heterogeneous. Given that the risk behavior profiles of protected group merges to the risky group over time, our findings underscore the need to mount tailored interventions to be designed for the protected group early in the process.     

南充市高坪区校内青少年艾滋病健康教育课效果分析

的分析南充市高坪区校内青少年艾滋病健康教育课教授效果，并探索其有效的健康教育模式。方法开展健康教育课前，按整群抽样原则，选择1所初中和1所高中作为基线调查，采取一对一方式按照中国-默沙东艾滋病防治合作项目调查表所列内容逐项询问登记。开课后再用同样的学校和方法调查，并将获得的信息分别录入Epidata2．1数据库统计分析。结果开课前调查534人，对8个问题总回答正确率为49．04％；开课后调查446人，回答正确率为70．40％，正确回答率差异有统计学意义（χ2=353．4，P〈0．01）。结论开展校内青少年艾滋病健康教育课能有效提高青少年对艾滋病的认知水平。     

Animal-Related Activities as Risk Factors for Injuries Among Youth on Agricultural Operations

ABSTRACT

Working with animals on agricultural operations is hazardous for youths. This study evaluated the associations between activities and injuries related to specific animal types. A case-control study within the Regional Rural Injury Study II included 425 youths (less than 20 years of age) with injuries related to their operation and 1,886 controls (randomly selected youths). Exposures of interest were collected for the months prior to injury events for cases and randomly selected months for controls, based on an injury incidence algorithm. Multivariate logistic regression characterized associations between specific animal-related activities and injury outcomes among youths who reported working with the same animals. Large proportions of cases and controls, respectively, worked with beef cattle (47%, 28%), followed by horses (28%, 14%), and dairy cattle (22%, 12%). Feeding was the primary activity associated with animals; over 80% of cases and controls were involved in this activity during relevant exposure months, followed by milking (63%, 44%) among those working with dairy cows and herding (81%, 61%) among beef cattle workers. Elevated risk of dairy cattle–related injury was associated with milking (odds ratio [OR]: 2.5; 95% confidence interval [CI]: 1.0–6.6) whereas beef cattle–related injuries were associated with calving (OR: 4.2; 95% CI: 2.1–8.6) and footwork (OR: 2.2; 95% CI: 1.0–4.9). Among youths working with animals, explicit activities can be identified that are associated with animal-specific injuries. The identification of relevant hazardous tasks is necessary for the development of effective prevention measures.     

Knowledge of HIV Risk Factors Among Immigrants in Thailand

This study is based on a sample of 3,374 immigrants from Cambodia and Myanmar who worked in 17 different provinces in Thailand. Many immigrants workers had not even heard of HIV/AIDS before coming to Thailand, but most have received instruction about HIV/AIDS from some source in Thailand, and a large majority are now aware of HIV/AIDS. While immigrant workers in Thailand are fairly knowledgeable about the risk factors for HIV transmission, important gaps remain. Women, persons with less than five years of education, seafarers, agricultural workers, those who do not personally know anyone affected by HIV/AIDS, and those who have not yet received instruction in HIV/AIDS are the ones most likely to have gaps in their knowledge of HIV/AIDS risk factors.

Food Sources for Homeless Youth: An Evaluation of Food Availability at a Homeless Youth Drop-In Center

Objective

We utilized a validated food inventory questionnaire to assess the types and quality of food available at a homeless youth drop-in center.