Comparing White and African American Homeless Youth in San Francisco: Research Findings and Policy Implications

Homeless youth are not a homogenous group. The needs of this population vary based on geographic location, demographic characteristics, and homelessness history. Some research indicates that racial and ethnic minorities are over-represented among homeless youth; other studies find that homeless youth generally reflect the racial and ethnic makeup of their local community. While researchers continue to identify the characteristics of homeless youth, it is important to understand the unique needs of all homeless young people. Research from the University of California at San Francisco School of Medicine, and the University Of California Berkeley School Of Public Health reveals important differences between white and African American homeless youth living on the streets in San Francisco. These differences may have significant implications for policy and programs to address and prevent youth homelessness in California

Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California.

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004. Methods. Using data collected from a longitudinal, venue-based sample of street youth 15-24 years of age, we calculated age, race, and gender-adjusted mortality rates. Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3-18.9]). Gender specific SMRs were 16.1 (95% CI [3.3-47.1]) for females and 9.4 (95% CI [4.0-18.4]) for males. Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the states general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population

Factors influencing abstinence, anticipation, and delay of sex among adolescent boys in high-STI prevalence communities

Purpose Abstinence is a core pregnancy and STI prevention strategy. We explore the attitudinal, behavioral, and family contexts relating to abstinence and the decision to delay sex among adolescent boys. Methods Adolescent boys ages 14–17 were recruited from community sites using a venue-based sampling method. All eligible boys at venues were invited to participate in an electronic survey. Question items included sexual behaviors, attitudes related to sex, relationships, masculine values, and family contextual items. Results We enrolled 667 participants, age 15.7 years, of diverse ethnicity. 252 (38%) were abstinent. Abstinent participants were younger, less likely to report non-coital behaviors, and reported lower conventional masculine values. Among abstinent participants, 62% planned to delay sex, while 38% anticipated sex in the next year. Participants with lower conventional masculine values, and more religious or moral motivations for abstinence were more likely to plan to delay sex. Discussion Abstinence among boys is common, even in high STI risk communities. For these boys, abstinence appears to be a complex behavioral decision, influenced by demographic, behavioral, attitudinal and contextual factors such as age, race, non-coital sexual behaviors and masculine values. Understanding the attitudes and contexts of abstinence, including plans to delay sex, can inform the development of public health programs for early fatherhood and STI prevention

Community-engaged Research with Rural Latino Adolescents: Design and Implementation Strategies to Study the Social Determinants of Health

The health of adolescents, perhaps more than in any other period of their life, is shaped by the social determinants of health (SDH). The constellation of SDH that disadvantages a specific group’s health may also make members of that population unable or unwilling to engage in health research. To build a comprehensive body of knowledge about how SDH operate within a specific social context, researchers must design studies that take into account how various vulnerabilities and oppressions may affect people’s experiences of being recruited, interviewed and retained in a study. In 2014, we initiated a prospective cohort study with Latino youth living in the agricultural area of Salinas, California. We began this study with the understanding that it was imperative to develop methodological strategies that actively addressed potential challenges in ways that were culturally responsive, community engaged and inclusive. In this article, we describe our approach to developing best practices in four key areas: 1) building community partnerships and engagement; 2) consideration of staffing and staff support; 3) engaging youth’s perspectives; and 4) developing culturally appropriate research protocols. In our sample of 599 participants, nearly all youth identify as Latinx (94 per cent), half (49 per cent) have at least one parent employed as a farmworker, 60 per cent reside in crowded housing conditions, and 42 per cent have mothers who did not complete high school. Given these multiple vulnerabilities, we view a robust number of youth expressing interest in study participation, the willingness of their parents to permit their children to be enrolled, and the achievement of an ambitious sample target as evidence that our efforts to undertake best practices in community-engaged and inclusive research were well received

Positive and Negative Experiences With Supportive Services and Programming: Gaps and Recommendations From Youth Experiencing Homelessness

Services for youth experiencing homelessness (YEH) are designed with limited input from the youth themselves. This study explored the experiences and recommendations for services aimed at mitigating the negative effects of homelessness among youth. A total of 45 interviews were conducted with YEH (ages 15 to 24, M = 21.5 years) who experienced at least one night of homelessness. Transcripts were coded by using a modified constructivist grounded theory approach. YEH reported myriad challenges to navigating disjointed programming and misguided policies. Recommendations from YEH for policy and programmatic change include peacekeeping and diffusion training for program staff, trauma-informed approaches, and conflict resolution among agency staff; and integrate creative outlets and transitional services into existing programs. Programming supporting YEH must extend beyond meeting only basic needs to creating opportunities for safety, autonomy, and growth. Programs targeting youth homelessness need input from YEH in their design and implementation

Research with Disadvantaged, Vulnerable and/or Marginalized Adolescents

Disadvantaged, vulnerable and/or marginalized adolescents (DVMAs) are individuals aged 10–19, who are excluded from social, economic and/or educational opportunities enjoyed by other adolescents in their community due to numerous factors beyond their control. These include factors at the social level (such as economic inequality, violence, stigma, racism, migration), family level (including neglect and abuse) and individual level (e.g. disability, ethnicity). DVMAs include adolescents who are immigrants or refugees; sexual minorities; orphans; incarcerated; those who have run away or been turned out of their homes following neglect and/or abuse; those who are trafficked; and those who belong to a stigmatized indigenous, ethnic, tribal or religious groups. Though gender plays an important role within each of these categories and for the group as a whole, in this brief we do not treat all girls and young women as DVMAs. As a result of their social exclusion, DVMAs suffer from health inequities, or avoidable inequalities in their health and well-being compared to the well-being of other adolescents. Research is needed to inform ways to address these inequities

The Sexual Health Needs of Adolescent Boys Involved in a Pregnancy

Objectives: Little is known about fatherhood in middle adolescence. In order to better understand their sexual health needs, we describe relationship characteristics, perception of masculinity and associated STI risk behaviors in a community-based sample of urban middle adolescent boys who have fathered a child or been involved with a pregnancy. Methods: We employed venue-based sampling to recruit 339 boys (14-17 years old) in neighborhoods with high STI prevalence. We administered a brief survey on sexual, relationship and pregnancy history, STI risk, juvenile justice involvement, and masculinity. Results: Fifteen percent had either fathered a child or been involved with a pregnancy. In multivariate analysis, controlling for age and ethnicity, adolescent fathers were more likely to be involved with juvenile justice and engage in STI risk behaviors. These included condom non-use and partner checking a cell phone. Although of borderline significance, older partners, past STI testing, and drug or alcohol use at last sex improved model fit. Conclusion: Adolescent fathers have distinct relational and sexual health needs. Their specific needs should be targeted by prevention programs. Implications and Contribution: Most research on young men involved in pregnancy is with older adolescents/young adults, and in clinical or institutional settings. Using community engagement and venue-based sampling, this study describes sexual behaviors, masculinity, and relationship characteristics among 14-17 year old boys who have caused a pregnancy. Findings identify their distinct sexual health needs

“It is all about the fear of being discriminated [against]…the person suffering from HIV will not be accepted”: a qualitative study exploring the reasons for loss to follow-up among HIV-positive youth in Kisumu, Kenya

BACKGROUND: Youth represent 40% of all new HIV infections in the world, 80% of which live in sub-Saharan Africa. Youth living with HIV (YLWH) are more likely to become lost to follow-up (LTFU) from care compared to all other age groups. This study explored the reasons for LTFU among YLWH in Kenya. METHODS: Data was collected from: (1) Focus group Discussions (n = 18) with community health workers who work with LTFU youth. (2) Semi-structured interviews (n = 27) with HIV + youth (15–21 years old) that had not received HIV care for at least four months. (3) Semi-structured interviews (n = 10) with educators selected from schools attended by LTFU interview participants. Transcripts were coded and analyzed employing grounded theory. RESULTS: HIV-related stigma was the overarching factor that led to LTFU among HIV + youth. Stigma operated on multiple levels to influence LTFU, including in the home/family, at school, and at the clinic. In all three settings, participants’ fear of stigma due to disclosure of their HIV status contributed to LTFU. Likewise, in the three settings, the dependent relationships between youth and the key adult figures in their lives were also adversely impacted by stigma and resultant lack of disclosure. Thus, at all three settings stigma influenced fear of disclosure, which in turn impacted negatively on dependent relationships with adults on whom they rely (i.e. parents, teachers and clinicians) leading to LTFU. CONCLUSIONS: Interventions focusing on reduction of stigma, increasing safe disclosure of HIV status, and improved dependent relationships may improve retention in care of YLWH