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Very high risk behaviors and the life cycle of youth homelessness: Are youth in disequilibrium at highest risk?
Abstracts / 36 (2005) 111-154
ipate on the basis of verbal and written information, and gave their informed consent. Results: Quantitative data suggested that young people’s intimate relationships and sexual behaviours, and in particular, reported experience of sexual intercourse, appear to be influenced by ethnicity and religious factors. Bangladeshi, Indian and Pakistani young men and women were significantly less likely to have had sex compared with White British adolescents. Black Caribbean and Mixed Ethnicity young men were more likely to have had sex than their White British counterparts. Qualitative data cast light on the ways in which gender and aspects of youth culture interact with ethnicity. The qualitative data illuminate our understanding of young peoples’ reports of having had sex (or not), contraception/protection use, meeting potential partners, locations for sex and sexual activities outside of intercourse. Young people and professionals repeatedly stressed variations in teenagers’ behaviour within ethnic and religious groups, and that knowing someone’s ethnicity or religion was not a shortcut to knowing their attitude to sexual relationships or sexual history. Some young people from ethnic groups who report a comparatively low rate of sexual intercourse are still having sex. This suggests that, while culturally targeted approaches to sexual health may be useful, young people across all ethnicities and religions need access to good sexual health services. Young people from all backgrounds told us they needed effective services that take their varying needs into account. Conclusion: Research and policy can be better informed by analysis which considers Black and Minority Ethnic young people’s social differentiations such as gender and youth alongside apparent cultural, ethnic and religious differences. Mixed qualitative and quantitative methods provide a means of doing this. Support: Our project was funded by the UK Department of Health.
PII: S1054-139X(04)00363-5 60.
ETHNIC DIFFERENCES IN THE ASSOCIATION BETWEEN PEER NORMS AND ADOLESCENTS’ SEXUAL INTENTIONS AND BEHAVIOR: A LONGITUDINAL PERSPECTIVE Joan K. Orrell-Valente, Ph.D., Ernest Valente, Jr., and Bonnie L. Halpern-Felsher, Ph.D. Division of Adolescent Med., Dept of Pediatrics, University of California, San Francisco. Purpose: Research suggests a positive association between peer norms (perceptions of peer-group sexual involvement) and adolescents’ sexual intentions and behavior. Very few studies have utilized a prospective design to examine relations among adolescents’ peer norms, intentions, and sexual behavior and no research has used a large, ethnically-diverse sample to examine how these relations may vary by race/ethnicity. In this study, we examine longitudinally ethnic differences in the relations among adolescents’ peer norms, intentions, and sexual risktaking behaviors. Methods: Data were collected in 9th grade (T1) and one year later (T2). Participants were 518 adolescents participating in a larger study on risk perceptions and sexual behavior. Mean age was 14.1 at T1, 59% were female, 41% White, 23% Latino, 18% Asian, and
141
18% other. Surveys were completed at school. Peer norms were the number of same-age adolescents out of 100 whom adolescents thought had already engaged in oral and/or vaginal sex; will wait until marriage for sex; have been tested for STDs; and enjoy sex. Adolescents rated their intention to engage in sexual behavior in the next 6 months on a 5-point scale (definitely will/will not). Sexual behavior was whether the adolescent reported ever having oral or vaginal sex. Preliminary analyses examined whether there were race/ethnicity differences in the relations between: (1) T1 peer norms and T1 intention to engage in sexual behavior; (2) T1 peer norms and T2 sexual behavior; and (3) T1 intentions and T2 sexual behavior. Relations among constructs were tested using separate logistic regression models within race/ethnic subgroups. Results: Different result patterns were observed among the race/ ethnic subgroups. The relation between adolescents’ peer norms and their concurrent reports of intention to have sex varied with adolescents’ ethnicity. For example, increased estimates of peer sexual behavior were positively associated with their intention to have sex in the next 6 months for Whites (p ⬍. 01), but not Latinos or Asians. Estimates of peer enjoyment of sex were positively related to intention to have sex for Whites (p ⬍ .05) and Latinos (p ⬍ .01) but not for Asians. Similarly, there were ethnic group differences in the relation between adolescents’ peer norms and reports of sexual engagement one year later. Reported intentions to have sex at age 14 predicted sexual engagement one year later for all groups (p ⬍ .001). Discussion: These results suggest that White and Latino adolescents are more likely to intend to and to actually engage in sex if they perceive that more of their peers are having sex. Interestingly, relations between estimates of aspects of peer sexual behavior and sexual intention or engagement do not hold for Asian youth. Future research to understand the factors that mediate relations among ethnicity, peer norms, and adolescent sexual behavior may yield important and novel avenues for intervention. Support: This research was supported by Grant No. R01 HD41349 awarded to the third author from the National Institute of Child Health and Human Development.
PII: S1054-139X(04)00364-7 61.
VERY HIGH RISK BEHAVIORS AND THE LIFE CYCLE OF YOUTH HOMELESSNESS: ARE YOUTH IN DISEQUILIBRIUM AT HIGHEST RISK? Colette Auerswald, MD,MS, Eiko Sugano, MPH, Eddie Cruz, BA, Jonathan Ellen, MD, Dept. of Ped., Univ. of California at San Francisco Sch. of Med, San Francisco, CA. Purpose: Homeless youth have disproportionately high rates of HIV and Hepatitis C, in large part due to their high rates of very high-risk behaviors, such as survival sex, injection drug use (IDU), and sharing of needles or works. However, rates of risk are not uniform among youth. We propose that the life cycle model of youth homelessness may predict which youth are at highest risk. The model is defined by four stages: initiation, stasis, disequilibrium and extrication. During initiation, youth are introduced to street survival. In stasis, they reach a tenuous equilibrium in which they can meet their basic needs. However, they are repeatedly thrown into disequilibrium, that is, minor or major crises that jeopardize their ability to survive (such as incarceration, illness or
142
Abstracts / 36 (2005) 111-154
loss of temporary shelter, possessions or street partners). During extrication, youth attempt to leave street life. We hypothesized that youth in disequilibrium would engage in the highest rates of risk. Methods: We recruited a venue-based sample of 15–24 year old of street youth. Eligibility criteria included having been homeless the prior 2 nights or in the 6 months prior to recruitment. To supplement our sample of youth in extrication, we recruited some youth from transitional housing programs. Data were collected by audio computer assisted self-interview. Life cycle stage was measured with 5 items, then dichotomized into disequilibrium vs. other stages. History of survival sex and IDU were each measured by a single item. Recent history of sharing of needles and of works were elicited from youth with a history of IDU. Results: 215 youth were sampled (174 street-recruited and 41 program-recruited youth). The sample included 12 youth in initiation, 21 youth in stasis, 67 in disequilibrium, 74 street-recruited youth in extrication and 41 program-based youth in extrication. Gender distribution was 63% male and did not differ by stage. Mean age was 20.6 years and did not differ by stage. Youth in disequilibrium were more likely than other youth to have a history of survival sex (OR ⫽ 1.99; 95% CI, 0.989 – 4.009) and to have a history of injection drug use (OR ⫽ 2.32; 95% CI, 1.27– 4.23). Of youth with a history of IDU (n ⫽ 92), youth in disequilibrium were more likely to have injected in the last 3 months (OR ⫽ 2.79; 95% CI, .934 – 8.338), and more likely to have shared needles (OR ⫽ 3.70; 95% CI, 1.24 –11.04)) or works (OR ⫽ 3.09; 95% CI, 1.14 – 8.36). Youth in stasis had the lowest rates of survival sex of all stages, but this difference was not significant (OR ⫽ 0.19, 95% CI 0.03–1.50). Conclusions: Youth in disequilibrium, whose ability to survive is disrupted, may engage in the highest rates of exchange sex, injection drug use and risky injection behaviors. Screening youth for disequilibrium may assist outreach and health care providers to identify the highest risk homeless youth for intensive intervention. Homeless youth in stasis, whose livelihood is not disrupted, may engage in lower rates of exchange sex than youth in other stages. Support: NICHD (K-23, HD 0149003), UCSF REAC and COR Awards (PI: C. Auerswald).
PII: S1054-139X(04)00365-9 62.
GENDER AND SEXUAL ORIENTATION DIFFERENCES IN PERSONAL RESOURCES, SOCIAL RESOURCES, AND SEXUAL HEALTH OUTCOMES IN HOMELESS YOUTH Margaret A. Taylor-Seehafer, Ph.D., R.N.; Lynn Rew, Ed.D., R.N., FAAN; and Weylin Sternglanz, Ph.D., School of Nursing, The University of Texas at Austin, Austin, Texas. Purpose: To describe gender and sexual orientation (heterosexual vs. gay, lesbian, bisexual, transgender, questioning [GLBTQ]) group differences in personal resources (sexual self-concept, perceived health status), social resources (social support and social connectedness), and sexual health outcomes (assertive communication, safe sex behaviors, sexual self-care, and sexual risk-taking) in homeless youth. Methods: Data for this secondary analysis were collected in 2003–2004 in the first phase of a larger repeated-measures sexual health intervention study (L. Rew, PI), and comprise the first phase of data collected. The parent study took place at a
street outreach center for homeless adolescents in a central southwestern urban community. Project personnel recruited 276 homeless youth between the ages of 16 and 23 years (M ⫽ 19.26, SD ⫽ 1.83) who were clients at a street outreach project. Participants were included if they had lived independently from adult supervision for a period of at least two months, spoke English, and gave written consent. The majority (64.6%) were males. Self-report instruments were administered by project personnel via audio computer-assisted self-interview (A-CASI) format on laptop computers set up in the outreach drop-in center. Results: Female participants reported engaging in safer sex behaviors (p ⫽ .01), better sexual self-care behaviors (p ⬍ .01), reported marginally greater social support (p ⫽ .07), and had marginally better sexual self-concept (p ⫽ .07) than male participants. Sexually abused participants reported worse sexual self-care behaviors (p ⫽ .01), less social connectedness ⫽ .07 (p ⫽ .01), marginally less social support (p ⫽ .07), poorer perceived health (p ⫽ .02), and more sexual risk taking (p ⫽ .04) than non-sexually abused participants. There were no statistically significant main effects for sexual orientation. Regarding interactions, a statistically significant interaction of gender X sexual abuse (p ⫽ .03) on sexual risk-taking (SSRT) was found, in that males who had been sexually abused reported engaging in the riskiest sexual behaviors. Statistically significant interactions were also found for gender X sexual orientation on three dependent measures: social connectedness (p ⫽ .05), perceived health status (p ⫽ .05), and sexual risk-taking (p ⫽ .01); GLTBQ females reported lower levels of social connectedness, lower levels of perceived health, and more sexual risk-taking than heterosexual females. Conclusions: Although female participants overall reported better personal resources, social resources, and sexual health outcomes than male participants, GLBTQ females reported engaging in more sexual risk-taking than heterosexual females. In addition, GLTBQ females perceived themselves to be less healthy than all males and heterosexual females. Finally, for both males and females, gay and straight, sexual abuse was associated with many negative outcomes, including lower perceived health, less social support, less social connectedness, and fewer safe-sex behaviors. Sexually abused participants may be the most at risk for future sexual health problems. Support: Research awards from the National Institute of Nursing Research, National Institutes of Health: R01NR04820-04 (Rew) and 3R01NR04820-04S1 (Taylor).
PII: S1054-139X(04)00366-0 63.
AN EXPLORATION OF ATTACHMENT, SEXUAL SELFCONCEPT, ASSERTIVE COMMUNICATION, AND INTENTION AND SELF-EFFICACY TO USE CONDOMS IN HOMELESS YOUTH Margaret A. Taylor-Seehafer, Ph.D., R.N., Regina J. Johnson, Dr.P.H., R.N., Lynn Rew, Ed.D., R.N., Rachel T. Fouladi, Ph.D., Lee N. Land, M.A., and Elizabeth Abel, Ph.D., R.N. School of Nursing, The University of Texas at Austin, Austin, Texas. Purpose: To investigate relationships and group differences in population characteristics, psychosocial factors (the attach-
ipate on the basis of verbal and written information, and gave their informed consent. Results: Quantitative data suggested that young people’s intimate relationships and sexual behaviours, and in particular, reported experience of sexual intercourse, appear to be influenced by ethnicity and religious factors. Bangladeshi, Indian and Pakistani young men and women were significantly less likely to have had sex compared with White British adolescents. Black Caribbean and Mixed Ethnicity young men were more likely to have had sex than their White British counterparts. Qualitative data cast light on the ways in which gender and aspects of youth culture interact with ethnicity. The qualitative data illuminate our understanding of young peoples’ reports of having had sex (or not), contraception/protection use, meeting potential partners, locations for sex and sexual activities outside of intercourse. Young people and professionals repeatedly stressed variations in teenagers’ behaviour within ethnic and religious groups, and that knowing someone’s ethnicity or religion was not a shortcut to knowing their attitude to sexual relationships or sexual history. Some young people from ethnic groups who report a comparatively low rate of sexual intercourse are still having sex. This suggests that, while culturally targeted approaches to sexual health may be useful, young people across all ethnicities and religions need access to good sexual health services. Young people from all backgrounds told us they needed effective services that take their varying needs into account. Conclusion: Research and policy can be better informed by analysis which considers Black and Minority Ethnic young people’s social differentiations such as gender and youth alongside apparent cultural, ethnic and religious differences. Mixed qualitative and quantitative methods provide a means of doing this. Support: Our project was funded by the UK Department of Health.
PII: S1054-139X(04)00363-5 60.
ETHNIC DIFFERENCES IN THE ASSOCIATION BETWEEN PEER NORMS AND ADOLESCENTS’ SEXUAL INTENTIONS AND BEHAVIOR: A LONGITUDINAL PERSPECTIVE Joan K. Orrell-Valente, Ph.D., Ernest Valente, Jr., and Bonnie L. Halpern-Felsher, Ph.D. Division of Adolescent Med., Dept of Pediatrics, University of California, San Francisco. Purpose: Research suggests a positive association between peer norms (perceptions of peer-group sexual involvement) and adolescents’ sexual intentions and behavior. Very few studies have utilized a prospective design to examine relations among adolescents’ peer norms, intentions, and sexual behavior and no research has used a large, ethnically-diverse sample to examine how these relations may vary by race/ethnicity. In this study, we examine longitudinally ethnic differences in the relations among adolescents’ peer norms, intentions, and sexual risktaking behaviors. Methods: Data were collected in 9th grade (T1) and one year later (T2). Participants were 518 adolescents participating in a larger study on risk perceptions and sexual behavior. Mean age was 14.1 at T1, 59% were female, 41% White, 23% Latino, 18% Asian, and
141
18% other. Surveys were completed at school. Peer norms were the number of same-age adolescents out of 100 whom adolescents thought had already engaged in oral and/or vaginal sex; will wait until marriage for sex; have been tested for STDs; and enjoy sex. Adolescents rated their intention to engage in sexual behavior in the next 6 months on a 5-point scale (definitely will/will not). Sexual behavior was whether the adolescent reported ever having oral or vaginal sex. Preliminary analyses examined whether there were race/ethnicity differences in the relations between: (1) T1 peer norms and T1 intention to engage in sexual behavior; (2) T1 peer norms and T2 sexual behavior; and (3) T1 intentions and T2 sexual behavior. Relations among constructs were tested using separate logistic regression models within race/ethnic subgroups. Results: Different result patterns were observed among the race/ ethnic subgroups. The relation between adolescents’ peer norms and their concurrent reports of intention to have sex varied with adolescents’ ethnicity. For example, increased estimates of peer sexual behavior were positively associated with their intention to have sex in the next 6 months for Whites (p ⬍. 01), but not Latinos or Asians. Estimates of peer enjoyment of sex were positively related to intention to have sex for Whites (p ⬍ .05) and Latinos (p ⬍ .01) but not for Asians. Similarly, there were ethnic group differences in the relation between adolescents’ peer norms and reports of sexual engagement one year later. Reported intentions to have sex at age 14 predicted sexual engagement one year later for all groups (p ⬍ .001). Discussion: These results suggest that White and Latino adolescents are more likely to intend to and to actually engage in sex if they perceive that more of their peers are having sex. Interestingly, relations between estimates of aspects of peer sexual behavior and sexual intention or engagement do not hold for Asian youth. Future research to understand the factors that mediate relations among ethnicity, peer norms, and adolescent sexual behavior may yield important and novel avenues for intervention. Support: This research was supported by Grant No. R01 HD41349 awarded to the third author from the National Institute of Child Health and Human Development.
PII: S1054-139X(04)00364-7 61.
VERY HIGH RISK BEHAVIORS AND THE LIFE CYCLE OF YOUTH HOMELESSNESS: ARE YOUTH IN DISEQUILIBRIUM AT HIGHEST RISK? Colette Auerswald, MD,MS, Eiko Sugano, MPH, Eddie Cruz, BA, Jonathan Ellen, MD, Dept. of Ped., Univ. of California at San Francisco Sch. of Med, San Francisco, CA. Purpose: Homeless youth have disproportionately high rates of HIV and Hepatitis C, in large part due to their high rates of very high-risk behaviors, such as survival sex, injection drug use (IDU), and sharing of needles or works. However, rates of risk are not uniform among youth. We propose that the life cycle model of youth homelessness may predict which youth are at highest risk. The model is defined by four stages: initiation, stasis, disequilibrium and extrication. During initiation, youth are introduced to street survival. In stasis, they reach a tenuous equilibrium in which they can meet their basic needs. However, they are repeatedly thrown into disequilibrium, that is, minor or major crises that jeopardize their ability to survive (such as incarceration, illness or
142
Abstracts / 36 (2005) 111-154
loss of temporary shelter, possessions or street partners). During extrication, youth attempt to leave street life. We hypothesized that youth in disequilibrium would engage in the highest rates of risk. Methods: We recruited a venue-based sample of 15–24 year old of street youth. Eligibility criteria included having been homeless the prior 2 nights or in the 6 months prior to recruitment. To supplement our sample of youth in extrication, we recruited some youth from transitional housing programs. Data were collected by audio computer assisted self-interview. Life cycle stage was measured with 5 items, then dichotomized into disequilibrium vs. other stages. History of survival sex and IDU were each measured by a single item. Recent history of sharing of needles and of works were elicited from youth with a history of IDU. Results: 215 youth were sampled (174 street-recruited and 41 program-recruited youth). The sample included 12 youth in initiation, 21 youth in stasis, 67 in disequilibrium, 74 street-recruited youth in extrication and 41 program-based youth in extrication. Gender distribution was 63% male and did not differ by stage. Mean age was 20.6 years and did not differ by stage. Youth in disequilibrium were more likely than other youth to have a history of survival sex (OR ⫽ 1.99; 95% CI, 0.989 – 4.009) and to have a history of injection drug use (OR ⫽ 2.32; 95% CI, 1.27– 4.23). Of youth with a history of IDU (n ⫽ 92), youth in disequilibrium were more likely to have injected in the last 3 months (OR ⫽ 2.79; 95% CI, .934 – 8.338), and more likely to have shared needles (OR ⫽ 3.70; 95% CI, 1.24 –11.04)) or works (OR ⫽ 3.09; 95% CI, 1.14 – 8.36). Youth in stasis had the lowest rates of survival sex of all stages, but this difference was not significant (OR ⫽ 0.19, 95% CI 0.03–1.50). Conclusions: Youth in disequilibrium, whose ability to survive is disrupted, may engage in the highest rates of exchange sex, injection drug use and risky injection behaviors. Screening youth for disequilibrium may assist outreach and health care providers to identify the highest risk homeless youth for intensive intervention. Homeless youth in stasis, whose livelihood is not disrupted, may engage in lower rates of exchange sex than youth in other stages. Support: NICHD (K-23, HD 0149003), UCSF REAC and COR Awards (PI: C. Auerswald).
PII: S1054-139X(04)00365-9 62.
GENDER AND SEXUAL ORIENTATION DIFFERENCES IN PERSONAL RESOURCES, SOCIAL RESOURCES, AND SEXUAL HEALTH OUTCOMES IN HOMELESS YOUTH Margaret A. Taylor-Seehafer, Ph.D., R.N.; Lynn Rew, Ed.D., R.N., FAAN; and Weylin Sternglanz, Ph.D., School of Nursing, The University of Texas at Austin, Austin, Texas. Purpose: To describe gender and sexual orientation (heterosexual vs. gay, lesbian, bisexual, transgender, questioning [GLBTQ]) group differences in personal resources (sexual self-concept, perceived health status), social resources (social support and social connectedness), and sexual health outcomes (assertive communication, safe sex behaviors, sexual self-care, and sexual risk-taking) in homeless youth. Methods: Data for this secondary analysis were collected in 2003–2004 in the first phase of a larger repeated-measures sexual health intervention study (L. Rew, PI), and comprise the first phase of data collected. The parent study took place at a
street outreach center for homeless adolescents in a central southwestern urban community. Project personnel recruited 276 homeless youth between the ages of 16 and 23 years (M ⫽ 19.26, SD ⫽ 1.83) who were clients at a street outreach project. Participants were included if they had lived independently from adult supervision for a period of at least two months, spoke English, and gave written consent. The majority (64.6%) were males. Self-report instruments were administered by project personnel via audio computer-assisted self-interview (A-CASI) format on laptop computers set up in the outreach drop-in center. Results: Female participants reported engaging in safer sex behaviors (p ⫽ .01), better sexual self-care behaviors (p ⬍ .01), reported marginally greater social support (p ⫽ .07), and had marginally better sexual self-concept (p ⫽ .07) than male participants. Sexually abused participants reported worse sexual self-care behaviors (p ⫽ .01), less social connectedness ⫽ .07 (p ⫽ .01), marginally less social support (p ⫽ .07), poorer perceived health (p ⫽ .02), and more sexual risk taking (p ⫽ .04) than non-sexually abused participants. There were no statistically significant main effects for sexual orientation. Regarding interactions, a statistically significant interaction of gender X sexual abuse (p ⫽ .03) on sexual risk-taking (SSRT) was found, in that males who had been sexually abused reported engaging in the riskiest sexual behaviors. Statistically significant interactions were also found for gender X sexual orientation on three dependent measures: social connectedness (p ⫽ .05), perceived health status (p ⫽ .05), and sexual risk-taking (p ⫽ .01); GLTBQ females reported lower levels of social connectedness, lower levels of perceived health, and more sexual risk-taking than heterosexual females. Conclusions: Although female participants overall reported better personal resources, social resources, and sexual health outcomes than male participants, GLBTQ females reported engaging in more sexual risk-taking than heterosexual females. In addition, GLTBQ females perceived themselves to be less healthy than all males and heterosexual females. Finally, for both males and females, gay and straight, sexual abuse was associated with many negative outcomes, including lower perceived health, less social support, less social connectedness, and fewer safe-sex behaviors. Sexually abused participants may be the most at risk for future sexual health problems. Support: Research awards from the National Institute of Nursing Research, National Institutes of Health: R01NR04820-04 (Rew) and 3R01NR04820-04S1 (Taylor).
PII: S1054-139X(04)00366-0 63.
AN EXPLORATION OF ATTACHMENT, SEXUAL SELFCONCEPT, ASSERTIVE COMMUNICATION, AND INTENTION AND SELF-EFFICACY TO USE CONDOMS IN HOMELESS YOUTH Margaret A. Taylor-Seehafer, Ph.D., R.N., Regina J. Johnson, Dr.P.H., R.N., Lynn Rew, Ed.D., R.N., Rachel T. Fouladi, Ph.D., Lee N. Land, M.A., and Elizabeth Abel, Ph.D., R.N. School of Nursing, The University of Texas at Austin, Austin, Texas. Purpose: To investigate relationships and group differences in population characteristics, psychosocial factors (the attach-