Angela L. Hudson

Social Interactions, Perceived Support, and Level of Distress in HIV-Positive Women

Although powerful pharmacological therapies are helping women with HIV infection live longer, women continue to experience the stressors of chronic illness. This study used a person-environment systems framework to describe social interactions, perceived social support, and psychological distress in HIV-positive women. A convenience sample of 104 HIV-positive women living in the San Francisco Bay Area completed a questionnaire on social interactions, perceived social support, and distress. Women reported limited social interactions with family and friends and a low level of perceived social support. Social support and level of distress did not differ by ethnicity. Limited perceived social support was a significant predictor of distress in this sample of women. Supportive interactions from health care providers can be useful in mediating the relationship between the stressor of HIV disease and distress in HIV-positive women. Community-based nurses can enhance HIV-positive womens support network by providing positive and supportive interactions as they intervene with women in symptom management, case management, and other health care services.

The Influence of Symptoms on Quality of Life among HIV-Infected Women

Symptoms serve as intervention foci for patients and health care providers. Research has established a relationship between symptoms and quality of life for persons living with HIV/AIDS. This article reports symptom prevalence and intensity data that include gynecological and cognitive symptoms self-reported by HIV-infected women (N = 118). Using a cross-sectional, descriptive design, data were obtained using the Center for Epidemiological Studies– Depression Scale (CES-D), Medical Outcomes Study Short Form-36 (MOS SF-36), and the revised Sign and Symptom Check-List for Persons Living with HIV/AIDS (SSC-HIV). Prevalent symptoms were depression (83%), muscle aches (84%), weakness (80%), and painful joints (71%). Symptoms with the highest mean intensity, however, were headaches, rash, insomnia, vaginal itching, and shortness of breath at rest. Symptoms also significantly predicted role functioning. This study contributes to our understanding the nature of symptoms and the influence of symptoms on role and physical functioning among HIV-infected women.

Homeless Youths' Interpersonal Perspectives of Health Care Providers

In the United States, youth run away from home due to poor interpersonal relationships with parents or guardians; often times, they have been the recipients of parental neglect or abuse. As youth become increasingly entrenched in street-based living and problem substance use, their ability to rehabilitate their lives is incumbent upon trusting and engaging relationships with adult service providers. A total of 54 substance-using homeless youth (18–25 years) participated in focus groups to provide their perspectives on encounters and interpersonal relationships with health care providers. Participants were recruited from shelters in Hollywood, California, and from a drop-in shelter in Santa Monica, California. Four themes related to interpersonal barriers to care from service providers were identified: authoritative communication, one-way communication, disrespect, and empathy. Participants appreciate care providers who convey information in a helpful, meaningful manner and prefer providers who can, themselves, share similar life experiences. Implications point to the need for agencies and services specifically tailored to homeless, drug-using youth. These agencies should employ care providers who are trained to understand the developmental needs and histories of runaway youth. For proper reintegration of this vulnerable population into mainstream society, the narratives of these youth underscore the necessity of targeted services.

Sleep Disturbances in Women With HIV or AIDS: Efficacy of a Tailored Sleep Promotion Intervention

Background: Poor sleep is a frequent complaint of persons with HIV infection. Objectives: To pilot test a tailored sleep promotion intervention protocol based on principles of sleep hygiene in a convenience sample of 30 HIV seropositive women. Methods: At baseline and 1 week after implementing the intervention, sleep was assessed by self-report measures and wrist actigraphy. Objective sleep measures include total sleep time, number of awakenings, and sleep efficiency, as well as level of daytime activity, 24-hr activity rhythm, and amount of sleep during the day. Results: Prior to the intervention, women averaged 6.4 hr (SD = 1.99) of sleep, and 67% (n = 20) of the sample napped more than 30 min per day. After allowing 1 week to implement sleep hygiene principles to promote healthy sleep behaviors, there was a significant improvement in their perception of sleep and a significant change in their 24-hr activity rhythm. This involved more activity and less napping during the day. Discussion: Although there was minimal change in objective measures of nighttime sleep for the group as a whole, those with initiation insomnia and maintenance insomnia benefited most from the intervention. These findings support the utility of a tailored sleep promotion intervention for women who are HIV positive to address their unique form of sleep disturbance.

Comparisons of substance abuse, high-risk sexual behavior and depressive symptoms among homeless youth with and without a history of foster care placement

Abstract Aims and objectives: The purpose of this study was to compare prevalence of substance use, high-risk sexual behaviors, and depression symptoms between homeless youth with and without a history of foster care placement. Background: Approximately 26,000 young persons exit foster care annually in the United States. Once they ‘age out’ of foster care, however, many young persons do not have access to comprehensive health care. They also are at risk for substance abuse, homelessness, or mental illness. Because persons with a history of foster care are at risk for negative psycho-social outcomes, it is unclear if these young people might be different than homeless youth without this history. Design: The design is descriptive and cross-sectional. Methods: A total of 156 homeless young persons, of whom 44 had a history of foster care placement, were recruited from a drop-in center that caters to homeless youth and young adults. Results: The sample was majority male and white; ages were 16–25. Significantly higher proportion of homeless former foster youth used methamphetamine within the last six months compared to non-fostered homeless youth p = 0.03). Homeless former foster youth were significantly older (p = 0.02) and less educated (p = 0.02) than their homeless counterparts without a history of foster care placement. Prevalence of using tobacco, marijuana, alcohol, crack cocaine, and powder cocaine were similar for both groups. Although not significant, a higher proportion of homeless former foster youth reported trading sex for money or drugs compared to non-fostered, homeless youth (19% versus 12% [trading sex for money], and 26% versus 14% [trading sex for drugs], respectively. Conclusions: Findings from this study show that, in general, homelessness is a negative outcome, irrespective of having a foster care history. However, those with that history need continued support when transitioning to independent living, such as access to health care, and encouragement to further their education. Relevance to clinical practice: It is important that nurses, who serve homeless youth populations, conduct a risk assessment profile, in order to ascertain a history of foster care placement, link former foster youth to social service agencies that provide risk reduction/health promotion education, and advocate for stable housing.

Characteristics of Homeless Youth Who Use Cocaine and Methamphetamine

This cross-sectional hepatitis health promotion study (N = 156) was designed to identify correlates of cocaine and methamphetamine use among young, homeless persons living in Los Angeles County. Structured questionnaires were administered at baseline to assess sociodemographic characteristics, drug history, and social support. Unadjusted analysis showed that older age, having a history of incarceration, injection drug use (IDU), 10 or more sexual partners, and sex for money were associated with both cocaine and methamphetamine use. Logistic regression results showed that injection drug users had over seven times greater odds of using each stimulant compared with nonusers of injection drugs; those reporting at least 10 sexual partners and alcohol use in the past 6 months were more likely to use cocaine than their respective counterparts. African Americans were also less likely than Whites to report cocaine use. Understanding of these relationships can guide interventions targeting the multiple challenges faced by this population.

Correlates of Substance Use Severity Among Homeless Youth

PROBLEM this cross-sectional study identified a number of factors that were correlated with drug-use severity among homeless youth. METHODS to examine a commonly used measure of substance-use severity, the TCU Drug Screen II, in a convenience sample of 156 homeless youth, ages 15-25 from a drop-in site in Santa Monica, California. FINDINGS higher drug-use severity scores were independently related to low levels of perceived health and maladaptive coping strategies. CONCLUSIONS the findings from this study are particularly relevant in that they support previous results showing that psychosocial variables are related to substance use behavior among young populations.

Predictors of Substance Use Severity among Homeless Youth

PROBLEM this cross-sectional study identified a number of factors that were correlated with drug-use severity among homeless youth. METHODS to examine a commonly used measure of substance-use severity, the TCU Drug Screen II, in a convenience sample of 156 homeless youth, ages 15-25 from a drop-in site in Santa Monica, California. FINDINGS higher drug-use severity scores were independently related to low levels of perceived health and maladaptive coping strategies. CONCLUSIONS the findings from this study are particularly relevant in that they support previous results showing that psychosocial variables are related to substance use behavior among young populations.

Correlates of Adult Assault among Homeless Women

The purpose of this study was to assess predictors of sexual and physical assault among homeless women. A multivariate, correlation design was utilized to identify independent correlates of adult physical and sexual assault. The sample consisted of 202 homeless women residing in shelters or living on the street in the Skid Row area of Los Angeles. Respondents reporting a history of child sexual abuse were almost four times more likely to report being sexually assaulted as adults and were almost two and one third times more likely to report being physically assaulted as adults. A range of factors increase homeless womens risk of adult physical and sexual victimization, including child sexual abuse, substance use, lifetime sex trade activity, and previous incarceration. It is important for homeless service providers to develop an individual risk profile for homeless women and to intervene in order to decrease their risk of re-victimization.

Where do youth in foster care receive information about preventing unplanned pregnancy and sexually transmitted infections

Adolescents in foster care are at risk for unplanned pregnancy and sexually transmitted infections, including HIV infection. A study using a qualitative method was conducted to describe how and where foster youth receive reproductive health and risk reduction information to prevent pregnancy and sexually transmitted infections. Participants also were asked to describe their relationship with their primary health care provider while they were in foster care. Nineteen young adults, recently emancipated from foster care, participated in individual interviews. Using grounded theory as the method of analysis, three thematic categories were generated: discomfort visiting and disclosing, receiving and not receiving the bare essentials, and learning prevention from community others. Recommendations include primary health care providers providing a confidential space for foster youth to disclose sexual activity and more opportunities for foster youth to receive reproductive and risk prevention information in the school setting.