Colleen Keenan

Estimates of alcohol use and clinical treatment needs among homosexually active men and women in the U.S. population.

Concerns about dysfunctional alcohol use among lesbians and gay men are longstanding. The authors examined alcohol use patterns and treatment utilization among adults interviewed in the 1996 National Household Survey on Drug Abuse. Sexually active respondents were classified into 2 groups: those with at least 1 same-gender sexual partner (n = 194) in the year prior to interview and those with only opposite-gender sexual partners (n = 9,714). The authors compared these 2 groups separately by gender. For men, normative alcohol use patterns or morbidity did not differ significantly between the 2 groups. However, homosexually active women reported using alcohol more frequently and in greater amounts and experienced greater alcohol-related morbidity than exclusively heterosexually active women. Findings suggest higher risk for alcohol-related problems among lesbians as compared with other women, perhaps because of a more common pattern of moderate alcohol consumption.

Type of social support among homeless women: its impact on psychosocial resources, health and health behaviors, and use of health services.

BACKGROUND Information about whether specific types of support are associated with poor psychosocial profiles, health behaviors, and positive use of medical care is critical for identifying homeless women at highest risk for negative outcomes. OBJECTIVES This study aimed to examine the impact that various levels of support from substance users and nonusers have on homeless womens psychosocial profiles, health and health behaviors, and use of health services. METHODS This cross-sectional survey used a sample of 1,302 sheltered homeless women. Using controls for potential confounders, outcomes were compared across four mutually exclusive subgroups of women reporting support from substance users only (n = 58), substance nonusers only (n = 439), both users and nonusers (n = 136), and no one (n = 669). Structured and psychometrically sound instruments measured social support, substance use, self-esteem, coping, and psychological symptoms. Additional instruments measured sociodemographic characteristics, sexual risk behavior, health status, and use of health services. RESULTS As compared with those who have little or no support, women whose support included substance nonusers reported better psychosocial profiles and somewhat greater use of health services. Support from substance nonusers only was associated with better health behaviors and greater use of health services. Support from substance users only was essentially equivalent to not having support. CONCLUSION Modifying the social networks of homeless women appears to be associated with improved mental health outcomes, less risky health behaviors, and greater use of health services.

Childhood Predictors of Daily Substance Use among Homeless Women of Different Ethnicities

The objective of this study was to describe associations between childhood factors and adult daily substance use profiles among homeless women and to identify independent predictors of daily substance use for the overall sample and for ethnic/acculturation subgroups. Structured surveys were administered to 1,331 homeless women in Los Angeles who were either daily drug and alcohol users for the past 6 months or nondaily substance users. Physical abuse and parental drug abuse predicted daily drug use in the whole sample and selected subgroups, whereas parental alcohol abuse predicted daily alcohol use in the whole sample. Teen self-esteem was also found to have a protective effect on daily alcohol use for the sample and for African American women. Negative peer influence in adolescence predicted daily drug use among high-acculturated Latinas. In summary, childhood abuse, parental substance use, and negative peer influence affect important roles in homeless womens daily substance use.

Differences in personal, cognitive, psychological, and social factors associated with drug and alcohol use and nonuse by homeless women.

The purpose of this study was to compare differences in personal, cognitive, behavioral, psychological, and social variables among homeless women who were current drug or alcohol users, or both, past drug or alcohol users, or both, and those who never used drugs or alcohol. The sample consisted of 1,013 women residing in 73 Los Angeles homeless shelters. Depression, anxiety, hostility, emotion-focused coping, lower self-esteem, and less social support were more prevalent among homeless women who continued to use drugs and alcohol than among past users or those who never used. AIDS knowledge was higher among past users. The results contribute important knowledge regarding the pattern of cognitive, psychological, and social differences between users and nonusers.

Correlates of Adherence among Rural Indian Women Living with HIV/AIDS

In this prospective, randomized clinical trial, correlates of adherence to antiretroviral therapy (ART) were assessed using a baseline questionnaire among 68 rural women living with AIDS (WLA) in India. Unadjusted analyses revealed positive relationships of ART adherence with Hindu religion and support from spouses and parents, whereas negative associations were found with depression, poor quality of life, and having 10 or more HIV symptoms. Multiple linear regression analysis also revealed that WLA who were Hindu, not depressed, had ART support from spouses and parents, and perceived some benefit from ART, were more adherent to ART than their respective counterparts. This study reveals the unique challenges which rural WLA experience and the need to mitigate these challenges early in ART treatment. Further, the findings enable the refinement of an intervention program that will focus on strengthening ART adherence among rural WLA.

Correlates of Depressed Mood among Young Stimulant-Using Homeless Gay and Bisexual Men

Homeless gay and bisexual (G/B) men are at risk for suicide attempts and have high risk of depressed mood, defined as elevated level of depressive symptoms. This study describes baseline socio-demographic, cognitive, psychosocial, and health- and drug-related correlates of depressed mood in 267 stimulant-using homeless G/B young men who entered a study designed to reduce drug use. G/B men without social support were 11 times more likely to experience depressed mood than their counterparts who had support; those who reported severe body pain were almost six times more likely to report depressed mood than those without pain. Other factors that increased risk of depressed mood included being homeless in the last four months, injecting drugs, reporting poor or fair health status, and high levels of internalized homophobia. This study is one of the first studies to draw a link between pain experienced and depressed mood in homeless young G/B men. Understanding the correlates of depressed mood among homeless G/B young men can help service providers design more targeted treatment plans and provide more appropriate referrals to ancillary care services.

Patterns of psychiatric service use by homeless mentally ill clients

The objective of this study was to describe the patterns of service use of homeless mentally ill clients prior to and for two years following an admission to Skid Row Mental Health (SRMH) services in Los Angeles during a recent year (N = 268). Twenty clients were still at SRMH two years later. These clients were older and more likely to be female; most of their prior service use was at SRMH. For the majority of the 124 clients in the second group, those who had been discharged and not readmitted, the index admission was their only admission. The 124 clients in the third group, those with admissions after the index admission, had long histories in the system. Cluster analysis showed distinct patterns in service use during the follow-up period. Knowledge of patterns of service use by homeless mentally ill persons will enhance understanding of interventions which have the greatest chance of success.

Correlates of Risky Alcohol and Methamphetamine Use Among Currently Homeless Male Parolees

Homeless men on parole are a hard-to-reach population with significant community reintegration challenges. This cross-sectional study describes sociodemographic, cognitive, psychosocial, and drug-related correlates of alcohol and methamphetamine use in 157 homeless male parolees (age range 18–60) enrolled in a substance abuse treatment center in Los Angeles, California. Logistic regression results revealed that being African American and older were negatively related to methamphetamine use, whereas being older and more hostile were related to riskier alcohol abuse. Findings from this study provide a greater understanding of correlates of methamphetamine and alcohol—-two of the most detrimental forms of substances abused among currently homeless parolees.

The Process of Instrument Development for Ethnically Diverse Early Adolescents

Through a combination of pilot study, consultation, and field-testing, an instrument was developed to evaluate the major content areas in the curriculum of a community-based family life education program: parent/child communication, peer influence, family values, self-efficacy, sexuality knowledge, and high-risk behaviors. The wording, format, and question content were structured to be appropriate developmentally for male and female early adolescents J0 through 14 years of age in diverse sociocultural communities in Los Angeles County. Age-related developmental issues facing early adolescents, combined with the ethnic diversity in the county, created serious challenges to the development of a valid, reliable, and relevant instrument for evaluating the effectiveness of an adolescent family life education program. An instrument with some stable and internally consistent components was developed through the key processes of pilot testing and field-testing with focus groups from the target population of ethnically diverse early adolescents.

Identifying women's descriptions of breast tissue for the promotion of breast self‐examination

The purpose of this study was to identify womens descriptions of their breast tissue. Concrete objective descriptions of the breast, in womens own words, are important to formulate an intervention, based on a self-regulation framework, designed to promote breast self-examination. Descriptions were initially generated from open-ended interviews with 27 women scheduled for mammography. The initial descriptions were validated by an additional 25 women scheduled for mammography. The descriptions of the breast that are relevant to women are presented, conclusions for a subsequent intervention study drawn, and implications for practice addressed.