Norweeta G. Milburn

Pro-social and problematic social network influences on HIV/AIDS risk behaviours among newly homeless youth in Los Angeles

Abstract We examined the social network composition among newly homeless youth over time and assessed how pro-social and problematic peers affected sexual and drug-using HIV/AIDS risk-behaviours among 183 youth in Los Angeles County, California. The percentage of newly homeless youth who reported that ‘most’ or ‘all’ of their friends were attending school, had jobs, and got along with their families was 73%, 24%, and 50% respectively. Logistic regression models indicated that presence of these pro-social peers reduced HIV risk behaviours at two years; odds of HIV-risk were lower with a greater number of peers who attend school, have a job, or have positive family relationships or if networks change over time to include more of these peers. Presence of problematic peers increased the likelihood of HIV risk-taking; odds of HIV risk behaviours increased with a greater number of peers at baseline who steal, have overdosed, have been arrested, or are in a gang, or if networks change to include more of these peers. Interventions should target newly homeless youth in networks that contain problematic peers, but should strive to harness the naturally occurring pro-social peer influences present in these networks.

The Effects of Peer Group Network Properties on Drug Use Among Homeless Youth

The authors examine how the properties of peer networks affect amphetamine, cocaine, and injection drug use over 3 months among newly homeless adolescents, aged 12 to 20 in Los Angeles (n = 217; 83% retention at 3 months) and Melbourne (n = 119; 72% retention at 3 months). Several hypotheses regarding the effects of social network properties on the peer influence process are developed. Multivariate logistic regression analyses show that higher concentrations of homeless peers in networks at recruitment were associated with increased likelihood of amphetamine and cocaine use at 3-month follow-up. Higher concentrations of injecting peers were associated with increased risk of injection drug use 3 months later. Change in network structure over time toward increased concentrations of homeless peers was associated with increased risk of cocaine use and injecting. Higher density networks at baseline were positively associated with increased likelihood of cocaine and amphetamine use at 3 months.

Predictors of Sexual Risk Behaviors Among Newly Homeless Youth: A Longitudinal Study

PURPOSE To longitudinally examine the association between newly homeless youth individual factors (sociodemographic characteristics, depression, substance use), and structural factors, such as living situation (family, institution, nonfamily), with sexual risk behaviors. METHODS A cohort of newly homeless youth from Los Angeles County (N = 261; aged 12-20 years) was interviewed at baseline, 3, 6, 12, 18, and 24 months. At each assessment youth were asked about symptoms of depression (using the Brief Symptom Inventory), substance use, living situation, and sexual risk behaviors (number of sexual partners and condom use). Random effects models were used to determine the effects of predictors on the number of sexual partners and on condom use over time, by gender. RESULTS At baseline, 77% of youth had been sexually active, increasing to 85% of youth at 24 months of follow-up. For predictors of multiple sexual partners, among male youth, these included living in nonfamily settings and using drugs; among females, living situation was not predictive of having multiple sexual partners but drug use was. For condom use, among females, living in a nonfamily setting and drug use decreased the odds of always using condoms; for males, no factors were found to be predictive of condom use. CONCLUSIONS Living with nonfamily members and drug use appear to be the most salient in explaining sexual risk among newly homeless youth. Our findings indicate that interventions aimed at reducing sexual risk behaviors, and thereby reducing sexually transmitted diseases and HIV among newly homeless youth, need to help youth in finding housing associated with supervision and social support (family and institutional settings) as well as aim to reduce drug use.

Mobilizing homeless youth for HIV prevention: a social network analysis of the acceptability of a face-to-face and online social networking intervention

The objective of the study is to use social network analysis to examine the acceptability of a youth-led, hybrid face-to-face and online social networking HIV prevention program for homeless youth.Seven peer leaders (PLs) engaged face-to-face homeless youth (F2F) in the creation of digital media projects (e.g. You Tube videos). PL and F2F recruited online youth (OY) to participate in MySpace and Facebook communities where digital media was disseminated and discussed. The resulting social networks were assessed with respect to size, growth, density, relative centrality of positions and homophily of ties. Seven PL, 53 F2F and 103 OY created two large networks. After the first 50 F2F youth participated, online networks entered a rapid growth phase. OY were among the most central youth in these networks. Younger aged persons and females were disproportionately connected to like youth. The program appears highly acceptable to homeless youth. Social network analysis revealed which PL were the most critical to the program and which types of participants (younger youth and females) may require additional outreach efforts in the future.

Paternal and Maternal Influences on Problem Behaviors Among Homeless and Runaway Youth

Using an Attachment Theory conceptual framework, associations were investigated among positive paternal and maternal relationships, and recent problem behaviors among 501 currently homeless and runaway adolescents (253 males, 248 females). Homeless and runaway youth commonly exhibit problem behaviors such as substance use, various forms of delinquency and risky sex behaviors, and report more emotional distress than typical adolescents. Furthermore, attachments to their families are often strained. In structural equation models, positive paternal relationships significantly predicted less substance use and less criminal behavior, whereas maternal relationships did not have a significant effect on or association with either behavior. Positive maternal relationships predicted less survival sex behavior. Separate gender analyses indicated that among the females, a longer time away from home was significantly associated with a poorer paternal relationship, and more substance use and criminal behavior. Paternal relations, a neglected area of research and often not addressed in attachment theory, should be investigated further. Attachments, particularly to fathers, were protective against many deleterious behaviors. Building on relatively positive relations and attachments may foster family reunifications and beneficial outcomes for at-risk youth.

Predictors of sexual transmission risk behaviors among HIV-positive young men

Reduction in the incidence of high-risk sexual behaviors among HIV-positive men is a priority. We examined the roles of proximal substance use and delinquency-related variables, and more distal demographic and psychosocial variables as predictors of serious high-risk sexual behaviors among 248 HIV-positive young males, aged 15–24 years. In a mediated latent variable model, demographics (ethnicity, sexual orientation and poverty) and background psychosocial factors (coping style, peer norms, emotional distress, self-esteem and social support) predicted recent problem behaviors (delinquency, common drug use and hard drug use), which in turn predicted recent high-risk sexual behaviors. Hard drug use and delinquency were found to predict sexual risk behaviors directly, as did lower self-esteem, white ethnicity and being gay/bisexual. Negative peer norms strongly influenced delinquency and substance use and positive coping predicted less delinquency. In turn, less positive coping and negative peer norms exerted indirect effects on sexual transmission risk behavior through delinquency and hard drug use. Results suggest targeting hard drug use, delinquency, maladaptive peer norms, dysfunctional styles of escaping stress and self-esteem in the design of intervention programs for HIV-positive individuals.

A family intervention to reduce sexual risk behavior, substance use, and delinquency among newly homeless youth

PURPOSE We evaluate the efficacy of a short family intervention in reducing sexual risk behavior, drug use, and delinquent behaviors among homeless youth. METHODS A randomized controlled trial of 151 families with a homeless adolescent aged 12 to 17 years. Between March 2006 and June 2009, adolescents were recruited from diverse sites in Southern California and were assessed at recruitment (baseline), and at 3, 6, and 12 months later. Families were randomly assigned to an intervention condition with five weekly home-based intervention sessions or a control condition (standard care). Main outcome measures reflect self-reported sexual risk behavior, substance use, and delinquent behaviors over the past 90 days. RESULTS Sexual risk behavior (e.g., mean number of partners; p < .001), alcohol use (p = .003), hard drug use (p < .001), and delinquent behaviors (p = .001) decreased significantly more during 12 months in the intervention condition compared with the control condition. Marijuana use, however, significantly increased in the intervention condition compared with the control condition (p < .001). CONCLUSIONS An intervention to reengage families of homeless youth has significant benefits in reducing risk over 12 months.

Acculturation, Coping Styles, and Health Risk Behaviors Among HIV Positive Latinas

This study examined the relationships among acculturation, coping styles, substance use, sexual risk behavior, and medication non-adherence among 219 Latinas living with HIV/AIDS in Los Angeles, CA. Coping styles were hypothesized to mediate the link between acculturation and health risk behaviors for HIV positive Latinas. Structural equation modeling revealed that greater acculturation was related to less positive coping and more negative coping. In turn, negative coping was associated with more health risk behaviors and more non-adherence. Positive coping was associated with less substance use as reflected in use of cigarettes and alcohol and less non-adherence. Coping styles mediated the relationship between acculturation and health risk behaviors. Findings echo previous works examining the Hispanic Health Paradox wherein more acculturated Latinos exhibit increased risk behavior and maladaptive coping styles. HIV/AIDS interventions need to be mindful of cultural differences within Hispanic populations and be tailored to address these differences.

Psychological health of military children: longitudinal evaluation of a family-centered prevention program to enhance family resilience.

Family-centered preventive interventions have been proposed as relevant to mitigating psychological health risk and promoting resilience in military families facing wartime deployment and reintegration. This study evaluates the impact of a family-centered prevention program, Families OverComing Under Stress Family Resilience Training (FOCUS), on the psychological adjustment of military children. Two primary goals include (1) understanding the relationships of distress among family members using a longitudinal path model to assess relations at the child and family level and (2) determining pathways of program impact on child adjustment. Multilevel data analysis using structural equation modeling was conducted with deidentified service delivery data from 280 families (505 children aged 3-17) in two follow-up assessments. Standardized measures included service member and civilian parental distress (Brief Symptom Inventory, PTSD Checklist-Military), child adjustment (Strengths and Difficulties Questionnaire), and family functioning (McMaster Family Assessment Device). Distress was significantly related among the service member parent, civilian parent, and children. FOCUS improved family functioning, which in turn significantly reduced child distress at follow-up. Salient components of improved family functioning in reducing child distress mirrored resilience processes targeted by FOCUS. These findings underscore the public health potential of family-centered prevention for military families and suggest areas for future research.

Adolescents in Wartime US Military Families: A Developmental Perspective on Challenges and Resources

Adolescents in wartime US military families are a unique group of young people who are experiencing the usual milestones of adolescent development, including establishing their identities and becoming autonomous, while they face the challenges of military life such as multiple frequent moves, relocation, and parent deployment to combat settings. This paper reviews research on adolescents in wartime US military families, within the context of adolescent development, to identify their behavioral, emotional and academic risk status, and challenges and resources. Recommendations for future research and interventions to foster the healthy development of these adolescents are also provided.