Preventing violence and related health-risking social behaviors in adolescents.
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Adolescent↗
Biomedical subjects
M D Kipke
Publications and source records attributed to M D Kipke.
HIV risk behavior and HIV testing: a comparison of rates and associated factors among homeless and runaway adolescents in two cities.
This study examined differences in self-reported rates and predictors of HIV testing between homeless and runaway youths in San Diego (N = 1,102) and Los Angeles (N = 1,167). Youths aged 13-23 were recruited from agency and street sites using a stratified probability sampling design. Interviewers administered a structured survey instrument lasting 20 minutes, which assessed youths' involvement in HIV risk-related sexual and drug-use behaviors, contact with outreach workers, and other variables. Significantly more Los Angeles youths (78%) reported testing than did San Diego youths (52%; p < .001). Multivariable analyses controlling for risk behaviors, knowing someone with HIV, and contact with outreach workers indicated that the higher rates of these factors in Los Angeles did not account for the difference in testing rates between the cities. Youths in Los Angeles were still 1.85 times as likely to be tested as San Diego youths (p < .001), possibly a result of differing normative behavior and accessibility of testing services.
AIDS Serodiagnosis↗
Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons.
PURPOSE: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. METHOD: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. RESULTS: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. CONCLUSIONS: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that barriers to use of these services are eliminated.
Adolescent↗
Service utilization among homeless and runaway youth in Los Angeles, California: rates and reasons.
PURPOSE: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area of Los Angeles, California; identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. METHOD: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. RESULTS: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%), substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles versus all others). Shelter use was strongly associated with use of all other services. Despite youths' generally positive reactions to services, barriers were described including rules perceived to be restrictive, and concerns youth had about confidentiality and mandated reporting. Youth suggested improvements including more targeted services, more long-term services, revised age restrictions, and more and/or better job training and transitional services to get them off the streets. CONCLUSIONS: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to-reach youth, it is vital that we understand the perceived barriers to service utilization.
Adolescent↗
A collaborative evaluation of a needle exchange program for youth.
Limited research has been conducted to examine the effectiveness of existing HIV prevention and harm reduction interventions targeted to injection drug-using youth. Moreover, although there are a growing number of needle exchange programs being developed for youth throughout the United States, the effects of these services have yet to be systematically evaluated. This article describes a collaborative evaluation conducted by the Division of Adolescent Medicine, Childrens Hospital Los Angeles, and Clean Needles Now, a needle exchange serving young injection drug users. The evaluation employed a multimethod research design that included both qualitative and quantitative methods. Findings are presented about how a community-based agency's service delivery philosophy can affect the design and implementation of an evaluation. Lessons learned from this collaborative evaluation are presented, including the potential benefits of incorporating harm reduction principles into research activities.
Adolescent↗
Childrens Hospital Los Angeles: a model of integrated care for HIV-positive and very high-risk youth.
Childrens Hospital Los Angeles (CHLA) provides an integrated care model for youth with and at high risk for human immunodeficiency virus (HIV) infection, through a grant from the Special Projects of National Significance Program, HIV/acquired immunodeficiency syndrome (AIDS) Bureau, Health Resources and Services Administration. The project has provided outreach to 8400 youth at risk and has provided clinical services to 296 young men (16.6% HIV positive) and 352 young women (9.1% HIV positive). Situated within the Division of Adolescent Medicine at Childrens Hospital Los Angeles, the project consists of a general medical clinic for youth along with psychosocial services including case management, counseling, and related ancillary services. A key part of the model is to provide health services within a general medical clinic for youth where participation in the clinic does not serve to identify a youth to his or her peers in the waiting room as having HIV. Another key part of the model is to provide extensive outreach within the community including contacts at bars and social clubs where high-risk youth congregate, on the street, and through the social networks of youth already identified as having HIV who participate in the CHLA clinics. In the last 2 years of the program, the peer outreach component has been strengthened and peer support activities have also been implemented. The program also has developed a Computer-Assisted Adolescent Referral System (CAARS), available on diskette and on the Internet, for the referral of youth to services in the Hollywood area.
Acquired Immunodeficiency Syndrome↗
Homeless youth and their exposure to and involvement in violence while living on the streets.
PURPOSE: The purpose of this research were to explore homeless youths' histories of exposure to violence, perpetration of violence, and fear of violent victimization, and to examine the extent to which these constructs are associated with demographic variables. METHODS: A sample of 432 youth (between 13 and 23 years old) who were homeless or at imminent risk for homelessness were sampled from both service and street sites. The percentage of youth who reported exposure to each type of violence was calculated. Multiple regression analyses were used to examine differences in the risk of exposure to violence across gender, ethnicity, age, and length of time homeless. RESULTS: Respondents reported a high rate of exposure to violence. Female respondents reported levels of exposure to violence that were as high as those reported by males. Females were more likely to report having been sexually assaulted and fearing victimization, and tended to be less likely to report perpetrating violence. With a few exceptions, ethnic identity was not a significant predictor of exposure to violence or fear of victimization. Age tended to be inversely associated with risk of exposure to violence. Length of time homeless was not associated with fear of victimization. CONCLUSIONS: Homeless youth are at high risk for exposure to a variety of forms violence as both witnesses and victims. The overall rates of exposure to violence and patterns of association with demographic variables are significantly higher than those reported in national samples of adolescents.
Adolescent↗
Homeless youths and young adults in Los Angeles: prevalence of mental health problems and the relationship between mental health and substance abuse disorders.
Although understanding of the subsistence patterns, service utilization, and HIV-risk behaviors of homeless youths and young adults in increasing, relatively little is known about the epidemiology of mental health problems in this group or the relationships between mental health problems and substance use. This study measured symptoms of depression, low self-esteem, ADHD, suicidality, self-injurious behavior (SIB), and drug and alcohol use disorder in a sample of homeless youth and young adults living in Hollywood, CA. Results indicated extremely high prevalences of mental health problems as compared with corresponding rates of mental health problems found among housed youths in previous studies. Prevalence of mental health problems differed by age and ethnicity. African Americans were at lower risk of suicidal thoughts and SIB than were those of other ethnicities. Older respondents and females were at increased risk of depressive symptoms, and younger respondents were at increased risk of SIB. Previous history of sexual abuse and/or assault was associated with increased risk of suicidality and SIB. Risk factors for drug abuse disorders included ethnicity other than African American, homelessness for 1 year or more, suicidality, SIB, depressive symptoms, and low self-esteem. Risk factors for alcohol abuse disorder included male gender, white ethnicity, homelessness for 1 year or more, suicidality, and SIB. Extremely high rates of mental health problems and substance abuse disorders in this sample suggest the need for street-based and nontraditional mental health services targeted toward these youths and young adults.
Adolescent↗
"Substance abuse" disorders among runaway and homeless youth.
This study used systematic sampling methods to recruit a sample of 432 homeless youth from both service and natural "hang-out" sampling sites. According to DSM-III criteria, the majority of respondents were classified as having an alcohol and/or illicit "drug abuse" disorder (71%). The results from multivariate logistic regression analyses indicate that cumulative length of time homeless is positively associated with risk for an "abuse" disorder. The implications of these findings and recommendations for service interventions are discussed.
Adolescent↗
Street youth, their peer group affiliation and differences according to residential status, subsistence patterns, and use of services.
This study characterizes subcultural differences within an inner-city street youth population. Variations in residential status, subsistence patterns, and service utilization according to peer group affiliation were explored. A brief structured interview was administered to 752 youth, ages 12 to 23 years, who had been living on the streets for two or more consecutive months, or who were fully integrated into the "street economy." Subjects were recruited for the study using a stratified probability sampling design, with 30% recruited from community-based service sites and 70% from street locations and at natural "hang-outs." Five street youth groups were identified: "punks/skinheads," "druggies," "hustlers," "gang members," and "loners." The results demonstrated unique patterns with respect to places stayed/slept, means of financial support and economic subsistence, and use of available services according to peer group affiliation. The implications of these findings and recommendations for future research and service provision are discussed.
Adolescent↗
Drug use, needle sharing, and HIV risk among injection drug-using street youth.
Infection drug use is the second most common HIV risk behavior in the United States, but little is known about injection drug use and needle-sharing behavior among street youth, a group at high risk for HIV infection. This study investigates the drug use histories, injection drug use behaviors, and needle-sharing practices of 106 injection drug using youth in Los Angeles, California. Respondents report high rates of injection drug use and needle sharing, indicating that these youth are at particularly high risk for HIV infection. Results suggest a need for outreach services tailored to the unique needs of injection drug-using adolescents.
Adolescent↗
Street youth in Los Angeles. Profile of a group at high risk for human immunodeficiency virus infection.
OBJECTIVE: To characterize an urban street youth population, their self-reported rates of drug use, and their involvement in behaviors that put them at risk for infection with the human immunodeficiency virus. DESIGN: A brief structured interview was administered to 409 youths who had been living on the streets for 2 or more consecutive months, or who were fully integrated into the "street economy." SETTING: Thirty percent of the sample were recruited from community-based service sites and 70% were recruited from street locations and at natural hangouts. PARTICIPANTS: Youths were aged 12 to 23 years; 74% were male, 48% were ethnic minorities, 72% were homeless, 14% were gang affiliated, 20% were involved in drug dealing, 43% were engaged in survival sex (ie, the exchange of a sexual favor for money, food, a place to stay, clothes, and/or drugs), and 40% were homosexual or bisexual. RESULTS: Seventy percent of the youths were sexually active, with an average of 11.7 sexual partners (past 30 days). Youths with multiple sexual partners were more likely to have had a previous sexually transmitted disease (P < .01), to use drugs during sex (P < .001), and to be involved in survival sex (P < .001). Marijuana (55%), methamphetamine (62%), and crack (38%) were the drugs of choice, with 30% of the sample reporting injecting drug use (58% of this subset reported injecting drug use within the past 30 days). Substance-abusing youth were 3.6 times more likely to use drugs during sex, 2.2 times more likely to engage in survival sex, and 2.5 times more likely to have been diagnosed as having a sexually transmitted disease. CONCLUSIONS: High-risk sexual and drug use behaviors were prevalent and interrelated in this urban street youth sample. This suggests the need for new and innovative educational promotions and prevention interventions targeted to this population.
Adolescent↗
An evaluation of an AIDS risk reduction education and skills training (ARREST) program.
PURPOSE: With the increasing rate of HIV infection among adolescents, there is an urgent need for interventions that will provide teenagers with information, the ability to make decisions, and the assertiveness and communication skills required for effective prevention and risk reduction. This study evaluated an AIDS Risk Reduction Education and Skills Training (ARREST) program designed for adolescents, ages 12-16 years. METHODS: Eighty-seven inner-city, African-American (36%) and Latino (55%) adolescents were recruited from community-based after-school programs, and randomly assigned to either the ARREST intervention or a wait-list control group. Adolescents assigned to the ARREST intervention participated in three 90-minute intervention sessions. ARREST was evaluated by comparing pre- and post-test scores on a battery of self-report measures and videotaped role-play simulations. RESULTS: Analyses revealed significant post-test differences between the ARREST and wait-list control groups, with teens in the ARREST group demonstrating significant changes in knowledge and negative attitudes about HIV/AIDS, perception of risk, and appropriate concern about contracting AIDS. Most importantly, adolescents in the ARREST group demonstrated a significant increase in behavioral skills for negotiating prevention and risk reduction, and resisting peer pressures to engage in risk-related sexual and drug-use behaviors. CONCLUSIONS: ARREST was effective in meeting its short-term objectives for changes in knowledge and behavioral skills, which are important prerequisites for behavior change. Replication with long-term follow-up assessment is needed, however, to determine this intervention's effectiveness at changing risk-related sexual and drug-use behaviors.
Acquired Immunodeficiency Syndrome↗
Substance use among youth seen at a community-based health clinic.
Despite recent surveys reporting a decline in adolescents' use of alcohol and other drugs in the general population, substance abuse may actually be increasing among particular subgroups of high-risk youth. This study examined the prevalence of alcohol and other drug use reported by 1121 youth, ages 12-24 years, seen for an initial medical visit at a free community-based primary health clinic. The clinic, located in the Hollywood/Wilshire area of Los Angeles, serves both homeless (62%) and non-homeless (38%) youth. Bivariate and multivariate analyses revealed that the homeless youth were significantly more likely to report use of alcohol and illicit drugs (marijuana, stimulants, hallucinogens, and narcotics) and prior involvement in injecting drug use (IDU). Variables found to be significantly associated with substance use among the homeless youth included length of time homeless, an attempted suicide, physical and sexual abuse, and involvement in survival sex/prostitution. Among the non-homeless youth, age of first intercourse, a previous suicide attempt, and a history of physical and sexual abuse were significantly associated with substance use. These findings suggest that rates of alcohol and other drug use may be higher among youth seen at community-based primary health clinics, particularly homeless youth underscoring the need for screening for these risk variables.
Adolescent↗
Health and health needs of homeless and runaway youth. A position paper of the Society for Adolescent Medicine.
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Adolescent↗
HIV infection and AIDS during adolescence.
It is clear from the evidence that a growing number of adolescents are acquiring HIV infection and developing AIDS. The impact this epidemic will have on all teenagers is overwhelming. Given the high prevalence of risk-related sexual behaviors, many adolescents are likely to become HIV infected, thus requiring extensive medical and psychosocial services. Other adolescents will lose a parent, relative, or friend to AIDS, and these adolescents will similarly require special services and psychological counseling. Thus, there is an immediate need for the development of methods for (1) providing all adolescents with age-appropriate and culturally relevant interventions for prevention and risk reduction, (2) identifying high-risk adolescents and triaging them to different levels of care and risk reduction counseling, and (3) providing ongoing medical and psychosocial treatments. Accessing adolescents at risk for HIV infection will require networking between the health care system and youth-serving and community-based agencies, particularly agencies servicing high-risk adolescents. We must begin addressing these needs now, in order to prevent further infection and to provide appropriate care for those adolescents who are or will become infected with HIV.
Acquired Immunodeficiency Syndrome↗
Reliability and construct validity of the needle sharing inventory.
The Needle Sharing Inventory (NSI) is a 59-item test developed to specify and assess behavior patterns associated with drug use and needle sharing. In order to determine its reliability and construct validity, the NSI was administered to 80 intravenous drug users (IVDUs) recruited from a methadone maintenance program in New York City. Patients were included in the study if they reported using intravenous drugs during the previous month. Factor analysis was performed indicating that 31 of the items loaded onto 6 factors similar to those hypothesized: four dealing with the social context of needle sharing - indiscriminate sharing, social sharing, intimate sharing, and use of shooting galleries; and two dealing with the emotional context of intravenous drug use negative affect states and positive affect states. These variables accounted for 71% of the total variance, suggesting internal consistency of these items. Factor scores significantly correlated to subjects' self-reported estimates of time using nonsterile needles and sharing needles. These data suggest that the NSI is both a reliable and a valid measure which may be used in future studies of intravenous drug use and needle sharing behavior patterns. The NSI may prove useful for the purpose of developing and evaluating interventions aimed at preventing or reducing the spread of HIV through needle sharing.
Adult↗