Risk evaluations and condom use decisions of homeless youth: a multi-level qualitative investigation

BMC Public Health

Joan S Tucker³  Gery W Ryan³  Loryana Vie¹  Penelope Morrison²  Ryan A Brown³  David P Kennedy³ 

[1] The Department of Psychology, University of California, Riverside, CA, USA;The RAND-University of Pittsburgh Health Institute, Pittsburgh, PA, USA;RAND Health, RAND Corporation, 1776 Main Street, Santa Monica 90407, CA, USA

关键词: Qualitative methods;    Reproductive health;    HIV;    Heterosexual sex;    Homeless youth;    Condoms;   

Others  :  1122801
DOI  :  10.1186/s12889-015-1419-9

 received in 2014-04-22, accepted in 2015-01-14,  发布年份 2015

【 摘 要 】

Background

Homeless youth are at higher risk for sexually transmitted infections and unwanted pregnancy than non-homeless youth. However, little is known about how they evaluate risk within the context of their sexual relationships. It is important to understand homeless youths' condom use decisions in light of their sexual relationships because condom use decisions are influenced by relationship dynamics in addition to individual attitudes and event circumstances. It is also important to understand how relationship level factors, sexual event circumstances, and individual characteristics compare and intersect.

Methods

To explore these issues, we conducted semi-structured interviews with 37 homeless youth in Los Angeles County in 2011 concerning their recent sexual relationships and analyzed the data using systematic methods of team-based qualitative data analysis.

Results

We identified themes of risk-related evaluations and decisions at the relationship/partner, event, and individual level. We also identified three different risk profiles that emerged from analyzing how different levels of risk intersected across individual respondents. The three profiles included 1) Risk Takers, who consistently engage in risk and have low concern about consequences of risk behavior, 2) Risk Avoiders, who consistently show high concern about protection and consistently avoid risk, and 3) Risk Reactors, those who are inconsistent in their concerns about risk and protection and mainly take risks in reaction to relationship and event circumstances.

Conclusions

Interventions targeting homeless youth should reflect multiple levels of risk behavior and evaluation in order to address the diversity of risk profiles. Relationship/partner-, event-, and individual-level factors are all important but have different levels of importance for different homeless youth. Interventions should be tailored to address the most important factor contributing to homeless youth reproductive needs.

【 授权许可】

   
2015 Kennedy et al.; licensee BioMed Central.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Rotheram-Borus MJ, Song M, Gwadz MV, Lee M, VanRossem R, Koopman C: Reductions in HIV risk among runaway youth. Prev Sci 2003, 4(3):173-187.
• [2]Rotheram-Borus MJ, O'Keefe Z, Kracker R, Foo H-H: Prevention of HIV Among Adolescents. Prev Sci 2000, 1(1):15-30.
• [3]Haley N, Roy E, Leclerc P, Lambert G, Boivin JF, Cedras L, et al.: Risk behaviours and prevalence of Chlamydia trachomatis and Neisseria gonorrhoeae genital infections among Montreal street youth. Int J STD AIDS 2002, 13(4):238-245.
• [4]Ringwalt CL, Greene JM, Robertson M, McPheeters M: The prevalence of homelessness among adolescents in the United States. Am J Public Health 1998, 88(9):1325-1329.
• [5]Greene JM, Ringwalt CL: Pregnancy among three national samples of runaway and homeless youth. J Adolesc Health 1998, 23(6):370-377.
• [6]Anderson JE, Freese TE, Pennbridge JN: Sexual risk behavior and condom use among street youth in Hollywood. Fam Plann Perspect 1994, 26(1):22-25.
• [7]UNAIDS: Condoms and HIV prevention: position statement by UNAIDS, UNFPA and WHO. In. UNAIDS, Geneva; 2009.
• [8]Crosby R, Warner L: Pending research issues in male condom use promotion. Sex Health 2008, 5(4):317-319.
• [9]Seal DW, Ehrhardt AA: HIV-prevention-related sexual health promotion for heterosexual men in the United States: Pitfalls and recommendations. Arch Sex Behav 2004, 33(3):211-222.
• [10]De Rosa CJ, Montgomery SB, Hyde J, Iverson E, Kipke MD: HIV risk behavior and HIV testing: A comparison of rates and associated factors among homeless and runaway adolescents in two cities. AIDS Educ Prev 2001, 13(2):131-148.
• [11]Tevendale HD, Lightfoot M, Slocum SL: Individual and Environmental Protective Factors for Risky Sexual Behavior among Homeless Youth: An Exploration of Gender Differences. AIDS Behav 2009, 13(1):154-164.
• [12]Tucker JS, Ryan G, Golinelli D, Ewing B, Wenzel S, Kennedy DP, et al.: Substance Use and Other Risk Factors for Unprotected Sex: Results from an Event-Based Study of Homeless Youth. AIDS Behav 2011, 16(6):1699-1707.
• [13]Halcón LL, Lifson AR: Prevalence and predictors of sexual risks among homeless youth. Journal of Youth and Adolescence 2004, 33(1):71-80.
• [14]Bronfenbrenner U: Toward an experimental ecology of human development. Am Psychol 1977, 32(7):513-531.
• [15]Sallis JF, Owen N, Fisher EB: Ecological Models of Health Behavior. In: Heath Behavior and Health Education: Theory, Research and Practice. 4th edn. Edited by Glanz K, Rimer BK, Viswanath K. San Francisco, CA: Josey-Bass; 2008: 465–482.
• [16]Karney BR, Hops H, Redding CA, Reis HT, Rothman AJ, Simpson JA: A Framework for Incorporating Dyads in Models of HIV-Prevention. AIDS Behav 2010, 14:S189-S203.
• [17]Naranbhai V, Karim QA, Meyer-Weitz A: Interventions to modify sexual risk behaviours for preventing HIV in homeless youth. Cochrane Database Syst Rev 2011(1) 1-46.
• [18]Slesnick N, Prestopnik JL: Ecologically based family therapy outcome with substance abusing runaway adolescents. J Adolesc 2005, 28(2):277-298.
• [19]Slesnick N, Kang MJ: The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial. J Behav Med 2008, 31(1):45-59.
• [20]Burton J, Darbes LA, Operario D: Couples-focused behavioral interventions for prevention of HIV: systematic review of the state of evidence. AIDS Behav 2010, 14(1):1-10.
• [21]El-Bassel N, Witte SS, Gilbert L, Wu E, Chang M, Hill J, et al.: The efficacy of a relationship-based HIV/STD prevention program for heterosexual couples. Am J Public Health 2003, 93(6):963-969.
• [22]Harman JJ, Amico KR: The Relationship-Oriented Information-Motivation-Behavioral Skills Model: A Multilevel Structural Equation Model among Dyads. AIDS Behav 2009, 13(2):173-184.
• [23]Misovich SJ, Fisher JD, Fisher WA: Close relationships and elevated HIV risk behavior: evidence and possible underlying psychological processes. Rev Gen Psychol 1997, 1(1):72-107.
• [24]Rayburn R, Corzine J: Your Shelter or Mine? Romantic Relationships Among the Homeless. Deviant Behavior 2010, 31(8):756-774.
• [25]Kennedy DP, Tucker JS, Green HD, Golinelli D, Ewing BA: Unprotected sex of homeless youth: Results from a multilevel analysis of individual, social network, and relationship factors. AIDS Behav 2012, 16(7):2015-2032.
• [26]Kennedy DP, Wenzel SL, Tucker JS, Green HD, Golinelli D, Ryan GW, et al.: Unprotected Sex of Homeless Women Living in Los Angeles County: An Investigation of the Multiple Levels of Risk. AIDS Behav 2010, 14(4):960-973.
• [27]Kennedy DP, Wenzel SL, Brown RW, Tucker JS, Golinelli D: Unprotected sex among heterosexually active homeless men: results from a multi-level dyadic analysis. AIDS Behav 2013, 17(5):1655-1667.
• [28]Ryan GW, Stern SA, Hilton L, Tucker JS, Kennedy DP, Golinelli D, et al.: When, Where, Why and with Whom Homeless Women Engage in Risky Sexual Behaviors: A Framework for Understanding Complex and Varied Decision-Making Processes. Sex Roles 2009, 61(7–8):536-553. doi:10.1007/s10461-012-0366-z
• [29]Brown RA, Kennedy DP, Tucker JS, Wenzel S, Golinelli D, Wertheimer S, et al.: Sex and Relationships on the Street: How Homeless Men Judge Partner Risk on Skid Row. AIDS Behav 2012, 16(3):774-784.
• [30]Rana Y, Brown RA, Kennedy DP, Ryan GW, Stern S, Tucker JS: Understanding condom use decision making among homeless youth using event-level data. J Sex Res 2014:1–11.doi:10.1080/00224499.2014.961185
• [31]Pulerwitz J, Gortmaker SL, DeJong W: Measuring sexual relationship power in HIV/STD research. Sex Roles 2000, 42(7–8):637-660.
• [32]Brown RA, Kennedy DP, Tucker JS, Golinelli D, Wenzel SL: Monogamy on the Street: A Mixed Methods Study of Homeless Men. Journal of Mixed Methods Research 2013, 7(4):328-346.
• [33]Tucker JS, Sussell J, Golinelli D, Zhou A, Kennedy DP, Wenzel SL: Understanding pregnancy-related attitudes and behaviors: a mixed-methods study of homeless youth. Perspect Sex Reprod Health 2012, 44(4):252-261. doi:10.1363/4425212
• [34]Bowen AM, Williams M, McCoy HV, McCoy CB: Crack smokers' intention to use condoms with loved partners: Intervention development using the theory of reasoned action, condom beliefs, and processes of change. AIDS Care 2001, 13(5):579-594.
• [35]Orr DP, Langefeld CD, Katz BP, Caine VA: Behavioral intervention to increase condom use among high-risk female adolescents. The Journal of Pediatrics 1996, 128(2):288-295.
• [36]Power R, French R, Connelly J, George S, Hawes D, Hinton T, et al.: Health, health promotion, and homelessness. BMJ 1999, 318(7183):590-592.
• [37]Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research [http://aspe.hhs.gov/hsp/homelessness/symposium07/toro/]
• [38]Kennedy DP, Brown RA, Golinelli D, Wenzel SL, Tucker JS, Wertheimer S: Masculinity and HIV Risk among Homeless Men in Los Angeles. Psychol Men Masculinity 2012, .:.. doi:10.1037/a0027570
• [39]Guest G, MacQueen KM: Handbook for Team Based Qualitative Research. Alta Mira Press, Lanham, MD; 2007.
• [40]Guest G, MacQueen KM, Namey EE: Applied Thematic Analysis. Sage Publications, Incorporated, Thousand Oaks, CA; 2011.
• [41]Landis JR, Koch GG: The measurement of observer agreement for categorical data. Biometrics 1977, 33(1):159-174.
• [42]Afifi WA: Harming the Ones We Love: Relational Attachment and Perceived Consequences as Predictors of Safe-Sex Behavior. The Journal of Sex Research 1999, 36(2):198-206.
• [43]Feeney JA, Kelly L, Gallois C, Peterson C, Terry DJ: Attachment style, assertive communication, and safer-sex behavior. J Appl Soc Psychol 1999, 29(9):1964-1983.
• [44]Impett EA, Peplau LA: Why some women consent to unwanted sex with a dating partner: Insights from attachment theory. Psychol Women Q 2002, 26(4):360-370.
• [45]Cabral RJ, Pulley L, Artz L, Brill I, Macaluso M: Women at risk of HIV/STD: the importance of male partners as barriers to condom use. AIDS Behav 1998, 2(1):75-85.
• [46]Jones R, Oliver M: Young urban women's patterns of unprotected sex with men engaging in HIV risk behaviors. AIDS Behav 2007, 11(6):812-821.
• [47]Tucker JS, Elliott MN, Wenzel SL, Hambarsoomian K: Relationship commitment and its implications for unprotected sex among impoverished women living in shelters and low-income housing in Los Angeles county. Health Psychol 2007, 26(5):644-649.
• [48]Devries KM, Free C: 'I told him not to use condoms': masculinities, femininities and sexual health of Aboriginal Canadian young people. Sociol Health Illn 2010, 32(6):827-842.
• [49]Noar SM, Carlyle K, Cole C: Why Communication Is Crucial: Meta-Analysis of the Relationship Between Safer Sexual Communication and Condom Use. J Health Commun 2006, 11(4):365-390.
• [50]Martino S, Tucker J, Ryan G, Wenzel S, Golinelli D, Munjas B: Increased Substance Use and Risky Sexual Behavior Among Migratory Homeless Youth: Exploring the Role of Social Network Composition. Journal of Youth and Adolescence 2011, 40(12):1634-1648.
• [51]Miller WR, Rose GS: Toward a Theory of Motivational Interviewing. Am Psychol 2009, 64(6):527-537.
• [52]Green HD, Tucker JS, Wenzel SL, Golinelli D, Kennedy DP, Ryan GW, et al. Association of childhood abuse with homeless women's social networks. Child Abuse & Neglect 2012, 36(1):21–31.