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PURPOSE: Our purpose was to describe the prevalence and predictors of symptom and function clusters in a diverse cohort of colorectal cancer survivors. METHODS: We used data from a cohort of 909 adult colorectal cancer survivors. Participants were surveyed at a median of 9 months after diagnosis to ascertain the co-occurrence of eight distinct symptom and functional domains. We used factor analysis to identify co-occurring domains and latent profile analysis (LPA) to identify subgroups of survivors with different symptom and function clusters. Multinomial logistic regression models were used to identify risk/protective factors. RESULTS: Factor analysis demonstrated a single underlying factor structure that included all eight health domains with depression and anxiety highly correlated (r = 0.87). The LPA identified three symptom and function clusters, with 30% of survivors in the low health-related quality of life (HRQOL) profile having the highest symptom burden and lowest functioning. In multivariable models, survivors more likely to be in the low HRQOL profile included being non-White, female, those with a history of cardiac or mental health conditions, and chemotherapy recipients. Survivors less likely to be in the low HRQOL profile included those with older age, greater financial well-being, and more spirituality. CONCLUSION: Nearly one-third of colorectal cancer survivors experienced a cluster of physical and psychosocial symptoms that co-occur with clinically relevant deficits in function. IMPLICATIONS FOR CANCER SURVIVORS: Improving the identification of risk factors for having the highest symptom and lowest function profile can inform the development of clinical interventions to mitigate their adverse impact on cancer survivors’ HRQOL.

Purpose This study aimed to explore the association between direct exposure, indirect exposure, and perpetration of gun violence and suicidal ideation among young adults experiencing homelessness (YAEH). Methods YAEH (n = 1,426) in seven cities across the U.S. were surveyed. Logistic regression analyses were conducted to examine the association between lifetime gun violence exposure and suicidal ideation in the past 12 months. Results Forty-five percent (n = 641) of YAEH had experienced direct or indirect gun violence, whereas 17% (n = 247) had engaged in gun violence perpetration. Gun violence perpetration is associated with elevated suicidal ideation risk (odds ratio = 1.46; 95% confidence interval = 1.02–2.01) among YAEH. Conclusions A high percentage of YAEH were exposed to firearm violence. Cross-sector, multiagency collaborations are warranted to reduce firearm violence exposure among this vulnerable population. Homeless service providers should screen for gun violence exposure and suicide risk and target prevention efforts on YAEH with a history of gun violence perpetration.

We examine the challenges formerly homeless young adults (FHYAs) face after they transition out of homelessness. Considering the adversities FHYAs face, it is unclear how transitioning to stable housing may affect their mental well-being or what types of stressors they may experience once housed. This study investigates the social environment young adults encounter in their transition to stable housing and examines trauma and social coping predictors of mental health symptoms in a sample of FHYAs to generate new knowledge for better intervening to meet their needs. Data were obtained from REALYST, a national research collaborative comprised of interdisciplinary researchers investigating young adults’ (ages 18–26) experiences with homelessness. Cross-sectional data for 1426 young adults experiencing homelessness were collected from 2016 to 2017 across seven cities in the United States (i.e., Los Angeles, Phoenix, Denver, Houston, San Jose, St. Louis, and New York City). The analytical sub-sample for this study consisted of 173 FHYAs who were housed in their own apartment (via voucher from Housing and Urban Development or another source) or in transitional living programs during their participation in the study. Ordinary Least Squares regression was used to examine the influence of trauma and social coping strategies on indicators of mental well-being. Findings indicated that higher adversity scores and higher mental health help-seeking intentions were positively associated with higher levels of stress, psychological distress, and depression severity. Higher level of social coping was associated with lower levels of depression severity. Logistic regression results showed that young adults with higher adversity scores had higher odds of reporting clinical levels of post-traumatic symptoms. The study implications suggest that FHYAs who transition to stable housing continue to need support navigating and coping with stressful life events; and interventions that help FHYAs develop strong networks of social supports are needed to promote positive mental well-being., Highlights • Formerly homeless young adults experienced significant stress and mental distress. • Mental health help-seeking intentions were associated with higher mental distress. • Young adults may need additional social support coping with stressful life events. • Interventions promoting well-being for formerly homeless young adults are needed.

INTRODUCTION: Young adults experiencing homelessness are vulnerable to firearm violence. This study aims to explore the correlates of firearm violence involvement among this vulnerable population, which may inform firearm violence reduction intervention development. METHODS: Between 2016 and 2017, young adults experiencing homelessness aged 18–26 years (N=1,426) were recruited in 7 U.S. cities. Respondents completed a self-administered computer-assisted anonymous survey regarding their homeless experiences and violence involvement. Separate multivariate logistic regression models were conducted in 2020 to explore the correlates of direct firearm violence victimization, witness of firearm violence, and firearm violence perpetration. RESULTS: A high proportion of young adults experiencing homelessness were involved in firearm violence (witnessing firearm violence: 40%; direct firearm violence victimization: 28%; perpetration: 18%). Stressful experiences, such as childhood trauma and street victimization, were associated with greater odds of firearm violence involvement. Black (OR=2.4, p

Objective: Previous research has indicated high rates of intercity movement among homeless young adults (HYAs) for a variety of prosocial (e.g., avoiding domestic violence and seeking new e...

Background and Purpose: Youth from continuation high schools (CHS) exhibit riskier sexual behaviors than other high school youth, yet the associations between intrapersonal and interpersonal constructs and condom-using behavior are not fully understood within this population. It is unknown which of these variables may be more strongly associated with condom use. This study explored the effects of parentadolescent communication, perceived HIV susceptibility, condom use peer norms, and condom use selfefficacy on lifetime and recent condom use and the potential moderating effects by gender and Latino ethnicity. Methods: A non-experimental study was conducted with 111 CHS young adults in Southern California who previously participated in a substance abuse prevention intervention. Ordinal logistic regression models assessed the associations between each construct and condom use and included interaction terms by gender and Latino ethnicity. Results: Parent-adolescent communication during adolescence and within the past 6 months as well as peer norms that support condom use were significantly associated with lifetime and recent condom use. Perceived HIV risk and condom use selfefficacy showed no effect. Relationships were not moderated by gender or Latino ethnicity. Conclusion: Findings highlight the salutary influence of parents and peers on personal condom use. Future research should explore intrapersonal factors that may motivate consistent condom use.

BACKGROUND: Youth from continuation high schools report greater substance use and sensation-seeking than youth from regular high schools, yet their long-term consequences on age at sexual onset and the number of sexual partners are unknown. OBJECTIVE: To examine substance use, sensation-seeking and sexual behaviors by gender and race/ethnicity and the effects of substance use and sensation-seeking in adolescence on age at sexual initiation and numbers of sexual partners by young adulthood. METHODS: Baseline and 4-year follow-up data on youth from 14 continuation high schools in Southern California who participated in a drug abuse prevention intervention were analyzed. Structural equation modeling assessed whether or not substance use or sensation-seeking in adolescence predicted age at sexual onset and numbers of sexual partners by young adulthood. RESULTS: Latinos had lower sensation-seeking and frequency of substance use and a later age at sexual onset than non-Latinos. Males were more likely than females to have multiple lifetime and recent sexual partners. The effects of adolescent substance use on the number of sexual partners by young adulthood were mediated fully by their age at sexual initiation. Sensation-seeking had no direct or indirect effects on sexual behaviors. CONCLUSIONS/IMPORTANCE: Factors leading to and actual sexual risk behaviors among youth from continuation high schools vary by race/ethnicity and gender. Targeting these antecedent factors by race/ethnicity and gender may improve prevention efforts.

OBJECTIVE: Limited research exists on how employment interventions contribute to employment outcomes for homeless youth. This study examines the comparative efficacy of 2 interventions—Social Enterprise Intervention (SEI) and Individual Placement and Support (IPS)—provided to homeless youth with mental illness in a randomized controlled trial. METHOD: Participants were recruited from 1 homeless youth agency in Los Angeles, CA, and randomized to the SEI (n = 36) or IPS (n = 36) conditions. Over 20 months, SEI participants received 4 SEI components, and IPS participants received IPS services based on 8 principles. Data were collected at baseline and follow-up for the primary employment outcome (paid employment) and 5 secondary employment outcomes. RESULTS: Over 20 months, 39% of SEI participants and 32% of IPS participants reported any paid employment. Across both groups, participants who reported working at baseline had nearly 8 times the odds of working at follow-up (OR = 7.91, p < 0.05). No statistically significant differences were detected across the full sample or between groups on the primary or secondary employment outcomes. CONCLUSIONS: Future effectiveness research is needed to compare the long-term employment outcomes of the SEI and IPS with a more heterogeneous sample of homeless youth using customized homelessness support services and more nuanced employment outcomes.

This study examines social estrangement factors associated with 3 forms of income generation used by homeless young adults: formal sources (i.e., full-time, part-time, temporary employment), informal sources (e.g., selling personal possessions, selling drugs, theft, prostitution), and the combination of formal and informal sources. A sample of 601 homeless young adults was recruited from 3 cities (Los Angeles, CA [n = 200], Austin, TX [n = 200], and Denver, CO [n = 201]) to participate in semi-structured interviews. A multinomial logistic regression model is used to assess whether demographic, homelessness history, arrest history, transience, peer substance use, antisocial personality disorder, and substance use disorder variables predict involvement in the 3 forms of income generation as compared with participants who report no work-related income. Homeless young adults who earn income through formal sources are differentiated from those who report no work-related income by 2 variables: gender an...

Methamphetamine use among homeless youths is an increasing problem. School officials and social work practitioners are presented with a classification problem in determining which youth are or are not using methamphetamines. The purpose of this study is to adopt a machine-learning approach to address this type of classification problem and to compare 2 models (decision rules and logistic regression) for classifying cases into methamphetamine users and nonusers. The selection of predictors in our models was guided by the risk and resilience framework. Logistic regression and decision rules analyses are used to test the models with a subset of data for 2,146 homeless youth who attend high school that was obtained from the 2007–08 California Healthy Kids Survey dataset. Results of logistic regression suggest methamphetamine use is associated with cigarette and marijuana use, having consumed alcohol, and being truant more than once per week. Results of decision rules analysis suggest a youth’s being c...

Prior research reveals high unemployment rates among homeless youth. The literature offers many examples of using evidence-informed and evidence-based supported employment models with vulnerable populations to assist them in obtaining and maintaining employment and concurrently addressing mental health challenges. However, there are few examples to date of these models with homeless youth with mental illness. The purpose of this article was thus to describe a methodology for establishing a university-agency research partnership to design, implement, evaluate, and replicate evidence-informed and evidence-based interventions with homeless youth with mental illness to enhance their employment, mental health, and functional outcomes. Data from two studies are used to illustrate the relationship between vocational skill-building/employment and mental health among homeless youth. The article concludes with a discussion of the implications of conducting community-based participatory employment and clinical intervention research. The author highlights the opportunities and tensions associated with this approach.

This article explores the psychosocial and behavioral adjustment outcomes associated with verbal, emotional, physical, and sexual abuse among homeless young adults as well as the associations among abuse types. Convenience sampling was used to select 28 homeless young adults (ages 18 to 24) from one drop-in center. Overall, subjects experienced high rates of direct abuse (that is, verbal, emotional, physical, and sexual abuse) and indirect abuse (that is, witnessing family verbal and physical abuse). Chi-square tests revealed that proportions of clinical depression, internalizing and externalizing behaviors, alcohol use, and foster care history were higher among subjects who experienced abuse than among those without reported abuse histories. The findings suggest that homeless young adults experience coexisting types of direct and indirect abuse, which can negatively influence outcomes related to their psychosocial functioning and behavioral adjustment. An inclusive multi-type abuse approach, with both direct and indirect abuse types, is needed to draw accurate conclusions regarding the effects of each specific abuse type on homeless young adults' psychological and behavioral adjustment. KEY WORDS: homeless young adults; multi-type abuse; physical abuse; sexual abuse; verbal abuse ********** Homeless young people are highly likely to come from multi-problem and abusive families. Various studies have cited high rates of physical abuse, sexual abuse, neglect, and parental rejection among this population (Powers, Eckenrode, & Jaklitsch, 1990; Rew, Taylor-Seehafer, & Fitzgerald, 2001; Ryan, Kilmer, Cauce, Watanabe, & Hoyt, 2000; Tyler, Cauce, & Whitbeck, 2004; Whitbeck, Hoyt, & Ackley, 1997a, 1997b). Parental abuse is frequently among the primary reasons homeless youths give for leaving home (Ryan et al., 2000; Sullivan & Knutson, 2000; Thompson, McManus, V Tyler et al., 2004; Whitbeck, Hoyt, & Bao, 2000). Evidence suggests that parental abuse is more prevalent among homeless youths than in the general population (Rew et al., 2001; Ryan et al., 2000). Previous studies reveal that 50% to 83% of homeless youths have experienced physical or sexual abuse (Cauce et al., 2000; Molnar, Shade, Kral, Booth, & Watters, 1998; Ryan et al., 2000; Thrane, Hoyt, Whitbeck, & Yoder, 2006; Warren, Gary, & Moorhead, 1994). Extant studies show that childhood sexual abuse prevalence rates in the general population range from 8% to 32% for female subjects and 1% 16% for male subjects (Finkelhor, 1994). Up to 22% of male subjects and 20% of female subjects report childhood physical abuse (Briere & Elliott, 2003). EFFECTS OF ABUSE ON YOUTH DEVELOPMENT AND OUTCOMES Researchers have documented the deleterious effects of abuse on homeless young people's development, psychological adjustment, and future outcomes. Kurtz, Kurtz, and Jarvis (1991) found that homeless youths who were physically and sexually abused experienced a greater number of personal, family, and school problems than those without abuse histories. Having a history of physical and sexual abuse is also considered a risk factor for suicide attempts in homeless youths (Kurtz et al., 1991; Molnar et al., 1998; Powers et al., 1990; Rew et al., 2001) and mental health problems, such as depression, conduct disorder, and trauma symptoms (Ryan et al., 2000; Stiffman, 1989; Thompson, Maccio, Desselle, & Zittel-Palamara, 2007; Whitbeck, Hoyt, & Yoder, 1999). Extant findings further indicate that early sexual abuse increases the probability of running away and early independence (Sullivan & Knutson, 2000; Thrane et al., 2006; Tyler, Hoyt, & Whitbeck, 2000) and using illicit substances and other deviant behaviors, such as trading sex to survive on the streets (Rew et al., 2001; Simons & Whitbeck, 1991; Tyler et al., 2000; Tyler, Hoyt, Whitbeck, & Cauce, 2001a, 2001b; Tyler et al. …

In light of the limitations of existing models of social work exchange, an alternative multidirectional model of technology transfer is presented. Based on social development principles, this model would be effective in depicting the global dissemination of initiatives originating in developing countries that are successfully applied in the developed world. French En l'absence d'un modèle d'échange en service social, cet article présente un modèle alternatif multidirectionnel de transfert de technologies. Fondé sur des principes de développement social, ce modèle pourrait s'avérer un moyen efficace visant à démontrer que des initiatives provenant de pays en voie de développement obtiennent du succès dans le monde développé. Spanish Para aclarar las limitaciones del intercambio existente de modelos de trabajo social, se presenta un modelo global y multidireccional de transferencia technológica. Basado en los principios del desarrollo social, este modelo sería efectivo para representar la diseminación global de iniciativas que se originan en los países en desarrollo, las cuales son aplicadas con éxito dentro del mundo desarrollado.

In Los Angeles, homeless, street-dwelling youths are a barometer for social progress and a conspicuous reminder that educational and employment opportunities are often not a right to all, but a privilege to some. The Institute for the Study of Homelessness and Poverty (ISHP) (2004) estimated that there are at least 10,000 homeless youths, most of whom reside on the streets of Hollywood. In census tract 2063, an eight-block area of downtown in which the homeless population is heavily concentrated, the 2000 census documented that 529 children and youths younger than 18 were homeless, up from the 13 reported in 1990. Service providers within this census tract, however, estimated that the number of homeless minors is closer to 700 (Dyrness, Spoto, & Thompson, 2004). Needless to say, most studies seeking to quantify the homeless youth population resort to head counting in shelters and in the streets. As a result, many youths may be overlooked, particularly if they are denied access to shelters or do not seek services because of their mistrust of authorities (Kipke, Unger, O'Connor, Palmer, & LaFrance, 1997). Myriad individual, familial, and structural factors precipitate the movement of youths into the streets to meet their needs. Individual risk factors include influences such as school difficulties and dropout, unwanted pregnancies, gang involvement, and alcohol and substance abuse (Greene, Ennett, & Ringwalt, 1997; Halcon & Litton, 2004; Kipke, O'Connor, Palmer, & MacKenzie, 1995). Problems with adults in the home are additional influences related to youth homelessness. Across studies, familial conflict, alcohol and substance abuse, and parental strictness, abuse, and neglect have all been cited as conditions present in the home environments of runaway youths (Cauce et al., 2000; Kurtz, Jarvis, & Kurtz, 1991). In addition, other family factors such as poverty, residential instability, and homelessness are implicated in the reasons youths run away (Halcon & Lifson). Lack of affordable housing is another major issue associated with homelessness in Los Angeles. The gap between the number of affordable housing units and demand is currently the largest on record (Burns, Drayse, Flaming, & Haydamack, 2003). This crisis has had a particularly severe effect on poor families with children, fueling the growth in the numbers of homeless women and children (Dennison, Mantley, Mendizabal, & White, 2001). Earlier studies reveal that street-dwelling youths are a heterogeneous group encompassing multiple subgroups. As evidenced, youth homelessness can be triggered by both short- and long-term crises. Thus, youths on the streets comprise those who have substantial street histories as well as those who are temporarily homeless (Halcon & Lifson, 2004). They may include runaways from families in which physical and sexual abuse occurred; throwaways who are discarded by their families; youths who are drawn to the streets by gangs, drugs, or alcohol; youths who live on the streets as part of homeless families; or even undocumented youths with families in their countries (Halcon & Lifson; Kipke et al., 1997). Emancipated foster youths are also disproportionately represented in the homeless youth population. In Los Angeles and Alameda counties, of the 1,500 youths who exit the foster care system each year, an estimated 50 percent will be homeless within six months (Covenant House California, 2004). Street-living youths are commonly involved in high-risk survival behaviors to meet their basic needs (Greene et al., 1997; Halcon & Lifson, 2004; Kipke et al., 1997). These behaviors may include prostitution or survival sex (participating in sexual acts in exchange for money, food, lodging, clothing, or drugs), pimping, pornography, panhandling, theft, selling stolen goods, mugging, dealing drugs, or conning others for goods. In an epidemiologic study of 752 homeless youths and their subsistence and service use patterns in Hollywood, Kipke and colleagues (1997) explored the multiple ways in which homeless youths financially support themselves. …