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Background: Although hepatitis A virus (HAV) and hepatitis B virus (HBV) infections are vaccine-preventable diseases, few homeless parolees coming out of prisons and jails have received the hepatitis A and B vaccination series. Objectives: The study focused on completion of the HAV and HBV vaccine series among homeless men on parole. The efficacy of three levels of peer coaching (PC) and nurse-delivered interventions was compared at 12-month follow-up: (a) intensive peer coaching and nurse case management (PC-NCM); (b) intensive PC intervention condition, with minimal nurse involvement; and (c) usual care (UC) intervention condition, which included minimal PC and nurse involvement. Furthermore, we assessed predictors of vaccine completion among this targeted sample. Methods: A randomized control trial was conducted with 600 recently paroled men to assess the impact of the three intervention conditions (PC-NCM vs. PC vs. UC) on reducing drug use and recidivism; of these, 345 seronegative, vaccine-eligible subjects were included in this analysis of completion of the Twinrix HAV/HBV vaccine. Logistic regression was added to assess predictors of completion of the HAV/HBV vaccine series and chi-square analysis to compare completion rates across the three levels of intervention. Results: Vaccine completion rate for the intervention conditions were 75.4% (PC-NCM), 71.8% (PC), and 71.9% (UC; p = .78). Predictors of vaccine noncompletion included being Asian and Pacific Islander, experiencing high levels of hostility, positive social support, reporting a history of injection drug use, being released early from California prisons, and being admitted for psychiatric illness. Predictors of vaccine series completion included reporting having six or more friends, recent cocaine use, and staying in drug treatment for at least 90 days. Discussion: Findings allow greater understanding of factors affecting vaccination completion in order to design more effective programs among the high-risk population of men recently released from prison and on parole.

This cross-sectional study of 540 homeless ex-offenders exiting prisons and jails assessed sociodemographic, childhood, and drug-related differences. Older ex-offenders from prison were more likely to have been married, come from a two-parent family, and used crack, whereas younger ex-offenders from prison were more likely to have used methamphetamine. Older ex-offenders from jail were more likely to be African American, have children, and report a history of crack and injection drug use, whereas younger ex-offenders from jail were more likely to have engaged in binge drinking and be in a gang. Our findings showcase the need to understand unique correlates of younger and older incarcerated populations.

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. © 2013 Taylor and Francis Group, LLC.

This study was part of a randomized controlled trial designed to improve hepatitis knowledge and health promoting behaviors and subsequently decrease stimulant use and incarceration with 422 (G/B) homeless men between 18 and 46years of age. Findings revealed that no significant program differences on incarceration in the 4months following the intervention. However, younger participants (p=.010), and those with prior incarceration (p=.001) were at greater risk for incarceration at 4months. An additional factor associated with incarceration at 4months included living on the street for at least 1week (p=.049).

Background: Alcohol use, and in particular, binge drinking, and methamphetamine use is pervasive among homeless youth and remains a social pressure among this vulnerable population. However, there is no compelling evidence that specific interventions for reducing drug and alcohol use are effective for homeless youth. Objectives: This community-based participatory action pilot study assessed the impact of an intervention study focused on decreasing use of drugs and alcohol among a sample of homeless young adults (N= 154) visiting a drop-in site in Santa Monica, California. The two programs consisted of an HIV/AIDS and Hepatitis Health Promotion (HHP) program led by nurses and an Art Messaging (AM) program led by artists. Six-month follow-up data were obtained from 100 of these individuals. Results: Findings revealed significant reductions in alcohol and marijuana use and binge drinking in both the HHP and AM programs. However, homeless youth in the HHP program reported additional reductions in methamphetamine, cocaine, and hallucinogen use at 6-month follow-up. Conclusions: Reductions in drugs and alcohol are important as these substances are linked to HIV/AIDS, hepatitis, and other health risks in homeless youth. Scientific Significance: The successful outcomes of the study intervention validate the utility of nurse-led and artistic health promotion strategies to decrease drug and alcohol use and other risky behaviors in homeless youth populations. (Am J Addict 2012;21:558-565). Language: en

This study used baseline data on recently released paroled men who are homeless (N = 157), residing in a residential drug treatment program, and enrolled in a longitudinal study to examine personal, developmental, and social correlates of parolees who are homeless and who have committed serious violent offenses. Having experienced childhood sexual abuse, poor parental relationships, and early-onset incarceration (prior to 21 years of age) were important correlates of serious violent crimes. These findings highlight the need for interventions that address offenders’ prior adult and childhood victimization and suggest that policies for reentering violent offenders should encompass an understanding of the broader family contexts in which these patterns of maltreatment often occur.

This study describes correlates of high levels of depressive symptoms among recently paroled men in Los Angeles who reside in a community substance abuse treatment program and report homelessness. Cross-sectional data were obtained from male residents who were released on parole within the last 30 days (N=157) to assess parental relationship, self-esteem, social support, coping behaviors, drug and alcohol use behaviors, depressive symptoms, and sociodemographic information. Results indicated that 40% of participants were classified as experiencing high levels of depressive symptoms (CES-D ≥ 10). Results of a logistic regression analysis showed that the following were predictors of depressive symptoms (p < .05): physical abuse in childhood, non-residential alcohol treatment, violent behaviors, low self-esteem, and disengagement coping. Being Mexican-American, Mexican, American Indian, or Asian) and not displaying cognitive problems was inversely related to depressive symptoms in the final model (B = −2.39, p < .05). Findings support proper use of both prison and community assessment services to at-risk individuals eligible for parole to increase self-esteem and coping.

The transition to adulthood is, in general, a difficult phase—one riddled with physical, mental, and social changes (Park, Kim, Kim & Sung, 2007; Votta & Manion, 2004). Among homeless youth, this transition is made more difficult due to circumstances of poverty, lack of support, exposure to violence and crime, and resulting mental health issues. For many, substance use is perceived as “self medication” as a support to deal with mental illness, as a social connection to peers and as a coping strategy when living on the streets (Christiani, Hudson, Nyamathi, Mutere, & Sweat, 2008). Compared to their non-homeless counterparts, homeless youth use substances earlier and with greater frequency (Barczyk & Thompson, 2008; Meade, Slesnick & Tonigan, 2001; Nyamathi et al., 2007; Park et al., 2007). While knowledge about correlates of heightened substance use is crucial for understanding homeless youth’s substance use and associated risk behaviors for HIV (Human Immunodeficiency Virus) and hepatitis B (HBV) and C (HCV) virus, the literature contains little information about such correlates among homeless youth. The purpose of this study is to assess correlates of substance use among homeless youth. Understanding these factors can lead to the development of targeted intervention programs that assist youth in areas that facilitate or discourage ongoing substance use. Although the literature on correlates of substance use among homeless youth is limited, sociodemographic information, peer and family influence, and childhood abuse have been identified as predictors of substance use among the general youth population (Martijn & Sharpe, 2006; Rew, Taylor-Seehafer, & Fitzgerald, 2001). Immutable factors, like race and gender, can forecast the frequency of substance use. For example, findings on ethnic and racial group differences in substance use among youth have been fairly consistent since the 1970s (Galanter, 2005). Native American youth reportedly have the highest use of alcohol (Galanter, 2005), followed by the Caucasian majority (Adams & Berzonsky, 2005; Miller & Carroll, 2006; Thompson, Kost & Pollio, 2003; Tyler & Torres-Stone, 2003). Hispanic youth consume alcohol the next most frequently, followed by African Americans (Adams & Berzonsky, 2005; Galanter, 2005; Tyler & Torres-Stone, 2003); Asian American youth have the lowest rate of alcohol use (Adams & Berzonsky, 2005; Miller & Carroll, 2006). Furthermore, African Americans have the highest rates of illicit substance use (Miller & Carroll, 2006). While racial/ethnic differentiation can sometimes predict future substance use among housed youth (Adams & Berzonsky, 2005; Miller & Carroll, 2006), few studies elaborate on whether such differences are found when comparing various ethnic groups of homeless youth (Rew et al., 2001). In terms of gender, regardless of race or other determinants, males are more likely than females to use alcohol and other drugs (Adams & Berzonsky, 2005; Galea, Nandi, & Vlahov, 2004; Park et al., 2007). Peer substance use and peer pressure often increase a youth’s substance use (Kim, Zane & Hong, 2002; von Sydow, Lieb, Pfister, Hofler & Wittchen, 2002). Prevalent drug and alcohol use within the youth’s social network strongly predicts self-reported substance use (Bousman et al., 2005; Galanter, 2005; Shaw, 2002). In fact, in a study of more than 2,000 high school students, social network characteristics were more responsible for explaining youth’s alcohol use than familial situations (Galea et al., 2004). At the opposite end of the social spectrum, youth without any social network also report heavy illicit substance use (Galanter, 2005), as substance use can serve as a coping mechanism for issues related to loneliness and resulting depression (Torres & Gore-Felton, 2007). Abuse within the family plays a significant role in predicting drug and alcohol use among youth. Families where relationships between parents and children are poor, where there is a sudden disruption in structure, or where other adverse conditions are present, often produce children with excessive alcohol and substance use (Adams & Berzonsky, 2005; Galea et al., 2004). Childhood abuse is one of the most serious risk factors for substance-using youth (Galanter, 2005; Park et al., 2007; Slesnick, Bartle-Haring, & Rashmi, 2006). In a recent study, the physical abuse rate of substance-using youth was six to 12 times higher than that of non-substance users (Park et al., 2007). Additionally, youth with alcohol abuse or dependence were 18–21 times more likely to have a history of sexual abuse than their counterparts without these alcohol problems (Park et al., 2007), underscoring the important link between victimization and substance use. Among homeless males, when these gender-dictated obligations of being self-sufficient and employed are not met, their self-esteem is lowered (LaGory et al., 2001), frequently leading to risky behaviors (Christiani et al., 2008). In addition, social networks and peers also play a large role in determining a homeless youth’s drug and alcohol use (Adams & Berzonsky, 2005; Galea et al., 2004; Shaw, 2002). Criminal involvement and academic failure have also been cited as predictors of homeless youth’s substance use (Barczyk & Thompson, 2008). However, the literature is inconsistent since schooling and the education domain have also been found to have only an indirect linkage to substance use (Kim et al., 2002). Such findings point to pain, trauma, and an inability to cope as predictors of drug and alcohol use (Slesnick, 2004). The difficult situations inherent in a homeless existence, including exposure to crime, victimization, a fluctuating family life, and impaired social networking, can have a great effect on a youth’s drug and alcohol use (Slesnick, 2004).

The purpose of this study was to explore homeless youths' perspectives on the power of drugs in their lives, the preferred type of drugs used, barriers to treatment, and strategies to prevent drug initiation and abuse. This was a descriptive, qualitative study using focus groups with a purposeful sample of 24 drug-using homeless youth. The results provided insight into the lives of drug-using homeless youth. The most commonly used drugs were marijuana and alcohol. Reported reasons for drug use were parental drug use, low self-esteem, and harsh living conditions on the streets. Barriers to treatment were pleasurable enjoyment of the drug, physical dependence, and non-empathetic mental health providers. Strategies to prevent initiation and abuse of drugs were creative activities, such as art, sports, and music, and disdain for parental/family drug use and abuse. Comparative research is needed on specific personal factors that cause initiation and deterrence of drugs use/abuse among homeless youth.

© 2014 Informa UK Ltd. Homeless men exiting California State jails and prisons are a heterogeneous community with varied childhood, incarceration and drug use histories. This cross-sectional study assessed whether homeless men who were discharged from either jail or prison into a residential substance abuse treatment program, differed in terms of methamphetamine and heroin use. This study utilized baseline data collected on 540 recently paroled men randomized to one of three programs that assessed the impact of a peer coaching intervention on subsequent drug use and reincarceration. We found that younger ex-offenders exiting prisons and jails were more likely to have used methamphetamine alone, whereas African-American ex-offenders were less likely to have used methamphetamine alone when compared to other ethnic groups. Further, ex-offenders exiting jails and self-reporting use of heroin only at baseline were significantly more likely than their counterparts to have been removed from home before age 18years. For men exiting jails, there was an association between lower self-esteem and having used methamphetamine but not heroin. However, having used both heroin and methamphetamine was associated with both violent crime and cognitive problems in both jail and prison samples. Our findings showcase the need to understand unique correlates of both heroin and methamphetamine as they relate to jail and prison populations.

High levels of hostility present a formidable challenge among homeless ex-offenders. This cross-sectional study assessed correlates of high levels of hostility using baseline data collected on recently-released male parolees (n =472; age 18 - 60) participating in a randomized trial focused on prevention of illicit drug use and recidivism. Predictors of high levels of hostility included greater depressive symptomatology, lower self-esteem, having a mother who was treated for alcohol/drugs, belonging to a gang, more tangible support, having used methamphetamine and having a history of cognitive difficulties. These findings highlight the need to understand predictors of hostility among recently released homeless men and how these predictors may relate to recidivism. Research implications are discussed, as these findings will shape future nurse-led harm reduction and community-based interventions. © 2014 Copyright Taylor & Francis Group, LLC.

Alcohol-using clients are considered at great risk for hepatitis and ongoing liver damage. This study explores the correlates of depression among a sample of methadone maintained treatment (MMT) adults in the Los Angeles area, and is part of a larger study on hepatitis health promotion among MMT clients who use alcohol.We sought to determine correlates of depressive symptoms among moderate and heavy alcohol-using adults enrolled in methadone maintenance.A cross-sectional correlation study was conducted of baseline data from a randomized control trial of adults (N= 189) receiving MMT in Los Angeles. Depressive symptoms were measured with the 10-item short-form CES-D.Multiple regression analysis revealed that pain and social support were key correlates of depressive symptoms. More pain was associated with higher levels of depressive symptoms (p= .001), while more social support was related to lower depressive symptom severity (p= .001). Having been in sufficiently poor health that a blood transfusion, clotting factors, or an organ transplant was necessary was associated with greater depressive symptomatology, as was having injected drugs in the past month (p= .024).The findings from this investigation can aid clinicians in selecting clients to monitor for early signs of depression and encourage early treatment for opioid users with comorbidities.The use of an interdisciplinary team to care for MMT clients, routinely screen for depressive symptoms, and emphasize adequate pain control is indicated.

In a prospective two-group pilot study of a convenient sample of 156 young adults, we assessed improvement in HIV cognitive and transmission knowledge, hepatitis knowledge, and mental health at six-month follow-up. Multiple linear regression analysis revealed higher six-month scores in total HIV/AIDS knowledge, HIV/AIDS cognitive knowledge, HIV transmission knowledge, and HBV and HCV knowledge at six months in the Hepatitis Health Promotion (HHP) group compared to the Art Messaging (AM) group. Moreover, homeless young participants who reported having significant others in their lives, and excellent or very good health did better than their counterparts. Youth who were attempting to get their lives together had higher scores for all types of knowledge except HBV. Hallucinogen users had significantly worse scores on all knowledge measures than non-users. Lastly, the HHP group revealed an improvement in psychological well-being compared to the AM group.

Homeless gay and bisexual (G/B) men are at risk for reporting 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 be experience depressed mood than their counterparts who had support while persons who reported severe body pain were almost 6 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 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 more appropriate referrals to ancillary care services.

The purpose of this study is to evaluate the effectiveness of three interventions (individual motivational interviewing, group motivational interviewing, or nurse-led hepatitis health promotion) in reducing drug use. A randomized, controlled trial was conducted with 256 methadone maintained moderate-to-heavy alcohol-using adults attending one of five MM outpatient clinics. Drug use in the overall sample was significantly reduced from baseline to 6-month follow-up, as assessed by a 30-day recall (p 0.0001), with a trend apparent for 6-month recall (p = 0.09). The group and individual programs revealed significant decreases in drug use at the 30-day recall. Copyright © Taylor & Francis Group, LLC.

BACKGROUND Approximately 1.5 to 2 million homeless young persons live on the streets in the United States. With the current economic situation, research is needed on quality of services geared toward homeless young adults. OBJECTIVES The objective of this study was to explore homeless young adults' perspectives on barriers and facilitators of health-care-seeking behavior and their perspectives on improving existing programs for homeless persons. METHODS This article is a descriptive qualitative study using focus groups, with a purposeful sample of 24 homeless drug-using young adults. RESULTS Identified themes were failing access to care based on perceived structural barriers (limited clinic sites, limited hours of operation, priority health conditions, and long wait times) and social barriers (perception of discrimination by uncaring professionals, law enforcement, and society in general). DISCUSSION Results provide insight into programmatic and agency resources that facilitate health-seeking behaviors among homeless young adults and include implications for more research with providers of homeless health and social services.

Background Methadone-maintained (MM) clients who engage in excessive alcohol use are at high risk for HIV and hepatitis B virus (HBV) infection. Nurse-led hepatitis health promotion (HHP) may be one strategy to decrease alcohol use in this population. Objective To evaluate the impact of nurse-led HHP, delivered by nurses compared to motivational interviewing (MI), delivered by trained therapists in group sessions or one-on-one on reduction of alcohol use. Methods A three-arm randomized, controlled trial, conducted with 256 MM adults attending one of five MM outpatient clinics in the Los Angeles area. Within each site, moderate-to-heavy alcohol-using MM participants were randomized into one of three conditions: (1) nurse-led hepatitis health promotion group sessions (n = 87); (2) MI delivered in group sessions (MI-group; n = 79), or (3) MI delivered one-on-one sessions (MI-single, n = 90). Results Self-reported alcohol use was reduced from a median of 90 drinks/month at baseline to 60 drinks/month at 6-month follow-up. A Wilcoxon sign-rank test indicated a significant reduction in alcohol use in the total sample (p Discussion As compared to two programs delivered by MI specialists, a culturally-sensitive and easy to implement nurse-led HHP program produced similar reductions in alcohol use over 6 months. Employing nurse-led programs may allow cost savings for treatment programs as well as a greater integration of alcohol reduction counseling along with a more comprehensive focus on general health-related issues than previously conducted.

The purpose of this article was to investigate the personal and social barriers experienced by methadone maintained clients when seeking treatment for alcohol abuse along with strategies for engaging such clients in treatment programs. A qualitative design using semi-structured focus groups was used to obtain the perspectives of 41 methadone-maintained clients in Los Angeles, California. Sessions were recorded, transcribed, and content-analyzed. Attitudes of health care providers were considered critical factors for engaging clients in treatment programs. Other facilitators included incentives and forms of support (emotional, financial, or material aid), whereas barriers consisted of lack of provider knowledge and insensitivity to acquiring needed resources. Clients also discussed the importance of personal attributes in achieving successful behavioral change, such as personal motivation. The findings suggest that healthcare providers' strategies designed to boost motivation, combined with various types of support, may prove successful in alcohol reduction among methadone-maintained clients.