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Objective: This study examines the association between public assistance use and depressive symptoms among young adults experiencing homelessness (YAEH). Method: A purposive sample of 1,342 YAEH (ages 18–26) residing in seven U.S. cities (Denver, CO; Houston, TX; Los Angeles and San Jose, CA; New York, NY; Phoenix, AZ; and St. Louis, MO) were asked whether they received any form of public assistance over the past year, of which 45% did. The Patient Health Questionnaire-9 was used to assess depressive symptoms. We used propensity score matching to balance the two groups (i.e., public assistance recipients and nonrecipients) and account for selection bias, then we conducted multivariate ordinary least squares regression analysis to examine the relationship between public assistance and depressive symptoms. Results: YAEH who had used public assistance had a significantly higher depression score (b = 1.13 , p =.004) than nonrecipients. Conclusions: Findings suggest many possible connections between public assistance use and depression, yet public assistance does not appear to improve mental health for a population facing multiple challenges and barriers. Further research is needed to understand the directional relationship between public assistance and mental health for this population. Social workers should be especially attentive to the mental well-being of young, homeless public assistance recipients. [ABSTRACT FROM AUTHOR]

Young adults experiencing homelessness (YAEH) face discrimination experiences placing them at risk for negative health outcomes. Prior research demonstrates discrimination and perceived stress among YAEH, yet few studies examine the protective role of online health information-seeking (OHIS) behaviors for YAEH. This study investigated the relationship among OHIS, discrimination, and perceived stress in YAEH (N = 1,426). Descriptive analysis and hierarchical multiple regression analysis were conducted. Results indicate that discrimination was significantly related to perceived stress. OHIS moderated the relationship between discrimination and perceived stress. Findings suggest that providing digital access and creating online informational resources are important engagement strategies for YAEH. [ABSTRACT FROM AUTHOR]

Youth experiencing homelessness (YEH) have a high risk of contracting HIV; however, they remain relatively unreached by pre-exposure prophylaxis (PrEP)-based HIV prevention initiatives. We used a cross-sectional mixed-methods study to explore PrEP knowledge, interest, facilitators, and barriers among YEH. Young adults were recruited from agencies serving YEH in Houston, TX (n = 30) and Los Angeles, CA (n = 15) to participate in an electronic self-report survey and a semistructured interview. Survey results indicate that 68.2% of YEH had low or no prior knowledge of PrEP, though 63.7% reported interest in taking PrEP. Qualitative results revealed facilitators of PrEP use, including high PrEP acceptability and awareness, and supportive social networks. Several barriers emerged, including medication-related barriers, adherence, cost, access barriers, low perceived HIV risk, perceived stigma of PrEP use, and low PrEP awareness. Despite high PrEP acceptability, PrEP use among YEH remains low partly due to low PrEP awareness, low perceived HIV risk, and medical mistrust. [ABSTRACT FROM AUTHOR]

Background: People experiencing homelessness have higher rates of HIV than those who are stably housed. Mental health needs, substance use problems, and issues unique to homelessness such as lack of shelter and transiency need to be considered with regard to HIV prevention. To date, HIV prevention interventions for young adults experiencing homelessness have not specifically addressed modifiable real-time factors such as stress, sexual or drug use urge, or substance use, or been delivered at the time of heightened risk. Real-time, personalized HIV prevention messages may reduce HIV risk behaviors.Objective: This pilot study tested the initial efficacy of an innovative, smartphone-based, just-in-time adaptive intervention that assessed predictors of HIV risk behaviors in real time and automatically provided behavioral feedback and goal attainment information.Methods: A randomized attention control design was used among young adults experiencing homelessness, aged 18-25 years, recruited from shelters and drop-in centers in May 2019. Participants were randomized to either a control or an intervention group. The intervention (called MY-RID [Motivating Youth to Reduce Infection and Disconnection]) consisted of brief messages delivered via smartphone over 6 weeks in response to preidentified predictors that were assessed using ecological momentary assessments. Bayesian hierarchical regression models were used to assess intervention effects on sexual activity, drug use, alcohol use, and their corresponding urges.Results: Participants (N=97) were predominantly youth (mean age 21.2, SD 2.1 years) who identified as heterosexual (n=51, 52%), male (n=56, 57%), and African American (n=56, 57%). Reports of sexual activity, drug use, alcohol use, stress, and all urges (ie, sexual, drug, alcohol) reduced over time in both groups. Daily drug use reduced by a factor of 13.8 times over 6 weeks in the intervention group relative to the control group (Multimedia Appendix 4). Lower urges for sex were found in the intervention group relative to the control group over the duration of the study. Finally, there was a statistically significant reduction in reports of feeling stressed the day before between the intervention and control conditions (P=.03).Conclusions: Findings indicate promising intervention effects on drug use, stress, and urges for sex in a hard-to-reach, high-risk population. The MY-RID intervention should be further tested in a larger randomized controlled trial to further investigate its efficacy and impact on sexual risk behaviors.Trial Registration: ClinicalTrials.gov NCT03911024; https://clinicaltrials.gov/ct2/show/NCT03911024. [ABSTRACT FROM AUTHOR]

Background: Homeless youth continue to be disproportionately affected by HIV compared with their housed peers, with prevalence rates as high as 13%. Yet, HIV prevention in this high-risk population has been only marginally effective. Objective: The aim of this study was to use ecological momentary assessments to examine real-time factors to determine the predictors of sexual activity among homeless youth. Methods: Youth experiencing homelessness aged between 18 and 24 years were recruited from a drop-in center in Houston, Texas, between August 2015 and May 2016. All the participants received a study-issued mobile phone that prompted brief ecological momentary assessments (EMAs) 5 times a day for 21 days. EMA items assessed near real-time sexual behaviors, cognitions, stress, affect, environmental factors, and environmental circumstances. Results: Participants (N=66) were predominantly male (41/66, 64%) and black (43/66, 66%) with a median age of 20 years. The mean number of EMAs completed by each participant was 45 out of 105 possible observations. During the study, 70% (46/66) of participants were sexually active and reported condomless sex in 102 of the 137 cases of sexual intercourse (74.5%). In total, 82% (38/46) of the youth who reported having sex during the 3 weeks of data collection also reported engaging in high-risk sexual activities, including having condomless sex (24/46, 53%), having multiple sexual partners on the same day (12/46, 26%), trading sex (7/46, 16%), and sharing needles while injecting drugs (1/46, 3%). Of those, 71% (27/38) were engaged in multiple sexual risk behaviors. The predictive model was based on observations from 66 subjects who reported 137 cases of sexual intercourse over 811 days; sexual orientation, race, mental health, drug use, and sexual urge were included as predictors in the parsimonious generalized linear mixed model selected on the basis of the Akaike information criterion. The estimated odds ratios (ORs) were notable for same-day drug use (OR 2.17, 95% CI 4.48-17.31; P<.001) and sexual urge (OR 1.44, 95% CI 1.60-11.28; P=.004). The performance of the risk estimator was satisfactory, as indicated by the value of 0.834 for the area under the receiver operating characteristic curve. Conclusions: Real-time EMA data can be used to predict sexual intercourse among a sample of high-risk, predominately unsheltered homeless youth. Sexual urge and drug use accounts for increased odds of engaging in sexual activity on any given day. Interventions targeting sexual urge and drug use may help predict sexual activity among a population at high risk of HIV. [ABSTRACT FROM AUTHOR]