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The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial

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Abstract

While many studies provide useful information on the risk behaviors in which homeless youth engage, few prior studies evaluate Human Immunodeficiency Virus (HIV) risk related reduction strategies. In this study, homeless youth (n = 180) were recruited from a drop-in center and randomly assigned to one of two conditions, either an integrated individual cognitive-behavioral treatment and HIV prevention intervention that focused on skills building and education or to treatment as usual. All youth were assessed at entry into the program and at 3 and 6 month follow-up points. Findings showed an interaction between treatment condition, age and time. In the interaction, youth assigned to the integrated treatment reported greater condom usage than youth assigned to treatment as usual, with younger youth assigned to treatment as usual showing no change in condom use. The number of sexual partners reported by youth in both treatment conditions was also reduced over time. However, youth in both conditions continued to engage in other high-risk behaviors. The integrated treatment findings are promising and suggest that interventions which target both HIV risk behavior in addition to other life areas (substance use, mental health and housing) among homeless youth may be necessary in order to significantly impact high-risk behaviors among this unique group.

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Notes

  1. A typical repeated measure MANOVA (RMANOVA) has only one dependent measure, which is measured multiple times. In the doubly multivariate repeated measure design, two or more dependent variables are measured at two or more points in time (Weinfurt 1995). Thus, the present research design which has nine dependent measures assessed for three times fits for doubly multivariate repeated MANOVA.

References

  • Anderson, J. E., Freese, T. E., & Pennbridge, J. N. (1994). Sexual risk behavior and condom use among street youth in Hollywood. Family Planning Perspective, 26, 22–25.

    Article  CAS  Google Scholar 

  • Ashworth, C. S., DuRant, R. H., Newman, C., & Gaillard, G. (1992). An evaluation of a school-based AIDS/HIV education program for high school students. Journal of Adolescent Health, 13, 582–588.

    Article  PubMed  CAS  Google Scholar 

  • Bachman, J. G., Wadsworth, K. N., O’Malley, P. M., Johnston, L. D., & Schulenberg, J. E. (1997). Smoking, drinking, and drug use in young adulthood: The impacts of new freedoms and new responsibilities. Mahwah: Lawrence Erlbaum.

    Google Scholar 

  • Beck, A. T., Steer, R. A., & Brown, G. K. (1996). BDI-II, beck depression inventory: Manual (2nd ed.). Boston: Harcourt Brace.

    Google Scholar 

  • Booth, R. E., Zhang, Y., & Kwiatkowski, C. F. (1999). The challenge of changing drugs and sex risk behaviors of runaway and homeless adolescents. Child Abuse & Neglect, 23, 1295–1306.

    Article  CAS  Google Scholar 

  • Bronfenbrenner, U., & Evans, G. A. (1999). Developmental science in the 21st century: Emerging questions, theoretical models, research designs and empirical findings. Social Development, 9, 115–125.

    Article  Google Scholar 

  • Cauce, A. M., Paradise, M., Ginzler, J. A., Embry, L., Morgan, C. J., Lohr, Y., & Theofelis, J. (2000). The characteristics and mental health of homeless adolescents: Age and gender differences. Journal of Emotional and Behavioral Disorders, 8, 230–239.

    Article  Google Scholar 

  • Clatts, M. C., & Davis, W. R. (1999). A demographic and behavioral profile of homeless youth in New York city: Implications for AIDS outreach and prevention. Medical Anthropology Quarterly, 10, 105–114.

    Google Scholar 

  • Clements, K., Gleghorn, A., Garcia, D., Katz, M., & Marx, R. (1997). A risk profile of street youth in northern California: Implications for gender-specific human immunodeficiency virus prevention. Journal of Adolescent Health, 20, 343–353.

    Article  PubMed  CAS  Google Scholar 

  • DiClemente, R. J. (1991). Predictors of HIV-preventive sexual behavior in a high-risk adolescent population: The influence of perceived peer norms and sexual communications on incarcerated adolescents’ consistent use of condoms. Journal of Adolescent Health, 12, 385–390.

    Article  PubMed  CAS  Google Scholar 

  • Duarte, A. P., & Stam, A. (1995). Discriminant analysis. In L. G. Grimm, & P. R. Yarnold (Eds.), Reading and understanding multivariate statistics (pp. 277–318). Washington, DC: American Psychological Association.

    Google Scholar 

  • Ennett, S. T., Bailey, S. L., & Federman, E. B. (1999). Social network characteristics associated with risky behaviors among runaway and homeless youth. Journal of Health and Social Behavior, 40, 63–78.

    Article  PubMed  CAS  Google Scholar 

  • Ensign, J., & Bell, M. (2004). Illness experiences of homeless youth. Qualitative Health Research, 14, 1239–1254.

    Article  PubMed  Google Scholar 

  • Exner, T. M., Seal, D. W., & Ehrhardt, A. A. (1997). A review of HIV interventions for at-risk women. AIDS and Behavior, 1, 93–124.

    Article  Google Scholar 

  • Field, A. (2005). Discovering statistics using SPSS (2nd ed., pp. 571–618). Thousand Oaks: Sage Publications.

    Google Scholar 

  • Gleghorn, A. A., Clements, K. D., Marx, R., Vittinghoff, E., Lee-Chu, P., & Katz, M. (1997). The impact of intensive outreach on HIV prevention activities of homeless, runaway, and street youth in San Francisco: The AIDS evaluation of street outreach project (AESOP). AIDS and Behavior, 1, 261–271.

    Article  Google Scholar 

  • Godley, S. H., Finch, M., Dougan, L., McDonnell, M., McDermeit, M., & Carey, A. (2000). Case management for dually diagnosed individuals involved in the criminal justice system. Journal of Substance Abuse Treatment, 18, 137–148.

    Article  PubMed  CAS  Google Scholar 

  • Halcon, L. L., & Lifson, A. R. (2004). Prevalence and predictors of sexual risks among homeless youth. Journal of Youth and Adolescence, 33, 71–80.

    Article  Google Scholar 

  • Hawkins, W. E., Latkin, C., & Green, D. L. (2005). Depression therapy with injection drug users: Results of a pilot study. The American Journal of Drug and Alcohol Abuse, 31, 243–251.

    Article  PubMed  Google Scholar 

  • Jacobson, N. S., & Truax, P. (1991). Clinical significance: A statistical approach to defining meaningful change in psychotherapy research. Journal of Consulting and Clinical Psychology, 59, 12–19.

    Article  PubMed  CAS  Google Scholar 

  • Jessor, R., & Jessor, S. L. (1977). The social-psychological framework. In R. Jessor, & S. L. Jessor (Eds.), Problem behavior and psychosocial development: A longitudinal study of youth (pp. 17–24). New York: Academic Press.

    Google Scholar 

  • Johnson, T. P., Aschkenasy, J. R., Herbers, M. R., & Gillenwater, S. A. (1996). Self-reported risk factors for AIDS among homeless youth. AIDS Education and Prevention, 8, 308–322.

    PubMed  CAS  Google Scholar 

  • Joniak, E. (2005). Exclusionary practices and the delegitimization of client voice: How staff create, sustain, and escalate conflict in a drop-In center for street kids. American Behavioral Scientist, 48, 961–988.

    Article  Google Scholar 

  • Kaliski, E. M., Rubinson, L., Lawrence, L., & Levy, S. R. (1990). AIDS, runaways, and self-efficacy. Family and Community Health, 13, 60–67.

    Google Scholar 

  • Kann, L., Nelson, G. D., Jones, J. T., & Kolbe, L. J. (1989). Establishing a system of complementary school-based surveys to annually assess HIV-related knowledge, beliefs, and behaviors among adolescents. Journal of School Health, 59, 55–58.

    Article  PubMed  CAS  Google Scholar 

  • Kelly, J. A., St. Lawrence, J. S., Hood, H. V., & Brasfield, T. L. (1989). Behavioral intervention to reduce AIDS risk activities. Journal of Consulting and Clinical Psychology, 57, 60–67.

    Article  PubMed  CAS  Google Scholar 

  • Kelly, J. A., St. Lawrence, J. S., Stevenson, L. Y., Hauth, A. C., Kalichman, S. C., Diaz, Y. E., Brasfeld, T. L., Koob, J. J., & Morgan, M. G. (1992). Community AIDS/HIV risk reduction: The effects of endorsements by popular people in 3 cities. American Journal of Public Health, 82, 1483–1489.

    PubMed  CAS  Google Scholar 

  • Kline, P. (1999). The handbook of psychological testing (2nd ed.). London: Routledge.

    Google Scholar 

  • McKay, M. M., Chasse, K. T., Paikoff, R., McKinney, L., Baptiste, D., Coleman, D., Madison, S., & Bell, C. C. (2004). Family-level impact of the CHAMP family program: A community collaborative effort to support urban families and reduce youth HIV risk exposure. Family Process, 43, 79–93.

    Article  PubMed  Google Scholar 

  • Meyers, R. J., & Smith, J. E. (1995). Clinical guide to alcohol treatment: The community reinforcement approach. New York: Guilford Press.

    Google Scholar 

  • Miles, J., & Shevlin, M. (2001). Applying regression and correlation: A guide for students and researchers (pp. 73–75). Thousand Oaks: Sage Publications.

    Google Scholar 

  • Office of National AIDS Policy. (2000). Office of national AIDS policy. Retrieved December 2005, from http://www.whitehouse.gov/onap/aids.html

  • Orr, S., Celentano, D., Santelli, J., & Burwell, L. (1994). Depressive symptoms and risk factors for HIV acquisition among black women attending urban health centers in Baltimore. AIDS Education and Prevention, 6, 230–236.

    PubMed  CAS  Google Scholar 

  • Paikoff, R. L. (1995). Early heterosexual debut: Situations of sexual possibility during the transition to adolescence. American Journal of Orthopsychiatry, 65, 389–402.

    Article  PubMed  CAS  Google Scholar 

  • Pendergast, M. L., Urada, D., & Podus, D. (2001). Meta-analysis of HIV risk-reduction interventions within drug abuse treatment programs. Journal of Consulting and Clinical Psychology, 69, 389–405.

    Article  Google Scholar 

  • Pfeiffer, R. W., & Oliver, J. (1997). A Study of HIV seroprevalence in a group of homeless youth in Hollywood, California. Journal of Adolescent Health, 20, 339–342.

    Article  Google Scholar 

  • Robertson, M. J., & Toro, P. A. (1999). Homeless youth: Research, intervention, and policy. In L. B. Fosburg, & D. L. Dennis (Eds.), Practical lessons: The 1998 national symposium on homelessness research. Washington, DC: Department of Housing and Urban Development.

    Google Scholar 

  • Rotheram-Borus, M. J., Koopman, C., Haignere, C., & Davies, M. (1991). Reducing HIV sexual risk behaviors among runaway adolescents. Journal of the American Medical Association, 266, 1237–1241.

    Article  PubMed  CAS  Google Scholar 

  • Rotheram-Borus, M. J., Song, J., Gwadz, M., Lee, M., Van Rossem, R., & Koopman, C. (2003). Reductions in HIV risk among runaway youth. Prevention Science, 4, 173–187.

    Article  PubMed  Google Scholar 

  • Roy, E., Haley, N., Leclerc, P., Sochanski, B., Boudreau, J., & Boivin, J (2004). Mortality in a cohort of street youth in Montreal. Journal of the American Medical Association, 292, 569–574.

    Article  PubMed  CAS  Google Scholar 

  • Runaway and Homeless Youth Program (Title 45), 4 C.F.R. pt. 1351 (1999).

  • Shaffer, D. (1992). The diagnostic interview schedule for children—2.3 Version. New York: Columbia University.

    Google Scholar 

  • Slesnick, N., Bartle-Haring, S., Glebova, T., Glade, A. (2006). Homeless adolescent parents: HIV risk, family structure and individual problem behaviors. Journal of Adolescent Health, 39, 774–777.

    Article  PubMed  Google Scholar 

  • Slesnick, N., & Prestopnik, J. L. (2005). Ecologically based family therapy outcome with substance abusing runaway adolescents. Journal of Adolescence, 28, 277–298.

    Article  PubMed  Google Scholar 

  • Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for homeless, street-living youth. Addictive Behaviors, 32, 1237–1251.

    Article  PubMed  Google Scholar 

  • St. Lawrence, J. S., Brasfield, T. L., Jefferson, K. W., & Alleyne, E. (1994). Social support as a factor in African–American adolescents’ risk for teen pregnancy, sexually transmitted disease, and HIV infection. Journal of Adolescent Research, 9, 292–310.

    Article  Google Scholar 

  • St. Lawrence, J. S., Jefferson, K. W., Alleyne, E., & Brasfield, T. L. (1995). Comparison of education versus behavioral skills training interventions in lowering sexual HIV-risk behavior of substance-dependent adolescents. Journal of Consulting and Clinical Psychology, 63, 154–157.

    Article  PubMed  CAS  Google Scholar 

  • Staton, M., Leukefeld, C., Logan, T. K., Zimmerman, R., Lynam, D., Mffich, R., Martin, C., McClanahan, K., & Clayton, R. (1999). Risky sex behavior and substance use among young adults. Health & Social Work, 24, 147–154.

    CAS  Google Scholar 

  • Stein, M. D., Anderson, B. J., Solomon, D. A., Herman, D. S., Ramsey, S. E., Brown, R. A., & Miller, I. W. (2005). Reductions in HIV risk behaviors among depressed drug injectors. The American Journal of Drug and Alcohol Abuse, 31, 417–432.

    Article  PubMed  Google Scholar 

  • Unger, J. B., Kipke, M. D., Simon, T. R., Johnson, C. J., Montgomery, S. B., & Iverson, E. (1998). Stress, coping, and social support among homeless youth. Journal of Adolescent Research, 13, 134–157.

    Article  Google Scholar 

  • Van Leeuwen, J. M., Hopfer, C., Hooks, S., White, R., Petersen, J., & Pirkopf, J. (2004). A snapshot of substance abuse among homeless and runaway youth in Denver, Colorado. Journal of Community Health, 29, 217–229.

    Article  PubMed  Google Scholar 

  • Wagner, L. S., Carlin, L., Cauce, A. M., & Tenner, A. (2001). A snapshot of homeless youth in Seattle: Their characteristics, behaviors, and beliefs about HIV protective strategies. Journal of Community Health, 26, 219–233.

    Article  PubMed  CAS  Google Scholar 

  • Weinfurt, K. P. (1995). Multivariate analysis of variance. In L. G. Grimm, & P. R. Yarnold (Eds.), Reading and understanding multivariate statistics (pp. 245–276). Washington, DC: American Psychological Association.

    Google Scholar 

  • Wingood, G. M., DiClemente, R. J., Harrington, K. F., Lang, D. L., Davies, S. L., Hook, E. W., Oh, K., & Hardin, J. W. (2006). Efficacy of an HIV prevention program among female adolescents experiencing gender-based violence. American Journal of Public Health, 96, 1085–1090.

    Article  PubMed  Google Scholar 

  • Woods, E. R., Samples, C. L., Melchiono, M. W., Keenan, P. M., Durrell, J. F., Harris, S. K., & the Boston HAPPENS Program Collaborators (2002). Initiation of services in the Boston HAPPENS program: Human immunodeficiency virus-positive, homeless, and at-risk youth can access services. AIDS Patient Care and STDs, 16, 497–510.

    Article  PubMed  Google Scholar 

  • Yoder, K. A., Whitbeck, L. B., & Hoyt, D. R. (2001). Event history analysis of antecedents to running away from home and being on the street. American Behavioral Scientist, 45, 51–65.

    Article  Google Scholar 

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  1. Human Development and Family Science, The Ohio State University, 1787 Neil Avenue, 135 Campbell Hall, Columbus, OH, 43210, USA

    Natasha Slesnick & Min Ju Kang

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  1. Natasha Slesnick
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  2. Min Ju Kang
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Correspondence to Natasha Slesnick.

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Slesnick, N., Kang, M.J. The impact of an integrated treatment on HIV risk behavior among homeless youth: a randomized controlled trial. J Behav Med 31, 45–59 (2008). https://doi.org/10.1007/s10865-007-9132-5

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