Where Is Family-Based HIV Prevention Needed Most: Poverty, Homelessness & Family-Level Mental Health Need As Critical Influences On Youth Outcomes

Background:The threats of HIV exposure, substance use, and mental health difficulties are significantly increased for those youth who reside in inner-city communities and who experience an associated range of urban “toxins,” particularly high rates of poverty, exposure to violence and resource scarcity. For those youth who experience homelessness along with accumulated risks (e.g. parent with mental health or substance abuse difficulties, extended family instability), factors appear to converge to place them at the highest risk for overlapping difficulties, particularly behavioral risk-taking.

Methods: This paper presents findings from a secondary analyses of baseline data of a sample of 335 youth and their families living in 10 family homeless shelters in poverty-impacted urban communities in the US. This data was collected in 2008-2010 as part of a NIDA-funded large scale field trial (R01 DA018574). Standard measures tapped the following constructs:  1) family communication; 2) within family support; 3) supervision and monitoring; 4) family conflict; 5) youth alcohol and drug use and; 6) depression and suicidal ideation; 7) adult mental health and; 8) youth HIV knowledge. Multivariate analytic approaches were applied. 

Results: Subgroup analyses revealed that youth were residing with parents who reported extended periods of homelessness, as well as serious adult need. They were:  a) 3 times more likely to indicate low parent-child communication and within family support; b) 5 times more likely to report low protective parenting processes, such as supervision and monitoring; c) 3 times more likely to evidence conduct difficulties; d) 7 times more likely to have high levels of distress in relationships with their parents; e) 4 times more likely to have used alcohol and marijuana; f)twice as likely to report suicidal ideation. Further, multivariate analyses revealed a significant interaction between length of homelessness, multiple episodes of housing instability, adult caregiver mental health needs and youth outcomes (e.g. HIV knowledge, mental health).

Implications: Youth living in poverty have differing levels of need and face various risk factors.  Homeless adolescents face the greatest level of deprivation and warrant specific interventions to protect them from dangerous environmental toxins.  In an era of scarcity of resources supporting youth-focused HIV prevention, targeting youth and families most in need of evidence-based prevention programming is critical.