A social network approach to estimating seroprevalence in the United States

Results from a representative survey of respondents in Florida are given, concerning their knowledge about members of their personal network, and specifically how many people respondents know in selected subpopulations. We employ a method known as a “network scale-up method”. By using a collection of subpopulations of known size, and also asking about one subpopulation (those who are seropositive) of unknown size, we make various estimates of personal network size and the size of the seropositive subpopulation. Our best (maximum likelihood, unbiased) estimates are 108 members of the network defined by “having been in contact with during the previous two years”, and (approximately unbiased) 1.6 million for the seropositive subpopulation. Because of the proportional over-representation of AIDS (and presumably, therefore, seropositive) in Florida, by a factor of about two, this latter estimate could be an overestimate.     

“I’m not homeless,I’m houseless”: identifying as homeless and associations with service utilization among Los Angeles homeless young people

Little is known about homeless young people’s identification of being homeless and how that identity may or may not be associated with service utilization. This study of 444 homeless young people attending Los Angeles area drop-in centers explores the associations of demographic characteristics, homelessness characteristics, negative lifetime experiences, mental health symptoms, technology use, and past month service utilization with identifying as homeless. Fifty-two percent of the sample identified as being homeless. Being Black, a current traveler, and history of injection drug use were all significantly associated with a decreased likelihood in identifying as homeless. However, having fair/poor health, accessing shelter services, and reporting one’s own substance use as a reason for homelessness were all significantly associated with identifying as homeless. There are important service implications for reaching young people who are in need of services but may not identify with the target population label of homeless.     

Stress,Coping, and Mental Health Differences among Homeless People

People who are chronically homeless are assumed to have higher rates of mental health problems than episodically or new‐entry homeless individuals. It is unclear to what extent early‐life and current stressors account for this disadvantage. Guided by cumulative disadvantage theory and stress research, we analyze data from a national study of the US homeless population to examine how stressors and coping resources throughout the life course are implicated in differences among homeless people in psychiatric disorders and alcohol or other drug abuse disorders. Logistic regression analysis reveals that new‐entry homeless persons are less likely than their chronically and episodically homeless counterparts to have current psychiatric disorders. This is explained by stressors and coping resources experienced in childhood and during adult homeless spells. Alcohol and other drug abuse is common but comparable across the three homeless types and shares an association with selected stress and coping measures. Findings lend credibility to an accumulation of risks perspective, highlighting how past as well as contemporaneous stressors are related to the mental health of homeless people.     

Getting it together: Social and institutional obstacles to getting off the streets

Avoiding macrostructural or individualistic explanations as to why homeless individuals cannot get off the streets, this paper examines the social structure of street life as it impinges on a sample of homeless persons' chances of obtaining nonshelter housing. Specifically, by interviewing 42 homeless individuals about a housing grant offered by New York State and the possibility of obtaining shared housing arrangements with such a grant, this study documents possible ways in which the social relations homeless people have with institutions and each other may dash potential efforts to obtain nonshelter housing. The research finds that distrust of the homeless among landlords and a high level of contingency with respect to welfare cases interact with distrustful personal relations among the sample of homeless themselves to reduce the likelihood of successful utilization of the housing grant. Due to sample limitations, findings from this study cannot be generalized to all homeless; nonetheless they offer insight into a dynamic which may be similar to those at work among other homeless sub-populations as well. An earlier version of this paper was presented at a regular session of the American Sociological Association Annual Meeting on August 9, 1994.     

Perceptions of and Reactions to the Homeless: A Survey of Fourth-Grade,High School,and College Students in a Small Midwestern Community

A total of 459 fourth-graders, high school students, and undergraduates completed a Homelessness Questionnaire developed for use in this study. Although participants generally expressed positive and supportive attitudes toward the homeless, attributing homelessness to either social maladjustment (e.g., drug problem) or negative characteristics (e.g., laziness) within the homeless was positively associated with “fear of and anger toward the homeless” for all groups of participants. In addition, perceptions of and reactions to the homeless were influenced by both the participants’ gender and age group. Although high school and college students’ interest in helping the homeless was associated with various attitudes and reactions (e.g., feelings of sympathy/support), their indication that they had ever helped homeless people (either directly or indirectly) was consistently associated only with the acknowledgment that their mother and father had ever helped homeless people (either directly or indirectly). Among these older participants, homelessness in the United States was rated as a more serious problem at the end of the questionnaire than at the beginning.     

Methods for Handling Missing Secondary Respondent Data

Secondary respondent data are underutilized because researchers avoid using these data in the presence of substantial missing data. The authors reviewed, evaluated, and tested solutions to this problem. Five strategies of dealing with missing partner data were reviewed: (a) complete case analysis, (b) inverse probability weighting, (c) correction with a Heckman selection model, (d) maximum likelihood estimation, and (e) multiple imputation. Two approaches were used to evaluate the performance of these methods. First, the authors used data from the National Survey of Fertility Barriers (n = 1,666) to estimate a model predicting marital quality based on characteristics of women and their husbands. Second, they conducted a simulation testing the 5 methods and compared the results to estimates where the true value was known. They found that the maximum likelihood and multiple imputation methods were advantageous because they allow researchers to utilize all of the available information as well as produce less biased and more efficient estimates.     

Lesbian, gay, and bisexual homeless youth: an eight-city public health perspective

This article reports on results of a one-day public health survey conducted in six states by homeless youth providers to measure and compare risk factors between lesbian, gay, and bisexual (LGB) homeless youth and non-LGB homeless youth. This article intends to inform the child welfare field on existing gaps in services and areas where more training and technical support is necessary in providing services to homeless LGB youth. The findings point to substantial differences within the homeless youth sample and demonstrate that in addition to the public health risks young people face merely by being homeless, the risks are exacerbated for those who self-identify as lesbian, gay, or bisexual. The article informs child welfare providers and policymakers about the substantial vulnerability of LGB youth beyond that of non-LGB homeless youth and the need to fund programming, training, technical assistance and further research to specifically respond to the complex needs of this population.     

Perceptions of and reactions to the homeless: A survey of fourth-grade, high school, and college students in a small Midwestern community

A total of 459 fourth-graders, high school students, and undergraduates completed a Homelessness Questionnaire developed for use in this study. Although participants generally expressed positive and supportive attitudes toward the homeless, attributing homelessness to either social maladjustment (e.g., drug problem) or negative characteristics (e.g., laziness) within the homeless was positively associated with “fear of and anger toward the homeless” for all groups of participants. In addition, perceptions of and reactions to the homeless were influenced by both the participants’ gender and age group. Although high school and college students’ interest in helping the homeless was associated with various attitudes and reactions (e.g., feelings of sympathylsupport), their indication that they had ever helped homeless people (either directly or indirectly) was consistently associated only with the acknowledgement that their mother and father had ever helped homeless people (either directly or indirectly). Among these older participants, homelessness in the United States was rated as a more serious problem at the end of the questionnaire than at the beginning.     

Age and gender differences and predictors of victimization of the older homeless

Using data from the National Survey of Homeless Assistance Providers and Clients (NSHAPC) and an application of Felson's Routine Activities Theory, this paper examines gender and age differences in victimization experiences of a sample of more than 4,200 homeless and near-homeless people, mostly adults. Results suggest that there are no differences in victimization experience by homelessness status and that the negative relationship between age and victimization rates found in the general population is also found in the homeless population. However, the relationship is relatively weak and erratic, suggesting that homeless older adults who are at least 50 years old are at increased risk of becoming victims, a finding consistent with Routine Activities Theory. In addition, similar to research with other populations, younger homeless males are statistically more likely to report being victims of theft and physical assault while females of all ages are more likely to report being victims of sexual assault. However, for older homeless adults, the gender difference in likelihood of victimization disappears. Perhaps because older homeless women are labeled as easy targets, they were equally as likely as men to be victims of physical assault and theft in old age. This is also consistent with Routine Activities Theory.     

When homeless people are allowed to decide by themselves. Rehousing homeless people in Germany

Several surveys on homeless people in Germany and evaluation results of studies in other European countries show that a majority of homeless people want to live in mainstream, self-contained housing. Research in the UK and in Germany also proves that most homeless single people with special difficulties and rough sleepers, who are often stigmatized as 'unable to live on their own', manage to sustain a normal tenancy, when additional social support is provided for those in need of it. This article presents the results of a long-term evaluation of two projects in Germany, which aimed at the reintegration of single homeless people into normal, permanent housing and were evaluated for a longer period of time. Both projects were part of a research scheme funded by the German Government.     

Prevalence of clinical autistic traits within a homeless population: barriers to accessing homeless services

ABSTRACT

Recent research suggests a high prevalence rate of Autism Spectrum Conditions (ASC) amongst the homeless population. Although, it is well-documented that autistic people experienced many barriers to accessing health services, little is known about their challenges in accessing homeless services. Thus, the present study aimed to measure prevalence of high levels of autistic traits, and to identify barriers that prevent autistic people accessing homeless services. Participants recruited from homeless services (n?=?65) completed the Autism Quotient-10 (AQ-10) alongside a questionnaire regarding perceived accessibility of homeless services. Results revealed that 18.5% of participants scored Above the Clinical Threshold of the AQ-10 (ACT-AQ). Moreover, the ACT-AQ group reported that encountering big groups in shared accommodation represent a significant barrier to engaging with homeless services. Further research is needed to identify the full degree of ASC representation and the factors that might prevent autistic homeless people accessing homeless services, and thus overcoming homelessness.     

‘I hope one more flower will bloom in my life’: retelling the stories of being homeless in Japan through narrative inquiry

Once becoming homeless, people confront various challenges. Despite hardships in their lives, the voices of people who are homeless are often silenced in society and the multiplicity of their experiences are undermined. To recognize the impact of homelessness from their understandings of life, the study reports in-depth conversations with people who are homeless in Japan. Through the qualitative research methodology of narrative inquiry, I engaged in a close relationship with three men who are/were homeless and inquired into their experiences of being homeless. From our conversations, four narrative threads emerged; (1) living with memories of loss, (2) feeling of being without control, (3) feeling discouraged from weaving forward-looking stories, and (4) nourishing generosity amidst unexpected life circumstances. Considering these narrative threads, we highlight the diversity in the experiences of becoming/being homeless in Japan embodied by the stories of three men. We put forward recommendations for future practice and knowledge development to support people who are homeless.     

Social Communities and Homelessness: A Broader Concept Analysis of Social Relationships and Homelessness

Pathways to and from homelessness were examined from the perspective of people who were both employed and homeless in Calgary, Alberta. Based on data collected through semi-structured open-end interviews (n = 61) with employed homeless people (N estimated at 2,400), we found that respondents identified aspects of five predominant social relationships that had the greatest impact on their present homeless situation: relationships with friends and family, acquaintances in shared accommodation, landlords and employers, other homeless people, and the social service delivery system. The findings provide a model for beginning to understand the complex social communities in which homelessness exists. Further research needs to explore the relationship between service providers and individuals' other social relationships and the role those can play in finding a pathway from homelessness.     

HIV seroprevalence and clinical characteristics of severe inpatient mentally Ill homeless

Two related studies were carried out at a state psychiatric center unit designed for the long-term hospitalization of homeless mentally ill people removed from the streets of New York City and taken to hospitals for psychiatric treatment. The first study, a chart review of 102 patients, documented high rates of severe psychiatric illness, alcohol and other substance use, and untreated medical problems. Patient histories showed significant social disadvantages, including high rates of criminal activity and inability to complete high school or establish long-term relationships. Our second study anonymously tested 87 patients between the ages of 18 and 59 for the presence of HIV antibodies. An overall seroprevalence rate of 5.8% is reported. Men and women in this population are likely to have similar rates of HIV infection. Being young, and Black, or Hispanic appears to be associated with increased risk. This disenfranchised population urgently needs a broad array of social, medical, and psychiatric services. Assertive community outreach programs are necessary to assure delivery of services to this population.     

Methods to reduce the impact of intraclass correlation in group-randomized trials

This study reports intraclass correlation (ICC) for dependent variables used in group-randomized trials (GRTs). The authors also document the effect of two methods suggested to reduce the impact of ICC in GRTs; these two methods are modeling time and regression adjustment for covariates. They coded and analyzed 1,188 ICC estimates from 17 published, in press, and unpublished articles representing 21 studies. Findings confirm that both methods can improve the efficiency of analyses shown to be valid across conditions common in GRTs. Investigators planning GRTs should obtain ICC estimates matched to their planned analysis so that they can size their studies properly.     

Homelessness and Substance Abuse: Which Comes First?

Abstract

The present paper uses a social selection and social adaptation framework to investigate whether problematic substance use normally precedes or follows homelessness. Clarifying temporal order is important for policy and program design. The paper uses information from a large dataset (n=4,291) gathered at two services in Melbourne, supplemented by 65 indepth interviews. We found that 43% of the sample had substance abuse problems. Of these people, one-third had substance abuse problems before they became homeless and two-thirds developed these problems after they became homeless. We also found that young people were more at risk of developing substance abuse problems after becoming homeless than older people and that most people with substance abuse issues remain homeless for 12 months or longer. The paper concludes with three policy recommendations.     

Substance Abuse,Homelessness, Developmental Decision-Making and Spirituality: A Women's Health Issue

ABSTRACT

A qualitative methodology was used to examine the relationship between homeless women's spirituality, substance abuse, moral reasoning and developmental decision-making. Findings indicated that a lack of development in spirituality and the ability to make decisions in childhood is related to homeless, addicted women's inability to maintain abstinence and achieve social independence. Spirituality impacted decisions to abstain from substance abuse and increased the women's social independence. Findings suggest that treatment needs to incorporate spirituality, family of origin, and the development of skills for independent decision-making. The authors propose that childhood maltreatment, homelessness and substance abuse impede spiritual development. Therefore, substance abuse treatment needs to include a focus on spirituality and moral reasoning in the recovery process.     

Comparison of Social Estrangement Among Youth Who Are Accessing Homeless Services in St. Louis,Missouri and Austin,Texas

The purpose of this study was to compare young people seeking homeless services in two distinct geographic locations (Austin, Texas and St. Louis, Missouri). To determine differences between the two populations, the study used a guiding conceptual model of social estrangement that included four domains: institutional disaffiliation, psychological dysfunction, human capital, and identification with homeless culture. A sample of homeless youth (N = 96; 46 from St. Louis, 50 from Austin) were recruited through youth-serving agencies. Findings indicate two unique samples of street-involved youth in regards to affiliation with formal institutions, family support, and informal peer networks, suggesting distinct service needs.     

Voices of Homeless Parents

Abstract

Homeless families with children comprise approximately 40% of homeless people and the fastest-growing group among the homeless. However, the pain and suffering faced by homeless parents, especially single mothers, as providers for and protectors of their children has yet to be documented and understood. In this paper, we illustrate the frustrations, guilt, confusion, and hope of 50 homeless parents staying at three homeless shelters in two large northeastern cities. We hope that a clear understanding of these parents' subjective experiences of homelessness will contribute to the evaluation and improvement of the effectiveness of social work interventions for homeless families.