Mixed-methods study of the feasibility and acceptability of ecological momentary assessment with young adults who are currently or formerly homeless (Preprint)

BACKGROUND The use of ecological momentary assessment (EMA) has been utilized with young people experiencing homelessness to gather information on contexts associated with homelessness and risk behavior in real time and has proven feasible with this population. However, the extent to which EMA may impact attitudes or behaviors of currently homeless and formerly young adults residing in supportive housing has not been well investigated. OBJECTIVE This study describes feedback regarding EMA study participation from currently and formerly homeless young adults and examines reactivity to EMA participation and compliance. METHODS This mixed-methods study uses cross-sectional data collected pre- and post-EMA, intensive longitudinal data from a seven-day EMA prompting period and focus groups with currently and formerly homeless young adults in Los Angeles, California between 2017 and 2019. RESULTS Qualitative data confirmed quantitative findings. Differences in the experience of EMA between currently and formerly homeless young adults were found related to stress/anxiety, interference with daily life, difficulty charging, behavior change, and honesty in response. Anxiety and depression symptomatology decreased from pre- to post-EMA, but compliance was not significantly associated with the decrease. CONCLUSIONS Results point to special considerations when administering EMA with currently and formerly homeless young adults. EMA appears to be slightly more burdensome for currently homeless young adults, compared to those residing in supportive housing; nuances to consider in study design. The lack of relationship between study compliance and symptomatology suggests low levels of reactivity.

Examining HIV Risk and Exchange Sex Among Current and Formerly Homeless Young Adults

This study investigated HIV risk among homeless and formerly homeless young adults by examining risky sex behaviors (e.g., condomless sex, exchange sex, and sex with multiple persons) using 90-day and daily recall methods. Data came from a sample of young adults (aged 18–27) with current (n = 101) or past (n = 109) homelessness experience in Los Angeles, California, recruited between 2017 and 2019. Baseline surveys queried demographics and sexual history. Daily retrospective surveys queried sexual events. Multiple logistic regressions were used to test the effects of demographic characteristics including homelessness history, relationship status, substance use, and sexual history on risky sex outcomes. In this sample, 26% reported never using a condom during anal or vaginal sex in the past 90 days, 5% reported testing positive for HIV, 82% had limited to no knowledge of preexposure prophylaxis, and 8% reported having had exchange sex during a 7-day measurement period, with those experiencing homelessness more likely to report. The study suggests supportive housing can reduce the occurrence of exchange sex but that HIV prevention services are still needed in homeless and housing programs to promote safe sexual practices.

“I’ve seen my friend get chopped”: The Influence of Peer Networks on Exposure to Violence Among Homeless Young Adults

Homeless young adults report being exposed to substantial violence and victimization. This often arises through street culture and norms associated with subcultures of violent behavior. In this exploratory study, we applied a decolonizing lens to conduct semi-structured interviews with 18 young adults experiencing homelessness in Victoria, Australia. In this study, we provide a contemporary description of peer relationships among homeless young adults. We examine how these relationships influence exposure to violence, and how young adults perceive and respond to injuries sustained by their peers because of exposure to violence. Findings showed bonds and relationships between homeless young adults appear to imitate the rapport and functions of sibling-kinship that typically exist in supportive family environments. Despite the care and protection provided within close peer relationships, these relationships may also contribute to exposure to violence by way of young adults witnessing violence perpetration and incidences of peers being physically victimized. There is an important duality between the perceived normalization of witnessing peers’ experiences of violence and young adults’ self-reflexive disclosure of vulnerability and helplessness in witnessing these incidents. Study findings have important research and practice implications for recognizing the influence and importance of peer relationships in the delivery of homelessness support programs.