Objective: Given the high prevalence of Black youth experiencing homelessness, this study sought to understand if race impacts service use and whether other marginalized identities (e.g., gender, sexual orientation) are associated with unique service patterns among youth experiencing homelessness. Method: We used data collected from 1,046 homeless youth (ages 13-24) in Los Angeles County, CA, between October 2011 and June 2013. We used classification tree analyses to rank predictors of service use in order of importance and to test linear and nonlinear relationships among selected variables. Results: Across service type (i.e., shelter, therapy, employment, or health services), the classification tree analyses highlighted race as a primary predictor of service use. Conclusions: Critical race theory may be a useful framework for future explorations of service use among Black youth experiencing homelessness. Furthermore, as race consistently emerges as a feature of importance, providers should consider how race impacts service use.

OBJECTIVES The purpose of this study is to explore main and interaction effects of minority and multiple minority statuses on exits from homelessness and the stability of homelessness exits over time. METHODS This study utilized the Homeless Management Information System administrative data of 10 922 youth experiencing homelessness collected from a convenience sample of 16 geographically diverse communities across the USA between 2015-17. Using multinomial logistic regression analyses and logistic regression, main effects and interaction effects of racial/ethnic minority identity and sexual/gender minority identity were examined on various homelessness exits (n = 9957) and housing sustainability (n = 5836). RESULTS Black youth, relative to White youth, were disproportionately exiting homelessness through incarceration (P < 0.001). Black and Latinx youth were less likely to successfully self-resolve their homelessness (both P < 0.05). Black heterosexual and Black and Latinx non-heterosexual youth were most frequently lost to the homeless system (all P < 0.01). Black youth, relative to White youth, were approximately half as likely to remain stably housed after returning to family (P < 0.01). CONCLUSIONS With respect to housing exits and exit stability, Black and Latinx heterosexual youth are consistently at a disadvantage. Homelessness/housing systems and programs need to conduct a deeper investigation into how they implement and develop equitable outreach and engagement practices.

Many real-world security scenarios can be modeled via a game-theoretic framework known as a security game in which there is a defender trying to protect potential targets from an attacker. Recent work in security games has shown that deceptive signaling by the defender can convince an attacker to withdraw his attack. For instance, a warning message to commuters indicating speed enforcement is in progress ahead might lead to them driving more slowly, even if it turns out no enforcement is in progress. However, the results of this work are limited by the unrealistic assumption that the attackers will behave with perfect rationality, meaning they always choose an action that gives them the best expected reward. We address the problem of training boundedly rational (human) attackers to comply with signals via repeated interaction with signaling without incurring a loss to the defender, and offer the four following contributions: (i) We learn new decision tree and neural network-based models of attacker compliance with signaling. (ii) Based on these machine learning models of a boundedly rational attacker’s response to signaling, we develop a theory of signaling in the Goldilocks zone, a balance of signaling and deception that increases attacker compliance and improves defender utility. (iii) We present game-theoretic algorithms to solve for signaling schemes based on the learned models of attacker compliance with signaling. (iv) We conduct extensive human subject experiments using an online game. The game simulates the scenario of an inside attacker trying to steal sensitive information from company computers, and results show that our algorithms based on learned models of attacker behavior lead to better attacker compliance and improved defender utility compared to the state-of-the-art algorithm for rational attackers with signaling.

Abstract Social relationships are important among persons experiencing homelessness, but there is little research on changes in social networks among persons moving into permanent supportive housing (PSH). Using data collected as part of a longitudinal study of 405 adults (aged 39+) moving into PSH, this study describes network upheaval during this critical time of transition. Interviews conducted prior to and after three months of living in PSH assessed individual-level (demographics, homelessness history, health, and mental health) and social network characteristics, including network size and composition (demographics, relationship type, and social support). Interviewers utilized network member characteristics to assess whether network members were new or sustained between baseline and three months post-housing. Multilevel logistic regression models assessed characteristics of network members associated with being newly gained or persisting in networks three months after PSH move-in. Results show only one-third of social networks were retained during the transition to PSH, and veterans, African Americans, and other racial/ethnic minorities, and those living in scattered site housing, were more likely to experience network disruption. Relatives, romantic partners, and service providers were most likely to be retained after move-in. Some network change was moderated by tie strength, including the retention of street-met persons. Implications are discussed.

Objective Persons who have experienced homelessness and are living in permanent supportive housing experience high rates of health and mental health problems. Given that physical activity is associated with improved health outcomes and persons with homelessness histories report high rates of cell phone use, phone-based interventions to increase physical activity may be effective for improving health and wellbeing among persons in permanent supportive housing. Methods To understand the acceptability and feasibility of a cell phone-based physical activity intervention in this population, this 6-week pilot study enrolled 13 persons living in permanent supportive housing. Participants were eligible if they had completed their final, 12-month follow-up interview in a larger, longitudinal study of persons moving into permanent supportive housing in the Los Angeles area, spoke English, and reported comorbid chronic physical and mental health conditions. For the study duration, participants wore a pedometer, received multiple weekly motivational text messages on set days (at times selected by the participant), and responded via text to weekly depression screeners and requests to report their weekly step totals, as recorded by their pedometers. Follow-up interviews asked open-ended questions about study participation and satisfaction. Results Participants were 53 years old on average, most were female (54%), and most were African-American (62%). Changes to people’s physical activity levels were limited, but participants reported increased quality of life during the intervention period. Interviews revealed that the intervention was well received and enjoyable for participants. Conclusions The efficacy of utilizing cell phones to improve health and wellbeing among adults living in permanent supportive housing requires further research, but these pilot findings suggest that such interventions are feasible and acceptable.

Objective: Although tobacco use is prevalent among adults experiencing homelessness, research deficits exist regarding the mental health, substance use, and demographic correlates of tobacco use behaviors in this population. This study examined whether correlates of tobacco use among housed adults identified by the Center for Disease Control (CDC) were significant correlates of tobacco use and cessation attempts among a sample of homeless adults. Methods: Participants (N = 421) were adults experiencing homelessness entering permanent supportive housing programs in Los Angeles. Multivariate logistic regression determined associations of lifetime mental health diagnoses, recent substance use, demographic characteristics, and lifetime literal homelessness with daily tobacco use and cessation attempts. Results: Lifetime diagnoses of schizophrenia, posttraumatic stress disorder, depression, bipolar disorder, and illicit substance use were associated with increased odds of daily tobacco use. A lifetime diagnosis of depression was associated with an increased likelihood of a past 3-month tobacco cessation attempt, while illicit substance use was associated with a lower likelihood of a cessation attempt. Conclusions: Findings suggest that demographic and clinical characteristics associated with tobacco use differ among this sample of homeless adults and those identified by the CDC among housed adults. Mental health conditions and substance use appear to be the primary correlates of tobacco use among adults experiencing homelessness and may be critical in efforts aimed at improving cessation.

Although homeless youth are likely to engage in concurrent sexual relationships and doing so can accelerate HIV transmission, the issue of sexual concurrency (i.e., having sexual partnerships that overlap in time) has received scarce attention in this vulnerable population. The literature that exists tends to focus on individuals’ characteristics that may be associated with concurrency and overlooks the influence of their social environment. Informed by the risk amplification and abatement model (RAAM), this study explored the association between pro-social and problematic social network connections, and sexual concurrency among homeless youth using drop-in center services (N = 841). Nearly 37% of youth engaged in concurrency. Partially consistent with the RAAM, regression analyses showed that affiliation with more problematic ties (i.e., having more network members who practice concurrency and unprotected sex) was associated with greater sexual concurrency. Programs addressing HIV risk among homeless youth in drop-in centers should consider the role youths’ network composition may play in concurrency.

Objective: Youth experiencing homelessness are at risk for HIV and need interventions to prevent risky sex behaviors. We tested the feasibility of using artificial intelligence (AI) to select peer change agents (PCAs) to deliver HIV prevention messages among youth experiencing homelessness. Method: We used a pretest–posttest quasi-experimental design. In the AI condition (n = 62), 11 PCAs were selected via AI algorithm; in the popularity comparison (n = 55), 11 PCAs were selected 6 months later based on maximum degree centrality (most ties to others in the network). All PCAs were trained to promote HIV testing and condom use among their peers. Participants were clients at a drop-in center in Los Angeles, CA. HIV testing and condom use were assessed via a self-administered, computer-based survey at baseline (n = 117), 1 month (n = 86, 74%), and 3 months (n = 70, 60%). Results: At 3 months, rates of HIV testing increased among participants in the AI condition relative to the comparison group (18.8% vs. 8.1%), as did condom use during anal sex (12.1% vs. 3.3%) and vaginal sex (29.2% vs. 23.7%). Conclusions: AI-enhanced PCA intervention is a feasible method for engaging youth experiencing homelessness in HIV prevention.

As a result of efforts to end homelessness among U.S. veterans, more former service members are entering permanent supportive housing (PSH). While PSH has been successfully used to house homeless veterans, more research is needed about services beyond housing placement and retention. This study uses the Gelberg-Andersen behavioral model for vulnerable populations to determine associations between predisposing, enabling, and need characteristics and recent service use (i.e., services to satisfy basic needs, occupational development, financial, healthcare, mental health) among unaccompanied homeless veterans (N=126) entering PSH in Los Angeles. Among the significant findings, as indicated using univariable logistic regression models, were veterans who had incarceration histories were more likely to utilize basic needs services, compared to those without incarceration histories. Veterans who received an honorable discharge were more likely to utilize occupational development services, compared to veterans with other discharge statuses. Veterans who had a case manager were more likely to utilize mental health services than those without a case manager, while those who received social security were less likely to utilize mental health services compared to veterans who did not receive social security. Veterans who met criteria for a psychological disability and veterans who met criteria for probable PTSD were more likely to use basic needs services and mental health services than veterans who fell below these thresholds. Clinical implications for social workers including "equal access to services," "enhancing economic stability," "providing safe and affordable housing with trauma-informed services," and "training service social workers to deliver well-informed linkages and services" are discussed.

Homeless youth report more marijuana use than stably housed youth; their marijuana use has been linked to the marijuana-using behaviors of their peers. This study was the first to examine the process of network influences in marijuana use with population-level (sociometric) social network data over time. Network data were collected from a population of homeless youth recruited from a drop-in center in Los Angeles every 6 months for 1 year (n = 237, 263, and 312). For each panel, a sociomatrix was generated based on youth nominating other youth in the sample. Degree centrality, betweenness, eigen vector centrality, and number of marijuana-using linkages represented network influence; logistic regression assessed associations with heavy marijuana use. Approximately 60% of the network membership changed between panels. Individuals with more network connections to other heavy marijuana users and youth with more connections to any other youth reported more heavy marijuana use. These results suggest that in transient, high-risk populations, social influence processes largely affect individual substance use patterns. Heavy marijuana use appears to be popular and important to the construction and reconstruction of these networks over time.

BackgroundPermanent supportive housing (PSH) has been recognized as an effective intervention and the national policy for addressing chronic homelessness in the United States. Due to an aging cohort of homeless adults and prioritizing those who are most vulnerable for housing, the health status of those entering PSH is likely worse than those previously reported in the literature.MethodsThis report examined the self-reported health and health conditions of a sample of 421 homeless adults entering PSH between 2014 and 2016. The average age of our sample was 54 years old.ResultsOverall, 90% reported two or more chronic conditions (either physical or mental), 68% reported at least two chronic physical health conditions and 56% indicated at least two chronic mental health conditions. Describing their health status, 57% reported fair, poor or very poor health.ConclusionsThese findings suggest that access to housing will not easily remedy the well-documented premature mortality among chronically homeless adults.

Homeless adults experience increased risk of negative health outcomes, and technology-based interventions may provide an opportunity for improving health in this population. However, little is known about homeless adults' technology access and use. Utilizing data from a study of 421 homeless adults moving into PSH, this paper presents descriptive technology findings, and compares results to age-matched general population data. The vast majority (94%) currently owned a cell phone, although there was considerable past 3-month turnover in phones (56%) and phone numbers (55%). More than half currently owned a smartphone, and 86% of those used Android operating systems. Most (85%) used a cell phone daily, 76% used text messaging, and 51% accessed the Internet on their cell phone. One-third reported no past 3-month Internet use. These findings suggest that digital technology may be a feasible means of disseminating health and wellness programs to this at-risk population, though important caveats are discussed.

Permanent supportive housing (PSH) is an evidence-based solution to homelessness for persons experiencing chronic or long-term homelessness and one or more physical or behavioral health problems. Health services through PSH typically focus on physical and behavioral health. With the exception of programs specifically designed for persons living with HIV/AIDS, little attention has focused on services through PSH to prevent transmission of HIV or other sexually transmitted infections (STIs), yet sexual risk behavior continues after homeless persons move into PSH. The purpose of this study was to investigate how PSH providers approach HIV prevention and the challenges they perceive surrounding HIV prevention in PSH. Results serve as a critical first step toward addressing the acceptability and feasibility of providing HIV/STI prevention services to PSH residents. As part of a longitudinal mixed methods study examining HIV risk and prevention behavior among homeless unaccompanied adults moving into PSH in Los Angeles, we conducted eleven focus groups with a total of 60 frontline staff across 10 PSH agencies. Thirty-three percent of focus group participants were African American, 32% were Hispanic, and 55% were women. Results suggest that provider awareness and knowledge of PrEP is very limited, and provision of formal HIV prevention programing for residents is perceived as challenging. Informal, ad hoc conversations with residents about sexual risk and HIV prevention do occur when providers have rapport with clients and perceive risk. There are significant gaps in HIV prevention services through PSH but also opportunities to enhance providers' efforts to promote the health of residents through prevention.

Background: Permanent supportive housing (PSH) is the leading intervention to end chronic homelessness. Little is known, however, about gender differences, including potential disparities in physical and mental health and social support, that might inform services available through PSH.Methods: This study included 421 homeless adults, at least 39 years old, English- or Spanish-speaking, who were moving into PSH through 26 different agencies in the Los Angeles area.Results: Compared with men entering PSH, homeless women (28% of the sample) were younger (p < .01), less likely to have achieved at least a high school education (p < .05), and had lower incomes (p < .01). Women had more chronic physical health conditions (p < .01), were more likely to have any chronic mental health condition (odds ratio, 2.5; p < .01), and had more chronic mental health conditions than men (p < .01). Women had more relatives in their social networks (Coefficient, 0.79, p < .01) and more relatives who provided support (coefficient, 0.38; p < .05), but also more relatives with whom they had conflict (coefficient, 0.19; p < .01). Additionally, women were less likely to have caseworkers (coefficient, -0.59; p < .001) or physical and mental health care providers in their networks (coefficient, -0.23 [p < .01]; coefficient, -0.37[p < .001], respectively). However, after correcting for multiple testing, three outcomes lost significance: number of chronic physical health conditions, number of relatives who provided any support, and number of relatives with whom there was conflict.Conclusions: There is evidence of gender differences in mental health and social support among homeless adults moving into PSH. PSH cannot be a one-size-fits-all approach. Supportive services within housing should be tailored based on gender and other individual needs. (c) 2017 Jacobs Institute of Women's Health. Published by Elsevier Inc.

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.

Experiencing sexual victimization prior to becoming homeless is common among homeless youth and is associated with increased HIV risk behavior. This study examined mediating variables that underlie this association, adding to the understanding of gender differences in these paths. Participants were homeless youth in Los Angeles recruited through service access centers who completed a computerized self-administered interview in English or Spanish using an iPad. Findings indicate a high presence of sexual victimization across both genders. Female participants experienced posttraumatic stress disorder and subsequent engagement with exchange sex, whereas male participants were primarily involved in substance use risk pathways. Results indicate paths in the association between sexual victimization and HIV risk behavior differ between male and female homeless youth. Gender-specific, mental-health-informed interventions targeting sexual risk reduction are warranted.

Studies have often described a specific model or models of permanent supportive housing (PSH), yet few studies have systematically examined what services are typically offered to PSH tenants in any given service system and how those services are offered. Using telephone surveys from 23 PSH agency supervisors and qualitative data collected from 11 focus groups with 60 frontline providers and 17 individual interviews with supervisors from a subset of surveyed agencies-all of which were completed between July 2014 and December 2015-the goal of this study is to better understand what services are being offered in PSH organisations located in Los Angeles and what barriers frontline providers face in delivering these services. Survey findings using statistical frequencies suggest the existence of robust support services for a high-needs population and that single-site providers may offer more services than scatter-site providers. Qualitative thematic analysis of interview and focus group transcripts suggests services may be less comprehensive than they appear. If PSH is to be regarded as an intervention capable of more than "just" ending homelessness, further consideration of the provision of supportive services is needed.

Insane Clown Posse is a musical duo whose fans are known as Juggalos. Many homeless youths (HY) identify as Juggalos, most likely because the group’s music embraces poverty and being an outsider in mainstream society. Juggalos are stereotyped as being violent, undereducated, poor, racist, crime-committing youth, and in 2011 the FBI officially labeled Juggalos as a gang. However, little is known about the intersection of HY and Juggalos. A convenience sample of Los Angeles-area, drop-in service-seeking HY completed a self-administered questionnaire ( N = 495). In the sample, 15 % of HY identified as Juggalos. Juggalo-identifying youth were more likely to have experienced childhood trauma, including physical and sexual abuse and witnessing community violence. Multivariable models revealed that identifying as a Juggalo was associated with increased odds of recent methamphetamine use, ecstasy use, chronic marijuana use, and prescription drug misuse. Juggalos were also more likely to experience suicidal ideation, attempt suicide, recently engage in interpersonal violence, become injured during a fight, and have unprotected sex. In conclusion, Juggalos constitute a unique subpopulation of HY. Implications for Juggalo-specific trauma-informed services, rather than punitive, are discussed as well as the potential for future research regarding resiliency associated with Juggalo identification.