Date of Award

Spring 5-2020

Degree Name

Doctor of Philosophy (PhD)

Advisor(s)

CHRISTINE MARKHAM, PHD

Second Advisor

DIANE SANTA MARIA, DRPH

Third Advisor

MICHAEL D SWARTZ, PHD

Abstract

Youth experiencing homelessness (YEH) have a high risk of adverse health outcomes and their utilization of healthcare services is low. This dissertation aims to further understand factors that impact YEH’s health behaviors and access to healthcare services. This dissertation is in the form of three manuscripts that each contribute to the overall aim. In manuscript 1, we examined the rates and correlates of human papillomavirus (HPV) vaccination initiation and completion among a sample of YEH in seven U.S. cities using logistic regression models. We found that HPV vaccination completion is low among male (19%) and female (37%) YEH. Among male YEH, we found that those who were older, non-white identifying, resided in San Jose or St. Louis as compared to New York City, had no prior history of sex, and had no history of being tested for transmitted infections (STI) were less likely to initiate and/or complete HPV vaccination. Among female YEH, we found that those who had a lower education level, resided in San Jose or Houston as compared to New York City, had no prior history of sex, and no previous STI testing were less likely to initiate and/or complete HPV vaccination. Additionally, gay males and bisexual females were more likely to complete HPV vaccination compared to their heterosexual counterparts.

In manuscript 2, we used a mixed-methods approach to assess the type of support that YEH receive from family members and to understand the complexities and social dynamics of YEH’s relationships with supportive family members. We found that 71% of participants had least one family member in their social network and 39% of participants received emotional and/or instrumental support from those family members. In addition, we found that YEH’s ties to supportive family members served as a source of motivation for YEH to work toward achieving their goals. We also found that the support that YEH receive is influenced by their familial circumstances and need for autonomy. In manuscript 3, we explored the barriers and facilitators that impact YEH’s access to healthcare services from the perspective of healthcare and social service providers. We identified several barriers to YEH’s access to healthcare services including: lack of awareness of healthcare services; lack of agency inclusivity of sexual and gender minorities; lack of trauma-informed care approach; complex, high-barrier healthcare service delivery system; cost of healthcare services; lack of consistency and continuity of care; and lack of coordination across healthcare facilities. We also identified several facilitators including: incorporating health assessments into social service intake protocols; building trust and promoting an accepting service environment; offering healthcare navigation assistance and accompanying YEH to appointments; mobile services and co-location of services; interagency partnerships and interprofessional collaborations; using multiple funding sources within and across agencies; and public health insurance and financial assistance programs. Overall, findings from these studies can be used to guide the development of interventions designed to promote healthy behaviors among YEH. Furthermore, findings from these studies can shed light on how to strengthen existing systems-of-care to better meet the healthcare needs of YEH.

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