Prevention Science

, Volume 19, Issue 4, pp 459–467 | Cite as

Predictors of Retention in an Alcohol and Risky Sex Prevention Program for Homeless Young Adults

  • Eric R. Pedersen
  • Brett A. Ewing
  • Elizabeth J. D’Amico
  • Jeremy N. V. Miles
  • Ann C. Haas
  • Joan S. Tucker


Homeless young adults are at risk for alcohol and other drug (AOD) use and risky sexual behavior. Interventions are needed to help these young people reduce their risky behavior, but this population is often difficult to engage and retain in services. We offered a four-session AOD and risky sex reduction program to 100 participants and examined if retention in the program was predicted by a number of factors: demographics, homelessness severity, other service use, AOD behaviors, mental health symptoms, sexual risk behaviors, and readiness to change AOD and condom use. Nearly half (48%) of participants completed all sessions. In bivariate analyses, participants were significantly less likely to be retained in the program if they had slept outdoors in the past month, engaged in more alcohol and marijuana use, experienced more alcohol-related consequences, and received the program in an urban drop-in center (as opposed to a drop-in center near the beach). When controlling for all significant bivariate relationships, only sleeping outdoors and receipt of the program in the urban setting predicted fewer sessions completed. The most endorsed reasons for program non-completion were being too busy to attend and inconvenient day/time of the program. Findings can help outreach staff and researchers better prepare methods to engage higher risk homeless youth and retain them in services. Finding unique ways to help youth overcome barriers related to location of services appears especially necessary, perhaps by bringing services to youth where they temporarily reside or offering meaningful incentives for program attendance.


Alcohol and drug use Homeless youth Retention Drop out Risky sex 



The authors want to thank Ruthie Brownfield, Ali Johnson, and Fred Mills of the RAND Survey Research Group for their assistance with data collection and intervention delivery, the two drop-in centers for their support of this research, and the youth who participated in the study.


This study was funded by grant R34 DA034813 from the National Institute on Drug Abuse (PI: Tucker).

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interests.

Ethical Approval Statement

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.


  1. Al-Tayyib, A. A., Rice, E., Rhoades, H., & Riggs, P. (2014). Association between prescription drug misuse and injection among runaway and homeless youth. Drug and Alcohol Dependence, 134, 406–409.CrossRefPubMedGoogle Scholar
  2. Baruch, G., Vrouva, I., & Fearon, P. (2009). A follow-up study of characteristics of young people that dropout and continue psychotherapy: Service implications for a clinic in the community. Child and Adolescent Mental Health, 14, 69–75.CrossRefGoogle Scholar
  3. Becker, K., Berry, S. H., Orr, N., & Perlman, J. (2014). Finding the hard to reach and keeping them engaged in research. In R. Tourangeau, B. Edwards, T. P. Johnson, K. M. Wolter, & N. Bates (Eds.), Hard-to-survey populations (pp. 619–641). Cambridge: Cambridge University Press.CrossRefGoogle Scholar
  4. Begun, S. (2015). The paradox of homeless youth pregnancy: A review of challenges and opportunities. Social Work in Health Care, 54, 444–460.CrossRefPubMedGoogle Scholar
  5. Bender, K., Brown, S. M., Thompson, S. J., Ferguson, K. M., & Langenderfer, L. (2015). Multiple victimizations before and after leaving home associated with PTSD, depression, and substance use disorder among homeless youth. Child Maltreatment, 20, 115–124.CrossRefPubMedGoogle Scholar
  6. Boudreaux, E. D., Sullivan, A., Abar, B., Bernstein, S. L., Ginde, A. A., & Camargo Jr., C. A. (2012). Motivation rulers for smoking cessation: A prospective observational examination of construct and predictive validity. Addiction Science & Clinical Practice, 7, 8.CrossRefGoogle Scholar
  7. Carmona, J., Slesnick, N., Guo, X., & Letcher, A. (2014). Reducing high risk behaviors among street living youth: Outcomes of an integrated prevention intervention. Children and Youth Services Review, 43, 118–123.CrossRefPubMedPubMedCentralGoogle Scholar
  8. De Rosa, C. J., Montgomery, S. B., Hyde, J., Iverson, E., & Kipke, M. D. (2001). HIV risk behavior and HIV testing: A comparison of rates and associated factors among homeless and runaway adolescents in two cities. AIDS Education and Prevention, 13, 131–148.CrossRefPubMedGoogle Scholar
  9. Dennis, M. L., Chan, Y. F., & Funk, R. R. (2006). Development and validation of the GAIN Short Screener (GSS) for internalizing, externalizing and substance use disorders and crime/violence problems among adolescents and adults. American Journal on Addictions, 15, 80–91.CrossRefPubMedGoogle Scholar
  10. Friedman, M. S., Marshal, M. P., Stall, R., Kidder, D. P., Henny, K. D., Courtenay-Quirk, C., & Holtgrave, D. R. (2009). Associations between substance use, sexual risk taking and HIV treatment adherence among homeless people living with HIV. AIDS Care, 21, 692–700.CrossRefPubMedGoogle Scholar
  11. Garvey, R., Pedersen, E. R., D'Amico, E. J., Ewing, B. E., & Tucker, J. S. (2018). Recruitment and retention of homeless youth in a substance use and HIV risk reduction program. Field Methods.
  12. Golinelli, D., Tucker, J. S., Ryan, G. W., & Wenzel, S. L. (2014). Strategies for obtaining probability samples of homeless youth. Field Methods, 27, 131–143.CrossRefGoogle Scholar
  13. Gomez, R., Thompson, S. J., & Barczyk, A. N. (2010). Factors associated with substance use among homeless young adults. Substance Abuse, 31, 24–34.CrossRefPubMedPubMedCentralGoogle Scholar
  14. Green, H. D., de la Haye, K., Tucker, J. S., & Golinelli, D. (2013). Shared risk: Who engages in substance use with American homeless youth? Addiction, 108, 1618–1624.CrossRefPubMedGoogle Scholar
  15. Greene, J. M., & Ringwalt, C. L. (1998). Pregnancy among three national samples of runaway and homeless youth. Journal of Adolescent Health, 23, 370–377.CrossRefPubMedGoogle Scholar
  16. Henry, M., Watt, R., Rosenthal, L., & Shivji, A. (2016). The 2016 annual homeless assessment report (AHAR) to congress. Part 1: Point-in-time estimates of homelessness. Retrieved from Washington, DC:
  17. Huba, G. J., Melchoir, L. A., Greenberg, B., Trevithick, L., Feudo, R., et al. (2000). Predicting substance abuse among youth with, or at high risk for, HIV. Psychology of Addictive Behaviors, 14, 197–205.CrossRefPubMedGoogle Scholar
  18. Kahler, C. W., Strong, D. R., & Read, J. P. (2005). Toward efficient and comprehensive measurement of the alcohol problems continuum in college students: The brief young adult alcohol consequences questionnaire. Alcoholism: Clinical and Experimental Research, 29, 1180–1189.CrossRefGoogle Scholar
  19. Kahler, C. W., Hustad, J., Barnett, N. P., Strong, D. R., & Borsari, B. (2008). Validation of the 30-day version of the Brief Young Adult Alcohol Consequences Questionnaire for use in longitudinal studies. Journal of Studies on Alcohol and Drugs, 69, 611–615.CrossRefPubMedPubMedCentralGoogle Scholar
  20. Kennedy, D. P., Tucker, J. S., Green, H. D., Golinelli, D., & Ewing, B. (2012). Unprotected sex of homeless youth: Results from a multilevel dyadic analysis of individual, social network, and relationship factors. AIDS and Behavior, 16, 2015–2032.CrossRefPubMedPubMedCentralGoogle Scholar
  21. Kipke, M. D., Montgomery, S. B., Simon, T. R., & Iverson, E. F. (1997). Substance abuse’ disorders among runaway and homeless youth. Substance Use & Misuse, 32, 969–986.CrossRefGoogle Scholar
  22. Koopman, C., Rosario, M., & Rotheramborus, M. J. (1994). Alcohol and drug-use and sexual behaviors placing runaways at risk for HIV-infection. Addictive Behaviors, 19, 95–103.CrossRefPubMedGoogle Scholar
  23. Kroenke, K., Spitzer, R. L., & Williams, J. B. W. (2003). The patient health Questionnaire-2—validity of a two-item depression screener. Medical Care, 41, 1284–1292.CrossRefPubMedGoogle Scholar
  24. Lankenau, S. E., Sanders, B., Bloom, J. J., Hathazi, D., Alarcon, E., Tortu, S., & Clatts, M. C. (2008). Migration patterns and substance use among young homeless travelers. In Y. F. Thomas, D. Richardson, & I. Cheung (Eds.), Geography and drug addiction (pp. 65–83). Dordrecht: Springer Netherlands.CrossRefGoogle Scholar
  25. Lee, M. T., Garnick, D. W., O'Brien, P. L., Panas, L., Ritter, G. A., et al. (2012). Adolescent treatment initiation and engagement in an evidence-based practice initiative. Journal of Substance Abuse Treatment, 42, 346–355.CrossRefPubMedGoogle Scholar
  26. Martino, S. C., Tucker, J. S., Ryan, G., Wenzel, S. L., Golinelli, D., & Munjas, B. (2011). Increased substance use and risky sexual behavior among migratory homeless youth: Exploring the role of social network composition. Journal of Youth and Adolescence, 40, 1634–1648.CrossRefPubMedPubMedCentralGoogle Scholar
  27. McKay, J. R. (2005). Is there a case for extended interventions for alcohol and drug use disorders? Addiction, 100, 1594–1610.CrossRefPubMedGoogle Scholar
  28. Medlow, S., Klineberg, E., & Steinbeck, K. (2014). The health diagnoses of homeless adolescents: A systematic review of the literature. Journal of Adolescence, 37, 531–542.CrossRefPubMedGoogle Scholar
  29. Miller, W. R., & Rollnick, S. (2012). Motivational interviewing: Helping people change (3rd ed.). New York: Guilford Press.Google Scholar
  30. Nyamathi, A., Hudson, A., Greengold, B., & Leake, B. (2012). Characteristics of homeless youth who use cocaine and methamphetamine. American Journal on Addictions, 21, 243–249.CrossRefPubMedPubMedCentralGoogle Scholar
  31. Pedersen, E. R., Tucker, J. S., & Kovalchik, S. A. (2016). Facilitators and barriers of drop-in center use among homeless youth. Journal of Adolescent Health, 59, 144–153.Google Scholar
  32. Prochaska, J. O., & Velicer, W. F. (1997). The transtheoretical model of health behavior change. American Journal of Health Promotion, 12, 38–48.CrossRefPubMedGoogle Scholar
  33. Rice, E., Milburn, N. G., Rotheram-Borus, M. J., Mallett, S., & Rosenthal, D. (2005). The effects of peer group network properties on drug use among homeless youth. American Behavioral Scientist, 48, 1102–1123.CrossRefPubMedPubMedCentralGoogle Scholar
  34. Rotheram-Borus, M. J., Song, J., Gwadz, M., Lee, M., Van Rossem, R., & Koopman, C. (2003). Reductions in HIV risk among runaway youth. Prevention Science, 4, 173–187.CrossRefPubMedGoogle Scholar
  35. Slesnick, N., Prestopnik, J. L., Meyers, R. J., & Glassman, M. (2007). Treatment outcome for street-living, homeless youth. Addictive Behaviors, 32, 1237–1251.CrossRefPubMedGoogle Scholar
  36. Slesnick, N., Kang, M. J., & Aukward, E. (2008). Treatment attendance among homeless youth: The impact of childhood abuse and prior suicide attempts. Substance Abuse, 29, 43–52.PubMedPubMedCentralGoogle Scholar
  37. Slesnick, N., Erdem, G., Collins, J., Bantchevska, D., & Katafiasz, H. (2011). Predictors of treatment attendance among adolescent substance abusing runaways: A comparison of family and individual therapy modalities. Journal of Family Therapy, 33, 66–84.CrossRefGoogle Scholar
  38. Slesnick, N., Feng, X., Guo, X., Brakenhoff, B., Carmona, J., et al. (2016). A test of outreach and drop-in linkage versus shelter linkage for connecting homeless youth to services. Prevention Science, 17, 450–460.CrossRefPubMedGoogle Scholar
  39. Spitzer, R. L., Kroenke, K., Williams, J. B. W., & Lowe, B. (2006). A brief measure for assessing generalized anxiety disorder. Archives of Internal Medicine, 166, 1092–1097.CrossRefPubMedGoogle Scholar
  40. Tucker, J. S., Ryan, G. W., Golinelli, D., Ewing, B., Wenzel, S. L., Kennedy, D. P., & Zhou, A. (2012a). Substance use and other risk factors for unprotected sex: Results from an event-based study of homeless youth. AIDS and Behavior, 16, 1699–1707.CrossRefPubMedPubMedCentralGoogle Scholar
  41. Tucker, J. S., Hu, J. H., Golinelli, D., Kennedy, D. P., Green, H. D., & Wenzel, S. L. (2012b). Social network and individual correlates of sexual risk behavior among homeless young men who have sex with men. Journal of Adolescent Health, 51, 386–392.CrossRefPubMedPubMedCentralGoogle Scholar
  42. Tucker, J. S., D’Amico, E. J., Ewing, B. A., Miles, J. N. V., & Pedersen, E. R. (2017). A group-based motivational interviewing brief intervention to reduce substance use and sexual risk behavior among homeless young adults. Journal of Substance Abuse Treatment, 76, 20–27.CrossRefPubMedGoogle Scholar
  43. Wenzel, S. L., Tucker, J. S., Golinelli, D., Green Jr., H. D., & Zhou, A. (2010). Personal network correlates of alcohol, cigarette, and marijuana use among homeless youth. Drug and Alcohol Dependence, 112, 140–149.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Society for Prevention Research 2018

Authors and Affiliations

  • Eric R. Pedersen
    • 1
  • Brett A. Ewing
    • 1
  • Elizabeth J. D’Amico
    • 1
  • Jeremy N. V. Miles
    • 1
  • Ann C. Haas
    • 1
  • Joan S. Tucker
    • 1
  1. 1.RAND CorporationSanta MonicaUSA

Personalised recommendations