Reducing Substance Use and Sexual Risk Behavior Among Homeless Emerging Adults: Results from a Pilot Randomized Controlled Trial of Aware

Introduction: Homeless emerging adults ages 18-25 exhibit high rates of alcohol and drug use, as well as sexual behaviors that increase their risk of HIV, STIs and unwanted pregnancy.  Yet few risk reduction programs exist for this at-risk population, particularly ones that are both effective and can be easily incorporated into settings serving this population (e.g., shelters and drop-in centers).  This study addresses an important gap in prevention services for homeless emerging adults by conducting a pilot randomized controlled trial of AWARE, an innovative group-MI (Motivational Interviewing) brief risk reduction intervention focusing on both substance use and sexual risk behavior.

Methods: AWARE consists of four 45-minute sessions.  Rolling admission is used so that youth can join the program at any time, regardless of session.  The evaluation took place in two drop-in centers for homeless young adults in the Los Angeles area.  Homeless young adults ages 18-25 (mean age = 21.8) received the AWARE program (n = 100) or usual care (n = 100).  The sample was 73% male, 79% heterosexual, and 31% non-Hispanic white (24.5% African American, 24% Hispanic, 20.5% multiracial/other).  Surveys were completed at baseline and three months after program completion.  The 3-month follow-up rate for the sample was 91%. 

Results: Satisfaction with the program was high and nearly half (48%) of AWARE participants completed all four sessions.  Compared to the control group, AWARE participants showed greater reductions in past 3 month and past 30 day alcohol use (ps ≤ .05) and greater increases in motivation (i.e., importance, readiness, and confidence) to reduce their drug use (ps < .05), as well as a marginally greater increase in their confidence that they could reduce their drinking (p < .10).  AWARE participants also showed a greater increase in their condom use self-efficacy (p = .055) and, among those with multiple partners at baseline, a marginally greater reduction in unprotected sexual events (p < .10).  No significant intervention effects were found for drug use, negative drinking consequences, or number of sex partners (all ps > .10).

Conclusions:  Results from this pilot evaluation are promising, and suggest that a brief group-MI risk reduction intervention can be effective in helping homeless young adults make positive changes in their substance use, condom use, and related cognitions.