“Having a Baby Can Wait”: Experiences of a Sexual and Reproductive Health Promotion Program in the Context of Homelessness among Asian American,Native Hawaiian,and Other Pacific Islander Youth Captured Through PhotoVoice

Abstract

Nearly half of female youth experiencing homelessness (YEH) become pregnant due to myriad individual, family, community, and structural factors. In response, our team developed and tested Wahine (“woman”) Talk, a multilevel, trauma-informed sexual and reproductive health intervention created with and for female YEH aged 14 to 22. After Wahine Talk, youth were invited to participate in a participatory action PhotoVoice project regarding experiences of the program, waiting to start or expand their families, and homelessness. Photographs were taken and captioned by youth, and then further examined through Thematic Analysis. Final project themes include (a) Youth-Driven Birth Timing Decisions; (b) A Sense of Place: Finding Safe Spaces; and (c) Glimpsing Hope. Because YEH live under society’s radar, it is critical to understand their experiences from their own perspectives to improve interventions at multiple levels. Implications for meeting the needs of YEH in the areas of reproductive justice, financial stability, and affordable housing are discussed.

Keywords

homelessness youth PhotoVoice sexual health reproductive health qualitative Hawai‘i

Get full access to this article

View all access options for this article.

References

Aidala

A. A.

Wilson

M. G.

Shubert

Gogolishvili

Globerman

Rueda

Bozack

A. K.

Caban

Rourke

S. B.

(2016). Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. American Journal of Public Health, 106(1), e1–e23. https://doi.org/10.2105/AJPH.2015.302905

Aparicio

E. M.

Kachingwe

O. N.

Phillips

D. R.

Fleishman

Novick

Okimoto

Kaleipumehana Cabral

Ka’opua

L. S.

Childers

Espero

Anderson

(2019). Holistic, trauma-informed adolescent pregnancy prevention and sexual health promotion for female youth experiencing homelessness: Initial outcomes of Wahine Talk. Children and Youth Services Review, 107, Article 104509. https://doi.org/10.1016/j.childyouth.2019.104509

Aparicio

E. M.

Phillips

D. R.

Okimoto

Cabral

M. K.

Houser

Anderson

(2018). Youth and provider perspectives of Wahine Talk: A holistic sexual health and pregnancy prevention program developed with and for homeless youth. Children and Youth Services Review, 93, 467–473. https://doi.org/10.1016/j.childyouth.2018.08.014

Ashdown

Jalloh

Wylie

J. L.

(2015). Youth perspectives on sexual health workshops: Informing future practice. Qualitative Health Research, 25(11), 1540–1550. https://doi.org/10.1177/1049732315570125

Barman-Adhikari

DeChants

J. P.

Brydon

D. M.

Portillo

Bender

(2019). On the fringes: How youth experiencing homelessness conceptualize social and economic inequality—A Photovoice study. Journal of Community Psychology, 47(4), 924–942. https://doi.org/10.1002/jcop.22164

Begun

Combs

K. M.

Torrie

Bender

(2019). “It seems kinda like a different language to us”: Homeless youths’ attitudes and experiences pertaining to condoms and contraceptives. Social Work in Health Care, 58(3), 237–257. https://doi.org/10.1080/00981389.2018.1544961

Bender

Barman-Adhikari

DeChants

Haffejee

Anyon

Begun

Portillo

Dunn

(2017). Asking for change: Feasibility, acceptability, and preliminary outcomes of a manualized photovoice intervention with youth experiencing homelessness. Children and Youth Services Review, 81, 379–389. https://doi.org/10.1016/j.childyouth.2017.08.028

Bender

Begun

Dunn

Mackay

Dechants

(2018). Homeless youths’ interests in social action via PhotoVoice. Journal of Community Practice, 26(1), 107–120. https://doi.org/10.1080/10705422.2017.1413027

Braun

Clarke

(2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.

10.

Can “Housing Firs,” Prevent Child Abuse and Neglect?—Chapin Hall. (n.d.). https://www.chapinhall.org/project/can-housing-first-prevent-child-abuse-and-neglect/

11.

Cheezum

R. R.

Rosso

M. T.

Niewolak

Cobb

(2019). Using PhotoVoice to understand health determinants of formerly homeless individuals living in permanent housing in Detroit. Qualitative Health Research, 29(7), 1043–1055. https://doi.org/10.1177/1049732318816670

12.

City and County of Honolulu. (n.d.). What is the city doing to help? Mayor’s Office of Housing. http://www.honolulu.gov/housing/homelessness/ohou-what.html

13.

Cronley

Hohn

Nahar

(2018). Reproductive health rights and survival: The voices of mothers experiencing homelessness. Women & Health, 58(3), 320–333. https://doi.org/10.1080/03630242.2017.1296060

14.

Damon

Callon

Wiebe

Small

Kerr

McNeil

(2017). Community-based participatory research in a heavily researched inner city neighbourhood: Perspectives of people who use drugs on their experiences as peer researchers. Social Science & Medicine, 176, 85–92. https://doi.org/10.1016/j.socscimed.2017.01.027

15.

Dworsky

Morton

M. H.

Samuels

G. M.

(2018). Missed opportunities: Pregnant and parenting youth in America. Chapin Hall at the University of Chicago. https://www.chapinhall.org/wp-content/uploads/VoYC-PP-Brief-FINAL.pdf

16.

Evans-Agnew

R. A.

Rosemberg

M.-A. S.

(2016). Questioning photovoice research: Whose voice? Qualitative Health Research, 26(8), 1019–1030. https://doi.org/10.1177/1049732315624223

17.

Franco Suglia

Duarte

C. S.

Sandel

M. T

. (2011). Housing quality, housing instability, and maternal mental health—SpringerLink. Journal of Urban Health, 88(6), 1105–1116.

18.

Frankenberg

(1993). White women, race matters: The social construction of whiteness. University of Minnesota Press.

19.

Freire

(1972). Pedagogy of the oppressed (30th anniversary ed). Continuum.

20.

Freire

(2013). Education for critical consciousness. Bloomsbury Academic.

21.

Golden

(2020). Reframing photovoice: Building on the method to develop more equitable and responsive research practices. Qualitative Health Research, 30(6), 960–972. https://doi.org/10.1177/1049732320905564

22.

Greene

J. M.

Ringwalt

C. L.

(1998). Pregnancy among three national samples of runaway and homeless youth. The Journal of Adolescent Health, 23(6), 370–377.

23.

Halcón

L. L.

Lifson

A. R.

(2004). Prevalence and predictors of sexual risks among homeless youth. Journal of Youth & Adolescence, 33(1), 71–80. https://doi.org/10.1023/A:1027338514930

24.

Haldenby

A. M.

Berman

Forchuk

(2007). Homelessness and health in adolescents. Qualitative Health Research, 17(9), 1232–1244. https://doi.org/10.1177/1049732307307550

25.

Hamilton

Martin

Osterman

(2016). Births: Preliminary data for 2015. National Vital Statistics Reports, 65, 1–15.

26.

Hawaii Health Data Warehouse. (2016). Pregnancy rate in Hawai’i for females aged 15-19 years. Hawaii State Department of Health Office of Health Status Monitoring, Vital Statistics.

27.

Helm

Lee

Hanakahi

Gleason

McCarthy

, & Haumana. (2015). Using PhotoVoice with youth to develop a drug prevention program in a rural Hawaiian community. American Indian and Alaska Native Mental Health Research, 22(1), 1–26. https://doi.org/10.5820/aian.2201.2015.1

28.

Hergenrather

K. C.

Rhodes

S. D.

Cowan

C. A.

Bardhoshi

Pula

(2009). PhotoVoice as community-based participatory research: A qualitative review. American Journal of Health Behaviour, 33(6), 686–698. https://doi.org/10.5993/AJHB.33.6.6

29.

HONU—Homeless Outreach and Navigation for Unsheltered Persons Summary Presentation. (2019, October). http://www.honolulu.gov/rep/site/ohou/HONU-191021.pdf

30.

Housing First. (n.d.). National Alliance to End Homelessness. https://endhomelessness.org/resource/housing-first/

31.

Kachingwe

O. N.

Anderson

Houser

Fleishman

J. L.

Novick

J. G.

Phillips

D. R.

Aparicio

E. M.

(2019). “She was there through the whole process”: Exploring how homeless youth access and select birth control. Children and Youth Services Review, 101, 277–284. https://doi.org/10.1016/j.childyouth.2019.04.012

32.

Liebenberg

(2018). Thinking critically about Photovoice: Achieving empowerment and social change. International Journal of Qualitative Methods, 17(1). https://doi.org/10.1177/1609406918757631

33.

Lindberg

Santelli

Desai

(2016). Understanding the decline in adolescent fertility in the United States, 2007–2012. Journal of Adolescent Health, 59(5), 577–583. https://doi.org/10.1016/j.jadohealth.2016.06.024

34.

McLeroy

K. R.

Bibeau

Steckler

Glanz

(1988). An ecological perspective on health promotion programs. Health Education Quarterly, 15(4), 351–377. https://doi.org/10.1177/109019818801500401

35.

Montgomery

Szymkowiak

Marcus

(2016). Homelessness, unsheltered status, and risk factors for mortality: Findings from the 100 000 Homes Campaign. Public Health Report, 131, 765–772.

36.

Morrison

(2009). Homelessness as an independent risk factor for mortality: Results from a retrospective cohort study. International Journal of Epidemiology, 38, 877–883.

37.

Morton

M. H.

Dworsky

Matjasko

J. L.

Curry

S. R.

Schlueter

Chávez

Farrell

A. F.

(2018). Prevalence and correlates of youth homelessness in the United States. Journal of Adolescent Health, 62(1), 14–21. https://doi.org/10.1016/j.jadohealth.2017.10.006

38.

Morton

M. H.

Horwitz

(2019). Federal actions to prevent and end youth homelessness: Recommendations based on research and a national convening of experts and stakeholders. Chapin Hall at the University of Chicago. https://www.chapinhall.org/wp-content/uploads/Federal-actions-to-prevent-and-end-youth-homelessness-final.pdf

39.

National Conference of State Legislatures. (n.d.). State policies on sex education in schools. http://www.ncsl.org/research/health/state-policies-on-sex-education-in-schools.aspx

40.

O’Connell

(2005). Premature mortality in homeless populations: A review of the literature. http://sbdww.org/wp-content/uploads/2011/04/PrematureMortalityFinal.pdf

41.

Prochaska

DiClemente

(1983). Stages and processes of self-change of smoking: Toward an integrative model of change. American Psychological Association, Inc, 51(3), 390–395. https://doi.org/10.1037//0022-006X.51.3.390

42.

Seitz

C. M.

Strack

R. W.

(2016). Conducting public health photovoice projects with those who are homeless: A review of the literature. Journal of Social Distress and the Homeless, 25(1), 33–40. https://doi.org/10.1080/10530789.2015.1135565

43.

Smid

Bourgois

Auerswald

C. L.

(2010). The challenge of pregnancy among homeless youth: Reclaiming a lost opportunity. Journal of the Health Care for the Poor and Underserved, 21(2), 140–156.

44.

The 2018 Annual Homeless Assessment Report (AHAR) to Congress, Part 1: Point-in-Time Estimates of Homelessness. (n.d.). 100.

45.

Tyler

K. A.

Whitbeck

L. B.

Hoyt

D. R.

Cauce

A. M.

(2004). Risk factors for sexual victimization among male and female homeless and runaway youth. Journal of Interpersonal Violence, 19(5), 503–520. https://doi.org/10.1177/0886260504262961

46.

U.S. Census Bureau QuickFacts: Hawaii; UNITED STATES. (n.d.). https://www.census.gov/quickfacts/fact/table/hi, US/PST045218

47.

U.S. Department of Health and Human Services. (2012). Promising strategies to end youth homelessness. U.S. Department of Health & Human Services, Administration for Children and Families Administration on Children, Youth and Families. https://www.acf.hhs.gov/sites/default/files/fysb/youth_homelessness.pdf

48.

U.S. Substance Abuse and Mental Health Services Administration. (2014). SAMHSA’s concept of trauma and guidance for a trauma-informed approach (HHS Publication No. (SMA) 14-4884; p. 27).

49.

Ventura

S. J.

Curtin

S. C.

Abma

J. C.

Henshaw

S. K.

(2012). Estimated pregnancy rates and rates of pregnancy outcomes for the United States, 1990-2008. National Vital Statistics Reports, 60(7), 1–21.

50.

Wang

Burris

(1997). PhotoVoice: Concept, methodology, and use for participatory needs assessment. Health Education & Behavior, 24(3), 369–387. https://doi.org/10.1177/109019819702400309

51.

Wang

C. C.

W. K.

Tao

Z. W.

Carovano

(1998). Photovoice as a participatory health promotion strategy. Health Promotion International, 13(1), 75–86. https://doi.org/10.1093/heapro/13.1.75

52.

Yuan

Stern

I. R.

Gauci

K. T.

Liu

(2018). Street youth study. University of Hawai’i at Manoa Center on the Family. https://uhfamily.hawaii.edu/sites/uhfamily.hawaii.edu/files/publications/StreetYouthStudy.pdf