Shelter-based homeless youth. Health and access to care

OBJECTIVES

To compare the self-reported risk-taking behaviors, health status, and access to care issues of 2 samples of shelter-based homeless youth who had previously been street youth (youth on streets or doubling-up with friends or lovers) and systems youth (youth involved in foster care) and to examine information on the etiology of homelessness, including parent or family of origin risk factors for both samples.

DESIGN

The study population consisted of 109 shelter-based homeless youth: 41 street youth and 68 systems youth. A chart audit was completed on all youth, noting documentation of past health problems, reasons for shelter placement, and parental risk factors. Adolescents from both samples completed a health history questionnaire followed by a physical examination. Differences between the 2 samples for behaviors and disease diagnoses were examined using chi 2 and 2-tailed t tests.

RESULTS

The street youth exhibited greater risk-taking behaviors and suffered from poorer health status and access to care than did systems youth. The main differences were in substance using and high-risk sexual behaviors. The street youth were more likely to report previous exposure to violence and having been victims of forced sex. Self-reported risk behaviors, including sexual activity and substance abuse were corroborated by more objective information on these items from medical record information. The street youth were more likely to be medically uninsured, to have used an emergency department in the past year, and to have used an emergency department for their last care.

CONCLUSIONS

There are important variations in health needs between samples of homeless youth, often overlooked in health planning for this population. Knowledge of parent or family of origin risk factors and causes of homelessness provides important contextual information for understanding the risk behaviors and health states of homeless youth.

Mental disorders and service utilization among youths from homeless and low-income housed families

OBJECTIVE

To assess the mental health of homeless and poor housed youths, using the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children (DISC) Version 2.3, and to examine mental health service use.

METHOD

As part of a comprehensive study of homeless and housed families Worcester, MA, data were collected on 41 homeless and 53 poor housed (never homeless) youths aged 9 to 17 using both the parent and youth versions of the DISC.

RESULTS

On the basis of the parent version of the DISC, current (6-month) prevalence rates of DSM-III-R disruptive behavior, affective, and anxiety disorders were comparable in homeless and housed youths but higher than rates found among youths in the NIMH-sponsored Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, which used the same diagnostic measure. Approximately 32% of the combined sample of homeless and housed youths had a current mental disorder accompanied by impairment in functioning. Mental health service use in the preceding 6 months among youths who had one or more current disorders and associated impairment ranged from 20% to 35%. A subgroup of youths with one or more current disorders and poor global functioning had never received treatment.

CONCLUSIONS

This sample of homeless and housed youths was found to have high rates of current mental disorders. Use of mental health services by children with mental health needs was low, particularly for youths with poor overall functioning.

Substance use among street children in Honduras

The hypothesis that drug use among Honduran street children is a function of developmental social isolation from cultural and structural influences is examined. Data from 1,244 children working and/or living on the streets of Tegucigalpa are described, separating "market" children from "street" children. The latter group is then divided into those who sniff glue and those who do not to identify salient distinguishing factors. An OLS regression of drug usage on these variables results in a model that explains 75% of the variance, where family relations, length of time on the street, and delinquency are the most important factors.

Drug use in Nepal: the view from the street

This study uses qualitative research techniques to examine heroin use in Nepal. It explores the life histories of 16 heroin users in Kathmandu, the country's capital, emphasizing those who are street children or who are otherwise displaced. The cases document that the initiation of use in Nepal is a complex process which includes: certain personality traits; an early history of culturally acceptable use of alcohol, tobacco, marijuana, or hashish; peer influence; and the specific social setting of users. Outside (i.e., foreign) influences are included in the mix, but never as a single determinant of drug use. Factors specific to the Nepali scene include the traditional association of forms of marijuana with certain religious contexts and the availability of heroin. An additional factor is the poverty of the urban setting. The approach in Nepal to dealing with drugs primarily involves a realization of the role played by the interaction between personality and social setting in the fullest meaning of that term.

"Substance abuse" disorders among runaway and homeless youth

This study used systematic sampling methods to recruit a sample of 432 homeless youth from both service and natural "hang-out" sampling sites. According to DSM-III criteria, the majority of respondents were classified as having an alcohol and/or illicit "drug abuse" disorder (71%). The results from multivariate logistic regression analyses indicate that cumulative length of time homeless is positively associated with risk for an "abuse" disorder. The implications of these findings and recommendations for service interventions are discussed.

Substance use among runaway and homeless youth in three national samples

OBJECTIVES

Standardized estimates of the prevalence of substance use by runaway and homeless youth between the ages of 12 and 21 in various settings were compared with each other and with estimates for youth in the general population.

METHODS

Four surveys were used: (1) a nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelters; (2) a multicity survey of street youth; (3) a nationally representative household survey of youth with and without recent runaway and homeless experiences; and (4) a nationally representative household survey of youth whose previous runaway/homeless status was unknown.

RESULTS

For almost every substance, substance use prevalence was highest among street youth. Shelter youth and household youth with recent runaway/homeless experiences reported similar rates. In the household surveys, substance use rates were lowest and were generally comparable.

CONCLUSIONS

Many homeless and runaway youth use tobacco, alcohol, and other drugs at rates substantially higher than nonrunaway and nonhomeless youth, indicating a need for comprehensive and intensive substance abuse prevention and treatment services for these youth.

What happened to street kids? An analysis of the Mexican experience

This paper documents some possible reasons of failure of programs for street children in Mexico, and provides background information on demographic and socioeconomic trends that underlay self-employment as well as a historical perspective of the social context of street children. It also describes the strategies used to survive in the streets, trends in drug use/misuse, the felt needs of children and the social responses to this problem. It documents how underlying failure there are unrealistic goals, a fragmented perception of the problem and consequently, a fragmented response to it. It also refers to the great pressure on institutions for results, lack of continuity of the programs and disregard of the perception and felt needs of working children who should benefit from these programs.

Characteristics of street children in Nazareth, Ethiopia

A census based survey was conducted in Nazareth, a town in south-eastern Ethiopia, to determine the number and background of the street children, in December 1994. 5138 street children were counted in the town during a one day census. 4626(90%) were males and 512(10%) were females. The age ranged from 5 to 18 with mean age of 12.9(SD = 3.16). 312(52.3%) of the children left their families before their tenth birthday. 109(18.3%) were attending school at the time of the survey. 326(54.6%) of the children were "on" the street type with a house to sleep in at night and 271(45.4%) were "of" the street type and completely homeless. 530(88.8%) of the children had at least one of their parents alive. Most of the street children take odd jobs to earn a living. Only 76(12.7%) were found to be living on begging. From this study it was concluded that the number of street children was very high, and exploration of opportunities to rehabilitate the children who still have their families alive is recommended.

Drug use among street children in southern Brazil

We studied the self-reported activities engaged in by children found wandering on the streets of Porto Alegre, Brazil, aiming to describe their drug abuse habits and practice of thefts or mendicancy. One hundred-and-five youngsters, 6-18 years old, were interviewed in the streets. Although the external appearance of the interviewed children lacked cues as to their life-style differences, three diverse life-style characteristics were depicted among them. Almost 25% of the children lived with their families and went to school (FAMSCH) and 46% lived with their families but didn't go to school (FAM). The other 29% spent all day long and slept in the streets (STREET). The most frequently used drug for the total group of children was tobacco, followed by alcohol, with a much higher prevalence of use of both alcohol and tobacco among children from the STREET subgroup. Alcohol was used by more than 25% of the STREET children and tobacco by 58% of the children from this subgroup, in a regular (almost daily) basis. Less than 12% of the FAMSCH children used illicit drugs. Inhalants were the preferred drugs for illicit drug experimental use. Only 4% of the children attending school sniffed solvents in a regular basis. Regular abuse of inhalants was reported much more frequently by the STREET subgroup of children, reaching a prevalence of 40%. Self-report of marijuana smoking was described to be regular by 4% of the FAMSCH children and 26% by the STREET children. A significantly higher number of the children who lived with their families in comparison to the STREET children described work activities (selling food, washing cars or polishing shoes) while out in the streets. On the other hand the practice of thefts was self-reported mainly by the children from the STREET group and only by the ones who used illicit drugs. Children who lived with their families reported less mendicancy and thefts than STREET children. These results show that very poor children might spend many hours of the day by themselves in the streets of a big city accompanied by children who are never under adult supervision. In spite of being alone for some hours a day and making friends with others who might use drugs, having a family and regularly attending school decreases the risk of delinquent acts and drug use.

Growth status of homeless Nepali boys: do they differ from rural and urban controls?

The rapid increase in numbers of homeless children in cities of the developed and developing world is a matter of grave concern. A multi-disciplinary study was undertaken to examine the health and lifestyles of the homeless in Nepal in comparison to other local children. Few studies have quantified the health of street-children in the developing world using anthropometric indicators, and to our knowledge this is the first to systematically compare the homeless with appropriate controls from both rural and urban areas. Heights and weights were measured for 307 six to fourteen year-old boys (III homeless 62 squatter, 82 privileged school and 52 village boys). Height for age (HAz), weight for age (WAz) and weight for height (WHz) I-scores relative to reference data from the National Center for Health Statistics (NCHS) were used as indicators of growth status. Stunting characterized all but the school-boys, but wasting was not observed. the homeless were less stunted than either poor squatter or village boys. On arrival on the streets, they were taller than village boys, and duration of homelessness had no effect on their growth status. Thus in terms of physical growth, and despite frequent health complaints, homeless boys in Nepal fare relatively better than control groups of poor urban and rural boys. Comparative studies which reveal some successful aspects of street-life show that urban homelessness may represent an appropriate response to circumstances of poverty.

Height and weight as a reflection of the nutritional situation of school-aged children working and living in the streets of Jakarta

The nutritional status of 89 school-aged children living and working on the streets of Jakarta, Indonesia was assessed. Seventy-nine percent of the children were children "on" the street who still had regular contact with their families, whereas only 21% of the children were "of" the street who had only remote or no contact with their families. The mother was more likely to be present in the home of the children on the street than in the home of the children of the street. The average earning of the children was between 2000 and 3000 rupiah/day (U.S.S1 = 2000 Indonesian Rupiah). The distribution of height-for-age relative to the NCHS reference standard indicated that 52% of the children were stunted (below the third centile of the standard). However the distribution of weight-for height was close to that of the reference population standard, and only 7% of the children were wasted (below the third centile of the standard). Comparison of the data from these street children weigh more and are taller than their socio-economic peers.

Characteristics of troubled youths in a shelter

The purposes of this descriptive study were to: (a) describe the identifiable characteristics of a population of runaway youths; (b) describe certain aspects of the youths' current and past situations, such as alcohol and drug use/abuse and a history of physical or sexual abuse; (c) identify significant life events by means of the Coddington Life Events Scale (LES); and (d) examine possible ways in which health and mental health practitioners can best assist these youths and their families through times of crisis. A convenience sample of 78 runaway youths was drawn from an available population of 780 youths who were admitted to a runaway shelter, during the 7-month period of the study. The shelter is located in a semiurban community in north central Florida. Data collection instruments included the Structured Clinical Interview Instrument and the LES. These were administered to volunteer youth participants during the face-to-face interviews. Data from the current study support the assertion that many runaway youths live in abusive situations and are exposed to drugs and alcohol from a variety of sources. Furthermore, the high scores on the LES show insurmountable levels of stressful life events that occur at any given time. Researchers recommend that prevention programs focusing on the antecedents of runaway behavior be developed to prevent future runaway episodes.

Severe aggression and related conduct problems among runaway and homeless adolescents

OBJECTIVE

The study assessed the prevalence of severe aggressive behavior and conduct disorder in a population of runaway and homeless adolescents and examined relationships between aggression, conduct disorder, other problem behaviors, and background characteristics.

METHODS

A total of 219 runaway and homeless youths recruited through a urban drop-in center were surveyed using the Adolescent Health Survey, a questionnaire about background and mental health experiences, and the revised version of the Diagnostic Interview Schedule for Children.

RESULTS

More than half of study participants met criteria for conduct disorder, and 62 percent reported a history of severe aggressive behavior. Although these constructs were related to each other, a third of the subjects met criteria for only one. Childhood sexual abuse was associated with conduct disorder, while living in a home where drugs were used was associated with aggression. Severe aggressive behavior was associated with other problem behaviors, including attempted suicide, behavior that precipitated residential psychiatric treatment, pregnancy, arrests, and convictions.

CONCLUSIONS

The assessment and systematic treatment of conduct disorder and aggression among runaway and homeless youths is urgently needed to reduce the effects of the disorder and associated problem behaviors.

Short report: prevalence of hepatitis C viral antibody among Brazilian children, adolescents, and street youths

The prevalence of hepatitis C antibodies (anti-HCV) was investigated in 1,378 central Brazilian children, students, and street youths (homeless adolescents without family links or adolescents working in poorly paid activities). Sera were tested with a second generation enzyme-linked immunosorbent assay, and positive samples were retested by a confirmatory assay (line immunoassay). All children attending day care centers were anti-HCV negative. Only one (0.2%) adolescent was positive in the student group. However, higher positivity was found in street youths; four (1.0%) living at home and three (3.0%) living in the streets and anti-HCV antibodies. Among these, the prevalence of anti-HCV increased significantly with age from 0% in the 9-12-year-old group to 6.9% in the 17-20-year-old group. Risk factors including blood transfusion, tattooing, intravenous drug use, and sexual intercourse with multiple partners were significantly associated with the presence of anti-HCV in street youths. These results indicate that apparently healthy children and adolescents attending day care centers or primary schools in central Brazil have a low exposure to HCV infection, but street youths in the same area are at risk for infection with this virus.

Drug use, binge drinking and attempted suicide among homeless and potentially homeless youth

In order to assess the need for drug-related services for at-risk youth, a survey was conducted among young people aged 12-17 years who, owing to severe family discord, were currently living away from home (homeless) or had experienced periods away from home in the past 12 months (potentially homeless). Prevalence of use and of potentially harmful levels of use of alcohol and other licit and illicit drugs were higher than in a comparative population. Of the 155 people interviewed, 54% reported past physical abuse, 28% reported past sexual abuse, and 73% had a family alcohol or other drug history. Of the total, 62% had been in a youth refuge at some time in the past 12 months. Twenty four per cent had been to hospital as a result of alcohol or other drug use and 45% had attempted suicide. Female sex and an interaction between sexual abuse and binge drinking predicted suicide attempts. This study points to the need for a comprehensive approach to interventions for troubled youth which gives greater recognition to mental health issues related to family circumstances, including abuse.

Street youth in Los Angeles. Profile of a group at high risk for human immunodeficiency virus infection

OBJECTIVE

To characterize an urban street youth population, their self-reported rates of drug use, and their involvement in behaviors that put them at risk for infection with the human immunodeficiency virus.

DESIGN

A brief structured interview was administered to 409 youths who had been living on the streets for 2 or more consecutive months, or who were fully integrated into the "street economy."

SETTING

Thirty percent of the sample were recruited from community-based service sites and 70% were recruited from street locations and at natural hangouts.

PARTICIPANTS

Youths were aged 12 to 23 years; 74% were male, 48% were ethnic minorities, 72% were homeless, 14% were gang affiliated, 20% were involved in drug dealing, 43% were engaged in survival sex (ie, the exchange of a sexual favor for money, food, a place to stay, clothes, and/or drugs), and 40% were homosexual or bisexual.

RESULTS

Seventy percent of the youths were sexually active, with an average of 11.7 sexual partners (past 30 days). Youths with multiple sexual partners were more likely to have had a previous sexually transmitted disease (P < .01), to use drugs during sex (P < .001), and to be involved in survival sex (P < .001). Marijuana (55%), methamphetamine (62%), and crack (38%) were the drugs of choice, with 30% of the sample reporting injecting drug use (58% of this subset reported injecting drug use within the past 30 days). Substance-abusing youth were 3.6 times more likely to use drugs during sex, 2.2 times more likely to engage in survival sex, and 2.5 times more likely to have been diagnosed as having a sexually transmitted disease.

CONCLUSIONS

High-risk sexual and drug use behaviors were prevalent and interrelated in this urban street youth sample. This suggests the need for new and innovative educational promotions and prevention interventions targeted to this population.

Teenagers at risk of human immunodeficiency virus type 1 infection. Results from seroprevalence surveys in the United States

OBJECTIVE

To describe the seroprevalence of human immunodeficiency virus type 1 (HIV-1) and risk factors for HIV-1 infection among teenagers attending selected clinics.

DESIGN

Anonymous, cross-sectional serosurveys conducted in 130 clinics in 24 cities.

SETTINGS

Adolescent medicine clinics, sexually transmitted disease clinics, clinics in juvenile detention and correctional facilities, and homeless and runaway youth centers.

PATIENTS

Teenagers in whom serum samples were drawn as part of routine medical services.

MAIN OUTCOME MEASURES

Prevalence of HIV-1 infection and reported HIV risk behaviors.

RESULTS

From January 1, 1990 through December 31, 1992, serum specimens were collected from 79,802 teenagers; 591 of these specimens were positive for HIV-1 antibody. Seropositive test results were found in all 24 cities surveyed, and in 95 (73%) of the 130 clinics surveyed. The median clinic-specific prevalence was 0.2% (range, 0% to 1.4%) in 22 adolescent medicine clinics, 0.3% (range, 0% to 6.8%) in 33 correctional facilities, 0.5% (range, 0% to 3.5%) in 70 sexually transmitted disease clinics, and 1.1% (range, 0% to 4.1%) in five homeless youth centers. Rates exceeded 1% in 37 sites (28%). Excluding sites with many men reporting sex with men, rates in women were similar or somewhat higher than rates in men. Rates were highest among young men reporting sex with men, with clinic rates ranging from 16% to 17% in two homeless youth sites and 13% to 17% in two sexually transmitted disease clinics. Most teenagers with risk information reported heterosexual activity as their only potential risk exposure to HIV-1.

CONCLUSIONS

Seroprevalence of HIV was generally low but varied by type of clinic and geographic area. The highest rates were observed among young women and gay men in some settings, suggesting that targeted prevention messages are needed.

Physical abuse in Canadian runaway adolescents

Recent studies with Canadian runaway youth have questioned the prevalence of abuse experienced by teenaged runaways and the causal contribution of such abuse to runaway experiences (Kufeldt, Duriux, Nimmo, & McDonald, 1992; Kufeldt, & Perry, 1989). This is a descriptive investigation of the physical abuse experienced in a sample of 195 Canadian adolescent runaways: the occurrence, nature and frequency of abuse, the age of onset and duration of abuse, the relationship between the victim and the perpetrator(s), and, who, if anyone, knew of the abuse. This investigation compared and contrasted the physical abuse experienced prior and subsequent to runaway experiences. In this sample, 86% of the population (74% of the males and 90% of the females) reported at least one physically abusive experience. The data reported suggest that this population of adolescents have been the victims of chronic, extreme abuse, experienced at a young age, often perpetrated by the biological parent (most often the mother), and was initiated prior to the first runaway episode. Female runaways were at greater risk than males for all types of abuse experience. Once youths left home, the physical abuse experiences decreased in frequency, but grew in severity, particularly for males.

Psychiatric disorders in and service use by young homeless people

OBJECTIVES

To examine psychiatric morbidity, including substance use disorders, and service use in young people with experience of homelessness.

DESIGN

A cross-sectional study of 34 new residents in a supported accommodation program in Melbourne. Current and lifetime psychiatric diagnoses were made using the Structured Clinical Interview for the Diagnostic and statistical manual of mental disorders, third edition, revised (DSM-III-R). Use of psychiatric and related services was also assessed.

RESULTS

Of the 21 women and 13 men (mean age, 18.1 years; standard deviation, 2.2 years), 50% had a current major DSM-III-R diagnosis, and 82% had a lifetime DSM-III-R diagnosis. The most common diagnoses were alcohol dependence, depressive disorders and cannabis dependence. Co-morbidity was common. Few of the young people had sought or received any treatment for depressive or substance use disorders.

CONCLUSIONS

Young people with experience of homelessness have a high prevalence of depressive disorders and substance use disorders, particularly alcohol and cannabis dependence. Despite this they have a low rate of service use. These findings suggest a need for closer interaction between mental health professionals and other agencies in the planning and provision of services to young homeless people.

Canadian street youth: correlates of sexual risk-taking activity

The purpose of this study was to develop a national perspective on the sexual activity of street youth in Canada and to determine the correlates of risky sexual behavior according to street youth's link to the street. Five categories of street youth (sex industry workers, heavy drug and/or alcohol users, young offenders, homeless and unemployed) ages 15 to 20 years were recruited in 1988 from 10 Canadian urban centers to participate in a 45-minute structured interview focusing on knowledge and attitudes regarding sexually transmitted diseases (STD)/human immunodeficiency virus, current sexual practices, sexual and STD history, demographic background, alcohol/drug use and relationship with parents and peers. Data from the survey were also compared with findings from more than 15,000 non-street youth adolescents surveyed in the same year with the use of parallel questionnaires. Of 712 street youth surveyed (391 males, mean age 17.3 years; 321 females, mean age 16.8 years), the majority were sexually active (95% males, 93% females) and 22% reported at least one previous STD (16% males, 30% females). The lowest STD rates were in unemployed males (5%) and the highest (68%) in female sex industry workers. STD/human immunodeficiency virus high risk behaviors were frequent with 47% of males and 41% of females having had at least 10 different partners, 73% of males and 75% of females inconsistently using condoms and 22% of males and 24% of females participating in anal intercourse. Even among sex industry workers more than 40% used condoms inconsistently.(ABSTRACT TRUNCATED AT 250 WORDS)