Child abuse, psychiatric disorder, and running away in a community sample of women

OBJECTIVE

Studies involving clinical samples of adolescents indicate that running away is a common problem associated with substantial emotional impairment, yet little information is available from community-based samples. This study aimed to investigate runaway behaviour in female adolescents with and without a history of maltreatment in childhood.

METHOD

We analyzed data from a province-wide community survey conducted in Ontario (n = 3760 girls and women, aged 15 to 64 years). Respondents returned a self-completed questionnaire regarding their history of maltreatment as children. Psychiatric disorder was assessed with a revised version of the Composite International Diagnostic Interview.

RESULTS

Respondents who reported physical abuse only, sexual abuse only, and physical abuse with sexual abuse were 2 to 4 times more likely to report running away from home before age 16 years. Parental psychiatric disorder, respondent psychiatric disorder, respondent age, and income were also significant correlates of running away.

CONCLUSIONS

Understanding the relation between exposure to maltreatment as a child, psychiatric disorder, and running away in women is important for determining ways to prevent a behaviour that puts youth at high risk for a wide range of difficulties.

Do street youths' perceptions of their caregivers predict HIV-risk behavior?

This study examined street youths' perceptions of their caregivers and the association between these perceptions and HIV-risk behavior in a random probability sample of 715 12- to 23-year-old street youths from Los Angeles and San Diego, CA (mean age, 18.7 years). All participants had been homeless at some point during the past 12 months, with 70% recruited from nonshelter sites. Although youths reported high rates of hostility, unavailability, substance use, and legal problems among their caregivers, 86% reported that their caregivers had at least one attribute associated with support. Caregiver problems were associated with youth having had more sexual partners in the past 30 days and having higher risk drug use. High caregiver support was associated with more sexual partners and lower use of condoms with steady partners. Caregiver attributes did not predict condom use with transient partners.

Hepatitis B vaccination rate of homeless children in Baltimore

OBJECTIVE

To investigate the hepatitis B vaccination rate in homeless children 2 to 18 years old living in Baltimore City.

METHODS

During a 21-month period, 250 children from homeless shelters were enrolled.

RESULTS

The percent of children who had received 3 or more doses of hepatitis B vaccine was inversely related to age; 90% in 2- to 5-year-olds and 29% in 13- to 18-year-olds (P<0.0001). Seventy percent of 2- to 5-year-olds had at least some of their vaccine history recorded in the Baltimore Immunization Registry Program but the history was complete in only half. Forty-two percent of 13- to 18-year-olds had no hepatitis B vaccine doses recorded in any source; 49 per cent of 10- to 18-year-olds were either not immunized or had received only one hepatitis B vaccine dose.

CONCLUSIONS

Hepatitis B vaccine coverage is high in homeless children up to 9 years of age, whereas the majority of homeless children 10 years of age and older are unprotected against hepatitis B virus infection. Tracking the vaccine records in homeless children is labor intensive. Better public health strategies to deliver hepatitis B vaccine to older homeless children are urgently needed.

Orphan care in Malawi: current practices

HIV and AIDS has moved rapidly throughout sub-Saharan Africa, dramatically adding to the crisis of orphaned children on the continent. Knowledge of African responses to their problem is needed so that interventions from the global community are culturally appropriate. An assessment of 73 programs caring for over 100,000 vulnerable and orphaned children in Malawi was conducted. A cross section of programs throughout the country was visited. Three primary care strategies were found: community-based orphan care, institutional and residential care, and self-care. The model of care preferred by Africans is community based because this keeps a child in a family environment in their own village and tribe. By listening to the people of Africa, the worldwide community can learn how to work with them as they care for millions of orphaned children.

Youths living away from families in the US mental health system

This study examines the clinical characteristics of youths who lived away from families at the time of admission to specialty mental health services, and investigates the association between type of nonfamily living situation and admission to residential versus outpatient programs. Of 3995 youths sampled from 1598 mental health programs in the United States, 14% lived away from their own families, either in foster care, group care settings, or correctional settings, or were emancipated. As a group, youths living away from families were more seriously emotionally disturbed and more likely to receive treatment in residential care programs. Youths who lived in foster care were more likely to be admitted to outpatient programs, while youths who lived in group care settings or correctional settings were more likely to be admitted to residential care programs, controlling on demographic and clinical characteristics. Targeting resources to enhance the availability and therapeutic capacity of foster care may facilitate community living, and decrease time spent in institutional settings.

Predictors of substance use among homeless youth in San Diego

This study examined the frequency of substance use among 14- to 24-year-old homeless youth (N=113) recruited from two community drop-in centers and explored the relationship between substance use and hypothesized psychosocial predictors. Audio-computer-assisted self-interviewing (A-CASI) was used for assessment. Including alcohol and tobacco, the mean number of different drugs used was 3.55 for lifetime and 2.34 for the last 3 months. A three-block hierarchical multiple regression was conducted to determine potential predictors of overall drug use (the sum of all different drugs used) during the last 3 months. Block 1 included demographic variables, Block 2 included a parental monitoring variable, and Block 3 included peer and environmental variables derived from learning theories. Parental monitoring (-) and peer variables (+) predicted overall 3-month drug use. The final model explained 36% of the variance in overall drug use. Results suggest that homeless adolescent drug use exists at high levels and is related to parental monitoring and peer modeling of other risk behaviors. These results may inform future prevention strategies for homeless youth and other high-risk populations.

Pathways to youth homelessness

Research documents high levels of psychopathology among homeless youth. Most research, however, has not distinguished between disorders that are present prior to homelessness and those that develop following homelessness. Hence whether psychological disorders are the cause or consequence of homelessness has not been established. The aim of this study is to investigate causal pathways to homelessness amongst currently homeless youth in Australia. The study uses a quasi-qualitative methodology to generate hypotheses for larger-scale research. High rates of psychological disorders were confirmed in the sample 35 homeless youth aged 14-25. The rates of psychological disorders at the point of homelessness were greater than in normative samples, but the rates of clinical disorder increased further once homeless. Further in-depth analyses were conducted to identify the temporal sequence for each individual with a view to establishing a set of causal pathways to homelessness and trajectories following homelessness that characterised the people in the sample. Five pathways to homelessness and five trajectories following homelessness were identified that accounted for the entire sample. Each pathway constituted a series of interactions between different factors similar to that described by Craig and Hodson (1998. Psychological Medicine, 28, 1379-1388) as "complex subsidiary pathways". The major findings were that (1) trauma is a common experience amongst homeless youth prior to homelessness and figured in the causal pathways to homelessness for over half of the sample; (2) once homeless, for the majority of youth there is an increase in the number of psychological diagnoses including drug and alcohol diagnoses; and (3) crime did not precede homelessness for all but one youth; however, following homelessness, involvement in criminal activity was common and became a distinguishing factor amongst youth. The implications of these findings for future research and service development are discussed.

The Miami, Florida, Young Men's Survey: HIV prevalence and risk behaviors among urban young men who have sex with men who have ever runaway

Youth in urban areas with a history of running away from home often have special needs. Importantly, risk factors for HIV/AIDS might be associated with such a history. We assessed the association between having a history of running away from home and the occurrence of HIV infection and risk behavior among young men who have sex with men (YMSM), aged 15-22 years. A cross-sectional epidemiologic and behavioral survey was conducted between 1995 and 1996 in Miami, Florida, as part of a national Young Men's Survey. Of 488 YMSM, the prevalence of HIV infection among those with a history of running away from home was 10.5% (adjusted odds ratio=3.4; 95% CI 1.5-7.8). YMSM who had ever run away were more likely to be HIV infected, be out of school, and have ever had vaginal or anal sex with females, been forced to have sex, injected drugs, and used needles for self-tattooing or body piercing. The prevalence of HIV infection and associated risk behaviors among runaways was high, highlighting the ongoing need for prevention and social support services for youth with a history of running away from home.

Covariates of length of stay in residential treatment

This study explores variables associated with length of stay in a child welfare residential treatment center. The study followed three entry cohorts (416 boys) from admission through discharge. The researchers conducted event history analyses to examine the rates of discharge over time and the covariates of length of stay. They conducted analyses by discharge destination (reunified, transferred, or ran away). The results demonstrated that mental health issues slowed down rates of discharge for youth who were reunified or transferred. For children who left by running away, age and prior substance history were associated with faster rates of exit. These results have important public policy implications for improving the application of length of stay variables in planning and treatment.

Street Youths Are the Only High-Risk Group for HIV in a Low-Prevalence South American Country

OBJECTIVES

To measure HIV prevalence in various subpopulations in Bolivia.

DESIGN

In 2002 in Cochabamba, we offered voluntary counseling and testing to homeless street youths, registered and unregistered commercial sex workers, truck drivers, and prisoners. We examined surveillance data of pregnant women and blood donors.

RESULTS

Among street youths over 15, overall HIV prevalence was 3.5% (11/313), higher among those recruited in the street, lower among those recruited in centers for homeless; prevalence was 0.6% (2/334) and 0.5% (1/189) in female registered and nonregistered sex workers, respectively, and below 0.3% in all other groups. All HIV cases were attributed to sexual transmission.

CONCLUSION

In a low-prevalence setting where intravenous drug use is uncommon, street youths are a threat for the expansion of the HIV epidemic. We argue that HIV prevention in this population requires a comprehensive approach to their health and social problems.

Sexual abuse of street children brought to an observation home

This study was conducted to assess the magnitude and pattern of sexual abuse among male inmates of an observation home in Delhi. A total of 189 boys aged 6 to 18 years were assessed for sexual abuse using Finkelhors scale and Child Maltreatment History Self-Report followed by clinical examination using American Medical Associations guidelines. Majority of boys were runaways and 38.1 percent had suffered sexual abuse. On clinical examination, 61.1 percent showed physical signs and 40.2 percent showed behavioral signs of sexual abuse. Forcible sex was reported by 44.4 percent of victims and 25 percent had signs suggestive of sexually transmitted diseases. Strangers were the most common perpetrators of sexual abuse.

Dual and multiple diagnosis among substance using runaway youth

Although research on runaway and homeless youth is increasing, relatively little is known about the diagnostic profile of runaway adolescents. The current study examined patterns of psychiatric dual and multiple diagnosis among a sample (N=226) of treatment-engaged substance-abusing youth (ages 13 to 17) who were residing at a runaway shelter. As part of a larger treatment outcome study, the youths' psychiatric status was assessed using the DSM-IV based computerized diagnostic interview schedule for children [CDISC; (1)]. The majority of the youth in our sample met criteria for dual or multiple diagnosis (60%) with many having more than one substance-use diagnosis (56%). The severity of mental-health and substance-use problems in this sample of substance-abusing runaways suggests the need for continued development of comprehensive services. The range and intensity of diagnoses seen indicates a need for greater focus on treatment development and strategies to address their multiple areas of risk.

Street and working children of Delhi, India, misusing toluene: an ethnographic exploration

Our qualitative study explored: the perceptions of street children indulging in whitener fluid misuse; the social, economic, and cultural determinants of use; and users' views regarding effective preventive and control strategies. Forty-five in-depth interviews and three focus group discussions were conducted between March and December 2003. A purposive sample of those working children who were using toluene was selected by Snowball sampling. The paper discusses the: determinants of initiation and continued use; drug user social networks; psycho emotional deprivation and frustrations of these children; socio-cultural aspects like work driven need; others' attitudinal response towards them and their work; parental support or the lack of it; and strategies for prevention of this misuse.

HIV risk profile of male street youth involved in survival sex

OBJECTIVES

To compare HIV risk factors of male street youth involved in survival sex with those of their never involved peers and to describe the sexual activities of the involved youths.

METHODS

From 2001 to 2003, street youth aged 14-23 years were recruited from street youth agencies in Montreal, Canada. Information was collected on sociodemographic characteristics, substance use, and sexual behaviours. Involvement in survival sex was defined as having ever exchanged sex for money, gifts, drugs, shelter, or other needs. Logistic regression was used to identify HIV risk factors associated with involvement in survival sex.

RESULTS

Among the 542 male participants recruited, 27.7% reported involvement in survival sex. HIV risk factors independently associated with such involvement were injection drug using partners (modulated by length of homelessness), unprotected oral sex with male partners, steroid injection, history of sexual abuse, and drug injection. Among involved youths, 32.0% had only female clients, 41.3% only male clients, and 26.7% had clients of both sexes. Unprotected sexual activities were common with clients. However, even more risks were taken with non-commercial sexual partners.

CONCLUSIONS

Male street youth involved in survival sex are at higher risk for HIV than their non-involved peers not only because of their unprotected commercial sexual activities. They have multiple other HIV risks related to non-commercial sexual activities, drug injection, and sexual abuse. All these risks need to be addressed when providing sexual health interventions for this population.

Mental disorder, subsistence strategies, and victimization among gay, lesbian, and bisexual homeless and runaway adolescents

This study compares participation in deviant subsistence strategies, street victimization, and lifetime prevalence of five mental disorders (conduct disorder, major depressive disorder, post-traumatic stress disorder, alcohol abuse, and drug abuse) among heterosexual males and females (n = 366) and gay, lesbian, and bisexual (n = 63) homeless and runaway adolescents from the first wave of a longitudinal study of homeless youth in four Midwestern states. The results indicate that gay, lesbian, and bisexual adolescents were more likely to have been physically and sexually abused by caretakers, we more likely to engage in risky survival strategies when on their own (including survival sex), were more likely to be physically and sexually victimized when on the streets, and were more likely to meet criteria for mental disorder than were their heterosexual counterparts.

Characteristics of adolescent street youth with a history of pregnancy

This study examines characteristics of adolescent street youth with histories of pregnancy and documents important factors that merit consideration when providing global sexual health care.

STUDY OBJECTIVE

To determine social and behavioral factors associated with a history of pregnancy among adolescent street youth.

DESIGN, SETTING, PARTICIPANTS

In a prospective cohort study, female adolescent street youth (14-19 years) ever pregnant (AEP) were compared with adolescents never pregnant (ANP) using data from baseline questionnaires.

RESULTS

Among the 225 participants, 41.8% were ever pregnant. Both groups were similar with respect to age (mean 17.8 years) and other socio-economic characteristics. However, AEP were more likely to have been kicked out of home (62.8% vs. 47.3%, P=0.022) and to have run away (78.7% vs. 64.9%, P=0.025) and were homeless younger (mean age: 13.9 vs. 14.7 years, P=0.011) and since a longer period (mean: 4.0 vs. 3.0 years, P=0.001). Both groups had problematic alcohol and drug use: 31.3% had a CAGE score >2; 72.2% had a DAST score >6. Almost half (44.0%) had ever injected drugs and AEP were younger at initiation into drug injection (15.2 years vs. 16.0 years, P=0.049). More AEP had experienced intra-familial or extra-familial sexual abuse (71.3% vs. 56.5%, P=0.024), and had had more than one abuser (71.6% vs. 50.0%, P=0.009). Among those abused by family members, abuse occurred at an earlier age for AEP (mean age: 7.4 vs. 8.9 years, P=0.090) and more AEP reported severe abuse: vaginal penetration (62.2% vs. 26.7%, P=0.004) and anal penetration (29.7% vs. 3.3%, P=0.005).

CONCLUSIONS

Histories of severe sexual abuse and early injection drug use are extremely frequent in ever pregnant street adolescents. These factors need to be addressed when planning global health care and sexual health education.

Can't do it alone: housing collaborations to improve foster youth outcomes

Research documents that youth transitioning out of the foster care system experience a variety of negative outcomes, including homelessness. Housing collaborations, which aim to comprehensively address resource and service needs for transitioning youth, including permanent connections, education, and employment, have resulted in innovative programming and forged new relationships among child welfare, social service and housing developers, and providers. This article describes the partners, models, and resources several collaborations used and their progress and outcomes; shares insights gained; and explores productive directions for future work.