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DiGuiseppi GT, Prindle J, Rice ER, Davis JP. Longitudinal Associations between Homelessness and Substance Use: Investigating Demographic Differences for Young Adults in Treatment. Subst Use Misuse 2023; 59:243-253. [PMID: 37897085 PMCID: PMC10872782 DOI: 10.1080/10826084.2023.2267124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
Objective: To examine prospective, bidirectional associations between homelessness and substance use frequency among young adults receiving substance use treatment in the United States. We also investigated potential differences across demographic subgroups. Methods: Young adults (N = 3717, Mage = 20.1, 28% female, 7.3% sexual/gender minority, and 37% non-Hispanic White) receiving substance use treatment in the U.S. completed assessments at intake, 3 months, 6 months, and 12 months post-intake. Latent growth curve models with structured residuals (LGC-SR) were used to examine cross-lagged associations between homeless days and frequency of substance use and associated problems. Models were stratified by sex, race/ethnicity, and sexual and/or gender minority status. Results: Overall, days spent homeless (μ slope = -0.19, p = 0.046) and substance use frequency (μ slope 1 = -6.19, p < 0.001) significantly decreased during treatment, with no significant cross-lagged associations between homeless days and substance use frequency. However, results differed by race and ethnicity. For non-Hispanic White young adults, greater substance use at treatment entry was associated with steeper declines in homeless days between-persons (ϕ standardized = -0.14, p = 0.04). For African Americans, homeless days at treatment entry were associated with greater increases in substance use between-persons (ϕ standardized = 0.29, p = 0.04). No significant differences were found by sex or sexual/gender minority status. Conclusions: Despite overall declines in homelessness and substance use during treatment, these outcomes may unfold differently for non-Hispanic White and African American young adults. More support may be needed for African American young adults reporting homelessness at treatment entry.
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Affiliation(s)
- Graham T. DiGuiseppi
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
- RAND Corporation, 4750 Fifth Avenue, Suite 600, Pittsburgh, PA 15213, USA
| | - John Prindle
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
| | - Eric R. Rice
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
| | - Jordan P. Davis
- Suzanne Dworak-Peck School of Social Work, University of Southern California, 669 W 34 Street, Los Angeles, California 90089, USA
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Goddard J, Montgomerie A, Gialamas A, Haag D, Anderson J, Lynch J. Excess Hospital Burden Among Young People in Contact With Homelessness Services in South Australia: A Prospective Linked Data Study. J Adolesc Health 2023; 73:519-526. [PMID: 37330707 DOI: 10.1016/j.jadohealth.2023.04.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2022] [Revised: 03/27/2023] [Accepted: 04/11/2023] [Indexed: 06/19/2023]
Abstract
PURPOSE Youth homelessness remains an ongoing public health issue worldwide. We aimed to describe the burden of emergency department (ED) presentations and hospitalizations among a South Australian population of young people in contact with specialist homelessness services (SHS). METHODS This whole-of-population study used de-identified, linked administrative data from the Better Evidence Better Outcomes Linked Data (BEBOLD) platform on all individuals born between 1996 and 1998 (N = 57,509). The Homelessness2Home data collection was used to identify 2,269 young people in contact with SHS at ages 16-17 years. We followed these 57,509 individuals to age 18-19 years and compared ED presentations and hospital separations related to mental health, self-harm, drug and alcohol, injury, oral health, respiratory conditions, diabetes, pregnancy, and potentially preventable hospitalizations between those in contact and not in contact with SHS. RESULTS Four percent of young people had contact with SHS at ages 16-17 years. Young people who had contact with SHS were 2 and 3 times more likely to have presented to an ED and hospital respectively, compared to those who did not contact SHS. This accounted for 13% of all ED presentations and 16% of all hospitalizations in this age group. Excess burden causes included mental health, self-harm, drug and alcohol, diabetes, and pregnancy. On average, young people in contact with SHS experienced an increased length of stay in ED (+0.6 hours) and hospital (+0.7 days) per presentation, and were more likely to not wait for treatment in ED and to self-discharge from hospital. DISCUSSION The 4% of young people who contacted SHS at ages 16-17 years accounted for 13% and 16% of all ED presentations and hospitalizations respectively at age 18-19 years. Prioritizing access to stable housing and primary health-care services for adolescents in contact with SHS in Australia could improve health outcomes and reduce health-care costs.
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Affiliation(s)
- Joshua Goddard
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia.
| | - Alicia Montgomerie
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Angela Gialamas
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Dandara Haag
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia
| | - Jemma Anderson
- Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia; Department of General and Adolescent Medicine, Women's and Children's Hospital, Adelaide, Australia
| | - John Lynch
- BetterStart Health and Development Research Group, School of Public Health, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, South Australia, Australia; Robinson Research Institute, University of Adelaide, Adelaide, South Australia, Australia; Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
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DiGuiseppi GT, Ring CR, Rice ER, Davis JP. Sex differences in poly-victimization among youth experiencing homelessness prior to substance use treatment. CHILD ABUSE & NEGLECT 2022; 129:105670. [PMID: 35569181 PMCID: PMC9228819 DOI: 10.1016/j.chiabu.2022.105670] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Revised: 04/26/2022] [Accepted: 05/06/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Poly-victimization is common among youth experiencing homelessness (YEH) and youth in substance use treatment. To date, studies have not examined poly-victimization among these two intersecting populations. OBJECTIVE To examine heterogeneity in lifetime victimization experiences among youth reporting homelessness at substance use treatment entry; identify demographic predictors of victimization class membership; and associations between victimization and clinical characteristics at treatment intake. PARTICIPANTS AND SETTING 1270 adolescents and young adults reporting past 90-day homelessness in a nationwide substance use treatment data set. METHODS Latent Class Analysis (LCA) and logistic regression were used to examine heterogeneity in poly-victimization experiences, and associations with demographics and clinical characteristics for males and females. RESULTS Four victimization classes emerged for males, and five victimization classes emerged for females. The prevalence of victimization and trauma characteristics were higher for females, except physical victimization, which was higher for males. Age, race/ethnicity, and sexual minority status were related to poly-victimization class membership, but not consistently across classes. Compared to low or single victimization classes, youth in the poly-victimization class had higher odds of post-traumatic stress disorder, major depressive disorder, and exchange sex (among females); Poly-victimization class membership was not associated with duration of recent homelessness or substance use disorder diagnoses, when compared to low/less complex victimization. CONCLUSION High rates of lifetime victimization were found for YEH in substance use treatment, with rates generally higher among females. Trauma-informed interventions are needed to address complex victimization experiences and poor mental health among unstably housed youth in treatment.
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Affiliation(s)
- Graham T DiGuiseppi
- University of Southern California, Suzanne Dworak-Peck School of Social Work, 669 W. 34th Street, Los Angeles, CA, USA.
| | - Colin R Ring
- Loma Linda University, School of Behavioral Health, 11065 Campus St., Loma Linda, CA. USA
| | - Eric R Rice
- University of Southern California, Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, 669 W. 34th Street, Los Angeles, California, USA
| | - Jordan P Davis
- University of Southern California, Suzanne Dworak-Peck School of Social Work, USC Center for Artificial Intelligence in Society, USC Center for Mindfulness Science, USC Institute of Addiction Science, 669 W. 34th Street, Los Angeles, California, USA
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