Shelter-based homeless youth: Health and access to care

Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md, USA.
Archives of Pediatrics and Adolescent Medicine (Impact Factor: 5.73). 09/1997; 151(8):817-23.
Source: PubMed


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.
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.
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.
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.

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    • "The Canadian survey showed that 40.1% of street youth reported that they had dropped out of school permanently and 37% reported that they had been permanently expelled [11]. Homeless youth have also limited access to health care services [26]. Poor access to health care has also been associated with general distrust of adult authority figures, perceived discrimination by health care workers, worries of confidentiality breeches and fears of being reported to the law enforcement authorities [27-29]. "
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    ABSTRACT: Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth. A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants' knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases. Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population. To provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group.
    BMC Public Health 05/2012; 12(1):338. DOI:10.1186/1471-2458-12-338 · 2.26 Impact Factor
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    • "Adolescents with experience as runaways are less likely to be sampled in school-based or household-based surveys [8]. Therefore, most studies to date on psychoactive substance use among runaway adolescents have recruited their participants either from shelters [9-13] or from the streets [14-17], which represent the tip of the iceberg of this population. Less explored, but important from the viewpoint of early detection and intervention, is the risk of psychoactive substance use among adolescents who are still living with their families, but have run away from home at some point. "
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    ABSTRACT: This study aimed to examine: 1) the relationship between being a runaway and the time since the first absconding event and adolescent substance use; 2) whether different kinds of psychoactive substances have a different temporal relationship to the first absconding event; and 3) whether the various reasons for the first absconding event are associated with different risks of substance use. Participants were drawn from the 2004-2006 nationwide outreach programs across 26 cities/towns in Taiwan. A total of 17,133 participants, age 12-18 years, who completed an anonymous questionnaire on their experience of running away and substances use and who were now living with their families, were included in the analysis. The lifetime risk of tobacco, alcohol, betel nut, and illegal drug/inhalant use increased steadily from adolescents who had experienced a trial runaway episode (one time lasting <or= 1 day), to those with extended runaway experience (>or= 2 times or lasting > 1 day), when compared to those who had never ran away. Adolescents who had their first running away experience > 6 months previously had a greater risk of betel nut or illegal drug/inhalant use over the past 6-months than those with a similar experience within the last 6 months. Both alcohol and tobacco use were most frequently initiated before the first running away, whereas both betel nut and illegal drug/inhalant use were most frequently initiated after this event. When adolescents who were fleeing an unsatisfactory home life were compared to those who ran away for excitement, the risk of alcohol use was similar but the former tended to have a higher risk of tobacco, betel nut, and illegal drug/inhalant use. More significant running away and a longer time since the first absconding experience were associated with more advanced substance involvement among adolescents now living in a family setting. Once adolescents had left home, they developed additional psychoactive substance problems, regardless of their reasons for running away. These findings have implications for caregivers, teachers, and healthcare workers when trying to prevent and/or intervening in adolescent substance use.
    BMC Public Health 01/2010; 10(1):29. DOI:10.1186/1471-2458-10-29 · 2.26 Impact Factor
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    • "Homeless youth often perceive their housing status to be one reason why police hassle them and in this sense, a lack of support from police may reinforce or in some cases actually create the housing difficulties they experience (Daiski, 2007; De Rosa et al. 1999). Importantly, individuals involved in the drug economy are significantly more likely to share syringes, inject with a greater number of contacts, spend more time on the street, and have larger social networks of active drug users (Buhrich et al., 2000; Ensign and Santelli, 1998). Taking into consideration the nature of their social networks, one approach to address the needs of this highly vulnerable population may be to include youth in the process as peer educators. "
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    ABSTRACT: Using multivariate logistic regression, we examined the prevalence and correlates of homelessness among youth enrolled in a community-recruited prospective cohort known as the At-Risk Youth Study (ARYS), between September 2005 and October 2006. Of 478 individuals included in this analysis, 132 (27.6%) were female and 120 (25.1%) self-identified as Aboriginal. The median age was 22 (IQR: 20-24). In total, 284 (56.9%) participants reported baseline homelessness, with most living either at no fixed address, on the street, or in a hostel or shelter. Factors associated with homelessness included public injecting, frequent crack use, experienced violence, having less than a high-school education, and not having been in any addiction treatment. Homeless individuals were at-risk for various adverse health outcomes. These findings indicate the need for additional interventions, including residential addiction treatment, to address homelessness and drug use among youth.
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