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CORK Bibliography: Runaways and Homeless Adolescents

50 citations. January 2003 to present

Prepared: June 2011

Altena AM; Brilleslijper-Kater SN; Wolf JLM. Effective interventions for homeless youth: A systematic review. American Journal of Preventive Medicine 38(6): 637-645, 2010. (53 refs.)

Context: To date, there has not been clear evidence regarding interventions that are effective in addressing the specific needs of homeless youth. A systematic and comprehensive international review on effective interventions for homeless youth is presented. This study seeks to provide an accurate and complete picture of effective interventions for homeless youth by collecting, summarizing, categorizing, and evaluating quantitative studies (i.e., those that have assessed treatment outcomes). Evidence acquistion: The following databases were searched in 2008: PsycINFO, ERIC, MEDLINE, and Cochrane were searched from 1985 through 2008 using specific key words: interventions and programs, with homeless youth (s), homeless adolescents, street youth (s), runaways and throwaways. In addition, references of key articles were searched by hand. Eleven studies met preestablished inclusion criteria. To determine study quality, a set of operational parameters was formulated to rate each study as either good, fair, or poor. Evidence synthesis: There is no compelling evidence that specific interventions are effective for homeless youth, owing to moderate study quality and the small number of intervention studies. Conclusions that can be drawn from the studies are limited by the heterogeneity of interventions, participants, methods, and outcome measures. Many interventions focused on reduction of substance abuse, whereas other important outcomes, such as quality of life, have received little attention. No study received a quality rating of good, and four studies were rated as fair. Most convincing, but still marginal, were results of interventions based on cognitive-behavioral approaches, which revealed some positive results on psychological measures. Conclusions: More methodologically sound research is needed to determine what specific interventions are beneficial for subgroups of homeless youth. Implications for future research are discussed.

Bal B; Mitra R; Mallick AH; Chakraborti S; Sarkar K. Nontobacco substance use, sexual abuse, HIV, and sexually transmitted infection among street children in Kolkata, India. Substance Use & Misuse 45(10): 1668-1682, 2010. (30 refs.)

A community-based cross-sectional study among 554 Kolkata city street children assessed nontobacco substance use and sexual abuses along with human immunodeficiency virus (HIV)/sexually transmitted infections (STIs) during 2007, using conventional cluster sampling technique for "hard-to-reach population" with a field-tested questionnaire and the collection of a blood sample for HIV and syphilis serology testing as a composite indicator of STIs. The reported prevalence of nontobacco substance use was 30%; 9% reported having been sexually abused. Some factors (age, lack of contact with family, orphan children, night stay at public place, etc.) were documented to be associated with substance use and sexual abuses. Seroprevalence of HIV was found to be 1% and that of STIs was 4%. This 1% HIV seroprevalence in street children is a matter of concern. Community-based intervention is necessary for them. The study's limitations are noted.

Champion JD. Context of sexual risk behaviour among abused ethnic minority adolescent women. International Nursing Review 58(1): 61-67, 2011. (37 refs.)

Background: Evidence suggests that multiple influences on sexual behaviour of adolescents exist, ranging from relationships with significant others including sexual or physical abuse and childhood molestation to substances used prior to sex and environmental circumstances such as sex work. Purpose: This study aims to describe associations between childhood molestation and sexual risk behaviour. Method: African American and Mexican American adolescent women aged 14-18 years (n = 562) with sexually transmitted infection (STI) or abuse histories and enrolled in a randomized controlled trial of behavioural interventions were interviewed via self-report concerning sexual risk behaviour, abuse and childhood molestation at study entry. Results: Sexual (59%), physical (77%) and psychological (82%) abuse and childhood molestation (25%) were self-reported without differences by ethnicity. Adolescents reporting childhood molestation experienced more forms of sexual, physical and psychological abuse than others and higher incidences of STI. Fewer attended school; however, more had arrests, convictions, incarcerations and probations. Stressors including depression, running away, thoughts of death and suicide were highest for those reporting childhood molestation. Those reporting childhood molestation engaged in higher sexual risk behaviours than adolescents experiencing other forms of sexual or physical abuse (lifetime partners, bisexual relationships, anal and group sex, sex with friends with benefits, sex for money, concurrent partners, drug use including multiple substances, alcohol use and alcohol problems). These adolescents reported 'getting high' and having sex when out of control as reasons for sex with multiple partners. Conclusion: Interventions for abused adolescent women necessitate a focus on associations between childhood molestation and a multiplicity of sexual risk behaviours for prevention of abuse, substance use and sex work, STI/human immunodeficiency virus (HIV) and sequelae.

Chen XJ; Tyler KA; Whitbeck LB; Hoyt DR. Early sexual abuse, street adversity, and drug use among female homeless and runaway adolescents in the midwest. Journal of Drug Issues 34(1): 1-21, 2004. (59 refs.)

Research on homeless and runaway adolescents has shown that this population is at high risk for illicit drug use. Though sexual abuse has been widely considered in the etiology of illicit drug use, we know less about how early sexual abuse affects young people's decisions to run away, to use drugs, and to engage in other deviant behavior on the streets. Based on interviews with 361 female homeless and runaway adolescents in four midwestern states, the current study revealed a high prevalence of drug use, especially use of cocaine among youths with sexual abuse histories. Path analyses showed that early sexual abuse indirectly affected drug use on the streets via running away at an earlier age, spending more time on the street, and use of deviant strategies to survive (e.g., affiliation with deviant peers, trading sex, and use of nonsexual deviant subsistence strategies).

Clatts MC; Goldsamt L; Yi H; Gwadz MV. Homelessness and drug abuse among young men who have sex with men in New York City: A preliminary epidemiological trajectory. Journal of Adolescence 28(2): 201-214, 2005. (32 refs.)

The objective of this paper is to profile the role of homelessness in drug and sexual risk in a population of young men who have sex with men (YMSM). Data are from a cross-sectional survey collected between 2000 and 2001 in New York City (N = 569). With the goal of examining the import of homelessness in increased risk for the onset of drug and sexual risk, we compare and contrast three subgroups: (1) YMSM with no history of homelessness, (2) YMSM with a past history of homelessness but who were not homeless at the time of the interview, and (3) YMSM who were currently homeless. For each group, we describe the prevalence of a broad range of stressful life events (including foster care and runaway episodes, involvement in the criminal justice system, etc.), as well as selected mental health problems (including past suicide attempts, current depression, and selected help-seeking variables). Additionally, we examine the prevalence of selected drug and sexual risk, including exposure to a broad range of illegal substances, current use of illegal drugs, and prevalence of lifetime exposure to sex work. Finally, we use an event history analysis approach (time-event displays and paired t-test analysis) to examine the timing of negative life experiences and homelessness relative to the onset of drug and sexual risk. High levels of background negative life experiences and manifest mental health distress are seen in all three groups. Both a prior experience of homelessness and currently being homeless are both strongly associated with both higher levels of lifetime exposure to drug and sexual risk as well as higher levels of current drug and sexual risk. Onset of these risks occur earlier in both groups that have had an experience of housing instability (e.g., runaway, foster care, etc.) but are delayed or not present among YMSM with no history of housing instability. Few YMSM had used drug prior to becoming homeless. While causal inferences are subject to the limitations of a cross-sectional design, the findings pose an empirical challenge to the prevailing assumption that prior drug use is a dominant causal factor in YMSM becoming homeless. More broadly, the data illustrate the complexity of factors that must be accounted for, both in advancing our epidemiological understanding of the complexity of homelessness and its relationship to the onset of drug and sexual risk among high risk youth populations.

Cuzmar I; Prestopnik J; Slesnick N. Delinquency and adolescents: What predicts delinquent behavior in primary alcohol-using runaway adolescents? (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 100A-100A, 2004. (0 refs.)

de Moura YG; Sanchez ZV; Noto AR. Diversity of contexts in drug use among street adolescents. Qualitative Health Research 20(9): 1241-1253, 2010. (32 refs.)

In this study we aimed to investigate through ethnographic methods the different contexts of drug use by street adolescents in Sao Paulo, Brazil. Participant observations and semistructured interviews were performed at 11 major points of adolescent concentration in the streets of the city and in 10 care institutions. The sample was composed of 17 adolescents between 12 and 17 years of age. Data showed diverse patterns of drug use distributed by geographic situation and street circumstances. Observations were grouped into three main contexts: (a) immersion: greater intensity of drug use associated with greater involvement in the street culture; (b) surface: less drug use associated with family closeness; and (c) alternative-migratory: greater involvement with drug trafficking and prostitution associated with less family closeness and street culture. The drug use patterns varied in accordance with the diversity of street situations. Therefore, the peculiarities of each context should be taken into consideration in the development of social/health policies.

Elkoussi A; Bakheet S. Volatile substance misuse among street children in upper Egypt. Substance Use & Misuse 46(Supplement 1): 35-39, 2011. (19 refs.)

This work assessed the extent, patterns, attitudes, motivations, and impacts of volatile substance misuse (VSM) among street children in Upper Egypt. In 2009, a 36-item questionnaire was administered to a randomly selected sample of 120 street children aged 10-18 years. Nearly 91%% (n = 109) reported misusing products containing volatile substances because they are inexpensive, legal, and easy to acquire. Familial neglect and lack of supervision were the main social motivations reported by street youth for misusing volatile substances. One-third (34.2%%, n = 41) reported inhaling "Kolla," a commercial glue; this study identifies its physicochemical, neuropharmacological, and toxicological properties. The study's limitations are noted.

Ferguson KM; Bender K; Thompson S; Xie B; Pollio D. Correlates of street-survival behaviors in homeless young adults in four US cities. American Journal of Orthopsychiatry 81(3): 401-409, 2011. (49 refs.)

This study assessed the prevalence and correlates of behaviors used by homeless young people to survive on the streets. Survival behaviors include prostitution, selling blood or plasma, dealing drugs, stealing, and panhandling. One hundred ninety-six homeless young adults from 4 metropolitan areas-Los Angeles, CA (n = 50); Austin, TX (n = 50); Denver, CO (n = 50); and St. Louis, MO (n = 46)-participated in individual, semistructured, face-to-face interviews. Researchers predicted that youth transience would be related to high rates of survival behaviors. Multivariate logistic regression was used to test a model predicting relationships between survival behaviors and transience, employment, substance use, and social support. Young adults who were transient, unemployed, drug-addicted, and reliant on peers for help were more likely to use these survival behaviors. In addition, among the transient subsample, being White, more reliant on peers for help, more transient, and having been victimized were associated with high use of these survival behaviors. Identification of the environmental and demographic factors associated with survival behaviors suggests that there may be value in combining harm-reduction strategies with efforts to reduce the transience of homeless young adults.

Gomez R; Thompson SJ; Barczyk AN. Factors associated with substance use among homeless young adults. Substance Abuse 31(1): 24-34, 2010. (52 refs.)

The purpose of this study was to investigate factors associated with substance use among homeless young adults. Multinomial logistic regression analyses examined the influence of social networks and economic factors among a group of homeless young adults with differing levels of alcohol and drug use. In addition, for those with an alcohol use disorder, the role of future time expectancies was examined. A sample (n = 185) of homeless young adults aged 18 to 23 were recruited from a community drop-in center and interviewed utilizing self-report instruments. Findings suggest that social networks, economic factors, and future expectancies are significant predictors of the level of substance use among homeless young adults. Being able to identify those areas that place homeless young adults at risk for substance abuse and dependence has implications for effective intervention.

Haber MG; Toro PA. Parent-adolescent violence and later behavioral health problems among homeless and housed youth. American Journal of Orthopsychiatry 79(3): 305-318, 2009. (95 refs.)

Parent-adolescent violence (i.e., violence between parents and adolescents) is an important pathway to homelessness and predicts poor behavioral health outcomes among youth. However, few studies have examined links between parent violence and outcomes among youth who are homeless. Existing research has also tended to ignore adolescent violence toward parents, despite evidence that mutual violence is common. The current study examines prospective links of parent-adolescent violence to outcomes among youth who were homeless and demographically matched youth, through two complementary substudies: (a) an exploratory factor analysis (EFA) of items measuring parent and adolescent violence combined in the same analysis; and (b) an examination of predictive relationships between the factors identified in the EFA and behavioral health problems, including mental health and alcohol abuse problems. Predictive relationships were examined in the overall sample and by gender, ethnic, and housing status subgroups. Results of the EFA suggested that parent-adolescent violence includes intraindividual (i.e., separate parent and adolescent) physical components and a shared psychological component. Each of these components contributed uniquely to predicting later youth behavioral health. Implications for research and practice with youth who are homeless are discussed.

Hadland SE; Marshall BDL; Kerr T; Qi JZ; Montaner JS; Wood E. Depressive symptoms and patterns of drug use among street youth. Journal of Adolescent Health 48(6): 585- 590, 2011. (40 refs.)

Purpose: Rates of depression among street youth are poorly characterized, particularly as they pertain to concurrent drug use. We sought to assess associations between drug type and degree of depression in this population. Methods: Between October 2005 and November 2007, data were collected from a cohort of street-recruited youth aged 14-26 residing in Vancouver, Canada, for the At-Risk Youth Study. Active drug users were classified by predominant substance of use: daily marijuana use, weekly cocaine/crack use, weekly crystal methamphetamine use, or weekly heroin use. Adjusted mean number of depressive symptoms (measured by the Center for Epidemiology Studies Depression [CES-D] scale) was compared among the four groups using multiple linear regression. Logistic regression was also used to assess adjusted odds of CES-D score >= 22. Results: Among 447 youth, mean CES-D score was the highest among heroin users (adjusted mean: 22.7; standard deviation [SD]: 1.2), followed by crystal methamphetamine users (adjusted mean: 21.8; SD: 1.1), then cocaine and/or crack users (adjusted mean: 19.1; SD: 1.0), and finally, marijuana users (adjusted mean: 18.3; SD: 1.1), resulting in a difference that was significant among groups (p < .001). When compared with daily marijuana users, odds of CES-D score >= 22 were higher among heroin users (adjusted odds ratio [AOR]: 2.64; 95% confidence interval [CI]: 1.39-4.99) and crystal methamphetamine users (AOR: 1.88; 95% CI: 1.04-3.42), but not among cocaine/crack users (AOR: 1.41; 95% CI: .79-2.52). Conclusion: To our knowledge, this is the first report of drug use typologies and depression among street youth. Policymakers might heed the apparent vulnerability of heroin and crystal methamphetamine users to even greater degrees of depression than their peers.

Hathazi D; Lankenau SE; Sanders B; Bloom JJ. Pregnancy and sexual health among homeless young injection drug users. Journal of Adolescence 32(2): 339-355, 2009. (46 refs.)

Research on pregnancy and sexual health among homeless youth is limited. In this Study, qualitative interviews were conducted with 41 homeless young injection drug users (IDUs) in Los Angeles with a history of pregnancy. The relationship between recent pregnancy outcomes, contraception practices. housing status, substance use, utilization of prenatal care, and histories of sexual victimization are described. A total of 81 lifetime pregnancies and 26 children were reported. Infrequent and Ineffective use of contraception was common. While pregnancy motivated some homeless youth to establish housing, miscarriages and terminations were more frequent among youth who reported being housed. Widespread access to prenatal and medical services was reported during pregnancy, but utilization varied. Many women continued to use substances throughout pregnancy. Several youth reported childhood sexual abuse and sexual victimization while homeless. Pregnancy presents a unique opportunity to encourage positive health behaviors in a high-risk Population seldom seen in a clinical setting.

Hemsath R; Porter N; Prestopnick J; Slesnick N. Adolescent runaway report of parental control and post treatment alcohol use. (meeting abstract). Alcoholism: Clinical and Experimental Research 28(5 Supplement): 105A-105A, 2004. (0 refs.)

Johnson KD; Whitbeck LB; Hoyt DR. Substance abuse disorders among homeless and runaway adolescents. Journal of Drug Issues 35(4): 799-816, 2005. (29 refs.)

This paper presents lifetime and 12-month prevalence rates and comorbidity data for substance abuse disorders among homeless and runaway adolescents. Data are from baseline interviews of a longitudinal diagnostic study of 428 (187 males and 241 females) homeless and runaway adolescents aged 16 to 19 years (mean age = 17.4 year, SD = 1.05). The data were collected by full-time interviewers on the streets and in shelters in eight Midwestern cities of various populations. About two thirds (60.5) of the runaways met lifetime criteria for at least one of three substance disorders (alcohol abuse, alcohol dependence, drug abuse), and nearly one half (48.1%) met 12-month criteria for at least one of the disorders. Nearly all of the adolescents (93%) who met criteria for a substance disorder met criteria for at least one other mental disorder. Those factors most predictive of meeting lifetime criteria include parenting practices, experience of abuse, and association with deviant peers.

Keeshin BR; Campbell K. Screening homeless youth for histories of abuse: Prevalence, enduring effects, and interest in treatment. Child Abuse & Neglect 35(6): 401-407, 2011. (34 refs.)

Objectives: To identify the incidence of self-reported physical and sexual child abuse among homeless youth, the self-perceived effects of past abuse, and current interest in treatment for past abuse among homeless youth with histories of abuse. Methods: Homeless and street-involved persons aged 18-23 filled out a questionnaire and participated in a structured assessment of histories of abuse, tobacco use and substance abuse. Results: Sixty-four homeless youth in Salt Lake City, Utah completed the study, 43 males and 21 females. Eighty-four percent screened positive for childhood physical and/or sexual abuse occurring before the age of 18; 42% screened positive for both physical and sexual abuse; 72% reported still being affected by their abuse. Among all abuse victims, 44% were interested in treatment for their abuse history and 62% of homeless youth who reported still being affected by their abuse were interested in treatment. Individuals were more likely to be interested in treatment if they were female, had not completed high school or had been previously asked about family dysfunction. Many victims who declined treatment offered spontaneous insight into their decision. Interest in treatment was similar to interest in treatment for other behaviors such as smoking and substance abuse. Conclusions: Histories of abuse are common among homeless youth. A majority of those reporting a history of abuse are still affected by their abuse. Interest in treatment for a history of abuse was comparable to interest in treatment for other morbidities in the homeless youth population such as tobacco use and substance abuse. Our finding that homeless youth continue to be impacted by their abuse and are interested in treatment should prompt more screening for histories of abuse.

Kulahci Y; Sever C; Noyan N; Uygur F; Ates A; Evinc R et al. Burn assault with paint thinner ignition: An unexpected burn injury caused by street children addicted to paint thinner. Journal of Burn Care & Research 32(3): 399- 404, 2011. (15 refs.)

The frequency of assault by burning among all burn patients varies from country to country. Assault by burning, although uncommon, is a serious form of trauma and a significant source of morbidity and mortality. The aim of this retrospective study was to identify the epidemiologic features, current etiological factors, and the mortality of nine patients admitted to our burn unit between January 1999 and January 2009 after unexpected burn assault by paint thinner ignition caused by street children addicted to paint thinner. The circumstances of this injury and preventive measures are discussed.

Marshall BDL; Kerr T; Qi JZ; Montaner JSG; Wood E. Public injecting and HIV risk behaviour among street-involved youth. Drug and Alcohol Dependence 110(3): 254-258, 2010. (33 refs.)

Background: Although street-involved youth who inject illicit drugs are known to be at an increased risk of HIV and other adverse health outcomes, little is known about public injecting among this population and how injecting in public environments may impact HIV risk behaviour. Methods: We used data derived from a study of 560 street-involved youth in Vancouver, Canada to examine the factors associated with injecting in public environments among youth who reported injecting drugs in the past 6 months. Results: At baseline, 162 (28.9%) reported injecting drugs in the past 6 months. Among injectors, the 124 (76.5%) participants who reported injecting in public were more likely to be homeless (odds ratio [OR] = 6.39, p < 0.001), engage in unprotected intercourse (OR = 3.09, p = 0.004), deal drugs (OR = 2.26, p = 0.032), smoke crack cocaine (OR = 3.00, p = 0.005), inject heroin (OR = 3.48, p = 0.001), drop used syringes outdoors (OR = 8.44, p < 0.001), share syringes (OR = 4.43, p = 0.004), and were less likely to clean injection sites >75% of the time (OR = 0.36, p = 0.008). The majority (62.1%) reported feeling rushed while injecting in public. Conclusions: Youth who inject in public are significantly more likely to engage in sexual and injection-related risk behaviour. Given the known elevated rates of HIV infection and other harms among this population, youth-focused interventions that target both sexual and drug-related risks associated with public drug-using environments are in urgent need of evaluation.

Merscham C; Van Leeuwen JM; McGuire M. Mental health and substance abuse indicators among homeless youth in Denver, Colorado. Child Welfare 88(2): 93-110, 2009. (17 refs.)

We report the results of mental health evaluations from 182 homeless youth residing in a Denver, Colorado, shelter. The literature on homeless youth, although developing, is still somewhat limited as it relates to mental health, substance abuse, and trauma. This study was motivated by clinically observed high rates of mental illness, trauma, dangerousness issues, and drug and alcohol abuse. Using archival data from mental health evaluations conducted over two years, variables including gender, age, ethnicity, primary diagnosis, drug of choice, trauma history, suicidal ideation, homicidal ideation, and legal history were assessed. Results discovered significantly higher than expected diagnoses of mental illness and associations between drug of choice and diagnosis, trauma history and suicidal ideation, and trauma history and diagnosis. Results suggest a strong need for co-occurring treatment, trauma-focused therapy, and attention to both mental illness and substance abuse in homeless youth.

Milburn N; Liang LJ; Lee SJ; Rotheram-Borus MJ; Rosenthal D; Mallett S et al. Who is doing well? A typology of newly homeless adolescents. Journal of Community Psychology 37(2): 135-147, 2009. (48 refs.)

There is growing evidence to support developing new typologies for homeless adolescents. Current typologies focus on the risks associated with being homeless, with less consideration, of the positive attributes of homeless adolescents. The authors examined both risk and protective factors in a sample of newly homeless adolescents. Using cluster analysis techniques, they identified three distinct clusters of newly homeless adolescents: those who are protected and doing relatively well while out of home with more protective than risk factors, those who are at-risk, and those who are risky with more risk than protective factors. Over half (51.9%) of these newly homeless adolescents were in the protected cluster. This typology has implications for the design and implementation of services and interventions for newly homeless adolescents to reconnect them with stable housing situations.

Molina BSG. High risk adolescent and young adult populations: Consumption and consequences. IN: Galanter M, ed. Recent Developments in Alcoholism. Volume 17: Alcohol Problems in Adolescents and Young Adults -- Epidemiology, Neurobiology, Prevention, Treatment. New York: Kluwer Academic, 2005. pp. 49-65. (68 refs.)

This chapter considers a number of risk factors for adolescent alcohol problems. Among the topics discussed are the following: the presence of comorbid conditions; the presence of a positive family history of alcohol problems; gay and lesbian youth; homeless and runaway youth; ethnic and racial minorities; and the presence of multiple risk factors.

Nada KH; Suliman ED. Violence, abuse, alcohol and drug use, and sexual behaviors in street children of Greater Cairo and Alexandria, Egypt. AIDS 24(Supplement 2): S39-S44, 2010. (15 refs.)

Objectives: To measure the prevalence of HIV/AIDS risk behaviors and related factors in a large, probability-based sample of boys and girls aged 12-17 years living on the streets of Egypt's largest urban centers of Greater Cairo and Alexandria. Methods: Time-location sampling (TLS) was used to recruit a cross-sectional sample of street children. Procedures entailed using key informants and field observation to create a sampling frame of locations at predetermined time intervals of the day, where street children congregate in the two cities, selecting a random sample of time-locations from the complete list, and intercepting children in the selected time-locations to assess eligibility and conduct interviews. Interviews gathered basic demographic information, life events on the street (including violence, abuse, forced sex), sexual and drug use behaviors, and HIV/AIDS knowledge. Results: A total of 857 street children were enrolled in the two cities, with an age, sex, and time-location composition matching the sampling frame. The majority of these children had faced harassment or abuse (93%) typically by police and other street children, had used drugs (62%), and, among the older adolescents, were sexually active (67%). Among the sexually active 15-17-year-olds, most reported multiple partners (54%) and never using condoms (52%). Most girls (53% in Greater Cairo and 90% in Alexandria) had experienced sexual abuse. The majority of street children experienced more than one of these risks. Overlaps with populations at highest risk for HIV were substantial, namely men who have sex with men, commercial sex workers, and injection drug users. Conclusion: Our study using a randomized TLS approach produced a rigorous, diverse, probability-based sample of street children and documented very high levels of multiple concurrent risks. Our findings strongly advocate for multiple services including those addressing HIV and STI prevention and care, substance use, shelters, and sensitization of authorities to the plight of street children in Egypt.

Njord L; Merrill RM; Njord R; Lindsay R; Pachano JDR. Drug use among street children and non-street children in the Philippines. Asia-Pacific Journal of Public Health 22(2): 203-211, 2010. (40 refs.)

This study characterizes the prevalence of drug use among Filipino street children compared with Filipino non street children. A cross-sectional survey was administered to 311 street children and 528 non street children aged 13 to 17 years. Participants were enrolled through 4 nonprofit organizations and 3 high schools located in Manila, Philippines. After adjustment for age and sex, street children with little or no contact with their families were 2.0 (95% confidence interval [CI] = 1.7-2.3) times more likely to smoke tobacco, 1.3 (95% Cl = 1.2-1.5) times more likely to use alcohol, 36.7 (95% CI = 16.4-82.0) times more likely to use inhalants, and 5.5 (95% Cl = 3.6-8.2) times more likely to use illegal drugs than their non street counterparts. Street children who maintained contact with their families, compared with non street children, were 8.7 (95% CI = 3.9-19.4) times more likely to use inhalants and 2.8 (95% Cl = 1.7-4.6) times more likely to use illegal drugs. There was no significant difference in tobacco or alcohol use between street children who maintained contact with their families and non street children. All street children were significantly more likely to have been given or sold a drug in the past 30 days and to have received drug education compared with non street children. Filipino street children are at greater risk of abusing drugs than are non street children, with street children who do not maintain family contact being at greatest risk.

Pollio DE; Thompson SJ; Tobias L; Reid D; Spitznagel E. Longitudinal outcomes for youth receiving runaway/homeless shelter services. Journal of Youth and Adolescence 35(5): 859-866, 2006. (33 refs.)

This research examined outcomes and use of specific types of services 6 weeks, 3 and 6 months post-discharge for a large sample of runaway/homeless youth using crisis shelter services. Data were collected for 371 runaway/homeless youth using emergency shelter and crisis services at eleven agencies across a four-state midwestern region. Outcomes were assessed for runaway behavior, family relationships, substance use, school behavior, employment, sexual behavior, and self-esteem. Additionally, the impact of services on outcomes was assessed. Findings indicated that although youth achieved a wide variety of positive outcomes 6 weeks post-discharge, there were signs of attenuation of certain outcomes by the 6 month follow-up. Service use after discharge did not demonstrate a strong impact on maintaining outcomes. The substantive findings reported here present encouraging evidence for providers of services for runaway/homeless youth. Crisis shelter services appear to facilitate broad-based short-term gains, but do not appear sufficient to maintain these gains over an extended period.

Rachlis BS; Wood E; Zhang R; Montaner JSG; Kerr T. High rates of homelessness among a cohort of street-involved youth. Health & Place 15(1): 10-17, 2009. (51 refs.)

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.

Reid JA. An exploratory model of girl's vulnerability to commercial sexual exploitation in prostitution. Child Maltreatment 16(2): 146- 157, 2011. (68 refs.)

Due to inaccessibility of child victims of commercial sexual exploitation, the majority of emergent research on the problem lacks theoretical framing or sufficient data for quantitative analysis. Drawing from Agnew's general strain theory, this study utilized structural equation modeling to explore: whether caregiver strain is linked to child maltreatment, if experiencing maltreatment is associated with risk-inflating behaviors or sexual denigration of self/others, and if these behavioral and psychosocial dysfunctions are related to vulnerability to commercial sexual exploitation. The proposed model was tested with data from 174 predominately African American women, 12% of whom indicated involvement in prostitution while a minor. Findings revealed child maltreatment worsened with increased caregiver strain. Experiencing child maltreatment was linked to running away, initiating substance use at earlier ages, and higher levels of sexual denigration of self/others. Sexual denigration of self/others was significantly related to the likelihood of prostitution as a minor. The network of variables in the model accounted for 34% of the variance in prostitution as a minor.

Rice E. The positive role of social networks and social networking technology in the condom-using behaviors of homeless young people. Public Health Reports 125(4): 588-595, 2010. (41 refs.)

Objective. To examine the impact of condom-using peers in the social networks of homeless young people, differences in behaviors were assessed based on the social location of ties (home-based vs. street-based) and how those ties are maintained (face-to-face vs. via social networking technology). Methods. "Ego-centric" social network data were collected from 103 currently sexually active homeless young people aged 16-26 years in Los Angeles, California. Associations between condom use and the condom-using behaviors of social network influences were assessed using standard logistic regression. Results. About 52% of respondents had a street-based peer who was a condom user. Having such a peer was associated with a 70% reduction in the odds of having unprotected sex at last intercourse. About 22% of respondents had a condom-using, home-based peer with whom they communicated only via social networking technology. Having such a peer was associated with a 90% reduction in risky sexual behavior and a 3.5 times increase in safer sex behavior. Conclusion. The study revealed several implications for new human immunodeficiency virus-prevention interventions that mobilize these networks and social networking technologies.

Rice E; Milburn NG; Monro W. Social networking technology, social network composition, and reductions in substance use among homeless adolescents. Prevention Science 12(1): 80-88, 2011. (51 refs.)

Peer-based prevention programs for homeless youth are complicated by the potential for reinforcing high-risk behaviors among participants. The goal of this study is to understand how homeless youth could be linked to positive peers in prevention programming by understanding where in social and physical space positive peers for homeless youth are located, how these ties are associated with substance use, and the role of social networking technologies (e.g., internet and cell phones) in this process. Personal social network data were collected from 136 homeless adolescents in Los Angeles, CA. Respondents reported on composition of their social networks with respect to: home-based peers and parents (accessed via social networking technology; e.g., the internet, cell phone, texting), homeless peers and agency staff (accessed face-to-face) and whether or not network members were substance-using or non-substance-using. Associations between respondent's lifetime cocaine, heroin, and methamphetamine use and recent (previous 30 days) alcohol and marijuana use were assessed by the number of non-substance-using versus substance-using ties in multivariate linear regression models. 43% of adolescents reported a non-substance-using home-based tie. More of these ties were associated with less recent alcohol use. 62% of adolescents reported a substance-using homeless tie. More of these ties were associated with more recent marijuana use as well as more lifetime heroin and methamphetamine use. For homeless youth, who are physically disconnected from positive peers, social networking technologies can be used to facilitate the sorts of positive social ties that effective peer-based prevention programs require.

Riehman KS; Stephens RL; Schurig ML. Substance use patterns and mental health diagnosis among youth in mental health treatment: A latent class analysis. Journal of Psychoactive Drugs 41(4): 363-368, 2009. (27 refs.)

This study examines patterns of substance use among youth served in systems of care, and how these patterns relate to diagnosis and other youth characteristics using latent class analysis. Results indicated a four-class solution with the four groups differing in their probabilities of reporting the use of 10 different substances. Class I was defined by high probabilities of all drug use. Class 2 had high probabilities of alcohol, tobacco, marijuana use, and low for other drugs. Class 3 had moderate probabilities of alcohol, tobacco, marijuana use, and low probabilities for other drugs. Class 4 had a high probability of tobacco use and no other drug use. Youth who had a mood disorder diagnosis, were male, older, White and had previously run away from home were significantly more likely to be in Class I relative to other classes. These differences have implications for prevention and treatment.

Slesnick N; Bartle-Haring S; Erdern G; Budde H; Letcher A; Bantchevska D et al. Troubled parents, motivated adolescents: Predicting motivation to change substance use among runaways. Addictive Behaviors 34(8): 675-684, 2009. (78 refs.)

Runaway adolescents engage in high rates of substance use and report significant family and individual problems. However, in general, adolescents report low motivation to change their substance use. Because a higher level of motivation for changing substance use is associated with greater substance abuse treatment success, identifying variables associated with motivation for change can be useful for enhancing treatment success. In this study, predictors of motivation for changing substance use were examined among 140 shelter-recruited adolescents and their parents/primary caretakers. Several findings were noteworthy. A perceived negative family environment increased parents' and adolescents' depressive symptoms, which increased adolescent's motivation to change. Also, greater severity of adolescent substance use predicted higher motivation to change. Consideration of the family environment and parent problems when addressing motivation for changing substance use among these adolescents might be important foci for motivational interventions and future research.

Slesnick N; Bartle-Haring S; Gangamma R. Predictors of substance use and family therapy outcome among physically and sexually abused runaway adolescents. Journal of Marital and Family Therapy 32(3): 261-281, 2006. (74 refs.)

There is a dearth of research that examines the impact of family systems therapy on problems among sexually and/or physically abused youth. Given this void, differential outcome and predictors of substance use change were evaluated for abused, as compared with nonabused, runaway adolescents who were randomly assigned to family therapy or treatment as usual. Abused adolescents reported lower family cohesion at baseline, although both abused and nonabused adolescents showed similar substance use reductions. Utilizing hierarchical linear modeling, we found that substance use changed with change in cohesion over time. These findings link change in family functioning to change in adolescent substance use, supporting family systems theory. Findings suggest that a potent target of intervention involves focus on increasing positive communication interactions.

Slesnick N; Bartle-Haring S; Glebova T; Glade A. Primary alcohol versus primary drug use among adolescents: An examination of differences. Addictive Behaviors 31(11): 2080-2093, 2006. (34 refs.)

Examination of differences between primary alcohol and drug abusing adolescents can provide valuable direction to intervention efforts, though little research in this area has been conducted. The current study compared primary alcohol and primary drug abusing runaway adolescents who were randomly assigned to family therapy or treatment as usual. Baseline differences, as well as response to treatment, were examined separately for alcohol and drug use and by gender. Although few baseline differences were found, hierarchical linear modeling indicated that alcohol and drug abusing male and female adolescents responded differently to therapy. Primary drug using males showed poorer alcohol use outcomes than did primary alcohol abusers. Specifically, alcohol use increased for primary drug using males receiving family therapy, while drug use decreased in all groups. Findings suggest that alcohol and drug use outcomes might be improved at treatment planning through consideration of client's gender and primary alcohol versus drug use.

Slesnick N; Prestopnik J. Dual and multiple diagnosis among substance using runaway youth. American Journal of Drug and Alcohol Abuse 31(1): 179-201, 2005. (94 refs.)

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]. 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.

Slesnick N; Prestopnik JL. Comparison of family therapy outcome with alcohol-abusing, runaway adolescents. Journal of Marital and Family Therapy 35(3): 255-277, 2009. (91 refs.)

Treatment evaluation for alcohol problem, runaway adolescents and their families is rare. This study recruited primary alcohol problem adolescents (N = 119) and their primary caretakers from two runaway shelters and assigned them to (a) home-based ecologically based family therapy (EBFT), (b) office-based functional family therapy (FFT), or (c) service as usual (SAU) through the shelter. Findings showed that both home-based EBFT and office-based FFT significantly reduced alcohol and drug use compared with SAU at 15-month postbaseline. Measures of family and adolescent functioning improved over time in all groups. However, significant differences among the home- and office-based interventions were found for treatment engagement and moderators of outcome.

Slesnick N; Prestopnik JL. Ecologically based family therapy outcome with substance abusing runaway adolescents. Journal of Adolescence 28(2): 277-298, 2005. (66 refs.)

Runaway youth report a broader range and higher severity of substance-related, mental health and family problems relative to non-runaway youth. Most studies to date have collected self-report data on the family and social history; virtually no research has examined treatment effectiveness with this population. This study is a treatment development project in which 124 runaway youth were randomly assigned to (1) ecologically based family therapy (EBFT) or (2) service as usual (SAU) through a shelter. Youth completed an intake, posttreatment, 6 and 12 months follow-up assessment. Youth assigned to EBFT reported greater reductions in overall substance abuse compared to youth assigned to SAU while other problem areas improved in both conditions. Findings suggest that EBFT is an efficacious intervention for this relatively severe population of youth.

Slesnick N; Prestopnik JL. Office versus home-based family therapy for runaway, alcohol, adolescents: Examination of factors associated with treatment attendance. Alcoholism Treatment Quarterly 22(2): 21-34, 2004

There is a dearth of research examining treatment engagement and attendance among runaway youth and their families. Such research is needed in order to inform treatment providers on factors associated with engagement and maintenance of these difficult to engage families into counseling. This study examined differential treatment attendance for alcohol abusing runaway youth residing at a local shelter. A traditional office-based family systems approach, Functional Family Therapy (FFT), was compared to a non-traditional, home-based, multisystemic family therapy approach, Ecologically Based Family Therapy (EBFT). As expected, treatment engagement and attendance was significantly higher for those assigned to EBFT (N = 37) compared to FFT (N = 40). Predictors of treatment attendance (income, family chaos, externalization problems and level of youth substance use) were examined within each treatment modality. Findings suggest that home-based (compared to office-based) treatment modalities may significantly increase treatment attendance and engagement of runaway youth and their families. Non-traditional forms of treatment may need to be considered in order to best meet the needs of highly chaotic and disorganized family systems.

Slesnick N; Tonigan JS. Assessment of alcohol and other drugs used by runaway youths: A test-retest study of the Form 90. Alcoholism Treatment Quarterly 22(2): 21-34, 2004

While excellent adolescent alcohol and drug screening tools are available, there are relatively few, if any, psychometrically validated measures to use in the assessment of adolescent treatment outcome. This study conducted a test-retest exercise of the Form 90 Drug and Alcohol (Form 90 DnA) to determine the stability of adolescent responses when administering the day-by-day calendar/grid approach. Homeless youth (N = 37) with alcohol, drug, or alcohol and drug abuse/ dependence combined were recruited to participate in the test-retest study. High pre-post stability in means was obtained on measures of frequency of substance use in general, and on specific measures of alcohol, cocaine, and marijuana use. The findings from this paper provide support for the reliability and validity of the Form 90 for use with adolescent runaways with a substance abuse or dependence diagnosis.

Thompson S; Jun J; Bender K; Ferguson KM; Pollio DE. Estrangement factors associated with addiction to alcohol and drugs among homeless youth in three US cities. Evaluation and Program Planning 33(4): 418-427, 2010. (59 refs.)

Substance use is highly prevalent among homeless, street-involved young people. Societal estrangement is often associated with substance use, particularly among this population. The current study sought to identify four domains of social estrangement (disaffiliation, human capital, identification with homeless culture, and psychological dysfunction) in relation to alcohol and drug addiction. Homeless young adults were recruited from three disparate urban areas: Los Angeles, CA (n = 50), Austin, TX (n = 50) and St. Louis, MO (n = 46) using comparable research methods and measurement instruments. Findings demonstrated that variables measuring psychological dysfunction and homeless culture predicted alcohol addiction, while institutional disaffiliation and homeless culture predicted drug addiction. Findings affirm distinct patterns of estrangement related to alcohol compared to drug addiction. Understanding these features and the heterogeneity of this population has strong potential for assisting development of programs targeting substance use among this underserved population.

Thompson SJ. Factors associated with trauma symptoms among runaway/homeless adolescents. IN: Bride BE; MacMaster SA, eds. Stress, Trauma and Substance Use. New York: Routledge, 2006. (48 refs.)

Runaway/homeless youth often suffer from exposure to chronic family distress and confront numerous traumatic events that may produce symptoms of PTSD. This study evaluated runaway/homeless youth's PTSD symptoms and associated factors. Data were collected at youth emergency shelters. Ninety-eight percent of participants had elevated PTSD symptom scores. Although use of inhalants and LSD was associated with PTSD symptoms, only depression, anxiety, and dissociation, mother's ecstasy or LSD use, youth's worry about family relationships, and poor family communication predicted higher PTSD scores. Runaway/homeless youth entering emergency shelters services must be evaluated concerning trauma and associated comorbid symptoms.

Thompson SJ. Risk/protective factors associated with substance use among runaway/homeless youth utilizing emergency shelter services nationwide. Substance Abuse 25(3): 13 -26, 2004

Rates of alcohol, tobacco, and marijuana use among runaway/homeless youth are substantially higher than found among American high school students. To understand the risk and protective factors associated with substance use, this study (1) assessed cigarette, alcohol, and marijuana use among a national sample of runaway/homeless youth, (2) identified risk/protective factors associated with lifetime substance use, and (3) examined risk/protective factors associated with six month frequency of substance use. Unduplicated cases (n = 11,841) from the 1997 Runaway/Homeless Youth Management Information System (RHY MIS) were analyzed. Results showed that substance use levels are greater than previously reported for this population. Predictors of cigarette, alcohol, and marijuana use and frequency were predominately individual youth risk factors and demographics rather than family risk factors. Providers in emergency youth shelters are in a prime position to assess substance use behaviors, as well as the associated risk factors. Provision of appropriate screening and referral to other services is essential to meet the needs of these youth.

Thompson SJ; Maccio EM; Desselle SK; Zittel-Palamara K. Predictors of posttraumatic stress symptoms among runaway youth utilizing two service sectors. Journal of Traumatic Stress 20(4): 553-563, 2007. (37 refs.)

Youth who run away often experience situations that produce symptoms of traumatic distress. This exploratory study assessed predictors of trauma symptomatology among runaway youth who had been admitted to youth emergency shelter services or juvenile detention. Findings demonstrated high levels of trauma-related symptoms for both groups. Worry about family, greater runaway episodes, and living with a father who abused alcohol/drugs significantly predicted higher posttraumatic stress symptoms in detained youth, whereas only worry about family relationships predicted higher trauma symptom scores among youth in emergency shelter care. Findings suggest distressful family life may induce complex emotional responses in youth. Although services to runaway youth must continue to focus on safe, short-term residential care, trauma issues must be acknowledged.

Thompson SJ; Rew L; Barczyk A; McCoy P; Mi-Sedhi A. Social estrangement: Factors associated with alcohol or drug dependency among homeless, street-involved young adults. Journal of Drug Issues 39(4): 905-929, 2009. (70 refs.)

Substance use is highly prevalent among homeless, street-involved young people, Societal estrangement is often associated with substance use, particularly among this population. The current study utilized a descriptive correlational design to identify four domains of social estrangement: disaffiliation, human capital, identification with homeless culture, and psychological dysfunction. These domains were tested to determine their association with alcohol or drug dependence. Interviews utilizing self-report instruments were conducted with 185 young adults aged 18-23 years of age who were receiving homeless services from a community drop-in center In this sample, the vast majority reported high levels of alcohol and drug use with more than half being identified as dependent on alcohol and/or drugs. Polysubstance use was highly prevalent and most reported marijuana their drug of choice. Findings indicate that identification with homeless culture was the most highly predictive domain of social estrangement for both alcohol and drug dependency. Implications for services to this population are discussed.

Thompson SJ; Zittel-Palamara KM; Forehand G. Risk factors for cigarette, alcohol, and marijuana use among runaway youth utilizing two services sectors. Journal of Child & Adolescent Substance Abuse 15(1): 17-36, 2005. (44 refs.)

The high rates of substance use among American adolescents are challenging; however, runaway youth are at particularly high-risk for substance use. Runaway youth utilizing two service sectors, emergency crisis shelters and juvenile detention centers, were recruited to evaluate differences in risk factors associated with substance use. Findings demonstrate that youth admitted to juvenile detention (n = 121) had proportionally higher levels of problem behaviors, including substance use, than youth admitted to shelter services (n = 156). Both groups of youth have significantly higher levels of substance use than national estimates. The most significant risk factor for alcohol and marijuana use among youth in both groups was using other substances. Addressing issues Of Substance abuse among runaway Youth must be a prime objective for future research and treatment for this high-risk population.

Tyler KA. Risk factors for trading sex among homeless young adults. Archives of Sexual Behavior 38(2): 290-297, 2009. (30 refs.)

Although numerous homeless youth report trading sex, few studies have examined risk factors associated with trading sex and even fewer have employed multivariate analyses to examine this relationship, even though trading sex is associated with many negative health outcomes. Based on a sample of 151 homeless young adults in the midwestern United States, logistic regression analyses revealed that for each additional year of age, youth were 37% more likely to have traded sex (AOR = 1.37; 95% CI = .99-1.90). White youth were 84% less likely to have traded sex than non-white youth (AOR = .16; 95% CI = .03-.77). Furthermore, youth who had been employed full time were 80% less likely to have traded sex (AOR = .20; 95% CI = .05-.85). For every one unit increase in depressive symptoms, there was an 11% increase in the likelihood of ever having traded sex (AOR = 1.11; 95% CI = .99-1.24). Additionally, those who had friends who traded sex were approximately five times more likely to have ever traded sex themselves compared to those with no friends who had traded sex (AOR = 5.17; 95% CI = .95-28.12). Finally, youth who were propositioned to trade sex were almost five and one-half times more likely to have ever done so compared to youth who had not been propositioned (AOR = 5.45; 95% CI = 1.02-29.17). Overall, the results have important implications for the health and well-being of this high-risk population.

Walsh SM; Donaldson RE. Invited Commentary. National Safe Place: meeting the immediate needs of runaway and homeless youth. (editorial). Journal of Youth and Adolescence 39(5): 437-445, 2010. (23 refs.)

An estimated 1.6 million youth run away from home each year. While on the run, these youth are vulnerable to exploitation, victimization, increased dangers and perpetration of criminal behavior. Runaway and homeless youth are far more likely to engage in substance use and delinquent behavior, drop out of school and suffer from sexually transmitted diseases and mental illness at greater rates than the norm. Timely and direct intervention in runaway and throwaway cases is imperative to protect youth from the high risks of living on the streets. National Safe Place is an outreach and prevention program that is uniquely designed to provide immediate safety and access to services for any youth in need. In partnership with over 360 youth serving agencies and over 10,000 businesses and community organizations across the United States, the Safe Place program educates youth about alternatives to running away and homelessness and provides easily accessible links to service providers. Ongoing data collection indicates that National Safe Place has been successful in reaching endangered youth at risk of abuse, neglect or serious family problems but that expanded program models remain needed. The challenges and successes of current programming and the future of National Safe Place program expansion are discussed.

Werb D; Kerr T; Fast D; Qi JZ; Montaner JSG; Wood E. Drug-related risks among street youth in two neighborhoods in a Canadian setting. Health & Place 16(5): 1061-1067, 2010. (49 refs.)

We compared drug-related behaviors, including initiation of drug use, among street youth residing in two adjacent neighborhoods in Vancouver. One neighborhood, the Downtown Eastside (DIES), features a large open-air illicit drug market. In multivariate analysis, having a primary illicit income source (adjusted odds ratio [AOR]=2.64, 95% confidence interval [CI] 1.16-6 02) and recent injection heroin use (AOR=4.25, 95% CI 1.26-14 29) were positively associated with DIES residence, while recent non-injection crystal methamphetamine use (AOR, 039, 95% CI: 0 16-0 94) was negatively associated with DIES residence. In univariate analysis, dealing drugs (odds ratio [OR]=5 43, 95% CI: 1 24-23.82) was positively associated with initiating methamphetamine use in the DTS compared to the DTES. These results demonstrate the importance of considering neighborhood variation when developing interventions aimed at reducing drug-related harms among street-involved youth at various levels of street entrenchment.

Westermeyer J; Thuras P; Waaijer A. Size and complexity of social networks among substance abusers: Childhood and current correlates. American Journal on Addictions 13(4): 372-380, 2004. (19 refs.)

The objective of this study was to identify parental, childhood, demographic, and social function factors associated with social network size and complexity among substance abusers using retrospective data regarding family and childhood history and current data regarding demographic characteristics and psychosocial function. The authors interviewed 505 voluntary patients with substance abuse at two university medical centers in Minnesota and Oklahoma with alcohol - drug programs located within departments of psychiatry. Data collection instruments included a childhood questionnaire, a demographic checklist, and two psychiatric rating scales of psychosocial function. The authors found that years of education, current residence with others, being actively occupied at work or school, and higher psychosocial function on two psychiatrist-rated scales were associated with increased social network size and complexity. Loss of mother, out-of-home placement, and runaway before age 18 were associated with smaller social networks in adulthood. Age, gender, and current marital status were not associated with social network. Regression analysis indicated that network size (i.e., the number of individuals in the network) was associated with higher psychosocial function over the last year but not over the last two weeks, whereas network complexity (ie, the number of subgroups in the network) was related to psychosocial function over both the last year and the last two weeks. These data indicate that in addicted persons, both childhood factors and current social factors affect network size and complexity. Network complexity may be amenable to short-term change, whereas network size may be more related to longer-term coping.

Whitbeck LB; Johnson KD; Hoyt DR; Cauce AM. Mental disorder and comorbidity among runaway and homeless adolescents. Journal of Adolescent Health 35(2): 132-140, 2004. (33 refs.)

Purpose: To investigate prevalence of mental disorder and comorbidity among homeless and runaway adolescents in small to medium sized cities in four Midwestern states. Methods: The study presents lifetime, 12-month prevalence, and comorbidity rates for five mental disorders (conduct disorder, major depressive episode, posttraumatic stress disorder, alcohol abuse, and drug abuse) based on UM-CIDI and DISC-R structured interviews from the baseline interviews of a longitudinal diagnostic study of 428 (187 males; 241 females) homeless and runaway adolescents aged 16-19 years (mean age = 17.4 years, SD = 1.05). The data were collected by full-time street interviewers on the streets and in shelters in eight Midwestern cities of various populations. Separate logistic regression models were used to investigate factors associated with meeting criteria for any disorder and two or more disorders. Results: Lifetime prevalence rates were compared with rates for same-aged respondents from the National Comorbidity Survey (NCS). Homeless and runaway adolescents were six times more likely than same-aged NCS respondents to meet criteria for two or more disorders and were from two to 17 times more likely to meet criteria for individual disorders than. Conclusions: Homeless and runaway adolescents in small and mid-sized Midwestern cities report significant levels of mental disorder and comorbidity that are comparable and often exceed that reported in studies of larger magnet cities.

Woods ER; Samples CL; Melchiono MW; Harris SK. Boston HAPPENS Program: HIV-positive, homeless, and at-risk youth can access care through youth-oriented HIV services. Seminars in Pediatric Infectious Diseases 14(1): 45-53, 2003

The Boston HAPPENS Program is a collaborative network of care consisting of multiservice outreach agencies; community health centers; and hospitals for HIV-positive, homeless, and hard-to-reach youth. In four years of data collection, the program served more than 2,000 youth, including 54 HIV-positive youth. The youth were 19.9 +/- 2.9 years old; 64 percent female; 45 percent youth of color; 11 percent gay/lesbian, bisexual, or undecided; and 13 percent homeless or runaway. Homeless youth were much more likely to have been involved with a mental health system (47% vs. 12%, P < 0.001), the criminal justice system (20% vs. 2%, P < 0.001), high-risk sexual behaviors (21% vs. 3%, P < 0.001), and substance abuse (25% vs. 6%, P < 0.001) than were other youth served by the program. Comprehensive networks of care offering a continuum of services and a variety of entry routes and types of care sites are needed to connect under-served youth to health care. Outreach and human immunodeficiency virus (HIV) counseling and testing services can offer important portals of entry into health services for at-risk youth. Support services such as outreach, case management, and mental health services are needed to complement medical services by all youth at-risk for contracting HIV. Support services are necessary for the initiation and retention of youth in care so that early case identification and complex treatment regimens can be initiated and tailored to the individual.

Yoder KA; Whitbeck LB; Hoyt DR. Gang involvement and membership among homeless and runaway youth. Youth & Society 34(4): 441-467, 2003. (58 refs.)

The present study documented the extent of gang involvement and gang membership in a sample of 602 homeless and runaway youth from four midwestern states. The study also compared gang members, gang-involved youth who were not members, and nongang youth on several dimensions including sociodemographic characteristics, family background, school experiences, street experiences and exposure, emotional problems, alcohol and drug use, and other delinquent and deviant behaviors. Findings indicated that a significant number of these youth were gang members (15.4% of the sample) or involved in gangs (32.2% of the sample). Youth gang members and gang-involved youth reported more family legal problems, had been suspended from school more, ran away at a younger age, used more alcohol and drugs, were exposed to more deviant peers, and attempted suicide more than did nongang youth. In addition, youth gang members reported less parental monitoring, more severe abuse, more street victimization, and more deviant subsistence strategies than did either gang-involved or noninvolved youth.