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CORK Bibliography: Runaways

34 citations. January 1997 to present

Prepared: June 2008

Adlaf EM; Zdanowicz YM; Smart RG. Alcohol and other drug use among street-involved youth in Toronto. Addiction Research 4(1): 11-24, 1996. (30 refs.)

This study presents findings from 217 interviews with street-involved youth (160 males, 57 females) conducted in 1992 in Toronto, Canada. Measures of mental health, physical and sexual abuse, substance use, and social service usage are described. In addition, potential predictors of substance use and abuse are evaluated, including demographics, family dysfunction, environmental influences, intrapersonal factors and motivations for substance use. The analysis indicated that coping and escapism motivations, street exposure and number of services used were positively related to substance use and abuse. In addition, family dysfunction had a positive effect on the number of drugs used. Intrapersonal factors had no direct effect on substance use outcomes.

Booth RE; Zhang Y. Severe aggression and related conduct problems among runaway and homeless adolescents. Psychiatric Services 47(1): 75-80, 1996. (46 refs.)

Objective: The study assessed the prevalence of severe aggressive behavior and conduct disorder in a population of runaway and homeless adolescents and examined relationships between aggression, conduct disorder, other problem behaviors, and background characteristics. Methods: A total of 219 runaway and homeless youths recruited through a urban drop-in center were surveyed using the Adolescent Health Survey, a questionnaire about background and mental health experiences, and the revised version of the Diagnostic Interview Schedule for Children. Results: More than half of study participants met criteria for conduct disorders, and 62 percent reported a history of severe aggressive behavior. Although these constructs were related to each other, a third of the subjects met criteria for only one. Childhood sexual abuse was associated with conduct disorder, while living in a home where drugs were used was associated with aggression. Severe aggressive behavior was associated with other problem behaviors, including attempted suicide, behavior that precipitated residential psychiatric treatment, pregnancy, arrests, and convictions. Conclusions: The assessment and systematic treatment of conduct disorder and aggression among runaway and homeless youths is urgently needed to reduce the effects of the disorder and associated problem behaviors.

Booth RE; Zhang YM. Conduct disorder and HIV risk behaviors among runaway and homeless adolescents. Drug and Alcohol Dependence 48(2): 69-76, 1997. (53 refs.)

This study was designed to assess the prevalence of conduct disorder (CD) among runaway and homeless adolescents and to investigate associations between CD and HIV risk behaviors. The Diagnostic Interview Schedule for Children and a standardized HIV risk assessment questionnaire were administered to 219 runaway and homeless adolescents recruited from a drop-in center serving high-risk youth. One-half of the males and 60% of the females were diagnosed with CD. In multivariate analyses, CD was the strongest predictor of lifetime use of heroin and/or cocaine and exchanging sex for money, drugs, food or shelter, as well as the number of drugs used and the number of sex partners in the 3 months preceding the interview. The high rate of CD in this population, and the association between CD and both drug and sex-related HIV risk behaviors, indicate a need for interventions that consider the influence of this psychiatric diagnosis on high-risk behaviors.

Booth RE; Zhang YM; Kwiatkowski CF. The challenge of changing drug and sex risk behaviors of runaway and homeless adolescents. Child Abuse & Neglect 23(12): 1295-1306, 1999. (53 refs.)

Objective: To assess HIV-related drug and sex risk behaviors and evaluate factors associated with change in risk behaviors among runaway and homeless adolescents, 244 street youth were recruited from a community drop-in center serving high-risk youth. Method: Using a cross-sectional design, approximately half of study participants received training in a peer-based intervention that included principles derived from the health belief model, while the remaining subjects received no intervention. Subjects were interviewed at baseline, immediately following the intervention (for those receiving the training) and 3 months later. Logistic regression and analysis of covariance were used to analyze intervention effects. Results: Compared to youth in the control condition, runaways receiving the intervention significantly increased their knowledge about HIV. Contrary to the health belief model, in multivariate analyses knowledge and greater perceived chance for HIV were associated with high risk behavior. On the other hand, lower concern about HIV infection was also associated with high risk behavior, supporting the health belief model. Conclusions: Despite the intervention's success in increasing knowledge of HIV and AIDS, the association between knowledge, perceived likelihood of infection and high risk behaviors suggest that, without other alternatives, runaways will maintain their risks. The association noted between lower concern and high risk behaviors underscores the challenge faced in developing effective interventions with this population.

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 Rosa CJ; Montgomery SB; Kipke MD; Iverson E; Ma JL; Unger JB. Service utilization among homeless and runaway youth in Los Angeles, California: Rates and reasons. Journal of Adolescent Health 24(3): 190-200, 1999. (16 refs.)

Purpose: To describe the service utilization patterns of homeless and runaway youth in a "service-rich" area (Los Angeles, California); identify demographic and other correlates of utilization; and contextualize the findings with qualitative data. Method: During Phase 1 of this study, survey data were collected from an ethnically diverse sample of 296 youth aged 13-23 years, recruited from both service and natural "hang-out" sites using systematic sampling methods. During Phase 2, qualitative data were collected from 46 youth of varying ethnicities and lengths of time homeless. Results: Drop-in centers and shelters were the most commonly used services (reported by 78% and 40%, respectively). Other services were used less frequently [e.g., medical services (28%) and substance abuse treatment (10%) and mental health services (9%)]. Utilization rates differed by ethnicity, length of time in Los Angeles, and city of first homeless episode (Los Angeles vs. all others). Shelter use was strongly associated with use-of all other services. Despite youths' generally positive reactions to services, barriers were described including restrictive rules, confidentiality and reporting problems, and negative interactions with staff members. Youth suggested improvements including more targeted services, more long- term services, revised age restrictions, and mote and/or better job training and transitional services to get them off the streets. Conclusions: Because shelters and drop-in centers act as gateways to other services and offer intervention potential for these hard-to- reach youth, it is vital that barriers to use of these services are eliminated.

Ennett ST; Bailey SL; Federman EB. Social network characteristics associated with risky behaviors among runaway and homeless youth. Journal of Health and Social Behavior 40(1): 63-78, 1999. (46 refs.)

Runaway and homeless youth are at high risk for substance abuse and unsafe sexual behavior: Our study describes the personal social networks of these youth and examines network characteristics associated with risky behaviors. In 1995 and 1996, we interviewed a purposive sample of youth aged 14 through 21 who were living in Washington, DC and were identified on the streets or through shelters or other service agencies (N = 327). Although we found that most youth reported current social relationships, a significant minority (26%) did not. Youth without a social network were significantly more likely to report current illicit drug use, multiple sex partners, and survival sex than youth with a network For youth with a network, the networks were small, strong in affective and supportive qualities, comprised primarily of friends, typically included an alcohol or illicit drug user; and usually were not a source of pressure for risky, behaviors. Our results indicate that networks had risk-enhancing and risk-decreasing properties in that network characteristics were associated in both positive and negative directions with risky behaviors.

Gleghorn AA; Marx R; Vittinghoff E; Katz MH. Association between drug use patterns and HIV risks among homeless, runaway, and street youth in Northern California. Drug and Alcohol Dependence 51(3): 219-227, 1998

We examined relationships between drug use patterns and HIV risk behaviors among 1121 street-recruited homeless, runaway, and 'street youth' in Northern California. Comparisons demonstrated that youth using any heroin, methamphetamine, or cocaine exhibited more sexual risks than non-users, while primary stimulant and combined heroin/stimulant users showed greatest sexual risk. Combined heroin/stimulant injectors showed higher risk injection practices than primary heroin or primary stimulant injectors, including frequent injections and backloading syringes. Interventions for street youth should be tailored to current drug use patterns since those using combinations of heroin and stimulants may require more comprehensive prevention, support and treatment services.

Greene JM; Ennett ST; Ringwalt CL. Substance use among runaway and homeless youth in three national samples. American Journal of Public Health 87(2): 229-235, 1997. (27 refs.)

OBJECTIVES: Standardized estimates of the prevalence of substance use by runaway and homeless youth between the ages of 12 and 21 in various settings were compared with each other and with estimates for youth in the general population. METHODS: Four surveys were used: (1) a nationally representative survey of runaway and homeless youth residing in federally and non-federally funded shelters; (2) a multicity survey of street youth; (3) a nationally representative household survey of youth with and without recent runaway and homeless experiences; and (4) a nationally representative household survey of youth whose previous runaway/homeless status was unknown. RESULTS: For almost every substance, substance use prevalence was highest among street youth. Shelter youth and household youth with recent runaway/homeless experiences reported similar rates. In the household surveys, substance use rates were lowest and were generally comparable. CONCLUSIONS: Many homeless and runaway youth use tobacco, alcohol, and other drugs at rates substantially higher than nonrunaway and nonhomeless youth, indicating a need for comprehensive and intensive substance abuse prevention and treatment services for these youth.

Greene JM; Ringwalt CL. Youth and familial substance use's association with suicide attempts among runaway and homeless youth. Substance Use & Misuse 31(8): 1041-1058, 1996. (19 refs.)

This study examined how youth suicide attempts are associated with youth and familial substance use among two samples of runaway and homeless youth (RHY) (a) a nationally representative sample of RHY residing in shelters, and (b) a multi-city, purposive sample of RHY found on the street. Data were collected using personal interviews from 640 shelter youth and 600 street youth in 1992. Logistic regression analyses revealed that, after controlling for key demographic characteristics, youth who had used substances (particularly sedatives, hallucinogens, and inhalants) were much more likely than those who had not used substances to have ever attempted suicide. In addition, after controlling for their own substance use, youth with family members who had used substances were twice as likely as those without such family members to have ever attempted suicide. This study suggests the importance of developing and focusing suicide prevention efforts on RHY known to have used (or are using) substances and to have substance-using family members.

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.)

Kingree JB; Braithwaite R; Woodring T. Psychosocial and behavioral problems in relation to recent experience as a runaway among adolescent detainees. Criminal Justice and Behavior 28(2): 190-205, 2001. (20 refs.)

This study examined the occurrence of psychosocial and behavioral problems in relation to recent experience as a runaway among adolescents recruited from two youth detention centers. The sample included 176 males and 132 females who were interviewed approximately 30 days after being initially detained. Results indicated that recent experience as a runaway was common, especially among females and Caucasians. Moreover, detainees who had recently run away reported more psychosocial and behavioral problems than did those who had not recently run away. The implications of these findings are discussed.

Kral AH; Molnar BE; Booth RE; Watters JK. Prevalence of sexual risk behaviour and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City. International Journal of STD & AIDS 8(2): 109-117, 1997. (57 refs.)

We aim to assess the prevalence of HIV sexual risk behaviours and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City. Survey data were examined from 775 runaway and homeless adolescents recruited from street settings and youth agencies during 1992/1993. Nearly all (98%) reported having engaged in sexual intercourse, of whom 49% first had intercourse by the age of Condom use during all vaginal intercourse in the previous months was reported by 42%. Among males, 23% indicated that they had exchanged sex fog money, as did 14% of the females. Ninety-seven per cent had used alcohol or drugs and 21% had injected drugs. Overall, 75% reported having had sex while under the influence of alcohol or drugs. Systematic epidemiological studies of this population and the development of innovative interventions are essential to reduce the threat of HIV among runaway and homeless youth.

Martinez TE; Gleghorn A; Marx R; Clements K; Boman M; Katz MH. Psychosocial histories, social environment, and HIV risk behaviors of injection and noninjection drug using homeless youths. Journal of Psychoactive Drugs 30(1): 1-10, 1998. (48 refs.)

Injection drug use is a common risk behavior for HIV infection among homeless, runaway and street youths. However, the psychosocial histories and current social environment of these youths are not well understood. The authors recruited 186 homeless, runaway and street youths using systematic street-based sampling methods, and assessed psychosocial histories, current daily activities, and sexual and drug-related risk behaviors using qualitative and quantitative techniques. Youths reported high lifetime rates of injection drug use (45%), recent drug and alcohol use (100%), and current homelessness (84%). Injection drug using youths were more likely than noninjection drug using youths to report traumatic psychosocial histories, including parental substance use and forced institutionalization, use of alcohol and other noninjection drugs, a history of survival sex, and the use of squats or abandoned buildings as shelter. These findings underscore the need for multifaceted service and prevention programs to address the varied needs of these high-risk youths.

McKenzie M; Tulsky JP; Long HL; Chesney M; Moss A. Tracking and follow-up of marginalized populations: A review. Journal of Health Care for the Poor and Underserved 10(4): 409-429, 1999. (44 refs.)

Maintaining study cohorts is a key element of longitudinal research. Participant attrition introduces the possibility of bias and limits the generalizability of a study's findings, but with appropriate planning it is possible to sustain contact with even the most transient participants. This paper reviews the essential elements of tracking and follow-up of marginalized populations, which are (1) collection of contact information, (2) thorough organization of tracking efforts, (3) attention to staff training and support, (4) use of phone and mail follow-up, (5) use of incentives, (6) establishing rapport with participants, (7) assurance of confidentiality, (8) use of agency tracking, (9) use of field tracking, and (10) attention to safety concerns. Diligent application of these tracking strategies allows researchers to achieve follow-up rates of 75 percent to 97 percent with vulnerable populations such as homeless, mentally ill adults, injection drug users, and runaway youth.

McMorris BJ; Tyler KA; Whitbeck LB; Hoyt DR. Familial and "on-the-street" risk factors associated with alcohol use among homeless and runaway adolescents. Journal of Studies on Alcohol 63(1): 34-43, 2002. (69 refs.)

Objective: This study investigated factors associated with alcohol use among homeless and runaway adolescents, using a risk- amplification model. Method: Homeless and runaway adolescents (N = 536, 60% female) were recruited and interviewed by outreach workers directly on the streets, in shelters and in drop-in centers in four Midwestern states. The average age was 16 years; ages ranged from 12 to 22. Results: Parent alcohol problems were indirectly linked to adolescent drinking through familial abuse and its relationship to deviant peers, time on own and risky subsistence behaviors. Parent alcohol problems also predicted offspring alcohol use through parental rejection and its association with deviant peers and with risky subsistence behaviors. The strongest direct effects on alcohol use were hanging out with antisocial friends and participating in deviant behaviors in order to survive on the street. Conclusions: This study sheds light on the nature of alcohol use in a high-risk population, Family background and "on-the-street" (time on own) factors must be taken into consideration when treating alcohol misuse in street youth. The alternative is a vicious cycle whereby homeless youth may become homeless adults.

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.

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.

Shultz JM; Garcia LM; Greer PJ. HIV surveillance of drug abuse and sexual risk behaviors among homeless persons in Miami-Dade County, Florida. IN: Community Epidemiology Work Group, eds. Epidemiologic Trends in Drug Abuse. Volume II: Proceedings. December 1998. Bethesda MD: National Institute on Drug Abuse, 1999. pp. 425-431. (6 refs.)

Homeless persons are at high risk for infection with HIV. Among 16 sites participating in a nationwide HIV seroprevalence survey of homeless adults and runaway youth, clients of the Miami clinic had the highest rate of HIV infection (15.9%) -- twice as high as the second ranking clinic. This reports provides the demographic characteristics of the homeless population, risk behaviors, time trends. A significant and broadly generalizable decline in HIV rates was observed, overall seroprevalence declining steadily from 23.2% to 7.2%; this was true for all risk groups. During this period there was concerted efforts by the police to destroy homeless sites and move individuals into either shelters or jails. Also, the clientele of the clinics changed with shift to lower risk subsets of clients.

Public Domain

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. Variables associated with therapy attendance in runaway substance abusing youth: Preliminary findings. American Journal of Family Therapy 29(5): 411-420, 2001. (29 refs.)

Service providers and researchers note that youth with substance abuse problems are difficult to engage in treatment and, when engaged, often drop out early. Estimates of the alcohol and drug abuse rate of runaway youth range from 70% to 95%. This study evaluated predictors of therapy attendance in a sample of substance abusing youth recruited through two southwestern runaway shelters. Runaway youth and their families (N = 36) were engaged into a 15- session ecologically-based family therapy (EBFT) intervention. Fewer days between the pretreatment assessment and the first therapy session, as well as less perceived parental care, predicted more therapy sessions attended. No relationship was found between level of substance use and treatment attendance. The findings highlight the importance of engaging families in therapy soon after the youth's arrival to the shelter, as treatment motivation may decrease as the crisis lessens.

Slesnick N; Meade M. System youth: A subgroup of substance-abusing homeless adolescents. Journal of Substance Abuse 13(3): 367-384, 2001. (78 refs.)

Purpose: While many youths residing at homeless shelters will return home, many are placed in group or foster homes. Few researchers have examined the experiences of adolescents with a history of these out-of-home placements. This study examined shelter residents and compared the experiences of system and non-system youth. Methods: Information regarding youths' family functioning, substance use, depression and related problem behaviors was obtained from substance abusing system (n = 62) and non-system (n = 82) adolescents staying at local runaway shelters. Results: System males engaged in significantly more delinquent behaviors than did non-system males and system females. Alcohol and drug problem consequences were positively associated with longevity in the system, while having ever attempted suicide was negatively associated with system longevity. System youth reported: 1) taking more prescribed psychotropic medications 2) experiencing more sexual abuse, and 3) less parental overprotection, as compared to non-system youth. Gender differences were found in which females reported more conflictual problem solving interactions with their parents than did males, as well as more comorbid diagnoses. Implications: Although longitudinal research is needed, findings argue that without intervention efforts targeted at identified problem behaviors, youth are at risk to continue their system involvement into adulthood.

Slesnick N; Meyers RJ; Meade M; Segelken DH. Bleak and hopeless no more: Engagement of reluctant substance-abusing runaway youth and their families. Journal of Substance Abuse Treatment 19(3): 215-222, 2000. (52 refs.)

Runaway/homeless shelters document high levels of substance abuse among runaway youth, at least double that of school youth. These youth present a constellation of problems and research suggests that this population may be unique in the range and intensity of associated problems. Most studies to date have collected self-report data on these youth; virtually no research has examined treatment effectiveness with the population. Given the void of treatment outcome research with these youths, there is need for identifying potent interventions. Given that issues of engagement and retention must assume prominence in the development of new treatments, this article presents a family-based treatment engagement strategy successfully employed with a sample of substance-abusing youth staying in a southwestern shelter. Youth and primary caretakers are engaged separately by the therapist utilizing motivating factors appropriate to context of the families' lives and to the developmental position of the client.

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. 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.

Sussman S; Simon TR; Stacy AW; Dent CW; Ritt A; Kipke MD et al. The association of group self-identification and adolescent drug use in three samples varying in risk. Journal of Applied Social Psychology 29(8): 1555-1581, 1999. (38 refs.)

This study provides a cross-sectional analysis of the relations between group self-identification and adolescent drug use in 3 samples of youth: comprehensive high-school, continuation high- school, and runaway/street youth. Youth identified with discrete groups in all 3 samples, and similar general groups were formed. In most comparisons, a high-risk group showed greater levels of drug use than did other groups. This is the first study to demonstrate that group self-identification (a) is a generalizable construct across different types of adolescent samples, (b) is related to use of drugs other than tobacco, and (c) remains a significant correlate of drug use controlling for its relations with demographic variables and several other psychosocial variables.

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; 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; Whitbeck LB; Hoyt DR; Yoder KA. Predictors of self-reported sexually transmitted diseases among homeless and runaway adolescents. Journal of Sex Research 37(4): 369-377, 2000. (42 refs.)

Path analysis was used to investigate factors associated with self- reported sexually, transmitted diseases among 569 homeless (and runaway adolescents in four Midwestern states. Youth were interviewed by outreach workers directly on the streets, in shelters and in drop- in centers. Results indicated that family abuse was positively related to substance use, affiliation with friends who sold sex and time on own. Early family abuse indirectly increased the likelihood of self-reported sexually, transmitted diseases through time on own, substance use, friends selling sex, and risky sexual behaviors. Finally, substance use and affiliation with friends who sold sex teas positively associated with risky sexual behaviors, which in turn was related to self-reported sexually transmitted diseases. No significant gender interactions were found for this model.

Whitbeck LB. Primary socialization theory: It all begins with the family. Substance Use & Misuse 34(7): 1025-1032, 1999. (12 refs.)

This commentary is a discussion of primary socialization theory emphasizing the centrality of family processes on adolescents' affiliation with deviant peers and subsequent deviant behaviors. The focus of the discussion is the persistent influence of family processes well into adolescence. An empirical model illustrating these processes is presented. The model is based on a sample of 257 runaway adolescents and indicates that the effects of an abusive family on adolescent behaviors are largely transmitted via affiliation with deviant peers. The author concludes that primary socialization theory would be strengthened by greater emphasis on the persistent influence of family on adolescent behaviors. Implications for family-based prevention programs are discussed.

Whitbeck LB; Hoyt DR; Bao WN. Depressive symptoms and co-occurring depressive symptoms, substance abuse, and conduct problems among runaway and homeless adolescents. Child Development 71(3): 721-732, 2000. (66 refs.)

This study examines factors that contribute to depressive symptoms and to co-occurring depression, substance abuse, and conduct problems among 602 runaway and homeless adolescents. The respondents were interviewed in shelters, drop-in centers, and directly on the streets in four Midwestern states (Missouri, Iowa, Nebraska, and Kansas). Results indicate that although family-of-origin factors contribute to depressive symptoms and comorbidity among runaway and homeless adolescents, experiences and behaviors when the adolescents are on their own also have powerful effects. The authors discuss the findings from a life-course perspective focusing: on mechanisms through which street experiences accentuate or amplify already high levels of psychological distress and behavioral problems among this population of young people.

Yoder KA; Hoyt DR; Whitbeck LB. Suicidal behavior among homeless and runaway adolescents. Journal of Youth and Adolescence 27(6): 753-771, 1998. (73 refs.)

The present study considered risk factors associated with suicidal ideation and the likelihood of a suicide attempt in a sample of 297 homeless and runaway youth from four Midwestern states. It was hypothesized that sociodemographic characteristics, family factors, suicide exposure, street factors, externalizing behavior, and internalizing behavior would be related to suicidal ideation and to the likelihood of a suicide attempt. It was also hypothesized that suicidal ideation would mediate the relationship between the other predictor variables and the likelihood of a suicide attempt. Over half the sample (53.9%) endorsed some level of suicidal ideation, and over one quarter (2.6.3%) attempted suicide in the year prior to the interview Univariate and multivariate results indicated that sexual abuse by a family member, knowing a friend who attempted suicide, drug abuse, and internalization were highly related to suicidal ideation. In the absence of suicidal ideation, sexual abuse, sexual victimization while on their own, and internalization were highly related to the likelihood of a suicide attempt. Finally, the hypothesized mediating effect was found for both sexual abuse and internalization.