Predictors of substance use among homeless youth in San Diego☆
Introduction
It is estimated that, in the United States, 300,000 youth are homeless (National Coalition for the Homeless, Homeless Youth, 1999); the annual prevalence of homelessness is at least 5% among youth aged 12–17 (Robertson & Toro, 1998). In California, estimates indicate that 35,000–100,000 children/adolescents are homeless, which constitutes 10–38% of the homeless population in the State (California Office of the Governor, March 2002). In San Diego County, approximately 800 youth are homeless at any given time (Regional Task Force on the Homeless, Youth and Homelessness, 1997), with only 202 shelter beds set aside (Regional Task Force on the Homeless, Homeless Service Profile, 2001). This leaves a substantial number of youth who are forced to live on the streets, “squat” in abandoned buildings, or sleep on the beach.
Substance use has been shown to be related to health risks in youth (Grunbaum et al., 2000, Huba & Melchior, 2000). It is reported that 75% of homeless youth use drugs because they believe it keeps them warm and/or suppresses their appetite (Regional Task Force on the Homeless, Youth and Homelessness, 1997). Research has shown that rates of drug use are much higher among homeless adolescents than among other youth (Kipke et al., 1993, Klein et al., 2000). Huba and Melchior (2000) reported that homeless male and female youth have 2.27 and 1.75 greater odds of substance use, than do their respective non-homeless counterparts.
A paucity of literature exists on the determinants of homeless adolescents' substance use. Current research has primarily focused on the prevalence of homeless adolescent substance users and their service needs (Kipke et al., 1993, Klein et al., 2000). Descriptions of the problem and a framework from which determinants can be assessed have been presented (Robertson & Toro, 1998, Whitbeck & Hoyt, 1999); however, only a few studies have identified possible determinants (Ennett et al., 1999, Hawkins et al., 1992, Swadi, 1999). Attempted suicide, history of sexual and physical abuse, “survival sex”, sexual orientation, lack of a social network, and long periods of homelessness have been found to be associated with substance use in homeless adolescents (Ennett et al., 1999, Kipke et al., 1993).
Many studies have investigated risk factors associated with substance use in non-homeless youth. Peer influences have been the most consistently reported positive predictors (Hawkins et al., 1992, McCuller et al., 2001, Sullivan & Farrell, 1999, Swadi, 1999). Violence/crime (Huba & Melchior, 2000, Sullivan & Farrell, 1999), poor school performance (Grunbaum et al., 2000, Sullivan & Farrell, 1999), and family conflict (Brook et al., 1998, McCuller et al., 2001, Ellickson & Morton, 1999) have also been shown to be significantly related to increased substance use in youth.
A number of factors have also been reported as being significantly negatively related to youth substance use. These include religiosity (Grunbaum et al., 2000, McCuller et al., 2001), parental monitoring (Griffin et al., 2000, Li et al., 2000), and physical activity (Collingwood, Sunderlin, Reynolds, & Kohl, 2000). Inconsistent findings have been reported for self-esteem (Brook et al., 1998, Grunbaum et al., 2000), depression (Grunbaum et al., 2000, McCuller et al., 2001, Sussman et al., 2000), and coping (Grunbaum et al., 2000, Sussman et al., 2000). These results may be attributed, in part, to the lack of a “gold standard” and to inconsistencies in the measurement of these constructs.
To date, no studies have examined both potential risk and protective factors for substance use in homeless youth. Given the high rates of substance use found in this population, and the increasing numbers of children and adolescents becoming homeless each year, it is critical that potential predictors of substance use in homeless youth are investigated.
In addition, the majority of the data on youth substance use has been collected using face-to-face or paper–pencil methods. These approaches may introduce biases via the interviewer or participant. Face-to-face interviews may be vulnerable to social desirability bias (Bloom, 1998); paper–pencil surveys may be complicated by literacy issues. Both methods may raise concerns about the lack of privacy for respondents, which, in turn, may lead to false reporting.
Recently, computer-based surveys have been used to attempt to reduce these types of errors. Audio-computer-assisted Self-interviewing (A-CASI) allows for the collection of sensitive information without the direct participation of an interviewer (Turner et al., 1998). Several studies (Macalino et al., 2002, Murphy et al., 2000) have used A-CASI to assess HIV-related risk behavior in adolescents and adults and have found higher rates of risk behaviors compared with those using face-to-face interviews. While conclusive evidence of increased accuracy of reporting with A-CASI has not yet been demonstrated, its potential for reducing possible biases merits further investigation. To date, no studies have used A-CASI in any homeless youth population. The purpose of the present study is to investigate potential risk and protective factors of substance use in homeless youth, using data collected with A-CASI technology. Learning theories were used as the theoretical bases for inclusion of the potential predictors examined.
Section snippets
Design
This study was part of a larger investigation designed to evaluate four youth drop-in centers in Southern California. These centers offered a variety of training/support services, referrals to schools and health/social services, recreational activities, and, in addition, focused on HIV risk reduction. The San Diego State University Institutional Review Board approved all measures and procedures for this study. A Federal Certificate of Confidentiality (No. MH-00-177) was obtained to protect the
Frequency of substance use
The frequencies of lifetime and 3-month drug use are presented in Table 1. Almost 96% (95.6%) of the sample reported use of at least one drug in their lifetime (80.5% excluding tobacco and alcohol). Over three quarters (75.2%) of the youth reported the use of three or more drugs, and 31.0% reported the use of five or more drugs in their lifetime. The mean number of lifetime drugs used was 3.55 (S.D.=1.64). The most commonly reported drugs ever used were alcohol (89.4%), tobacco (85.8%), and
Discussion
The purpose of this study was to examine potential psychosocial determinants of substance use in homeless adolescents. Determinants were based on learning theories, with emphasis on adolescent high-risk behavior. This study was part of a larger evaluation designed to evaluate drop-in centers. This delimited the resources available for examining potential predictors of substance use. Thus, this analysis is a conservative test of learning theory-based predictors. Nonetheless, our results help
References (29)
- et al.
Pathways to marijuana use among adolescents: Cultural/ecological, family, peer, and personality influences
Journal of the American Academy of Child and Adolescent Psychiatry
(1998) - et al.
Identifying adolescents at risk for hard drug use: Racial/ethnic variations
Journal of Adolescent Health
(1999) - et al.
Cultural, social, and intrapersonal factors associated with substance use among alternative high school students
Addictive Behaviors
(2000) - et al.
Substance use among youth seen at a community-based health clinic
Journal of Adolescent Health
(1993) - et al.
Homeless and runaway youths' access to health care
Journal of Adolescent Health
(2000) - et al.
Perceived parental monitoring and health risk behaviors among urban low-income African-American children and adolescents
Journal of Adolescent Health
(2000) - et al.
Concurrent prediction of drug use among high-risk youth
Addictive Behaviors
(2001) - et al.
The one-year prospective prediction of substance abuse and dependence among high-risk adolescents
Journal of Substance Abuse
(2000) Individual risk factors for adolescents substance use
Drug and Alcohol Dependence
(1999)Technology, experimentation, and the quality of survey data
Science
(1998)
Physical training as a substance abuse prevention intervention for youth
Journal of Drug Education
Social network characteristics associated with risky behaviors among runaway and homeless youth
Journal of Health and Social Behavior
Cited by (77)
“I just needed someone to believe in me.” A qualitative analysis of youths’ experiencing homelessness perspectives of a housing first intervention
2022, Children and Youth Services ReviewCitation Excerpt :Lastly, it is interesting that multiple youth reported changes in their social network as a result of receiving housing. Youth experiencing homelessness often form strong bonds with peers, which can support youth resilience or reinforce unhealthy behaviors if their peers are engaged in deviant activities (Bender et al., 2007; Bousman et al., 2005; DiGuiseppi et al., 2020; Rew & Horner, 2003). Three participants in this study reported shedding negative social connections once they were housed and two participants reported increases in positive friendships.
Exploring the relationship between foster care experiences and social network engagement among a sample of homeless former foster youth
2020, Children and Youth Services ReviewCitation Excerpt :This homelessness is a risk factor for a variety of negative outcomes, but rates of drug use are particularly high for homeless youth, correlating to use at an early age, polysubstance use, use within the last 30 days, and likelihood of lifetime use. Homelessness also serves as a risk factor for the presence of a substance abuse disorder (Bousman et al., 2005; Greene, Ennett, & Ringwalt, 1997; Kipke et al., 1997; Salomonson-Sautel et al., 2008). Moreover, drug use among homeless youth carries more risks than just the associated poor health outcomes, such as sexual risk-taking, particularly where combined heroin/stimulant users are concerned (Gleghorn, Marx, Vittinghoff, & Katz, 1998).
Smoking cessation methods among homeless youth in a Midwestern city
2020, Addictive Behaviors ReportsRisk and protective factors for substance use among youth experiencing homelessness
2019, Children and Youth Services ReviewPatterns of alternative tobacco product use among youth experiencing homelessness
2019, Addictive BehaviorsCitation Excerpt :Tobacco use is a widespread health problem among youth experiencing homelessness (Shadel, Tucker, & Golinelli, 2015), and one that is particularly concerning given their already vulnerable health status and challenges in seeking health-related care (Hudson, Nyamathi, Greengold, et al., 2010; Pedersen, Tucker, Klein, et al., 2018). Studies of homeless young people have found that 70% or greater report past month cigarette use (Baer, Ginzler, & Peterson, 2003; Bousman, Blumberg, Shillington, et al., 2005; Wenzel, Tucker, Golinelli, et al., 2010), compared to about 22% of 18–25 year olds in the general U.S. population (Substance Abuse and Mental Health Services Administration, 2018). In addition, rates of alternative tobacco product (ATP) use are substantially higher than among non-homeless young people (which tend to fall under 12% across ATPs (Jamal, Gentzke, Hu, et al., 2017)).
- ☆
This research was supported, in part, by grant PE00-SDSU-153 awarded to Dr. Shillington and by grants IS99-SDSUF-206 and IS02-CBECH-711 awarded to Dr. Hovell from the Universitywide AIDS Research Program, University of California.