Shelter-based homeless youth. Health and access to care
J. Ensign and J. Santelli
Department of International Health, Johns Hopkins School of Hygiene and Public Health, Baltimore, Md, USA. bjensign@u.washington.edu
OBJECTIVES: To compare the self-reported risk-taking behaviors, health
status, and access to care issues of 2 samples of shelter-based homeless
youth who had previously been street youth (youth on streets or doubling-up
with friends or lovers) and systems youth (youth involved in foster care)
and to examine information on the etiology of homelessness, including
parent or family of origin risk factors for both samples. DESIGN: The study
population consisted of 109 shelter-based homeless youth: 41 street youth
and 68 systems youth. A chart audit was completed on all youth, noting
documentation of past health problems, reasons for shelter placement, and
parental risk factors. Adolescents from both samples completed a health
history questionnaire followed by a physical examination. Differences
between the 2 samples for behaviors and disease diagnoses were examined
using chi 2 and 2-tailed t tests. RESULTS: The street youth exhibited
greater risk-taking behaviors and suffered from poorer health status and
access to care than did systems youth. The main differences were in
substance using and high-risk sexual behaviors. The street youth were more
likely to report previous exposure to violence and having been victims of
forced sex. Self-reported risk behaviors, including sexual activity and
substance abuse were corroborated by more objective information on these
items from medical record information. The street youth were more likely to
be medically uninsured, to have used an emergency department in the past
year, and to have used an emergency department for their last care.
CONCLUSIONS: There are important variations in health needs between samples
of homeless youth, often overlooked in health planning for this population.
Knowledge of parent or family of origin risk factors and causes of
homelessness provides important contextual information for understanding
the risk behaviors and health states of homeless youth.
