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Health and Access to Care

Jo Ensign, FNP, DrPH; John Santelli, MD, MPH

Arch Pediatr Adolesc Med. 1997;151(8):817-823.

Abstract
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 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.

Arch Pediatr Adolesc Med. 1997;151:817-823

Author Affiliations
From the Departments of International Health (Dr Ensign) and Maternal and Child Health (Dr Santelli), The Johns Hopkins School of Hygiene and Public Health, and the Baltimore City Department of Health (Dr Santelli), Baltimore, Md. Dr Ensign is now with the Department of Psychosocial and Community Health, University of Washington School of Nursing, Seattle.

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