A health-profile comparison of delinquent and homeless youths

Can Better Emotion Regulation Protect Against Interpersonal Violence in Homeless Youth Social Networks?

Homeless youth experience all types of violence at higher rates than their housed counterparts. This is typically the result of many contributing factors including childhood experiences of trauma, subsistence survival strategies, and exposure to perpetrators while living on the streets. Reducing violence in the lives of homeless youth is imperative and can contribute to a young person's ability to safely and successfully exit the streets and lead a long and productive life in society. However, developing public health and social interventions to reduce violence in adolescent and young adult populations is difficult due to the complex interplay of extrinsic and intrinsic drivers of this phenomenon. Los Angeles area homeless youth (N = 366) were asked questions regarding recent violence experiences, emotion regulation, and their social network. Multivariable logistic regressions tested the overall effect of emotion regulation on violence, controlling for age, gender, race, sexual identity, experience of childhood abuse, and data collection site. In this sample, 56% of youth endorsed fighting in the previous year, and those who reported more difficulties with emotion regulation were significantly more likely to fight. In addition, youth who scored below the mean on difficulties with regulation and belonged to networks characterized by low-difficulty peers were 60% less likely to report fighting. Emotion regulation skills represent a malleable target for intervention that may contribute to reduced propensity for violence in this population. Implications for network-based interventions to improve individual emotion regulation and reduce overall violence among homeless youth and other at-risk populations are discussed.

Violence in the Social Networks of Homeless Youths

This study examined social network processes related to interpersonal violence using a sample of 360 homeless youths from Los Angeles. Results indicated that violence is pervasive among homeless youths. Consistent with previous findings, hard drug use and childhood maltreatment experiences were closely related to violence experiences. Social network analyses revealed that having a higher proportion of violence-engaged peers in a youth’s network is associated with increased risk of personal violent behavior as well as having a high k-core number within the larger overall homeless youth network. The findings have important implications for the development of violence prevention programs for homeless youths, particularly the potential for network-based programs.

Psychiatric and medical health care policies in juvenile detention facilities

OBJECTIVES

Many adolescents admitted to detention facilities have serious mental and physical health problems. Little is known about policies for the delivery of mental and physical health care in these settings. Our objective was to describe current health care policies in U.S. detention facilities.

METHOD

Telephone interviews were requested from 83 juvenile detention facility administrators across the United States.

RESULTS

The response rate was 97.6%. Data were collected over 12 months, from 2003-2004. Policies for admission health screening existed in 99% of facilities; 90% included mental health screening. Most sites had policies about psychopharmacotherapy and 92% had crisis services. Continuation of existing psychotropic medication treatment was provided at 96% of facilities. Seventy-three percent of facilities used physicians to manage medications in-house; in 61% of the centers, these physicians were psychiatrists. Medication administration policies most often specified nurses, but 16% of facilities used guards. Provisions for discharge psychotropic medication existed at 84% of sites, but there was wide variation in dispensing policies.

CONCLUSIONS

Detention health care policies for adolescents have significant gaps, particularly for mental health care. Future research should include an epidemiological study of detained youths, evaluating their health needs and the actual care received.

Female conduct disorder: health status in young adulthood

PURPOSE

One of the risk factors for poor adult health may be adolescent antisocial behavior, especially in girls. This study was conducted to determine if negative young adult health outcomes in girls who previously had adolescent antisocial behavior could be explained by demographic factors and pre-existing health problems.

METHODS

This 3-year longitudinal study recruited 93 girls, ages 15-17 years (52 with conduct disorder [CD]; 41 with no psychiatric illness [normal controls; NC]) from the community. Baseline interviews of girls and parents collected demographic, psychiatric, and medical history data. Three annual interviews collected data about medical problems, health care service utilization, and reproductive health. In addition, the final follow-up included a standardized self-report questionnaire about young adult health status.

RESULTS

CD and NC groups did not differ in age, racial composition, social class, proportion of smokers, or drug and alcohol experimentation. They were qualitatively different in baseline medical histories. Controlling for age at follow-up and baseline medical problems, the CD group as young adults had worse overall health, more discomfort, higher rates of unhealthy habits, lower rates of healthy behaviors, and more pregnancies at earlier ages. There were no group differences in rates of disorders, injuries, or health care usage.

CONCLUSIONS

Adolescent girls with CD as young adults have poorer overall health, more discomfort, more health risk behaviors, and earlier onset of adult reproductive behaviors, even when controlling for demographic factors and pre-existing health history. Clinical and research implications are discussed.

Women with antisocial behaviour: long-term health disability and help-seeking for emotional problems

BACKGROUND

Previous studies have reported that women who display antisocial behaviour (ASB) as adults or adolescents are at increased risk of poor mental and physical health, but have not tested effects of sociodemographics, or used only incarcerated samples.

AIMS

The authors sought first to test associations between ASB and emotional or physical health problems in non-incarcerated women, and second whether any such association could be explained by sociodemographic factors.

METHOD

The sample was 1218 mothers, aged 22-59, of boys randomly selected from grades 1, 4 and 7 (aged about 7, 10 and 13 respectively) in US urban public schools in 1987 and 1988. The 30% of boys designated most antisocial on initial examination and a 30% random sample of the remainder entered the longitudinal study. Demographics for the mothers, data on their lifetime ASB, help-seeking for emotional and/or physical health problems were collected at interview with them. A history of adolescent conduct problems and/or lifetime police contacts led to classification as antisocial for this study.

RESULTS

A total of 214 (17.6 %) of the mothers met our criteria for ASB. Compared with the women without such history, the women with ASB were younger, less well educated, of lower socioeconomic status, had a higher rate of unemployment and more of them were single mothers. They more often sought help for emotional problems and reported higher rates of long-term physical health problems, even when the effects of sociodemographic factors were taken into account.

CONCLUSIONS

Although the findings rule out many sociodemographic factors as simple explanations for the association between ASB and poor emotional and physical health, more work is needed on the nature and extent of such disorder, and of temporal relationships between the key events: poor health and ASB.

Predictors of initiation into prostitution among female street youths

Prostitution among female street youths represents an important risk factor for several health problems. Little is known about the incidence and determinants of prostitution in this vulnerable population, and no data have been previously reported based on a longitudinal follow-up study. The objective of this study was to determine predictors of initiation into prostitution among female street youths. Female youths aged 14 to 25 years were enrolled in the Montreal Street Youth Cohort. They completed a baseline and at least one follow-up questionnaire between January 1995 and March 2000. Girls who reported never having engaged in prostitution at baseline were followed prospectively to estimate the incidence and predictors of prostitution. Of the 330 female street youths enrolled as of September 2000 in the cohort, 148 reported no history of involvement in prostitution at baseline and completed at least one follow-up questionnaire. Of these 148 girls, 33 became involved in prostitution over the course of the study (mean follow-up 2.4 years), resulting in an incidence rate of 11.1/100 person-years. Multivariate Cox regression analysis revealed having a female sex partner (adjusted hazard ratio [AHR] 3.8; 95% confidence interval [CI] 1.6-9.1) was an independent predictor of initiation into prostitution after controlling for having been on the street at age 15 years or younger (AHR 1.8, 95% CI 0.9-3.8), using acid or phencyclidine (PCP; AHR 2.0, 95% CI 0.9-4.6), using heroin (AHR 1.9, 95% CI 0.7-5.5), the use of drugs greater than twice per week (AHR 1.9, 95% CI 0.9-4.2), and injection drug use (AHR 0.8, 95% CI 0.3-2.4). The incidence of prostitution in female street youths was elevated. Having a female sex partner was a strong predictor of initiating involvement in prostitution.

Personal strengths of homeless adolescents living in a high-risk environment

Health-risk behaviors and associated adverse health outcomes in homeless adolescents are well documented. Strengths of these youth that contribute to their health and well-being are seldom acknowledged. The purpose of this secondary analysis of qualitative data was to identify strengths that protect homeless youth. Two types of strengths emerged: resources and self-improvement. Resources served as the foundation for survival whereas self-improvement served as a process that enabled youth to consider a more healthy future. By recognizing the many strengths of homeless youth, nurses may develop community-based programs to help this population reenter society.

HIV risk profile and prostitution among female street youths

The objective of this study was to compare human immunodeficiency virus (HIV) risk factors among female street youths involved in prostitution and those with no history of prostitution. Youths aged 14 to 25 years were recruited into the Montreal Street Youth Cohort. Semiannually, youths completed an interviewer-administered questionnaire. Statistical analyses comparing characteristics and HIV risk factors for girls involved in prostitution and those never involved were carried out using parametric and nonparametric methods. Of the girls, 88 (27%) reported involvement in prostitution, and 177 girls reported no history of prostitution at the baseline interview. Girls involved in prostitution were two times and five times more likely to have reported bingeing on alcohol and on drugs, respectively. A history of injection drug use was four times more likely to have been reported by girls involved in prostitution. Further, these girls were 2.5 times more likely to have reported injected cocaine as their drug of choice. Girls involved in prostitution were younger the first time they had consensual sex and were twice as likely to have reported anal sex. Consistent condom use for anal, vaginal, and oral sex was low for all girls. Girls involved in prostitution reported more risky sexual partners. In conclusion, girls involved in prostitution may be at increased risk of HIV infection due to their injection drug use and risky sexual behaviors. Unique intervention strategies are necessary for reducing HIV infection among female street youths involved in prostitution.

Embracing street culture: fitting health care into the lives of street youth

The purpose of this article is to describe a unique model for the provision of comprehensive primary health care for homeless youth in Seattle, Washington. Through the description of our program, we argue for the use of youth-centric instead of youth-friendly programs. This means a change from using the friendly health program as the central focus to having the young people be the starting point and adapting the health service to meet their needs. We describe how our model of care optimizes chances for homeless youth to establish positive connections with caring adults. We also show how homeless youth have their own street culture, which is of primary importance to them and which has a powerful impact on how they use and view health care.