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      Prevalence and Correlates of Youth Homelessness in the United States

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          Abstract

          Purpose

          Unaccompanied youth homelessness is a serious concern. Response, however, has been constrained by the absence of credible data on the size and characteristics of the population and reliable means to track youth homelessness over time. We sought to address these gaps.

          Methods

          Using a nationally representative phone-based survey (N = 26,161), we solicited household and individual reports on different types of youth homelessness. We collected household reports on adolescents aged 13–17 and young adults aged 18–25, as well as self-reports from young adults aged 18–25. Follow-up interviews with a subsample (n = 150) provided additional information on youth experiences and enabled adjustment for inclusion errors.

          Results

          Over a 12-month period, approximately 3.0% of households with 13- to 17-year-olds reported explicit youth homelessness (including running away or being asked to leave) and 1.3% reported experiences that solely involved couch surfing, resulting in an overall 4.3% household prevalence of any homelessness, broadly defined. For 18- to 25-year-olds, household prevalence estimates were 5.9% for explicitly reported homelessness, 6.6% for couch surfing only, and 12.5% overall. The 12-month population prevalence estimates, available only for 18- to 25-year-olds, were 5.2%, 4.5%, and 9.7%, respectively. Incidence rates were about half as high as prevalence rates. Prevalence rates were similar across rural and nonrural counties. Higher risk of homelessness was observed among young parents; black, Hispanic, and lesbian, gay, bisexual, or transgender (LGBT) youth; and those who did not complete high school.

          Conclusions

          The prevalence and incidence of youth homelessness reveal a significant need for prevention and youth-centric systems and services, as well as strategies to address disproportionate risks of certain subpopulations.

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          Most cited references32

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          Housing instability and food insecurity as barriers to health care among low-income Americans.

          Homelessness and hunger are associated with poor health outcomes. Housing instability and food insecurity describe less severe problems securing housing and food. To determine the association between housing instability and food insecurity and access to ambulatory health care and rates of acute health care utilization. Secondary data analysis of the National Survey of American Families. 16,651 low-income adults. Self-reported measures of past-year access: (1) not having a usual source of care, (2) postponing needed medical care, or (3) postponing medication; and past-year utilization: (1) not having an ambulatory care visit, (2) having emergency department (ED) visits, or (3) inpatient hospitalization. 23.6% of subjects had housing instability and 42.7% had food insecurity. In multivariate logistic regression models, housing instability was independently associated with not having a usual source of care (adjusted odds ratio [AOR] 1.31, 95% confidence interval [CI] 1.08 to 1.59), postponing needed medical care (AOR 1.84, 95% CI 1.46 to 2.31) and postponing medications (AOR 2.16, 95% CI 1.70 to 2.74), increased ED use (AOR: 1.43, 95% CI 1.20 to 1.70), and hospitalizations (AOR 1.30, 95% CI 1.01 to 1.67). Food insecurity was independently associated with postponing needed medical care (AOR 1.74, 95% CI 1.38 to 2.21) and postponing medications (AOR 2.15, 95% CI 1.62 to 2.85), increased ED use (AOR 1.39, 95% CI 1.17 to 1.66), and hospitalizations (AOR 1.42, 95% CI 1.09 to 1.85). Housing instability and food insecurity are associated with poor access to ambulatory care and high rates of acute care. These competing life demands may lead to delays in seeking care and predispose to acute care.
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            Making sense of odds and odds ratios.

            Odds and odds ratios are hard for many clinicians to understand. Odds are the probability of an event occurring divided by the probability of the event not occurring. An odds ratio is the odds of the event in one group, for example, those exposed to a drug, divided by the odds in another group not exposed. Odds ratios always exaggerate the true relative risk to some degree. When the probability of the disease is low (for example, less than 10%), the odds ratio approximates the true relative risk. As the event becomes more common, the exaggeration grows, and the odds ratio no longer is a useful proxy for the relative risk. Although the odds ratio is always a valid measure of association, it is not always a good substitute for the relative risk. Because of the difficulty in understanding odds ratios, their use should probably be limited to case-control studies and logistic regression, for which odds ratios are the proper measures of association.
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              Substance use among runaway and homeless youth in three national samples.

              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. 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. 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. 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.

                Author and article information

                Journal
                9102136
                1030
                J Adolesc Health
                J Adolesc Health
                The Journal of adolescent health : official publication of the Society for Adolescent Medicine
                1054-139X
                1879-1972
                17 February 2018
                15 November 2017
                January 2018
                26 February 2018
                : 62
                : 1
                : 14-21
                Affiliations
                [a ]Chapin Hall at the University of Chicago, Chicago, Illinois
                [b ]Division of Violence Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
                [c ]School of Social Services Administration, University of Chicago, Chicago, Illinois
                [d ]Department of Biostatistics, Vanderbilt University School of Medicine, Nashville, Tennessee
                [e ]Department of Social Welfare, University of California, Berkeley, California
                Author notes
                [* ]Address correspondence to: Matthew Morton, Ph.D., Chapin Hall at the University of Chicago, 1313 E 60th Street, Chicago, IL 60637. mmorton@ 123456chapinhall.org (M. Morton)
                Article
                HHSPA943908
                10.1016/j.jadohealth.2017.10.006
                5826721
                29153445
                af5152b7-20d7-4b1d-b045-c310d2bd3b8a

                This is an open access article under the CC BY-NC-ND license ( http://creativecommons.org/licenses/by-nc-nd/4.0/).

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                Article

                Health & Social care
                unaccompanied,runaway,housing instability,housing insecurity,adolescence,at-risk youth,couch surfing,doubled up

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