STASH, Vol 4(8) – Safe housing for homeless, drug injecting adolescents

Rates of substance use among homeless adolescents are high (e.g., Greene, Ennett, & Ringwalt, 1997). Some factors might exacerbate the likelihood that a homeless adolescent uses illicit substances.  This week’s STASH explores the relationship between injection drug use and the quality of housing that homeless adolescents are able to find (Rhule-Louie, Bowen, Baer, & Perterson, 2008).

Participants

• Participants were 285 homeless adolescents (average age 17.4) from Seattle, recruited from homeless agencies or from the street.  The sample was 72.8% Caucasian and 54.6% male.
• Homelessness: The participants had an unstable living arrangement (i.e., did not live with a family member or in a group home) for the past month and had no plan for a stable living environment for the next month.
  • The average length of time they lived away from home was 2.49 years.
• Substance use: During the past month, all participants used an
  illicit substance 4+ times or had 1+ binge drinking episode(s).
  • 36.1% of the sample used injection drug(s) during the past month

Measures
An in-person interview determined:

• Past month frequency and type of substance use, and
• Places they lived during the past month.

Method

• Authors rated the safety of the living arrangements (e.g., squatting or living on the street were both considered riskier than staying with a friend).
• The authors used chi square analyses to explore the relationship between their housing-related safety and their substance use.

Results

• A path analysis showed that teens who injected drugs lived in fewer places during the past month (standardized beta weight = -.146, p<.05).
• However, Table 1 shows that teens who injected drugs were more likely to live in riskier places and less likely to live in safer places than the rest of the sample.

Figure. Chi Square analysis of injection drug users’ living situations, as compared to the rest of the sample. Adapted from Rhule-Louie et al. (2008). Click image to enlarge.

Limitations

• Interview data was derived from participants’ self report.
• There was no independent confirmation of substance use habits.
• The sample is not nationally representative; results might not generalize to all homeless youth.
• Authors did not report basic proportions, so judging whether the results are clinically significant is difficult.

Conclusion
Injection drug users had more consistent living situations, but these situations were more risky, leaving them consistently unsafe.  There is an assumption that stability for teens, particularly homeless teens, is optimal, but the context of this stability is important. For example, obtaining and injecting drugs might be easier to do when consistently living in a car than a halfway house, with a friend, and/or some adult relative’s house.  Therefore, interventions should focus on maximizing safety, as well as stability.  Placing a teen in a safe, stable home could ultimately reduce drug use; similarly, drug treatment could provide a foundation for seeking safer housing.

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References

Greene, J. M., Ennett, S. T., & Ringwalt, C. L. (1997). Substance use among runaway and homeless youth in three national samples. American Journal of Public Health, 87, 229-235.

Rhule-Louie, D. M., Bowen, S., Baer, J. S., & Perterson, P. L. (2008). Substance use and health and safety among homeless youth. Journal of Child and Family Studies, 17, 306-319.