Knowledge,Attitudes, and Substance Use Practices Among Street Children in Western Kenya

The study describes the knowledge of and attitudes toward substance use among street-involved youth in Kenya, and how they relate to their substance use practices. In 2011, 146 children and youth ages 10–19 years, classified as either children on the street or children of the street were recruited to participate in a cross-sectional survey in Eldoret, Kenya. Bivariate analysis using χ² or Fisher's Exact Test was used to test the associations between variables, and multiple logistic regression analysis was used to identify independent covariates associated with lifetime and current drug use. The study's limitations and source of funding are noted.     

Treatment outcome for street-living, homeless youth

Comprehensive intervention for homeless, street living youth that addresses substance use, social stability, physical and mental health issues has received very little attention. In this study, street living youth aged 14-22 were recruited from a drop-in center and randomly assigned to the Community Reinforcement Approach (CRA) or treatment as usual (TAU) through a drop-in center. Findings showed that youth assigned to CRA, compared to TAU, reported significantly reduced substance use (37% vs. 17% reduction), depression (40% vs. 23%) and increased social stability (58% vs. 13%). Youth in both conditions improved in many other behavioral domains including substance use, internalizing and externalizing problems, and emotion and task oriented coping. This study indicates that homeless youth can be engaged into treatment and respond favorably to intervention efforts. However, more treatment development research is needed to address the barriers associated with serving these youth.     

A community based study of patterns of psychoactive substance use among street children in a local government area of Nigeria

BACKGROUND: The nature of continuous exposure to the street and its associated lifestyles make street children vulnerable to the use of psychoactive substances. At present, there is insufficient information regarding the pattern of psychoactive substance use among this group of children in Nigeria. AIMS: To determine the pattern of psychoactive substance use among street children and to explore those socio-demographic and street factors that could be related to current psychoactive substance use. METHODS: Using a multistage sampling method in a local government area in Nigeria, 180 children aged 18 years and below who had left the custody of their parents for a period of not less than a month were interviewed. RESULTS: The most commonly used psychoactive substances were alcohol, kolanut, tobacco and cannabis. None of the respondents reported the use of cocaine, opiates or hallucinogens. Length of stay on the street was found to be significantly predictive of current psychoactive substance use. CONCLUSION: The readily available and relatively cheap substances were in common use among street children with the length of stay on the street being a significant predictive factor. The affected community and the government should design methods of curtailing the problem of drug use and helping the children off the street.     

Youth and Familial Substance Use's Association with Suicide Attempts among Runaway and Homeless Youth

This study examined how youth suicide attempts are associated with youth and familial substance use among two samples of runaway and homeless youth (RHY): (a) a nationally representative sample of RHY residing in shelters, and (b) a multicity, purposive sample of RHY found on the street. Data were collected using personal interviews from 640 shelter youth and 600 street youth in 1992. Logistic regression analyses revealed that, after controlling for key demographic characteristics, youth who had used substances (particularly sedatives, hallucinogens, and inhalants) were much more likely than those who had not used substances to have ever attempted suicide. In addition, after controlling for their own substance use, youth with family members who had used substances were twice as likely as those without such family members to have ever attempted suicide. This study suggests the importance of developing and focusing suicide prevention efforts on RHY known to have used (or are using) substances and to have substance-using family members.     

Sequential Progression of Substance Use Among Homeless Youth: An Empirical Investigation of the Gateway Theory

We examined the sequence of substance-use initiation in 375 street youth (age 13–21) who were interviewed from 1994–99 in Seattle, Washington. Based on the “gateway theory,” participants were categorized into six profiles to describe the order in which they initiated use of various substances (i.e., alcohol, marijuana, other drugs), or classified as nonprogressors if they had not tried all three classes of drugs. Youth progressing in the hypothesized gateway order (i.e., alcohol preceding marijuana, followed by other drugs) initiated their use at an earlier age than youth who had not progressed through all three substance classes. However, there was no relationship between a substance initiation profile and current substance-use. Implications include the recognition that street youth may follow different patterns of use than normative groups, and that interventions geared toward youth who use substances heavily must include contextual factors, in addition to substance-use history.     

Sequential progression of substance use among homeless youth: an empirical investigation of the gateway theory

We examined the sequence of substance-use initiation in 375 street youth (age 13-21) who were interviewed from 1994-99 in Seattle, Washington. Based on the "gateway theory," participants were categorized into six profiles to describe the order in which they initiated use of various substances (i.e., alcohol, marijuana, other drugs), or classified as nonprogressors if they had not tried all three classes of drugs. Youth progressing in the hypothesized gateway order (i.e., alcohol preceding marijuana, followed by other drugs) initiated their use at an earlier age than youth who had not progressed through all three substance classes. However, there was no relationship between a substance initiation profile and current substance-use. Implications include the recognition that street youth may follow different patterns of use than normative groups, and that interventions geared toward youth who use substances heavily must include contextual factors, in addition to substance-use history.     

Nontobacco Substance Use,Sexual Abuse,HIV, and Sexually Transmitted Infection Among Street Children in Kolkata,India

A community-based cross-sectional study among 554 Kolkata city street children assessed nontobacco substance use and sexual abuses along with human immunodeficiency virus (HIV)/ sexually transmitted infections (STIs) during 2007, using conventional cluster sampling technique for “hard-to-reach population” with a field-tested questionnaire and the collection of a blood sample for HIV and syphilis serology testing as a composite indicator of STIs. The reported prevalence of nontobacco substance use was 30%; 9% reported having been sexually abused. Some factors (age, lack of contact with family, orphan children, night stay at public place, etc.) were documented to be associated with substance use and sexual abuses. Seroprevalence of HIV was found to be 1% and that of STIs was 4%. This 1% HIV seroprevalence in street children is a matter of concern. Community-based intervention is necessary for them. The study's limitations are noted.     

Transition to injection drug use among street youth--a qualitative analysis

OBJECTIVES: To examine social contexts and processes influencing transition to drug injection among street youth. METHODS: 42 street youth participated in in-depth interviews. A typology of experiences was built founded on youth's street life and drug use trajectories. The transition to drug injection was examined through these experiences. RESULTS: We identified five types of mutually exclusive experiences. The "downtowner's" experience is characterised by early street life and drug consumption trajectories, and a strong identification with the downtown milieu. These youth progress from one drug to another and, in a milieu where drug injection is omnipresent, this escalation culminates in transition to injection. The "tripper" street life and substance use trajectories begin later and are less intense. Most "tripper" youth are already chronic hallucinogens users when they arrive in downtown Montréal. Although they judge "junkies" severely, they show some ambivalence towards injection. The "on the go" experience is characterised by trajectories of drug use and street life that are intermingled, leading to a loss of control. These youth, who often have serious delinquent behaviours, come to downtown Montréal to party and consume drugs, mostly stimulants. Their drug use pattern and network make them at high risk of starting cocaine injection. The "hard-luck's" experience is characterised by a lack of identification with the downtown milieu. These youth who use drugs recreationally, end up in the streets accidentally, often because of unemployment. The "alcoholic' experience is related to alcohol misuse. These youth usually end up in the streets due to this dependence. Their street involvement is mostly an experience of solitude. The risk of transitioning to injection for both these types is low. CONCLUSIONS: Some combinations of street life and drug use trajectories seem to contribute to injection among street youth. Some important factors interact and increase the risk of street youth transitioning to injection: poor personal assets; early rupture with primary social institutions; social integration into subcultures where both street life and "drug trips" are fashionable, drug preferences and the local drug market.     

Children in the Streets of Brazil: Drug Use,Crime, Violence,and HIV Risks

The presence of vast numbers of unsupervised and unprotected children is a phenomenon that is common throughout Latin America, and in few places are the street children more visible, and reviled, than in Brazil. Estimates of their numbers in Brazil have ranged from 7 to 17 million, but more informed assessments suggest that between 7 and 8 million children, ages 5 to 18, live and/or work on the streets of urban Brazil. Accounts of drug misuse among street youths in Brazil are commonplace. Numerous scientific studies and media stories have reported the widespread use of inhalants, marijuana and cocaine, and Valium among street children. Also common is the use of coca paste and Rohypnol. Risk of exposure to HIV is rapidly becoming an area of concern because of the large number of street youths engaging in unprotected sexual acts, both renumerated and nonrenumerated. Moreover, Brazil's street children are targets of fear. Because of their drug use, predatory crimes, and general unacceptability on urban thoroughfares, they are frequently the targets of local vigilante groups, drug gangs, and police “death squads.” Although there have been many proposals and programs for addressing the problems of Brazilian street youth, it would appear that only minimal headway has been achieved. [Translations are provided in the International Abstracts Section of this issue.]     

Child Maltreatment,Relationship With Father,Peer Substance Use,and Adolescent Marijuana Use

Abstract

This longitudinal prospective study examined the relationship between child maltreatment as per reports to child protective services (CPS) and adolescent self-reported marijuana use, and the association between relationships with mothers and fathers and use of marijuana. The association between relationships with parents early in childhood (ages 6 to 8?years) and during adolescence with adolescent marijuana use were also probed. Another aim examined whether relationships with parents moderated the link between child maltreatment and youth marijuana use. The sample included 702 high-risk adolescents from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a consortium of five studies related to maltreatment. Children were recruited at age 4 or 6?years together with their primary caregiver. Some were recruited due to their risk for child maltreatment, others were already involved with CPS, and children in one site had been placed in foster care. Logistic regression analysis was performed using youth self-report of marijuana use as the criterion variable and child maltreatment and the relationships with parents as predictor variables, controlling for youths’ perceptions of peer substance use and parental monitoring, parental substance use, race/ethnicity, sex, and study site. Approximately half the youths had used marijuana. Most of them described quite positive relationships with their mothers and fathers. Participant marijuana use was associated with a poorer quality of relationship with mother during adolescence, and with peer and parental substance use. A better relationship with father, but not mother, during adolescence attenuated the connection between child maltreatment and youth marijuana use.     

Volatile substance misuse among street children in Upper Egypt

This work assessed the extent, patterns, attitudes, motivations, and impacts of volatile substance misuse (VSM) among street children in Upper Egypt. In 2009, a 36-item questionnaire was administered to a randomly selected sample of 120 street children aged 10-18 years. Nearly 91% (n = 109) reported misusing products containing volatile substances because they are inexpensive, legal, and easy to acquire. Familial neglect and lack of supervision were the main social motivations reported by street youth for misusing volatile substances. One-third (34.2%, n = 41) reported inhaling "Kolla," a commercial glue; this study identifies its physicochemical, neuropharmacological, and toxicological properties. The study's limitations are noted.     

Family composition, socioeconomic status, and adolescent substance use

The hypothesis that deprivation in the form of parental absence and economic hardship causes youth substance use was tested in a study population consisting of two hundred sixty-two adolescents, ages 13 through 17, and one parent of each. No correlation between family composition and youth substance use was found. Two measures of socioeconomic status, family income and parents' subject rating, also revealed no correlation with youths' substance use behavior. However, when father's occupation was used to evaluate this relationship, significantly more abstainers were shown to have fathers who are professionals, and significantly more users had fathers occupying managerial or foreman-level positions; a possible explanation for this result is that occupation may somehow be related to parental style. The common sense assumption that parental absence and economic hardship are directly responsible for youth substance use is unsupported by our data.     

The International Catholic Child Bureau and drug abuse: contributions to drug abuse prevention by a non-governmental organization concerned with children

The present article is an attempt to demonstrate that a broad-based approach to matters directly affecting children, with special emphasis on meeting their non-material and spiritual needs, can effectively contribute to drug abuse prevention, in particular, by promoting personal values that encourage constructive use of goods and time. The International Catholic Child Bureau (ICCB) has adopted its approach to drug abuse prevention, particularly in respect of "street children", and, through its vast network of experts and practitioners familiar with intercultural and interdenominational education, has implemented a number of projects in Africa, Europe and Latin America, primarily involving the use of therapeutic communities, workshops and "street educators". The religious dimension of the work of ICCB is particularly important because it highlights a fundamental aspect for youth of all cultures, i.e. integrated preparation for life as responsible members of the community. ICCB is of the view that it is imperative to provide children with possibilities for a life that is free of substance dependence, once they are able to make the right decisions.     

A national study of risk and protective factors for substance use among youth in the child welfare system

While child welfare services are intended, in part, to diminish maltreatment's negative impact on adolescents' development, there is evidence that receiving child welfare services affects adolescents' substance use adversely. The literature on the extent and correlates of this problem is still emerging. The present study aims to fill part of this gap by examining the association between baseline psychosocial risk and protective factors on engagement in substance use behavior over a period of 36 months for child welfare involved youth. It further compares substance use behavior between youth placed in out-of-home care and those who remained with their biological families. Data come from the National Survey of Child and Adolescent Well-Being (NSCAW), a national probability study of children and adolescents undergoing investigation for abuse or neglect. The sample for this analysis was restricted to 827 youth who were 11 years or older at baseline data collection. Key findings include a high rate of social substance use (47.7%) and illicit substance use (17.4%). There was a limited role of protective factors in mitigating risk behavior for social substance use (caregiver connectedness; OR=0.51, p<0.05). Avoiding foster care placement was a protective factor for illicit substance use (OR=0.43, p<0.05). Delinquency was a risk factor associated with both social substance use (OR=1.06, p<0.01) and hard substance use (OR=1.10, p<0.001). Given the high prevalence of substance use among child welfare involved youth, prevention efforts for this population require a better understanding of biological, psychological, and social protective factors. The child welfare system is an untapped resource that has the potential to be a gateway to and a platform for substance abuse prevention services that should be incorporated into child welfare safety and permanency interventions.     

Patterns of substance use onset among Hispanics in Puerto Rico and the United States

PURPOSE: Examine patterns of progression in substance use among Hispanic youth 13 to 17 years of age from two longitudinally representative studies. METHOD: Patterns of substance use among youth in Puerto Rico were examined using a longitudinal study (n=663) of adolescents living on the island. The National Longitudinal Study of Youth was used to examine patterns of substance use among Hispanics living in the United States (n=1,445). Latent transition analysis was used to estimate the probability of membership in each stage of substance use and incidence of transitions between different substance use stages over time. RESULTS: Six stages best described the heterogeneity in substance use among youth in Puerto Rico. Five stages were sufficient to describe patterns of substance use among youth in the United States. Youth living in Puerto Rico reported lower rates of smoking and illicit drug use, but higher rates of alcohol use, when compared with rates among Hispanics in the United States. DISCUSSION: Similar patterns of substance use were identified for Hispanic youth living in the United States and youth living in Puerto Rico.     

Epidemiology of substance use in adolescence: prevalence, trends and policy implications.

This paper reviews the epidemiology of substance use among adolescents. There is a public health imperative in all countries to assess the population rates of tobacco, alcohol and illicit drug use among adolescents. In addition, monitoring trends over time may reflect the net effects of activities and programs carried out to prevent adolescent substance use. School based surveys provide prevalence estimates of substance use, but do not capture street and homeless youth and other high risk adolescents not found in the school environment. Overall, the results of this review suggest that tobacco, hazardous alcohol use, and most categories of illicit drug use have shown consistent increases in prevalence since about 1990 in most developed countries, for school-based adolescents, suggesting that the substance use problem among adolescents remains unsolved. These trends are remarkably similar across substance use behaviours, and among most developed countries, although limited data has emanated from adolescents in the developing world. Interventions to reduce or prevent substance use have shown mixed results, with those focusing on the adolescents' social environment showing the most promise. Broader public health approaches, including the linkage to community-wide prevention, and greater enforcement or regulatory and legislative approaches to tobacco and alcohol access are future directions for research and practice.     

The substance use profile of Canadian youth: exploring the prevalence of alcohol, drug and tobacco use by gender and grade

The current study examined the prevalence of alcohol, tobacco and drug use and comorbid use of these substances among 45,425 students in grades 7 to 12 as part of the 2008-09 Canadian Youth Smoking Survey. The results of this paper suggest that alcohol, tobacco, marijuana and illicit drugs are currently used by a substantial number of youth in Canada, and that comorbid use is also very widespread among users. Alcohol was the most prevalent substance used by youth and it was rare to find youth who had used tobacco or drugs without also currently using alcohol. By grade 12, the majority of students were current users of alcohol, tobacco or drugs. Future research should consider developing a better understanding of how to prevent substance use among this population.     

Paternal, perceived maternal, and youth risk factors as predictors of youth stage of substance use a longitudinal study

This longitudinal study examined paternal, perceived maternal, and youth risk factors at Time 1 (T1) (e.g., substance use, violent victimization, parental rules) as predictors of the stage of substance use in the adolescent child at Time 2 (T2). Participants (N = 296) consisted of drug-abusing fathers and one of their adolescent children, aged 12 to 20 years. Fathers and youths were each administered structured interviews separately and in private. Adolescents were re-interviewed approximately one year later. Pearson correlation analyses showed that the paternal, perceived maternal, and youth risk factors were significantly related to adolescent stage of substance use at T2. With an increase in risk factors, there was an increase in T2 stage of substance use in the child. Findings imply that father-oriented treatment programs should focus on how paternal behaviors, such as illegal drug use, inadequate parenting skills, and a poor father-child relationship contribute to youth problem behaviors, including alcohol, tobacco, and illicit drug use.