Substance use among runaway and homeless youth in three national samples.

OBJECTIVES: 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. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.     

Adolescent suicide in New York City: plenty of room for new research

The act of adolescent suicide continues to threaten adolescent populations in New York City (NYC). Consistent positive correlations have been found between a plethora of risk factors present in NYC adolescent populations and suicidal ideations and behaviors. Psychiatric conditions that may contribute to the rate of adolescent suicide in NYC include depression, bipolar disorder, substance abuse and schizophrenia. Unique factors that have been found to contribute to increased rates of completed suicides in NYC include the phenomena of railway suicides and suicide tourism. Homelessness and income inequality in NYC have also been consistently correlated with increased suicidality; with one study finding suicide attempts reported by a significant percentage of new admissions to homeless shelters. Adolescent populations in NYC that have been identified as particularly vulnerable to suicidality include runaway youth, homosexual youth, victimized adolescents and adolescents with a recent history of posttraumatic stress disorder (PTSD). Longitudinal studies in NYC have found that physical and sexual abuse is highly predictive of adolescent suicidality, with variations by ethnic group. Currently, there is a disturbing lack of sufficient research on adolescent suicide in NYC, specifically regarding causal factors, the effects of television on suicide, comorbid suicidality and drug abuse, and cultural factors contributing to suicide. This dearth of literature may be related to the ethical problems inherent in suicide research, self reports and/or post mortem analyses.     

Runaway Youth Utilizing Crisis Shelter Services: Predictors of Presenting Problems

The evidence is clear that the problems of runaway youth are immense, varied, and persistent. Services must be designed to address these problems and the factors associated with them. This study investigated a sample (n=156) of runaway youths admitted to basic shelter services and evaluated the individual and family factors associated with various problem domains, including: family relationships, abuse, mental health, substance use, and educational difficulties. Findings demonstrated that family-oriented issues were the predominant predictors of youth problems. Results point to the need for developing and evaluating new approaches in solving problems of runaway youth that incorporate strengthening family relationships.     

Examining Risk Factors Associated With Family Reunification for Runaway Youth: Does Ethnicity Matter?

This study investigated the likelihood of family reunification across ethnic groups of 14,419 youth using runaway shelter services nationwide. Among White, African American, Hispanic, Native American, and Asian ethnic groups, youths who reported abuse or neglect by their parental figures or had parent(s) who were unemployed were less likely to reunify following a runaway episode. However, completing youth shelter services markedly increased the likelihood of reunification. Implications for cultural sensitivity in service delivery, particularly regarding family issues, are discussed.     

Assessment of abuse in runaway and homeless youth

Many youth are leaving abusive living situations and, as a result, becoming runaways and homeless. This paper presents the findings of a qualitative study that focuses on discovering how shelter staff actually assess youth for the possible problems of sexual, physical, and family substance abuse. Respondents included a counselor and a supervisor selected from each of four runaway/homeless shelters. The findings reveal that assessment does not follow a structured format or protocol, nor do the respondents rely on a checklist of warning signs or red flags. Rather, they watch for physical signs and atypical behavior that may be an indication of underlying problems. Although respondents seem aware of the importance of assessing sexual, physical, and substance abuse, they bring a wide range in levels of vigilance and skill to the assessment of each problem.     

Bridging the Gap Between Family-Focused Research and Substance Abuse Prevention Practice: Preface

This paper introduces the contributions of this special section on connecting family-focused substance abuse prevention research and practice. Other expert reviews and the meta-analyses discussed in this and the following papers have given us a good idea about what works in this area. They have specified a number of family-focused substance abuse prevention approaches and programs effective in decreasing substance abuse in youth. Unfortunately, some practitioners are still primarily implementing untested, ineffective programs. A number of recommendations are made by the authors of this special section to help improve the adoption of evidence-based family programs to prevent substance abuse by youth.     

A sample of homeless and runaway youth in New Jersey and their health status

In this study of homeless and runaway young people served by youth shelters in New Jersey mental health problems were predominant. They include anxiety, depression, suicide attempts, drug and alcohol abuse. The sample exhibited high levels of general behavioral problems and school and/or peer problems. One quarter of the sample had had trouble with the law. About two thirds of the sample were homeless rather than runaway. For a similar proportion of the sample this was a repeat experience and/or had lasted a week or more. Only one third were able to be reunited with their families after being served. The prognosis for these youth is poor without specific programs to protect them and their physical and mental health.     

Effectiveness of a universal drug abuse prevention approach for youth at high risk for substance use initiation

BACKGROUND: Universal school-based prevention programs for alcohol, tobacco, and other drug use are typically designed for all students within a particular school setting. However, it is unclear whether such broad-based programs are effective for youth at high risk for substance use initiation. METHOD: The effectiveness of a universal drug abuse preventive intervention was examined among youth from 29 inner-city middle schools participating in a randomized, controlled prevention trial. A subsample of youth (21% of full sample) was identified as being at high risk for substance use initiation based on exposure to substance-using peers and poor academic performance in school. The prevention program taught drug refusal skills, antidrug norms, personal self-management skills, and general social skills. RESULTS: Findings indicated that youth at high risk who received the program (n = 426) reported less smoking, drinking, inhalant use, and polydrug use at the one-year follow-up assessment compared to youth at high risk in the control condition that did not receive the intervention (n = 332). Results indicate that a universal drug abuse prevention program is effective for minority, economically disadvantaged, inner-city youth who are at higher than average risk for substance use initiation. CONCLUSIONS: Findings suggest that universal prevention programs can be effective for a range of youth along a continuum of risk.     

A Life Course Perspective on Depressive Symptoms in Mid-Pregnancy

Objective: To examine the prevalence of depressive symptoms in mid-pregnancy and their relation to life circumstances across the life course in a community-based sample. Methods: The Pregnancy Outcomes and Community Health (POUCH) Study enrolled women at 16–26 weeks' gestation from 52 clinics in five Michigan communities. At enrollment women completed a screening instrument for depressive symptoms (CES-D) and questions about life circumstances covering three “periods,” i.e. previous 6 months, adulthood, and childhood. Questions were grouped into sub-constructs (e.g., abuse, economic, substance use, loss, and legal) for each “period” and evaluated in relation to CES-D scores. Analyses included 1321 POUCH participants divided into three subgroups: teens; women ≥20 years insured by Medicaid (disadvantaged); and women ≥20 years not insured by Medicaid (advantaged). Results: A positive CES-D screen (≥16) was more common in teens (46%) and disadvantaged women (47%) than in advantaged women (23%). Recent problems (previous 6 months) with abuse, economics, and substance use in someone close were each associated with higher adjusted mean CES-D scores (2.3–7.5 increase) in the three subgroups of women. In life course analyses, abuse and substance use in teens, and abuse and economic problems in disadvantaged and advantaged women were strongly linked to higher adjusted mean CES-D scores when these problems occurred both in childhood and adulthood (range 2.2–7.1 increase), whereas the associations were more modest when problems were confined to childhood. Conclusions: Strategies for addressing the public health problem of depressive symptoms in mid-pregnancy will benefit from a life course perspective.     

Sexually Coercive Behavior in Male Youth: Population Survey of General and Specific Risk Factors

Little is known about risk/protective factors for sexually coercive behavior in general population youth. We used a Swedish school-based population survey of sexual attitudes and experiences (response rate 77%) and investigated literature-based variables across sexually coercive (SEX), non-sexual conduct problem (CP), and normal control (NC) participants to identify general and specific risk/protective factors for sexual coercion. Among 1,933 male youth, 101 (5.2%) reported sexual coercion (ever talked or forced somebody into genital, oral, or anal sex) (SEX), 132 (6.8%) were classified as CP, and the remaining 1,700 (87.9%) as NC. Of 29 tested variables, 25 were more common in both SEX and CP compared to NC youth, including minority ethnicity, separated parents, vocational study program, risk-taking, aggressiveness, depressive symptoms, substance abuse, sexual victimization, extensive sexual experiences, and sexual preoccupation. When compared to CP youth only, SEX youth more often followed academic study programs, used less drugs and were less risk-taking. Further, SEX more frequently than CP youth reported gender stereotypic and pro-rape attitudes, sexual preoccupation, prostitution, and friends using violent porn. Finally, in a multivariate logistic regression, academic study program, pro-rape attitudes, sexual preoccupation, and less risk-taking independently remained more strongly associated with SEX compared to CP offending. In conclusion, several sociodemographic, family, and individual risk/protective factors were common to non-sexual and sexually coercive antisocial behavior in late adolescence. However, pro-rape cognitions, and sexual preoccupation, were sexuality-related, specific risk factors. The findings could inform preventive efforts and the assessment and treatment of sexually coercive male youth.     

Supervisory Turnover in Outpatient Substance Abuse Treatment

Staff turnover is a significant issue within substance abuse treatment, with implications for service delivery and organizational health. This study examined factors associated with turnover among supervisors in outpatient substance abuse treatment. Turnover was conceptualized as being an individual response to organizational-level influences, and predictors represent aggregate program measures. Participants included 532 staff (including 467 counselors and 65 clinical/program directors) from 90 programs in four regions of the USA. Using logistic regression, analyses of structural factors indicated that programs affiliated with a parent organization and those providing more counseling hours to clients had higher turnover rates. When measures of job attitudes were included, only parent affiliation and collective appraisal of satisfaction were related to turnover. Subsequent analyses identified a trend toward increased supervisory turnover when satisfaction was low following the departure of a previous supervisor. These findings suggest that organizational-level factors can be influential in supervisory turnover.     

A review of validated youth prevention and positive youth development programs in Asia

In view of the intensification of adolescent developmental issues in different Asian contexts, there is an urgent need for developing prevention and positive youth development programs in different Asian communities. In this paper, adolescent prevention and positive youth development programs in Asia which have been evaluated by studies adopting true experimental or quasi-experimental designs are reviewed. Several observations are highlighted from this review. First, compared with Western societies, the number of validated programs in different Asian communities was extremely low. Second, there were comparatively more programs addressing substance abuse than other mental health problems. Third, compared with evaluated prevention programs, there were very few positive youth development programs. Finally, there were very few rigorously designed evaluative studies of prevention and positive youth development programs over a long period of time.     

A Snapshot of Substance Abuse Among Homeless and Runaway Youth in Denver, Colorado

We report on results of a one-day survey measuring rates of substance use and HIV risk behaviors among the homeless youth population of Denver, Colorado. On March 15, 2001, staff of Urban Peak, conducted a single-day survey of homeless and runaway youth in the Denver metropolitan region, going to locations known to be frequented by this population. All youth encountered were asked to fill out a brief survey asking about past nine month use of the following substances: alcohol, marijuana, cocaine, methamphetamine, heroin, hallucinogens, ecstasy and ketamine, and HIV risk behaviors. Chi-square analyses of the association of substance used and gender, age, living situation, and ethnicity were conducted. In addition, the use of any club drug was examined. One-hundred-eighty-six homeless or runaway youth were surveyed; 74 percent were between 16 and 25. Rates of use over the last nine months were as follows: alcohol, 69 percent; marijuana, 75 percent; methamphetamine, 18 percent; cocaine, 19 percent; heroin, 12 percent; hallucinogens, 30 percent; ecstasy, 25 percent; and ketamine, 13 percent. Eleven percent reported trading sex for drugs, money, food, or shelter; and 13 percent reported sharing needles. There were significant associations between living situation and use of marijuana, cocaine and hallucinogens. Prevalence rates of club drugs show 75 percent, 77 percent and 77 percent of homeless or runaway youth ihaving used ecstasy, ketamine and hallucinogens one to three times per month over the last nine months, respectively. Prevalence rates of substance use among homeless youth in the Denver metropolitan are similar to rates reported in other larger metropolitan areas. Routine screening for every substance needs to be part of the assessment for all homeless youth. Initial data points to a need for more research exploring protective factors among this population and to better understand the prevalence of club drug use.     

Psychosocial correlates of health compromising behaviors among adolescents

The objective of the present study was to examine psychosocial correlates of diverse health-compromising behaviors among adolescents of different ages. The study population included 123,132 adolescents in sixth, ninth and 12th grades. Psychosocial correlates of substance abuse, delinquency, suicide risk, sexual activity and unhealthy weight loss behaviors were examined. Risk-taking disposition was significantly associated with nearly every behavior across age and gender groups. Other consistent correlates included sexual abuse and family connectedness. Correlates of health-compromising behaviors tended to be consistent across age groups. However, stronger associations were noted between sexual abuse and substance use for younger adolescents, and risk-taking disposition and school achievement were stronger correlates for older youth. The results suggest the presence of both common and unique etiological factors for different health-compromising behaviors among youth. The results emphasize the importance of focusing on positive 'risk-taking' experiences for youth in prevention programs; being sensitive to possible sexual abuse experiences among both female and male adolescents in health-care consultations; integrating strategies for improved family connectedness into health promotion efforts; and making school relevant for all adolescents.     

Characteristics of Effective Substance Abuse Prevention Programs for High-Risk Youth

The last two decades have witnessed a rapid development of substance abuse prevention programs. Most efforts to evaluate these programs have been limited to single program studies, and nearly all studies involving multiple drug prevention programs have involved school-based programs for general youth populations. In 1995, the Center for Substance Abuse Prevention (CSAP), with the Substance Abuse and Mental Health Administration (SAMHSA), funded the CSAP National Cross-site Evaluation of High Risk Youth Programs, a five-year, multi-site evaluation study involving 46 programs and over 10,500 youth at high risk for substance use (CSAP, 2002(a)). This article reports findings from this evaluation, focusing on program characteristics that help explain reductions in 30-day substance use among program participants. Programs found to be most effective in reducing substance use were those that offered strong behavioral life skills development content, emphasized team-building and interpersonal delivery methods, emphasized introspective learning approaches focusing on self-reflection, were based upon a clearly articulated and coherent program theory, and provided intense contact with youth. Programs utilizing these positive program components produced consistent and lasting reductions in substance use. These findings provide a solid basis for the adoption of positive program characteristics in the development of future prevention programming for high-risk youth.     

Substance abuse and high-risk needle-related behaviors among homeless youth in minneapolis: Implications for prevention

Homeless and runaway youth face a variety of health, risks, including those related to substance abuse and use of unsterile needles. During 1998–1999, we recruited 201 Minneapolis homeless youths aged 15–22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or “couch hopping.” There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization.     

Substance Abuse by Youth and Young Adults in Rural America

ABSTRACT:  Purpose: Addressing substance abuse in rural America requires extending our understanding beyond urban-rural comparisons to how substance abuse varies across rural communities of different sizes. We address this gap by examining substance abuse prevalence across 4 geographic levels, focusing on youth (age 12-17 years) and young adults (age 18-25 years). Methods: The analysis is based on 3 years (2002-2004) of pooled data from the National Survey on Drug Use and Health. We measure rurality using a four-tier consolidation of the 2003 Rural-Urban Continuum Codes: urban, rural-adjacent, rural-large, and rural-small and medium. Findings: Rural youth have higher alcohol use and methamphetamine use than urban youth and the more rural the area, the higher the use. Rural young adults living in rural-large areas have higher rates of substance abuse than their urban peers; those living in the most rural areas have nearly twice the rate of methamphetamine use as urban young adults. Rural youth are more likely than urban youth to have engaged in the high-risk behavior of driving under the influence of alcohol or other illicit drugs. Conclusions: Higher prevalence rates, coupled with high-risk behavior, place rural youth and young adults at risk of continued substance use and problems associated with this use. Rural community infrastructure should be enhanced to support substance abuse prevention and intervention for these populations.     

Trends in acute mental health care: Comparing psychiatric and substance abuse treatment programs

This study compared psychiatric and substance abuse acute care programs, within both inpatient and residential modalities of care, on organization and staffing, clinical management practices and policies, and services and activities. A total of 412 (95% of those eligible) Department of Veterans Affairs' programs were surveyed nationwide. Some 40% to 50% of patients in psychiatric and substance abuse programs, in both inpatient and residential venues of care, had dual diagnoses. Even though psychiatric programs had a sicker patient population, they provided fewer services, including basic components of integrated programs, than substance abuse programs did. Findings also showed that there is a strong emphasis on the use of clinical practice guidelines, performance monitoring, and obtaining client satisfaction and outcome data in mental health programs. The author's suggest how psychiatric programs might better meet the needs of acutely ill and dually diagnosed patients (eg, by incorporating former patients as role models and mutual help groups, as substance abuse programs do; and by having policies that balance patient choice with program demand).