Elsevier

Addictive Behaviors

Volume 30, Issue 6, July 2005, Pages 1100-1110
Addictive Behaviors

Predictors of substance use among homeless youth in San Diego

https://doi.org/10.1016/j.addbeh.2004.10.006Get rights and content

Abstract

This study examined the frequency of substance use among 14- to 24-year-old homeless youth (N=113) recruited from two community drop-in centers and explored the relationship between substance use and hypothesized psychosocial predictors. Audio-computer-assisted self-interviewing (A-CASI) was used for assessment. Including alcohol and tobacco, the mean number of different drugs used was 3.55 for lifetime and 2.34 for the last 3 months. A three-block hierarchical multiple regression was conducted to determine potential predictors of overall drug use (the sum of all different drugs used) during the last 3 months. Block 1 included demographic variables, Block 2 included a parental monitoring variable, and Block 3 included peer and environmental variables derived from learning theories. Parental monitoring (−) and peer variables (+) predicted overall 3-month drug use. The final model explained 36% of the variance in overall drug use. Results suggest that homeless adolescent drug use exists at high levels and is related to parental monitoring and peer modeling of other risk behaviors. These results may inform future prevention strategies for homeless youth and other high-risk populations.

Introduction

It is estimated that, in the United States, 300,000 youth are homeless (National Coalition for the Homeless, Homeless Youth, 1999); the annual prevalence of homelessness is at least 5% among youth aged 12–17 (Robertson & Toro, 1998). In California, estimates indicate that 35,000–100,000 children/adolescents are homeless, which constitutes 10–38% of the homeless population in the State (California Office of the Governor, March 2002). In San Diego County, approximately 800 youth are homeless at any given time (Regional Task Force on the Homeless, Youth and Homelessness, 1997), with only 202 shelter beds set aside (Regional Task Force on the Homeless, Homeless Service Profile, 2001). This leaves a substantial number of youth who are forced to live on the streets, “squat” in abandoned buildings, or sleep on the beach.

Substance use has been shown to be related to health risks in youth (Grunbaum et al., 2000, Huba & Melchior, 2000). It is reported that 75% of homeless youth use drugs because they believe it keeps them warm and/or suppresses their appetite (Regional Task Force on the Homeless, Youth and Homelessness, 1997). Research has shown that rates of drug use are much higher among homeless adolescents than among other youth (Kipke et al., 1993, Klein et al., 2000). Huba and Melchior (2000) reported that homeless male and female youth have 2.27 and 1.75 greater odds of substance use, than do their respective non-homeless counterparts.

A paucity of literature exists on the determinants of homeless adolescents' substance use. Current research has primarily focused on the prevalence of homeless adolescent substance users and their service needs (Kipke et al., 1993, Klein et al., 2000). Descriptions of the problem and a framework from which determinants can be assessed have been presented (Robertson & Toro, 1998, Whitbeck & Hoyt, 1999); however, only a few studies have identified possible determinants (Ennett et al., 1999, Hawkins et al., 1992, Swadi, 1999). Attempted suicide, history of sexual and physical abuse, “survival sex”, sexual orientation, lack of a social network, and long periods of homelessness have been found to be associated with substance use in homeless adolescents (Ennett et al., 1999, Kipke et al., 1993).

Many studies have investigated risk factors associated with substance use in non-homeless youth. Peer influences have been the most consistently reported positive predictors (Hawkins et al., 1992, McCuller et al., 2001, Sullivan & Farrell, 1999, Swadi, 1999). Violence/crime (Huba & Melchior, 2000, Sullivan & Farrell, 1999), poor school performance (Grunbaum et al., 2000, Sullivan & Farrell, 1999), and family conflict (Brook et al., 1998, McCuller et al., 2001, Ellickson & Morton, 1999) have also been shown to be significantly related to increased substance use in youth.

A number of factors have also been reported as being significantly negatively related to youth substance use. These include religiosity (Grunbaum et al., 2000, McCuller et al., 2001), parental monitoring (Griffin et al., 2000, Li et al., 2000), and physical activity (Collingwood, Sunderlin, Reynolds, & Kohl, 2000). Inconsistent findings have been reported for self-esteem (Brook et al., 1998, Grunbaum et al., 2000), depression (Grunbaum et al., 2000, McCuller et al., 2001, Sussman et al., 2000), and coping (Grunbaum et al., 2000, Sussman et al., 2000). These results may be attributed, in part, to the lack of a “gold standard” and to inconsistencies in the measurement of these constructs.

To date, no studies have examined both potential risk and protective factors for substance use in homeless youth. Given the high rates of substance use found in this population, and the increasing numbers of children and adolescents becoming homeless each year, it is critical that potential predictors of substance use in homeless youth are investigated.

In addition, the majority of the data on youth substance use has been collected using face-to-face or paper–pencil methods. These approaches may introduce biases via the interviewer or participant. Face-to-face interviews may be vulnerable to social desirability bias (Bloom, 1998); paper–pencil surveys may be complicated by literacy issues. Both methods may raise concerns about the lack of privacy for respondents, which, in turn, may lead to false reporting.

Recently, computer-based surveys have been used to attempt to reduce these types of errors. Audio-computer-assisted Self-interviewing (A-CASI) allows for the collection of sensitive information without the direct participation of an interviewer (Turner et al., 1998). Several studies (Macalino et al., 2002, Murphy et al., 2000) have used A-CASI to assess HIV-related risk behavior in adolescents and adults and have found higher rates of risk behaviors compared with those using face-to-face interviews. While conclusive evidence of increased accuracy of reporting with A-CASI has not yet been demonstrated, its potential for reducing possible biases merits further investigation. To date, no studies have used A-CASI in any homeless youth population. The purpose of the present study is to investigate potential risk and protective factors of substance use in homeless youth, using data collected with A-CASI technology. Learning theories were used as the theoretical bases for inclusion of the potential predictors examined.

Section snippets

Design

This study was part of a larger investigation designed to evaluate four youth drop-in centers in Southern California. These centers offered a variety of training/support services, referrals to schools and health/social services, recreational activities, and, in addition, focused on HIV risk reduction. The San Diego State University Institutional Review Board approved all measures and procedures for this study. A Federal Certificate of Confidentiality (No. MH-00-177) was obtained to protect the

Frequency of substance use

The frequencies of lifetime and 3-month drug use are presented in Table 1. Almost 96% (95.6%) of the sample reported use of at least one drug in their lifetime (80.5% excluding tobacco and alcohol). Over three quarters (75.2%) of the youth reported the use of three or more drugs, and 31.0% reported the use of five or more drugs in their lifetime. The mean number of lifetime drugs used was 3.55 (S.D.=1.64). The most commonly reported drugs ever used were alcohol (89.4%), tobacco (85.8%), and

Discussion

The purpose of this study was to examine potential psychosocial determinants of substance use in homeless adolescents. Determinants were based on learning theories, with emphasis on adolescent high-risk behavior. This study was part of a larger evaluation designed to evaluate drop-in centers. This delimited the resources available for examining potential predictors of substance use. Thus, this analysis is a conservative test of learning theory-based predictors. Nonetheless, our results help

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    This research was supported, in part, by grant PE00-SDSU-153 awarded to Dr. Shillington and by grants IS99-SDSUF-206 and IS02-CBECH-711 awarded to Dr. Hovell from the Universitywide AIDS Research Program, University of California.

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