TUESDAY, Aug. 3, 2004 (HealthDayNews) -- Homelessness and substance abuse both contribute to a death rate among street kids that is 11 times higher than that of other children.
Suicide and infection with HIV also contributed to this disturbing reality, says a study in the Aug. 4 issue of the Journal of the American Medical Association, a theme issue on "Violence and Human Rights."
"Homeless youth, who lack the family support that usually makes the transition into adulthood possible, are thrust into an unimaginably harsh environment without the experience or resources to succeed," said John N. Lozier, executive director of National Health Care for the Homeless Council. "This new research demonstrates that in numbers far exceeding their peers, they do not survive the ordeal of homelessness."
Street youth are at times homeless and at other times living in unstable situations. "There are kids that go home intermittently," said Dr. Sue Ellen Abdalian, author of an accompanying editorial in the journal and head of adolescent medicine at Tulane University School of Medicine in New Orleans.
The study was designed to look at street youth in Montreal for several years to determine what factors, including homelessness, might increase the risk of death.
The authors "set it up in a way so homelessness was a time-dependent variable, especially during times when they were actually homeless, just not in a crummy situation," said Abdalian, who also cares for New Orleans street youth as medical director of The Adolescent Drop-In Center.
From 1995 to 2000, the authors recruited 1,103 young people between the ages of 14 and 25. The participants were interviewed twice a year and were eligible for follow-up until they turned 30 or they reported consecutively four times that they were not homeless and were not using services from street youth organizations.
The study participants were paid $20 a visit and were followed for an average of 33.4 months.
During the course of the research, 26 participants died -- a mortality rate more than 11 times that of youth in the general population. It was a rate the study authors characterized as "extremely high."
Thirteen of the young people died of suicide, eight from drug overdoses, two from accidents and one each from hepatitis A and heart disease. Another one died of "unidentified" causes. Four of the dead were infected with HIV, the virus that causes AIDS.
The researchers found that HIV infection, daily alcohol use in the month before death, homelessness in the last six months of life, drug injection in the last six months, and being male were also risk factors.
"If you look at what they died from, mostly it's suicide and drug overdose, but they were at higher risk for those things during homeless periods," Abdalian said.
The problems may be even worse in the United States, the researcher said.
"The reality that 18- to 24-year-olds in the U.S. are more likely than any other age group to be uninsured only aggravates the severe health problems underlying these results from Canada, where universal [health] coverage is at least theoretically available," Lozier said.
The study authors suggested that treating addiction and mental health problems should be priorities. Abdalian added that moving people off the street also should be a priority.
"What this really tells me is that, yes, we have to address all the social issues around homelessness, but we also need to make sure that there are places to stay for kids who need them," she said.
"Getting off the street and being able to bathe and wash and actually have a place to sleep where they are not frightened of getting picked up or getting hurt or losing their stuff" is important, Abdalian said. "It's really hard to make plans for the future when your stuff gets stolen every other day."
"[We give them expensive antibiotics], three days later their squat [camping spot} gets raided, they have to run out and everything gets trashed so they weren't able to take their medications," she added. "It's really very difficult to live on the street."
The National Health Care for the Homeless Council has more on the health concerns of homeless people.