Substance Use Behaviors and Associated Psychosocial Characteristics of Homeless Youth

Introduction:
There are currently between 1 and 1.7 million young homeless Americans living in the United States. A significant proportion of these homeless adolescents use recreational substances such as alcohol, tobacco, and other drugs. Substance use among this vulnerable population can amplify the numerous psychosocial challenges they already face. Our study examined the prevalence of substance use behaviors and its relationship to psychosocial characteristics of homeless adolescents.

Methods:
A cross-sectional study was conducted on homeless adolescents who underwent state-mandated physical exams at a youth shelter between 2/19/2015 and 9/05/2019 in the Lehigh Valley, Pennsylvania. Patient demographics, along with psychiatric, social, and substance use histories were recorded. Substance use data was categorized into tobacco, alcohol, marijuana, and other illicit drugs. A chi-square test of independence was used to determine the association between substance use behaviors and psychosocial data.

Results:
440 total patient charts were reviewed. 55.7% of patients were female, 42.5% were male, and 1.8% were transgender. 47.0% were white and the mean age was 15.3. The most commonly used drug was marijuana (37.6%), followed by tobacco (27.7%) and alcohol (12.0%). Only 9.7% of patients reported using other illicit drugs, such as inhalants, cocaine, and methamphetamine. Tobacco use was associated with psychiatric diagnoses (X2 = 6.92, p = .01), previous suicide or self-harm attempts (X2 = 16.05, p < .001), past aggressive behaviors (X2 = 10.30, p = 0.001), history of traumatic events (X2 = 6.53, p = .01), and sexual activity (X2 = 79.60, p < .001). Alcohol use was associated with past aggressive behaviors (X2 = 6.97, p = .01) and sexual activity (X2 = 25.29, p < .001). There was a relationship between marijuana use and past aggressive behaviors (X2 = 34.27, p < .001), history of traumatic events (X2 = 7.53, p = 0.01), and sexual activity (X2 = 52.13, p <.001).

Conclusion:
Our study found that many homeless adolescents used at least one type of recreational substance, with marijuana being the most popular choice. Additionally, substance use habits were associated with various psychiatric diagnoses, behavioral factors, and sexual activity practices commonly seen among homeless youth. In particular, a history of aggressive behavior toward others and being sexually active were associated with the use of most types of recreational substances. This study highlights the need to address substance use behaviors and associated psychosocial factors when providing medical care to homeless adolescents.

References:
1. Youth Homelessness. National Coalition for the Homeless. Accessed May 6, 2020. https://nationalhomeless.org/issues/youth/

2. Maria DS, Padhye N, Yang Y, et al. Drug use patterns and predictors among homeless youth: Results of an ecological momentary assessment. The American Journal of Drug and Alcohol Abuse. 2018;44(5):551-560. doi:10.1080/00952990.2017.1407328

3. Wenzel SL, Tucker JS, Golinelli D, Green HD, Zhou A. Personal network correlates of alcohol, cigarette, and marijuana use among homeless youth. Drug and Alcohol Dependence. 2010;112(1):140-149. doi:10.1016/j.drugalcdep.2010.06.004

Learning Objective: Identify psychiatric, behavioral, and social factors that are associated with substance use habits in homeless adolescents.