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Children's Health

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Homeless youths have numerous health and access to care problems that vary between street and shelter-based youths

An estimated 1.6 million homeless young people roam U.S. streets each year. The realities of street life—including substance use, survival sex, lack of safe shelter, and need for basic hygiene—place homeless youths at high risk for health problems ranging from sexually transmitted diseases and unintended pregnancies to depression, injuries, and malnutrition. A recent study by University of Washington researchers, Josephine Ensign, Dr.P.H., and Michelle Bell, Ph.D., detailed the illness experiences of homeless youths in Seattle, WA. Their study was supported by the Agency for Healthcare Research and Quality (HS11414).

Drs. Ensign and Bell interviewed 45 homeless youths aged 15 to 23 years visiting a free clinic for homeless youths (clinic-based youths) or mobile medical vans in two street settings (street-based youths). Compared with clinic-based youths, street-based youths reported longer and more entrenched homelessness, more illnesses related to drug use, increased reliance on the emergency department (ED) for health care, and less use of emergency shelters. Street-based youths also tended to come from childhoods of more poverty and disruption and to have traveled farther from their hometowns.

Interviews with street youths revealed that if the medical van were not available, most of them would ignore their health concerns until illness forced them to go to a local ED. Many did not appear ready to access other primary health care due to their substance use and chaotic lifestyles. However, some others did want to access health services not offered by the mobile clinic. Better integration and coordination between the medical van and the free clinic for homeless youths has begun in Seattle, in part as a result of the feedback from young people.

More details are in "Illness experiences of homeless youth," by Drs. Ensign and Bell, in the November 2004 Qualitative Health Research 14(9), pp. 1239-1254.

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