Running head: HOMELESS ADOLESCENTS AT RISK

Homeless Adolescents at Risk

Lindsay M Johnson
Ferris State University

HOMELESS ADOLESCENTS AT RISK

Homeless Adolescents at Risk

Homelessness in America is more prevalent than many would believe and it spreads
across every ethnicity and is not limited to the minorities. Homelessness is not bias in its
population, it spans from African Americans, Caucasians, Hispanics, Asians, to Native
Americans and more and varies from infants to the elderly. There are many misconceptions of
the homeless as people may think they put themselves in that particular situation or they look at
the homeless as perpetrators of violence rather than victims (Crawford, Whitbeck, & Hoyt,
2011, p 952). The terrifying factor about the homeless population is that adolescents compose a
large portion of it. The problems that arise with adolescent homelessness vary from pregnancy,
sexually transmitted infections, housing, and drug or sexual abuse. This all narrows down to the
need for one thing: minimal cost or free health care for not only homeless adolescents, but all
adolescents.
Demographics
Homeless is defined as having spent any of the past 30 nights in a mission, homeless
shelter, or transitional shelter; a hotel paid for by a voucher; a church or chapel; an all-night
theater or other indoor public place; an abandoned building; a car or other vehicle; the street or
other outdoor public place (Barkin, Balkrishnan, Manuel, Andersen, & Gelberg, 2003, p 253).
That being said worldwide there are 300 million people considered to be homeless; within the
United States upwards of 3.5 million people suffer homelessness each year (Dorsen, 2010). Of
that many homeless people 1.5 million are adolescents (Dorsen, 2010). In Michigan for
adolescents through twelfth grade, approximately 23,017 are homeless (The National Center on
Family Homelessness). On a local level, in Grand Rapids approximately 2,000 adolescents are
suffering from homelessness (Hagar, 2014).

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Health Concerns
With teens and children living on the streets, in vehicles, in shelters, or anywhere that is
not a stable home environment it is nearly expected that some of them will participate in risky
sexual behavior or experiment with drugs and alcohol. Not only are they are experimenting with
sex and drugs, but homeless youth have a higher rate of suicidal ideation and attempted suicide
(Noell & Ochs, 2001, p 31). The issues with sex and drugs, however, is more prevalent in the
homeless adolescent population. Nearly fifty percent of homeless youth engage in risky sex in
exchange for food, shelter, drugs, or money (Busen & Beech, 1997).
The issue narrows down to the fact that, ultimately, sex is the underlying issue leading to
the issues of the sexually transmitted infections (STIs) and pregnancy. As STIs will be discussed
later, teen pregnancy may be an issue across homeless and not homeless adolescents, however,
homeless females are four times more likely to become pregnant; in other terms almost twenty
percent of homeless female adolescents do in fact become pregnant (Thompson, Bender, Lewis,
& Watkins, 2008). Pregnant and homeless teens lack financial resources and adequate health
care, resulting in increased risk for lowbirth-weight babies and high infant mortality
(Thompson et al, 2008). Teen pregnancy among this population has been related to various
factors including substance use, lack of knowledge of or resistance to contraceptive use, and
low motivation for academic achievement, as well as family factors such as lack of intrafamilial
support, sexual and physical abuse, and single-parent families (Thompson et al, 2008). Due to
their living situations this population less likely to not only receive prenatal care, but general
medicinal care as well because of lack of resources and inadequate access to care.
Homeless youth do not have access to regular sources of care or, in some cases, even the
knowledge of where they can get this care. Fifty percent of homeless youth and thirty-six percent

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of adolescents living in shelters reported they did not have access to regular care (Klein, Woods,
Wilson, Prospero, Greene, & Ringwalt, 2000). Homeless adolescents may not seek care for the
main reason that they do not have any health insurance; for those of them that do have health
insurance they do not seek care because they do not want to give a real name or contact
information (Evans, Handschin & Giesel, 2013). Often when these adolescents do seek care from
a clinic it is for reasons like pregnancy and testing for sexually transmitted infections. A study
was performed to compare if a free clinic was available what homeless adolescent male and
females chief complaint would be; in males it was related to dermatologic conditions and in
females they wanted tested for STIs (Evans, Handschin & Giesel, 2013). See table 1 in the
appendix for other chief complaints reported.
Prevalent Disease
Among the homeless adolescents, it may not be the most prevalent problem, but maybe
the problem easiest to resolve would be the rate of STIs among them. The additional issues with
STIs besides that many homeless adolescents do not have health insurance, is that many STIs are
asymptomatic leading the youth to not even be aware of the risks they are putting their body at.
Across the nation, the rate of Human Immunodeficiency Virus (HIV)/Acquired
Immunodeficiency Syndrome (AIDS) is significantly greater in homeless adolescents (Busen &
Beech, 1997). This high risk for HIV/AIDS is directly correlated with homeless adolescents
sharing needles for intravenous drugs, multiple sex partners, the longer they are homeless the
greater the chances are they contract HIV/AIDS, and unprotected, frequent sexual activity
(Busen & Beech, 1997).
Health Policy

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Nurses come into play to this specific population in the community because there are
many actions nurses can take to prevent STIs like HIV/AIDS in the homeless population.
Community nurses have many upstream approaches they can take in the prevention of STIs,
pregnancy, suicide, and lack of access to care for these adolescents. Approaches as simple as
providing the neighborhood with safe needle disposal spots. Many STIs can be transferred by
shared intravenous needle use, these are probably usually stolen. Potentially giving diabetics a
safe place to dispose of needles can lead to less needles being available to the public for
inappropriate use. It was mentioned previously that homeless youth may not go to a clinic for
fear of giving their true name to the clinic. Nurses could possibly prevent the need in some cases
for these youth to have to go to the clinic by providing homeless youth with barrier contraception
methods right along with education on how to use the barrier methods provided.
Barrier methods are not successful if the adolescent is unaware of how to properly use
them. Barrier methods can decrease the amount of sexually transmitted infections along with
decrease the rate of pregnancy in homeless teenagers. Suicide prevention programs could be
coordinated by nurses within homeless shelters. Nurses could coordinate with social workers to
provide free suicide prevention programs to the youth. As far as the lack of access to care, this
spectrum is partly limited to how much nurses can help. Nurses can do small things like provide
free urine screenings for the teenagers, however, if the teenager is diagnosed with a sexually
transmitted infection it is possible that the need for some sort of compensation will be required
for various treatment options. Aside from sexually transmitted infections and pregnancy, nurses
can provide education about the balanced diet teenagers need as their body is still continuing to
grow and mature. Nurses can provide resources for where homeless adolescents can get healthy
food for free from food trucks to provide adequate nutrition to their bodies.

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Conclusion
It is apparent that many of the most influential actions a community health nurse can take
for this specific population are directly related to education. Educating the youth about
prevention of sexually transmitted infections, educating them about preventing pregnancy and
what to do if pregnancy does occur, educating them simply about why drugs and alcohol are
especially bad in developing teenagers, teaching them where they can go if they feel or are
thinking about suicide, and educating them about proper health for their bodies. Lastly it is
incredibly important that nurses are encouraging the support of shelters for these youth and little
to no cost clinics that can diagnose and treat this population.

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References
Barkin, S., Balkrishnan, R., Manuel, J., Andersen, R., & Gelberg, L. (2003). Health care
utilization among homeless adolescents and young adults. Journal of Adolescent Health.
32(4), 253-256. DOI: 10.1016-S1054-139X(02)00474-3
Busen, N., & Beech, B. (1997). A collaborative model for community-based health care
screening of homeless adolescents. Journal of Professional Nursing. 13(5), 316-324.
DOI: 10.1016/S8755-7223(97)80110-X
Crawford, D., Whitbeck, L., & Hoyt. R. (2011). Propensity for violence among homeless and
runaway adolescents: An event history analysis. Crime Delinq. 57(6), 950-568. DOI:
10.1177/0011128709335100
Dorsen, C. (2010). Vulnerability in homeless adolescents: concept analysis. Journal of Advanced
Nursing. 66(12), 2819-2827. DOI: 10.1111/j.1365-2468.2010.05375.x
Evans, Y., Handschin, S., & Giesel, A. (2013). Health care utilization in homeless youth. Journal
of Community Health. 39(3), 521-523. DOI: 10.1007/s10900-013-9789-3
Hagar, J. (2014). Drop-in center for runaways and homeless youth ready to open near downtown
and Heritage Hill. The Grand Rapids Press. Retrieved from
http://www.mlive.com/business/west-michigan/index.ssf/2014/11/new_dropin_center_for_runaway.html
Klein, J., Woods, A., Wilson, K., Prospero, M., Greene, J., & Ringwalt, C. (2000). Homeless and
runaway youths access to health care. Journal of Adolescent Health. 27(5), 331-339.
DOI: 10.1016/S1054-139X(00)00146-4

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The National Center on Family Homelessness. (ND). America's youngest outcasts: State report
card on child homelessness. Homeless Children America. 1-7. Retrieved from
http://www.homelesschildrenamerica.org/pdf/report_cards/long/mi_long.pdf
Noell, J., & Ochs, L. (2001). Relationship of sexual orientation to substance use, suicidal
ideation, suicide attempts, and other factors in a population of homeless adolescents.
Journal of Adolescent Health. 29(1), 31-36. DOI: 10.1016/S1054-139X(01)00205-1
Thompson, S., Bender, K., Lewis, C., & Watkins, R. (2008). Runaway and pregnant: Risk factors
associated with pregnancy in a national sample of runaway/homeless female adolescents.
Journal of Adolescent Health. 43(2), 125-132. DOI: 10.1016/j.jadohealth2007.12.015

Appendix

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Table 1