A new study at the University of California (UC), Berkeley found that homeless youth living on the streets of San Francisco are at 10 times greater risk of death than their peers living in homes, mostly due to suicide and substance abuse. The findings show that stigma is a big contributing factor to these preventable deaths.
“This population is highly stigmatized. That stigma leads to neglect and, in turn, to increased mortality. All the deaths in this cohort were preventable,” said lead author Dr. Colette Auerswald, a pediatrician and adolescent medicine specialist who is an associate professor of public health at UC Berkeley. “Stigma kills.”
On any given night, there are an estimated 1,378 homeless young people on the streets of San Francisco. Most of these youth cycle in and out of their homes because of abuse, family problems, or drug use, Auerswald said.
In a recent editorial she wrote for the journal JAMA Pediatrics, Auerswald praised a new study that confirmed the fact that homeless youth are not homeless by choice.
“That study once again blew out of the water the myth that youth either choose to be on the street or are on the street because they are delinquents,” she said. “For the vast majority of youth in developed countries, homelessness is due to abuse or neglect or family conflict, often related to poverty.”
The study involved 218 young people, ages 15 to 24, two-thirds male. Young people were considered homeless if they reported unstable housing for at least two days during the previous six months; that is, they lived outside their home with non-family members, such as in a car, a shelter, a squat, outdoors, with a stranger or someone they did not know well, on public transportation or in a single room occupancy (SRO) hotel.
During a six-year period, 11 of these young people died — eight males and three females, or five percent of the study group — 10.6 times higher than expected for a similar group matched for age, race, and gender.
Three had committed suicide, one was murdered, and the other deaths were related to drug or alcohol use, either from an accidental overdose or disease linked to substance abuse or sexual behavior. One young person died from complications of HIV, a death that was also preventable, Auerswald noted.
Furthermore, the researchers found that injection drug use may be a potential predictor of death for homeless youth. Two-thirds of those who died had injected drugs at some point, as opposed to one-third of survivors.
“It is critical that we have on-demand access to substance abuse treatment for all youth, including minors, in San Francisco, where drugs are a huge problem regardless of homelessness,” Auerswald said. “Drugs are a major cause of morbidity and mortality and of the failure of young people to remove themselves from the street.”
While the study is relatively small, the findings are in line with other data in Europe and the U.S. that recorded the deaths of young homeless people.
For their research, Auerswald and her team actually went out on the street to talk to the young people, instead of finding them at homeless programs or drop-in centers. Such program-based recruitment produces a biased sample favoring lower-risk youth who access services, she said.
In this study, young women were slightly more likely to die than young men: They had a mortality rate 16.1 times greater than their race- and age-matched female peers. The homeless young men were 9.4 times more likely to die than their race- and age-matched male peers.
“Being homeless is dangerous for everybody, but the social environment of the street is particularly treacherous for young women,” she said.
In the end, she said, it is not normal, healthy, or safe for young people to live on the street.
“The bottom line is to have a society that gives youth safe options for not living on the street, that does not tolerate youth homelessness as an acceptable option for our youth,” she said.
“Yes, provide shelter and substance-abuse counseling, but also provide access to housing and education, instead of passing no-sit, no-lie laws that criminalize youth, make it harder for them to access housing or funding for schooling and keep them on the street. Not having a way out leads to survival behaviors that place them at high risk of preventable death.”
The study is published in the open-access journal PeerJ.