Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California

Abstract

Objectives. The mortality rate of a street-recruited homeless youth cohort in the United States has not yet been reported. We examined the six-year mortality rate for a cohort of street youth recruited from San Francisco street venues in 2004.Methods. Using data collected from a longitudinal, venue-based sample of street youth 15–24 years of age, we calculated age, race, and gender-adjusted mortality rates.Results. Of a sample of 218 participants, 11 died from enrollment in 2004 to December 31, 2010. The majority of deaths were due to suicide and/or substance abuse. The death rate was 9.6 deaths per hundred thousand person-years. The age, race and gender-adjusted standardized mortality ratio was 10.6 (95% CI [5.3–18.9]). Gender specific SMRs were 16.1 (95% CI [3.3–47.1]) for females and 9.4 (95% CI [4.0–18.4]) for males.Conclusions. Street-recruited homeless youth in San Francisco experience a mortality rate in excess of ten times that of the state’s general youth population. Services and programs, particularly housing, mental health and substance abuse interventions, are urgently needed to prevent premature mortality in this vulnerable population.

Independent predictors of mortality in adolescents ascertained for conduct disorder and substance use problems, their siblings and community controls

“…That is, there was no discernible independent effect of SADV in any models accounting for CD symptoms or clinical ascertainment status, although the latter accounted for independent variance regardless of which covariates were presented in the model. However, consistent with previous findings , substance‐related causes comprised the largest proportion of observed deaths and occurred disproportionately among clinical probands and their siblings vis‐á‐vis controls. In light of these findings, we echo previous researchers’ recommendations , that intervention and prevention efforts include SUD treatment within constellation treatment foci including additional psychiatric resources and social services.…”

“…Substance‐related and violent causes accounted for the majority of deaths among clinical probands and their siblings, with the substance‐related causes accounting for 32% of deaths among clinical probands (Table ). Results from univariate models confirmed previous findings that male sex , conduct problems and SAD are each associated with increased mortality risk (Table ).…”

“…Previous research has identified numerous demographic variables and individual differences that predict premature mortality among adolescents and young adults with externalizing problems, including male sex , minority ethnic status (i.e. Black/African American or Latino) , substance abuse and previous criminal history . These findings mirror studies of mortality in previously incarcerated individuals .…”

“…Further, although both genetic and environmental familial factors contribute to conduct problems and substance abuse , no study has examined whether these identified risk factors for premature death account for independent or redundant variance beyond that explained by demographics, or whether familial effects remain salient after accounting for individual differences. In particular, it remains unclear whether severity of substance abuse increases mortality hazard after accounting for CD, a point of clinical relevance given that several researchers have suggested that further dissemination and implementation of SUD treatments will reduce mortality in youth with externalizing problems . Finally, it is unknown whether risk for premature death is heightened among siblings of adolescents with externalizing problems, and whether any differences between clinically ascertained youth and their siblings are evident after accounting for individual differences in CD and SUD severity.…”

The relationship between hazardous alcohol use and violence among street‐involved youth

“…6, 7 Increased exposure to physical endangerment on the street and limited access to resources can predispose to numerous health risks, including violence. 8, 9 One study of homeless Canadian youth found two out of three youth had been a victim of physical violence and one out of three youth had been sexually assaulted while living on the street.…”