Health and Adverse Childhood Experiences Among Homeless Youth

Abstract

Background and Objectives Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.Methods Using data from 119,254 8th-11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.Results The prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p<0.001), such that ACE-related health risks were moderated by housing status.Conclusions ACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Being homeless unaccompanied is also riskier than being homeless with family, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

Toxic stress and disconnection from work and school among youth in Detroit

“…A barrier was also included if it was a part of a widely accepted assessment of trauma or toxic stress, such as the ACEs survey (Centers for Disease Control and Prevention, 2020). Ultimately, indicators of toxic stress exposure included having: experience with homelessness (Barnes et al, 2021), experience with the foster care system (Forkey & Szilagyi, 2014), an incarcerated parent (Felitti et al, 1998) documented difficulty with alcohol or substance abuse (Mandavia et al, 2016), a record of engaging in violent behavior (Ross & Arsenault, 2018), and contact with the criminal justice system (Dierkhising et al, 2013).…”

Review: Can digital mental health interventions bridge the ‘digital divide’ for socioeconomically and digitally marginalised youth? A systematic review

“…By understanding the digital divide as a spectrum of digital connectivity (Katz, 2017;Livingstone & Helsper, 2007), one can identify communities of young people who exist on the lower end of the digital connectivity spectrum, including but not limited to socioeconomically marginalised youth. For example, homeless youth experience great adversity with unique social-and healthrelated needs and are highly likely to be digitally marginalised, both in access to devices and internet connection (Barnes, Gower, Sajady, & Lingras, 2021;Sathi, 2018). Other communities may be complexly and less evidently identifiable as digitally marginalised, such as those living rurally.…”

Pregnancy and parenting support for youth experiencing homelessness

“…Annually, one in 10 young adults 18–25 years old experience homelessness in the United States (Morton et al., 2018). Adverse childhood experiences including homelessness, poverty, and violence place youth at risk of homelessness (Barnes et al., 2021). Youth experiencing homelessness (YEH) are vulnerable to multiple challenges, including unmet basic needs, untreated mental health disorders, substance use, sexually transmitted infections, and sexual and physical violence (Barnes et al., 2021; Brott, 2019).…”

“…Adverse childhood experiences including homelessness, poverty, and violence place youth at risk of homelessness (Barnes et al., 2021). Youth experiencing homelessness (YEH) are vulnerable to multiple challenges, including unmet basic needs, untreated mental health disorders, substance use, sexually transmitted infections, and sexual and physical violence (Barnes et al., 2021; Brott, 2019). The tumultuous experiences of homelessness contribute to a significantly higher morbidity and a mortality rate up to 10 times higher than housed peers (Auerswald et al., 2016).…”