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Journal of Urban Health : Bulletin of the New York Academy of Medicine logoLink to Journal of Urban Health : Bulletin of the New York Academy of Medicine
. 2001 Dec;78(4):690–698. doi: 10.1093/jurban/78.4.690

Substance abuse and high-risk needle-related behaviors among homeless youth in minneapolis: Implications for prevention

Alan R Lifson 1,✉, Linda L Halcón 2
PMCID: PMC3455879  PMID: 11796815

Abstract

Homeless and runaway youth face a variety of health, risks, including those related to substance abuse and use of unsterile needles. During 1998–1999, we recruited 201 Minneapolis homeless youths aged 15–22 years; these youths were interviewed by experienced street outreach workers from settings where street youth were known to congregate. Respondents spent a median of 6 months in the previous year living on the streets or “couch hopping.” There were 37% who reported having 15 or more alcoholic drinks per week, 41% smoked 1 pack or more of cigarettes per day, and 37% used marijuana 3 or more times a week; 15% reported lifetime injection drug use, including 6% who used injection drugs within the previous month. Twenty percent had received a tattoo, and 18% body piercing with a needle that had not been sterilized or had been used by someone else. There were 68% who had been tested for human immunodeficiency virus (HIV), 52% for hepatitis B, and 25% for hepatitis C. There were 44% who said they did not have enough information about hepatitis B and C. Less than half (43%) received hepatitis B vaccine; however, 51% of unvaccinated youths indicated that they would receive vaccination if offered. These Midwestern homeless youths face multiple health risks, including those related to substance use and exposure to unsterile needles. Despite unsafe behaviors, many of these youths were interested in methods to protect their health, including education, knowing their HIV or viral hepatitis serostatus, and obtaining hepatitis B immunization.

Keywords: Adolescence, Hepatitis B virus, Hepatitis C virus, Human immunodeficiency virus, Substance use

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References

  • 1.Ringwalt CL, Greene JM, Robertson M, McPheeters M. The prevalence of homelessness among adolescents in the United States. Am J Public Health. 1998;88:1325–1329. doi: 10.2105/AJPH.88.9.1325. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 2.Farrow JA, Deisher RW, Brown R, Kulig JW, Kipke MD. Health and health needs of homeless and runaway youth: a position paper of the Society for Adolescent Medicine. J Adolesc Health. 1992;13:717–726. doi: 10.1016/1054-139X(92)90070-R. [DOI] [PubMed] [Google Scholar]
  • 3.Council on Scientific Affairs Health care needs of homeless and runaway youths. JAMA. 1989;262:1358–1361. doi: 10.1001/jama.262.10.1358. [DOI] [PubMed] [Google Scholar]
  • 4.Greene JM, Ennett ST, Ringwalt CL. Substance use among runaway and homeless youth in three national samples. Am J Public Health. 1997;87:229–235. doi: 10.2105/AJPH.87.2.229. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 5.Kipke MD, O'Connor S, Palmer R, MacKenzie RG. Street youth in Los Angeles: profile of a group at high risk for human immunodeficiency virus infection. Arch Pediatr Adolesc Med. 1995;149:513–519. doi: 10.1001/archpedi.1995.02170180043006. [DOI] [PubMed] [Google Scholar]
  • 6.Tweeten SS, Rickman LS. Infectious complications of body piercing. Clin Infect Dis. 1998;26:735–740. doi: 10.1086/514586. [DOI] [PubMed] [Google Scholar]
  • 7.Conry-Cantilena C, VanRaden M, Gibble J, et al. Routes of infection, viremia, and liver disease in blood donors found to have hepatitis C virus infection. N Engl J Med. 1996;334:1691–1696. doi: 10.1056/NEJM199606273342602. [DOI] [PubMed] [Google Scholar]
  • 8.Long GE, Rickman LS. Infectious complications of tattoos. Clin Infect Dis. 1994;18:610–619. doi: 10.1093/clinids/18.4.610. [DOI] [PubMed] [Google Scholar]
  • 9.Ko YC, Ho MS, Chiang TA, Chang SJ, Chang PY. Tattooing as a risk of hepatitis C virus infection. J Med Virol. 1992;38:288–291. doi: 10.1002/jmv.1890380411. [DOI] [PubMed] [Google Scholar]
  • 10.Limentani AE, Elliott LM, Noah ND, Lamborn JK. An outbreak of hepatitis B from tattooing. Lancet. 1979;2:86–88. doi: 10.1016/S0140-6736(79)90132-6. [DOI] [PubMed] [Google Scholar]
  • 11.Minnesota Statewide Survey of Persons Without Permanent Shelter, Vol 2: Unaccompanied Youth. St. Paul, MN: Amherst H. Wilder Foundation; 1998. [Google Scholar]
  • 12.Centers for Disease Control and Prevention Youth risk behavior surveillance—United States, 1999 MMWR Morb Mortal Wkly Rep 200049SS-51–94.10993565 [Google Scholar]
  • 13.Hingson RW, Strunin L, Berlin BM, Heeren T. Beliefs about AIDS, use of alcohol and drugs, and unprotected sex among Massachusetts adolescents. Am J Public Health. 1990;80:295–299. doi: 10.2105/AJPH.80.3.295. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 14.Ford K, Norris A. Urban minority youth: alcohol and marijuana use and exposure to unprotected intercourse. J Acquir Immune Defic Syndr. 1994;7:389–396. [PubMed] [Google Scholar]
  • 15.Lowry R, Holtzman D, Truman BI, Kann L, Collins JL, Kolbe LJ. Substance use and HIV-related sexual behaviors among US high school students: are they related? Am J Public Health. 1994;84:1116–1120. doi: 10.2105/AJPH.84.7.1116. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 16.Kral AH, Molnar BE, Booth RE, Watters JK. Prevalence of sexual risk behaviour and substance use among runaway and homeless adolescents in San Francisco, Denver and New York City. Int J STD AIDS. 1997;8:109–117. doi: 10.1258/0956462971919651. [DOI] [PubMed] [Google Scholar]
  • 17.Centers for Disease Control and Prevention Alcohol policy and sexually transmitted disease rates—United States, 1981–1995. MMWR Morb Mortal Wkly Rep. 2000;49:346–349. [PubMed] [Google Scholar]
  • 18.Harrison PA, Fulkerson JA, Beebe TJ. Multiple substance use among adolescent physical and sexual abuse victims. Child Abuse Neglect. 1997;21:529–539. doi: 10.1016/S0145-2134(97)00013-6. [DOI] [PubMed] [Google Scholar]
  • 19.Centers for Disease Control and Prevention Assessment of street outreach for HIV prevention—selected sites, 1991–1993. MMWR Morb Mortal Wkly Rep. 1993;42:873–873. [PubMed] [Google Scholar]
  • 20.Rotheram-Borus MJ, Koopman C, Haignere C, Davies M. Reducing HIV sexual risk behaviors among runaway adolescents. JAMA. 1991;266:1237–1241. doi: 10.1001/jama.266.9.1237. [DOI] [PubMed] [Google Scholar]
  • 21.Centers for Disease Control and Prevention Update: syringe exchange programs—United States, 1998. MMWR Morb Mortal Wkly Rep. 2001;50:384–387. [PubMed] [Google Scholar]
  • 22.Allen DM, Lehman JS, Green TA, Lindegren ML, Onorato IM, Forrester W. HIV infection among homeless adults and runaway youth, United States, 1989–1992. AIDS. 1994;8:1593–1598. doi: 10.1097/00002030-199411000-00011. [DOI] [PubMed] [Google Scholar]
  • 23.Goodman E, Berecochea JE. Predictors of HIV testing among runaway and homeless adolescents. J Adolesc Health. 1994;15:566–572. doi: 10.1016/1054-139X(94)90140-X. [DOI] [PubMed] [Google Scholar]
  • 24.Wang EE, King S, Goldberg E, Bock B, Milner R, Read S. Hepatitis B and human immunodeficiency virus infection in street youths in Toronto, Canada. Pediatr Infec Dis. 1991;10:130–133. doi: 10.1097/00006454-199102000-00011. [DOI] [PubMed] [Google Scholar]
  • 25.Sweeny P, Lindegren ML, Buehler JW, Onorato IM, Janssen RS. Teenagers at risk of human immunodeficiency virus type 1 infection: results from seroprevalelnce surveys in the United States. Arch Pediatr Adolesc Med. 1995;149:521–528. doi: 10.1001/archpedi.1995.02170180051007. [DOI] [PubMed] [Google Scholar]
  • 26.Centers for Disease Control and Prevention Immunization of adolescents: recommendations of the Advisory Committee on Immunization Practices, the American Academy of Pediatrics, the American Academy of Family Physicians, and the American Medical Association. MMWR Morb Mortal Wkly Rep. 1996;45(RR-13):1–16. [PubMed] [Google Scholar]
  • 27.Hahn JA, Page-Shafer K, Lum PJ, Ochoa K, Moss AR. Hepatitis C virus infection and needle exchange use among young injection drug users in San Francisco. Hepatology. 2001;34:180–187. doi: 10.1053/jhep.2001.25759. [DOI] [PubMed] [Google Scholar]
  • 28.Garfein RS, Vlahov D, Galai N, Doherty MC, Nelson KE. Viral infections in short-term injection drug users: the prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. Am J Public Health. 1996;86:655–661. doi: 10.2105/AJPH.86.5.655. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 29.HIV/AIDS Treatment Information Service. Guidelines for the use of antiretroviral agents in HIV-infected adults and adolescents, updated August 13, 2001. Available at: www. hivatis.org/trtgdlns.html. Accessed October 6, 2001.
  • 30.Lauer GM, Walker BD. Hepatitis C virus infection. N Engl J Med. 2001;345:41–52. doi: 10.1056/NEJM200107053450107. [DOI] [PubMed] [Google Scholar]
  • 31.Centers for Disease Control and Prevention Hepatitis B virus: a comprehensive strategy for eliminating transmission in the United States through universal childhood vaccination: recommendations of the Immunization Practices Advisory Committee (ACIP) MMWR Morb Mortal Wkly Rep. 1991;40(RR-13):1–25. [PubMed] [Google Scholar]
  • 32.HIV/AIDS Treatment Information Service. Public Health Service Task Force recommendations for use of antiretroviral drugs in pregnant HIV-1-infected women for maternal health and interventions to reduce perinatal HIV-1 transmission in the United States. Updated May 4, 2001. Available at: www.hivatis.org/trtgdlns.html. Accessed October 6, 2001.
  • 33.Weinhardt LS, Carey MP, Johnson BT, Bickham NL. Effects of HIV counseling and testing on sexual risk behavior: a meta-analytic review of published research, 1985–1997. Am J Public Health. 1999;89:1397–1405. doi: 10.2105/AJPH.89.9.1397. [DOI] [PMC free article] [PubMed] [Google Scholar]
  • 34.Rotheram-Borus MJ, Futterman D. Promoting early detection of human immunodeficiency virus infection among adolescents. Arch Pediatr Adolesc Med. 2000;154:435–439. doi: 10.1001/archpedi.154.5.435. [DOI] [PubMed] [Google Scholar]
  • 35.Centers for Disease Control and Prevention Update: HIV counseling and testing using rapid tests—United States, 1995. MMWR Morb Mortal Wkly Rep. 1998;47:211–215. [PubMed] [Google Scholar]
  • 36.King SD, Wynter SH, Bain BC, Brown WA, Johnston JN, Delk AS. Comparison of testing saliva and serum for detection of antibody to human immunodeficiency virus in Jamaica, West Indies. J Clin Virol. 2000;19:157–161. doi: 10.1016/S1386-6532(00)00143-8. [DOI] [PubMed] [Google Scholar]
  • 37.Minnesota Department of Health Hepatitis B vaccination—new school requirements. Dis Control Newsl. 1998;26:32–32. [Google Scholar]
  • 38.Centers for Disease Control and Prevention. Estimated vaccination coverage with individual vaccines and selected vaccination series among children 19–35 months of age by state—US National Immunization Survey, Q1/2000-Q4/2000. Available at: www.cdc. gov/nip/coverage. Accessed October 6, 2001.
  • 39.Centers for Disease Control and Prevention Hepatitis B vaccination of adolescents—California, Louisiana, and Oregon, 1992–1994. MMWR Morb Mortal Wkly Rep. 1994;43:605–609. [PubMed] [Google Scholar]
  • 40.Lawrence MH, Goldstein MA. Hepatitis B immunization in adolescents. J Adolesc Health. 1995;17:234–243. doi: 10.1016/1054-139X(95)00165-O. [DOI] [PubMed] [Google Scholar]
  • 41.Centers for Disease Control and Prevention Hepatitis B vaccination for injection drug users—Pierce County, Washington, 2000. MMWR Morb Mortal Wkly Rep. 2001;50:388–390. [PubMed] [Google Scholar]
  • 42.Centers for Disease Control and Prevention Adult immunization programs in nontraditional settings: quality standards and guidance for program evaluation. A report of the National Vaccine Advisory Committee. MMWR Morb Mortal Wkly Rep. 2000;49(RR-1):1–13. [PubMed] [Google Scholar]
  • 43.Kerr DL. Out-of-school youth at risk for HIV infection. J School Health. 1989;59:451–451. doi: 10.1111/j.1746-1561.1989.tb04666.x. [DOI] [PubMed] [Google Scholar]
  • 44.Sherman DJ. The neglected health care needs of street youth. Public Health Rep. 1992;107:433–440. [PMC free article] [PubMed] [Google Scholar]

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