Perceptions and experiences of homeless youth vary by race, UCSF study shows

The self-perceptions and life experiences of young homeless people vary significantly by race, according to a new study by researchers at the University of California, San Francisco. The findings underscore the need for a more tailored approach to youth homelessness intervention and prevention programs.

UCSF researchers surveyed 205 white and African American youth in San Francisco who had been homeless in the prior six months, and discovered two groups who told starkly different stories about life on the streets and how they ended up there.

Colette (Coco) Auerswald , M.D., M.S. Assistant Adjunct Professor. PHONE: (415) 476-6692, FAX: (510) 643-8771, LOCATION: 570 University Hall. E-MAIL: auerswaldc@peds.ucsf.edu

"During the course of the study it became clear that while these two groups of homeless youth occupied the same geographic spaces, they seemed to inhabit very different worlds," said senior study author Colette Auerswald, MD, MS, an associate professor of pediatrics and adolescent medicine specialist at UCSF Children's Hospital. The study is currently published online by the journal "Social Science and Medicine" and is available at http://dx.doi.org/10.1016/j.socscimed.2008.12.030. It will appear in an upcoming print edition of the journal. A combination of ethnographic interviews and epidemiological surveys was used to collect data about issues related to family, housing status, self-identification, street survival strategies, service utilization, and drug use.

The researchers found that the majority of white homeless youth in San Francisco had come from other parts of California and the United States. The African Americans were all born and raised in the greater San Francisco Bay Area.

"Our findings showed the African American youth come from Bay Area communities that are in decline with limited opportunities for young people and their families. The resulting dysfunction and lack of resources to support them at home drive them to the streets," said Benjamin Hickler, the study's first author and a PhD candidate in the Medical Anthropology Program at UCSF and UC Berkeley. "White youth, in contrast, are more likely to be runaways from dysfunctional homes where the cost of staying comes at too high a physical and emotional price."

With regard to family relationships, African American youth maintained closer ties to their families than white youth. While 27 percent of the African Americans said they had stayed with their families in the prior month, only 8 percent of the whites had done so.

The researchers also examined the severity of homelessness in the two groups and found that 81 percent of white youth reported being homeless the night before the interview, compared to 62 percent of African Americans. In addition, 81 percent of whites reported being literally homeless – meaning they had lived in a place not meant for human habitation in the last month, such as on the street, in a park, or in a vehicle – compared to 37 percent of African Americans.

The degree to which each group identified with being homeless also varied significantly. In general, white youth seemed to embrace the label of "homelessness" and maintain outward appearances that "looked the part," including having poor hygiene, tattoos and piercings. African Americans had a very different attitude toward being homeless, with many saying it was shameful and something that should be hidden at all costs, while also emphasizing the importance of appearing financially prosperous.

"That difference in self-identity is one of the most salient between the two groups," Auerswald said. "It shows that, in order to be successful, intervention programs must be consistent with the ways in which these kids view themselves. By defining themselves differently, they are also defining their needs differently."

Auerswald also emphasized the importance of having intervention programs that address long-term housing needs and offer vocational services for homeless youth, in addition to basic street outreach efforts.

For both African American and white youth, drug dealing was a common source of income on the streets, with 40 and 36 percent of each group, respectively, reporting that they sold drugs – primarily marijuana. The two groups were also equally as likely to have engaged in survival sex (sex for money, drugs or shelter) with 16 percent of all youth surveyed reporting that they had done so. White youth, however, were significantly more likely to engage in other activities associated with homelessness, such as panhandling or selling items on the sidewalk.

Patterns of drug use also varied between groups. Although both groups reported regularly using marijuana and alcohol, they had very different experiences with injection drugs. Only 1.7 percent of African Americans said they had injected drugs at some point in their lives, compared to 44 percent of white youth. This difference was reflected in a much higher rate of hepatitis C infection among whites.

In the first part of the study, the researchers conducted in-depth, face-to-face interviews with 54 homeless youth in San Francisco between 15 and 24 years old. The information collected during these interviews was used to generate hypotheses about the similarities and differences between groups. These hypotheses were then validated by surveying the larger sample of 205 youth in the same age range. ###

Study participants were recruited on the streets, in three San Francisco neighborhoods where homeless youth typically congregate. Data were collected from May 2003 to March 2005.

The research was funded primarily through the National Institute of Child Health and Development. Additional funding came from the UCSF Research Evaluation and Allocation Committee and the Health Resources and Services Administration Title IV/Ryan White Funds.

One of the nation's top children's hospitals, UCSF Children's Hospital creates an environment where children and their families find compassionate care at the healing edge of scientific discovery, with more than 150 experts in 50 medical specialties serving patients throughout Northern California and beyond. The hospital admits about 5,000 children each year, including 2,000 babies born in the hospital.

UCSF is a leading university dedicated to promoting health worldwide through advanced biomedical research, graduate-level education in the life sciences and health professions, and excellence in patient care. For further information, visit www.ucsf.edu.

Contact: Kate Schoen kschoen@pubaff.ucsf.edu 415-476-2557 University of California - San Francisco