A representative sample of newly homeless adolescents was recruited in Los Angeles County. Three criteria were used to select participants: 1) age ranging from 12 to 20 years; 2) spent at least two consecutive nights away from home without parent/guardian’s permission if under age 17 years or been told to leave home if aged 18 to 20 years; and 3) had been away from home for six months or less. Using six months as the cut-off period to define newly homeless adolescents was determined from conversations with service providers. The number of episodes was not included in the operational definition because the length of time out of home is a more critical measure of the level of homelessness experience than number of times out of home. These adolescents often have a pattern of going back and forth between the streets and home before actually leaving home, so youth who report multiple episodes of homelessness over a short period are unlikely to be considered “chronically” homeless youth. The baseline sample consisted of 262 newly homeless adolescents.
Recruitment sites were selected through a systematic process. First, all of the potential recruitment sites for homeless adolescents in Los Angeles County were identified by interviewing line and supervisory staff in agencies that served homeless adolescents throughout the county (Brooks, Milburn, Witkin, & Rotheram-Borus, 2004
). Thirty sites were identified, including 17 shelters and drop-in centers and 13 street hangout sites. Next, the sites were audited at pre-selected times and days per week over three different week-long time periods. This determined the number of homeless adolescents that could be found at each site to develop a representative sampling plan that encompassed the entire geographic region of the county (Milburn et al., 2005
, for a detailed description of the sampling; Witkin, Milburn, Rotheram-Borus, Brooks, & Batterham, in press
Based on the sampling plan, interviewers were sent out in pairs to screen and recruit eligible homeless adolescents from July 2000 to March 2002. Interviewers screened adolescents with a 13-item screening instrument to determine whether they were eligible to participate in the study. The screening instrument masked the eligibility criteria, confirmed eligibility, and established the length of time the adolescent had been away from home. Following screening, voluntary informed consent was obtained from each adolescent, with the caveats that physical or sexual abuse, suicidal and homicidal feelings would be reported. Informed consent was obtained directly from all participants 18 years and older. For minors, en locus parentis consent was obtained from a member of the outreach (recruitment) team present, and assent was obtained from the minor. The study fulfilled all human subject guidelines and was approved by the Institutional Review Board (IRB) at the University of California, Los Angeles. All newly homeless adolescents who were eligible and agreed to participate were included in the study, resulting in a sample of 262 adolescents. The refusal rate for newly homeless adolescents was 9.3%. Results from overall chi-square tests, examining race/ethnicity, gender and age, showed newly homeless adolescents who refused to participate tended to be European-American and older.
The 227 adolescents who completed the six month follow-up assessment comprised the sample for this paper. The mean age of these newly homeless adolescents was 15.5 years (± SD = 1.9 years). Most were female (60%) and ethnic/racial minorities (23% African-American, 31% U.S.-born Latino, 14% foreign-born Latino, 2% American Indian, < 1% Asian/Pacific Islander and 12% mixed-race/ethnicity). Mixed-race/ethnicity included African-American and European-American (26%), Latino and European-American (33%), African-American and Latino (15%) and other mixed-race/ethnicity identities (26%). Most (84%) were heterosexual.
All interviews were conducted face-to-face by trained interviewers using an audio-taped computer assisted interview schedule that lasted between 1 and 1 ½ hours. Paper and pencil surveys were used at a few street sites out of necessity. The interviewers received approximately 40 hours of training, which included lecture, role-playing, mock surveys, ethics training, emergency procedures, and technical training. Participants received $20 as compensation for their time for the baseline interview and $30 for the follow-up at six months. Up to six follow-up assessments were completed by the newly homeless adolescents, at 3, 6, 12, 18, 24 and 30 months after the baseline interview. The six month follow-up rate was 88% (n = 227). Tracking was done systematically to maintain participant retention. At baseline, participants signed Social Security and General Tracking consent forms for tracking purposes. At baseline and each follow-up, interviewers filled out a locator form asking participants for their primary contact information (e.g., phone number and/or mailing address) as well as the contact information (e.g., phone number and/or mailing address) for family, friends, and service providers to determine how each participant could be found in the future. One month prior to the opening of participants’ assessment windows, retention cards were mailed to participants using their contact information to remind them of their upcoming interviews. This mailing included postcards for participants to mail back updated contact information as well as a study phone number that accepted collect calls for participants to call to schedule their follow-ups. Seasonally, greeting cards (e.g., Happy Holidays!) were mailed to participants to remind them about the study. Birthday cards were also sent to participants during their birth month. When participants were due for follow-ups, the primary methods for tracking were the retention card mailing and phone calls to the participants and/or their family, friends, and service provider contacts. On occasion, interviewers would locate participants in the streets or at agencies while doing outreach work.
The measures used in this paper were administered as part of a 1½ hour interview that included other measures pertaining to homelessness, mental health, and HIV risk. Exiting homelessness was defined as returning to stable housing, as assessed by an item with 21 response categories that asked adolescents where they were currently living. Adolescents were coded as exiting homelessness (1) if they responded that they were living in any of the following situations: birth (biological) family home, foster family home, step-family home, grandparent’s home, relative’s home, boarding school, adoptive family home, or own apartment. Adolescents were coded as not exiting homelessness (0) if they responded they were living in the following situations: friend’s house, family group home, early adolescent unit, medium-term accommodation, refuge/shelter/single-room occupancy, hotel/motel, secure welfare unit, juvenile detention center/jail, Job Corps facility, psychiatric hospital, caravan park (trailer park), street/squat/abandoned building, or if they refused to answer the question. Adolescents who responded that they lived in some “other” situation were treated on a case-by-case basis, and categorized into one of the situations listed above.
Age, gender, race/ethnicity, and sexual orientation were ascertained at baseline and six months. Age was determined at baseline from the reported date of birth. Gender was reported at baseline as male, female, transgender male-female, or transgender female-male. None of the newly homeless adolescents reported they were transgender. Race/ethnicity was asked as a single choice item, “Which of these would you say is your main racial or ethnic group? White or Caucasian but not Hispanic or Latino, Black or African-American but not Hispanic or Latino, Hispanic or Latino, American Indian or Alaskan Native, Asian or Pacific Islander, Mixed-race, or Other.” Five categories were used for the analysis involving race/ethnicity comparisons: European-American, African-American, U.S.-born Latino, foreign-born Latino, or mixed-race/ethnicity. If adolescents reported that they were “mixed-race/ethnicity,” they responded to an open-ended item: “What mixed-race is that?” Responses were classified as African-American and European-American, Latino and European-American, African-American and Latino, or other mixed racial/ethnic identities. These mixed-race ethnicity categories were based upon adolescents’ self-reports of their mixed-race/ethnicity. Hence, some categories may seem atypical. American Indian (n = 4), Asian/Pacific Islander (n = 1), and other racial/ethnic group (n = 1) were excluded from analysis that involved race/ethnicity comparisons due to the small sample sizes for these categories. Latino participants were categorized as U.S.-born or foreign-born based upon their responses to one item: “Were you born in this country?” Sexual orientation was a dichotomous item: those who identified as bisexual, gay, lesbian, or undecided/unsure were classified as LGB and those who did not were classified as heterosexual. The four adolescents who were “undecided/unsure” of their sexuality at baseline were also included in the analysis on discrimination because they were asked the follow-up questions regarding discrimination based on sexual orientation. We assumed in designing our measures that adolescents who were uncertain about how to report their sexual orientation were more likely to be LGB.
was defined as harassment (i.e., being verbally or physically hassled or abused because of one’s social status). It had two dimensions: the source of the harassment (police, peers or family) and the social status that was the target of the harassment (being homeless, being gay, lesbian, or bisexual, or being a racial/ethnic minority). The discrimination measure used in this analysis was adapted from Fisher and colleagues (2000)
and Diaz and Ayala (2001)
, with the specific problems of adolescent homelessness in mind. Our adaptation of the discrimination scale combined psychometric testing from previous research with Latino gay men (e.g., Diaz & Ayala, 2001
) and discussions with service providers and other investigators to tailor the items to the experiences of homeless adolescents.
Discrimination was assessed by nine items at baseline and six months that asked participants if they had ever been verbally or physically hassled, abused and/or assaulted by police, peers or family members because of their homeless status, race/ethnicity, or LGB status. For example, adolescents were asked: “In the last three months, have you ever been verbally or physically hassled, abused, and/or assaulted in the places you spend most of your time by the police?”; “In the last three months, have you ever been verbally or physically hassled, abused, and/or assaulted because of your race/ethnicity by the police?”; and, “In the last three months, have you ever been verbally or physically hassled, abused, and/or assaulted because of your being LGB by the police?” Adolescents who responded “yes” to any of the three questions were coded as having experienced harassment (1) from the police due to homelessness, race/ethnicity, or being LGB and those who responded “no” to all three questions were coded as not having experienced harassment (0). The same steps were followed for harassment due to homelessness, race/ethnicity and being LGB by peers and family. These items were combined to create six binary measures: discrimination from family, discrimination from peers, discrimination from police, discrimination due to homelessness, discrimination due to being LGB, and discrimination due to race/ethnicity. For the questions regarding discrimination due to homelessness, the term “homelessness” was not explicitly used in the question text, to mitigate against the possibility that some youth would not identify as “homeless” or find the term stigmatizing, biasing their responses. The questions about discrimination due to being LGB were only asked of adolescents who self-identified as LGB.
Bivariate comparisons using chi-square statistics and McNemar’s statistic were made to examine baseline differences in discrimination by race/ethnicity and sexual orientation; how discrimination changed over time from baseline to six months and whether homelessness status had an effect on changes in discrimination; and differences in discrimination among those who exited homelessness after six months and those who did not. Logistic regression analyses were performed to further investigate the association between discrimination and exiting homelessness. The outcome variable was whether participants had exited homelessness by six months after baseline. Discrimination measures were included as predictors in separate models to examine which, if any, predicted exiting homelessness. Age, gender, ethnicity and sexual orientation were also included in the models to mitigate confounding. Interactions between discrimination and these characteristics were also investigated.