A University of California, Berkeley, study of homeless teens living on the streets of San Francisco found that they have a 10 times higher mortality rate than their peers, mostly due to suicide and substance abuse.
“This population is highly stigmatized. That stigma leads to neglect and, in turn, to increased mortality. All the deaths in this cohort were preventable,” said the study’s main author, Colette Auerswald, a pediatrician and adolescent medicine specialist who is an associate professor of public health at UC Berkeley. “Stigma kills.”
The study will appear online April 14 in the open-access journal PeerJ. Auerswald, co-founder of Innovations for Youth (I4Y), the UC Berkeley School of Public Health’s center for adolescent population health, co-authored the study with Jessica Lin of UC Berkeley’s School of Public Health and Andrea Parriott of UCSF’s Phillip R. Lee Institute for Health Policy Studies.
“These sobering data provide evidence of what homeless youth face when their only option is life on the streets,” added Sherilyn Adams, executive director of Larkin Street Youth Services in San Francisco. “We must not ignore or underestimate the gravity of homelessness or its tragic impact on young lives cut short. No young person deserves to die a preventable death because they didn’t get the help they needed.”
The most recent HUD-mandated point-in-time count in San Francisco, mandated by the Department of Housing and Urban Development, led to an estimate that 1,378 homeless young people are on the streets of San Francisco on any given night, though most of them cycle in and out of their homes because of abuse, family problems or drug use, Auerswald said. In an editorial she wrote last week for the journal JAMA Pediatrics, she praised a new study that reinforced the fact that homeless youth are not homeless by choice.
“That study once again blew out of the water the myth that youth either choose to be on the street or are on the street because they are delinquents,” she said. “For the vast majority of youth in developed countries, homelessness is due to abuse or neglect or family conflict, often related to poverty.”
Auerswald’s study was conducted between 2004 and the end of 2010 as part of a larger longitudinal study of the effect of social environments on the health of homeless youth in San Francisco. The study involved 218 youths 15 to 24 years of age, two-thirds of them male and one-third female. Young people were considered to be homeless if they reported unstable housing for at least two days during the previous six months — that is, they lived outside their home with non-family members, such as in a car, a shelter, a squat, outdoors, with a stranger or someone they did not know well, on public transportation or in an SRO hotel.
During the six-year period, 11 died – eight men and three women, or 5 percent of the study group – 10.6 times higher than expected for a similar group matched for age, race and gender. Six of the deaths took place outside California.
Auerswald acknowledged that the study was relatively small, but its findings are in line with other data in Europe and the US. A recent census-based study of life expectancies in Canada found that a 25-year-old male living in shelters, rooming houses or hotels had a 32 percent chance of surviving to the age of 75, as compared to 51 percent of housed males from the lowest-fifth income bracket.
“This is the first North American study of mortality, and the only one I know of globally, focused solely on a street-based cohort of youth,” Auerswald said.
In this study, young women were slightly more likely to die than young men: They had a mortality rate 16.1 times greater than their race- and age-matched female peers. The homeless young men were 9.4 times more likely to die than their race- and age-matched male peers.
“The bottom line is to have a society that gives youth safe options for not living on the street, that does not tolerate youth homelessness as an acceptable option for our youth,” she said.