Corliss et al. Respond

Abstract

The letter by Rice et al. provides further evidence that sexual-minority adolescents are at greater risk for homelessness than adolescents in general. To understand the scope of the problem nationally, we strongly urge surveillance mechanisms, such as the Youth Risk Behavior Surveillance System (YRBSS), to collect standardized data on sexual orientation and homelessness. In addition to Massachusetts, a number of other state and regional YRBSSs collect sexual orientation data. Standardizing sexual orientation questions across surveys and increasing the number of surveys that collect these data will improve our ability to quantify the scope of the problem. Additionally, we suggest using a homeless question like the one in the Massachusetts YRBSS1 because it is based on the McKinney-Vento2 federal definition of homelessness (i.e., lacking a fixed, regular, and adequate nighttime residence) and provides detailed information on type of living situation and unaccompanied status. As Rice et al. note, there is great variation in homelessness by region. There are also regional differences in attitudes toward homosexuality and gender-role norms.3,4 Systematic data collection will allow us to examine how risk for homelessness in sexual-minority teens may vary by region and other sociodemographic characteristics such as race/ethnicity and gender. The 2005 Massachusetts YRBSS estimated that 4.2% of Massachusetts public high school students were homeless, yet only 0.6% of Massachusetts high school students were identified by schools as homeless during the 2004–2005 academic year.5 Health and social service professionals need to do a better job working with schools to identify homeless students and to link them with services to find stable housing, to assist them with their educational needs, and to support their health and well-being. In public health, these efforts are known as secondary (i.e., intervening early to end homelessness) and tertiary (i.e., providing services to those currently homeless such as temporary shelter, food, and other social and medical services) prevention efforts. Equally important are primary prevention efforts that focus on preventing homelessness in the first place. Efforts to identify effective primary, secondary, and tertiary prevention strategies for sexual-minority youth at risk for homelessness are clearly needed. What strategies help families overcome challenges leading to sexual-minority teen homelessness? Are programs in schools and communities for homeless youth effective at reaching sexual minorities and addressing their specific needs? Because homeless sexual-minority teens are likely to be unaccompanied by their parents/guardians, does this influence their access to shelter-based and other services? Answers to these and other questions will help us eliminate the unconscionable sexual orientation disparities in youth homelessness.