Health and adverse childhood experiences among homeless youth

Andrew J Barnes,Mollika Sajady,Katherine A Lingras,Amy L Gower

doi:10.1186/s12887-021-02620-4

Abstract

BackgroundHomelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. This study investigated the relationship between ACEs, housing, and child health, and whether: 1) ACEs and health vary by housing context; 2) ACEs and homelessness confer independent health risks; and 3) ACEs interact with housing with regard to adolescent health.MethodsUsing data from 119,254 8th–11th graders, we tested independent and joint effects of ACEs and past-year housing status (housed, family homelessness, unaccompanied homelessness) on overall health and chronic health conditions, controlling for sociodemographic covariates.ResultsThe prevalence of ACEs varied by housing status, with 34.1% of housed youth experiencing ≥1 ACE vs. 56.3% of family-homeless and 85.5% of unaccompanied-homeless youth. Health status varied similarly. Homelessness and ACEs were independently associated with low overall health and chronic health conditions, after adjusting for covariates. Compared to housed youth, both family-homeless youth and unaccompanied-homeless youth had increased odds of low overall health and chronic physical and/or mental health conditions. All ACE x housing-status interactions were significant (all p < 0.001), such that ACE-related health risks were moderated by housing status.ConclusionsACEs and housing status independently predict health status during adolescence beyond other sociodemographic risks. Experiencing homelessness, whether unaccomapnied or with family, is associated with increased health risk, and every additional ACE increases this risk. Clinicians and health systems should advocate for policies that include stable housing as a protective factor.

Highlights

Homelessness is associated with health problems and with adverse childhood experiences (ACEs)
Prevalence of Adverse Childhood Experience (ACE) and health problems The sample is described in Table 1; missing data ranged from 0% to 6.0% (ACEs)
Participants were roughly evenly split by sex and grade, and race/ethnicity distributions were consistent with the demographics of Minnesota youth

Summary

Introduction

Homelessness is associated with health problems and with adverse childhood experiences (ACEs). The risk of chronic health conditions for homeless compared to housed youth, and how this risk interacts with ACEs remains unclear. Adverse Childhood Experiences (ACEs) are common during childhood, with over 32 million youth (45%) under 17 years having experienced at least one ACE in the United States [1]. The health consequences of ACEs are well-established in adults [5,6,7,8,9], and increasing evidence suggests that these pernicious effects often emerge during childhood and adolescence. Chronic health conditions that emerge during childhood in the context of ACEs occur along a risk gradient, with each additional ACE conferring

Objectives

Methods

Results

Conclusion