What Type of Transience Places Homeless Youth at Risk for Drug Use and Addiction?

Background: Transience, or frequent mobility, is a robust predictor of substance use among homeless youth. However, it is not clear how transience places youth at risk, with some proposing instability is created through multiple moves and others suggesting risk is associated with the unfamiliar surroundings associated with moving to a new location. One key to better understanding this risk factor is to differentiate types of transience and their relative influence on drug use. The current study builds on previous research by comparing two forms of transience--intracity transience (moves within a metropolitan area) and intercity transience (moves between cities)--and their relationships to homeless youths’ use of various drugs and their drug addiction. Such inquiry will help develop a more nuanced understanding of how transience places homeless youth at risk, thereby informing services aimed at buffering youth from use and addiction.

Methods: Data were collected from cross-sectional quantitative interviews conducted in a multisite study of homeless youth (N=601), ages 18-24, seeking services in Denver (n=201), Austin (n=200) and Los Angeles (n=200). A retrospective interview, utilizing standardized and researcher-developed measures, sought information on demographics, primary living situation, duration of homelessness, and self-reported, past-year, use of a list of drugs (i.e., marijuana, prescription pills, cocaine, inhalants, and heroin). In addition, the Mini International Neuropsychiatric Interview assessed whether youth met DSM-IV criteria for a drug addiction (abuse/dependence). Transience was measured with a calendar-based event history instrument tracking all moves since the youth left home until interview location; this variable was then recoded into two count variables: intracity transience and intercity transience. Six logistic regression models were analyzed. Controlling for demographic and homelessness factors, each model investigated whether intracity and intercity transience predicted youths’ use of each of the 5 types of substances (i.e., marijuana, prescription pills, cocaine, inhalants, and heroin) as well as meeting criteria for drug addiction. Bonferroni correction (p<.008) was used to adjust for multiple comparisons.

Results: Youth moved between cities (M=3.5, SD=3.7) more than they moved within cities (M=.80, SD=1.3). Intercity transience was associated with an increased odds of using marijuana (OR=1.14, p<.001),  cocaine (OR=1.16, p<.001),  prescription pills (OR=1.16, p<.001), inhalants (OR=1.17,p<.001), and heroin (OR=1.22,p<.001) and increased odds of drug addiction (OR=1.13, p<.001). Conversely, intracity transience did not significantly increase risk in any of the models.

Discussion: Intercity transience, as opposed to intracity transience, appears to be a risk factor for substance use and addiction among homeless youth. Moving further, to potentially unfamiliar environments, may expose youth to substance use opportunities and/or substance-using peer groups. Such moves may also heighten risk by requiring youth to disengage from established support systems and resources, whereas, moves within a city may not involve such disruption. It is also possible that substance use and addiction encourage moves between cities to seek substances or make money to fund substance use.  Further research is needed understand how intercity transience places youth at risk and how services may stabilize youth within one metropolitan area as protection.