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Over 3.5 million young people ages 18-25 in the United States experience some form of homelessness annually. Young people experiencing homelessness (YEH) are disproportionately impacted by substance use. Illicit substance use such as cocaine, crack and methamphetamine are a cause for concern among YEH. This current study builds on previous research by (1), describing, with greater specificity, patterns and correlates of illicit substance use across a large, national, 7-city sample, and (2) identifying risk factors associated with specific illicit substances.
Methods:
From June 2016 to July 2017, 1,426 YEH (aged 18–26) were recruited from seven cities (Houston, Los Angeles, Denver, Phoenix, New York City, St. Louis, San Jose). Participants provided information via a self-administered electronic survey on substance use, mental health, trauma, and sexual-risk behaviors. Multivariable logistic regression models were utilized to assess demographic, psychological, and behavioral correlates of self-reported past-month illicit substance use (cocaine, crack, methamphetamine, ecstasy, and IDU).
Results:
Approximately 17.7% had used cocaine, 8.2% crack, 17.5% methamphetamine, 15.4% ecstasy, and 8.6% had engaged in IDU. In regards to substance use across study sites, methamphetamine use was the highest in three cities (LA, Denver and St. Louis), cocaine was highest in two cities (San Jose and New York) and ecstasy use was the highest in Phoenix.
In regards to demographic and other behavioral characteristics, multivariate logistic regressions revealed that gender (OR=.21, p<.01), sexual orientation (OR=.30, p<.05), having a history of suicidal ideation (OR=6.07, p<.01) and survival sex (OR=.04, p<.001) was associated with crack use. Age (OR=1.18, p<.01), and gender (OR=2.09, p<.01) was associated with methamphetamine use. While there were no geographical differences for cocaine use, YEH who were interviewed in San Jose (OR=3.15, p<.05) and Houston (OR=7.77, p<.001) were more likely to engage in ecstasy use, YEH in Denver (OR=9.33, p<.05) were more likely to use crack, YEH in Phoenix (OR=2.31, p<.05) were more likely to use methamphetamine, YEH in San Jose (OR=4.54, p<.05) were more likely to engage in injection drug use relative to YEH interviewed in Los Angeles.
The multivariate findings also reflected the clustered nature of substance use. Marijuana use was associated with ecstasy use (OR=2.03, p<.01), cocaine use (OR=3.03, p<.001) but not crack, methamphetamine or IDU. Synthetic marijuana use was associated with ecstasy use (OR=3.41, p<.001), cocaine use (OR=2.62, p<.01), crack use (OR=6.27, p<.01), methamphetamine use (OR=3.61, p<.001), but not IDU. Methamphetamine use was associated with ecstasy use (OR=3.01, p<.01), cocaine use (OR=3.13, p<.001), crack use (OR=4.52, p<.05) but not IDU. Cocaine use was associated with ecstasy use (OR=10.86, p<.001), crack use (OR=92.88, p<.001), methamphetamine use (OR=2.98, p<.001), but not IDU. Heroin use was associated with cocaine use (OR=15.80, p<.001), crack use (OR=8.23, p<.01), methamphetamine use (OR=25.36, p<.001), IDU (OR=22.42, p<.001), but not ecstasy use.
Conclusions:
This study is significant because it reveals geographic differences in rates and types of substance use. These geographical differences may reflect various drug-use patterns across the country and might further indicate a need for targeted interventions that encompass local and regional contexts.