Perceptions of and Factors Associated with Substance Use Among Youth Experiencing Homelessness

Background: Youth experiencing homelessness (YEH) engage in substance use at significantly high rates. To explore more effective ways of changing young people’s engagement in substance use, researchers and practitioners have emphasized the need to better understand YEH’s perceptions of and factors related to substance use and abuse. While there have been many studies assessing factors related to substance use and abuse among YEH from a top-down quantitative approach, few have engaged YEH’s voices through qualitative community-based-participatory-research (CBPR) strategies.

Given these knowledge gaps, this study had two overarching aims:

1. Explore qualitatively how YEH define substances, differentiate between substance use vs. abuse, the most common substances used, and consequences of use on health.
2. Understand YEH’s perceptions of salient factors leading to and deterring substance use and abuse.

Methods: Using a purposive sampling design, recruitment took place at Urban-Peak, a non-profit organization serving YEH located in the Ballpark neighborhood of downtown Denver. Eligibility for this study included engagement in Urban Peak services, ages 18 and below 25, and the ability to speak and understand English. Verbal consent was obtained from all participants. Five focus groups were carried out, and a total of thirty-nine YEH (24 males, 11 females and 4 gender-minority) participated.

Results: Using a content analysis approach, we read transcripts, took notes on initial impressions, and created a preliminary codebook. These coding schemes were then used to label the transcripts. Four members of the research team coded independently and then met to discuss their impressions and reach consensus. We also used multiple strategies to ensure the trustworthiness and rigor of our analysis. We generated an audit trail comprising analytical memos and meeting notes, to track our collective decision‐making process and ensure consistency. Data Analysis revealed four main themes:

1. Differences in perceptions of substance use and abuse: Youth in this study thought of substance abuse as being dependent on a drug for survival, while substance use was considered as using drugs many didn’t consider a drug (such as alcohol and marijuana).
   
2. Context of substance use: Common contexts within which substance use occurred were primarily group settings, including parties and parks. The accessibility and cost of particular drugs were also identified.
3. Motivators for initiating substance use: Identified motivators for initiating substance use included peer influence, using drugs as a coping mechanism and/or for social recreation, and survival.
4. Deterrents of substance use: Identified deterrents to drug use included identifying relatable role models, awareness of the consequences of drug use, as well as identifying personal goals in which drug use would present as a barrier.

Conclusion/Next Steps: Findings highlight the need for researchers and practitioners to avoid developing and implementing substance use interventions based on their preconceived assumptions of substance use, and instead work with YEH to explore their preferences around both the definitions and interventions related to substance use. Additionally, more research is needed to assess the effectiveness of employing CBPR strategies in interventions targeted towards YEH.