Health inequalities among homeless adolescents

this is a convergent parallel mixed-methods study. The population consisted of adolescents who are homeless, with purposeful sampling and data saturation. Quantitative data were obtained with a questionnaire and qualitative data through semi-structured interviews.

Results:

19 homeless adolescents participated in the study, 13 (68.4%) aged 16 to 19 years; 11 (57.9%) were male, 3 (15.8%) were female, and 5 (26.3%) were transgender adolescents. Participants experienced different levels of exposure and vulnerabilities to conditions that affect health and were directly related to intermediate determinants of health.

Conclusion:

this study provides an understanding of the inequalities related to the health of homeless adolescents and shows evidence that supports strategies to promote equity and dignity in health care.

Descriptors:
Nursing; Adolescent; Vulnerable Populations; Homeless People; Social Determinants of Health; Contextual Effects of Health Disparities

Highlights:

(1) Contribute with strategies towards equal access to health services and dignity in adolescent care. (2) Understand the health needs of homeless adolescents. (3) Reflect on adolescent health care. (4) Support the health system and reduce health inequities.

Characteristic	Frequency	Percentage	Cumulative percentage
ID document possession
Birth/marriage certificate	9	47.4	47.4
ID card	2	10.5	57.9
ID card and birth/marriage certificate	5	26.3	84.2
ID card, CPF^*	2	10.5	94.7
No document possession	1	5.3	100.0
Illnesses and health problems of Homeless adolescents
Yes	9	47.4	47.4
No	10	52.6	100.0
Place they go when they have health problems
Public health center	8	42.1	42.1
Hospital/UPA^†	9	47.4	89.5
Does not know/remember	2	10.5	100.0

Characteristic	Test	Value	Degrees of freedom	P-value
ID document/Age group	Pearson’s chi-square	1.310	1	0.252
	Likelihood ratio	1.326	1	0.250
	Linear-by-linear association	1.241	1	0.265
	Number of valid cases	19
ID document/Race	Pearson’s chi-square	6.632	4	0.157
	Likelihood ratio	7.250	4	0.123
	Linear-by-linear association	0.010	1	0.920
	Number of valid cases	19
Illnesses and health problems on the streets/Age group	Pearson’s chi-square	3.161	4	0.531
	Likelihood ratio	4.603	4	0.330
	Linear-by-linear association	0.934	1	0.334
	Number of valid cases
Illnesses and health problems on the streets/Gender identity	Pearson’s chi-square	4.852	2	0.088
	Likelihood ratio	6.125	2	0.047
	Linear-by-linear association	4.546	1	0.033
	Number of valid cases	19
Illnesses and health problems on the street/Race	Pearson’s chi-square	1.552	1	0.213
	Likelihood ratio	1.598	1	0.206
	Linear-by-linear association	1.470	1	0.225
	Number of valid cases	19

Characteristic	Frequency	Percentage	Cumulative percentage
Sleep at a house	6	31.6	31.6
Sleep on the street	13	68.4	100.0
Sleep alone	11	57.9	57.9
Sleep with a partner	8	42.1	100.0
Buy own food	12	63.2	63.2
Eat at an accessible restaurant	7	36.8	100.0
Personal hygiene on the street	4	21.1	21.1
Personal hygiene in public toilets	11	57.9	78.9
Personal hygiene at parents’ house/their house	4	21.1	100.0

Characteristic	Test	Value	Degrees of freedom	P-value
Where they sleep/Age group	Pearson’s chi-square	1.377	1	0.241
	Likelihood ratio	1.336	1	0.248
	Linear-by-linear association	1.305	1	0.253
	Number of valid cases	19
Who they sleep with/Age group	Pearson’s chi-square	0.224	1	0.636
	Likelihood ratio	0.223	1	0.637
	Linear-by-linear association	0.212	1	0.645
	Number of valid cases	19
Daily food/Age group	Pearson’s chi-square	0.046	1	0.829
	Likelihood ratio	0.047	1	0.829
	Linear-by-linear association	0.044	1	0.834
	Number of valid cases	19
Place of personal hygiene/Age group	Pearson’s chi-square	4.484	2	0.106
	Likelihood ratio	4.270	2	0.118
	Linear-by-linear association	3.196	1	0.074
	Number of valid cases	19
Where they sleep/Gender identity	Pearson’s chi-square	3.292	2	0.193
	Likelihood ratio	4.722	2	0.094
	Linear-by-linear association	1.498	1	0.221
	Number of valid cases	19
Who they sleep with/Gender identity	Pearson’s chi-square	5.276	2	0.072
	Likelihood ratio	6.439	2	0.040
	Linear-by-linear association	4.975	1	0.026
	Number of valid cases	19
Daily food/Gender identity	Pearson’s chi-square	2.122	2	0.346
	Likelihood ratio	3.120	2	0.210
	Linear-by-linear association	0.834	1	0.361
	Number of valid cases	19
Place of personal hygiene/Gender identity	Pearson’s chi-square	2.486	4	0.647
	Likelihood ratio	3.470	4	0.482
	Linear-by-linear association	0.707	1	0.400
	Number of valid cases	19
Where they sleep/Race	Pearson’s chi-square	0.101	1	0.750
	Likelihood ratio	0.105	1	0.746
	Linear-by-linear association	0.096	1	0.756
	Number of valid cases	19
Who they sleep with/Race	Pearson’s chi-square	0.130	1	0.719
	Likelihood ratio	0.128	1	0.720
	Linear-by-linear association	0.123	1	0.726
	Number of valid cases	19
Daily food/Race	Pearson’s chi-square	0.377	1	0.539
	Likelihood ratio	0.368	1	0.544
	Linear-by-linear association	0.357	1	0.550
	Number of valid cases	19
Place of personal hygiene/Race	Pearson’s chi-square	1.360	2	0.507
	Likelihood ratio	2.167	2	0.338
	Linear-by-linear association	1.010	1	0.315
	Number of valid cases	19

Escola de Enfermagem de Ribeirão Preto / Universidade de São Paulo Av. Bandeirantes, 3900, 14040-902 Ribeirão Preto SP Brazil, Tel.: +55 (16) 3315-3451 / 3315-4407 - Ribeirão Preto - SP - Brazil
E-mail: rlae@eerp.usp.br

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[1] Corresponding author: Edna Johana Mondragón-Sánchez E-mail: ejmondragon@uniquindio.edu.co https://orcid.org/0000-0002-7950-2809