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Homeless youth and their exposure to and involvement in violence while living on the streets
JOURNALOF ADOLESCENTHEALTH1997;20:360-367
ORIGINAL ARTICLE
Homeless Youth and Their Exposure to and Involvement in Violence While Living on the Streets M I C H E L E D. KIPKE, Ph.D., T H O M A S R. S I M O N , Ph.D., S U S A N N E B. M O N T G O M E R Y , Ph.D., J E N N I F E R B. U N G E R , Ph.D., A N D ELLEN F. IVERSEN, M.P.H.
Purpose: The purpose of this research were to explore homeless youths' histories of exposure to violence, perpetration of violence, and fear of violent victimization, and to examine the extent to which these constructs are associated with demographic variables. Methods: A sample of 432 youth (between 13 and 23 years old) who were homeless or at imminent risk for homelessness were sampled from both service and street sites. The percentage of youth who reported exposure to each type of violence was calculated. Multiple regression analyses were used to examine differences in the risk of exposure to violence across gender, ethnicity, age, and length of time homeless. Results: Respondents reported a high rate of exposure to violence. Female respondents reported levels of exposure to violence that were as high as those reported by males. Females were more likely to report having been sexually assaulted and fearing victimization, and tended to be less likely to report perpetrating violence. With a few exceptions, ethnic identity was not a significant predictor of exposure to violence or fear of victimization. Age tended to be inversely associated with risk of exposure to violence. Length of time homeless was not associated with fear of victimization. Conclusions: Homeless youth are at high risk for exposure to a variety of forms violence as both witnesses and victims. The overall rates of exposure to violence and patterns of association with demographic variables
From the Division of Adolescent Medicine, Children's Hospital Los Angeles, and the Department of Pediatrics, University of Southern California School of Medicine; and the School of Public Health and Department of Preventive Medicine, Loma Linda School of Medicine, Linda Loma University, Los Angeles, California. Address correspondence to: Michele D. Kipke, Ph.D., Associate Director, Research and Evaluation, Division of Adolescent Medicine, Children's Hospital Los Angeles, P.O. Box 54700, Mailstop No. 2, Los Angeles, CA 90054-0700. Manuscript accepted September 16, 1996. 1054-139X/97/$17.00
PII $1054-139X(97)00037-2
are significantly higher than those reported in national samples of adolescents. © Society for Adolescent Medicine, 1997
KEY WORDS:
Adolescence Homeless Violence
The homicide rate in the United States is highest among those between the ages of 15 and 19 years old (1). Recent evidence suggests that certain subgroups of adolescents are at increased risk for exposure to and involvement in violence, and hence are at increased risk for mortality and morbidity associated with violence. One such group is the runaway and homeless youth population. Indeed, a high percentage of these youth left their homes because they were being physically or sexually abused. For example, a study conducted with 261 Canadian street youth found that 47% of respondents had been physically assaulted by a family member and 15% had been sexually assaulted by a family member (2). In another study which compared runaway youth with homeless adults, the runaways came from more abusive family backgrounds, were more likely to rely on deviant survival strategies, and were more likely to be criminally victimized than their adult counterparts (3). By virtue of the fact that the homeless live on the streets, these youth are exposed on a daily basis to street and gang-related violence. They also become vulnerable to a wide range of attacks, such as physical and sexual assaults, stabbings, and shootings. A
© Societyfor AdolescentMedicine,1997 Publishedby ElsevierScienceInc.,655 Avenueof the Americas,New York,NY 10010
May 1997
study of all homicides occurring in New York City in 1990 and 1991 revealed that the most frequent places of occurrence were the streets and other outdoor places (49.6%) (4). Whereas the very young and older victims are more likely to be killed at home, young males are more likely to be killed on the streets because they spend more time on the streets (5). Although most studies of homeless adults and runaway or homeless youth have not collected data on their perpetration of criminal behavior (6,7), several studies suggest that homelessness is conducive to crime. For example, in a study using data on youths from Colorado and from a national sample of adolescents, 33% of runaways admitted to stealing after leaving home (15% indicated that they stole objects worth $50 or more) and 20% reported stealing drugs (6). The authors also note that these activities were positively associated with the length of time away from home and with the number of previous episodes of homelessness. However, involvement in illegal activities may be largely driven by the need to survive on the streets. The results from previous research with homeless youth suggest that hunger causes theft of food, problems of hunger and shelter lead to serious theft, and problems of unemployment and shelter are associated with prostitution. The purposes of this study were to explore youths' histories of direct and indirect exposure to violence, perpetration of violence, and fear of violence, and to assess the associations among these variables and demographic characteristics. This research was conducted with youth recruited from the Hollywood area of Los Angeles, a geographic area with a high concentration of youth who are homeless or at imminent risk for homelessness (9).
Methods Setting, Sampling Design, and Recruitment Procedures Youth were eligible to participate in the study if they were 12-23 years of age and homeless or at imminent risk for homelessness. Youth were considered homeless if their primary night residence was in a supervised public or private shelter, an institution that provides a temporary residence (e.g., halfway house, motel/hotel, boarding house, treatment facility, prison), or a public or private place not ordinarily used as a regular sleeping accommodation (e.g., on the street, in an abandoned building, park, or abandoned car). Youth were considered to be at imminent risk
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for homelessness if they were temporarily and inadequately housed in a residence that was not their own (e.g., platonic friend's house or apartment). This research project, called Project S.U.N.S. (Searching to Understand New to the Street), was conducted in the Hollywood area of Los Angeles, California. Youth were recruited using systematic sampling methods in an effort to obtain a sample that was representative of the target population in the Hollywood area. Based on an initial community assessment, two distinct yet similar sampling frames were developed, one for "fixed" or service sites (i.e., shelter and drop-in centers) and one for "natural" street sites (i.e., street corners or highly populated blocks) and "hang-outs" (e.g., parks, alleys, bars, fast-food restaurants, etc.). Survey research, filed observations, and service provider census data suggested that sampling within the shelter and drop-in centers located within Hollywood would reach approximately half of the Hollywood runaway, homeless youth population. Thus, three shelters and six drop-in locations were selected for the fixed primary sampling units (PSUs), and 50% of the sampling assignments were at these fixed sites. At each of the fixed PSUs, interviewer teams (consisting of 2-4 members) first reviewed the agency's sign-in roster to determine how many youth were in the agency. They then determined the sampling fraction (from a sampling fraction table) according to the number of potential participants and the number of interviewers. For example, if there were 4 potential participants and 4 interviewers at a particular site, the sampling fraction was 1/1. If there were 15 potential participants and 4 interviewers, the sampling fraction was 1/4. To avoid bias in the selection of youth to interview, the interviewers used a computer-generated, predetermined random start number to determine which potential participant to select from the sign-in roster as the starting point for the selection. The sampling fraction was then used to systematically select potential participants from the sign-in roster. Street-based sampling occurred along five major boulevards within a 12-square-mile area of Hollywood. Along these boulevards, 73 street areas (divided into three block segments), corners, a n d / o r alleys, 4 parks, and 3 restaurants were identified as natural PSUs. At each of the natural PSUs, interviewer teams first determined the number of potentially eligible youth (i.e., along the street block segment, on the street corner, in the alley, or in a previously selected area of a park) and then determined the sampling fraction. Youth were then
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"counted out" and selected according to the sampling fraction and predetermined random start number. Youth selected for recruitment were asked to answer an eight-item screening instrument to determine whether they were eligible to participate in the study. If eligible, youth were asked to participate in a structured interview which was conducted at a nearby coffee shop or fast-food restaurant (such patronage permitted the interview to occur in a safe, quiet setting). A meal worth a maximum of $10 was purchased for the youth, which they ate during the course of the interview. Youth received $3.00 in bus tokens for completing the screening instrument and $10 in food vouchers for completing the interview instrument. The research received formal institutional review board approval, and all subjects signed an informed consent form prior to completing the screening and survey instruments. During the period of July 1994 to September 1995, a total of 601 individuals were approached and asked to complete the screening interview, of whom 17 had been approached two or more times and 29 (5%) refused to participate; thus, a total of 584 were approached only once and 555 were screened for their eligibility to participate in the study. Of those screened, 26 (5%) were ineligible to participate in the study (i.e., 5 youth were too young and 21 were too old, and 14 youth did not meet the criteria for homelessness or imminent risk for homelessness). Of the 515 eligible youth, 83 (16%) refused to participate in the study. The final sample therefore consisted of 432 subjects. This sample represents 84% of the eligible youth contacted, 78% of the youth screened, and 74% of the total number of youth approached for recruitment. Preliminary analyses were conducted to test for differences between youth who volunteered to participate versus those who did not. These analyses revealed no significant gender or ethnic differences between the two groups. However, youth who volunteered to participate in the study were significantly older than those who refused (P < .05). The response rate of 84% was consistent across sampling sites (street and hangout versus service).
Survey Instrument The study is part of a larger research project designed to examine the prevalence of drug use and human immunodeficiency virus (HIV) risk behaviors among youth who are homeless or at imminent risk
JOURNALOF ADOLESCENTHEALTHVol. 20, No. 5
for homelessness, and to explore the natural history of homelessness among youth. All study participants were interviewed for 60-75 rain. The structured interview asked respondents about (a) the violence they had witnessed, including seeing someone being physically attacked by another person, seeing someone being sexually assaulted, seeing someone who was seriously hurt after a violent event or attack, seeing someone being killed by another person, seeing a dead person somewhere in the community, and the number of violent events witnessed within the past year; (b) the violence they had been a victim of, including sexual assault; having been chased; having been threatened with serious physical harm; having been seriously hurt after a violent attack; having been slapped, punched, hit, burned, or beaten; having been attacked or stabbed with a knife; having been shot at (not hit); and having been shot and hit by gunfire; and (c) the violence that they had been perpetrators of, including attacking someone with a knife and shooting at someone. These questions were asked with respect to witnessing, victimization, and perpetration for: (a) ever during the participant's lifetime and (b) since the participant became homeless or began working on the streets. Finally, respondents were asked about their fear of violence, including fear of being stabbed by a knife, shot by a gun, beaten, sexually assaulted, molested, a n d / o r raped. Respondents were provided with three response choices: not at all afraid, somewhat afraid, and very afraid. Responses were dichotomized to indicate no fear versus any level of fear.
Statistical Analysis The binary measures of exposure to violence since living on the streets and fear of violence were included as dependent variables in separate logistic regression models. The demographic variables of gender, ethnicity, and age were entered as simultaneous predictors in each logistic regression model. Because the participants were asked to report exposure to violence since the time that they became homeless or began working on the street, length of time homeless was included as a covariate in each model. Each of the predictor variables was d u m m y coded so that gender = female, age = under 18, ethnicity = white, and time homeless = 0-3 months were used as the reference levels. Odds ratios and 95% confidence intervals were calculated to determine risk of experiencing the dependent variable (exposure to violence or fear) for each level of the
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HOMELESSYOUTHS' EXPERIENCEOF VIOLENCE
Table 1. Demographic profile of the study sample
tories of homelessness, with 31% having been homeless for <3 months, 25% for 3 months to I year, 23% for 1-3 years, and 21% for >-3 years.
(n = 432) Age (yr) ---17 18-19 ->20 Gender Males Females Ethnicity African-American Latino White Other Time homeless 0-3 mo >3 mo to 1 yr >1 yr to 3 yr >3 yr Places slept Friend's (platonic)house or apartment Abandoned building/"squat" Street/subway/abandoned car Shelter or mission Motel, hotel, boarding house With parent or relative Own house or apartment With girl/boyfriendor lover Car, bus, van (not abandoned) Prison/jail Beach/"squat" on the beach
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108 (25) 148 (34) 174 (41) 284 (66) 148 (34)
Witnessing Violence, Victimization, Fear, and Perpetration
87 (20) 65 (15) 215 (51) 59 (14)
Violence exposure rates were extremely high among these youth. Among the total sample, 85% of the participants reported having seen a person being physically attacked (72% since living on the streets), 69% had seen someone who had been seriously hurt from a violent event or attack (57% since living on the streets), 44% had seen a dead person somewhere in the community (30% since living on the streets), 31% had seen someone being killed (20% since living on the streets), and 24% had seen someone being sexually assaulted (16% since living on the streets). Respondents also reported extensive histories of victimization, with 70% having been punched, hit, burned, or beaten up (51% since living on the streets); 65% having been threatened with serious physical harm (50% since living on the streets); 57% having been chased (45% since living on the streets); 33% having been seriously hurt during a violent attack (23% since living on the streets); 32% having been attacked or stabbed by a knife (19% since living on the streets); 37% having been shot at (26% since living on the streets); 14% having been shot at and hit by gunfire (7% since living on the streets); and 32% having been sexually assaulted (15% since living on the streets). The majority of the respondents reported that they were somewhat or very afraid of being shot (58%) or stabbed (56%). Also, nearly half the sample reported experiencing fear of being beaten up (40%), or sexually assaulted, molested, or raped (44%). Although a sizable percentage of respondents reported engaging in violent behavior, rates of perpetration were far lower than rates of victimization. Specifically, 25% of respondents reported having attacked someone with a knife (17% since living on the streets) and 22% reported having shot at someone (14% since living on the streets).
129 (31) 103 (25) 94 (23) 87 (21) 231 (54) 219 (51) 178 (41) 164 (38) 121 (28) 121 (28) 74 (17) 59 (17) 44 (10) 40 (9) 29 (7)
demographic variables relative to the risk for the reference level. Odds ratios >1 indicate a positive association, and odds ratios <1 indicate an inverse association. Confidence intervals which do not ind u d e the value of 1 are statistically significant (P value < .05).
Results As presented in Table 1, the majority of respondents were male (66%) and nearly half the sample were youth from ethnic minorities (49%). Ages ranged from 13 to 23 years. The mean age was 19.0 years. Respondents reported having slept or lived in a variety of different locations within the prior 12 months, with the most common places being a friend's house or apartment (54%), an abandoned building or "squat" (51%), on the street or in an abandoned car (41%), or in a shelter or mission (38%); 9% reported having been in prison or jail within the previous 12 months. The majority of respondents also reported having had extensive his-
Demographic Correlates of Risk for Exposure to Violence, Perpetration, and Fear As shown in Table 2, with the exception of victimization from sexual assault and perpetration of vio-
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lence with a knife, the levels of exposure to violence were surprisingly similar for males and females. There were only two significant gender differences: Females were significantly more likely to have been sexually assaulted, and less likely to have used a knife to attack or stab someone. Females were as likely as males to report having witnessed each of the violent events examined. In addition, females were as likely as males to report having been chased, threatened, attacked by someone with and without weapons, and to have been seriously hurt after a violent attack. However, as shown in Table 2, females reported significantly greater fear of violence for three of the four measures used. Females reported greater fear of being shot, stabbed, and sexually assaulted than males. A nonsignificant trend for greater fear of being beaten up among females was found. With a few exceptions, ethnic identity tended not to be a significant predictor of exposure to violence or level of fear of victimization. However, relative to white youth, African-American youth were less likely to report having seen someone who was seriously hurt after a violent attack, less likely to have been threatened with physical harm, and less likely to have been slapped, punched, hit, burned, or beaten up by someone than white youth. AfricanAmerican youth also were less likely to report fear of being beaten up than white youth. Latino youth were found to be at greater risk for having seen someone being killed by another person (marginally significant), and reported greater fear of being sexually assaulted than white youth. Ethnicity was not associated with risk for perpetration of violence. Age of the respondent was inversely associated with exposure to several types of violence. Relative to those between the ages of 13 and 17 years, respondents in the older age groups tended to be less likely to have seen someone being sexually assaulted, have seen someone being killed by another person, have been chased by people, or have used a knife to attack or stab someone. Age was not significantly associated with fear of violence. As expected, given that the time frame specified for the exposure to violence measures was since living or working on the streets, cumulative length of time homeless was positively associated with all of the violent exposure variables examined. Subjects who had spent a total of ->3 years homeless were between 3.3 and 6.6 times more likely to report witnessing violence, 2.2 and 4.7 times more likely to have been victimized, and 4.1 and 11.5 times more likely to have perpetrated violence than youth who
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had spent <3 months homeless. Length of time homeless was not found to be associated with fear of violence.
Discussion To date, research conducted with runaway and homeless youth has been fraught with methodological limitations (10). Sample sizes have tended to be small, and subjects are usually recruited from single, nonrepresentative service sites such as a youthserving shelter. These findings can only be generalized to the estimated 30% of the runaway, homeless youth who use sheltering services (11). Moreover, typologies have largely been created based on researchers' intuition rather than findings from qualitative a n d / o r quantitative research. To overcome these limitations, we administered a standardized survey instrument to a large sample of runaway and homeless youth who were recruited from both service (i.e., shelter and drop-in agencies) and street and other natural "hang-out" (e.g., parks, street corners, etc.) sites using systematic and representative sampling methodologies. This study is limited by the fact that measurement relied entirely on subject's self-reports of exposure to violence. Previous research has shown that individuals who have been exposed to certain forms of traumatic victimization may experience periods in life when the victimization experience will not be recalled (12). Furthermore, subjects also might deliberately fail to report certain instances of victimization, witnessing of violence, or perpetration of violence owing to fear of repercussions. Subjects may have been concerned that such disclosures would prompt the interviewer to report the incident to the police department or child protection services. Despite these limitations, the participants in the study were found to report extremely high rates of exposure to violence. A second limitation is that although this sample is likely to be representative of the street youth population in the Hollywood area of Los Angeles, the extent to which these findings can be generalized to street youth populations in other cities is unclear. However, the rates of victimization reported by this sample are comparable to those reported by homeless youth in other areas of the country. For example, previous research with a sample of 156 homeless adolescents from a large midwestern city found that 43% of the sample had been beaten up and 46% had been threatened with a weapon (3). In the current
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study, 51% of the sample report having been "slapped, punched, hit, burned, or beaten up by someone," and 50% report having been "threatened with serious physical harm by someone." Contrary to results obtained in studies with samples from the general population of adolescents which indicate that African-American adolescents are more likely than white adolescents to be the victims of violence (1,13), ethnicity was not consistently associated with exposure to violence in the current study. In fact, African-American youth were less likely than white youth to report having been threatened, or slapped, punched, hit, burned, or beaten-up by someone. Similarly, Latino ethnicity tended not to be significantly associated with exposure to violence. The findings regarding the association between gender and victimization also are inconsistent with results from studies with samples representative of the larger population of adolescents. In the current study, males reported rates of exposure to violence that are higher than those observed among samples of in-school adolescent males from small cities and suburbs and comparable to rates observed among adolescent males from inner-city high schools (14). However, the rates of exposure reported among the female respondents in the current study are substantially higher than the rates reported among in-school adolescent females, even among inner-city females. In fact, contrary to findings from national level data on the general population of adolescents (13), reported exposure to violence generally was not associated with gender in the current study. Females were as likely as males to witness violence and to be violently victimized, and more likely to be victims of sexual assault. These findings suggest that the increase in risk for violent victimization associated with life on the streets is particularly strong for females. Life on the streets effectively eliminates the gender difference in nonsexual victimization rates that has been observed repeatedly among other populations of adolescents (1,13,14). Other research has shown that the strength of the association between gender and victimization decreases substantially after adjusting for participation in delinquent activities (15). Perhaps the level of environmental and behavioral risk factors for exposure to violence is so extreme among street youth as to reduce the predictive influence of more distal variables such as ethnicity and gender. This is not to suggest that homeless youth represent a homogeneous population in terms of risk behaviors; rather, it indicates the need to find alternative means of iden-
JOURNALOF ADOLESCENTHEALTHVol. 20, No. 5
tifying subgroups of homeless youth that are most at risk so that they can be targeted for need-specific interventions. Homeless adolescents readily report affiliation with distinct peer subcultural groups (i.e., gang members, "punks," "druggies," etc.), and peer group affiliation has been found to be associated with participation in high-risk behaviors as well as protective behaviors (16). Perhaps among street youth, other characteristics such as peer group affiliation replace gender and ethnicity as determinants of personal identity and what is construed as appropriate behavior. For example, female gang members may be as likely as male gang members to be exposed to violent situations and to respond aggressively to conflicts, thus increasing their risk for victimization relative to homeless youth who do not affiliate with gangs. Interestingly, the rates of fear of victimization were not as high as one might expect. Despite the high rates of exposure to violence, a large proportion of the sample reported that they felt "not at all afraid" of being beaten up (60%) or sexually assaulted, molested, or raped (54%). It is possible that some youth reported subjective perceptions of fearlessness because they have failed to acknowledge their risk of victimization to themselves, to avoid the cognitive dissonance that would result from continuing to subject themselves or be subjected to the dangers of life on the street. Shootings were associated with the highest rate of fear despite the fact that they represent the least common form of victimization. On the other hand, physical beatings were associated with the lowest rates of fear despite the fact that they represent the most common form of victimization. Consistent with previous research on the measurement of fear in high-risk populations, these findings suggest that the fear of victimization can be determined more by the consequences of victimization than the likelihood of victimization (17). Future research is necessary to determine the extent to which fear of victimization while on the streets influences youths' decisions regarding use of shelters, peer group affiliation, and substance abuse as coping mechanisms. In summary, homeless youth are particularly vulnerable to exposure to a variety of forms violence, both as spectators and victims. It is likely that these youth lack the social support and mental health services necessary to cope with the physical and emotional consequences of witnessing violence or being violently victimized. Subsequently, these youth are likely to be at increased risk for a variety of psychological consequences from these exposures,
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including post-traumatic stress disorder and depression (14). Also, these youth may be at increased risk for perceiving violence as a normative response to conflict situations and use violence themselves as a means of resolving conflicts. However, the results from the current study regarding perpetration of violence with weapons suggest that relatively few youth resort to these potentially lethal forms of violence.
6. Brennan T, Huizinga D, Elliott D. The Social Psychology of Runaways. Lexington, MA: Heath, 1978. 7. Rossi P. Down and Out in America: The Origins of Homelessness. Chicago, IL: University of Chicago Press, 1989. 8. McCarthy B, Hagan J. Surviving on the street: The experiences of homeless youth. J Adolesc Res 1992;7:412. 9. Kipke MD, O'Connor S, Palmer R, MacKenzie RG. Street youth in Los Angeles: Profile of a group at high risk for human immunodeficiencyvirus infection. Arch Pediatr Adolesc Med 1995;149:513.
This study was supported by the National Institute on Drug Abuse (Grant RO1-DA07613-03).The views expressed are those of the authors, not necessarily the funding agency. Special thanks go to Drs. Richard MacKenzie, Mary Ann Pentz, Clyde Dent, Lisa Russell, Raymond F. Palmer, Ms. Ellen Iverson, members of the field research team (Kim Brown, Christine Johnson, Tammy Jones, Burke Nelson, Sara Parker, Vanessa Parker, Audruin Pittman, and Germon Rodriguez), and collaborating youth serving agencies (Covenant House California, Los Angeles Free Cliru'c,Los Angeles Youth Network, My Friend's Place, Teen Canteen, and The Way In).
10. Robertson MJ, Greenblatt M. Homelessness: A National Perspective. New York: Plenum Press, 1992. 11. Kipke MD, O'Connor S, Palmer R, LaFrance S. Street youth, outreach and H1V risk: Facing the challenge in two communities. In: Program and Abstracts of the American Public Health Association Meeting, October 24, 1993, San Francisco, CA. Abstract 3144.
References 1. Fingerhut LA, Ingram DD, Feldman JJ. Firearm and nonfirearm homicide among persons 15 through 19 years of age: Differences by level of urbanization, United States, 1979-1989. JAMA 1992;267:3048. 2. Smart RG, Ogborne AC. Street youth in substance abuse treatment: Characteristics and treatment compliance. Adolescence 1994;29:733. 3. Whitbeck LB, Simons RL. A comparison of adaptive strategies and patterns of victimization among homeless adolescents and adults. Violence Victims 1993;8:135. 4. Tardiff K, Marzuk PM, Leon AC, et al. Homicide in New York City: Cocaine use and firearms. JAMA 1994;272:43. 5. Messner SF, Tardiff K. The social ecology of urban violence: An application of the "routine activities" approach. Criminology 1985;23:241.
12. Williams LM. Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. J Consult Clin Psychol 1994;62:1167. 13. Whitaker CJ, Bastian LD. Teenage victims: A national crime survey report. U.S. Department of Justice, Bureau of Justice Statistics, 1991. 14. Singer MI, Anglin TM, Song LY, Lunghofer L. Adolescents' exposure to violence and associated symptoms of psychological trauma. JAMA 1995;273:477. 15. Jensen GF, Brownfield D. Gender, lifestyles, and victimization: Beyond routine activity. Violence Victims 1986;1:85. 16. Kipke MD, Montgomery SB, Simon TR, Palmer R, Iverson E. Homeless youth: Drug use patterns and HIV risk profiles according to peer group affiliation. In: Program and Abstracts of the Third Science Symposium on HIV Prevention: Current Status and Future Directions, 1995, Flagstaff, AZ. 17. Coston CTM, Finckenauer, JO. Fear of crime among vulnerable populations: Homeless women. J Social Distress Homeless 1993;2:1.
ORIGINAL ARTICLE
Homeless Youth and Their Exposure to and Involvement in Violence While Living on the Streets M I C H E L E D. KIPKE, Ph.D., T H O M A S R. S I M O N , Ph.D., S U S A N N E B. M O N T G O M E R Y , Ph.D., J E N N I F E R B. U N G E R , Ph.D., A N D ELLEN F. IVERSEN, M.P.H.
Purpose: The purpose of this research were to explore homeless youths' histories of exposure to violence, perpetration of violence, and fear of violent victimization, and to examine the extent to which these constructs are associated with demographic variables. Methods: A sample of 432 youth (between 13 and 23 years old) who were homeless or at imminent risk for homelessness were sampled from both service and street sites. The percentage of youth who reported exposure to each type of violence was calculated. Multiple regression analyses were used to examine differences in the risk of exposure to violence across gender, ethnicity, age, and length of time homeless. Results: Respondents reported a high rate of exposure to violence. Female respondents reported levels of exposure to violence that were as high as those reported by males. Females were more likely to report having been sexually assaulted and fearing victimization, and tended to be less likely to report perpetrating violence. With a few exceptions, ethnic identity was not a significant predictor of exposure to violence or fear of victimization. Age tended to be inversely associated with risk of exposure to violence. Length of time homeless was not associated with fear of victimization. Conclusions: Homeless youth are at high risk for exposure to a variety of forms violence as both witnesses and victims. The overall rates of exposure to violence and patterns of association with demographic variables
From the Division of Adolescent Medicine, Children's Hospital Los Angeles, and the Department of Pediatrics, University of Southern California School of Medicine; and the School of Public Health and Department of Preventive Medicine, Loma Linda School of Medicine, Linda Loma University, Los Angeles, California. Address correspondence to: Michele D. Kipke, Ph.D., Associate Director, Research and Evaluation, Division of Adolescent Medicine, Children's Hospital Los Angeles, P.O. Box 54700, Mailstop No. 2, Los Angeles, CA 90054-0700. Manuscript accepted September 16, 1996. 1054-139X/97/$17.00
PII $1054-139X(97)00037-2
are significantly higher than those reported in national samples of adolescents. © Society for Adolescent Medicine, 1997
KEY WORDS:
Adolescence Homeless Violence
The homicide rate in the United States is highest among those between the ages of 15 and 19 years old (1). Recent evidence suggests that certain subgroups of adolescents are at increased risk for exposure to and involvement in violence, and hence are at increased risk for mortality and morbidity associated with violence. One such group is the runaway and homeless youth population. Indeed, a high percentage of these youth left their homes because they were being physically or sexually abused. For example, a study conducted with 261 Canadian street youth found that 47% of respondents had been physically assaulted by a family member and 15% had been sexually assaulted by a family member (2). In another study which compared runaway youth with homeless adults, the runaways came from more abusive family backgrounds, were more likely to rely on deviant survival strategies, and were more likely to be criminally victimized than their adult counterparts (3). By virtue of the fact that the homeless live on the streets, these youth are exposed on a daily basis to street and gang-related violence. They also become vulnerable to a wide range of attacks, such as physical and sexual assaults, stabbings, and shootings. A
© Societyfor AdolescentMedicine,1997 Publishedby ElsevierScienceInc.,655 Avenueof the Americas,New York,NY 10010
May 1997
study of all homicides occurring in New York City in 1990 and 1991 revealed that the most frequent places of occurrence were the streets and other outdoor places (49.6%) (4). Whereas the very young and older victims are more likely to be killed at home, young males are more likely to be killed on the streets because they spend more time on the streets (5). Although most studies of homeless adults and runaway or homeless youth have not collected data on their perpetration of criminal behavior (6,7), several studies suggest that homelessness is conducive to crime. For example, in a study using data on youths from Colorado and from a national sample of adolescents, 33% of runaways admitted to stealing after leaving home (15% indicated that they stole objects worth $50 or more) and 20% reported stealing drugs (6). The authors also note that these activities were positively associated with the length of time away from home and with the number of previous episodes of homelessness. However, involvement in illegal activities may be largely driven by the need to survive on the streets. The results from previous research with homeless youth suggest that hunger causes theft of food, problems of hunger and shelter lead to serious theft, and problems of unemployment and shelter are associated with prostitution. The purposes of this study were to explore youths' histories of direct and indirect exposure to violence, perpetration of violence, and fear of violence, and to assess the associations among these variables and demographic characteristics. This research was conducted with youth recruited from the Hollywood area of Los Angeles, a geographic area with a high concentration of youth who are homeless or at imminent risk for homelessness (9).
Methods Setting, Sampling Design, and Recruitment Procedures Youth were eligible to participate in the study if they were 12-23 years of age and homeless or at imminent risk for homelessness. Youth were considered homeless if their primary night residence was in a supervised public or private shelter, an institution that provides a temporary residence (e.g., halfway house, motel/hotel, boarding house, treatment facility, prison), or a public or private place not ordinarily used as a regular sleeping accommodation (e.g., on the street, in an abandoned building, park, or abandoned car). Youth were considered to be at imminent risk
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for homelessness if they were temporarily and inadequately housed in a residence that was not their own (e.g., platonic friend's house or apartment). This research project, called Project S.U.N.S. (Searching to Understand New to the Street), was conducted in the Hollywood area of Los Angeles, California. Youth were recruited using systematic sampling methods in an effort to obtain a sample that was representative of the target population in the Hollywood area. Based on an initial community assessment, two distinct yet similar sampling frames were developed, one for "fixed" or service sites (i.e., shelter and drop-in centers) and one for "natural" street sites (i.e., street corners or highly populated blocks) and "hang-outs" (e.g., parks, alleys, bars, fast-food restaurants, etc.). Survey research, filed observations, and service provider census data suggested that sampling within the shelter and drop-in centers located within Hollywood would reach approximately half of the Hollywood runaway, homeless youth population. Thus, three shelters and six drop-in locations were selected for the fixed primary sampling units (PSUs), and 50% of the sampling assignments were at these fixed sites. At each of the fixed PSUs, interviewer teams (consisting of 2-4 members) first reviewed the agency's sign-in roster to determine how many youth were in the agency. They then determined the sampling fraction (from a sampling fraction table) according to the number of potential participants and the number of interviewers. For example, if there were 4 potential participants and 4 interviewers at a particular site, the sampling fraction was 1/1. If there were 15 potential participants and 4 interviewers, the sampling fraction was 1/4. To avoid bias in the selection of youth to interview, the interviewers used a computer-generated, predetermined random start number to determine which potential participant to select from the sign-in roster as the starting point for the selection. The sampling fraction was then used to systematically select potential participants from the sign-in roster. Street-based sampling occurred along five major boulevards within a 12-square-mile area of Hollywood. Along these boulevards, 73 street areas (divided into three block segments), corners, a n d / o r alleys, 4 parks, and 3 restaurants were identified as natural PSUs. At each of the natural PSUs, interviewer teams first determined the number of potentially eligible youth (i.e., along the street block segment, on the street corner, in the alley, or in a previously selected area of a park) and then determined the sampling fraction. Youth were then
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"counted out" and selected according to the sampling fraction and predetermined random start number. Youth selected for recruitment were asked to answer an eight-item screening instrument to determine whether they were eligible to participate in the study. If eligible, youth were asked to participate in a structured interview which was conducted at a nearby coffee shop or fast-food restaurant (such patronage permitted the interview to occur in a safe, quiet setting). A meal worth a maximum of $10 was purchased for the youth, which they ate during the course of the interview. Youth received $3.00 in bus tokens for completing the screening instrument and $10 in food vouchers for completing the interview instrument. The research received formal institutional review board approval, and all subjects signed an informed consent form prior to completing the screening and survey instruments. During the period of July 1994 to September 1995, a total of 601 individuals were approached and asked to complete the screening interview, of whom 17 had been approached two or more times and 29 (5%) refused to participate; thus, a total of 584 were approached only once and 555 were screened for their eligibility to participate in the study. Of those screened, 26 (5%) were ineligible to participate in the study (i.e., 5 youth were too young and 21 were too old, and 14 youth did not meet the criteria for homelessness or imminent risk for homelessness). Of the 515 eligible youth, 83 (16%) refused to participate in the study. The final sample therefore consisted of 432 subjects. This sample represents 84% of the eligible youth contacted, 78% of the youth screened, and 74% of the total number of youth approached for recruitment. Preliminary analyses were conducted to test for differences between youth who volunteered to participate versus those who did not. These analyses revealed no significant gender or ethnic differences between the two groups. However, youth who volunteered to participate in the study were significantly older than those who refused (P < .05). The response rate of 84% was consistent across sampling sites (street and hangout versus service).
Survey Instrument The study is part of a larger research project designed to examine the prevalence of drug use and human immunodeficiency virus (HIV) risk behaviors among youth who are homeless or at imminent risk
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for homelessness, and to explore the natural history of homelessness among youth. All study participants were interviewed for 60-75 rain. The structured interview asked respondents about (a) the violence they had witnessed, including seeing someone being physically attacked by another person, seeing someone being sexually assaulted, seeing someone who was seriously hurt after a violent event or attack, seeing someone being killed by another person, seeing a dead person somewhere in the community, and the number of violent events witnessed within the past year; (b) the violence they had been a victim of, including sexual assault; having been chased; having been threatened with serious physical harm; having been seriously hurt after a violent attack; having been slapped, punched, hit, burned, or beaten; having been attacked or stabbed with a knife; having been shot at (not hit); and having been shot and hit by gunfire; and (c) the violence that they had been perpetrators of, including attacking someone with a knife and shooting at someone. These questions were asked with respect to witnessing, victimization, and perpetration for: (a) ever during the participant's lifetime and (b) since the participant became homeless or began working on the streets. Finally, respondents were asked about their fear of violence, including fear of being stabbed by a knife, shot by a gun, beaten, sexually assaulted, molested, a n d / o r raped. Respondents were provided with three response choices: not at all afraid, somewhat afraid, and very afraid. Responses were dichotomized to indicate no fear versus any level of fear.
Statistical Analysis The binary measures of exposure to violence since living on the streets and fear of violence were included as dependent variables in separate logistic regression models. The demographic variables of gender, ethnicity, and age were entered as simultaneous predictors in each logistic regression model. Because the participants were asked to report exposure to violence since the time that they became homeless or began working on the street, length of time homeless was included as a covariate in each model. Each of the predictor variables was d u m m y coded so that gender = female, age = under 18, ethnicity = white, and time homeless = 0-3 months were used as the reference levels. Odds ratios and 95% confidence intervals were calculated to determine risk of experiencing the dependent variable (exposure to violence or fear) for each level of the
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Table 1. Demographic profile of the study sample
tories of homelessness, with 31% having been homeless for <3 months, 25% for 3 months to I year, 23% for 1-3 years, and 21% for >-3 years.
(n = 432) Age (yr) ---17 18-19 ->20 Gender Males Females Ethnicity African-American Latino White Other Time homeless 0-3 mo >3 mo to 1 yr >1 yr to 3 yr >3 yr Places slept Friend's (platonic)house or apartment Abandoned building/"squat" Street/subway/abandoned car Shelter or mission Motel, hotel, boarding house With parent or relative Own house or apartment With girl/boyfriendor lover Car, bus, van (not abandoned) Prison/jail Beach/"squat" on the beach
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108 (25) 148 (34) 174 (41) 284 (66) 148 (34)
Witnessing Violence, Victimization, Fear, and Perpetration
87 (20) 65 (15) 215 (51) 59 (14)
Violence exposure rates were extremely high among these youth. Among the total sample, 85% of the participants reported having seen a person being physically attacked (72% since living on the streets), 69% had seen someone who had been seriously hurt from a violent event or attack (57% since living on the streets), 44% had seen a dead person somewhere in the community (30% since living on the streets), 31% had seen someone being killed (20% since living on the streets), and 24% had seen someone being sexually assaulted (16% since living on the streets). Respondents also reported extensive histories of victimization, with 70% having been punched, hit, burned, or beaten up (51% since living on the streets); 65% having been threatened with serious physical harm (50% since living on the streets); 57% having been chased (45% since living on the streets); 33% having been seriously hurt during a violent attack (23% since living on the streets); 32% having been attacked or stabbed by a knife (19% since living on the streets); 37% having been shot at (26% since living on the streets); 14% having been shot at and hit by gunfire (7% since living on the streets); and 32% having been sexually assaulted (15% since living on the streets). The majority of the respondents reported that they were somewhat or very afraid of being shot (58%) or stabbed (56%). Also, nearly half the sample reported experiencing fear of being beaten up (40%), or sexually assaulted, molested, or raped (44%). Although a sizable percentage of respondents reported engaging in violent behavior, rates of perpetration were far lower than rates of victimization. Specifically, 25% of respondents reported having attacked someone with a knife (17% since living on the streets) and 22% reported having shot at someone (14% since living on the streets).
129 (31) 103 (25) 94 (23) 87 (21) 231 (54) 219 (51) 178 (41) 164 (38) 121 (28) 121 (28) 74 (17) 59 (17) 44 (10) 40 (9) 29 (7)
demographic variables relative to the risk for the reference level. Odds ratios >1 indicate a positive association, and odds ratios <1 indicate an inverse association. Confidence intervals which do not ind u d e the value of 1 are statistically significant (P value < .05).
Results As presented in Table 1, the majority of respondents were male (66%) and nearly half the sample were youth from ethnic minorities (49%). Ages ranged from 13 to 23 years. The mean age was 19.0 years. Respondents reported having slept or lived in a variety of different locations within the prior 12 months, with the most common places being a friend's house or apartment (54%), an abandoned building or "squat" (51%), on the street or in an abandoned car (41%), or in a shelter or mission (38%); 9% reported having been in prison or jail within the previous 12 months. The majority of respondents also reported having had extensive his-
Demographic Correlates of Risk for Exposure to Violence, Perpetration, and Fear As shown in Table 2, with the exception of victimization from sexual assault and perpetration of vio-
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lence with a knife, the levels of exposure to violence were surprisingly similar for males and females. There were only two significant gender differences: Females were significantly more likely to have been sexually assaulted, and less likely to have used a knife to attack or stab someone. Females were as likely as males to report having witnessed each of the violent events examined. In addition, females were as likely as males to report having been chased, threatened, attacked by someone with and without weapons, and to have been seriously hurt after a violent attack. However, as shown in Table 2, females reported significantly greater fear of violence for three of the four measures used. Females reported greater fear of being shot, stabbed, and sexually assaulted than males. A nonsignificant trend for greater fear of being beaten up among females was found. With a few exceptions, ethnic identity tended not to be a significant predictor of exposure to violence or level of fear of victimization. However, relative to white youth, African-American youth were less likely to report having seen someone who was seriously hurt after a violent attack, less likely to have been threatened with physical harm, and less likely to have been slapped, punched, hit, burned, or beaten up by someone than white youth. AfricanAmerican youth also were less likely to report fear of being beaten up than white youth. Latino youth were found to be at greater risk for having seen someone being killed by another person (marginally significant), and reported greater fear of being sexually assaulted than white youth. Ethnicity was not associated with risk for perpetration of violence. Age of the respondent was inversely associated with exposure to several types of violence. Relative to those between the ages of 13 and 17 years, respondents in the older age groups tended to be less likely to have seen someone being sexually assaulted, have seen someone being killed by another person, have been chased by people, or have used a knife to attack or stab someone. Age was not significantly associated with fear of violence. As expected, given that the time frame specified for the exposure to violence measures was since living or working on the streets, cumulative length of time homeless was positively associated with all of the violent exposure variables examined. Subjects who had spent a total of ->3 years homeless were between 3.3 and 6.6 times more likely to report witnessing violence, 2.2 and 4.7 times more likely to have been victimized, and 4.1 and 11.5 times more likely to have perpetrated violence than youth who
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had spent <3 months homeless. Length of time homeless was not found to be associated with fear of violence.
Discussion To date, research conducted with runaway and homeless youth has been fraught with methodological limitations (10). Sample sizes have tended to be small, and subjects are usually recruited from single, nonrepresentative service sites such as a youthserving shelter. These findings can only be generalized to the estimated 30% of the runaway, homeless youth who use sheltering services (11). Moreover, typologies have largely been created based on researchers' intuition rather than findings from qualitative a n d / o r quantitative research. To overcome these limitations, we administered a standardized survey instrument to a large sample of runaway and homeless youth who were recruited from both service (i.e., shelter and drop-in agencies) and street and other natural "hang-out" (e.g., parks, street corners, etc.) sites using systematic and representative sampling methodologies. This study is limited by the fact that measurement relied entirely on subject's self-reports of exposure to violence. Previous research has shown that individuals who have been exposed to certain forms of traumatic victimization may experience periods in life when the victimization experience will not be recalled (12). Furthermore, subjects also might deliberately fail to report certain instances of victimization, witnessing of violence, or perpetration of violence owing to fear of repercussions. Subjects may have been concerned that such disclosures would prompt the interviewer to report the incident to the police department or child protection services. Despite these limitations, the participants in the study were found to report extremely high rates of exposure to violence. A second limitation is that although this sample is likely to be representative of the street youth population in the Hollywood area of Los Angeles, the extent to which these findings can be generalized to street youth populations in other cities is unclear. However, the rates of victimization reported by this sample are comparable to those reported by homeless youth in other areas of the country. For example, previous research with a sample of 156 homeless adolescents from a large midwestern city found that 43% of the sample had been beaten up and 46% had been threatened with a weapon (3). In the current
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study, 51% of the sample report having been "slapped, punched, hit, burned, or beaten up by someone," and 50% report having been "threatened with serious physical harm by someone." Contrary to results obtained in studies with samples from the general population of adolescents which indicate that African-American adolescents are more likely than white adolescents to be the victims of violence (1,13), ethnicity was not consistently associated with exposure to violence in the current study. In fact, African-American youth were less likely than white youth to report having been threatened, or slapped, punched, hit, burned, or beaten-up by someone. Similarly, Latino ethnicity tended not to be significantly associated with exposure to violence. The findings regarding the association between gender and victimization also are inconsistent with results from studies with samples representative of the larger population of adolescents. In the current study, males reported rates of exposure to violence that are higher than those observed among samples of in-school adolescent males from small cities and suburbs and comparable to rates observed among adolescent males from inner-city high schools (14). However, the rates of exposure reported among the female respondents in the current study are substantially higher than the rates reported among in-school adolescent females, even among inner-city females. In fact, contrary to findings from national level data on the general population of adolescents (13), reported exposure to violence generally was not associated with gender in the current study. Females were as likely as males to witness violence and to be violently victimized, and more likely to be victims of sexual assault. These findings suggest that the increase in risk for violent victimization associated with life on the streets is particularly strong for females. Life on the streets effectively eliminates the gender difference in nonsexual victimization rates that has been observed repeatedly among other populations of adolescents (1,13,14). Other research has shown that the strength of the association between gender and victimization decreases substantially after adjusting for participation in delinquent activities (15). Perhaps the level of environmental and behavioral risk factors for exposure to violence is so extreme among street youth as to reduce the predictive influence of more distal variables such as ethnicity and gender. This is not to suggest that homeless youth represent a homogeneous population in terms of risk behaviors; rather, it indicates the need to find alternative means of iden-
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tifying subgroups of homeless youth that are most at risk so that they can be targeted for need-specific interventions. Homeless adolescents readily report affiliation with distinct peer subcultural groups (i.e., gang members, "punks," "druggies," etc.), and peer group affiliation has been found to be associated with participation in high-risk behaviors as well as protective behaviors (16). Perhaps among street youth, other characteristics such as peer group affiliation replace gender and ethnicity as determinants of personal identity and what is construed as appropriate behavior. For example, female gang members may be as likely as male gang members to be exposed to violent situations and to respond aggressively to conflicts, thus increasing their risk for victimization relative to homeless youth who do not affiliate with gangs. Interestingly, the rates of fear of victimization were not as high as one might expect. Despite the high rates of exposure to violence, a large proportion of the sample reported that they felt "not at all afraid" of being beaten up (60%) or sexually assaulted, molested, or raped (54%). It is possible that some youth reported subjective perceptions of fearlessness because they have failed to acknowledge their risk of victimization to themselves, to avoid the cognitive dissonance that would result from continuing to subject themselves or be subjected to the dangers of life on the street. Shootings were associated with the highest rate of fear despite the fact that they represent the least common form of victimization. On the other hand, physical beatings were associated with the lowest rates of fear despite the fact that they represent the most common form of victimization. Consistent with previous research on the measurement of fear in high-risk populations, these findings suggest that the fear of victimization can be determined more by the consequences of victimization than the likelihood of victimization (17). Future research is necessary to determine the extent to which fear of victimization while on the streets influences youths' decisions regarding use of shelters, peer group affiliation, and substance abuse as coping mechanisms. In summary, homeless youth are particularly vulnerable to exposure to a variety of forms violence, both as spectators and victims. It is likely that these youth lack the social support and mental health services necessary to cope with the physical and emotional consequences of witnessing violence or being violently victimized. Subsequently, these youth are likely to be at increased risk for a variety of psychological consequences from these exposures,
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including post-traumatic stress disorder and depression (14). Also, these youth may be at increased risk for perceiving violence as a normative response to conflict situations and use violence themselves as a means of resolving conflicts. However, the results from the current study regarding perpetration of violence with weapons suggest that relatively few youth resort to these potentially lethal forms of violence.
6. Brennan T, Huizinga D, Elliott D. The Social Psychology of Runaways. Lexington, MA: Heath, 1978. 7. Rossi P. Down and Out in America: The Origins of Homelessness. Chicago, IL: University of Chicago Press, 1989. 8. McCarthy B, Hagan J. Surviving on the street: The experiences of homeless youth. J Adolesc Res 1992;7:412. 9. Kipke MD, O'Connor S, Palmer R, MacKenzie RG. Street youth in Los Angeles: Profile of a group at high risk for human immunodeficiencyvirus infection. Arch Pediatr Adolesc Med 1995;149:513.
This study was supported by the National Institute on Drug Abuse (Grant RO1-DA07613-03).The views expressed are those of the authors, not necessarily the funding agency. Special thanks go to Drs. Richard MacKenzie, Mary Ann Pentz, Clyde Dent, Lisa Russell, Raymond F. Palmer, Ms. Ellen Iverson, members of the field research team (Kim Brown, Christine Johnson, Tammy Jones, Burke Nelson, Sara Parker, Vanessa Parker, Audruin Pittman, and Germon Rodriguez), and collaborating youth serving agencies (Covenant House California, Los Angeles Free Cliru'c,Los Angeles Youth Network, My Friend's Place, Teen Canteen, and The Way In).
10. Robertson MJ, Greenblatt M. Homelessness: A National Perspective. New York: Plenum Press, 1992. 11. Kipke MD, O'Connor S, Palmer R, LaFrance S. Street youth, outreach and H1V risk: Facing the challenge in two communities. In: Program and Abstracts of the American Public Health Association Meeting, October 24, 1993, San Francisco, CA. Abstract 3144.
References 1. Fingerhut LA, Ingram DD, Feldman JJ. Firearm and nonfirearm homicide among persons 15 through 19 years of age: Differences by level of urbanization, United States, 1979-1989. JAMA 1992;267:3048. 2. Smart RG, Ogborne AC. Street youth in substance abuse treatment: Characteristics and treatment compliance. Adolescence 1994;29:733. 3. Whitbeck LB, Simons RL. A comparison of adaptive strategies and patterns of victimization among homeless adolescents and adults. Violence Victims 1993;8:135. 4. Tardiff K, Marzuk PM, Leon AC, et al. Homicide in New York City: Cocaine use and firearms. JAMA 1994;272:43. 5. Messner SF, Tardiff K. The social ecology of urban violence: An application of the "routine activities" approach. Criminology 1985;23:241.
12. Williams LM. Recall of childhood trauma: A prospective study of women's memories of child sexual abuse. J Consult Clin Psychol 1994;62:1167. 13. Whitaker CJ, Bastian LD. Teenage victims: A national crime survey report. U.S. Department of Justice, Bureau of Justice Statistics, 1991. 14. Singer MI, Anglin TM, Song LY, Lunghofer L. Adolescents' exposure to violence and associated symptoms of psychological trauma. JAMA 1995;273:477. 15. Jensen GF, Brownfield D. Gender, lifestyles, and victimization: Beyond routine activity. Violence Victims 1986;1:85. 16. Kipke MD, Montgomery SB, Simon TR, Palmer R, Iverson E. Homeless youth: Drug use patterns and HIV risk profiles according to peer group affiliation. In: Program and Abstracts of the Third Science Symposium on HIV Prevention: Current Status and Future Directions, 1995, Flagstaff, AZ. 17. Coston CTM, Finckenauer, JO. Fear of crime among vulnerable populations: Homeless women. J Social Distress Homeless 1993;2:1.