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Illness experiences of homeless youth: age and gender differences
JOURNAL OF ADOLESCENT HEALTH 2003;32:137–139
RESEARCH SYMPOSIA
Abstracts of Research Symposia Presented at the Annual Meeting of the Society for Adolescent Medicine—March 2003
CONDUCTING RESEARCH WITH SPECIAL POPULATIONS ILLNESS EXPERIENCES OF HOMELESS YOUTH: AGE AND GENDER DIFFERENCES Josephine Ensign, F.N.P., Dr.P.H. Department of Psychosocial and Community Health, Seattle, WA. Purpose: Homeless youth are widely acknowledged as being a particularly medically vulnerable population in the United States. While the health problems of homeless youth are well-established, factors related to monitoring and improving the quality of primary health care for these youth and for subgroups of these youth are not well-established. The purpose of this study was to document the illness experiences of homeless youth, and whether these experiences differed by age and gender. Methods: The research was qualitative, using in-depth narrative interviews with a purposeful sample of 30 homeless youth ages 13–24 in a large West Coast city. Of the sample, 14 youth were male, 14 were female, and two were transgender identified (one male-tofemale and one female-to-male). The youth interviewed were evenly divided between the age groups of 18–24 years and 17 years and younger. Half of the youth were accessed and interviewed at youth clinics, and half were accessed and interviewed on the streets. The interviews covered topics of last illness experience, self-care practices, health-seeking behaviors, and experiences in accessing health care. All interviews were tape-recorded, transcribed, and analyzed for major themes and for age and gender differences. Results: The majority of clinic-based youth reported a last illness experience of either colds or of those consistent with viral gastroenteritis; the majority of street-based youth reported a last illness that was related to intravenous drug use. Gender differences were noted for health-seeking behaviors, with most male youth reporting that they often were embarrassed by needing to seek care and by not being able to take care of it themselves. In contrast, the majority of female youth spoke of their fears over increased vulnerability and safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status and not having a parent or guardian to consent for care. Youth over age 18 stated that it was more difficult for them to obtain health insurance since turning 18, and that unpaid health care bills contributed to their inability to obtain and maintain stable housing.
Conclusions: There were important age and gender differences in the illness experiences of homeless youth. Policies and programs aimed at improving the health status of homeless youth need to address these differences. MORE NORMAL THAN NOT: A QUALITATIVE ASSESSMENT OF THE DEVELOPMENTAL EXPERIENCES OF GAY YOUTH TA Eccles, M.D., MA Sayegh, Ph.D., JD Fortenberry, M.D., M.S., and GD Zimet, Ph.D. Indiana University School of Medicine, Section of Adolescent Medicine. Purpose: Most studies of gay youth have focused on stresses and resultant pathologies related to sexual orientation. Contemporary gay youth appear to develop within a less harsh social environment than earlier generations. Openly gay youth increasingly see themselves as a normalized segment of the youth population. This qualitative study examines the experiences of openly gay youth within the context of normal adolescent development. Methods: In-depth interviews with 15 self-identified gay male youth, ages 16 –22, were completed by a single interviewer. As an inclusion criterion, each participant reported minimal distress associated with his sexual identity. Thematic analysis was done by 2 independent researchers in order to assess interrater reliability. The analysis was assisted by the use of MAXqda威, a program designed for the systematic evaluation of text-based qualitative data. Areas of analysis included: (1) Identification of each participant’s level of developmental maturity within the domains of family relationships, friendships, romantic relationships, and school experience. [Maturity was defined as a stable sense of self arrived at after some degree of identity exploration.] (2) Identification of common and unique themes generated in each developmental domain. (3) Identification of developmental differences when participants compared themselves to their non-gay peers. Results: (1) Few (2 of 15) participants reported their overall developmental experience to be markedly different from that of non-gay peers. (2) Peer interaction, reflected in both the quality and the size of peer networks, was seen by the participants as being the domain most different when comparing themselves to non-gay peers. (3) Open gay self-identification enhanced the quality and size of both gay and non-gay peer networks. (4) Peer interaction appeared to enhance movement toward developmental maturity in all domains. This effect was most marked in those participants whose peer networks were most restricted to begin
© Society for Adolescent Medicine, 2003 Published by Elsevier Science Inc., 360 Park Avenue South, New York, NY 10010
1054-139X/03/$–see front matter
RESEARCH SYMPOSIA
Abstracts of Research Symposia Presented at the Annual Meeting of the Society for Adolescent Medicine—March 2003
CONDUCTING RESEARCH WITH SPECIAL POPULATIONS ILLNESS EXPERIENCES OF HOMELESS YOUTH: AGE AND GENDER DIFFERENCES Josephine Ensign, F.N.P., Dr.P.H. Department of Psychosocial and Community Health, Seattle, WA. Purpose: Homeless youth are widely acknowledged as being a particularly medically vulnerable population in the United States. While the health problems of homeless youth are well-established, factors related to monitoring and improving the quality of primary health care for these youth and for subgroups of these youth are not well-established. The purpose of this study was to document the illness experiences of homeless youth, and whether these experiences differed by age and gender. Methods: The research was qualitative, using in-depth narrative interviews with a purposeful sample of 30 homeless youth ages 13–24 in a large West Coast city. Of the sample, 14 youth were male, 14 were female, and two were transgender identified (one male-tofemale and one female-to-male). The youth interviewed were evenly divided between the age groups of 18–24 years and 17 years and younger. Half of the youth were accessed and interviewed at youth clinics, and half were accessed and interviewed on the streets. The interviews covered topics of last illness experience, self-care practices, health-seeking behaviors, and experiences in accessing health care. All interviews were tape-recorded, transcribed, and analyzed for major themes and for age and gender differences. Results: The majority of clinic-based youth reported a last illness experience of either colds or of those consistent with viral gastroenteritis; the majority of street-based youth reported a last illness that was related to intravenous drug use. Gender differences were noted for health-seeking behaviors, with most male youth reporting that they often were embarrassed by needing to seek care and by not being able to take care of it themselves. In contrast, the majority of female youth spoke of their fears over increased vulnerability and safety issues while ill and homeless. Most youth under age 18 stated that they were often denied health care at hospitals because of their underage status and not having a parent or guardian to consent for care. Youth over age 18 stated that it was more difficult for them to obtain health insurance since turning 18, and that unpaid health care bills contributed to their inability to obtain and maintain stable housing.
Conclusions: There were important age and gender differences in the illness experiences of homeless youth. Policies and programs aimed at improving the health status of homeless youth need to address these differences. MORE NORMAL THAN NOT: A QUALITATIVE ASSESSMENT OF THE DEVELOPMENTAL EXPERIENCES OF GAY YOUTH TA Eccles, M.D., MA Sayegh, Ph.D., JD Fortenberry, M.D., M.S., and GD Zimet, Ph.D. Indiana University School of Medicine, Section of Adolescent Medicine. Purpose: Most studies of gay youth have focused on stresses and resultant pathologies related to sexual orientation. Contemporary gay youth appear to develop within a less harsh social environment than earlier generations. Openly gay youth increasingly see themselves as a normalized segment of the youth population. This qualitative study examines the experiences of openly gay youth within the context of normal adolescent development. Methods: In-depth interviews with 15 self-identified gay male youth, ages 16 –22, were completed by a single interviewer. As an inclusion criterion, each participant reported minimal distress associated with his sexual identity. Thematic analysis was done by 2 independent researchers in order to assess interrater reliability. The analysis was assisted by the use of MAXqda威, a program designed for the systematic evaluation of text-based qualitative data. Areas of analysis included: (1) Identification of each participant’s level of developmental maturity within the domains of family relationships, friendships, romantic relationships, and school experience. [Maturity was defined as a stable sense of self arrived at after some degree of identity exploration.] (2) Identification of common and unique themes generated in each developmental domain. (3) Identification of developmental differences when participants compared themselves to their non-gay peers. Results: (1) Few (2 of 15) participants reported their overall developmental experience to be markedly different from that of non-gay peers. (2) Peer interaction, reflected in both the quality and the size of peer networks, was seen by the participants as being the domain most different when comparing themselves to non-gay peers. (3) Open gay self-identification enhanced the quality and size of both gay and non-gay peer networks. (4) Peer interaction appeared to enhance movement toward developmental maturity in all domains. This effect was most marked in those participants whose peer networks were most restricted to begin
© Society for Adolescent Medicine, 2003 Published by Elsevier Science Inc., 360 Park Avenue South, New York, NY 10010
1054-139X/03/$–see front matter