title: Challenges to immunization: the experiences of homeless youth.
abstract: BACKGROUND
  Homelessness is a critical social issue, both a product of, and contributing to, poor mental and physical health. Over 150,000 young Canadians live on the streets. Homeless youth experience a high incidence of infectious diseases, many of which are vaccine preventable. Early departure from school and limited access to public health services makes them a particularly vulnerable high-risk group. This study explores challenges to obtaining essential vaccines experienced by homeless youth.
  
  
  METHODS
  A qualitative research study to explore knowledge, attitudes, beliefs, and experiences surrounding immunization of hard-to-reach homeless youth was designed. Participants were recruited for focus groups from Phoenix House and Shelter, a non-profit, community-based organization assisting homeless youth in Halifax, Nova Scotia, Canada. An experienced facilitator guided the recorded discussions. Transcripts of audiotapes were analyzed using a constant comparative method until data revealed a set of exemplars and themes that best captured participants' knowledge, attitudes, beliefs and experiences surrounding immunization and infectious diseases.
  
  
  RESULTS
  Important themes emerged from our analysis. Considerable variability in knowledge about immunization and vaccine preventable diseases was found. The homeless youth in the study had limited awareness of meningitis in contrast to a greater knowledge about sexually transmitted infections and influenza, gained during the H1N1/09 public health campaign. They recognized their poverty as a risk for contracting infectious diseases, along with their inability to always employ known strategies to prevent infectious diseases, due to circumstances. They showed considerable insight into the detrimental effects of poor hygiene, sleeping locations and risk behaviour. Interviewed homeless youth regarded themselves as good compliers of health professional advice and offered valuable suggestions to improve immunization in their population.
  
  
  CONCLUSIONS
  To provide effective public health interventions, it is necessary to consider the knowledge, attitudes, beliefs, and experiences of hard to reach, high risk groups. Our study shows that homeless youth are interested and capable in discussing immunization. Active targeting of homeless youth for public health immunization programs is needed. Working collaboratively with non-profit organizations that assist homeless youth provides an opportunity to increase their knowledge of infectious risks and to improve immunization strategies in this vulnerable group.
authors.affiliation: Department of Pediatrics, Canadian Center for Vaccinology, Dalhousie University, Halifax, Nova Scotia, Canada. alex.doroshenko@gnb.ca
authors.forename: Alexander
authors.initials: A
authors.lastname: Doroshenko
authors.forename: Jill
authors.initials: J
authors.lastname: Hatchette
authors.forename: Scott A
authors.initials: SA
authors.lastname: Halperin
authors.forename: Noni E
authors.initials: NE
authors.lastname: MacDonald
authors.forename: Janice E
authors.initials: JE
authors.lastname: Graham
mesh_terms: D000293:Adolescent; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D018453:Homeless Youth; D006801:Humans; D017589:Immunization Programs / Q000706:statistics & numerical data*; D008297:Male; D009674:Nova Scotia; D055815:Young Adult