Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth.
Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by <5 % of surveyed youth. Significant predictors of having seen a doctor in the past 12 months included sexual minority status (OR 2.8, p = 0.04) and possession of health insurance (OR 4.9, p < 0.001). Female sex (OR 5.2, p < 0.001) and reported external barriers other than health insurance (OR 0.2, p < 0.001) were associated with having a regular care provider. Fear-based concerns were associated (OR 3.8, p = 0.02) with frequent ED visits, as was being insured (OR 2.2, p = 0.03). These results underscore the need to clearly define healthcare outcomes when investigating barriers to care among homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.
Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA. gayathri.chelvakumar@nationwidechildrens.org.|The Ohio State University College of Medicine, Columbus, OH, USA. gayathri.chelvakumar@nationwidechildrens.org.
Gayathri
G
Chelvakumar
Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
Nancy
N
Ford
The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Hillary M
HM
Kapa
The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Hannah L H
HLH
Lange
Division of General Pediatrics & Adolescent Health, University of Minnesota, Minneapolis, MN, USA.
Annie-Laurie
AL
McRee
Division of Adolescent Medicine, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.|The Ohio State University College of Medicine, Columbus, OH, USA.|The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA.
Andrea E
AE
Bonny
D000293:Adolescent; D000328:Adult; D003430:Cross-Sectional Studies; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology / Q000706:statistics & numerical data; D018453:Homeless Youth / Q000523:psychology / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009820:Ohio / Q000453:epidemiology; D055815:Young Adult
Barriers; Healthcare; Homeless; Youth