Editor’s Note: Dr. Kayla Cooper (she/her/hers) is a current resident physician at the Children’s Hospital of Philadelphia (CHOP) on the Leadership in Equity, Advocacy, and Policy (LEAP) track. She is interested in promoting health literacy through media, and fights for health justice in the pediatric population. -Rachel Y. Moon, MD, Associate Editor, Digital Media, Pediatrics
Homelessness is a national issue that has plagued municipalities and states for decades. Conversations surrounding homelessness, however, have traditionally centered on individuals older than 18 years. For many individuals, the factors contributing to homelessness are prominent well before entering adulthood. Therefore, it is critical for pediatricians to conceptualize both the unique needs of adolescents facing homelessness and the intersectionality of homelessness with health.
The American Academy of Pediatrics’ policy statement on homelessness and housing insecurity outlined strategies and recommendations to support adolescents in these communities. In response, J.J Cutuli and colleagues at Nemours Children’s Health, Hope PHL (an organization that provides housing, advocacy and trauma-responsive social services for families in Philadelphia), and Rutgers University conducted a study that describes the first national estimate of adolescent homelessness among high school students since the pandemic and its impact on health and education (10.1542/peds.2024-070065).
The authors utilized data from the National Youth Risk Behavior Survey, which monitors health-related behaviors amongst youth. They used the definition by the US Department of Education for homelessness: “lacking fixed, regular, and adequate housing . . . if they’re living in shelters, parks, motels, hotels, public spaces, camping grounds, cars, abandoned buildings, or they’re temporarily living with other people because they have nowhere else to go.” They looked at the association of homelessness with substance use problem, alcohol use problem, risky sexual behavior, and poor grades.
The authors calculated the 30-day prevalence of homelessness among US high school students in 2023 as 3.4%, a significant increase from previously described. They also found that students facing homelessness were:
- More than 2 times as likely to report severe suicidality
- More than twice as likely to have poor grades
- More than 2.5 times as likely to report risky sexual behavior
- More than 2.5 times as likely to report a substance use problem, and
- 3 times as likely to report an alcohol use problem.
These results highlight that homelessness is “age-agnostic” and has serious consequences for adolescents that pediatricians serve every day. Pediatricians must recognize that homelessness is associated with dangerous habits in adolescence, and that these may persist into adulthood. The authors discuss the need for continued screening of homelessness and housing instability when treating all patients, but particularly adolescents, in our practices and hospitals. Pediatricians serve as the liaison for patients and healthcare, and it is critical that we work closely and are aware of services that are tailored to the needs of adolescents facing homelessness.
