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Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth

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Abstract

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.

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Acknowledgments

The authors would like to thank the staff and youth at Star House and Huckleberry House for their assistance and participation in this project.

Funding

This work was funded by The Ohio State University Center for Clinical and Translational Science (CCTS), CTSA Grant Number UL1TR001070. The content of this manuscript is solely the responsibility of the authors and does not necessarily represent the official views of OSU CCTS.

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Authors and Affiliations

  1. Division of Adolescent Medicine, Nationwide Children’s Hospital, 700 Children’s Drive, Columbus, OH, 43205, USA

    Gayathri Chelvakumar, Nancy Ford & Andrea E. Bonny

  2. The Ohio State University College of Medicine, Columbus, OH, USA

    Gayathri Chelvakumar & Andrea E. Bonny

  3. The Research Institute at Nationwide Children’s Hospital, Columbus, OH, USA

    Hillary M. Kapa, Hannah L. H. Lange & Andrea E. Bonny

  4. Division of General Pediatrics & Adolescent Health, University of Minnesota, Minneapolis, MN, USA

    Annie-Laurie McRee

Authors
  1. Gayathri Chelvakumar
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  2. Nancy Ford
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  3. Hillary M. Kapa
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  4. Hannah L. H. Lange
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  5. Annie-Laurie McRee
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  6. Andrea E. Bonny
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Correspondence to Gayathri Chelvakumar.

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Chelvakumar, G., Ford, N., Kapa, H.M. et al. Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth. J Community Health 42, 437–443 (2017). https://doi.org/10.1007/s10900-016-0274-7

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  • DOI: https://doi.org/10.1007/s10900-016-0274-7

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