RESEARCH ARTICLE
Homelessness and Sexual Identity Among Middle School Students ERIC RICE, PhDa ROBIN PETERING, MSWb HARMONY RHOADES, PhDc ANAMIKA BARMAN-ADHIKARI, PhDd HAILEY WINETROBE, MPHe AARON PLANT, MPHf JORGE MONTOYA, PhDg TIMOTHY KORDIC, MAh
ABSTRACT BACKGROUND: Lesbian, gay, bisexual, or questioning (LGBQ) high school students experience higher rates of homelessness than their heterosexual peers. Moreover, LGBQ high school students are more likely to stay in riskier locations (eg, with a stranger) and less likely to stay in a shelter. This study tested whether these trends also apply to middle school students. METHODS: Using representative data, we examined sexual identity and homelessness among Los Angeles Unified School District middle school students. RESULTS: Nearly 10% of middle school students identified as LGBQ and 23.5% experienced at least 1 night of homelessness during the previous year. Contrary to high school data, LGBQ students did not experience higher rates of homelessness overall. However, when limiting the sample to students who had experienced homelessness, LGBQ students were more than 5 times as likely as heterosexual students to have stayed in a public place and 63% as likely to have stayed in a shelter. CONCLUSIONS: Lesbian, gay, bisexual, or questioning students are more likely to experience public homelessness. Schools must implement homelessness surveillance systems to assist in identifying early episodes of homelessness, thereby reducing the likelihood of poor physical and mental health outcomes associated with chronic homelessness. Keywords: special populations; mental health; LGBQ youth; human sexuality; school health instruction; child and adolescent health; school health services. Citation: Rice E, Petering R, Rhoades H, Barman-Adhikari A, Winetrobe H, Plant A, Montoya J, Kordic T. Homelessness and sexual identity among middle school students. J Sch Health. 2015; 85: 552-557. Received on March 17, 2014 Accepted on January 23, 2015
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pproximately 1.6 million youth are homeless in the United States each year.1 During the 2008-2009 school year, public schools enrolled nearly 1 million homeless children and youth.2 Recent studies among high school students have found that sexual minority (ie, lesbian, gay, bisexual, and questioning—LGBQ) youth experience higher rates of homelessness than their heterosexual peers.3-5 This is especially problematic because LGBQ students are often at greater risk of negative outcomes like depression, suicidality, drug use, and academic difficulties.6
What is unknown, however, is how the prevalence of homelessness among high school students compares to homelessness experiences of middle school students and if LGBQ middle school youth face the same disproportionate burden of homelessness. The context of sexual identity is believed to be different in middle school, because research has found that sexual identity is fluid throughout adolescence and the self-concept of sexual identity in early adolescence may not be fully developed.7,8 Recent research, however, has found that contrary to conventional wisdom, American
a Assistant Professor, ([email protected]), School of Social Work, University of Southern California, 1150 S. Olive Street, 14th floor, Los Angeles, CA 90015. bPhD student, ([email protected]), School of Social Work, University of Southern California, 1150 S. Olive Street, 14th floor, Los Angeles, CA 90015. c Research Assistant Professor, ([email protected]), School of Social Work, University of Southern California, 1149 S. Hill Street, Suite 360, Los Angeles, CA 90015. dAssistant Professor, ([email protected]), Department of Social Work Education, Fresno State University, 5310 N. Campus Drive, M/S PHS 144, Fresno, CA 93710-8019. e Project Specialist, ([email protected]), School of Social Work, University of Southern California, 1149 S. Hill Street, Suite 360, Los Angeles, CA 90015. f Vice President, ([email protected]), Program Planning and Evaluation, Sentient Research, 231 N. Walnuthaven Drive, West Covina, CA 91790. gPresident and CEO, ([email protected]), Sentient Research, 231 N. Walnuthaven Drive, West Covina, CA 91790. hProgram Manager, ([email protected]), LAUSD Health Education Programs, HIV/AIDS Prevention Unit, 333 S. Beaudry Avenue, 29th floor, Los Angeles, CA 90017.
Address correspondence to: Eric Rice, Assistant Professor, ([email protected]), School of Social Work, University of Southern California, 1150 S. Olive Street, 14th floor, Los Angeles, CA 90015. Data collection was supported by the Centers for Disease Control and Prevention (award 5U87DP001201-04).
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children become aware of their sexual identities much earlier than previously thought, at approximately 10 years of age.9 Additionally, studies have found that more LGBQ youth are ”coming out,” or disclosing their sexual orientation, at younger ages compared with previous generations.10-12 Furthermore, a 2007 national survey of lesbian, gay, bisexual, and transgender (LGBT) middle and high school students found that these students reported facing more hostile school climates than those in high school.13 About 90% of LGBT students reported facing verbal harassment, about 59% experienced physical harassment, and about 39% stated that they were physically assaulted because of their sexual orientation. Approximately half of LGBT students who responded to the survey reported missing school because they felt unsafe.13 In addition to peer rejection, LGBT youth often face stigma and lack of acceptance from their families, leaving them with little or no support. Because youth at this age are still dependent on their families to meet most of their needs, middle school children might be particularly vulnerable to homelessness if they face conflict or family rejection related to their sexual identity. Additionally, because of their age, these students might be more vulnerable to experiencing victimization while homeless. In addition to exploring the prevalence of homelessness among middle school students, this study examined where youth are more likely to spend the night when homeless. Previous findings revealed that high school LGBQ youth are less likely to use shelter services compared with heterosexual youth.4 Sleeping unsheltered, such as in a public place, outside, or in an abandoned building, has direct health consequences including sleep deprivation,14 poor nutrition, difficulty recovering from common illnesses,15 and poor personal hygiene due to a lack of access to sanitary facilities.14,16 Of particular concern, living unsheltered also has been associated with higher rates of victimization because it increases exposure to violent perpetrators14-18 and teaches youth that physical aggression is necessary to guarantee safety from future victimization.19 Additionally, homeless youth who are highly transient are at increased risk of being victimized in dangerous and unfamiliar environments.20 Living unsheltered also can be dangerous because homeless youth often live in areas with high rates of drug use and sex work.17 Although shelters are a safer and more secure option, they can be scary and uncomfortable for youth, who may dislike rules and regulations or distrust agency staff members and volunteers.15 For LGBQ youth, the possibility of encountering discrimination from staff members or other youth may make some unwilling to use shelter services.21 Furthermore, because homeless LGBQ youth are more likely to be unaccompanied,2 they may simply not know how to access shelters on their own. Journal of School Health
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Currently, the McKinney-Vento Homeless Assistance Act is the primary federal law that addresses the education of children and youth who experience homelessness.22 The law aims to provide school stability and access for youth while they or their families are homeless. The McKinney-Vento Act also ensures that educational institutions are responsible for gathering reliable, valid, and comprehensive information regarding the extent of homelessness among schoolchildren. However, there are no federal programs in place specifically designed to meet the needs of LGBQ homeless youth in school settings, nor do data collection methods identify the sexual identity of homeless youth, either in programs serving homeless youth or in school settings, to understand the proportions and disparities of sexual identity and homelessness.2 This used data from a representative sample of middle school youth enrolled in the Los Angeles Unified School District (LAUSD) to assess the following research questions: (1) What is the prevalence of youth homelessness among students enrolled in public middle school? (2) What types of homelessness are middle school students experiencing (sheltered, unsheltered, or staying with strangers)? (3) How is sexual identity associated with middle school homelessness and type of homeless experience?
METHODS Participants and Procedure In 2012, a supplemental survey to the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Survey (YRBS) containing questions regarding sexual identity and past-year homelessness was administered to a 2-stage random probability sample of LAUSD sixth- to eighth-grade students at 25 schools. The YRBS is required to be completed by the LAUSD per a cooperative agreement between the LAUSD and the CDC. Of the 1320 sampled students, 1285 students completed the supplemental survey, yielding a response rate of 97.35%. The YRBS usually yields high response rates because of steps taken by the LAUSD to stimulate responses from participants. Research with minors typically requires parental consent and can reduce response rates because it is more labor intensive. LAUSD schools use passive parental permission, meaning that parents send back a signed form only if they do not want their child to participate in the survey. Passive parental consent typically increases participation rates. Additionally, the district requires teachers to administer the survey and they receive an incentive if they administer the survey in a timely manner, which also potentially increases student participation rates. These procedures were fully approved by the LAUSD Health Education Programs Unit’s institutional review board. Of the 1285 respondents, 99 respondents were excluded from the
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analysis for identifying as transgender and one was excluded for reporting an age of 17 years. In total, 1185 respondents comprised the sample used for the current analysis. Student ages ranged from 10 to 15 years old. Sampling weights adjusted for the distribution of students by race and ethnicity.
or Latino (59.8%) and 9.5% identified as LGBQ. Overall, 23.5% of heterosexual and 23.2% of LGBQ youth experienced at least 1 night of homelessness during the previous year. While 14.9% of heterosexual youth reported staying in a shelter, only 8.13% of LGBQ youth reported doing the same. In contrast, LGBQ students reported staying in a public place at more than twice the rate of heterosexual students: 14.4% versus 6.0%, respectively. Because these are representative data, we were able to extrapolate these rates to estimate that more than 28,000 LAUSD middle school students during the 2011-2012 school year experienced at least 1 night of past-year literal homelessness (Table 1). More than 17,000 youth spent at least 1 night in a shelter, 7000 in a public place, and more than 5000 in the home of a stranger (these are not mutually exclusive categories). Multivariable logistic regression results are presented in Table 2. Younger youth were less likely to report any type of homelessness; other demographic characteristics were not statistically significantly associated with overall homelessness experiences. Students who identified as LGBQ were equally as likely as their non-LGBQ peers to experience any type of homelessness episode during the previous year. However, sexual identity was the only statistically significant correlate of different types of homelessness experiences. LGBQ youth were 65% as likely as heterosexual youth to spend a night in a shelter and 5.7 times as likely to have stayed in a public place.
Instrumentation Demographic variables included age, sex, sexual identity, race, and ethnicity. Sexual identity was dichotomized as LGBQ versus heterosexual based on the question: ‘‘What do you consider your sexual orientation? (homosexual [gay or lesbian], bisexual, heterosexual [straight], transgender, or questioning/unsure).’’ Transgender was erroneously included in the sexual identity question rather than the sex item; as such, respondents who selected transgender were excluded from analyses. Race and ethnicity were classified into 5 categories: Hispanic or Latino, White, Black or African American, mixed race, and other race. Other race was an aggregate category of Asian, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander. Past-year homelessness was assessed by asking: ‘‘During the past 12 months, have you spent the night in any of the following places (Check all that apply)?’’ Responses assessed literal homelessness experiences: staying in a youth or adult shelter; a public place such as a train or bus station, a restaurant, or an office building; in an abandoned building; outside in a park, on the street, under a bridge or overhang, or on a rooftop; in a subway or other public place underground; or with someone not known to the respondents because they needed a place to stay. This assessment of youth homelessness was adapted from previous work by Ringwalt et al.23,24 The measure was designed based on federal guidelines and considers youth to be homeless if they spent the night in a youth or adult shelter or in any of several locations that are not intended for dwelling or where their safety would be compromised.
DISCUSSION This is one of the relatively few studies that have examined youth homelessness and sexual identity in the same representative sample, and it focused specifically on middle school students, a population that has been even less studied. These results have important policy and programmatic implications. We estimate that at least one-fourth of the 120,408 LAUSD middle school students enrolled in the 2011-2012 academic year experienced some form of homelessness during the previous year, or more than 28,000 students. However, this is an approximation to the general population based on estimates of this study. It is possible that this estimate is low because students who may have been experiencing homelessness may not have been in attendance the day of survey administration. Also of concern is the finding that being older increased the likelihood of experiencing any type of homelessness. Contrary to findings among high school students, LGBQ middle school youth did not report more overall homelessness than their heterosexual peers. However, LGBQ students were significantly more likely than heterosexual students to report having stayed in a public place and significantly less likely to report
Data Analysis Multivariable logistic regression models assessed demographic associations with experiences of homelessness and separately for staying in a shelter, with a stranger, or in a public place (among those who had experienced homelessness). For these analyses, staying in an abandoned building, a public place, outside, or underground were collapsed into 1 variable: staying in a public place.
RESULTS As seen in Table 1, respondents were 12.3 years old on average (SD = 0.88) and slightly more than half (51.4%) were boys. The majority identified as Hispanic 554 •
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Table 1. Demographic Characteristics and Homelessness Experiences by Sexual Identity: Supplement to the Youth Risk Behavior Survey, Los Angeles, CA, 2012 Estimated Homeless LAUSD Students∗ Overall Sample % (N) n Age† Sex Boys Girls Sexual identity Heterosexual Nonheterosexual (LGBQ) Race and ethnicity Hispanic or Latino White Black or African American Mixed race Other race Any homelessness Location of homelessness Youth or adult shelter Public place‡ Stranger’s home
Heterosexual Nonheterosexual Students Students % (N) % (N)
Homeless Students % (N)
Overall Heterosexual Nonheterosexual Homeless Homeless Homeless Students Students Students N N N
1185 12.30 (0.88)
1048 12.32 (0.84)
137 12.09 (0.90)
269 12.15 (0.90)
28,260
25,903
2357
51.39 (599) 48.61 (586)
51.39 (541) 48.61 (507)
31.88 (45) 68.12 (92)
55.30 (149) 44.70 (20)
15,628 12,632
14,296 11,556
1332 1076
91.66 (244) 8.34 (25)
25,903 2357
90.46 (1048) 9.54 (137) 59.78 (732) 15.2 (119) 18.3 (83) 1.26 (86) 5.63 (90) 23.54 (269)
59.78 (669) 15.20 (100) 18.30 (76) 1.26 (74) 5.63 (82) 23.54 (263)
60.44 (61) 28.66 (18) 18.27 (6) 1.91 (44) 4.45 (8) 23.16 (25)
61.56 (177) 13.04 (24) 17.85 (19) 1.06 (25) 6.49 (24)
17,397 3685 5044 300 1834
15,914 3371 4615 274 1678
1482 314 430 26 156
14.94 (165) 5.97 (66) 4.61 (51)
14.94 (155) 5.97 (54) 4.61 (42)
8.32 (10) 14.44 (12) 7.91 (9)
61.46 (165) 25.09 (66) 18.98 (51)
17,369 7090 5364
15,889 6486 4907
1480 604 457
LAUSD, Los Angeles Unified School District; LGBQ, lesbian, gay, bisexual, or questioning. Table features weighted percentages and unweighted subsample sizes. ∗ Total middle school students enrolled in LAUSD 2012-2013 = 120,408. † Figures reflect mean and standard deviation. ‡ Aggregate of abandoned building, outside, underground, or other public place.
Table 2. Weighted Multivariable Logistic Regression of Any Homelessness Experience and Type of Experience, LAUSD Middle School Students Type of Homelessness Experience†
Any Homelessness Stranger OR 0.769**
Age Sex (boy= 1) 1.314 Sexual identity (LGBQ= 1) 0.791 Race (Hispanic or Latino= 1) Black or African American 0.814 White 0.763 Other race‡ 1.068 Mixed 0.773 N in final model 1185 2 log likelihood −1256.46 R2 .013
Shelter
95% CI
OR
95% CI
OR
95% CI
0.655-0.904 0.995-1.736 0.473-1.323
1.418 0.567 2.406
0.992-2.027 0.301-1.070 0.886-6.534
0.845 0.710 0.367*
0.634-1.127 0.426-1.184 0.141-0.953
0.561-1.183 0.505-1.154 0.603-1.891 0.212-2.819
1.036 2.146 1.310 0.928 259 −250.35 .051
1.172 0.690 0.922 0.776 259 −353.34 .034
0.572-2.401 0.323-1.474 0.333-2.554 0.097-6.222
0.412-2.601 0.907-5.078 0.364-4.715 0.040-21.581
Public Place OR 1.142 1.563 5.670** 1.606 0.718 1.049 1.602 259 −288.39 .062
95% CI 0.826-1.579 0.859-2.842 2.089-15.391 0.751-3.435 0.277-1.862 0.320-3.440 0.170-15.045
* p < .05; ** p < .01.
LAUSD, Los Angeles Unified School District; OR, odds ratio; CI, confidence interval; LGBQ, lesbian, gay, bisexual, or questioning. † Of those who experienced past-year homelessness. ‡ Aggregate of Asian, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander.
having stayed in a shelter. These results reinforce prior research that indicated LGBQ youth are less likely than their heterosexual peers to spend the night in a shelter,5 perhaps because they perceive greater stigma and discrimination at these sites.21 This is particularly problematic, because shelters are protective for Journal of School Health
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youth experiencing homelessness25,26 and sleeping in a public place has several health consequences and increases the risk of victimization.14-17 Living unsheltered likely contributes to homeless LGBQ youth being at higher risk of victimization, mental health problems, and unsafe sexual practices.23,25-27
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These results suggest that early intervention with LGBQ youth at risk of homelessness, coupled with the creation and promotion of LGBQ-friendly services for these youth, is needed.
physical and mental health problems associated with homelessness.28 Based on our findings, we developed the following suggestions to address middle school homelessness. More aggressive homelessness surveillance systems need to be created for middle school students. School administrators and personnel should develop informed procedures for identifying youth at greatest risk of homelessness. Results from the most recent youth homelessness research should be incorporated with information reflecting each school’s unique characteristics, most importantly taking into consideration student cultures and values. We also recommend that the CDC incorporate the past-year homelessness item that was used in this current study (as part of a supplemental questionnaire) into the standard YRBS as a way of annually assessing the accuracy of school district surveillance efforts. Students may be underreporting their homelessness in traditional routes (eg, with school personnel) due to the stigma of homelessness. The anonymity of the YRBS may reduce this social desirability bias. Moreover, the items we propose do not use the word ‘‘homeless’’ and are also less likely to trigger social desirability bias. Middle school districts would benefit from creating a Youth Homelessness Task Force that would carefully develop and enforce these procedures. The results also indicate a need for shelters to be more responsive to the unique needs of younger LGBQ youth experiencing homelessness. Likewise, school systems need to understand that young LGBQ adolescents who are experiencing homelessness are more likely to be experiencing the dangerous context of staying in public places and not the relatively safer environment of shelters. It is important that schools collaborate with local youth homelessness agencies, particularly those that offer temporary or permanent shelter. Middle schools could also benefit from an overall homelessness awareness campaign. Increasing students’ knowledge of the definitions and root causes of homelessness could potentially lower feelings of stigma and increase their willingness to reach out for assistance.
Limitations This study had some limitations, including the cross-sectional nature of these data that did not allow for causal claims to be made with respect to homelessness and sexual identity and that these data were based on self-reports. Moreover, we do not know if homeless youth in our study were unaccompanied or experienced homelessness with their families. The strengths of the probability sampling strategy, however, increased the generalizability of these unique findings. In addition, because transgender was erroneously classified under sexual identity, we excluded 99 respondents who identified as transgender. It is possible that these individuals also might have experienced greater homelessness, which might have skewed the results. Another limitation is that a relatively small number of LGBQ students reported homelessness (N = 24); however, one of the strengths of the study is its sufficiently large overall sample size that enabled the detection of differences. Approximately 10% of the youth who experienced homelessness identified as LGBQ, which is similar to LGBQ rates in the overall student sample. Conclusions Despite these limitations, the findings highlight the large number of middle school students in the LAUSD who may be experiencing limited educational opportunities as the result of a homelessness experience in a given year. Homeless students are more likely to repeat a grade, drop out of school, or be placed in a special education program than housed peers.28 Schools should be the first to identify youth at risk of homelessness in their system.
IMPLICATIONS FOR SCHOOL HEALTH Results from this study indicate that a substantial percentage of survey respondents reported experiencing at least 1 night of homelessness during the previous year. Identifying and preventing homelessness at a young age is critical, because early intervention is associated with shorter experiences of homelessness.29 The experience of multiple living situations and the lack of a permanent residence put homeless youth on a trajectory toward early independence.30 It is also important to address homelessness as quickly as possible because unaccompanied, newly homeless youth are more likely to return home compared with youth who have experienced longer durations of homelessness,31 thereby reducing the likelihood of 556 •
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Human Subjects Approval Statement This study analyzed existing, de-identified data collected by the LAUSD. As such, it was granted exemption from human subjects review by the institutional review board of the affiliated university.
REFERENCES 1. Toro PA, Dworsky A, Fowler PJ. Homeless youth in the United States: recent research findings and intervention approaches. Paper presented at: Toward Understanding Homelessness: The 2007 National Symposium on Homelessness Research; March 1-2, 2007; Washington, DC. Available •
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at: http://aspe.hhs.gov/hsp/homelessness/symposium07/toro/. Accessed October 12, 2013. Quitana NS, Rosenthal J, Krehely J. The federal response to gay and transgender homeless youth. 2010. Available at: http://www.americanprogress.org/issues/lgbt/report/2010/06/ 21/7983/on-the-streets/. Accessed October 25, 2013. Corliss HL, Goodenow CS, Nichols L, Austin SB. High burden of homelessness among sexual-minority adolescents: findings from a representative Massachusetts high school sample. Am J Public Health. 2010;101(9):1683-1689. Rice E, Fulginiti A, Winetrobe H, Montoya J, Plant A, Kordic T. Sexuality and homelessness in Los Angeles public schools. Am J Public Health. 2012;102(2):200-201. Rice E, Barman-Adhikari A, Rhoades H, et al. Homelessness experiences, sexual orientation, and sexual risk taking among high school students in Los Angeles. J Adolesc Health. 2013;52(6):773-778. Birkett M, Espelage DL, Koenig B. LGB and questioning students in schools: the moderating effects of homophobic bullying and school climate on negative outcomes. J Youth Adolesc. 2009;38(7):989-1000. Igartua K, Thombs BD, Burgos G, Montoro R. Concordance and discrepancy in sexual identity, attraction, and behavior among adolescents. J Adolesc Health. 2009;45(6):602-608. Zhao Y, Montoro R, Igartua K, Thombs BD. Suicidal ideation and attempt among adolescents reporting ‘‘unsure’’ sexual identity or heterosexual identity plus same-sex attraction or behavior: forgotten groups? J Am Acad Child Adolesc Psychiatry. 2010;49(2):104-113. Herdt G, McClintock M. The magical age of 10. Arch Sex Behav. 2000;29(6):587-606. Savin-Williams RC. The new gay teen: shunning labels. Gay Lesbian Rev. 2005;12(6):16. Floyd FJ, Bakeman R. Coming-out across the life course: implications of age and historical context. Arch Sex Behav. 2006;35(3):287-296. Grov C, Bimbi DS, Nan´ın JE, Parsons JT. Race, ethnicity, gender, and generational factors associated with the comingout process among gay, lesbian, and bisexual individuals. J Sex Res. 2006;43(2):115-121. Gay, Lesbian & Straight Education Network. The Experiences of Lesbian, Gay, Bisexual and Transgender Middle School Students: Findings from the 2007 National School Climate Survey. New York, NY: Gay, Lesbian and Straight Education Network; 2009. Higgitt N, Wingert S, Ristock J, et al. Voices from the Margins: Experiences of Street-Involved Youth in Winnipeg. Winnipeg, Canada: Winnipeg Inner-City Research Alliance; 2003. Dachner N, Tarasuk V. Homeless ‘‘squeegee kids’’: food insecurity and daily survival. Soc Sci Med. 2002;54(7):1039-1049. McCreary Centre Society. Between the Cracks: Homeless Youth in Vancouver. Burnaby, Canada: McCreary Centre Society; 2002.
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17. Witkin AL, Milburn NG, Rotheram-Borus MJ, Batterham P, May S, Brooks R. Finding homeless youth: patterns based on geographical area and number of homeless episodes. Youth Soc. 2005;37(1):62-84. 18. Baron SW. General strain, street youth and crime: a test of Agnew’s revised theory. Criminology. 2004;42(2):457-484. 19. Gaetz S. Whose safety counts? street youth, social exclusion, and criminal victimization. In: Hulchanski JD, Campsie P, Chau SBY, Hwang SW, Paradis E, eds. Finding Home: Policy Options for Addressing Homelessness in Canada. Toronto, Canada: University of Toronto; 2009. 20. Bender K, Ferguson K, Thompson S, Komlo C, Pollio D. Factors associated with trauma and posttraumatic stress disorder among homeless youth in three US cities: the importance of transience. J Trauma Stress. 2010;23(1):161-168. 21. Ray N. Lesbian, Gay, Bisexual and Transgender Youth: An Epidemic of Homelessness. New York, NY: National Gay and Lesbian Task Force Policy Institute and the National Coalition for the Homeless; 2006. 22. McKinney-Vento Homeless Education Assistance Improvements Act of 2001, 42 USC §11431 et seq. (1987). 23. Tsemberis S, McHugo G, Williams V, Hanrahan P, Stefancic A. Measuring homelessness and residential stability: the Residential Time-Line Follow-Back Inventory. J Community Psychol. 2007;35(1):29-42. 24. Ringwalt CL, Greene JM, Robertson M, McPheeters M. The prevalence of homelessness among adolescents in the United States. Am J Public Health. 1998;88(9):1325-1329. 25. Rice E, Stein JA, Milburn N. Countervailing social network influences on problem behaviors among homeless youth. J Adolesc. 2008;31(5):625-639. 26. Thompson SJ, Pollio DE, Constantine J, Reid D, Nebbitt V. Short-term outcomes for youth receiving runaway and homeless shelter services. Res Soc Work Pract. 2002;12(5):589603. 27. National Coalition for the Homeless. LGBT homeless. 2009. Available at: http://www.nationalhomeless.org/factsheets/ lgbtq.html. Accessed July 14, 2013. 28. Institute for Children and Poverty. Access to Success: Meeting the Educational Needs of Homeless Children and Families. 1993. Available at: http://www.icphusa.org/PDF/ reports/AccesstoSuccess.pdf. Accessed June 3, 2013. 29. Robertson MJ, Toro PA. Homeless youth: research, intervention, and policy. In: Fosburg LB, Dennis DL, eds. Practical Lessons: The 1998 National Symposium on Homelessness Research. Washington, DC: US Department of Housing and Urban Development and US Department of Health and Human Services; 1999:3-1. 30. Tyler KA, Schmitz RM. Family histories and multiple transitions among homeless young adults: pathways to homelessness. Child Youth Serv Rev. 2013;35(10):1719-1726. 31. Milburn NG, Rosenthal D, Rotheram-Borus MJ, et al. Newly homeless youth typically return home. J Adolesc Health. 2007;40(6):574-576.
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Homelessness and Sexual Identity Among Middle School Students ERIC RICE, PhDa ROBIN PETERING, MSWb HARMONY RHOADES, PhDc ANAMIKA BARMAN-ADHIKARI, PhDd HAILEY WINETROBE, MPHe AARON PLANT, MPHf JORGE MONTOYA, PhDg TIMOTHY KORDIC, MAh
ABSTRACT BACKGROUND: Lesbian, gay, bisexual, or questioning (LGBQ) high school students experience higher rates of homelessness than their heterosexual peers. Moreover, LGBQ high school students are more likely to stay in riskier locations (eg, with a stranger) and less likely to stay in a shelter. This study tested whether these trends also apply to middle school students. METHODS: Using representative data, we examined sexual identity and homelessness among Los Angeles Unified School District middle school students. RESULTS: Nearly 10% of middle school students identified as LGBQ and 23.5% experienced at least 1 night of homelessness during the previous year. Contrary to high school data, LGBQ students did not experience higher rates of homelessness overall. However, when limiting the sample to students who had experienced homelessness, LGBQ students were more than 5 times as likely as heterosexual students to have stayed in a public place and 63% as likely to have stayed in a shelter. CONCLUSIONS: Lesbian, gay, bisexual, or questioning students are more likely to experience public homelessness. Schools must implement homelessness surveillance systems to assist in identifying early episodes of homelessness, thereby reducing the likelihood of poor physical and mental health outcomes associated with chronic homelessness. Keywords: special populations; mental health; LGBQ youth; human sexuality; school health instruction; child and adolescent health; school health services. Citation: Rice E, Petering R, Rhoades H, Barman-Adhikari A, Winetrobe H, Plant A, Montoya J, Kordic T. Homelessness and sexual identity among middle school students. J Sch Health. 2015; 85: 552-557. Received on March 17, 2014 Accepted on January 23, 2015
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pproximately 1.6 million youth are homeless in the United States each year.1 During the 2008-2009 school year, public schools enrolled nearly 1 million homeless children and youth.2 Recent studies among high school students have found that sexual minority (ie, lesbian, gay, bisexual, and questioning—LGBQ) youth experience higher rates of homelessness than their heterosexual peers.3-5 This is especially problematic because LGBQ students are often at greater risk of negative outcomes like depression, suicidality, drug use, and academic difficulties.6
What is unknown, however, is how the prevalence of homelessness among high school students compares to homelessness experiences of middle school students and if LGBQ middle school youth face the same disproportionate burden of homelessness. The context of sexual identity is believed to be different in middle school, because research has found that sexual identity is fluid throughout adolescence and the self-concept of sexual identity in early adolescence may not be fully developed.7,8 Recent research, however, has found that contrary to conventional wisdom, American
a Assistant Professor, ([email protected]), School of Social Work, University of Southern California, 1150 S. Olive Street, 14th floor, Los Angeles, CA 90015. bPhD student, ([email protected]), School of Social Work, University of Southern California, 1150 S. Olive Street, 14th floor, Los Angeles, CA 90015. c Research Assistant Professor, ([email protected]), School of Social Work, University of Southern California, 1149 S. Hill Street, Suite 360, Los Angeles, CA 90015. dAssistant Professor, ([email protected]), Department of Social Work Education, Fresno State University, 5310 N. Campus Drive, M/S PHS 144, Fresno, CA 93710-8019. e Project Specialist, ([email protected]), School of Social Work, University of Southern California, 1149 S. Hill Street, Suite 360, Los Angeles, CA 90015. f Vice President, ([email protected]), Program Planning and Evaluation, Sentient Research, 231 N. Walnuthaven Drive, West Covina, CA 91790. gPresident and CEO, ([email protected]), Sentient Research, 231 N. Walnuthaven Drive, West Covina, CA 91790. hProgram Manager, ([email protected]), LAUSD Health Education Programs, HIV/AIDS Prevention Unit, 333 S. Beaudry Avenue, 29th floor, Los Angeles, CA 90017.
Address correspondence to: Eric Rice, Assistant Professor, ([email protected]), School of Social Work, University of Southern California, 1150 S. Olive Street, 14th floor, Los Angeles, CA 90015. Data collection was supported by the Centers for Disease Control and Prevention (award 5U87DP001201-04).
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children become aware of their sexual identities much earlier than previously thought, at approximately 10 years of age.9 Additionally, studies have found that more LGBQ youth are ”coming out,” or disclosing their sexual orientation, at younger ages compared with previous generations.10-12 Furthermore, a 2007 national survey of lesbian, gay, bisexual, and transgender (LGBT) middle and high school students found that these students reported facing more hostile school climates than those in high school.13 About 90% of LGBT students reported facing verbal harassment, about 59% experienced physical harassment, and about 39% stated that they were physically assaulted because of their sexual orientation. Approximately half of LGBT students who responded to the survey reported missing school because they felt unsafe.13 In addition to peer rejection, LGBT youth often face stigma and lack of acceptance from their families, leaving them with little or no support. Because youth at this age are still dependent on their families to meet most of their needs, middle school children might be particularly vulnerable to homelessness if they face conflict or family rejection related to their sexual identity. Additionally, because of their age, these students might be more vulnerable to experiencing victimization while homeless. In addition to exploring the prevalence of homelessness among middle school students, this study examined where youth are more likely to spend the night when homeless. Previous findings revealed that high school LGBQ youth are less likely to use shelter services compared with heterosexual youth.4 Sleeping unsheltered, such as in a public place, outside, or in an abandoned building, has direct health consequences including sleep deprivation,14 poor nutrition, difficulty recovering from common illnesses,15 and poor personal hygiene due to a lack of access to sanitary facilities.14,16 Of particular concern, living unsheltered also has been associated with higher rates of victimization because it increases exposure to violent perpetrators14-18 and teaches youth that physical aggression is necessary to guarantee safety from future victimization.19 Additionally, homeless youth who are highly transient are at increased risk of being victimized in dangerous and unfamiliar environments.20 Living unsheltered also can be dangerous because homeless youth often live in areas with high rates of drug use and sex work.17 Although shelters are a safer and more secure option, they can be scary and uncomfortable for youth, who may dislike rules and regulations or distrust agency staff members and volunteers.15 For LGBQ youth, the possibility of encountering discrimination from staff members or other youth may make some unwilling to use shelter services.21 Furthermore, because homeless LGBQ youth are more likely to be unaccompanied,2 they may simply not know how to access shelters on their own. Journal of School Health
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Currently, the McKinney-Vento Homeless Assistance Act is the primary federal law that addresses the education of children and youth who experience homelessness.22 The law aims to provide school stability and access for youth while they or their families are homeless. The McKinney-Vento Act also ensures that educational institutions are responsible for gathering reliable, valid, and comprehensive information regarding the extent of homelessness among schoolchildren. However, there are no federal programs in place specifically designed to meet the needs of LGBQ homeless youth in school settings, nor do data collection methods identify the sexual identity of homeless youth, either in programs serving homeless youth or in school settings, to understand the proportions and disparities of sexual identity and homelessness.2 This used data from a representative sample of middle school youth enrolled in the Los Angeles Unified School District (LAUSD) to assess the following research questions: (1) What is the prevalence of youth homelessness among students enrolled in public middle school? (2) What types of homelessness are middle school students experiencing (sheltered, unsheltered, or staying with strangers)? (3) How is sexual identity associated with middle school homelessness and type of homeless experience?
METHODS Participants and Procedure In 2012, a supplemental survey to the Centers for Disease Control and Prevention’s (CDC) Youth Risk Behavior Survey (YRBS) containing questions regarding sexual identity and past-year homelessness was administered to a 2-stage random probability sample of LAUSD sixth- to eighth-grade students at 25 schools. The YRBS is required to be completed by the LAUSD per a cooperative agreement between the LAUSD and the CDC. Of the 1320 sampled students, 1285 students completed the supplemental survey, yielding a response rate of 97.35%. The YRBS usually yields high response rates because of steps taken by the LAUSD to stimulate responses from participants. Research with minors typically requires parental consent and can reduce response rates because it is more labor intensive. LAUSD schools use passive parental permission, meaning that parents send back a signed form only if they do not want their child to participate in the survey. Passive parental consent typically increases participation rates. Additionally, the district requires teachers to administer the survey and they receive an incentive if they administer the survey in a timely manner, which also potentially increases student participation rates. These procedures were fully approved by the LAUSD Health Education Programs Unit’s institutional review board. Of the 1285 respondents, 99 respondents were excluded from the
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analysis for identifying as transgender and one was excluded for reporting an age of 17 years. In total, 1185 respondents comprised the sample used for the current analysis. Student ages ranged from 10 to 15 years old. Sampling weights adjusted for the distribution of students by race and ethnicity.
or Latino (59.8%) and 9.5% identified as LGBQ. Overall, 23.5% of heterosexual and 23.2% of LGBQ youth experienced at least 1 night of homelessness during the previous year. While 14.9% of heterosexual youth reported staying in a shelter, only 8.13% of LGBQ youth reported doing the same. In contrast, LGBQ students reported staying in a public place at more than twice the rate of heterosexual students: 14.4% versus 6.0%, respectively. Because these are representative data, we were able to extrapolate these rates to estimate that more than 28,000 LAUSD middle school students during the 2011-2012 school year experienced at least 1 night of past-year literal homelessness (Table 1). More than 17,000 youth spent at least 1 night in a shelter, 7000 in a public place, and more than 5000 in the home of a stranger (these are not mutually exclusive categories). Multivariable logistic regression results are presented in Table 2. Younger youth were less likely to report any type of homelessness; other demographic characteristics were not statistically significantly associated with overall homelessness experiences. Students who identified as LGBQ were equally as likely as their non-LGBQ peers to experience any type of homelessness episode during the previous year. However, sexual identity was the only statistically significant correlate of different types of homelessness experiences. LGBQ youth were 65% as likely as heterosexual youth to spend a night in a shelter and 5.7 times as likely to have stayed in a public place.
Instrumentation Demographic variables included age, sex, sexual identity, race, and ethnicity. Sexual identity was dichotomized as LGBQ versus heterosexual based on the question: ‘‘What do you consider your sexual orientation? (homosexual [gay or lesbian], bisexual, heterosexual [straight], transgender, or questioning/unsure).’’ Transgender was erroneously included in the sexual identity question rather than the sex item; as such, respondents who selected transgender were excluded from analyses. Race and ethnicity were classified into 5 categories: Hispanic or Latino, White, Black or African American, mixed race, and other race. Other race was an aggregate category of Asian, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander. Past-year homelessness was assessed by asking: ‘‘During the past 12 months, have you spent the night in any of the following places (Check all that apply)?’’ Responses assessed literal homelessness experiences: staying in a youth or adult shelter; a public place such as a train or bus station, a restaurant, or an office building; in an abandoned building; outside in a park, on the street, under a bridge or overhang, or on a rooftop; in a subway or other public place underground; or with someone not known to the respondents because they needed a place to stay. This assessment of youth homelessness was adapted from previous work by Ringwalt et al.23,24 The measure was designed based on federal guidelines and considers youth to be homeless if they spent the night in a youth or adult shelter or in any of several locations that are not intended for dwelling or where their safety would be compromised.
DISCUSSION This is one of the relatively few studies that have examined youth homelessness and sexual identity in the same representative sample, and it focused specifically on middle school students, a population that has been even less studied. These results have important policy and programmatic implications. We estimate that at least one-fourth of the 120,408 LAUSD middle school students enrolled in the 2011-2012 academic year experienced some form of homelessness during the previous year, or more than 28,000 students. However, this is an approximation to the general population based on estimates of this study. It is possible that this estimate is low because students who may have been experiencing homelessness may not have been in attendance the day of survey administration. Also of concern is the finding that being older increased the likelihood of experiencing any type of homelessness. Contrary to findings among high school students, LGBQ middle school youth did not report more overall homelessness than their heterosexual peers. However, LGBQ students were significantly more likely than heterosexual students to report having stayed in a public place and significantly less likely to report
Data Analysis Multivariable logistic regression models assessed demographic associations with experiences of homelessness and separately for staying in a shelter, with a stranger, or in a public place (among those who had experienced homelessness). For these analyses, staying in an abandoned building, a public place, outside, or underground were collapsed into 1 variable: staying in a public place.
RESULTS As seen in Table 1, respondents were 12.3 years old on average (SD = 0.88) and slightly more than half (51.4%) were boys. The majority identified as Hispanic 554 •
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Table 1. Demographic Characteristics and Homelessness Experiences by Sexual Identity: Supplement to the Youth Risk Behavior Survey, Los Angeles, CA, 2012 Estimated Homeless LAUSD Students∗ Overall Sample % (N) n Age† Sex Boys Girls Sexual identity Heterosexual Nonheterosexual (LGBQ) Race and ethnicity Hispanic or Latino White Black or African American Mixed race Other race Any homelessness Location of homelessness Youth or adult shelter Public place‡ Stranger’s home
Heterosexual Nonheterosexual Students Students % (N) % (N)
Homeless Students % (N)
Overall Heterosexual Nonheterosexual Homeless Homeless Homeless Students Students Students N N N
1185 12.30 (0.88)
1048 12.32 (0.84)
137 12.09 (0.90)
269 12.15 (0.90)
28,260
25,903
2357
51.39 (599) 48.61 (586)
51.39 (541) 48.61 (507)
31.88 (45) 68.12 (92)
55.30 (149) 44.70 (20)
15,628 12,632
14,296 11,556
1332 1076
91.66 (244) 8.34 (25)
25,903 2357
90.46 (1048) 9.54 (137) 59.78 (732) 15.2 (119) 18.3 (83) 1.26 (86) 5.63 (90) 23.54 (269)
59.78 (669) 15.20 (100) 18.30 (76) 1.26 (74) 5.63 (82) 23.54 (263)
60.44 (61) 28.66 (18) 18.27 (6) 1.91 (44) 4.45 (8) 23.16 (25)
61.56 (177) 13.04 (24) 17.85 (19) 1.06 (25) 6.49 (24)
17,397 3685 5044 300 1834
15,914 3371 4615 274 1678
1482 314 430 26 156
14.94 (165) 5.97 (66) 4.61 (51)
14.94 (155) 5.97 (54) 4.61 (42)
8.32 (10) 14.44 (12) 7.91 (9)
61.46 (165) 25.09 (66) 18.98 (51)
17,369 7090 5364
15,889 6486 4907
1480 604 457
LAUSD, Los Angeles Unified School District; LGBQ, lesbian, gay, bisexual, or questioning. Table features weighted percentages and unweighted subsample sizes. ∗ Total middle school students enrolled in LAUSD 2012-2013 = 120,408. † Figures reflect mean and standard deviation. ‡ Aggregate of abandoned building, outside, underground, or other public place.
Table 2. Weighted Multivariable Logistic Regression of Any Homelessness Experience and Type of Experience, LAUSD Middle School Students Type of Homelessness Experience†
Any Homelessness Stranger OR 0.769**
Age Sex (boy= 1) 1.314 Sexual identity (LGBQ= 1) 0.791 Race (Hispanic or Latino= 1) Black or African American 0.814 White 0.763 Other race‡ 1.068 Mixed 0.773 N in final model 1185 2 log likelihood −1256.46 R2 .013
Shelter
95% CI
OR
95% CI
OR
95% CI
0.655-0.904 0.995-1.736 0.473-1.323
1.418 0.567 2.406
0.992-2.027 0.301-1.070 0.886-6.534
0.845 0.710 0.367*
0.634-1.127 0.426-1.184 0.141-0.953
0.561-1.183 0.505-1.154 0.603-1.891 0.212-2.819
1.036 2.146 1.310 0.928 259 −250.35 .051
1.172 0.690 0.922 0.776 259 −353.34 .034
0.572-2.401 0.323-1.474 0.333-2.554 0.097-6.222
0.412-2.601 0.907-5.078 0.364-4.715 0.040-21.581
Public Place OR 1.142 1.563 5.670** 1.606 0.718 1.049 1.602 259 −288.39 .062
95% CI 0.826-1.579 0.859-2.842 2.089-15.391 0.751-3.435 0.277-1.862 0.320-3.440 0.170-15.045
* p < .05; ** p < .01.
LAUSD, Los Angeles Unified School District; OR, odds ratio; CI, confidence interval; LGBQ, lesbian, gay, bisexual, or questioning. † Of those who experienced past-year homelessness. ‡ Aggregate of Asian, American Indian or Alaska Native, and Native Hawaiian or Pacific Islander.
having stayed in a shelter. These results reinforce prior research that indicated LGBQ youth are less likely than their heterosexual peers to spend the night in a shelter,5 perhaps because they perceive greater stigma and discrimination at these sites.21 This is particularly problematic, because shelters are protective for Journal of School Health
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youth experiencing homelessness25,26 and sleeping in a public place has several health consequences and increases the risk of victimization.14-17 Living unsheltered likely contributes to homeless LGBQ youth being at higher risk of victimization, mental health problems, and unsafe sexual practices.23,25-27
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These results suggest that early intervention with LGBQ youth at risk of homelessness, coupled with the creation and promotion of LGBQ-friendly services for these youth, is needed.
physical and mental health problems associated with homelessness.28 Based on our findings, we developed the following suggestions to address middle school homelessness. More aggressive homelessness surveillance systems need to be created for middle school students. School administrators and personnel should develop informed procedures for identifying youth at greatest risk of homelessness. Results from the most recent youth homelessness research should be incorporated with information reflecting each school’s unique characteristics, most importantly taking into consideration student cultures and values. We also recommend that the CDC incorporate the past-year homelessness item that was used in this current study (as part of a supplemental questionnaire) into the standard YRBS as a way of annually assessing the accuracy of school district surveillance efforts. Students may be underreporting their homelessness in traditional routes (eg, with school personnel) due to the stigma of homelessness. The anonymity of the YRBS may reduce this social desirability bias. Moreover, the items we propose do not use the word ‘‘homeless’’ and are also less likely to trigger social desirability bias. Middle school districts would benefit from creating a Youth Homelessness Task Force that would carefully develop and enforce these procedures. The results also indicate a need for shelters to be more responsive to the unique needs of younger LGBQ youth experiencing homelessness. Likewise, school systems need to understand that young LGBQ adolescents who are experiencing homelessness are more likely to be experiencing the dangerous context of staying in public places and not the relatively safer environment of shelters. It is important that schools collaborate with local youth homelessness agencies, particularly those that offer temporary or permanent shelter. Middle schools could also benefit from an overall homelessness awareness campaign. Increasing students’ knowledge of the definitions and root causes of homelessness could potentially lower feelings of stigma and increase their willingness to reach out for assistance.
Limitations This study had some limitations, including the cross-sectional nature of these data that did not allow for causal claims to be made with respect to homelessness and sexual identity and that these data were based on self-reports. Moreover, we do not know if homeless youth in our study were unaccompanied or experienced homelessness with their families. The strengths of the probability sampling strategy, however, increased the generalizability of these unique findings. In addition, because transgender was erroneously classified under sexual identity, we excluded 99 respondents who identified as transgender. It is possible that these individuals also might have experienced greater homelessness, which might have skewed the results. Another limitation is that a relatively small number of LGBQ students reported homelessness (N = 24); however, one of the strengths of the study is its sufficiently large overall sample size that enabled the detection of differences. Approximately 10% of the youth who experienced homelessness identified as LGBQ, which is similar to LGBQ rates in the overall student sample. Conclusions Despite these limitations, the findings highlight the large number of middle school students in the LAUSD who may be experiencing limited educational opportunities as the result of a homelessness experience in a given year. Homeless students are more likely to repeat a grade, drop out of school, or be placed in a special education program than housed peers.28 Schools should be the first to identify youth at risk of homelessness in their system.
IMPLICATIONS FOR SCHOOL HEALTH Results from this study indicate that a substantial percentage of survey respondents reported experiencing at least 1 night of homelessness during the previous year. Identifying and preventing homelessness at a young age is critical, because early intervention is associated with shorter experiences of homelessness.29 The experience of multiple living situations and the lack of a permanent residence put homeless youth on a trajectory toward early independence.30 It is also important to address homelessness as quickly as possible because unaccompanied, newly homeless youth are more likely to return home compared with youth who have experienced longer durations of homelessness,31 thereby reducing the likelihood of 556 •
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Human Subjects Approval Statement This study analyzed existing, de-identified data collected by the LAUSD. As such, it was granted exemption from human subjects review by the institutional review board of the affiliated university.
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