Street Children and Drug Abuse: Social and Health Consequences

United States

Executive Summary

When NIDA and the World Health Organization (WHO) assembled 37 representatives from 16 nations to discuss vulnerable children and youth and substance abuse, participants described a sense of urgency in creating research-based interventions to reduce substance abuse and address the numerous challenges facing the world's vulnerable children and youth. Street Children and Drug Abuse: Social and Health Consequences was convened September 17 through 19 in Marina Del Rey, California. The researchers and community-based organizers met to enhance networks for communication and cooperation, examine science-based interventions from around the world, and set action priorities to shape a collaborative, cross-national, multidisciplinary research agenda that will promote the health and well-being of young people.

Through a series of formal presentations, panel discussions, and working groups, the participants discussed the state of basic research on solvents and inhalants (which are commonly abused by vulnerable children and youth because they are mostly legally available and inexpensive), epidemiological and ethnographic research, data collection and measurement issues, and developing effective programs to reduce substance abuse. A panel of young men who have moved from life as street youth to become peer counselors and outreach workers with the Los Angeles Youth Network joined meeting participants for a wide-ranging discussion of research, treatment, and service issues related to vulnerable children and youth.

NIDA and WHO cosponsored the meeting, with support from the U.S. Department of State. The organizing committee was cochaired by Dr. M. Patricia Needle, International Program Director, NIDA Office of Science Policy and Communications; and Dr. Andrew Ball, Medical Officer, WHO Department of Child and Adolescent Health and Development, and included Dr. Mary Jane Rotheram-Borus, University of California Los Angeles; Dr. John Howard, Macquarie University, Sydney, Australia; and Ms. Moira O'Brien, Community Research Branch, NIDA Division of Epidemiology, Services and Prevention Research. Dr. Needle welcomed the participants, calling their varied backgrounds and diverse cultural experiences a unique advantage in generating opportunities for multinational and multidisciplinary research. Dr. Ball provided background information on the WHO Street Children project and described current WHO research interests. Dr. Howard proposed a number of connections between researchers, service providers, and young people to define the contextual, structural, and social conditions that researchers work within, and identified areas for future collaboration. He reported that effective projects reunite or recreate families and train vulnerable children and youth for meaningful employment. Finally, he urged researchers to connect their findings to broad policy and practice issues so that policymakers make addressing the long-term needs of vulnerable children and youth a global priority, and service providers can establish quality of care standards. Dr. Rotheram-Borus outlined the network of interconnected risk factors that are shaped by national variations in policies, values, and systems of care to create definite pathways into and out of the street for children around the world, including alcohol and drug use, sex work, unemployment, HIV, suicide, sexual and physical abuse, incarceration, illness, psychiatric issues, economic instability, war, and violence. She urged participants to form a coordinated research network to develop a participatory action agenda that identifies both universal and unique characteristics of policies, care systems, and service agencies so that researchers can design, implement, and evaluate interventions.

Inhalant Abuse by Vulnerable Children and Youth

Vulnerable children and youth frequently abuse inhalants. Unlike other drugs of abuse, inhalants are defined by their route of administration and are mostly legal substances (such as art and office supplies, industrial chemicals, or aerosol propellants) which are easily available, inexpensive, and used primarily by disadvantaged groups. Dr. Silvia Cruz, Cinvestav, Mexico, discussed the characteristics of this wide variety of chemically different substances, which are all volatile, inhaled, and affect the central nervous system. She warned that researchers must take into account the conditions that affect vulnerable children and youth, such as age, gender, poverty, malnutrition, lack of services, and other health problems, and outlined a number of questions for future investigations. Discussing U.S. trends in inhalant use, Mr. Harvey Weiss, U.S. National Inhalant Prevention Coalition, reported that surveys of school- and college-age young people document that the prevalence of inhalant abuse is exceeded only by the prevalence of alcohol, tobacco, and marijuana abuse, and is most common among middle and upper class White youth, which is a very different use pattern than that observed in developing countries. National Inhalant Prevention Coalition researchers noted that inhalant use declined when young people and their parents perceived inhalants as dangerous and harmful. The coalition developed a prevention program that uses the Poison Control Center education approach to stress that inhalants are poisons and different from other drugs of abuse.

Participant Panel Presentations

In panel discussions organized by geographical regions, participants described research and services targeted to vulnerable children and youth around the world. Whether they were discussing the most economically powerful nations or countries with extremely limited resources, participants described uniquely similar situations, where the number of vulnerable children and youth is increasing; their age is decreasing; and substance abuse, sexual abuse, and violence are all part of a complex series of factors affecting their lives. Substance abuse by vulnerable children and youth begins with those substances that are most readily available and inexpensive. Inhalants are often the first abused substance because they are inexpensive and mostly legally available, but in some communities the first drug of abuse is alcohol, tobacco, marijuana, or a coca product. Injection drug use was reported most commonly in developed countries, probably because children who live on the streets there tend to be older than their counterparts in developing countries, and injection drug use appears to be related to age and physical and emotional development. There is evidence that injection drug use is increasing among vulnerable children and youth in some regions of both transitional and developing countries. The number of vulnerable children and youth increases with cultural shifts from rural to urban societies, economic and social instability, and decreased importance of nuclear families. Vulnerable children and youth in developing countries are more likely to have continuing contact with families, school, and work than are vulnerable children and youth in developed countries. But, for many children in developing countries, the street is home.

Research Methods and Data Collection Issues

Dr. Philippe Bourgois, University of California San Francisco, discussed ways to integrate the qualitative and quantitative approaches to data collection, particularly participant observation. Although epidemiologists seek a large sample size to provide accuracy, Dr. Bourgois explained that ethnographers can achieve similar accuracy with smaller samples because they develop indepth relationships with study participants that allow them to break down socially desirable answers, document what actually happens by observing taboo behaviors in natural settings, address the larger social and cultural context in which study subjects operate, and provide more accurate understanding of study participants' behaviors and motivations. The research team can then integrate the observations within the epidemiological hypothesis, tailor fieldwork around expected and unexpected associations, and adapt the interview process where necessary. Introducing a discussion of data collection and measurement issues, Dr. Ball asked participants to adopt common issues, research methods, and measurement tools to develop consistent and comparable strategies and approaches that could be applied nationally, regionally, and globally. Describing how Health Canada developed an enhanced surveillance tool to track trends in sexually transmitted diseases among Canadian youth living on the streets, Dr. Suzanne Shields stressed that enhanced surveillance requires a commitment from all those involved, is a valuable tool to conduct research among hard-to-reach groups, and complements routinely collected data rather than collecting repetitive data. Addressing ways to conduct user-friendly assessments that become part of the daily life for a service-providing agency, Dr. Rotheram-Borus described how data collection at intake, routine assessments, and followup could be used to reduce risk behaviors, evaluate programs, and empower vulnerable children and youth to become active participants in the research agenda. Dr. Michael Clatts, National Development Research Institute, New York City, illustrated how ethnography contributes voice and variability to public health discussions, describing his research that used participant observation to document a number of distinct behavioral patterns of needle-sharing. Drs. Needle, Ball, and Sutherland discussed relevant funding mechanisms, professional development programs, and technical assistance available to support international collaborative research on drug abuse.

Workgroups and Recommendations

Participants formed four workgroups to discuss cross-cutting issues; contrast developed and developing country experiences; identify ways to involve vulnerable children and youth in the research process; and review training, funding, and networking resources. Each group focused on one of four assigned topics: research on inhalants and solvents, developing effective interventions, effective data collection, and pathways to and from the streets. The discussions centered on the status of current research efforts, the application of research findings to policy and practice, and action priorities. Members of the workgroup on inhalants and solvents research sought ways to generate data that will promote understanding of the changing patterns of substance abuse among vulnerable children and youth, especially new drugs and routes of administration, and determine the sociocultural factors that influence those changing patterns of substance abuse. The participants reviewed methods to design effective prevention messages, strategies to deter individuals from starting substance use, the role of the family in prevention, and the role of the Poison Control Center in inhalant abuse treatment. Members of the workgroup on developing effective interventions defined effective programs for reducing substance abuse as evidence-based, multidisciplinary projects with multiple components and a well-defined mission to serve a specialized target group. Effective programs start small and grow in small steps, and promote local ownership of the program. The group concluded that effective interventions require structured expectations; coordination with networks of service providers; involvement by family members, peers, the community, police, and Government officials; sustainable staff and financing; and ongoing evaluation and advocacy. Members of the workgroup on effective data collection agreed that monitoring at the local and international levels provides a valuable cross-national perspective for countries as they assess the nature and extent of problems relating to substance abuse and vulnerable children and youth in neighboring countries, predict the local impact of these problems, and direct resources to address the issues. The workgroup focused on basic surveillance and ways to enhance existing systems, capacity building, and research collaborations. Discussants recommended that research be linked to services and interventions as well as use a broad range of methods to identify new and emerging health issues and drug use trends. Participants in the workgroup on pathways to and from the streets stressed that no single factor is responsible for children living on the streets, and suggested that researchers focus their investigations on the complex interaction of factors that influence pathways to the streets. The workgroup members explored ways that researchers and service providers could use flexibility and creativity in seeking information from different resources and through everyday interactions in different settings, and suggested that researchers identify which approaches are effective in influencing governmental policies on vulnerable children and youth and substance abuse.

Meeting participants adopted recommendations presented by each workgroup during the closing plenary session, as well as five general recommendations:

• NIDA and WHO should establish a workgroup on substance abuse by vulnerable children and youth that will adopt a modest agenda of activity and coordinate a followup meeting within 18 months.
   
• NIDA should assist researchers with communications, and participants should commit to continued communications within and among the workgroups established at this meeting, as well as on a regional, national, and global basis.
   
• NIDA and WHO should facilitate international teams of researchers to help nations share and translate research methodologies as they develop a national research agenda, including design, implementation, and evaluation of best practices.
   
• NIDA and WHO should coordinate a special issue of a research journal to disseminate best practices and model interventions.
   
• Attendees should participate in the activities of other international working groups, such as Mapping the AIDS Pandemic, which produces a report immediately before major AIDS meetings, and the Global Research Network on HIV Prevention in Drug-Using Populations, which will next meet in Melbourne, Australia, in conjunction with the 2001 International Congress on AIDS in Asia and the Pacific.

This program book is also available for download [PDF, 475 KB].