Toronto Street-Involved Youth and Barriers to Access of Health Services

Abstract

Purpose: Street-involved youth (SY) are a physically and emotionally vulnerable group. Living conditions and background circumstances, such as history of abuse, lack of education, or ethnic background, may lead SY to engage in high risk behaviors such as unsafe sexual practices and substance abuse. Previous studies have shown that SY's access to basic health care services is inequitable compared to their peers in the general population. Consequently, SY who are unable to access health services are more likely to report high risk behaviors. In this study we describe the barriers faced by Toronto SY in accessing health care services and how perception of barriers differs by demographics, physical and mental health, and history of abuse. Methods: Enhanced Street Youth Surveillance (E-SYS) is a repeated cross-sectional study of SY (15-24 years) across major urban centers across Canada. Participants completed a nurse-administered questionnaire and provided urine and sera samples for sexually transmitted and blood-borne infections testing. Using Toronto data from E-SYS Cycle 6 (2010) we calculated descriptive statistics and chisquare tests were performed to investigate bivariate relationships. Results: Among Toronto SY surveyed (N= 194), the mean age was 21.1 years (SD=2.4), 61.3% identified as males and 15.0% identified as Aboriginal. Commonly reported health care access points included youth drop-in centre (47.9%), family doctor (18.4%), street nurse (13.4%) and hospital or emergency room (12.5%). Over half of SY reported barriers accessing health care ( 52.5%). Commonly reported barriers included limited opening hours (8.8%), long waiting times ( 6.9%), social norms (8.8%), and lack of a health insurance card (29.4%). We did not find any differences in reporting barriers to accessing health care by gender, ethnicity or education level. A high proportion of SY reported a lifetime history of abuse (73.5%), including emotional (56.5%), physical (53.0%), and sexual (28.5%) abuse; neglect (48.0%); and witnessing violence (56.5%). More females than males reported being abused (81.8% vs. 68.3%, p=.03). Barriers to accessing health care did not differ by history of abuse.Reported barriers to accessing health care differed by self-reported physical and mental health. SY who reported their physical health as being fair or poor (34.5%) compared to those who reported excellent, very good or good health, reported significantly higher barriers to accessing health services (69.4% vs. 47.0%, p < .01). Similarly, SY reporting poor or fair mental health (30.5%) reported significantly more barriers than those reporting excellent, very good or good mental health (63.9% vs. 47.8%, p=.01). Conclusions: In our Toronto experience, a high proportion of SY faced barriers accessing health care irrespective of gender, ethnicity, education, and history of abuse. The association between lower levels of mental and physical health and higher reported levels of barriers accessing health care may indicate that those most in need of services face the greatest challenges in accessing them. Common structural barriers reported included a lack of health card, financial concerns, and difficulty obtaining transportation. These indicate the need for solutions addressing these specific barriers to better aid youth in accessing health care.