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Figure.
Overall and Development-Level–Specific Forest Plot of Pooled-Prevalence Estimates and 95% CIs for Reasons for Street Involvement
Overall and Development-Level–Specific Forest Plot of Pooled-Prevalence Estimates and 95% CIs for Reasons for Street Involvement
Table 1.  
Characteristics of the 49 Studies Included in the Review
Characteristics of the 49 Studies Included in the Review
Table 2.  
Overall and Development-Level–Specific Pooled-Prevalence Estimates Comparing Reasons for Street Involvement
Overall and Development-Level–Specific Pooled-Prevalence Estimates Comparing Reasons for Street Involvement
Table 3.  
Pooled-Prevalence Estimates Comparing Reasons for Street Involvement by Geographic Regions
Pooled-Prevalence Estimates Comparing Reasons for Street Involvement by Geographic Regions
Supplement.

eAppendix. Methods

eTable 1. Study Quality of the 49 studies included in the review

eFigure 1. Flow Diagram of Study Selection

eFigure 2. Forest plot of poverty-related reasons

eFigure 3. Forest plot of abuse-related reasons

eFigure 4. Forest plot of family conflict-related reasons

eFigure 5. Forest plot of psychosocial-related reasons

eFigure 6. Forest plot of delinquency-related reasons

eFigure 7. Forest plot of other reasons

eFigure 8. Forest plot of poverty-related reasons stratified by level of development

eFigure 9. Forest plot of abuse-related reasons stratified by level of development

eFigure 10. Forest plot of family conflict-related reasons stratified by level of development

eFigure 11. Forest plot of psychosocial-related reasons stratified by level of development

eFigure 12. Forest plot of delinquency-related reasons stratified by level of development

eFigure 13. Forest plot of other reasons stratified by level of development

eTable 2. Overall and development-level specific pooled-prevalence estimates comparing reasons for street-involvement after removing outlier(s)

eFigure 14. Sensitivity analysis forest plot of poverty-related reasons (Lugalla)

eFigure 15. Sensitivity analysis forest plot of poverty-related reasons (Peressini)

eFigure 16. Sensitivity analysis forest plot of poverty-related reasons stratified by level of development (Lugalla)

eFigure 17. Sensitivity analysis forest plot of poverty-related reasons stratified by level of development (Peressini)

eFigure 18. Forest plot of poverty-related reasons stratified by geographic region

eFigure 19. Forest plot of abuse-related reasons stratified by geographic region

eFigure 20. Forest plot of family conflict-related reasons stratified by geographic region

eFigure 21. Forest plot of psychosocial-related reasons stratified by geographic region

eFigure 22. Forest plot of delinquency-related reasons stratified by geographic region

eFigure 23. Forest plot of other reasons stratified by geographic region

eFigure 24. Pooled-prevalence estimates grouped by geographic region for reasons for street-involvement

eTable 3. Pooled-prevalence comparing reasons for street-involvement by geographic regions after removing outlier(s)

eFigure 25. Sensitivity analysis forest plot of poverty-related reasons stratified by level of development (Lugalla)

eFigure 26. Sensitivity analysis forest plot of poverty-related reasons stratified by level of development (Peressini)

eTable 4. Pooled-prevalence estimates comparing reasons for street involvement stratified by gender within development-level categories

1.
United Nations Human Rights Office of the High Commissioner. Protection and promotion of the rights of children working and/or living on the street. http://www.streetchildrenresources.org/wp-content/uploads/2013/07/OHCHR-protection-promotion.pdf. Published 2012. Accessed February 16, 2016.
2.
Public Health Agency of Canada. Street youth in Canada: findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003. http://www.phac-aspc.gc.ca/std-mts/reports_06/pdf/street_youth_e.pdf. Published March 2006. Accessed February 16, 2016.
3.
Ray  P, Davey  C, Nolan  P; Global Child Protection Services. Still on the street—still short of rights: analysis of policy and programmes related to street involved children. Published April 29, 2011. Accessed February 16, 2016.
4.
Convention on the Rights of the Child. Adopted and opened for signature, ratification and accession by General Assembly resolution 44/25 of 20 November 1989, entry into force 2 September 1990, in accordance with article 49. United Nations Human Rights Office of the High Commissioner website. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx. Accessed February 16, 2016.
5.
United Nations Children’s Fund. The state of the world’s children 2012: children in an urban world. http://www.unicef.org/sowc/files/SOWC_2012-Main_Report_EN_21Dec2011.pdf. Published February 2012. Accessed February 16, 2016.
6.
Human Rights Watch. “Where do you want us to go?” abuses against Street Children in Uganda. https://www.hrw.org/sites/default/files/reports/uganda0714_forinsert_ForUpload.pdf. Published July 2014. Accessed February 16, 2016.
7.
Human Rights Watch. “Children of the dust”—abuse of Hanoi street children in detention. https://www.hrw.org/reports/2006/vietnam1106/vietnam1106web.pdf. Published November 2006. Accessed February 16, 2016.
8.
Woan  J, Lin  J, Auerswald  C.  The health status of street children and youth in low- and middle-income countries: a systematic review of the literature.  J Adolesc Health. 2013;53(3):314-321. PubMedGoogle ScholarCrossref
9.
Embleton  L, Mwangi  A, Vreeman  R, Ayuku  D, Braitstein  P.  The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis.  Addiction. 2013;108(10):1722-1733.PubMedGoogle ScholarCrossref
10.
Roy  E, Haley  N, Leclerc  P, Sochanski  B, Boudreau  JF, Boivin  JF.  Mortality in a cohort of street youth in Montreal.  JAMA. 2004;292(5):569-574.PubMedGoogle ScholarCrossref
11.
Boivin  JF, Roy  E, Haley  N, Galbaud du Fort  G.  The health of street youth: a Canadian perspective.  Can J Public Health. 2005;96(6):432-437. PubMedGoogle Scholar
12.
Heerde  JA, Scholes-Balog  KE, Hemphill  SA.  Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review.  Arch Sex Behav. 2015;44(1):181-212.PubMedGoogle ScholarCrossref
13.
Malik  K; United Nations Development Programme.  Human Development Report 2013: The Rise of the South—Human Progress in a Diverse World. New York, NY: United Nations; 2013.
14.
Sorber  R, Winston  S, Koech  J,  et al.  Social and economic characteristics of street youth by gender and level of street involvement in Eldoret, Kenya.  PLoS One. 2014;9(5):e97587.PubMedGoogle ScholarCrossref
15.
DuRant  RH.  Checklist for the evaluation of research articles.  J Adolesc Health. 1994;15(1):4-8.PubMedGoogle ScholarCrossref
16.
Rew  L, Taylor-Seehafer  M, Thomas  NY, Yockey  RD.  Correlates of resilience in homeless adolescents.  J Nurs Scholarsh. 2001;33(1):33-40.PubMedGoogle ScholarCrossref
17.
Rew  L, Fouladi  RT, Yockey  RD.  Sexual health practices of homeless youth.  J Nurs Scholarsh. 2002;34(2):139-145.PubMedGoogle ScholarCrossref
18.
Mallett  S, Rosenthal  D, Keys  D.  Young people, drug use and family conflict: pathways into homelessness.  J Adolesc. 2005;28(2):185-199. PubMedGoogle ScholarCrossref
19.
Rosenthal  D, Mallett  S, Myers  P.  Why do homeless young people leave home?  Aust N Z J Public Health. 2006;30(3):281-285.PubMedGoogle ScholarCrossref
20.
MacLean  MG, Embry  LE, Cauce  AM.  Homeless adolescents’ paths to separation from family: comparison of family characteristics, psychological adjustment, and victimization.  J Community Psychol. 1999;27(2):179-187. Google ScholarCrossref
21.
Cauce  AM, Paradise  M, Ginzler  JA,  et al.  The characteristics and mental health of homeless adolescents: age and gender differences.  J Emot Behav Disord. 2000;8(4):230-239. doi:10.1177/106342660000800403.Google ScholarCrossref
22.
Cochran  BN, Stewart  AJ, Ginzler  JA, Cauce  AM.  Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts.  Am J Public Health. 2002;92(5):773-777.PubMedGoogle ScholarCrossref
23.
Baker  R, Panter-Brick  C, Todd  A.  Methods used in research with street children in Nepal.  Child. 1996;3(2):171-193. doi:10.1177/0907568296003002005.Google ScholarCrossref
24.
Baker  R, Panter-Brick  C, Todd  A.  Homeless street boys in Nepal: their demography and lifestyle.  J Comp Fam Stud. 1997;28(1):129-146.Google Scholar
25.
Strobbe  F, Olivetti  C, Jacobson  M.  Breaking the net: family structure and street-connected children in Zambia.  J Dev Stud. 2013;49(5):670-688. doi:10.1080/00220388.2012.709619.Google ScholarCrossref
26.
Ward  CL, Seager  JR.  South African street children: a survey and recommendations for services.  Dev South Afr. 2010;27(1):85-100. doi:10.1080/03768350903519374.Google ScholarCrossref
27.
Tadele  G.  ‘Unrecognized victims’: sexual abuse against male street children in Merkato area, Addis Ababa.  Ethopian J Health Dev. 2009;23:174-182. doi:10.4314/ejhd.v23i3.53238.Google Scholar
28.
Plummer  ML, Kudrati  M, Dafalla El Hag Yousif  N.  Beginning street life: factors contributing to children working and living on the streets of Khartoum, Sudan.  Child Youth Serv Rev. 2007;29(12):1520-1536. doi:10.1016/j.childyouth.2007.06.008.Google ScholarCrossref
29.
Young  L.  Journeys to the street: the complex migration geographies of Ugandan street children.  Geoforum. 2004;35(4):471-488. doi:10.1016/j.geoforum.2003.09.005.Google ScholarCrossref
30.
Motala  S, Smith  T.  Exposed to risk: girls and boys living on the streets.  Agenda. 2003;17(56):62-72.Google Scholar
31.
Veale  A, Donà  G.  Street children and political violence: a socio-demographic analysis of street children in Rwanda.  Child Abuse Negl. 2003;27(3):253-269. PubMedGoogle ScholarCrossref
32.
Lockhart  C.  Kunyenga, “real sex,” and survival: assessing the risk of HIV infection among urban street boys in Tanzania.  Med Anthropol Q. 2002;16(3):294-311. PubMedGoogle ScholarCrossref
33.
Salem  EM, Abd el-Latif  F.  Sociodemographic characteristics of street children in Alexandria.  East Mediterr Heal J. 2002;8(1):64-73. PubMedGoogle Scholar
34.
Tchombe  TM, Nuwanyakpa  M, Etmonia  T.  Street children in Cameroon: problems and perspectives.  J Psychol Africa. 2001;11(2):101-125.Google Scholar
35.
Abdella  R, Hoot  J, Tadesse  S.  Seldom heard voices: child prostitutes in Ethiopia.  Int J Early Child. 2006;38(2):81-85. doi:10.1007/BF03168210.Google ScholarCrossref
36.
Aderinto  AA.  Social correlates and coping measures of street-children: a comparative study of street and non-street children in south-western Nigeria.  Child Abuse Negl. 2000;24(9):1199-1213. PubMedGoogle ScholarCrossref
37.
Lalor  KJ.  Street children: a comparative perspective.  Child Abuse Negl. 1999;23(8):759-770. PubMedGoogle ScholarCrossref
38.
Lugalla  JLP, Mbwambo  JK.  Street children and street life in urban Tanzania: the culture of surviving and its implications for children’s health.  Int J Urban Reg Res. 1999;23(2):329-344. doi:10.1111/1468-2427.00198.Google ScholarCrossref
39.
Matchinda  B.  The impact of home background on the decision of children to run away: the case of Yaounde City street children in Cameroon.  Child Abuse Negl. 1999;23(3):245-255. PubMedGoogle ScholarCrossref
40.
Anarfi  JK.  Vulnerability to sexually transmitted disease: street children in Accra.  Health Transit Rev. 1997;7 Suppl:281-306. PubMedGoogle Scholar
41.
Senaratna  BCV, Wijewardana  BVN.  Street children in Colombo: what brings them to and sustains them on the streets?  Sri Lanka J Child Health. 2013;42(2):70-75. doi:10.4038/sljch.v42i2.5626.Google ScholarCrossref
42.
Bhat  DP, Singh  M, Meena  GS.  Screening for abuse and mental health problems among illiterate runaway adolescents in an Indian metropolis.  Arch Dis Child. 2012;97(11):947-951.PubMedGoogle ScholarCrossref
43.
Gupta  A.  Social determinants of health—street children at crossroads.  Health. 2012;4(9):634-643. doi:10.4236/health.2012.49100.Google ScholarCrossref
44.
Sherman  SS, Plitt  S. ul Hassan  S, Cheng  Y, Zafar  ST.  Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan.  J Urban Health. 2005;82(suppl 4):iv113-iv124. PubMedGoogle ScholarCrossref
45.
Ali  M, Shahab  S, Ushijima  H, de Muynck  A.  Street children in Pakistan: a situational analysis of social conditions and nutritional status.  Soc Sci Med. 2004;59(8):1707-1717.PubMedGoogle ScholarCrossref
46.
Tiwari  PA, Gulati  N, Sethi  GR, Mehra  M.  Why do some boys run away from home?  Indian J Pediatr. 2002;69(5):397-399.PubMedGoogle ScholarCrossref
47.
Senanayake  MP, Ranasinghe  A, Balasuriya  C.  Street children—a preliminary study.  Ceylon Med J. 1998;43(4):191-193.PubMedGoogle Scholar
48.
Patel  S.  Street children, hotel boys and children of pavement dwellers and construction workers in Bombay—how they meet their daily needs.  Environ Urban. 1990;2(2):9-26. doi:10.1177/095624789000200203.Google ScholarCrossref
49.
Huang  CC, Barreda  P, Mendoza  V, Guzman  L, Gilbert  P.  A comparative analysis of abandoned street children and formerly abandoned street children in La Paz, Bolivia.  Arch Dis Child. 2004;89(9):821-826.PubMedGoogle ScholarCrossref
50.
Lee  JAB, Odie-Ali  S.  Carry me home: a collaborative study of street children in Georgetown, Guyana.  J Soc Work Res Eval. 2000;1(2):185-196.Google Scholar
51.
Raffaelli  M, Koller  SH, Reppold  CT,  et al.  Gender differences in Brazilian street youth’s family circumstances and experiences on the street.  Child Abuse Negl. 2000;24(11):1431-1441. PubMedGoogle ScholarCrossref
52.
Aneci Rosa  CS, Borba  ES, Ebrahim  GJ.  The street children of Recife: a study of their background.  J Trop Pediatr. 1992;38(1):34-40.PubMedGoogle ScholarCrossref
53.
Murray  LK, Singh  NS, Surkan  PJ, Semrau  K, Bass  J, Bolton  P.  A qualitative study of Georgian youth who are on the street or institutionalized.  Int J Pediatr. 2012;2012:921604. PubMedGoogle ScholarCrossref
54.
Mayfield Arnold  E, Song  EY, Legault  C, Wolfson  M.  Risk behavior of runaways who return home.  Vulnerable Child Youth Stud. 2012;7(3):283-297. doi:10.1080/17450128.2012.687843.Google ScholarCrossref
55.
Coates  J, McKenzie-Mohr  S.  Out of the frying pan, into the fire: trauma in the lives of homeless youth prior to and during homelessness.  J Sociol Soc Welf. 2010;37(4):65-96. https://www.wmich.edu/hhs/newsletters_journals/jssw_institutional/individual_subscribers/37.4.Coates.pdf. Accessed February 16, 2016.Google Scholar
56.
Peressini  T.  Perceived reasons for homelessness in Canada: testing the heterogeneity hypothesis.  Can J Urban Res. 2007;16(1):112-126.Google Scholar
57.
Hyde  J.  From home to street: understanding young people’s transitions into homelessness.  J Adolesc. 2005;28(2):171-183. PubMedGoogle ScholarCrossref
58.
Safyer  AW, Thompson  SJ, Maccio  EM, Zittel-Palamara  KM, Forehand  G.  Adolescents’ and parents’ perceptions of runaway behavior: problems and solutions.  Child Adolesc Social Work J. 2004;21(5):495-512. doi:10.1023/B:CASW.0000043361.35679.73.Google ScholarCrossref
59.
Moon  MW, Binson  D, Page-Shafer  K, Díaz  R.  Correlates of HIV risk in a random sample of street youths in San Francisco.  J Assoc Nurses AIDS Care. 2001;12(6):18-27.PubMedGoogle ScholarCrossref
60.
Ennett  ST, Federman  EB, Bailey  SL, Ringwalt  CL, Hubbard  ML.  HIV-risk behaviors associated with homelessness characteristics in youth.  J Adolesc Health. 1999;25(5):344-353.PubMedGoogle ScholarCrossref
61.
Nadon  SM, Koverola  C, Schludermann  EH.  Antecedents to prostitution: childhood victimization.  J Interpers Violence. 1998;13(2):206-221. doi:10.1177/088626098013002003.Google ScholarCrossref
62.
Ringwalt  CL, Greene  JM, Robertson  MJ.  Familial backgrounds and risk behaviors of youth with thrownaway experiences.  J Adolesc. 1998;21(3):241-252.PubMedGoogle ScholarCrossref
63.
Boesky  LM, Toro  PA, Bukowski  PA.  Differences in psychosocial factors among older and younger homeless adolescents found in youth shelters.  J Prev Intervent Community. 1997;15(2):19-36.Google ScholarCrossref
64.
Booth  RE, Zhang  Y.  Severe aggression and related conduct problems among runaway and homeless adolescents.  Psychiatr Serv. 1996;47(1):75-80.PubMedGoogle ScholarCrossref
65.
Janus  MD, Archambault  FX, Brown  SW, Welsh  LA.  Physical abuse in Canadian runaway adolescents.  Child Abuse Negl. 1995;19(4):433-447.PubMedGoogle ScholarCrossref
66.
Whitbeck  LB, Simons  RL.  A comparison of adaptive strategies and patterns of victimization among homeless adolescents and adults.  Violence Vict. 1993;8(2):135-152. PubMedGoogle Scholar
67.
Howard  J.  Taking a chance on love: risk behaviour of Sydney street youth.  J Paediatr Child Health. 1993;29(suppl 1):S60-S65.PubMedGoogle ScholarCrossref
68.
Hier  SJ, Korboot  PJ, Schweitzer  RD.  Social adjustment and symptomatology in two types of homeless adolescents: runaways and throwaways.  Adolescence. 1990;25(100):761-771.PubMedGoogle Scholar
69.
Medlow  S, Klineberg  E, Steinbeck  K.  The health diagnoses of homeless adolescents: a systematic review of the literature.  J Adolesc. 2014;37(5):531-542.PubMedGoogle ScholarCrossref
70.
Hillis  SD, Zapata  L, Robbins  CL,  et al.  HIV seroprevalence among orphaned and homeless youth: no place like home.  AIDS. 2011;26(1):105-110. doi:10.1097/QAD.0b013e32834c4be4.Google ScholarCrossref
71.
Marshall  BD, Kerr  T, Livingstone  C, Li  K, Montaner  JS, Wood  E.  High prevalence of HIV infection among homeless and street-involved Aboriginal youth in a Canadian setting.  Harm Reduct J. 2008;5:35. PubMedGoogle ScholarCrossref
72.
Coren  E, Hossain  R, Pardo Pardo  J,  et al.  Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.  Cochrane Database Syst Rev. 2013;2(2):CD009823.PubMedGoogle Scholar
73.
Fiszbein  A, Schady  N, Ferreira  FHG,  et al; World Bank.  Conditional Cash Transfers: Reducing Present and Future Poverty. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2009.
74.
Barrientos  A, Byrne  J, Peña  P, Villa  JM.  Social transfers and child protection in the South.  Child Youth Serv Rev. 2014;47(pt 2):105-112. doi:10.1016/j.childyouth.2014.07.011.Google ScholarCrossref
75.
Zlotnick  C, Tam  T, Zerger  S.  Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.  Health Soc Care Community. 2012;20(5):449-476.PubMedGoogle ScholarCrossref
Original Investigation
Adolescent and Young Adult Health
May 2016

Causes of Child and Youth Homelessness in Developed and Developing CountriesA Systematic Review and Meta-analysis

Author Affiliations
  • 1Institute of Medical Sciences, University of Toronto, Toronto, Ontario, Canada
  • 2Department of Biostatistics, Brown University, Providence, Rhode Island
  • 3Division of Epidemiology and Biostatistics, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson
  • 4Department of Behavioral Sciences, College of Health Sciences, Moi University, Eldoret, Kenya
  • 5Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
  • 6Department of Medicine, College of Health Sciences, School of Medicine, Moi University, Eldoret, Kenya
  • 7Department of Epidemiology, Fairbanks School of Public Health, Indiana University, Indianapolis
  • 8Regenstrief Institute Inc, Indianapolis, Indiana
JAMA Pediatr. 2016;170(5):435-444. doi:10.1001/jamapediatrics.2016.0156
Abstract

Importance  A systematic compilation of children and youth’s reported reasons for street involvement is lacking. Without empirical data on these reasons, the policies developed or implemented to mitigate street involvement are not responsive to the needs of these children and youth.

Objective  To systematically analyze the self-reported reasons why children and youth around the world become street-involved and to analyze the available data by level of human development, geographic region, and sex.

Data Sources  Electronic searches of Scopus, PsychINFO, EMBASE, POPLINE, PubMed, ERIC, and the Social Sciences Citation Index were conducted from January 1, 1990, to the third week of July 2013. We searched the peer-reviewed literature for studies that reported quantitative reasons for street involvement. The following broad search strategy was used to search the databases: “street children” OR “street youth” OR “homeless youth” OR “homeless children” OR “runaway children” OR “runaway youth” or “homeless persons.”

Study Selection  Studies were included if they met the following inclusion criteria: (1) participants were 24 years of age or younger, (2) participants met our definition of street-connected children and youth, and (3) the quantitative reasons for street involvement were reported. We reviewed 318 full texts and identified 49 eligible studies.

Data Extraction and Synthesis  Data were extracted by 2 independent reviewers. We fit logistic mixed-effects models to estimate the pooled prevalence of each reason and to estimate subgroup pooled prevalence by development level or geographic region. The meta-analysis was conducted from February to August 2015.

Main Outcomes and Measures  We created the following categories based on the reported reasons in the literature: poverty, abuse, family conflict, delinquency, psychosocial health, and other.

Results  In total, there were 13 559 participants from 24 countries, of which 21 represented developing countries. The most commonly reported reason for street involvement was poverty, with a pooled-prevalence estimate of 39% (95% CI, 29%-51%). Forty-seven studies included in this review reported family conflict as the reason for street involvement, with a pooled prevalence of 32% (95% CI, 26%-39%). Abuse was equally reported in developing and developed countries as the reason for street involvement, with a pooled prevalence of 26% (95% CI, 18%-35%). Delinquency was the least frequently cited reason overall, with a pooled prevalence of 10% (95% CI, 5%-20%).

Conclusions and Relevance  The street-connected children and youth who provided reasons for their street involvement infrequently identified delinquent behaviors for their circumstances and highlighted the role of poverty as a driving factor. They require support and protection, and governments globally are called on to reduce the socioeconomic inequities that cause children and youth to turn to the streets in the first place, in all regions of the world.

Introduction

There are vast numbers of children and youth in the world who find themselves connected to the streets. Owing to the difficulties of counting and defining this very fluid population, no accurate estimates exist on the numbers of children and youth spending a portion or majority of their time on the streets; however, they are estimated to be in the tens to hundreds of millions.1

A variety of definitions have been put forth to define children and youth with street connections. Previously, the United Nations Children’s Fund broadly defined these children and youth as “[a]ny girl or boy who has not reached adulthood, for whom the street in the widest sense of the word, including unoccupied dwellings, wasteland, and so on, has become his or her habitual abode and/or source of livelihood, and who is inadequately protected, directed, and supervised by responsible adults.”1(p9) A further categorization placed these children living and working on the street into 3 categories: children of the street (those who spend both days and nights on the street with limited or no family contact), children on the street (those who spend a portion or majority of their time on the street while returning home to a family/guardian at night), and children from street families (children from families living on the streets).1 In very high-income settings, youth connected to the streets are typically defined by their residential instability and precarious living arrangements, and they are referred to as homeless youth, runaway youth, system youth, or throwaway youth.2 Most recently, the term street-connected children and youth has been used to refer to those for whom the street is a central reference point—one that plays a significant role in their everyday life.1 While no clear definition encompasses the situations of all children and youth connected to the streets, it is important to understand that their circumstances are fluid and that the streets play a central role in their lives.3 It is also important to understand that children and youth connected to the streets are rights holders3,4 who often find themselves in situations that violate their basic human rights.1,4

It is suspected that the dynamics driving this phenomenon (ie, street involvement of children and youth) are diverse and consist of complex pathways that vary between developed and developing countries, within geographic regions, by sex and age.1,3 However, the literature lacks any systematic compilation of children and youth’s reported reasons for street involvement, and there is an absence of consensus among academics, policy makers, stakeholders, and international organizations regarding these factors.1 Without empirical data on these reasons, policies are developed or implemented to mitigate street involvement without taking these causes into account. Often in resource-constrained settings, the prevailing paradigm assumes that children on the street are predominantly juvenile delinquents, and the government response is often characterized by social exclusion, criminalization, and oppression by police and civic authorities.5 Strategies frequently involve violent street sweeps conducted by police with children being placed in overcrowded detention centers or repatriated to unsafe care environments.6,7 Many of these children subsequently return to the streets. Resource-constrained settings typically lack well-established child protection systems,3 resulting in weak policies to mitigate children’s street involvement. In developed regions, child protection systems may be better equipped and able to respond to street youth with policies, legislation, and programs coordinated by government and nongovernmental agencies; yet despite this, children and youth in developed regions continue to find themselves in street circumstances.

Globally, street-connected children and youth have significant morbidity and mortality.812 To develop effective evidenced-based international and national policies aimed at preventing and mitigating the harms associated with street involvement, upholding children’s rights, and ameliorating the circumstances of the world’s most vulnerable children and youth, it is crucial to have rigorous evidence to comprehend this phenomenon. This review aims to systematically analyze the self-reported reasons why children and youth around the world become street-involved and to analyze the available data by level of human development, geographic region, and sex.

Box Section Ref ID

Key Points

  • Question What are the self-reported reasons why children and youth around the world become street-involved?

  • Findings This meta-analysis compiled data from 49 studies representing 24 countries. Street-connected children and youth most frequently reported poverty, family conflict, and abuse as their reasons for street involvement and infrequently identified delinquent behaviors as a reason for their circumstances.

  • Meaning Children and youth’s self-reported reasons for street involvement indicate that they are in extremely difficult circumstances and require support, protection, and policies to mitigate their street involvement.

Methods
Operational Definitions
Street-Connected Children and Youth

For the purposes of this review, the term street-connected children and youth refers to any child (<1-18 years of age) or youth (15-24 years of age) who spends a portion or majority of his or her time on the streets living or working. Children and youth may have been defined as any of the following in the literature: children of the street, children on the street, children from street families, homeless youth, runaway youth, throwaway youth, or working children. In the broadest sense, we included any study that referred to a child or youth who had connections to the streets and for whom the street played a significant role in his or her life.

Developed and Developing Regions

We used the United Nations Development Programme 2013 Human Development Index for categorizing studies into developing vs developed regions. The Human Development Index uses a combination of indicators to measure development and categorizes countries into very high, high, medium, and low development countries.13 We defined developing countries as all those in the high, medium, and low development categories and developed countries as those in the top quartile and classified as very high in the United Nations Development Programme 2013 Human Development Index Report.13

Search Strategy and Study Selection

We searched for any published peer-reviewed study from 1990 through July 2013 that reported quantitative reasons for street involvement. Studies were included if they met the following inclusion criteria: (1) participants were 24 years of age or younger, (2) participants met our definition of street-connected children and youth, and (3) quantitative reasons for street involvement were reported. We included the following study designs: cross-sectional, cohort, case-control, mixed-methods, qualitative studies reporting quantitative reasons, and interventions that provided baseline data on reasons for street involvement. We excluded publications that were not written in English or that were dissertations, books, and conference abstracts.

Electronic searches of Scopus, PsychINFO, EMBASE, POPLINE, PubMed, ERIC, and the Social Sciences Citation Index were conducted from January 1, 1990, to the third week of July 2013. The following broad search strategy was used to search the databases: “street children” OR “street youth” OR “homeless youth” OR “homeless children” OR “runaway children” OR “runaway youth” or “homeless persons.”

After duplicates were removed, 2 independent reviewers (L.E. and J.G.) screened the titles and abstracts and excluded all records that did not meet the inclusion criteria. If either of the reviewers found an article to be relevant, a full-text copy of the article was obtained, and its eligibility assessed independently. Disagreements were resolved by discussion between the 2 reviewers, and a third reviewer assisted when consensus could not be reached. A final list of studies to be included in this systematic review was agreed on, and the data were extracted. The authors included data from their own unpublished work that was under review at the time of their search.14 Reference lists of selected articles were scanned to identify additional relevant documents.

Study Quality

The assessment of methodological quality was used to determine whether the studies adequately reported study components essential to any study design. A critical appraisal tool was adapted to assess 10 items that should be reported to effectively assess the validity of a study’s findings.15 Details of the study quality assessment tool and the results of assessing study quality are available in the eAppendix and eTable 1 in the Supplement. The quality assessment was performed independently by L.E. and J.G. Afterward, the 2 sets of results were compared, and any disagreements were discussed until a consensus was reached.

Data Extraction

Data were extracted by 2 independent reviewers (L.E. and J.G.) and included details about the study’s design, setting, population demographics, and results for all reported reasons for street involvement. When more than 1 study reported on the same sample population,1624 the source containing the most detailed data about the reasons for street involvement was selected for the review.17,19,21,24 Data extraction was performed independently by L.E. and J.G., and then the results were compared. Any disagreements were discussed until a consensus was reached. When it was not possible to extract the data from the publication, we contacted the authors to ask for clarification.

Reasons and Variables

Extracted data on reasons were sorted and compiled into categories. The review team agreed on 6 categories that best represented the themes that emerged: poverty, abuse, family conflict, delinquency, psychosocial health, and other reasons. When studies reported multiple reasons per category, we used the most frequent response in the meta-analysis. Poverty consisted of the following variables: poverty, hunger, work to get money, housing instability, rural to urban migration, structural, and refugee/conflict/war displacement. Abuse consisted of the following variables as reported in the studies: physical abuse, sexual abuse, and abuse/maltreatment and neglect. Family conflict consisted of the following variables: family conflict, escape home problems, abandoned, family issues, domestic violence, orphaned, substance use at home, alcoholism at home, thrown out, mutual decision with parents, and brought to the streets by family/relative. Delinquency consisted of the following variables: delinquency, conflict with the law, and removed by authorities. Psychosocial health consisted of the following variables: sexuality/gender issues, mental health, anxiety/depression, conflict with friends, traumatic events, personal drug and alcohol use, pregnancy, and peer pressure. Other reasons consisted of the following variables: runaway, desire to go to the city, independence, no clear reason, and other.

Analysis

We considered a binary response (yes/no) for each reason for street involvement to estimate pooled prevalence and to assess effect of covariates, while accounting for individual study variations by introducing random intercepts. First, we fit logistic mixed-effects models to estimate the pooled prevalence (ie, pooled mean proportion) of each reason, and to estimate subgroup pooled prevalence by development level or geographic region. Separate models were fit for each reason using only studies that examined the reason as a source of street involvement. To evaluate sex difference, we first created the number of female and male youth who reported yes/no to each reason from a study, and reshaped the data into a long format where each sex-yes/no datum is in a separate observation. For example, individual study data were separated into 4 observations with a variable (say, num) representing number of male-poverty yes, male-poverty no, female-poverty yes, and female-poverty no. Interactions between sex and the other covariates, such as development level or geographic region, were generated to estimate the subgroup pooled prevalence of each reason and to assess sex difference within a specific covariate level (eg, sex difference among developing countries). Because some studies reported only male data (ie, zero cells for female-yes and female-no categories), we used weighted logistic mixed models using the “num” variable as a frequency weight to avoid removing those studies from analysis. The Wald test was used throughout to assess the effect of covariate(s) and to calculate corresponding P values. We conducted a sensitivity analysis to drop outliers identified from diagnostic tests (available in metafor package in R version 3.0.2) and through visual inspection of forest plots.

Results

Our search identified 14 782 titles and abstracts for review after removing duplicates, theses, and books. After screening, we reviewed 318 full texts and identified 64 eligible studies, of which 49 contained reasons for street involvement that could be extracted (eFigure 1 in the Supplement). In total, there were 13 559 participants from 24 countries. Of these, there were 31 studies conducted in 21 developing countries (16 low development, 10 medium development, and 5 high development countries), with 9060 participants. The majority of these studies were conducted in Africa (55%) and Asia (29%). Eighteen studies represented 3 developed countries and 4499 participants (Table 1). In developing regions, 57% of participants were male and 12% were female, with 31% of unknown sex due to nonreporting. In contrast, 52% of participants were male and 48% were female in developed countries.

Table 2 and the Figure show the overall and development-level–specific pooled-prevalence estimates for each reason category. Detailed forest plots and pooled-prevalence estimates for each category of reason stratified by level of development are provided in eFigures 2 to 13 in the Supplement. Globally, the most commonly reported reason for street involvement was poverty, with a pooled prevalence of 39% (95% CI, 29%-51%), followed by family conflict, abuse, other, psychosocial health, and, lastly, delinquency. Of the 49 studies included in this review, 47 (96%) reported family conflict–related reasons for street involvement, with a pooled-prevalence estimate of 32% (95% CI, 26%-39%). Abuse was almost equally reported in developing and developed countries, with an overall pooled prevalence of 26% (95% CI, 18%-35%). Other reasons had an overall pooled prevalence of 20% (95% CI, 13%-29%). Within the other category, “running away” was the most frequently reported reason in North America (38%), and “independence” was the most frequently reported reason in the Pacific, representing the developed world; a “desire to go the city” (10%) and “other general reasons” (12%) were the most frequently reported reasons in the developing regions. Psychosocial-related reasons had a pooled-prevalence estimate of 16% (95% CI, 11%-23%). Lastly, delinquency was the least frequently cited reason overall, with a pooled prevalence of 10% (95% CI, 5%-20%).

Street involvement due to poverty-related reasons was reported in all 31 studies representing developing regions and was the most frequently reported factor with a pooled-prevalence estimate of 41% (95% CI, 30%-53%). Similar pooled-prevalence estimates for abuse- and family conflict–related reasons were reported at 24% (95% CI, 16%-35%) and 24% (95% CI, 18%-31%), respectively, in the developing regions.

In developed countries, family conflict was the most frequently reported reason for street involvement with a pooled-prevalence estimate of 48% (95% CI, 38%-58%), with all the studies from developed regions contributing to this estimate. Similar pooled-prevalence estimates for abuse (29% [95% CI, 15%-48%]) and psychosocial health (26% [95% CI, 19%-35%]) were reported in developed countries.

Tests for differences between developing and developed region subgroups resulted in significant differences in all reported reasons for street involvement with the exception of poverty and abuse. We conducted a sensitivity analysis (eTable 2 and eFigures 14-17 in the Supplement) to exclude outliers identified in diagnostic tests and through visual inspection of forest plots, but no significant difference was observed for poverty-related reasons between developed and developing countries.

Table 3 demonstrates the most frequently reported reasons for street involvement by geographic region. Detailed forest plots and pooled-prevalence estimates for each category of reason stratified by geographic region are provided in eFigures 18 to 23 in the Supplement. Poverty-related reasons for street involvement were most commonly reported in Africa (49% [95% CI, 34%-65%]), Asia (28% [95% CI, 18%-41%]), Eurasia (83% [95% CI, 71%-91%]), and South and Central America (27% [95% CI, 5%-71%]). Family conflict was the primary reason in North America (47% [95% CI, 36%-58%]) and the Pacific region (54% [95% CI, 30%-76%]). Tests for differences between geographic regions resulted in significant differences for family conflict, delinquency, and other reasons. Family conflict was different by geographic regions (P = .02). eFigure 24 in the Supplement shows the pooled-prevalence estimates for reported reasons of street involvement grouped by geographic region. We conducted a sensitivity analysis comparing reasons for street involvement by geographic region when removing outliers identified by diagnostic tests and visual inspection (eTable 3 and eFigures 25-26 in the Supplement). This resulted in no changes to significant differences by different regions at a significance level of .05. However, the results indicated that poverty reported in Peressini56 might deviate from other North American studies.

Finally, we examined sex differences for stated reasons within developing and developed regions when the data were reported (eTable 4 in the Supplement). We found no significant differences in the reasons male and female participants reported for their street involvement, with the exception of abuse in developed regions. Female participants in developed regions more frequently reported abuse-related reasons for street involvement (28% [95% CI, 14%-49%]) than male participants (18% [95% CI, 8%-37%]) (P = .01). In contrast, in developing countries, male participants were more likely to report abuse as a primary reason for being street connected (22%) compared with female participants (13%), although it failed to reach statistical significance.

Discussion

This review shows that the leading cause of street involvement as self-reported by children and youth worldwide is related to variables categorized as poverty, and when stratified by development level, this remains true in developing countries, whereas family conflict–related reasons are most commonly reported in developed countries. It is likely that more than 1 factor contributes to children and youth’s street involvement and that the reasons may interact synergistically. Nonetheless, with poverty, family conflict, and abuse being the most commonly reported reasons for street involvement across levels of development, it is apparent that children and youth who have turned to the streets are doing so as a means of survival due to unfavorable conditions within their homes and that they are not typically delinquents (as they are so often perceived).1,3,6,7 These results have strong implications for policy internationally; demonstrating that criminalization and policies that place street-connected children and youth in detention centers are likely to be ineffective strategies that violate their human rights instead of providing protection.

Globally, street-connected children and youth have significant morbidity8,69 and mortality10 and are at high risk of substance use,9 sexual exploitation,12 and the human immunodeficiency virus.70,71 There is a dearth of evaluated interventions for street-connected children and youth, particularly in low- and middle-income countries.72 To prevent and reduce these high rates of morbidity and mortality and high number of rights violations, strategies are urgently needed to mitigate street involvement, and interventions are required to respond to those already on the street.

There is a clear need to develop and strengthen social protection policies and child welfare systems in both developing and developed countries to address poverty, abuse, and family conflict impacting children’s street involvement. Poverty reduction strategies, such as cash-transfer programs, feeding programs, and universal free primary and secondary education, aimed at supporting vulnerable households and increasing human capital, may greatly reduce children’s street involvement. Social cash transfers have had positive effects on children’s well-being in many settings73 and may affect child protection outcomes, including reducing the probability of abuse, exploitation, and violence against children through direct or indirect effects.74 Expanding and augmenting social protection programs are likely to significantly reduce street involvement in association with poverty reduction and child protection.

In low- and middle-income countries with weak or nonexistent child protection systems, policies should be designed, implemented, and enforced to protect children and youth in situations of abuse and family conflict. In developed regions, the child welfare system may not be adequately protecting vulnerable children and youth. Family breakdown, maltreatment, and conflict often lead to homelessness18 and involvement in the foster care system. There is a clear relationship between a youth’s homelessness and his or her involvement in the foster care system, and there is hope for improving the safety net for vulnerable youth in developed regions.75

This review has several strengths and limitations. To the best of our knowledge, this is the first study to compile data and present pooled estimates concerning reported reasons for street involvement. It includes studies across 24 countries comparing results by level of development and sex, making it generalizable to street children and youth globally. This review only included English language peer-reviewed studies, which may have resulted in the exclusion of studies published in other languages and may reflect the lack of studies from Europe and South and Central America, limiting generalizability to these regions. Second, not all studies measured or reported the same reasons, and we compiled reported reasons into categories reflecting their general theme; this may have resulted in some misclassification bias. We attempted to limit bias by independently extracting and comparing data, and reviewing final categorization as a team. Third, we did not include gray literature and, therefore, may have missed reported reasons in reports. Fourth, self-reported reasons for street involvement are subject to reporting and social desirability bias, which may not accurately reflect the reasons for street involvement. Fifth, the “other” category should be interpreted with caution owing to the grouping of data. Studies in the “other” category that reported reasons as “runaway,” “other,” or “no clear reason” may not represent the underlying reason that the child or youth left home and, therefore, should be interpreted with caution. Sixth, our assessment of outliers with diagnostic tests may not have been sufficiently powered, and our assessment based on visual inspection may be inaccurate; therefore, the sensitivity analyses should be interpreted with caution. Seventh, we were unable to analyze reasons by age owing to a lack of data stratified by age. It is possible that self-reported reasons vary by age and the age they first came to the streets, which would have important policy implications. Lastly, there was a disparity in the inclusion of girls in developing regions compared with developed regions, which may have impacted the analysis of sex. Data were not always reported stratified by sex, and there were a large proportion of study participants not classified as either male or female in developing country studies. This points to a need to ensure research reaches girls on the street because they are an especially vulnerable and hard-to-reach population.

Conclusions

Preventing street involvement and mitigating its harms are critical to helping children and youth achieve their potential. There is an urgent need for international collaborations among researchers, policy makers, stakeholders, and organizations working with street-connected children and youth to formulate strategies to prevent them from turning to the streets and assist those already involved in street life. The street-connected children and youth who provided reasons for their street involvement infrequently identified delinquent behaviors for their circumstances and highlighted the role of poverty as a driving factor for their street involvement. With the global refugee crisis, it will be important to monitor changes in the number of children taking to the streets as a result of displacement and conflict. The self-reported reasons that were given indicate that these children and youth are in extremely difficult circumstances and are subject to numerous human rights violations. They require support and protection, and governments globally are called on to reduce the socioeconomic inequities that cause children and youth to turn to the streets in the first place, in all regions of the world.

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Article Information

Accepted for Publication: January 17, 2016.

Corresponding Author: Paula Braitstein, PhD, Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, 155 College St, Toronto, ON M5T 3M7, Canada (pbraitstein@gmail.com).

Published Online: April 4, 2016. doi:10.1001/jamapediatrics.2016.0156.

Author Contributions: Dr Braitstein and Ms Embleton had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Study concept and design: Embleton, Gunn, Ayuku, Braitstein.

Acquisition, analysis, or interpretation of data: Embleton, Lee, Gunn.

Drafting of the manuscript: Embleton, Lee, Gunn, Braitstein.

Critical revision of the manuscript for important intellectual content: Embleton, Ayuku.

Statistical analysis: Embleton, Lee.

Obtained funding: Ayuku.

Administrative, technical, or material support: Embleton, Gunn, Braitstein.

Study supervision: Embleton, Ayuku.

Conflict of Interest Disclosures: None reported.

Funding/Support: This project was supported in part by the Eunice Kennedy Shriver National Institute of Child Health and Human Development (grant R01HD060478). This work was also supported by the Canadian Institutes of Health Research through an Applied Public Health Chair award to Dr Braitstein.

Role of the Funder/Sponsor: The Eunice Kennedy Shriver National Institute of Child Health and Human Development and the Canadian Institutes of Health Research had no role in the design and conduct of the study; collection, management, analysis, or interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Disclaimer: The content is solely the responsibility of the authors and does not necessarily represent the official views of the Eunice Kennedy Shriver National Institute of Child Health and Human Development, the National Institutes of Health, or the Canadian Institutes of Health Research.

Additional Contributions: We thank Beth Rachlis, PhD, at the Ontario HIV Treatment Network, Toronto, Canada, for assisting in data extraction and quality assessment as a third reviewer, Samuel Ayaya, MBChB, MMed, at the Department of Child Health and Paediatrics, Moi University, College of Health Sciences, Eldoret, Kenya, for his review of the manuscript, and Thomas Trikalinos, PhD, at the Department of Health Services, Policy and Practice, School of Public Health, Brown University, Providence, Rhode Island, for his expert advice. No compensation was received from a funding sponsor for such contributions.

References
1.
United Nations Human Rights Office of the High Commissioner. Protection and promotion of the rights of children working and/or living on the street. http://www.streetchildrenresources.org/wp-content/uploads/2013/07/OHCHR-protection-promotion.pdf. Published 2012. Accessed February 16, 2016.
2.
Public Health Agency of Canada. Street youth in Canada: findings from Enhanced Surveillance of Canadian Street Youth, 1999-2003. http://www.phac-aspc.gc.ca/std-mts/reports_06/pdf/street_youth_e.pdf. Published March 2006. Accessed February 16, 2016.
3.
Ray  P, Davey  C, Nolan  P; Global Child Protection Services. Still on the street—still short of rights: analysis of policy and programmes related to street involved children. Published April 29, 2011. Accessed February 16, 2016.
4.
Convention on the Rights of the Child. Adopted and opened for signature, ratification and accession by General Assembly resolution 44/25 of 20 November 1989, entry into force 2 September 1990, in accordance with article 49. United Nations Human Rights Office of the High Commissioner website. http://www.ohchr.org/EN/ProfessionalInterest/Pages/CRC.aspx. Accessed February 16, 2016.
5.
United Nations Children’s Fund. The state of the world’s children 2012: children in an urban world. http://www.unicef.org/sowc/files/SOWC_2012-Main_Report_EN_21Dec2011.pdf. Published February 2012. Accessed February 16, 2016.
6.
Human Rights Watch. “Where do you want us to go?” abuses against Street Children in Uganda. https://www.hrw.org/sites/default/files/reports/uganda0714_forinsert_ForUpload.pdf. Published July 2014. Accessed February 16, 2016.
7.
Human Rights Watch. “Children of the dust”—abuse of Hanoi street children in detention. https://www.hrw.org/reports/2006/vietnam1106/vietnam1106web.pdf. Published November 2006. Accessed February 16, 2016.
8.
Woan  J, Lin  J, Auerswald  C.  The health status of street children and youth in low- and middle-income countries: a systematic review of the literature.  J Adolesc Health. 2013;53(3):314-321. PubMedGoogle ScholarCrossref
9.
Embleton  L, Mwangi  A, Vreeman  R, Ayuku  D, Braitstein  P.  The epidemiology of substance use among street children in resource-constrained settings: a systematic review and meta-analysis.  Addiction. 2013;108(10):1722-1733.PubMedGoogle ScholarCrossref
10.
Roy  E, Haley  N, Leclerc  P, Sochanski  B, Boudreau  JF, Boivin  JF.  Mortality in a cohort of street youth in Montreal.  JAMA. 2004;292(5):569-574.PubMedGoogle ScholarCrossref
11.
Boivin  JF, Roy  E, Haley  N, Galbaud du Fort  G.  The health of street youth: a Canadian perspective.  Can J Public Health. 2005;96(6):432-437. PubMedGoogle Scholar
12.
Heerde  JA, Scholes-Balog  KE, Hemphill  SA.  Associations between youth homelessness, sexual offenses, sexual victimization, and sexual risk behaviors: a systematic literature review.  Arch Sex Behav. 2015;44(1):181-212.PubMedGoogle ScholarCrossref
13.
Malik  K; United Nations Development Programme.  Human Development Report 2013: The Rise of the South—Human Progress in a Diverse World. New York, NY: United Nations; 2013.
14.
Sorber  R, Winston  S, Koech  J,  et al.  Social and economic characteristics of street youth by gender and level of street involvement in Eldoret, Kenya.  PLoS One. 2014;9(5):e97587.PubMedGoogle ScholarCrossref
15.
DuRant  RH.  Checklist for the evaluation of research articles.  J Adolesc Health. 1994;15(1):4-8.PubMedGoogle ScholarCrossref
16.
Rew  L, Taylor-Seehafer  M, Thomas  NY, Yockey  RD.  Correlates of resilience in homeless adolescents.  J Nurs Scholarsh. 2001;33(1):33-40.PubMedGoogle ScholarCrossref
17.
Rew  L, Fouladi  RT, Yockey  RD.  Sexual health practices of homeless youth.  J Nurs Scholarsh. 2002;34(2):139-145.PubMedGoogle ScholarCrossref
18.
Mallett  S, Rosenthal  D, Keys  D.  Young people, drug use and family conflict: pathways into homelessness.  J Adolesc. 2005;28(2):185-199. PubMedGoogle ScholarCrossref
19.
Rosenthal  D, Mallett  S, Myers  P.  Why do homeless young people leave home?  Aust N Z J Public Health. 2006;30(3):281-285.PubMedGoogle ScholarCrossref
20.
MacLean  MG, Embry  LE, Cauce  AM.  Homeless adolescents’ paths to separation from family: comparison of family characteristics, psychological adjustment, and victimization.  J Community Psychol. 1999;27(2):179-187. Google ScholarCrossref
21.
Cauce  AM, Paradise  M, Ginzler  JA,  et al.  The characteristics and mental health of homeless adolescents: age and gender differences.  J Emot Behav Disord. 2000;8(4):230-239. doi:10.1177/106342660000800403.Google ScholarCrossref
22.
Cochran  BN, Stewart  AJ, Ginzler  JA, Cauce  AM.  Challenges faced by homeless sexual minorities: comparison of gay, lesbian, bisexual, and transgender homeless adolescents with their heterosexual counterparts.  Am J Public Health. 2002;92(5):773-777.PubMedGoogle ScholarCrossref
23.
Baker  R, Panter-Brick  C, Todd  A.  Methods used in research with street children in Nepal.  Child. 1996;3(2):171-193. doi:10.1177/0907568296003002005.Google ScholarCrossref
24.
Baker  R, Panter-Brick  C, Todd  A.  Homeless street boys in Nepal: their demography and lifestyle.  J Comp Fam Stud. 1997;28(1):129-146.Google Scholar
25.
Strobbe  F, Olivetti  C, Jacobson  M.  Breaking the net: family structure and street-connected children in Zambia.  J Dev Stud. 2013;49(5):670-688. doi:10.1080/00220388.2012.709619.Google ScholarCrossref
26.
Ward  CL, Seager  JR.  South African street children: a survey and recommendations for services.  Dev South Afr. 2010;27(1):85-100. doi:10.1080/03768350903519374.Google ScholarCrossref
27.
Tadele  G.  ‘Unrecognized victims’: sexual abuse against male street children in Merkato area, Addis Ababa.  Ethopian J Health Dev. 2009;23:174-182. doi:10.4314/ejhd.v23i3.53238.Google Scholar
28.
Plummer  ML, Kudrati  M, Dafalla El Hag Yousif  N.  Beginning street life: factors contributing to children working and living on the streets of Khartoum, Sudan.  Child Youth Serv Rev. 2007;29(12):1520-1536. doi:10.1016/j.childyouth.2007.06.008.Google ScholarCrossref
29.
Young  L.  Journeys to the street: the complex migration geographies of Ugandan street children.  Geoforum. 2004;35(4):471-488. doi:10.1016/j.geoforum.2003.09.005.Google ScholarCrossref
30.
Motala  S, Smith  T.  Exposed to risk: girls and boys living on the streets.  Agenda. 2003;17(56):62-72.Google Scholar
31.
Veale  A, Donà  G.  Street children and political violence: a socio-demographic analysis of street children in Rwanda.  Child Abuse Negl. 2003;27(3):253-269. PubMedGoogle ScholarCrossref
32.
Lockhart  C.  Kunyenga, “real sex,” and survival: assessing the risk of HIV infection among urban street boys in Tanzania.  Med Anthropol Q. 2002;16(3):294-311. PubMedGoogle ScholarCrossref
33.
Salem  EM, Abd el-Latif  F.  Sociodemographic characteristics of street children in Alexandria.  East Mediterr Heal J. 2002;8(1):64-73. PubMedGoogle Scholar
34.
Tchombe  TM, Nuwanyakpa  M, Etmonia  T.  Street children in Cameroon: problems and perspectives.  J Psychol Africa. 2001;11(2):101-125.Google Scholar
35.
Abdella  R, Hoot  J, Tadesse  S.  Seldom heard voices: child prostitutes in Ethiopia.  Int J Early Child. 2006;38(2):81-85. doi:10.1007/BF03168210.Google ScholarCrossref
36.
Aderinto  AA.  Social correlates and coping measures of street-children: a comparative study of street and non-street children in south-western Nigeria.  Child Abuse Negl. 2000;24(9):1199-1213. PubMedGoogle ScholarCrossref
37.
Lalor  KJ.  Street children: a comparative perspective.  Child Abuse Negl. 1999;23(8):759-770. PubMedGoogle ScholarCrossref
38.
Lugalla  JLP, Mbwambo  JK.  Street children and street life in urban Tanzania: the culture of surviving and its implications for children’s health.  Int J Urban Reg Res. 1999;23(2):329-344. doi:10.1111/1468-2427.00198.Google ScholarCrossref
39.
Matchinda  B.  The impact of home background on the decision of children to run away: the case of Yaounde City street children in Cameroon.  Child Abuse Negl. 1999;23(3):245-255. PubMedGoogle ScholarCrossref
40.
Anarfi  JK.  Vulnerability to sexually transmitted disease: street children in Accra.  Health Transit Rev. 1997;7 Suppl:281-306. PubMedGoogle Scholar
41.
Senaratna  BCV, Wijewardana  BVN.  Street children in Colombo: what brings them to and sustains them on the streets?  Sri Lanka J Child Health. 2013;42(2):70-75. doi:10.4038/sljch.v42i2.5626.Google ScholarCrossref
42.
Bhat  DP, Singh  M, Meena  GS.  Screening for abuse and mental health problems among illiterate runaway adolescents in an Indian metropolis.  Arch Dis Child. 2012;97(11):947-951.PubMedGoogle ScholarCrossref
43.
Gupta  A.  Social determinants of health—street children at crossroads.  Health. 2012;4(9):634-643. doi:10.4236/health.2012.49100.Google ScholarCrossref
44.
Sherman  SS, Plitt  S. ul Hassan  S, Cheng  Y, Zafar  ST.  Drug use, street survival, and risk behaviors among street children in Lahore, Pakistan.  J Urban Health. 2005;82(suppl 4):iv113-iv124. PubMedGoogle ScholarCrossref
45.
Ali  M, Shahab  S, Ushijima  H, de Muynck  A.  Street children in Pakistan: a situational analysis of social conditions and nutritional status.  Soc Sci Med. 2004;59(8):1707-1717.PubMedGoogle ScholarCrossref
46.
Tiwari  PA, Gulati  N, Sethi  GR, Mehra  M.  Why do some boys run away from home?  Indian J Pediatr. 2002;69(5):397-399.PubMedGoogle ScholarCrossref
47.
Senanayake  MP, Ranasinghe  A, Balasuriya  C.  Street children—a preliminary study.  Ceylon Med J. 1998;43(4):191-193.PubMedGoogle Scholar
48.
Patel  S.  Street children, hotel boys and children of pavement dwellers and construction workers in Bombay—how they meet their daily needs.  Environ Urban. 1990;2(2):9-26. doi:10.1177/095624789000200203.Google ScholarCrossref
49.
Huang  CC, Barreda  P, Mendoza  V, Guzman  L, Gilbert  P.  A comparative analysis of abandoned street children and formerly abandoned street children in La Paz, Bolivia.  Arch Dis Child. 2004;89(9):821-826.PubMedGoogle ScholarCrossref
50.
Lee  JAB, Odie-Ali  S.  Carry me home: a collaborative study of street children in Georgetown, Guyana.  J Soc Work Res Eval. 2000;1(2):185-196.Google Scholar
51.
Raffaelli  M, Koller  SH, Reppold  CT,  et al.  Gender differences in Brazilian street youth’s family circumstances and experiences on the street.  Child Abuse Negl. 2000;24(11):1431-1441. PubMedGoogle ScholarCrossref
52.
Aneci Rosa  CS, Borba  ES, Ebrahim  GJ.  The street children of Recife: a study of their background.  J Trop Pediatr. 1992;38(1):34-40.PubMedGoogle ScholarCrossref
53.
Murray  LK, Singh  NS, Surkan  PJ, Semrau  K, Bass  J, Bolton  P.  A qualitative study of Georgian youth who are on the street or institutionalized.  Int J Pediatr. 2012;2012:921604. PubMedGoogle ScholarCrossref
54.
Mayfield Arnold  E, Song  EY, Legault  C, Wolfson  M.  Risk behavior of runaways who return home.  Vulnerable Child Youth Stud. 2012;7(3):283-297. doi:10.1080/17450128.2012.687843.Google ScholarCrossref
55.
Coates  J, McKenzie-Mohr  S.  Out of the frying pan, into the fire: trauma in the lives of homeless youth prior to and during homelessness.  J Sociol Soc Welf. 2010;37(4):65-96. https://www.wmich.edu/hhs/newsletters_journals/jssw_institutional/individual_subscribers/37.4.Coates.pdf. Accessed February 16, 2016.Google Scholar
56.
Peressini  T.  Perceived reasons for homelessness in Canada: testing the heterogeneity hypothesis.  Can J Urban Res. 2007;16(1):112-126.Google Scholar
57.
Hyde  J.  From home to street: understanding young people’s transitions into homelessness.  J Adolesc. 2005;28(2):171-183. PubMedGoogle ScholarCrossref
58.
Safyer  AW, Thompson  SJ, Maccio  EM, Zittel-Palamara  KM, Forehand  G.  Adolescents’ and parents’ perceptions of runaway behavior: problems and solutions.  Child Adolesc Social Work J. 2004;21(5):495-512. doi:10.1023/B:CASW.0000043361.35679.73.Google ScholarCrossref
59.
Moon  MW, Binson  D, Page-Shafer  K, Díaz  R.  Correlates of HIV risk in a random sample of street youths in San Francisco.  J Assoc Nurses AIDS Care. 2001;12(6):18-27.PubMedGoogle ScholarCrossref
60.
Ennett  ST, Federman  EB, Bailey  SL, Ringwalt  CL, Hubbard  ML.  HIV-risk behaviors associated with homelessness characteristics in youth.  J Adolesc Health. 1999;25(5):344-353.PubMedGoogle ScholarCrossref
61.
Nadon  SM, Koverola  C, Schludermann  EH.  Antecedents to prostitution: childhood victimization.  J Interpers Violence. 1998;13(2):206-221. doi:10.1177/088626098013002003.Google ScholarCrossref
62.
Ringwalt  CL, Greene  JM, Robertson  MJ.  Familial backgrounds and risk behaviors of youth with thrownaway experiences.  J Adolesc. 1998;21(3):241-252.PubMedGoogle ScholarCrossref
63.
Boesky  LM, Toro  PA, Bukowski  PA.  Differences in psychosocial factors among older and younger homeless adolescents found in youth shelters.  J Prev Intervent Community. 1997;15(2):19-36.Google ScholarCrossref
64.
Booth  RE, Zhang  Y.  Severe aggression and related conduct problems among runaway and homeless adolescents.  Psychiatr Serv. 1996;47(1):75-80.PubMedGoogle ScholarCrossref
65.
Janus  MD, Archambault  FX, Brown  SW, Welsh  LA.  Physical abuse in Canadian runaway adolescents.  Child Abuse Negl. 1995;19(4):433-447.PubMedGoogle ScholarCrossref
66.
Whitbeck  LB, Simons  RL.  A comparison of adaptive strategies and patterns of victimization among homeless adolescents and adults.  Violence Vict. 1993;8(2):135-152. PubMedGoogle Scholar
67.
Howard  J.  Taking a chance on love: risk behaviour of Sydney street youth.  J Paediatr Child Health. 1993;29(suppl 1):S60-S65.PubMedGoogle ScholarCrossref
68.
Hier  SJ, Korboot  PJ, Schweitzer  RD.  Social adjustment and symptomatology in two types of homeless adolescents: runaways and throwaways.  Adolescence. 1990;25(100):761-771.PubMedGoogle Scholar
69.
Medlow  S, Klineberg  E, Steinbeck  K.  The health diagnoses of homeless adolescents: a systematic review of the literature.  J Adolesc. 2014;37(5):531-542.PubMedGoogle ScholarCrossref
70.
Hillis  SD, Zapata  L, Robbins  CL,  et al.  HIV seroprevalence among orphaned and homeless youth: no place like home.  AIDS. 2011;26(1):105-110. doi:10.1097/QAD.0b013e32834c4be4.Google ScholarCrossref
71.
Marshall  BD, Kerr  T, Livingstone  C, Li  K, Montaner  JS, Wood  E.  High prevalence of HIV infection among homeless and street-involved Aboriginal youth in a Canadian setting.  Harm Reduct J. 2008;5:35. PubMedGoogle ScholarCrossref
72.
Coren  E, Hossain  R, Pardo Pardo  J,  et al.  Interventions for promoting reintegration and reducing harmful behaviour and lifestyles in street-connected children and young people.  Cochrane Database Syst Rev. 2013;2(2):CD009823.PubMedGoogle Scholar
73.
Fiszbein  A, Schady  N, Ferreira  FHG,  et al; World Bank.  Conditional Cash Transfers: Reducing Present and Future Poverty. Washington, DC: The International Bank for Reconstruction and Development/The World Bank; 2009.
74.
Barrientos  A, Byrne  J, Peña  P, Villa  JM.  Social transfers and child protection in the South.  Child Youth Serv Rev. 2014;47(pt 2):105-112. doi:10.1016/j.childyouth.2014.07.011.Google ScholarCrossref
75.
Zlotnick  C, Tam  T, Zerger  S.  Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.  Health Soc Care Community. 2012;20(5):449-476.PubMedGoogle ScholarCrossref
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