STREET KID DEATH TOLL ALARMING

More than 11 times more likely to die. Researchers found 3-year
Montreal study unsettling because the youths 'are dying of things we
could do something about'

SHARON KIRKEY, GARY FRANCOEUR of The Gazette contributed to this
report CanWest News Service

Canada's street youth often romanticize themselves as "adventurers"
and people "living life on their own terms," but in reality they face
a higher death rate than others in their age bracket, researchers have
found.

Of 1,013 Montreal street youth who were followed for an average of
nearly three years, 26 died - a death rate more than 11 times that of
youth in the general population.

Thirteen died by suicide (hanging, jumping from a bridge or jumping
out of or in front of a moving vehicle), eight by drug overdose and
two from an unintentional injury, like an accident. There was one
death from hepatitis A and one from heart disease. In one case, the
cause of death is unknown.

Five of the youths died before reaching age 20.

For young people living on the streets of Montreal, the results of the
study aren't surprising.

"It's a struggle," Tom, 24, said yesterday as he panhandled for beer
money on St. Denis St.

"You spend most of your time getting high, and when you're not, all
you think about is finding money to buy drugs."

Tom was sporting black eyes and a bruised lip; he'd been jumped by
five other street kids the night before.

Street kids will go to surprising lengths to get money, including
prostituting themselves and robbery, he explained.

"Very few people on the streets are there by choice," added his
friend, Jeremy, 23, who has lived on the streets for at least four
years.

"I've had to deal with things as a kid that no one should have to go
through," he said. "But you take it one day at a time and hope
tomorrow will be better than today."

You can't trust anyone, said Jonathan, 18, who has been on the streets
for almost a year.

"There's no one you can depend on," he said. "Sure, you make friends,
but they're not your real friends. They'll stab you in the back if it
can help them."

The scrawny Siberian husky who sat quietly beside him is his only true
companion, he said.

According to the study, risks for dying on the street included being
HIV-infected, being recently homeless, daily alcohol or injection-drug
use in the previous month, and gender: Male youth are nearly three
times more likely than females to die on the street.

The death rates shocked even the researchers, who warn that street
youth urgently need to become a public health priority in Canada.

"We were not expecting that at all," said Dr. Nancy Haley, a
pediatrician with the Montreal regional public health department and
co-author of the study, published in today's issue of the Journal of
the American Medical Association. "Even more unsettling, they are
dying of things we could do something about."

An estimated 67,000 youths age 18 or younger are reported as missing
in Canada. Ninety-five per cent are runaways, according to the Missing
Children Society of Canada.

Many are repeat and long-term runners.

An accompanying editorial in today's Journal calls the Montreal study
stark evidence "of the vulnerability of street youth that belies their
bravado."

"Living without a regular place to stay; squatting in blighted housing
and abandoned buildings; camping in doorways, parks, overpasses or
wooded areas" and spending days and nights begging for spare change
make street life dangerous, violent and unpredictable, writes Dr. Sue
Ellen Abdalian, of Tulane University Health Sciences Centre in New
Orleans.

Some end up severely depressed and use drugs to self-medicate. Others
turn to prostitution, break-ins and drug-running in exchange for food,
clothing or a place to stay.

In the Montreal study, street youth age 14 to 25 were recruited from
drop-in centres, shelters and outreach vans from January 1995 to
September 2000.

Two-thirds were boys. Most reported having used cannabis, cocaine,
crack or other drugs, and one-quarter had been involved in "survival
sex" - performing sexual favours in exchange for food, shelter, gifts
or drugs, but not necessarily money.

Youth were interviewed face to face every six months and followed
until age 30 or until they were no longer "street-involved."

The team originally wanted to determine rates and risk factors for HIV
infection and injection-drug use.

But when they began having trouble retracing some of the youth, the
team started contacting the coroner's office.

Suicide and drug overdoses were the two leading causes of death, while
HIV infection was the biggest "predictor" of an early death: infection
with the virus increased the risk of dying by 5.6 times.

Those who used alcohol every day in the previous month were 3.2 times
more likely to die, and being homeless tripled the risk of death.

Of the four deaths among HIV-infected street youth, one died from
hepatitis A, for which a vaccine exists, two from a drug overdose and
one from a heart condition.

Haley, a public health infectious-disease consultant, said more
outreach services are needed - particularly in mental health,
addiction, and family mediation - as well as better access to housing,
given that homelessness dramatically increases the risk of death.

More school-based prevention programs are needed to identify at-risk
kids early, she added.

"Some of these kids were drinking in elementary school and started
multi-drug use early on. Many have serious family and mental health
problems. And we didn't pick it up early enough."