YOUNG PEOPLE LIVING ON STREET DIE AT 11 TIMES NATIONAL RATE

Canada's street youth often romanticize themselves as adventurers and
people living life on their own terms, but in reality these youngsters
face a higher death rate than anyone expected, Canadian researchers
have found.

Of 1,013 Montreal street youth who were followed for nearly three
years on average, 26 died -- more than 11 times the death rate 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. There was one death each from
hepatitis A and heart disease. In one case the cause of death was unknown.

Five of the youth died before reaching age 20.

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

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

"We were not expecting that at all," says Dr. Nancy Haley,
pediatrician with Montreal Regional Public Health 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 youth aged 18 and under are listed as missing in
Canada. Ninety-five per cent are runaways, according to the Missing
Children Society of Canada.

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 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-and-enters and drug running in exchange
for food, clothing or a place to stay.

In the Montreal study, street youth aged 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" -- doing sexual acts for food, shelter,
gifts or drugs, but not necessarily money.

Youth were interviewed 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, they contacted 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 by a factor of 5.6 the risk of dying.

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

Among the four deaths in HIV-infected street youth, one was from
hepatitis A, for which a vaccine exists, two were from a drug overdose
and one was from a heart condition.

For youth living on the streets of Montreal, the results of the study
are not surprising. "It's a struggle," said Tom, 24, as he panhandled
for beer money.

"You spend most of your time getting high, and when you're not, all
you think about is finding money to buy drugs," he said, nursing black
eyes and a bruised lip after he was jumped by five other street kids
the night before.

"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."

Haley, a public health infectious disease consultant, says 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, she said. "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."