Correlates of Alcohol Consumption and Drug Injection among Homeless Youth: A Case Study in the Southeast of Iran

Document Type : Original Article


1 Modeling in Health Research Center, Institute for Futures Studies in Health AND Department of Biostatistics and Epidemiology, School of Health, Kerman University of Medical Sciences, Kerman, Iran

2 Adolescent and Youth Health Office, Ministry of Health and Medical Education, Women’s Health Research Center, Tehran, Iran

3 Adolescent and Youth Health Office, Ministry of Health and Medical Education, Tehran, Iran

4 Social Determinants of Health Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran

5 Department of Public Health, School of Public Health, Jiroft University of Medical Sciences, Jiroft, Iran

6 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance, Kerman University of Medical Sciences, Kerman, Iran

7 HIV/STI Surveillance Research Center, and WHO Collaborating Center for HIV Surveillance AND Department of Health Education and Promotion, School of Health Sciences, Kerman University of Medical Sciences, Kerman, Iran


Background: Alcohol use and drug injection are prevalent among homeless youths. The aim of this study was
to identify the associated factors of alcohol consumption and drug injection among homeless youths aged
18-29 years.
Methods: Data on 202 homeless youths (111 males and 91 females) were collected using a standardized
questionnaire and face-to-face interview. Lasso logistic regression was applied to determine the impact of
associated factors on alcohol consumption and drug injection.
Findings: The mean age of the participants was 26.30 ± 3.19 years. Also, the prevalence of alcohol
consumption and drug injection was 33.0% [95% confidence interval (CI): 30-36] and 4.0% (95% CI: 0-8),
respectively; 6 people (3.0%) consumed alcohol and injected drugs at the same time. Correlates of alcohol
consumption and drug injection were male sex [odds ratio (OR)Alc = 5.7], age (ORAlc = 0.96 and ORDI = 0.98),
bachelor or higher education level (ORAlc = 1.34), non-Iranian nationality (ORAlc = 0.05 and ORDI = 0.18),
food score (ORDI = 0.92), smoking (ORAlc = 2.05), substance use (ORAlc = 1.12), opposite sex relationship
(ORAlc = 1.6), homosexual relationship (ORAlc = 3.56 and ORDI = 2.69), and mental disorder (ORAlc = 0.99).
Conclusion: Based on our findings, it seems that the homeless youth are more desired to use alcohol and drug
injection, whereas the prevalence of alcohol consumption and drug injection in homeless youth was higher
than general youth population in Iran. Therefore, some suitable solutions are needed to prevent the
homelessness. Also, the effective variables that were identified in this study for alcohol use and drug injection
can help design and implement beneficial interventions.


James Frankish C, Hwang SW, Quantz D. The
relationship between homelessness and health: An
overview of research in Canada. In: Hulchanski JD,
Campsie P, Chao SBY, Hwang SH, paradis e,
editors. finding home: policy Options for
Addressing Homelessness in Canada. Toronto, ON:
Canadian Observatory on Homelessness; 2009.
2. Johnson RJ, Rew L, Sternglanz RW. The
relationship between childhood sexual abuse and
sexual health practices of homeless adolescents.
Adolescence 2006; 41(162): 221-34.
3. Kulik DM, Gaetz S, Crowe C, Ford-Jones EL.
Homeless youth's overwhelming health burden: A
review of the literature. Paediatr Child Health 2011;
16(6): e43-e47.
4. Toro PA, Fowler PJ, Dworsky A. Homeless youth
in the United States: Recent research findings and
intervention approaches. Proceedings of the 2007
National Symposium on Homelessness Research;
2007 Mar 1-2; Washington, DC, USA:
5. Zare Z. Access to social support among homeless
urban women and men in Tehran (Iran). Housing,
Care and Support 2016; 19(2): 55-63.
6. Whiteford HA, Degenhardt L, Rehm J, Baxter AJ,
Ferrari AJ, Erskine HE, et al. Global burden of
disease attributable to mental and substance use
disorders: Findings from the Global Burden of
Disease Study 2010. Lancet 2013; 382(9904):
7. Kipke MD, Montgomery S, MacKenzie RG.
Substance use among youth seen at a communitybased health clinic. J Adolesc Health 1993; 14(4):
8. Bousman CA, Blumberg EJ, Shillington AM,
Hovell MF, Ji M, Lehman S, et al. Predictors of
substance use among homeless youth in San Diego.
Addict Behav 2005; 30(6): 1100-10.
9. Hoyt DR, Ryan KD, Cauce AM. Personal
victimization in a high-risk environment: Homeless
and runaway adolescents. J Res Crime Delinq
1999; 36(4): 371-92.
10. Bender K, Ferguson K, Thompson S, Komlo C,
Pollio D. Factors associated with trauma and
posttraumatic stress disorder among homeless
youth in three U.S. cities: The importance of
transience. J Trauma Stress 2010; 23(1): 161-8.
11. Vittinghoff E, McCulloch CE. Relaxing the rule of
ten events per variable in logistic and Cox
regression. Am J Epidemiol 2007; 165(6): 710-8.
12. Lin J. Solving multicollinearity in the process of
fitting regression model using the nested estimate
procedure. Qual Quant 2008: 42(3); 417-26.
13. Vigneaua E, Bertrand D, Qannari M. Application of
latent root regression for calibration in nearinfrared spectroscopy. Comparison with principal
component regression and partial least squares.
Chemometr Intell Lab Syst 1996; 35(2): 231 -8.
14. Slinker BK, Glantz SA. Multiple regression for
physiological data analysis: the problem of
multicollinearity. Am J Physiol 1985; 249(1 Pt 2):
15. Tibshirani R. Regression Shrinkage and Selection
via the Lasso. J R Stat Soc Series B Stat Methodol
1996; 58(1): 267-88.
16. Haji-Maghsoudi S, Haghdoost AA, Rastegari A,
Baneshi MR. Influence of pattern of missing data
on performance of imputation methods: an example
using national data on drug injection in prisons. Int
J Health Policy Manag 2013; 1(1): 69-77.
17. Huchon D, Szitenberg A, Shefer S, Ilan M,
Feldstein T. Mitochondrial group I and group II
intronsin the sponge orders Agelasida
andAxinellida. BMC Evolutionary Biology 2015;
15: 278.
18. Roshanpajouh M. A comparative review on
national alcohol prevention policies in different
selected countries. Asia Pac J Med Toxicol 2014;
3(Suppl 1): 22.
19. Nikfarjam A, Shokoohi M, Shahesmaeili A,
Haghdoost AA, Baneshi MR, Haji-Maghsoudi S, et
al. National population size estimation of illicit
drug users through the network scale-up method in
2013 in Iran. Int J Drug Policy 2016; 31: 147-52.
20. Santa MD, Padhye N, Yang Y, Gallardo K, Santos
GM, Jung J, et al. Drug use patterns and predictors
among homeless youth: Results of an ecological
momentary assessment. Am J Drug Alcohol Abuse
2018; 44(5): 551-60.
21. Parriott AM, Auerswald CL. Incidence and
predictors of onset of injection drug use in a San
Francisco cohort of homeless youth. Subst Use
Misuse 2009; 44(13): 1958-70.
22. Teesson M, Hodder T, Buhrich N. Alcohol and
other drug use disorders among homeless people in
Australia. Subst Use Misuse 2003; 38(3-6): 463-74.
23. Unger JB, Kipke MD, Simon TR, Montgomery SB,
Johnson CJ. Homeless youths and young adults in
Los Angeles: prevalence of mental health problems
and the relationship between mental health and
substance abuse disorders. Am J Community
Psychol 1997; 25(3): 371-94.
24. Greenland S, Mansournia MA, Altman DG. Sparse
data bias: A problem hiding in plain sight. BMJ
2016; 352: i1981.
25. DeWit DJ, Adlaf EM, Offord DR, Ogborne AC.
Age at first alcohol use: a risk factor for the
Alcohol Consumption and Drug Injection in Homeless Youth Hosseinnataj et al.
214 Addict Health, Autumn 2019; Vol 11, No 4, 07 October
development of alcohol disorders. Am J Psychiatry
2000; 157(5): 745-50.
26. Thompson S, Jun J, Bender K, Ferguson KM,
Pollio DE. Estrangement factors associated with
addiction to alcohol and drugs among homeless
youth in three U.S. cities. Eval Program Plann
2010; 33(4): 418-27.
27. Galea S, Vlahov D. Social determinants and the
health of drug users: Socioeconomic status,
homelessness, and incarceration. Public Health Rep
2002; 117(Suppl 1): S135-S145.
28. Nyamathi A, Branson C, Kennedy B, Salem B,
Khalilifard F, Marfisee M, et al. Impact of nursing
intervention on decreasing substances among
homeless youth. Am J Addict 2012; 21(6): 558-65.
29. Grosso AL, Downing MJ, Thomann M, Chiasson
MA, Schrimshaw EW, Hirshfield S. Age of onset
of alcohol consumption and subsequent negative
health outcomes in gay and bisexual men who have
sex with men. J Homosex 2019; 66(11): 1609-25.
30. Haghdoost A A, Emami M, Esmaili M, Soberinia
A, Nezhad Ghaderi M, Mehrolhassani M H. Survey
the status and causes of alcohol consumption: A
case study of the epidemic alcohol poisoning in
Rafsanjan in 2013. J Rafsanjan Univ Med Sci 2015;
13(10): 991 -1006. [In Persian].
31. Petering R. Sexual risk, substance use, mental
health, and trauma experiences of gang-involved
homeless youth. J Adolesc 2016; 48: 73-81.
32. Hosseinifard SM, Ahmadian A, Smaeelifar N. The
synergistic (Marathon) effect of combined
methamphetamine with sexual stimulant drugs on
increasing the likelihood of high-risk sexual
behaviors. Addict Health 2014; 6(3-4): 112-8.
33. Markel A. Methamphetamine use among
HIV-positive men who have sex with men (MSM)
[MSc Thesis]. Carbondale, IL: Southern Illinois
University; 2010.
34. Tucker JS, Wenzel SL, Golinelli D, Ryan G, Zhou
A, Beckman R, et al. Is substance use a barrier to
protected sex among homeless women? Results
from between- and within-subjects event analyses. J
Stud Alcohol Drugs 2010; 71(1): 86-94.
35. Rounds-Bryant JL, Kristiansen PL, Hubbard RL.
Drug abuse treatment outcome study of
adolescents: A comparison of client characteristics
and pretreatment behaviors in three treatment
modalities. Am J Drug Alcohol Abuse 1999; 25(4):
36. Coleman-Jensen A, Gregory C, Singh A. Household
food security in the United States in 2013. USDAERS Economic Research Report Number 173
[Online]. [cited 2014 Sep 1]; Available from: UrL:
37. Huang H. Controlling the false discoveries in
LASSO. Biometrics 2017; 73(4): 1102-10.
38. Mallick H, Yi N. Bayesian methods for high
dimensional linear models. J Biom Biostat 2013;
1: 005.
39. Radchenko P, James GM. Variable Inclusion and
Shrinkage Algorithms. J Am Stat Assoc 2008;
103(483): 1304-15.
40. Zou H. The adaptive lasso and its oracle properties.
J Am Stat Assoc 2006; 101(476): 1418-29.
41. Zou H, Hastie T. Regularization and variable
selection via the elastic net. J R Stat Soc Series B
Stat Methodol 2005; 67(2): 301-20.
42. Park T, Casella G. The Bayesian Lasso. J Am Stat
Assoc 2008; 103(482): 681-6.