Causes of Child and Youth Homeless in Developed and Developing Countries A Systematic Review - Part3

Causes of Child and Youth Homelessness Original Investigation Research
development countries.13 We defined developing countries as sons for street involvement. When more than 1 study
all those in the high, medium, and low development catego- reported on the same sample population,16-24 the source
ries and developed countries as those in the top quartile and containing the most detailed data about the reasons for
classified as very high in the United Nations Development Pro- street involvement was selected for the review.17,19,21,24 Data
gramme 2013 Human Development Index Report.13 extraction was performed independently by L.E. and J.G.,
and then the results were compared. Any disagreements
Search Strategy and Study Selection were discussed until a consensus was reached. When it was
We searched for any published peer-reviewed study from 1990 not possible to extract the data from the publication, we
through July 2013 that reported quantitative reasons for street contacted the authors to ask for clarification.
involvement. Studies were included if they met the following
inclusion criteria: (1) participants were 24 years of age or Reasons and Variables
younger, (2) participants met our definition of street- Extracted data on reasons were sorted and compiled into cat-
connected children and youth, and (3) quantitative reasons for egories. The review team agreed on 6 categories that best rep-
street involvement were reported. We included the following resented the themes that emerged: poverty, abuse, family con-
study designs: cross-sectional, cohort, case-control, mixed- flict, delinquency, psychosocial health, and other reasons.
methods, qualitative studies reporting quantitative reasons, When studies reported multiple reasons per category, we used
and interventions that provided baseline data on reasons for the most frequent response in the meta-analysis. Poverty con-
street involvement. We excluded publications that were not sisted of the following variables: poverty, hunger, work to get
written in English or that were dissertations, books, and con- money, housing instability, rural to urban migration, struc-
ference abstracts. tural, and refugee/conflict/war displacement. Abuse con-
Electronic searches of Scopus, PsychINFO, EMBASE, sisted of the following variables as reported in the studies:
POPLINE, PubMed, ERIC, and the Social Sciences Citation In- physical abuse, sexual abuse, and abuse/maltreatment and ne-
dex were conducted from January 1, 1990, to the third week glect. Family conflict consisted of the following variables: fam-
of July 2013. The following broad search strategy was used to ily conflict, escape home problems, abandoned, family is-
search the databases: “street children” OR “street youth” OR sues, domestic violence, orphaned, substance use at home,
“homeless youth” OR “homeless children” OR “runaway chil- alcoholism at home, thrown out, mutual decision with par-
dren” OR “runaway youth” or “homeless persons.” ents, and brought to the streets by family/relative. Delin-
After duplicates were removed, 2 independent reviewers quency consisted of the following variables: delinquency, con-
(L.E. and J.G.) screened the titles and abstracts and excluded flict with the law, and removed by authorities. Psychosocial
all records that did not meet the inclusion criteria. If either of health consisted of the following variables: sexuality/gender
the reviewers found an article to be relevant, a full-text copy issues, mental health, anxiety/depression, conflict with friends,
of the article was obtained, and its eligibility assessed inde- traumatic events, personal drug and alcohol use, pregnancy,
pendently. Disagreements were resolved by discussion be- and peer pressure. Other reasons consisted of the following vari-
tween the 2 reviewers, and a third reviewer assisted when con- ables: runaway, desire to go to the city, independence, no clear
sensus could not be reached. A final list of studies to be included reason, and other.
in this systematic review was agreed on, and the data were ex-
tracted. The authors included data from their own unpub- Analysis
lished work that was under review at the time of their search.14 We considered a binary response (yes/no) for each reason for
Reference lists of selected articles were scanned to identify ad- street involvement to estimate pooled prevalence and to
ditional relevant documents. assess effect of covariates, while accounting for individual
study variations by introducing random intercepts. First, we
Study Quality fit logistic mixed-effects models to estimate the pooled
The assessment of methodological quality was used to deter- prevalence (ie, pooled mean proportion) of each reason, and
mine whether the studies adequately reported study compo- to estimate subgroup pooled prevalence by development
nents essential to any study design. A critical appraisal tool was level or geographic region. Separate models were fit for each
adapted to assess 10 items that should be reported to effec- reason using only studies that examined the reason as a
tively assess the validity of a study’s findings.15 Details of the source of street involvement. To evaluate sex difference, we
study quality assessment tool and the results of assessing study first created the number of female and male youth who
quality are available in the eAppendix and eTable 1 in the reported yes/no to each reason from a study, and reshaped
Supplement. The quality assessment was performed indepen- the data into a long format where each sex-yes/no datum is
dently by L.E. and J.G. Afterward, the 2 sets of results were com- in a separate observation. For example, individual study
pared, and any disagreements were discussed until a consen- data were separated into 4 observations with a variable (say,
sus was reached. num) representing number of male-poverty yes, male-
poverty no, female-poverty yes, and female-poverty no.
Data Extraction Interactions between sex and the other covariates, such as
Data were extracted by 2 independent reviewers (L.E. and development level or geographic region, were generated to
J.G.) and included details about the study’s design, setting, estimate the subgroup pooled prevalence of each reason and
population demographics, and results for all reported rea- to assess sex difference within a specific covariate level (eg,
jamapediatrics.com (Reprinted) JAMA Pediatrics Published online April 4, 2016 E3
Copyright 2016 American Medical Association. All rights reserved.
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Causes of Child and Youth Homelessness Original Investigation Research

jamapediatrics.com (Reprinted) JAMA Pediatrics Published online April 4, 2016 E3

Copyright 2016 American Medical Association. All rights reserved.

Downloaded From: http://archpedi.jamanetwork.com/ by a Universite Laval User on 04/05/2016

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