Exploring Substance Use Patterns Among Homeless High School Adolescents in Georgia: A Youth Risk Behavior Survey Analysis

Background: Adolescent substance use is a significant public health concern, with homeless high school students being particularly vulnerable. However, the relationship between homelessness and substance use among this population remains understudied. Methods: This study used data from the 2021 Youth Risk Behavior Survey (YRBS) to investigate substance use behaviors among high school students in Georgia. Substance use prevalence, and the association between homelessness and substance use were analyzed using weighted chi-square tests with Rao-Scott correction. Results: Among 604 surveyed high school students, 4.9% were homeless adolescents who exhibited notably higher substance use rates than housed peers. Homelessness showed moderate associations with current electronic vapor product use (Phi=0.1274), lifetime methamphetamine use (Phi=0.1155), and cigarettes (Phi=0.1204). Homeless adolescents reported significantly higher rates of current electronic vapor product use (36.9% vs. 15.2%), current cigarette smoking (10.4% vs. 2.0%), lifetime methamphetamine use (13.1% vs. 3.1%), and lifetime ecstasy use (11.0% vs. 3.8%). While not statistically significant, trends indicated elevated rates among homeless adolescents for cigar smoking, smokeless tobacco, lifetime prescription pain medication, and lifetime cocaine use. Conclusion: Our findings underscore the urgent need for comprehensive support services and targeted interventions to address substance use disparities among homeless adolescents. Long-term research is crucial to clarify the relationship between homelessness and substance use and mitigate adverse health outcomes.