The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population.

Zack Almquist,Jessica Perkins,Ashley Hazel,Mary-Catherine Anderson

doi:10.3390/ijerph18147328

Abstract

People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments.

Highlights

Compared with the general population, people experiencing homelessness (PEH)display disproportionately negative health outcomes, including higher rates of addiction, mental and physical health problems, and premature mortality [1,2,3,4,5,6,7]
We examine how the homeless environment may be associated with both general health and emotional well-being among unsheltered PEH through physical, tangible elements of the homeless environment—such as seasonality and environmental exposure—and through the social ties that comprise the social environment
We aimed to investigate health among unsheltered PEH through an ecological lens, wherein we explored how various dimensions of the homelessness environment may jointly or differentially affect health through direct and indirect pathways

Summary

Introduction

Compared with the general population, people experiencing homelessness (PEH)display disproportionately negative health outcomes, including higher rates of addiction, mental and physical health problems, and premature mortality [1,2,3,4,5,6,7]. Compared with the general population, people experiencing homelessness (PEH). Most published research on health among PEH is limited to sheltered homeless populations. Less is known about the health of over 225,000 people experiencing unsheltered homelessness in America, who made up nearly 40% of America’s total homeless population in 2020 [8]. Past work finds that unsheltered PEH generally have poorer physical and mental health outcomes than sheltered PEH. They have been observed to be more likely to engage in risky behaviors, such as substance use and having multiple sexual partners, and to experience higher rates of victimization and premature mortality [10,11,12]

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