Homeless Group Research Articles

The Pediatric Nurse Practitioner's Role in Reducing Oral Health Disparities in Homeless Children

Dental caries is the most common infectious disease of children. The majority of children in the United States who experience dental decay are from low-income, minority families. Many low- income, minority families are at risk for homelessness and, indeed, mothers with children are the fastest growing homeless group. Once homeless, families end up in shelters. Shelters are a unique source for the provision of health care; however, the provision of dental care to mothers and children in shelters is limited. At a shelter-based clinic, of a total number of children assessed in a 24-month period (n = 264), 22.7% (n = 60) had obvious gross dental cavities. The school-aged children (6-12 years) (n = 41) had the highest prevalence of dental cavities (34%). Consistent with the literature, dental caries was the most prevalent condition of homeless children and the most difficult for which to obtain treatment. Follow-up was difficult because of the transient nature of homeless families.

Personality and criminal outcomes of homeless youth in a Nigerian jail population: results of PDS and MAACL-H assessments

Objective: The unprecedented incidence of armed robberies and the involvement of young people in these crimes necessitated — as part of a comprehensive study on homelessness and criminal behaviour in Nigeria — an assessmet and comparison of homeless youths incarcerated in prisons with a control group of non-prison and never-homeless youths from the general population using the Psychopathic Deviate Scale (PDS) and the Multiple Affect Adjective Checklist hostility subscale (MAACL-H). Method: Through in-depth interviews using a questionnaire, data were collected from 100 randomly selected homeless inmates in three Nigerian medium-security prisons aged 15 to 26 (mean = 17.2), and another 100 non-prison and never-homeless youths from the general population aged 15 to 31 (mean = 25.2). Results: Hypothesis 1 showed a higher score on the PDS (mean = 29.3) and MAACL-H (mean = 21.7) among the homeless group than the non-prison and never homeless group (PDS mean = 21.2) and (MAACL-H = mean 12.5), (PDS (t = (98) = 6.62, p < .05) and MAACL-H (t = (98) = 21.7, p < .0001). The second hypothesis also showed a significant relationship between PDS and the type of crime committed by homeless inmates (F (2, 97) = 3.213; p < .05) and the direction of this relationship was higher for PDS and felony followed by misdemeanour offences (p < .05, LSD = 2.81). The MAACL-H did not reach an acceptable level of significance for type of crime. Conclusion: These findings have significant practical and theoretical implications for personality and criminal outcomes for homeless youths in prisons when compared with non-prison and never-homeless youths. The study also suggests the need for more research in this direction and a review of antiquated penal policies for children, while the effective roles of governments and non-governmental organisations were also stressed.

Predictors of Homelessness among Older Adults in New York City

We interviewed 61 housed and 79 homeless adults aged 55 and over about disability; economic, human and social capital; and stressful life events prior to becoming homeless. Over half of the homeless group had previously led conventional lives. Human capital, social capital and life events were more important than disability or economic capital in predicting homelessness. The homeless adults were younger, more likely to be male and better educated than housed adults, but had shorter job tenure and fewer social ties. Homeless adults faced multiple, cascading risks, including job loss and housing loss. Implications for prevention are discussed.

The homeless mentally ill - an audit from an inner city hospital.

To determine the proportion of those that are homeless attending the Mater Misericordiae Hospital's (MUH) psychiatric service, including those presenting to accident and emergency who were homeless, and to compare the homeless group with the non-homeless so as to obtain a profile of this group. All adults over 16, referred for psychiatric assessment, attending A&E were included, as were those attending outpatient clinics, liaison consultations and inpatients in the psychiatric unit, in the six-month period from January to June 2003. Excluded were those who were under 16, who refused to participate, who did not speak English, those with a diagnosis of personality disorder and organic brain damage. Questionnaires were completed by psychiatric registrars and a community psychiatric nurse, with an ICD-10 diagnosis recorded on each individual, in consultation with the treating consultant psychiatrist. A total of 628 patients were seen in MUH during the study period, and 13.8% were homeless. Of the homeless, 56.3% were seen as emergency referrals in the A&E, 23% were inpatients (including the psychiatric unit and consultations in medical/surgical wards) and 20.7% were seen in the outpatient department. Of all the A&E referrals to psychiatry, 34.8% were homeless. The homeless presented most commonly in suicidal crisis (26.6%) compared with 12.5% in the non-homeless group. Substance-abuse disorders were the primary diagnosis in 42.3% of the homeless group, accounting for 14.2% in the housed sample. Outcome for both groups was similar, with slightly more homeless being referred for psychiatric admission (17.8%), as compared to 12.0% in the nonhomeless group. Mental illness and the need for psychiatric services remain a serious issue for a significant segment of the homeless population. The homeless are overrepresented in our accident and emergency department, with their psychological and medical needs not being met in primary care. An integrated multi-disciplinary treatment approach, including outreach work, that addresses their many needs, appears to hold the greatest promise of success in this population.

Treating Homeless Opioid Dependent Patients with Buprenorphine in an Office-Based Setting

ContextAlthough office-based opioid treatment with buprenorphine (OBOT-B) has been successfully implemented in primary care settings in the US, its use has not been reported in homeless patients.ObjectiveTo characterize the feasibility of OBOT-B in homeless relative to housed patients.DesignA retrospective record review examining treatment failure, drug use, utilization of substance abuse treatment services, and intensity of clinical support by a nurse care manager (NCM) among homeless and housed patients in an OBOT-B program between August 2003 and October 2004. Treatment failure was defined as elopement before completing medication induction, discharge after medication induction due to ongoing drug use with concurrent nonadherence with intensified treatment, or discharge due to disruptive behavior.ResultsOf 44 homeless and 41 housed patients enrolled over 12 months, homeless patients were more likely to be older, nonwhite, unemployed, infected with HIV and hepatitis C, and report a psychiatric illness. Homeless patients had fewer social supports and more chronic substance abuse histories with a 3- to 6-fold greater number of years of drug use, number of detoxification attempts and percentage with a history of methadone maintenance treatment. The proportion of subjects with treatment failure for the homeless (21%) and housed (22%) did not differ (P = .94). At 12 months, both groups had similar proportions with illicit opioid use [Odds ratio (OR), 0.9 (95% CI, 0.5–1.7) P = .8], utilization of counseling (homeless, 46%; housed, 49%; P = .95), and participation in mutual-help groups (homeless, 25%; housed, 29%; P = .96). At 12 months, 36% of the homeless group was no longer homeless. During the first month of treatment, homeless patients required more clinical support from the NCM than housed patients.ConclusionsDespite homeless opioid dependent patients’ social instability, greater comorbidities, and more chronic drug use, office-based opioid treatment with buprenorphine was effectively implemented in this population comparable to outcomes in housed patients with respect to treatment failure, illicit opioid use, and utilization of substance abuse treatment.

A Comparison between Homeless, Domiciled and Vulnerable Populations in Madrid

Many descriptive studies of the homeless have been conducted in the USA (Rossi, 1989) and, to a lesser extent, in Europe and other industrialized countries (Brousse et al., 2002: Marpsat and Firdion, 1998, 2000; Meltzer, 1994). Similar studies have also been carried out in Spain (Munoz et al., 2003; Vazquez, Munoz and Rodriguez, 1999), and they have found results that are generally comparable to those found in other countries. The homeless population is largely male, with an average age around 40, low educational levels, high unemployment rates, and significant mental and general health problems.Although the psychosocial profile of the homeless population has been investigated extensively, there are not many studies comparing the profile of homeless people to that of the general population and of vulnerable people (e.g. the poor) who are not homeless (Koegel and Burnam, 1988). One of the problems with that type of study is that the concept of vulnerability to homelessness is not easy to define. At first, research centreed almost exclusively on mental health disorders as risk factors (Fisher and Breaky, 1991). Further studies have identified a number of additional variables involved in the risk of becoming homeless such as, for example, the lack of robust family or social networks (Unger et al., 1998), the lack of schooling and job training (Brooks and Buckner, 1996; Stronge, 1993), employment difficulties (Epel, Bandura and Zimbardo, 1999), health problems (Ropers and Boyer, 1987), and stressful life events (Munoz et al., 1999). It is also well known that socio-economic variables, especially poverty and difficulties to gain access to the housing market, may influence the onset of homelessness.In order to determine which variables are most important and their exact role in homelessness, some researchers have begun to introduce control groups that are similar to the homeless group in some specific aspects. The majority of the studies focusing on those groups have analysed single women with and without children (Metraux and Culhane, 1999), the chronic mentally ill, people with substance-abuse disorders (Clark, Teague and Henry, 1999), and the elderly in high-risk situations (Keigher, Berman and Greenblatt, 1991). Although these populations provide an interesting contrast, they may differ from the homeless with respect to important key variables such as their socio-economic level.The main objective of the investigation was to compare two vulnerable groups (i.e., homeless people and users of services for the homeless) with available data (on socio-demographic, employment, educational and health variables) from a representative sample of the Spanish general population (Juarez, 1994). Comparisons of data from homeless groups and the general population are relatively rare. Furthermore, it is also necessary to assess the specificity of the findings by including other groups of disadvantaged people. Thus, as in other comparative studies of vulnerable populations, we used a control group of people who have a regular place to sleep but who use services for the homeless (i.e., soup kitchens and public baths). The second control group made up of vulnerable housed people was included as a means of analysing factors that, besides economic difficulties, may differentiate the homeless population.I. The samples1. The homeless group (HG)Sampling of the homeless group was conducted in Madrid, Spain, during four weeks in February and March 1997. Madrid is a city of three million people. The most reliable estimate of the number of homeless persons, based on field samples and service centre statistics, is around 3,000 people (Vazquez, Munoz and Rodriguez, 1999). The city's social services network providing shelter to the homeless consists of 10 public and private year-round shelters and 2 emergency shelters, open during the winter. At the time of the study, all of the 12 shelters were filled to capacity (1,086 beds). …

Belief Systems of Homeless Veterans

Using the Irrational Beliefs Test (Jones, 1977), 171 homeless veterans were assessed regarding various personal philosophies. It was found that the homeless group achieved higher (more irrational) scores than general adults on scales measuring Emotional Irresponsibility, Avoidance, and Helplessness. Lower (less irrational) scores were obtained by the homeless group on scales measuring Approval and Dependence. The homeless sample also was found to score lower (more rational) on the Approval scale than the psychiatric sample provided in the norms. Interventions designed to impact at least some aspects ofthe “irrational” beliefs may be important to facilitate the homeless to achieve a greater degree ofintegration within mainstream society. Those interventions may result in a greater reliance on social agencies that are part ofthe “safety net,” designed to minimize the need to live on the streets.

Homeless Drug Users in Rotterdam, The Netherlands: Profile, Way of Life, and the Need for Assistance

Decreasing the number of homeless drug users is one of the main characteristics of inner city drugs policy. The present study selected an urban-ethnographic perspective (the subculture theory) in order to explore why one drug user is homeless and another 7 not, and to attempt to describe and define the homeless and their immediate social environment. These issues were formulated into the following research questions:What are the sociodemographic characteristics of homeless drug users in Rotterdam, and do they differ from domiciled drug users?What are their living conditions?What are the reasons for being homeless?Does the period of homelessness play a role in the need to change one's lifestyle?Five research methods were employed for this study: a literature search, interviews with key persons, field notes from community fieldworkers, a survey among drug users (n = 204), and photographic reports from six homeless users. Data were collected in 1998/1999. The results document that in our study population there were more women, more illegal persons, and more foreigners than among domiciled drug users, and that the homeless group used heroin and cocaine on more days. A large proportion of the homeless users had no identity papers and no health insurance. This did not, however, lead to more self-reported sickness or a higher prevalence of infectious diseases compared with nonhomeless drug users. Easily accessible (low threshold) social care centers and assistance are very important. Few of the homeless had voluntarily chosen a homeless life—most describe an event that was a trigger for their homelessness. The average duration of being homeless was 17 months, and the longer someone had been homeless the less inclined they were to change their situation. This paper also discusses policymaking implications.

Homelessness and High-Dosage Buprenorphine Misuse

Aim. To determine whether intravenous drug users (IDUs) are more likely to misuse high dosage buprenorphine (HDB) if they are homeless. Design. We carried out a cross-sectional study using data collected from HDB users between 1998 and 1999. Data were collected by use of a structured questionnaire with questions about demographic characteristics, and use of HDB and other substances. IDUs were considered to be homeless if they did not live on their own or with their parents or friends. Setting. IDUs were recruited from three centers for the treatment of drug users, three health care networks, one prison, one sleep-in, and two centers that provide psychosocial support for IDUs. Participants. Of the 788 eligible patients, 779 answered the questionnaire (response rate: 98.9%). Results. Homeless IDUs were more likely to have injected HDB than those who were not homeless (67% vs. 47%; p<0.001), and their injection behaviors were more likely to be unsafe. The first HDB injection was more likely to result in medical complications in the homeless group than in the nonhomeless group (58% vs. 38%; p = 0.001). Homeless IDUs were less likely to receive medical followed-up and were less well informed about the correct way of using HDB than nonhomeless IDUs. Conclusion. Homeless IDUs are more likely to misuse HDB. Thus, HDB maintenance therapy may not be the most appropriate maintenance therapy for this group.

SHORT‐ AND LONG‐TERM HOMELESSNESS AND ADOLESCENTS' SELF‐ESTEEM, DEPRESSION, LOCUS OF CONTROL AND SOCIAL SUPPORTS

The study investigated the effect of length of homelessness, (less than three months as against six months or longer), on four variables: self‐esteem, depression, locus of control and social supports. Respondents, (50 homeless adolescents, 25 male and 25 female, aged between 16–21), completed four questionnaires. Multivariate Analysis of Variance indicated that a combination of the four variables was dependent on the length of homelessness. The short‐term homeless group reported significantly higher levels of self‐esteem and significantly lower levels of depression compared with the long‐term homeless. Furthermore, the long‐term homeless group scored towards a more external locus of control, as compared with the short‐term homeless. While no significant difference was found between the two groups in the number of social supports, the short‐term homeless group reported significantly greater levels of satisfaction with their supports. We discuss the implications of these findings.

Homelessness among persons with serious mental illness in an enhanced community-based mental health system.

Homelessness and patterns of service use were examined among seriously mentally ill persons in an area with a well-funded community-based mental health system. The sample consisted of 438 individuals referred between 1990 and 1992 to an extended acute care psychiatric hospital after a stay in a general hospital. Those experiencing an episode of homelessness, defined as an admission to a public shelter between 1990 and 1993, were compared with those who were residentially stable. Data from a longitudinal integrated database of public mental health and medical services were used to construct service utilization measures to test the mediating effect of outpatient mental health care on preventing homelessness. A homelessness rate of 24 percent was found among the 438 persons with serious mental illness. Those who experienced homelessness were more likely to be African American, receive general assistance, and have a comorbid substance abuse problem. They used significantly more inpatient psychiatric, emergency, and health care services than the subjects who did not become homeless. Forty to 50 percent of the homeless group received outpatient care during the year before and after their shelter episode. The number of persons who received intensive case management services increased after shelter admission. An enhanced community-based mental health system was not sufficient to prevent homelessness among high-risk persons with serious mental illness. Eleven percent of this group experienced homelessness after referral to an extended acute care facility. Strategies to prevent homelessness should be considered, perhaps at the time of discharge from the referring community hospital or extended acute care facility.

Moral Judgement and Delinquency in Homeless Youth

The impact of the individuals' life condition on the relation between moral judgement and (delinquent) behaviour was investigated in a sample of 162 adolescents and young adults. The sample consisted of two groups: homeless youth and institutional youth, i.e. youth with a history of residential care. The difference in life conditions between both groups is characterised by a lack of stable social relationships and specific survival demands for the homeless youth group. Homeless youth reported much more delinquent behaviour than institutional youth, but this difference could not be attributed to the level of moral judgement. However, while for institutional youth a conventional level of moral reasoning was associated with lower levels of delinquency in four domains of deviant behaviour, including violence and vandalism, no such association was found for homeless youth. In the latter group, important predictor variables explaining delinquent behaviour, besides being male, were: a restrictive and affectionless parenting style, predominance of individuation over attachment and a passive coping style. It is concluded that delinquent behaviour in homeless youth appeared to be caused by a lack of stable social relationships, as well as a by a lack of moral internalisation, with affect and cognition not being integrated.

Determinants of health and service use patterns in homeless and low-income housed children.

Previous studies of homeless children have described more health problems and service use than in housed children, but failed to control for potential confounding factors that may differ between these children. This observational study examines the relationship of homelessness and other determinants to health status and service use patterns in 627 homeless and low-income housed children. Case-control study of 293 homeless and 334 low-income housed children aged 3 months to 17 years and their mothers conducted in Worcester, Massachusetts. Information was collected about mothers' housing history, income, education, emotional distress, and victimization history. Standardized instruments were administered to assess children's health. Health service use questions were adapted from national surveys. Main outcome measures included health status, acute illness morbidity, emergency department and outpatient medical visits. Multivariable regression analyses were used to examine the association of family and environmental determinants, including homelessness, with health status and service use outcomes. Mothers of homeless children were more likely to report their children as being in fair or poor health compared with their housed counterparts. Homeless children were reported to experience a higher number of acute illness symptoms, including fever, ear infection, diarrhea, and asthma. Emergency department and outpatient medical visits were higher among the homeless group. After controlling for potential explanatory factors, homeless children remained more likely to experience fair or poor health status (adjusted odds ratio [OR] = 2.83; 95% confidence interval [CI], 1.16, 4.87), and a higher frequency of outpatient (OR = 1.71; 95% CI, 1.18, 2.48) and emergency department visits (OR = 1.21; 95% CI, 0.83, 1.74). Mothers' emotional distress was independently associated with acute illness symptoms and frequent use of outpatient and emergency department settings. Homelessness is an independent predictor of poor health status and high service use among children. The present findings highlight the importance of preventive interventions and efforts to increase access to primary care among homeless children.

The health of homeless people in Britain. A review

Housing has long been identified as a prerequisite for good health. In Britain not all members of the population have access to housing. The homeless population may be divided into those who are officially accepted as homeless and the unofficial homeless population. The official homeless population is dominated by families with children whilst the unofficial homeless population includes a range of circumstances from those living in squats to those literally living on the streets. In Britain the number of official homeless tripled between 1978 and 1992 and is currently 143,500 households (approximately 330,500 people). It is estimated that there are a further 6, 000 people living on the streets and 50,000 in hostels giving a total estimated homeless population of 386, 050. Demographic data indicate that there are important differences in the composition of the official and unofficial homeless populations. The official homeless group consists almost exclusively of young families, usually headed by a lone female. The unofficial homeless group is predominantly male and older. The official homeless population report higher prevalences of chronic health problems and general psychiatric problems than the general population whilst the unofficial group are characterized by elevated rates of psychiatric disturbance and alcohol consumption. These data indicate that homeless people are not a homogeneous social group but present a variety of different health needs which require the provision of appropriate services.

Use of psychiatric services by homeless veterans.

Patients treated in a Department of Veterans Affairs (VA) emergency room were evaluated to delineate the differences in use of services between homeless and domiciled veterans who have mental disorders. Data were obtained and compared on DSM-III-R diagnoses, number of hospitalizations, lengths of stay, and outpatient visits in the preceding year. Homeless veterans with mental disorders were significantly more likely to have emergency visits and psychiatric admissions in the preceding 12 months than were the domiciled veterans. However, the average length of stay was shorter for the homeless group. These differences must be accounted for in the design of programs targeting homeless veterans with mental illness.

The mental health of single homeless people in Northampton hostels

Much research evidence about homelessness and health relates to large population centres with correspondingly large homeless populations. Such results may not necessarily apply to small towns such as Northampton. A local need was identified for information relating to health and access to health care for homeless people.Seventy five single, homeless people temporarily residing at open access hostels in Northampton were interviewed.The interviews covered:uȂrecent accommodation historiesȂrecent physical healthȂmental healthȂaccess to health careȂcurrent social contacts, life style and aspirationsThe General Health Questionnaire (GHQ30) was administered to allow assessment of the levels of mental morbidity in the population studied.The results presented here relate to mental health issues. Current mental health problems were reported by 53% of thesample (40 people); of these only 40% (16 people) were receiving treatment. Three people had been admitted to a psychiatric hospital within the past year. Using standard scoring, the GHQ30 identified as cases 72% (44) of the 61 homeless people who completed the GHQ.It was concluded that levels of mental morbidity were higher in the homeless group than would be expected in the general population. This finding, mirrors those of studies in larger population centres.The main form of access to mental health services appeared to be via hospital admission. Any GP treatment offeredwas likely to be medication. There was no mention of Community Psychiatric Nurse involvement in treatment or care.The results may indicate a significant level of umnet need for mental health intervention amongst the local homeless population.

Interpersonal relationships and adjustment of children in homeless and economically distressed families

Assessing the protective elements of social relationships for sixty 7- to 12-year-old children and their mothers residing in homeless shelters and 61 children and their mothers in low-income housing allowed us to test an ecological model of the impact of social relationships, income, stress, and maternal mental health on child adjustment for children in these two types of distressed families. Social relationships included the quality of the child's relationships with parents, teachers, other relatives, and friends. The model showed that for the homeless group, a lack of social support and maternal depression were significantly associated with adjustment difficulties in the child, whereas for the housed low-income group, environmental stress was associated with behavioral adjustment problems in the child. Perceptions of self-worth were associated with the presense of supportive relationships for children in both groups.

The health of the temporary homeless population

Housing has long been identified as a prerequisite for good health. In Britain not all members of the population have access to housing. The homeless population may be divided into those who are ‘officially' accepted as homeless under the 1977 Housing Act and the ‘unofficial' homeless population. In Britain the number of official homeless tripled between 1978 and 1992 and is currently 143,500 households (approximately 330,500 people). Approximately one third (35%) of all those accepted as officially homeless spend some time in ‘temporary' accommodation such as ‘bed and breakfast' hotels, often located away from their home area. Using data from a large scale health survey of families living in bed and breakfast hotels it is demonstrated that the ‘official' homeless group consists almost exclusively of young families, usually headed by a lone female. This population demonstrates high rates of physical and mental morbidity when compared with the general population. The children of such families appear to exp...

Different HIV Risk Profiles in Samples of College Students and Homeless Persons

A cross-sectional survey examined demographic characteristics, self-reported sexual behaviors, and knowledge of AIDS in samples of 106 homeless persons and 260 college students. As expected, the two samples differed with respect to age, gender, race, and education. Respondents in both samples possessed moderate knowledge of HIV infection and AIDS and reported they considered their personal risk of HIV infection low. Both samples acknowledged frequent use of alcohol with sexual activity, active and passive oral sex, and lax use of condoms. A discriminant analysis indicated that a greater percentage of college students were sexually active than of the homeless sample and that the homeless group had a higher proportion of individuals who were either homosexual or bisexual, who had sexual contact with multiple partners or who had visited a prostitute, who had sexually transmitted diseases, and who had injected drugs. Although the risk profiles differed, each group reported high-risk behaviors and perceptions of low personal risk of HIV infection.

Problems associated with homelessness and young pregnant teenagers

Study Objective: Homelessness is a major complication to adolescent pregnancy. We hypothesized that homelessness was associated with an increased incidence of other psychosocial and health risk factors for young pregnant teens.Design, Setting, Participants: We conducted a nationwide study of homeless young pregnant teens living in group residential facilities and of a control population of young pregnant teens living at home with their families. Clinical social workers involved in services for these patients were located by consulting a national directory of maternity homes and through contact with hospital-based social service departments randomly selected through long-distance telephone information. After a telephone conversation detailing the nature of the project, questionnaires were mailed to each social worker. They were to complete a questionnaire for each of the two youngest pregnant teens cared for at their facility in the previous 12 months. The data from the returned questionnaires were evaluated by chi-square analysis and Fisher's exact test.Main Outcome Measures: We distributed 736 questionnaires and collected data on 509 subjects (278 homeless, 231 controls) from 191 cities throughout the United States. The return rates were 69.1% from each group. There were no significant differences between the two groups in median age (14 years), race (50 and 42% white, 32 and 39% black, 10 and 14% Hispanic), school grade level (8th), or dropout rates (19 and 18%).Results: Findings included a greater likelihood for those in the homeless group to be under the guardianship of a social service agency (29 vs. 3%, p < .001), to be known to family court (54 vs. 13%, p < .001), to have been declared by the courts to be “a person in need of supervision” (43 vs. 7%, p < 0.001), and to have been convicted of a criminal offense (12 vs. 0%, p < .001). Homeless young pregnant teens were likely to have been victims of physical abuse (47 vs. 9%, p < .001), victims of sexual abuse (46 vs. 16%, p < .001), to have abused illicit drugs or alcohol (24 vs. 7%, p < .001), to have sold illicit drugs (3 vs. 0%, p < 0.01), to have exchanged sex for drugs (6 vs. 0%, p < .001), and to have exchanged sex for food and shelter (9 vs. 0%, p < .001).Conclusions: Homelessness should alert prenatal care providers to the expected coexistence of numerous additional psychosocial and health risk factors in young pregnant teens.