Literal Homelessness Research Articles

Sleep-related impairment among people who use opioids: The critical role of structural vulnerability

ObjectivePeople who use opioids are vulnerable to sleep disturbances due to a range of factors, including the substances they use and the various structural vulnerabilities they face. We aimed to understand the burden of sleep-related impairment and problems pertaining to sleep context and schedule among people who use opioids. MethodsWe explored sleep quality and problems among a suburban sample of people who use opioids experiencing extensive structural vulnerabilities (N = 170). Participants reported their most urgent concern in the past week (e.g., sleep, drug use, housing), their sleep context, sleep problems, sleep schedules, and scores on the PROMIS Sleep-Related Impairment measure. We then quantified associations between Sleep-Related Impairment scores and sociodemographics and substance use. ResultsParticipants were primarily men (66%) and non-Hispanic Black (67%) with a mean age of 42 (SD: 12.1). Many experienced hunger (44%) and literal homelessness (40%). One-quarter (28%) reported that sleep was their most urgent concern in the past week. The most common problems when falling or staying asleep were mental health-related symptoms (81%) and pain/discomfort (32%). Literal homelessness (β = 2.2, 95% CI: 0.6, 3.7), hunger (β = 2.3, 95% CI: 1.0, 3.6), and frequent alcohol use (β = 1.5, 95% CI: 0.2, 2.7) were significantly associated with Sleep-Related Impairment scores. ConclusionsHomelessness and hunger are associated with sleep-related impairment in people who use opioids. Poor sleep quality, substance use, structural vulnerability, and mental health problems are all interrelated sources of functional impairment in this population. Interventions that address poverty as an underlying cause of sleep-related impairment and provide safe sleeping environments are needed.

Quantifying Doubled-Up Homelessness: Presenting a New Measure Using U.S. Census Microdata

Some definitions of homelessness include doubling up—living with others because of economic hardship or housing loss. Doubling up can have negative consequences that should be addressed, but the U.S. Department of Housing and Urban Development’s methods for enumerating homelessness exclude these arrangements, and Department of Education counts of doubling up include only school children. We provide a new method for measuring doubled-up homelessness in the total population using American Community Survey public use microdata. Using this method, we find that 3.7 million people in the U.S. population were doubled up in 2019 and show significant differences in doubling up by geography, race and ethnicity, marital status, educational attainment, school enrollment, and employment status, and compare these findings with research on sheltered and unsheltered homelessness. Notably, rates of Hispanic/Latinx doubled-up homelessness were high, in contrast to their rates of literal homelessness, and some rural areas with low rates of sheltered and unsheltered homelessness had high rates of doubling up. To aid in future research and policy, supplemental materials provide open-source tools for replicating the measure. Findings suggest that policies addressing homelessness and housing insecurity consider those experiencing doubled-up homelessness and that the current measure can assist in those efforts.

Archival Readiness

This article explores the challenges of engaging historically excluded communities with archives and archival discourse, focusing on people and communities experiencing homelessness. Positioning the phrase literal homelessness, which is used in the United States to determine eligibility for an annual census of people experiencing homelessness, as representative of ongoing exclusive and non-collaborative forms of recordkeeping, the author proposes a concept that she calls archival readiness to move toward archive making, rather than archive taking, with historically excluded communities. Using her experiences as a part-time staff member in a temporary emergency shelter that was established during the COVID-19 pandemic, she shows how archival readiness, based on ongoing relationships among archivists, researchers, community organizations, and individuals, would increase the likelihood that shelter guests would participate in archiving. Exploring how homelessness creates challenges for the development of inclusive institutional and community-archiving praxes, she argues that while archival readiness would not solve each of these challenges, it could enable historically excluded communities to participate in generating other approaches. The author enacts archival readiness by sharing three records from the shelter and her interpretations of them, introducing forms of information about shelter living that is not collected in official data that tracks “literal homelessness.”

A prospective longitudinal study of child custody status among homeless population mothers

ABSTRACT Most women in homeless populations are mothers, the majority being single mothers. Retaining child custody is challenging in homeless circumstances. Prospective longitudinal studies are needed to follow the moving pieces of housing and child custody in the context of carefully-assessed psychiatric and substance use disorders over time. A 2-year prospective longitudinal study of an epidemiologic sample of individuals with literal homelessness included 59 mothers. Annual assessments included structured diagnostic interviews, detailed assessment of homeless circumstances, urine drug testing, and service use documented by both self report and data from agencies serving these individuals. More than one-third of the mothers consistently lacked child custody throughout the course of the study and the proportions of mothers with child custody did not increase significantly. Nearly one-half of the mothers had a current year drug use disorder at baseline, mostly including cocaine disorder. Continuing lack of child custody over time was associated with longitudinal lack of housing and use of drugs. The importance of drug use disorders in the longitudinal course of child custody points to a critical need for formal substance abuse treatment, not just initiatives to decrease drug use, in helping mothers regain and maintain custody of their children.

Listening from the in-between

With homelessness being prevalent across the United Kingdom and showing no sign of decreasing, it is imperative to better understand the experiences of individuals who fall into these diffi cult circumstances. A previously unexplored aspect of homelessness is engagement with sound. This article addresses this lacuna by investigating how the understanding of sonic space is related to individuals’ experiences of homelessness. The article considers homelessness through the analytical lens of ‘liminality’—a period when an individual or space has neither a former nor future identity, whilst simultaneously, paradoxically, possessing both (van Gennep, 1960). Taking a phenomenological approach, interviews were undertaken with residents of a halfway house in Leeds, UK, whose circumstances are between ‘literal homelessness’ and social housing. The study demonstrates the ways in which participants actively engage with sound and liminality in day-to-day life, regularly curating inhabited sonic environments which are often seen by members of ‘mainstream’ society as ‘non-places’. A distinction is made between quietness and silence: whereas quietness offered the participants an escape, the prospect of silence—being left alone with one’s thoughts—was often worrisome. Further differentiation is made between actively ‘listening to’ and ‘hearing’ (Oliveros, 2005) these individual sonic spaces—the participants’ focus is positioned between external sonic stimuli and their own internal thoughts, highlighting a betweenness of consciousness. Overall, the article fi nds that interactions with sound are key components of the liminal experience of homelessness.

Does the Timing of Incarceration Impact the Timing and Duration of Homelessness? Evidence from “The Transitions to Housing” Study

Compared to their non-homeless peers, chronically homeless adults are much more likely to have a history of incarceration. In turn, homelessness is associated with increased morbidity, lack of access to adequate healthcare services, and decreased life expectancy. This study investigates whether age at first incarceration is associated with age at first homeless experience and with lifetime duration of literal homelessness. Study participants are homeless adults entering permanent supportive housing (PSH) in Los Angeles County, California, that have experienced incarceration prior to their first experience of homelessness (n = 230). Multivariate linear regressions were conducted to determine association between age at first incarceration with: 1) age at first literal homelessness and 2) lifetime duration of literal homelessness. Results indicate that incarceration as a juvenile, and young adult is significantly associated with earlier literal homelessness experiences and may be associated with longer durations of literal homelessness, for adults entering PSH. Moreover, women incarcerated as juveniles and entering PSH first experienced literal homelessness earlier than comparable men. Our findings suggest the need for long-term supportive services for persons incarcerated before 25 years old, especially for women. Moreover, these findings refine the working knowledge that prior incarceration increases risk for prolonged homelessness and can help agencies complete more accurate risk assessments.

Childhood homelessness, resilience, and adolescent mental health: A prospective, person-centered approach.

School districts and other service providers are increasingly aware of the substantial mental health needs of students experiencing family homelessness. Past findings are mixed regarding whether homelessness conveys unique risk beyond the risks associated with extreme poverty. With prospective longitudinal data on homelessness experiences across childhood, we utilized latent profile analysis as a person-centered approach to conceptualizing mental health outcomes in adolescence for 3,778 youth. We considered literal family homelessness as well as families living doubled-up, and we employed propensity score matching to identify a comparison group of non-homeless students balanced across a range of covariates to address systematic bias. Results indicated that students who experienced literal homelessness during childhood were significantly less likely to demonstrate profiles of resilience in mental health functioning. We considered our approach and findings in light of challenges and opportunities particularly relevant to the school context.

Assessing the impact of Connect 2 Care on the residential stability of homeless and vulnerably housed clients

Background
 Certain kinds of housing instability, such as foreclosure and homelessness, have been associated with poorer physical and mental health. The Connect 2 Care (C2C) program targets medically complex individuals who are unstably housed, primarily aimed at reducing acute care utilization and connecting clients to appropriate community-based care. However, because housing status is a fundamental determinant of health, the team also assists clients in finding permanent housing. As the C2C program aims to improve the health of its clients, we hope that this intervention positively impacts the housing stability of clients.
 Objective
 To determine whether the C2C program is effective in reducing factors of housing instability, such as the frequency of housing moves made, and time spent in unstable housing (such as shelters or sleeping outside).
 Methods
 C2C clients were asked to participate in 6- and 12- month follow-up surveys with a member of the research team. During both surveys, participants were prompted to describe their housing history using the Residential Time-Line Follow-Back (rTLFB) inventory. Starting at six months prior to their intake into C2C, participants created a twelve- to eighteen-month timeline that detailed their residential locations and number of housing transitions. Location descriptions provided by clients were categorized as stable, temporary, institutional, or literal homelessness. The number of housing transitions and the proportion of time spent in each housing category were then calculated for each individual. Changes in proportion of time spent over three unique time periods were evaluated using Wilcoxon’s paired rank test with Holm’s multiplicity correction.
 Results
 Since September 2018, housing data was collected from 100 unique clients. In comparing the six months preceding C2C intake with the six-to-twelve months after C2C intake, significant reductions in the amount of time spent in literal homelessness (p < 0.001) and reductions in the number of housing changes (p = 0.014) were observed.
 Discussion
 Housing stability for C2C clients improved after enrolment in the program. This study was potentially limited by incomplete sampling of the C2C population. Based on our findings, further research should be conducted in evaluating the relationship between increases in housing stability and increases of health status.
 Acknowledgements
 The C2C research team thanks Alberta Innovates and the Canadian Institute of Health Research for their financial support. The authors have no conflict of interests to state.

Sociodemographic and substance use characteristics associated with typologies and composition of social support networks among youth experiencing homelessness in Los Angeles, USA

Youth experiencing homelessness are a vulnerable population with increased behavioural health risks. Social networks are a consistent correlate of youths' substance use behaviours. However, less is known about the reciprocal relationships among these constructs. This study classified youth experiencing homelessness according to their social support network type (e.g. instrumental, emotional, service) and composition (e.g. family, peers, service staff) and linked their membership in these social network classes to sociodemographic and substance use characteristics. Four waves of cross-sectional data were collected between October 2011 and June 2013 from youth experiencing homelessness, ages 14-29, at three drop-in centres in Los Angeles, CA (N=1,046). This study employed latent class analysis to identify subgroups of youth experiencing homelessness according to the type and composition of their social support networks. Multinomial logistic regression analyses were then conducted to identify the sociodemographic and substance use characteristics associated with social support network class membership. Five latent classes of youths' social support networks were identified: (a) high staff emotional and service support; (b) high home-based peer and family emotional, service and instrumental support; (c) moderate street- and home-based peer emotional support; (d) low or no support and (e) high home-based peer and family emotional and instrumental support. Multinomial logistic regression models indicated that race/ethnicity, gender, sexual orientation, literal homelessness, former foster care experience, depression, heroin and marijuana use were significant correlates of social support network class membership. Results indicate distinct classes of social support networks among youth experiencing homelessness, with certain sociodemographic and substance use characteristics implicated in youths' social networks.

The Role of Mental Health and Substance Use in Homeless Adults’ Tobacco Use and Cessation Attempts

Objective: Although tobacco use is prevalent among adults experiencing homelessness, research deficits exist regarding the mental health, substance use, and demographic correlates of tobacco use behaviors in this population. This study examined whether correlates of tobacco use among housed adults identified by the Center for Disease Control (CDC) were significant correlates of tobacco use and cessation attempts among a sample of homeless adults. Methods: Participants (N = 421) were adults experiencing homelessness entering permanent supportive housing programs in Los Angeles. Multivariate logistic regression determined associations of lifetime mental health diagnoses, recent substance use, demographic characteristics, and lifetime literal homelessness with daily tobacco use and cessation attempts. Results: Lifetime diagnoses of schizophrenia, posttraumatic stress disorder, depression, bipolar disorder, and illicit substance use were associated with increased odds of daily tobacco use. A lifetime diagnosis of depression was associated with an increased likelihood of a past 3-month tobacco cessation attempt, while illicit substance use was associated with a lower likelihood of a cessation attempt. Conclusions: Findings suggest that demographic and clinical characteristics associated with tobacco use differ among this sample of homeless adults and those identified by the CDC among housed adults. Mental health conditions and substance use appear to be the primary correlates of tobacco use among adults experiencing homelessness and may be critical in efforts aimed at improving cessation.

More than just a seat at the table: the power of youth voice in ending youth homelessness in the United States

ABSTRACTEach year, over 600 youth under the age of 25 experience literal homelessness in Austin, Texas. Of these youth, 76% have a history of involvement with foster care or the juvenile justice system—far exceeding the rates of system involvement observed among homeless youth in other large communities in the United States (approximately 54%; Voices of Youth Count, 2017). Recently, Austin was selected by the U.S. Department of Housing & Urban Development as one of ten communities nationwide to participate in the Youth Homelessness Demonstration Program (YHDP), a federal initiative designed to effectively end youth homelessness by 2020. Youth with lived experience are central players in the development and implementation of Austin's response to the youth homelessness crisis. A group of twelve of these youth (the “Austin Youth Collective to End Youth Homelessness,” or AYC) serve as key decision-making partners within the Austin YHDP team. Representatives of the AYC are deeply involved at every level of the community planning process, from the development of youth-centric housing options to system redesign efforts to ensure that youth do not exit the foster care or juvenile justice systems to homelessness. The article provides an overview of the development and contributions of the AYC—including their programmatic recommendations and advocacy work—as well as key recommendations for communities looking to leverage youth voice at the systems level.

Substance use and homelessness among emergency department patients

BackgroundHomelessness and substance use often coexist, resulting in high morbidity. Emergency department (ED) patients have disproportionate rates of both homelessness and substance use, yet little research has examined the overlap of these issues in the ED setting. We aimed to characterize alcohol and drug use in a sample of homeless vs. non-homeless ED patients. MethodsA random sample of urban hospital ED patients were invited to complete an interview regarding housing, substance use, and other health and social factors. We compared substance use characteristics among patients who did vs. did not report current literal (streets/shelter) homelessness. Additional analyses were performed using a broader definition of homelessness in the past 12-months. ResultsPatients who were currently homeless (n = 316, 13.7%) versus non-homeless (n = 1,993, 86.3%) had higher rates of past year unhealthy alcohol use (44.4% vs. 30.5%, p < .0001), any drug use (40.8% vs. 18.8%, p < .0001), heroin use (16.7% vs. 3.8%, p < .0001), prescription opioid use (12.5% vs. 4.4%, p < .0001), and lifetime opioid overdose (15.8% vs. 3.7%, p < .0001). In multivariable analyses, current homelessness remained significantly associated with unhealthy alcohol use, AUDIT scores among unhealthy alcohol users, any drug use, heroin use, and opioid overdose; past 12-month homelessness was additionally associated with DAST-10 scores among drug users and prescription opioid use. ConclusionsPatients experiencing homelessness have higher rates and greater severity of alcohol and drug use than other ED patients across a range of measures. These findings have implications for planning services for patients with concurrent substance use and housing problems.

Psychological distress and homeless duration

We examine whether psychological distress levels vary with homeless and housed duration. We do this using longitudinal data from a national survey of persons facing housing insecurity that, unlike prior studies, is not restricted to those who are currently homeless (or to particular subsets of the homeless), but instead follows a nationally representative sample of Australians experiencing housing insecurity. This allows us to use methods that isolate the effects of changes in time spent homeless and time spent housed on psychological distress holding constant all unobserved person-specific effects that are time invariant. We find that the relationship between psychological distress and homelessness varies by gender and by type of homelessness. Males recently experiencing literal homelessness (i.e. sleeping rough or in crisis accommodation) exhibit the highest levels of distress, but consistent with the adaptation hypothesis, distress levels decline as homeless duration increases. This pattern is not seen when examining a broader notion of homelessness for males. Likewise, there is no clear pattern with regard to homeless duration for females.

Homelessness and aging out of foster care: A national comparison of child welfare-involved adolescents

The present study represents the first large-scale, prospective comparison to test whether aging out of foster care contributes to homelessness risk in emerging adulthood. A nationally representative sample of adolescents investigated by the child welfare system in 2008 to 2009 from the second cohort of the National Survey of Child and Adolescent Well-being Study (NSCAW II) reported experiences of housing problems at 18- and 36-month follow-ups. Latent class analyses identified subtypes of housing problems, including literal homelessness, housing instability, and stable housing. Regressions predicted subgroup membership based on aging out experiences, receipt of foster care services, and youth and county characteristics. Youth who reunified after out-of-home placement in adolescence exhibited the lowest probability of literal homelessness, while youth who aged out experienced similar rates of literal homelessness as youth investigated by child welfare but never placed out of home. No differences existed between groups on prevalence of unstable housing. Exposure to independent living services and extended foster care did not relate with homelessness prevention. Findings emphasize the developmental importance of families in promoting housing stability in the transition to adulthood, while questioning child welfare current focus on preparing foster youth to live.

Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review

Background. Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking “upstream” economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual’s control that affect housing and residential environments and the health resources or risk exposures such contexts provide. Objectives. We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. Search methods. We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. Selection criteria. We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. Data collection and analysis. Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. Results. Searches yielded 5528 references from which we included 152 studies, representing 139 757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. Conclusions. Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.

A journey home: What drives how long people are homeless?

This paper uses survival analysis to model exits from two alternative forms of homelessness: sleeping on the streets (‘literal homelessness’) and not having a home of one's own (‘housing insecurity’). We are unique in being able to account for time-invariant, unobserved heterogeneity. Like previous researchers, we find results consistent with negative duration dependence in models which ignore unobserved heterogeneity. However, controlling for unobserved heterogeneity, we find that duration dependence has an inverted U-shape with exit rates initially increasing (indicating positive duration dependence) and then falling. Exit rates out of both literal homelessness and housing insecurity fall with age. Women are more likely than men to exit housing insecurity for a home of their own, but are less likely to exit literal homelessness. Persons with dependent children have higher exit rates. Finally, education seems to protect people from longer periods of housing insecurity.

Housing Status, Medical Care, and Health Outcomes Among People Living With HIV/AIDS: A Systematic Review.

Accumulating evidence suggests responses to HIV that combine individual-level interventions with those that address structural or contextual factors that influence risks and health outcomes of infection. Housing is such a factor. Housing occupies a strategic position as an intermediate structural factor, linking "upstream" economic, social, and cultural determinants to the more immediate physical and social environments in which everyday life is lived. The importance of housing status for HIV prevention and care has been recognized, but much of this attention has focused on homeless individuals as a special risk group. Analyses have less often addressed community housing availability and conditions as factors influencing population health or unstable, inadequate, or unaffordable housing as a situation or temporary state. A focus on individual-level characteristics associated with literal homelessness glosses over social, economic, and policy drivers operating largely outside any specific individual's control that affect housing and residential environments and the health resources or risk exposures such contexts provide. We examined the available empirical evidence on the association between housing status (broadly defined), medical care, and health outcomes among people with HIV and analyzed results to inform future research, program development, and policy implementation. We searched 8 electronic health and social science databases from January 1, 1996, through March 31, 2014, using search terms related to housing, dwelling, and living arrangements and HIV and AIDS. We contacted experts for additional literature. We selected articles if they were quantitative analyses published in English, French, or Spanish that included at least 1 measure of housing status as an independent variable and at least 1 health status, health care, treatment adherence, or risk behavior outcome among people with HIV in high-income countries. We defined housing status to include consideration of material or social dimensions of housing adequacy, stability, and security of tenure. Two independent reviewers performed data extraction and quality appraisal. We used the Cochrane Risk of Bias Tool for randomized controlled trials and a modified version of the Newcastle Ottawa Quality Appraisal Tool for nonintervention studies. In our quality appraisal, we focused on issues of quality for observational studies: appropriate methods for determining exposure and measuring outcomes and methods to control confounding. Searches yielded 5528 references from which we included 152 studies, representing 139,757 HIV-positive participants. Most studies were conducted in the United States and Canada. Studies examined access and utilization of HIV medical care, adherence to antiretroviral medications, HIV clinical outcomes, other health outcomes, emergency department and inpatient utilization, and sex and drug risk behaviors. With rare exceptions, across studies in all domains, worse housing status was independently associated with worse outcomes, controlling for a range of individual patient and care system characteristics. Lack of stable, secure, adequate housing is a significant barrier to consistent and appropriate HIV medical care, access and adherence to antiretroviral medications, sustained viral suppression, and risk of forward transmission. Studies that examined the history of homelessness or problematic housing years before outcome assessment were least likely to find negative outcomes, homelessness being a potentially modifiable contextual factor. Randomized controlled trials and observational studies indicate an independent effect of housing assistance on improved outcomes for formerly homeless or inadequately housed people with HIV. Housing challenges result from complex interactions between individual vulnerabilities and broader economic, political, and legal structural determinants of health. The broad structural processes sustaining social exclusion and inequality seem beyond the immediate reach of HIV interventions, but changing housing and residential environments is both possible and promising.

Homelessness in Canada and New Zealand: A Comparative Perspective on Numbers and Policy Responses

This article provides a comparative perspective on homelessness in Canada and New Zealand, with a focus on three urban regions. It seeks to document homeless numbers in the chosen cities, to evaluate the utility of counting the homeless, and to identify common and divergent approaches in homelessness policy. Research involved document analysis, key informant interviews, and participant observation. Literal homelessness is found to be several orders of magnitude higher in the Canadian cities. In one of the Canadian centers, suburban homelessness is emerging as a significant phenomenon. Efforts to count the homeless allow such trends to be tentatively quantified, and inform policymaking. Policy differences between the countries are stark: Canadian cities are seeking to respond to an emergency, which may call for a radical change of approach in the form of "housing first." In New Zealand, a national program of social housing, combined with cultural factors, reduces pressure to act.

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Associations of Housing Status With Substance Abuse Treatment and Service Use Outcomes Among Veterans

Homelessness in Europe and the United States: A Comparison of Prevalence and Public Opinion

Random samples of 250–435 adults were interviewed by telephone in five different nations (N= 1,546): Belgium, Germany, Italy, the UK, and the United States. The interview included questions on respondent attitudes, knowledge, and opinions regarding homelessness; respondents' own personal experiences with homelessness and homeless people; and demographic characteristics of the respondents. The highest rates for lifetime literal homelessness were found in the UK (7.7%) and United States (6.2%), with the lowest rate in Germany (2.4%), and intermediate rates in Italy (4.0%) and Belgium (3.4%). Less compassionate attitudes toward the homeless were also found on many dimensions in the United States and the UK. Possible explanations of these findings, drawn from various theoretical perspectives, and policy implications are provided.