Sample Of Homeless Research Articles

Revolving Doors: Imprisonment Among the Homeless and Marginally Housed Population

We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. Almost one fourth of participants (23.1%) had a history of imprisonment. Models that examined lifetime substance use showed cocaine use (odds ratio [OR]=1.67; 95% confidence interval [CI]=1.04, 2.70), heroin use (OR=1.51; 95% CI=1.07, 2.12), mental illness (OR=1.41; 95% CI=1.01, 1.96), HIV infection (OR=1.69; 95% CI=1.07, 2.64), and having had more than 100 sexual partners were associated with a history of imprisonment. Models that examined recent substance use showed past-year heroin use (OR = 1.65; 95% CI = 1.14, 2.38) and methamphetamine use (OR=1.49; 95% CI=1.00, 2.21) were associated with lifetime imprisonment. Currently selling drugs also was associated with lifetime imprisonment. Despite high levels of health risks among all homeless and marginally housed people, the levels among homeless former prisoners were even higher. Efforts to eradicate homelessness also must include the unmet needs of inmates who are released from prison.

Cash Benefits are Associated with Lower Risk Behavior Among the Homeless and Marginally Housed in San Franciscos

To address the widespread debate about the role of public assistance to the urban poor, the authors determined characteristics of individuals receiving cash assistance and explored the link between cash subsidies and risk behavior. From 1999 to 2000, a representative sample of homeless and marginally housed (HMH) adults living in San Francisco was recruited and interviewed about subsidies, shelter, jail, and drug use. Among 1,156 adults, 87% were ever homeless, 22% currently injected drugs, and 14% were HIV positive. Sixty percent of participants reported that most of their income came from subsidies [mostly subsidized (MS)]. The MS had lower odds of receiving any income from selling drugs or trading sex. Adjusting for HIV infection, the MS had higher odds of sleeping in a hotel [odds ratio (OR) = 2.39] or shelter (OR = 1.61) compared to the street. The MS had lower odds of injection drug use (OR = 0.69) and recent incarceration (OR = O.77). Among San Francisco's homeless, being MS was positively associated with having shelter and negatively associated with injection drug use and incarceration. These data suggest that government subsidies are associated with positive health behaviors among the urban poor.

ARRESTS AMONG HOMELESS AND RUNAWAY YOUTHS: THE EFFECTS OF RACE AND GENDER

ABSTRACT This study examined the contributions of race and gender to the likelihood of a first post-run arrest for a more serious and less serious offense in a sample of homeless and runaway youths from four Midwestern states. Event history analysis was used to test the hypothesis that race and gender would interact so that the likelihood of a first post-run arrest for a more serious and less serious offense would be highest for non-white males and non-white females, respectively. Potentially confounding factors—deviant subsistence strategies, substance use, gang involvement and membership, prior arrests, age, prior physical abuse, age on own, and spending time on the street—were controlled in the analyses. The hypotheses regarding the interaction of race and gender were not supported by the data. Non-whites were more likely than whites, and males were more likely than females, to be arrested for a more serious offense, and white females were more likely than non-white females to be arrested for a less serious offense.

Psychiatric morbidity in homeless single men

The aim of this cross sectional study was to establish the extent of psychiatric morbidity among homeless men and compare this group with a sample of formerly homeless. [corrected] 82 homeless and a comparison group of 37 formerly homeless were interviewed using a psychopathological interview according to AMDP (Arbeitsgemeinschaft für medizinische Dokumentation) as well as selected modules of the CIDI (Composite International Diagnostic Interview). Diagnoses were established according to ICD-10. The lifetime prevalence of psychiatric disorders was 95.1 %, the current prevalence was 87.8 %. Substance related disorders were the most common group of disorders. In the formerly homeless prevalences were slightly lower. Psychiatric morbidity among the homeless is high. Services have to be tailored to meet the needs of this special group. Formerly homeless continue to need intensive psychiatric input.

Depression and drug use impact health status among marginally housed HIV-infected individuals.

A representative sample of HIV-positive homeless and marginally housed individuals completed SF-36 health surveys and responses were analyzed for associations with sociodemographic, health, health care, and drug use variables. Among 330 respondents, 83% were male, 43% were African American, and the median age was 39 years. Negative associations were found between female gender and vitality as well as physical functioning; older age and physical functioning; drug use or drug treatment and role-emotional, social functioning, body pain, as well as vitality; health care utilization and depression with all scales. It appeared that depression and drug-related variables were associated with multiple dimensions of health status in this population. Interventions to treat depression and addiction may improve the health status of HIV-infected HMH.

Risk factors for hepatitis C virus infection among homeless adults.

To describe the prevalence of hepatitis C virus (HCV) infection in a sample of homeless and impoverished adults and examine risk factors for HCV infection in the overall sample and as a function of injection drug use. Assays were conducted on stored sera. Sociodemographic characteristics and risky sexual activity were measured by content-specific items. Substance use was measured by a structured questionnaire. HCV antibodies were tested by enzyme-linked immunosorbent assay; a confirmatory level was defined by recombinant immunoblot assay. Shelters ( N = 36) and outdoor locations in Los Angeles. Eight hundred eighty-four homeless women and/or partners or friends. Among this sample of 884 homeless and impoverished adults, 22% were found to be HCV infected. Lifetime injection drug users (IDUs) (cocaine, crack, and methamphetamine) and recent daily users of crack were more likely than nonusers or less-frequent users of these drugs to be HCV-infected. Similar results were found for those who had been hospitalized for a mental health problem. Among non-injection drug users and persons in the total sample, those who reported lifetime alcohol abuse were more likely than those who did not to be HCV infected. Controlling for sociodemographic characteristics, multiple logistic regression analyses revealed IDUs have over 25 times greater odds of having HCV infection than non-IDUs. HCV infection was also predicted by older age, having started living on one's own before the age of 18, and recent chronic alcohol use. Males and recent crack users had about one and a half times greater odds of HCV infection when compared to females and non-chronic crack users. Targeted outreach for homeless women and their partners, including HCV testing coupled with referrals to HCV and substance abuse treatments, may be helpful.

Mental Disorders and Service Utilization Among Youths From Homeless and Low-Income Housed Families

To assess the mental health of homeless and poor housed youths, using the National Institute of Mental Health (NIMH) Diagnostic Interview Schedule for Children (DISC) Version 2.3, and to examine mental health service use. As part of a comprehensive study of homeless and housed families Worcester, MA, data were collected on 41 homeless and 53 poor housed (never homeless) youths aged 9 to 17 using both the parent and youth versions of the DISC. On the basis of the parent version of the DISC, current (6-month) prevalence rates of DSM-III-R disruptive behavior, affective, and anxiety disorders were comparable in homeless and housed youths but higher than rates found among youths in the NIMH-sponsored Methods for the Epidemiology of Child and Adolescent Mental Disorders (MECA) Study, which used the same diagnostic measure. Approximately 32% of the combined sample of homeless and housed youths had a current mental disorder accompanied by impairment in functioning. Mental health service use in the preceding 6 months among youths who had one or more current disorders and associated impairment ranged from 20% to 35%. A subgroup of youths with one or more current disorders and poor global functioning had never received treatment. This sample of homeless and housed youths was found to have high rates of current mental disorders. Use of mental health services by children with mental health needs was low, particularly for youths with poor overall functioning.

Reliability, Validity, and Composition of a Subset of the Centers for Disease Control and Prevention Acquired Immunodeficiency Syndrome Knowledge Questionnaire in a Sample of Homeless and Impoverished Adults

Measures of acquired immunodeficiency syndrome (AIDS)-related knowledge that have good psychometric properties are needed to evaluate the impact of educational interventions, particularly among impoverished populations. Few measures that satisfy these requirements are available. The authors describe the psychometric characteristics and composition of a subset of 21 AIDS knowledge items from the questionnaire used by the National Center for Health Statistics. The study was conducted with a convenience sample of women and their significant others or close friends in nine homeless shelters and 11 residential drug recovery programs in the skid row area of Los Angeles from 1991 to 1993. Trained nurses and outreach workers collected data from 486 predominately African-American adults before delivery of well-established, culturally sensitive AIDS educational intervention. A subset of 334 participants were re-interviewed 6 months later. A total scale score was calculated from a one-factor solution, and two subscale scores were formed based on a two-factor solution. One subscale was composed of primarily cognitive items, whereas the second subscale contained mainly transmission-related items. The internal consistency reliability of the overall scale was 0.89; the two subscales had alphas of 0.80 and 0.92. The measures have face validity, and support for convergent validity was found. Further, even though AIDS knowledge in the sample was relatively high, all three measures showed marked improvement in the subsample of respondents who were re-interviewed after receiving AIDS-related educational information. These measures show promise for assessing AIDS knowledge and the efficacy of AIDS education programs in vulnerable populations. The findings reported here, however, are preliminary. Test-retest reliability needs to be examined, and additional studies are needed with samples that are more culturally diverse and include socially isolated individuals.

Association between time homeless and perceived health status among the homeless in San Francisco.

The purpose of this study was to describe the perceived health of the homeless, and to measure the effect of time homeless on perceived health status, after controlling for sociodemographic characteristics and health conditions. The design was cross-sectional; the population was a representative sample of homeless in San Francisco, interviewed on health issues. Analysis of predictors of poor or fair health status was by logistic regression. In this sample of 2780 persons, 37.4% reported that their health status was poor or fair as compared to good or excellent. Reporting poor or fair health status was significantly associated with time homeless, after controlling for sociodemographic variables and health problems including results from screening for HIV and TB (OR = 1.49, 95% CI 1.24-1.79). Comparisons with data from the National Health Interview Survey (NHIS) showed poorer health status among the homeless persons in this study. Standardized morbidity ratios were highest for asthma; there was twice the number of homeless persons reporting asthma, in younger as well as older adults, as would be expected using NHIS rates. There was also an excess of arthritis, high blood pressure and diabetes in those age 18-44 as compared to adults in the Health Interview Survey. The time spent homeless remains associated with self-reported health status, after known contributors to poor health are controlled. Persons who have been homeless for longer periods of time may be the persons to whom health care interventions should be aimed.

An ecological approach to health risk: a case study of urban elderly homeless people.

The purposes of this paper are: to describe an ecological approach to assessing health risk, and to apply the approach to a sample of elderly homeless within the context of a single day in a single urban setting. In the approach described, a method of progressive contextualization was used by adding different hazards to the risk profile in a single geographic area. The various hazards were applied to the same time and space frame, that of a 24-hour period and in the urban space used by elderly homeless people. Incorporated into the approach are the concepts of high-risk areas and space-time geography, and the theory of disease ecology. The spatial-temporal distribution of resources, factors in the natural environment (patterns of daylight and dark and ambient temperature) and factors in the human-created environment (traffic and crime patterns) were identified as important hazards within the urban environment. Homelessness itself, the effects of aging, the social milieu, and behavior patterns commonly seen in homeless people--particularly, alcohol abuse--were identified as important hazards for elderly homeless people. Each hazard's spatial-temporal pattern within the 24-hour period is discussed. Then the convergence of hazards forming an interactive effect is discussed. Finally, approaches to nursing interventions aimed at reducing risk are presented.

Disaffiliation revisited: A comparison of homeless and nonhomeless women's perceptions of family of origin and social supports

This study investigated the ability of a developmental model of disaffiliation that included family of origin variables and social support variables to discriminate between a sample of homeless (N=76) and nonhomeless women (N=74). Eighty-nine percent of the homeless sample was Black and 10% was White; the nonhomeless sample was 91% Black and 9% White. Both groups were from low SES populations. A descriptive analysis of the demographic data indicated that the homeless and nonhomeless women were more alike than different. The family of origin data and social support data were analyzed through a series of discriminant analyses. The results of the analyses revealed that the multidimensional model significantly discriminated between the homeless and nonhomeless women in the study.

A sample of homeless and runaway youth in New Jersey and their health status.

In this study of homeless and runaway young people served by youth shelters in New Jersey mental health problems were predominant. They include anxiety, depression, suicide attempts, drug and alcohol abuse. The sample exhibited high levels of general behavioral problems and school and/or peer problems. One quarter of the sample had had trouble with the law. About two thirds of the sample were homeless rather than runaway. For a similar proportion of the sample this was a repeat experience and/or had lasted a week or more. Only one third were able to be reunited with their families after being served. The prognosis for these youth is poor without specific programs to protect them and their physical and mental health.

Racial Differences Regarding Shelter and Housing in a Sample of Urban Elderly Homeless

A sample of elderly homeless persons in Detroit is discussed with an emphasis on distinctions between black and white racial strata. The analyses, based on a field survey conducted in 1988, reveal that several variables distinguish racial groups, including social relationships and kinship, frequency and duration of homelessness, and previous insitutional experiences. Economic differences were not found between black and white elderly homeless men who are the subjects of many urban sociological studies of skid row, while the black elderly homeless are presented as a newly emerged subset of homelessness.