International Journal of Public Health

, Volume 64, Issue 3, pp 399–409 | Cite as

Residential moves and its association with substance use, healthcare needs, and acute care use among homeless and vulnerably housed persons in Canada

  • Miriam Harris
  • Anne Gadermann
  • Monica Norena
  • Matthew To
  • Anita M. Hubley
  • Tim Aubry
  • Stephen Hwang
  • Anita PalepuEmail author
Original Article



To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization.


A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-administered surveys at baseline and annually for 4 years from 2009 to 2013. Generalized mixed effects logistic regression models were used to examine the association between the number of residential moves and each of the three outcome variables, adjusting for potential confounders.


The number of residential moves was significantly associated with higher acute care utilization [adjusted odds ratio (AOR) 1.25; 95% confidence interval (CI) CI: 1.17–1.33], unmet healthcare needs (AOR 1.14; 95% CI: 1.07–1.22), and problematic substance use (AOR 1.26; 95% CI: 1.16–1.36). Having chronic physical or mental conditions and recent incarceration were also found to be associated with the outcomes.


Housing instability increased the odds of all three poor health metrics, highlighting the importance of stable housing as a critical social determinant of health.


Health Homelessness Housing Housing instability Residential moves Substance use Unmet healthcare needs Acute care utilization Hospitalization Emergency department 



We would like to acknowledge the following individuals from our community partner organizations: Street Health—Laura Cowan, Erika Khandor, Stephanie Gee; PHS Community Services Society—Liz Evans, Clare Hacksel; Ottawa Inner City Health—Wendy Muckle. The authors also thank the study coordinators and interviewers in each of the three cities as well as the shelter, drop-in, and municipal and provincial staff for their assistance with participant recruitment and follow-up. We also thank Dr. Hubert Wong for his guidance on the statistical analyses. We are especially grateful to the Health and Housing in Transition study participants for their contribution to these data.


This study was funded by the Canadian Institutes of Health Research Operating Grant Award Number: MOP-86765. This project was supported by an operating Grant (MOP-86765) and an Interdisciplinary Capacity Enhancement Grant on Homelessness, Housing and Health (HOA-80066) from the Canadian Institutes of Health Research. The Canadian Institute for Health Research had no role in the study design, in the collection, analysis or interpretation of data, in the writing of the report, or in the decision to submit the article for publication.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethics approval and consent to participate

All study participants provided informed written consent and were reimbursed $20 CDN for each interview. The Research Ethics Board at St. Michael’s Hospital, the University of Ottawa, and the University of British Columbia approved this study. All procedures performed involving human participants in this study were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Swiss School of Public Health (SSPH+) 2018

Authors and Affiliations

  • Miriam Harris
    • 1
  • Anne Gadermann
    • 2
    • 3
  • Monica Norena
    • 2
  • Matthew To
    • 4
  • Anita M. Hubley
    • 5
  • Tim Aubry
    • 6
  • Stephen Hwang
    • 4
    • 7
  • Anita Palepu
    • 2
    • 8
    Email author
  1. 1.Division of General Internal Medicine, Department of MedicineMcGill UniversityMontrealCanada
  2. 2.Centre for Health Evaluation and Outcome SciencesSt. Paul’s HospitalVancouverCanada
  3. 3.School of Population and Public HealthUniversity of British ColumbiaVancouverCanada
  4. 4.Centre for Urban Health SolutionsSt. Michael’s HospitalTorontoCanada
  5. 5.Department of Education Counselling Psychology and Special EducationUniversity of British ColumbiaVancouverCanada
  6. 6.School of PsychologyUniversity of OttawaOttawaCanada
  7. 7.Division of General Internal Medicine, Department of MedicineUniversity of TorontoTorontoCanada
  8. 8.Division of General Internal Medicine, Department of MedicineUniversity of British ColumbiaVancouverCanada

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