Homelessness and Health Disparities: A Health Equity Lens

  • Elizabeth BowenEmail author
  • Ryan Savino
  • Andrew Irish


In this chapter, we describe a variety of health disparities experienced by homeless people, outline the pathways that link housing and health, and point to promising solutions for enhancing health equity. Whether living in shelters, on the street, or couch-surfing, homeless people exhibit high rates of disease and disability, reduced access to treatment, and poorer prognoses relative to their housed counterparts. Many of the health conditions common among people experiencing homelessness, such as tuberculosis, are comparatively rare within the general population. Mental health conditions and substance use disorders are also strongly associated with homelessness and poor physical health. Disparities widen as homeless individuals struggle to satisfy basic needs, such as accessing adequate food. People experiencing homelessness are also subject to high degrees of victimization and physical and sexual violence, both precipitating and during periods of homelessness. Taken together, the cyclical and successive magnification of risk factors that contribute to health disparities for people experiencing homelessness is termed cumulative disadvantage. Permanent supportive housing and especially Housing First models, medical-legal partnerships, and mobile health outreach programs are among the promising policy and programming interventions to reduce health disparities for homeless populations. In sum, given that housing and health are so closely linked, achieving health equity for homeless populations is closely tied to strategies to improve housing stability and address the most upstream social determinants of health.


Cumulative disadvantage Health care Health disparities Health equity Social determinants of health Couch-surfing Health care for the homeless HIV/AIDS Infectious disease Food insecurity Violence Permanent supportive housing Mental illness Substance use disorder Trauma Multi-morbidity Homeless women Homeless youth Chronic homelessness Dual diagnoses Violence 

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  1. Aidala, A. A., Wilson, M. G., Shubert, V., Gogolishvili, D., Globerman, J., Rueda, S., et al. (2016). Housing status, medical care, and health outcomes among people living with HIV/AIDS: A systematic review. American Journal of Public Health, 106(1), e21–e23.CrossRefGoogle Scholar
  2. American College of Obstetricians and Gynecologists Committee on Healthcare for Underserved Women. (2013). Healthcare for homeless women. Accessed 27 July 2018.
  3. Arbelle, J. E., Chodick, G., Goldstein, A., & Porath, A. (2014). Multiple chronic disorders – health care system’s modern challenge in the Maccabi Health Care System. Israel Journal of Health Policy Research, 3(1), 29.CrossRefGoogle Scholar
  4. Argintaru, N., Chambers, C., Gogosis, E., Farrell, S., Palepu, A., Klodawsky, F., & Hwang, S. W. (2013). A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities. BMC Public Health, 13(1), 577–577.CrossRefGoogle Scholar
  5. Aubry, T., Duhoux, A., Klodawsky, F., Ecker, J., & Hay, E. (2016). A longitudinal study of predictors of housing stability, housing quality, and mental health functioning among single homeless individuals staying in emergency shelters. American Journal of Community Psychology, 58(1–2), 123–135.CrossRefGoogle Scholar
  6. Aykanian, A., & Larkin, H. (2015). Health care innovations for homeless families: Emerging opportunities under Medicaid and the Affordable Care Act. Journal of Children and Poverty, 21(1), 59–68.CrossRefGoogle Scholar
  7. Baggett, T. P., O’Connell, J. J., Singer, D. E., & Rigotti, N. A. (2010). The unmet health care needs of homeless adults: A national study. American Journal of Public Health, 100(7), 1326–1333.CrossRefGoogle Scholar
  8. Baggett, T. P., Singer, D. E., Rao, S. R., O’Connell, J. J., Bharel, M., & Rigotti, N. A. (2011). Food insufficiency and health services utilization in a national sample of homeless adults. Journal of General Internal Medicine, 26(6), 627–634.CrossRefGoogle Scholar
  9. Baggett, T. P., Hwang, S. W., O’Connell, J. J., Porneala, B. C., Stringfellow, E. J., Orav, E. J., et al. (2013). Mortality among homeless adults in Boston: Shifts in causes of death over a 15-year period. JAMA Internal Medicine, 173(3), 189–195.CrossRefGoogle Scholar
  10. Baker, C. K., Billhardt, K. A., Warren, J., Rollins, C., & Glass, N. E. (2010). Domestic violence, housing instability, and homelessness: A review of housing policies and program practices for meeting the needs of survivors. Aggression and Violent Behavior, 15(6), 430–439.CrossRefGoogle Scholar
  11. Ball, S. A., Cobb-Richardson, P., Connolly, A. J., Bujosa, C. T., & O’Neall, T. W. (2005). Substance abuse and personality disorders in homeless drop-in center clients: Symptom severity and psychotherapy retention in a randomized clinical trial. Comprehensive Psychiatry, 46(5), 371–379.CrossRefGoogle Scholar
  12. Bamberger, J. D., Unick, J., Klein, P., Fraser, M., Chesney, M., & Katz, M. H. (2000). Helping the urban poor stay with antiretroviral HIV drug therapy. American Journal of Public Health, 90(5), 699–701.CrossRefGoogle Scholar
  13. Bamrah, S., Yelk Woodruff, R. S., Powell, K., Ghosh, S., Kammerer, J. S., & Haddad, M. B. (2013). Tuberculosis among the homeless, United States, 1994–2010. The International Journal of Tuberculosis and Lung Disease, 17(11), 1414–1419.CrossRefGoogle Scholar
  14. Barnett, K., Mercer, S. W., Norbury, M., Watt, G., Wyke, S., & Guthrie, B. (2012). Epidemiology of multimorbidity and implications for health care, research, and medical education: A cross-sectional study. Lancet, 380(9836), 37–43.CrossRefGoogle Scholar
  15. Barney, L. (2017). Doctors could prescribe housing to the homeless under radical Hawaii bill. The Guardian. Accessed 27 July 2018.
  16. Bazerghi, C., McKay, F. H., & Dunn, M. (2016). The role of food banks in addressing food insecurity: A systematic review. Journal of Community Health, 41(4), 732–740.CrossRefGoogle Scholar
  17. Beijer, U., Wolf, A., & Fazel, S. (2012). Prevalence of tuberculosis, hepatitis C virus, and HIV in homeless people: A systematic review and meta-analysis. The Lancet Infectious Diseases, 12(11), 859.CrossRefGoogle Scholar
  18. Bender, K., Brown, S. M., Thompson, S. J., Ferguson, K. M., & Langenderfer, L. (2015). Multiple victimizations before and after leaving home associated with PTSD, depression, and substance use disorder among homeless youth. Child Maltreatment, 20(2), 115–124.CrossRefGoogle Scholar
  19. Bharel, M., Creaven, B., Morris, G., Robertshaw, D., Uduhiri, K., Valvassori, P., et al. (2011). Health care delivery strategies: Addressing key preventive health measures in homeless health care settings. National Health Care for the Homeless Coalition. Accessed 27 July 2018.
  20. Blank, M. B., Himelhoch, S., Walkup, J., & Eisenberg, M. M. (2013). Treatment considerations for HIV-infected individuals with severe mental illness. Current HIV/AIDS Reports, 10(4), 371–379.CrossRefGoogle Scholar
  21. Bosick, S. J., Rennison, C. M., Gover, A. R., & Dodge, M. (2012). Reporting violence to the police: Predictors through the life course. Journal of Criminal Justice, 40(6), 441–451.CrossRefGoogle Scholar
  22. Bowen, E. A., Bowen, S. K., & Barman-Adhikari, A. (2016). Prevalence and covariates of food insecurity among residents of single-room occupancy housing in Chicago, IL, USA. Public Health Nutrition, 19(6), 1122–1130.CrossRefGoogle Scholar
  23. Bowen, E. A., Canfield, J., Moore, S., Hines, M., Hartke, B., & Rademacher, C. (2017). Predictors of CD4 health and viral suppression outcomes for formerly homeless people living with HIV/AIDS in scattered site supportive housing. AIDS Care, 29(11), 1458–1462.CrossRefGoogle Scholar
  24. Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27(1), 167–194.CrossRefGoogle Scholar
  25. Braveman, P., Egerter, S., & Williams, D. R. (2011). The social determinants of health: Coming of age. Annual Review of Public Health, 32(1), 381–398.CrossRefGoogle Scholar
  26. Brown, M., Chodzen, G., Mihelicova, M., & Collins, K. (2017). Applying a time-patterned typology of homelessness among individuals with mental illness. American Journal of Community Psychology, 59(3–4), 306–315.CrossRefGoogle Scholar
  27. Brubaker, M. D., Amatea, E. A., Torres-Rivera, E., Miller, M. D., & Nabors, L. (2013). Barriers and supports to substance abuse service use among homeless adults. Journal of Addictions and Offender Counseling, 34(2), 81–98.CrossRefGoogle Scholar
  28. Burgard, S. A., Seefeldt, K. S., & Zelner, S. (2012). Housing instability and health: Findings from the Michigan recession and recovery study. Social Science and Medicine, 75(12), 2215–2224.CrossRefGoogle Scholar
  29. Castellow, J., Kloos, B., & Townley, G. (2015). Previous homelessness as a risk factor for recovery from serious mental illnesses. Community Mental Health Journal, 51(6), 674–684.CrossRefGoogle Scholar
  30. Caton, C. M., Dominguez, B., Schanzer, B., Hasin, D. S., Shrout, P. E., Felix, A., et al. (2005). Risk factors for long-term homelessness: Findings from a longitudinal study of first-time homeless single adults. American Journal of Public Health, 95, 1753–1759.CrossRefGoogle Scholar
  31. Center for Behavioral Health Statistics and Quality. (2015). Behavioral health trends in the United States: Results from the 2014 National Survey on Drug Use and Health [HHS Publication No. SMA 15–4927, NSDUH Series H-50]. Accessed 27 July 2018.
  32. Chang, H., Fisher, F., Reitzel, L., Kendzor, D., Nguyen, M., & Businelle, M. (2015). Subjective sleep inadequacy and self-rated health among homeless adults. American Journal of Health Behavior, 39(1), 14–21.CrossRefGoogle Scholar
  33. Cheung, R. C., Hanson, A. K., Maganti, K., Keeffe, E. B., & Matsui, S. M. (2002). Viral hepatitis and other infectious diseases in a homeless population. Journal of Clinical Gastroenterology, 34(4), 476–480.CrossRefGoogle Scholar
  34. Coady, M. H., Latka, M. H., Thiede, H., Golub, E. T., Ouellet, L., Hudson, S. M., et al. (2007). Housing status and associated differences in HIV risk behaviors among young injection drug users (IDUs). AIDS and Behavior, 11(6), 854–863.CrossRefGoogle Scholar
  35. Cohen, S. M., van Handel, M. M., Branson, B. M., Blair, J. M., Irene Hall, H., Hu, X., et al. (2011). Vital signs: HIV prevention through care and treatment — United States. Morbidity and Mortality Weekly Report, 60(47), 1618–1623.Google Scholar
  36. Coleman-Jensen, A., Gregory, C., & Singh, A. (2014). Household food security in the United States in 2013 (USDA-ERS Economic Research Report Number 173). SSRN. Accessed 27 July 2018.
  37. Connolly, A. J., Cobb-Richardson, P., & Ball, S. A. (2008). Personality disorders in homeless drop-in center clients. Journal of Personality Disorders, 22(6), 573–588.CrossRefGoogle Scholar
  38. Cougnard, A., Grolleau, S., Lamarque, F., Beitz, C., Brugère, S., & Verdoux, H. (2006). Psychotic disorders among homeless subjects attending a psychiatric emergency service. Social Psychiatry and Psychiatric Epidemiology, 41(11), 904–910.CrossRefGoogle Scholar
  39. Cutler, D. H., Bevilacqua, J., & McFarland, B. H. (2003). Four decades of community mental health: A symphony in four movements. Community Mental Health Journal, 39, 381–398.CrossRefGoogle Scholar
  40. Davis, K., Stremikis, K., Squires, D., & Schoen, C. (2014). Mirror, mirror on the wall, 2014 update: How the U.S. health care system compares internationally. Commonwealth Fund. Accessed 27 July 2018.
  41. Deiss, R. G., Rodwell, T. C., & Garfein, R. S. (2009). Tuberculosis and illicit drug use: Review and update. Clinical Infectious Diseases, 48(1), 72–82.CrossRefGoogle Scholar
  42. Denniston, M. M., Jiles, R. B., Drobeniuc, J., Klevens, R. M., Ward, J. W., McQuillan, G. M., & Holmberg, S. D. (2014). Chronic hepatitis C virus infection in the United States, National Health and Nutrition Examination Survey 2003 to 2010. Annals of Internal Medicine, 160(5), 293–293.CrossRefGoogle Scholar
  43. Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186(1), 125–145.CrossRefGoogle Scholar
  44. Dixon, L. B., & Schwarz, E. C. (2013). Fifty years of progress in community mental health in US: The growth of evidence-based practices. Epidemiology and Psychiatric Sciences, 23(01), 5–9.CrossRefGoogle Scholar
  45. Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.CrossRefGoogle Scholar
  46. Dutton, M. A., Green, B. L., Kaltman, S. I., Roesch, D. M., Zeffiro, T. A., & Krause, E. D. (2006). Intimate partner violence, PTSD, and adverse health outcomes. Journal of Interpersonal Violence, 21(7), 955–968.CrossRefGoogle Scholar
  47. Edens, E. L., Mares, A. S., & Rosenheck, R. A. (2011). Chronically homeless women report high rates of substance use problems equivalent to chronically homeless men. Women’s Health Issues, 21(5), 383–389.CrossRefGoogle Scholar
  48. Fazel, S., Khosla, V., Doll, H., & Geddes, J. (2008). The prevalence of mental disorders among the homeless in western countries: Systematic review and meta-regression analysis. PLoS Medicine, 5(12), e225.CrossRefGoogle Scholar
  49. Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet, 384(9953), 1529–1540.CrossRefGoogle Scholar
  50. Feldman, S. (2003). Reflections on the 40th anniversary of the U.S. Community Mental Health Centers Act. Australian and New Zealand Journal of Psychiatry, 37(6), 662–667.CrossRefGoogle Scholar
  51. Fitzpatrick-Lewis, D., Ganann, R., Krishnaratne, S., Ciliska, D., Kouyoumdjian, F., & Hwang, S. W. (2011). Effectiveness of interventions to improve the health and housing status of homeless people: A rapid systematic review. BMC Public Health, 11(1), 638–638.CrossRefGoogle Scholar
  52. Flentje, A., Leon, A., Carrico, A., Zheng, D., & Dilley, J. (2016). Mental and physical health among homeless sexual and gender minorities in a major urban U.S. city. Journal of Urban Health, 93(6), 997–1009.CrossRefGoogle Scholar
  53. Fletcher, J. M., Andreyeva, T., & Busch, S. H. (2009). Assessing the effect of changes in housing costs on food insecurity. Journal of Children and Poverty, 15(2), 79–93.CrossRefGoogle Scholar
  54. Folsom, D. P., McCahill, M., Bartels, S. J., Lindamer, L. A., Ganiats, T. G., & Jeste, D. V. (2002). Medical comorbidity and receipt of medical care by older homeless people with schizophrenia or depression. Psychiatric Services, 53(11), 1456–1460.CrossRefGoogle Scholar
  55. Folsom, D. P., Hawthorne, W., Lindamer, L., Gilmer, T., Bailey, A., Golshan, S., et al. (2005). Prevalence and risk factors for homelessness and utilization of mental health services among 10,340 patients with serious mental illness in a large public mental health system. American Journal of Psychiatry, 162(2), 370–376.CrossRefGoogle Scholar
  56. Garfein, R. S., Vlahov, D., Galai, N., Doherty, M. C., & Nelson, K. E. (1996). Viral infections in short-term injection drug users: The prevalence of the hepatitis C, hepatitis B, human immunodeficiency, and human T-lymphotropic viruses. American Journal of Public Health, 86(5), 655–661.CrossRefGoogle Scholar
  57. Gattis, M. N., & Larson, A. (2016). Perceived racial, sexual identity, and homeless status-related discrimination among Black adolescents and young adults experiencing homelessness: Relations with depressive symptoms and suicidality. American Journal of Orthopsychiatry, 86(1), 79–90.CrossRefGoogle Scholar
  58. Gelberg, L., Robertson, M. J., Arangua, L., Leake, B. D., Sumner, G., Moe, A., et al. (2012). Prevalence, distribution, and correlates of Hepatitis C virus infection among homeless adults in Los Angeles. Public Health Reports, 127(4), 407–421.CrossRefGoogle Scholar
  59. Geller, J. L. (2000). The last half century of psychiatric services as reflected in psychiatric services. Psychiatric Services, 51, 41–67.CrossRefGoogle Scholar
  60. Goldfinger, S. M., Schutt, R. K., Tolomiczenko, G. S., Seidman, L., Penk, W. E., Turner, W., & Caplan, B. (1999). Housing placement and subsequent days homeless among formerly homeless adults with mental illness. Psychiatric Services, 50(5), 674–679.CrossRefGoogle Scholar
  61. Gonzalez, G., & Rosenheck, R. A. (2002). Outcomes and service use among homeless persons with serious mental illness and substance abuse. Psychiatric Services, 53(4), 437–446.CrossRefGoogle Scholar
  62. Goodman, L. A., Dutton, M. A., & Harris, M. (1997). The relationship between violence dimensions and symptom severity among homeless, mentally ill women. Journal of Traumatic Stress, 10(1), 51–70.Google Scholar
  63. Greene, J. M., Ennett, S. T., & Ringwalt, C. L. (1999). Prevalence and correlates of survival sex among runaway and homeless youth. American Journal of Public Health, 89, 1406–1409.CrossRefGoogle Scholar
  64. Greenwood, R. M., Schaefer-McDaniel, N. J., Winkel, G., & Tsemberis, S. J. (2005). Decreasing psychiatric symptoms by increasing choice in services for adults with histories of homelessness. American Journal of Community Psychology, 36(3), 223–238.CrossRefGoogle Scholar
  65. Hawkins, R. L., & Abrams, C. (2007). Disappearing acts: The social networks of formerly homeless individuals with co-occurring disorders. Social Science and Medicine, 65(10), 2031–2042.CrossRefGoogle Scholar
  66. Henny, K. D., Kidder, D. P., Stall, R., & Wolitski, R. J. (2007). Physical and sexual abuse among homeless and unstably housed adults living with HIV: Prevalence and associated risks. AIDS and Behavior, 11(6), 842–853.CrossRefGoogle Scholar
  67. Henry, M., Shivji, A., de Sousa, T., Cohen, R., Khadduri, J., & Culhane, D. P. (2015). The 2015 Annual Homelessness Assessment Report (AHAR) to Congress, Part 1: Point-in-Time Estimates of Homelessness. U.S. Department of Housing and Urban Development. Accessed 27 July 2018.
  68. Henwood, B. F., Cabassa, L. J., Craig, C. M., & Padgett, D. K. (2013a). Permanent supportive housing: Addressing homelessness and health disparities? American Journal of Public Health, 103(S2), S188–S192.CrossRefGoogle Scholar
  69. Henwood, B. F., Stanhope, V., Brawer, R., Weinstein, L. C., Lawson, J., Stwords, E., & Crossan, C. (2013b). Addressing chronic disease within supportive housing programs. Progress in Community Health Partnerships: Research, Education, and Action, 7(1), 67–75.CrossRefGoogle Scholar
  70. Henwood, B. F., Matejkowski, J., Stefancic, A., & Lukens, J. M. (2014). Quality of life after housing first for adults with serious mental illness who have experienced chronic homelessness. Psychiatry Research, 220(1), 549–555.CrossRefGoogle Scholar
  71. Hudson, C. G. (2016). A model of deinstitutionalization of psychiatric care across 161 nations: 2001-2014. International Journal of Mental Health, 45(2), 135–153.CrossRefGoogle Scholar
  72. Huey, L. (2008). ‘When it comes to violence in my place, I am the police!’: Exploring the policing functions of service providers in Edinburgh’s Cowgate and Grassmarket. Policing and Society, 18(3), 207–224.CrossRefGoogle Scholar
  73. Huey, L., & Quirouette, M. (2010). ‘Any girl can call the cops, no problem’: The influence of gender on support for the decision to report criminal victimization within homeless communities. British Journal of Criminology, 50(2), 278–295.CrossRefGoogle Scholar
  74. Huey, L., Broll, R., Hryniewicz, D., & Fthenos, G. (2014). “They just asked me why I became homeless”: “Failure to ask” as a barrier to homeless women’s ability to access services post-victimization. Violence and Victims, 29(6), 952–966.CrossRefGoogle Scholar
  75. Irwin, J. D., Ng, V. K., Rush, T. J., Nguyen, C., & He, M. (2007). Can food banks sustain nutrient requirements? A case study in Southwestern Ontario. Canadian Journal of Public Health /Revue Canadienne de Sante’e Publique, 98(1), 17–20.CrossRefGoogle Scholar
  76. Jones, A. A., Vila-Rodriguez, F., Leonova, O., Langheimer, V., Lang, D. J., Barr, A. M., et al. (2015). Mortality from treatable illnesses in marginally housed adults: A prospective cohort study. BMJ Open, 5(8), e008876.CrossRefGoogle Scholar
  77. Kennedy, J. F. (1963). Mental illness and mental retardation: Message from the President of the United States relative to mental illness and mental retardation. American Psychologist, 18(6), 280–289.CrossRefGoogle Scholar
  78. Kidder, D. P., Wolitski, R. J., Campsmith, M. L., & Nakamura, G. V. (2007). Health status, health care use, medication use, and medication adherence among homeless and housed people living with HIV/AIDS. American Journal of Public Health, 97(12), 2238–2245.CrossRefGoogle Scholar
  79. Kim, M. M., Ford, J. D., Howard, D. L., & Bradford, D. W. (2010). Assessing trauma, substance abuse, and mental health in a sample of homeless men. Health and Social Work, 35(1), 39–48.CrossRefGoogle Scholar
  80. Kirkpatrick, S. I., & Tarasuk, V. (2011). Housing circumstances are associated with household food access among low-income urban families. Journal of Urban Health, 88(2), 284–296.CrossRefGoogle Scholar
  81. Kuhn, R., & Culhane, D. P. (1998). Applying cluster analysis to test a typology of homelessness by pattern of shelter utilization: Results from the analysis of administrative data. American Journal of Community Psychology, 26(2), 207–232.CrossRefGoogle Scholar
  82. Kushel, M. B., Perry, S., Bangsberg, D., Clark, R., & Moss, A. R. (2002). Emergency department use among the homeless and marginally housed: Results from a community-based study. American Journal of Public Health, 92(5), 778–784.CrossRefGoogle Scholar
  83. Kushel, M. B., Evans, J. L., Perry, S., Robertson, M. J., & Moss, A. R. (2003). No door to lock: Victimization among homeless and marginally housed persons. Archives of Internal Medicine, 163(20), 2492–2499.CrossRefGoogle Scholar
  84. Kushel, M. B., Gupta, R., Gee, L., & Haas, J. S. (2006). Housing instability and food insecurity as barriers to health care among low-income Americans. Journal of General Internal Medicine, 21(1), 71–77.CrossRefGoogle Scholar
  85. Lebrun-Harris, L. A., Baggett, T. P., Jenkins, D. M., Sripipatana, A., Sharma, R., Hayashi, A. S., Daly, C., & Ngo-Metzger, Q. (2013). Health status and health care experiences among homeless patients in federally supported health centers: Findings from the 2009 patient survey. Health Services Research, 48(3), 992–1017.CrossRefGoogle Scholar
  86. Lee, B. A., & Greif, M. J. (2008). Homelessness and Hunger. Journal of Health and Social Behavior, 49(1), 3–19.CrossRefGoogle Scholar
  87. Lifson, A. R., & Halcón, L. L. (2001). Substance abuse and high-risk needle-related behaviors among homeless youth in Minneapolis: Implications for prevention. Journal of Urban Health, 78(4), 690–698.CrossRefGoogle Scholar
  88. Lin, W.-C., Bharel, M., Zhang, J., O’Connell, E., & Clark, R. E. (2015). Frequent emergency department visits and hospitalizations among homeless people with Medicaid: Implications for Medicaid expansion. American Journal of Public Health, 105(S5), S716–S722.CrossRefGoogle Scholar
  89. Link, B. G., Susser, E., Stueve, A., Phelan, J., Moore, R., & Struening, E. (1994). Lifetime and five-year prevalence of homelessness in the United States. American Journal of Public Health, 84, 1907–1912.CrossRefGoogle Scholar
  90. Linton, S. L., Celentano, D. D., Kirk, G. D., & Mehta, S. H. (2013). The longitudinal association between homelessness, injection drug use, and injection-related risk behavior among persons with a history of injection drug use in Baltimore, MD. Drug and Alcohol Dependence, 132(3), 457–465.CrossRefGoogle Scholar
  91. Lönnroth, K., Williams, B. G., Stadlin, S., Jaramillo, E., & Dye, C. (2008). Alcohol use as risk factor for tuberculosis disease – A systematic review. BMC Public Health, 8, 289.CrossRefGoogle Scholar
  92. Maness, D. L., & Khan, M. (2014). Care of the homeless: An overview. American Family Physician, 89(8), 634–640.Google Scholar
  93. Maremmani, A. G. I., Bacciardi, S., Gehring, N. D., Cambioli, L., Schütz, C., Akiskal, H. S., & Krausz, M. (2015). The impact of mood symptomatology on pattern of substance use among homeless. Journal of Affective Disorders, 176, 164–170.CrossRefGoogle Scholar
  94. McNiel, D. E., & Binder, R. L. (2005). Psychiatric emergency service use and homelessness, mental disorder, and violence. Psychiatric Services, 56(6), 699–704.CrossRefGoogle Scholar
  95. Mechanic, D., & Rochefort, D. A. (1990). Deinstitutionalization: An appraisal of reform. Annual Review of Sociology, 16(1), 301–327.CrossRefGoogle Scholar
  96. Miewald, C., & McCann, E. (2014). Foodscapes and the geographies of poverty: Sustenance, strategy, and politics in an urban neighborhood. Antipode, 46(2), 537–556.CrossRefGoogle Scholar
  97. Milloy, M. J., Marshall, B. D., Montaner, J., & Wood, E. (2012). Housing status and the health of people living with HIV/AIDS. Current HIV/AIDS Reports, 9(4), 364–374.CrossRefGoogle Scholar
  98. Mohtashemi, M., & Kawamura, L. M. (2010). Empirical evidence for synchrony in the evolution of TB cases and HIV+ contacts among the San Francisco homeless: e8851. PLoS One, 5(1), e8851.CrossRefGoogle Scholar
  99. Montgomery, A. E., Metraux, S., & Culhane, D. (2013). Rethinking homelessness prevention among persons with serious mental illness. Social Issues and Policy Review, 7(1), 58–82.CrossRefGoogle Scholar
  100. National Health Care for the Homeless Council. (2013). Fact sheet 2013. Accessed 27 July 2018.
  101. National Health Care for the Homeless Council. (2017). Frequently asked questions. Accessed 27 July 2018.
  102. National Institute of Mental Health. (2015). Serious mental illness (SMI) among adults. Accessed 27 July 2018.
  103. Night Ministry. (2016). Annual report FY 2016. Accessed 27 July 2018.
  104. North, C. S., Pollio, D. E., Smith, E. M., & Spitznagel, E. L. (1998). Correlates of early onset and chronicity of homelessness in a large urban homeless population. Journal of Nervous and Mental Disease, 186(7), 393–400.CrossRefGoogle Scholar
  105. North, C. S., Eyrich, K. M., Pollio, D. E., & Spitznagel, E. L. (2004). Are rates of psychiatric disorders in the homeless population changing? American Journal of Public Health, 94(1), 103–108.CrossRefGoogle Scholar
  106. Norton, B. L., Voils, C. I., Timberlake, S. H., Hecker, E. J., Goswami, N. D., Huffman, K. M., et al. (2014). Community-based HCV screening: Knowledge and attitudes in a high risk urban population. BMC Infectious Diseases, 14(1), 74–74.CrossRefGoogle Scholar
  107. Novella, E. J. (2008). Theoretical accounts on deinstitutionalization and the reform of mental health services: A critical review. Medicine, Health Care and Philosophy, 11(3), 303–314.CrossRefGoogle Scholar
  108. Nyamathi, A., Flaskerud, J. H., Leake, B., Dixon, E. L., & Lu, A. (2001). Evaluating the impact of peer, nurse case-managed, and standard HIV risk-reduction programs on psychosocial and health-promoting behavioral outcomes among homeless women. Research in Nursing and Health, 24(5), 410–422.CrossRefGoogle Scholar
  109. Nyamathi, A., Stein, J. A., Schumann, A., & Tyler, D. (2007). Latent variable assessment of outcomes in a nurse-managed intervention to increase latent tuberculosis treatment completion in homeless adults. Health Psychology, 26(1), 68–76.CrossRefGoogle Scholar
  110. O’Connell, J. J. (2015). Stories from the shadows: Reflections of a street doctor. Boston: BHCHP Press.Google Scholar
  111. Padgett, D. K., Leibson Hawkins, R., Abrams, C., & Davis, A. (2006). In their own words: Trauma and substance abuse in the lives of formerly homeless women with serious mental illness. American Journal of Orthopsychiatry, 76(4), 461–467.CrossRefGoogle Scholar
  112. Padgett, D. K., Smith, B. T., Henwood, B. F., & Tiderington, E. (2012). Life course adversity in the lives of formerly homeless persons with serious mental illness: Context and meaning. American Journal of Orthopsychiatry, 82(3), 421–430.CrossRefGoogle Scholar
  113. Padgett, D. K., Henwood, B. F., & Tsemberis, S. J. (2016). Housing first: Ending homelessness, transforming systems, and changing lives. New York: Oxford University Press.Google Scholar
  114. Paradise, J., & Ross, D. C. (2017). Linking Medicaid and supportive housing: Opportunities and on-the-ground examples [issue brief]. Accessed 27 July 2018.
  115. Parpouchi, M., Moniruzzaman, A., Russolillo, A., & Somers, J. M. (2016). Food insecurity among homeless adults with mental illness. PLoS One, 11(7), e0159334.CrossRefGoogle Scholar
  116. Patterson, M. L., Somers, J. M., & Moniruzzaman, A. (2012). Prolonged and persistent homelessness: Multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver, British Columbia. Mental Health and Substance Use, 5(2), 85–101.CrossRefGoogle Scholar
  117. Polonsky, M., Aykanian, A., Records, J., & Larkin, H. (2014). Strengthening homeless services: Funding streams and emerging opportunities in Medicaid and the Affordable Care Act. Accessed 27 July 2018.
  118. Ponce, A. N., Lawless, M. S., & Rowe, M. (2014). Homelessness, behavioral health disorders and intimate partner violence: Barriers to services for women. Community Mental Health Journal, 50(7), 831–840.CrossRefGoogle Scholar
  119. Project Homeless Connect. (2017). Results. Accessed 27 July 2018.
  120. Purser, G. L., Mowbray, O. P., & O’Shields, J. (2017). The relationship between length and number of homeless episodes and engagement in survival sex. Journal of Social Service Research, 43(2), 262–269.CrossRefGoogle Scholar
  121. Roberts, H., Kruszon-Moran, D., Ly, K. N., Hughes, E., Iqbal, K., Jiles, R. B., & Holmberg, S. D. (2016). Prevalence of chronic hepatitis B virus (HBV) infection in U.S. households: National Health and Nutrition Examination Survey (NHANES), 1988–2012. Hepatology, 63(2), 388–397.CrossRefGoogle Scholar
  122. Rog, D. J., Marshall, T., Dougherty, R. H., George, P., Daniels, A. S., Ghose, S. S., & Delphin-Rittmon, M. E. (2014). Permanent supportive housing: Assessing the evidence. Psychiatric Services, 65(3), 287–294.CrossRefGoogle Scholar
  123. Santiago, C. D., Wadsworth, M. E., & Stump, J. (2011). Socioeconomic status, neighborhood disadvantage, and poverty-related stress: Prospective effects on psychological syndromes among diverse low-income families. Journal of Economic Psychology, 32(2), 218–230.CrossRefGoogle Scholar
  124. Schmidt, L. M., Hesse, M., & Lykke, J. (2011). The impact of substance use disorders on the course of schizophrenia – a 15-year follow-up study: Dual diagnosis over 15 years. Schizophrenia Research, 130(1–3), 228–233.CrossRefGoogle Scholar
  125. Schwarcz, S. K., Hsu, L. C., Vittinghoff, E., Vu, A., Bamberger, J. D., & Katz, M. H. (2009). Impact of housing on the survival of persons with AIDS. BMC Public Health, 9(1), 220–220.CrossRefGoogle Scholar
  126. Seabrook, J. A., & Avison, W. R. (2012). Socioeconomic status and cumulative disadvantage processes across the life course: Implications for health outcomes. Canadian Review of Sociology, 49(1), 50–68.CrossRefGoogle Scholar
  127. Seligman, H. K., Davis, T. C., Schillinger, D., & Wolf, M. S. (2010a). Food insecurity is associated with hypoglycemia and poor diabetes self-management in a low-income sample with diabetes. Journal of Health Care for the Poor and Underserved, 21(4), 1227–1233.Google Scholar
  128. Seligman, H. K., Laraia, B. A., & Kushel, M. B. (2010b). Food insecurity is associated with chronic disease among low-income NHANES participants. Journal of Nutrition, 140(2), 304–310.CrossRefGoogle Scholar
  129. Semba, R. D., Darnton-Hill, I., & de Pee, S. (2010). Addressing tuberculosis in the context of malnutrition and HIV coinfection. Food and Nutrition Bulletin, 31(4 Suppl), S345–S364.CrossRefGoogle Scholar
  130. Siefert, K., Heflin, C. M., Corcoran, M. E., & Williams, D. R. (2001). Food insufficiency and the physical and mental health of low-income women. Women and Health, 32(1–2), 159–177.CrossRefGoogle Scholar
  131. Slesnick, N., & Prestopnik, J. (2005). Dual and multiple diagnosis among substance using runaway youth. American Journal of Drug and Alcohol Abuse, 31(1), 179–201.CrossRefGoogle Scholar
  132. Stanley, J. L., Jansson, A. V., Akinyemi, A. A., & Mitchell, C. S. (2016). Characteristics of violent deaths among homeless people in Maryland, 2003–2011. American Journal of Preventive Medicine, 51(5), S260–S266.CrossRefGoogle Scholar
  133. Stein, J. A., & Nyamathi, A. (2004). Correlates of hepatitis C virus infection in homeless men: A latent variable approach. Drug and Alcohol Dependence, 75(1), 89–95.CrossRefGoogle Scholar
  134. Strehlow, A. J., Robertson, M. J., Zerger, S., Rongey, C., Arangua, L., Farrell, E., et al. (2012). Hepatitis C among clients of Health Care for the Homeless primary care clinics. Journal of Health Care for the Poor and Underserved, 23(2), 811–833.CrossRefGoogle Scholar
  135. Substance Abuse and Mental Health Services Administration. (2013). Results from the 2012 National Survey on Drug Use and Health: Mental health findings (NSDUH Series H-47, HHS Publication No. [SMA] 13–4805). Accessed 27 July 2018.
  136. Suglia, S. F., Duarte, C. S., & Sandel, M. T. (2011). Housing quality, housing instability, and maternal mental health. Journal of Urban Health, 88(6), 1105–1116.CrossRefGoogle Scholar
  137. Tarasuk, V., Dachner, N., Poland, B., & Gaetz, S. (2009). Food deprivation is integral to the ‘hand to mouth’ existence of homeless youths in Toronto. Public Health Nutrition, 12(9), 1437–1442.CrossRefGoogle Scholar
  138. Thakarar, K., Morgan, J. R., Gaeta, J. M., Hohl, C., & Drainoni, M. L. (2016). Homelessness, HIV, and incomplete viral suppression. Journal of Health Care for the Poor and Underserved, 27(1), 145–156.CrossRefGoogle Scholar
  139. Thompson, R. G., Wall, M. M., Greenstein, E., Grant, B. F., & Hasin, D. S. (2013). Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States. American Journal of Public Health, 103(2), S282–S288.CrossRefGoogle Scholar
  140. Thomson, H., & Thomas, S. (2015). Developing empirically supported theories of change for housing investment and health. Social Science and Medicine, 124, 205–214.CrossRefGoogle Scholar
  141. Thornton, R. L. J., Glover, C. M., Cené, C. W., Glik, D. C., Henderson, J. A., & Williams, D. R. (2016). Evaluating strategies for reducing health disparities by addressing the social determinants of health. Health Affairs, 35(8), 1416–1423.CrossRefGoogle Scholar
  142. To, M. J., Brothers, T. D., & Van Zoost, C. (2016). Foot conditions among homeless persons: A systematic review. PLoS One, 11(12), e0167463.CrossRefGoogle Scholar
  143. Tsai, J., Kasprow, W. J., & Rosenheck, R. A. (2014). Alcohol and drug use disorders among homeless veterans: Prevalence and association with supported housing outcomes. Addictive Behaviors, 39(2), 455–460.CrossRefGoogle Scholar
  144. Tsai, J., Jenkins, D., & Lawton, E. (2017). Civil legal services and medical-legal partnerships needed by the homeless population: A national survey. American Journal of Public Health, 107(3), 398–e394.CrossRefGoogle Scholar
  145. Tyler, K., Whitbeck, L., Hoyt, D., & Cauce, A. (2004). Risk factors for sexual victimization among male and female homeless and runaway youth. Journal of Interpersonal Violence, 19, 503–520.CrossRefGoogle Scholar
  146. U.S. Department of Housing and Urban Development. (2015a). Homeless emergency assistance and rapid transition to housing: Defining “chronically homeless”. Accessed 27 July 2018.
  147. U.S. Department of Housing and Urban Development. (2015b). HUD 2015 continuum of care homeless assistance programs: Homeless populations and subpopulations. Accessed 27 July 2018.
  148. U.S. Interagency Council on Homelessness. (2016). The President’s 2016 budget: Fact sheet on homelessness assistance. Accessed 27 July 2018.
  149. University at Buffalo Jacobs School of Medicine and Biomedical Sciences. (2017). Medical students take to streets to aid Buffalo’s homeless population. University at Buffalo. Accessed 27 July 2018.
  150. Vijayaraghavan, M., Jacobs, E. A., Seligman, H., & Fernandez, A. (2011). The association between housing instability, food insecurity, and diabetes self-efficacy in low-income adults. Journal of Health Care for the Poor and Underserved, 22(4), 1279–1291.CrossRefGoogle Scholar
  151. Vijayaraghavan, M., Tochterman, A., Hsu, E., Johnson, K., Marcus, S., & Caton, C. L. M. (2012). Health, access to health care, and health care use among homeless women with a history of intimate partner violence. Journal of Community Health, 37(5), 1032–1039.CrossRefGoogle Scholar
  152. Vila-Rodriguez, F., Panenka, W. J., Lang, D. J., Thornton, A. E., Vertinsky, T., Wong, H., et al. (2013). The hotel study: Multimorbidity in a community sample living in marginal housing. American Journal of Psychiatry, 170(12), 1413–1422.CrossRefGoogle Scholar
  153. Vogenthaler, N. S., Kushel, M. B., Hadley, C., Frongillo, E. A., Jr., Riley, E. D., Bangsberg, D. R., et al. (2013). Food insecurity and risky sexual behaviors among homeless and marginally housed HIV-infected individuals in San Francisco. AIDS and Behavior, 17(5), 1688–1693.CrossRefGoogle Scholar
  154. Walls, N. E., & Bell, S. (2011). Correlates of engaging in survival sex among homeless youth and young adults. Journal of Sex Research, 48, 423–436.CrossRefGoogle Scholar
  155. Weiser, S. D., Fernandes, K. A., Brandson, E. K., Lima, V. D., Anema, A., Bangsberg, D. R., et al. (2009). The association between food insecurity and mortality among HIV- infected individuals on HAART. Journal of Acquired Immune Deficiency Syndromes, 52(3), 342–349.CrossRefGoogle Scholar
  156. Wenzel, S. L., Koegel, P., & Gelberg, L. (2000a). Antecedents of physical and sexual victimization among homeless women: A comparison to homeless men. American Journal of Community Psychology, 28(3), 367–390.CrossRefGoogle Scholar
  157. Wenzel, S. L., Leake, B. D., & Gelberg, L. (2000b). Health of homeless women with recent experience of rape. Journal of General Internal Medicine, 15(4), 265–268.CrossRefGoogle Scholar
  158. Wenzel, S. L., Tucker, J. S., Elliott, M. N., Hambarsoomians, K., Perlman, J., Becker, K., et al. (2004). Prevalence and co-occurrence of violence, substance use and disorder, and HIV risk behavior: A comparison of sheltered and low-income housed women in Los Angeles County. Preventive Medicine, 39(3), 617–624.CrossRefGoogle Scholar
  159. Withers, J. (2011). Street medicine: An example of reality-based health care. Journal of Health Care for the Poor and Underserved, 22(1), 1–4.Google Scholar
  160. Wright, B. J., Vartanian, K. B., Li, H. F., Royal, N., & Matson, J. K. (2016). Formerly homeless people had lower overall health care expenditures after moving into supportive housing. Health Affairs, 35(1), 20–27.CrossRefGoogle Scholar
  161. Zakrison, T. L., Hamel, P. A., & Hwang, S. W. (2004). Homeless people’s trust and interactions with police and paramedics. Journal of Urban Health, 81(4), 596–605.CrossRefGoogle Scholar

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© Springer Nature Switzerland AG 2019

Authors and Affiliations

  1. 1.University at BuffaloBuffaloUSA

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