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Homelessness and Health Disparities: A Health Equity Lens

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Abstract

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.

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References

  • 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.

    Article  Google Scholar 

  • American College of Obstetricians and Gynecologists Committee on Healthcare for Underserved Women. (2013). Healthcare for homeless women. https://www.acog.org/Resources-And-Publications/Committee-Opinions/Committee-on-Health-Care-for-Underserved-Women/Health-Care-for-Homeless-Women. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Barney, L. (2017). Doctors could prescribe housing to the homeless under radical Hawaii bill. The Guardian. https://www.theguardian.com/us-news/2017/feb/28/hawaii-homeless-housing-bill-healthcare-costs. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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. https://www.nhchc.org/wp-content/uploads/2012/02/KeyPrevHealthMeas_FINAL.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Braveman, P. (2006). Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27(1), 167–194.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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]. https://www.samhsa.gov/data/sites/default/files/NSDUH-FRR1-2014/NSDUH-FRR1-2014.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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. https://doi.org/10.2139/ssrn.2504067. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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. http://www.commonwealthfund.org/~/media/files/publications/fund-report/2014/jun/1755_davis_mirror_mirror_2014.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Diez Roux, A. V., & Mair, C. (2010). Neighborhoods and health. Annals of the New York Academy of Sciences, 1186(1), 125–145.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Drake, R. E., & Latimer, E. (2012). Lessons learned in developing community mental health care in North America. World Psychiatry, 11, 47–51.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Geller, J. L. (2000). The last half century of psychiatric services as reflected in psychiatric services. Psychiatric Services, 51, 41–67.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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. https://www.hudexchange.info/resources/documents/2015-AHAR-Part-1.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Lee, B. A., & Greif, M. J. (2008). Homelessness and Hunger. Journal of Health and Social Behavior, 49(1), 3–19.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Maness, D. L., & Khan, M. (2014). Care of the homeless: An overview. American Family Physician, 89(8), 634–640.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • McNiel, D. E., & Binder, R. L. (2005). Psychiatric emergency service use and homelessness, mental disorder, and violence. Psychiatric Services, 56(6), 699–704.

    Article  Google Scholar 

  • Mechanic, D., & Rochefort, D. A. (1990). Deinstitutionalization: An appraisal of reform. Annual Review of Sociology, 16(1), 301–327.

    Article  Google Scholar 

  • Miewald, C., & McCann, E. (2014). Foodscapes and the geographies of poverty: Sustenance, strategy, and politics in an urban neighborhood. Antipode, 46(2), 537–556.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • National Health Care for the Homeless Council. (2013). Fact sheet 2013. http://www.nhchc.org/wp-content/uploads/2011/09/hch-fact-sheet-2013.pdf. Accessed 27 July 2018.

  • National Health Care for the Homeless Council. (2017). Frequently asked questions. https://www.nhchc.org/resources/general-information/faq/. Accessed 27 July 2018.

  • National Institute of Mental Health. (2015). Serious mental illness (SMI) among adults. https://www.nimh.nih.gov/health/statistics/prevalence/serious-mental-illness-smi-among-us-adults.shtml. Accessed 27 July 2018.

  • Night Ministry. (2016). Annual report FY 2016. https://www.thenightministry.org/TNM_Annual%20Report_2016.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • O’Connell, J. J. (2015). Stories from the shadows: Reflections of a street doctor. Boston: BHCHP Press.

    Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • Paradise, J., & Ross, D. C. (2017). Linking Medicaid and supportive housing: Opportunities and on-the-ground examples [issue brief]. https://www.kff.org/report-section/linking-medicaid-and-supportive-housing-issue-brief/. Accessed 27 July 2018.

  • Parpouchi, M., Moniruzzaman, A., Russolillo, A., & Somers, J. M. (2016). Food insecurity among homeless adults with mental illness. PLoS One, 11(7), e0159334.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Polonsky, M., Aykanian, A., Records, J., & Larkin, H. (2014). Strengthening homeless services: Funding streams and emerging opportunities in Medicaid and the Affordable Care Act. http://www.albany.edu/excellencehomelessservices/assets/StrengtheningHomelessServices-ACA-2014-FINAL.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • Project Homeless Connect. (2017). Results. https://www.projecthomelessconnect.org/about/results/. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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). https://www.samhsa.gov/data/sites/default/files/NSDUHresults2012/NSDUHresults2012.pdf. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • Thomson, H., & Thomas, S. (2015). Developing empirically supported theories of change for housing investment and health. Social Science and Medicine, 124, 205–214.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • To, M. J., Brothers, T. D., & Van Zoost, C. (2016). Foot conditions among homeless persons: A systematic review. PLoS One, 11(12), e0167463.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • U.S. Department of Housing and Urban Development. (2015a). Homeless emergency assistance and rapid transition to housing: Defining “chronically homeless”. http://www.hudexchange.info/resources/documents/Defining-Chronically-Homeless-Final-Rule.pdf. Accessed 27 July 2018.

  • U.S. Department of Housing and Urban Development. (2015b). HUD 2015 continuum of care homeless assistance programs: Homeless populations and subpopulations. https://www.hudexchange.info/resource/reportmanagement/published/CoC_PopSub_NatlTerrDC_2015.pdf. Accessed 27 July 2018.

  • U.S. Interagency Council on Homelessness. (2016). The President’s 2016 budget: Fact sheet on homelessness assistance. https://www.usich.gov/resources/uploads/asset_library/2016_Budget_Fact_Sheet_on_Homelessness_Assistance.pdf. Accessed 27 July 2018.

  • 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. https://medicine.buffalo.edu/news_and_events/news.host.html/content/shared/smbs/news/2017/01/ub-heals-street-medicine-6588.detail.html. Accessed 27 July 2018.

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

  • 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 

  • 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.

    Article  Google Scholar 

  • 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.

    Article  Google Scholar 

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Bowen, E., Savino, R., Irish, A. (2019). Homelessness and Health Disparities: A Health Equity Lens. In: Larkin, H., Aykanian, A., Streeter, C.L. (eds) Homelessness Prevention and Intervention in Social Work. Springer, Cham. https://doi.org/10.1007/978-3-030-03727-7_3

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