Homelessness is an escalating national problem and women are disproportionately affected. Nevertheless, few studies have focused on the special circumstances associated with being a homeless woman. For instance, while both genders experience serious barriers to obtaining health care, homeless women face an additional burden by virtue of their sexual and reproductive health needs. The current study was conducted as the first stage of a qualitative/quantitative investigation of homeless women's access and barriers to family planning and women's health care. We interviewed 47 homeless women of diverse ages and ethnic backgrounds. A qualitative approach was initially taken to explore the factors homeless women themselves perceive as barriers to their use of birth control and women's health services, and factors they believe would facilitate their use. Key findings are that health is not a priority for homeless women, that transportation and scheduling can be particularly burdensome for homeless women, and that being homeless leads some to feel stigmatized by health care providers. Despite being homeless, having children was extremely important to the women in our study. At the same time, those interested in contraception confronted significant barriers in their efforts to prevent pregnancies. We conclude with suggested interventions that would make general, gynecological, and reproductive health care more accessible to homeless women.

While disparities in health and health care between vulnerable (e.g., minorities, low income) and majority populations are well documented, less is known about disparities within these special populations that are large and diverse. Such knowledge is essential to determine the most needy within these generally needy populations and to plan interventions to reduce their health and health care disparities. With data from 1,331 women residing in Los Angeles County, in one of the largest, most comprehensive studies of the health of homeless women to date, we examined the health and health care disparities among homeless African American, Latina and white women. We further explored if race/ethnicity and other factors that predispose homeless women to poor health or enable them to obtain better health care were associated with their unmet need for medical care. We found that white, non-Latina women were more likely to report unmet need than African Americans and Latinas, and women suffering from drug abuse, violence, or depression were most in need of care. These findings should be considered in targeting and addressing the special needs of homeless women of different racial/ethnic groups.

Aims To assess the effect of a multi-component primary care (PC)-delivered BI for reducing risky drug use (RDU) among patients identified by screening. Design Multicenter single-blind two-arm randomized controlled trial of patients enrolled from February 2011 to November 2012 with 3-month follow-up. Randomization and allocation to trial group were computer-generated. Setting Primary care waiting rooms of 5 federally qualified health centers (FQHCs) in Los Angeles County (LAC), USA. Participants 334 adult primary care patients (171 intervention; 163 control) with RDU scores (4–26) on the WHO Alcohol, Smoking and Substance Involvement Screening Test (ASSIST) self-administered on tablet PCs; 261 (78%) completed follow-up. Mean age was 41.7 years; 63% were male; 38% were Caucasian. Intervention(s) and Measurement Intervention patients received brief (typically 3–4 minutes) clinician advice to quit/reduce their drug use reinforced by a video doctor message, health education booklet, and up to two 20–30 minute follow-up telephone drug use coaching sessions. Controls received usual care and cancer screening information. Primary outcome was patient self-reported use of highest scoring drug (HSD) at follow-up. Findings Intervention and control patients reported equivalent baseline HSD use; at follow-up, after adjustment for covariates in a linear regression model, intervention patients reported using their HSD an average of 2.21 fewer days in the previous month than controls (p<0.005). No compensatory increases in use of other measured substances were found (p>0.10). Conclusions A clinician-delivered brief intervention with follow-up counseling calls may decrease drug use among risky users compared with usual care in low-income community health centers of Los Angeles County, USA.

Findings suggest physician characteristics that may be associated with filling workforce gaps in underserved areas. Restructuring financial incentive programs to support physician leaders and specialists with characteristics associated with IWUP may complement similar policies in primary care and could have key impacts on health equity in underserved areas.