In 2023, the number of homeless US individuals on any given day was more than 650 000, an increase of more than 70 000 from just 1 year earlier. 1 Individuals experiencing homelessness represent all segments of society: 30% are members of families with children, and 20% are older than 55 years. 1 There are substantial racial disparities; 37% of unhoused people are Black (compared with 13% of US population), while Latino/Hispanic individuals comprise more than half of the recent increase in people experiencing homelessness.The association between housing status and health is clear. Adults who experience homelessness are more likely to receive substandard care for cardiovascular disease and cancer and experience higher hospitalization rates, inferior obstetric outcomes, and an overall poorer health status. 2-5 So it is not surprising that homeless individuals experience a mortality rate more than 3-fold higher than the general population. 6 Access to adequate housing is not only an issue of independence and dignity, but also a clinical and public health concern.Housing status can be associated with health through exposure to violence. In an ambitious survey study in this issue of JAMA Internal Medicine, Hargrave and colleagues 7 address an important knowledge gap by assessing the prevalence of physical, sexual, and other forms of violence among individuals experiencing homelessness in California. Recruiting in homeless shelters, nonshelter support venues, and encampments, the investigators surveyed a sample of more than 3000 individuals, more than half of whom reported spending most nights sleeping in unsheltered outdoor locations.Their findings are deeply unsettling, as 74% reported experiencing lifetime violence. During the 6 months before their current episode of homelessness, 24.5% of participants reported that they had experienced physical violence, with 36% experiencing physical violence during their current episode. Violent victimization before homelessness was associated with 3-fold to 4-fold increased odds of physical or sexual victimization during homelessness. During the current episode of homelessness, 36.1% experienced physical violence, 9.8% sexual violence, and 37.9% either.These findings underscore the continuing need to address homelessness through clinical and policy lenses. Access to appropriate and comprehensive care for depression, schizophrenia, and substance misuse (all risk factors for homelessness) can be associated with improved financial stability and ability to maintain employment and housing. However,
