The Urban Homeless: Estimating Composition and Size

Rossi, Peter H.; Wright, James; Fisher, Gene A.; Willis, Georgianna

doi:10.1126/science.2950592

Cited by 250 publications

(149 citation statements)

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“…Recurrent housing instability can lead to homelessness as a result of selective accumulation of these social, behavioral, and childhood risk factors over time. 4,12 White homeless women, when compared with homeless women of other racial/ethnic minorities and all homeless men, are more likely to experience mental health and substance use disorders, intimate partner violence, problematic childhood experiences such as foster care or institutional placement, childhood sexual and physical abuse, and family disruptions. 12,13,44 To some extent, homelessness among black or Latina women stem more from extreme poverty or an inability to afford low-income housing, than from social, behavioral, or childhood risk factors that are significantly more prevalent among white women.…”

Section: Discussionmentioning

confidence: 99%

“…We created a composite measure of housing instability, which we defined as 92 persons per bedroom (total number of people living in the household including children/number of bedrooms in the household), 33 or moving frequently (eight or more moves in the past 2 years, excluding people who were currently in school, college or graduate school) or currently occupying a place without paying rent or money as a proxy for living doubled up. [1][2][3][4][5] For the latter component, participants were asked, "Is the home where you live: owned or being bought by you (or someone else in the household), rented for money, or occupied without paying rent or money?" Participants who reported living in a home that was occupied without paying rent or money were considered as living doubled up.…”

Section: Housing Instabilitymentioning

confidence: 99%

“…Definitions include living doubled up with family or friends or moving frequently due to an inability to pay rent, living in overcrowded conditions, or spending more than 50 % of household income on rent. [1][2][3][4][5][6] Housing instability, a growing public health problem, has received national attention because of the lack of affordable low-income housing, the foreclosure crisis, and rising unemployment. 7, 8 The number of people living doubled up (one definition of housing instability) increased by 5 % from 4.6 million in 2005 to 4.8 million adults in 2008.…”

Section: Introductionmentioning

confidence: 99%

“…8,10 Recurrent housing instability can lead to homelessness. 4 Blacks and men are disproportionately represented among homeless adults. 11 While white women are least likely to experience homelessness, those who are homeless comprise a uniquely vulnerable group with respect to psychosocial risk factors that are distinct from being black or male.…”

Section: Introductionmentioning

confidence: 99%

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Housing Instability and Incident Hypertension in the CARDIA Cohort

et al. 2012

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Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990-1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N=5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N=4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9-1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, G0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4-9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.

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Section: Discussionmentioning

confidence: 99%

Section: Housing Instabilitymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Housing Instability and Incident Hypertension in the CARDIA Cohort

et al. 2012

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“…[59][60][61][62] Three sampling strata were defined: individuals who used shelter beds, those who did not use shelter beds but did use soup lines, and those sampled from street locations who used neither. Interviews were allocated to each stratum in proportion to the estimated number of homeless persons in that stratum.…”

Section: Subjects and Proceduresmentioning

confidence: 99%

Tuberculosis Skin Testing Among Homeless Adults

Gelberg

Panarites²,

Morgenstern

et al. 1997

J Gen Intern Med

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OBJECTIVE:To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB. DESIGN:Cross-sectional study. SETTING: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.PARTICIPANTS: A representative sample of 260 homeless adults. MEASUREMENTS AND MAIN RESULTS:Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%: 40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age. nderstanding the epidemiology of tuberculosis (TB) among the homeless, as well as other high-risk populations, is critical. Despite relatively recent predictions that TB could be eradicated in the United States by the year 2010, 1-3 we have been confronted by a sharp rise in active TB (10% increase between 1985 and 1994) 4 and an increase in multidrug-resistant TB since 1985 when reported cases of TB reached their lowest levels since national reporting began in 1953. [4][5][6][7] This increase in active TB has also led to increased numbers of individuals with newly acquired asymptomatic TB infection resulting from contact with persons with active contagious disease. Such individuals are at increased risk of developing active disease: the 1-year risk of becoming an active case is 3% within 1 year of infection and 0.5% in each subsequent year after 2 years of infection. 8 A multiplicity of factors, including the HIV/AIDS epidemic, increasing poverty and homelessness in America's cities, illicit drug use, budgetary constraints on local health departments, immigration from high-prevalence nations, and high rates of noncompliance among TB patients, have contributed to the resurgence of TB. [9][10][11][12][13][14][15][16][17][18][19][20][21][22] Previous research on homeless adults demonstrated their elevated risk of asymptomatic TB infection, active disease, and multidrug-resistant TB. [23][24][25][26][27][28] Further, reports have cited outbreaks of TB in emergency shelters for the homeless in Boston and Ohio,29,30 as well as in a neighborhood bar frequented by a homeless person with active disease. 31 Why is the risk of TB increased among homeless persons? Among the homeless, men outnumber women approximately four to one and ethnic and racial minority groups, especially African Americans, are overrepresented. [32][33][34] A disproportionate number of individuals with serious mental health problems (including previous psychiatric hospitalization), or a history of substance dependence, have been found among the homeless, and a significant number of homeless persons have dual diagnoses of mental illness and substance dependence. [35][36][37][38] Further, homeless persons have gr...

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The Cutaneous Manifestations of Violence and Poverty

Moy¹

1992

Arch Dermatol

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The Urban Homeless: Estimating Composition and Size

Cited by 250 publications

References 6 publications

Housing Instability and Incident Hypertension in the CARDIA Cohort

Housing Instability and Incident Hypertension in the CARDIA Cohort

Tuberculosis Skin Testing Among Homeless Adults

The Cutaneous Manifestations of Violence and Poverty

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