Unsheltered homeless and unstably housed adults have higher levels of stress and more health risk factors than sheltered homeless adults

Abstract

Background: In the United States, approximately 568,000 individuals are homeless on a single night. Homelessness can be categorized into three subgroups: sheltered homeless, unsheltered homeless, and unstably housed. Few studies have examined the relations between homelessness subtypes, shelter service utilization, levels of stress experienced, and health risk factors. This study aimed to empirically examine whether shelter status the previous night was related to current stress, recent utilization of shelter-based mental health services, and current health risk factors. Methods: Data were collected at multiple homeless shelters in 2016 in the Oklahoma City area (N=575). All participants completed assessments of demographic characteristics, including age, sex, race, marital status, years of education, and incarceration history and victimization. Multiple linear and logistic regression analyses were conducted to examine relations between homelessness subgroups and outcomes (shelter-based service utilization, health risk factors, and stressors).Results: Results indicated that the sheltered group was younger and more likely to be White than the unsheltered group, had higher levels of education, and reported more lifetime months in jail than the unstably housed group. In addition, unsheltered homeless and unstably housed adults used fewer shelter-based health services, exhibited more health risk factors, experienced greater levels of stress, and had higher levels of food insecurity than sheltered homeless adults.Conclusion: Homeless adults who reside at shelters bene t most from available shelter services. The development of policies and programs targeted toward increasing sheltering options for unsheltered and unstably housed adults is needed.

Analysis of older adult blood pressure readings and hypertension treatment rates among the unsheltered population of Miami‐Dade County

“…Participants with elevated blood pressure are likely facing barriers preventing them from obtaining a diagnosis of hypertension. Previous studies on older adult PEUH diagnosed with hypertension show they face numerous barriers to accessing disease monitoring and management services 6,9,12–14,19,20 . However, participants in these studies already have overcome a significant barrier to care compared to one‐third of our older PEUH cohort, as their hypertension was diagnosed.…”

“…It is also important to consider hypertension rates in older adults experiencing unsheltered homelessness (PEUH) 8 . Studies that compare PEUH to shelter‐based PEH have found these two populations experience different health vulnerabilities 9–14 . For example, a study by Treglia et al 9 .…”

“…Studies conducted in states with Medicaid expansion are reporting results from states with reduced barriers to health care, and PEUH in those states, as a result of the expansion, have easier access to health care. PEUH in the southeast face policies that exacerbate their inability to access housing and health care, limiting the generalizability of results published in other regions 7,22,23 For example, a study on PEUH primary care utilization in Los Angeles, California found less than 10% of PEUH routinely use a primary care physician 13 . These numbers may be further reduced among PEUH living in southeastern states where Medicaid is more limited.…”

“… 8 Studies that compare PEUH to shelter‐based PEH have found these two populations experience different health vulnerabilities. 9 , 10 , 11 , 12 , 13 , 14 For example, a study by Treglia et al. 9 found that shelter‐based PEH tend to use inpatient hospital services at greater rates than PEUH, likely indicating their sheltered status grants them at least a slight reduction in barriers of entry to the health care system.…”

“…PEUH in the southeast face policies that exacerbate their inability to access housing and health care, limiting the generalizability of results published in other regions 7 , 22 , 23 For example, a study on PEUH primary care utilization in Los Angeles, California found less than 10% of PEUH routinely use a primary care physician. 13 These numbers may be further reduced among PEUH living in southeastern states where Medicaid is more limited.…”