Biomedical subjects

Stephen W Hwang

Publications and source records attributed to Stephen W Hwang.

21 records · Page 2Linked to original sources

PubMedDate not supplied

Is homelessness hazardous to your health? Obstacles to the demonstration of a causal relationship.

BACKGROUND: Homeless people suffer from high levels of morbidity and mortality, but there is surprisingly little empiric evidence that homelessness has a direct adverse effect on health. METHODS: This study examined the relationship between shelter use and risk of death using longitudinal data in a cohort of 8,769 homeless men in Toronto, Ontario. Shelter use was modelled as a time-dependent covariate in a Cox regression analysis. RESULTS: In a model adjusted for age and previous pattern of homelessness, the risk of death during months in which homeless shelters were used was significantly increased (hazard ratio, 1.84; 95% confidence interval, 1.27-2.67). CONCLUSIONS: Among men, periods of homeless shelter use are associated with higher mortality. There are three reasons why this finding does not necessarily mean that homelessness itself increases the risk of death. First, the hazard of death associated with shelter use compared to non-shelter use may be significantly different from that associated with homelessness compared to non-homelessness. Second, the association between shelter use and risk of death may be confounded by other variables such as alcohol and drug use. Finally, because the mechanism and time-course of the putative effect of homelessness on health is uncertain, appropriate modelling of the time-dependent covariate is difficult to ensure. Further research into the possible adverse effects of homelessness on health is needed and would have important implications for public policy.

Adolescent↗

PubMedDate not supplied

The relationship between housing conditions and health status of rooming house residents in Toronto.

BACKGROUND: Rooming houses are an important source of housing for low-income Canadians. Little information is available on the relationship between housing conditions and health status in this vulnerable population. METHODS: Interviews were conducted with a representative sample of 295 residents in 171 rooming houses in Toronto. Health status was assessed using the SF-36. The physical attractiveness of each rooming house was rated using the Multiphasic Environmental Assessment Procedure. Associations between the health status of residents and the physical attractiveness and organizational characteristics of rooming houses were examined. RESULTS: Rooming house residents aged 35 years and older had significantly poorer health status than their counterparts in the Canadian general population. Eight of the ten dimensions of individual health status assessed by the SF-36 were significantly correlated with the physical attractiveness of the rooming house in which the individual lived. However, there was no significant association between residents' health status and the rooming house's non-profit status, provision of meals, or the presence of an on-site landlord. CONCLUSIONS: Rooming house residents suffer from a high prevalence of ill health. Residents reporting worst health are concentrated in rooming houses in the poorest physical condition. This relationship may be mediated by selection processes that place the sickest individuals in the lowest-quality rooming houses, and/or by a direct effect of adverse housing conditions on health status. Further research is needed to elucidate these processes and to improve the health of this vulnerable population.

Adult↗

PubMedDate not supplied

Homelessness and health in Canada: research lessons and priorities.

This article was for prepared for an international think-tank on reducing health disparities and promoting equity for vulnerable populations. Its purposes are to provide an overview of homelessness research and to stimulate discussion on strategic directions for research. We identified studies on homelessness, with an emphasis on Canadian research. Studies were grouped by focus and design under the following topics: the scope of homelessness, the health status of homeless persons, interventions to reduce homelessness and improve health, and strategic directions for future research. Key issues include the definition of homelessness, the scope of homelessness, its heterogeneity, and competing explanations of homelessness. Homeless people suffer from higher levels of disease and the causal pathways linking homelessness and poor health are complex. Efforts to reduce homelessness and improve health have included biomedical, educational, environmental, and policy strategies. Significant research gaps and opportunities exist in these areas. Strategic research will require stakeholder and community engagement, and more rigorous methods. Priorities include achievement of consensus on measuring homelessness, health status of the homeless, development of research infrastructure, and ensuring that future initiatives can be evaluated for effectiveness.

Adult↗