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PubMed1992

A model of homeless migration: homeless men in Skid Row, Los Angeles.

"In this paper a conceptual model of homeless migration is developed that links migration behavior with the coping status of homeless individuals. The model is evaluated by using data drawn from a recent random probability sample of men surveyed in Skid Row, Los Angeles, [California]. Results indicate that homeless migrants tended to be young, never married, white, mentally disabled, and either newly or cyclically homeless individuals. Long-term residents, in contrast, were apt to be older, physically disabled or suffering from a health-related problem, and had been homeless for some time. The dominant reason given for moving was to find a job...." Coping strategies and migration behaviors are also described.

Age Factors↗
PubMed1991

Characteristics of a random sample of emergency food program users in New York: II. Soup kitchens.

A random sample of soup kitchen clients in New York City was studied and specific comparisons made on various parameters including homelessness. Compared with the general population of low income persons, soup kitchen users were overwhelmingly male, disproportionately African-American, and more likely to live alone. The homeless (41 percent of the sample) were less likely to receive food stamps or free food, or to use food pantries. Fewer of them received Medicaid or had health insurance. Forty-seven percent had no income in contrast to 29 percent of the total sample.

Adult↗
PubMed2005

Housing status and HIV risk behaviors: implications for prevention and policy.

This paper examines housing as a contextual factor affecting drug and sexual risk behaviors among HIV positive people using pooled interview data from 2149 clients presenting for services at 16 medical and social service agencies participating in a multi-site evaluation study. The odds of recent drug use, needle use or sex exchange at the baseline interview was 2-4 times as high among the homeless and unstably housed compared to persons with stable housing. Follow-up data collected 6-9 months after baseline showed that change in housing status was associated with change in risk behaviors. Persons whose housing status improved between baseline and follow-up significantly reduced their risks of drug use, needle use, needle sharing and unprotected sex by half in comparison to individuals whose housing status did not change. In addition, for clients whose housing status worsened between baseline and follow-up, their odds of recently exchanging sex was over five times higher than for clients whose housing status did not change. The provision of housing is a promising structural intervention to reduce the spread of HIV.

Adolescent↗
PubMed2005

Voluntary HIV testing among adults with severe mental illness: frequency and associated factors.

Adults with severe mental illness (SMI) are disproportionately affected by HIV/AIDS. This study describes the frequency and associated factors of HIV testing among psychiatric outpatients (N = 150) in a small Northeastern city. A structured clinical interview assessed demographic, psychosocial, behavioral, and psychiatric factors. In the past year, 41% of participants were HIV tested. A hierarchical linear regression model revealed the following multivariate correlates: lower educational attainment, HIV risk behavior, greater social support, homelessness, non-psychotic disorder, borderline personality disorder, and greater treatment utilization. Psychiatric factors remained significant correlates of HIV testing after accounting for psychosocial and behavioral factors. Although HIV testing occurred among a substantial proportion of participants, 45% of individuals who engaged in HIV risk behavior were not tested in the past year. Adults with SMI are in need of interventions promoting routine HIV testing and risk-reduction counseling.

AIDS Serodiagnosis↗
PubMed1991

Specialty roles in community health nursing: a national survey of educational needs.

This study identified population groups, health conditions, and employment settings considered appropriate for graduate-level community health nursing (CHN) practice and employment, and described the relative importance of each of these areas as assessed by CHN leaders. According to 588 leaders in CHN service and education, (1) the population groups most in need of graduate-prepared CHNs are the elderly, persons of low socioeconomic status, the homeless, adolescents, and the unemployed; and (2) the health conditions most in need of CHN services are AIDS, pregnancy and prenatal problems, low birth weight and infant mortality, stress-related illness, and Alzheimer's and other chronic diseases of the elderly. Among the many employment settings rated as having a great need for CHNs are state and local health departments and home health agencies. The findings provide the direction and justification for developing specialty options within CHN that correspond to these identified and changing needs. This article provides suggestions and possible alternatives for initiating educational change to prepare graduate-level CHNs for these various specialties and for the settings in which the specialties will be applied.

Community Health Nursing↗
PubMed1994

Community analysis: a collaborative community practice project.

Lack of access to health care is a concern in many communities. A group of representatives from health, social service, other community agencies and nursing education meet regularly to address issues in providing care to homeless, low-income, and uninsured persons in Spokane, Washington. This group's efforts has been hampered by lack of clearly identified factors that adversely affect access to care. One aspect of community analysis performed by this group used a collaborative community practice model. Community diagnoses were determined from information collected from service providers. Community health nursing faculty, as clinical specialists, can play a role in such a collaborative process.

Community Health Nursing↗
PubMed1996

Impoverished women at risk for AIDS. Social support variables.

1. Among impoverished and homeless individuals, little is known about the impact of social support, defined as emotional, informational, and tangible help that may have health-sustaining and stress-reducing functions. 2. A lack of positive social support, unemployment, and the prevalence of poor physical health and psychological distress may contribute to the extreme vulnerability of indigent populations. 3. Information is needed about the social support network of homeless and impoverished women related to personal and behavioral variables, particularly illegal drug use and risky sexual activity, and mental health status.

Acquired Immunodeficiency Syndrome↗
PubMed2001

[Stomato-oncological screening examinations: possibilities for early diagnosis]

The dramatic increase in the mortality of lip- and oral cancers in Hungary in the last decades points to the importance of primary and secondary prevention. Stomato-oncological screening examinations belong to the latter category, and might represent useful tools in the early diagnosis and treatment of oral carcinomas and precancerous lesions. The aim of the paper is to review the methods, results and effectivity of stomato-oncological screening examinations in Hungary. Between 1962 and 2000 nine screening examinations were performed: one on a population sample, one in an industrial setting, four connected to X-ray lung-screening examinations (one with the help of a mobile unit), one on voluntary persons, one on high risk people (homeless), one in general medical practice. Among these, in the last five years, in the course of the stomato-oncological examination of 17325 individuals, oral carcinoma has been found in 0.12%, and oral precanceroses in 2.63%. Although the general dentist is obliged by law to perform a stomato-oncological examination on the patients appearing in the practice, unfortunately, about 50-to-90% of the population does not visit a dentist regularly. The regular examination of these - high risk - groups by the help of the above methods, including the help of general medical practitioners is highly recommended.

Journal Article↗
PubMed1999

Mortality among homeless shelter residents in New York City.

OBJECTIVES: This study examined the rates and predictors of mortality among sheltered homeless men and women in New York City. METHODS: Identifying data on a representative sample of shelter residents surveyed in 1987 were matched against national mortality records for 1987 through 1994. Standardized mortality ratios were computed to compare death rates among homeless people with those of the general US and New York City populations. Logistic regression analysis was used to examine predictors of mortality within the homeless sample. RESULTS: Age-adjusted death rates of homeless men and women were 4 times those of the general US population and 2 to 3 times those of the general population of New York City. Among homeless men, prior use of injectable drugs, incarceration, and chronic homelessness increased the likelihood of death. CONCLUSIONS: For homeless shelter users, chronic homelessness itself compounds the high risk of death associated with disease/disability and intravenous drug use. Interventions must address not only the health conditions of the homeless but also the societal conditions that perpetuate homelessness.

Adult↗
PubMed1996

[Psychiatric homelessness research. From "psychopathology of the vagrant" to "homeless mentally ill"].

German psychiatrists around 1900 reported that dementia praecox and other mental disorders were common among homeless individuals. On the basis of the concept of psychopathy, homelessness in the 1920s was viewed as an "inferiority of character". The combination of psychiatric diagnosis and social prejudice was used as a justification for the "elimination of abnormal personalities" during the Third Reich. Growing numbers of homeless individuals in the last two decades stimulated a new interest in psychiatric research on the homeless. Larger epidemiological studies show high prevalence rates for severe mental disorders (schizophrenia, affective disorders, substance abuse). This points to the urgent need to develop sophisticated and sensible concepts to deal effectively with the complex problems associated with homelessness.

Germany↗
PubMed2005

Homelessness among people with severe mental illness in Switzerland.

QUESTIONS UNDER STUDY: This study addresses socio-demographic and clinical characteristics among homeless people in Switzerland admitted to inpatient care, the use of and pathways to inpatient care by this group and, the extent to which psychiatric disorders contribute to the risk of homelessness. METHODS: Based on data of a psychiatric case register we analysed 16247 people consecutively referred to psychiatric hospitals of a catchment area in Switzerland between 1998 and 2001. RESULTS: 1.6% of all admitted patients (N = 257) were homeless (mean age: 34.4 years; women: 30.0%). The homeless as compared to other psychiatric inpatients had higher rates of substance use disorders, equal rates of psychotic and personality disorders, but lower rates of organic and affective disorders. Homeless people were more often compulsorily or as an emergency admitted. General practitioners (GPs) were less involved in the admission. The homeless had a shorter inpatient stay and their health status did not equally improve like in other patients. Risk factors of being homeless at psychiatric admission were: young age, male gender, single, low education level, urban residence, abuse of illicit drugs, especially multiple substance use, and having a dual diagnosis. CONCLUSIONS: Social factors and psychopathology are independently contributing to the risk of homelessness. Health care inequalities were found with regard to pathways to inpatient care (high rate of compulsory and emergency admissions, low involvement of GPs) and hospital stay (shorter stay, less improvement). Compared to other countries, disproportionate use of inpatient resources by homeless people could not be confirmed.

Adult↗
PubMed1990

The homeless mentally ill and community-based care: changing a mindset.

The care of persons with severe, persistent and disabling mental illness has received increasing attention during the past ten years. This focus is due, to some extent, to the increased visibility of a subset of this population, the large number of individuals with psychiatric problems who have become homeless. These men and women, who are without homes or in temporary residences, present a sophisticated array of needs and a multiplicity of problems which have rendered most communities impotent to provide appropriate and adequate rehabilitative services. To date, there is no "perfect" community-based system of care for these men and women. What exists is a hodge-podge of shelter, outreach and drop-in center services. Most of these provide little more than a bed (or a chair) to sleep on, a hot meal and refuge from inclement weather. This article discusses some of the issues and assumptions that inhibit and foster the development and provision of a comprehensive system of community-based care for persons with serious and persistent mental disorders who have become homeless. A framework, useful in reconceptualizing the clients, the services and the interaction between them is presented.

Community Mental Health Services↗
PubMed1991

Sampling the difficult-to-sample.

Difficult-to-sample populations are defined as rare populations or populations that are difficult to locate, enumerate or interview. This definition includes subgroups of the United States population that are at increased risk of adverse health effects associated with malnutrition. Examples include persons who are rare (pregnant women), difficult to locate (migrant farm workers), difficult to enumerate (homeless individuals) or difficult to interview (substance abusers). Probability methods to sample rare and elusive populations are reviewed briefly. Methods include disproportionately allocated sampling, multiplicity sampling and the use of multiple frames. The advantages and disadvantages of nonprobability sampling methods are compared using criteria typically applied to assess alternative probability sampling methods. The cost of data collection alone may prohibit consideration of probability sampling methods, but caution is urged before abandoning this statistically sound approach to sample selection. Considerations for sampling the difficult-to-sample are illustrated for one such population, the homeless.

Female↗
PubMed2003

Finding contacts of homeless tuberculosis patients in New York City.

OBJECTIVE: To determine factors associated with no contacts identified for homeless patients in New York City. DESIGN: Culture-confirmed pulmonary tuberculosis cases in persons >18 years old diagnosed in 1997-1999 were included. Demographic and clinical characteristics of tuberculosis patients associated with the number of contacts identified according to homeless status were analyzed using unconditional logistic regression. RESULTS: Homeless patients (n = 152) had a significantly lower median number of contacts than non-homeless patients (n = 2836) (1 vs. 4, P < 0.001). Among homeless patients, having AFB smear-positive sputum with cavitary lesions reduced the likelihood of having no contacts identified. Homeless patients who lived on the street at the time of diagnosis were more likely to have no contacts identified compared to those with contacts identified (61.4% vs. 56.1%); however, the difference was not statistically significant (P = 0.506). Unlike non-homeless patients, being hospitalized at the time of tuberculosis diagnosis was not associated with having contacts identified in homeless patients. CONCLUSIONS: Homelessness independently predicted the likelihood of having no contacts identified. Strategies such as interviews that focus on location rather than persons may be more effective for identifying contacts. Furthermore, being homeless at the time of diagnosis should be used as an indicator for prioritizing prompt contact evaluation.

Adult↗
PubMed1992

Street youth and the AIDS pandemic.

Children responsible for their own survival exist in all countries. Despite social and cultural differences between street youth in developing countries versus homeless youth in developed countries, the predictors and correlates of homelessness are similar among youth. The AIDS pandemic is inextricably linked to homelessness and is a particularly devastating threat to the welfare of the world's disenfranchised youth, as they are continually forced into multiple HIV-related high risk situations and behaviors. Specific recommendations regarding clinical care, prevention programs, research, and the implications for policy and legislative action are discussed in relation to reducing the incidences and impact of HIV. For the world's populations of street children the issue of globally providing AIDS education and prevention within the context of health care services is emphasized, particularly by the promotion and training of physicians and other health professionals in street-based care.

Acquired Immunodeficiency Syndrome↗
PubMed1990

Drug resistant tuberculosis among the homeless in New York City.

The purpose of this study was to compare the frequency of infections due to drug resistant Mycobacterium tuberculosis between homeless and nonhomeless populations in an urban community hospital. We retrospectively examined the mycobacteriology registry of this hospital for culture-proven, susceptibility-tested cases of M tuberculosis disease from 1982 to 1987. Clinical records were analyzed for age, ethnicity, sex, residence, and history of alcoholism, intravenous drug abuse, acquired immunodeficiency syndrome, or previous tuberculosis. Of a total of 132 cases, 53 patients were homeless and 79 were not. Drug resistance was found in 21% of the isolates from homeless individuals and 8% of those from nonhomeless persons. Resistance to isoniazid was found in 19% and 1% (p less than 0.01), and for two or more drugs in 15% and 0% (p, 0.01), respectively. Forty-two patients were black, and among them, resistance to one or more drugs was 26.2%, versus 6.6% in nonblacks (p less than 0.01). Ten of 24 homeless blacks had resistant organisms, as opposed to 1 of 18 nonhomeless blacks (p less than 0.05). No other significant differences were noted for the other variables. To our knowledge, this is the first comparison of drug-resistant tuberculosis between homeless and nonhomeless patients using an internal control group. Forty percent of isolates from homeless blacks were resistant, two thirds to both isonlazid and rifampin. These findings support the use of an initial four-drug regimen to treat tuberculosis in this specific population.

Black or African American↗
PubMed1991

Street youth: adaptation and survival in the AIDS decade.

This article discusses adaptational and survival strategies of homeless youth and describes how pilot research, begun in 1982 on these strategies in the western United States, led to additional research and activity focused upon the related international street youth problem. The results of this research suggest that a critical relationship exists between survival strategies and the AIDS pandemic. The impact of this pandemic on street youth can be mitigated only by immediate and comprehensive preventive actions at both national and international levels.

Acquired Immunodeficiency Syndrome↗