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31.10.2018 | Original Article

Residential moves and its association with substance use, healthcare needs, and acute care use among homeless and vulnerably housed persons in Canada

verfasst von: Miriam Harris, Anne Gadermann, Monica Norena, Matthew To, Anita M. Hubley, Tim Aubry, Stephen Hwang, Anita Palepu

Erschienen in: International Journal of Public Health | Ausgabe 3/2019

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Abstract

Objectives

To determine the relationship between housing instability, as measured by the number of residential moves, with problematic substance use, unmet healthcare needs, and acute care utilization.

Methods

A cohort of homeless or vulnerably housed persons from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396) completed interviewer-administered surveys at baseline and annually for 4 years from 2009 to 2013. Generalized mixed effects logistic regression models were used to examine the association between the number of residential moves and each of the three outcome variables, adjusting for potential confounders.

Results

The number of residential moves was significantly associated with higher acute care utilization [adjusted odds ratio (AOR) 1.25; 95% confidence interval (CI) CI: 1.17–1.33], unmet healthcare needs (AOR 1.14; 95% CI: 1.07–1.22), and problematic substance use (AOR 1.26; 95% CI: 1.16–1.36). Having chronic physical or mental conditions and recent incarceration were also found to be associated with the outcomes.

Conclusions

Housing instability increased the odds of all three poor health metrics, highlighting the importance of stable housing as a critical social determinant of health.

Ardilly P, Le Blanc D (2001) Sampling and weighting a survey of homeless persons: a French example. Surv Methodol 27:109–118

Aubry T, Nelson G, Tsemberis S (2015) Housing first for people with severe mental illness who are homeless: a review of the research and findings from the at home—chez soi demonstration project. Can J Psychiatry 60:467–474CrossRefPubMedPubMedCentral

Aubry T, Duhoux A, Klodawsky F, Ecker J, Hay E (2016) A longitudinal study of predictors of housing stability, housing quality, and mental health functioning among single homeless individuals staying in emergency shelters. Am J Community Psychol 58:123–135. https://doi.org/10.1002/ajcp.12067 CrossRefPubMed

Baggett TP, O’Connell JJ, Singer DE, Rigotti NA (2010) The unmet health care needs of homeless adults: a national study. Am J Public Health 100:1326–1333. https://doi.org/10.2105/ajph.2009.180109 CrossRefPubMedPubMedCentral

Baggett TP et al (2013) Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med 173:189–195. https://doi.org/10.1001/jamainternmed.2013.1604 CrossRefPubMedPubMedCentral

Barbor TF, de la Fuente JR, Saunders J, Grant M (1992) AUDIT: the alcohol use disorders identification test: guidelines for use in primary health care. World Health Organization, Geneva

Binswanger IA, Stern MF, Deyo RA, Heagerty PJ, Cheadle A, Elmore JG, Koepsell TD (2007) Release from prison—a high risk of death for former inmates. N Engl J Med 356:157–165. https://doi.org/10.1056/NEJMsa064115 CrossRefPubMedPubMedCentral

Costa D, Matanov A, Canavan R et al (2012) Service provision and barriers to care for homeless people with mental health problems across 14 European capital cities. BMC Health Serv Res 12:222. https://doi.org/10.1186/1472-6963-12-222 CrossRef

Cunningham WE, Andersen RM, Katz MH et al (1999) The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Med Care 37:1270–1281CrossRefPubMed

Duchon LM, Weitzman BC, Shinn M (1999) The relationship of residential instability to medical care utilization among poor mothers in New York City. Med Care 37:1282–1293CrossRefPubMed

Firestone M, Tyndall M, Fischer B (2015) Substance use and related harms among aboriginal people in Canada: a comprehensive review. J Health Care Poor Underserved 26:1110–1131. https://doi.org/10.1353/hpu.2015.0108 CrossRefPubMed

Frankish CJ, Hwang SW, Quantz D (2005) Homelessness and health in Canada: research lessons and priorities. Can J Public Health 96(Suppl 2):S23–S29PubMedPubMedCentral

French MT, Roebuck MC, McGeary KA, Chitwood DD, McCoy CB (2001) Using the drug abuse screening test (DAST-10) to analyze health services utilization and cost for substance users in a community-based setting. Subst Use Misuse 36:927–946CrossRefPubMed

Gelberg L, Gallagher TC, Andersen RM, Koegel P (1997) Competing priorities as a barrier to medical care among homeless adults in Los Angeles. Am J Public Health 87:217–220CrossRefPubMedPubMedCentral

Gerlitz J, Joyce R, Gadermann AM, Hubley AM, Zhu SM, Stowe M, Palepu A (2017) Observations from the field: interviewers’ experiences in interviewing and retaining homeless and vulnerably housed participants in longitudinal research. J Soc Distress Homeless 26:128–137CrossRef

Hwang SW (2000) Mortality among men using homeless shelters in Toronto, Ontario. JAMA 283:2152–2157CrossRefPubMed

Hwang SW (2005) Fifteen per cent of people treated for mental health disorders are homeless. Evid Based Ment Health 8:118CrossRefPubMed

Hwang SW, Aubry T, Palepu A et al (2011) The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities. Int J Public Health 56:609–623. https://doi.org/10.1007/s00038-011-0283-3 CrossRefPubMed

Hwang SW, Chambers C, Katic M (2016) Accuracy of self-reported health care use in a population-based sample of homeless adults. Health Serv Res 51(1):282–301. https://doi.org/10.1111/1475-6773.12329 CrossRefPubMed

Jaworsky D et al (2016) Residential stability reduces unmet health care needs and emergency department utilization among a cohort of homeless and vulnerably housed persons in Canada. J Urban Health 93:666–681. https://doi.org/10.1007/s11524-016-0065-6 CrossRefPubMedPubMedCentral

Khandor E, Mason K, Chambers C, Rossiter K, Cowan L, Hwang SW (2011) Access to primary health care among homeless adults in Toronto, Canada: results from the street health survey. Open Med 5:e94–e103PubMedPubMedCentral

Kirby JB, Kaneda T (2006) Access to health care: does neighborhood residential instability matter? J Health Soc Behav 47:142–155CrossRefPubMed

Krausz RM, Clarkson AF, Strehlau V, Torchalla I, Li K, Schuetz CG (2013) Mental disorder, service use, and barriers to care among 500 homeless people in 3 different urban settings. Soc Psychiatry Psychiatr Epidemiol 48:1235–1243. https://doi.org/10.1007/s00127-012-0649-8 CrossRefPubMed

Kushel MB, Gupta R, Gee L, Haas JS (2006) Housing instability and food insecurity as barriers to health care among low-income Americans. J Gen Intern Med 21:71–77. https://doi.org/10.1111/j.1525-1497.2005.00278.x CrossRefPubMedPubMedCentral

Lasser KE, Himmelstein DU, Woolhandler S (2006) Access to care, health status, and health disparities in the United States and Canada: results of a cross-national population-based survey. Am J Public Health 96:1300–1307. https://doi.org/10.2105/ajph.2004.059402 CrossRefPubMedPubMedCentral

Leaver CA, Bargh G, Dunn JR, Hwang SW (2007) The effects of housing status on health-related outcomes in people living with HIV: a systematic review of the literature. AIDS Behav 11:85–100CrossRefPubMed

Lee TC, Hanlon JG, Ben-David J, Booth GL, Cantor WJ, Connelly PW, Hwang SW (2005) Risk factors for cardiovascular disease in homeless adults. Circulation 111:2629–2635CrossRefPubMed

Maisto SA, Carey MP, Carey KB, Gordon CM, Gleason JR (2000) Use of the AUDIT and the DAST-10 to identify alcohol and drug use disorders among adults with a severe and persistent mental illness. Psychol Assess 12:186–192CrossRefPubMed

O’Campo P et al (2016) How did a housing first intervention improve health and social outcomes among homeless adults with mental illness in Toronto? two-year outcomes from a randomised trial. BMJ Open 6:e010581. https://doi.org/10.1136/bmjopen-2015-010581 CrossRefPubMedPubMedCentral

O’Connell MJ, Kasprow W, Rosenheck RA (2008) Rates and risk factors for homelessness after successful housing in a sample of formerly homeless veterans. Psychiatr Serv 59:268–275CrossRefPubMed

Reid KW, Vittinghoff E, Kushel MB (2008) Association between the level of housing instability, economic standing and health care access: a meta-regression. J Health Care Poor Underserved 19:1212–1228CrossRefPubMed

Russolillo A, Moniruzzaman A, Parpouchi M, Currie LB, Somers JM (2016) A 10-year retrospective analysis of hospital admissions and length of stay among a cohort of homeless adults in Vancouver, Canada. BMC Health Serv Res 16:60. https://doi.org/10.1186/s12913-016-1316-7 CrossRefPubMedPubMedCentral

Sadowski LS, Kee RA, VanderWeele TJ, Buchanan D (2009) Effect of a housing and case management program on emergency department visits and hospitalizations among chronically ill homeless adults: a randomized trial. JAMA 301:1771–1778CrossRefPubMed

Sanmartin C, Houle C, Tremblay S, Berthelot JM (2002) Changes in unmet health care needs. Health Rep 13:15–21PubMed

Schinka JA, Curtiss G, Leventhal K, Bossarte RM, Lapcevic W, Casey R (2016) Predictors of mortality in older homeless veterans. J Gerontol Ser B Psychol Sci Soc Sci 1:9. https://doi.org/10.1093/geronb/gbw042 CrossRef

Stahre M, VanEenwyk J, Siegel P, Njai R (2015) Housing insecurity and the association with health outcomes and unhealthy behaviors, Washington State, 2011. Prev Chronic Dis 12:E109. https://doi.org/10.5888/pcd12.140511 CrossRefPubMedPubMedCentral

Suglia SF, Duarte CS, Sandel MT (2011) Housing quality, housing instability, and maternal mental health. J Urban Health 88:1105–1116. https://doi.org/10.1007/s11524-011-9587-0 CrossRefPubMedPubMedCentral

The Health and Housing in Transition (HHiT) Study Team (2015) Housing definitions and housing variables. University of Toronto TSpace. https://tspace.library.utoronto.ca/handle/1807/69938. Published 2015. Accessed 21 June 2018

To MJ, Palepu A, Aubry T et al (2016) Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study. BMC Public Health 16:1041. https://doi.org/10.1186/s12889-016-3711-8 CrossRefPubMedPubMedCentral

Tsemberis S, McHugo G, Williams V, Hanrahan P, Stefancic A (2007) Measuring homelessness and residential stability: the residential time-line follow-back inventory. J Community Psychol 35:29–42CrossRef

Weinreb L, Goldberg R, Perloff J (1998) Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers. J Gen Intern Med 13:389–397CrossRefPubMedPubMedCentral

Weinreb L, Perloff J, Goldberg R, Lessard D, Hosmer DW (2006) Factors associated with health service utilization patterns in low-income women. J Health Care Poor Underserved 17:180–199. https://doi.org/10.1353/hpu.2006.0036 CrossRefPubMed

Titel: Residential moves and its association with substance use, healthcare needs, and acute care use among homeless and vulnerably housed persons in Canada
verfasst von: Miriam Harris
Anne Gadermann
Monica Norena
Matthew To
Anita M. Hubley
Tim Aubry
Stephen Hwang
Anita Palepu
Publikationsdatum: 31.10.2018
Verlag: Springer International Publishing
Erschienen in: International Journal of Public Health / Ausgabe 3/2019
Print ISSN: 1661-8556
Elektronische ISSN: 1661-8564
DOI: https://doi.org/10.1007/s00038-018-1167-6

Springer Medizin

Abstract

Objectives

Methods

Results

Conclusions

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