Special Issue "Health and Health Care for Homeless People in Various Contexts"

Special Issue Editors

Dr. Stéphanie Vandentorren
E-Mail Website
Guest Editor
Department of social epidemiology, Institut Pierre Louis d’Epidémiologie et de Santé Publique (IPLESP), Sorbonne Université, Inserm, F75012 Paris, France
Interests: environmental health; social epidemiology; vulnerable populations; outbreaks; epidemiology; children
Special Issues and Collections in MDPI journals
Dr. Pierre Chauvin
E-Mail Website
Guest Editor
INSERM, Sorbonne Universités, UPMC Univ Paris 06, Institut Pierre Louis d’Épidémiologie et de Santé Publique, Department of social epidemiology, 27 rue Chaligny, 75012 Paris, France
Interests: social epidemiology; social exclusion; migrants health; homelesness; health care access; neighborhood factors; urban health

Special Issue Information

Dear Colleagues,

Homelessness has increased in recent years in many industrialized countries, even though this evolution and the profiles of homeless populations could differ according to national and local contexts. In some countries, people may have lost their homes at the peak of the economic crisis. In some wealthy cities, the cost of housing or the saturation of social housing may fuel a growing homeless population. Even in welfare states, some holes in safety nets may result in the inability to provide adequate housing to various populations for a number of reasons: Rural–urban migration, refugees, minorities, disabled, unemployed, poor or precarious people faced with misfortune, etc.

People experiencing homelessness are sicker than their housed counterparts. Studies of health and healthcare in homeless showed that their physical and mental health statuses are cause for concern. They are more likely to die prematurely—with a life expectancy no more than 50 years—have higer prevalence of sexually transmitted infections, heart attacks, chronic disease, invasive cancers, and mental health problems. The lack of secure and stable shelter, food, income, hygiene, and barriers in accessing health care make it nearly impossible to be healthy. Living conditions on the streets or in shelters (unstable housing, food insecurity, access to drinking water, irregular meal times, etc.) makes it more difficult to stick to complex medicine regimens and for medical follow-up. In addition, the homeless encounter many barriers to accessing health services, such as cost, language, transportation, and discrimination.

Being sick can also induce homelessness. For example, people with mental health diseases are at greater risk of becoming homeless because of their personal vulnerability, disaffiliation, lack of social support, and employment.

The evolution in homelessness in various countries makes it important to study the specific characteristics of some subgroups of homeless. For instance, in some places, the services targeting the homeless population were designed mainly for men, and may not be properly suited to women’s needs. In others, migrants or minorities represent a growing part of homeless people and have specific needs. Homeless children and families also raise specific problems and need specific responses.

Facing these issues, social and health care services and professionals have developped some new programs and practices that deserve to be disseminated in an international perspective, as do results of intervention research, which have been evaluated properly.

Given the potentially heterogeneous features of the homeless population, policy makers need indicators and results of quantitative studies to evaluate and monitor the health needs of these populations, as well as exemples of adequate responses, in order to legitimately allocate the required resources in a general context of public budget constraints.

Dr. Stéphanie Vandentorren
Dr. Pierre Chauvin
Guest Editors

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Keywords

  • Homeless
  • Health status
  • Chronic conditions
  • Social and health care
  • Intervention research
  • Community care
  • Migrants and minorities
  • Women and children
  • Mental health
  • Preventive care
  • Outreach care

Published Papers (8 papers)

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Editorial

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Open AccessEditorial
Health and Health Care for Homeless People in Various Contexts
Int. J. Environ. Res. Public Health 2018, 15(5), 948; https://doi.org/10.3390/ijerph15050948 - 10 May 2018
Abstract
Although there is some uncertainty about the exact number of homeless people at any given time in different countries, it is undeniable that this number has steadily and dramatically grown in the recent years [...] Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)

Research

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Open AccessArticle
Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France
Int. J. Environ. Res. Public Health 2018, 15(3), 520; https://doi.org/10.3390/ijerph15030520 - 14 Mar 2018
Cited by 4
Abstract
This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded [...] Read more.
This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded theory was used to construct an interview guide, conduct multiple interviews with 35 Housing First participants sampled for heterogeneity, and produce memos on their trajectories before and after entering the program based on interview information. Thematic analysis of a representative subsample (n = 13) of memos identified 12 objective factors and 6 subjective factors key to the recovery process. An in-depth re-analysis of the memos generated four recovery themes: (1) the need for secure space favorable to self-reflexivity; (2) a “honeymoon” effect; (3) the importance of even weak social ties; (4) support from and hope among peers. Three challenges to recovery were identified: (1) finding a balance between protection and risk; (2) breaking downward spirals; (3) bifurcating the trajectory. This study provides new insight into the recovery process, understood as a non-linear transformation of an experience—the relationship between objective life conditions and subjective perception of those conditions—which reinforces protective support over risk elements. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
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Open AccessFeature PaperArticle
Food Insecurity in Homeless Families in the Paris Region (France): Results from the ENFAMS Survey
Int. J. Environ. Res. Public Health 2018, 15(3), 420; https://doi.org/10.3390/ijerph15030420 - 28 Feb 2018
Cited by 2
Abstract
The number of families living in shelters in the Paris region (France) has increased by a factor of three in 10 years. In 2013, a survey was performed on homeless families in order to characterize their living conditions, their health needs, and the [...] Read more.
The number of families living in shelters in the Paris region (France) has increased by a factor of three in 10 years. In 2013, a survey was performed on homeless families in order to characterize their living conditions, their health needs, and the developmental problems in children. This probability survey was conducted in 17 languages among 801 homeless families sheltered in emergency centers for asylum-seekers, emergency housing centers, social rehabilitation centers, and social hotels in the Paris region. Among the 772 families that provided data on food security only 14.0% were with food security, whereas 43.3% were with low food security and 9.8% with very low food security (a situation where children are also affected). Stratified multivariate robust Poisson models showed that some characteristics are associated with a higher risk of food insecurity and/or of falling into very low food security, such as residential instability, single parenthood, having more than three children, depressive symptoms, housing in social hostels, and difficult access to cheap or free food locally. Given the wealth of the Paris region, resources and programs should be concentrated on improving the living situation of this vulnerable population. It needs better detection of these families, a closer social follow-up, and an increase in food aid. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
Open AccessFeature PaperArticle
Prevalence of Mental Disorders and Addictions among Homeless People in the Greater Paris Area, France
Int. J. Environ. Res. Public Health 2018, 15(2), 241; https://doi.org/10.3390/ijerph15020241 - 31 Jan 2018
Cited by 6
Abstract
The Samenta study was conducted in 2009 in the Greater Paris area to estimate the prevalence of psychiatric disorders in homeless people. A cross-sectional survey was performed with a three-stage random sample of homeless people (n = 859), including users of day [...] Read more.
The Samenta study was conducted in 2009 in the Greater Paris area to estimate the prevalence of psychiatric disorders in homeless people. A cross-sectional survey was performed with a three-stage random sample of homeless people (n = 859), including users of day services, emergency shelters, hot meal distribution, long-term rehabilitation centres, and social hotels. Information was collected by a lay interviewer, using the Mini International Neuropsychiatric Interview, and completed by a psychologist through an open clinical interview. In the end, a psychiatrist assessed the psychiatric diagnosis according to the International Statistical Classification of Diseases and Related Health Problems (ICD, 10th revision). One third of homeless people in the Paris area had at least one severe psychiatric disorder (SPD): psychotic disorders (13%), anxiety disorders (12%), or severe mood disorders (7%). One in five was alcohol-dependent and 18% were drug users. Homeless women had significantly higher prevalence of anxiety disorders and depression compared to men, who were more likely to suffer from psychotic disorders. Homeless people of French origin were at higher risk of SPD, as well as people who experienced various adverse life events before the age of 18 (running away, sexual violence, parental disputes, and/or addictions) and those who experienced homelessness for the first time before the age of 26. The prevalence rates of the main psychiatric disorders within the homeless population of our study are consistent with those reported in other Western cities. Our results advocate for an improvement in the detection, housing, and care of psychiatric homeless people. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
Open AccessArticle
Current Age, Age at First Sex, Age at First Homelessness, and HIV Risk Perceptions Predict Sexual Risk Behaviors among Sexually Active Homeless Adults
Int. J. Environ. Res. Public Health 2018, 15(2), 218; https://doi.org/10.3390/ijerph15020218 - 26 Jan 2018
Cited by 2
Abstract
While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually [...] Read more.
While HIV disproportionately impacts homeless individuals, little is known about the prevalence of HIV risk behaviors in the southwest and how age factors and HIV risk perceptions influence sexual risk behaviors. We conducted a secondary data analysis (n = 460) on sexually active homeless adults from a cross-sectional study of participants (n = 610) recruited from homeless service locations, such as shelters and drop-in centers, in an understudied region of the southwest. Covariate-adjusted logistic regressions were used to assess the impact of age at homelessness onset, current age, age at first sex, and HIV risk perceptions on having condomless sex, new sexual partner(s), and multiple sexual partners (≥4 sexual partners) in the past 12 months. Individuals who first experienced homelessness by age 24 were significantly more likely to report condomless sex and multiple sexual partners in the past year than those who had a later onset of their first episode of homelessness. Individuals who were currently 24 years or younger were more likely to have had condomless sex, new sexual partners, and multiple sexual partners in the past 12 months than those who were 25 years or older. Those who had low perceived HIV risk had lower odds of all three sexual risk behaviors. Social service and healthcare providers should consider a younger age at homelessness onset when targeting HIV prevention services to youth experiencing homelessness. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
Open AccessArticle
The Relationship between Survival Sex and Borderline Personality Disorder Symptoms in a High Risk Female Population
Int. J. Environ. Res. Public Health 2017, 14(9), 1031; https://doi.org/10.3390/ijerph14091031 - 08 Sep 2017
Cited by 1
Abstract
Engaging in survival sex and mental illness are overrepresented within homeless populations. This article assesses the relationship between symptoms of borderline personality disorder (BPD) and engaging in survival sex among homeless women. One hundred and fifty-eight homeless women completed surveys on self-reported BPD [...] Read more.
Engaging in survival sex and mental illness are overrepresented within homeless populations. This article assesses the relationship between symptoms of borderline personality disorder (BPD) and engaging in survival sex among homeless women. One hundred and fifty-eight homeless women completed surveys on self-reported BPD symptomology and sexual history. Bivariate and multivariate analyses conducted in this study provided insights into the association of experiencing BPD symptoms and engaging in survival sex. Results indicate that some symptoms of BPD are robustly correlated with engaging in survival sex among homeless adult women. Implications for service agencies and others working with at-risk female populations are discussed. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
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Open AccessArticle
Personal Hygiene Practices among Urban Homeless Persons in Boston, MA
Int. J. Environ. Res. Public Health 2017, 14(8), 928; https://doi.org/10.3390/ijerph14080928 - 18 Aug 2017
Cited by 4
Abstract
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors [...] Read more.
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)

Review

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Open AccessReview
Improving Health Care Management in Primary Care for Homeless People: A Literature Review
Int. J. Environ. Res. Public Health 2018, 15(2), 309; https://doi.org/10.3390/ijerph15020309 - 10 Feb 2018
Cited by 4
Abstract
Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of [...] Read more.
Background: Homeless people have poorer health status than the general population. They need complex care management, because of associated medical troubles (somatic and psychiatric) and social difficulties. We aimed to describe the main characteristics of the primary care programs that take care of homeless people, and to identify which could be most relevant. Methods: We performed a literature review that included articles which described and evaluated primary care programs for homeless people. Results: Most of the programs presented a team-based approach, multidisciplinary and/or integrated care. They often proposed co-located services between somatic health services, mental health services and social support services. They also tried to answer to the specific needs of homeless people. Some characteristics of these programs were associated with significant positive outcomes: tailored primary care organizations, clinic orientation, multidisciplinary team-based models which included primary care physicians and clinic nurses, integration of social support, and engagement in the community’s health. Conclusions: Primary health care programs that aimed at taking care of the homeless people should emphasize a multidisciplinary approach and should consider an integrated (mental, somatic and social) care model. Full article
(This article belongs to the Special Issue Health and Health Care for Homeless People in Various Contexts)
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