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Homelessness and Public Health

A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Global Health".

Deadline for manuscript submissions: closed (30 April 2021) | Viewed by 89533

Special Issue Editors


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Guest Editor
Edmonton Clinic Health Academy, University of Alberta, Edmonton, AB T6G 1C9, Canada
Interests: homelessness; patients experiencing homelessness; injury control; health advocacy; transformational leadership; media advocacy; safety culture assessment; firefighters wellness
Special Issues, Collections and Topics in MDPI journals

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Guest Editor
The Bizzell Group, LLC and Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Interests: road safety; injury prevention; health promotion
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

On any given night, hundreds of thousands of people are homeless in the United States and Canada, as well as in other developed countries. Globally, the problem is many times worse, making homelessness a global public health and environmental problem.

Homelessness is closely connected to declines in physical and mental health; homeless persons experience high rates of health problems, such as HIV infection, alcohol and drug abuse, mental illness, tuberculosis, and other serious conditions. The health problems facing homeless persons result from various factors, including barriers to healthcare, lack of access to adequate food and protection, and limited resources for social services. Legal and policy interventions have often been used to attempt to address homelessness, although not always from a public health perspective. In healthcare, for example, if someone experiencing homelessness comes to an emergency room with a need for medical aid, the only alternative once treated is to release the patient back onto the street. This creates an endless cycle of emergency room visits, not to mention the challenges patients face in having a successful recovery. The costs are severe, both to the person experiencing homelessness and to the healthcare system.

This Special Issue will explore the public health implications and potential solutions to homelessness, explore emerging research and innovative strategies, and highlight best practices to address homelessness among this key population. In addition to elevating and articulating a clear strategy to reduce homelessness and suggest how to provide more adequate health and housing for this population, authors in this Special Issue will explore solutions for important subpopulations, including young adults, veterans, and those experiencing chronic homelessness.

Prof. Dr. Louis Hugo Francescutti
Prof. Dr. David A. Sleet
Guest Editors

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Keywords

  • homelessness and health
  • emergency department care
  • transitional housing
  • poverty and the environment
  • substance abuse and homeless populations
  • living on the street
  • injury and homelessness

Published Papers (15 papers)

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Editorial

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6 pages, 282 KiB  
Editorial
Homelessness and Public Health: A Focus on Strategies and Solutions
by David A. Sleet and Louis Hugo Francescutti
Int. J. Environ. Res. Public Health 2021, 18(21), 11660; https://doi.org/10.3390/ijerph182111660 - 6 Nov 2021
Cited by 16 | Viewed by 12741
Abstract
On any given night, hundreds of thousands of people are homeless in the United States and Canada [...] Full article
(This article belongs to the Special Issue Homelessness and Public Health)

Research

Jump to: Editorial, Other

17 pages, 1447 KiB  
Article
Conceptualizing an Interdisciplinary Collective Impact Approach to Examine and Intervene in the Chronic Cycle of Homelessness
by Mounah Abdel-Samad, Jerel P. Calzo, Jennifer K. Felner, Lianne Urada, Matthew E. Verbyla, Hala Madanat, Brian E. Adams, Thais Alves, Bruce Appleyard, Joshua Chanin, Shawn Flanigan, Hisham Foad, Maya Ginsberg, Matthew Higgins, Eunjeong Ko, Kristen Maher, Natalie Mladenov, Peggy Peattie, Megan Welsh and David Sleet
Int. J. Environ. Res. Public Health 2021, 18(4), 2020; https://doi.org/10.3390/ijerph18042020 - 19 Feb 2021
Cited by 6 | Viewed by 5523
Abstract
Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched [...] Read more.
Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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13 pages, 363 KiB  
Article
Mental Illness and Youth-Onset Homelessness: A Retrospective Study among Adults Experiencing Homelessness
by Chisom N. Iwundu, Tzu-An Chen, Kirsteen Edereka-Great, Michael S. Businelle, Darla E. Kendzor and Lorraine R. Reitzel
Int. J. Environ. Res. Public Health 2020, 17(22), 8295; https://doi.org/10.3390/ijerph17228295 - 10 Nov 2020
Cited by 13 | Viewed by 6009
Abstract
Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively [...] Read more.
Financial challenges, social and material instability, familial problems, living conditions, structural issues, and mental health problems have been shown to contribute to youth homelessness. Based on the paucity of literature on mental illness as a reason for youth homelessness, the current study retrospectively evaluated the association between the timing of homelessness onset (youth versus adult) and mental illness as a reason for homelessness among homeless adults living in homeless shelters and/or receiving services from homeless-serving agencies. Homeless participants (N = 919; 67.3% men) were recruited within two independent studies from Dallas and Oklahoma. Covariate-adjusted logistic regressions were used to measure associations between homelessness onset and mental illness as a reason for current homelessness, history of specific mental illnesses, the historical presence of severe mental illness, and severe mental illness comorbidity. Overall, 29.5% of the sample reported youth-onset homelessness and 24.4% reported mental illness as the reason for current homelessness. Results indicated that mental illness as a reason for current homelessness (AOR = 1.62, 95% CI = 1.12–2.34), history of specific mental illnesses (Bipolar disorder–AOR = 1.75, 95% CI = 1.24–2.45, and Schizophrenia/schizoaffective disorder–AOR = 1.83, 95% CI = 1.22–2.74), history of severe mental illness (AOR = 1.48, 95% CI = 1.04–2.10), and severe mental illness comorbidities (AOR = 1.30, 95% CI: 1.11–1.52) were each associated with increased odds of youth-onset homelessness. A better understanding of these relationships could inform needs for early interventions and/or better prepare agencies that serve at-risk youth to address precursors to youth homelessness. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
13 pages, 704 KiB  
Article
Well-Being without a Roof: Examining Well-Being among Unhoused Individuals Using Mixed Methods and Propensity Score Matching
by Naina J Ahuja, Allison Nguyen, Sandra J Winter, Mark Freeman, Robert Shi, Patricia Rodriguez Espinosa and Catherine A Heaney
Int. J. Environ. Res. Public Health 2020, 17(19), 7228; https://doi.org/10.3390/ijerph17197228 - 2 Oct 2020
Cited by 7 | Viewed by 3520
Abstract
The morbidity and mortality experiences of people who are unhoused have been well-described, but much less is known about the overall well-being of these individuals. In this mixed methods study, housed and unhoused participants completed a multi-faceted 10 domain measure of well-being (the [...] Read more.
The morbidity and mortality experiences of people who are unhoused have been well-described, but much less is known about the overall well-being of these individuals. In this mixed methods study, housed and unhoused participants completed a multi-faceted 10 domain measure of well-being (the Stanford WELL Survey), and a subset of unhoused participants shared their experiences during qualitative interviews. Using propensity score matching, unhoused participants (n = 51) were matched at a ratio of 1:5 with housed participants (n = 255). The mean overall well-being score of the unhoused participants was significantly lower than that of the matched housed participants (B = −5.022, p = 0.013). Additionally, the two groups differed on some of the constituent domains of well-being, with unhoused participants reporting statistically significantly lower mean scores on social connectedness (B = −1.086, p = 0.000), lifestyle and daily practices (B = −1.219, p = 0.000), stress and resilience (B = −0.493, p = 0.023), experience of emotions (B = −0.632, p = 0.009), physical health (B = −0.944, p = 0.0001), and finances (B = −3.099, p = 0.000). The unhoused participants had a statistically significantly higher mean score for spirituality and religiosity (B = 2.401, p = 0.000) than their matched housed counterparts. The qualitative interviews further highlighted spirituality and religion as a coping mechanism for the unhoused. The results of this study highlight both unexpected strengths exhibited by the unhoused individuals and areas of challenge. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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19 pages, 562 KiB  
Article
Combatting Homelessness in Canada: Applying Lessons Learned from Six Tiny Villages to the Edmonton Bridge Healing Program
by Anson Wong, Jerry Chen, Renée Dicipulo, Danielle Weiss, David A. Sleet and Louis Hugo Francescutti
Int. J. Environ. Res. Public Health 2020, 17(17), 6279; https://doi.org/10.3390/ijerph17176279 - 28 Aug 2020
Cited by 9 | Viewed by 6401
Abstract
Emerging evidence shows that homelessness continues to be a chronic public health problem throughout Canada. The Bridge Healing Program has been proposed in Edmonton, Alberta, as a novel approach to combat homelessness by using hospital emergency departments (ED) as a gateway to temporary [...] Read more.
Emerging evidence shows that homelessness continues to be a chronic public health problem throughout Canada. The Bridge Healing Program has been proposed in Edmonton, Alberta, as a novel approach to combat homelessness by using hospital emergency departments (ED) as a gateway to temporary housing. Building on the ideas of Tiny Villages, the Bridge Healing Program provides residents with immediate temporary housing before transitioning them to permanent homes. This paper aims to understand effective strategies that underlie the Tiny Villages concept by analyzing six case studies and applying the lessons learned to improving the Bridge Healing Program. After looking at six Tiny Villages, we identified four common elements of many successful Tiny Villages. These include a strong community, public support, funding with few restrictions, and affordable housing options post-graduation. The Bridge Healing Program emphasizes such key elements by having a strong team, numerous services, and connections to permanent housing. Furthermore, the Bridge Healing Program is unique in its ability to reduce repeat ED visits, lengths of stay in the ED, and healthcare costs. Overall, the Bridge Healing Program exhibits many traits associated with successful Tiny Villages and has the potential to address a gap in our current healthcare system. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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16 pages, 1878 KiB  
Article
Change in Housing Status among Homeless and Formerly Homeless Individuals in Quebec, Canada: A Profile Study
by Gesthika Kaltsidis, Guy Grenier, Zhirong Cao and Marie-Josée Fleury
Int. J. Environ. Res. Public Health 2020, 17(17), 6254; https://doi.org/10.3390/ijerph17176254 - 27 Aug 2020
Cited by 4 | Viewed by 2687
Abstract
Housing stability is a key outcome in studies evaluating housing services for the homeless population. Housing stability has typically been defined dichotomously and based on a fixed duration of maintenance in housing accommodations, which does not fully capture change in housing status among [...] Read more.
Housing stability is a key outcome in studies evaluating housing services for the homeless population. Housing stability has typically been defined dichotomously and based on a fixed duration of maintenance in housing accommodations, which does not fully capture change in housing status among homeless individuals. Moreover, few typologies have examined housing trajectories across different housing types. Cluster analysis was used to develop a typology of housing status change for 270 currently or formerly homeless individuals in Quebec (Canada) residing in shelters and temporary and permanent housing. Participants were interviewed at baseline (T0) and 12 months later (T1). The Gelberg–Andersen Model was used to organize housing-related variables into predisposing, needs and enabling factors. Comparison analyses were conducted to assess group differences. Three groups (Groups 1, 3 and 4) had more favorable and two (Groups 2 and 5) less favorable, housing status at T1. Findings suggest that maintenance or improvement of housing status requires suitable types and frequencies of service use (enabling factors) that are well adapted to the nature and complexity of health problems (needs factors) among homeless individuals. Specific interventions, such as outreach programs and case management, should be prioritized for individuals at higher risk for returning to homelessness. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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15 pages, 1091 KiB  
Article
Urban Stress Indirectly Influences Psychological Symptoms through Its Association with Distress Tolerance and Perceived Social Support among Adults Experiencing Homelessness
by Daphne C. Hernandez, Sajeevika S. Daundasekara, Michael J. Zvolensky, Lorraine R. Reitzel, Diane Santa Maria, Adam C. Alexander, Darla E. Kendzor and Michael S. Businelle
Int. J. Environ. Res. Public Health 2020, 17(15), 5301; https://doi.org/10.3390/ijerph17155301 - 23 Jul 2020
Cited by 12 | Viewed by 3952
Abstract
Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress–depression and urban stress–Post-Traumatic Stress Disorder [...] Read more.
Traditionally, intrapersonal characteristics (distress tolerance) and interpersonal characteristics (social support) have been studied separately rather than simultaneously. In the current study, we address this gap by simultaneously examining these characteristics as potential indirect associations linking established urban stress–depression and urban stress–Post-Traumatic Stress Disorder (PTSD) relationships. Adults experiencing homelessness were recruited from six homeless shelters in Oklahoma City (n = 567). Participants self-reported urban life stress (Urban Life Stress Scale), distress tolerance (Distress Tolerance Scale), social support (Interpersonal Support Evaluation List 12), major depressive disorder (Patient Health Questionnaire-8), and PTSD symptoms (Primary Care Post-Traumatic Stress Disorder screener). Covariate-adjusted structural equation models indicated a significant indirect effect of distress tolerance on the urban stress–depression (b = 0.101, 95% CI = 0.061, 0.147) and urban stress–PTSD (b = 0.065, 95% CI = 0.023, 0.112) relationships. Additionally, a significant indirect effect of social support on the urban stress–depression (b = 0.091, 95% CI = 0.053, 0.133) and urban stress-PTSD relationships (b = 0.043, 95% CI = 0.006, 0.082) was evident. Further, both the urban stress–depression (b = 0.022, 95% CI = 0.011, 0.037) and urban stress–PTSD relationships (b = 0.014, 95% CI = 0.005, 0.026) were associated indirectly through social support to distress tolerance. Interventions that aim to increase social support may also increase distress tolerance skills and indirectly reduce depressive and PTSD symptoms in the context of urban stress among adults experiencing homelessness. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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15 pages, 348 KiB  
Article
I Felt Safe”: The Role of the Rapid Rehousing Program in Supporting the Security of Families Experiencing Homelessness in Salt Lake County, Utah
by Ivis García and Keuntae Kim
Int. J. Environ. Res. Public Health 2020, 17(13), 4840; https://doi.org/10.3390/ijerph17134840 - 5 Jul 2020
Cited by 12 | Viewed by 6472
Abstract
Homelessness is a public health issue that many organizations are addressing through a Housing First Model. One such organization is The Road Home (TRH), which provides services to homeless individuals and families in Salt Lake County. TRH is perhaps best known for their [...] Read more.
Homelessness is a public health issue that many organizations are addressing through a Housing First Model. One such organization is The Road Home (TRH), which provides services to homeless individuals and families in Salt Lake County. TRH is perhaps best known for their emergency shelters, but the organization also administers the Rapid Rehousing Program (RRHP), designed to help families experiencing homelessness transition back into stable housing. Those experiencing homelessness tend to have high rates of chronic mental/physical disabilities as well as issues related to substance abuse. Having a home is the first step toward achieving some kind of stability in their lives. The RRHP allows families to find housing in the private rental market and will cover the initial costs and several months of rent for clients. While the program has been praised by policymakers and social service providers for helping homeless families find rental housing, there is no empirical research about participant perspectives regarding their residential (in)security. The research question of this article is: what is the role of the RRHP in supporting the security of families experiencing homelessness? Researchers collected qualitative data through focus groups and interviews with 31 participants, 23 families experiencing homelessness, two landlords, six case managers, and service providers. Lastly, we identify recommendations for program improvements based on information gathered from research participants. It is our hope that the information presented in this article can and will be used in a way that improves public health by increasing the residential security of families experiencing homelessness. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
24 pages, 2538 KiB  
Article
“It’s Just a Band-Aid on Something No One Really Wants to See or Acknowledge”: A Photovoice Study with Transitional Aged Youth Experiencing Homelessness to Examine the Roots of San Diego’s 2016–2018 Hepatitis A Outbreak
by Jennifer K. Felner, Talia Kieu, Andrew Stieber, Hunter Call, Daniel Kirkland, Amanda Farr and Jerel P. Calzo
Int. J. Environ. Res. Public Health 2020, 17(13), 4721; https://doi.org/10.3390/ijerph17134721 - 30 Jun 2020
Cited by 9 | Viewed by 4272
Abstract
San Diego, California is consistently ranked among regions with the highest rates of homelessness in the United States. From 2016 to 2018, San Diego experienced an unprecedented outbreak of hepatitis A virus (HAV), largely attributed in media and public health discourse to the [...] Read more.
San Diego, California is consistently ranked among regions with the highest rates of homelessness in the United States. From 2016 to 2018, San Diego experienced an unprecedented outbreak of hepatitis A virus (HAV), largely attributed in media and public health discourse to the region’s growing population of people experiencing homelessness. Little attention, however, was devoted to examining the experiences and needs of this population, particularly transitional aged youth (TAY, aged 18–24) experiencing homelessness who may have been uniquely affected by the outbreak. This community-based participatory research study leveraged diverse qualitative methods, principally photovoice, to explore how the social and built environment shapes health among TAY experiencing homelessness in San Diego, how these environments may have contributed to the HAV outbreak, and TAY’s perceptions of HAV-related public health interventions. Emergent findings include stigmatization of TAY and other people experiencing homelessness, interventions that failed to address root causes of the outbreak, and interactions with housing-related and other social support resources that limit rather than support economic and social mobility. Findings have implications for understanding how media and public discourse, public health interventions, and availability and delivery of resources can contribute to and perpetuate stigma and health inequities faced by TAY experiencing homelessness. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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9 pages, 323 KiB  
Communication
Predictors of Overnight and Emergency Treatment among Homeless Adults
by Chisom N. Iwundu, Pooja Agrawal, Michael S. Businelle, Darla E. Kendzor and Lorraine R. Reitzel
Int. J. Environ. Res. Public Health 2020, 17(12), 4271; https://doi.org/10.3390/ijerph17124271 - 15 Jun 2020
Cited by 6 | Viewed by 2639
Abstract
High usage of emergency treatment and hospitalization has been reported among homeless individuals. Hence, this study aimed to identify the sociodemographic predictors associated with overnight and emergency hospital treatment among a sample of homeless adults. Participants were recruited from a shelter in Dallas, [...] Read more.
High usage of emergency treatment and hospitalization has been reported among homeless individuals. Hence, this study aimed to identify the sociodemographic predictors associated with overnight and emergency hospital treatment among a sample of homeless adults. Participants were recruited from a shelter in Dallas, Texas (N = 354; Mage = 43.7 ± 11.7) and were predominantly uninsured, low-income men from various racial groups. The outcome variables were: (a) stayed overnight for treatment in a hospital; and (b) treated in a hospital emergency room. In logistic regression models, sex emerged as the only predictor of overnight treatment in a hospital (OR = 2.68, 95% CI = 1.61–4.47), and treatment in an emergency room (OR = 2.21, 95% CI = 1.34–3.65), such that women were more likely than men to be treated overnight and use emergency care. Targeted interventions and policies are needed to address homeless women’s primary care needs and reduce costlier treatment. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
10 pages, 339 KiB  
Communication
Association of Problematic Alcohol Use and Food Insecurity among Homeless Men and Women
by Lorraine R. Reitzel, Surya Chinamuthevi, Sajeevika S. Daundasekara, Daphne C. Hernandez, Tzu-An Chen, Yashwant Harkara, Ezemenari M. Obasi, Darla E. Kendzor and Michael S. Businelle
Int. J. Environ. Res. Public Health 2020, 17(10), 3631; https://doi.org/10.3390/ijerph17103631 - 21 May 2020
Cited by 19 | Viewed by 4802
Abstract
Food insecurity results from unreliable access to affordable and nutritious food. Homeless adults are particularly vulnerable to both food insecurity and problematic alcohol use. The current study examined the link between problematic alcohol use and food insecurity among homeless adults. Participants (N = [...] Read more.
Food insecurity results from unreliable access to affordable and nutritious food. Homeless adults are particularly vulnerable to both food insecurity and problematic alcohol use. The current study examined the link between problematic alcohol use and food insecurity among homeless adults. Participants (N = 528; 62.7% men; Mage = 43.6 ± 12.2) were recruited from homeless-serving agencies in Oklahoma City. Problematic alcohol use was measured using the Alcohol Quantity and Frequency Questionnaire and the Patient Health Questionnaire. The latter used DSM-IV diagnostic criteria to assess probable alcohol use dependence/abuse. Heavy drinking was considered >7 drinks (women) and >14 drinks (men) per week. Food insecurity was measured with the USDA Food Security Scale-Short Form. The link between alcohol problems and food insecurity was examined with logistic regression analyses controlling for sex, age, education, income, and months homeless. Overall, 28.4% of the sample had probable alcohol dependence, 25% were heavy drinkers, and 78.4% were food insecure. Probable alcohol dependence and heavy drinking were correlated at 0.53 (p < 0.001). Results indicated that heavy drinking (OR = 2.12, CI.95 = 1.21, 3.73) and probable alcohol dependence/abuse (OR = 2.72, CI.95 = 1.55, 4.77) were each associated with increased odds of food insecurity. Food insecurity and problematic alcohol use are major issues among homeless populations; this study suggests they are associated. Future research is needed to shed light on potential causal mechanisms and on whether alcohol may take precedence over eating or food purchases. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
22 pages, 8481 KiB  
Article
Exploring Tiny Homes as an Affordable Housing Strategy to Ameliorate Homelessness: A Case Study of the Dwellings in Tallahassee, FL
by April Jackson, Bridget Callea, Nicholas Stampar, Abigail Sanders, Alberto De Los Rios and Jake Pierce
Int. J. Environ. Res. Public Health 2020, 17(2), 661; https://doi.org/10.3390/ijerph17020661 - 20 Jan 2020
Cited by 18 | Viewed by 13383
Abstract
An emerging strategy to combat homelessness is the development of “tiny homes”. However, the advent of tiny homes as a new form of housing intervention raises a number of questions about their intentions, efficacy, and policy feasibility. This paper seeks to understand the [...] Read more.
An emerging strategy to combat homelessness is the development of “tiny homes”. However, the advent of tiny homes as a new form of housing intervention raises a number of questions about their intentions, efficacy, and policy feasibility. This paper seeks to understand the strategies used by stakeholders to plan, design, and implement a tiny home community to meet the needs of those experiencing homelessness, and to understand where these plans were effective and where challenges arose in meeting the intended project goals. Utilizing the recent development of Tallahassee’s “The Dwellings” project as a case study, we examine how the community was planned, resident experiences, and constraints to implementing a tiny home development. We use qualitative methods that include interviews with stakeholders who were integral to the planning and development process. Our findings highlight how funding constraints and NIMBYism (Not in My Backyard-ism) stymied stakeholder efforts to achieve equity and affordability at The Dwellings, resulting in the inability to achieve project aims of developing housing that serves the homeless population. We conclude by offering some observations and lessons learned for future research on tiny homes as a solution to ameliorate homelessness. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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12 pages, 332 KiB  
Article
Predictors of Emergency Department Use among Individuals with Current or Previous Experience of Homelessness
by Morgane Gabet, Guy Grenier, Zhirong Cao and Marie-Josée Fleury
Int. J. Environ. Res. Public Health 2019, 16(24), 4965; https://doi.org/10.3390/ijerph16244965 - 6 Dec 2019
Cited by 7 | Viewed by 2883
Abstract
This study assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with current or previous experience of homelessness. Participants were recruited from three different types of housing (shelter, temporary housing and permanent housing) in [...] Read more.
This study assessed the contributions of predisposing, enabling, and needs factors in predicting emergency department (ED) use among 270 individuals with current or previous experience of homelessness. Participants were recruited from three different types of housing (shelter, temporary housing and permanent housing) in Montreal, Quebec (Canada). They were interviewed at baseline (T0), and again 12 months after recruitment (T1). Longitudinal data analyses were conducted on associations between a set of baseline predictors (T0) with the dependent variable (ED users vs. non-users) from T1. Predictors were identified according to the Gelberg–Andersen Behavioral Model. Findings revealed two needs factors associated with ED use: having a substance use disorder (SUD) and low perceived physical health. Two enabling factors, use of ambulatory specialized services and stigma, were also related to ED use. No predisposing factors were retained in the model, and ED use was not associated with type of housing. Improvements are needed in SUD and physical health management in order to reduce ED use, as well as interventions aimed at stigma prevention for this vulnerable population. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
19 pages, 717 KiB  
Article
Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home
by Mzwandile A. Mabhala and Asmait Yohannes
Int. J. Environ. Res. Public Health 2019, 16(23), 4620; https://doi.org/10.3390/ijerph16234620 - 21 Nov 2019
Cited by 7 | Viewed by 3983
Abstract
Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, [...] Read more.
Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories—education, employment, and health—emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one’s way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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Other

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8 pages, 560 KiB  
Commentary
Investing in Public Health Infrastructure to Address the Complexities of Homelessness
by John P. Allegrante and David A. Sleet
Int. J. Environ. Res. Public Health 2021, 18(16), 8887; https://doi.org/10.3390/ijerph18168887 - 23 Aug 2021
Cited by 8 | Viewed by 6991
Abstract
Homelessness is now recognized as a significant public health problem in North America and throughout advanced economies of the world. The causes of homelessness are complex but the lack of affordable housing, unemployment, poverty, addiction, and mental illness all contribute to the risk [...] Read more.
Homelessness is now recognized as a significant public health problem in North America and throughout advanced economies of the world. The causes of homelessness are complex but the lack of affordable housing, unemployment, poverty, addiction, and mental illness all contribute to the risk for homelessness. We argue that homelessness is increasingly exacerbated by system-wide infrastructure failures occurring at the municipal, state, and federal government levels and whose catastrophic impacts on population health and the response to the COVID-19 pandemic are the consequence of the decades-long devolution of government and neglect to invest in public infrastructure, including a modern public health system. Full article
(This article belongs to the Special Issue Homelessness and Public Health)
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