Unsheltered homeless and unstably housed adults have higher levels of stress and more health risk factors than sheltered homeless adults

ABSTRACT

In the United States, approximately 580,000 individuals were homeless on a single night in 2020. Homelessness can be categorized into three subgroups: sheltered homeless, unsheltered homeless, and unstably housed. This study aimed to empirically examine whether homelessness subgroups were related to current stress, recent utilization of shelter-based mental health services, and current health risk factors. Data were collected at multiple homeless shelters in 2016 in the Oklahoma City area (N = 575). All participants completed assessments of demographic characteristics, including age, sex, race, marital status, years of education, and incarceration history and victimization. Multiple linear and logistic regression analyses were conducted. Results indicated that the sheltered group was younger and more likely to be White than the unsheltered group, had higher levels of education, and reported more lifetime months in jail than the unstably housed group. Unsheltered homeless and unstably housed adults used fewer shelter-based health services, exhibited more health risk factors, experienced greater levels of stress, and had higher levels of food insecurity than sheltered homeless adults. Homeless adults who reside at shelters benefit most from available shelter services. The development of policies and programs targeted toward increasing sheltering options for unsheltered and unstably housed adults is needed.

KEYWORDS:

• Homeless
• housing
• health
• selter
• health services

Acknowledgements

We would like to thank the study participants for their time and effort.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Authors’ contributions

CKR had full access to all of the study data. MSB and CKR are responsible for the integrity of the data and the accuracy of the data analysis.

Concept and design: CKR, ETH, and MSB

Acquisition, analysis, or interpretation of data: CKR, ETH, RS, and MSB

Drafting the manuscript: CKR, ETH, AA, DEK, and MSB

Critical revision of the manuscript for important intellectual content: CKR, ETH, AA, DEK, RS, and MSB

Statistical Analysis: CKR, ETH, and MSB

List of abbreviations

Not applicble

Declarations

Ethics approval and consent to participate

Participants read and signed the informed consent document to participate in research. The study procedure was approved by the Institutional Review Board at the University of Oklahoma Health Sciences Center.

Consent for publication

Not applicable

Availability of data and materials

Data and materials are not available to public yet.

Additional information

Funding

This study was supported by the Stephenson Cancer Center via an NCI Cancer Center Support Grant (P30CA225520) and through the Oklahoma Tobacco Settlement Endowment Trust (TSET) grant (092-016-0002). Data analysis and manuscript preparation were additionally supported through K99DA046564. The contents of the manuscript are solely the responsibility of the authors and do not necessarily represent the official views of the sponsoring organizations.

Notes on contributors

Chaelin K. Ra

Dr. Chaelin K. Ra is a postdoctoral research fellow at the TSET Health Promotion Research Center. Her research interests include health disparities, mental health, and substance use using mobile health technologies.

Emily T. Hébert

Dr. Emily T. Hébert is an assistant professor at the University of Texas Health Science Center at Houston.

Adam Alexander

Dr. Adam Alexander is an assistant professor at the TSET Health Promotion Research Center and the Department of Family and Preventive Medicine of the University of Oklahoma.

Darla E. Kendzor

Dr. Darla E. Kendzor is a co-director at the TSET Health Promotion Research Center and an associate professor at the Department of Family and Preventive Medicine of the University of Oklahoma.

Robert Suchting

Dr. Robert Suchting is an assistant professor in the Department of Psychiatry and Behaviroal Sciences of the McGovern Medical School at UTHealth.

Michael S. Businelle

Dr. Michael S. Businelle is a co-director at the TSET Health Promotion Research Center and a professor at the Department of Family and Preventive Medicine of the University of Oklahoma.