Journal of Urban Health

, Volume 87, Issue 6, pp 920-930

First online:

Open Access This content is freely available online to anyone, anywhere at any time.

Health and Oral Health Care Needs and Health Care-Seeking Behavior Among Homeless Injection Drug Users in San Francisco

  • Jonathan Leserman RobbinsAffiliated withJoint Medical Program, University of California, Berkeley and University of California, San Francisco Email author 
  • , Lynn WengerAffiliated withUniversity of California, San Francisco, RTI International
  • , Jennifer LorvickAffiliated withUniversity of California, San Francisco, RTI InternationalSchool of Public Health, University of California, Berkeley
  • , Caroline ShiboskiAffiliated withDepartment of Orofacial Sciences, School of Dentistry, University of California
  • , Alex H. KralAffiliated withUniversity of California, San Francisco, RTI InternationalDepartment of Family and Community Medicine, University of California


Few existing studies have examined health and oral health needs and treatment-seeking behavior among the homeless and injection drug users (IDUs). This paper describes the prevalence and correlates of health and oral health care needs and treatment-seeking behaviors in homeless IDUs recruited in San Francisco, California, from 2003 to 2005 (N = 340). We examined sociodemographic characteristics, drug use patterns, HIV status via oral fluid testing, physical health using the Short Form 12 Physical Component Score, self-reported needs for physical and oral health care, and the self-reported frequency of seeking medical and oral health care. The sample had a lower health status as compared to the general population and reported a frequent need for physical and oral health care. In bivariate analysis, being in methadone treatment was associated with care-seeking behavior. In addition, being enrolled in Medi-Cal, California’s state Medicaid program, was associated with greater odds of seeking physical and oral health care. Methamphetamine use was not associated with higher odds of needing oral health care as compared to people who reported using other illicit drugs. Homeless IDUs in San Francisco have a large burden of unmet health and oral health needs. Recent cuts in Medi-Cal’s adult dental coverage may result in a greater burden of oral health care which will need to be provided by emergency departments and neighborhood dental clinics.


IDU Homeless Health Care Oral Health Methamphetamine Dental Care