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International Journal of Public Health

, Volume 56, Issue 6, pp 609–623 | Cite as

The health and housing in transition study: a longitudinal study of the health of homeless and vulnerably housed adults in three Canadian cities

  • Stephen W. HwangEmail author
  • Tim Aubry
  • Anita Palepu
  • Susan Farrell
  • Rosane Nisenbaum
  • Anita M. Hubley
  • Fran Klodawsky
  • Evie Gogosis
  • Elizabeth Hay
  • Shannon Pidlubny
  • Tatiana Dowbor
  • Catharine Chambers
Original Article

Abstract

Objectives

While substantial research has demonstrated the poor health status of homeless populations, the health status of vulnerably housed individuals is largely unknown. Furthermore, few longitudinal studies have assessed the impact of housing transitions on health. The health and housing in transition (HHiT) study is a prospective cohort study that aims to track the health and housing status of a representative sample of homeless and vulnerably housed single adults in three Canadian cities (Toronto, Ottawa, and Vancouver). This paper discusses the HHiT study methodological recruitment strategies and follow-up procedures, including a discussion of the limitations and challenges experienced to date.

Methods

Participants (n = 1,192) were randomly selected at shelters, meal programmes, community health centres, drop-in centres, rooming houses, and single-room occupancy hotels from January to December 2009 and are being re-interviewed every 12 months for a 2-year period.

Results

At baseline, over 85% of participants reported having at least one chronic health condition, and over 50% reported being diagnosed with a mental health problem.

Conclusions

Our findings suggest that, regardless of housing status, participants had extremely poor overall health.

Keywords

Homeless persons Vulnerable populations Housing Health Mental health Quality of life Longitudinal studies 

Notes

Acknowledgments

This project was supported by an operating grant (MOP-86765) and an Interdisciplinary Capacity Enhancement Grant on Homelessness, Housing and Health (HOA-80066) from the Canadian Institutes of Health Research. The Centre for Research on Inner City Health in the Li Ka Shing Knowledge Institute at St. Michael’s Hospital gratefully acknowledges the support of the Ontario Ministry of Health and Long-Term Care. The authors thank Ying Di, Centre for Research on Inner City Health, for her expert programming and analyses. We would like to acknowledge the following individuals from our community partner organizations: Laura Cowan, Liz Evans, Sarah Evans, Stephanie Gee, Clare Haskel, Erika Khandor, and Wendy Muckle. The authors also thank the shelter, drop-in, and municipal and provincial staff for their assistance with participant recruitment and follow-up. The views expressed here are the views of the authors and do not necessarily reflect the views of the Ontario Ministry of Health and Long-Term Care or any of the other named individuals or organizations.

References

  1. Ardilly P, Le Blanc D (2001) Sampling and weighting a survey of homeless persons: a French example. Surv Methodol 27:109–118Google Scholar
  2. Aubry T, Klodawsky F (2003) Panel study on persons who are homeless in Ottawa: phase one results. City of Ottawa, OttawaGoogle Scholar
  3. Aubry T, Klodawsky F, Hay E, Nemiroff R, Hyman S (2004) Developing a methodology for tracking person who are homeless over time. Final Report Canada Mortgage and Housing Corporation, OttawaGoogle Scholar
  4. Aubry T, Klodawsky F, Nemiroff R, Birnie S, Bonetta C (2007) Panel study on persons who are homeless in Ottawa: phase two results. Centre for Research on Community Services, University of Ottawa, OttawaGoogle Scholar
  5. Aubry T, Klodawsky F, Coulombe D (2011) Comparing the housing trajectories of different clusters within a diverse homeless population. Am J Commun Psychol [Epub ahead of print]Google Scholar
  6. Babor TF, Higgins-Biddle JC, Saunders JB (2001) AUDIT: the alcohol use disorders identification test: guidelines for use in primary care. World Health Organization Department of Mental Health and Substance Dependence, GenevaGoogle Scholar
  7. Burt MR, Aron LY, Douglas T, Valente J, Lee E, Iwen B (1999) Homelessness: programs and the people they serve. Findings of the national survey of homeless assistance providers and clients. Interagency Council on the Homeless, Washington, DCGoogle Scholar
  8. Canada Mortgage and Housing Corporation (2009) Housing market information. Rental market reports—major centres. https://www03.cmhc-schl.gc.ca/catalog/productList.cfm?cat=79&lang=en&fr=1287667818008. Accessed 21 October 2010
  9. City of Toronto (2009) Street needs assessment results. Shelter, support, and housing administration. City of Toronto, TorontoGoogle Scholar
  10. City of Toronto (2010) Employment and social services. http://www.toronto.ca/socialservices/. Accessed 21 October 2010
  11. Crowe C, Hardill K (1993) Nursing research and political change: the Street Health report. Can Nurse 89:21–24PubMedGoogle Scholar
  12. Culhane D, Dejowski EF, Ibanez J, Needham E, Macchina I (1994) Public shelter admission rates in Philadelphia and New York City: the implications of turnover for sheltered population counts. Housing Policy Debate 5:107–140CrossRefGoogle Scholar
  13. Cutrona CE, Russell D (1987) The provisions of social relationships and adaptation to stress. In: Jones WH, Perlman D (eds) Advances in personal relationships, vol 1. JAI Press, Greenwich, pp 37–67Google Scholar
  14. Dewa CS, Durbin J, Eastabrook S, Ochoka J, Boydell K, Wasylenki D et al (2002) Considering a multi-site study? Taking the leap and having a soft landing. J Commun Psychol 30:1–15CrossRefGoogle Scholar
  15. Dewa CS, Butterill D, Durbin J, Goering P (2004) No matter how you land: challenges of a longitudinal multi-site study. Can J Program Eval 19(3 Special Issue):1–28Google Scholar
  16. Dinning LB, Davis C (2008) Community action plan on homelessness: 2009–2014. The road to ending homelessness in Ottawa. The Homelessness Community Capacity Building Steering Committee, OttawaGoogle Scholar
  17. Dunn JR, Burgess B, Ross NA (2005) Income distribution, public services expenditures, and all cause mortality in US States. J Epidemiol Commun Health 59:768–774CrossRefGoogle Scholar
  18. Flaherty JA, Gaviria FM, Pathak DS (1983) The measurement of social support: the social support network inventory. Compr Psychiatry 24:521–529PubMedCrossRefGoogle Scholar
  19. Frankish CJ, Hwang SW, Quantz D (2005) Homelessness and health in Canada. Can J Public Health 96:23–29Google Scholar
  20. Gavin DR, Ross HE, Skinner HA (1989) Diagnostic validity of the drug abuse screening test in the assessment of DSM-III drug disorders. Br J Addict 84:301–307PubMedCrossRefGoogle Scholar
  21. Hardill K (1993) How the Street Health survey was one: developing a methodology for survey research with homeless women and men. Street Health, TorontoGoogle Scholar
  22. Hartig T, Lawrence RJ (2003) Introduction: the residential context of health. J Soc Issues 59:455–473CrossRefGoogle Scholar
  23. Hubley AM, Russell LB, Gadermann AM, Palepu A (2009) Quality of life for homeless and hard-to-house individuals (QoLHHI) inventory: administration and scoring manual. Vancouver. http://educ.ubc.ca/faculty/hubley/qolhhi/QoLHHI%20Manual.pdf
  24. Human Resources and Skills Development Canada (2010) The homelessness partnering strategy. http://www.hrsdc.gc.ca/eng/homelessness/index.shtml. Accessed 16 September 2010
  25. Hwang SW (2001) Homelessness and health. CMAJ 164:229–233PubMedGoogle Scholar
  26. Hwang SW, Dunn JR (2005) Homeless people. In: Galea S, Vlahov D (eds) Handbook of urban health: populations methods and practice. Kluwer/Plenum, New York, pp 19–42CrossRefGoogle Scholar
  27. Hwang SW, Wilkins R, Tjepkema M, O’Campo PJ, Dunn JR (2009) Mortality among residents of shelters, rooming houses, and hotels in Canada: 11 year follow-up study. BMJ 339:b4036PubMedCrossRefGoogle Scholar
  28. Kish L (1995) Survey sampling. Wiley, New YorkGoogle Scholar
  29. Krabbe P, Weijnen T (2003) Guidelines for analyzing and reporting EQ-5D outcomes. In: Brooks R, Rabin RE, de Charro F (eds) The measurement and valuation of health status using EQ-5D: a European perspective. Kluwer, Boston, pp 7–20Google Scholar
  30. Kushel MB, Vittinghoff E, Haas JS (2001) Factors associated with the health care utilization of homeless persons. JAMA 285:200–206PubMedCrossRefGoogle Scholar
  31. Laird G (2007) Shelter. Homelessness in a growth economy: Canada’s 21st century paradox. A report for the Sheldon Chumir Foundation for Ethics in Leadership. Sheldon Chumir Foundation for Ethics in Leadership and Gordon Laird, CalgaryGoogle Scholar
  32. Lenskyj HJ (2002) Best Olympics ever? Social impacts of Sydney 2000. State University of New York Press, AlbanyGoogle Scholar
  33. McKenzie M, Tulsky JP, Long HL, Chesney M, Moss A (1999) Tracking and follow-up of marginalized populations: a review. J Health Care Poor Underserved 10:409–429PubMedGoogle Scholar
  34. Ministry of Housing and Social Development (2007) BC employment and assistance rates tables (effective July 1, 2007). http://www.eia.gov.bc.ca/mhr/rates.htm. Accessed 21 October 2010
  35. Piccinelli M, Tessari E, Bortolomasi M, Piasere O, Semenzin M, Garzotto N et al (1997) Efficacy of the alcohol use disorders identification test as a screening tool for hazardous alcohol intake and related disorders in primary care: a validity study. BMJ 314:420–424PubMedCrossRefGoogle Scholar
  36. Rabin R, de Charro F (2001) EQ-5D: a measure of health status from the EuroQol Group. Ann Med 33:337–343PubMedCrossRefGoogle Scholar
  37. Ross NA, Wolfson MC, Dunn JR, Berthelot JM, Kaplan GA, Lynch JW (2000) Relation between income inequality and mortality in Canada and in the United States: cross sectional assessment using census data and vital statistics. BMJ 320:898–902PubMedCrossRefGoogle Scholar
  38. Ross NA, Dorling D, Dunn JR, Henriksson G, Glover J, Lynch J et al (2005) Metropolitan income inequality and working-age mortality: a cross-sectional analysis using comparable data from five countries. J Urban Health 82:101–110PubMedCrossRefGoogle Scholar
  39. Roy E, Haley N, Boudreau JF, Leclerc P, Boivin JF (2004) Mortality in a cohort of street youth in Montreal. JAMA 292:569–574PubMedCrossRefGoogle Scholar
  40. Russell LB, Gadermann A, Hubley AM, Palepu A (2008) A new measure of quality of life: results from a pilot study of the health section of the quality of life for homeless and hard-to-house individuals (QoLHHI) survey. Presented at the international conference on urban health (ICUH), Vancouver, Canada. http://educ.ubc.ca/faculty/hubley/icuh2008/mdt.pdf
  41. Shaw JW, Johnson JA, Coon SJ (2005) US valuation of the EQ-5D health states: development and testing of the D1 valuation model. Med Care 43:203–220PubMedCrossRefGoogle Scholar
  42. Social Planning and Research Council of BC (SPARC BC), Eberle Planning and Research, Jim Woodward & Associates Inc., Graves J, Huhtala K, Campbell K, In Focus Consulting, Goldberg M (2008) Still on our streets. Results of the 2008 Metro Vancouver homeless count. Greater Vancouver Regional Steering Committee on Homelessness, 3 Ways to Home, VancouverGoogle Scholar
  43. Statistics Canada (2010) Canadian community health survey (CCHS). http://www.statcan.gc.ca/cgi-bin/imdb/p2SV.pl?Function=getSurvey&SDDS=3226&lang=en&db=imdb&adm=8&dis=2. Accessed 21 October 2010
  44. Toro PA, Bellavia CW, Daeschler CV, Owens BJ, Wall DD, Passero JM et al (1995) Distinguishing homelessness from poverty: a comparative study. J Consult Clin Psychol 63:280–289PubMedCrossRefGoogle Scholar
  45. Tsemberis S, McHugo G, Williams V, Hanrahan P, Stefancic A (2007) Measuring homelessness and residential stability: the residential time-line follow-back inventory. J Commun Psychol 35:29–42CrossRefGoogle Scholar
  46. Ware JE, Kosinski M, Keller D (1995) SF-12: how to score the SF-12 physical and mental health summary scales, 2nd edn. The Health Institute New England Medical Center, BostonGoogle Scholar

Copyright information

© Swiss School of Public Health 2011

Authors and Affiliations

  • Stephen W. Hwang
    • 1
    • 2
    Email author
  • Tim Aubry
    • 3
  • Anita Palepu
    • 4
  • Susan Farrell
    • 5
  • Rosane Nisenbaum
    • 1
  • Anita M. Hubley
    • 6
  • Fran Klodawsky
    • 7
  • Evie Gogosis
    • 1
  • Elizabeth Hay
    • 3
  • Shannon Pidlubny
    • 4
  • Tatiana Dowbor
    • 1
  • Catharine Chambers
    • 1
  1. 1.Centre for Research on Inner City Health, The Keenan Research Centre at the Li Ka Shing Knowledge Institute, St. Michael’s HospitalTorontoCanada
  2. 2.Division of General Internal Medicine, Department of MedicineUniversity of TorontoTorontoCanada
  3. 3.Centre for Research on Educational and Community ServicesUniversity of OttawaOttawaCanada
  4. 4.Centre for Health Evaluation and Outcome Studies, Division of General Internal MedicineUniversity of British ColumbiaVancouverCanada
  5. 5.Royal Ottawa Health Care GroupOttawaCanada
  6. 6.Measurement, Evaluation, and Research Methodology, Department of Educational and Counselling Psychology, and Special EducationUniversity of British ColumbiaVancouverCanada
  7. 7.Department of Geography and Environmental StudiesCarleton UniversityOttawaCanada

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