Journal of General Internal Medicine

, Volume 13, Issue 6, pp 389–397 | Cite as

Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers

  • Linda Weinreb
  • Robert Goldberg
  • Jennifer Perloff
Original Articles

Abstract

OBJECTIVE: To compare the health characteristics and service utilization patterns of homeless women and low-income housed women who are heads of household.

DESIGN: Case-control study.

SETTING: Community of Worcester, Massachusetts.

PARTICIPANTS: A sample of 220 homeless mothers and 216 low-income housed mothers receiving welfare.

MEASUREMENTS AND MAIN RESULTS: Outcome measures included health status, chronic conditions, adverse lifestyle practices, outpatient and emergency department use and hospitalization rates, and use of preventive screening measures. Both homeless mothers and housed mothers demonstrated low levels of physical and role functioning and high levels of bodily pain. Prevalence rates of asthma, anemia, and ulcer disease were high in both groups. More than half of both groups were current smokers. Compared with the housed mothers, homeless mothers reported more HIV risk behaviors. Although 90% of the homeless mothers had been screened for cervical cancer, almost one third had not been screened for tuberculosis. After controlling for potential confounding factors, the homeless mothers, compared with the housed mothers, had more frequent emergency department visits in the past year (adjusted mean, homeless vs housed, 1.41 vs .95, p=.10) and were significantly more likely to be hospitalized in the past year (adjusted odds ratio 2.22; 95% confidence interval 1.13, 4.38).

CONCLUSIONS: Both homeless mothers and low-income housed mothers had lower health status, more chronic health problems, and higher smoking rates than the general population. High rates of hospitalization, emergency department visits, and more risk behaviors among homeless mothers suggest that they are at even greater risk of adverse health outcomes. Efforts to address gaps in access to primary care and to integrate psychosocial supports with health care delivery may improve health outcomes for homeless mothers and reduce use of costly medical care services.

Key words

homelessness health status women’s health service utilization primary care 

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References

  1. 1.
    Link B, Susser E, Steve A, Phelan J, Moore R, Strenning E. Life-time and five-year prevalence of homelessness in the United States. Am J Public Health. 1994;84:1907–12.PubMedGoogle Scholar
  2. 2.
    US Conference of Mayors. A Status Report on Hunger and Homelessness in America’s Cities: 1995. Washington, DC: US Conference of Mayors; 1995.Google Scholar
  3. 3.
    Wright J. Poor people, poor health: the health status of homeless. J Social Issues. 1990;46:49–64.CrossRefGoogle Scholar
  4. 4.
    Gelberg L, Linn L. Assessing the physical health of homeless adults. JAMA. 1989;262:1973–9.PubMedCrossRefGoogle Scholar
  5. 5.
    Usherwood T, Jones N, and the Hanover Project Team. Self-perceived health status of hotel residents: use of the SF 36-D health survey questionnaire. J Public Health Med. 1993;15(4):311–4.PubMedGoogle Scholar
  6. 6.
    Gelberg L, Linn L, Usatine R, Smith M. Health, homelessness and poverty. Arch Intern Med. 1990; 150:2325–30.PubMedCrossRefGoogle Scholar
  7. 7.
    Wright J, Weber E. Homelessness and Health. New York, NY: McGraw-Hill; 1987.Google Scholar
  8. 8.
    Robertson M, Cousineau M. Health status and access to health services among urban homeless. Am J Public Health. 1986;76(5):561–3.PubMedGoogle Scholar
  9. 9.
    Parker R, Rescorla L, Finklestein J, Barnes N, Holmes J, Stolley P. A survey of the health of homeless children in Philadelphia shelters. Am J Dis Child. 1991;145:520–6.PubMedGoogle Scholar
  10. 10.
    Winkleby M. Comparison of risk factors of ill health in a sample of homeless and non-homeless poor. Public Health Rep. 1990;105(4):404–10.PubMedGoogle Scholar
  11. 11.
    Wood D, Valdez R, Hayashi T, Shen A. Homeless and housed families in Los Angeles: a study comparing demographic, economic, and family functioning characteristics. Am J Public Health. 1990;80:1049–52.PubMedGoogle Scholar
  12. 12.
    Miller D, Lin E. Children in sheltered homeless families: reported health status and use of health services. Pediatrics. 1998;81:668–73.Google Scholar
  13. 13.
    Adkins C, Fields J. Health care values of homeless women and children. Fam Commun Health. 1992;15(3):20–9.Google Scholar
  14. 14.
    Rog D, McCombs-Thornton KL, Gilbert-Mongelli A, Brito M, Holupka C. Implementation of homeless families program, 2: characteristics, strengths and needs of participant families. Am J Orthopsychiatry. 1995;65:514–28.PubMedCrossRefGoogle Scholar
  15. 15.
    Chavkin W, Kristal A, Seabron C, et al. The reproductive experience of women living in hotels for the homeless in New York City. NY State J Med. 1987;87:10–3.Google Scholar
  16. 16.
    Wagner J, Menke E. Substance abuse by homeless pregnant mothers. J Health Care Poor Underserved. 1992;3:93–106.Google Scholar
  17. 17.
    Bassuk EL, Rubin L, Lauriat A. Characteristics of sheltered homeless families. Am J Public Health. 1986;76:1097–1101.PubMedGoogle Scholar
  18. 18.
    Weitzman B, Knickman J, Shinn M. Predictors of shelter use among low income families: psychiatric histories, substance abuse and victimization. Am J Public Health. 1992;82:1547–50.PubMedGoogle Scholar
  19. 19.
    Smith E, North C, Spitznagel E. Alcohol, drugs and psychiatric comorbidity among homeless women: an epidemiologic study. J Clin Psychiatry. 1993;54:82–7.PubMedGoogle Scholar
  20. 20.
    Nyamathi A. Relationship of resources to emotional distress. somatic conflicts and high-risk behaviors in drug recovery and homeless minority women. Res Nurs Health. 1991;14:269–77.PubMedCrossRefGoogle Scholar
  21. 21.
    Christiano A, Susser I. Knowledge and perceptions of HIV infection among homeless pregnant women. J Nurse Midwifery. 1989;34:318–22.PubMedCrossRefGoogle Scholar
  22. 22.
    Bassuk E,Weinreb L, Buckner J, Browne A, Salomon A, Bassuk S. The characteristics and needs of sheltered homeless and low income housed mothers. JAMA. 1996;276:646–9.CrossRefGoogle Scholar
  23. 23.
    O’Flaherty B. Making Room: The Economics of Homelessness. Cambridge, Mass: Harvard University Press; 1996.Google Scholar
  24. 24.
    Ware JE, Sherbourne DC. The MOS 36-Item Short Form Health Status Survey, I: conceptual framework and item selection. Med Care. 1991;30:473–83.CrossRefGoogle Scholar
  25. 25.
    McHorney CA. Ware JE, Lu JFR, Sherbourne DC. The MOS 36-item short-form Health Survey (SF-36): III: tests of data quality, scaling assumptions, and reliability across diverse patient groups. Med Care. 1994;32:40–66.PubMedCrossRefGoogle Scholar
  26. 26.
    Adams PF, Benson V, National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1989. Vital Health Stat 10. 1990;176.Google Scholar
  27. 27.
    Shoenborn CA, National Center for Health Statistics. Health promotion and disease prevention: United States, 1985. Vital Health Stat 10. 1989;163.Google Scholar
  28. 28.
    US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.Google Scholar
  29. 29.
    Spitzer RL, William JBW, Gibben M, First MB. Structured Clinical Interview for DSM-III-R Non Patient Edition (SCID-NP, version 1.0). Washington, DC: American Psychiatric Press; 1990.Google Scholar
  30. 30.
    American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed., revised. Washington, DC: American Psychiatric Association; 1987.Google Scholar
  31. 31.
    Miller BA, Downs WR, Gondoli DM, Keil A. The role of childhood sexual assault in the developement of alcoholism in women. Vilence Vict. 1987;2:157–72.Google Scholar
  32. 32.
    Barrow S, Hellan R, Lovell A, et al. Personal History Form. New York, NY: New York State Psychiatric Institute; 1985.Google Scholar
  33. 33.
    Dunst CH, Trivett CM. Personal Assessment of Social Support Scale. Moranton, NC: Family, Infant and Preschool Program, Western Carolina Center; 1988.Google Scholar
  34. 34.
    National Center for Health Statistics. National Health Interview Survey. 1993. Vital Health Stat 10. 1994;188–90.Google Scholar
  35. 35.
    Mackenebush J, Looman C, Van der Meer J. Differences in misreporting of chronic conditions by level of education: the effect of inequalities in prevalence rates. Am J Public Health. 1996;86:706–11.Google Scholar
  36. 36.
    Ware J, Snow K, Kosinski M, Gandek B. SF-36 Health Survey, Manual and Interpretation Guide. Boston, Mass: The Health Institute, New England Medical Center; 1993.Google Scholar
  37. 37.
    Council on Scientific Affairs, American Medical Association. Violence against women. JAMA. 1992;267(23):3184–9.CrossRefGoogle Scholar
  38. 38.
    Leserman J, Toomey T, Drossman D. Medical consequences of sexual and physical abuse in women. Humane Med. 1995:11:(1).Google Scholar
  39. 39.
    Surveillance for selected tobacco-use behaviors—United States. MMWR CDC Surveill Summ. 1994;43(SS-3):1–43.Google Scholar
  40. 40.
    National Center for Health Statistics. National Health Interview Survey. Vital Health Stat 10. 1990;185.Google Scholar
  41. 41.
    Covey L, Hughes D, Glassman A, Blazer D, George L. Ever-smoking, quitting, and psychiatric disorders: evidence from Durham, North Carolina, Epidemiologic Catchment Area. Tobacco Control. 1994;3:222–7.CrossRefGoogle Scholar
  42. 42.
    Covey L, Glassman A, Stetner F, Becker J. Effect of history of alcoholism or major depression on smoking cessation. Am J Psychiatry. 1993;150:1546–7.PubMedGoogle Scholar
  43. 43.
    Makuc D, Freid V, Kleinman J. National trends in the use of preventive health care by women. Am J Public Health. 1989;79:21–6.PubMedCrossRefGoogle Scholar
  44. 44.
    Zima BT, Wells KB, Benjamin B, Duan N. Mental health problems among homeless mothers. Arch Gen Psychiatry. 1996;53:332–8.PubMedGoogle Scholar
  45. 45.
    1990 Census of Population: Metropolitan Areas. Washington, DC: US Bureau of the Census; 1990.Google Scholar

Copyright information

© Society of General Internal Medicine 1998

Authors and Affiliations

  • Linda Weinreb
    • 1
  • Robert Goldberg
    • 2
  • Jennifer Perloff
    • 3
  1. 1.Dept. of Family and Community MedicineUniversity of Massachusetts Medical CenterWorcester
  2. 2.Department of MedicineUniversity of Massachusetts Medical CenterWorcester
  3. 3.The Better Homes FundNewton Center

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