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.
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References
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.
US Conference of Mayors. A Status Report on Hunger and Homelessness in America’s Cities: 1995. Washington, DC: US Conference of Mayors; 1995.
Wright J. Poor people, poor health: the health status of homeless. J Social Issues. 1990;46:49–64.
Gelberg L, Linn L. Assessing the physical health of homeless adults. JAMA. 1989;262:1973–9.
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.
Gelberg L, Linn L, Usatine R, Smith M. Health, homelessness and poverty. Arch Intern Med. 1990; 150:2325–30.
Wright J, Weber E. Homelessness and Health. New York, NY: McGraw-Hill; 1987.
Robertson M, Cousineau M. Health status and access to health services among urban homeless. Am J Public Health. 1986;76(5):561–3.
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.
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.
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.
Miller D, Lin E. Children in sheltered homeless families: reported health status and use of health services. Pediatrics. 1998;81:668–73.
Adkins C, Fields J. Health care values of homeless women and children. Fam Commun Health. 1992;15(3):20–9.
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.
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.
Wagner J, Menke E. Substance abuse by homeless pregnant mothers. J Health Care Poor Underserved. 1992;3:93–106.
Bassuk EL, Rubin L, Lauriat A. Characteristics of sheltered homeless families. Am J Public Health. 1986;76:1097–1101.
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.
Smith E, North C, Spitznagel E. Alcohol, drugs and psychiatric comorbidity among homeless women: an epidemiologic study. J Clin Psychiatry. 1993;54:82–7.
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.
Christiano A, Susser I. Knowledge and perceptions of HIV infection among homeless pregnant women. J Nurse Midwifery. 1989;34:318–22.
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.
O’Flaherty B. Making Room: The Economics of Homelessness. Cambridge, Mass: Harvard University Press; 1996.
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.
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.
Adams PF, Benson V, National Center for Health Statistics. Current estimates from the National Health Interview Survey, 1989. Vital Health Stat 10. 1990;176.
Shoenborn CA, National Center for Health Statistics. Health promotion and disease prevention: United States, 1985. Vital Health Stat 10. 1989;163.
US Preventive Services Task Force. Guide to Clinical Preventive Services. 2nd ed. Baltimore, Md: Williams & Wilkins; 1996.
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.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed., revised. Washington, DC: American Psychiatric Association; 1987.
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.
Barrow S, Hellan R, Lovell A, et al. Personal History Form. New York, NY: New York State Psychiatric Institute; 1985.
Dunst CH, Trivett CM. Personal Assessment of Social Support Scale. Moranton, NC: Family, Infant and Preschool Program, Western Carolina Center; 1988.
National Center for Health Statistics. National Health Interview Survey. 1993. Vital Health Stat 10. 1994;188–90.
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.
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.
Council on Scientific Affairs, American Medical Association. Violence against women. JAMA. 1992;267(23):3184–9.
Leserman J, Toomey T, Drossman D. Medical consequences of sexual and physical abuse in women. Humane Med. 1995:11:(1).
Surveillance for selected tobacco-use behaviors—United States. MMWR CDC Surveill Summ. 1994;43(SS-3):1–43.
National Center for Health Statistics. National Health Interview Survey. Vital Health Stat 10. 1990;185.
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.
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.
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.
Zima BT, Wells KB, Benjamin B, Duan N. Mental health problems among homeless mothers. Arch Gen Psychiatry. 1996;53:332–8.
1990 Census of Population: Metropolitan Areas. Washington, DC: US Bureau of the Census; 1990.
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This work was supported by grants from the National Institute of Mental Health (MH47312 and MH51479) and the Maternal and Child Health Bureau (MCJ250809).
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Weinreb, L., Goldberg, R. & Perloff, J. Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers. J GEN INTERN MED 13, 389–397 (1998). https://doi.org/10.1046/j.1525-1497.1998.00119.x
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DOI: https://doi.org/10.1046/j.1525-1497.1998.00119.x