Perceptions of Housing and Shelter among People with Histories of Unstable Housing in three Cities in Canada: A Qualitative Study.

Housing is a key social determinant of health that contributes to the well-documented relationship between socioeconomic status and health. This study explored how individuals with histories of unstable and precarious housing perceive their housing or shelter situations, and the impact of these settings on their health and well-being. Participants were recruited from the Health and Housing in Transition study (HHiT), a longitudinal, multi-city study that tracked the health and housing status of people with unstable housing histories over a 5-year period. For the current study, one-time semi-structured interviews were conducted with a subset of HHiT study participants (n = 64), living in three cities across Canada: Ottawa, Toronto, and Vancouver. The findings from an analysis of the interview transcripts suggested that for many individuals changes in housing status are not associated with significant changes in health due to the poor quality and precarious nature of the housing that was obtained. Whether housed or living in shelters, participants continued to face barriers of poverty, social marginalization, inadequate and unaffordable housing, violence, and lack of access to services to meet their personal needs.

A Longitudinal Study of Predictors of Housing Stability, Housing Quality, and Mental Health Functioning Among Single Homeless Individuals Staying in Emergency Shelters.

The current study examined risk and resilience factors at multiple levels that affect homeless individuals' ability to exit homelessness and achieve housing stability. It also examined the relationship between housing status, housing quality and mental health functioning. The methodology is a longitudinal study of single homeless individuals staying in emergency shelters in a medium-sized Canadian city who were followed for a 2 year period. Data were collected from participants at a baseline interview when they were homeless and at a 2-year follow-up. There were 329 participants interviewed at baseline and 197 (59.9%) participants interviewed at follow-up. Results from a structural equation modelling analysis found that having interpersonal and community resources were predictive of achieving housing stability. Specifically, having a larger social support network, access to subsidized housing, and greater income was related to achieving housing stability. On the other hand, having a substance use problem was a risk factor associated with a failure to achieving housing stability. Being female, feeling personally empowered, having housing that is perceived of being of higher quality were directly predictive of mental health functioning at follow-up. Findings are discussed in the context of previous research and their policy implications.

A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities.

BACKGROUND: Homeless persons experience a high burden of health problems; yet, they face significant barriers in accessing health care. Less is known about unmet needs for care among vulnerably housed persons who live in poor-quality or temporary housing and are at high risk of becoming homeless. The objectives of this study were to examine the prevalence of and factors associated with unmet needs for health care in a population-based sample of homeless and vulnerably housed adults in three major cities within a universal health insurance system. METHODS: Participants were recruited at shelters, meal programs, community health centers, drop-in centers, rooming houses, and single room occupancy hotels in Vancouver, Toronto, and Ottawa, Canada, throughout 2009. Baseline interviews elicited demographic characteristics, health status, and barriers to health care. Logistic regression was used to identify factors associated with self-reported unmet needs for health care in the past 12 months. RESULTS: Of the 1,181 participants included in the analysis, 445 (37%) reported unmet needs. In adjusted analyses, factors associated with a greater odds of reporting unmet needs were having employment in the past 12 months (AOR = 1.40, 95% CI = 1.03-1.91) and having ≥3 chronic health conditions (AOR = 2.17, 95% CI = 1.24-3.79). Having higher health-related quality of life (AOR = 0.21, 95% CI = 0.09-0.53), improved mental (AOR = 0.97, 95% CI = 0.96-0.98) or physical health (AOR = 0.98, 95% CI = 0.96-0.99), and having a primary care provider (AOR = 0.63, 95% CI = 0.46-0.85) decreased the odds of reporting unmet needs. CONCLUSIONS: Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed.

Comparing the housing trajectories of different classes within a diverse homeless population.

The paper presents findings from a longitudinal study identifying different classes of homeless individuals in a mid-size Canadian city based on health-related characteristics and comparing the housing trajectories of these classes 2 years later. Using data collected through in-person interviews with a sample of 329 single persons who have experienced homelessness, the paper presents results of a latent class analysis. Results found four distinct latent classes characterized by different levels of severity of health problems--i.e., a class of individuals who are "Higher Functioning" (28.7%), a second class with "Substance Abuse Problems" (27.1%), a third class with "Mental Health Substance Abuse Problems" (22.6%), and a fourth class with "Complex Physical and Mental Health Problems" (21.6%) that included having diminished physical functioning, multiple chronic physical health conditions, mental health difficulties, and in some cases substance abuse problems. Follow-up interviews with 197 of these individuals (59.9%) 2 years later showed the class of individuals with substance abuse problems experiencing the greatest difficulty in exiting homelessness and achieving housing stability. Implications of these findings for social policy development and program planning are discussed.

The relationship between victimization and mental health functioning in homeless youth and adults.

This study examined the relationship between victimization and mental health functioning in homeless individuals. Homeless populations experience higher levels of victimization than the general population, which in turn have a detrimental effect on their mental health. A sample of 304 homeless adults and youth completed one-on-one interviews, answering questions on mental health, past victimization, and recent victimization experiences. A hierarchical linear regression showed that experiences of childhood sexual abuse predicted lower mental health functioning after controlling for the sex and age of individuals. The study findings are applicable to current support programs for victims in the homeless population and are relevant to future research on homelessness and victimization.

Neighbourhood amenities and health: examining the significance of a local park.

This paper reports the results of a qualitative study that examines the links between neighbourhood spaces and quality of life for nine formerly homeless women who live in a supportive housing development in Ottawa, Ontario. It explores a local park that participants subjectively identified as the most meaningful place influencing their health and quality of life. Looking at the neighbourhood from the participants' perspectives, this paper discusses the links between access to nearby urban green space, feelings of well-being, and having a sense of belonging to the broader community. The primary methods used in our study were photovoice, whereby participants were asked to take pictures of both healthy and unhealthy aspects of their neighbourhood, and participant observation of the women's interactions with their immediate and neighbourhood living environments. The participants used photographs as a tool to help describe their experiences of the park as not only a therapeutic or health-promoting place, but also an un-therapeutic or health-denying place. Participant observation helped fill the gaps that women were unable to articulate in the interviews. The results reveal that participants placed more emphasis on inclusive (free of charge) social events and the ability to interact with others at the park than on its aesthetics. This finding supports the notion that while beautification certainly has value, resources to support free community events in public spaces are at least equally important for establishing feelings of inclusion in the community among marginalized populations.

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

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.