How Feasible is Multiple Time Point Web-Based Data Collection with Individuals Experiencing Street Homelessness?

Three barriers investigators often encounter when conducting longitudinal work with homeless or other marginalized populations are difficulty tracking participants, high rates of no-shows for follow-up interviews, and high rates of loss to follow-up. Recent research has shown that homeless populations have substantial access to information technologies, including mobile devices and computers. These technologies have the potential both to make longitudinal data collection with homeless populations easier and to minimize some of these methodological challenges. This pilot study's purpose was to test whether individuals who were homeless and sleeping on the streets-the "street homeless"-would answer questions remotely through a web-based data collection system at regular "follow-up" intervals. We attempted to simulate longitudinal data collection in a condensed time period. Participants (N = 21) completed an in-person baseline interview. Each participant was given a remotely reloadable gift card. Subsequently, weekly for 8 weeks, participants were sent an email with a link to a SurveyMonkey questionnaire. Participants were given 48 h to complete each questionnaire. Data were collected about life on the streets, service use, community inclusion, substance use, and high-risk sexual behaviors. Ten dollars was remotely loaded onto each participant's gift card when they completed the questionnaire within the completion window. A substantial number of participants (67% of the total sample and 86% of the adjusted sample) completed at least seven out of the eight follow-up questionnaires. Most questionnaires were completed at public libraries, but several were completed at other types of locations (social service agencies, places of employment, relative/friend/acquaintance's domiciles, or via mobile phone). Although some of the questions were quite sensitive, very few participants skipped any questions. The only variables associated with questionnaire completion were frequency of computer use and education-both positive associations. This pilot study suggests that collecting longitudinal data online may be feasible with a subpopulation of persons experiencing homelessness. We suspect that participant follow-up rates using web-based data collection methods have the potential to exceed follow-up rates using traditional in-person interviews. If this population of persons experiencing street homelessness can be successful with this method of data collection, perhaps other disenfranchised, difficult-to-track, or difficult-to-reach populations could be followed using web-based data collection methods. Local governments are striving to decrease the "digital divide," providing free or greatly discounted wi-fi connectivity as well as mobile computer lab access to low-income geographic areas. These actions, in combination with increased smart phone ownership, may permit vulnerable populations to connect and communicate with investigators.

Problem gambling and homelessness: results from an epidemiologic study.

The purpose of this study was to investigate the prevalence of gambling disorder and comorbid psychiatric disorders in a homeless population and identify features related to potential subtypes. At baseline, participants were administered a structured interview including socio-demographic sections of the National Comorbidity Study (NCS) interview; seven diagnostic sections of the Diagnostic Interview Schedule (DIS); the alcohol and drug abuse sections of the Composite International Diagnostic Interview-Substance Abuse Module (CIDI-SAM); and the Homeless Supplement to the DIS. At nine months post-baseline assessment, participants were administered additional NCS family history questions and the South Oaks Gambling Screen (SOGS). Participants were an epidemiologic sample of 275 predominately African-American homeless individuals, grouped as lifetime non-gamblers (n = 60), recreational gamblers (n = 152), and problem gamblers (n = 63), recruited on the street and through homeless shelters. Results indicate that lifetime rates of sub-clinical problem (46.2%) and disordered (12.0%) gambling were significantly higher than in the general population. Problem gamblers were more likely than non-problem gamblers to meet diagnostic criteria for antisocial personality disorder, post-traumatic stress disorder, bipolar disorder, and any psychiatric disorder, and more likely than non-gamblers to use illicit drugs or meet criteria for abuse/dependence for nicotine, alcohol, or any substance. This study provides evidence that problem gambling is a significant public health issue among the African-American homeless population. Homeless services should include assessment for problem gambling along with psychiatric disorders and referrals to resources and treatment programs. Future studies should explore the relationship of the onset and course of problem gambling and other psychiatric disorders with homelessness as well as racial differences in gambling patterns and problem severity over time.

The potential for health-related uses of mobile phones and internet with homeless veterans: results from a multisite survey.

BACKGROUND: Addressing the health needs of homeless veterans is a priority in the United States, and, although information technologies can potentially improve access to and engagement in care, little is known about this population's use of information technologies or their willingness to use technologies to communicate with healthcare providers and systems. MATERIALS AND METHODS: This study fills this gap through a survey of homeless veterans' use of information technologies and their attitudes about using these technologies to assist with accessing needed healthcare services. RESULTS: Among the 106 homeless veterans surveyed, 89% had a mobile phone (one-third were smartphones), and 76% used the Internet. Among those with a mobile phone, 71% used text messaging. Nearly all respondents (93%) were interested in receiving mobile phone reminders (text message or phone call) about upcoming medical appointments, and a similar proportion (88%) wanted mobile phone outreach asking if they would like to schedule an appointment if they had not been seen by a health provider in over a year. In addition, respondents already used these technologies for information and communication related to health, housing, and jobs. CONCLUSIONS: These findings suggest new avenues for communication and health interventions for hard-to-reach homeless veterans.

Mobile phone technology: a new paradigm for the prevention, treatment, and research of the non-sheltered "street" homeless?

Individuals experiencing homelessness have disproportionately high rates of health problems. Those who perceive themselves as having greater access to their social support networks have better physical and mental health outcomes as well as lower rates of victimization. Mobile phones offer a connection to others without the physical constraints of landlines and, therefore, may make communication (e.g., access to one's social support networks) more feasible for homeless individuals. This, in turn, could lead toward better health outcomes. This exploratory study examined mobile phone possession and use among a sample of 100 homeless men and women who do not use the shelter system in Philadelphia, PA. Interviews were comprised of the Homeless Supplement to the Diagnostic Interview Schedule, a technology module created for this investigation, and the substance use and psychiatric sections of the Addiction Severity Index. Almost half (44%) of the sample had a mobile phone. In the past 30 days, 100% of those with mobile phones placed or received a call, over half (61%) sent or received a text message, and one fifth (20%) accessed the Internet via their mobile phone. Participants possessed and used mobile phones to increase their sense of safety, responsibility (employment, stable housing, personal business, and sobriety or "clean time"), and social connectedness. Mobile phones could potentially be used by public health/health care providers to disseminate information to the street homeless, to enhance communication between the street homeless and providers, and to increase access for the street homeless to prevention, intervention, and aftercare services. Finally, this technology could also be used by researchers to collect data with this transient population.

A prospective study of substance use and housing stability in a homeless population.

OBJECTIVES: This study examined self-report and urine test data about homeless substance use over time, prospectively comparing substance use with attainment of stable housing. METHODS: 400 homeless people systematically sampled from shelters and streets in St. Louis, Missouri were assessed with structured diagnostic interviews and urine substance testing annually over 2 years. Nearly two-thirds (n = 255) completed all three assessments, constituting the sample for this prospective study. RESULTS: More than half (55%) of this homeless sample had detectable cocaine use during the study. Most cocaine users continued using during the next 2 years and failed to achieve and maintain stable housing. Cocaine use in the first follow-up year predicted housing patterns over the next 2 years, independent of lifetime diagnosis of cocaine use disorder. Alcohol abuse/dependence in the 2-year follow-up period did not predict housing outcomes. CONCLUSIONS: The course of cocaine use and abuse/dependence, but not continuing alcohol addiction, was associated with subsequent attainment of stable housing, especially cocaine use in the first prospective year. Replication of these findings in other locations to determine generalizability may have implications for designing housing service models.

Youth Homelessness: Prevalence and Associations with Weight in Three Regions.

This study investigated the utility of the Youth Risk Behavior Survey (YRBS) to document associations between homeless status and weight while estimating the prevalence of youth homelessness in three regions. A school-based survey, the YRBS includes youths who have been difficult to involve in past research. Analysis of 2011 YRBS data produced population-weighted estimates of youth homelessness prevalence separately for Connecticut, Delaware, and Philadelphia. Public high school students anonymously reported their housing status, height, and weight on the YRBS. Height and weight were converted to body mass index (BMI) percentile-for-age scores. Homelessness was associated with higher BMI percentile scores for youths compared with nonhomeless peers. Associations between BMI percentile and different forms of homelessness (homeless with family, unaccompanied homeless without family) were explored at each site. Estimates of one-month homelessness prevalence ranged from 3.9 percent to 5.9 percent at each site. Homelessness, especially family homelessness, is associated with risk for higher BMI. The YRBS is an informative tool for estimating the prevalence of youth homelessness, expanding on what is known through other, more commonly used methods.

Subjective versus Objective Definitions of Homelessness: Are there Differences in Risk Factors among Heavy-Drinking Women?

Investigations with homeless populations have focused on those living on the streets or in shelters; few have examined phenomena based on respondents' self-definitions as homeless or not. This investigation examined similarities and differences among risk factors (including mental health, substance abuse, religion/spirituality, social support, and risky sexual behaviors) using two definitions of homelessness: one where place of residence defined individuals as homeless (the `objective', or traditional, definition) and another where respondents defined themselves as homeless (the `subjective' definition). Data come from the baseline survey of the NIAAA-funded "Sister-to-Sister" study (n=339) of heavy-drinking women. Subjectively-defined homelessness was associated with higher rates of mental health and substance use disorders, lower rates of condom use, higher rates of trading sex for food, and less social support. Objectively-defined homelessness was associated with higher rates of drinking in abandoned buildings, on the streets, and in public restrooms, more new sexual partners, and higher rates of trading sex for heroin and speedballs. Investigations failing to ask for subjective information may misattribute some factors to homelessness which may overestimate the effect of various factors on homelessness. Investigators should ask respondents to define their homelessness, or they lose an important dimension of the concept of homelessness.

Individual characteristics of the literally homeless, marginally housed, and impoverished in a US substance abuse treatment-seeking sample.

BACKGROUND: Many researchers and clinicians believe that understanding substance use problems is key to understanding homelessness. This study's purpose was to test, in a national sample of urban substance abuse treatment seekers, whether (1) income was related to amount of money spent on substances and (2) homeless chronic substance users had more severe psychosocial problems or histories than housed chronic substance users. METHOD: Questions assessing homelessness were inserted into the Drug Evaluation Network System-a computer-assisted intake interview (including the Addiction Severity Index) implemented in addiction treatment programs across the U.S. Based on these data, clients were divided into four residential groups: literally homeless (n = 654), marginally housed (n = 1138), housed poor (n = 3119), and housed not poor (n = 718). Income, human capital (education level and acquisition of a trade/skill), substance use, mental health, and social support were examined. RESULTS: The literally homeless was not the poorest group, although these clients did spend the most money on substances. All four groups' incomes were positively related to amount of money spent on drugs, but only the marginally housed's income was related to money spent on alcohol. The literally homeless had the most severe alcohol, mental health, and social support problems. The literally homeless and marginally housed had similar incomes and human capital and the most severe cocaine problems. In general the housed poor and housed not poor fared better than the literally homeless and marginally housed groups. DISCUSSION: Practitioners should continue to intervene with the homeless and consider working with the marginally housed's social support systems. Future research should examine the marginally housed as an at-risk group for homelessness.