Winkleby Lab In the Prevention Research Center


Homelessness has become one of the most significant and challenging social problems to face the United States during the last decade. Using figures from the 1988 National Alliance to End Homelessness, it can be estimated that on any given night in 1988, 1 in 350 people in the United States were homeless, 1 in 130 were homeless for one night or more, and that 1 in 40 were at extreme risk of becoming homeless. These figures are representative of Santa Clara Valley where there are an estimated 13,000 homeless persons.

Health problems of the homeless are abundant with the homeless experiencing a higher prevalence of illnesses and injuries than the population as a whole. Three sets of health problems that relate to homelessness can be identified, including those that increase the risk of homelessness (e.g., injuries resulting in loss of employment, mental illness, substance abuse, or AIDS); those that are a consequence of homelessness (e.g., malnutrition, periodontal disease, infectious hepatitis, tuberculosis, sexually transmitted diseases, or physical assault); and those that relate to the provision of health care services (e.g., diabetes, hypertension or other chronic conditions requiring bed rest, medications, and diet modification).

Progress in research on the health of the homeless has been impaired by methodologic as well as analytic problems. Despite the extensiveness of this public health problem only a small number of articles on homelessness and health have been published in the medical literature and for the most part, these have collected data on small, unrepresentative samples; examined prevalence data rather than causal factors; and analyzed results on combined groups rather than subgroups. As a result, little is known about risk factors that may predict homelessness and the homeless have often been stereotyped as a group of mentally and/or physically disabled adults.

We are seeking funds to conduct a cross-sectional survey of approximately 2,000 homeless adults in San Jose, California. The purpose of the proposed research is to: 1) identify risk factors that may predict homelessness so that preventive services can be planned, and 2) delineate different subgroups within the homeless whose risk profiles and health needs may vary significantly so that health care services can be tailored to specific risk groups. It is proposed that current interventions to improve the health of the homeless are severely compromised by not understanding antecedent risk factors and by viewing the homeless as a homogeneous group. Without this knowledge, program planning and funding may be misdirected and ineffective.

This work will identify risk factors than are antecedent to homelessness so that future efforts can focus on preventive rather than treatment and rehabilitative measures. In addition, it will begin the delineation of different subgroups within the homeless whose risk profiles and health needs may vary significantly. By accurately characterizing these variations, subgroups of the homeless can be linked to appropriate services and funding, and program planning can be tailored to meet the health needs of each subgroup.


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