Stefan G Kertesz1, Aerin J DeRussy2, Kevin R Riggs3, April E Hoge2, Allyson L Varley3, Ann Elizabeth Montgomery4, Erika L Austin5, John R Blosnich6, Audrey L Jones7, Sonya E Gabrielian8, Lillian Gelberg9, Adam J Gordon7, Joshua S Richman10. 1. Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama; Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama. Electronic address: skertesz@uabmc.edu. 2. Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama. 3. Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Medicine, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama. 4. Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Health Behavior, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama. 5. Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Biostatistics, School of Public Health, The University of Alabama at Birmingham, Birmingham, Alabama. 6. Department of Social Change and Innovation, University of Southern California Suzanne Dworak-Peck School of Social Work, Los Angeles, California; Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania. 7. Informatics, Decision-Enhancement and Analytic Sciences Center, VA Salt Lake City Health Care System, Salt Lake City, Utah; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah. 8. Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Psychiatry and Biobehavioral Sciences, University of California Los Angeles, Los Angeles, California. 9. Center for the Study of Healthcare Innovation, Implementation and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Department of Family Medicine, University of California Los Angeles, Los Angeles, California. 10. Research Service, Birmingham Veterans Affairs Health Care System, Birmingham, Alabama; Department of Surgery, School of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama.
Abstract
INTRODUCTION: Unsheltered homelessness is a strongly debated public issue. The study objective is to identify personal and community characteristics associated with unsheltered homelessness in veterans and to test for interactions between these characteristics. METHODS: In a 2018 national survey of U.S. veterans with homeless experiences; investigators assessed unsheltered time; psychosocial characteristics; and community measures of shelter access, weather, and rental affordability. Associations between these characteristics and unsheltered status were tested in July-August 2020. This study also tested whether the count of personal risk factors interacted with community characteristics in predicting unsheltered status. RESULTS: Among 5,406 veterans, 481 (8.9%) reported ≥7 nights unsheltered over 6 months. This group was more likely to report criminal justice history, poor social support, medical and drug problems, financial hardship, and being unmarried. Their communities had poorer shelter access and warmer temperatures. The likelihood of unsheltered experience rose with risk factor count from 2.0% (0-1) to 8.4% (2-3) and to 24.2% (4-11). Interaction tests showed that the increase was greater for communities with warmer weather and higher rents (p<0.05). CONCLUSIONS: Among veterans experiencing homelessness, unsheltered experiences correlate with individual and community risk factors. Communities wishing to address unsheltered homelessness will need to consider action at both levels. Published by Elsevier Inc.
INTRODUCTION: Unsheltered homelessness is a strongly debated public issue. The study objective is to identify personal and community characteristics associated with unsheltered homelessness in veterans and to test for interactions between these characteristics. METHODS: In a 2018 national survey of U.S. veterans with homeless experiences; investigators assessed unsheltered time; psychosocial characteristics; and community measures of shelter access, weather, and rental affordability. Associations between these characteristics and unsheltered status were tested in July-August 2020. This study also tested whether the count of personal risk factors interacted with community characteristics in predicting unsheltered status. RESULTS: Among 5,406 veterans, 481 (8.9%) reported ≥7 nights unsheltered over 6 months. This group was more likely to report criminal justice history, poor social support, medical and drug problems, financial hardship, and being unmarried. Their communities had poorer shelter access and warmer temperatures. The likelihood of unsheltered experience rose with risk factor count from 2.0% (0-1) to 8.4% (2-3) and to 24.2% (4-11). Interaction tests showed that the increase was greater for communities with warmer weather and higher rents (p<0.05). CONCLUSIONS: Among veterans experiencing homelessness, unsheltered experiences correlate with individual and community risk factors. Communities wishing to address unsheltered homelessness will need to consider action at both levels. Published by Elsevier Inc.
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