Department of Psychology, University of California, Los Angeles, CA 90095-1563, USA.
Health Psychol. 2012 Jan;31(1):20-30. doi: 10.1037/a0023643. Epub 2011 May 16.
Homeless people have disproportionately high rates of viral hepatitis. The Gelberg-Andersen Behavioral Model for Vulnerable Populations (predisposing, enabling, and need variables) was expanded to predict prevalence and awareness of hepatitis B (HBV) or hepatitis C (HCV) infection, as well as health services utilization (HSU) among homeless adults using structural equation modeling.
A population-based sample of 534 homeless adults in Los Angeles' "Skid Row" was interviewed and tested for HBV and HCV.
Main outcome measures included HBV/HCV seropositivity, awareness of seropositivity, and HSU in the previous 12 months.
Seropositivity (43%), usually unknown (72% of seropositives), was predicted by injection drug use, alcohol use, older age, and risky sexual behavior. No regular source of care, risky sexual behavior, less case management, and greater age predicted not knowing one's positive status. Health insurance, younger age, alcohol use, perceived bad health and more medical conditions predicted emergency room (ER) use; ER use was less likely among seropositives. Hospitalizations were predicted by more medical conditions and greater percentage of life homeless and were less frequent among African Americans and males. Ambulatory visits were predicted by a regular source of care, case management, more education and perceived bad health; they were less likely among seropositives.
The Gelberg-Andersen Behavioral Model provided a useful guide for predicting HBV/HCV positivity as well as HSU in homeless adults. Most hepatitis-positives did not know their status and used health services less often than other homeless adults. More aggressive detection of hepatitis B and C among homeless adults is needed.
无家可归者患有病毒性肝炎的比例过高。扩展了 Gelberg-Andersen 弱势群体行为模型（易感性、赋权和需求变量），以使用结构方程模型预测无家可归成年人中乙型肝炎（HBV）或丙型肝炎（HCV）感染的流行率和知晓率，以及卫生服务利用（HSU）。
在洛杉矶“贫民区”对 534 名无家可归的成年人进行了基于人群的抽样调查，并对他们进行了 HBV 和 HCV 检测。
主要观察指标包括 HBV/HCV 血清阳性率、对血清阳性的知晓率以及过去 12 个月的 HSU。
血清阳性率（43%），通常不为人知（72%的血清阳性者），由注射吸毒、饮酒、年龄较大和危险性行为预测。没有固定的医疗来源、危险性行为、较少的病例管理和较大的年龄预示着不知道自己的阳性状态。健康保险、年龄较小、饮酒、认为健康状况不佳和更多的医疗条件预测急诊室（ER）就诊；ER 就诊的可能性较小。住院治疗由更多的医疗条件和更大比例的无家可归生活以及非裔美国人及男性预测。门诊就诊由固定的医疗来源、病例管理、更多的教育和健康状况不佳预测；在血清阳性者中，门诊就诊的可能性较小。
Gelberg-Andersen 行为模型为预测无家可归成年人的 HBV/HCV 阳性率以及 HSU 提供了有用的指导。大多数肝炎阳性者不知道自己的状况，并且比其他无家可归者使用卫生服务的频率更低。需要更积极地在无家可归者中检测乙型肝炎和丙型肝炎。
