Department of Community Health Sciences, Jonathan and Karin Fielding School of Public Health, University of California Los Angeles, Los Angeles, California.
Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, California.
J Adolesc Health. 2023 Dec;73(6):1038-1045. doi: 10.1016/j.jadohealth.2023.06.013. Epub 2023 Aug 12.
We examined the impact of duration and number of homelessness episodes on health outcomes for unsheltered homeless young adults.
We analyzed the 2018/2019 Los Angeles County homeless youth demographic surveys. We addressed five summary health outcomes: physical health, mental health, substance use disorder, tri-morbidity, and any condition. Respondents were classified into three homeless trajectory groups: (1) short-term-homeless < 1 year in one episode, (2) episodic-homeless < 1 year and multiple episodes, and (3) long-term-homeless continuously for > 1 year. Weighted bivariate and multivariate logistic regression models tested the relationship between homeless trajectory group and health, with controls for sociodemographic factors and structural exposures.
Mental health and substance use were high among unsheltered young adults compared to national rates. Long-term homeless respondents were significantly more likely than short-term to report a mental health condition (53.3% vs. 39.8%, p < .001), substance use disorder (25.5% vs. 18.3%, p < .001), and physical conditions (26.0% vs. 15.6%, p = .008). Episodic respondents were more likely to report a mental health condition (50.5%, p < .001). In multivariate models, long-term respondents had twice the odds of tri-morbidity (odds ratio [OR] = 2.14, p < .05) and any health condition (OR 2.00, p < .01) as short term and significantly higher odds of a physical health condition (OR = 1.64, p < .05).
Youth with longer durations and more frequent episodes of homelessness have substantially poorer health outcomes. The association of longer duration to poorer health persisted in multivariate models. Longer duration of unsheltered homelessness may drive the onset of physical and mental health problems.
我们研究了无家可归的年轻成年人经历无家可归期的持续时间和次数对健康结果的影响。
我们分析了 2018/2019 年洛杉矶县无家可归青年人口普查调查。我们解决了五个总体健康结果：身体健康、心理健康、物质使用障碍、三重病症和任何疾病。受访者被分为三组无家可归轨迹组：（1）短期无家可归<1 年且仅经历过一次，（2）偶发性无家可归<1 年且经历过多次，（3）长期无家可归持续时间超过 1 年。加权二变量和多变量逻辑回归模型测试了无家可归轨迹组与健康之间的关系，并控制了社会人口因素和结构暴露。
与全国水平相比，无家可归的年轻成年人心理健康和物质使用问题较高。与短期相比，长期无家可归的受访者更有可能报告心理健康状况（53.3%比 39.8%，p<0.001）、物质使用障碍（25.5%比 18.3%，p<0.001）和身体状况（26.0%比 15.6%，p=0.008）。偶发性受访者更有可能报告心理健康状况（50.5%，p<0.001）。在多变量模型中，长期受访者患有三重病症的可能性是短期的两倍（优势比[OR]2.14，p<0.05）和任何健康状况（OR 2.00，p<0.01），并且身体状况的可能性显著更高（OR 1.64，p<0.05）。
经历无家可归期持续时间和次数更长的年轻人健康结果明显更差。多变量模型中，持续时间较长与健康状况较差之间存在关联。无家可归的持续时间较长可能会导致身心健康问题的发生。
