Goldshear Jesse Lloyd, Ganesh Siddhi S, Borquez Annick, Gelberg Lillian, Corsi Karen F, Bluthenthal Ricky N
University of California, San Diego.
University of Southern California.
Res Sq. 2024 Dec 18:rs.3.rs-5221742. doi: 10.21203/rs.3.rs-5221742/v1.
Homelessness is a growing concern in the United States, especially among people who use drugs (PWUD). The degree of material hardship among this population may be linked to worse health outcomes. PWUD experiencing homelessness in urban areas are increasingly subjected to policies and social treatment, such as forced displacement, which may worsen material hardship. It is critical to describe hardship among PWUD and examine if it is linked to health outcomes.
Data were collected as part of a prospective cohort study of PWUD in Los Angeles, California and Denver, Colorado (n = 476). Analysis sample size was smaller (N = 395) after selecting for people experiencing homelessness and for whom data were complete. Five indicators assessing hardship (difficulty finding food, clothing, restrooms, places to wash/shower, and shelter) in the past three months were obtained from participants at baseline and were used in latent class analysis (LCA). We chose a base latent class model after examination of global fit statistics. We then built three auxiliary models using the three-step Bolck-Croon-Hagenaars (BCH) method to test the relationship of latent class membership to several hypothesized social and health variables in this same three month time period.
Fit statistics, minimum classification probabilities, and ease of interpretation indicated a three-class solution for level of material difficulty. We termed these classes "High Difficulty" (n = 82), "Mixed Difficulty" (n = 215), and "Low Difficulty" (n = 98). Average classification probabilities indicated good class separability. "High Difficulty" participants had high probabilities of usually having difficulty accessing all five resources. "Mixed Difficulty" participants indicated a range of difficulty accessing all resources, with restrooms and bathing facilities being the most difficult. "Low Difficulty" participants were defined by high probabilities of never having access difficulty. In auxiliary analyses, there were significant (p < 0.05) differences in experiences of displacement, opioid withdrawal symptoms, nonfatal overdose, and violent victimization between classes.
This LCA indicates that among PWUD experiencing homelessness there exist distinct differences in resource access and material hardship, and that these differences are linked with political, social, substance use, and other health outcomes. We add to the literature on the relationship between poverty and health among PWUD. Policies which increase difficulty accessing necessary material resources may negatively impact health in this population.
在美国，无家可归问题日益受到关注，尤其是在吸毒人群（PWUD）中。这一人群的物质困难程度可能与更差的健康结果相关。在城市地区经历无家可归的吸毒人群越来越多地受到诸如强制搬迁等政策和社会待遇的影响，这可能会加剧物质困难。描述吸毒人群中的困难情况并研究其是否与健康结果相关至关重要。
数据收集是加利福尼亚州洛杉矶市和科罗拉多州丹佛市对吸毒人群进行的一项前瞻性队列研究的一部分（n = 476）。在选择了经历无家可归且数据完整的人群后，分析样本量较小（N = 395）。从参与者基线时获得了五个评估过去三个月困难程度的指标（寻找食物、衣物、洗手间、洗漱/淋浴场所和住所的困难程度），并用于潜在类别分析（LCA）。在检查全局拟合统计量后，我们选择了一个基本潜在类别模型。然后，我们使用三步Bolck - Croon - Hagenaars（BCH）方法构建了三个辅助模型，以测试潜在类别成员资格与同一三个月时间段内几个假设的社会和健康变量之间的关系。
拟合统计量、最小分类概率和易于解释性表明物质困难程度存在三类解决方案。我们将这些类别称为“高难度”（n = 82）、“混合难度”（n = 215）和“低难度”（n = 98）。平均分类概率表明类别可分性良好。“高难度”参与者通常在获取所有五种资源方面都有很高的困难概率。“混合难度”参与者表明在获取所有资源方面存在一系列困难，其中洗手间和洗浴设施最难获取。“低难度”参与者的定义是从未有获取困难的高概率。在辅助分析中，不同类别在搬迁经历、阿片类药物戒断症状、非致命过量用药和暴力受害经历方面存在显著（p < 0.05）差异。
这项潜在类别分析表明，在经历无家可归的吸毒人群中，资源获取和物质困难存在明显差异，并且这些差异与政治、社会、物质使用和其他健康结果相关。我们补充了关于吸毒人群中贫困与健康关系的文献。增加获取必要物质资源难度的政策可能会对这一人群的健康产生负面影响。
