Health and lifestyle issues as risk factors for homelessness.

BACKGROUND: The objective of this study was to test the hypothesis that there are health and lifestyle issues among homeless persons that differentiate them from other segments of the population and that can be described as risk factors for homelessness.

METHODS: This case-control study investigated health and lifestyle issues in a panel of patients visiting a health care clinic for homeless persons. The same information was collected from a panel of county indigent patients and an equal number of privately insured patients enrolled in a nearby academic family practice center.

RESULTS: We found significant differences among these three groups. Differences in health problems were evident, as significantly more homeless persons reported mental health, drug and alcohol abuse, and smoking problems. There were no differences in the prevalence of other general medical conditions as listed by the patients. Homeless persons were younger than the control group respondents and more likely to be male, a member of a minority group, and unmarried. The childhood experiences of homeless persons were distinctive; they were more likely to have lived in a group home or some other nonfamily situation, considered themselves to have been delinquent, run away from home, been expelled from school, or been placed in reform school. The same held true for having been in jail as an adult. They had significantly less education, their job experiences were in manual and unskilled arenas, and they were more likely to have a gambling problem. A continuum of risk also appeared in that for the most part the characteristics and experiences of the indigent group members ranked in frequency between those of the homeless and insurance groups.

CONCLUSIONS: Causes of homelessness appear to be multifactorial. Issues related to mental health, alcohol, nicotine, and other drug and substance abuse could be responsible for their medical problems, whereas other lifestyle issues might be regarded as risk factors for homelessness.