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Comparing the Characteristics of Homeless Adults in Poland and the United States

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This study compared the characteristics of probability samples of homeless adults in Poland (N = 200 from two cities) and the United States (N = 219 from one city), using measures with established reliability and validity in homeless populations. The same measures were used across nations and a systemic translation procedure assured comparability of measurement. The two samples were similar on some measures: In both nations, most homeless adults were male, many reported having dependent children and experiencing out-of-home placements when they themselves were children, and high levels of physical health problems were observed. Significant national differences were also found: Those in Poland were older, had been homeless for longer, showed lower rates on all psychiatric diagnoses assessed (including severe mental and substance abuse disorders), reported less contact with family and supportive network members, were less satisfied when they sought support from their networks, and reported fewer recent stressful life events and fewer risky sexual behaviors. Culturally-informed interpretations of these findings and their implications are presented.
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ORIGINAL ARTICLE
Comparing the Characteristics of Homeless Adults in Poland
and the United States
Paul A. Toro Karen L. Hobden Kathleen Wyszacki Durham
Marta Oko-Riebau Anna Bokszczanin
Published online: 29 January 2014
ÓSociety for Community Research and Action 2014
Abstract This study compared the characteristics of
probability samples of homeless adults in Poland (N =200
from two cities) and the United States (N =219 from one
city), using measures with established reliability and
validity in homeless populations. The same measures were
used across nations and a systemic translation procedure
assured comparability of measurement. The two samples
were similar on some measures: In both nations, most
homeless adults were male, many reported having depen-
dent children and experiencing out-of-home placements
when they themselves were children, and high levels of
physical health problems were observed. Significant
national differences were also found: Those in Poland were
older, had been homeless for longer, showed lower rates on
all psychiatric diagnoses assessed (including severe mental
and substance abuse disorders), reported less contact with
family and supportive network members, were less satis-
fied when they sought support from their networks, and
reported fewer recent stressful life events and fewer risky
sexual behaviors. Culturally-informed interpretations of
these findings and their implications are presented.
Keywords Homelessness Poland International
comparison Baby boom generation Psychiatric disorders
Introduction
Over the past three decades, homelessness has emerged as
a major social issue in most developed nations of the
world. Although the problem is now recognized in many
nations, most of the research on homelessness has been
conducted in the United States (US), with some research
done in a few other nations such as the United Kingdom
(UK), Canada, France, and Australia (Toro 2007). Home-
lessness in Eastern European nations has only recently
been acknowledged as a social problem and there is little
existing research on the topic (Hradecky and Hladikova
2007). Such research in the former communist nations of
Eastern Europe could yield especially interesting results
because homelessness appears to have been very rare prior
to the fall of communism in the 1990s and has shown a
rapid increase in the past 20 years (Przymen
´ski 2008).
A number of authors have recently suggested that
research on homelessness that compares nations could lead
to a richer understanding of the causes of and solutions to
homelessness (e.g., Shinn 2007; Toro 2007). To date,
however, there have been very few published reports that
attempt such comparisons. Early comparative publications
generally failed to use sound research methods, often
relying on anecdotal evidence (e.g., Avramov 1998;
Cohen 1994; Daly 1990; Helvie and Kunstmann 1999;
Marpsat 1999; Sleegers 2000). A few recent publications
have used more sophisticated methods, carefully replicated
across nations, to help us understand differences between
nations on the prevalence of homelessness, the character-
istics of homeless people, and policy and cultural
P. A. Toro (&)K. Wyszacki Durham
Research Group on Homelessness and Poverty, Department of
Psychology, Wayne State University, 5057 Woodward St.,
Detroit, MI, USA
e-mail: paul.toro@wayne.edu
P. A. Toro A. Bokszczanin
University of Opole, Opole, Poland
K. L. Hobden
University of Windsor, Windsor, Canada
M. Oko-Riebau
University of Denver, Denver, CO, USA
123
Am J Community Psychol (2014) 53:134–145
DOI 10.1007/s10464-014-9632-8
differences influencing the development and resolution of
homelessness.
For example, Milburn et al. (2006) compared large
samples of homeless youth from Melbourne, Australia
(N=673) and Los Angeles (N=618). Compared to the
Australians, the US homeless youth were younger, and
more likely to be in school and to have spent time in jail.
They showed less substance use and fewer suicidal
attempts. In another paper based on the same two-nation
sample, Milburn et al. (2007) used structural equation
modeling to examine predictors of HIV risk behaviors.
They found that the predictors of HIV risk behaviors were
similar across nations, even though the overall level of
such behaviors was higher among the Australians. The
predictors included high levels of delinquent behaviors and
substance use, associating with delinquent peers, and
experience with victimization on the streets. Having posi-
tive peer relationships and better quality housing predicted
fewer HIV risk behaviors in both nations. This study
highlights how homeless populations may have different
problems and needs across nations but, at the same time,
there may be some common predictors of success.
Based on her review of various studies, including ones
explicitly comparing the prevalence of homelessness
across nations, Shinn (2007) suggested that the breadth and
efficiency of health and human services across nations
could help explain the variation in rates of homelessness
observed. Germany and France, for example, seem to have
relatively low rates of homelessness and have a strong
array of services, including a ‘‘guaranteed minimum
income,’’ readily available national health care, and gen-
erous unemployment benefits (Helvie and Kunstmann
1999). Shinn (2007) and others (e.g., Adams 1986; Hobden
et al. 2007; Toro and Rojansky 1990; Toro et al. 2007)
have offered further explanations for higher rates of
homelessness observed among some nations (such as the
US, Canada, and the UK). These explanations include
strong capitalist and individualist national tendencies,
intense immigration, an uneven distribution of wealth,
relatively weak family and community ties, and levels and
patterns of alcohol and other substance abuse.
One common problem with the existing studies on
homelessness (mostly from the US) has been poor sam-
pling methods (Robertson 1992; Toro et al. 1999). Many
studies have not documented their sampling methods at all.
More recent studies have begun to use sophisticated
probability sampling methods to obtain large representative
samples of homeless people (e.g., Burnam and Koegel
1988; Toro et al. 1999; Zlotnick et al. 1999). Another
weakness of existing studies involves the use of measures
without documented reliability and validity among home-
less populations. The assessment of mental disorders has
been especially difficult and early studies produced a wide
range of estimates amid considerable controversy (e.g.,
Snow et al. 1986; Susser et al. 1989). More recent studies
have used structured diagnostic interviews with docu-
mented psychometric properties (e.g., North and Smith
1993; Toro et al. 1999).
To our knowledge, there is no existing published
empirical study that systematically compares the charac-
teristics of homeless people in an Eastern European nation
to homeless people in another nation in or outside of
Eastern Europe. The present study used careful sampling
and assessment methods, designed specifically for use with
homeless adults, to interview homeless adults in both the
US and Poland. The study attempted to document the needs
of homeless people in each nation so as both to understand
the context of homelessness in each nation and to suggest
possible ways to reduce and/or prevent homelessness and
its harmful consequences across nations.
Method
Participants
Participants for the study included 419 adults currently
experiencing homelessness, 219 from the county sur-
rounding Detroit in the US (total 2000 population was 2.1
million) and 200 homeless adults from two nearby cities in
southwestern Poland (total 2005 populations of 2.9 for
Wroclaw and 1.0 million for Opole). Probability sampling
methods, developed in several recent studies of homeless
people in the US (e.g., Burnam and Koegel 1988; Toro
et al. 1999; Zlotnick et al. 1999), were used to obtain
representative samples of homeless adults in the targeted
regions in both nations. Sampling was conducted at each
program site in each region based on the estimated number
of homeless people using that program annually, with more
participants interviewed at the sites with larger numbers.
In the US, participants were recruited from local
homeless shelters and soup kitchens throughout the large
urban county in proportion to the number of individuals
likely to be at each site, as determined by previously
obtained data on service utilization in the prior year.
Respondents came from the 29 sites with the largest unique
populations of homeless persons served in the prior year.
Street sites were not sampled, as it had been estimated in a
prior study that\1 % of the homeless in the county live on
the streets but do not come into contact with service pro-
viders over the course of a year (Toro et al. 1999; see this
report for additional details on the sampling methods used).
In Poland, the interviews were conducted at 31 different
sites across the two cities. These 31 sites comprised vir-
tually all of the known places where significant numbers of
homeless adults could be found in the region. The sites
Am J Community Psychol (2014) 53:134–145 135
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included shelters and other forms of emergency housing.
Unlike in the US city, we did not sample from food pro-
grams in Poland. This was because relatively few such
programs existed in the two cities and because those that
did exist served mostly poor, but not homeless, people.
Thus, relatively small numbers of homeless people would
be found at the soup kitchens, even after considerable time
spent screening clients. As in the US, participants were
recruited in proportion to the number of individuals likely
to be served at each site on an annual basis, as determined
by previously obtained service use data. To maintain
comparability with the US sampling design, no street sites
were sampled in the Polish cities (as in the US, it appeared
that most homeless people found on the streets also used
shelters, at least on occasion).
In Poland, almost half of the respondents (46.5 %) had a
vocational or technical education (without a high school
degree) and 32.0 % more had only an elementary level of
education. Only 16.0 % graduated from high school and
another 5.5 % received advanced training (e.g., at a college
or university). All but two of the participants were of Polish
ethnicity, a fact that is not surprising in a country as ethnically
homogenous as Poland (there was one Ukrainian and one
Romanian). In the US, with a different educational system,
32.3 % failed to complete high school, 38.6 % more com-
pleted high school, and 29.1 % reported taking at least some
college courses. Most respondents were African-American
(77.6 %), with smaller numbers of Caucasians (17.4 %), and
very small numbers of other or mixed ethnicity (5.0 %).
1
Across the characteristics mentioned above, plus others (e.g.,
those in Table 1), the US sample was generally similar in
composition to earlier samples of homeless adults obtained in
the city studied as well as in other US cities (e.g., Israel et al.
2010; Shlay and Rossi 1992; Solarz and Bogat 1990; Toro
1998; Toro et al. 1997; Zlotnick et al. 1999). The Polish
sample also appeared similar to samples of homeless adults
from a few other existing studies done elsewhere in Poland
(e.g., Stankiewicz 2002).
Measures
Demographic Information
Demographic information was collected on participant age,
gender, ethnicity, educational attainment, dependent chil-
dren, public assistance, time homeless (in current episode),
and experience with out-of-home placement (in childhood).
Diagnostic Interview Schedule (DIS)
The DIS is a structured diagnostic interview that yields
current and lifetime estimates of various psychiatric dis-
orders based on DSM-III-R criteria (Eaton and Kessler
1985). It has extensive reliability and validity data (e.g.,
Robins et al. 1981) and has been widely used with home-
less populations (Fischer and Breakey 1991;Toro1998). In
the present study, the samples obtained from each nation
were compared on diagnoses of schizophrenia, mood dis-
orders (major depression and bipolar disorders), alcohol
abuse and dependence, and drug abuse and dependence
(across all forms of illicit drugs, including marijuana,
stimulants, opiods, and hallucinigens).
Brief Symptom Inventory (BSI)
The BSI is a 53-item checklist of current psychological
symptoms (Derogatis and Melisaratos 1983). Participants
were asked whether they had been troubled by each
symptom during the past 2 weeks. The BSI, and the full
length SCL90R (Derogatis 1977) from which the BSI was
adapted, have found homeless persons to have significantly
higher scores than matched and normative samples (e.g.,
Morse and Calsyn 1986; Toro et al. 1995) and reliability
and other validity data also exist based on homeless sam-
ples (Calsyn et al. 1993; Wolfe and Toro 1992). The total
score was used here.
Physical Health Symptoms Checklist (PHSC)
The PHSC is a 78-item list of acute symptoms used in a
number of prior studies of homeless adults (e.g., Toro et al.
1995,1997,1999). In one study, the acute symptom total
used had a test–retest reliability coefficient of .85 and
internal consistency of .89–.92 (Wolfe and Toro 1992).
Risky Sexual Behaviors (RSB)
The RSB measure assessed the following sexual behaviors,
each on a 4-point scale, during the past 6 months: Fre-
quency of sexual activity (0 =abstinent, 1 =not at all or
rarely, 2 =sometimes, 3 =several times a week), number
of sexual partners (0 =abstinent, 1 =1 partner, 2 =2–3
partners, and 3 =4 or more partners), and age at first oral,
anal, or vaginal intercourse (0 =abstinent, 1 =at or after
15, 2 =between 13 and 14, and 3 =age 12 or before). A
3-point scale was used to assess the following: Condom use
(0 =abstinent, 1 =always used condom, 2 =used con-
dom inconsistently) and STD history (0 =abstinent;
1=no STD history, 2 =at least one STD). Dichotomous
items (0 =no, 1 =yes) assessed the presence of other
RSBs including drug and/or alcohol use while having sex,
1
The racial breakdown of the total county population was as follows:
42.2 % African–American, 51.7 % Caucasian, and 6.1 % other or
mixed ethnicity (US Census 2000). Thus, as in most other US cities
(Ahmed and Toro 2004), African-Americans are heavily over-
represented among the county’s homeless population.
136 Am J Community Psychol (2014) 53:134–145
123
sex with intravenous drug users, anal sex, oral sex, and
exchanging sex for money or drugs. All self-reported
sexual behaviors were summed to derive a total score. A
similar total score demonstrated good internal consistency
in a prior study of homeless adults (a=.86; Forney et al.
2007). This study also found evidence for validity of the
measure (e.g., those with diagnoses of substance abuse and
having been homeless for longer had higher RSB scores).
The total score ranged from 0 (for people who did not have
sex in the past 6 months) to 18. Sizable numbers received 0
scores (50, 22.8 %, in the US sample and 123, 61.5 %, in
the Polish sample).
Modified Life Events Inventory (MLEI)
The MLEI is an interview used to assess stressful life
events. As used here it contained 87 items assessing events
experienced in the last 6 months across relationships,
housing situations, employment, education and job train-
ing, and mental and physical health. It was developed
specifically for use with homeless populations and has
demonstrated good test–retest reliability in a previous
study involving homeless participants (r =.84; Wolfe and
Toro 1992).
Interpersonal Support Evaluation List (ISEL)
The ISEL is a 40-item questionnaire in which people are
asked to rate the perceived availability of different types of
social support. As in recent studies on homeless and poor
people (Bates and Toro 1999; Israel et al. 2010; Toro et al.
1995,1997,1999), a 4-point rating scale was used on each
item, rather than the original dichotomous format. The ISEL
consists of four subscales tapping different types of support:
tangible, concerning the provision of material aid; apprai-
sal, the belief that one has persons to turn to for advice; self-
esteem, the belief that one’s status is equal to that of friends;
and belonging, concerning having people with whom one
can do things. The Polish version of the ISEL was abridged
to 39 items, due to cultural differences making translation
difficult on one item (the missing item was dropped from
the US version in analyses reported here). The four sub-
scales of the ISEL have had test–retest reliabilities of .71–
.87 in various community samples (Cohen et al. 1985) and
.62–.85 in a sample of homeless and poor adults (Bates and
Toro 1999). Bates and Toro (1999) also found that the ISEL
subscales were associated with various outcomes (e.g.,
physical and psychological symptoms).
Social Network Inventory (SNI)
The SNI has been used in several recent studies of home-
less people (Bates and Toro 1999; Israel et al. 2010;
Tompsett et al. 2013; Toro et al. 1995,1997,1999).
Respondents were asked to answer various questions about
people who are important to them and with whom they
have interacted within the last 6 months. Four SNI vari-
ables were used: (1) a family contact measure based on the
mean frequency of contact across all family members,
ranging from 1.00 to 5.00 (with 0 s for those with no
contact with any family members in the past 6 months; 35
(14.6 %) in the US sample and 70 (35.0 %) in the Polish
sample); (2) a friend contact measure based on the mean
frequency of contact across all friends in the network,
ranging from 1.00 to 5.00 (with 0 s for those having no
contact with any friends in the past 6 months; 69 (31.5 %)
in the US sample and 35 (34.5 %) in the Polish sample); (3)
a support contact measure based on the mean frequency of
contact across all network members who the respondent
indicated as having provided emotional, tangible, or other
support, ranging from 1.00 to 5.00 (with 0 s for those
reporting no supporters in the past 6 months; 19 (8.7 %) in
the US sample and 40 (20 %) in the Polish sample); and (4)
a support satisfaction measure based on the mean fre-
quency of satisfaction with the support obtained across all
supporters, ranging from 1.00 to 5.00 (with 0 s for those
reporting no supporters in the past 6 months, as for the
support contact measure). In their homeless and poor
sample, Bates and Toro (1999) found test–retest reliabili-
ties of .74 to .82 for several key SNI variables. They also
found that SNI variables were associated with various
outcomes and yielded a stress-buffering effect (i.e., those
under high stress and with small family networks showed
the highest levels of physical health symptoms).
Measures: Translation
The interview measures described above were translated in
a systematic fashion. First, the measures were translated
from English to Polish by a graduate student in psychology
who was a native Polish speaker fluent in English. She
obtained assistance with the translation, as needed, from
other Polish colleagues also fluent in English and from the
first author. Next, a second psychology graduate student,
also a native Polish-speaker fluent in English, indepen-
dently translated the Polish version back into English.
Finally, the first author (a native English-speaker) com-
pared the original English protocol to the back-translated
protocol. Any discrepancies were discussed and the Polish
version adjusted so that the intended original meaning
came across accurately through the translation process.
Procedure
Interview data on homeless participants were collected
over 18 months in both nations (November 2000 through
Am J Community Psychol (2014) 53:134–145 137
123
May 2002 in the US, and January 2005 through June 2006
in Poland). The structured interviews were conducted by
trained interviewers in both nations. Persons at each site
were selected using a method agreed to beforehand that
assured random selection, such as approaching every n-th
person on the evening’s guest list. Few approached refused
to be interviewed (\5 % across all sites in both nations).
The interviews were generally conducted in private spaces
(usually an office) within the agency, in an area away from
other clients. The interviews generally lasted 1.5–3.0 h.
Participants received $40 for participation in the US and 10
zloty (about $4 US) in Poland.
2
Interviews in each nation were conducted by trained
interviewers (paid full- and part-time staff and graduate
students in psychology in the US and graduate students in
psychology in Poland). Training included extensive role-
playing and practice interviews in both nations. To assure
comparability of interview methods, Polish interviewers
were trained by one of the key US interviewers who spoke
Polish (all Polish interviewers also spoke English to assist
the training process). To control for variations in literacy
among participants, interviewers in both nations read the
whole interview to all respondents, recording their
responses. Participation in the research was completely
voluntary in both nations. There was written, informed
consent obtained from each respondent before the
interview.
Results
Chi square, ANOVA and MANOVA statistics were used to
compare the two samples, depending on the type of
dependent variable under comparison (categorical or con-
tinuous). Rational groupings of characteristics were used in
order to facilitate statistical comparisons and data presen-
tation. Categories of characteristics under consideration
included demographics (Table 1), psychiatric diagnoses
(Table 2), and social support, stress, and symptoms (psy-
chological, physical, and sexual; Table 3). For the contin-
uous variables presented in Table 3, MANOVA was used
to screen for overall significance, and follow-up univariate
ANOVAs were tested.
Descriptive statistics regarding basic characteristics of
the two samples are displayed in Table 1. A majority of the
homeless adults found in each nation were male
(72.5–74.4 %). The samples for the two nations differed
significantly on age, with the Polish being on average
4.4 years older than the US homeless adults (Ms=46.7
and 42.3 years). Closer review of the age distributions in
Table 1reveals that the US sample included a much larger
proportion of people in their 40 s (42.5 vs. only 16.5 % in
Poland) but much smaller proportions of people older than
this (19.7 % in their 50 s or older vs. 50.0 % in Poland).
The Polish sample had also been homeless for much
Table 1 Background
characteristics of homeless
adults in Poland and the US
*p\.05, ** p\.01,
*** p\.001
a
Although presented in
categories in this table, the
samples were compared in
ANOVAs on these two
continuous variables
b
When the respondent was a
minor
US (N =219) Poland (N =200) Statistical test
n%n %
Gender v
2
(1) =0.20
Male 163 74.4 145 72.5
Female 56 25.6 55 27.5
Age
a
F(1,417) =15.60***
18–29 19 8.7 22 11.0
30–39 64 29.2 45 22.5
40–49 93 42.5 33 16.5
50–59 35 16.0 64 32.0
60–78 8 3.7 36 18.0
Time homeless (current episode)
a
F(1,417) =148.77***
\6 months 105 47.9 13 6.5
6–36 months 71 32.4 65 32.5
[36 months 43 19.6 122 61.0
Public assistance (ever) 181 82.7 149 74.5 v
2
(1) =4.15*
Has dependent child (ren) 75 34.7 57 28.5 v
2
(1) =1.86
Out-of-home placement
b
30 13.7 34 17.4 v
2
(1) =1.10
2
The same approach was used in each nation in order to determine
the level of compensation: We discussed with agency staff and
potential homeless participants what would be the minimum amount
we could provide in order to encourage most participants to agree to a
3-h interview. In Poland, with a much lower standard of living than
the US, this amount was determined to be 10 zloty (about $4 US),
while in the US this amount was $40. The fact that we achieved very
similar rates of refusal (\5 %) in each nation supports the levels set
prior to data collection.
138 Am J Community Psychol (2014) 53:134–145
123
longer, on average, than the US sample. Indeed, a majority
(61.0 %) of the Polish had been homeless for more than
3 years, as compared with only 19.6 % among the US
homeless sample.
Many of the adults in both nations reported having
dependent children (34.7 % in the US and 28.5 % in
Poland), although many of these did not currently have
their children with them while homeless (especially for the
men in both samples). Many in both national samples also
reported having been in some sort of out-of-home place-
ment as children (13.7 % in the US and 17.4 % in Poland).
In Poland, many of these placements were in orphanages.
Most in both samples also reported having received some
sort of public assistance at some point, with somewhat
more of the US sample reporting such assistance (82.7 %
vs. 74.5 % in Poland, p\.05).
Table 2presents Chi square analyses on DIS diagnoses.
Significant (p\.05) national differences were found in the
rates of all the lifetime diagnoses in the table. Both of the
serious mental disorders assessed showed significant and
substantial national differences: In the US, 34.7 % showed
either of the two main disorders assessed, 29.7 % showed a
Table 2 Psychiatric diagnoses of homeless adults in Poland and the US
Diagnoses US (N =219) Poland (N =200) v
2
(1) Normative
n % n % US rate (%)
Mental illness 76 34.7 37 18.8 13.51***
Mood disorder 65 29.7 31 15.7 11.36*** 8
Schizophrenic disorder 24 11.1 7 3.6 8.48** 2
Substance abuse/dependence 168 76.7 92 46.0 41.87*** 16
Alcohol 131 59.8 89 44.5 9.84** 13
Drug 126 57.5 12 6.0 126.69*** 6
Dual diagnosis 59 27.1 16 8.1 25.08***
Either diagnosis 185 84.9 113 57.4 38.66***
All diagnoses based on the Diagnostic Interview Schedule (DIS). Those with a dual diagnosis had both a severe mental illness and a substance
abuse/dependence disorder. Those with either diagnosis had either of these. Total Ns for the above diagnoses varied from 415 to 419. US national
normative rates are based on the total five-site ECA sample (N=18,571; Regier et al. 1988)
*p\.05, ** p\.01, *** p\.001
Table 3 Social support, stress, and symptoms among homeless adults in Poland and the US
US (N =219) Poland (N =200) F (df)
M (SD) M (SD)
Social Network Interview 11.86*** (4,414)
Family contact 3.07 (1.54) 2.05 (1.80) 39.42*** (1,417)
Friend contact 2.80 (2.04) 2.64 (2.13) 0.59 (1,417)
Support contact 3.53 (1.34) 3.01 (1.79) 11.49*** (1,417)
Support satisfaction 3.67 (1.47) 2.98 (1.82) 18.02*** (1,417)
ISEL perceived support 8.37*** (4,414)
Tangible 26.81 (7.30) 28.35 (7.48) 4.52* (1,417)
Self-Esteem 27.76 (4.68) 26.46 (6.09) 5.98* (1,417)
Belonging 28.06 (6.43) 28.59 (6.52) 0.80 (1,417)
Appraisal 27.47 (5.22) 26.40 (6.62) 3.40 (1,417)
Stress and symptoms 52.45*** (4,414)
MLEI stressful events 18.13 (8.38) 9.31 (7.13) 133.39*** (1,417)
BSI symptom total 0.81 (0.62) 0.79 (0.67) 0.02 (1,417)
Physical health symptoms 15.87 (11.42) 15.20 (11.66) 0.35 (1,417)
Risky sexual behavior 5.76 (5.39) 2.18 (3.47) 64.38*** (1,417)
MANOVA Fs appear opposite the variable group label (e.g., Social Network Interview). All other Fs are from ANOVAs
*p\.05, ** p\.01, *** p\.001
Am J Community Psychol (2014) 53:134–145 139
123
mood disorder (mostly major depressive episode), and
11.1 % showed a schizophrenic disorder (rates for the
Polish sample, were 18.8 %, 15.7 %, and 3.6 %, respec-
tively). For all of these diagnostic rates, the US sample
showed nearly or more than double the rate of the Polish
sample.
Both of the substance abuse and/or dependence disor-
ders assessed also showed significant national differences:
In the US, 76.7 % showed either disorder, 59.8 % showed
an alcohol abuse/dependence disorder, and 57.5 % showed
a drug abuse/dependence disorder (rates for the Polish
sample were 46.0 %, 44.5 %, and 6.0 %, respectively).
The rate difference on drug abuse/dependence was partic-
ularly large, with the US sample showing almost 10 times
the rate seen in the Polish sample. The rate of dual diag-
nosis (i.e., having both a severe mental illness and sub-
stance abuse/dependence disorder) was also much higher in
the US sample as compared to the Polish sample (27.1 %
vs. 8.1 %).
There were also many significant differences between
the two homeless samples on the various continuous social
support, stress, and symptom variables presented in
Table 3. All three MANOVAs were statistically significant
(p\.001). For the univariate ANOVAs from the SNI, the
US sample reported significantly more frequent contact
with family and with members of their support network,
and they reported more satisfaction with the support
received from their network members. This difference was
due, in part, to the fact that larger numbers of the Polish
sample reported no contact with any family or any sup-
porters in the prior 6 months (35 % and 20 % vs. 15 % and
9 % in the US sample). US respondents also obtained
higher scores on the ISEL self-esteem subscale, but less
available tangible support on another ISEL subscale. There
was a significant and substantial difference in the number
of stressful life events reported in the prior 6 months, with
the US sample reporting almost twice as many (18.1)
events as compared with the Polish sample (9.3). The US
sample also obtained significantly higher scores on the
measure of risky sexual behaviors (5.8 vs. 2.2 for the Polish
sample). This difference was due in large part to the fact
that more than half of the Polish sample had been sexually
inactive during the prior 6 months (61.5 % vs. 22.8 %, for
the US sample). Both samples reported large numbers of
physical health symptoms (15.9 in the US sample and 15.2
in the Polish). There was no significant national difference
found on the level of self-report symptoms on the BSI.
To assess whether the significant difference between the
two samples on age could account for the difference on time
homeless (in current episode), age were statistically con-
trolled (by entering it as a covariate) in a post hoc ANCOVA.
The nation difference on time homeless remained statisti-
cally significant in this analysis [F(1,416) =133.01;
p\.001]. To assess whether the significant differences
between the two samples on both age and time homeless
could account for other national differences obtained, these
two variables were statistically controlled (by entering them
both as covariates) in a set of post hoc (M)ANCOVAs on the
continuous variables listed in Table 3. All the multivariate
Fs and all but one of the originally significant univariate Fs
remained significant (p\.05) in these (M)ANCOVAs. Only
the univariate nation difference on the ISEL self-esteem
subscale became nonsignificant after controlling for the two
covariates [F(1,412) =0.81; p[.05].
Discussion
This study identified many differences, but also some
similarities, between representative samples of homeless
adults obtained in US and Polish cities. The similarities
included finding that a clear majority of the adult homeless
population was male in both nations (73–74 %), and many
reported having dependent children (29–35 %; even if
these children were not homeless with them). Both samples
also showed high levels of physical health problems
(Ms =15–16 symptoms) and many indicated that they had
been in some sort of out-of-home placement when they
were children (14–17 %).
The differences included finding that the Polish sample
was considerably older than the US sample (with a mean
difference of 4.4 years). This age difference closely par-
allels the difference in time between data collection for the
US and Polish samples (4.2 years on average). This parallel
could be the result of a similar birth cohort effect associ-
ated with the baby boom generation in both nations.
Culhane et al. (2013) recently analyzed the aging of the
homeless population in the US based on 22 years of shelter
utilization data for single homeless adults in New York
City and 20 years of US Census information on the size of
the adult male population found in homeless shelters.
Similar results were found based on these two different
large datasets. Focusing on the Census information, the
authors found that, in 1990, ‘‘those aged between 34 and 36
had over one and a half times the relative risk for home-
lessness as the rest of the US population (RR =1.6). In
subsequent enumerations, the age groups with the highest
relative risks for homelessness shifted to 40–42 (RR =1.7)
in 2000, and then to 49–51 (RR =2.0) in 2010’’ (p. 4). The
authors conclude that the highest risk group for home-
lessness in the US has come consistently from the tail end
of the baby boom generation (i.e., those born in
1959–1964). They cite a variety of factors that might
explain this particular risk in the US context, including the
fact that this cohort ‘‘came of age’’ during the recessionary
period of the late 1970s and early 1980s, rising housing
140 Am J Community Psychol (2014) 53:134–145
123
costs for low-income people, the growing prison popula-
tion, and the crack cocaine epidemic.
Poland also experienced a post-World War II baby
boom, though it seems to have begun and ended somewhat
earlier than in the US. The peak of the post-war baby boom
in Poland is considered to have occurred in 1956, when the
birth rate reached a record high of 19.6 % (Koz
´lak 2012).
Fertility rates then showed gradual annual declines in the
late 1950s, somewhat quicker declines through 1964
(considered the last year of the baby boom in the US), and
continued gradual declines through to 2005 (when our
Polish data collection began; GUS 2008). It is surprising
that the same sort of cohort-related high risk for home-
lessness would be found in Poland, with its very different
economic and political history (especially prior to the fall
of communism in 1989). But this appears to be the case.
While the factors outlined by Culhane et al. (2013)to
explain why this cohort has been at risk in the US generally
do not seem to apply in the Polish context, there are other
important factors that could explain this cohort risk in
Poland, as well as across both the US and Poland.
For sure, Poland has experienced dramatic economic and
political changes since the fall of communism in 1989, after
widespread strikes in Gdansk and other cities by the Soli-
darity labor movement. The peaceful transformation that
followed allowed Poland to move relatively smoothly from
the centrally-controlled communist system to the current
democratic and capitalist system. The late baby-boom cohort
we identify as at-risk in this study, in their late 40 s, 50 s and
early 60 s when our data collection occurred in 2005–2006,
were mostly in their 30 s and 40 s during the 1990s (15 years
earlier) when the new economic and political order began to
develop. These age groups, accustomed to the communist
system, perhaps were poorly equipped to compete in the new
system. They also were, perhaps, less likely to be willing or
able (as compared to younger cohorts) to emigrate to nations
with better employment opportunities in Western Europe
and North America.
3
Their failure to adapt during the 1990s
may have put them at a continuing disadvantage in the job
and housing markets and led to heightened risk for home-
lessness, as was the case (for different reasons) in the same
cohort in the US.
But what is common in both the US and Polish contexts
that might explain the high risk for homelessness among
the late baby-boomers? One such common factor is what
we will call a ‘‘demographic bottle-neck.’’ Both in terms of
the housing and job markets, we can consider the cir-
cumstances facing the late baby boom cohort as especially
difficult in both nations. The large numbers of young adults
coming of age before them (the early baby-boomers) took
most of the available housing (especially at lower rent
levels) as well as most of the jobs in the economy (espe-
cially unskilled positions), leaving only the ‘‘crumbs’’ for
the late baby boomers. Many failed to prosper in this
competitive job and housing market and many became
homeless as a result. As Culhane et al. (2013) note, it was
not necessarily the case that the same individuals experi-
enced long-term or repeated homelessness throughout the
past few decades. Rather, in both nations, the late baby-
boomers, as an at-risk cohort, were more likely to show up
in the homeless population at any point in time. Home-
lessness has been described as a ‘‘game of musical chairs’
(McChesney 1990). As Shinn (2007) describes it: ‘‘In the
game children walk around a set of chairs, with fewer
chairs than the number of children, while music plays.
When the music stops, the children scramble for chairs, but
because there are too few chairs, some are left standing,
and are ‘‘out’’ of the game. In the analogy, the players are
poor households, and the chairs are the housing units they
can afford; if there are fewer affordable units than poor
households, some will be left homeless when the music
stops. The children who fail to nab chairs are those who
move more slowly than others. Similarly, individuals and
families who fail to obtain housing, under conditions of
scarcity, are those who are most vulnerable, by reason of
individual factors or social exclusion’’ (p. 672). Members
of the late baby boom cohort in both nations simply seem
much more likely to be ‘‘without a chair’’ (i.e., a home)
when the ‘‘music stops.’
The differences between the Polish and US samples also
included the length of time homeless (in the current epi-
sode). This difference was not only statistically significant,
but quite substantial, with a majority of the Polish home-
less adults (61 %) having been homeless for more than
3 years (the comparable figure for the US sample was
20 %). The difference could, of course, reflect the age
difference discussed above, because older homeless people
in the Polish sample could have more opportunity, due to
their age, for longer homeless episodes. However, an
ANCOVA on time homeless, controlling for age, found the
national difference on time homeless remained statistically
significant. Perhaps this difference could be a consequence
of the particular difficulties that the Polish late baby
boomers had in negotiating the new economic system (as
described above). Discussions with some Polish service
providers also suggested that permanent public housing
often takes years to arrange for many homeless people,
especially men who seem ‘‘able-bodied,’’ without an
3
The ‘‘brain drain’’ and general loss of young people wishing to
work abroad, especially in Western European nations, has become a
serious problem for Polish society in recent decades, especially since
Poland entered the European Union in 2004. In fact, along with this
intense emigration by Poles, there have been many recent reports on
the growing numbers of Poles among the homeless populations in
many large cities of Europe, including London and Brussels
(Mostowska 2010).
Am J Community Psychol (2014) 53:134–145 141
123
obvious physical or mental disability. Without some form
of employment, many of the older men in our Polish
sample were forced to wait for long periods of time in hope
of locating suitable public housing.
The Polish and US samples differed significantly on the
full range of psychiatric diagnoses assessed. The largest
such difference involved drug abuse and/or dependence:
The US sample had a rate of lifetime diagnosis (58 %) that
was almost 10 times the rate observed in Poland (6 %).
This is readily explained by the much easier access to, and
probably the lower cost of, illicit drugs in the US as
compared to Poland. Especially during the communist
period, it was very difficult to obtain most illicit drugs in
Poland. In fact, systematic study of the use of psychoactive
substances, other than alcohol and tobacco, did not occur
until the 1990s (after the fall of communism). However,
some surveys in the 1980s asked a few questions about
experience with drugs, as part of national research on the
patterns of drinking alcohol. These surveys consistently
found a general lack of such experiences, with the few who
had tried drugs typically having done so during visits
abroad (Sieroslawski and Zielinski 1998).
After 1989, the use of illicit drugs has likely increased
somewhat due to greater availability and to better standards
of living (giving more Poles the discretionary funds nec-
essary to purchase drugs). However, it appears that use still
continues to be relatively low compared to other developed
nations. For example, a nationwide survey conducted in
eight different regions of Poland (Sierosławski 2011) found
that only 14.6 % of the respondents had tried cannabis at
least once in their lives and only 5.4 % admitted to fre-
quent use. The second most prevalent drug used was
amphetamine, with 2.5 % reporting occasional use (no one
admitted use in the 30 days before the survey). Third place
belonged to ecstasy which was used regularly by 1.4 % of
the respondents.
The rate of alcohol abuse and/or dependence also showed
a difference (58 % in the US vs. 45 % in Poland), although
the size of this difference was much smaller than for drugs.
The lower rate of alcohol abuse/dependence in Poland may
be related to the fact that, in the Polish shelters sampled,
alcohol and inebriation from alcohol consumption were
consistently prohibited: If a homeless person was carrying
alcohol, it would be confiscated; if drunk, he/she would
typically be denied entry into the shelter. In the US such
policies are also prevalent, but less consistently so (partic-
ularly in soup kitchens). Especially given the long-term stays
seen in the Polish shelters sampled in this study, we could
expect, over time, less reporting of symptoms of alcohol
abuse and dependence in shelters in the context of such firm
prohibition. The prohibition seen in the Polish shelters could
also explain why our Polish sample showed somewhat lower
rates of alcoholism compared to a few other existing studies
on homeless adults done in Poland. For example, one study
of 40 homeless adults found that, based on clinical interviews
by psychiatrists, 60 % were alcohol addicted (Sidorowicz
et al. 1989).
The Polish and US samples differed significantly on two
major psychiatric diagnoses assessing severe forms of
mental illness. The US sample had higher rates of both
mood disorders (30 % vs. 16 % in Poland; mostly severe
depression in both nations) and schizophrenic disorders
(11 % vs. 4 % in Poland). These differences could be due
to the fact that Poland has a national health system that
provides basic services for all citizens, including psychi-
atric care. In the region studied, as elsewhere in Poland,
there are several public mental hospitals and many out-
patient clinics that serve all citizens, free of charge. On the
contrary, in the US mental health services can be difficult
to access, especially for poor people without an employer-
supported health insurance plan and not enrolled in Med-
icaid. Because of the lack of access to traditional mental
health care, shelters (and jails) in the US have often
become overwhelmed with persons having mental health
problems (Daniel 2007; Koegel et al. 1999).
The two samples also differed on many other variables.
The US respondents reported significantly more frequent
contact with family members and their support networks.
While this might seem to be, at least in part, due to the fact
that the Polish sample was older and had been homeless for
longer, these findings remained significant after statistically
controlling for age and time homeless in (M)ANCOVAs.
Perhaps there is greater stigma toward homeless people in
Poland and, as a result, they are more ashamed of their cir-
cumstances. As a result, family and others may avoid contact
with the homeless person and the homeless person may
similarly avoid social contact. There is some evidence sug-
gesting difficult emotional bonds in the family of origin
among homeless people in Poland. Piekut-Brodzka (2003)
conducted interviews with 318 homeless people in three
large Polish cities (Warsaw, Krakow and Gdansk) in
1997–1999. The study focused on the conditions prevailing
in the family of origin of the currently homeless. Almost
80 % of the respondents indicated an unfavorable atmo-
sphere in the home of their family of origin. A lack of warm
emotional relationships with children was reported by 22 %;
20 % reported fights, quarrels, and direct threats; 17 %
indicated an atmosphere of tension and mistrust; and 12 %
emphasized depressed mood, sadness, and resignation in
relation to their families.
However, the Polish respondents reported significantly
higher scores on the ISEL tangible support subscale. Per-
haps, even despite the stigma that may often operate, Polish
people are more charitable in providing basic help to
homeless people than US citizens. The vast majority of Poles
are Catholics, who have a strong tradition of obligation to
142 Am J Community Psychol (2014) 53:134–145
123
help the poor and otherwise disadvantaged. Giving money to
homeless beggars on the streets in Poland is a very common
practice, as is giving donations to various humanitarian
campaigns (especially around the holidays). Supporting this
view, a recent nine-nation study involving large random
national samples of people called by telephone about their
attitudes toward homelessness found that Polish respondents
(N=302) were more likely than US respondents (N=462)
to report giving money to homeless panhandlers (57 %
reporting sometimes or almost always giving in Poland
versus 39 % in the US; Toro et al. 2008).
In aggregate, the differences observed between the char-
acteristics and circumstances of homeless adults in Poland
versus the US do not present a consistent pattern suggesting
that the experience of homelessness is ‘‘worse’’ in one nation
or the other. In the US, homeless adults more often showed a
wide range of psychiatric diagnoses, including severe mental
and substance abuse disorders, they may have less access to
mental health care, and they reported more stressful events
and risky sexual behavior and less tangible social support.
On the other hand, in Poland, homeless adults were older,
experienced longer episodes of homelessness, had less
contact with family and supportive network members, and
reported less satisfaction after they seek help from support-
ers. Certainly, despite these differences, the experience of
homelessness is unpleasant, stressful, and often traumatic for
people in both nations.
This study had a number of limitations. First, all data were
based on self-report from a single interview. Future research
would do well to include other data sources. For example,
given the social network differences observed here, it could
be useful to have the perspective of family members or other
important people in the homeless person’s life. Why don’t
they offer housing or other assistance to their homeless
family or friend? Are resources or attitudes different among
family members of homeless people across the nations? A
second limitation is that only one specific city was studied in
the US and two cities in the same region in Poland. While it is
possible that there are city and regional differences within
each nation, some studies from the US, at least, suggest more
similarities than differences in homeless populations across
cities, given the use of similar methodologies (e.g., Toro
1998;Toroetal.1999). Third, only homeless adults were
included. Although, in both samples, there were a number of
cases of children homeless along with their parents, data
were not collected on the children. Finally, the Polish sample
was collected about 4 years later than the US sample. While
we don’t believe there were any major political, economi c, or
social changes in the two nations during these 4 years
(roughly 2001–2005), there could be some changes that may,
at least in part, account for the differences observed.
The study also had many strengths. It used careful
probability sampling methods, comparable across nations,
to obtain representative samples of homeless adults. This
allowed some confidence that the characteristics and cir-
cumstances experienced by the research participants can be
trusted as truly reflecting the reality of life for homeless
people across the cities in the two nations. The study also
represents the first study to compare the situation of
homeless people in an Eastern European nation (Poland) to
another nation (the US). Finally, the study assessed a wide
array of life domains based on measures with established
reliability and validity for use in homeless populations.
In summary, the present study compared the character-
istics of homeless adults across two nations, the US and
Poland, and found many national differences. Substance
abuse and serious mental disorders were more common in the
US, perhaps due to less readily available health, mental
health, and other social services. Recent health care reforms,
such as the Affordable Care Act, may improve this situation
in the US. However, as Culhane et al. (2013) note, the health
care system in the US is likely to experience some serious
stresses due to the aging of the homeless population in the
coming decades.
Perhaps just as interesting as the differences, the study
also found some striking similarities in the characteristics
and contexts of homeless people across these two nations
with very difference political, social, and economic histories.
In particular, our findings suggest a high risk for homeless-
ness among people born around the end of the post-war baby
boom in both nations. This age cohort seems to have expe-
rienced tremendous obstacles in Poland, leading to large
numbers with very long-term homelessness in that nation.
Poland should also, perhaps, brace for serious challenges in
its health care system in the coming decade as this cohort
ages.
Acknowledgments Funding for this research came from the Uni-
versity of Opole (in Poland) and (in the US) from Wayne State
University (through an Undergraduate Research Grant to Kathleen
Wyszacki Durham), the City of Detroit, Wayne County, and the
Homeless Action Network of Detroit. We wish to thank Michael
Bekheet, Magdalena Czyczylo, Amey Dallas, Jason Forney, Marilyn
Goldstein, Yakim Israel, Anna Jedrzej, Delma Kemp, Grzegorz
Kwiatkowski, Waldemar Piechota, Laurenn Rowland, Malgorzata
Szarzynska, Carolyn J. Tompsett, Izabella Wojtaszek, Pawel Zyla,
and others associated with our Research Group on Homelessness and
Poverty, both in the US and in Poland, who assisted with data col-
lection, data analysis, and/or review of this paper. We also thank the
many homeless people, and the agencies that serve them, who par-
ticipated in this research in Detroit in the US and in Opole and
Wroclaw in Poland.
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... While most homeless are still individuals, families and children have entered the landscape (Hoag, 2013;National Alliance to End Homelessness, 2015). Among individuals who are homeless, most are male (Toro, Hobden, Durham, Oko-Riebau, & Bokszczanin, 2014;Wasserman & Clair, 2010). This is especially true for the street homeless. ...
... They could not demonstrate addiction behaviors, mental illness, or cognitive impairment as observed by the mission staff. Men were chosen because the majority of individuals who sleep in unsheltered locations are middle-aged males (Toro et al., 2014;Wasserman & Clair, 2010). It should be noted that a small sample size was used for this study, and the limitations and challenges of working with the homeless will be addressed later in the paper. ...
Article
On any given night in 2015, over 500,000 people were homeless and 31% of them slept in unsheltered locations. Given the seriousness of this situation, the purpose of this research study was to test a student prototyped, portable shelter with six men who were homeless. Qualitative interview questions were developed by the research team. Six, open-ended questions for baseline interviews and 11 open-ended questions were used after the men slept in the shelter for two nights. The men ranged in age from 25 to 56 years and had been homeless for 1-5 years. Two of the men were African American and four were Caucasian. Several themes emerged from the data collected: dignity, safety, security, control, privacy, and portability. While the research team thought that carrying the shelter on your back was a novel idea, none of the men liked this design feature. The majority of men carried backpacks and stated that individuals who are homeless would not carry the shelter, rather they would hide it. Dignity also became an issue, as these men did not want to advertise their homeless condition by carrying the shelter. Safety and security from the "law," "animals," and "other homeless" people were other concerns. All of the men liked the privacy and control the shelter provided as it allowed them to eat, sleep, and talk on their cell phone when they wanted to. Giving these men a voice and allowing them to actively sleep in the prototype gave the research team a better understanding of design suggestions needed for portable homeless shelters.
... Second, the Working Alliance Inventory (WAI) will be used to measure the perceived level of connection and shared goals between the outreach worker and client and yields 3 subscale scores: task agreement, goal agreement, and bond development [72]. Third, the Social Network Inventory (SNI) will be collected as a measure of social support and has been used in multiple studies with homeless populations and high risk adolescents [73][74][75], with test-retest reliabilities of 0.74 to 0.82 for the key SNI variables [76]. Satisfaction, substance use and illegal behaviors of network members is queried. ...
Article
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Background Homeless youth experience high rates of substance use disorders, exposures to violence, mental and physical health conditions, and mortality. They have been particularly affected by the opioid crisis. However, no study to date has used a randomized controlled design to test preventive interventions of opioid and other drug use among this vulnerable population. Resolution of youth homelessness through housing and supportive services including prevention services, often referred to as “Housing First,” has great potential to reduce the likelihood for the development of an opioid use disorder as well as other problem behaviors associated with living on the streets. Housing First has been tested through randomized trials among homeless adults with mental health and substance use disorders, but has not been empirically tested for opioid prevention among homeless youth. Methods Homeless youth will be recruited from a drop-in shelter site frequented by disconnected youth; they will be screened for eligibility, including current homelessness, age 18–24 years, and not currently meeting criteria for opioid use disorder (OUD). In a controlled trial, 240 youth will then be randomized to one of two conditions, (1) housing + opioid and related risk prevention services, or (2) opioid and related risk prevention services alone. This project utilizes existing efficacious models of prevention to address opioid-related risks, including motivational interviewing, strengths-based outreach and advocacy, and an HIV risk preventive intervention. Follow-up will be conducted at 3, 6, 9 and 12-months post-baseline. The economic cost of each intervention will be determined to support implementation decisions with other providers and their funders. Discussion This study will provide essential information for researchers and providers on the efficacy of housing + opioid and related risk prevention services in an RCT for effects on opioid use and mechanisms underlying change. Because youth experiencing homelessness are at increased risk for a variety of adverse outcomes, the proposed intervention may produce substantial health care benefits to the youths and society at large. Trial registration ClinicalTrials.gov, NCT04135703, Registered October 13, 2019, https://clinicaltrials.gov/ct2/show/NCT04135703?term=NCT04135703&draw=2&rank=1#contacts
... However, those with lower perceived HIV risk reported lower risk for all 3 sexual risk factors. 33 Although our data show a large number of participants who indicate readiness to change health risk factors, a considerable amount did not indicate readiness to change (smoking 64%, unsafe sex 60%, at-risk drinking 44%, physical activity 51%, fruit/vegetable consumption 26%, and overweight/ obese 26%). These issues remain key elements necessary to address among homeless populations in the US. ...
Article
Objectives: In this study, we examined the prevalence of modifiable health risk factors (eg, smoking, unsafe sexual practices, at-risk drinking, low fruit/vegetable consumption, inadequate physical activity, and overweight/obesity) and readiness to change among homeless adults in Oklahoma City, OK. A secondary aim was to examine the relationship between self-rated health and readiness to change. Methods: We examined readiness to change using "ladder of change" variables. We used linear regression models to predict self-rated health and readiness to change. Results: Participants (N = 581) were largely smokers (79%), consumed less than 5 fruit and vegetable servings per day (64%) and were overweight or obese (64%). Many participants were ready to change at-risk drinking (56%), fruit/vegetable consumption (74%), and overweight/obesity (74%). Regression analyses indicated that low fruit/vegetable consumption and physical activity were associated with lower self-rated health. Lower self-rated health was not significantly related to readiness to change any health risk factors. Conclusions: Among homeless adults, the prevalence of modifiable health risk factors was high, as was readiness to change. Research is needed to reduce individual risk factors in this understudied population.
... Among the homeless, (mental) health problems are often present (Schanzer et al. 2007;Fazel et al. 2008;Nielsen et al. 2011;Nusselder et al. 2013;Krausz et al. 2013;Fazel et al. 2014;Toro et al. 2014). Among the general population, health is strongly related to social exclusion (Santana 2002;Popay et al. 2008;Coumans and Schmeets 2015;Evans-Lacko et al. 2014); e.g. ...
Article
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Although homelessness is inherently associated with social exclusion, homeless individuals are rarely included in conventional studies on social exclusion. Use of longitudinal survey data from a cohort study on homeless people in four major Dutch cities (n = 378) allowed to examine: changes in indicators of social exclusion among homeless people over a 2.5-year period after reporting to the social relief system, and associations between changes in indicators of social exclusion and changes in psychological distress. Multinomial logistic regression analysis was applied to investigate the associations between changes in indicators of social exclusion and changes in psychological distress. Improvements were found in various indicators of social exclusion, whereas financial debts showed no significant improvement. Changes in unmet care needs, health insurance, social support from family and relatedness to others were related to changes in psychological distress. This study demonstrated improvements in various indicators of social exclusion among homeless people over a period of 2.5 years, and sheds light on the concept of social exclusion in relation to homelessness.
... The mean age of homeless individuals in the study population was 55.36 years, which was quite typical of the values reported in similar studies for Central European countries [24]. While they most commonly deal with slightly younger populations, American and Western European authors also emphasise the phenomenon of ageing in their homeless populations [5,32,33]. ...
Article
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Background and Objectives The ways in which homeless individuals cope with stress may differ from those relied upon by the members of the general population and these differences may either be the result or the cause of their living conditions. The aim of the study was to determine the preferred coping style among the homeless and its relationship with alcohol dependence. Methods The study included 78 homeless individuals and involved the collection of demographic, sociological, psychological and medical data from each participant. Coping styles relied upon when dealing with stressful situations were assessed using a Polish adaptation of the Coping Inventory for Stressful Situations. Alcohol dependence was assessed using the Michigan Alcoholism Screening Test (MAST) and a quantitative analysis of alcohol consumption. Results Men accounted for 91.93% of the study population. Nearly 75% of the subjects met the alcohol dependence criterion. Significant relationships were observed between the individual's age, preferred coping style and alcohol consumption level. As an individual?s age increased, the use of emotion-oriented coping styles decreased, while an increase in alcohol consumption was associated with a more frequent use of emotion- and avoidance-oriented strategies. Conclusions The findings of this study, similarly to those of many other studies of homeless individuals but investigating other areas (e.g. epidemiology of tuberculosis and traumatic injuries), are an exaggerated representation of associations observed in the general population. The results describe a group of people living on the margins of the society, often suffering from extremely advanced alcoholism, with clear evident psychodegradation. The presence of specific ways of coping with stress related to excessive alcohol consumption in this group of individuals may interfere with active participation in support programmes provided for the homeless and may further exacerbate their problems.
... [8] It is estimated that one in three homeless individuals suffer from alcoholism compared to one in nine of the general population and that 20-25% of homeless suffer from mental illness compared to 4-6% of the general population. [2,[9][10][11] The difficulties associated with both substance abuse and mental illness create a vicious cycle, which ultimately leads to poverty because these conditions often result in increased stress, loss of employment, and loss of housing. In addition, other health problems such as cardiovascular disease, diabetes, and skin disorders, are frequently reported among the persons experiencing homelessness. ...
Article
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Objective: Persons experiencing homelessness are a vulnerable population and are at increased risk for morbidity and all-cause mortality compared to the general population. This study sought to evaluate medication use, regular physician visits, and identify health conditions among the homeless population of Long Beach, California. Methods: Two “brown bag” medication review events were held at homeless shelters in the Long Beach area. Demographic information, medication use, and comorbid disease states were obtained through surveys. Findings: Three-fourths of the cohort (95 participants) consisted of males, and the average age of participants was 48 years. Psychiatric disorders and cardiovascular disease were the most common disease states reported at 32% and 46%, respectively and so were medications used in treating these chronic diseases. Medication adherence was found to be a significant problem in this population, where more than 30% of patients were nonadherent to medications for chronic diseases. Furthermore, foot problems, hearing and vision difficulties constitute the most commonly overlooked health problems within the homeless population. Conclusion: Based on this and other similar finding, we must accept that the homeless represent a vulnerable population, and that because of this fact, more programs should be focused at improving availability and access to health care among the homeless. Regarding the high number of reported health problems in the study, more studies are needed and more studies should incorporate screening for foot, hearing, and vision issues, both to increase awareness and to provide an opportunity for devising possible solutions to these highly preventable conditions.
Article
Given the changes in our society and worldwide massive migrations across borders, this article argues that we need to change the paradigm of how we think about "the homeless," that is, to rethink our approach to not only those who cannot afford housing, the "economically homeless," but especially important also the larger group-those with chronic, serious medical-psychiatric-addictive disorders, the "medically/mentally ill homeless." We must place a greater emphasis on providing mental health services along with housing, legal, general medical, employment, and other services. The first and most crucial step toward adequate care is to understand these individuals and their lives as well as how we react to them. Second, we must become more proactive in helping those who live on the streets to receive adequate and coordinated services. And finally, for those who are unable to live independently in the community, we need to reinvent long-term, structured, humane residential, and inpatient settings.
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Family factors, such as poor family functioning and trauma, have been associated with negative outcomes for homeless adolescents. Further study is needed to better understand how family factors and trauma jointly relate to mental health problems and externalizing behaviors among homeless adolescents. Structural equation modeling was used to examine the influence of trauma (encompassing traumatic events experienced prior to, and after, becoming homeless) and family factors (poor family functioning and family conflict) on mental health problems and externalizing behaviors (substance use, delinquent behaviors, and sexual risk) among 201 homeless adolescents, ages 12 to 17 years. Trauma, poor family functioning, and family conflict significantly predicted greater mental health problems, delinquent behaviors, high-risk sexual behaviors and substance use. Overall, the findings suggest that family factors appear to be key to understanding mental health problems and externalizing behaviors among homeless adolescents. Implications, limitations and future directions are addressed.
Article
This article reviews existing research on homelessness and presents some developing areas of new research. Prevalence estimates, as well as demographic, social, and diagnostic characteristics of homeless adults, youth, and family subgroups are presented. The article describes some preventive and other interventions for homeless people, including those with severe mental illness and substance use disorders.
Article
Evidence from England, Australia, Canada, Japan and the USA indicates that the single homeless population is ageing, and that increasing numbers of older people are homeless. This paper reviews evidence of changes in the age structure of the single homeless population, and the factors that are likely to have had an influence on the growth of the older homeless population. In many Western cities, the housing situation of older people is changing and there is a growing reliance on the private rented sector. Unemployment is also having an impact on older people who are under the official retirement age. An increasing number of older people are experiencing problems linked to alcohol, drugs, gambling and criminality, and these are all behaviours that can contribute to homelessness. Despite high levels of morbidity and disability among older homeless people, they are a relatively neglected group and receive little attention from policy makers and mainstream aged care services.
Article
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A public opinion survey was administered by telephone to nationally representative samples in Canada and the United States to assess prevalence of homelessness as well as attitudes, opinions, and knowledge regarding homelessness. A total of 378 Canadians and 435 Americans participated in this study. Comparisons between nations found no differences in lifetime prevalence of homelessness or homelessness in the previous five years. Compared to U.S. respondents, Canadians felt homelessness was a less serious problem in the nearest city and nationwide, were more likely to favour increases in Federal spending to combat homelessness, and were more supportive of rights for the homeless. Copyright © 2007 by the Institute of Urban Studies. All rights of reproduction in any form reserved.
Article
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Reliability and validity of self-report data provided by homeless mentally ill clients were generally favorable. More specifically, test-retest reliability coefficients for eight measures ranged from .81 to .99 over a 1 week period. With two exceptions, internal consistency estimates of reliability ranged from .70 to .96. Interrater reliability estimates on a new self-report measure of client resource use were generally above .75. Client self-reports of service use also agreed with treatment staff estimates for most service categories, providing evidence for the validity of self-reports of service use made by homeless mentally ill individuals.
Book
Epidemiologic Field Methods in Psychiatry: The NIMH Epidemiologic Catchment Area Program focuses on the methodology employed in the National Institute of Mental Health (NIMH) Epidemiologic Catchment Area (ECA) Program. The selection first elaborates on the historical context, major objectives, and study design and sampling the household population. Topics include the development of the ECA program, DIS instrument, program design, general issues in sampling community resident populations, household and respondent eligibility, household and respondent selection, weighting, and variance estimation. The manuscript then examines institutional survey and the characteristics, training, and field work of interviewers. Discussions focus on the changing nature of institutions, value of the institutional component, institutions included in institutional stratum, interviewer recruitment and selection, demographic characteristic of interviewers, and field work. The publication ponders on nonresponse and nonresponse bias in the ECA surveys, data preparation, and proxy interview, as well as quality of proxy data, item nonresponse, editing and coding, data entry and data cleaning, understanding nonresponse, and assessment of evidence for nonresponse bias. The selection is a valuable source of information for psychiatrists and readers interested in the Epidemiologic Catchment Area (ECA) Program.
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A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).
Article
• A new interview schedule allows lay interviewers or clinicians to make psychiatric diagnoses according to DSM-III criteria, Feighner criteria, and Research Diagnostic Criteria. It is being used in a set of epidemiological studies sponsored by the National Institute of Mental Health Center for Epidemiological Studies. Its accuracy has been evaluated in a test-retest design comparing independent administrations by psychiatrists and lay interviewers to 216 subjects (inpatients, outpatients, ex-patients, and nonpatients).
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Amidst concern about the implications of an aging U.S. population, recent evidence suggests that there is a unique aging trend among the homeless population. Building on this, we use data from New York City and from the last three decennial Census enumerations to assess how the age composition of the homeless population—both single adults and adults in families—has changed over time. Findings show diverging trends in aging patterns for single adults and adults in families over the past 20 years. Among single adults, the bulk of the sheltered population is comprised of persons born during the latter part of the baby boom era whose high risk for homelessness has continued as they have aged. Specifically, the age group in this population facing the highest risk for homelessness was 34–36 (born 1954–1956) in 1990; 37–42 (born 1958–1963) in 2000; and 49–51 (born 1959–1961) in 2010. In contrast, among adults in sheltered families, there is no indication of any progressive aging of the family household heads. The modal age across the study period remains at 21–23 years of age. We consider implications for the health care and social welfare systems, and policy responses to homelessness.
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While the twin problems of homelessness and squatting are usually associated with the cities of the Third World, this article examines them in the context of Western postindustrial metropolises. It argues that the growing numbers of homeless and squatters in the United States and Europe reflect not simply the current economic situation, but rather the longer-term changes in economic and demographic structure that have accompanied the transition of such cities from industrial to postindustrial centers. A critical factor contributing to the problem has been shrinkage in the private rental sector, which must be given priority by housing policymakers.
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This paper calls into question the double-edged thesis that the majority of the homeless are mentally ill and that the streets of urban America have consequently become the asylums of today. We present data from a triangulated field study of nearly 1,000 unattached homeless adults in Texas that contradict this stereotypic imagery. We also suggest that this root image is due to the medicalization of the problem of homelessness, a misplaced emphasis on the causal role of deinstitutionalization, the heightened visibility of homeless individuals who are mentally ill, and several conceptual and methodological shortcomings of previous attempts to assess the mental status of the homeless. We conclude by arguing that the most common face on the street is not that of the psychiatrically-impaired individual, but of one caught in a cycle of low-paying, dead-end jobs that fail to provide the means to get off and stay off the streets.