文章基本信息

标题：Prevalence, Characteristics, and Associated Health and Health Care of Family Homelessness Among Fifth-Grade Students
本地全文：下载
作者：Tumaini R. Coker ; Marc N. Elliott ; David E. Kanouse 等
期刊名称：American journal of public health
印刷版ISSN：0090-0036
出版年度：2009
卷号：99
期号：8
页码：1446-1452
DOI：10.2105/AJPH.2008.147785
语种：English
出版社：American Public Health Association
摘要：Objectives. We describe the lifetime prevalence and associated health-related concerns of family homelessness among fifth-grade students. Methods. We used a population-based, cross-sectional survey of 5147 fifth-grade students in 3 US cities to analyze parent-reported measures of family homelessness, child health status, health care access and use, and emotional, developmental, and behavioral health and child-reported measures of health-related quality of life and exposure to violence. Results. Seven percent of parents reported that they and their child had experienced homelessness (i.e., staying in shelters, cars, or on the street). Black children and children in the poorest families had the highest prevalence of homelessness (11%). In adjusted analyses, most general health measures were similar for children who had and had not been homeless. Children who had ever experienced homelessness were more likely to have an emotional, behavioral, or developmental problem (odds ratio [OR] = 1.7; 95% confidence interval [CI] = 1.1, 2.6; P = .01), to have received mental health care (OR = 2.2; 95% CI = 1.6, 3.2; P < .001), and to have witnessed serious violence with a knife (OR = 1.6; 95% CI = 1.1, 2.3; P = .007) than were children who were never homeless. Conclusions. Family homelessness affects a substantial minority of fifth-grade children and may have an impact on their emotional, developmental, and behavioral health. An estimated 23% of homeless persons in the United States are children younger than 18 years.¹ Of individuals who have experienced an episode of homelessness and used a homelessness assistance program over the course of a year, an estimated 38% are children living with parents.² Families defined as homeless may be literally homeless (spending the night in emergency shelters, abandoned buildings, cars, on the street, and so on) or precariously housed (at imminent risk of literal homelessness).^{3 , 4} Data available on the prevalence of literal homelessness (henceforth referred to as “homelessness”) are generally based on emergency shelter use, requests for emergency shelter use, and nighttime counts of those living on the streets.⁵ The prevalence of homelessness in US cities ranges from a 1-day prevalence of 0.3% to a 3-year prevalence of 3% (prevalence rates increase as the period of time increases because of rapid turnover among the homeless).^{4 , 6 – 8} Population-based studies have estimated the prevalence of episodic homelessness among adults.^{9 – 11} One random-digit-dialing survey of US adults found a 7% lifetime prevalence of homelessness.⁹ A Philadelphia population-based study linked emergency shelter intake records to all adult women with a recorded live birth over a 2-year period and reported 11% homelessness between 3 years before and 4 years after the birth.¹⁰ Unlike studies of currently homeless people, these population-based estimates include individuals who have a history of homelessness.^{6 , 8} There are no population-based data that estimate the lifetime prevalence of family homelessness among children. Studies of children in sheltered, homeless families have shown that many have poor health status, high rates of asthma, high rates of emergency department visits, delays in obtaining preventive care, and high rates of emotional, developmental, and behavioral problems.^{7 , 12 – 17} In most studies, health and health-related outcomes were worse for children in sheltered, homeless families compared with children in the general population. In most studies, homeless children also had worse outcomes compared with low-income housed children, although in a few studies the 2 groups had similar outcomes.¹⁸ In a study of 82 families using shelters and transitional housing in King County, Washington, 59% of children had no usual health care provider; these children experienced rates of emergency department visits higher than that of the national rate for children.¹³ In another study of 220 homeless families in shelters in Worcester, Massachusetts, homeless children were more likely to be reported in poor to fair health and made more frequent emergency department and outpatient visits than did low-income housed children.¹² Other studies have found high rates of developmental delay and emotional or behavioral problems among sheltered children.^{13 , 14 , 19 , 20} Most data on the health status and needs of homeless children compare currently homeless children and their families residing in emergency shelters with low-income housed children or the general population.^{12 – 14} Many poor families may experience 1 or more episodes of homelessness over a period of time, but most studies have only examined currently homeless children.^{3 , 21} No published studies to date have described the lifetime prevalence of homelessness and the associated health and health-related problems of a school-aged, nonsheltered, population-based sample of children. We aimed to describe (1) the lifetime prevalence and characteristics of family homelessness among fifth-grade students and (2) the health and health-related concerns of these students.