The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population

Abstract

People experiencing homelessness (PEH) face extreme weather exposure and limited social support. However, few studies have empirically assessed biophysical and social drivers of health outcomes among unsheltered PEH. Social network, health, and outdoor exposure data were collected from a convenience sample of unsheltered PEH (n = 246) in Nashville, TN, from August 2018–June 2019. Using multivariate fixed-effects linear regression models, we examined associations between biophysical and social environments and self-reported general health and emotional well-being. We found that study participants reported the lowest general health scores during winter months—Nashville’s coldest season. We also found a positive association between the number of nights participants spent indoors during the previous week and general health. Participants who spent even one night indoors during the past week had 1.8-point higher general health scores than participants who spent zero nights indoors (p < 0.01). Additionally, participants who experienced a conflict with a social contact in the past 30 days had lower emotional well-being scores than participants who experienced no conflict. Finally, women had worse general health and emotional well-being than men. Ecologically framed research about health and well-being among PEH is critically needed, especially as climate change threatens to increase the danger of many homeless environments.

Perceived Social Support Attenuates the Association between Stress and Health-Related Quality of Life among Adults Experiencing Homelessness

“…Individuals experiencing homelessness are at a very high risk for social exclusion, limited social support, and disruptions in social support [43,44]. Prior studies with domiciled adults have found that high social support is associated with increased resilience and reduced stress [29]; our results suggest similar relations may be applicable to homeless adults.…”

“…Moreover, recognizing that social support can come in various forms (e.g., financial, practical, and emotional), it is imperative that individual deficits and personal needs be considered in intervention planning. Additionally, building social support is not merely about adding to the social network; research suggests that the quality of social relationships is important to health, particularly for homeless women, suggesting the importance of having low-conflict social relationships [44,48]. Finally, the effect of individual circumstances (e.g., living in sheltered versus unsheltered settings, transition to more permanent housing, or caregivers for children) should be considered in interventions to build and maintain social support for this population, knowing that circumstances, and a change in them, can be disruptive to extant support networks, requiring reassessment and additional resource/resiliency planning [49][50][51][52].…”

Environmental and socio-economic determinants of mosquito vector species presence and abundance in Los Angeles County, California

“…quinquefasciatus and Ae. Aegypti we documented in this work, amplifying already significant disparities faced by certain groups, such as individuals experiencing homelessness [41], and occupational hazards, like the ones faced by construction and landscaping workers [42,43], by increasing their risk of infection [44].…”

“I don’t think of it as a shelter. I say I’m going home”: a qualitative evaluation of a low-threshold shelter for women who use drugs

“…Consistent with literature on homeless individuals’ experiences of safety, participants in this study felt safer in this shelter than in encampments or other local shelters, reporting freedom from coercion and less interpersonal conflict when their basic material needs were met [ 38 , 41 ]. This safety was cultivated by the gender-specific setting, the staff’s ability to support women with complex mental health and trauma histories, and the low-conflict, nurturing environment [ 11 , 41 , 42 ]. Importantly, the shelter provided a single-gender space for women facing intersectional stigma from their gender, substance use, and street homelessness.…”

“…This freedom was essential in retaining guests at the shelter. Since each night spent inside is associated with health benefits, this policy was an effective way to support the social, psychological, and physical health of this population [ 42 ]. Spending nights away from the shelter allowed guests to see partners, friends and family outside of the shelter, buffering against loneliness and isolation often experienced in homelessness.…”