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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.

SUBMITTER: Anderson MC

PROVIDER: S-EPMC8306744 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ImportancePrevious studies have shown high mortality rates among homeless people in general, but little is known about the patterns of mortality among "rough sleepers," the subgroup of unsheltered urban homeless people who avoid emergency shelters and primarily sleep outside.ObjectivesTo assess the mortality rates and causes of death for a cohort of unsheltered homeless adults from Boston, Massachusetts.Design, setting, and participantsA 10-year prospective cohort study (2000-2009) of 445 unsheltered homeless adults in Boston, Massachusetts, who were seen during daytime street and overnight van clinical visits performed by the Boston Health Care for the Homeless Program's Street Team during 2000. Data used to describe the unsheltered homeless cohort and to document causes of death were gathered from clinical encounters, medical records, the National Death Index, and the Massachusetts Department of Public Health death occurrence files. The study data set was linked to the death occurrence files by using a probabilistic record linkage program to confirm the deaths. Data analysis was performed from May 1, 2015, to September 6, 2016.ExposureBeing unsheltered in an urban setting.Main outcomes and measuresAge-standardized all-cause and cause-specific mortality rates and age-stratified incident rate ratios that were calculated for the unsheltered adult cohort using 2 comparison groups: the nonhomeless Massachusetts adult population and an adult homeless cohort from Boston who slept primarily in shelters.ResultsOf 445 unsheltered adults in the study cohort, the mean (SD) age at enrollment was 44 (11.4) years, 299 participants (67.2%) were non-Hispanic white, and 72.4% were men. Among the 134 individuals who died, the mean (SD) age at death was 53 (11.4) years. The all-cause mortality rate for the unsheltered cohort was almost 10 times higher than that of the Massachusetts population (standardized mortality rate, 9.8; 95% CI, 8.2-11.5) and nearly 3 times higher than that of the adult homeless cohort (standardized mortality rate, 2.7; 95% CI, 2.3-3.2). Non-Hispanic black individuals had more than half the rate of death compared with non-Hispanic white individuals, with a rate ratio of 0.4 (95% CI, 0.2-0.7; P < .001). The most common causes of death were noncommunicable diseases (eg, cancer and heart disease), alcohol use disorder, and chronic liver disease.Conclusions and relevanceMortality rates for unsheltered homeless adults in this study were higher than those for the Massachusetts adult population and a sheltered adult homeless cohort with equivalent services. This study suggests that this distinct subpopulation of homeless people merits special attention to meet their unique clinical and psychosocial needs.

Project description:Background: Environmental volunteering can increase well-being, but environmental volunteer well-being has rarely been compared to participant well-being associated with other types of volunteering or nature-based activities. This paper aims to use a multidimensional approach to well-being to explore the immediately experienced and later remembered well-being of environmental volunteers and to compare this to the increased well-being of participants in other types of nature-based activities and volunteering. Furthermore, it aims to compare volunteer managers' perceptions of their volunteers' well-being with the self-reported well-being of the volunteers. Methods: Onsite surveys were conducted of practical conservation and biodiversity monitoring volunteers, as well as their control groups (walkers and fieldwork students, respectively), to measure general well-being before their nature-based activity and activity-related well-being immediately after their activity. Online surveys of current, former and potential volunteers and volunteer managers measured remembered volunteering-related well-being and managers' perceptions of their volunteers' well-being. Data were analysed based on Seligman's multidimensional PERMA ('positive emotion', 'engagement', 'positive relationship', 'meaning', 'achievement') model of well-being. Factor analysis recovered three of the five PERMA elements, 'engagement', 'relationship' and 'meaning', as well as 'negative emotion' and 'health' as factors. Results: Environmental volunteering significantly improved positive elements and significantly decreased negative elements of participants' immediate well-being, and it did so more than walking or student fieldwork. Even remembering their volunteering up to six months later, volunteers rated their volunteering-related well-being higher than volunteers rated their well-being generally in life. However, volunteering was not found to have an effect on overall mean well-being generally in life. Volunteer managers did not perceive the significant increase in well-being that volunteers reported. Conclusions: This study showed how environmental volunteering immediately improved participants' well-being, even more than other nature-based activities. It highlights the benefit of regarding well-being as a multidimensional construct to more systematically understand, support and enhance volunteer well-being.

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

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