Risk Factors for Homelessness

This paper reviews risk factors for home-lessness among adults in the contemporary period in the United States. In the 1980s, homelessness increased in the United States (1, 2). The reversal of this trend is of vital importance to public health. Homelessness has manifold adverse effects on the health of homeless persons (3-5) and may also have important effects on the health of domiciled persons. For example, homelessness may impede effective control of infectious dis-eases, such as tuberculosis and human im-munodeficiency virus (6, 7). Moreover, homelessness disproportionately afflicts people with disabling mental health disor-ders, such as schizophrenia (8-10). We first review findings on risk factors for which there is compelling evidence of an effect on homelessness. These include de-mographic characteristics, health disorders, and childhood experiences. The data are drawn from studies published in peer review journals since 1980. We then propose a conceptual framework and study designs to investigate causal path-ways linking these risk factors to homeless-ness. The framework is meant to be appli-cable also to homelessness research on other risk factors and other populations. In addi-tion, it explicitly acknowledges the role of broad societal processes as causes of home-lessness. As we have shown in previous publications (11, 12), epidemiologic per-Received for publication February 1, 1993, and in final form July 29, 1993.