Exploring the Impacts of Housing Instability on Intimate Partner Violence, Adverse Health and Risk Behaviours Among Women

AIM: To examine associations between housing instability and intimate partner violence (IPV) exposure, adverse mental health, sexually transmitted infection (STI) and HIV incidence, and substance use among women across the U.S. and its territories. DESIGN: Cross-sectional analysis of data from the American Women: Assessing Risk Epidemiologically (AWARE) study. METHODS: Survey data and STI/HIV results from 1626 women between July 2023 and March 2025 were used to conduct multivariable regression analyses adjusted for sociodemographic factors. RESULTS: Sixteen percent of women reported current housing instability. Housing instability was associated with higher levels of IPV (B = 2.43, 95% CI = 1.68-3.18), depression (B = 3.25, 95% CI = 2.61-3.88), and anxiety (B = 3.38, 95% CI = 2.60-4.15), and increased likelihood of STI/HIV diagnosis (RRR = 1.85, 95% CI = 1.16-2.97). Unstably housed women were more than twice as likely to report hazardous use of marijuana (OR = 2.02, 95% CI = 1.38-2.95), stimulants (OR = 2.31, 95% CI = 1.45-3.69), and opioids (OR = 2.72, 95% CI = 1.33-5.56), although no association was observed for alcohol use. CONCLUSION: These findings align with research linking housing instability to poor health and violence victimization. IMPACT: These findings are relevant to nurses, advanced practice providers, public health practitioners, HIV/STI prevention programs, behavioural health clinicians, and housing-service providers who care for women in emergency departments, community health centres, sexual health clinics, substance use treatment programs, and shelter-based or outreach settings. Results support integrating housing instability screening with IPV, mental health, substance use, and HIV/STI prevention services, and strengthening referral pathways to trauma-informed housing support, safety planning, behavioural health care, harm reduction services, and sexual health services. PATIENT OR PUBLIC CONTRIBUTION: Not applicable.