Summary Post

The aims of my research were to comparatively analyze asthma, diabetes, HIV, mental health issues, obesity, and substance use among four homeless subpopulations. The analysis manifested via a focus on the disease’s process, prevalence, incidence, determinants of the disease which limit health care and social service utilization among the homeless, and other factors specific to the disease’s manifestation in homeless subpopulations. My findings demonstrated a dearth of research for asthma, diabetes, and obesity across all subpopulations with little research among the homeless elderly for all diseases. The determinants and factors investigated spanned across the physical, medical, social, financial, and political domains. Moreover, based on all the disease and cohort specific factors, conclusions, current services, and needs for further research, I classified research and policy implications into six areas for improvement. In order of importance and urgency, they are understanding homeless populations, health care and physical needs, service integration and coordination, health care providers and researchers, settings and shelters, and social networks. All of these areas for improvement call for specified and integrated approaches to understanding the specific burdens of homeless groups. Providing health care is inadequate if the competing needs of shelter and nutrition remain unattended. Furthermore, referrals to secondary care have no value if they are inaccessible to individuals based on geographic, physical, or financial limitations. In conclusion, we must not treat ‘the homeless’ as a homogeneous mass, rather programs, policies, and researchers must be proactive in providing efficient services tailored towards the barriers and determinants experienced by different cohorts.

Research Update #3 – Findings and Holes in Published Research

Throughout this study, 186 sources were analyzed, 62 of which were for homeless children and youth, 48 for homeless adults, 30 for the homeless elderly, and 46 for homeless veterans. These sources were classified as being direct or indirect. Direct sources were those in which the primary goal of the literature corresponded to the specific homeless subpopulation and the disease of study. Indirect sources included those that related to disease specific factors and/or sources with a secondary goal of analyzing the subpopulation and disease. All subpopulations except the elderly had a majority of direct sources. In the past, researchers neglected the homeless elderly population through their research. With an average of only 1.5 direct studies per disease, little effort has gone into investigating the burden of disease among such a vulnerable population. Similarly, though MH had a majority of direct sources (62%), that proportion is still 27-38% lower than the other subpopulations for MH illnesses. Continually, across all subpopulations, asthma, diabetes, and obesity were discussed less as the average numbers of direct sources were 1, 2, and 2 respectively. Furthermore, these diseases only had 23, 24, and 22 total sources compared to the other diseases which had a range of 35-44 total publications. Thus, previous research has failed to understand these diseases among the identified homeless cohorts.

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Research Update #2 – A Reflection After Studying 4 out of 6 Diseases

Thus far, I have researched asthma, diabetes, HIV/AIDS, and obesity among homeless children and youth, adults, elderly, and veterans. There is a significant lack of research pertaining to asthma, diabetes, and obesity among most all subpopulations. The homeless elderly subpopulation has been the cohort with the least amount of published research. Asthma, diabetes, and obesity, compared to the other three diseases of study, are less popular as there are definite stigmas and social movements aimed at lowering the burden of HIV/AIDS, mental health illnesses, and substance abuse among all populations, including the homeless. Therefore, I believe that the lack of research surrounding asthma, diabetes, and obesity for these homeless subpopulations portrays a limitation of public health research and funding methods. In some cases, these diseases are similar in prevalence across homeless and nonhomeless lines. However, my research demonstrates that there are factors and determinants that directly and profoundly impact the homeless subpopulations in ways that vary from the general or low-income populations. In turn, I have learned that clinicians, practitioners, and policymakers need to be more specific in their research and in their population analyses in order to strengthen our understanding of diseases, why people are homeless, why they stay homeless, and how to help them out of homelessness. On a different note, I look forward to studying substance abuse and mental health as I expect there to be more research due to these diseases’ ‘trendy’ nature.

Research Update #1 – Determining the Diseases of Focus and the Methods of Analysis

No governmental surveys have broken down the homeless population into the subpopulations utilized in this study. Furthermore, most research, public and private, treats the homeless population as a unified cohort making subpopulation analyses difficult. The Health Resources and Services Administration (HRSA), part of the Department of Health and Human Services (HHS), conducts an annual report of the patient demographics and morbidities for those using their Health Centers designated to underserved populations, including the homeless. Though the data from the 2017 survey is unusable as it did not address specific subpopulations, I adapted the questions from the survey to create a list of study. By asking the questions, the HRSA and HHS expressed interest in these diseases as a demonstration of their prevalence in underserved populations and in the general population, therefore, making these diseases worthy of studying. Thus, I am qualitatively assessing all of the subpopulations regarding asthma, diabetes, HIV/AIDS, mental health disorders, obesity, and substance abuse. Other diseases, such as hepatitis, hypertension, and high cholesterol, were excluded as the HRSA did not survey children and youth for these morbidities and as these disorders are not common in younger populations. Continually, I am conducting a literature review spanning Medline, PubMed, and Primo incorporating Boolean search phrases (i.e. “homeless AND the disease of study AND the population of study”). All usable articles are to be published within the last 10 years and from a peer reviewed journal. For some diseases, I incorporate factors relevant to the diseases, for instance food insecurity for diabetes and obesity, into the database search. The analysis focuses on the disease’s process, prevalence, incidence, risk factors of the disease which limit health care and social service utilization among the homeless, and other factors specific to the disease’s manifestation in the homeless subpopulation.