title: Cash benefits are associated with lower risk behavior among the homeless and marginally housed in San Francisco.
abstract: To address the widespread debate about the role of public assistance to the urban poor, the authors determined characteristics of individuals receiving cash assistance and explored the link between cash subsidies and risk behavior. From 1999 to 2000, a representative sample of homeless and marginally housed (HMH) adults living in San Francisco was recruited and interviewed about subsidies, shelter, jail, and drug use. Among 1,156 adults, 87% were ever homeless, 22% currently injected drugs, and 14% were HIV positive. Sixty percent of participants reported that most of their income came from subsidies [mostly subsidized (MS)]. The MS had lower odds of receiving any income from selling drugs or trading sex. Adjusting for HIV infection, the MS had higher odds of sleeping in a hotel [odds ratio (OR) = 2.39] or shelter (OR = 1.61) compared to the street. The MS had lower odds of injection drug use (OR = 0.69) and recent incarceration (OR = O.77). Among San Francisco's homeless, being MS was positively associated with having shelter and negatively associated with injection drug use and incarceration. These data suggest that government subsidies are associated with positive health behaviors among the urban poor.
authors.affiliation: University of California, San Francisco General Hospital, Epidemiology and Prevention Interventions Center, San Francisco, California 94110, USA. eriley@epi-center.ucsf.edu
authors.forename: Elise D
authors.initials: ED
authors.lastname: Riley
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Moss
authors.forename: Richard A
authors.initials: RA
authors.lastname: Clark
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Monk
authors.forename: David R
authors.initials: DR
authors.lastname: Bangsberg
mesh_terms: D000328:Adult; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000517:prevention & control; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007182:Income; D007407:Interviews as Topic; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011203:Poverty / Q000523:psychology*; D011632:Public Assistance / Q000706:statistics & numerical data*; D011638:Public Housing / Q000706:statistics & numerical data*; D040242:Risk Reduction Behavior; D012495:San Francisco / Q000453:epidemiology; D012946:Social Welfare / Q000191:economics; D019966:Substance-Related Disorders / Q000453:epidemiology / Q000517:prevention & control; D014505:Urban Population
references.citation: Psychiatr Serv. 2000 Jan;51(1):116-8
references.pmid: 10647145
references.citation: J Gen Intern Med. 2000 Oct;15(10):731-8
references.pmid: 11089717
references.citation: Psychiatr Serv. 2000 Dec;51(12):1549-54
references.pmid: 11097652
references.citation: J Health Soc Policy. 2001;13(2):61-73
references.pmid: 11190657
references.citation: Am J Public Health. 2004 Jul;94(7):1207-17
references.pmid: 15226145
references.citation: Am J Drug Alcohol Abuse. 1991;17(4):415-22
references.pmid: 1746503
references.citation: N Engl J Med. 1995 Sep 21;333(12):777-83
references.pmid: 7643886
references.citation: Psychiatr Serv. 1995 Sep;46(9):922-6
references.pmid: 7583504
references.citation: N Engl J Med. 1996 Mar 7;334(10):664; author reply 665
references.pmid: 8592537
references.citation: Am J Public Health. 1997 Feb;87(2):241-8
references.pmid: 9103104
references.citation: Psychiatr Serv. 1997 Jun;48(6):792-5
references.pmid: 9175187
references.citation: Am J Community Psychol. 1997 Dec;25(6):755-69
references.pmid: 9534218
references.citation: J Urban Health. 1998 Mar;75(1):170-83
references.pmid: 9663975
references.citation: Am J Public Health. 1998 Nov;88(11):1651-7
references.pmid: 9807531
references.citation: J Health Polit Policy Law. 1999 Feb;24(1):91-114
references.pmid: 10342256
references.citation: N Engl J Med. 1999 Jul 8;341(2):93-8
references.pmid: 10395634