Homelessness and health care access after emancipation: results from the Midwest Evaluation of Adult Functioning of Former Foster Youth.
OBJECTIVE
To estimate the association between housing status and health care access and outcomes among young adults aging out of the child welfare system.


METHODS
Prospective cohort study


METHODS
Illinois, Iowa, and Wisconsin. Baseline interviews were conducted between May 2002 and March 2003 and follow-up interviews, between March and December 2004.


METHODS
Participants were foster youth aged 17 or 18 years in Illinois, Wisconsin, or Iowa. We invited a random sample of 67% of eligible Illinois youth and all eligible youth from Wisconsin and Iowa to participate. Researchers interviewed 749 at baseline (94.7% response) and 643 at follow-up (85.8%); we excluded 8 participants without housing data (n=635). We included only the 345 emancipated participants in analyses of health care access. MAIN EXPOSURE Housing status after emancipation: stable housing; unstable housing; or homeless.


METHODS
Multivariate adjusted odds ratio (AOR) of association between main exposure variables with 3 measures of access to care and 2 health outcomes.


RESULTS
Among the 345 emancipated participants, 14.2% experienced homelessness and 39.4% were unstably housed. In multivariate analysis of emancipated participants, homelessness was associated with being uninsured (AOR, 3.41; 95% confidence interval, 1.52-7.63) and having unmet need for health care (AOR, 3.26; 95% confidence interval, 1.40-7.56); it was not associated with not having had ambulatory care. In multivariate analysis of all participants, housing status was not associated with reporting fair or poor health at follow-up or, among women, with having had a pregnancy.


CONCLUSIONS
Having had an episode of homelessness after emancipation is associated with worse health access, but not worse outcomes, among youth emancipated from foster care.
Kushel
Margot B
MB
Division of General Internal Medicine, University of California, San Francisco, and San Francisco General Hospital, Box 1364, San Francisco, CA 94143, USA. mkushel@medsfgh.ucsf.edu
Yen
Irene H
IH
Gee
Lauren
L
Courtney
Mark E
ME
D000293:Adolescent; D000367:Age Factors; D002649:Child Abuse; D005260:Female; D005581:Foster Home Care; D005610:Freedom; D019538:Health Care Surveys; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D018453:Homeless Youth; D006801:Humans; D007087:Illinois; D007407:Interviews as Topic; D007484:Iowa; D007604:Juvenile Delinquency; D008297:Male; D033242:Minors; D017063:Outcome Assessment, Health Care; D011446:Prospective Studies; D011581:Psychological Tests; D011594:Psychometrics; D012946:Social Welfare / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014922:Wisconsin