title: Food insufficiency and health services utilization in a national sample of homeless adults.
abstract: BACKGROUND
  Homeless people have high rates of hospitalization and emergency department (ED) use. Obtaining adequate food is a common concern among homeless people and may influence health care utilization.
  
  
  OBJECTIVE
  We tested the hypothesis that food insufficiency is related to higher rates of hospitalization and ED use in a national sample of homeless adults.
  
  
  METHODS
  We analyzed data from the 2003 Health Care for the Homeless (HCH) User Survey.
  
  
  METHODS
  Participants were 966 adults surveyed at 79 HCH clinic sites throughout the US. The study sample was representative of over 436,000 HCH clinic users nationally.
  
  
  METHODS
  We determined the prevalence and characteristics of food insufficiency among respondents. Using multivariable logistic regression, we examined the association between food insufficiency and four past-year acute health services utilization outcomes: (1) hospitalization for any reason, (2) psychiatric hospitalization, (3) any ED use, and (4) high ED use (≥ 4 visits).
  
  
  RESULTS
  Overall, 25% of respondents reported food insufficiency. Among them, 68% went a whole day without eating in the past month. Chronically homeless (p = 0.01) and traumatically victimized (p = 0.001) respondents were more likely to be food insufficient. In multivariable analyses, food insufficiency was associated with significantly greater odds of hospitalization for any reason (AOR 1.59, 95% CI 1.07, 2.36), psychiatric hospitalization (AOR 3.12, 95% CI 1.73, 5.62), and high ED utilization (AOR 2.83, 95% CI 1.32, 6.08).
  
  
  CONCLUSIONS
  One-fourth of homeless adults in this national survey were food insufficient, and this was associated with increased odds of acute health services utilization. Addressing the adverse health services utilization patterns of homeless adults will require attention to the social circumstances that may contribute to this issue.
authors.affiliation: General Medicine Division, Massachusetts General Hospital, 50 Staniford Street, 9th floor, Boston, MA 02114, USA. tbaggett@partners.org
authors.forename: Travis P
authors.initials: TP
authors.lastname: Baggett
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Singer
authors.forename: Sowmya R
authors.initials: SR
authors.lastname: Rao
authors.forename: James J
authors.initials: JJ
authors.lastname: O'Connell
authors.forename: Monica
authors.initials: M
authors.lastname: Bharel
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Rigotti
mesh_terms: D000328:Adult; D003625:Data Collection / Q000379:methods*; D004435:Eating / Q000502:physiology / Q000523:psychology; D005260:Female; D005523:Food Supply; D006296:Health Services / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000523:psychology; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D044342:Malnutrition / Q000175:diagnosis / Q000453:epidemiology* / Q000523:psychology; D008875:Middle Aged; D009752:Nutritional Status / Q000502:physiology; D010342:Patient Acceptance of Health Care / Q000523:psychology; D014481:United States / Q000453:epidemiology