title: Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study.
abstract: Homelessness is a major concern in many urban communities across North America. Since vulnerably housed individuals are at risk of experiencing homelessness, it is important to identify predictive factors linked to subsequent homelessness in this population. The objectives of this study were to determine the probability of experiencing homelessness among vulnerably housed adults over three years and factors associated with higher risk of homelessness.
  
  
  
  Vulnerably housed adults were recruited in three Canadian cities. Data on demographic characteristics, chronic health conditions, and drug use problems were collected through structured interviews. Housing history was obtained at baseline and annual follow-up interviews. Generalized estimating equations were used to characterize associations between candidate predictors and subsequent experiences of homelessness during each follow-up year.
  
  
  
  Among 561 participants, the prevalence of homelessness was 29.2 % over three years. Male gender (AOR = 1.59, 95 % CI: 1.14-2.21) and severe drug use problems (AOR = 1.98, 95 % CI: 1.22-3.20) were independently associated with experiencing homelessness during the follow-up period. Having ≥3 chronic conditions (AOR = 0.55, 95 % CI: 0.33-0.94) and reporting higher housing quality (AOR = 0.99, 95 % CI: 0.97-1.00) were protective against homelessness.
  
  
  
  Vulnerably housed individuals are at high risk for experiencing homelessness. The study has public health implications, highlighting the need for enhanced access to addiction treatment and improved housing quality for this population.
authors.affiliation: Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada. mto3@alumni.uwo.ca.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: To
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anita
authors.initials: A
authors.lastname: Palepu
authors.affiliation: University of Ottawa, Ottawa, ON, Canada.
authors.forename: Tim
authors.initials: T
authors.lastname: Aubry
authors.affiliation: Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.affiliation: Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Evie
authors.initials: E
authors.lastname: Gogosis
authors.affiliation: Centre for Health Evaluation and Outcome Sciences, Division of General Internal Medicine, University of British Columbia, Vancouver, BC, Canada.
authors.forename: Anne
authors.initials: A
authors.lastname: Gadermann
authors.affiliation: University of Ottawa, Ottawa, ON, Canada.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Cherner
authors.affiliation: Royal Ottawa Health Care Group, Ottawa, ON, Canada.
authors.forename: Susan
authors.initials: S
authors.lastname: Farrell
authors.affiliation: Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
authors.forename: Vachan
authors.initials: V
authors.lastname: Misir
authors.affiliation: Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.|Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D000328:Adult; D002170:Canada / Q000453:epidemiology; D002947:Cities; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D011446:Prospective Studies; D012940:Social Problems; D019966:Substance-Related Disorders / Q000453:epidemiology; D035862:Vulnerable Populations / Q000706:statistics & numerical data*
keywords: Homeless persons; Housing; Public health; Substance-related disorders; Urban health