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Cited by 105Homelessness and Social IssuesFood Security and Health in Diverse PopulationsFood Security and Socioeconomic Dynamics

Food insufficiency and health services utilization in a national sample of homeless adults

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Baggett, Travis P., Singer, Daniel E., Rao, Sowmya R., O’Connell, James J., Bharel, Monica, Rigotti, Nancy A.·2011·Journal of General Internal Medicine
DOI 10.1007/s11606-011-1638-4PMC PMC3101971
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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.Design We analyzed data from the 2003 Health Care for the Homeless (HCH) User Survey.Participants 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.Measures 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.

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  • Homeless individuals have worse physical and emotional health status than the general population, including people from deprived neighbourhoods.

    “Homeless individuals have worse physical and emotional health status than the general population, including those from deprived neighbourhoods.32,49-51”

    From The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations (2014) · cites this paper as [50]

    Table 1 reports serious emotional problems among the homeless adults studied, and the Covariates section describes a measure of general health status. The Discussion compares food insufficiency and health-service use with the US general population, but our copy does not compare physical and emotional health status with either the general population or people from deprived neighbourhoods. (LLM, conf=0.73)

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Research works printed but not linked: 8

  1. The United States Conference of Mayors. Hunger and Homelessness Survey: A Status Report on Hunger and Homelessness in America’s Cities: A 27-City Survey. Washington, DC: The United States Conference of Mayors; 2009.
  2. National Research Council. Food insecurity and hunger in the United States: an assessment of the measure. Panel to review the US Department of Agriculture’s measurement of food insecurity and hunger. In: Wunderlich GS, Norwood JL, eds. Committee on National Statistics, Division of Behavioral and Social Sciences and Education. Washington, DC: The National Academies Press; 2006.
  3. Greene J, Fahrney K, Byron M. Health Care for the Homeless User/Visit Surveys, RTI Project Number 07147.021. Research Triangle Park, NC: RTI International; 2004.
  4. Carlson S, Briefel RR. The USDA and NHANES food sufficiency question as an indicator of hunger and food insecurity. Paper presented at: Conference on Food Security Measurement and Research. 1995; Washington, DC
  5. Babor TF, Higgins-Biddle JC, Saunders JB, Monteiro MG. The Alcohol Use Disorders Test: Guidelines for Use in Primary Care, Second Edition. Document No. WHO/MSD/MSB/01.6a: World Health Organization; 2001.
  6. National Center for Health Statistics. Data File Documentation, National Health Interview Survey of Topics Related to the Year 2000 Health Objectives, 1995. Hyattsville, MD: National Center for Health Statistics; 1997.
  7. Burt MR. Urban Institute. Homelessness: Programs and the People They Serve: Findings of the National Survey of Homeless Assistance Providers and Clients: Technical Report. Washington, DC: US Department of Housing and Urban Development, Office of Policy Development and Research; 1999.
  8. Bickel G, Nord M, Price C, Hamilton W, Cook J. Guide to Measuring Household Food Security. Alexandria, VA: US Department of Agriculture, Food and Nutrition Service; 2000.

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Authors
Baggett, T. P., Singer, D. E., Rao, S. R., O’Connell, J. J., Bharel, M., & Rigotti, N. A.
Affiliations
  • Massachusetts General Hospital (US)
  • Harvard University (US)
Corresponding author
Baggett, Travis P.
ORCID
Venue
Journal of General Internal Medicine
Publisher
Springer Science and Business Media LLC
Published
2011-01-29
Volume
26
Issue
6
Pages
627-634
ISSN
  • 0884-8734 (ISSN-L)
  • 1525-1497
DOI
10.1007/s11606-011-1638-4
PMC
PMC3101971
OpenAlex
W2094329398
Cited by
105
References
48
Citations by year
2026: 3 · 2025: 3 · 2024: 2 · 2023: 5 · 2022: 7 · 2021: 10 · 2020: 10 · 2019: 9 · 2018: 11 · 2017: 6 · 2016: 6 · 2015: 11 · 2014: 5 · 2013: 10 · 2012: 5
FWCI
13.06
Type
journal article
Language
en
Open access
Licence
www.springer.com/tdm (tdm)
Locations
  • Journal of General Internal Medicine (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • The Journal of the American Medical Association (JAMA) Network (American Medical Association) (submittedVersion)
Funders
  • U.S. Department of Health and Human Services
  • Health Resources and Services Administration (T32 HP10251)
  • U.S. Public Health Service (T32 HP10251)
  • National Center for Research Resources (UL1RR031982)
Topics
  • Social Sciences › Sociology and Political Science › Homelessness and Social Issues
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Food Security and Health in Diverse Populations
  • Life Sciences › Agricultural and Biological Sciences › General Agricultural and Biological Sciences › Food Security and Socioeconomic Dynamics
Keywords
food insufficiency, homelessness, health care utilization, hospitalization, emergency department utilization, psychiatric hospitalization, chronic homelessness, food insecurity
MeSH terms
Adult, Data Collection, Eating, Female, Food Supply, Health Services, Ill-Housed Persons, Hospitalization, Humans, Male, Middle Aged, Nutritional Status, Patient Acceptance of Health Care, United States, Malnutrition

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