{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T04:13:53Z","timestamp":1791864833122,"version":"4.3.4"},"reference-count":40,"publisher":"SAGE Publications","issue":"5","license":[{"start":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T00:00:00Z","timestamp":1707264000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"National Center on Homelessness Among Veterans and Veterans Health Administration"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Public Health Rep"],"published-print":{"date-parts":[[2024,9]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Veteran homelessness has declined in the past decade, but the proportion of unsheltered homeless veterans has increased. We identified characteristics of unsheltered homelessness in a large contemporary veteran cohort and examined outpatient and inpatient encounters before and after intake to US Department of Veterans Affairs (VA) homeless programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>National data from the Homeless Operations Management Evaluation System (HOMES) database and the Corporate Data Warehouse were analyzed on 191 204 veterans experiencing housing instability from January 2018 through December 2021. We used hierarchical multivariate logistic regressions to model associations between sheltered status and veteran correlates. Repeated-measures analysis of variance assessed changes in care utilization after intake in homeless programs.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Age &lt;50 years (odds ratio [OR] = 1.3; 95% CI, 1.2-1.4), Hispanic ethnicity (OR = 1.2; 95% CI, 1.1-1.3), some college education (OR = 1.1; 95% CI, 1.0-1.1), and a bachelor\u2019s degree (OR = 1.2; 95% CI, 1.1-1.2) were associated with veteran unsheltered homelessness. Unsheltered veterans were more likely to have a VA service-connected disability (OR = 1.4; 95% CI, 1.4-1.5), military sexual trauma (OR = 1.1; 95% CI, 1.0-1.1), and\/or combat exposure (OR = 1.1; 95% CI, 1.0-1.1). Unsheltered and sheltered homeless veterans had an increase in outpatient encounters and a decrease in inpatient care after intake to the VA homeless program.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Contemporary unsheltered homeless veterans are younger and Hispanic with some college education. Innovative public health approaches that better engage and reduce barriers to entry need to be tested for a diverse unsheltered homeless population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/00333549241227155","type":"journal-article","created":{"date-parts":[[2024,2,7]],"date-time":"2024-02-07T06:51:45Z","timestamp":1707288705000},"page":"582-590","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":12,"title":["Growing Concern About Unsheltered Homelessness Among Veterans: Clinical Characteristics and Engagement in Health Care Services"],"prefix":"10.1177","volume":"139","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6752-5715","authenticated-orcid":false,"given":"Rebecca L.","family":"Kinney","sequence":"first","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Washington, DC, USA"},{"name":"VA Central Western Massachusetts Healthcare System, Leeds, MA, USA"},{"name":"Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Szymkowiak","sequence":"additional","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Washington, DC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-648X","authenticated-orcid":false,"given":"Jack","family":"Tsai","sequence":"additional","affiliation":[{"name":"VA National Center on Homelessness Among Veterans, US Department of Veterans Affairs, Washington, DC, USA"},{"name":"Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA"},{"name":"Department of Psychiatry, Yale School of Medicine, New Haven, CT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2024,2,7]]},"reference":[{"key":"#cr-split#-bibr1-00333549241227155.1","unstructured":"US Department of Health and Human Services. After halting rapid rise in homelessness, Biden-Harris administration announces plan to reduce homelessness 25% by 2025. News release. United States Interagency Council on Homelessness"},{"key":"#cr-split#-bibr1-00333549241227155.2","unstructured":"December 19, 2022. Accessed February 11, 2023. https:\/\/www.hhs.gov\/about\/news\/2022\/12\/19\/biden-harris-administration-announces-plan-to-reduce-homelessness-25-percent-by-2025.html"},{"key":"bibr2-00333549241227155","unstructured":"United States Interagency Council on Homelessness. All in: the federal strategic plan to prevent and end homelessness. December 2022. Accessed January 8, 2023. https:\/\/www.usich.gov\/fsp"},{"key":"bibr3-00333549241227155","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2021.03.017"},{"key":"bibr4-00333549241227155","unstructured":"US Government Accountability Office. Homelessness: issue summary. 2023. 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US Department of Housing and Urban Development; 2021. Accessed January 5, 2023. https:\/\/www.huduser.gov\/portal\/sites\/default\/files\/pdf\/2020-AHAR-Part-1.pdf"},{"key":"bibr16-00333549241227155","unstructured":"US Census. Veterans. 2023. Accessed January 5, 2023. https:\/\/www.census.gov\/topics\/population\/veterans.html"},{"key":"bibr17-00333549241227155","unstructured":"National Alliance to End Homelessness. Honoring veterans by ending their homelessness. November 9, 2021. Accessed December 16, 2022. https:\/\/endhomelessness.org\/blog\/honoring-veterans-by-ending-their-homelessness"},{"key":"bibr18-00333549241227155","unstructured":"US Department of Health and Human Services. New data shows 11% decline in veteran homelessness since 2020\u2014the biggest drop in more than 5 years. News release. US Department of Housing and Urban Development; November 3, 2022. 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