{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,14]],"date-time":"2026-02-14T09:01:36Z","timestamp":1771059696359,"version":"3.50.1"},"reference-count":38,"publisher":"Public Library of Science (PLoS)","issue":"7","license":[{"start":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T00:00:00Z","timestamp":1625097600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000024","name":"Canadian Institutes of Health Research","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000024","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100000085","name":"Ontario HIV Treatment Network","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000085","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Introduction<\/jats:title>\n<jats:p>Housing affects an individual\u2019s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. \u201cStable housing\u201d was defined as residence in a house or apartment and \u201cunstable housing\u201d was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0253923","type":"journal-article","created":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T18:14:23Z","timestamp":1625163263000},"page":"e0253923","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":10,"title":["A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada"],"prefix":"10.1371","volume":"16","author":[{"given":"Ellen C.","family":"Rowlands Snyder","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lisa M.","family":"Boucher","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahmed 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in supportive housing","volume":"13","author":"DP Culhane","year":"2002","journal-title":"Hous Policy Debate"},{"key":"pone.0253923.ref004","doi-asserted-by":"crossref","first-page":"122","DOI":"10.1016\/j.healthplace.2013.06.003","article-title":"Transitions into and out of homelessness among street-involved youth in a Canadian setting","volume":"23","author":"T Cheng","year":"2013","journal-title":"Heal Place"},{"issue":"1","key":"pone.0253923.ref005","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1186\/s12889-016-3711-8","article-title":"Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study","volume":"16","author":"MJ To","year":"2016","journal-title":"BMC Public Health"},{"issue":"2","key":"pone.0253923.ref006","doi-asserted-by":"crossref","first-page":"258","DOI":"10.2105\/AJPH.90.2.258","article-title":"Risk factors for homelessness among indigent urban adults with no history of psychotic illness: a case-control study.","volume":"90","author":"CL Caton","year":"2000","journal-title":"Am J Public Health"},{"issue":"4","key":"pone.0253923.ref007","doi-asserted-by":"crossref","first-page":"465","DOI":"10.1176\/ps.2009.60.4.465","article-title":"Risk Factors for Homelessness: Evidence From a Population-Based Study","volume":"60","author":"KH Shelton","year":"2009","journal-title":"Psychiatr Serv"},{"issue":"1","key":"pone.0253923.ref008","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1353\/hpu.0.0237","article-title":"Risk Factors for Homelessness among Women VeteransJ","volume":"21","author":"DL Washington","year":"2010","journal-title":"Health Care Poor Underserved"},{"issue":"10","key":"pone.0253923.ref009","doi-asserted-by":"crossref","first-page":"1753","DOI":"10.2105\/AJPH.2005.063321","article-title":"Risk factors for long-term homelessness: findings from a longitudinal study of first-time homeless single adults","volume":"95","author":"CLM Caton","year":"2005","journal-title":"Am J Public Health"},{"issue":"1\u20132","key":"pone.0253923.ref010","doi-asserted-by":"crossref","first-page":"142","DOI":"10.1007\/s10464-011-9444-z","article-title":"Comparing the Housing Trajectories of Different Classes Within a Diverse Homeless Population.","volume":"49","author":"T Aubry","year":"2012","journal-title":"Am J Community Psychol"},{"issue":"4","key":"pone.0253923.ref011","doi-asserted-by":"crossref","first-page":"499","DOI":"10.1016\/j.jadohealth.2012.07.011","article-title":"Homelessness independently predicts injection drug use initiation among street-involved youth in a Canadian setting","volume":"52","author":"C Feng","year":"2013","journal-title":"J Adolesc Health"},{"issue":"1","key":"pone.0253923.ref012","doi-asserted-by":"crossref","first-page":"131","DOI":"10.1186\/s12889-016-2802-x","article-title":"Predictors of residential stability among homeless young adults: a cohort study","volume":"16","author":"\u00c9 Roy","year":"2015","journal-title":"BMC Public Health"},{"issue":"S2","key":"pone.0253923.ref013","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1007\/s10461-007-9239-2","article-title":"Homelessness and HIV-Associated Risk Behavior Among African American Men Who Inject Drugs and Reside in the Urban South of the United States","volume":"11","author":"LF Salazar","year":"2007","journal-title":"AIDS Behav"},{"issue":"3","key":"pone.0253923.ref014","doi-asserted-by":"crossref","first-page":"251","DOI":"10.1007\/s10461-005-9000-7","article-title":"Housing Status and HIV Risk Behaviors: Implications for Prevention and Policy","volume":"9","author":"A Aidala","year":"2005","journal-title":"AIDS Behav"},{"issue":"11","key":"pone.0253923.ref015","doi-asserted-by":"crossref","first-page":"1681","DOI":"10.1080\/10826080500222834","article-title":"Injection Risk Behavior among Women Syringe Exchangers in San Francisco","volume":"40","author":"PJ Lum","year":"2005","journal-title":"Subst Use Misuse"},{"issue":"1","key":"pone.0253923.ref016","doi-asserted-by":"crossref","first-page":"79","DOI":"10.1016\/j.healthplace.2004.10.004","article-title":"Unstable Housing, Associated Risk Behaviour, and Increased Risk for hiv Infection among Injection Drug Users.","volume":"12","author":"TA Corneil","year":"2006","journal-title":"Health Place"},{"issue":"4","key":"pone.0253923.ref017","first-page":"415","article-title":"Hospital utilization and costs in a cohort of injection drug users","volume":"165","author":"A Palepu","year":"2001","journal-title":"CMAJ"},{"issue":"26","key":"pone.0253923.ref018","first-page":"1","article-title":"Establishing a community-based participatory research partnership among people who use drugs in Ottawa: the PROUD cohort study","volume":"11","author":"L Lazarus","year":"2014","journal-title":"Harm Reduct J"},{"issue":"2","key":"pone.0253923.ref019","first-page":"ii3","article-title":"Community-Based Research Partnerships: Challenges and Opportunities","volume":"82","author":"M Minkler","year":"2005","journal-title":"J Urban Heal Bull New York Acad Med"},{"key":"pone.0253923.ref020","unstructured":"Canadian HIV\/AIDS Legal Network. Nothing About Us Without Us\u201d. Greater Meaningful Involvement of People Who Use Illegal Drugs: A Public Health, Ethical and Human Rights Imperative. 2005; Available from: http:\/\/www.hivlegalnetwork.ca\/site\/wp-content\/uploads\/2013\/04\/Greater+Involvement+-+Rpt+-+Drug+Policy+-+ENG.pdf."},{"issue":"1","key":"pone.0253923.ref021","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1353\/ken.0.0000","article-title":"Ethical Analysis of Research Partnerships with Communities","volume":"18","author":"E Wallwork","year":"2008","journal-title":"Kennedy Inst Ethics J"},{"issue":"7","key":"pone.0253923.ref022","doi-asserted-by":"crossref","first-page":"e11697","DOI":"10.1371\/journal.pone.0011697","article-title":"Addiction Treatment and Stable Housing among a Cohort of Injection Drug Users","volume":"5","author":"A Palepu","year":"2010","journal-title":"PLoS One"},{"key":"pone.0253923.ref023","article-title":"On the Integration of Mental Health and Substance Use Services and Systems: Main Report","volume":"128","author":"B Rush","year":"2008","journal-title":"Summ report Can Exec Counc Addict"},{"issue":"4","key":"pone.0253923.ref024","doi-asserted-by":"crossref","first-page":"268","DOI":"10.7326\/M16-2149","article-title":"Primary Care\u2013Based Models for the Treatment of Opioid Use Disorder","volume":"166","author":"PT Korthuis","year":"2017","journal-title":"Ann Intern Med"},{"key":"pone.0253923.ref025","doi-asserted-by":"crossref","first-page":"94","DOI":"10.1016\/j.drugpo.2011.08.005","article-title":"The accessibility, acceptability, health impact and cost implications of primary healthcare outlets that target injecting drug users: A narrative synthesis of literature","author":"MM Islam","year":"2012","journal-title":"International Journal of Drug Policy"},{"issue":"5","key":"pone.0253923.ref026","doi-asserted-by":"crossref","first-page":"E115","DOI":"10.1503\/cmaj.190732","article-title":"Use of a primary care and pharmacy-based model for the delivery of injectable opioid agonist treatment for severe opioid use disorder: a case report","volume":"192","author":"T Wilson","year":"2020","journal-title":"Can Med Assoc J"},{"issue":"2","key":"pone.0253923.ref027","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1081\/ADA-100100605","article-title":"Homelessness and Gender in Out-of-Treatment Drug Users","volume":"26","author":"D Royse","year":"2000","journal-title":"Am J Drug Alcohol Abuse"},{"issue":"3","key":"pone.0253923.ref028","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1080\/10550887.2012.694602","article-title":"Housing First for Severely Mentally Ill Homeless Methadone Patients","volume":"31","author":"PW Appel","year":"2012","journal-title":"J Addict Dis."},{"key":"pone.0253923.ref029","first-page":"1","article-title":"The mechanisms underpinning peer support: a literature review","author":"E Watson","year":"2017","journal-title":"J Ment Heal."},{"issue":"10","key":"pone.0253923.ref030","doi-asserted-by":"crossref","first-page":"992","DOI":"10.1016\/j.drugpo.2015.01.005","article-title":"Evaluation of two community-controlled peer support services for assessment and treatment of hepatitis C virus infection in opioid substitution treatment clinics: The ETHOS study, Australia","volume":"26","author":"C Treloar","year":"2015","journal-title":"Int J Drug Policy"},{"issue":"5","key":"pone.0253923.ref031","doi-asserted-by":"crossref","first-page":"598","DOI":"10.1007\/s10597-017-0102-2","article-title":"Experts by Experience: Peer Support and its Use with the Homeless.","volume":"53","author":"SL Barker","year":"2017","journal-title":"Community Ment Health J"},{"key":"pone.0253923.ref032","unstructured":"Income Security Advocacy Centre. OW and ODSP Rates and the OCB 2017. Toronto, ON; 2017."},{"issue":"6","key":"pone.0253923.ref033","doi-asserted-by":"crossref","first-page":"e550","DOI":"10.17269\/CJPH.107.5607","article-title":"The effect of incarceration on housing stability among homeless and vulnerably housed individuals in three Canadian cities: A prospective cohort study","volume":"107","author":"MJ To","year":"2016","journal-title":"Can J Public Heal"},{"issue":"1","key":"pone.0253923.ref034","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1186\/s13722-019-0136-6","article-title":"Illicit substance use after release from prison among formerly incarcerated primary care patients: a cross-sectional study","volume":"14","author":"A Chamberlain","year":"2019","journal-title":"Addict Sci Clin Pract"},{"issue":"16","key":"pone.0253923.ref035","first-page":"1","article-title":"A Cohort Study Examining Emergency Department Visits and Hospital Admissions Among People Who Use Drugs in Ottawa, Canada","volume":"14","author":"C Kendall","year":"2017","journal-title":"Harm Reduct J."},{"key":"pone.0253923.ref036","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/j.drugpo.2008.10.003","article-title":"Risk environments and drug harms- a social science for harm reduction approach","volume":"20","author":"T Rhodes","year":"2009","journal-title":"Int J Drug Policy"},{"issue":"1","key":"pone.0253923.ref037","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1001\/archinte.161.1.85","article-title":"Benefits of Linking Primary Medical Care and Substance Abuse Services","volume":"161","author":"JH Samet","year":"2001","journal-title":"Arch Intern Med"},{"issue":"5","key":"pone.0253923.ref038","article-title":"Integrated Prevention Services for HIV Infection, Viral Hepatitis, Sexually Transmitted Diseases, and Tuberculosis for Persons Who Use Drugs Illicitly: Summary Guidance from CDC and the U.S","volume":"61","author":"Centers for Disease Control and Prevention","year":"2012","journal-title":"Department of Health and Human Services Morbidity and Mortality"}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253923","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,7,1]],"date-time":"2021-07-01T18:14:59Z","timestamp":1625163299000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0253923"}},"subtitle":[],"editor":[{"given":"Sungwoo","family":"Lim","sequence":"first","affiliation":[],"role":[{"role":"editor","vocabulary":"crossref"}]}],"short-title":[],"issued":{"date-parts":[[2021,7,1]]},"references-count":38,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2021,7,1]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0253923","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,7,1]]}}}