{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T12:51:04Z","timestamp":1776775864375,"version":"3.51.2"},"reference-count":36,"publisher":"MDPI AG","issue":"4","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Across California, the seven largest cities\u2014Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, and Long Beach\u2014carry a disproportionate share of the state\u2019s homelessness crisis, even though they operate under the same statewide policy framework. Each city\u2019s homelessness system reflects its own history, political climate, and housing market conditions, and this study shows that a common set of structural forces especially severe housing scarcity, fragmented behavioral\u2013health systems, and uneven local capacity shapes homelessness across these urban areas while producing different outcomes on the ground. Drawing on multidisciplinary research, statewide policy analyses, and municipal data, the analysis compares how cities interpret and implement key interventions, including permanent supportive housing, interim shelter expansion, prevention strategies, and enforcement-oriented responses. The findings make clear that California\u2019s homelessness crisis cannot be reduced to a single cause; instead, understanding it requires a systems-oriented perspective that accounts for the intertwined economic, social, and policy forces shaping conditions in each community. By situating city-level strategies within broader statewide patterns, the study identifies points of convergence and divergence, as well as persistent structural constraints that limit the effectiveness of current responses, underscoring the need for coordinated, scalable, and context-responsive policy solutions.<\/jats:p>","DOI":"10.3390\/ijerph23040537","type":"journal-article","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:42:45Z","timestamp":1776771765000},"page":"537","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Urban Homelessness in California: A Multicity Analysis of Structural Constraints and Policy Implementation"],"prefix":"10.3390","volume":"23","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-7027-7940","authenticated-orcid":false,"given":"Peter G.","family":"Kreysa","sequence":"first","affiliation":[{"name":"Department of Family and Consumer Sciences, California State University, Long Beach, CA 90840, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,4,21]]},"reference":[{"key":"ref_1","unstructured":"California Interagency Council on Homelessness (2021). Statewide Homelessness Assessment Sacramento."},{"key":"ref_2","unstructured":"U.S. Department of Housing and Urban Development (2024). The 2024 Annual Homelessness Assessment Report (AHAR) to Congress."},{"key":"ref_3","unstructured":"Benioff Homelessness and Housing Initiative (2026, March 26). Toward a New Understanding: The California Statewide Study of People Experiencing Homelessness. Available online: https:\/\/homelessness.ucsf.edu\/our-impact\/studies\/california-statewide-study-people-experiencing-homelessness."},{"key":"ref_4","unstructured":"California Department of Housing and Community Development (2024). California\u2019s Housing Future 2040: The Next Regional Housing Needs Allocation (RHNA)."},{"key":"ref_5","unstructured":"Stanford Institute for Economic Policy Research (2026, March 26). Homelessness in California. Available online: https:\/\/siepr.stanford.edu\/news\/video-series\/homelessness-california."},{"key":"ref_6","unstructured":"Sacramento City Auditor (2024). Preliminary Report on the City\u2019s Homeless Response."},{"key":"ref_7","unstructured":"National Academies of Sciences Engineering, and Medicine (2018). Permanent Supportive Housing: Evaluating the Evidence for Improving Health Outcomes Among People Experiencing Chronic Homelessness, The National Academies Press."},{"key":"ref_8","unstructured":"(2026, February 26). State of Homelessness: 2025 Edition. National Alliance to End Homelessness. Available online: https:\/\/endhomelessness.org\/state-of-homelessness\/."},{"key":"ref_9","unstructured":"Dear, M., and Wolch, J. (1987). Landscapes of Despair: From Deinstitutionalization to Homelessness, Princeton University Press."},{"key":"ref_10","unstructured":"Sacramento County Department of Health Services (2024). Behavioral Health Services: 2024 Annual Performance Report."},{"key":"ref_11","first-page":"455","article-title":"Do criminalization policies impact local homelessness?","volume":"53","author":"Lebovits","year":"2025","journal-title":"Policy Stud. J."},{"key":"ref_12","unstructured":"Los Angeles County (2024). Homeless Initiative. Annual Performance Evaluation for Year Six of the Countywide Homeless Initiative."},{"key":"ref_13","unstructured":"City of Long Beach Department of Health and Human Services (2024). 2024 Homelessness Count."},{"key":"ref_14","unstructured":"California Interagency Council on Homelessness (2024). Homeless Housing, Assistance and Prevention (HHAP) Rounds 1\u20134: Grantee Data Snapshot."},{"key":"ref_15","unstructured":"California Department of Housing and Community Development (2021). Homekey: A Journey Home."},{"key":"ref_16","unstructured":"California Department of Housing and Community Development (2024). Homekey."},{"key":"ref_17","unstructured":"City of San Diego (2023). Progress Report 2023."},{"key":"ref_18","unstructured":"City of San Jos\u00e9 Housing Department (2022). Annual Homelessness Report: Fiscal Year 2021\u20132022."},{"key":"ref_19","unstructured":"Los Angeles Homeless Services Authority (2020). 2020 Greater Los Angeles Homeless Count: Subpopulation and Demographic Data, Los Angeles Homeless Services Authority."},{"key":"ref_20","unstructured":"Los Angeles Homeless Services Authority (2021). A Bridge Home: Program Implementation and Interim Housing Outcomes Report, Los Angeles Homeless Services Authority."},{"key":"ref_21","unstructured":"San Diego Housing Commission (2026, February 26). SDHC and City of San Diego Homelessness Programs. Available online: https:\/\/sdhc.org\/homelessness-solutions\/city-homeless-shelters-services\/#supportive."},{"key":"ref_22","first-page":"105","article-title":"Unmet needs of individuals experiencing homelessness near San Diego waterways: The roles of displacement and overburdened service systems","volume":"43","author":"Flanigan","year":"2020","journal-title":"J. Health Hum. Serv. Adm."},{"key":"ref_23","unstructured":"County of Santa Clara Office of Supportive Housing (2023). Point-in-Time Count: 2023 Santa Clara County Homeless Census and Survey."},{"key":"ref_24","unstructured":"Central Valley Health Policy Institute (2026, March 26). 2020 Community Health Needs Assessment: Fresno County. Available online: https:\/\/chhs.fresnostate.edu\/cvhpi\/documents\/2020-chna-report.pdf."},{"key":"ref_25","unstructured":"County of Santa Clara Office of Supportive Housing (2023). 2023 Measure A Affordable Housing Bond Independent Audit and Progress Report."},{"key":"ref_26","unstructured":"City of San Jose (2023). Interim Housing Communities."},{"key":"ref_27","unstructured":"(2026, March 26). Destination: Home. Preventing Homelessness With Financial Assistance: Homelessness Prevention. Available online: https:\/\/destinationhomesv.org\/homelessness-prevention\/."},{"key":"ref_28","unstructured":"City and County of San Francisco Department of Homelessness and Supportive Housing (2024). San Francisco Point-in-Time Count, City and County of San Francisco."},{"key":"ref_29","unstructured":"Office of the Controller\u2014City and County of San Francisco (2023). Homelessness Services: Performance and Spending Analysis FY2022\u201323."},{"key":"ref_30","unstructured":"City and County of San Francisco Controller\u2019s Office (2023). San Francisco Housing Policy and Practice Review."},{"key":"ref_31","unstructured":"City and County of San Francisco Department of Homelessness and Supportive Housing (2025). Assessment of the San Francisco Shelter System, City and County of San Francisco."},{"key":"ref_32","unstructured":"San Francisco Department of Public Health (2024). Annual Report."},{"key":"ref_33","unstructured":"City and County of San Francisco Department of Emergency Management (2024). San Francisco Coordinated Street Response Teams."},{"key":"ref_34","unstructured":"Fresno Madera Continuum of Care (2023). Fresno-Madera Continuum of Care 2023 Point-in-Time Count Executive Summary, Fresno Madera Continuum of Care."},{"key":"ref_35","unstructured":"Sacramento Steps Forward (2024). 2024 Point-in-Time Count Report for Sacramento County, Sacramento Steps Forward."},{"key":"ref_36","unstructured":"Sacramento Steps Forward (2025). Community Standards for Service Providers, Sacramento Steps Forward."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/537\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T11:53:22Z","timestamp":1776772402000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/4\/537"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,21]]},"references-count":36,"journal-issue":{"issue":"4","published-online":{"date-parts":[[2026,4]]}},"alternative-id":["ijerph23040537"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23040537","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,21]]}}}