{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T05:51:18Z","timestamp":1787032278852,"version":"build-2736575974"},"reference-count":42,"publisher":"California Digital Library (CDL)","issue":"6","license":[{"start":{"date-parts":[[2022,10,28]],"date-time":"2022-10-28T00:00:00Z","timestamp":1666915200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["WestJEM"],"abstract":"<jats:p>Introduction: People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness. \n\nMethods: We surveyed patients in an urban, safety-net ED from June\u2013August 2018. Patients completed two social needs screening tools and responded to additional questions on housing. Housing status was determined using validated questions about housing stability.\n\nResults: Of the 1,263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race\/ethnicities. The median age was 42 years (interquartile range [IQR]: 29-57). and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness were male (63.3%) and Black (54.2%), P &lt;0.001, and a disproportionate number of unstably housed patients were Latinx (56.8%) or were primarily Spanish speaking (49.3%), P &lt;0.001. Social needs increased across the spectrum of housing from housed to unstably housed and homeless, even when controlling for demographic characteristics. \n\nConclusion: Over one in three ED patients experience homelessness, and nearly one in three are unstably housed. Notable disparities exist by housing status, and there is a clear increase of social needs across the housing spectrum. Emergency departments should consider integrating social screening tools for patients with unstable housing.<\/jats:p>","DOI":"10.5811\/westjem.2022.8.55705","type":"journal-article","created":{"date-parts":[[2022,11,11]],"date-time":"2022-11-11T18:20:27Z","timestamp":1668190827000},"source":"Crossref","is-referenced-by-count":5,"title":["Association of Social Needs and Housing Status Among Urban Emergency Department Patients"],"prefix":"10.5811","volume":"23","author":[{"given":"Kadia","family":"Wormley","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine, Alameda Health System, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Drusia","family":"Dickson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Alameda Health System, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Harrison","family":"Alter","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Alameda Health System, Oakland, California; Andrew Levitt Center for Social Emergency Medicine, Berkeley, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ndidi","family":"Njoku","sequence":"additional","affiliation":[{"name":"Howard University College of Medicine, Washington, DC"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Partow","family":"Imani","sequence":"additional","affiliation":[{"name":"University of California Berkeley, School of Public Health, Berkeley, California"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Erik","family":"Anderson","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine, Alameda Health System, Oakland, California; Substance Use Disorder Treatment Program, Alameda Health System, Oakland, California"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"29705","published-online":{"date-parts":[[2022,10,28]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Fazel S, Geddes JR, Kushel M. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations. Lancet. 2014;384(9953):1529-40.","DOI":"10.1016\/s0140-6736(14)61132-6"},{"key":"ref1","doi-asserted-by":"publisher","unstructured":"Aldridge RW, Story A, Hwang SW, et al. Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: a systematic review and meta-analysis. Lancet. 2018;391(10117):241-50.","DOI":"10.14324\/000.ds.10073113"},{"key":"ref2","doi-asserted-by":"publisher","unstructured":"Baggett TP, O\u2019Connell JJ, Singer DE, et al. The unmet health care needs of homeless adults: a national study. Am J Public Health. 2010;100(7):1326-33.","DOI":"10.2105\/ajph.2009.180109"},{"key":"ref3","doi-asserted-by":"publisher","unstructured":"Baggett TP, Hwang SW, O\u2019Connell JJ, et al. Mortality among homeless adults in Boston: shifts in causes of death over a 15-year period. JAMA Intern Med. 2013;173(3):189.","DOI":"10.1001\/jamainternmed.2013.1604"},{"key":"ref4","doi-asserted-by":"publisher","unstructured":"Seastres RJ, Hutton J, Zordan R, et al. Long-term effects of homelessness on mortality: a 15-year Australian cohort study. Aust N Z J Public Health. 2020;44(6):476-81.","DOI":"10.1111\/1753-6405.13038"},{"key":"ref5","doi-asserted-by":"crossref","unstructured":"Morrison DS. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. Int J Epidemiol. 2009;38(3):877-83.","DOI":"10.1093\/ije\/dyp160"},{"key":"ref6","doi-asserted-by":"publisher","unstructured":"Ivers JH, Zgaga L, O\u2019Donoghue-Hynes B, et al. Five-year standardised mortality ratios in a cohort of homeless people in Dublin. BMJ Open. 2019;9(6):e023010corr1.","DOI":"10.1136\/bmjopen-2018-023010corr1"},{"key":"ref7","doi-asserted-by":"publisher","unstructured":"Homeless Mortality Data Workgroup. Homeless Mortality Data Toolkit: Understanding and Tracking Deaths of People Experiencing Homelessness. 2021. Available at: https:\/\/nhchc.org\/wp-content\/uploads\/2020\/12\/Homeless-Mortality-Toolkit-FULL-FINAL.pdf. Accessed September 26, 2021.","DOI":"10.1093\/oso\/9780190695132.003.0010"},{"key":"ref8","doi-asserted-by":"crossref","unstructured":"Drake RE, Osher FC, Wallach MA. Homelessness and dual diagnosis. Am Psychol. 1991;46(11):1149-58.","DOI":"10.1037\/0003-066X.46.11.1149"},{"key":"ref9","doi-asserted-by":"publisher","unstructured":"Doran KM, Rahai N, McCormack RP, et al. Substance use and homelessness among emergency department patients. Drug Alcohol Depend. 2018;188:328-33.","DOI":"10.1016\/j.drugalcdep.2018.04.021"},{"key":"ref10","doi-asserted-by":"crossref","unstructured":"Farrell M, Howes S, Taylor C, et al. Substance misuse and psychiatric comorbidity. Addict Behav. 1998;23(6):909-18.","DOI":"10.1016\/S0306-4603(98)00075-6"},{"key":"ref11","doi-asserted-by":"publisher","unstructured":"Maremmani AGI, Bacciardi S, Gehring ND, et al. Substance use among homeless individuals with schizophrenia and bipolar disorder. J Nerv Ment Dis. 2017;205(3):173-7.","DOI":"10.1097\/nmd.0000000000000462"},{"key":"ref12","doi-asserted-by":"publisher","unstructured":"Gerber E, Gelberg L, Rotrosen J, et al. Health-related material needs and substance use among emergency department patients. Subst Abuse. 2020;41(2):196-202.","DOI":"10.1080\/08897077.2019.1635960"},{"key":"ref13","doi-asserted-by":"publisher","unstructured":"Torchalla I, Strehlau V, Li K, et al. Substance use and predictors of substance dependence in homeless women. 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Acad Emerg Med. 2018;25(5):577-93.","DOI":"10.1111\/acem.13358"},{"key":"ref18","unstructured":"Hernandez S, Gloria A, Mitchell S. An act to amend, repeal, and add section 1262.5 of the Health and Safety Code, Relating to Public Health. 2018. Available at: https:\/\/leginfo.legislature.ca.gov\/faces\/billTextClient.xhtml?bill_id=201720180SB1152. Accessed September 26, 2021."},{"key":"ref19","doi-asserted-by":"crossref","unstructured":"Samuels-Kalow ME, Boggs KM, Cash RE, et al. Screening for health-related social needs of emergency department patients. Ann Emerg Med. 2021;77(1):62-8.","DOI":"10.1016\/j.annemergmed.2020.08.010"},{"key":"ref20","doi-asserted-by":"publisher","unstructured":"Frederick TJ, Chwalek M, Hughes J, et al. How stable is stable? Defining and measuring housing stability. J Community Psychol. 2014;42(8):964-79.","DOI":"10.1002\/jcop.21665"},{"key":"ref21","doi-asserted-by":"publisher","unstructured":"Geller A, Curtis MA. A sort of homecoming: incarceration and the housing security of urban men. Soc Sci Res. 2011;40(4):1196-213.","DOI":"10.1016\/j.ssresearch.2011.03.008"},{"key":"ref22","doi-asserted-by":"publisher","unstructured":"Riley ED, Vittinghoff E, Kagawa RMC, et al. Violence and emergency department use among community-recruited women who experience homelessness and housing instability. J Urban Health. 2020;97(1):78-87.","DOI":"10.1007\/s11524-019-00404-x"},{"key":"ref23","doi-asserted-by":"publisher","unstructured":"Arum C, Fraser H, Artenie AA, et al. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health. 2021;6(5):e309-e323.","DOI":"10.1016\/s2468-2667(21)00013-x"},{"key":"ref24","doi-asserted-by":"publisher","unstructured":"Cusack M, Montgomery AE, Cashy J, et al. Examining veteran housing instability and mortality by homicide, suicide, and unintentional injury. J Soc Distress Homelessness. 2021;30(2):174-80.","DOI":"10.1080\/10530789.2020.1801020"},{"key":"ref25","doi-asserted-by":"publisher","unstructured":"Zivanovic R, Milloy MJ, Hayashi K, et al. Impact of unstable housing on all-cause mortality among persons who inject drugs.\u00a0BMC Public Health. 2015;15:106.\u00a0","DOI":"10.1186\/s12889-015-1479-x"},{"key":"ref26","doi-asserted-by":"crossref","unstructured":"Hatem C, Lee CY, Zhao X, et al. Food insecurity and housing instability during early childhood as predictors of adolescent mental health. J Fam Psychol. 2020;34(6):721-30.","DOI":"10.1037\/fam0000651"},{"key":"ref27","doi-asserted-by":"publisher","unstructured":"Drake RE, Wallach MA, Hoffman JS. Housing instability and homelessness among aftercare patients of an urban state hospital. Psychiatr Serv. 1989;40(1):46-51.","DOI":"10.1176\/ps.40.1.46"},{"key":"ref28","doi-asserted-by":"publisher","unstructured":"Reid K, Vittinghoff E, Kushel MB. Association between the level of housing instability, economic standing and health care access: a meta-regression. J Health Care Poor Underserved. 2008;19(4):1212-28.","DOI":"10.1353\/hpu.0.0068"},{"key":"ref29","doi-asserted-by":"publisher","unstructured":"Kushel MB, Perry S, Bangsberg D, et al. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002;92(5):778-84.","DOI":"10.2105\/ajph.92.5.778"},{"key":"ref30","doi-asserted-by":"publisher","unstructured":"To MJ, Palepu A, Aubry T, et al. Predictors of homelessness among vulnerably housed adults in 3 Canadian cities: a prospective cohort study. BMC Public Health. 2016;16(1):1041.","DOI":"10.1186\/s12889-016-3711-8"},{"key":"ref31","doi-asserted-by":"publisher","unstructured":"Fraimow-Wong L, Sun J, Imani P, et al. Prevalence and temporal characteristics of housing needs in an urban emergency department. West J Emerg Med. 2021;22(2).","DOI":"10.5811\/westjem.2020.9.47840"},{"key":"ref32","unstructured":"National Association of Community Health Centers. PRAPARE: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences. 2016. Available at: https:\/\/www.nachc.org\/research-and-data\/prapare\/prapare_one_pager_sept_2016-2\/. Accessed September 5, 2019."},{"key":"ref33","doi-asserted-by":"publisher","unstructured":"Centers for Medicare & Medicaid Services. The Accountable Health Communities Health-Related Social Needs Screening Tool. 2017. Available at: https:\/\/innovation.cms.gov\/files\/worksheets\/ahcm-screeningtool.pdf. Accessed September 5, 2019.","DOI":"10.31478\/201705b"},{"key":"ref34","doi-asserted-by":"publisher","unstructured":"Harris PA, Taylor R, Thielke R, et al. Research Electronic Data Capture (REDCap)\u2014A metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377-81.","DOI":"10.1016\/j.jbi.2008.08.010"},{"key":"ref35","doi-asserted-by":"crossref","unstructured":"Harris PA, Taylor R, Minor BL, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.","DOI":"10.1016\/j.jbi.2019.103208"},{"key":"ref36","doi-asserted-by":"crossref","unstructured":"Feldman BJ, Calogero CG, Elsayed KS, et al. Prevalence of homelessness in the emergency department setting. West J Emerg Med. 2017;18(3):366-72.","DOI":"10.5811\/westjem.2017.1.33054"},{"key":"ref37","doi-asserted-by":"publisher","unstructured":"Tsai M, Weintraub R, Gee L, et al. Identifying homelessness at an urban public hospital: a moving target? J Health Care Poor Underserved. 2005;16(2):297-307.","DOI":"10.1353\/hpu.2005.0042"},{"key":"ref38","unstructured":"Goodman N, Morris M, Boston K, et al. Financial inequality: disability, race and poverty in America. 2017. Available at: http:\/\/www.advancingstates.org\/node\/69790. Accessed December 9, 2021."},{"key":"ref39","doi-asserted-by":"publisher","unstructured":"Flores G. The impact of medical interpreter services on the quality of health care: a systematic review. Med Care Res Rev. 2005;62(3):255-99.","DOI":"10.1177\/1077558705275416"},{"key":"ref40","doi-asserted-by":"publisher","unstructured":"Jacobs E, Chen AH, Karliner LS, et al. The need for more research on language barriers in health care: a proposed research agenda. Milbank Q. 2006;84(1):111-33.","DOI":"10.1111\/j.1468-0009.2006.00440.x"},{"key":"ref41","doi-asserted-by":"publisher","unstructured":"Kushel MB, Gupta R, Gee L, et al. Housing instability and food insecurity as barriers to health care among low-income Americans. 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