Our Research

New commentary from BHHI faculty Dr. Maria Raven, published in JAMA Network Open, examines what recent findings on VA mobile medical units (MMUs) reveal about outreach, healthcare use, and evaluation in care for veterans experiencing homelessness.

Tobacco use remains the leading cause of preventable deaths worldwide. Despite efforts by many countries to reduce the impact of tobacco products and lower smoking rates, smoking prevalence is higher among people experiencing homelessness. The reasons are complex and go beyond individual choices, including limited awareness about quitting, restricted access to services, and previous negative experiences. Using the SEM framework, which emphasizes the policy and environmental contexts, this study offers a deeper understanding of the context of the lives women experiencing homelessness. The evidence from this study supports the implementation of gender- and age-appropriate holistic approaches to healthcare and tobacco interventions tailored to this community.

The U.S. overdose crisis is now driven by polysubstance use involving fentanyl and stimulants. We received funding through the National Institutes on Drug Abuse’s Helping to End Addiction Long-Term (HEAL) initiative to conduct longitudinal qualitative research on polysubstance use among people experiencing homelessness (PEH) in San Francisco, California. This paper discusses the rationale for these combined approaches and lessons learned from conducting longitudinal qualitative research with a community in real-time during enhanced risk for criminalization and overdose fatality.

Homelessness is dynamic; some individuals cycle between homelessness and housing. BHHI examined the prevalence of and factors associated with exits from and returns to homelessness among adults aged 50 and older. With a median 4 years of follow-up, 80% of participants exited homelessness into housing. Having a permanent rental subsidy was associated with retaining housing.

Incarceration is a recognized risk factor for homelessness. However, most research focuses on the relationship between homelessness and prison incarceration. This study examines the occurrence of housing loss after jail incarceration among individuals without prior evidence of homelessness and the associated risk of reincarceration.

People with lived experience hold insights and networks that academic researchers alone cannot access. Building trust-based partnerships between researchers and lived experts takes time, vulnerability, and institutional change. But it’s essential to producing knowledge that leads to equitable and effective solutions.

Older homeless-experienced adults are at higher risk of loneliness than general older adults, yet less is known about the factors contributing to loneliness for this group. Loneliness is associated with multiple adverse health and mental health outcomes. This study examines this gap in our knowledge.

Injury is a leading cause of hospitalization in people experiencing homelessness, yet post-injury care use is unknown. This study examines care use patterns in the 12 months after injury in people experiencing homelessness versus housed low-income Medicaid beneficiaries.

The United States has fewer labor protections and wage guarantees than most wealthy nations, leaving many workers vulnerable to economic hardship from job loss, reduced hours, or work-related injuries. Based on data from the California Statewide Study of People Experiencing Homelessness (CASPEH), this study shows how income disruptions—through layoffs, unstable gig work, caregiving tied to housing, illness or injury, probation and parole demands, and COVID-19-related impacts—can quickly lead to homelessness when housing costs are high and wages are low.

People experiencing homelessness have lower rates of cancer screening than housed people, contributing to later stages of cancer diagnosis and poor outcomes. We examined whether gaining housing increased rates of cancer screening in a cohort of homeless veterans. This study of nearly 120,000 homeless veterans finds that gaining housing was linked to higher screening rates for both breast and colorectal cancer—key to detecting cancer earlier, reducing the need for emergency surgery, and saving lives.

Globally, tobacco use causes 8.7 million deaths annually. Approximately 50 % of formerly homeless adults in permanent supportive housing (PSH) in the United States smoke cigarettes. Secondhand smoke exposure is high in the absence of smoke-free policies. There is a need to understand attitudes toward smoke-free policies and factors associated with smoke-free home adoption attempts among PSH residents.