A growing number of people with lived experience of homelessness are finding opportunities in California to influence academic projects. More entities are beginning to create entire boards or councils of people who know what it is like to lose their housing. With regards to including a lived expertise advisory board in UCSF BHHI's California Statewide Study of People Experiencing Homelessness, Kara Young Ponder, PhD, director of community engagement and racial justice at the UCSF Benioff Homelessness and Housing Initiative, said, "The researchers had missed an entire world of economic insecurity, and the survey was much richer because the board members could see things the researchers could not."

The homeless population is aging and people experiencing homelessness are at a heightened risk of experiencing physical and sexual victimization. This study examined whether homelessness is independently associated with experiencing physical or sexual abuse. Researchers found that older homeless adults experience high rates of victimization.

Homeless adults in their 50s and 60s have a similar prevalence of geriatric conditions, including functional and cognitive impairment, as adults in their 70s and 80s in the general population. Researchers aimed to describe the prevalence of symptoms among older homeless-experienced adults, analyze factors associated with moderate–high physical symptom burden, and identify symptom clusters. They conducted a cross-sectional analysis within longitudinal cohort study. Researchers found a high prevalence of symptomatology across multiple domains. They found that symptom domains clustered together: those with higher physical symptomatology had a high prevalence of other symptom domains.

This topic brief examines who experiences pregnancy during homelessness, how they lost their housing, their experiences during homelessness, and obstacles to regaining housing. The findings highlight the urgent need for the homelessness system to advance evidence-based strategies to meet the reproductive health needs of people experiencing homelessness.

Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness. Researchers aimed to understand the relationship between race and the experience of homelessness for older adults. They developed a theoretical model of the way experiences with overt and structural racism may lead to and perpetuate homelessness for older Black adults. Researchers recommend that efforts aimed at ending homelessness target the effects of structural racism with polices.

Adults aged 50 and older make up half of individuals experiencing homelessness and have high rates of morbidity and mortality. Researchers administered structured interviews including assessments of health, history of homelessness, social support, and life course. They found that compared to those who were unsheltered, having social support when last stably housed was significantly associated with cohabiting and institution use. Further research on the newly homeless individuals and cohabiters in this cohort may elucidate more clearly the trajectories of these different phenotypes of homelessness.

The proportion of single homeless adults over the age of 50 is increasing. In this longitudinal cohort study, researchers examined the prevalence of and risk of falling in a cohort of older homeless adults. Researchers interviewed participants every 6 months for 3 years. They found a high prevalence of falls. Participants reported a prevalence of falls higher than older adults with a mean age of 78 in the general population. Researchers recommended identifying people at high risk of falls reducing unsheltered homelessness.

Sleep is essential to health and affected by environmental and clinical factors. There is limited longitudinal research examining sleep quality in homeless older adults. This exploratory study examined the factors associated with poor sleep quality in a cohort of older adults in Oakland, California. Researchers found that participants had higher prevalence of poor sleep and worse Pittsburgh Sleep Quality Index (PSQI) scores than in studies of housed adults 20 years older.

A new UCSF BHHI study challenges common perceptions about homelessness and drug use in California, revealing that only 37% of surveyed unhoused Californians use drugs regularly, while 25% have never used them at all. Methamphetamine, not opioids, is the most commonly used drug, often as a means to stay alert while living on the streets. The study also highlights the complex relationship between addiction and homelessness—while drug use can increase the risk of losing housing, “Homelessness itself increases drug use because people use it as a coping strategy,” said Margot Kushel, MD. With homelessness on the rise and only 7% of respondents in treatment, experts stress that expanding affordable housing and accessible treatment options is crucial to addressing both crises.

Research from UCSF Benioff Homelessness and Housing Initiative reveals that most people experiencing homelessness in California are not illegal drug users—contrary to widespread public perception. These findings challenge common stereotypes and underscore the urgent need for better treatment options and housing solutions across the state. KCBS Radio news anchor Eric Thomas spoke with Margot Kushel, MD, Professor of Medicine and Chief of UCSF’s Division for Health Equity and Society, to dive deeper into the issue.

Recently the demographic characteristics of people experiencing individual homelessness have changed; more individuals over the age of 50 are experiencing homelessness. BHHI researchers examined the motivations for and challenges of older adults experiencing homelessness staying with or moving in with family or friends. Researchers found barriers to stay such as feelings of shame and concerns about burdening the hosts. Findings suggest that family members and friends may play an important role in supporting older adults experiencing homelessness.

Loss of income is considered the number one factor for why Californians experience homelessness, according to new research from UCSF. The new findings highlight the idea that money is not only the main cause of the homelessness, but also a potential solution. "I think it’s really important to note how desperately poor people are, and how much it is their poverty and the high housing costs that are leading to this crisis" said Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative and principal investigator of the landmark study.

Intimate partner violence (IPV) is a risk factor for people experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing. Researchers purposefully sampled 104 adults who reported experiencing IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH), a representative, mixed-methods study. They identified six primary themes regarding IPV and homelessness.

Researchers at UCSF Benioff Homelessness and Housing Initiative have released the largest representative survey of homeless people in more than 25 years. Researchers surveyed over 3200 people experiencing homelessness in California, and conducted over 300 in-depth interviews. The California Statewide Study on People Experiencing Homelessness paints a different picture, debunking common myths and providing evidence-based solutions.

Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. The study aimed to characterize the experience, understanding, and management of physical, psychological, social (e.g., loneliness), and existential (e.g., regret, loss of dignity) symptoms among older homeless adults. Researchers conducted semistructured interviews from June 2016 to March 2017 with a purposive sample of participants from the Health Outcomes of People Experiencing Homelessness in Older Middle Age cohort, a longitudinal study of homeless adults aged 50 and older. They found that homelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering.

Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, delivered the Harvard Joint Center for Housing Studies’ 23rd John T. Dunlop Lecture. Dr. Kushel spoke about the impact that homelessness has on an individual’s quality of life, highlighting the lived experiences of unhoused Californians who participated in the California Statewide Study of People Experiencing Homelessness. After the lecture there was a panel, featuring, Boston Healthcare for the Homeless founder, Harvard Medical School professor James J. O’Connell, and Peggy Bailey, a leader of a housing policy research center. JCHS Managing Director Chris Herbert, the moderated the panel. Dr. Kushel said, "While it is really easy to blame people impacted by homelessness, doing so not only is not fair or right, but it also isn’t going to get us any closer to a solution."

For the California Statewide Study on People Experiencing Homelessness, the largest study on homelessness in California since 1996, the research team included people who were formerly or are currently unhoused residents in California. The CASPEH Lived Expertise Advisory Board members at the UCSF Benioff Homelessness and Housing Initiative provided input on survey questions and planned outreach to people experiencing homelessness. Robynne Rose-Haymer, CASPEH Lived Expertise Advisory Board representative, said, "We did extensive training with our interview team, not just in being trauma-informed, but in being empathetic listeners and approaching everyone with dignity."

A special report, released by UCSF Benioff Homelessness and Housing Initiative, explored the relationship between intimate partner violence (IPV) and homelessness in California. Findings from the report showed how violence and economic insecurity can be intertwined. Margot Kushel, MD, director of the UCSF Benioff Homelessness and Housing Initiative, said, "There are only so many places you can hide when you’re unsheltered."

Tobacco-attributable deaths contribute significantly to the increased mortality observed among homeless adults aged 50 years or more. In this longitudinal cohort study, researchers examine smoking behaviors and factors associated with smoking cessation among homeless individuals aged 50 years or more. Researchers found tobacco use in older homeless adults and rates of quit attempts were similar to that observed in the general population, but successful quitting was lower.

People experiencing homelessness have significantly lower life expectancies than the general population, and among those aged ≥ 45, tobacco-related illnesses are the leading cause of death.[1] Compared to the general population, tobacco use among people experiencing homelessness is six times higher, and the quit ratio (ratio of former to ever-smokers) is five times lower. [2],[3] We used the largest representative study of people experiencing homelessness since the 1990s to estimate tobacco use prevalence and its association with shelter status, behavioral health, and health services use among adults experiencing homelessness in California to identify opportunities to address unmet tobacco treatment needs.

Conducted by the UCSF Benioff Homelessness and Housing Initiative, the California Statewide Study of People Experiencing Homelessness (CASPEH) is the largest representative study of homelessness in the United States since the mid-1990s. The study provides a comprehensive look at the causes and consequences of homelessness in California and recommends policy changes to shape programs in response.

To better understand the experiences of older adults experiencing homelessness, the UCSF Benioff Homelessness and Housing Initiative examined findings from the California Statewide Study of People Experiencing Homelessness (CASPEH), the largest representative study of homelessness since the mid-1990s. This report reviews who experiences homelessness in late life, how they lost their housing, their experiences during homelessness, and the barriers they face to regaining housing. These findings highlight the urgent need for research-backed solutions and policy interventions to address the unique challenges faced by older adults experiencing homelessness.

Latine Californians represent more than one-third of the state's homeless population. Yet their experiences are too often left out of research, policy, and service design. To better understand these experiences, we examined data from the California Statewide Study of People Experiencing Homelessness. This report, based on the California Statewide Study of People Experiencing Homelessness (CASPEH), examines who experiences homelessness in the Latine community, their experiences while homeless, and offers evidence-based policy and program solutions.

To better understand the experiences of Black Californians experiencing homelessness, the UCSF Benioff Homelessness and Housing Initiative examined the experience of Black Californians within the California Statewide Study of People Experiencing Homelessness (CASPEH), the largest representative study of homelessness since the mid-1990s. This report reviews who experiences homelessness in the Black community, what may have precipitated their homelessness, experiences during their episode of homelessness, and what impacts their return to permanent housing. These findings aim to inform evidence-based solutions for preventing and ending homelessness for Black Californians.

To better understand the experiences of survivors of intimate partner violence currently experiencing homelessness, this report analyzed data related to IPV in the California Statewide Study of People Experiencing Homelessness (CASPEH)—the largest representative study of homelessness since the mid-1990s. The mixed-methods study included data about participants’ experiences of violence across the life course, in the six months prior to homelessness, and during their current episode of homelessness. The report presents these findings to advance research-backed solutions for preventing and responding to homelessness among survivors of IPV.