Research Matters Blog

March 02, 2015
Categories: Topics

Image of a statue holding its head.Trauma may be defined as an event outside the range of usual human experiences that would be markedly distressing to almost anyone and cause victimization. This includes a serious threat to his or her life or physical integrity; a serious threat to harm his or her children, spouse or close relatives or friends; the sudden destruction of his or her home and community; or seeing another person seriously injured or killed in an accident or by physical violence. 

Trauma can destroy the trust relationship of the victim with themselves and the world. This creates an inordinate amount of stress on the mental, emotional and physical capacities of the victim whose coping behaviours and belief structures have been shattered by trauma. The victim no longer knows how to act or what to expect from the world in order to survive. Their unique living conditions and life histories make homeless people particularly vulnerable to traumatic events. This physical or psychological trauma may precede or follow the onset of homelessness 

Homelessness is associated with a variety of traumatic social problems, including family breakdown and abuse, adverse childhood experiences, foster care, youth pregnancy and inadequate parenting skills, and child development problems. Homeless adults typically experienced sexual and physical abuse as children. For women, escape from domestic violence is a frequent cause for homelessness. While homeless youth come from all classes, most come from families where physical abuse, exacerbated by long term unemployment and parental drug and alcohol use is the norm. Effectively reducing child abuse may significantly reduce the number of homeless people. 

Trauma and victimization continues for a person that ends up homeless. The most frequent violent trauma occurring among homeless women is rape. The most common violent trauma among homeless men is assault. The homeless with mental illnesses are more susceptible to trauma. They tend to wander in public places, display detachment and respond slowly to events due to their depression. Being homeless precipitates more traumatic experiences and the cycle is difficult to end. 

Numerous studies have established that homeless people experience high levels of violence and victimization. Homeless people are more often victims of crime than housed people. In research, many homeless people, regardless of gender or age, have reported experiences of physical assault or aggression (sometimes by police), sexual assault, sexual harassment, and/or rape. Rough sleepers are especially vulnerable to being victimized. 

Most homeless people that are victims of crime choose not to report it to the police, for a number of reasons. They have been dissatisfied with the response of police in the past (ineffective or uninterested), they mistrust the police and are not in a good position to challenge mistreatment, or they fear retribution for “squealing”. Violations of street culture may result in retaliation from other homeless people, drug dealers or pimps. 

People who are homeless suffer from a lack of guardianship, increased exposure to criminals, and the inability to avoid dangerous areas. All of these factors increase an individual’s vulnerability to crimes that include assault, robbery, theft, vandalism and sexual assault. In turn, homeless people adapt and survive by committing their own offenses such as carrying weapons or seeking their own retribution against criminals, as relations with law enforcement are typically strained.

Photo credit: Flickr/quinnanya

Canadian Observatory on Homelessness/Homeless Hub: York University
February 27, 2015
Categories: Ask the Hub

This question came from Joy via our latest website survey. Though she specifically asked about divorce, I’ll respond with information on general relationship breakdown as well, as not all people are legally married.

Oh, how I wish I could just give you statistics. Due to the complicated nature of homelessness and inaccurate population counts, we don’t have solid numbers on how divorce and relationship/family breakdown contribute to homelessness.

Avalon Housing's triggers of homelessness graphicAccording to Homeless Link and Crisis, relationship breakdown—be it between partners, family members, and/or friends—is the number one reported cause of lost accommodations. Avalon Housing, a U.S. supportive housing organization, estimates it triggers homelessness 10% of the time (pictured right). Chamberlain and Guy’s study on pathways to adult homelessness found that of the five “main pathways” to homelessness, family breakdown accounted for 11% of instances. A report from the Parliament of Canada also lists marital breakdown as a key “risk factor” for homelessness, citing Finnie’s analysis that after divorce, 40% of women are in worse economic circumstances and are three times as likely to live in poverty. For Indigenous people living on reserves, marital breakdown often meant one spouse (often with children) had to leave the reserve entirely, putting them at risk of homelessness.

Sudden breakups or divorces are often traumatic, life-altering circumstances that contribute to homelessness for many reasons: loss of combined income, legal fees, extra payments, and so on. Both men and women are affected by relationship breakdown, but describe their experiences differently. One Canadian study found that women reported becoming homeless due to social circumstances or leaving bad/abusive relationships, while men more often framed their actions as “walking away” from situations. In almost all of the interviews, participants described other non-relationship factors that also contributed to their homelessness.

One particularly vulnerable population is older people. A Canadian study on older people frequenting homeless shelters found that family breakdown is more of a contributor to homelessness for people over 65. Older women who are separated, widowed or divorced are particularly vulnerable (as I wrote before) due to a variety of factors that result in financial instability.

This is also the case outside of North America. A 2004 UK study reported that the rise of divorce contributed to more homelessness in people over the age of 50. A news report on the study stated that over 27,000 householders became homeless directly because of relationship breakdown, but the study outlines other causes as well: negative outcomes in investing and economic difficulties, to name a few.

While family and relationship breakdowns are significant factors in many people losing their housing, we have to also be mindful of how they relate with other causes of homelessness, like structural factors and systems failures.

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

Photo credit: Avalon Housing

York University; Canadian Observatory on Homelessness/Homeless Hub
February 25, 2015

Young people who are homeless have few of the securities that those with shelter take for granted. Youth who are homeless face an increased risk of being victims of violence, especially sexual violence. The relationship between sexual violence and homelessness is complicated: sexual violence is both a contributor to homelessness and a factor resulting from homelessness. The below infographic, published by the National Sexual Violence Resource Center in the United States, looks into the link that exists between youth homelessness and sexual violence.

Homeless Youth & Sexual Violence Infographic

One way of understanding the scope of the problem at hand is by comparing the rates of sexual violence among youth in the general population to the rates of sexual violence among youth living in homelessness.  The infographic states that 21-41% of homeless youth in the US report sexual abuse compared to just 1%-3% of youth in the general population. This is a startlingly high discrepancy. Clearly, living on the streets dramatically increases the risk of being a victim of sexual violence.

Among homeless youth, certain groups are at increased risk of being victims of sexual violence. Findings from a 2009 survey among homeless youth in Toronto found that among female youth, black females were more likely to be victims of sexual assaults (47%) than white females (33%). The same survey found that 33.4% of homeless LGBTTQ youth (who represented a quarter of youth surveyed) had been victims of sexual assaults, compared to 13.5% of homeless heterosexual youth. Despite this knowledge, there are zero specialized housing initiatives for LGBTQ2 youth in Canada. We need to ensure that services and supports available to youth adequately addressed heightened risks and dangers that exist among the lines of gender, race and sexual identity.

When interpreting the above figures, it’s important to keep in mind that many assaults go unreported. This means the incidence rate of violent crime against homeless youth is likely far higher than these numbers suggest. The presence of stigma, as well as victim-blaming stereotypes, play a large role in keeping youth from speaking up about the problems they are facing. Research shows that widespread acceptance of victim-blaming stereotypes can lead to the internalization of these beliefs. This means that a youth who is a regular victim of sexual violence may come to believe that he or she is somehow responsible for crimes that have been committed against them. If we want victims of sexual violence to feel secure about reporting assaults, it’s essential that the stigma associated with being homeless and being a victim of sexual violence are removed. The removal of stigma needs to be coupled with robust responses by law enforcement authorities that demonstrate our commitment to the wellbeing of youth living in homelessness.

The incidence of sexual violence among youth has strong implications for the healthy physical, psychological, and emotional development of youth. Municipalities and provincial governments need to work directly with service providers to ensure measures are in place to protect homeless youth. We have a responsibility to these youth to bridge the existing gaps in supports and service provision.

February 23, 2015
Categories: Topics

Effective drug prevention imageSubstance use prevention refers to interventions that seek to delay the onset of substance use, or to avoid substance use problems before they occur. Effective prevention strategies begin early in life and continue through adolescence and into adulthood; they reinforce consistent messages across the life span. Prevention is more than education though. It also includes a broad range of health promotion strategies such as building skills, engaging youth in the development of appropriate messages, and ensuring that environmental supports are in place such as employment, positive school culture and strong family supports. It also includes strengthening the health, social and economic factors that can reduce the risk of substance use. This includes access to health care, stable housing, education and employment. 

Adolescence is an important developmental stage in life. Young people are learning to be independent and take on roles and patterns that will carry them into adulthood. This includes decisions about what substances they use and how they use them. While some trends in substance use among youth are of concern, the majority of youth try alcohol and other drugs without becoming frequent or problem users. Research has found that experimentation with drugs and alcohol is in many ways part of normal adolescent development and levels of use and experimentation decline, as youth get older and take on adult roles and responsibilities. It is unrealistic to think that all youth won’t try alcohol or other drugs like cannabis. But prevention strategies can encourage youth to delay their use until they’re older and help them learn safer, more sensible ways to use substances, if they are already using them. 

Providing young people with good information is important. However, the research is clear that simply educating youth about avoiding substance use is not effective. Scare tactics or hard-line approaches like zero-tolerance have little or no effect. When kids are told that substances, including marijuana, are extremely dangerous and addictive, and then they learn through experimentation that this is false, the rest of the message is discredited. Honest drug education is one key to ensuring that individuals know how to make informed decisions. Effective programs start with the very young and extend through all stages of life. They use a range of health promotion strategies and target policy and legislative change.

Canadian Observatory on Homelessness/Homeless Hub: York University
February 20, 2015
Categories: Ask the Hub

Do you have any estimate of immunization rates among people living on the street or in shelters? That's such a good place to communicate disease among already weakened people.

In short, there is no one single estimate. The literature on this subject finds those who are homeless are less likely to be immunized against a variety of diseases, including influenza. One Toronto influenza study found that out of 75 participants, only 6.7% had documentation indicating they had received vaccination the year before the study. In Buchner et. al’s study in New York, only 25% of people experiencing homelessness had received an influenza vaccine. (The authors also highlight the fact that influenza or influenza-like illness was the suspected cause of death for 3.4% of deaths among the homeless in the city.)

Immunization rates can also be lower for certain groups, such as youth, whose early departure from school and non-participation in public health programs makes them more vulnerable to vaccine-preventable diseases. 

Doctor preparing vaccines

But immunization is complicated, and even housed people sometimes have difficulty keeping track of their vaccinations. Even healthcare providers have been found to be lacking knowledge about immunization schedules. 

With cases of measles popping up in Canada, immunization has become quite a hot topic. The immunization rate for measles, tuberculosis and DPT3 has been declining over the past decade—so much so that a 2013 UNICEF report card ranked Canada 28 of 29 developed countries in that category. According to an article in The Globe and Mail, Canada has an approximate measles vaccination rate of 95%, but there are areas where it’s as low as 50%. Religious and philosophical beliefs often play roles in parents deciding whether or not to vaccinate their children. 

While early vaccination is important, according to Immunize Canada, even adults need booster shots to maintain immunity. Due to inconsistent record keeping, many people are not aware of vaccination schedules or what they’ve been immunized for. 

These issues are even more complicated for people experiencing homelessness. As we’ve covered before, health, poverty and homelessness are interrelated and introduce some key challenges. People experiencing homelessness often have poorer health and are susceptible to a number of communicable diseases. Many have difficulty accessing healthcare, even from public programs, due to a number of barriers, including: missing identification, lack of permanent address, fear of stigma or discrimination, and limited or no funds for prescription medication. 

Solutions: Education, incentives and tracking

The unpredictability of homeless people’s lives makes it difficult to adhere to vaccination schedules, as explored in Stein and Nyamathi’s research on hepatitis B vaccination. With case management, incentives and tracking, however, researchers found that 68% of the participants completed their schedules. 

One Vancouver study found that immunization in non-traditional settings is very successful in reducing reported diseases. Vaccines were offered in blitz formats and combined, achieving vaccination rates among participants between 58% and 79%. In a Halifax study with homeless youth, participants recommended better advertising of free vaccination programs, and generally more youth- and homeless-friendly approaches to care. 

When it comes to avoiding pandemics, communities can greatly reduce transmission and impact through comprehensive planning. For people working in the social services, the Influenza Planning Guide for Alberta’s Vulnerable Populations and Shelter Serving Agencies is a great resource. 

As some experts have argued, it’s important to go beyond calculating medical risks to keep the social determinants of health in mind when discussing pandemics, disease and immunization. Social factors—like poverty and other sites of oppression—are key to helping us understand how risk and vulnerability vary from person to person.

This post is part of our Friday "Ask the Hub" blog series. Have a homeless-related question you want answered? E-mail us at thehub@edu.yorku.ca and we will provide a research-based answer.

Photo: PATH Global Health

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The analysis and interpretations contained in the blog posts are those of the individual contributors and do not necessarily represent the views of the Canadian Observatory on Homelessness.