UCLA

Homelessness is a pervasive and urgent social problem. Using a life course and socioecological framework, this dissertation examines how shelter status and homeless trajectories shape health outcomes. I present three studies.1) To understand the impact of shelter status on health outcomes, I conducted a systematic review of 42 studies on unsheltered homelessness and health. Unsheltered populations experience higher rates of chronic disease, serious mental illness, and substance abuse compared to sheltered populations. Unsheltered homelessness is strongly associated with chronic homelessness that exacerbates serious mental illness and substance use, which is often co-occurring. Despite having large unmet health needs, unsheltered populations have lower health care utilization and often lack health insurance. 2) To understand the impact of duration and frequency of homelessness on health, I conducted secondary data analysis using the Los Angeles Homeless Services Authority (LAHSA) youth survey data from 2018 and 2019 for unsheltered young adults (aged 18-24). Rates of unsheltered homelessness for racial and sexual minority young adults were high relative to Los Angeles County’s population. Young adults experiencing long-term homelessness had twice the odds of having a physical health condition, mental health condition, and substance use disorder and of having any health condition. Youth with multiple marginal identities may be especially vulnerable to poor health outcomes. Primary reasons for homelessness among young adults were financial insecurity, household conflict, and not having social support. 3) To explore antecedents and consequences of housing insecurity and homeless among young adults, I conducted 13 qualitative interviews with University of California, Los Angeles (UCLA) students. Structural and individual factors influence housing insecurity, which leads to poor health and academic outcomes. Social stigma and shame are barriers to help seeking for students. More research and high-quality data are needed to examine the relationship between homelessness and health and to identify causal mechanisms. Public health practitioners can advance unsheltered health by improving access to shelter and housing and expedite exits out of homelessness by connecting young adults to health and social services. Resolving structural constraints at the community and institutional level may be most effective at reducing young adult homelessness in Los Angeles County.