Characteristics and Dynamics of Homeless Families with Children. Health Outcomes


The early studies of homeless children that assessed health outcomes found a higher prevalence of health-related problems compared to low-income housed children or children in the general population. For instance, Alperstein et al. (1987) in a study of outpatient medical records in a New York City pediatric clinic, compared 265 homeless children under the age of five in New York City with poor housed children attending the same clinic. Homeless children were behind in their immunizations and had elevated blood lead levels compared to housed children. Homeless children also had higher rates of hospital admissions and reports of child abuse/neglect. The two groups were comparable in terms of height, weight, and free erythroprotoporphyrin (FEP) levels (a measure of iron deficiency).

Miller and Lin (1988) conducted a survey in King County, Washington, involving a representative sample of 82 homeless families living in emergency shelters. A total of 158 children ranging from 1 month to 17 years of age were assessed, and the investigators compared their findings on these homeless children to normative data in the general population. Although Miller and Lin (1988) found that the majority of children were described as in “good” or ”excellent“ health, the proportion whose health was described as ”fair“ or “poor” was 4 times that of the general U.S. pediatric population (13% vs. 3.2%) and 2 times higher than low-income children (13% vs. 6.5%). Homeless children in this study were also found to lack a regular health care provider (true for 59%), use emergency rooms a rate 2 to 3 times higher than in the general population, and were more likely to lack standard immunizations and preventative health care.

Another health outcome study took place in Los Angeles and involved a comparison of 196 homeless families to 194 stably housed poor families (Wood et al., 1990). Children in both groups had compared global ratings of their health status (i.e., excellent, good, fair, poor) and similar rates of symptoms (e.g., fever, cough, vomiting, diarrhea) indicative of an illness during the past month. However, these rates were 2 to 5 times higher than those reported in the general child population. Children in both groups had poor dietary intakes and problems with obesity. Homeless children were more likely than housed children to have experienced an episode of hunger in the past month (21% vs. 7%).

The only second generation study involving health outcomes is that of Weinreb, Goldberg, Bassuk, and Perloff (1998), which was part of the Worcester study that took place during the mid 1990s. They compared 293 homeless children ranging from 2 months to 17 years of age to 334 low-income housed (never homeless children). Their results are fairly consistent with prior studies, although the study is more rigorous because they used multivariate analyses to statistically control for imbalances between the two groups in order to better isolate genuine differences between the two groups. Eighty-eight percent of the homeless children and 94 percent of low-income housed children were reported to be in “good” to “excellent” health, while about 12 percent of the homeless children and 6 percent of the housed children’s health were rated as “fair or poor.” Overall, the difference in health ratings between the two groups was statistically significant at the p <.05 level. Rates of acute illnesses in the past month were generally comparable between the two groups although homeless children had higher rates of ear infections and asthma. Homeless children had higher service use rates, including visits to an emergency room and outpatient clinic visits.

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