11/18/91
CONTACT: Stanford University News Service (650) 723-2558
STANFORD -- Being homeless can make you sick. Sometimes, being sick can make you homeless.
When the Stanford Studies of Homeless Families, Children and Youth looked at health, researchers found more illness among adults and less medical care among homeless families than among other poor families. They found that most homeless children, like children in general, are robust and healthy. They were no more likely to be sick than poor children with homes.
However, when a family lived in an inappropriate place - a park, an empty building or a car - its children were more likely to have chronic illnesses, such as problems with growing muscles and bones. The longer a family was homeless, the more often parents reported a decline in their children's health. Homeless children tended to have physical and emotional ailments that persisted even after the family had found a home.
The Stanford sociologists also found that poor health itself sometimes was the cause of homelessness. A costly illness not covered by insurance was one of the triggering events that caused some families to lose their homes.
Poor access to health care - especially to dental care - was a problem whether a family was homeless, or poor and at risk of homelessness. One optimistic finding, however: Families who had found a way out of homelessness also obtained somewhat better medical and dental care.
The study, led by Sanford Dornbusch, a Stanford University professor of sociology, and research coordinator Melissa Beacham, compared the physical and emotional health of the members of 596 homeless families with two other sets of poor families: those who were formerly homeless and those at risk of losing their homes.
They found that some of the stereotypes about homeless individuals' health did not apply to family members. For example, only 34 percent of the homeless parents reported any history of substance abuse, and only 5 percent had been previously treated for mental illness - rates much lower than for homeless individuals. There was no difference in rates of substance abuse between homeless parents and those who had managed to find homes again.
The Stanford researchers attributed the lower rates to differences in the forces that push families - rather than individuals - into homelessness. Also, they said, homeless parents are predominantly women, while homeless individuals are mostly men; rates of substance abuse in the general population are higher among men.
Only 29 percent of the mothers had been under 18 when they gave birth to their first child; only 30 percent of single-parent families were headed by teen mothers.
"The image of homelessness as predominantly a product of teenage parenthood is incorrect," Beacham said.
Parents in families that had been homeless more than once or homeless for a long time often reported a decline in their children's health. "Charley is sicker now because he's releasing a lot of pain from the past," a formerly homeless mother told the researchers. "He has psychological pain and he gets physically sick from it."
Overall, a decline in health was reported for 23 percent of the homeless children and 29 percent of formerly homeless children. They had more chronic illnesses, such as asthma, and more acute illnesses, such as colds and flu, trauma, skin diseases and nutritional problems.
The study seemed to point to a strong link between adverse living conditions and certain chronic illnesses. Thirty-four percent of the homeless families reported having to live in inappropriate places, such as cars or garages, in empty public buildings or outdoors. More children from these families had eye and ear troubles, musculoskeletal and urogenital problems - 13 percent as compared with 5 percent for other homeless children.
A 15-year-old girl's story illustrated the discomforts of homeless life:
"We used to live in a garage and it had rats," she said. "When we wanted to go to the bathroom, we had to go to the neighbors. I didn't feel comfortable. We would have to wake up the people we were staying with to let us in."
There was a strong link between children's physical health and their parents' feelings of depression, anxiety and stress. Homeless parents who reported an increase in these emotional symptoms were more likely to have children whose health declined.
The researchers said the children's physical problems might have been a stress-related response to their parents' emotional distress. Or the parents might have been anxious because their children were ill.
"Clearly, the health issues of homeless children must be addressed within the context of their family, for parents and their children's health are linked in powerful ways," Dornbusch said.
Teenagers living on their own live with an alarming array of health problems - strep throat, bladder infections, anemia, malnutrition, venereal diseases, stomach ulcers, hepatitis and scabies. Of the 50 adolescents on their own who were interviewed for the Stanford study, half refused to visit shelters or drop-in centers for teens: 85 percent of these young people had health problems. This compares with 38 percent of the teens who used shelters.
Homeless parents also fared worse in terms of health: 27 percent reported having a chronic illness, compared with 8 percent of their children.
Parents reported that 31 percent of homeless children were not receiving regular health care, and 8 percent had untreated medical problems - both figures twice as high as for children from poor families with homes. Thirty-one percent of homeless parents had untreated illnesses.
Differences in health care between homeless and other poor families were a matter of degree. For most, "regular" health care meant a visit to the emergency room. Health insurance was an important factor - 35 percent of homeless parents had none, and 22 percent of the children were not covered by private or government-subsidized insurance. Among families who lacked medical insurance, both parents and children were more likely to report untreated medical problems, and parents were more likely to have chronic health problems.
"All these families are poor," Dornbusch said, "but not all qualify for MediCal."
Paperwork is often the barrier: Dornbusch interviewed one woman who was seven months pregnant and had no prenatal care. It took six trips to social service agencies to certify her husband as unemployed.
The number of children under 6 who had not received all their immunizations was high for all three groups: 18 percent of homeless children, 16 percent in the at-risk group and 12 percent of the formerly homeless. Nationally, only 3 percent of young children have not been immunized.
Lack of insurance had its biggest impact on dental care.
The average time elapsed since a homeless child had seen a dentist was three to five years. The figure was the same for children in impoverished at-risk families. Half of homeless parents and one-third of at-risk parents told the researchers they needed dental care but could not afford it.
One reason, the researchers found, was a Medi-Cal rule reimbursing dentists for extractions but not for fillings. Some of the homeless adults reported that, given their lack of money, they feared that the dentist would pull their teeth rather than fill their cavities.
For many families, getting a home also meant getting medical care. Compared to the homeless, the formerly homeless had a slightly lower rate of untreated medical problems among children and a significantly lower rate among parents - 15 percent, compared to 38 percent. The number of adults who needed dental work dropped from 51 percent to 23 percent. The average time since formerly homeless children had seen a dentist was only one to three months.
"Clearly, the families we interviewed that were previously homeless and had found their way out had a strong link to the services that they needed," Beacham said. "Somehow, they get tied into the system."
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