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Violence and Emergency Department Use among Community-Recruited Women Who Experience Homelessness and Housing Instability

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Abstract

Women who experience housing instability are at high risk for violence and have disproportionately high rates of emergency department (ED) use. However, little has been done to characterize the violence they experience, or to understand how it may be related to ED use. We recruited homeless and unstably housed women from San Francisco shelters, free meal programs, and single room occupancy (SRO) hotels. We used generalized estimating equations to examine associations between violence and any ED use (i.e., an ED visit for any stated reason) every 6 months for 3 years. Among 300 participants, 44% were African-American, and the mean age was 48 years. The prevalence of violence experienced in the prior 6 months included psychological violence (87%), physical violence without a weapon (48%), physical violence with a weapon (18%), and sexual violence (18%). While most participants (85%) who experienced physical violence with a weapon or sexual violence in the prior 6 months had not visited an ED, these were the only two violence types significantly associated with ED use when all violence types were included in the same model (ORphysical/weapon = 1.83, 95% CI 1.02–3.28; ORsexual = 2.15, 95% CI 1.30–3.53). Only violence perpetrated by someone who was not a primary intimate partner was significantly associated with ED use when violence was categorized by perpetrator. The need to reduce violence in this population is urgent. In the context of health care delivery, policies to facilitate trauma-informed ED care and strategies that increase access to non-ED care, such as street-based medicine, could have substantial impact on the health of women who experience homelessness and housing instability.

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Acknowledgments

The authors thank the Shelter, Health, and Drug Outcomes among Women project team, with special thanks to Jennifer Cohen for making the study possible. The study was funded by the National Institute on Drug Abuse (grants R01DA015605, R01 DA037012, and K24 DA039780).

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Authors and Affiliations

  1. Department of Medicine, University of California, San Francisco, 1001 Potrero Ave., UCSF mailbox 0874, San Francisco, CA, 94143-0874, USA

    Elise D. Riley, Alison Cohee & Samantha E. Dilworth

  2. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Eric Vittinghoff

  3. Department of Emergency Medicine, University of California, Davis, Davis, CA, USA

    Rose M. C. Kagawa

  4. Department of Emergency Medicine, University of California, San Francisco, San Francisco, CA, USA

    Maria C. Raven

  5. Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA

    Maria C. Raven

  6. Department of Public Health, Tom Waddell Urban Health Clinic, San Francisco, CA, USA

    Kellene V. Eagen

  7. Department of Family and Community Medicine, University of California, San Francisco, San Francisco, CA, USA

    Kellene V. Eagen

  8. Department of Psychiatry, University of California, San Francisco, San Francisco, CA, USA

    Martha Shumway

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  1. Elise D. Riley
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  3. Rose M. C. Kagawa
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  4. Maria C. Raven
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Correspondence to Elise D. Riley.

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The Institutional Review Board at the University of California, San Francisco approved all study procedures.

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Riley, E.D., Vittinghoff, E., Kagawa, R.M.C. et al. Violence and Emergency Department Use among Community-Recruited Women Who Experience Homelessness and Housing Instability. J Urban Health 97, 78–87 (2020). https://doi.org/10.1007/s11524-019-00404-x

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