Homelessness During Infancy: Associations With Infant and Maternal Health and Hardship Outcomes

Diana B. Cutts
Hennepin County Medical Center

Allison Bovell-Ammon
Boston Medical Center

Stephanie Ettinger de Cuba
Boston University

Richard Sheward
Boston Medical Center

Meg Shaefer
The Everett Clinic

Cassie Huang
Boston University

Maureen M. Black
University of Maryland

Patrick H. Casey
University of Arkansas for Medical Sciences

Sharon Coleman
Boston University

Megan Sandel
Deborah A. Frank
Boston Medical Center

• Objective: Homelessness among children is correlated with developmental delays, fair or poor health, and high healthcare utilization (AAP, 2013). Associations of homelessness specifically among infants younger than 12 months, however, are unknown. This study evaluates homelessness during infancy as a risk for adverse infant and maternal health and hardship.
• Methods: From May 2009 to December 2015, 9,980 mothers of infants younger than 12 months were surveyed at emergency departments and primary care clinics in five U.S. cities. Infants were classified as having a history of homelessness if they were homeless at any point versus being consistently housed during their first year. Infant health outcomes included caregiver report of fair or poor health, developmental risk, and hospitalizations. Maternal health outcomes included self-report of fair or poor health and positive screen for depressive symptoms. Hardships included household and child food insecurity and foregone medical care or prescriptions due to cost.
• Results: After adjusting for potential confounders, homelessness during infancy was associated with higher adjusted odds of fair or poor infant health (adjusted odds ratio [AOR] 1.71; 95-percent confidence interval [CI] 1.18, 2.47; p < 0.01) and developmental risk (AOR 1.62; 95-percent CI 1.04, 2.53; p = 0.03), but not hospitalizations. Compared with consistently housed mothers, mothers with a history of homelessness had higher adjusted odds of fair or poor health and depressive symptoms. History of homelessness was associated with higher adjusted odds of household and child food insecurity and foregone health care for family members other than the infant.
• Conclusions: Homelessness in infancy is associated with adverse outcomes for infants and mothers. Interventions providing housing and other health-related resources to homeless families with infants may improve health and family hardship.