The Housing Instability Scale: Determining a Cutoff Score and Its Utility for Contextualizing Health Outcomes in People Who Use Drugs

Fawaz Shanun, Daniel Jackson Smith, Beatrice King, Lydia Vlachou, Roesheen McGilvery, Stella Zine, Hayden Henderson, Emily Reichman, Nadiah Cunningham, Morgan Zare and Sarah Febres-Cordero ()
Additional contact information
Fawaz Shanun: Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Daniel Jackson Smith: School of Nursing, University at Buffalo, Buffalo, NY 14214, USA
Beatrice King: Opioid Program, Fulton County Board of Health, Atlanta, GA 30303, USA
Lydia Vlachou: Rollins School of Public Health, Emory University, Atlanta, GA 30322, USA
Roesheen McGilvery: Georgia Harm Reduction Coalition, Inc., Atlanta, GA 30314, USA
Stella Zine: National Survivors’ Union, Greensboro, NC 27304, USA
Hayden Henderson: Positive Impact Health Centers, Decatur, GA 30030, USA
Emily Reichman: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 220, Atlanta, GA 30322, USA
Nadiah Cunningham: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 220, Atlanta, GA 30322, USA
Morgan Zare: Georgia Harm Reduction Coalition, Inc., Atlanta, GA 30314, USA
Sarah Febres-Cordero: Nell Hodgson Woodruff School of Nursing, Emory University, 1520 Clifton Road NE, Room 220, Atlanta, GA 30322, USA

IJERPH, 2025, vol. 22, issue 11, 1-14

Abstract: (1) Background: Housing instability, a key social determinant of health, disproportionately affects people who use drugs (PWUD), increasing their risk for adverse outcomes. This study explores the relationship between housing status and drug-related health outcomes among PWUD in an urban setting in the Southeastern United States (US) and determines the cutoff point for the Housing Instability Scale (HIS). (2) Methods: We conducted a cross-sectional survey from July to November 2024 among adult PWUD. Recruitment was through syringe services programs (SSPs), nightlife venues, and community outreach. HIS was used to assess housing status, while cluster analysis and Gaussian Mixture Modeling (GMM) were used to suggest a potential cutoff. Logistic regression models were employed to examine associations between housing instability and health outcomes. (3) Results: Among 164 participants (mean age = 41.2; 79.9% Black/African American), the average HIS score was 3.23. Cluster analysis suggested a singular cutoff, while GMM suggested four levels of housing instability. Multivariate logistic regression revealed that housing instability was significantly associated with infections (AOR = 1.55, p = 0.064), blackouts (AOR = 1.47, p = 0.0457), and seizures (AOR = 1.28, p = 0.0667). Overdose and wounds showed no significant association. SSP use, opioid use, and Xanax use were also identified as potential predictors.

Keywords: housing instability; people who use drugs (PWUD); drug-related health outcomes; cut-off (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2025
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