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Victimization Among Homeless and Marginally Housed Persons

Margot B. Kushel, MD; Jennifer L. Evans, MS; Sharon Perry, PhD; Marjorie J. Robertson, PhD; Andrew R. Moss, PhD

Arch Intern Med. 2003;163:2492-2499.

Background  Homeless persons experience high rates of sexual and physical assault; homeless women are thought to be at highest risk. To determine the prevalence, distribution, and factors associated with sexual and physical assault, we surveyed homeless and marginally housed adults in San Francisco, Calif.

Methods  We interviewed 2577 respondents about their history of recent sexual and physical assault, housing history, sexual practices, substance use, health status, and criminal justice history. The main outcome measures were self-reported sexual and physical assault in the previous 12 months.

Results  Overall, 32.3% of women, 27.1% of men, and 38.1% of transgendered persons reported a history of either sexual or physical assault in the previous year; 9.4% of women, 1.4% of men, and 11.9% of transgendered persons reported sexual assault, and 30.6% of women, 26.6% of men, and 33.3% of transgendered persons reported physical assault. In multivariate models, being homeless (as opposed to marginally housed) was associated with sexual assault for women, but not for men (adjusted odds ratio for homeless women, 3.4 [1.2-9.7]). Housing status was not associated with physical assault for women or men. Mental illness and sex work were both common and associated with high rates of assault in multivariate analyses.

Conclusions  Sexual and physical assault are common experiences for homeless and marginally housed persons. Housing is associated with lower rates of sexual assault among women. Strategies to decrease sexual and physical assault and its consequences are needed in this population.

From the Division of General Internal Medicine, University of California, San Francisco/San Francisco General Hospital (Dr Kushel); Department of Epidemiology and Biostatistics, University of California, San Francisco (Ms Evans and Dr Moss); Division of Geographic Medicine and Infectious Diseases, Stanford University School of Medicine, Stanford, Calif (Dr Perry); and Alcohol Research Group, Public Health Institute, Berkeley, Calif (Dr Robertson). Dr Kushel has been a consultant for the Frequent Users of Health Care Initiative, a joint project of the California Endowment and California HealthCare Foundation.

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