摘要：Objectives. We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. Methods. We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. Results. Almost one fourth of participants (23.1%) had a history of imprisonment. Models that examined lifetime substance use showed cocaine use (odds ratio [OR]=1.67; 95% confidence interval [CI]=1.04, 2.70), heroin use (OR=1.51; 95% CI=1.07, 2.12), mental illness (OR=1.41; 95% CI=1.01, 1.96), HIV infection (OR=1.69; 95% CI=1.07, 2.64), and having had more than 100 sexual partners were associated with a history of imprisonment. Models that examined recent substance use showed past-year heroin use (OR = 1.65; 95% CI = 1.14, 2.38) and methamphetamine use (OR=1.49; 95% CI=1.00, 2.21) were associated with lifetime imprisonment. Currently selling drugs also was associated with lifetime imprisonment. Conclusions. Despite high levels of health risks among all homeless and marginally housed people, the levels among homeless former prisoners were even higher. Efforts to eradicate homelessness also must include the unmet needs of inmates who are released from prison. People who were homeless at the time of arrest are overrepresented in prisons. 1 Additionally, homeless populations include higher proportions of former prisoners compared with the general population, 2 and inmates who are released from prison have a high risk for homelessness. 3 – 5 The association between homelessness and imprisonment is bidirectional: imprisonment may precipitate homelessness by disrupting family and community contacts and by decreasing employment and housing prospects. 5 – 7 Homelessness may increase the risk for imprisonment through shared risk factors and through increased likelihood of arrest. Both substance abuse and mental illness are important risk factors for homelessness and imprisonment. 7 – 16 Homeless persons who have mental health and substance abuse disorders have low rates of receipt of treatment for their disorders. 17 Mentally ill inmates are more likely to have been homeless in the year before their arrest than non–mentally ill inmates, 1 and inmates who had been homeless were more likely to be mentally ill than inmates who had not been homeless immediately before their arrest. 18 Homelessness also increases the risk for recidivism among former prisoners. 19 Homeless and prison populations have high rates of communicable diseases because of poor health, unsafe sexual practices, illicit drug use, and close living quarters. 20 – 23 Among homeless mentally ill persons, those who have a history of incarceration have elevated rates of psychiatric problems and substance abuse disorders. 24 It is not known whether homeless persons who have a history of imprisonment are more likely to have poor health status and to be more at-risk for infectious disease than homeless persons who do not have a history of imprisonment. We hypothesized that homeless persons who had a history of imprisonment would have higher rates of substance abuse disorders, mental health disorders, physical health problems, and illegal activities than those who did not have a history of imprisonment. We assessed a sample of homeless and marginally housed individuals to compare whether persons who had a history of imprisonment differed from persons who did not have a history of imprisonment regarding (a) lifetime health and illegal activities and (b) current health and illegal activities.
