An article in Housing Policy Debate, “Housing Instability and Homeless Program Use Among Veterans: The Intersection of Race, Sex, and Homelessness,” looks at the variation in housing instability among veterans by race and sex. Comparing rates of reported housing instability and rates of Veteran Health Administration (VHA) program use, the authors find that nonwhite veterans have greater odds of reporting housing instability and greater odds of participating in VHA programs.
The authors examined responses to the Homelessness Screening Clinical Reminder (HSCR) survey administered to all veteran outpatients at VHA health care facilities. Between October 2012 and March 2016, there were 5,355,858 responses to the HSCR, and 147,771 respondents screened positive for housing instability. Respondents screened positive if they indicated that they had not been living in a stable home they own, rent, or stay in as part of a household in the past two months, or if they were concerned that they might not have stable housing in the next two months. The authors also collected information about veterans’ race, sex, age, marital status, VA Enrollment Priority Group as a proxy for income, exposure to combat, experience of military sexual trauma, mental health conditions, substance abuse disorders, and chronic medical conditions. Collecting this information allowed the authors to control for other variables when looking at the relationship between housing instability, race, and sex.
Among the 5.3 million veterans who responded to the HSCR, 76.1% were white men, 14.7% were Black men, 4.6% were white women, 2.2% were Black women, 1.6% were Asian/Pacific Islander men, 0.6% were American Indian/Alaska Native men, 0.2% were Asian/Pacific Islander women, and 0.1% were American Indian/Alaska Native women. White men were underrepresented among those reporting housing instability, as they made up 59% of that group, while all other race/sex combinations were overrepresented. For example, Black men made up 27.6% of those reporting housing instability, and Black women made up 4.1%.
Women generally and in each racial category had higher rates of housing instability than men. The women who responded to the HSCR screen, though, were different from the male respondents in several ways beyond their sex – for example, women veterans are younger. After the authors examined the 5.3 million responses to the HSCR, they built two models to control for variables such as age, marital status, exposure to combat, and mental health conditions. Controlling for these variables separates the effect that each has on the likelihood of experiencing housing instability from the effects that race or sex has, which allows the authors to take a closer look at the relationship between race and housing instability or sex and housing instability. Younger ages, being unmarried, having experienced military sexual trauma, and having a mental health diagnosis were all associated with higher odds of housing instability. When taking into account all of these other variables, the authors found that nonwhite veterans and veterans identifying as Hispanic had increased odds of housing instability. Perhaps surprisingly, they found that women had lower odds for screening positive for housing instability. Their research suggests that higher rates of housing instability among women are explained by other factors, like their younger age.
The authors also examined the proportion of veterans in each race/sex category who used a VHA homeless program within six months of screening positive for housing stability. The lowest rates of VHA homeless-program use were among veterans aged 65 years or older, across all race/sex categories. A greater proportion of Black men and women and American Indian/Alaska Native men with an indicator of depression, psychosis, suicide ideation, or substance abuse accessed VHA programs compared to white men and women. Asian/Pacific Islander men and women and American Indian/Alaska Native women with these indicators had lower rates of VHA homeless program use.
In discussing their findings, the authors emphasize that nonwhite veterans are disproportionately represented among veterans who screen positive for housing instability and that they have higher rates of VHA homeless program utilization. While this study does not examine the quality of care received, the authors infer that there is no evidence of disparities in accessing care that would disadvantage racial and ethnic minority veterans. The authors caution that their study sample contains only veterans who accessed VHA outpatient care, so the results may not be generalized to the entire veteran population.
“Housing Instability and Homeless Program Use Among Veterans: The Intersection of Race, Sex, and Homelessness” is at: https://bit.ly/37JAPsr