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Margot B. Kushel, MD, Judith A. Hahn, PhD, MPH, Jennifer L. Evans, MS, David R. Bangsberg, MD, MPH and Andrew R. Moss, PhD

Margot B. Kushel is with the Division of General Internal Medicine, University of California at San Francisco at San Francisco General Hospital, San Francisco, Calif. Judith A. Hahn is with the Epi-Center, Department of Medicine, University of California at San Francisco at San Francisco General Hospital. Jennifer L. Evans and Andrew R. Moss are with the Department of Epidemiology and Biostatistics, University of California, San Francisco. David R. Bangsberg is with the Division of Infectious Diseases and the Positive Health Program, University of California at San Francisco at San Francisco General Hospital.

Correspondence: Requests for reprints should be sent to Margot B. Kushel, MD, UCSF at SFGH, Box 1364, San Francisco, CA 94143 (e-mail: kushel{at}itsa.ucsf.edu).

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.

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