Study Protocol: Homelessness and Health: Integrating Structural, Social, and Behavioral Pathways

This protocol paper describes the methods of a multi-year study examining individual, community, and structural-level influences on health among people experiencing homelessness in a mid-sized Oregon city. We draw on biocultural theory and method to examine three distinct social ecologies of homelessness in the study setting: unsheltered homelessness, temporarily sheltered homelessness, and permanent supportive or transitional housing. Our mixed-method approach incorporates epidemiological-style questionnaires, biomarkers sampled via finger prick blood and hair, and in-depth case study interviews to holistically examine the pathways that connect homelessness and physical and mental health, and to compare outcomes across the three social ecologies of homelessness. Preliminary results are now emerging and are being used in public advocacy as well as research publications.