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Publication Briefs

Study Reveals Both Personal and Community Risk Factors Associated with Unsheltered Homelessness among Veterans

Experiences of homelessness vary in visibility – from sleeping in public areas to staying in shelters or others’ homes. “Unsheltered” status, which includes sleeping outdoors, in vehicles, or in public areas, characterizes about half of the individuals experiencing homelessness in the US. Unsheltered homelessness spurs debate about what makes it more common in some places (e.g., Seattle) and for some people (e.g., individuals with mental health and/or substance use disorder). However, less is known about factors contributing to unsheltered status. This study sought to answer the question, “Among Veterans who have experienced homelessness, what distinguishes those who were recently unsheltered from those who were not?” Investigators analyzed responses from a survey of Veterans (n=5,406) who had experienced homelessness and were receiving primary care at one of 26 VAMCs in 2018. The survey assessed unsheltered time based on the number of nights in the last six months spent, “outside or in some other place not meant for sleeping (e.g., an abandoned building, bus station, or car).” Affirming “7 or more nights” counted as “unsheltered” (n=481, 9% of the sample). The survey also posed questions about marital status, education, employment, income, and problems gaining employment or acquiring housing due to a criminal record. In addition, community indicators (shelter access, rental affordability, and climate) were assessed for the 26 communities where the participating VA facilities were located.


  • Among Veterans experiencing homelessness, being unsheltered correlated with individual (e.g., poverty) and community risk factors (e.g., poor access to shelter). Veterans who reported being unsheltered were more likely to report a criminal justice history, poor social support, medical and drug problems, and financial hardship, and they were more likely to be unmarried.
  • Unsheltered Veterans more often came from communities with warmer weather (87% vs 76%) and higher rent burden (32% vs 29% for affordable rental wage), and from communities with lower shelter bed availability (56% versus 68% for ratio of beds to persons homeless).
  • Having a greater number of personal and community risk factors was associated with a greater likelihood of having been unsheltered.


  • Collective medical and psychosocial vulnerabilities of persons who have experienced being unsheltered are substantial. For that reason, VA supportive housing interventions based on a Housing First approach should offer robust clinical supports. Further, communities wishing to address unsheltered homelessness will need to address both medical and psychosocial issues.


  • Methodologically, this study considered individuals as the unit of analysis, which may reduce the impact of community characteristics.

This study was partly supported by HSR&D (IIR 15-095). Dr. Kertesz is part of the Birmingham VAMC, Birmingham, AL, and all authors are affiliated with VA.

Kertesz S, deRussy A, Riggs K, et al. Characteristics Associated with Unsheltered Status among Veterans. American Journal of Preventive Medicine. July 15, 2021; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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