This assignment comprises the second part of the Epidemiology Paper. Write a
1,100 word paper that provides the following:

  1. Identify an existing at-risk population in the U.S. Using aggregated statistics,
    include identified criteria and data that substantiates why this population is at risk.
  2. Using analyzed population data, identify a health risk within this population that
    nursing science can impact. Describe the specific variables. Provide SPSS data that
    correlates population to the identified health risk.
  3. Identify potential obstacles that may hinder the implementation of the prevention
    and health promotion activities.
  4. Identify stakeholders, individuals, and agencies with whom you may need to

Analysis and Application

Homelessness is a social issue that has attracted national attention in the United States of
America (USA). According to The United States Department of Housing and Urban
Development (HUD), the homeless population is composed of people who lack a regular, fixed
and appropriate place for shelter (HUD, 2017). Further, according to HUD, (2018) the homeless
population makes up to 0.17 % of the total population of the USA. Drug and substance abuse and
lack of physical and emotional well being have been identified as some of the healthcare issues

that are known to cause or to be a result of homelessness in the USA (Fazel, Geddes, & Kushel,
2014). The following essay discusses the health risk of the homeless in the USA.

At-Risk Population

According to the United States Department of Health and Human Services (HHS), (2018), the
mortality and morbidity rates in the USA are high in the homeless among people regarded as
homeless. According to The United States Interagency Council on Homelessness (USICH), the
homeless population presents with unique health care needs such as sexually transmitted
diseases, for example, HIV/AIDS, mental health conditions, for instance, drug addiction, and
chronic conditions such as hypertension and diabetes. According to the HHS, (2018), the people
who are classified as homeless live in environments that expose them to infectious diseases. In
order to meet the unique healthcare needs of the individuals termed as the homeless, the USICH
co-ordinates programs for healthcare provision, specifically for the homeless (USICH, 2018).
According to the HHS, the closure of psychiatric centers in the 1980’s without the establishment
of sufficient community, mental health programs cause the rise of individuals termed as the
homeless population in the USA. Around the same time, the increase in the use of cocaine
resulted in a large portion of the USA population turning homeless. (Baggett, Chang, Porneala,
Bharel, Singer, & Rigotti, 2015).

Health Risk

Generally, according to the figures provided in the table, the prevalence of all the
healthcare conditions is higher among the homeless populations than the general population.
According to Flentje, Leon, Carrico, Zheng, & Dilley (2016), infectious conditions, such as
bacterial infections, are more prevalent among the homeless because of environmental exposure

to the causative bacterial micro-organisms. Sexually transmitted infections, such as HIV/AIDS
are highly prevalent among the homeless because of the lack of preventive measures and health
promotion services.
The following is a table showing the prevalence of various conditions among the
homeless in the USA

Condition Prevalence (among

Prevalence (General

HIV 0-20 0·1–0·7%
Body louse 6-20 <1.5%

2-31 <1%

Tuberculosis 0-6 0.004-0.33
Scabies 3-54 <1.3%
Hepatitis C 3-35 0·5–2·1%
Hepatitis B 16-31 <1%
According to Torchalla, Strehlau, Linden, Noel, & Krausz (2014), among the aged
homeless population in the USA, conditions that affect the elderly have an early onset. For
instance, cognitive impairment and chronic conditions among the poor start approximately ten to
fifteen years earlier compared to the aged in the general population. Therefore, nurses should
recommend enrolment in welfare programs at the age of fifty years and not the usual age of 65
years. The homeless populations are associated with a significant reduction in capability to carry
out activities of daily living. Therefore, nursing and healthcare interventions should take into

consideration the prevalence of activity performance among the homeless (Torchalla et al.,
According to the HHS, health risk behaviors, for instance, smoking and poor nutrition are
more prevalent among the homeless than the general population. Medical conditions such as
hypertension and hyperlipidemia are therefore associated with homelessness. According to a
study done by Taylor, Kendzor, Reitzel, & Businelle, (2016), the homeless population has
inadequate access to health care services, are faced with a transport barrier, lack of medical
covers and inability to afford the cost of healthcare. Therefore, nurses should collaborate with
other professionals such as social workers to identify the healthcare needs among the homeless in
the USA. Interventions that should be appropriately carried out by nurses include; preventive
programs such as education on behavioral modification, physical activities and dietary
modifications. Additional interventions should include enrollment of the homeless into welfare
programs designed for the economically poor members of the USA population (Taylor et al.,
The prevalence of specific mental health conditions is higher in the population regarded
as homeless as compared to other population groups, according to Taylor, Kendzor, Reitzel, &
Businelle, (2016). Depression, personality disorders and drug and substance abuse are common
in the homeless population. The homeless are faced with socio-economic stress, that manifests as
depression and thus abuse drugs and substances to relieve the stress. Chronic drug use and abuse
lead to substance-related psychotic symptoms.
The following table summarized the data on psychiatric conditions in the homeless

Conditions Prevalence
(homeless people)


Traumatic brain injury 7–50% 2-6%

Personality disorder 2–65% 5–15%

Depression 0–50% 3–8%

Alcohol dependence






Nursing management should consider the general trend in the co-morbidity of psychiatric
conditions. Among the homeless population, posttraumatic stress disorder and schizophrenia are
associated with alcohol and the use of cocaine. Further, psychiatry disorders have been identified
to be associated with the history of various forms of abuse among the homeless. In a study, to
investigate the co-morbidity pattern among the homeless in the USA, more than half of the
respondents reported having experienced a form of abuse and approximately 75% reported to
have experienced sexual abuse during childhood. Nursing interventions for homeless populations
should deal with the history of abuse as one of the common causes of mental health conditions
among the homeless (Tsai and Rosenheck, 2015).
Potential Obstacles

According to Byrne, Treglia, Culhane, Kuhn, & Kane (2016), one of the barriers to
preventive measures is the lack of sufficient statistics on the homeless. So far, only a few studies
have been conducted to provide data on the disease pattern and etiology of the various conditions
prevailing among the homeless in the USA. Byrne et al., (2016) conducted a meta-analysis of
studies done on homelessness in the USA and concluded that there is insufficient evidence on the
association between homelessness and other psychiatric conditions and demographic
characteristics of the homeless. For example, there is not enough evidence to show the disparities
in healthcare needs between the male and females and across the ages in the homeless population
(Golinelli, Tucker, Ryan, & Wenzel, 2015). The homeless mostly live in cities and other urban
centers. However, the population of the homeless varies. Also, the rapidly increasing number of
homeless in the USA is increasing. The size and characteristics of the homeless population in the
USA are not easily predictable (Byrne et al., 2016).

USICH coordinates all programs for the homeless. Further, the HHS provides healthcare services
to the homeless (USICH, 2018). The HUD provides statistics on healthcare for the homeless.
The government funds the care for the homeless through the HUD and HHS. Charity
organizations should be involved in funding the programs of prevention of healthcare conditions
among the homeless (HUD, 2017). Healthcare providers should offer services to homeless
individuals who have been diagnosed with medical or psychiatric conditions. Healthcare
providers will identify members of the population regarded as homeless and who are at the
highest risk of developing healthcare conditions and carry out interventional measures (HHS,
2017; HUD, 2017; USICH, 2018).


In conclusion, the homeless population is at risk group in the USA. Research studies
indicate that homeless individuals are faced with health care issues that are unique among this
group of the population. The homeless experience both communicable and non-communicable
conditions. Therefore, specific nursing interventions need to be directed to the healthcare needs
of the homeless.


Baggett, T. P., Chang, Y., Porneala, B. C., Bharel, M., Singer, D. E., & Rigotti, N. A. (2015).
Disparities in mortality at Boston health care for the homeless program. American
Journal Of Preventive Medicine, 49(5), 694-702.

Byrne, T., Treglia, D., Culhane, D. P., Kuhn, J., & Kane, V. (2016). Predictors of homelessness
among families and single adults after exit from homelessness prevention and rapid re-
housing program Housing Policy Debate, 26(1), 252-275.
Fazel, S., Geddes, J. R., & Kushel, M. (2014). The health of homeless people in high-income
countries: descriptive epidemiology, health consequences, and clinical and policy
recommendations. The Lancet, 384(9953), 1529-1540.
Flentje, A., Leon, A., Carrico, A., Zheng, D., & Dilley, J. (2016). Mental and physical health
among homeless sexual and gender minorities in a major urban US City. Journal Of
Urban Health, 93(6), 997-1009.
Golinelli, D., Tucker, J. S., Ryan, G. W., & Wenzel, S. L. (2015). Strategies for obtaining
probability samples of homeless youth. Field Methods, 27(2), 131-143.
Taylor, E. M., Kendzor, D. E., Reitzel, L. R., & Businelle, M. S. (2016). Health risk factors and
desire to change among homeless adults. American Journal Of Health Behavior, 40(4),
Torchalla, I., Strehlau, V., Li, K., Aube Linden, I., Noel, F., & Krausz, M. (2014). Posttraumatic
stress disorder and substance use disorder comorbidity in homeless adults: prevalence,
correlates, and sex differences. Psychology of Addictive Behaviors, 28(2), 443.
Tsai, J., & Rosenheck, R. A. (2015). Risk factors for homelessness among US veterans.
Epidemiologic Reviews, 37(1), 177-195.
U.S. Department of Health and Human Services (HHS). (2018, 0ctober 01). Retrieved October
09, 2018, from U.S. Department of Health and Human Services (HHS):

U. S. Interagency Council on Homelessness (USICH). (2018, July 02) Retrieved October 09,
2018, from U. S. Interagency Council on Homelessness (USICH):
U.S Department of Hoiusisng and Urban Developement. (2017, June 15)Retrieved October 9,
2018, from U.S Department of Housing and Urban Development: