The 131st Annual Meeting (November 15-19, 2003) of APHA

Abstract #62277

Elise Riley, PhD¹, David Bangsberg, MD², Richard Clark, MPH³, Sandra Monk, BA³, and Andrew R Moss, PhD². (1) Department of Medicine, University of California at San Francisco, SFGH--995 Potrero Ave., Bldg. 90, 5th Floor, San Francisco, CA 94110, (415) 206-4983, eriley@epi-center.ucsf.edu, (2) Department of Medicine, University of California, San Francisco, 1001 Potrero Avenue, Campus Box 1372, San Francisco General Hospital - Building 100, San Francisco, CA 94110, (3) Epidemiology and Biostatistics, University of California at San Francisco, SFGH--995 Potrero Ave., Bldg. 90, 5th Floor, San Francisco, CA 94110

BACKGROUND: Homelessness and the number of people receiving public assistance have risen sharply over the past year in many US cities. There is widespread debate about the role of subsidies to the urban poor. We sought to characterize individuals receiving subsidies (general assistance, SSI, veteran’s benefits) among San Francisco’s urban poor. METHODS: From 1996 to 2000, a representative sample of indigent adults was recruited from free meal programs, homeless shelters and low-income hotels. Participants were interviewed and tested for HIV. Those reporting that at least 50% of their income came from subsidies were “mostly subsidized” (MS) and compared to those reporting less than 50% by housing, drug use and health care use. RESULTS: Among 1156 adults, 74% were male, 59% nonwhite and 87% ever homeless; 47% injected drugs, the median age was 42 years and 14% were HIV+. Subsidies were received by 75% of participants and 64% were MS. In adjusted analysis, MS was positively associated with HIV infection (OR=2.04, p=0.02), being insured (OR=4.21, p<0.01), receiving outpatient health care (OR=1.69, p<0.01) and sleeping in a hotel (OR=2.22, p=0.02) compared to the street. MS was negatively associated with injection drug use (OR=0.51, p<0.01) and being jailed in the past year (OR=O.59, p=0.01). CONCLUSIONS: Among San Francisco’s urban poor, the MS were more likely to receive health care and have shelter; they were less likely to inject drugs or be jailed. These data suggest that government subsidies are associated with positive health behaviors and may facilitate better health among the urban poor.

Learning Objectives:

• At the end of this session, participants will have an empirically-based framework with which to consider the debate over the role and function of subsidies to the urban poor.

Keywords: Vulnerable Populations, Policy/Policy Development

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.