An innovative approach to study characteristics and health of homeless families: The ENFAMS survey in Greater Paris area (France)

Background

Families are a constantly growing population among homeless in the French capital region but remain little surveyed in epidemiological studies. The main objectives of this study were to estimate the size of this population, to describe families' life trajectories, living conditions and health, and to analyze the impact of homelessness on children’s growth and development.

Methods

In 2013, we conducted a cross sectional survey among a random sample of homeless families housed in the various types of accommodations dedicated to them in the Greater Paris area. Pairs composed of a bilingual interviewer and a psychologist conducted the face to face interviews in 17 languages. A nurse took anthropometric measures and blood samples to identify nutritional deficiencies, and collected health data from child health and immunization cards.

Results

The sample consisted in 801 adults, 566 children 0-5 years old and 235 children 6-12 years old. The population size was estimated at 10,280 families (95%CI [9642; 10917]) in Greater Paris area. Half were female single-parent families and 22% had more than 3 children; 94% of the parents were born outside France and had been living in France for 5 years in average, 40% had no school education and only 18% had a job; 94% of the families were living below the poverty line. Most of families had experimented housing instability (94% had moved at least once over the reported homeless period). Malnutrition was found to be a major problem, as demonstrated by the high prevalence of food insecurity (80%), anaemia (50% of mothers and 38% of children), overweight and obesity (38% of mothers were obese, 32% were overweight and more than 26% of children were either overweight or obese). Homeless mothers experienced high rates of depressive disorders (30%) and 20% of children had a suspicion of a mental health trouble.

Discussion

This is the first survey in France specifically designed to assess living conditions and health of homeless families, using innovative and target tailored methods. These first results stressed on the growing number of families among the homeless population. Homeless families differed from other homeless people regarding social characteristics such as birth place, low income, single-parent status, and also housing conditions. In particular, residential instability is likely to encompass major factors of vulnerability on schooling, health or access to care. It provides important insights for the implementation of a dedicated program of prevention.