Of 2,516 individuals screened at homeless shelters and meal programs, 1,189 people were included in the study (). In total, 882 (35%) were ineligible because 229 (9%) did not meet our definition of homelessness, 104 (4%) were unable to communicate in English, 54 (2%) were homeless shelter users encountered at meal programs, and 53 (2%) were unable to give informed consent. Because this study was part of a larger study of homeless people's health care utilization, 442 individuals (18%) were excluded because they did not have an Ontario health insurance number. Most of these 442 individuals were refugees, refugee claimants, or recent migrants to the province of Ontario. Of 1,634 eligible individuals, 443 declined to participate. We enrolled 1,191 (73% of those eligible) in the study, of which information on immigrant status was obtained for 1,189 individuals and missing on 2 individuals.
Flow diagram of participant recruitment
Characteristics of the 1,189 homeless study participants are displayed in . A total of 116 (10%) study participants were recent immigrants, 261 (22%) were non-recent immigrants, and 812 (68%) were Canadian-born individuals. Mean age was 28.0 years for recent immigrants, 39.7 years for non-recent immigrants, and 36.2 years for Canadian-born individuals (p<0.001). Compared to non-recent immigrants and Canadian-born individuals, recent immigrants were more likely to be female, accompanied by dependent children, married, and had a non-caucasian racial status (). Recent immigrants were also more highly educated and had a somewhat shorter duration of homelessness.
Characteristics of study participants
Homeless recent immigrants were unlikely to have alcohol problems, drug problems, and mental health problems (). Although mental health problems were also less prevalent among recent immigrants (23%) than non-recent immigrants (35%) and Canadian-born individuals (40%), the gradient across the 3 groups was less steep (p=0.002) compared to that for alcohol and drug problems. Recent immigrants were also less likely to have chronic conditions and more likely to have better SF-12 physical health scores compared to non-recent immigrants and Canadian-born individuals ().
These three groups gave significantly different responses regarding the single most important thing keeping them from getting out of homelessness (p<0.001) (). Recent immigrants were more likely to report financial reasons (i.e., insufficient income or lack of job/employment) and housing reasons (i.e., lack of suitable/adequate housing). In contrast, recent immigrants were less likely to report mental health conditions or addictions, compared to non-recent immigrants and Canadian-born individuals.
Reasons cited by participants as the single most important thing keeping them from getting out of homelessness
shows the findings from multivariate regression analyses examining the association between immigrant status and current health problems. In models adjusted for age, sex, accompaniment by dependent children, race/ethnicity, education, income, and lifetime years of homelessness, homeless recent immigrants were significantly less likely to have chronic conditions, mental health problems, alcohol problems, and drug problems compared to homeless non-recent immigrants and homeless Canadian-born individuals. Recent immigrants also had significantly better mental and physical health status. In all models, the health status of non-recent immigrants was not significantly different from that of Canadian-born individuals.
Association between immigrant status and health status