付記する学位プログラム名: グローバル生存学大学院連携プログラム / 京都大学 / 新制・課程博士 / 博士(医学) / 甲第24510号 / 医博第4952号 / 新制||医||1064(附属図書館) / 京都大学大学院医学研究科医学専攻 / (主査)教授 中山 健夫, 教授 小杉 眞司, 教授 村井 俊哉 / 学位規則第4条第1項該当 / Doctor of Medical Science / Kyoto University / DFAM

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Introduction: Homelessness is a complex and systemic problem within the United States, made more complicated by distributing federal funding to address this crucial issue. Regional Continuums of Care (CoC) is the primary method of designating organizational units by geography responsible for addressing homelessness within a given area. The primary duties of each CoC are to oversee the operation for the designated region, to maintain the Homeless Management Information System (HMIS), and plan for the CoC. The size and scope of CoCs can vary within some states, indicating larger or smaller groups of counties responsible for addressing homelessness in a given area. However, some states have entities known as Balance of the State (BoS) CoCs, which cover large geographic areas. The extent to which the smaller CoC model or the larger BoS model is associated with the overall effectiveness of addressing homelessness within a given state has not been examined and is the focus of this study. Methods: A cross-sectional study examining CoC structure and homelessness was used for this project. Per capita rates of homelessness were the primary outcome variable of interest. Per capita homeless was derived from general population numbers reported by the US Census Bureau in 2022 by PIT count per state as reported by HUD in the same year. States organizational structure as defined by the number of CoCs in a state was the independent variable of interest. To examine this potential relationship further, as well as the impact of other known factors that impact homelessness, an OLS regression was performed. Results: Overall, the number of CoCs ranged from 1 to 44. Overall the OLS regression model including three variables (CoC, state geographic location, and rurality) was statistically significant, F(6, 43)=4.406, p Conclusion: The initial examination of the relationship between homelessness per capita and the number of CoCs in a state suggests that other elements to account for effectiveness of CoC within a community setting need to be considered. Further explorations such as policy implications, weather patterns, and funding may need to be considered in seeing a reduction of homelessness per capita. A more comprehensive analysis of the relationship between states with exclusively CoCs and those BoS occupying large geographic areas indicates a need for standardization of data collection, distribution of federal funding, and culturally competent strategic planning for the reduction of homelessness.

Homelessness is an important social problem in Canada, and the needs and experiences of women may differ from those of other homeless people. Little research has looked beyond rehousing to examine community integration following homelessness. Predictive models of three distinct facets of community integration for women who have experienced homelessness are presented and tested in this thesis. The first model examines physical integration, which is defined in terms of attaining and retaining stable housing. The second model predicts economic integration, defined in terms of participation in work or education. The third model predicts psychological integration, defined as psychological sense of community in one’s neighbourhood. Data for this research comes from a two-year longitudinal study conducted in Ottawa. Participants were women aged 20 and over (N =101) who were homeless at the study’s outset. Family status was an important predictor of community integration. Women who were accompanied by dependent children were more likely than those unaccompanied by children to be physically, economically and psychologically integrated in their communities. Having access to subsidized housing predicted becoming rehoused and living in one’s current housing for longer. Greater perceived social support predicted living in one’s current housing for longer. Past work history and mental health functioning predicted economic integration. Lower levels of education predicted returns to full-time studies. Living in higher quality housing and having more positive contact with neighbours predicted psychological integration, while living in one’s current housing for longer predicted lower levels of psychological integration. Overall, participants achieved a moderate level of community integration. The majority had been housed for at least 90 days at follow-up. However, only a minority were participating in the workforce or education at follow-up. Participants achieved only a moderate level of psychological integration. Results are discussed in terms of implications for policy and service provision. Improvements in the availability and quality of affordable housing, as well as employment support are recommended. Special attention needs to be paid to providing adequate and effective services for women who are unaccompanied by dependent children. / Fonds québécois de la recherche sur la societé et la culture

Homelessness is a complex problem replete with profound social distress and suffering, but with few adequate solutions. The homeless are a marginalized population particularly vulnerable to structural forces and policy decisions, including lack of affordable housing, unemployment, systemic inequalities, and lack of adequate social safety net. Perspectives of homeless people are understudied in anthropological scholarship which tends to focus on service providers, with comparatively less attention on homeless people themselves who are commonly subjected to medicalizing and criminalizing discourses. Using ethnographic research methods, including participant-observation and interviews with homeless people who pursue food pantry services at Hope Helps NGO in Oviedo, Florida, this paper examines the experiences of homeless people in Florida, where the issue of homelessness has been acute and is often depoliticized in public discourses. Specifically , it focuses on coping strategies of homeless people in Oviedo, and ways in which they understand their life circumstances and secure necessary services. Findings demonstrate that the Florida homeless view reasons for their homelessness as primarily economic, but rarely critique policies behind low wages or unaffordable housing. The narratives also show that the homeless in this study obtain resources through networking, and despite use of assistance services, view themselves as independent, active agents. Results of this research have potential to improve the way social services for the homeless are structured, and to inform policy relevant to homeless in Florida. Furthermore, this research brings attention to a marginalized problem and population, and considers how particular discourses function to maintain a structurally inadequate system.

This study investigated the comparison between the Rich et al (1995) study done in Tampa Bay, Fl and Burt et al (2001) national study. Rich et al conducted a study of elder homeless Americans and later, Burt et al conducted a replication study on a national level using a similar study. My secondary analysis of the data covered four aspects: Demographics between the two groups of respondents; current housing issues; current alcohol, drug and mental health issues; and finally homeless services being used by both homeless, formally homeless and never homeless respondents. This was all compared to those that were 55 and older and those that were under 55. Recommendations were made concerning improvement of senior's health services by the government, and the need for more research into determining the overall seemingly underrepresented elderly homeless population.

This study uses two quantitative and two qualitative data sources to determine if homeless people are viewed as dangerous and if they are what factors contribute to this perception. Areas examined are respondent's characteristics, media affects and the perceived rights of homeless people to urban space. Actual levels of perpetration among the homeless are examined to allow for comparisons between perception and reality to be made. Findings showed that race plays a major role in the perception of homeless peo-ple among whites, while gender is more influential among blacks. There was no rela-tionship between media and perceptions. A negative relationship was found between support of rights of the homeless and the perception that they are dangerous. While the homeless have higher incarceration rate as compared to the poor-but-never-homeless, the crimes for which they are sentenced appear to be non-violent in nature and are of-ten what are characterized as nuisance crimes. Recommendations were made to study actual perpetration rates among the homeless to allow for a more in-depth analysis of criminal involvement.

This study sought to examine pathways of coping and healing for women experiencing homelessness and poverty in the Boston area. Data was collected through participant observations of shelter dynamics, semi-structured interviews with shelter clients (referred to as “guests”), card-sorting activities in which participants were asked to rank self-generated cards for support groups, coping mechanisms, and internal selves across a range of situations, and a free association task, which involved having participants submit whatever self-generated cards of the above groups they associated with the terms “health,” “safety,” “shame,” and “pride,” respectively. Results were subsequently organized into three analytical chapters representative of the three levels of physiological response to threat. The first level of analysis looks at social engagement in the form of receiving and giving care. The second level examines expressions of rage and how these contribute into cycles of isolation, violence, and suffering. The third level further explores these dynamics within the realm of grief and erasure. The final chapter of this thesis then discusses the implications of these areas, as well as some suggestions for how to improve or potentially intervene in the perpetuation of these cycles, with a focus on how to emphasize healing while decreasing the need for coping.

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