Margot E. Ackermann, Ph.D. and Erika Jones-Haskins, MSW

1. Risk Factors for Heart Disease: How Homeless Individuals in Richmond Stack Up Put your Title here Margot E. Ackermann, Ph.D. and Erika Jones-Haskins, MSW Homeward  1125 Commerce Rd.  Richmond, VA 23220 www.homewardva.org Introduction Coronary heart disease (CHD) is the leading cause of death for adults in the United States (American Heart Association, 2009). The prevalence of CHD tends to be higher among individuals with low socio-economic status (SES) even after potentially modifiable lifestyle factors (e.g., smoking, weight, cholesterol-level) have been accounted for (Fiscella & Tancredi, 2008). Little research has addressed the prevalence of CHD among individuals experiencing homelessness. In one such study, Kim et al. (2008) compared low SES individuals and males experiencing homelessness. Though overall there were minimal differences, one striking disparity was in smoking rates, with 14.1% of low SES males and 9.9% of low SES females reporting current smoking as compared to 73.5% of homeless males. Twice a year, representatives of local agencies that provide services to people experiencing homelessness count and survey individuals experiencing homelessness to learn more about their experiences and conditions. In January 2009, we decided to examine risk factors for heart disease within this population in order to see whether our community’s data were in line with existing research that indicates higher rates of health problems among low SES individuals. We also aimed to learn more specifically about those individuals experiencing homelessness in our community and compare their rates of risk factors for heart disease with state-wide rates. Method A cross-sectional, self-report survey was administered in locations where people experiencing homelessness are typically found (e.g., shelters, meals programs, outdoor campsites). Only adults who were homeless on the night of January 29, 2009, were surveyed. The survey was either self-administered or verbally administered by a volunteer or shelter provider. See Figure 1 for the portion of the survey used to assess risk factors for heart disease. 653 adults (64.3% of the 1014 adults who were counted as a part of the survey process) who were experiencing homelessness completed the long version of the survey, which included questions similar to those from the Behavioral Risk Factor Surveillance System (BRFSS), along with questions about whether individuals were receiving treatment. Virginia statistics from the BRFSS was provided by the Virginia Department of Health. Overall, the sample was 73.2% male. A majority of participants indicated that their race was African-American/Black (67.8%), followed by White (25.8%). Few (4.5%) indicated that they were Hispanic. The average age was 44.3 years old. Discussion The purpose of the present study was to investigate risk factors for heart disease among individuals experiencing homelessness. Compared to the general population surveyed for the BRFSS, it appears that homeless individuals have substantially higher rates of smoking. One unexpected finding was that individuals experiencing homelessness reported lower rates of high cholesterol. Given the positive relationship between smoking and cholesterol levels, it is possible that this risk factor for heart disease is underdiagnosed within this population. The point-in-time count has a number of limitations to note. Data collected is self-report from clients. Clients were also surveyed using different methods; while some clients self-administered the survey, others were administered the survey verbally by shelter staff or trained volunteers. Another limitation is that the sample does not necessarily generalize to the larger population of people experiencing homelessness. In spite of these limitations, this study also reflects several strengths, including the community’s ability to collect timely data and the participation rate of individuals experiencing homelessness in the community. Perhaps the most important strength is in the potential for practical application of these findings. Future research might address the smoking habits of people experiencing homelessness in more detail, including the amount smoked and whether or not individuals have attempted to quit or have a desire to quit. It would also be of interest in future research to use methods other than self-report (e.g., medical testing for diabetes and cholesterol) to determine whether people are getting diagnoses in order to adequately address their risk factors. Figure 1: Survey instrument Has a doctor, nurse, or other health professional EVER told you … … that you have diabetes?  No  Yes If YES, are you currently taking medication, changing your exercise habits or diet, or seeing a doctor regularly to address this?  No  Yes … that you have high blood pressure?  No  Yes If YES, are you currently taking medication, changing your exercise habits or diet, or seeing a doctor regularly to address this?  No  Yes … that your blood cholesterol is high?  No  Yes If YES, are you currently taking medication, changing your exercise habits or diet, or seeing a doctor regularly to address this?  No  Yes … that your health would be better if you lost weight?  No  Yes If YES, are you currently taking medication, changing your exercise habits or diet, or seeing a doctor regularly to address this?  No  Yes … that you had angina or coronary heart disease?  No  Yes If YES, are you currently taking medication, changing your exercise habits or diet, or seeing a doctor regularly to address this?  No  Yes During the past month, other than your regular job, did you participate in any physical activities or exercises such as running or walking for exercise?  Yes  No Have you ever had a heart attack?  Yes  No Have you ever had a stroke?  Yes  No Do you smoke cigarettes?  Yes, every day  Yes, some days  No Results Descriptive statistics were run on the six variables that identified specific risk factors for heart disease, and these numbers were compared to similar data available from the Virginia Department of Health from the BRFSS data on Virginia. These data appear in Figure 2. Figure 2: Risk factors for heart disease among homeless and state populations *Note that data on high blood pressure and high cholesterol were collected for 2007 BRFSS; not available for 2008. Results from the questions related to individuals addressing four of these risk factors appear in Figure 3. Additionally, diagnoses of specific heart diseases were compared to similar data from the Virginia Department of Health from the BRFSS data on Virginia. These data appear in Figure 4. Figure 4: Heart disease diagnoses among homeless and state populations • Objectives • To compare people experiencing homelessness to the general population in terms of their risk factors for heart disease. • To highlight the need for smoking cessation offerings among a sample of homeless adults. Conclusion A major finding was that smoking rates of the homeless population were quite high. While little research addresses the smoking rates of homeless individuals, the serious health risks posed by smoking suggest that more aggressive intervention is needed. Shelters would be a good place to solicit participants into smoking cessation programs. Smoking cessation could improve the health of participants and increase the income they have available to pay for housing or other necessary costs. Acknowledgements The Richmond region’s community of government agencies and nonprofits, as well as numerous community volunteers, deserve special thanks for their integral role in counting and surveying people experiencing homelessness. We also appreciate the Virginia Department of Health sharing specific data from the BRFSS. Figure 3: Individuals experiencing homelessness addressing risk factors Risk factors N % Diabetes 59 81.4% High blood pressure 187 72.2% High cholesterol 92 64.1% Overweight 108 64.8%