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Cross-sectional association between ZIP code-level gentrification and homelessness among a large community-based sample of people who inject drugs in 19 US cities
  1. Sabriya L Linton1,
  2. Hannah LF Cooper1,
  3. Mary E Kelley1,
  4. Conny C Karnes1,
  5. Zev Ross2,
  6. Mary E Wolfe1,
  7. Samuel R Friedman3,
  8. Don Des Jarlais4,
  9. Salaam Semaan5,
  10. Barbara Tempalski3,
  11. Catlainn Sionean5,
  12. Elizabeth DiNenno5,
  13. Cyprian Wejnert5,
  14. Gabriela Paz-Bailey5
  15. for the National HIV Behavioral Surveillance Study Group
  1. 1 Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
  2. 2 ZevRoss Spatial Analysis, Ithaca, New York, USA
  3. 3 Institute for Infectious Disease Research, National Development and Research Institutes, New York, New York, USA
  4. 4 Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, USA
  5. 5 Centers for Disease Control and Prevention, Atlanta, Georgia, USA
  1. Correspondence to Sabriya L Linton; sabriya.linton{at}


Background Housing instability has been associated with poor health outcomes among people who inject drugs (PWID). This study investigates the associations of local-level housing and economic conditions with homelessness among a large sample of PWID, which is an underexplored topic to date.

Methods PWID in this cross-sectional study were recruited from 19 large cities in the USA as part of National HIV Behavioral Surveillance. PWID provided self-reported information on demographics, behaviours and life events. Homelessness was defined as residing on the street, in a shelter, in a single room occupancy hotel, or in a car or temporarily residing with friends or relatives any time in the past year. Data on county-level rental housing unaffordability and demand for assisted housing units, and ZIP code-level gentrification (eg, index of percent increases in non-Hispanic white residents, household income, gross rent from 1990 to 2009) and economic deprivation were collected from the US Census Bureau and Department of Housing and Urban Development. Multilevel models evaluated the associations of local economic and housing characteristics with homelessness.

Results Sixty percent (5394/8992) of the participants reported homelessness in the past year. The multivariable model demonstrated that PWID living in ZIP codes with higher levels of gentrification had higher odds of homelessness in the past year (gentrification: adjusted OR=1.11, 95% CI=1.04 to 1.17).

Conclusions Additional research is needed to determine the mechanisms through which gentrification increases homelessness among PWID to develop appropriate community-level interventions.

  • HIV & AIDS
  • Substance misuse

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  • Contributors SLL and HLFC conceptualized this analysis. SLL constructed and compiled place-level data, designed and conducted the analysis, and interpreted the analysis and results. MEK and HLFC provided input on the analytic plan. MEK, CCK, ZR and MEW contributed to interpreting the geographical data, and SS, ED, CS, CW and GP-B planned, designed and oversaw data collection for NHBS in collaboration with project site directors. SLL, HLFC, MEK, CCK, ZR, MEW, SRF, DDJ, SS, BT, CS, ED, CW, GP-B contributed to revising and finalizing the manuscript.

  • Funding This research was supported by two grants from the National Institutes of Health: “Place Characteristics & Disparities in HIV in IDUS: A Multilevel Analysis of NHBS” (R01DA035101; Cooper, PI) and the Emory Center for AIDS Research (P30 AI050409;Curran, PI).

  • Disclaimer The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

  • Competing interests None declared.

  • Patient consent Detail has been removed from this case description/these case descriptions to ensure anonymity. The editors and reviewers have seen the detailed information available and are satisfied that the information backs up the case the authors are making.

  • Ethics approval The Institutional Review Boards (IRBs) of Emory University and each NHBS site and the CDC approved study protocols.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement National HIV Behavioral Surveillance System data are available from the CDC. Due to ethical restrictions regarding potentially identifiable information, place-based data are available upon request. Requests for all data may be sent to Gabriela Paz-Bailey, MD, PhD, MSc (Team Lead for the Behavioral Surveillance Team, BCSB/DHAP/NCHHSTP/CDC) at

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