Incidence and Associated Risk Factors of Traumatic Brain Injury in a Cohort of Homeless and Vulnerably Housed Adults in 3 Canadian Cities

Mohammadali Nikoo, Anne Gadermann, Matthew J. To, Michael Krausz, Stephen W. Hwang, Anita Palepu
2017 The journal of head trauma rehabilitation  
Always cite the published version, so the author(s) will receive recognition through services that track citation counts, e.g. Scopus. If you need to cite the page number of the TSpace version (original manuscript or accepted manuscript) because you cannot access the published version, then cite the TSpace version in addition to the published version using the permanent URI (handle) found on the record page. Abstract 1 Objective: To examine the factors associated with incident traumatic brain
more » ... jury (TBI) 2 among homeless and vulnerably housed persons over a three-year follow-up period. measure was self-reported incident TBI during the follow-up period. Associated risk 7 factorsFactors associated with TBI were ascertained using mixed effects logistic 8 regression. Results: During 1 st , 2 nd and 3 rd years of follow-up, 187 (19.4%), 166 (17.1%) 9 and 172 (17.9%) participants reported a minimum of one incident TBI, respectively. 10 Among 825 participants with available data for all 3-years of follow-up, 307 (37.2 %) 11 reported at least one incident TBI during the 3-year follow-up period. Lifetime 12 prevalence of TBI, endorsing a history of mental health diagnoses at baseline, 13 problematic alcohol and drug use, younger age, poorer mental health and residential 14 instability were associated with increased risk of incident TBI during follow-up period. 15 Conclusion: Rehabilitation programs for TBI,Mental health support and addressing 16 residential instability and problematic substance use may reduce further risk of TBI and 17 its associated poor health and social outcomes in this population. 18 Key words 19 traumatic brain injury, homeless, risk factor, prevalence, incidence 20 Masked Manuscript (All Manuscript Text Pages in MS Word format) TBI during follow-up among a cohort of homeless or vulnerably housed persons who 43 participated in the Health and Housing in Transition (HHiT) study. 44 45 Methods 46 Participants and Recruitment 47 The data for these analyses were obtained from the HHiT study 10 " a multi-site 48 longitudinal study that tracked the health and housing status of a sample of homeless or 49 vulnerably housed individuals in Canada. At baseline, 1,190 participants who were 50 homeless or vulnerably housed and 18 years old and over were recruited in three major 51 Canadian urban areas, i.e. Vancouver, British Columbia; Ottawa, Ontario; and Toronto, 52 Ontario, from January to December 2009. Individuals were re-interviewed every 12 53 months for a 3-year time period. A homeless participant was defined as a person living in 54 a shelter, public space and motor vehicle, abandoned building, or not having their own 55 place. A vulnerably housed participant was defined as a person living in their own room, 56 apartment or place, but had been homeless and/or had two or more moves over the past 57 12 months. The sampling procedure of the study is described in detail elsewhere 10 . 58 Briefly, homeless participants were recruited in shelters and meal programs. Vulnerably 59 housed participants were randomly selected from the stock of low-cost housing in Ottawa 60 and Toronto and single room occupancy (SRO) hotels in Vancouver. Due to challenges in 61 gaining access to residents at these sites, our sampling plan for vulnerably housed 62 participants was modified to also recruit from meal programs, community health centers, 63 and drop-in centers. 64 Ethical Considerations 65 Informed consent was obtained from each participant before inclusion in the study. The 66 participants were paid an honorarium ($20 CAD) following the interview. Research 67 Ethics Boards at St. Michael's Hospital (Toronto), the University of Ottawa, and the 68 University of British Columbia (Vancouver) approved the study. 69 Study Instrument and Measures 70 The complete description of the survey questionnaire and its application has been 71 previously published 10 . Data were obtained through structured in-person interviews with 72 trained interviewers, which lasted approximately 60-90 minutes. From baseline 73 assessments, we ascertained socio-demographic characteristics (age, gender, self-reported 74 ethnicity/cultural group, education), city of recruitment, lifetime prevalence of TBI and 75 epilepsy, problematic drug and alcohol use, lifetime prevalence of mental health 76 diagnoses, mental health status, and lifetime duration of homelessness. 77
doi:10.1097/htr.0000000000000262 pmid:28489699 fatcat:ss7bjinjmbb3ffbu43gi5oxlve