Adverse Childhood Experiences: Are They Risk Factors for Adult Homelessness? Daniel B. Hernmani, DSW, Ezra S. Slusser, MD, DrPH, Elmiier L. Struleninlg, PhD, and Bruce L. Link, PhD Introduction Recent research indicates that 5 to 15 million Americans have experienced an episode of homelessness during their lifetimes." 2 Structural factors such as labor market changes, an inadequate supply of low-cost housing, and cuts in income assistance programs have created the social conditions in which homeless- ness has grown during the past 15 years.3 4 Individual-level risk factors-those per- sonal characteristics and circumstances that make certain persons more vulnerable to becoming homeless under these condi- tions-have also been identified. These include poverty, gender (more males than females are homeless), ethnicity (home- lessness affects more African Americans than members of other groups), age group (most homeless persons are between 30 and 39 years old), and psychiatric and substance abuse disorders.5 The purpose of this study was to determine whether adverse childhood experiences are nsk factors for adult homelessness. A substantial body of epide- miological research provides strong evi- dence that such experiences, especially physical or sexual abuse and inadequate parental care, are risk factors for negative psychiatric outcomes in adulthood.>'3 Meanwhile, studies of homeless persons have found remarkably high prevalences of adverse experiences during childhood, primarily histories of out-of-home care (foster, group, or institutional care) and running away from home."-20 The high prevalence of childhood adversity in samples of homeless people, taken to- gether with the epidemiological literature that links such adverse experiences to adult psychiatric status, have led some researchers to speculate that early experi- ences may also be risk factors for adult homelessness.5-' Nonetheless, the research to date, while suggestive, has been unable to clearly demonstrate a causal association between adverse childhood experiences and adult homelessness. First, with some notable exceptions,2 122 data on the preva- lence of such experiences in a suitable nonhomeless comparison group have gen- erally not been available. In addition, measures of adverse childhood experi- ences have generally been restricted to foster care and running away,5 variables which, at best, are limited proxy measures of childhood adversity. Finally, most studies to date have employed sampling methods that overrepresent persons who use shelters and whose homelessness is particularly long term. The present study was designed to build on prior research by examining the connection between childhood adversity and adult homelessness with more defini- tive methods. It employed a national probability sample of formerly homeless persons and a comparison group of never-homeless persons. In addition, the study used measures of early adversity that more directly assessed a conceptually meaningful set of childhood risks, namely physical and sexual abuse and inadequate parental care. The authors are with the New York State Psychiatric Institute. New York, NY. Daniel B. Herman and Ezra S. Susser are also with the Department of Psychiatry, and Elmer L. Struen- ing and Bruce L. Link are with the School of Public Health, Columbia University. New York, NY. Requests for reprints should be sent to Daniel B. Hernan. DSW, 100 Haven Ave, # 31F. New York, NY 10032. This paper was accepted May 17, 1996. American Journal of Public Health 249