Stephen W Hwang
Biographic Data
| ID | 3887419 |
|---|---|
| NAME | Stephen W Hwang |
| GIVEN NAMES | Stephen W |
| FAMILY NAME | Hwang |
| SIGNATURE | HWANG S W |
| AFFILIATIONS | Unity Health Toronto |
| VERIFIED | No |
| TOTAL WORKS | 63 |
| TOTAL CITATIONS | 128 |
| AUTHOR COUNT | 62 |
| EDITOR COUNT | 1 |
| FIRST PUBLICATION YEAR | 2000 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 6 |
Ethno-Racial Differences in the Effectiveness of Housing First on Healthcare Utilization Among Homeless Adults with Mental Illness: At Home Chez-Soi, a Pragmatic Randomized Trial
This study evaluates the impact of the Housing First (HF) intervention on healthcare utilization among homeless adults with mental illness, comparing ethno-racial (ER) and non-ER groups with moderate mental health support needs. We linked data from the At Home/Chez-Soi (AH/CS) randomized controlled trial with health administrative data from Ontario, including the Ontario Health Insurance Plan and several healthcare databases (e.g., Discharge Abst…
Addressing housing insecurity as a social determinant of health: A systematic review of interventions in healthcare settings
Disparities in all-cause mortality among people experiencing homelessness in Toronto, Canada during the Covid-19 pandemic: A cohort study
People experiencing homelessness have historically had high mortality rates compared to housed individuals in Canada, a trend believed to have become exacerbated during the COVID-19 pandemic. In this matched cohort study conducted in Toronto, Canada, we investigated all-cause mortality over a one-year period by following a random sample of people experiencing homelessness ( n = 640) alongside matched housed ( n = 6,400) and low-income housed ( n …
Uptake of Covid-19 vaccination among community-dwelling individuals receiving healthcare for substance use disorder and major mental illness: A matched retrospective cohort study
Introduction Patients with major mental illness (MMI) and substance use disorders (SUD) face barriers in accessing healthcare. In this population-based retrospective cohort study, we investigated the uptake of COVID-19 vaccination in Ontario, Canada among community-dwelling individuals receiving healthcare for major mental illness (MMI) and/or substance use disorders (SUD), comparing them to matched general population controls. Methods Using link…
Predictors of housing instability and stability among Housing First participants: A 24-month study
This study examined the characteristics of people who experienced housing instability and stability after 24 months of being enrolled in Housing First (HF). A companion study addresses the same objective using qualitative methods. A sequential logistic regression was conducted to determine predictors of unstable and stable housing at 24 months of enrollment in HF in a randomized trial. We applied the Gelberg-Andersen. Behavioral Model for Vulnera…
Effect of a housing intervention on major cardiovascular events among homeless adults with mental illness
Homelessness is associated with excess cardiovascular morbidity and mortality. This study reports on the long-term effects of a Canadian housing first initiative, compared to treatment as usual, on major cardiovascular events among adults experiencing homelessness and mental illness. Over the 7-year follow-up period, 34 of 527 participants (6.5%) experienced at least one cardiovascular event. There was no significant difference in the incidence o…
The effect of cash transfers on health in high-income countries: A scoping review
High-income countries use cash transfer programs to mitigate poverty, in part to improve the health of low-income populations and potentially reduce their use of public health care. This review synthesizes evidence from studies that employed experimental or quasi-experimental designs to evaluate the effect of cash transfer interventions on health outcomes or health care utilization in high-income countries. We excluded interventions if they requi…
The role of housing stability in predicting social capital: Exploring social support and psychological integration as mediators for individuals with histories of homelessness and vulnerable housing
Social capital is a collective asset important for individual and population well‐being. Individuals who experience homelessness may face barriers in accessing social capital due to health challenges, small social networks, and social exclusion. Data from a 4‐year longitudinal study was used to determine if housing stability predicted greater social capital and if this relationship was mediated by social support and psychological integration for …
Using healthcare encounter data to identify high-cost users among adults with a history of homelessness: A validation study
People experiencing homelessness are often considered frequent healthcare users. Although their service use is not uniform, it can be difficult to identify the highest-cost users without access to comprehensive cost data. This study validated a set of algorithms that apply healthcare encounter data to identify high-cost users among adults with a history of homelessness. Administrative healthcare cost data were compared across common frequent user…
Effect of Free Medicine Distribution on Health Care Costs in Canada Over 3 Years: A Secondary Analysis of the CLEAN Meds Randomized Clinical Trial
ClinicalTrials.gov Identifier: NCT02744963
When I think about my future, I just see darkness”: How youth exiting homelessness navigate the hazy, liminal space between socioeconomic exclusion and inclusion
A holistic approach integrating coaching and attention to identity capital alongside economic supports may be key to helping youth exiting homelessness achieve socioeconomic inclusion
Coordinated Access and Coordinated Entry System Processes in the Housing and Homelessness Sector: A Critical Commentary on Current Practices
Coordinated access and coordinated entry systems have become central features in community responses to homelessness in Canada and the United States. Coordinated systems assess individuals and families experiencing homelessness on their needs, prioritize them based upon these needs, and then match them to appropriate housing. Despite the widespread implementation of coordinated systems, there have been few evaluations of the effectiveness of thes…
Cycles of instability: Proximal and distal influences on residential instability among people with histories of homelessness in three Canadian cities
People with histories of homelessness often have difficulties obtaining and maintaining adequate housing. This qualitative study examined the residential transitions of people with histories of residential instability and homelessness to understand factors contributing to the instability they experience. Interviews were conducted with 64 participants about their housing transitions, in the final year of a 4-year, prospective cohort study in three…
The Impact of Financial Incentives on Service Engagement Among Adults Experiencing Homelessness and Mental Illness: A Pragmatic Trial Protocol
Background: People experiencing homelessness and mental illness have poorer service engagement and health-related outcomes compared to the general population. Financial incentives have been associated with increased service engagement, but evidence of effectiveness is limited. This protocol evaluates the acceptability and impact of financial incentives on service engagement among adults experiencing homelessness and mental illness in Toronto, Can…
Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation
Objective: Grounded in principles of adult education, Recovery Education Centres (RECs) hold promise in promoting recovery for adults with mental health challenges, but research on recovery outcomes for hard-to-reach populations participating in RECs is scant. This quasi-experimental study compares 12-month recovery outcomes of adults with histories of homelessness and mental health challenges enrolled in a REC, to those of participants of other …
Chronic Pain among Individuals Experiencing Homelessness and Its Interdependence with Opioid and Other Substance Use and Mental Illness
Chronic pain and substance use disorders are serious conditions that are prevalent among homeless populations. The aim of this study was to examine the association between chronic pain and substance use among individuals experiencing homelessness and mental illness. We analyzed cross-sectional data from two sites of the At Home/Chez Soi study (Vancouver and Toronto) using bivariate statistics and multivariate logistic regression. Substance use an…
Food insecurity and mental health outcomes among homeless adults: A scoping review
Objective: This review summarises and synthesises the existing literature on the relationship between food insecurity (FS) and mental health conditions among adult individuals experiencing homelessness. Design: Scoping review. Papers published between 1 January 2008 and 2 November 2018, searched in PubMed, Web of Science, Scopus, PsycINFO, Cochrane Library and CINAHL, using homelessness, food security and mental health keywords. Setting: Global e…
Health of people experiencing co-occurring homelessness, imprisonment, substance use, sex work and/or severe mental illness in high-income countries: A systematic review and meta-analysis
Does Housing Improve Health Care Utilization and Costs? A Longitudinal Analysis of Health Administrative Data Linked to a Cohort of Individuals With a History of Homelessness
BACKGROUND: Individuals who are homeless have complex health care needs, which contribute to the frequent use of health services. In this study, we investigated the relationship between housing and health care utilization among adults with a history of homelessness in Ontario. METHODS: Survey data from a 4-year prospective cohort study were linked with administrative health records in Ontario. Annual rates of health encounters and mean costs were…
Housing First and Severe Mental Disorders: The Challenge of Exiting Homelessness
We examine the long-term housing trajectories of 543 program participants at the Toronto site of the At Home/Chez-Soi project, a randomized controlled trial of a Housing First (HF) intervention for adults with mental disorders. The average follow-up period for our study was 5.5 years. We find that the HF approach, which includes housing subsidies and support services, was strongly associated with rapid transitions to sustained housing (70.4 perce…
Housing Trajectories, Risk Factors, and Resources among Individuals Who Are Homeless or Precariously Housed
This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leading to high levels of housing stability, decreasing levels of housing stability over time, and low lev…
Covid-19 and people experiencing homelessness: Challenges and mitigation strategies
KEY POINTS Infectious disease epidemics and pandemics have a disproportionate impact on people experiencing poverty, marginalization, stigmatization and discrimination.[1][1]–[3][2] Amid the current coronavirus disease 2019 (COVID-19) pandemic, this disparity is particularly relevant for
Dental problems and chronic diseases in mentally ill homeless adults: A cross-sectional study
Dental health problems in homeless individuals with serious mental disorders are associated with several CDs. Dental care should be better integrated into existing social and health programs serving this population to improve their overall health status. The AH/CS study is registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374)
Cold-related injuries in a cohort of homeless adults
People experiencing homelessness have an increased risk of cold-related injuries. This study determined the rate of emergency department (ED) visits for cold-related injuries among homeless adults and low-income controls in Toronto, Canada. Homeless individuals were recruited at shelters and meal programs. Age- and sex-matched controls living in low-income neighborhoods were selected. ED utilization was ascertained over 4-years of follow-up (2005…
Longitudinal Associations between Perceived Quality of Living Spaces and Health-Related Quality of Life among Homeless and Vulnerably Housed Individuals Living in Three Canadian Cities
The objective of this study was to examine longitudinal associations between perceived quality of living spaces and mental and physical health-related quality of life (HRQoL) among homeless and vulnerably housed individuals living in three Canadian cities. The Health and Housing in Transition (HHiT) study was a prospective cohort study conducted between 2009 and 2013 of N = 1190 individuals who were homeless and vulnerably housed at baseline. Per…
Identifying the Patterns of Emergency Shelter Stays of Single Individuals in Canadian Cities of Different Sizes
The study analyzed the patterns of emergency shelter stays of single persons in three Canadian cities of different sizes (i.e., Toronto, Ottawa, and Guelph). Similar to findings of previous research conducted in large American cities in the early 1990s, cluster analyses defined three clusters with distinct patterns of shelter stays (temporary, episodic, and long stay). A temporary cluster (88–94 per cent) experienced a small number of homeless ep…
A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance
Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and…
Universal Health Insurance and Health Care Access for Homeless Persons
Objectives. We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system. Methods. We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with u…
Enriching qualitative research by engaging peer interviewers: A Case Study
Engaging peer-interviewers in qualitative inquiry is becoming more popular. Yet, there are differing opinions as to whether this practice improves the research process or is prohibitively challenging. Benefits noted in the literature are improved awareness/acceptance of disenfranchised groups, improved quality of research, and increased comfort of participants in the research process. Challenges include larger investment in time and money to hire…
Factors Associated with Poor Mental Health Status Among Homeless Women With and Without Dependent Children
High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults
Objectives. We identified predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Ontario. Methods. We assessed ED visit rates using administrative data from the Institute for Clinical Evaluative Sciences (2005–2009). We then used logistic regression to identify predictors of ED use. Frequent users were defined as participants with rates in the top decile (≥ 4.7 visits per person-year…
Homelessness & Health in Canada
Psychological Services, Centre for Addiction and
Housing Trajectories, Risk Factors, and Resources among Individuals Who Are Homeless or Precariously Housed
This study identifies time-patterned trajectories of housing stability among homeless and vulnerably housed individuals who participated in a multisite four-year longitudinal study in Canada. Findings show four distinct trajectories for the homeless and vulnerably housed: high levels of sustained housing stability, improving levels over time leading to high levels of housing stability, decreasing levels of housing stability over time, and low lev…
Housing First and Severe Mental Disorders: The Challenge of Exiting Homelessness
We examine the long-term housing trajectories of 543 program participants at the Toronto site of the At Home/Chez-Soi project, a randomized controlled trial of a Housing First (HF) intervention for adults with mental disorders. The average follow-up period for our study was 5.5 years. We find that the HF approach, which includes housing subsidies and support services, was strongly associated with rapid transitions to sustained housing (70.4 perce…
I Haven't Given Up and I'm Not Gonna: A Phenomenographic Exploration of Resilience Among Individuals Experiencing Homelessness
Resilience is a factor related to positive health outcomes. Exploring this concept among adults experiencing homelessness can inform interventions while subsequently considering individuals' strengths. A phenomenographic approach was applied to examine this concept among a sample of 22 individuals involved in qualitative interviews. The phenomenographic inquiry identified eight conceptions and found resilience is captured in both positive and neg…
The effect of incarceration on housing stability among homeless and vulnerably housed individuals in three Canadian cities: A prospective cohort study
I want to be able to show everyone that it is possible to go from being nothing in the world to being something”: Identity as a determinant of social integration
Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults
Objectives. We identified factors associated with inpatient hospitalizations among a population-based cohort of homeless adults in Toronto, Ontario. Methods. We recruited participants from shelters and meal programs. We then linked them to administrative databases to capture hospital admissions during the study (2005–2009). We used logistic regression to identify predictors of medical or surgical and psychiatric hospitalizations. Results. Among 1…
When I think about my future, I just see darkness”: How youth exiting homelessness navigate the hazy, liminal space between socioeconomic exclusion and inclusion
A holistic approach integrating coaching and attention to identity capital alongside economic supports may be key to helping youth exiting homelessness achieve socioeconomic inclusion
Mortality Among Men Using Homeless Shelters in Toronto, Ontario
CONTEXT: Homeless persons in US cities have high mortality rates. However, few comparison data exist for death rates among homeless persons in other developed countries. OBJECTIVES: To compare mortality rates among men using homeless shelters and the general population in Toronto, Ontario, and to determine whether mortality rates differ significantly among men using homeless shelters in Canadian and US cities. DESIGN: Cohort study conducted from …
The Effects of Housing Status on Health-Related Outcomes in People living with HIV: A Systematic Review of the Literature
Homeless People’s Perceptions of Welcomeness and Unwelcomeness in Healthcare Encounters
BACKGROUND: Homeless people face many barriers to obtaining health care, and their attitudes toward seeking health care services may be shaped in part by previous encounters with health care providers. OBJECTIVE: To examine how homeless persons experienced "welcomeness" and "unwelcomeness" in past encounters with health care providers and to characterize their perceptions of these interactions. DESIGN: Qualitative content analysis of 17 in-depth …
Health Care Cost Matters for Homeless People: An Example of Costing Mental Health and Addiction Services in Homeless Shelters in Canada
Universal Health Insurance and Health Care Access for Homeless Persons
Objectives. We examined the extent of unmet needs and barriers to accessing health care among homeless people within a universal health insurance system. Methods. We randomly selected a representative sample of 1169 homeless individuals at shelters and meal programs in Toronto, Ontario. We determined the prevalence of self-reported unmet needs for health care in the past 12 months and used regression analyses to identify factors associated with u…
Low Rates of Cervical Cancer Screening Among Urban Immigrants: A Population-Based Study in Ontario, Canada
OBJECTIVE: Women who are immigrants or socioeconomically disadvantaged have been found to have significantly lower cervical cancer screening rates than their peers in Toronto, Ontario, Canada. The objective of this study was to examine rates of appropriate cervical cancer screening among women living in Ontario, Canada, using recent registration with Ontario's universal health insurance plan as an indicator of immigrant status. METHODS: This retr…
The At Home/Chez Soi trial protocol: A pragmatic, multi-site, randomised controlled trial of a Housing First intervention for homeless individuals with mental illness in five Canadian cities
Introduction Housing First is a complex housing and support intervention for homeless individuals with mental health problems. It has a sufficient knowledge base and interest to warrant a test of wide-scale implementation in various settings. This protocol describes the quantitative design of a Canadian five city, $110 million demonstration project and provides the rationale for key scientific decisions. Methods A pragmatic, mixed methods, multi-…
The assessment of food security in homeless individuals: A comparison of the Food Security Survey Module and the Household Food Insecurity Access Scale
Objective To compare the Household Food Insecurity Access Scale (HFIAS), the US Food Security Survey Module (US FSSM) and a modified version of the US FSSM in which references to buying food were changed to references to getting food, in terms of their classification of food security levels among homeless individuals, and to determine which of these instruments was most preferred by homeless individuals. Design A cross-sectional survey. Setting R…
Hospital Costs and Length of Stay Among Homeless Patients Admitted to Medical, Surgical, and Psychiatric Services
BACKGROUND: Homeless individuals often suffer from serious health conditions and are frequently hospitalized. This study compares hospitalization costs for homeless and housed patients, with and without adjustment for patient and service characteristics. METHODS: Administrative data on 93,426 admissions at an academic teaching hospital in Toronto, Canada, were collected over a 5-year period. These data included an identifier for patients who were…
Homeless and Housed Inpatients with Schizophrenia: Disparities in Service Access upon Discharge from Hospital
Harm reduction services as a point-of-entry to and source of end-of-life care and support for homeless and marginally housed persons who use alcohol and/or illicit drugs: A qualitative analysis
While partnerships between harm reduction programs and end-of-life care services are identified as one way to improve access, it is noted that more comprehensive harm reduction services might be needed in end-of-life care settings if they are to engage this underserved population
Ending homelessness among people with mental illness: The At Home/Chez Soi randomized trial of a Housing First intervention in Toronto
Recruitment at the Toronto site of AH/CS project produced a sample of participants that reflects the diverse demographics of the target population. This study will provide much needed data on how to best address the issue of homelessness and mental illness in Canada
Dental health of homeless adults in Toronto, Canada
Homeless adults in Toronto have poor oral health, significant oral health treatment needs, and a lack of access to dental care
Mortality Among Homeless Adults in Boston: Shifts in Causes of Death Over a 15-Year Period
BACKGROUND: Homeless persons experience excess mortality, but US-based studies on this topic are outdated or lack information about causes of death. To our knowledge, no studies have examined shifts in causes of death for this population over time. METHODS: We assessed all-cause and cause-specific mortality rates in a cohort of 28 033 adults 18 years or older who were seen at Boston Health Care for the Homeless Program from January 1, 2003, throu…
A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian cities
Homeless and vulnerably housed adults have a similar likelihood of experiencing unmet health care needs. Strategies to improve access to primary care and reduce barriers to accessing care in these populations are needed
Identifying the Patterns of Emergency Shelter Stays of Single Individuals in Canadian Cities of Different Sizes
The study analyzed the patterns of emergency shelter stays of single persons in three Canadian cities of different sizes (i.e., Toronto, Ottawa, and Guelph). Similar to findings of previous research conducted in large American cities in the early 1990s, cluster analyses defined three clusters with distinct patterns of shelter stays (temporary, episodic, and long stay). A temporary cluster (88–94 per cent) experienced a small number of homeless ep…
Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults
Objectives. We identified factors associated with inpatient hospitalizations among a population-based cohort of homeless adults in Toronto, Ontario. Methods. We recruited participants from shelters and meal programs. We then linked them to administrative databases to capture hospital admissions during the study (2005–2009). We used logistic regression to identify predictors of medical or surgical and psychiatric hospitalizations. Results. Among 1…
High Utilizers of Emergency Health Services in a Population-Based Cohort of Homeless Adults
Objectives. We identified predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Ontario. Methods. We assessed ED visit rates using administrative data from the Institute for Clinical Evaluative Sciences (2005–2009). We then used logistic regression to identify predictors of ED use. Frequent users were defined as participants with rates in the top decile (≥ 4.7 visits per person-year…
A Comprehensive Assessment of Health Care Utilization Among Homeless Adults Under a System of Universal Health Insurance
Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and…
Factors Associated with Poor Mental Health Status Among Homeless Women With and Without Dependent Children
Health interventions for people who are homeless
Subjective Quality of Life Among Individuals who are Homeless: A Review of Current Knowledge
Homelessness & Health in Canada
Psychological Services, Centre for Addiction and
Effect of Scattered-Site Housing Using Rent Supplements and Intensive Case Management on Housing Stability Among Homeless Adults With Mental Illness: A Randomized Trial
Importance Scattered-site housing with Intensive Case Management (ICM) may be an appropriate and less-costly option for homeless adults with mental illness who do not require the treatment intensity of Assertive Community Treatment. Objective To examine the effect of scattered-site housing with ICM services on housing stability and generic quality of life among homeless adults with mental illness and moderate support needs for mental health servi…
A Systematic Review of Randomized Controlled Trials of Interventions to Improve the Health of Persons During Imprisonment and in the Year After Release
We systematically reviewed randomized controlled trials of interventions to improve the health of people during imprisonment or in the year after release. We searched 14 biomedical and social science databases in 2014, and identified 95 studies. Most studies involved only men or a majority of men (70/83 studies in which gender was specified); only 16 studies focused on adolescents. Most studies were conducted in the United States (n = 57). The ri…
Medicine (52 works) · Homelessness and Social Issues (50 works) · Psychiatry (31 works) · Gerontology (28 works) · Mental health (23 works) · Environmental health (22 works) · Food Security and Health in Diverse Populations (21 works) · Population (21 works) · Psychology (18 works) · Gerontology (15 works)