Margot Kushel
Biographic Data
| ID | 81218 |
|---|---|
| NAME | Margot Kushel |
| GIVEN NAMES | Margot |
| FAMILY NAME | Kushel |
| SIGNATURE | KUSHEL M |
| AFFILIATIONS | San Francisco General Hospital |
| ORCID | 0000-0002-1361-6889 |
| VERIFIED | Yes |
| TOTAL WORKS | 46 |
| TOTAL CITATIONS | 175 |
| AUTHOR COUNT | 46 |
| EDITOR COUNT | 0 |
| FIRST PUBLICATION YEAR | 2001 |
| LATEST PUBLICATION YEAR | 2026 |
| H-INDEX | 6 |
Money Helps: Financial Incentives for Smoking Cessation Among People Experiencing Homelessness
Introduction Over 70% of people experiencing homelessness report current cigarette smoking. We conducted a randomized controlled trial of an extended (6-month) contingency management (CM) intervention for smoking cessation among adults experiencing homelessness and who were engaged in primary care. We examined experiences and perspectives on cessation among a subset of participants in the trial.Methods The CM group received escalating incentives …
“Everybody out there in the real world is one paycheck away from being homeless”: Job loss and housing precarity among people experiencing homelessness
The United States has fewer labor protections and wage guarantees than most wealthy industrialized nations; thus, workers can fall into economic hardship by the loss of employment, reduction in work hours, or work-related accidents or injuries. Even when fully employed, low wage workers typically face substantial rent burdens, which place them at risk for being evicted from their homes and ultimately falling into homelessness. This paper examines…
Improving health and housing outcomes through a simulation and economic model: An evidence-based protocol of a group model building approach to develop an agent-based model
Introduction: Homelessness in the United States increased every year since 2016, with a 38% increase from 2023 to 2024. Much of the increase is attributable to rising home and rent costs, economic hardship caused by the recent pandemic, and the ending of protective legislation. Notably, people who experience homelessness have an increased risk of substance use disorders, HIV infection and poorer HIV outcomes than people who are stably housed. The…
What Would It Take to End Homelessness in the United States
Ending homelessness in the United States has remained stubbornly out of reach. Despite hundreds of federal, state, and local plans to end homelessness, most have ended unsuccessfully—due to a range of issues, notably insufficient resources. Homelessness persists and, in many communities, has increased because of myriad intervening factors—many of which lie outside the control of the systems tasked with solving it. This paper summarizes the eviden…
Factors Associated With Exits From and Returns to Homelessness Among Older Homeless Adults: Results From the Hope Home Study
Homelessness is dynamic; some individuals cycle between homelessness and housing. In a longitudinal study of 411 adults aged 50 and older who were homeless at study enrollment, we examined the prevalence of and factors associated with exits from and returns to homelessness. With a median 4 years of follow-up, 80% of participants exited homelessness into housing. Having a permanent rental subsidy was associated with retaining housing. Rental subsi…
The Built Environment, PTSD Symptoms, and Tobacco Use among Permanent Supportive Housing Residents
INTRODUCTION: 50% of permanent supportive housing (PSH) residents in the U.S. smoke cigarettes, and tobacco-related mortality is their number one cause of death. Over 30% of PSH residents have post-traumatic stress disorder (PTSD), and many perceive their built environment (e.g., housing) as inadequate for mental and physical health recovery. It is unknown whether built environment factors moderate the relationship between PTSD and tobacco use am…
Health Care Access and Use Among Adults Experiencing Homelessness
This cross-sectional study found that adults experiencing homelessness reported poor access to ambulatory care and a high prevalence of short-term care use, despite high rates of insurance. Changes in homelessness during the past 30 years were associated with worsened health care access and use
Potential Changes in US Homelessness by Ending Federal Support for Housing First Programs
This decision analytical model estimates the change in the number of people experiencing homelessness in a year following termination of federal support for Housing First programs
“We remember the pain”: A qualitative study of intergenerational trauma among older adults experiencing homelessness in the Hope Home study
Rates of homelessness among adults aged 50 and over are rising. Common strategies for exiting homelessness rely on social and family support. However, intergenerational trauma may disrupt these social support networks and contribute to homelessness. Understanding the impact of intergenerational trauma on living with family or friends may give insight into addressing homelessness among older adults. We purposefully sampled 46 adults who reported l…
Loneliness among homeless-experienced older adults with cognitive or functional impairments: Qualitative findings from the Hope Home study
Loneliness is a complex and heterogenous social phenomenon, with homeless-experienced older adults with cognitive or functional impairments exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessn…
Accounting for the interplay of interpersonal and structural trauma in the treatment of chronic non-cancer pain, opioid use disorder, and mental health in urban safety-net primary care clinics
While the epidemiological literature recognizes associations between chronic non-cancer pain (CNCP), opioid use disorder (OUD), and interpersonal trauma stemming from physical, emotional, sexual abuse or neglect, the complex etiologies and interplay between interpersonal and structural traumas in CNCP populations are underexamined. Research has documented the relationship between experiencing multiple adverse childhood experiences (ACEs) and the …
Barriers and facilitators to resolving older adult homelessness through stays with family: Qualitative findings from the Hope Home study
Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We conducted semi-structured interviews with 46 homeless participants from the HOPE HOME study, a cohort of 350 community-recruited homeless adults age 50 or older in Oakland, CA, who reported having staye…
Longitudinal Relationship Between Food Insecurity, Engagement in Care, and ART Adherence Among US Women Living with HIV
A mereological qualitative study protocol for understanding the lived experience of homelessness in California
Although qualitative interview studies provide in-depth understandings of the opinions and lived experiences of social groups, they are typically small in scale, bounded by a small number of physical or virtual spaces, and designed to capture relatively demarcated aspects of participants' experiences. This paper describes the qualitative component of a large mixed method study of homelessness in California. The qualitative study consisted of seve…
Temporary stays with housed family and friends among older adults experiencing homelessness: Qualitative findings from the Hope Home study
Background: The proportion of adults age 50 and older experiencing homelessness is growing. People at risk for homelessness may stay with family and friends to prevent homelessness. Moving in with housed family and friends is a strategy used to exit homelessness. Little is known about these stays with family and friends. This study examined the motivations for and challenges of older adults experiencing homelessness staying with or moving in with…
The smoke-free home study: Study protocol for a cluster randomized controlled trial of a smoke-free home intervention in permanent supportive housing
This study was registered with the U.S. National Institute of Health Clinical Trials register on April 22, 2021: NCT04855357
Community Supervision, Housing Insecurity, and Homelessness
In recent decades, the United States has seen the simultaneous rise of mass incarceration and homelessness. The two crises are driven by the same structural factors and interact with one another, exacerbating their detrimental effects in a feedback loop. People under community supervision face many barriers to housing, putting them at high risk of experiencing homelessness in the months following release. People who experience homelessness are at…
Racial discrimination in the life course of older adults experiencing homelessness: Results from the Hope Home study
Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness but little research has examined the relationship between race and homelessness. We aimed to understand the relationship between race and the experience of homelessness for older adults. We used grounded theory methodology to analyze in-depth qualitative interviews (n = 65) of persons e…
Unmet mental health and substance use treatment needs among older homeless adults: Results from the Hope Home Study
AIMS: To examine the prevalence of and factors associated with unmet need for mental health and substance use treatment in older homeless adults. METHODS: Among 350 homeless adults aged ≥50, we examined prevalence of mental health and substance use problems and treatment. Using logistic regression, we examined factors associated with unmet treatment need. RESULTS: Among those with a mental health problem, being aged ≥65 was associated with an inc…
Oral health and access to dental care among older homeless adults: Results from the Hope Home study
Tooth loss and oral pain are highly prevalent in older homeless adults. Increasing age, alcohol, drug, and tobacco use are associated with tooth loss
Homelessness: A Potent Risk Factor for Readmission
Rated as one of the top ten journals in healthcare administration, Medical Care is devoted to all aspects of the administration and delivery of healthcare. This scholarly journal publishes original, peer-reviewed papers documenting the most current developments in the rapidly changing field of healthcare. This timely journal reports on the findings of original investigations into issues related to the research, planning, organization, financing, …
Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States
Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use
The land of the sick and the land of the healthy: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States
Residential patterns in older homeless adults: Results of a cluster analysis
Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study
Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons. Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models. Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% e…
The land of the sick and the land of the healthy: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States
Engaging Individuals Recently Released From Prison Into Primary Care: A Randomized Trial
Objectives. Individuals released from prison have high rates of chronic conditions but minimal engagement in primary care. We compared 2 interventions designed to improve primary care engagement and reduce acute care utilization: Transitions Clinic, a primary care–based care management program with a community health worker, versus expedited primary care. Methods. We performed a randomized controlled trial from 2007 to 2009 among 200 recently rel…
Revolving Doors: Imprisonment Among the Homeless and Marginally Housed Population
Objectives. We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. Methods. We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. Results. Almost one fourth of participants (23.1%) had a …
Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use
Public Health Care Utilization in a Cohort of Homeless Adult Applicants to a Supportive Housing Program
Housing Instability and Incident Hypertension in the Cardia Cohort
Residential patterns in older homeless adults: Results of a cluster analysis
Community Supervision, Housing Insecurity, and Homelessness
In recent decades, the United States has seen the simultaneous rise of mass incarceration and homelessness. The two crises are driven by the same structural factors and interact with one another, exacerbating their detrimental effects in a feedback loop. People under community supervision face many barriers to housing, putting them at high risk of experiencing homelessness in the months following release. People who experience homelessness are at…
Factors Associated With the Health Care Utilization of Homeless Persons
CONTEXT: Homeless persons face numerous barriers to receiving health care and have high rates of illness and disability. Factors associated with health care utilization by homeless persons have not been explored from a national perspective. OBJECTIVE: To describe factors associated with use of and perceived barriers to receipt of health care among homeless persons. DESIGN AND SETTING: Secondary data analysis of the National Survey of Homeless Ass…
Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study
Objectives. This study examined factors associated with emergency department use among homeless and marginally housed persons. Methods. Interviews were conducted with 2578 homeless and marginally housed persons, and factors associated with different patterns of emergency department use were assessed in multivariate models. Results. Findings showed that 40.4% of respondents had 1 or more emergency department encounters in the previous year; 7.9% e…
No Door to Lock: Victimization Among Homeless and Marginally Housed Persons
BACKGROUND: Homeless persons experience high rates of sexual and physical assault; homeless women are thought to be at highest risk. To determine the prevalence, distribution, and factors associated with sexual and physical assault, we surveyed homeless and marginally housed adults in San Francisco, Calif. METHODS: We interviewed 2577 respondents about their history of recent sexual and physical assault, housing history, sexual practices, substan…
Revolving Doors: Imprisonment Among the Homeless and Marginally Housed Population
Objectives. We studied a sample of homeless and marginally housed adults to examine whether a history of imprisonment was associated with differences in health status, drug use, and sexual behaviors among the homeless. Methods. We interviewed 1426 community-based homeless and marginally housed adults. We used multivariate models to analyze factors associated with a history of imprisonment. Results. Almost one fourth of participants (23.1%) had a …
Housing instability and food insecurity as barriers to health care among low-income americans
Public Health Care Utilization in a Cohort of Homeless Adult Applicants to a Supportive Housing Program
Food Insecurity is Associated with Diabetes Mellitus: Results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999–2002
Association between the Level of Housing Instability, Economic Standing and Health Care Access: A Meta-Regression
Introduction . To determine the relationship between housing instability, economic standing, and access to health care and use of acute care services. Methods . We performed a meta-regression using four nationally representative surveys. The independent variable was an ordered measure of economic and housing instability: 1) the general population, 2) low-income population, 3) never homeless users-of-subsistence-services, 4) unstably housed, 5) fo…
Implementation of the Medicare Part D Prescription Drug Benefit is Associated with Antiretroviral Therapy Interruptions
Food Insecurity Among Homeless and Marginally Housed Individuals Living with HIV/Aids in San Francisco
Food insecurity is a risk factor for both HIV transmission and worse HIV clinical outcomes. We examined the prevalence of and factors associated with food insecurity among homeless and marginally housed HIV-infected individuals in San Francisco recruited from the Research on Access to Care in the Homeless Cohort. We used multiple logistic regression to determine socio-demographic and behavioral factors associated with food insecurity, which was m…
Food Insecurity Is Associated with Chronic Disease among Low-Income NHANES Participants
Conceptual framework for understanding the bidirectional links between food insecurity and HIV/Aids
Specific psychiatric correlates of acute care utilization among unstably housed HIV-positive adults
The role of specific psychiatric diagnoses in emergency department use and/or inpatient hospitalizations (acute care) has not been extensively examined among HIV-infected, unstably housed persons. A community-recruited sample of 284 HIV-infected, unstably housed adults completed the Diagnostic Interview Schedule for DSM-IV. One-third of participants screened positive for major depression and stimulant use disorders. Sleeping on the street [adjust…
Food Insecurity and Risky Sexual Behaviors Among Homeless and Marginally Housed HIV-Infected Individuals in San Francisco
Housing Instability and Incident Hypertension in the Cardia Cohort
Engaging Individuals Recently Released From Prison Into Primary Care: A Randomized Trial
Objectives. Individuals released from prison have high rates of chronic conditions but minimal engagement in primary care. We compared 2 interventions designed to improve primary care engagement and reduce acute care utilization: Transitions Clinic, a primary care–based care management program with a community health worker, versus expedited primary care. Methods. We performed a randomized controlled trial from 2007 to 2009 among 200 recently rel…
Smoking Behaviors in a Community-Based Cohort of HIV-Infected Indigent Adults
Opioid Analgesic Misuse is Associated with Incomplete Antiretroviral Adherence in a Cohort of HIV-Infected Indigent Adults in San Francisco
Wang et al. Respond
chronic disease; emergency health service; female; health promotion; human; male; methodology; note; primary health care; prisoner; utilization review, Chronic Disease; Emergency Service, Hospital; Female; Health Promotion; Humans; Male; Primary Health Care; Prisoners
The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations
Food Insecurity is Longitudinally Associated with Depressive Symptoms Among Homeless and Marginally-Housed Individuals Living with HIV
Residential patterns in older homeless adults: Results of a cluster analysis
Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States
Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use
The land of the sick and the land of the healthy: Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States
Medicine (38 works) · Homelessness and Social Issues (36 works) · Environmental health (25 works) · Psychology (23 works) · Psychiatry (22 works) · Food Security and Health in Diverse Populations (20 works) · Gerontology (19 works) · Population (15 works) · Demography (13 works) · Sociology (13 works)