Rural versus urban homelessness: A comparison of homeless men in Nebraska

Background: Rural homelessness is a problem that is hardly recognized and rarely studied. More specifically, how rural homeless individuals differ from those who are homeless in urban areas is not well-understood. Understanding rural homelessness is important to rural health and efforts to expand access to care for all, especially disadvantaged populations. Objectives: This study examines the unique needs of rural homeless men by 1) comparing their sociodemographic and clinical characteristics with urban homeless men; and 2) observing their service use patterns compared to urban homeless men. Methods: A sample of 247 homeless men (41 rural, 206 urban) were recruited from shelters, transitional housing, and homeless programs in rural and urban regions of Nebraska. Data on sociodemographic and clinical characteristics as well as health service use were collected and analyzed. Resuts: Compared to urban homeless men, rural homeless men were more likely to be White, never married, and military veterans. Rural homeles men were also more transient and more likely to have various mental disorders and a greater number of medical problems. Rural homeless men also reported using more medical, mental health, and substance abuse services than urban homeless men and reported easier access to services. Discussion: Homeless and health services in rural areas are often co-located allowing rural homeless men easy access to care. However, assessing the prevalence and needs of rural homeless populations can be difficult because sampling often leads to only capturing those already engaged in services. These findings suggest there may be an "invisible" rural homeless population. Conclusion: Innovative ways to provide outreach and study rural homeless populations should be a focus of rural health efforts.