Project Profile - The Health and Housing in Transition (HHiT) Study: A Longitudinal Study of the Health of Homeless and Vulnerably Housed Adults in Vancouver, Toronto, and Ottawa

Centre for Research on Inner City Health - Keenan Research Centre


The Health and Housing in Transition (HHiT) Study is an ambitious and innovative longitudinal cohort study that will track the health and housing status of a representative sample of 1,200 homeless and vulnerably housed single adults in 3 Canadian cities (Vancouver, Toronto, and Ottawa).

Principal Investigator:


Canadian Institutes of Health Research


A substantial body of research over the last two decades has shown that homeless people suffer from high rates of physical and mental illness, substance abuse, injuries and assaults, and mortality. Homeless people frequently encounter barriers to accessing health care and social services, despite their high level of need for such services. Homelessness itself is thought to contribute to poor health, but empirical evidence of such a relationship has proved difficult to obtain. The majority of studies of the health of homeless and vulnerably housed people have used a cross-sectional design, despite the fact that housing is a fluid state with vulnerable individuals making frequent transitions between homelessness and inadequate, unstable, or insecure housing. A relatively small number of studies have reported on longitudinal changes in the health and housing status of homeless individuals.

The paucity of longitudinal research in Canada restricts our understanding of the course of homelessness, the factors that help individuals escape homelessness, and the effectiveness of services and supports to address homelessness. Identification of these factors holds significant promise as a source of information to guide the creation of effective social and health programs and policies. The HHiT study will address these gaps.


The main objectives of this study are:

  • To determine (a) the rate at which homeless individuals achieve residential stability and (b) the rate at which vulnerably housed individuals become homeless over a 2-year follow-up period;
  • To identify the risk factors and individual, interpersonal, and community-level resources that are associated with (a) the attainment of stable housing among homeless individuals, and (b) the onset of homelessness among vulnerably housed individuals; and
  • To determine whether changes in housing status are associated with subsequent changes in physical and mental health, utilization of health care services, alcohol and drug use, and social supports.


This longitudinal cohort study is recruiting a total of 1,200 homeless and vulnerably housed adults in Vancouver, Toronto, and Ottawa (200 homeless adults and 200 vulnerably housed adults in each city). This study is using rigorous research methods to obtain a representative sample of the homeless and vulnerably housed populations.  Recruitment is taking place at shelters, meal programs, SRO hotels, and rooming houses. A baseline interview lasting about 90 minutes is being administered to obtain information on demographics, housing status, health status, health care utilization, substance use, risk behaviors, and quality of life. Carefully developed procedures will be used to track participants in order to administer follow-up interviews 1 year and 2 years after the baseline interview. Statistical analyses will estimate the incidence and examine predictors of transitions in housing status and the relationship between housing transitions and changes in health and health behaviors.

Research Partners:

  • Street Health - Toronto
  • Portland Hotel Society - Vancouver
  • Ottawa Inner City Health

Project Contact:

For more information contact Dr. Stephen Hwang at 416-864-5991.