Persons living in precarious housing face numerous mental and physical health risks, including disproportionally higher incidence of traumatic brain injury (TBI) compared with the general population. A number of challenges hamper the existent literature on incident TBI in this population, potentially attenuating estimates of TBI occurrence. In precariously housed persons, this study (1) captured TBI events in a prospective design that included participant education regarding injury sequelae and the use of a comprehensive and validated screening tool deployed repeatedly and proximate (i.e., monthly) to incident TBI, (2) characterized the types of TBI events that occurred through detailed assessment of injury details (i.e., count, severity, mechanism, acute intoxication), with test-retest reliability analyses on self-reported injury characteristics, and (3) identified specific risk factors for incident TBI, amongst broad predictor categories (i.e., substance dependence, psychiatric illness, prior brain injury, psychological functioning), through detailed pre-injury assessment, in order to inform targeted assessment and prevention strategies. Three hundred and twenty six participants were recruited from single-room occupancy hotels and screened monthly for incident TBI. Observed and estimated rates of TBI were obtained, and logistic and poisson regression identified pre-injury risk factors for TBI occurrence, severity, and count. Across TBI definitions and approaches to missing data, incidence proportion ranged from 18.7 to 50.7 percent, event proportion ranged from 27.9 to 91.1 percent, incidence rate ranged from 30,086 to 50,674 per 100,000 person-years, and event rate ranged from 44,882 to 91,104 per 100,000 person-years. Education, role functioning, schizophrenia spectrum disorder, opioid dependence, lifetime number of TBI, and lifetime history of TBI were significant predictors of TBI occurrence. This study makes four important contributions: (1) screening for brain injury at repeated proximal assessments (i.e., monthly) obtains a considerably higher self-reported rate of TBI in precariously housed persons, (2) this multimorbid population suffers from remarkably high rates of self-reported brain injury, and (3) several key and specific risk factors for TBI occurrence and (4) TBI severity were identified. Harm reduction strategies targeting those most vulnerable are imperative to improve functioning and prevent further injury and associated consequences.
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Thesis advisor: Thornton, Allen
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