The Housing Instability Scale: Determining a Cutoff Score and Its Utility for Contextualizing Health Outcomes in People Who Use Drugs

Background: Housing instability, a key social determinant of health, dispro-portionately affects people who use drugs (PWUD), increasing their risk for adverse outcomes. This study explores the relationship between housing status and drug-related health outcomes among PWUD in an urban setting in the Southeastern United States (US) and determines the cut-off point for the Housing Instability Scale (HIS). (2) Methods: We conducted a cross-sectional survey from July to November 2024 among adult PWUD. Recruitment was through syringe services programs (SSPs), nightlife venues, and community outreach. HIS was used to assess housing status, cluster analysis to determine cutoff, and Gaussian Mixture Modeling (GMM) to validate. Logistic regression models were employed to examine associations between housing instability and health outcomes. (3) Results: Among 164 participants (mean age = 41.2; 79.9% Black/African American), the average HIS score was 3.23. Scores of 0-3 represented stable housing; 4-7 represented unstable housing on the HIS. Multivariate logistic regression revealed that housing in-stability was significantly associated with infections (AOR = 1.55, p = 0.064), blackouts (AOR = 1.47, p = 0.0457), and seizures (AOR = 1.28, p = 0.0667). Overdose and wounds showed no significant association. SSP use, opioid, and Xanax use were strong predictors.