percent of all homeless women are estimated to have experienced abuse at some point during their life (Bassuk and Weinreb, 1993).

Although somewhat sparse, the empirical evidence, as identified below, documents poorer pregnancy outcomes, increased risk of malnutrition and health problems, low utilization of preventive health services, and a higher incidence of developmental delays and learning problems among homeless families with women and their children.

Women. In general, homeless women experience a variety of health disorders and problems. Higher than expected levels of iron deficiency anemia, overweight and obesity, and high serum cholesterol concentrations were found among single homeless women living in temporary housing shelters in Kansas City, Missouri (Drake, 1992), and among homeless men and women in New York City (Luder et al., 1990). Homeless women are also found to have higher prevalence of such chronic health problems as hypertension, diabetes mellitus, coronary heart disease, mental illness, alcoholism, and tuberculosis (Drake, 1992; Luder et al., 1990).

Pregnancy outcomes are worse for low-income homeless women than for other low-income women. A study of homeless pregnant women in New York City found significantly higher infant mortality rates and rates of low birth weight (LBW) among the homeless women than among women living in low-income public housing (Chavkin et al., 1987). Another study of birth outcomes in New York City found that pregnant WIC participants were three times more likely to have LBW newborns if they were homeless (Jaffee et al., 1992).

The explanation of the poorer pregnancy and health outcomes for homeless pregnant women is most likely a combination of inadequate prenatal care, poor nutrition, and other behavioral and health problems. In the 1982–1984 New York City study of homeless pregnant women and housed low-income pregnant women, 40 percent of the homeless women received no prenatal care, compared with less than 15 percent of the women living in public housing (Chavkin et al., 1987). In Jaffee's study of homeless pregnant women in New York City, pregnant homeless WIC program participants were four times more likely to lack prenatal care than similar WIC program participants with housing (Jaffee et al., 1992).

Studies of the diets and eating patterns of all homeless individuals suggest the following: increased risk of protein-energy malnutrition and chronic malnutrition; high intakes of sodium, saturated fat, and cholesterol; shortages of essential nutrients; low dietary adequacy scores; and primary sources of food that include fast-food restaurants, shelters, delicatessens, and garbage bins

FRONT MATTER (R1-R14)

SUMMARY (1-22)

1 OVERVIEW (23-40)

2 POVERTY AND NUTRITION RISK (41-52)

3 PRINCIPLES UNDERLYING THE NUTRITION RISK CRITERIA FOR WIC ELIGIBILITY (53-66)

4 ANTHROPOMETRIC RISK CRITERIA (67-148)

5 BIOCHEMICAL AND OTHER MEDICAL RISK CRITERIA (149-250)

6 DIETARY RISK CRITERIA (251-294)

7 PREDISPOSING NUTRITION RISK CRITERIA (295-334)

8 CONCLUSIONS AND RECOMMENDATIONS (335-352)

APPENDIXES (353-352)

A PARTICIPANTS AT THE FIRST PUBLIC MEETING, MAY 19, 1994 (353-354)

B PARTICANTS AT THE SECOND PUBLIC MEETING, SEPTEMBER 19-20, 1994 (355-356)

C WIC PROGRAM: COMMON NUTRITIONAL RISK CRITERIA (357-358)

D DEFINITIONS OF YIELD AND SENSITIVITY OF CUTOFF POINTS FOR NUTRITION RISK (359-360)

E BIOGRAPHICAL SKETCHES (361-370)

ACRONYMS (371-372)

INDEX OF RISK CRITERIA (373-377)