Substance Use
Low Threshold Shelters promote racial equity in housing for chronically unsheltered people with substance use disorder in Boston. Ariela Braverman Bronstein* Ariela Braverman Bronstein Shanyin Yang Sumaiya Miah Jeffrey Desmarais Krystal Garcia Shoba Nair
Background Unsheltered homelessness disproportionately affects communities of color and people with substance use disorder (SUD). In response, Boston implemented seven low-threshold shelters (LTS) in 2022–2023 to house chronically unsheltered individuals with SUD. Guided by Housing First and harm reduction principles, LTS offer transitional housing and support services focused on permanent placement. While these programs may reduce racial disparities, their effectiveness in promoting racial equity remains underexplored. This study examines sociodemographic characteristics, move-out reasons by race/ethnicity, and their association with housing placement. Methods We analyzed LTS guests’ race/ethnicity, gender, age, and housing placement (January 2022–June 2024) sourced from Boston Public Health Commission systems. Disability status, earned income, and benefits data were sourced from the Homeless Management Information System. A total of 460 LTS guests (80%) had matching records and were included. Descriptive analyses were conducted by race/ethnicity and move-out reason. Competing risk multivariate models assessed associations between sociodemographic characteristics and housing placement. Results Among included guests, 24% were Hispanic, 29% Black non-Hispanic, 46% White non-Hispanic, and 4% of another race. Gender and age distributions differed by race/ethnicity but not move-out reasons. Disabilities other than SUD and benefits varied by move-out reasons but not race/ethnicity. Black guests were more likely to be placed in permanent housing (HR = 1.5, 95% CI: 1.0–2.1), as were guests with disabilities other than SUD (HR = 1.3, 95% CI: 1.0–1.6) and earned income (HR = 1.7, 95% CI: 1.0–2.7). Discussion LTS may promote equitable housing outcomes, particularly for people of color. Positive trends for Black guests highlight the potential of LTS models, but further research is needed to confirm findings and improve housing stability across diverse populations.