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this study found that individuals who were homeless had elevated odds of public crack use and rush public crack use compared to individuals who were not homeless, which is consistent with other literature that has found that homelessness is one of the strongest predictors of using injection drugs in public [ 22, 33 35 ]. among individuals who use crack in particular, rates of homelessness have been found to be disproportionately higher than individuals who use other illicit drugs [ 2 ]. therefore, one way to reduce risky public crack use may involve addressing barriers to securing stable housing among this population, such as increasing accessibility to supportive housing and housing support staff who may assist with issues such as social assistance and tenancy rights [ 22 ].


further, homelessness was also found to be positively associated with public crack smoking. the positive association between homelessness and crack use in public is consistent with several other studies that have found homelessness to be a risk factor for crack use in public [ 23, 34, 37 ]. this is perhaps due to the fact that homeless individuals may find it difficult to access health care, particularly for infectious diseases such as hepatitis c infection [ 38 ], or to access sterile injecting equipment [ 39 ], which are important for the prevention of hiv and other bloodborne pathogens. further, homeless persons are often at increased risk of drug use in public due to the heightened vulnerability to theft, and exposure to violence and victimization while experiencing homelessness [ 40, 41 ]. 84d34552a1