{"paper_id":"40e063ca-0563-49af-894f-d4d484377169","body_text":"Determinant factors amplifying climate vulnerability and their effects on the health of homeless persons: A scoping review | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Determinant factors amplifying climate vulnerability and their effects on the health of homeless persons: A scoping review José Erivelton de Souza Maciel Ferreira, Clara Beatriz Costa da Silva, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6662770/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background : Climate change has led to adverse events such as heat waves and floods, disproportionately affecting vulnerable populations, including homeless persons. These populations face challenges such as lack of access to shelters and essential resources, increasing their exposure to climate-related risks and health issues. Aim : To map the determinant factors that amplify the climate vulnerability of homeless persons, analyzing their health impacts and the barriers to adaptation and resilience. Methods : A scoping review was conducted using the PCC framework (Population, Concept, Context). The search was performed in PubMed/MEDLINE, Web of Science, Embase, Scopus, Cochrane Library, and SciELO. Studies published in multiple languages were included, with no date restrictions. Results : A total of 3,046 studies were identified, of which 38 were selected for data extraction. The mapped determinant factors were grouped into five categories: extreme weather conditions, air quality and environmental inequality, infrastructure and access to services, social and economic impacts, and health aspects. The findings highlight how these vulnerabilities are exacerbated by climate events and suggest macro-, meso-, and micro-level interventions to mitigate their effects. Conclusion : The factors amplifying the climate vulnerability of homeless persons require an integrated approach encompassing public policies, infrastructure, and healthcare practices. Targeted actions can help reduce the negative impacts of climate change on this population. Nursing Health Policy Environmental Policy ill-housed persons climate change social vulnerability Figures Figure 1 Figure 2 Figure 3 Figure 4 Introduction Climate change is reshaping global health, with extreme weather events such as heat waves and severe flooding posing unprecedented challenges [ 1 ]. These phenomena exacerbate heat-related illnesses, dehydration, respiratory conditions, and cardiovascular diseases, disproportionately affecting vulnerable populations [ 2 ]. The increasing frequency and intensity of these events underscore the urgent need for targeted public health interventions. Among the most affected groups, homeless individuals face heightened risks due to constant exposure to extreme weather, lack of adequate shelter, and limited access to essential resources such as potable water and healthcare services [ 3 , 4 ]. Chronic exposure to harsh climatic conditions, combined with preexisting health conditions, malnutrition, and inadequate medical care, significantly increases their susceptibility to climate-related health complications [ 5 ]. Climate vulnerability—defined by exposure, sensitivity, and adaptive capacity—disproportionately affects homeless populations due to their high exposure to environmental hazards, poor baseline health, and lack of access to protective infrastructure [ 3 , 5 , 6 ]. Recent studies demonstrate that these vulnerabilities are widespread across diverse geographic regions impacted by extreme weather events. For instance, McLean et al. (2024) and Hussainzad & Gou (2024) report elevated mortality rates from heat waves and cold spells, as well as increased respiratory and cardiovascular infections due to prolonged exposure to pollutants. These findings indicate that regardless of location, homelessness universally exacerbates climate vulnerability [ 7 , 8 ]. Beyond physical health, extreme weather events also have profound mental health consequences for homeless populations. Trauma from natural disasters, prolonged exposure to environmental stressors, and sudden temperature fluctuations contribute to heightened rates of depression and anxiety, further exacerbating their precarious situation [ 9 , 10 ]. Despite the growing body of research, existing studies remain largely localized and cross-sectional, limiting a comprehensive understanding of homeless individuals’ climate-related vulnerabilities. This study seeks to address this gap by providing a broader analysis of the factors that increase risk and susceptibility. By mapping these vulnerabilities, the findings will inform evidence-based policies and interventions aimed at strengthening resilience and improving healthcare strategies for this population. Ultimately, this research contributes to the development of more effective approaches to mitigate the health impacts of climate change on homeless individuals. Methods Objective and research question The objective of this scoping review was to map the key determinants that amplify the climate vulnerability faced by homeless persons. The research question was formulated using the PCC framework (Population, Concept, Context), where \"P\" represented the population—homeless persons, \"C\" denoted the concept—vulnerabilities, and \"C\" signified the context—climate change. The research question was: \"What are the climate-related vulnerabilities of homeless persons?\" The term \"vulnerabilities\" was selected as the Concept in the PCC framework because it encompasses structural conditions that increase susceptibility to climate change and hinder resilience. These determinants not only exacerbate climate vulnerability among homeless persons but also constitute vulnerabilities themselves, as they reflect systemic barriers to adaptation and health protection. Study design This scoping review followed the evidence synthesis guidelines outlined in the Joanna Briggs Institute (JBI) Manual and adhered to the methodological framework proposed by the extension for Scoping Reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) [ 11 , 12 ]. The review was conducted in four stages: (1) development of the search strategy; (2) screening and selection of studies; (3) data extraction; and (4) analysis and presentation of results. The research protocol was registered on the Open Science Framework (OSF) [ 11 ]. Inclusion and exclusion criteria The inclusion criteria encompassed studies published in multiple languages and employing diverse methodological designs, provided they fully addressed the research question and were available in full text. No time restrictions were applied to maximize the inclusion of relevant literature and historical data on climate vulnerabilities. Language bias was mitigated by including studies in languages accessible to the research team or through professional translation services when necessary. Exclusion criteria included duplicate studies, incomplete articles, research in the project phase, and studies without reported results. Data sources Data were extracted from scientific databases, including PubMed/MEDLINE, Web of Science (WoS), Embase, Scopus, Cochrane Library, and Scientific Electronic Library Online (SciELO). Additionally, the Virtual Health Library (BVS) was consulted, with all available data sources selected except for SciELO. To retrieve gray literature, WorldWideScience (WWS), a global scientific and technical research portal, was utilized. WWS provides access to various repositories, including PubMed, Science.gov, Europe PMC, ArXiv, CERN Document Server, National Agricultural Library (NAL), and NASA Technical Reports Server (NTRS). The Epistemonikos portal was also consulted to supplement the review with additional evidence. A detailed overview of the search strategies adopted is presented in Table 1 . Table 1 Presentation of the search strategies adopted. DATABASE STRATEGY PUBMED/MEDLINE (\"Homeless Persons\"[MeSH] OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\") AND (\"Climate Change\"[MeSH] OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\") AND (vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\") EMBASE ('homeless persons' OR homeless OR 'people without homes' OR 'unsheltered individuals' OR 'people experiencing homelessness' OR 'homeless populations' OR 'street people' OR 'houseless individuals' OR 'roofless people' OR 'transient populations' OR 'vulnerable populations') AND ('climate change' OR 'climatic changes' OR 'global warming' OR 'climate variability' OR 'extreme weather' OR 'environmental change' OR 'extreme heat' OR 'extreme cold' OR 'natural disasters' OR 'climate crisis' OR 'environmental hazards') AND (vulnerabilities OR risks OR susceptibilities OR 'health risks' OR 'social vulnerabilities' OR 'climate vulnerability' OR 'exposure risks' OR 'environmental risks' OR 'public health threats' OR 'disaster risks' OR 'climate impacts') Cochrane Library (\"Homeless Persons\" OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\") AND (\"Climate Change\" OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\") AND (vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\") SCOPUS (TITLE-ABS-KEY(\"Homeless Persons\" OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\")) AND (TITLE-ABS-KEY(\"Climate Change\" OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\")) AND (TITLE-ABS-KEY(vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\")) BVS (\"Homeless Persons\" OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\") AND (\"Climate Change\" OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\") AND (vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\") SCIELO (\"Homeless Persons\" OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\") AND (\"Climate Change\" OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\") AND (vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\") WOS TS=(\"Homeless Persons\" OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\") AND TS=(\"Climate Change\" OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\") AND TS=(vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\") Epistemonikos (\"Homeless Persons\" OR homeless OR \"people without homes\" OR \"unsheltered individuals\" OR \"People Experiencing Homelessness\" OR \"homeless populations\" OR \"street people\" OR \"houseless individuals\" OR \"roofless people\" OR \"transient populations\" OR \"vulnerable populations\") AND (\"Climate Change\" OR \"climatic changes\" OR \"global warming\" OR \"climate variability\" OR \"extreme weather\" OR \"environmental change\" OR \"extreme heat\" OR \"extreme cold\" OR \"natural disasters\" OR \"climate crisis\" OR \"environmental hazards\") AND (vulnerabilities OR risks OR susceptibilities OR \"health risks\" OR \"social vulnerabilities\" OR \"climate vulnerability\" OR \"exposure risks\" OR \"environmental risks\" OR \"public health threats\" OR \"disaster risks\" OR \"climate impacts\") WorldWiseScience (\"Homeless\" OR \"homeless persons\" OR \"people without homes\" OR \"unsheltered individuals\" OR \"people experiencing homelessness\") AND (\"vulnerabilities\" OR \"risks\" OR \"health risks\" OR \"climate vulnerability\") AND (\"climate change\" OR \"climate\" OR \"environmental hazards\") Study selection After executing the search strategy, the results were organized and exported to the bibliographic management software Rayyan QCRI® for study selection. The selection process was conducted in three stages by two independent and blinded reviewers, with a third reviewer (the principal investigator) resolving any disagreements. In the first stage, the reviewers screened studies based on the inclusion and exclusion criteria. Then, in the second stage, the full text of selected studies was independently evaluated. Discrepancies between reviewers were resolved through discussion or consultation with the principal investigator. The study selection process is detailed in Fig. 1 in the Results section. Results synthesis After study selection, data were extracted using a standardized form to ensure consistency. Extracted data included study methodology, population characteristics, key findings, and conclusions. A narrative synthesis approach was applied to organize the data into emerging themes and patterns. An abductive categorization method was used, wherein categories and subcategories were developed iteratively from the data while being informed by existing literature [ 13 ]. This method ensured that the categories remained flexible and aligned with the specificities of the reviewed studies [ 14 – 19 ]. The identified vulnerability categories included: (1) extreme climatic conditions, (2) air quality and environmental inequality, (3) infrastructure and access to services, (4) social and economic impacts, and (5) health aspects. The absolute frequency of these categories was calculated to quantify their occurrence across studies. To further enhance analytical depth, a network analysis was employed to map the interconnections between different vulnerability categories. This approach helped identify how these vulnerabilities interact and compound each other. Network analysis was performed using [name of software], allowing for the visualization of relationships among categories [ 20 ]. Additionally, a three-level classification—macro, meso, and micro—was applied to analyze the impact of climate-related vulnerabilities on homeless persons. This classification is widely discussed in the literature on vulnerability and disaster resilience [ 21 – 24 ], providing a structured approach to understanding different levels of susceptibility. Although not universally standardized, similar frameworks have been used in various research contexts [ 25 – 27 ]. To improve the clarity of results, tables, figures, and charts, were incorporated to provide descriptive summaries of study characteristics and key findings. Results Initially, a total of 3,046 studies were identified. After title and abstract screening, 88 studies were selected for further consideration. Subsequently, after full-text screening, 38 studies remained. Following a second full-text screening, these 38 studies were selected for data extraction, as they met the inclusion criteria. The search process is summarized in a PRISMA flow diagram in Fig. 1 (see Supplementary Material, Table 1 for more details). The articles identified in this review are notably recent, with 29 studies published in the last five years (2019–2024). The studies were conducted in eight countries, predominantly in high-income countries (6) and upper-middle-income countries (1). Only one study was conducted in a low-income country. The income levels of the countries were determined based on the World Bank classification [ 28 ]. The three countries with the highest number of studies were the United States (25), Canada (6), and Australia (2). The geographical distribution of publications per country is depicted in Fig. 2 and in the (Supplementary material, Table 1 ) [ 29 – 66 ]. The analysis of the different types of studies revealed the following counts: reviews (13), mixed methods (3), reflections (3), cohort (3), systematic reviews (2), time series analyses (3), cross-sectional studies (3), and scoping reviews (2). The remaining studies included exploratory analysis, evidence-based clinical practice, observational and analytical studies, empirical applied research, ecological time series studies, case-crossover studies, case series studies, environmental case studies, case studies, exploratory quantitative studies, and ecology studies (Supplementary material, Table 2 ) [ 29 – 66 ]. Table 2 Vulnerabilities of homeless persons related to climatic conditions. Vulnerability category Definition Mapped vulnerabilities Extreme weather conditions (n = 33) Exposure to adverse weather conditions that exceed the physical and mental adaptation capacity, leading to serious risks for the health and well-being of homeless persons. Extreme heat exposure (n = 22): Homeless persons face elevated risks of dehydration, heatstroke, and exacerbation of health conditions, such as cardiovascular diseases, during heatwaves. Extreme cold exposure (n = 10): Contributes to an increase in cases of hypothermia and other cold-related complications, exacerbating pre-existing health conditions and increasing the risk of mortality. Fluctuations in heat, cold, and rain (n = 5): Sudden changes in weather conditions increase the risk of weather-related illnesses and physical stress, hindering adaptation and management of extreme weather conditions. Extreme heat and high pollution exposure (n = 2): The combination of high temperatures and air pollution worsens respiratory and cardiovascular problems, intensifying climate-sensitive diseases in this population. Intense precipitation (n = 5): Causes flooding and increases exposure to waterborne diseases, while also hindering the maintenance of proper hygiene and health conditions. Water insecurity (n = 12): Lack of access to potable water and sanitation facilities increases the risk of infectious diseases and deteriorates the health of this population. Air quality and environmental inequality (n = 12) Disparities in access to clean and safe environmental resources, exacerbating health risks for homeless persons. Increased air pollution (n = 6): Worsens existing health problems and increases the risk of chronic respiratory diseases. Co-occurrence of heat and air pollution (n = http://dx.doi.org/10.37689/acta-ape/2024EDT013i ): Amplifies the adverse effects of heat, raising the risk of respiratory and cardiovascular issues, and hinders the ability to adapt to heat. Environmental inequality (n = 11): Lack of access to essential resources such as clean air, potable water, and basic sanitation worsens health conditions and perpetuates the marginalization of homeless persons. Infrastructure and access to services (n = 22) Lack of access to essential facilities and services, such as shelter, water, sanitation, and healthcare, especially during climate emergencies. Challenges and insecurity in WASH facilities (n = 11): The lack of adequate water, sanitation, and hygiene infrastructure increases the risk of infectious diseases and compromises overall health. Difficulties in accessing essential services (n = 7): Barriers to accessing healthcare and additional support result in inadequate treatment and limited disease prevention. Shelter deficiencies (n = 10): The lack of resources and budget constraints affect the quality and availability of shelters, exposing individuals to adverse weather conditions and increasing health risks. Lack of cooling/heating locations (n = 7): The absence of safe places to cool off or warm up during extreme weather events undermines health and well-being. Difficulty with proper clothing during snowstorms (n = 2): The lack of appropriate clothing for snowy conditions increases the risk of hypothermia and other cold-related complications. Social and economic impacts (n = 9) Negative consequences of climate change on social and economic conditions, worsening marginalization and hindering social integration and access to economic opportunities. Worsening stigma (n = 1): Climate change intensifies the stigma faced by Homeless persons, making social integration and acceptance more difficult. Barriers to conducting research (n = 4): Adverse conditions and marginalization hinder data collection and research on the needs and situation of this population. Barriers to communication and information (n = 4): Difficulties in communication and access to information about resources and services exacerbate vulnerability and social exclusion. Forced selection of commercial areas (n = 1): The need to find shelter and resources in commercial areas may increase exposure to risks and complications, as well as exacerbate marginalization. Forced geographic displacement (n = 2): Climate change and adverse conditions force individuals to relocate, making stability and safety more difficult to achieve. Delay in the transition to housing stability (n = 2): The lack of adequate conditions and worsening climate vulnerabilities delay the ability to transition to stable housing. Health aspects (n = 29) Increased risks and negative impacts on physical and mental health due to adverse climatic conditions, including the worsening of existing diseases and exposure to new risks. Unequal distribution of health emergencies (n = 3): Health emergency management is unequal, with homeless persons facing additional difficulties in accessing appropriate care during climate crises. Intensification of climate-sensitive diseases (n = 25): Extreme weather conditions exacerbate pre-existing chronic diseases, increasing the severity and frequency of symptoms. Detrimental effects related to heat (n = 25): Extreme heat can cause severe dehydration, heatstroke, and other serious health conditions, particularly for individuals without access to adequate shelter. Substance use (n = 1): Stress associated with adverse climatic conditions may lead to increased substance use, further worsening health conditions. Decompensation of NCDs and long-term impacts (n = 25): Climatic conditions can trigger the decompensation of non-communicable diseases (NCDs) and have long-term health impacts, contributing to the overall deterioration of physical and mental health. The studies were retrieved from various databases and portals, including PubMed/Medline (23), Scopus (8), EBSCO (1), National Agricultural Library (1), WOS (1), and WWS (4). Other databases were investigated, but only these provided relevant results (Supplementary material, Table 3) [ 29 – 66 ]. The scoping review identified multiple factors affecting homeless populations in relation to climatic conditions. Table 2 provides a comprehensive overview of these factors, detailing each specific aspect and demonstrating how they exacerbate preexisting vulnerabilities within this population. Additionally, it highlights the challenges faced and the number of articles addressing these vulnerabilities (see Supplementary Material, Table 4 for references). Exposure to extreme climatic conditions, such as intense heat and severe cold, represents a significant vulnerability, increasing health risks including hypothermia, dehydration, and the worsening of chronic diseases. Moreover, co-exposure to heat and air pollution intensifies respiratory problems, underscoring how these factors compound the fragility of vulnerable populations. Environmental inequality, characterized by limited access to essential resources and inadequate infrastructure, further restricts access to healthcare services and WASH (Water, Sanitation, and Hygiene) facilities, exacerbating living conditions during extreme weather events. In the social and economic sphere, stigma, communication barriers, and forced displacements heighten vulnerability and hinder the transition to stable housing. The analysis also reveals an uneven distribution of health emergencies, which worsens chronic conditions and has long-term effects on the well-being of homeless populations. To better understand the complex interactions between the determinants of climate vulnerability faced by homeless individuals, it is essential to visualize how these factors interconnect and amplify one another. Figure 3 illustrates these interrelations, depicting how they have been linked in climate change scenarios impacting homeless populations worldwide. Figure 4 presents a sunset diagram titled \"Determinants of climate vulnerability for homeless persons\", illustrating the progressive influence of various factors on this population. The diagram depicts how these determinants interact across multiple levels, ultimately reducing adaptive capacity and resilience. The factors are categorized into three hierarchical levels: macrodeterminants, mesodeterminants, and microdeterminants. Macrodeterminants encompass broad, external factors such as extreme climatic conditions and air quality disparities. These large-scale influences shape the overall environmental risks that exacerbate health challenges for homeless individuals. Mesodeterminants represent intermediary aspects, including infrastructure limitations and restricted access to essential services. These factors directly affect daily survival, constraining the availability of healthcare, shelter, and WASH (Water, Sanitation, and Hygiene) facilities, thereby intensifying exposure to environmental hazards. Microdeterminants focus on individual-level health conditions and vulnerabilities. These include chronic illnesses, mental health disorders, and acute medical conditions exacerbated by prolonged exposure to adverse climatic factors. By structuring these determinants hierarchically, the diagram highlights the interconnected nature of climate-related vulnerabilities among homeless populations. It underscores how broad systemic issues cascade into immediate, personal health risks, reinforcing cycles of vulnerability and limiting opportunities for adaptation and resilience. Discussion MACRO level: Public policies, extreme climate conditions, air quality, and environmental inequality At the MACRO level, public policies and climate change emerge as critical determinants of vulnerability among homeless populations. The findings indicate that the absence of integrated and adaptive policies significantly exacerbates their exposure to climate-related hazards. Current public policies often fail to adequately address the intersection of climate change and socioeconomic vulnerability, leaving substantial gaps in protection and support [ 31 , 67 ]. The increasing frequency and severity of extreme climate events, such as heatwaves and severe storms, further compound these challenges. The lack of a coordinated, proactive response undermines the effectiveness of existing protective measures, exposing homeless individuals to heightened risks [ 68 ]. Addressing this issue requires a holistic, climate-informed approach to public health and social assistance policies—one that explicitly incorporates climate change as a central factor in risk mitigation and emergency response strategies. Moreover, improving the integration of public policies and assistance programs is essential to ensuring a cohesive and effective response during extreme climate events. The fragmentation of policies and lack of coordination between governmental and non-governmental organizations often result in disjointed, inefficient interventions. A greater intersectoral collaboration is needed to develop and implement policies that not only acknowledge climate-related risks but also holistically address the specific vulnerabilities of homeless populations [ 29 ]. To enhance policy effectiveness, continuous assessment and monitoring must be prioritized. Implementing climate monitoring systems that incorporate real-time data on social vulnerability can enable more responsive policy adjustments. Policies must remain flexible and adaptive, evolving alongside climate trends and the shifting needs of vulnerable populations. This dynamic approach would ensure more resilient, proactive, and sustained protection for homeless individuals facing the growing threats posed by climate change [ 33 ]. MESO level: Infrastructure and access to services, social and economic impacts At the MESO level, the adequacy and accessibility of local infrastructure and services play a crucial role in mitigating the impacts of extreme climate conditions on homeless populations. However, shelters and support services often struggle to meet growing demands during extreme weather events due to overcrowding, resource shortages, and inadequate infrastructure. During heatwaves or severe cold, the number of individuals seeking refuge increases, yet many shelters already operate at full capacity. Furthermore, poor ventilation, insufficient heating, and lack of thermal insulation reduce their effectiveness in protecting against extreme temperatures. Logistical barriers, such as flooding and storm-related disruptions, further hinder access to shelters and the distribution of essential supplies. These challenges collectively weaken the responsiveness of support services, exacerbating the climate vulnerability of homeless populations [ 29 , 69 ]. Beyond infrastructure deficiencies, the location and quality of health and social support services are critical determinants of access to assistance during extreme climate events. Geographic inaccessibility significantly limits the ability of homeless individuals to seek help when they need it most. This underscores an urgent need to reassess resource allocation strategies and improve infrastructure to ensure services are effectively tailored to the specific needs of homeless populations, particularly during crises [ 33 ]. Integrating climate adaptation measures into service structures is essential for enhancing resilience. This includes upgrading shelter infrastructure by incorporating climate control systems and designated spaces adapted to different weather conditions. Equally important is ensuring that health and social services are well-distributed and easily accessible, enabling timely and equitable assistance. A collaborative approach involving local governments, non-governmental organizations, and other stakeholders is vital for developing sustainable, adaptive solutions that strengthen protection and support systems in response to climate challenges [ 33 ]. Beyond immediate infrastructure and accessibility concerns, findings highlight the need for a cohesive and proactive approach to managing services for homeless populations. Local support services, such as shelters and health programs, must develop specific contingency plans for extreme climate events. This includes establishing clear protocols to expand service capacity during crises and ensuring the availability of essential resources, such as water, food, and medications. The absence of coordinated emergency planning can result in inadequate responses, further exacerbating the hardships faced by homeless individuals [ 29 , 69 ]. Finally, inclusive policymaking and participatory approaches are essential at the MESO level. Actively engaging homeless individuals in the assessment of needs and development of solutions can provide valuable insights, improving the effectiveness of services and infrastructure. By incorporating their perspectives into decision-making processes, support systems can become more responsive and better aligned with their lived experiences, ultimately promoting greater equity and effectiveness in climate resilience strategies [ 33 ]. MICRO level: Individual experiences and health aspects At the MICRO level, extreme climate conditions have deeply personal and varied effects on homeless individuals. Finding adequate shelter during heatwaves, cold spells, and severe storms remains a persistent challenge. Prolonged exposure to these harsh conditions exacerbates preexisting health issues and creates new risks, including hypothermia, heat exhaustion, and dehydration [ 53 , 70 ]. These risks are further intensified by the lack of continuous support networks and the already precarious living conditions faced by this population. Beyond shelter insecurity, limited access to healthcare presents a critical barrier, especially during extreme weather events. Homeless individuals often face significant obstacles in obtaining medical care, such as lack of transportation, unawareness of available services, and bureaucratic hurdles (e.g., absence of identification or insurance). The inaccessibility of timely medical interventions contributes to the progression of respiratory, cardiovascular, and chronic diseases, which are further aggravated by extreme climatic conditions [ 70 ]. Addressing these disparities requires proactive strategies to ensure continuous and facilitated access to essential healthcare services, particularly during climate crises. Another factor compounding their vulnerability is the social stigma surrounding homelessness. Widespread discrimination and prejudice not only hinder access to services but also discourage individuals from seeking assistance. Fear of mistreatment or rejection can lead to self-exclusion from shelters, medical facilities, and other support systems, exacerbating their hardships during extreme weather events [ 71 ]. Tackling this issue requires inclusive, stigma-reducing initiatives that foster a more welcoming environment for homeless individuals. Additionally, the psychological toll of climate adversity on this population is profound. Chronic exposure to extreme conditions, coupled with the uncertainty of survival, contributes to heightened stress, anxiety, and depression. These mental health burdens can further deteriorate physical well-being and impair coping mechanisms, making it even more difficult for individuals to navigate daily struggles [ 53 ]. Therefore, interventions must incorporate psychological support strategies, such as mental health outreach, counseling services, and stress management programs, to bolster resilience and improve overall well-being. To effectively mitigate these challenges, comprehensive intervention strategies must address both practical and emotional barriers. Raising awareness through stigma-reduction campaigns can enhance service accessibility, ensuring that homeless individuals receive the support they need. Moreover, expanding emergency shelter capacity, integrating climate-adaptive infrastructure, and facilitating direct access to medical care are critical steps toward safeguarding this vulnerable population. Holistic, person-centered approaches are essential to minimizing harm and promoting equity in climate response efforts for homeless individuals [ 71 ]. Integration of levels: Strategies and recommendations Addressing the impacts of extreme weather conditions on homeless populations requires an integrated, multi-level approach. The MACRO, MESO, and MICRO levels must be strategically aligned to develop comprehensive, sustainable, and effective solutions. At the MACRO level, public policies should be restructured to explicitly recognize and address the heightened vulnerability of homeless individuals to climate-related risks. This includes integrating climate adaptation strategies into social protection programs, ensuring funding for emergency response initiatives, and promoting equitable access to essential services. At the MESO level, local infrastructures and service networks must be strengthened to better support homeless populations during climate crises. This requires enhancing shelter capacity, improving climate-adaptive infrastructure (e.g., cooling centers, emergency heating shelters), and ensuring uninterrupted access to healthcare and social services. Effective coordination between local governments, shelters, and healthcare providers is critical to optimizing resource allocation and response efficiency. At the MICRO level, individual factors—including health conditions, service accessibility, and social barriers—must be considered to ensure that solutions are practical and responsive to the actual needs of homeless individuals. Strategies should focus on reducing stigma, facilitating barrier-free access to healthcare, and implementing mental health and psychosocial support initiatives to enhance overall resilience. To comprehensively tackle these challenges, it is recommended to implement public policies that integrate climate monitoring with social assistance, improve support infrastructures, and create specific programs to reduce access barriers and social stigma. Collaboration between governments, non-governmental organizations, and local communities is critical to developing and implementing effective and sustainable solutions. Implications The results of this study have significant implications for public health, emergency management, social assistance policies, and urban planning, highlighting the need for adaptations in policies and practices to address extreme weather conditions affecting the homeless population. It is suggested that the creation of adequate infrastructure, such as shelters and cooling and heating centers, along with strengthening the capacities of health institutions, will be crucial to mitigate the adverse effects of these conditions. Projections indicate that integrating continuous monitoring strategies and training healthcare professionals to address risks related to heat, cold, and pollution will be essential for an effective response. Final considerations Extreme weather conditions significantly amplify the climate vulnerability of homeless populations, posing serious threats to their health and well-being. Prolonged exposure to heatwaves and extreme cold exacerbates preexisting climate-sensitive health conditions, including respiratory and cardiovascular diseases, while increasing the risk of dehydration, hypothermia, and frostbite. Additionally, floods and water scarcity heighten water insecurity and susceptibility to waterborne diseases. Beyond these direct health risks, structural and social barriers further limit the adaptation and resilience of homeless individuals by restricting access to healthcare, shelter, and essential resources needed to cope with climate impacts. The findings underscore the urgent need for targeted interventions to mitigate the adverse effects of climate change on this population. Developing climate-adaptive infrastructure, such as temperature-controlled shelters and cooling and heating centers, is critical to reducing prolonged exposure to extreme conditions. Additionally, enhancing the capacity of healthcare institutions to respond effectively to climate-related crises is essential. This includes ongoing training for healthcare professionals to equip them with the skills and knowledge necessary to address emerging climate-related health challenges in the coming decades. A coordinated, multi-level approach—integrating policy reform, infrastructure improvements, and direct support services—is essential to ensuring a more resilient, equitable, and sustainable response to the growing climate-related risks faced by homeless populations. Abbreviations CSD Climate Sensitive Diseases NCD Non-Communicable Diseases References Fowler H (2024) Rapidly intensifying extreme weather events in a warming world: how important are large-scale dynamics in generating extreme floods? EMS Annual Meeting. 10.5194/ems2024-1052 Ferreira JE, de SM, Cavalcante TF, Moreira RP (2024) Nursing care in times of climate change: towards a resilient future. Acta Paulista de Enfermagem 37. http://dx.doi.org/10.37689/acta-ape/2024EDT013i Nouri M, Ostadtaghizadeh A, Vickery J, Azami-Aghdash S, Sari AA (2024) Universal health coverage for homeless persons in disasters: a scoping review. J Social Distress Homelessness 1–17. 10.1080/10530789.2024.2310950 Koh KA, Alix A (2023) Climate-Related Disasters and Homelessness: What Psychiatrists Can Do. Psychiatric News 58(10). 10.1176/appi.pn.2023.10.10.33 Ezzatvar Y, López-Gil JF (2024) Urgent call for enhanced flood preparedness and response in Spain. Lancet 404(10470):2419–2420. 10.1016/S0140-6736(24)02506-6 Sun L, Chu J (2024) Review of research on disaster mitigation emergency congregate shelter planning for vulnerable group. J Mechatronics Artif Intell Eng 5(2):144–157. 10.21595/jmai.2024.24234 McLean KE, Lee MJ, Coker ES, Henderson SB (2024) A population-based case-control analysis of risk factors associated with mortality during the 2021 western North American heat dome: focus on chronic conditions and social vulnerability. Environ Research: Health 2(3):035010. 10.1088/2752-5309/ad5eac Hussainzad EA, Gou Z (2024) Climate Risk and Vulnerability Assessment in Informal Settlements of the Global South: A Critical Review. Land 13(9):1357. 10.3390/land13091357 Oliveira EFB, Moutinho BF, De Angeli DB, Rabelo LM, Ribeiro BRS, Santos LG et al (2024) Mental Health in the Context of Climate Change. Health Soc 4(05):283–293. 10.51249/hs.v4i05.2281 Amnuaylojaroen T, Parasin N (2024) Human Health Adaptation Strategies to Climate-Induced Extreme Weather Events: A Systematic Review. Earth 5(4):724–742. 10.3390/earth5040038 Aromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z (2024) JBI Manual for Evidence Synthesis. JBI. 10.46658/JBIMES-24-01 Tricco AC, Lillie E, Zarin W, O’Brien KK, Colquhoun H, Levac D et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 169(7):467–473. 10.7326/M18-0850 Charmaz K (2014) Constructing Grounded Theory (2nd ed.). Sage Publications. ISBN: 978-1446247395 IPCC (2022) Climate Change 2022: Impacts, Adaptation, and Vulnerability. Cambridge University Press Downing TE, Patwardhan A, Klein RJ, Mukhala E, Stephen L, Winograd M, Ziervogel (2005) G. Assessing vulnerability for climate adaptation Manangan AP, Uejio CK, Saha S, Schramm PJ, Marinucci GD, Hess JJ et al (1914) Assessing health vulnerability to climate change: a guide for health departments. Available from: https://stacks.cdc.gov/view/cdc/24906 . Accessed 16 oct 2024 Manangan AP, Uejio CK, Saha S, Schramm PJ, Marinucci GD, Hess JJ et al (2015) Assessing health vulnerability to climate change. Cent Dis Control Prev, 1–23. Available from: https://www.cdc.gov/climate-health/media/pdfs/AssessingHealthVulnerabilitytoClimateChange_1.pdf . Accessed 19 oct 2024 Nyashilu IM, Kiunsi RB, Kyessi AG (2023) Assessment of exposure, coping and adaptation strategies for elements at risk to climate change-induced flooding in urban areas. The case of Jangwani Ward in Dar es Salaam City, Tanzania. Heliyon 9(4):e15000. 10.1016/j.heliyon.2023.e15000 Kocur-Bera K, Czyża S (2023) Socio-Economic Vulnerability to Climate Change in Rural Areas in the Context of Green Energy Development—A Study of the Great Masurian Lakes Mesoregion. Int J Environ Res Public Health 20(3):2689. 10.3390/ijerph20032689 Borgatti SP, Everett MG, Johnson JC (2018) Analyzing Social Networks, 2nd edn. Sage Akhtar Z, Sajjad M, Imran M, Ofli F (2023) Risk Mapping in Managing Flood Vulnerability in Disaster Management. International Handbook of Disaster Research. Springer Nature Singapore, Singapore, pp 743–776. DOI: 10.1007/978-981-19-8388-7_177 de Souza MF, Santos ACMZ dos, de Souza MQB (2021) Employability in the bioecological model of human development in vulnerability contexts. Revista Psicologia Organizações e Trabalho. ;21(4). 10.5935/rpot/2021.4.22071 Blaikie P, Cannon T, Davis I, Wisner B (2004) At risk: natural hazards, people's vulnerability and disasters. Routledge Cutter SL, Boruff BJ, Shirley WL (2012) Social vulnerability to environmental hazards. Hazards vulnerability and environmental justice. Routledge, pp 143–160 McCormick KA, Samora J, Claborn KR, Holleran Steiker LK, DiNitto DM (2024) A systematic review of macro-, meso-, and micro-level harm reduction interventions addressing the U.S. opioid overdose epidemic. Drugs: Educ Prev Policy 1–14. 10.1080/09687637.2024.2306826 Kühl C, Skipworth HD, Bourlakis M, Aktas E (2023) The circularity of product-service systems: the role of macro-, meso- and micro-level contextual factors. Int J Oper Prod Manage 43(4):619–650. 10.1108/IJOPM-01-2022-0055 Wang C, Zhang H, Wang Y, Wu J, Kirlikovali KO, Li P et al (2023) A General Strategy for the Synthesis of Hierarchically Ordered Metal–Organic Frameworks with Tunable Macro-, Meso‐, and Micro‐Pores. Small 19(3). 10.1002/smll.202206116 World Bank. World Bank Country and Lending Groups [Internet]. The World Bank (2024) Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups . Accessed 19 oct 2024 Van Tol Z, Vanos JK, Middel A, Ferguson KM (2024) Concurrent Heat and Air Pollution Exposures among Homeless persons. Environ Health Perspect 132(1). 10.1289/EHP13402 Robertson BW, Dow K, Salinas J, Cutter SL (2024) Heat Risk Perceptions and Coping Strategies of the Unhoused. Int J Environ Res Public Health 21(6):737. 10.3390/ijerph21060737 Khoshnaw LJ, Johnson RJ, Young SE (2024) Ten tips on how to care for your CKD patients in episodes of extreme heat. Clin Kidney J 17(6). 10.1093/ckj/sfae156 Anthonj C, Mingoti Poague KIH, Fleming L, Stanglow S (2024) Invisible struggles: WASH insecurity and implications of extreme weather among urban homeless in high-income countries - A systematic scoping review. Int J Hyg Environ Health 255:114285. 10.1016/j.ijheh.2023.114285 Tetzlaff EJ, Mourad F, Goulet N, Gorman M, Siblock R, Kidd SA et al (2024) Death Is a Possibility for Those without Shelter: A Thematic Analysis of News Coverage on Homelessness and the 2021 Heat Dome in Canada. Int J Environ Res Public Health 21(4):405. 10.3390/ijerph21040405 Braun P, Lookingbill T, Zizzamia B, Hoffman J, Rosner J, Banta D (2024) A Heat Emergency: Urban Heat Exposure and Access to Refuge in Richmond, VA. GeoHealth 8(6). 10.1029/2023GH000985 Slesnick TD, Slesnick N (2024) Environmental Risks Among Youth Experiencing Homelessness: The Need for Justice. Environ Justice 17(5):369–375. 10.1089/env.2023.0034 Christensen K (2024) A Matter of Climate Justice: Heat and Air Pollution Combine to Worsen Effects of Homelessness. Environ Health Perspect 132(5). 10.1289/EHP14613 Meehan AA, Milazzo KE, Bien M, Nall SK, Vickery KD, Mosites E et al (2024) Involuntary displacement and self-reported health in a cross-sectional survey of homeless persons in Denver, Colorado, 2018–2019. BMC Public Health 24(1):1159. 10.1186/s12889-024-18681-w Seshadri S, Morgan O, Moore A, Parmar S, Schnur J, Montgomery G et al (2023) Analysis of older adult blood pressure readings and hypertension treatment rates among the unsheltered population of Miami-Dade County. 6(4):320–327 Aging medicine (Milton (NSW)). 10.1002/agm2.12272 Henry T, Khachemoune A (2023) Dermatologic conditions and risk factors in homeless persons (PEH): systematic review. Arch Dermatol Res 315(10):2795–2803. 10.1007/s00403-023-02722-2 Taylor SN, Munson D (2023) Health Care of Homeless persons: Part I. NEJM Evid 2(8). 10.1056/EVIDra2300123 du Bray Mv, Stotts R, Southee R, Wutich A (2023) Beyond Extreme: Heat Emergency and Water Insecurity for People Experiencing Houselessness in Phoenix, Arizona, USA During and After the Heatwave of 2023. Hum Ecol 51(5):799–808. 10.1007/s10745-023-00447-4 Gabbe CJ, Chang JS, Kamson M, Seo E (2023) Reducing heat risk for people experiencing unsheltered homelessness. Int J Disaster Risk Reduct 96:103904. 10.1016/j.ijdrr.2023.103904 Vega A, Carl Y, Molina-Perez X, Collazo-Malave G, Ortiz-Camacho K, Gonzalez-Burgos B et al (2024) Mental Health Assessment and Risk Characterization in Puerto Rico’s Homeless Post-Hurricane Maria. J Poverty 28(6):528–548. 10.1080/10875549.2023.2235360 Schwarz L, Castillo EM, Chan TC, Brennan JJ, Sbiroli ES, Carrasco-Escobar G et al (2022) Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012–2019. Am J Public Health 112(1):98–106. 10.2105/AJPH.2021.306557 Verbyla ME, Calderon JS, Flanigan S, Garcia M, Gersberg R, Kinoshita AM et al (2021) An Assessment of Ambient Water Quality and Challenges with Access to Water and Sanitation Services for Individuals Experiencing Homelessness in Riverine Encampments. Environ Eng Sci 38(5):389–401. 10.1089/ees.2020.0319 Anderson MC, Hazel A, Perkins J, Almquist Z (2021) The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population. Int J Environ Res Public Health 18(14):7328. 10.3390/ijerph18147328 Harlan SL, Declet-Barreto JH, Stefanov WL, Petitti DB (2013) Neighborhood Effects on Heat Deaths: Social and Environmental Predictors of Vulnerability in Maricopa County, Arizona. Environ Health Perspect 121(2):197–204. 10.1289/ehp.1104625 Pepper DA (2014) Will Homeless Populations Benefit from Global Warming? In: Clark C (ed) Homelessness: Prevalence, Impact of Social Factors and Mental Health Challenges (Social Issues, Justice and Status). Nova Science Pub Inc, UK ed. edition, pp 251–258 Nicolay M, Brown M, Johns L, Ialynytchev R (2016) A study of heat related illness preparedness in homeless veterans. Int J Disaster Risk Reduct 18:72–74. 10.1016/j.ijdrr.2016.05.009 DeMyers C, Warpinski C, Wutich A (2017) Urban Water Insecurity: A Case Study of Homelessness in Phoenix, Arizona. Environ Justice 10(3):72–80. 10.1089/env.2016.0043 Hines JZ, Jagger MA, Jeanne TL, West N, Winquist A, Robinson BF et al (2018) Heavy precipitation as a risk factor for shigellosis among homeless persons during an outbreak — Oregon, 2015–2016. J Infect 76(3):280–285. 10.1016/j.jinf.2017.11.010 Lane K, Ito K, Johnson S, Gibson EA, Tang A, Matte T (2018) Burden and Risk Factors for Cold-Related Illness and Death in New York City. Int J Environ Res Public Health 15(4):632. 10.3390/ijerph15040632 Somani R (2023) Global Warming in Pakistan and Its Impact on Public Health as Viewed Through a Health Equity Lens. Int J Social Determinants Health Health Serv 53(2):154–157. 10.1177/27551938231154467 Kidd SA, Bezgrebelna M, Hajat S, Keevers L, Ravindran A, Stergiopoulos V et al (2023) A response framework for addressing the risks of climate change for homeless populations. Clim Policy 23(5):623–636. 10.1080/14693062.2023.2194280 Bezgrebelna M, McKenzie K, Wells S, Ravindran A, Kral M, Christensen J et al (2021) Climate Change, Weather, Housing Precarity, and Homelessness: A Systematic Review of Reviews. Int J Environ Res Public Health 18(11):5812. 10.3390/ijerph18115812 Ramin B, Svoboda T (2009) Health of the Homeless and Climate Change. J Urb Health 86(4):654–664. 10.1007/s11524-009-9354-7 Crick F, Wandel J, Maclellan N, Vincent K (2013) Climate change adaptation pathways. Climate Adaptation Futures. Wiley, pp 242–253. DOI: 10.1002/9781118529577.ch23 Zhang P, Bassil K, Gower S, Katic M, Kiss A, Gogosis E et al (2019) Cold-related injuries in a cohort of homeless adults. J Social Distress Homeless 28(1):85–89. 10.1080/10530789.2018.1523103 Kidd SA, Greco S, McKenzie K (2021) Global Climate Implications for Homelessness: A Scoping Review. J Urb Health 98(3):385–393. 10.1007/s11524-020-00483-1 English T, Larkin M, Vasquez Hernandez A, Hutton J, Currie J (2022) Heat Illness Requiring Emergency Care for Homeless persons: A Case Study Series. Int J Environ Res Public Health 19(24). 10.3390/ijerph192416565 Every D, Richardson J, Osborn E (2019) There’s nowhere to go: counting the costs of extreme weather to the homeless community. Disasters 43(4):799–817. 10.1111/disa.12400 Anthonj C, Stanglow SN, Grunwald N (2024) Co-defining WASH (In)Security challenges among homeless persons. A qualitative study on the Human Right to Water and Sanitation from Bonn, Germany. Soc Sci Med 342:116561. 10.1016/j.socscimed.2024.116561 de Jesus Faleiro GT, Beray Armond N (2024) Urban Climate and the Homeless Population: Exposure, Impacts, and Strategies. Environ Justice 17(3):193–202. 10.1089/env.2022.0055 Hajat S, Sarran CE, Bezgrebelna M, Kidd SA (2023) Ambient Temperature and Emergency Hospital Admissions in Homeless persons: London, United Kingdom, 2011–2019. Am J Public Health 113(9):981–984. 10.2105/AJPH.2023.307351 Ikäheimo TM, Hassi J (2011) Frostbites in circumpolar areas. Global health action. ;4. 10.3402/gha.v4i0.8456 Grammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M et al (2021) Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 154:31–45. 10.1016/j.maturitas.2021.09.007 Moreira RP, de Oliveira FBB, de Araujo TL, Morais HCC, Cavalcante TF, Gomez MBS et al (2022) Health Interventions for Preventing Climate-Sensitive Diseases: Scoping Review. J Urb Health 99(3):519–532. 10.1007/s11524-022-00631-9 Hauer ME, Jacobs SA, Kulp SA (2024) Climate migration amplifies demographic change and population aging. Proceedings of the National Academy of Sciences. ;121(3). 10.1073/pnas.2206192119 Rathjen NA, Shahbodaghi SD, Brown JA (2019) Hypothermia and Cold Weather Injuries. American family physician, 100(11), 680–686. Available from: https://www.aafp.org/pubs/afp/issues/2019/1201/p680.html . Accessed 19 oct 2024 Leggat J, Dearman C, Bainbridge S, de Zoete E, Petrokofsky C (2024) Heatwaves and homelessness. Perspect Public Health 144(2):70–71. 10.1177/17579139231224690 Llobet-Estany M, Serrano-Miguel M, Muñoz A, Boixadós-Porquet A, Campomar B (2024) Stigma in homelessness and health care: reflections from a Housing First program in Barcelona, Spain. Salud Colectiva 20:e4826. 10.18294/sc.2024.4826 Additional Declarations The authors declare no competing interests. Supplementary Files Supplementarydocuments.docx Documentos suplementares PRISMAScRFillableChecklist10.docx Prisma DeclarationofAbsenceofFunding.docx declaração de que não houve financiamento Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {\"props\":{\"pageProps\":{\"initialData\":{\"identity\":\"rs-6662770\",\"acceptedTermsAndConditions\":true,\"allowDirectSubmit\":true,\"archivedVersions\":[],\"articleType\":\"Research Article\",\"associatedPublications\":[],\"authors\":[{\"id\":456464753,\"identity\":\"3528ba57-258b-42f6-bbdf-93fd45aaf771\",\"order_by\":0,\"name\":\"José Erivelton de Souza Maciel Ferreira\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0003-2668-7587\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"José\",\"middleName\":\"Erivelton de Souza Maciel\",\"lastName\":\"Ferreira\",\"suffix\":\"\"},{\"id\":456464755,\"identity\":\"1c17d66f-7f5b-4053-9209-87669a1fb85d\",\"order_by\":1,\"name\":\"Clara Beatriz Costa da Silva\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0002-6104-9612\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Clara\",\"middleName\":\"Beatriz Costa da\",\"lastName\":\"Silva\",\"suffix\":\"\"},{\"id\":456464756,\"identity\":\"bdb90764-24ea-4057-93da-ab254dd2b733\",\"order_by\":2,\"name\":\"Jamile Domingos do Nascimento\",\"email\":\"data:image/png;base64,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\",\"orcid\":\"https://orcid.org/0000-0001-9413-0233\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":true,\"prefix\":\"\",\"firstName\":\"Jamile\",\"middleName\":\"Domingos do\",\"lastName\":\"Nascimento\",\"suffix\":\"\"},{\"id\":456464757,\"identity\":\"e5379242-fc6d-49a2-a89d-d29d9069b671\",\"order_by\":3,\"name\":\"Caroline Evaristo Lourenço\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0002-1351-0320\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Caroline\",\"middleName\":\"Evaristo\",\"lastName\":\"Lourenço\",\"suffix\":\"\"},{\"id\":456464758,\"identity\":\"438bd88d-78df-4df4-a24d-e50e067a08d6\",\"order_by\":4,\"name\":\"Vanessa Emille Carvalho de Sousa Freire\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0003-3571-0267\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Vanessa\",\"middleName\":\"Emille Carvalho de Sousa\",\"lastName\":\"Freire\",\"suffix\":\"\"},{\"id\":456464759,\"identity\":\"60111dda-3b39-4f0d-bd91-2c3ae1c906c6\",\"order_by\":5,\"name\":\"Patrícia Freire de Vasconcelos\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0002-6158-9221\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Patrícia\",\"middleName\":\"Freire\",\"lastName\":\"de Vasconcelos\",\"suffix\":\"\"},{\"id\":456464760,\"identity\":\"72330df0-6f16-4055-8d0b-90d2c67be638\",\"order_by\":6,\"name\":\"Alexandre Cunha Costa\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0002-4771-1382\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Alexandre\",\"middleName\":\"Cunha\",\"lastName\":\"Costa\",\"suffix\":\"\"},{\"id\":456464761,\"identity\":\"3a0e361a-349f-4d97-9882-b459855c5e46\",\"order_by\":7,\"name\":\"Rafaella Pessoa Moreira\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0003-2341-7936\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Rafaella\",\"middleName\":\"Pessoa\",\"lastName\":\"Moreira\",\"suffix\":\"\"},{\"id\":456464762,\"identity\":\"59a30f4f-abd8-4086-8e16-34630bc10523\",\"order_by\":8,\"name\":\"Tahissa Frota Cavalcante\",\"email\":\"\",\"orcid\":\"https://orcid.org/0000-0002-2594-2323\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira\",\"correspondingAuthor\":false,\"prefix\":\"\",\"firstName\":\"Tahissa\",\"middleName\":\"Frota\",\"lastName\":\"Cavalcante\",\"suffix\":\"\"}],\"badges\":[],\"createdAt\":\"2025-05-14 09:41:07\",\"currentVersionCode\":1,\"declarations\":{\"humanSubjects\":false,\"vertebrateSubjects\":false,\"conflictsOfInterestStatement\":false,\"humanSubjectEthicalGuidelines\":false,\"humanSubjectConsent\":false,\"humanSubjectClinicalTrial\":false,\"humanSubjectCaseReport\":false,\"vertebrateSubjectEthicalGuidelines\":false},\"doi\":\"10.21203/rs.3.rs-6662770/v1\",\"doiUrl\":\"https://doi.org/10.21203/rs.3.rs-6662770/v1\",\"draftVersion\":[],\"editorialEvents\":[],\"editorialNote\":\"\",\"failedWorkflow\":false,\"files\":[{\"id\":82765688,\"identity\":\"55b6c745-c8e8-40e1-959f-40a355fbbbcf\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:30:25\",\"extension\":\"png\",\"order_by\":1,\"title\":\"Figure 1\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":259021,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eFlowchart of study selection based on the PRISMA-ScR framework.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure1.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/6537eee08c809fa29c4f35db.png\"},{\"id\":82765111,\"identity\":\"66cebed8-dfdb-4204-b9fe-43b353d6a1a5\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:14:25\",\"extension\":\"png\",\"order_by\":2,\"title\":\"Figure 2\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":99569,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eGeographical distribution of publications by country (2024).\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure2.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/31888f0d1a8378bf6a79696a.png\"},{\"id\":82765115,\"identity\":\"3c3a35fe-75ea-4109-8817-b69c20a4ed89\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:14:25\",\"extension\":\"png\",\"order_by\":3,\"title\":\"Figure 3\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":273518,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eRelationships between the arrangements of determinant factors that amplify climate vulnerability affecting homeless persons.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCaption:\\u003c/strong\\u003eThis entity-relationship diagram illustrates the interconnection between categories and how determinant factors in one area can exacerbate and trigger problems in others or within itself. The figure demonstrates how extreme weather conditions, air quality, and environmental inequality affect access to services and generate social and economic impacts, directly reflecting on the health of homeless persons. This diagram provides a deeper understanding of the complex interactions and vulnerabilities that impact health, both directly and indirectly.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cem\\u003eNote\\u003c/em\\u003e: NCD – Non-Communicable Diseases.\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure3.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/20c0d591f52b3b2cd3e79621.png\"},{\"id\":82765689,\"identity\":\"4187a42e-6f7f-4675-abe6-8445ef2a49b5\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:30:25\",\"extension\":\"png\",\"order_by\":4,\"title\":\"Figure 4\",\"display\":\"\",\"copyAsset\":false,\"role\":\"figure\",\"size\":2009845,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDeterminants of climate vulnerability for homeless persons.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eCaption\\u003c/strong\\u003e: The diagram highlights the interaction and overlap of these layers, showing how determining factors overlap and intensify the living conditions, health, and well-being of this population. The arrows in the diagram indicate the direct relationships between the layers and their cumulative effects on the health and well-being of individuals\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Figure4.png\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/c58619d7ddfaad0607a8d40c.png\"},{\"id\":82766019,\"identity\":\"bd56ef17-9c58-4002-9e29-46e488691378\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:38:32\",\"extension\":\"pdf\",\"order_by\":0,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"manuscript-pdf\",\"size\":2716444,\"visible\":true,\"origin\":\"\",\"legend\":\"\",\"description\":\"\",\"filename\":\"manuscript.pdf\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/5e355fcf-6ada-45ba-a824-6783d8fdc620.pdf\"},{\"id\":82765119,\"identity\":\"5270ab3c-b94b-4379-a334-08d4195a013c\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:14:25\",\"extension\":\"docx\",\"order_by\":1,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":362246,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003eDocumentos suplementares\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"Supplementarydocuments.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/e42b56630522d96b0ac455f7.docx\"},{\"id\":82765303,\"identity\":\"b2e89cef-fc6e-47f1-b622-d5244c42e784\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:22:25\",\"extension\":\"docx\",\"order_by\":2,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":110891,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003ePrisma\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"PRISMAScRFillableChecklist10.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/45530dda5b71ecf8c473414f.docx\"},{\"id\":82765300,\"identity\":\"40360bf2-b3fb-4e08-bdb2-d2b0ba86a537\",\"added_by\":\"auto\",\"created_at\":\"2025-05-15 04:22:25\",\"extension\":\"docx\",\"order_by\":3,\"title\":\"\",\"display\":\"\",\"copyAsset\":false,\"role\":\"supplement\",\"size\":26865,\"visible\":true,\"origin\":\"\",\"legend\":\"\\u003cp\\u003edeclaração de que não houve financiamento\\u003c/p\\u003e\",\"description\":\"\",\"filename\":\"DeclarationofAbsenceofFunding.docx\",\"url\":\"https://assets-eu.researchsquare.com/files/rs-6662770/v1/5188c91477bda0cff4ec509f.docx\"}],\"financialInterests\":\"The authors declare no competing interests.\",\"formattedTitle\":\"\\u003cp\\u003e\\u003cstrong\\u003eDeterminant factors amplifying climate vulnerability and their effects on the health of homeless persons: A scoping review\\u003c/strong\\u003e\\u003c/p\\u003e\",\"fulltext\":[{\"header\":\"Introduction\",\"content\":\"\\u003cp\\u003eClimate change is reshaping global health, with extreme weather events such as heat waves and severe flooding posing unprecedented challenges [\\u003cspan citationid=\\\"CR1\\\" class=\\\"CitationRef\\\"\\u003e1\\u003c/span\\u003e]. These phenomena exacerbate heat-related illnesses, dehydration, respiratory conditions, and cardiovascular diseases, disproportionately affecting vulnerable populations [\\u003cspan citationid=\\\"CR2\\\" class=\\\"CitationRef\\\"\\u003e2\\u003c/span\\u003e]. The increasing frequency and intensity of these events underscore the urgent need for targeted public health interventions.\\u003c/p\\u003e \\u003cp\\u003eAmong the most affected groups, homeless individuals face heightened risks due to constant exposure to extreme weather, lack of adequate shelter, and limited access to essential resources such as potable water and healthcare services [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR4\\\" class=\\\"CitationRef\\\"\\u003e4\\u003c/span\\u003e]. Chronic exposure to harsh climatic conditions, combined with preexisting health conditions, malnutrition, and inadequate medical care, significantly increases their susceptibility to climate-related health complications [\\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eClimate vulnerability\\u0026mdash;defined by exposure, sensitivity, and adaptive capacity\\u0026mdash;disproportionately affects homeless populations due to their high exposure to environmental hazards, poor baseline health, and lack of access to protective infrastructure [\\u003cspan citationid=\\\"CR3\\\" class=\\\"CitationRef\\\"\\u003e3\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR5\\\" class=\\\"CitationRef\\\"\\u003e5\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR6\\\" class=\\\"CitationRef\\\"\\u003e6\\u003c/span\\u003e]. Recent studies demonstrate that these vulnerabilities are widespread across diverse geographic regions impacted by extreme weather events. For instance, McLean et al. (2024) and Hussainzad \\u0026amp; Gou (2024) report elevated mortality rates from heat waves and cold spells, as well as increased respiratory and cardiovascular infections due to prolonged exposure to pollutants. These findings indicate that regardless of location, homelessness universally exacerbates climate vulnerability [\\u003cspan citationid=\\\"CR7\\\" class=\\\"CitationRef\\\"\\u003e7\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR8\\\" class=\\\"CitationRef\\\"\\u003e8\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eBeyond physical health, extreme weather events also have profound mental health consequences for homeless populations. Trauma from natural disasters, prolonged exposure to environmental stressors, and sudden temperature fluctuations contribute to heightened rates of depression and anxiety, further exacerbating their precarious situation [\\u003cspan citationid=\\\"CR9\\\" class=\\\"CitationRef\\\"\\u003e9\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR10\\\" class=\\\"CitationRef\\\"\\u003e10\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eDespite the growing body of research, existing studies remain largely localized and cross-sectional, limiting a comprehensive understanding of homeless individuals\\u0026rsquo; climate-related vulnerabilities. This study seeks to address this gap by providing a broader analysis of the factors that increase risk and susceptibility. By mapping these vulnerabilities, the findings will inform evidence-based policies and interventions aimed at strengthening resilience and improving healthcare strategies for this population. Ultimately, this research contributes to the development of more effective approaches to mitigate the health impacts of climate change on homeless individuals.\\u003c/p\\u003e\"},{\"header\":\"Methods\",\"content\":\"\\u003cdiv id=\\\"Sec3\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eObjective and research question\\u003c/h2\\u003e \\u003cp\\u003eThe objective of this scoping review was to map the key determinants that amplify the climate vulnerability faced by homeless persons. The research question was formulated using the PCC framework (Population, Concept, Context), where \\\"P\\\" represented the population\\u0026mdash;homeless persons, \\\"C\\\" denoted the concept\\u0026mdash;vulnerabilities, and \\\"C\\\" signified the context\\u0026mdash;climate change. The research question was: \\\"What are the climate-related vulnerabilities of homeless persons?\\\"\\u003c/p\\u003e \\u003cp\\u003eThe term \\\"vulnerabilities\\\" was selected as the Concept in the PCC framework because it encompasses structural conditions that increase susceptibility to climate change and hinder resilience. These determinants not only exacerbate climate vulnerability among homeless persons but also constitute vulnerabilities themselves, as they reflect systemic barriers to adaptation and health protection.\\u003c/p\\u003e \\u003c/div\\u003e\\n\\u003ch3\\u003eStudy design\\u003c/h3\\u003e\\n\\u003cp\\u003eThis scoping review followed the evidence synthesis guidelines outlined in the Joanna Briggs Institute (JBI) Manual and adhered to the methodological framework proposed by the extension for Scoping Reviews of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-ScR) [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR12\\\" class=\\\"CitationRef\\\"\\u003e12\\u003c/span\\u003e]. The review was conducted in four stages: (1) development of the search strategy; (2) screening and selection of studies; (3) data extraction; and (4) analysis and presentation of results. The research protocol was registered on the Open Science Framework (OSF) [\\u003cspan citationid=\\\"CR11\\\" class=\\\"CitationRef\\\"\\u003e11\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003ch3\\u003eInclusion and exclusion criteria\\u003c/h3\\u003e\\n\\u003cp\\u003eThe inclusion criteria encompassed studies published in multiple languages and employing diverse methodological designs, provided they fully addressed the research question and were available in full text. No time restrictions were applied to maximize the inclusion of relevant literature and historical data on climate vulnerabilities. Language bias was mitigated by including studies in languages accessible to the research team or through professional translation services when necessary. Exclusion criteria included duplicate studies, incomplete articles, research in the project phase, and studies without reported results.\\u003c/p\\u003e\\n\\u003ch3\\u003eData sources\\u003c/h3\\u003e\\n\\u003cp\\u003eData were extracted from scientific databases, including PubMed/MEDLINE, Web of Science (WoS), Embase, Scopus, Cochrane Library, and Scientific Electronic Library Online (SciELO). Additionally, the Virtual Health Library (BVS) was consulted, with all available data sources selected except for SciELO.\\u003c/p\\u003e \\u003cp\\u003eTo retrieve gray literature, WorldWideScience (WWS), a global scientific and technical research portal, was utilized. WWS provides access to various repositories, including PubMed, Science.gov, Europe PMC, ArXiv, CERN Document Server, National Agricultural Library (NAL), and NASA Technical Reports Server (NTRS). The Epistemonikos portal was also consulted to supplement the review with additional evidence. A detailed overview of the search strategies adopted is presented in Table\\u0026nbsp;\\u003cspan refid=\\\"Tab1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e.\\u003c/p\\u003e \\u003cp\\u003e \\u003cdiv class=\\\"gridtable\\\"\\u003e\\u003ctable float=\\\"Yes\\\" id=\\\"Tab1\\\" border=\\\"1\\\"\\u003e \\u003ccaption language=\\\"En\\\"\\u003e \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 1\\u003c/div\\u003e \\u003cdiv class=\\\"CaptionContent\\\"\\u003e \\u003cp\\u003ePresentation of the search strategies adopted.\\u003c/p\\u003e \\u003c/div\\u003e \\u003c/caption\\u003e \\u003ccolgroup cols=\\\"2\\\"\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c1\\\" colnum=\\\"1\\\"\\u003e\\u003c/div\\u003e \\u003cdiv align=\\\"left\\\" class=\\\"colspec\\\" colname=\\\"c2\\\" colnum=\\\"2\\\"\\u003e\\u003c/div\\u003e \\u003cthead\\u003e \\u003ctr\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003eDATABASE\\u003c/p\\u003e \\u003c/th\\u003e \\u003cth align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eSTRATEGY\\u003c/p\\u003e \\u003c/th\\u003e \\u003c/tr\\u003e \\u003c/thead\\u003e \\u003ctbody\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003ePUBMED/MEDLINE\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(\\\"Homeless Persons\\\"[MeSH] OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\") AND (\\\"Climate Change\\\"[MeSH] OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\") AND (vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEMBASE\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e('homeless persons' OR homeless OR 'people without homes' OR 'unsheltered individuals' OR 'people experiencing homelessness' OR 'homeless populations' OR 'street people' OR 'houseless individuals' OR 'roofless people' OR 'transient populations' OR 'vulnerable populations') AND ('climate change' OR 'climatic changes' OR 'global warming' OR 'climate variability' OR 'extreme weather' OR 'environmental change' OR 'extreme heat' OR 'extreme cold' OR 'natural disasters' OR 'climate crisis' OR 'environmental hazards') AND (vulnerabilities OR risks OR susceptibilities OR 'health risks' OR 'social vulnerabilities' OR 'climate vulnerability' OR 'exposure risks' OR 'environmental risks' OR 'public health threats' OR 'disaster risks' OR 'climate impacts')\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eCochrane Library\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(\\\"Homeless Persons\\\" OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\") AND (\\\"Climate Change\\\" OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\") AND (vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSCOPUS\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(TITLE-ABS-KEY(\\\"Homeless Persons\\\" OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\")) AND (TITLE-ABS-KEY(\\\"Climate Change\\\" OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\")) AND (TITLE-ABS-KEY(vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\"))\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eBVS\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(\\\"Homeless Persons\\\" OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\") AND (\\\"Climate Change\\\" OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\") AND (vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eSCIELO\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(\\\"Homeless Persons\\\" OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\") AND (\\\"Climate Change\\\" OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\") AND (vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eWOS\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003eTS=(\\\"Homeless Persons\\\" OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\") AND TS=(\\\"Climate Change\\\" OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\") AND TS=(vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eEpistemonikos\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(\\\"Homeless Persons\\\" OR homeless OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"People Experiencing Homelessness\\\" OR \\\"homeless populations\\\" OR \\\"street people\\\" OR \\\"houseless individuals\\\" OR \\\"roofless people\\\" OR \\\"transient populations\\\" OR \\\"vulnerable populations\\\") AND (\\\"Climate Change\\\" OR \\\"climatic changes\\\" OR \\\"global warming\\\" OR \\\"climate variability\\\" OR \\\"extreme weather\\\" OR \\\"environmental change\\\" OR \\\"extreme heat\\\" OR \\\"extreme cold\\\" OR \\\"natural disasters\\\" OR \\\"climate crisis\\\" OR \\\"environmental hazards\\\") AND (vulnerabilities OR risks OR susceptibilities OR \\\"health risks\\\" OR \\\"social vulnerabilities\\\" OR \\\"climate vulnerability\\\" OR \\\"exposure risks\\\" OR \\\"environmental risks\\\" OR \\\"public health threats\\\" OR \\\"disaster risks\\\" OR \\\"climate impacts\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003ctr\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c1\\\"\\u003e \\u003cp\\u003e\\u003cb\\u003eWorldWiseScience\\u003c/b\\u003e\\u003c/p\\u003e \\u003c/td\\u003e \\u003ctd align=\\\"left\\\" colname=\\\"c2\\\"\\u003e \\u003cp\\u003e(\\\"Homeless\\\" OR \\\"homeless persons\\\" OR \\\"people without homes\\\" OR \\\"unsheltered individuals\\\" OR \\\"people experiencing homelessness\\\") AND (\\\"vulnerabilities\\\" OR \\\"risks\\\" OR \\\"health risks\\\" OR \\\"climate vulnerability\\\") AND (\\\"climate change\\\" OR \\\"climate\\\" OR \\\"environmental hazards\\\")\\u003c/p\\u003e \\u003c/td\\u003e \\u003c/tr\\u003e \\u003c/tbody\\u003e \\u003c/colgroup\\u003e \\u003c/table\\u003e\\u003c/div\\u003e \\u003c/p\\u003e\\n\\u003ch3\\u003eStudy selection\\u003c/h3\\u003e\\n\\u003cp\\u003eAfter executing the search strategy, the results were organized and exported to the bibliographic management software Rayyan QCRI\\u0026reg; for study selection. The selection process was conducted in three stages by two independent and blinded reviewers, with a third reviewer (the principal investigator) resolving any disagreements.\\u003c/p\\u003e \\u003cp\\u003eIn the first stage, the reviewers screened studies based on the inclusion and exclusion criteria. Then, in the second stage, the full text of selected studies was independently evaluated. Discrepancies between reviewers were resolved through discussion or consultation with the principal investigator. The study selection process is detailed in Fig.\\u0026nbsp;\\u003cspan refid=\\\"Fig1\\\" class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e in the Results section.\\u003c/p\\u003e \\u003cdiv id=\\\"Sec8\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eResults synthesis\\u003c/h2\\u003e \\u003cp\\u003eAfter study selection, data were extracted using a standardized form to ensure consistency. Extracted data included study methodology, population characteristics, key findings, and conclusions.\\u003c/p\\u003e \\u003cp\\u003eA narrative synthesis approach was applied to organize the data into emerging themes and patterns. An abductive categorization method was used, wherein categories and subcategories were developed iteratively from the data while being informed by existing literature [\\u003cspan citationid=\\\"CR13\\\" class=\\\"CitationRef\\\"\\u003e13\\u003c/span\\u003e]. This method ensured that the categories remained flexible and aligned with the specificities of the reviewed studies [\\u003cspan additionalcitationids=\\\"CR15 CR16 CR17 CR18\\\" citationid=\\\"CR14\\\" class=\\\"CitationRef\\\"\\u003e14\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR19\\\" class=\\\"CitationRef\\\"\\u003e19\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe identified vulnerability categories included: (1) extreme climatic conditions, (2) air quality and environmental inequality, (3) infrastructure and access to services, (4) social and economic impacts, and (5) health aspects. The absolute frequency of these categories was calculated to quantify their occurrence across studies.\\u003c/p\\u003e \\u003cp\\u003eTo further enhance analytical depth, a network analysis was employed to map the interconnections between different vulnerability categories. This approach helped identify how these vulnerabilities interact and compound each other. Network analysis was performed using [name of software], allowing for the visualization of relationships among categories [\\u003cspan citationid=\\\"CR20\\\" class=\\\"CitationRef\\\"\\u003e20\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eAdditionally, a three-level classification\\u0026mdash;macro, meso, and micro\\u0026mdash;was applied to analyze the impact of climate-related vulnerabilities on homeless persons. This classification is widely discussed in the literature on vulnerability and disaster resilience [\\u003cspan additionalcitationids=\\\"CR22 CR23\\\" citationid=\\\"CR21\\\" class=\\\"CitationRef\\\"\\u003e21\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR24\\\" class=\\\"CitationRef\\\"\\u003e24\\u003c/span\\u003e], providing a structured approach to understanding different levels of susceptibility. Although not universally standardized, similar frameworks have been used in various research contexts [\\u003cspan additionalcitationids=\\\"CR26\\\" citationid=\\\"CR25\\\" class=\\\"CitationRef\\\"\\u003e25\\u003c/span\\u003e\\u0026ndash;\\u003cspan citationid=\\\"CR27\\\" class=\\\"CitationRef\\\"\\u003e27\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eTo improve the clarity of results, tables, figures, and charts, were incorporated to provide descriptive summaries of study characteristics and key findings.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Results\",\"content\":\"\\u003cp\\u003eInitially, a total of 3,046 studies were identified. After title and abstract screening, 88 studies were selected for further consideration. Subsequently, after full-text screening, 38 studies remained. Following a second full-text screening, these 38 studies were selected for data extraction, as they met the inclusion criteria. The search process is summarized in a PRISMA flow diagram in Fig.\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e (see Supplementary Material, Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e for more details).\\u003c/p\\u003e\\n\\u003cp\\u003eThe articles identified in this review are notably recent, with 29 studies published in the last five years (2019\\u0026ndash;2024). The studies were conducted in eight countries, predominantly in high-income countries (6) and upper-middle-income countries (1). Only one study was conducted in a low-income country. The income levels of the countries were determined based on the World Bank classification [\\u003cspan class=\\\"CitationRef\\\"\\u003e28\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003cp\\u003eThe three countries with the highest number of studies were the United States (25), Canada (6), and Australia (2). The geographical distribution of publications per country is depicted in Fig. \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e and in the (Supplementary material, Table \\u003cspan class=\\\"InternalRef\\\"\\u003e1\\u003c/span\\u003e) [\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003cp\\u003eThe analysis of the different types of studies revealed the following counts: reviews (13), mixed methods (3), reflections (3), cohort (3), systematic reviews (2), time series analyses (3), cross-sectional studies (3), and scoping reviews (2). The remaining studies included exploratory analysis, evidence-based clinical practice, observational and analytical studies, empirical applied research, ecological time series studies, case-crossover studies, case series studies, environmental case studies, case studies, exploratory quantitative studies, and ecology studies (Supplementary material, Table \\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e) [\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003cdiv class=\\\"gridtable\\\"\\u003e\\n \\u003ctable id=\\\"Tab2\\\" border=\\\"1\\\"\\u003e\\n \\u003ccaption\\u003e\\n \\u003cdiv class=\\\"CaptionNumber\\\"\\u003eTable 2\\u003c/div\\u003e\\n \\u003cdiv class=\\\"CaptionContent\\\"\\u003e\\n \\u003cp\\u003eVulnerabilities of homeless persons related to climatic conditions.\\u003c/p\\u003e\\n \\u003c/div\\u003e\\n \\u003c/caption\\u003e\\n \\u003cthead\\u003e\\n \\u003ctr\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eVulnerability category\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDefinition\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003cth align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eMapped vulnerabilities\\u003c/p\\u003e\\n \\u003c/th\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/thead\\u003e\\n \\u003ctbody\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eExtreme weather conditions (n\\u0026thinsp;=\\u0026thinsp;33)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eExposure to adverse weather conditions that exceed the physical and mental adaptation capacity, leading to serious risks for the health and well-being of homeless persons.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eExtreme heat exposure (n\\u0026thinsp;=\\u0026thinsp;22): Homeless persons face elevated risks of dehydration, heatstroke, and exacerbation of health conditions, such as cardiovascular diseases, during heatwaves.\\u003c/p\\u003e\\n \\u003cp\\u003eExtreme cold exposure (n\\u0026thinsp;=\\u0026thinsp;10): Contributes to an increase in cases of hypothermia and other cold-related complications, exacerbating pre-existing health conditions and increasing the risk of mortality.\\u003c/p\\u003e\\n \\u003cp\\u003eFluctuations in heat, cold, and rain (n\\u0026thinsp;=\\u0026thinsp;5): Sudden changes in weather conditions increase the risk of weather-related illnesses and physical stress, hindering adaptation and management of extreme weather conditions.\\u003c/p\\u003e\\n \\u003cp\\u003eExtreme heat and high pollution exposure (n\\u0026thinsp;=\\u0026thinsp;2): The combination of high temperatures and air pollution worsens respiratory and cardiovascular problems, intensifying climate-sensitive diseases in this population.\\u003c/p\\u003e\\n \\u003cp\\u003eIntense precipitation (n\\u0026thinsp;=\\u0026thinsp;5): Causes flooding and increases exposure to waterborne diseases, while also hindering the maintenance of proper hygiene and health conditions.\\u003c/p\\u003e\\n \\u003cp\\u003eWater insecurity (n\\u0026thinsp;=\\u0026thinsp;12): Lack of access to potable water and sanitation facilities increases the risk of infectious diseases and deteriorates the health of this population.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eAir quality and environmental inequality (n\\u0026thinsp;=\\u0026thinsp;12)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eDisparities in access to clean and safe environmental resources, exacerbating health risks for homeless persons.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIncreased air pollution (n\\u0026thinsp;=\\u0026thinsp;6): Worsens existing health problems and increases the risk of chronic respiratory diseases.\\u003c/p\\u003e\\n \\u003cp\\u003eCo-occurrence of heat and air pollution (n\\u0026thinsp;=\\u0026thinsp;\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttp://dx.doi.org/10.37689/acta-ape/2024EDT013i\\u003c/span\\u003e\\u003c/span\\u003e): Amplifies the adverse effects of heat, raising the risk of respiratory and cardiovascular issues, and hinders the ability to adapt to heat.\\u003c/p\\u003e\\n \\u003cp\\u003eEnvironmental inequality (n\\u0026thinsp;=\\u0026thinsp;11): Lack of access to essential resources such as clean air, potable water, and basic sanitation worsens health conditions and perpetuates the marginalization of homeless persons.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eInfrastructure and access to services\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;22)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eLack of access to essential facilities and services, such as shelter, water, sanitation, and healthcare, especially during climate emergencies.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eChallenges and insecurity in WASH facilities (n\\u0026thinsp;=\\u0026thinsp;11): The lack of adequate water, sanitation, and hygiene infrastructure increases the risk of infectious diseases and compromises overall health.\\u003c/p\\u003e\\n \\u003cp\\u003eDifficulties in accessing essential services (n\\u0026thinsp;=\\u0026thinsp;7): Barriers to accessing healthcare and additional support result in inadequate treatment and limited disease prevention.\\u003c/p\\u003e\\n \\u003cp\\u003eShelter deficiencies (n\\u0026thinsp;=\\u0026thinsp;10): The lack of resources and budget constraints affect the quality and availability of shelters, exposing individuals to adverse weather conditions and increasing health risks.\\u003c/p\\u003e\\n \\u003cp\\u003eLack of cooling/heating locations (n\\u0026thinsp;=\\u0026thinsp;7): The absence of safe places to cool off or warm up during extreme weather events undermines health and well-being.\\u003c/p\\u003e\\n \\u003cp\\u003eDifficulty with proper clothing during snowstorms (n\\u0026thinsp;=\\u0026thinsp;2): The lack of appropriate clothing for snowy conditions increases the risk of hypothermia and other cold-related complications.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eSocial and economic impacts\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;9)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eNegative consequences of climate change on social and economic conditions, worsening marginalization and hindering social integration and access to economic opportunities.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eWorsening stigma (n\\u0026thinsp;=\\u0026thinsp;1): Climate change intensifies the stigma faced by Homeless persons, making social integration and acceptance more difficult.\\u003c/p\\u003e\\n \\u003cp\\u003eBarriers to conducting research (n\\u0026thinsp;=\\u0026thinsp;4): Adverse conditions and marginalization hinder data collection and research on the needs and situation of this population.\\u003c/p\\u003e\\n \\u003cp\\u003eBarriers to communication and information (n\\u0026thinsp;=\\u0026thinsp;4): Difficulties in communication and access to information about resources and services exacerbate vulnerability and social exclusion.\\u003c/p\\u003e\\n \\u003cp\\u003eForced selection of commercial areas (n\\u0026thinsp;=\\u0026thinsp;1): The need to find shelter and resources in commercial areas may increase exposure to risks and complications, as well as exacerbate marginalization.\\u003c/p\\u003e\\n \\u003cp\\u003eForced geographic displacement (n\\u0026thinsp;=\\u0026thinsp;2): Climate change and adverse conditions force individuals to relocate, making stability and safety more difficult to achieve.\\u003c/p\\u003e\\n \\u003cp\\u003eDelay in the transition to housing stability (n\\u0026thinsp;=\\u0026thinsp;2): The lack of adequate conditions and worsening climate vulnerabilities delay the ability to transition to stable housing.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003ctr\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eHealth aspects\\u003c/p\\u003e\\n \\u003cp\\u003e(n\\u0026thinsp;=\\u0026thinsp;29)\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eIncreased risks and negative impacts on physical and mental health due to adverse climatic conditions, including the worsening of existing diseases and exposure to new risks.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003ctd align=\\\"left\\\"\\u003e\\n \\u003cp\\u003eUnequal distribution of health emergencies (n\\u0026thinsp;=\\u0026thinsp;3): Health emergency management is unequal, with homeless persons facing additional difficulties in accessing appropriate care during climate crises.\\u003c/p\\u003e\\n \\u003cp\\u003eIntensification of climate-sensitive diseases (n\\u0026thinsp;=\\u0026thinsp;25): Extreme weather conditions exacerbate pre-existing chronic diseases, increasing the severity and frequency of symptoms.\\u003c/p\\u003e\\n \\u003cp\\u003eDetrimental effects related to heat (n\\u0026thinsp;=\\u0026thinsp;25): Extreme heat can cause severe dehydration, heatstroke, and other serious health conditions, particularly for individuals without access to adequate shelter.\\u003c/p\\u003e\\n \\u003cp\\u003eSubstance use (n\\u0026thinsp;=\\u0026thinsp;1): Stress associated with adverse climatic conditions may lead to increased substance use, further worsening health conditions.\\u003c/p\\u003e\\n \\u003cp\\u003eDecompensation of NCDs and long-term impacts (n\\u0026thinsp;=\\u0026thinsp;25): Climatic conditions can trigger the decompensation of non-communicable diseases (NCDs) and have long-term health impacts, contributing to the overall deterioration of physical and mental health.\\u003c/p\\u003e\\n \\u003c/td\\u003e\\n \\u003c/tr\\u003e\\n \\u003c/tbody\\u003e\\n \\u003c/table\\u003e\\n\\u003c/div\\u003e\\n\\u003cp\\u003eThe studies were retrieved from various databases and portals, including PubMed/Medline (23), Scopus (8), EBSCO (1), National Agricultural Library (1), WOS (1), and WWS (4). Other databases were investigated, but only these provided relevant results (Supplementary material, Table\\u0026nbsp;3) [\\u003cspan class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e\\u0026ndash;\\u003cspan class=\\\"CitationRef\\\"\\u003e66\\u003c/span\\u003e].\\u003c/p\\u003e\\n\\u003cp\\u003eThe scoping review identified multiple factors affecting homeless populations in relation to climatic conditions. Table\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e2\\u003c/span\\u003e provides a comprehensive overview of these factors, detailing each specific aspect and demonstrating how they exacerbate preexisting vulnerabilities within this population. Additionally, it highlights the challenges faced and the number of articles addressing these vulnerabilities (see Supplementary Material, Table\\u0026nbsp;4 for references).\\u003c/p\\u003e\\n\\u003cp\\u003eExposure to extreme climatic conditions, such as intense heat and severe cold, represents a significant vulnerability, increasing health risks including hypothermia, dehydration, and the worsening of chronic diseases. Moreover, co-exposure to heat and air pollution intensifies respiratory problems, underscoring how these factors compound the fragility of vulnerable populations.\\u003c/p\\u003e\\n\\u003cp\\u003eEnvironmental inequality, characterized by limited access to essential resources and inadequate infrastructure, further restricts access to healthcare services and WASH (Water, Sanitation, and Hygiene) facilities, exacerbating living conditions during extreme weather events. In the social and economic sphere, stigma, communication barriers, and forced displacements heighten vulnerability and hinder the transition to stable housing.\\u003c/p\\u003e\\n\\u003cp\\u003eThe analysis also reveals an uneven distribution of health emergencies, which worsens chronic conditions and has long-term effects on the well-being of homeless populations. To better understand the complex interactions between the determinants of climate vulnerability faced by homeless individuals, it is essential to visualize how these factors interconnect and amplify one another. Figure\\u0026nbsp;\\u003cspan class=\\\"InternalRef\\\"\\u003e3\\u003c/span\\u003e illustrates these interrelations, depicting how they have been linked in climate change scenarios impacting homeless populations worldwide.\\u003c/p\\u003e\\n\\u003cp\\u003eFigure \\u003cspan class=\\\"InternalRef\\\"\\u003e4\\u003c/span\\u003e presents a sunset diagram titled \\u0026quot;Determinants of climate vulnerability for homeless persons\\u0026quot;, illustrating the progressive influence of various factors on this population. The diagram depicts how these determinants interact across multiple levels, ultimately reducing adaptive capacity and resilience. The factors are categorized into three hierarchical levels: macrodeterminants, mesodeterminants, and microdeterminants.\\u003c/p\\u003e\\n\\u003cp\\u003eMacrodeterminants encompass broad, external factors such as extreme climatic conditions and air quality disparities. These large-scale influences shape the overall environmental risks that exacerbate health challenges for homeless individuals.\\u003c/p\\u003e\\n\\u003cp\\u003eMesodeterminants represent intermediary aspects, including infrastructure limitations and restricted access to essential services. These factors directly affect daily survival, constraining the availability of healthcare, shelter, and WASH (Water, Sanitation, and Hygiene) facilities, thereby intensifying exposure to environmental hazards.\\u003c/p\\u003e\\n\\u003cp\\u003eMicrodeterminants focus on individual-level health conditions and vulnerabilities. These include chronic illnesses, mental health disorders, and acute medical conditions exacerbated by prolonged exposure to adverse climatic factors.\\u003c/p\\u003e\\n\\u003cp\\u003eBy structuring these determinants hierarchically, the diagram highlights the interconnected nature of climate-related vulnerabilities among homeless populations. It underscores how broad systemic issues cascade into immediate, personal health risks, reinforcing cycles of vulnerability and limiting opportunities for adaptation and resilience.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u0026nbsp;\\u003c/p\\u003e\"},{\"header\":\"Discussion\",\"content\":\"\\u003cdiv id=\\\"Sec11\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMACRO level: Public policies, extreme climate conditions, air quality, and environmental inequality\\u003c/h2\\u003e \\u003cp\\u003eAt the MACRO level, public policies and climate change emerge as critical determinants of vulnerability among homeless populations. The findings indicate that the absence of integrated and adaptive policies significantly exacerbates their exposure to climate-related hazards. Current public policies often fail to adequately address the intersection of climate change and socioeconomic vulnerability, leaving substantial gaps in protection and support [\\u003cspan citationid=\\\"CR31\\\" class=\\\"CitationRef\\\"\\u003e31\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR67\\\" class=\\\"CitationRef\\\"\\u003e67\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eThe increasing frequency and severity of extreme climate events, such as heatwaves and severe storms, further compound these challenges. The lack of a coordinated, proactive response undermines the effectiveness of existing protective measures, exposing homeless individuals to heightened risks [\\u003cspan citationid=\\\"CR68\\\" class=\\\"CitationRef\\\"\\u003e68\\u003c/span\\u003e]. Addressing this issue requires a holistic, climate-informed approach to public health and social assistance policies\\u0026mdash;one that explicitly incorporates climate change as a central factor in risk mitigation and emergency response strategies.\\u003c/p\\u003e \\u003cp\\u003eMoreover, improving the integration of public policies and assistance programs is essential to ensuring a cohesive and effective response during extreme climate events. The fragmentation of policies and lack of coordination between governmental and non-governmental organizations often result in disjointed, inefficient interventions. A greater intersectoral collaboration is needed to develop and implement policies that not only acknowledge climate-related risks but also holistically address the specific vulnerabilities of homeless populations [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eTo enhance policy effectiveness, continuous assessment and monitoring must be prioritized. Implementing climate monitoring systems that incorporate real-time data on social vulnerability can enable more responsive policy adjustments. Policies must remain flexible and adaptive, evolving alongside climate trends and the shifting needs of vulnerable populations. This dynamic approach would ensure more resilient, proactive, and sustained protection for homeless individuals facing the growing threats posed by climate change [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec12\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMESO level: Infrastructure and access to services, social and economic impacts\\u003c/h2\\u003e \\u003cp\\u003eAt the MESO level, the adequacy and accessibility of local infrastructure and services play a crucial role in mitigating the impacts of extreme climate conditions on homeless populations. However, shelters and support services often struggle to meet growing demands during extreme weather events due to overcrowding, resource shortages, and inadequate infrastructure. During heatwaves or severe cold, the number of individuals seeking refuge increases, yet many shelters already operate at full capacity. Furthermore, poor ventilation, insufficient heating, and lack of thermal insulation reduce their effectiveness in protecting against extreme temperatures. Logistical barriers, such as flooding and storm-related disruptions, further hinder access to shelters and the distribution of essential supplies. These challenges collectively weaken the responsiveness of support services, exacerbating the climate vulnerability of homeless populations [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eBeyond infrastructure deficiencies, the location and quality of health and social support services are critical determinants of access to assistance during extreme climate events. Geographic inaccessibility significantly limits the ability of homeless individuals to seek help when they need it most. This underscores an urgent need to reassess resource allocation strategies and improve infrastructure to ensure services are effectively tailored to the specific needs of homeless populations, particularly during crises [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eIntegrating climate adaptation measures into service structures is essential for enhancing resilience. This includes upgrading shelter infrastructure by incorporating climate control systems and designated spaces adapted to different weather conditions. Equally important is ensuring that health and social services are well-distributed and easily accessible, enabling timely and equitable assistance. A collaborative approach involving local governments, non-governmental organizations, and other stakeholders is vital for developing sustainable, adaptive solutions that strengthen protection and support systems in response to climate challenges [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eBeyond immediate infrastructure and accessibility concerns, findings highlight the need for a cohesive and proactive approach to managing services for homeless populations. Local support services, such as shelters and health programs, must develop specific contingency plans for extreme climate events. This includes establishing clear protocols to expand service capacity during crises and ensuring the availability of essential resources, such as water, food, and medications. The absence of coordinated emergency planning can result in inadequate responses, further exacerbating the hardships faced by homeless individuals [\\u003cspan citationid=\\\"CR29\\\" class=\\\"CitationRef\\\"\\u003e29\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR69\\\" class=\\\"CitationRef\\\"\\u003e69\\u003c/span\\u003e].\\u003c/p\\u003e \\u003cp\\u003eFinally, inclusive policymaking and participatory approaches are essential at the MESO level. Actively engaging homeless individuals in the assessment of needs and development of solutions can provide valuable insights, improving the effectiveness of services and infrastructure. By incorporating their perspectives into decision-making processes, support systems can become more responsive and better aligned with their lived experiences, ultimately promoting greater equity and effectiveness in climate resilience strategies [\\u003cspan citationid=\\\"CR33\\\" class=\\\"CitationRef\\\"\\u003e33\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec13\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eMICRO level: Individual experiences and health aspects\\u003c/h2\\u003e \\u003cp\\u003eAt the MICRO level, extreme climate conditions have deeply personal and varied effects on homeless individuals. Finding adequate shelter during heatwaves, cold spells, and severe storms remains a persistent challenge. Prolonged exposure to these harsh conditions exacerbates preexisting health issues and creates new risks, including hypothermia, heat exhaustion, and dehydration [\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e, \\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e]. These risks are further intensified by the lack of continuous support networks and the already precarious living conditions faced by this population.\\u003c/p\\u003e \\u003cp\\u003eBeyond shelter insecurity, limited access to healthcare presents a critical barrier, especially during extreme weather events. Homeless individuals often face significant obstacles in obtaining medical care, such as lack of transportation, unawareness of available services, and bureaucratic hurdles (e.g., absence of identification or insurance). The inaccessibility of timely medical interventions contributes to the progression of respiratory, cardiovascular, and chronic diseases, which are further aggravated by extreme climatic conditions [\\u003cspan citationid=\\\"CR70\\\" class=\\\"CitationRef\\\"\\u003e70\\u003c/span\\u003e]. Addressing these disparities requires proactive strategies to ensure continuous and facilitated access to essential healthcare services, particularly during climate crises.\\u003c/p\\u003e \\u003cp\\u003eAnother factor compounding their vulnerability is the social stigma surrounding homelessness. Widespread discrimination and prejudice not only hinder access to services but also discourage individuals from seeking assistance. Fear of mistreatment or rejection can lead to self-exclusion from shelters, medical facilities, and other support systems, exacerbating their hardships during extreme weather events [\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e]. Tackling this issue requires inclusive, stigma-reducing initiatives that foster a more welcoming environment for homeless individuals.\\u003c/p\\u003e \\u003cp\\u003eAdditionally, the psychological toll of climate adversity on this population is profound. Chronic exposure to extreme conditions, coupled with the uncertainty of survival, contributes to heightened stress, anxiety, and depression. These mental health burdens can further deteriorate physical well-being and impair coping mechanisms, making it even more difficult for individuals to navigate daily struggles [\\u003cspan citationid=\\\"CR53\\\" class=\\\"CitationRef\\\"\\u003e53\\u003c/span\\u003e]. Therefore, interventions must incorporate psychological support strategies, such as mental health outreach, counseling services, and stress management programs, to bolster resilience and improve overall well-being.\\u003c/p\\u003e \\u003cp\\u003eTo effectively mitigate these challenges, comprehensive intervention strategies must address both practical and emotional barriers. Raising awareness through stigma-reduction campaigns can enhance service accessibility, ensuring that homeless individuals receive the support they need. Moreover, expanding emergency shelter capacity, integrating climate-adaptive infrastructure, and facilitating direct access to medical care are critical steps toward safeguarding this vulnerable population. Holistic, person-centered approaches are essential to minimizing harm and promoting equity in climate response efforts for homeless individuals [\\u003cspan citationid=\\\"CR71\\\" class=\\\"CitationRef\\\"\\u003e71\\u003c/span\\u003e].\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec14\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eIntegration of levels: Strategies and recommendations\\u003c/h2\\u003e \\u003cp\\u003eAddressing the impacts of extreme weather conditions on homeless populations requires an integrated, multi-level approach. The MACRO, MESO, and MICRO levels must be strategically aligned to develop comprehensive, sustainable, and effective solutions.\\u003c/p\\u003e \\u003cp\\u003eAt the MACRO level, public policies should be restructured to explicitly recognize and address the heightened vulnerability of homeless individuals to climate-related risks. This includes integrating climate adaptation strategies into social protection programs, ensuring funding for emergency response initiatives, and promoting equitable access to essential services.\\u003c/p\\u003e \\u003cp\\u003eAt the MESO level, local infrastructures and service networks must be strengthened to better support homeless populations during climate crises. This requires enhancing shelter capacity, improving climate-adaptive infrastructure (e.g., cooling centers, emergency heating shelters), and ensuring uninterrupted access to healthcare and social services. Effective coordination between local governments, shelters, and healthcare providers is critical to optimizing resource allocation and response efficiency.\\u003c/p\\u003e \\u003cp\\u003eAt the MICRO level, individual factors\\u0026mdash;including health conditions, service accessibility, and social barriers\\u0026mdash;must be considered to ensure that solutions are practical and responsive to the actual needs of homeless individuals. Strategies should focus on reducing stigma, facilitating barrier-free access to healthcare, and implementing mental health and psychosocial support initiatives to enhance overall resilience.\\u003c/p\\u003e \\u003cp\\u003eTo comprehensively tackle these challenges, it is recommended to implement public policies that integrate climate monitoring with social assistance, improve support infrastructures, and create specific programs to reduce access barriers and social stigma. Collaboration between governments, non-governmental organizations, and local communities is critical to developing and implementing effective and sustainable solutions.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec15\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eImplications\\u003c/h2\\u003e \\u003cp\\u003eThe results of this study have significant implications for public health, emergency management, social assistance policies, and urban planning, highlighting the need for adaptations in policies and practices to address extreme weather conditions affecting the homeless population. It is suggested that the creation of adequate infrastructure, such as shelters and cooling and heating centers, along with strengthening the capacities of health institutions, will be crucial to mitigate the adverse effects of these conditions. Projections indicate that integrating continuous monitoring strategies and training healthcare professionals to address risks related to heat, cold, and pollution will be essential for an effective response.\\u003c/p\\u003e \\u003c/div\\u003e \\u003cdiv id=\\\"Sec16\\\" class=\\\"Section2\\\"\\u003e \\u003ch2\\u003eFinal considerations\\u003c/h2\\u003e \\u003cp\\u003eExtreme weather conditions significantly amplify the climate vulnerability of homeless populations, posing serious threats to their health and well-being. Prolonged exposure to heatwaves and extreme cold exacerbates preexisting climate-sensitive health conditions, including respiratory and cardiovascular diseases, while increasing the risk of dehydration, hypothermia, and frostbite. Additionally, floods and water scarcity heighten water insecurity and susceptibility to waterborne diseases. Beyond these direct health risks, structural and social barriers further limit the adaptation and resilience of homeless individuals by restricting access to healthcare, shelter, and essential resources needed to cope with climate impacts.\\u003c/p\\u003e \\u003cp\\u003eThe findings underscore the urgent need for targeted interventions to mitigate the adverse effects of climate change on this population. Developing climate-adaptive infrastructure, such as temperature-controlled shelters and cooling and heating centers, is critical to reducing prolonged exposure to extreme conditions. Additionally, enhancing the capacity of healthcare institutions to respond effectively to climate-related crises is essential. This includes ongoing training for healthcare professionals to equip them with the skills and knowledge necessary to address emerging climate-related health challenges in the coming decades.\\u003c/p\\u003e \\u003cp\\u003eA coordinated, multi-level approach\\u0026mdash;integrating policy reform, infrastructure improvements, and direct support services\\u0026mdash;is essential to ensuring a more resilient, equitable, and sustainable response to the growing climate-related risks faced by homeless populations.\\u003c/p\\u003e \\u003c/div\\u003e\"},{\"header\":\"Abbreviations\",\"content\":\"\\u003cp\\u003eCSD Climate Sensitive Diseases\\u003c/p\\u003e\\n\\u003cp\\u003eNCD Non-Communicable Diseases\\u003c/p\\u003e\"},{\"header\":\"References\",\"content\":\"\\u003col\\u003e\\u003cli\\u003e\\u003cspan\\u003eFowler H (2024) Rapidly intensifying extreme weather events in a warming world: how important are large-scale dynamics in generating extreme floods? EMS Annual Meeting. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.5194/ems2024-1052\\u003c/span\\u003e\\u003cspan address=\\\"10.5194/ems2024-1052\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eFerreira JE, de SM, Cavalcante TF, Moreira RP (2024) Nursing care in times of climate change: towards a resilient future. Acta Paulista de Enfermagem 37. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttp://dx.doi.org/10.37689/acta-ape/2024EDT013i\\u003c/span\\u003e\\u003cspan address=\\\"10.37689/acta-ape/2024EDT013i\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNouri M, Ostadtaghizadeh A, Vickery J, Azami-Aghdash S, Sari AA (2024) Universal health coverage for homeless persons in disasters: a scoping review. J Social Distress Homelessness 1\\u0026ndash;17. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/10530789.2024.2310950\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/10530789.2024.2310950\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKoh KA, Alix A (2023) Climate-Related Disasters and Homelessness: What Psychiatrists Can Do. Psychiatric News 58(10). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1176/appi.pn.2023.10.10.33\\u003c/span\\u003e\\u003cspan address=\\\"10.1176/appi.pn.2023.10.10.33\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEzzatvar Y, L\\u0026oacute;pez-Gil JF (2024) Urgent call for enhanced flood preparedness and response in Spain. Lancet 404(10470):2419\\u0026ndash;2420. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/S0140-6736(24)02506-6\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/S0140-6736(24)02506-6\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSun L, Chu J (2024) Review of research on disaster mitigation emergency congregate shelter planning for vulnerable group. J Mechatronics Artif Intell Eng 5(2):144\\u0026ndash;157. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.21595/jmai.2024.24234\\u003c/span\\u003e\\u003cspan address=\\\"10.21595/jmai.2024.24234\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcLean KE, Lee MJ, Coker ES, Henderson SB (2024) A population-based case-control analysis of risk factors associated with mortality during the 2021 western North American heat dome: focus on chronic conditions and social vulnerability. Environ Research: Health 2(3):035010. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1088/2752-5309/ad5eac\\u003c/span\\u003e\\u003cspan address=\\\"10.1088/2752-5309/ad5eac\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHussainzad EA, Gou Z (2024) Climate Risk and Vulnerability Assessment in Informal Settlements of the Global South: A Critical Review. Land 13(9):1357. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/land13091357\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/land13091357\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eOliveira EFB, Moutinho BF, De Angeli DB, Rabelo LM, Ribeiro BRS, Santos LG et al (2024) Mental Health in the Context of Climate Change. Health Soc 4(05):283\\u0026ndash;293. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.51249/hs.v4i05.2281\\u003c/span\\u003e\\u003cspan address=\\\"10.51249/hs.v4i05.2281\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAmnuaylojaroen T, Parasin N (2024) Human Health Adaptation Strategies to Climate-Induced Extreme Weather Events: A Systematic Review. Earth 5(4):724\\u0026ndash;742. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/earth5040038\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/earth5040038\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAromataris E, Lockwood C, Porritt K, Pilla B, Jordan Z (2024) JBI Manual for Evidence Synthesis. JBI. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.46658/JBIMES-24-01\\u003c/span\\u003e\\u003cspan address=\\\"10.46658/JBIMES-24-01\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTricco AC, Lillie E, Zarin W, O\\u0026rsquo;Brien KK, Colquhoun H, Levac D et al (2018) PRISMA Extension for Scoping Reviews (PRISMA-ScR): Checklist and Explanation. Ann Intern Med 169(7):467\\u0026ndash;473. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.7326/M18-0850\\u003c/span\\u003e\\u003cspan address=\\\"10.7326/M18-0850\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCharmaz K (2014) Constructing Grounded Theory (2nd ed.). Sage Publications. ISBN: 978-1446247395\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eIPCC (2022) Climate Change 2022: Impacts, Adaptation, and Vulnerability. Cambridge University Press\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDowning TE, Patwardhan A, Klein RJ, Mukhala E, Stephen L, Winograd M, Ziervogel (2005) G. Assessing vulnerability for climate adaptation\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eManangan AP, Uejio CK, Saha S, Schramm PJ, Marinucci GD, Hess JJ et al (1914) Assessing health vulnerability to climate change: a guide for health departments. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://stacks.cdc.gov/view/cdc/24906\\u003c/span\\u003e\\u003cspan address=\\\"https://stacks.cdc.gov/view/cdc/24906\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Accessed 16 oct 2024\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eManangan AP, Uejio CK, Saha S, Schramm PJ, Marinucci GD, Hess JJ et al (2015) Assessing health vulnerability to climate change. Cent Dis Control Prev, 1\\u0026ndash;23. Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.cdc.gov/climate-health/media/pdfs/AssessingHealthVulnerabilitytoClimateChange_1.pdf\\u003c/span\\u003e\\u003cspan address=\\\"https://www.cdc.gov/climate-health/media/pdfs/AssessingHealthVulnerabilitytoClimateChange_1.pdf\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Accessed 19 oct 2024\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNyashilu IM, Kiunsi RB, Kyessi AG (2023) Assessment of exposure, coping and adaptation strategies for elements at risk to climate change-induced flooding in urban areas. The case of Jangwani Ward in Dar es Salaam City, Tanzania. Heliyon 9(4):e15000. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.heliyon.2023.e15000\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.heliyon.2023.e15000\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKocur-Bera K, Czyża S (2023) Socio-Economic Vulnerability to Climate Change in Rural Areas in the Context of Green Energy Development\\u0026mdash;A Study of the Great Masurian Lakes Mesoregion. Int J Environ Res Public Health 20(3):2689. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph20032689\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph20032689\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBorgatti SP, Everett MG, Johnson JC (2018) Analyzing Social Networks, 2nd edn. Sage\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAkhtar Z, Sajjad M, Imran M, Ofli F (2023) Risk Mapping in Managing Flood Vulnerability in Disaster Management. International Handbook of Disaster Research. Springer Nature Singapore, Singapore, pp 743\\u0026ndash;776. DOI:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/978-981-19-8388-7_177\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/978-981-19-8388-7_177\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ede Souza MF, Santos ACMZ dos, de Souza MQB (2021) Employability in the bioecological model of human development in vulnerability contexts. Revista Psicologia Organiza\\u0026ccedil;\\u0026otilde;es e Trabalho. ;21(4). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.5935/rpot/2021.4.22071\\u003c/span\\u003e\\u003cspan address=\\\"10.5935/rpot/2021.4.22071\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBlaikie P, Cannon T, Davis I, Wisner B (2004) At risk: natural hazards, people's vulnerability and disasters. Routledge\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCutter SL, Boruff BJ, Shirley WL (2012) Social vulnerability to environmental hazards. Hazards vulnerability and environmental justice. Routledge, pp 143\\u0026ndash;160\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMcCormick KA, Samora J, Claborn KR, Holleran Steiker LK, DiNitto DM (2024) A systematic review of macro-, meso-, and micro-level harm reduction interventions addressing the U.S. opioid overdose epidemic. Drugs: Educ Prev Policy 1\\u0026ndash;14. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/09687637.2024.2306826\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/09687637.2024.2306826\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eK\\u0026uuml;hl C, Skipworth HD, Bourlakis M, Aktas E (2023) The circularity of product-service systems: the role of macro-, meso- and micro-level contextual factors. Int J Oper Prod Manage 43(4):619\\u0026ndash;650. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1108/IJOPM-01-2022-0055\\u003c/span\\u003e\\u003cspan address=\\\"10.1108/IJOPM-01-2022-0055\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWang C, Zhang H, Wang Y, Wu J, Kirlikovali KO, Li P et al (2023) A General Strategy for the Synthesis of Hierarchically Ordered Metal\\u0026ndash;Organic Frameworks with Tunable Macro-, Meso‐, and Micro‐Pores. Small 19(3). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/smll.202206116\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/smll.202206116\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eWorld Bank. World Bank Country and Lending Groups [Internet]. The World Bank (2024) Available from: \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups\\u003c/span\\u003e\\u003cspan address=\\\"https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Accessed 19 oct 2024\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVan Tol Z, Vanos JK, Middel A, Ferguson KM (2024) Concurrent Heat and Air Pollution Exposures among Homeless persons. Environ Health Perspect 132(1). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1289/EHP13402\\u003c/span\\u003e\\u003cspan address=\\\"10.1289/EHP13402\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRobertson BW, Dow K, Salinas J, Cutter SL (2024) Heat Risk Perceptions and Coping Strategies of the Unhoused. Int J Environ Res Public Health 21(6):737. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph21060737\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph21060737\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKhoshnaw LJ, Johnson RJ, Young SE (2024) Ten tips on how to care for your CKD patients in episodes of extreme heat. Clin Kidney J 17(6). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1093/ckj/sfae156\\u003c/span\\u003e\\u003cspan address=\\\"10.1093/ckj/sfae156\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAnthonj C, Mingoti Poague KIH, Fleming L, Stanglow S (2024) Invisible struggles: WASH insecurity and implications of extreme weather among urban homeless in high-income countries - A systematic scoping review. Int J Hyg Environ Health 255:114285. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.ijheh.2023.114285\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.ijheh.2023.114285\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTetzlaff EJ, Mourad F, Goulet N, Gorman M, Siblock R, Kidd SA et al (2024) Death Is a Possibility for Those without Shelter: A Thematic Analysis of News Coverage on Homelessness and the 2021 Heat Dome in Canada. Int J Environ Res Public Health 21(4):405. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph21040405\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph21040405\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBraun P, Lookingbill T, Zizzamia B, Hoffman J, Rosner J, Banta D (2024) A Heat Emergency: Urban Heat Exposure and Access to Refuge in Richmond, VA. GeoHealth 8(6). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1029/2023GH000985\\u003c/span\\u003e\\u003cspan address=\\\"10.1029/2023GH000985\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSlesnick TD, Slesnick N (2024) Environmental Risks Among Youth Experiencing Homelessness: The Need for Justice. Environ Justice 17(5):369\\u0026ndash;375. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1089/env.2023.0034\\u003c/span\\u003e\\u003cspan address=\\\"10.1089/env.2023.0034\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eChristensen K (2024) A Matter of Climate Justice: Heat and Air Pollution Combine to Worsen Effects of Homelessness. Environ Health Perspect 132(5). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1289/EHP14613\\u003c/span\\u003e\\u003cspan address=\\\"10.1289/EHP14613\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMeehan AA, Milazzo KE, Bien M, Nall SK, Vickery KD, Mosites E et al (2024) Involuntary displacement and self-reported health in a cross-sectional survey of homeless persons in Denver, Colorado, 2018\\u0026ndash;2019. BMC Public Health 24(1):1159. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1186/s12889-024-18681-w\\u003c/span\\u003e\\u003cspan address=\\\"10.1186/s12889-024-18681-w\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSeshadri S, Morgan O, Moore A, Parmar S, Schnur J, Montgomery G et al (2023) Analysis of older adult blood pressure readings and hypertension treatment rates among the unsheltered population of Miami-Dade County. 6(4):320\\u0026ndash;327 Aging medicine (Milton (NSW)). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/agm2.12272\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/agm2.12272\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHenry T, Khachemoune A (2023) Dermatologic conditions and risk factors in homeless persons (PEH): systematic review. Arch Dermatol Res 315(10):2795\\u0026ndash;2803. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s00403-023-02722-2\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s00403-023-02722-2\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eTaylor SN, Munson D (2023) Health Care of Homeless persons: Part I. NEJM Evid 2(8). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1056/EVIDra2300123\\u003c/span\\u003e\\u003cspan address=\\\"10.1056/EVIDra2300123\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003edu Bray Mv, Stotts R, Southee R, Wutich A (2023) Beyond Extreme: Heat Emergency and Water Insecurity for People Experiencing Houselessness in Phoenix, Arizona, USA During and After the Heatwave of 2023. Hum Ecol 51(5):799\\u0026ndash;808. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s10745-023-00447-4\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s10745-023-00447-4\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGabbe CJ, Chang JS, Kamson M, Seo E (2023) Reducing heat risk for people experiencing unsheltered homelessness. Int J Disaster Risk Reduct 96:103904. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.ijdrr.2023.103904\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.ijdrr.2023.103904\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVega A, Carl Y, Molina-Perez X, Collazo-Malave G, Ortiz-Camacho K, Gonzalez-Burgos B et al (2024) Mental Health Assessment and Risk Characterization in Puerto Rico\\u0026rsquo;s Homeless Post-Hurricane Maria. J Poverty 28(6):528\\u0026ndash;548. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/10875549.2023.2235360\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/10875549.2023.2235360\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSchwarz L, Castillo EM, Chan TC, Brennan JJ, Sbiroli ES, Carrasco-Escobar G et al (2022) Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012\\u0026ndash;2019. Am J Public Health 112(1):98\\u0026ndash;106. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.2105/AJPH.2021.306557\\u003c/span\\u003e\\u003cspan address=\\\"10.2105/AJPH.2021.306557\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eVerbyla ME, Calderon JS, Flanigan S, Garcia M, Gersberg R, Kinoshita AM et al (2021) An Assessment of Ambient Water Quality and Challenges with Access to Water and Sanitation Services for Individuals Experiencing Homelessness in Riverine Encampments. Environ Eng Sci 38(5):389\\u0026ndash;401. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1089/ees.2020.0319\\u003c/span\\u003e\\u003cspan address=\\\"10.1089/ees.2020.0319\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAnderson MC, Hazel A, Perkins J, Almquist Z (2021) The Ecology of Unsheltered Homelessness: Environmental and Social-Network Predictors of Well-Being among an Unsheltered Homeless Population. Int J Environ Res Public Health 18(14):7328. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph18147328\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph18147328\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHarlan SL, Declet-Barreto JH, Stefanov WL, Petitti DB (2013) Neighborhood Effects on Heat Deaths: Social and Environmental Predictors of Vulnerability in Maricopa County, Arizona. Environ Health Perspect 121(2):197\\u0026ndash;204. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1289/ehp.1104625\\u003c/span\\u003e\\u003cspan address=\\\"10.1289/ehp.1104625\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ePepper DA (2014) Will Homeless Populations Benefit from Global Warming? In: Clark C (ed) Homelessness: Prevalence, Impact of Social Factors and Mental Health Challenges (Social Issues, Justice and Status). Nova Science Pub Inc, UK ed. edition, pp 251\\u0026ndash;258\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eNicolay M, Brown M, Johns L, Ialynytchev R (2016) A study of heat related illness preparedness in homeless veterans. Int J Disaster Risk Reduct 18:72\\u0026ndash;74. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.ijdrr.2016.05.009\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.ijdrr.2016.05.009\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eDeMyers C, Warpinski C, Wutich A (2017) Urban Water Insecurity: A Case Study of Homelessness in Phoenix, Arizona. Environ Justice 10(3):72\\u0026ndash;80. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1089/env.2016.0043\\u003c/span\\u003e\\u003cspan address=\\\"10.1089/env.2016.0043\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHines JZ, Jagger MA, Jeanne TL, West N, Winquist A, Robinson BF et al (2018) Heavy precipitation as a risk factor for shigellosis among homeless persons during an outbreak \\u0026mdash; Oregon, 2015\\u0026ndash;2016. J Infect 76(3):280\\u0026ndash;285. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.jinf.2017.11.010\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.jinf.2017.11.010\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLane K, Ito K, Johnson S, Gibson EA, Tang A, Matte T (2018) Burden and Risk Factors for Cold-Related Illness and Death in New York City. Int J Environ Res Public Health 15(4):632. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph15040632\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph15040632\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eSomani R (2023) Global Warming in Pakistan and Its Impact on Public Health as Viewed Through a Health Equity Lens. Int J Social Determinants Health Health Serv 53(2):154\\u0026ndash;157. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1177/27551938231154467\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/27551938231154467\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKidd SA, Bezgrebelna M, Hajat S, Keevers L, Ravindran A, Stergiopoulos V et al (2023) A response framework for addressing the risks of climate change for homeless populations. Clim Policy 23(5):623\\u0026ndash;636. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/14693062.2023.2194280\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/14693062.2023.2194280\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eBezgrebelna M, McKenzie K, Wells S, Ravindran A, Kral M, Christensen J et al (2021) Climate Change, Weather, Housing Precarity, and Homelessness: A Systematic Review of Reviews. Int J Environ Res Public Health 18(11):5812. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph18115812\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph18115812\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRamin B, Svoboda T (2009) Health of the Homeless and Climate Change. J Urb Health 86(4):654\\u0026ndash;664. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11524-009-9354-7\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11524-009-9354-7\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eCrick F, Wandel J, Maclellan N, Vincent K (2013) Climate change adaptation pathways. Climate Adaptation Futures. Wiley, pp 242\\u0026ndash;253. DOI:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1002/9781118529577.ch23\\u003c/span\\u003e\\u003cspan address=\\\"10.1002/9781118529577.ch23\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eZhang P, Bassil K, Gower S, Katic M, Kiss A, Gogosis E et al (2019) Cold-related injuries in a cohort of homeless adults. J Social Distress Homeless 28(1):85\\u0026ndash;89. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1080/10530789.2018.1523103\\u003c/span\\u003e\\u003cspan address=\\\"10.1080/10530789.2018.1523103\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eKidd SA, Greco S, McKenzie K (2021) Global Climate Implications for Homelessness: A Scoping Review. J Urb Health 98(3):385\\u0026ndash;393. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11524-020-00483-1\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11524-020-00483-1\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEnglish T, Larkin M, Vasquez Hernandez A, Hutton J, Currie J (2022) Heat Illness Requiring Emergency Care for Homeless persons: A Case Study Series. Int J Environ Res Public Health 19(24). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3390/ijerph192416565\\u003c/span\\u003e\\u003cspan address=\\\"10.3390/ijerph192416565\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eEvery D, Richardson J, Osborn E (2019) There\\u0026rsquo;s nowhere to go: counting the costs of extreme weather to the homeless community. Disasters 43(4):799\\u0026ndash;817. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1111/disa.12400\\u003c/span\\u003e\\u003cspan address=\\\"10.1111/disa.12400\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eAnthonj C, Stanglow SN, Grunwald N (2024) Co-defining WASH (In)Security challenges among homeless persons. A qualitative study on the Human Right to Water and Sanitation from Bonn, Germany. Soc Sci Med 342:116561. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.socscimed.2024.116561\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.socscimed.2024.116561\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003ede Jesus Faleiro GT, Beray Armond N (2024) Urban Climate and the Homeless Population: Exposure, Impacts, and Strategies. Environ Justice 17(3):193\\u0026ndash;202. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1089/env.2022.0055\\u003c/span\\u003e\\u003cspan address=\\\"10.1089/env.2022.0055\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHajat S, Sarran CE, Bezgrebelna M, Kidd SA (2023) Ambient Temperature and Emergency Hospital Admissions in Homeless persons: London, United Kingdom, 2011\\u0026ndash;2019. Am J Public Health 113(9):981\\u0026ndash;984. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.2105/AJPH.2023.307351\\u003c/span\\u003e\\u003cspan address=\\\"10.2105/AJPH.2023.307351\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eIk\\u0026auml;heimo TM, Hassi J (2011) Frostbites in circumpolar areas. Global health action. ;4. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.3402/gha.v4i0.8456\\u003c/span\\u003e\\u003cspan address=\\\"10.3402/gha.v4i0.8456\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eGrammatikopoulou MG, Gkiouras K, Pepa A, Persynaki A, Taousani E, Milapidou M et al (2021) Health status of women affected by homelessness: A cluster of in concreto human rights violations and a time for action. Maturitas 154:31\\u0026ndash;45. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1016/j.maturitas.2021.09.007\\u003c/span\\u003e\\u003cspan address=\\\"10.1016/j.maturitas.2021.09.007\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eMoreira RP, de Oliveira FBB, de Araujo TL, Morais HCC, Cavalcante TF, Gomez MBS et al (2022) Health Interventions for Preventing Climate-Sensitive Diseases: Scoping Review. J Urb Health 99(3):519\\u0026ndash;532. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1007/s11524-022-00631-9\\u003c/span\\u003e\\u003cspan address=\\\"10.1007/s11524-022-00631-9\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eHauer ME, Jacobs SA, Kulp SA (2024) Climate migration amplifies demographic change and population aging. Proceedings of the National Academy of Sciences. ;121(3). \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1073/pnas.2206192119\\u003c/span\\u003e\\u003cspan address=\\\"10.1073/pnas.2206192119\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eRathjen NA, Shahbodaghi SD, Brown JA (2019) Hypothermia and Cold Weather Injuries. American family physician, 100(11), 680\\u0026ndash;686. Available from:\\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003ehttps://www.aafp.org/pubs/afp/issues/2019/1201/p680.html\\u003c/span\\u003e\\u003cspan address=\\\"https://www.aafp.org/pubs/afp/issues/2019/1201/p680.html\\\" targettype=\\\"URL\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e. Accessed 19 oct 2024\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLeggat J, Dearman C, Bainbridge S, de Zoete E, Petrokofsky C (2024) Heatwaves and homelessness. Perspect Public Health 144(2):70\\u0026ndash;71. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.1177/17579139231224690\\u003c/span\\u003e\\u003cspan address=\\\"10.1177/17579139231224690\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e \\u003cli\\u003e\\u003cspan\\u003eLlobet-Estany M, Serrano-Miguel M, Mu\\u0026ntilde;oz A, Boixad\\u0026oacute;s-Porquet A, Campomar B (2024) Stigma in homelessness and health care: reflections from a Housing First program in Barcelona, Spain. Salud Colectiva 20:e4826. \\u003cspan class=\\\"ExternalRef\\\"\\u003e\\u003cspan class=\\\"RefSource\\\"\\u003e10.18294/sc.2024.4826\\u003c/span\\u003e\\u003cspan address=\\\"10.18294/sc.2024.4826\\\" targettype=\\\"DOI\\\" class=\\\"RefTarget\\\"\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/span\\u003e\\u003c/li\\u003e\\u003c/ol\\u003e\"}],\"fulltextSource\":\"\",\"fullText\":\"\",\"funders\":[],\"hasAdminPriorityOnWorkflow\":false,\"hasManuscriptDocX\":true,\"hasOptedInToPreprint\":true,\"hasPassedJournalQc\":\"\",\"hasAnyPriority\":true,\"hideJournal\":true,\"highlight\":\"\",\"institution\":\"Universidade da Integração Internacional da Lusofonia Afro-Brasileira \",\"isAcceptedByJournal\":false,\"isAuthorSuppliedPdf\":false,\"isDeskRejected\":\"\",\"isHiddenFromSearch\":false,\"isInQc\":false,\"isInWorkflow\":false,\"isPdf\":false,\"isPdfUpToDate\":true,\"isWithdrawnOrRetracted\":false,\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true},\"keywords\":\"ill-housed persons, climate change, social vulnerability\",\"lastPublishedDoi\":\"10.21203/rs.3.rs-6662770/v1\",\"lastPublishedDoiUrl\":\"https://doi.org/10.21203/rs.3.rs-6662770/v1\",\"license\":{\"name\":\"CC BY 4.0\",\"url\":\"https://creativecommons.org/licenses/by/4.0/\"},\"manuscriptAbstract\":\"\\u003cp\\u003e\\u003cstrong\\u003eBackground\\u003c/strong\\u003e: Climate change has led to adverse events such as heat waves and floods, disproportionately affecting vulnerable populations, including homeless persons. These populations face challenges such as lack of access to shelters and essential resources, increasing their exposure to climate-related risks and health issues.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eAim\\u003c/strong\\u003e: To map the determinant factors that amplify the climate vulnerability of homeless persons, analyzing their health impacts and the barriers to adaptation and resilience.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eMethods\\u003c/strong\\u003e: A scoping review was conducted using the PCC framework (Population, Concept, Context). The search was performed in PubMed/MEDLINE, Web of Science, Embase, Scopus, Cochrane Library, and SciELO. Studies published in multiple languages were included, with no date restrictions.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eResults\\u003c/strong\\u003e: A total of 3,046 studies were identified, of which 38 were selected for data extraction. The mapped determinant factors were grouped into five categories: extreme weather conditions, air quality and environmental inequality, infrastructure and access to services, social and economic impacts, and health aspects. The findings highlight how these vulnerabilities are exacerbated by climate events and suggest macro-, meso-, and micro-level interventions to mitigate their effects.\\u003c/p\\u003e\\n\\u003cp\\u003e\\u003cstrong\\u003eConclusion\\u003c/strong\\u003e: The factors amplifying the climate vulnerability of homeless persons require an integrated approach encompassing public policies, infrastructure, and healthcare practices. Targeted actions can help reduce the negative impacts of climate change on this population.\\u003c/p\\u003e\",\"manuscriptTitle\":\"Determinant factors amplifying climate vulnerability and their effects on the health of homeless persons: A scoping review\",\"msid\":\"\",\"msnumber\":\"\",\"nonDraftVersions\":[{\"code\":1,\"date\":\"2025-05-15 04:14:20\",\"doi\":\"10.21203/rs.3.rs-6662770/v1\",\"editorialEvents\":[{\"type\":\"communityComments\",\"content\":0}],\"status\":\"published\",\"journal\":{\"display\":true,\"email\":\"info@researchsquare.com\",\"identity\":\"researchsquare\",\"isNatureJournal\":false,\"hasQc\":true,\"allowDirectSubmit\":true,\"externalIdentity\":\"\",\"sideBox\":\"\",\"snPcode\":\"\",\"submissionUrl\":\"/submission\",\"title\":\"Research Square\",\"twitterHandle\":\"researchsquare\",\"acdcEnabled\":true,\"dfaEnabled\":false,\"editorialSystem\":\"\",\"reportingPortfolio\":\"\",\"inReviewEnabled\":false,\"inReviewRevisionsEnabled\":true}}],\"origin\":\"\",\"ownerIdentity\":\"395799a2-913c-4eb5-9921-467e02c33ef2\",\"owner\":[],\"postedDate\":\"May 15th, 2025\",\"published\":true,\"recentEditorialEvents\":[],\"rejectedJournal\":[],\"revision\":\"\",\"amendment\":\"\",\"status\":\"posted\",\"subjectAreas\":[{\"id\":48517741,\"name\":\"Nursing\"},{\"id\":48517742,\"name\":\"Health Policy\"},{\"id\":48517743,\"name\":\"Environmental Policy\"}],\"tags\":[],\"updatedAt\":\"2025-05-15T04:14:20+00:00\",\"versionOfRecord\":[],\"versionCreatedAt\":\"2025-05-15 04:14:20\",\"video\":\"\",\"vorDoi\":\"\",\"vorDoiUrl\":\"\",\"workflowStages\":[]},\"version\":\"v1\",\"identity\":\"rs-6662770\",\"journalConfig\":\"researchsquare\"},\"__N_SSP\":true},\"page\":\"/article/[identity]/[[...version]]\",\"query\":{\"redirect\":\"/article/rs-6662770\",\"identity\":\"rs-6662770\",\"version\":[\"v1\"]},\"buildId\":\"8U1c8b4HqxoKbykW_rLl7\",\"isFallback\":false,\"isExperimentalCompile\":false,\"dynamicIds\":[84888],\"gssp\":true,\"scriptLoader\":[]}","source_license":"CC-BY-4.0","license_restricted":false}