Featured Research: Mid-Sized Cities & Homelessness

While study settings are often selected out of convenience, they can also be purposefully identified to explore differences. And their way, context can inform the plausibility that findings are representative of other similar settings. Research on homelessness often seeks to contextualize findings within the local area, often in relation to size or resources. For example, to compensate for a historical focus on larger centres, specific issues related to rural homelessness emerged in both research (see HUD Exchange on “Rural Homelessness” and “How is Rural Homelessness Different from Urban Homelessness? by the COH) and cooperation (see, e.g. National Alliance to End Rural and Remote Homelessness).

A similar argument might be made in favor of targeted inquiry for mid-sized centres. A recent COH blog post provides a succinct summary in support of this, in the example context of community opposition:

“Mid-sized cities (populations 50,000-500,000) face unique challenges understanding and responding to homelessness given the increasing visibility of homelessness, and the demand by community members to ‘do something’ to maintain smaller suburban identities. As a result, mid-sized cities struggle to develop evidence-informed policies and practices that are appropriate for their resource and contexts.” (From NIMBY to Neighbour – Erin Dej, Carrie Sanders, Jessica Braimoh 2021)

While there are many different interpretations of the size cutoffs among the labels “large”, “moderate”, “small”, and “rural” for municipality size (see table below), there is a general acceptance that these distinctions might carry meaningful implications for understanding variations in the capabilities and challenges facing individual communities,  as well as a subset of literature on the experiences of mid-sized cities. In 2018, Evergreen hosted a Mid-Sized Research Series that overviewed some of these factors, including that:

  • Many mid-sized cities (MSCs) are experiencing economic restructuring of their industrial pasts, which is, in turn, causing extreme changes in employment options, infrastructure demands, and the labour market. (p.6)
  • Many MSCs are also facing significant social issues: systemic racism against newcomers, rising rates of mental health issues, drug abuse, and homelessness concentrated in the downtown core, as well as an aging population and the ongoing outmigration of youth. (p.6)
  • Midsized cities are seeing a new generation of civic and municipal leaders that are more attuned to the unique assets of the mid-sized city. There is a rising recognition of the benefits of dense living as well as the issues created by sprawl and suburban planning. Midsized cities are also the perfect size for maximizing the impact of focused actions. (p.6)

“Mid-Sized” Cities – A Variable Category

Term Definition Source
“midsized cities” (Government of Canada, Immigration) 100,000 to one million LINK
“medium population centres” (StatsCan, Census) 30,000 to 99,999 LINK
“mid-sized cities” (UoC, School of Public Policy) 300,000 to two million LINK
“medium-sized urban areas” (OECD) 200,000 to 500,000 LINK
“mid-sized CMAs” (StatsCan, Census) 225,000 and 500,000 LINK
“mid-sized metropolitan areas” (StatsCan, Transportation) 250,000 to 999,999 LINK
“mid-sized city” (SFU) 50,000 to 500,000 LINK


For more information on rates of homelessness, check out the KHRC Research Blog: Homelessness in BC’s Small- and Mid-Sized Communities (Sept 1, 2021)

While Canada has a system of coordinated Point-In-Time counts, additional inquiry — and likely, additional information — will be needed to identify any potential association between community size and rates of homelessness. This and other potential hypotheses should be explored further, including contextual factors such as the role mid-sized communities play as service hubs for surrounding regions. As one featured Municipal World story identified, if one adopts a definition of this category as being “cities with populations between 50,000 to 500,000”, that would cover almost a third of Canada’s population; the category would include 88 municipalities with a combined population of nearly 11 million (or ~31% of the Census 2016, with another 33% in “large” cities, and the remaining population residing across rural and remote areas).

In another potential distinction from larger centres, a report from Reconnecting America (2012) also highlighted how mid-sized communities have a diverse range of potential configurations (p.9):

While each municipality and region will of course have its own unique socioeconomic and political contexts and history, mid-sized cities might still look to the growing body of size-based inquiry as a source of potential evidence as well as a source for inspiration. Likewise, a greater consideration of regional context in general might illuminate situations in which a proposed solution might have a better or worse fit, as well as which factors might be needed to facilitate successful adoption and mitigate known challenges.

Homelessness in Mid- / Medium- / Moderate-Sized Cities

Note that the default setting is to show the first 10 entries. That can be changed below to see all items in this section.

Social assets and mental distress among the homeless: Exploring the roles of social support and other forms of social capital on depressionIrwin, Jay2008The role of social capital in mediating the effects of stressors on depression among a disadvantaged population, and the relevance of social capital for quality of life. A mid-sized Southern metropolitan statistical area (MSA)LINK
Characteristics of Homeless Alcohol and Drug Abusers Identified Through an Assertive Outreach ProgramCohen, David C.1993Differences between substance abusers and non-abusers, and among abusers of alcohol, drugs, or both substances, were investigated for 1166 persons identified as homeless or at risk of homelessness by an assertive outreach program.Bakersfield, a city of ~175,000 at the center of an otherwise rural metropolitan area [moderate-sized city in the Southwest]LINK
Barriers and Facilitators to Veterans Administration Collaboration With Community Providers: The Lodge Project for Homeless VeteransCretzmeyer, Margaret2014This article presents qualitative findings from a mixed-method, two-year formative evaluation of the implementation of the Lodge, a supportive housing program aimed at homeless veterans. Iowa City is an urban area (metro area population of 152,586) surrounded by rural, mostly agricultural communities [Mid-Western mid-size city]LINK
Utilization of foot care services among homeless adults: Implications for advanced practice nursesMuirhead, L., Roberson, A. J., & Secrest, J. 2011Purpose: To present the findings of a survey that examined the reason(s) for use of foot care services among homeless adults in a mid-size southeastern city.A mid-size southeastern cityLINK
Including people who experience homelessness: a scoping review of the literatureNorman, Trudy; Pauly, Bernadette. 2013The purpose of this paper is to provide an overview of the evidence base and insights into recommendations for development and implementation of policies and practices to promote meaningful involvement of people experiencing homelessness as part of a community response to homelessness.Greater Victoria / a mid-sized Canadian cityLINK
Personal and Political?: Exploring the Feminization of the American Homeless PopulationTara N. Richards, Tammy S. Garland, Vic W. Bumphus & Roger Thompson2010Using a feminist lens, this exploratory study discusses self-reported differences between male and female homelessness, and to investigate the factors associated with the growing female homeless population. A mid-size southern cityLINK
Between the Wizard and the Deep Blue Sea: Notes on Homeless Youth Advocacy and Community Coalition BuildingWoolworth, Stephen2009A series of short self-reflective narrative vignettes about the experiences that led the author to build and ultimately lead a coalition of homeless youth advocates to call attention to the plight of homeless teenagers in a city concerned primarily with providing for and controlling its chronic adult homeless population.Northwest city of nearly a quarter million peopleLINK
Assessing the relationship between housing and health among medically complex, chronically homeless individuals experiencing frequent hospital use in the United StatesChhabra, M., Spector, E., Demuynck, S., Wiest, D., Buckley, L., & Shea, J. A.2020This study used qualitative methods to explore how housing stability affected chronic disease management and social and community relationships among individuals with complex health and social needs and patterns of high hospital utilisation who were housed as part of a scattered-site Housing First program.A mid-size city in the northeastern United StatesLINK
Factors associated with health-compromising behavior among the homelessFitzpatrick, K. M., La Gory, M. E., & Ritchey, F. J. 2003This exploratory study examined a set of sociodemographic, risk, and protective factors associated with health-compromising behavior among the homeless.A midsize, southern metropolitan statistical area (MSA)LINK
Life Experiences and Vulnerabilities of Homeless Women: A Comparison of Women Unaccompanied Versus Accompanied by Minor Children, and Correlates With Children's Emotional DistressPage, T., Nooe, R.M.2002The histories and service needs of 2 groups of homeless women, those unaccompanied by minor children (n = 46) and those accompanied by minor children (n = 22), were compared, on the basis of their responses to a biennial survey. Knoxville, TN [a midsize city in the southeast United States]LINK
Screening for Problem Substance Use in Community-Based AgenciesRose, S. J., Brondino, M. J., & Barnack, J. L. 2009Brief screening for problem substance use was conducted in community-based agencies that provided a range of services. Over 3 years, 14,162 persons requesting both substance-use-specific and non-substance-use-specific services were screened with the Rapid Alcohol Problem Screen.A midsize Midwestern cityLINK
Identifying the Patterns of Emergency Shelter Stays of Single Individuals in Canadian Cities of Different SizesAubry, T., Farrell, S., Hwang, S. W., & Calhoun, M.2013The study analyzed the patterns of emergency shelter stays of single persons in three Canadian cities of different sizes (i.e., Toronto, Ottawa, and Guelph). Similar to findings of previous research conducted in large American cities in the early 1990s, cluster analyses defined three clusters with distinct patterns of shelter stays (temporary, episodic, and long stay).Cities of three different sizes in Ontario (Toronto, 2 503 281; Ottawa, 812 129; Guelph, 114 943; Statistics Canada, 2006).LINK
Beliefs, attitudes, and knowledge about homelessness: A survey of the general publicToro, Paul A; McDonnell, Dennis M. 1992Obtained measures of policy-related beliefs, attitudes, and knowledge about homelessness through a telephone survey of a representative sample of 240 persons conducted over nearly a full year - The study's data were compared to a national poll and to a local study documenting the actual characteristics of homeless persons.Erie County, which surrounds Buffalo, NY. With a population of somewhat over 1 million (about one third within the city limits), the county is representative of many medium-size metropolitan areas in the nation. [Northeast]LINK
Barriers to healthcare for American Indians experiencing homelessnessWille, S. M., Kemp, K. A., Greenfield, B. L., & Walls, M. L. 2017In-depth semi-structured interviews were conducted with 12 service providers and 16 homeless participants to identify barriers to care for homeless participants, with a focus on American Indians (AI).A northern city in Minnesota that experiences harsh winter weather conditions dangerous for homeless individuals. One tribal reservation is in close proximity to the city and other reservations are several hours away. [mid-size Midwestern city]LINK
Commentary: Discharging the Homeless – A Daily Issue in Acute CareForchuk, Cheryl2020Commentary on complex issues surrounding hospital discharge planning for people experiencing homelessness - Different models for different types of communities (large urban, mid-size, small and rural areas) likely need to be developed as well as for different types of conditions and different housing histories. Different types of communities (large urban, mid-sized, small and rural areas)LINK
The Multi-Dimensional Lives of Children Who Are HomelessGrineski, Steve2014Generated from a two-year community- and shelter-based activity program these findings push back against a narrowing social construction of children who are homeless, as do several studies investigating this idea. A more holistic narrative that illustrates multidimensional children who act on varied interests, gifts, and talents are suggested.A Midwestern mid-size city [a small northwestern Minnesota city]LINK
Victims hidden in plain sight: the reality of victimization among the homelessGarland, T. S., Richards, T., & Cooney, M.2010Using the framework of structural choice theory, this exploratory study discusses self‐reported differences in criminality and victimization within the homeless population as a predictor of future victimization.A midsize southern cityLINK
Comparing the Housing Trajectories of Different Classes Within a Diverse Homeless PopulationAubry, Tim; Klodawsky, Fran; Coulombe, Daniel. 2012The paper presents findings from a longitudinal study identifying different classes of homeless individuals in a mid-size Canadian city based on health-related characteristics and comparing the housing trajectories of these classes 2 years later. Ottawa, Canada [a mid-size Canadian city]LINK
Willingness to use drug checking within future supervised injection services among people who inject drugs in a mid-sized Canadian cityMary Clare Kennedy, Ayden Scheim, Beth Rachlis, Sanjana Mitra, Geoff Bardwell, Sean Rourke and Thomas Kerr2018Drug checking offered within supervised injection services (SIS) is being considered as a potential measure for reducing overdose and related harms. We therefore sought to characterize the willingness of people who inject drugs (PWID) to use drug checking within SIS.London, Canada, a mid-sized city. LINK
Mental disorder and comorbidity among runaway and homeless adolescentsWhitbeck, L. B., Johnson, K. D., Hoyt, D. R., & Cauce, A. M. 2004Purpose: To investigate prevalence of mental disorder and comorbidity among homeless and runaway adolescents in small to medium sized cities in four Midwestern states.Eight Midwestern cities of various populations (St. Louis, Kansas City, Omaha, Lincoln, Des Moines, Cedar Rapids, Iowa City, Wichita).LINK
Life Chances and Choices: Assessing Quality of Life among the HomelessMark LaGory, Kevin Fitzpatrick and Ferris Ritchey2001A Weberian lifestyles approach is employed to examine differences in quality of life among the homeless. A mid-sized, Southern metropolitan areaLINK
"Hello, you're not supposed to be here": homeless emerging adults' experiences negotiating food accessBowen, Elizabeth A; Irish, Andrew. 2018We aimed to examine the food-seeking experiences of homeless emerging adults (age 18–24 years) in a US urban context.Buffalo, a mid-sized city in the Northeastern USA.LINK
The need for safe spaces: Exploring the experiences of homeless LGBTQ youth in sheltersCoolhart, Deborah2017Using an exploratory, grounded theory approach, this study utilized data from interviews with LGBTQ youth with a history of homelessness as well as service providers -- Findings suggest youth experience multiple challenges, barriers, and mistreatment in the shelters; further, data suggests several ideas about how to transform shelters to better meet the needs of LGBTQ youth.A mid-sized Northeastern cityLINK
Characteristics of Mothers Caring for Children During Episodes of HomelessnessWelch-lazoritz, Melissa L; Whitbeck, Les B; Armenta, Brian E. 2015This study provides a description of the physical, psychological, and substance use problems of adult homeless women who are and are not caring for children. We also examined differences in the characteristics of these two groups of women.three mid-sized U.S. cities (Omaha, NE, Pittsburgh, PA, and Portland, OR)LINK
Gender differences in Brazilian street youth’s family circumstances and experiences on the streetRaffaelli, Marcela; Koller, Silvia H; Reppold, Caroline T ; Kuschick, Mateus B; Krum, Fernanda M.B; Bandeira, Denise R; Simões, Carson2000The current analysis examined whether male and female street youth in a mid-sized Brazilian city differed in their family circumstances and day-to-day functioning on the street. Porto Alegre, a mid-sized city (population 1.5 million) in Southern
Public and semi-public injection drug use in Thunder Bay, Ontario: the case for supervised injection servicesRebecca Gower, Zack Marshall, Sanjana Mitra, Alexandra Musten, Bonnie Krysowaty & Thomas Kerr2021Although public injecting has been studied in large urban centres, little is known about the factors that drive public injecting in remote communities. This study sought to explore public and semi-public injection in Thunder Bay, ON.Thundey Bay, a remote and mid-sized city in Northwestern OntarioLINK
The 'Hilton' as a Fecal Court: The Socio-spatial Aspects of HomelessnessHejnal, Ondřej2013This article sets out to analyse the social (re)production of an object inhabited by homeless people that is located on the periphery of a mid-sized Czech city. Drawing on Edward Soja's model of the trialectics of spatiality and Petr Vašát's empirically based concept of heterotopia, the author describes three spheres (or space-types) of the object.A mid-sized Czech cityLINK
Intimate Partner Violence in Extremely Poor Women: Longitudinal Patterns and Risk MarkersBassuk, Ellen; Dawson, Ree; Huntington, Nicholas2006This paper describes patterns of domestic violence longitudinally and uses multivariate analyses to delineate childhood and adult risk markers for recent intimate partner violence in this population of women.Worcester, a mid-sized city in Massachusetts (169,000 residents)LINK
Just Thinking about It: Social Capital and Suicide Ideation among Homeless PersonsFitzpatrick, Kevin M; Irwin, Jessica; LaGory, Mark ; Ritchey, Ferris2007Suicide ideation is a sensitive indicator of personal well-being. While ideation occurs in roughly 3 percent of the US population annually, in this study rates are 10 times higher. This article explores the role of social capital in mediating negative life circumstances on ideation.A mid-sized Southern US Metropolitan Statistical Area (MSA)LINK
The experience of occupational engagement of chronically homeless persons in a mid-sized urban contextMarshall, Carrie Anne; Lysaght, Rosemary; Krupa, Terry2017This research sought to explicate the meaning and experience of occupational engagement for homeless persons in a mid-sized urban context.A mid-sized urban centre in Eastern Ontario, Canada (population approximately 120,000)LINK
Rolling forward: addressing needs in the homeless communityBrallier, Sara; Southworth, Stephanie; Ryan, Brenda2019The purpose of this pilot study was to use a bottom up, or grounded, approach to understand, from the perspective of the individuals living in the homeless community, what they feel would enable them to become housed and stay permanently housed.A mid-sized metropolitan area (approximately 32,000 residents) with a tourist-centered economy in the south eastern United StatesLINK
Employment among unaccompanied women experiencing homelessnessGroton, Danielle B; Radey, Melissa2019This study explored how unaccompanied women experiencing homelessness perceived and negotiated employment in a mid-sized community.A mid-size, Southeastern US cityLINK
Mental disorder and comorbidity among runaway and homeless adolescentsWhitbeck, Les B; Johnson, Kurt D; Hoyt, Dan R ; Cauce, Ana Mari2004Objective: To investigate prevalence of mental disorder and comorbidity among homeless and runaway adolescents in small to medium sized cities in four Midwestern states. Eight small to medium sized cities in four Midwestern states (St. Louis, Kansas City, Omaha, Lincoln, Des Moines, Cedar Rapids, Iowa City, Wichita)LINK
An evaluation of a Housing First program for chronically homeless womenOudshoorn, Abe; Forchuk, Cheryl; Hall, Jodi ; Smith-Carrier, Tracy; Van Berkum, Amy2018Using a critical feminist lens, this evaluation assessed a Housing First program delivered in a mid-sized city in Ontario, CanadaA mid-sized city in Ontario, CanadaLINK
Physical and Mental Health Issues among Homeless Youth in British Columbia, Canada: Are they Different from Older Homeless Adults?Saddichha, Sahoo; Linden, Isabelle; Krausz, Michael Reinhardt2014This paper aimed to study the homeless youth and identify specific vulnerabilities, which rendered them different from the adult homeless population. It also aimed to describe the youth homeless population and their significant co-morbidities. Three cities in British Columbia, Canada: the large urban centre of Vancouver (n=250); the mid-sized city and capital, Victoria (n=150); and the more remote, but largest rural city of Prince George (n=100)LINK
Taking a leap of faith: Meaningful participation of people with experiences of homelessness in solutions to address homelessnessNorman, Trudy; Pauly, Bernadette; Marks, Hilary ; Palazzo, Dakota2015The purpose of this study was to gain insights from people who have been homeless in a mid-sized Canadian city, as to strategies that facilitate meaningful participation in solutions to end homelessness.A mid-sized Canadian city (in association with the Greater Victoria Coalition to End Homelessness)LINK
Dangerous places: Exposure to Violence and Its Mental Health Consequences for the HomelessFitzpatrick, Kevin M; LaGory, Mark E; Ritchey, Ferris J1999The association between exposure to violence and symptoms of mental health problems among 161 homeless adults in a mid‐sized Southern metropolitan area was examined.A mid‐sized Southern metropolitan statistical area (Birmingham, Alabama)LINK
TOADS go to New Jersey: Implications for Land Use and Public Health in Mid-sized and Large US CitiesGreenberg, Michael; Popper, Frank; West, Bernadette ; Schneider, Dona1992 Using a sample of 21 mid-sized cities in New Jersey, we show that communities with a poor real estate market, many poor, minority residents and a weak economic base are likely to have serious TOADS (Temporarily obsolete abandoned derelict sites)-related problems. 21 mid-sized cities in New Jersey with populations ranging from 20,000 to 315,000LINK
Life on the Streets: The Victimization of Runaway and Homeless AdolescentsWhitbeck, Les B; Simons, Ronald L. 1990This research is concerned with homeless youth in a smaller urban community. A smaller midwestern city of 250,000LINK