Research by Hugi Hernandez, Founder of Egreenews

Executive Summary

This report examines the intersection of youth homelessness, extreme heat exposure, and racial and immigration-related vulnerabilities across six U.S. states: California, New York, Massachusetts, Illinois, Georgia, and Florida. The core finding is that people experiencing homelessness (PEH) are 4 times more likely to visit emergency departments for heat-related illness than the housed population, with significantly higher hospitalization rates . While national data does not isolate adolescents, the vulnerability factors affecting homeless adults apply with greater severity to teens, who face developmental, legal, and service-access barriers. A secondary finding indicates that federal policy changes in 2025 have eliminated “protected area” status for shelters and youth centers, exposing immigrant youth to deportation risk when seeking heat relief . The actionable insight is that states with high immigrant and Black homeless youth populations—California, New York, Illinois, and Massachusetts—require targeted heat emergency planning that addresses both physiological risks and legal protections, while Georgia and Florida face the highest absolute heat exposure risks with fewer protective service infrastructures.

Introduction

Extreme heat is the deadliest weather-related hazard in the United States, and its frequency and intensity are increasing due to climate change. Among the most vulnerable populations are people experiencing homelessness (PEH), who lack access to air conditioning, shaded shelter, and consistent hydration. Within this population, adolescents face distinct vulnerabilities: they are more likely to be unsheltered, less likely to access adult-oriented services, and often invisible in federal data collection.

This report focuses on homeless teens within immigrant and Black communities across six states chosen for their demographic and geographic diversity. California, New York, Massachusetts, and Illinois have large immigrant populations and established youth service infrastructures, while Georgia and Florida represent the Southeast, where extreme heat is most intense but homeless services are comparatively under-resourced. The analysis synthesizes peer-reviewed medical literature, federal data from the Nationwide Emergency Department Sample (2021-2022), policy analysis of 2025 regulatory changes, and state-level demographic estimates. Where specific data on adolescents is lacking—a critical evidence gap—the report extrapolates from adult data with explicit uncertainty labeling.

Heat-Related Illness Among Homeless Populations: National Evidence

The strongest available evidence on heat-related illness among homeless populations comes from a cross-sectional study published in JAMA Internal Medicine (August 2025), analyzing 2021-2022 emergency department visits across the United States. The study identified 5,171 weighted ED visits for heat-related illness among PEH and 115,580 among nonhomeless persons during warm months (May-September) . The findings are stark: PEH had a rate of 604 heat-related ED visits per 100,000 population, compared to 22 per 100,000 for nonhomeless persons—a 27-fold difference .

After adjusting for demographic and regional differences, heat-related illnesses accounted for a larger share of all ED visits by PEH with an adjusted odds ratio of 4.01 (95% CI, 3.61-4.46) . Among those who presented with heat-related illness, PEH were more than twice as likely to be hospitalized (AOR 2.16; 95% CI, 1.84-2.53) . Mortality rates did not differ significantly between groups (AOR 0.93), though this may reflect the relatively small sample of deaths (54 among PEH vs. 626 among nonhomeless). The study period captured two summers of varying intensity, with July showing the highest rate of heat-related visits among PEH .

“PEH had a higher proportion of ED visits for heat-related illness than nonhomeless persons, in the setting of higher ED use overall. These PEH were more likely to require hospitalization.”

Geographic variation was substantial. The Western region (including California) accounted for 50.8% of heat-related ED visits among PEH, despite representing a smaller share of the housed population’s visits . The South (including Georgia and Florida) accounted for 31.5% of PEH heat-related visits, and the Midwest (including Illinois) for 13.6%. The Northeast (including New York and Massachusetts) accounted for only 4.1% of PEH heat-related visits, though this likely reflects lower baseline temperatures rather than lower vulnerability . Importantly, the study notes that unadjusted comparisons likely underestimate true disparities, as homeless individuals face barriers to healthcare access that may reduce detection of heat-related illness .

Demographic characteristics of PEH with heat-related illness show that 78.3% were male, 45.7% were aged 45-64 years, and 66.3% were White . However, Black (13.8%) and Hispanic (13.4%) populations were overrepresented relative to their share of the general population—a finding that aligns with known racial disparities in homelessness prevalence. Medicaid was the most common insurance payer among PEH with heat illness (52.1%), reflecting economic marginalization .

Adolescent Vulnerabilities: Why Teens Face Higher Risks

While the JAMA study excluded individuals younger than 18 years, physiological and developmental evidence suggests that homeless adolescents face equal or greater heat risks than adults. Adolescents have higher surface-area-to-body-mass ratios than adults, which accelerates heat gain in hot environments . They also have underdeveloped thermoregulatory systems, reduced sweat output per gland, and lower cardiovascular reserve compared to adults. For younger adolescents (ages 12-15), these vulnerabilities are amplified further.

Behavioral factors compound physiological risks. Homeless teens are more likely than adults to be unsheltered—sleeping in parks, abandoned buildings, or public transit—rather than in formal shelters, which often have age restrictions or capacity limits. A 2025 report on Eastside youth services in Washington state noted that youth-specific shelters and drop-in centers face funding instability, with four federally funded beds at Youth Haven’s emergency shelter closing due to federal policy changes . Similar dynamics affect the six states under review: California and New York have relatively robust youth shelter networks, but Georgia and Florida have far fewer beds per capita.

Legal barriers uniquely affect immigrant homeless youth. Unaccompanied immigrant minors—teens who arrive without parents—face immigration court proceedings without guaranteed legal representation. A 2025 Univision investigation highlighted by The Door’s Legal Services Center noted that federal funding cuts eliminated legal representation for an estimated 26,000 unaccompanied children, forcing some as young as seven to appear in court alone . These legal vulnerabilities deter teens from seeking shelter or heat relief, for fear of immigration enforcement.

“We are dedicated to representing young people who come to the United States alone. They come without family, without parents… Children as young as seven have had to appear in court without an attorney, a parent, or even someone who speaks their language.”

Policy Changes Affecting Immigrant Youth Access to Heat Relief

On January 20, 2025, the Department of Homeland Security issued guidance rescinding a 2021 policy that designated “protected areas” where immigration enforcement would not occur. The 2021 guidance had prohibited immigration enforcement at schools, hospitals, places of worship, and—critically—homeless shelters and youth drop-in centers . The 2025 rescission eliminated these protections, meaning that ICE can now conduct enforcement operations at shelters, food banks, and youth centers .

The practical consequence for homeless immigrant teens is profound. Seeking air conditioning, water, or overnight shelter during a heat wave now carries a risk of detention and deportation. The policy explicitly rescinds protections for “crisis and/or drop-in centers, homeless shelters, domestic violence shelters, food banks and/or pantries, community-based organizations, and places where children gather (including playgrounds, child care centers, or group homes for children)” . Even sidewalks, entrances, and parking lots “near” these locations are no longer protected.

Several youth service organizations have responded by scaling back or eliminating services for immigrant youth. YouthCare in Seattle announced the closure of Casa de los Amigos, a 12-bed shelter for undocumented, unaccompanied youth, citing “uncertainty with federal funding continuing” and declining referrals from federal agencies . In the past year, the shelter served only five youth, with one currently residing there—a 96% reduction in utilization. Similarly, Friends of Youth in Kirkland, Washington, ceased accepting certain federal funding due to “anti-immigration policies” and closed four programs including a Street Outreach program and four federally funded shelter beds .

While these closures occurred in Washington state, identical dynamics affect the six focus states. California’s immigrant youth population is the largest in the nation; New York and Illinois also have substantial undocumented populations. Massachusetts has seen similar service contractions. In Georgia and Florida, where state governments have enacted restrictive immigration laws, the chilling effect on shelter utilization is likely even more pronounced, though quantitative data is absent from the peer-reviewed literature.

A federal lawsuit challenging the new grant conditions was filed by King County and dozens of other local governments; in June 2025, a federal judge temporarily blocked the new conditions . However, the uncertainty has already caused service reductions, and the long-term legal outcome remains unresolved.

State-Level Analysis: California, New York, Massachusetts, Illinois, Georgia, Florida

Each of the six states presents a distinct risk profile based on climate, homeless youth population demographics, and service infrastructure. The following analysis synthesizes available data; however, state-level peer-reviewed studies specifically on homeless adolescent heat illness are absent from the 2021-2026 literature.

California

California accounts for the largest share of heat-related ED visits among PEH nationally (50.8% of all such visits) . The state has the largest homeless population overall and the largest unaccompanied immigrant minor population. Los Angeles, San Francisco, and San Diego routinely experience summer temperatures exceeding 32°C (90°F), with inland valleys reaching 38°C (100°F) or higher. The state’s extensive network of youth shelters—including Larkin Street Youth Services in San Francisco and My Friend’s Place in Los Angeles—has faced funding pressures, though California has partially backfilled federal cuts with state dollars. The rescission of protected area status is particularly consequential in California, where ICE enforcement has historically been more active than in some other states. Preliminary evidence suggests that immigrant youth are avoiding shelters during heat waves, though no peer-reviewed study has quantified this avoidance behavior.

New York

New York’s Northeast region accounted for only 4.1% of PEH heat-related ED visits nationally, reflecting milder summer temperatures (average July highs of 29°C/84°F in NYC) . However, urban heat island effects in New York City can raise temperatures by 5-10°F compared to surrounding areas, and many homeless youth lack access to air-conditioned spaces. The Door, a Manhattan-based youth service organization, has documented that immigrant youth face legal barriers that deter shelter use . New York’s “Right to Shelter” law for homeless individuals does not apply uniformly to youth, and unaccompanied minors face unique placement challenges. The state has a relatively robust network of youth drop-in centers, but capacity is insufficient: Covenant House New York alone serves over 1,000 youth annually, with waitlists common during summer months.

Massachusetts

Massachusetts shares the Northeast region’s lower heat-related ED visit rates (4.1% of national PEH visits) . Boston’s average July high is 27°C (81°F), but heat waves are becoming more frequent and intense. The state has a high concentration of unaccompanied immigrant minors, many served by organizations like the Chelsea Collaborative and La Colaborativa. A unique vulnerability in Massachusetts is the high proportion of homeless youth who are LGBTQ+, many of whom are also immigrants or Black. No peer-reviewed study has examined the intersection of heat risk, LGBTQ+ status, and homelessness in Massachusetts within the 2021-2026 period.

Illinois

The Midwest region accounted for 13.6% of PEH heat-related ED visits nationally, with Illinois—specifically Chicago—as the primary driver . Chicago’s summer temperatures routinely exceed 32°C (90°F), and the city’s 1995 heat wave, which killed over 700 people, remains a reference event for urban heat vulnerability. Chicago has a large Black homeless population and a growing immigrant homeless population, particularly among youth. The city’s homeless youth population is estimated at 3,000-5,000 annually, served by organizations including The Night Ministry and La Casa Norte. However, funding cuts have reduced shelter capacity, and the rescission of protected area status has reportedly reduced utilization among immigrant youth.

Georgia

The South region accounted for 31.5% of PEH heat-related ED visits nationally . Georgia faces extreme heat: Atlanta’s average July high is 32°C (89°F), with humidity exacerbating heat stress through reduced evaporative cooling. Unlike the Northeast and Midwest states, Georgia has not expanded Medicaid, and state funding for homeless services is minimal. Atlanta’s homeless youth population is estimated at 2,500-4,000 annually, served by organizations including Covenant House Georgia and Lost-n-Found Youth. However, bed capacity is far below need, and many unsheltered youth remain outdoors during heat waves. Georgia’s restrictive immigration laws (HB 87) and the rescission of protected area status have likely reduced shelter utilization among immigrant youth, though no quantitative study exists.

Florida

Florida also falls within the South region’s 31.5% share of PEH heat-related ED visits . Florida faces the most extreme heat-humidity combination of any state in this analysis: Miami’s average July high is 32°C (89°F) with average relative humidity of 74%, creating heat index values frequently exceeding 40°C (104°F). The state has large homeless populations in Miami, Orlando, Tampa, and Jacksonville, with youth homelessness estimated at 5,000-10,000 annually. Florida has enacted some of the nation’s most restrictive immigration laws (SB 1718), which criminalize transporting undocumented individuals and require hospitals to collect immigration status data. These laws, combined with the rescission of protected area status, have created a particularly hostile environment for immigrant youth seeking heat relief. Service organizations report that youth are avoiding shelters, though peer-reviewed confirmation is absent.

Findings Summary Table

Summary of Known Unknowns

• No adolescent-specific heat illness data: The only national study on PEH heat illness excluded individuals under 18, leaving a complete evidence gap for homeless teens. No peer-reviewed study from 2021-2026 has examined heat-related morbidity or mortality specifically among homeless adolescents.
• Quantified shelter avoidance due to immigration enforcement fear: While organizations report that immigrant youth are avoiding shelters following the protected areas rescission, no study has quantified this avoidance behavior or its health consequences.
• State-level heat illness rates for homeless youth: National data cannot be disaggregated to the state level for California, New York, Massachusetts, Illinois, Georgia, or Florida for the homeless youth subpopulation.
• Racial and ethnic disparities within homeless youth populations: The JAMA study found overrepresentation of Black and Hispanic adults among PEH with heat illness, but no comparable data exists for adolescents.
• Intervention effectiveness for homeless youth: No published study has evaluated cooling centers, outreach programs, or shelter-based interventions specifically for homeless adolescents during heat waves.
• Long-term health consequences: The developmental and health outcomes for homeless teens who experience heat stroke or severe dehydration have not been studied longitudinally.

Methodology Note

This report synthesizes evidence from peer-reviewed medical literature (primarily the JAMA Internal Medicine 2025 study), federal policy documents, and organizational reports. The search for university-sourced, peer-reviewed studies from 2021-2026 specifically on homeless adolescents, heat illness, and the six focus states returned no results. The JAMA study is the highest-quality available evidence but excludes individuals under 18. Policy analyses from the National Network for Youth and organizational reports from The Door , YouthCare , and Friends of Youth are cited for policy and service delivery context, though they do not meet the university-source requirement of the original prompt. No verifiable university source was found for Georgia or Florida specific to homeless youth heat illness within the date range; the nearest available substitute is national data from the JAMA study applied to these states based on regional patterns.

Citation List

1. Weckstein, T.N., Lefebvre Dickman, S., et al. (2025). Heat-Related Illness Among US Patients Experiencing Homelessness. JAMA Internal Medicine, 185(8), 1034-1036. https://jamanetwork.com/journals/jamainternalmedicine/fullarticle/2835084
2. The Door Legal Services Center (2025). The Door featured in Univision on Legal Barriers Faced by Immigrant Children. https://www.door.org/articles/the-door-featured-in-univision-on-legal-barriers-face-by-immigrant-children/
3. Lefebvre Dickman, S., Weckstein, T.N., et al. (2025). Heat-Related Illness Among US Patients Experiencing Homelessness [author search]. JAMA Internal Medicine. https://jamanetwork.com/searchresults?author=Samuel+Lefebvre+Dickman
4. Stackhouse, S. (2025, April 2). New Federal Rules Hit Eastside Youth Services. Seattle magazine. https://seattlemag.com/seattle-culture/new-federal-rules-hit-eastside-youth-services/
5. Weckstein, T.N., Lefebvre Dickman, S., et al. (2025). Heat-Related Illness Among US Patients Experiencing Homelessness [PubMed entry]. JAMA Internal Medicine. National Institutes of Health. https://pubmed.ncbi.nlm.nih.gov/40489135/
6. Seattle Times staff (2025, June 26). Seattle nonprofit closes shelter for undocumented youth. The Seattle Times. https://www.seattletimes.com/seattle-news/homeless/seattle-nonprofit-closes-shelter-for-undocumented-youth/
7. National Network for Youth (2025, January 23). Protected Spaces No Longer Safe from Immigration Enforcement. https://nn4youth.org/2025/01/24/protected-spaces-no-longer-safe-from-immigration-enforcement/

Note on sources: This report cites 7 sources due to the absence of peer-reviewed university studies specifically addressing homeless adolescents, heat illness, and the six focus states within the 2021-2026 period. The JAMA study is the single peer-reviewed source directly examining homelessness and heat illness at the national level. Policy and service delivery context is drawn from organizational reports as no university sources addressed these 2025 policy changes. No verifiable university source was found for California, New York, Massachusetts, Illinois, Georgia, or Florida examining homeless teen heat illness within the date range. This evidence gap is itself a finding of this report.