Managing the unexpected: The role of homeless service providers during the 2017-2018 California wildfires

Under the radar: Examining how people experiencing homelessness sense impending disasters

This study investigates the intersection of homelessness and disaster preparedness, focusing on how people experiencing homelessness (PEH) receive and respond to disaster-related information. The research emphasizes the critical roles of environmental cues and technology in alerting PEH to potential hazards. Environmental indicators, such as changes in the sky, wind patterns, and animal behavior, are commonly relied upon, although they can delay protective actions. Mobile phones serve as essential tools for accessing vital information, despite challenges related to affordability and charging access. The study also highlights the importance of trusted community members in disseminating information through informal networks. Using Lindell and Perry's Protective Action Decision Model as a framework, this qualitative study examines the lived experiences of 41 unsheltered PEH. Key findings underscore the need for tailored communication strategies, integrating services and information into emergency plans, and establishing local government dashboards to enhance disaster preparedness and resilience among PEH. The study provides actionable recommendations for emergency management to better support this vulnerable population.

Neoliberalism, Climate Change, and Displaced and Homeless Populations: Exploring Interactions Through Case Studies

There is a growing attention to neoliberal policies and practices as they relate to climate change and housing within academic literature. However, the combined effects of neoliberal political and economic decisions on the interaction between climate change and displaced and homeless populations have not been substantially explored. In this paper, we identify and focus on three key re-emerging themes prevalent within neoliberal discourses: economic considerations, individualization, and short-termism. To examine the intersecting influence of climate change and these themes on vulnerable populations, the following case studies are discussed: displaced populations in the Middle East and North Africa (MENA) region, refugees in Kenya, and tiny homes programs in the U.S. and Canada. The diversified contexts and levels of analysis allow for more nuanced understanding of the variety of ways in which neoliberal influences and climate-induced events impact the most vulnerable populations. We argue for the need to change the framing of these issues, which are often presented in neoliberal terms and are driven by neoliberal logic. We then present potential avenues for resolving the identified issues, such as through systemic changes, development of long-term solutions, and focusing on community-based adaptation (CBA) programs.

COVID-19 vaccination uptake and receptivity among veterans enrolled in homelessness-tailored primary health care clinics: provider trust vs. misinformation

BACKGROUND

Compared to the general population, individuals experiencing homelessness are at greater risk of excess morbidity and mortality from COVID-19 but have been vaccinated at lower rates. The U.S. Department of Veterans Affairs (VA)'s Homeless Patient Aligned Care Team (HPACT) program integrates health care and social services for Veterans experiencing homelessness to improve access to and utilization of care.

METHODS

This study explores the vaccination uptake behavior and attitudes through a qualitative comparative case study of two HPACT clinics, one in California (CA) and one in North Dakota (ND). Semi-structured telephone interviews were conducted with Veterans enrolled in the two VA HPACT clinics from August to December 2021 with 20 Veterans (10 at each clinic).

RESULTS

Four themes emerged from the interviews: (1) Vaccination uptake and timing- While half of the Veterans interviewed were vaccinated, ND Veterans were more likely to be vaccinated and got vaccinated earlier than CA Veterans; (2) Housing- Unsheltered or precariously housed Veterans were less likely to be vaccinated; (3) Health Care- Veterans reporting positive experiences with VA health care and those who trusted health providers were more likely to vaccinate than those with negative or nuanced satisfaction with health care; (4) Refusers' Conspiracy Theories and Objectivity Claims- Veterans refusing the vaccine frequently mentioned belief in conspiracy theories while simultaneously asserting their search for objective information from unbiased sources.

CONCLUSIONS

These findings amplify the importance of improving access to population-tailored care for individuals experiencing homelessness by reducing patient loads, expanding housing program enrollment, and increasing the provider workforce to ensure personalized care. Health care providers, and housing providers, social workers, and peers, who offer information without discrediting or criticizing Veterans' beliefs, are also key to effectively delivering vaccine messaging to this population.

Social Vulnerability in US Communities Affected by Wildfire Smoke, 2011 to 2021

Objectives. To describe demographic and social characteristics of US communities exposed to wildfire smoke. Methods. Using satellite-collected data on wildfire smoke with the locations of population centers in the coterminous United States, we identified communities potentially exposed to light-, medium-, and heavy-density smoke plumes for each day from 2011 to 2021. We linked days of exposure to smoke in each category of smoke plume density with 2010 US Census data and community characteristics from the Centers for Disease Control and Prevention's Social Vulnerability Index to describe the co-occurrence of smoke exposure and social disadvantage. Results. During the 2011-to-2021 study period, increases in the number of days of heavy smoke were observed in communities representing 87.3% of the US population, with notably large increases in communities characterized by racial or ethnic minority status, limited English proficiency, lower educational attainment, and crowded housing conditions. Conclusions. From 2011 to 2021, wildfire smoke exposures in the United States increased. As smoke exposure becomes more frequent and intense, interventions that address communities with social disadvantages might maximize their public health impact. (Am J Public Health. 2023;113(7):759-767. https://doi.org/10.2105/AJPH.2023.307286).

Extreme weather events and HIV: development of a conceptual framework through qualitative interviews with people with HIV impacted by the California wildfires and their clinicians

BACKGROUND

People with HIV (PWH) are disproportionately vulnerable to the impacts of wildfires, given the need for frequent access to healthcare systems, higher burden of comorbidities, higher food insecurity, mental and behavioral health challenges, and challenges of living with HIV in a rural area. In this study, we aim to better understand the pathways through which wildfires impact health outcomes among PWH.

METHODS

From October 2021 through February 2022, we conducted individual semi-structured qualitative interviews with PWH impacted by the Northern California wildfires and clinicians of PWH who were impacted by wildfires. The study aims were to explore the influence of wildfires on the health of PWH and to discuss measures at the individual, clinic, and system levels that helped to mitigate these impacts.

RESULTS

We interviewed 15 PWH and 7 clinicians. While some PWH felt that surviving the HIV epidemic added to their resilience against wildfires, many felt that the wildfires compounded the HIV-related traumas that they have experienced. Participants outlined five main routes by which wildfires negatively impacted their health: (1) access to healthcare (medications, clinics, clinic staff), (2) mental health (trauma; anxiety, depression, or stress; sleep disturbances; coping strategies), (3) physical health (cardiopulmonary, other co-morbidities), (4) social/economic impacts (housing, finances, community), and (5) nutrition and exercise. The recommendations for future wildfire preparedness were at the (1) individual-level (what to have during evacuation), (2) pharmacy-level (procedural, staffing), and (3) clinic- or county-level (funds and vouchers; case management; mental health services; emergency response planning; other services such as telehealth, home visits, home laboratory testing).

CONCLUSIONS

Based on our data and prior research, we devised a conceptual framework that acknowledges the impact of wildfires at the community-, household-, and individual-level with implications for physical and mental health outcomes among PWH. These findings and framework can help in developing future interventions, programs, and policies to mitigate the cumulative impacts of extreme weather events on the health of PWH, particularly among individuals living in rural areas. Further studies are needed to examine health system strengthening strategies, innovative methods to improve access to healthcare, and community resilience through disaster preparedness.

TRIAL REGISTRATION

N/A.

Active Fire Detection from Landsat-8 Imagery Using Deep Multiple Kernel Learning

Active fires are devastating natural disasters that cause socio-economical damage across the globe. The detection and mapping of these disasters require efficient tools, scientific methods, and reliable observations. Satellite images have been widely used for active fire detection (AFD) during the past years due to their nearly global coverage. However, accurate AFD and mapping in satellite imagery is still a challenging task in the remote sensing community, which mainly uses traditional methods. Deep learning (DL) methods have recently yielded outstanding results in remote sensing applications. Nevertheless, less attention has been given to them for AFD in satellite imagery. This study presented a deep convolutional neural network (CNN) “MultiScale-Net” for AFD in Landsat-8 datasets at the pixel level. The proposed network had two main characteristics: (1) several convolution kernels with multiple sizes, and (2) dilated convolution layers (DCLs) with various dilation rates. Moreover, this paper suggested an innovative Active Fire Index (AFI) for AFD. AFI was added to the network inputs consisting of the SWIR2, SWIR1, and Blue bands to improve the performance of the MultiScale-Net. In an ablation analysis, three different scenarios were designed for multi-size kernels, dilation rates, and input variables individually, resulting in 27 distinct models. The quantitative results indicated that the model with AFI-SWIR2-SWIR1-Blue as the input variables, using multiple kernels of sizes 3 × 3, 5 × 5, and 7 × 7 simultaneously, and a dilation rate of 2, achieved the highest F1-score and IoU of 91.62% and 84.54%, respectively. Stacking AFI with the three Landsat-8 bands led to fewer false negative (FN) pixels. Furthermore, our qualitative assessment revealed that these models could detect single fire pixels detached from the large fire zones by taking advantage of multi-size kernels. Overall, the MultiScale-Net met expectations in detecting fires of varying sizes and shapes over challenging test samples.

Vaccinating Veterans Experiencing Homelessness for COVID-19: Healthcare and Housing Service Providers' Perspectives

This study examines challenges experienced during COVID-19 vaccination efforts, facilitating factors that increased vaccination, and lessons learned from healthcare providers and housing program staff who delivered healthcare and services to Veterans experiencing homelessness during the SARS-CoV-2 pandemic. Qualitative, semi-structured interviews were conducted with seven transitional housing program staff in northern California, southern California, Florida, Iowa, Kentucky, Massachusetts, and New Jersey (January-April 2021) and six primary care providers serving Veterans experiencing homelessness, four from clinics in California and two from a clinic in North Dakota (July-August 2021). Interviews were transcribed and analyzed using a rapid analysis approach. COVID-19 vaccination rates were between 40 and 60% among Veterans who received care from the primary care providers and between 20 and 90% among Veterans who were enrolled in the transitional housing programs. Barriers that providers and housing staff encountered when getting Veterans vaccinated for COVID-19 included lack of eligibility, the vaccine appointment scheduling process, transportation and communication challenges, Veterans' distrust in the government, vaccine mandates, and vaccine hesitancy among organization staff. Recommendations to increase COVID-19 vaccine uptake included making vaccination more convenient, using trusted sources such as homeless program staff or Veteran peers to provide educational information about the safety and efficacy of COVID-19 vaccines, and encouraging rather than mandating vaccination. These lessons will enable entities providing care to people experiencing homelessness to develop more effective policies and educational campaigns to improve vaccine acceptance and uptake among this vulnerable population.

Responding to COVID-19 While Serving Veterans Experiencing Homelessness: The Pandemic Experiences of Healthcare and Housing Providers

The U.S. Department of Veterans Affairs (VA) provides essential care through transitional housing and healthcare for Veterans experiencing homelessness through the Grant and Per Diem (GPD) program and the Homeless Patient Aligned Care Team (HPACT), respectively. At the onset of the SARS-CoV-2 pandemic, GPD organizations and HPACT clinics faced the challenge of being essential providers tasked with ensuring the well-being of Veterans under their care. Through semi-structured interviews with 13 providers (6 HPACT health care providers representing 2 HPACT programs, and 7 GPD staff members) across the U.S., this study explored their experiences navigating the tasks of keeping Veterans safe and providing ongoing care from the start of the pandemic up to the 2021 interview dates. Both GPD and HPACT providers reported amplified safety concerns about COVID-19 infection among staff at the start of the pandemic, which diminished to a lower, stable level after a few months as adaptations made for safety became embedded in their routines. However, ongoing challenges included isolation and mental health challenges among Veterans, inherent limitations of telehealth as a care delivery avenue, provider frustration and burnout due to increased workload and frequent change, and the logistics of administering testing for Veterans to enter GPD housing. Enhanced pandemic preparedness planning for GPD organizations, funding for personal protective equipment (PPE) and providing technology to facilitate Veterans' telehealth access, and strategies for preventing provider burnout are critical to both sustaining homeless providers' capabilities during this pandemic and enhancing readiness to respond to the next public health emergency.

Predictors of COVID-19 Vaccination among Veterans Experiencing Homelessness

Sufficient uptake of the COVID-19 vaccine is key to slowing the spread of the coronavirus among the most vulnerable in society, including individuals experiencing homelessness. However, COVID-19 vaccination rates among the Veteran homeless population are currently unknown. This study examines the COVID-19 vaccination rate among homeless Veterans who receive care at the U.S. Department of Veterans Affairs (VA), and the factors that are associated with vaccine uptake. Using VA administrative and clinical data, bivariate and multivariate analyses were conducted to identify the sociodemographic, health-related, and healthcare and housing services utilization factors that influenced COVID-19 vaccine uptake during the first eight months of the vaccine rollout (December 2020-August 2021). Of the 83,528 Veterans experiencing homelessness included in the study, 45.8% were vaccinated for COVID-19. Non-white, older Veterans (65+), females, those who received the seasonal flu vaccine, and Veterans with multiple comorbidities and mental health conditions were more likely to be vaccinated. There was a strong association between COVID-19 vaccination and Veterans who utilized VA healthcare and housing services. VA healthcare and homeless service providers are particularly well-positioned to provide trusted information and overcome access barriers for homeless Veterans to receive the COVID-19 vaccine.