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Tsai J, Alarcón J. The Annual Homeless Point-in-Time Count: Limitations and Two Different Solutions. Am J Public Health 2022; 112:633-637. [PMID: 35319943 PMCID: PMC8961826 DOI: 10.2105/ajph.2021.306640] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2021] [Indexed: 11/04/2022]
Abstract
The point-in-time (PIT) homeless count conducted annually in communities across the United States is a major metric reported to the federal government that has a number of limitations. With the PIT count in 2021 being optional because of the COVID-19 pandemic and potential increases in homeless-related needs in the aftermath of the pandemic, there are opportunities for renewed efforts to improve how the United States enumerates homelessness, determines needs of communities, and tracks progress in ending homelessness throughout the nation. This article describes 2 divergent solutions: (1) improve the PIT by standardizing methodologies across jurisdictions and supplementing counts with other data sources or (2) replace the PIT with a new system. There are strengths and limitations of both solutions. Advocates for either solution agree that there are important funding considerations to take into account and advancing technologies to utilize. As the nation continues to ramp up public health efforts, homelessness is a public health crisis that could benefit from improved epidemiological and data science methods. (Am J Public Health. 2022;112(4):633-637. https://doi.org/10.2105/AJPH.2021.306640).
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Affiliation(s)
- Jack Tsai
- Jack Tsai is with the School of Public Health, University of Texas Health Science Center, Houston, and the US Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL. Jemma Alarcón is with Ventura County Medical Center, Ventura, CA
| | - Jemma Alarcón
- Jack Tsai is with the School of Public Health, University of Texas Health Science Center, Houston, and the US Department of Veterans Affairs National Center on Homelessness Among Veterans, Tampa, FL. Jemma Alarcón is with Ventura County Medical Center, Ventura, CA
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Noor MN, Bryant J, de Wit J, Holt M. Resourcefulness of homeless young people who practise sex work in Pakistan: a qualitative study. Sex Health 2021; 18:378-384. [PMID: 34634229 DOI: 10.1071/sh21024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 07/19/2021] [Indexed: 11/23/2022]
Abstract
Background Many homeless young people in Pakistan use sex work as a way to generate income, particularly if they have few other options for work. Because it is highly stigmatised, little attention has been paid to the strategies homeless young people use to practise sex work, and what this suggests about their capacities and strengths. Methods Semi-structured interviews were conducted with 29 homeless young people (aged 16-25years) from Rawalpindi, Pakistan, including nine cisgender heterosexual men, six cisgender heterosexual women, seven cisgender gay men, and seven transgender heterosexual women. Results Participants sought memberships in street-based peer groups where financial gains were contingent on dancing and sex work. To practise their work successfully, participants learned novel skills and mobilised material resources available to them on the streets. Participants talked about how they acquired and benefitted from skills related to beautification, dancing, communication, and sexual services to achieve the necessary standards for entertainment and sex work. Access to material resources like makeup, clothes, rented rooms, mobile phones and condoms made dancing and sex work possible and safer for participants. Conclusions Participants' improvisation with limited resources on the streets has important implications for policy and programs. Showcasing the resourcefulness and capacities of young people encourages a different way of thinking about them. This potential could be utilised in productive ways if they were given the chance to receive mainstream and technical education, better health support and access to the formal job market.
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Affiliation(s)
- Muhammad Naveed Noor
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - Joanne Bryant
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
| | - John de Wit
- Department of Interdisciplinary Social Science, Utrecht University, Utrecht, The Netherlands
| | - Martin Holt
- Centre for Social Research in Health, The University of New South Wales, Sydney, NSW, Australia
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Trick WE, Hill JC, Toepfer P, Rachman F, Horwitz B, Kho A. Joining Health Care and Homeless Data Systems Using Privacy-Preserving Record-Linkage Software. Am J Public Health 2021; 111:1400-1403. [PMID: 34464174 PMCID: PMC8489603 DOI: 10.2105/ajph.2021.306304] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- William E Trick
- William E. Trick is with the Center for Health Equity & Innovation, Cook County Health, Chicago, IL. Jennifer C. Hill is with the Alliance to End Homelessness in Suburban Cook County, Hillside, IL. Peter Toepfer is with the Center for Housing and Health, Chicago, IL. Fred Rachman is with AllianceChicago, Chicago. Beth Horwitz is with All Chicago Making Homelessness History, Chicago. Abel Kho is with the Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Jennifer C Hill
- William E. Trick is with the Center for Health Equity & Innovation, Cook County Health, Chicago, IL. Jennifer C. Hill is with the Alliance to End Homelessness in Suburban Cook County, Hillside, IL. Peter Toepfer is with the Center for Housing and Health, Chicago, IL. Fred Rachman is with AllianceChicago, Chicago. Beth Horwitz is with All Chicago Making Homelessness History, Chicago. Abel Kho is with the Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Peter Toepfer
- William E. Trick is with the Center for Health Equity & Innovation, Cook County Health, Chicago, IL. Jennifer C. Hill is with the Alliance to End Homelessness in Suburban Cook County, Hillside, IL. Peter Toepfer is with the Center for Housing and Health, Chicago, IL. Fred Rachman is with AllianceChicago, Chicago. Beth Horwitz is with All Chicago Making Homelessness History, Chicago. Abel Kho is with the Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Fred Rachman
- William E. Trick is with the Center for Health Equity & Innovation, Cook County Health, Chicago, IL. Jennifer C. Hill is with the Alliance to End Homelessness in Suburban Cook County, Hillside, IL. Peter Toepfer is with the Center for Housing and Health, Chicago, IL. Fred Rachman is with AllianceChicago, Chicago. Beth Horwitz is with All Chicago Making Homelessness History, Chicago. Abel Kho is with the Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Beth Horwitz
- William E. Trick is with the Center for Health Equity & Innovation, Cook County Health, Chicago, IL. Jennifer C. Hill is with the Alliance to End Homelessness in Suburban Cook County, Hillside, IL. Peter Toepfer is with the Center for Housing and Health, Chicago, IL. Fred Rachman is with AllianceChicago, Chicago. Beth Horwitz is with All Chicago Making Homelessness History, Chicago. Abel Kho is with the Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
| | - Abel Kho
- William E. Trick is with the Center for Health Equity & Innovation, Cook County Health, Chicago, IL. Jennifer C. Hill is with the Alliance to End Homelessness in Suburban Cook County, Hillside, IL. Peter Toepfer is with the Center for Housing and Health, Chicago, IL. Fred Rachman is with AllianceChicago, Chicago. Beth Horwitz is with All Chicago Making Homelessness History, Chicago. Abel Kho is with the Center for Health Information Partnerships, Department of Medicine, Feinberg School of Medicine, Northwestern University, Evanston, IL
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Castañeda E, Smith B, Vetter E. Hispanic health disparities and housing: Comparing measured and self-reported health metrics among housed and homeless Latin individuals. J Migr Health 2021; 1-2:100008. [PMID: 34405163 PMCID: PMC8352211 DOI: 10.1016/j.jmh.2020.100008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 11/23/2020] [Accepted: 11/24/2020] [Indexed: 12/20/2022] Open
Abstract
Previous studies argue that Hispanics are healthier and less likely to experience homelessness than other populations in their same socioeconomic position. However, earlier studies have not explored the relationship between housing status and health for Latin individuals. This study examines 1) the health disparities between homeless and housed Hispanics in El Paso, Texas, and 2) the Hispanic health and homelessness paradoxes using an intersectional framework to understand health risks. A large number of Hispanic residents of El Paso (N = 1152) were surveyed. Demographic, health, and housing data were collected. We contribute to the literature by providing detailed health indicators for homeless Hispanics. To our knowledge, this is the first study to examine health disparities between housed and homeless Hispanics. Bivariate analysis, as well as data coded from interviews, indicated that homeless Hispanics were more likely to have barriers to care, less likely to have health insurance, slightly more likely than housed Hispanics to experience mental illness, alcoholism, and addiction, and more likely to be underdiagnosed for health problems, including hypertension. This study shows how certain traditional methods for collecting health data, including self-rated health and reported diagnoses, can be ineffective at revealing health disparities. This paper calls for innovative, mixed-methods approaches to understand the social and structural determinants of health for marginalized populations.
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Affiliation(s)
- Ernesto Castañeda
- Department of Sociology, American University, 4400 Massachusetts Ave NW, Watkins 115, Washington, DC 20016, United States
- Corresponding author.
| | - Blaine Smith
- Boston University, 100 Cummington Mall, Room 260, Boston, MA 02215, United States
| | - Emma Vetter
- American University, 4400 Massachusetts Ave NW, Watkins 115, Washington, DC 20016, United States
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Effectiveness of a housing support team intervention with a recovery-oriented approach on hospital and emergency department use by homeless people with severe mental illness: a randomised controlled trial. Epidemiol Psychiatr Sci 2020; 29:e169. [PMID: 32996442 PMCID: PMC7576524 DOI: 10.1017/s2045796020000785] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
AIMS Many people who are homeless with severe mental illnesses are high users of healthcare services and social services, without reducing widen health inequalities in this vulnerable population. This study aimed to determine whether independent housing with mental health support teams with a recovery-oriented approach (Housing First (HF) program) for people who are homeless with severe mental disorders improves hospital and emergency department use. METHODS We did a randomised controlled trial in four French cities: Lille, Marseille, Paris and Toulouse. Participants were eligible if they were 18 years or older, being absolutely homeless or precariously housed, with a diagnosis of schizophrenia (SCZ) or bipolar disorder (BD) and were required to have a high level of needs (moderate-to-severe disability and past hospitalisations over the last 5 years or comorbid alcohol or substance use disorder). Participants were randomly assigned (1:1) to immediate access to independent housing and support from the Assertive Community Treatment team (social worker, nurse, doctor, psychiatrist and peer worker) (HF group) or treatment as usual (TAU group) namely pre-existing dedicated homeless-targeted programs and services. Participants and interviewers were unmasked to assignment. The primary outcomes were the number of emergency department (ED) visits, hospitalisation admissions and inpatient days at 24 months. Secondary outcomes were recovery (Recovery Assessment Scale), quality of life (SQOL and SF36), mental health symptoms, addiction issues, stably housed days and cost savings from a societal perspective. Intention-to-treat analysis was performed. RESULTS Eligible patients were randomly assigned to the HF group (n = 353) or TAU group (n = 350). No differences were found in the number of hospital admissions (relative risk (95% CI), 0.96 (0.76-1.21)) or ED visits (0.89 (0.66-1.21)). Significantly less inpatient days were found for HF v. TAU (0.62 (0.48-0.80)). The HF group exhibited higher housing stability (difference in slope, 116 (103-128)) and higher scores for sub-dimensions of S-QOL scale (psychological well-being and autonomy). No differences were found for physical composite score SF36, mental health symptoms and rates of alcohol or substance dependence. Mean difference in costs was €-217 per patient over 24 months in favour of the HF group. HF was associated with cost savings in healthcare costs (RR 0.62(0.48-0.78)) and residential costs (0.07 (0.05-0.11)). CONCLUSION An immediate access to independent housing and support from a mental health team resulted in decreased inpatient days, higher housing stability and cost savings in homeless persons with SCZ or BP disorders.
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Predicting Daily Sheltering Arrangements among Youth Experiencing Homelessness Using Diary Measurements Collected by Ecological Momentary Assessment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17186873. [PMID: 32962272 PMCID: PMC7558709 DOI: 10.3390/ijerph17186873] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/02/2020] [Revised: 08/28/2020] [Accepted: 09/11/2020] [Indexed: 11/25/2022]
Abstract
Youths experiencing homelessness (YEH) often cycle between various sheltering locations including spending nights on the streets, in shelters and with others. Few studies have explored the patterns of daily sheltering over time. A total of 66 participants completed 724 ecological momentary assessments that assessed daily sleeping arrangements. Analyses applied a hypothesis-generating machine learning algorithm (component-wise gradient boosting) to build interpretable models that would select only the best predictors of daily sheltering from a large set of 92 variables while accounting for the correlated nature of the data. Sheltering was examined as a three-category outcome comparing nights spent literally homeless, unstably housed or at a shelter. The final model retained 15 predictors. These predictors included (among others) specific stressors (e.g., not having a place to stay, parenting and hunger), discrimination (by a friend or nonspecified other; due to race or homelessness), being arrested and synthetic cannabinoids use (a.k.a., “kush”). The final model demonstrated success in classifying the categorical outcome. These results have implications for developing just-in-time adaptive interventions for improving the lives of YEH.
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Sick Enough? Mental Illness and Service Eligibility for Homeless Individuals at the Border. SOCIAL SCIENCES 2020. [DOI: 10.3390/socsci9080145] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This paper measures mental illness among individuals experiencing homelessness in a border city and compares it to the general housed population. We use original data from a homeless survey conducted in El Paso, Texas. Respondents self-reported any possible mental illness or related symptoms. We find that mental illness is not disproportionally common among the homeless, yet this is something that is often claimed by laypersons, some social service workers, and some researchers that limit sampling to institutionalized settings where formal mental illness is often among the prerequisites for admission. We find that “severe mental illness” among homeless persons is 6.2% (only around 2–3% higher than the general population), and “any mental illness” is 20.8% (only 1–3% higher than in the general population). Our results are consistent with other research focusing on street samples.
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Khouzam N, Gelberg L, Guo R, Tseng CH, Bhattacharya D. Opiate Dependence: A Risk Factor for Hepatitis B Virus Exposure in Homeless Adults. FAMILY & COMMUNITY HEALTH 2020; 43:161-169. [PMID: 32079972 DOI: 10.1097/fch.0000000000000246] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The prevalence of hepatitis B virus (HBV) in the homeless population is underestimated despite multiple behavioral risks. Data from a sample of 534 homeless adults from downtown Los Angeles were analyzed to examine the prevalence and predictors of HBV infection in this community. The prevalence of HBV was 7 to 10 times higher than in the US general population rate. Opiate dependence, injection and noninjection use, was an independent predictor of HBV exposure. Testing and counseling occurred at significantly lower rates for HBV than for human immunodeficiency virus. Findings emphasize the need to enhance screening and counseling in homeless communities and other populations with opiate use.
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Affiliation(s)
- Nour Khouzam
- Departments of Medicine, Division of Infectious Diseases (Drs Khouzam and Bhattacharya), Family Medicine (Dr Gelberg), and Biomathematics (Ms Guo and Dr Tseng), David Geffen School of Medicine, University of California, Los Angeles; and Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles (Dr Gelberg)
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Schreiter S, Bermpohl F, Krausz M, Leucht S, Rössler W, Schouler-Ocak M, Gutwinski S. The Prevalence of Mental Illness in Homeless People in Germany. DEUTSCHES ARZTEBLATT INTERNATIONAL 2018; 114:665-672. [PMID: 29070426 DOI: 10.3238/arztebl.2017.0665] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 03/27/2017] [Accepted: 07/05/2017] [Indexed: 11/27/2022]
Abstract
BACKGROUND The number of homeless people in Germany is increasing. Studies from multiple countries have shown that most homeless people suffer from mental illnesses that require treatment. Accurate figures on the prevalence of mental illness among the homeless in Germany can help improve care structures for this vulnerable group. METHODS We carried out a systematic review and meta-analysis on the prevalence of mental illness among homeless people in Germany. RESULTS 11 pertinent studies published from 1995 to 2013 were identified. The overall study population consisted of 1220 homeless people. The pooled prevalence of axis I disorders was 77.4%, with a 95% confidence interval [95% CI] of [71.3; 82.9]. Substance-related disorders were the most common type of disorder, with a pooled prevalence of 60.9% [53.1; 68.5]. The most common among these was alcoholism, with a prevalence of 55.4% [49.2; 61.5]. There was marked heterogeneity across studies. CONCLUSION In Germany, the rate of mental illness requiring treatment is higher among the homeless than in the general population. The development and implementation of suitable care models for this marginalized and vulnerable group is essential if their elevated morbidity and mortality are to be reduced.
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Affiliation(s)
- Stefanie Schreiter
- Charité Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität of Berlin, and Berlin Institute of Health, Department of Psychiatry and Psychotherapy; Department of Psychiatry, University of British Columbia (UBC), Vancouver, Kanada; Psychiatric Clinic of the Ludwig-Maximilians-Universität München; Department of Psychiatry, Psychotherapy, and Psychosomatics, Psychiatric Hospital, University of Zürich
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Rhenter P, Moreau D, Laval C, Mantovani J, Albisson A, Suderie G, Boucekine M, Tinland A, Loubière S, Greacen T, Auquier P, Girard V. Bread and Shoulders: Reversing the Downward Spiral, a Qualitative Analyses of the Effects of a Housing First-Type Program in France. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29538346 PMCID: PMC5877065 DOI: 10.3390/ijerph15030520] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
This paper is a qualitative analysis of the effects of accompagnement, a support framework, on recovery trajectories of people with long-term homelessness and severe psychiatric disorders during 24 months in a Housing First-type program in France. A comprehensive methodology based on grounded theory was used to construct an interview guide, conduct multiple interviews with 35 Housing First participants sampled for heterogeneity, and produce memos on their trajectories before and after entering the program based on interview information. Thematic analysis of a representative subsample (n = 13) of memos identified 12 objective factors and 6 subjective factors key to the recovery process. An in-depth re-analysis of the memos generated four recovery themes: (1) the need for secure space favorable to self-reflexivity; (2) a “honeymoon” effect; (3) the importance of even weak social ties; (4) support from and hope among peers. Three challenges to recovery were identified: (1) finding a balance between protection and risk; (2) breaking downward spirals; (3) bifurcating the trajectory. This study provides new insight into the recovery process, understood as a non-linear transformation of an experience—the relationship between objective life conditions and subjective perception of those conditions—which reinforces protective support over risk elements.
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Affiliation(s)
- Pauline Rhenter
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
| | - Delphine Moreau
- Research Laboratory, Maison Blanche Hospital, 75018 Paris, France.
| | - Christian Laval
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
| | - Jean Mantovani
- Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France.
| | - Amandine Albisson
- Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France.
| | - Guillaume Suderie
- Observatory Regional of Health, Midi Pyrenees, 31000 Toulouse, France.
| | - Mohamed Boucekine
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Public Hospital of Marseille (AP-HM), 13005 Marseille, France.
| | - Aurelie Tinland
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Community Mental Health Outreach Team, MARS (Movement and Action for Social Recovery), Public Hospital of Marseille (AP-HM), 13005 Marseille, France.
| | - Sandrine Loubière
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Department of Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, Public Hospital of Marseille (AP-HM), 13005 Marseille, France.
| | - Tim Greacen
- Research Laboratory, Maison Blanche Hospital, 75018 Paris, France.
| | - Pascal Auquier
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- French Housing First Study Group, 13000 Marseille, France.
| | - Vincent Girard
- Aix-Marseille University, Public Health Research Unit EA 3279, 13005 Marseille, France.
- Regional Health Agency PACA (ARS), 13002 Marseille, France.
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Abstract
As part of the April 2001 “Common Ground, Common Language, Common Goals: Bringing Substance Abuse Practice and Research Together” conference, a panel of treatment provider experts was assembled to discuss the unique treatment needs of “special populations.” The “Special Populations” panel was initially guided by the assumption that clients with unique needs should be considered as distinct homogeneous groups, outside the mainstream. However, as panel members revealed, the heterogeneity of the substance abuse treatment client population suggests that the concept of “special populations” may be inappropriate and that alternative approaches to conceptualizing diversity within the substance abuse treatment client population are needed. The present paper provides background on the use of term “special populations” in the substance abuse field and summarizes discussions that occurred during the “Special Populations” panel regarding the application of this concept to clients in substance abuse treatment.
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Christian J, Armitage CJ, Abrams D. Evidence That Theory of Planned Behaviour Variables Mediate the Effects of Socio-demographic Variables on Homeless People's Participation in Service Programmes. J Health Psychol 2016; 12:805-17. [PMID: 17855464 DOI: 10.1177/1359105307080615] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
This article reports findings from two studies ( N = 88, N = 100) using Ajzen's theory of planned behaviour (TPB) to predict homeless people's uptake of service programmes. Study 1 was conducted with an opportunity sample whereas Study 2 employed a representative sample. Both studies provide support for the application of the TPB, and demonstrate that the effects of demographic characteristics on behaviour were mediated by TPB variables. The discussion focuses on the role of attitudinal and normative components in actual behaviour, and on the potential role of social normative processes and stigmatization in homeless people's uptake of services.
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Affiliation(s)
- Julie Christian
- School Of Psychology, University of Birmingham, Edgbaston, Birmingham, UK.
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Characteristics of Mothers Caring for Children During Episodes of Homelessness. Community Ment Health J 2015; 51:913-20. [PMID: 25536936 PMCID: PMC4722539 DOI: 10.1007/s10597-014-9794-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2013] [Accepted: 12/06/2014] [Indexed: 10/24/2022]
Abstract
This 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. Interviews were conducted with 148 homeless women from three mid-sized U.S. cities, 24.3 % of whom were caring for at least one child. Our results showed that women caring for children were more likely to be sheltered and have health insurance. Homeless women caring for children and solitary homeless women were generally similar in terms of substance abuse problems. However, rates of Borderline Personality Disorder were higher among women caring for children than among solitary homeless women. Our results are somewhat consistent with previous research, with the exception of substance abuse problems and mental health problems, which were shown to be equally problematic for all women, regardless of current caregiving status.
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Abstract
UNLABELLED POLICY POINTS: A retrospective analysis of federally funded homeless research in the 1980s serves as a case study of how politics can influence social and behavioral science research agendas today in the United States. These studies of homeless populations, the first funded by the National Institute of Mental Health, demonstrated that only about a third of the homeless population was mentally ill and that a diverse group of people experienced homelessness. This groundbreaking research program set the mold for a generation of research and policy characterizing homelessness as primarily an individual-level problem rather than a problem with the social safety net. CONTEXT A decade after the nation's Skid Rows were razed, homelessness reemerged in the early 1980s as a health policy issue in the United States. While activists advocated for government-funded programs to address homelessness, officials of the Reagan administration questioned the need for a federal response to the problem. In this climate, the National Institute of Mental Health (NIMH) launched a seminal program to investigate mental illness and substance abuse among homeless individuals. This program serves as a key case study of the social and behavioral sciences' role in the policy response to homelessness and how politics has shaped the federal research agenda. METHODS Drawing on interviews with former government officials, researchers, social activists, and others, along with archival material, news reports, scientific literature, and government publications, this article examines the emergence and impact of social and behavioral science research on homelessness. FINDINGS Research sponsored by the NIMH and other federal research bodies during the 1980s produced a rough picture of mental illness and substance abuse prevalence among the US homeless population, and private foundations supported projects that looked at this group's health care needs. The Reagan administration's opposition to funding "social research," together with the lack of private-sector support for such research, meant that few studies examined the relationship between homelessness and structural factors such as housing, employment, and social services. CONCLUSIONS The NIMH's homelessness research program led to improved understanding of substance abuse and mental illness in homeless populations. Its primary research focus on behavioral disorders nevertheless unwittingly reinforced the erroneous notion that homelessness was rooted solely in individual pathology. These distortions, shaped by the Reagan administration's policies and reflecting social and behavioral scientists' long-standing tendencies to emphasize individual and cultural rather than structural aspects of poverty, fragmented homelessness research and policy in enduring ways.
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Hilton TP, Trella DL. “You Just Gotta Do It, 'Cause Those are Your Kids”: Survival Parenting and Rural Homelessness. WORLD MEDICAL & HEALTH POLICY 2014. [DOI: 10.1002/wmh3.115] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Castañeda E, Klassen JD, Smith C. Hispanic and Non-Hispanic Homeless Populations in El Paso, Texas. HISPANIC JOURNAL OF BEHAVIORAL SCIENCES 2014. [DOI: 10.1177/0739986314552993] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This article compares Hispanic and non-Hispanic homeless populations in El Paso, Texas. Surveys were collected in “traditional homeless spaces” as well as in non-traditional spaces where Hispanics may be more heavily represented. Snowball techniques were also used to find and survey marginally housed individuals. Despite these improvements to typical homeless counts, this study finds Hispanics to be underrepresented when compared with the general population of El Paso, which is 80.7% Hispanic. Of the 678 individuals who answered the survey, 670 reported their race or ethnicity, of which 445 (66%) were Hispanic and 225 (34%) were non-Hispanic. Comparisons were made between the two populations’ experiences and characteristics, and many disparities were found. Researchers, policy makers, and practitioners should keep these differences in mind when designing policies to address homelessness.
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Thiberville SD, Salez N, Benkouiten S, Badiaga S, Charrel R, Brouqui P. Respiratory viruses within homeless shelters in Marseille, France. BMC Res Notes 2014; 7:81. [PMID: 24499605 PMCID: PMC3918144 DOI: 10.1186/1756-0500-7-81] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Accepted: 01/30/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Homeless shelters are identified as places where humans are at high risk of acquiring respiratory disease. We previously reported the prevalence of the main respiratory diseases affecting a population of homeless in Marseille, France. Here, we investigated the prevalence of 10 respiratory viruses in a similar homeless population during 2 successive winter seasons. FINDINGS Following a clinical examination, we collected nasal specimens from which the RT-PCR detection of 10 respiratory viruses was performed through snapshot investigations. Among the 265 patients included, 150 (56.6%) reported at least one respiratory symptom of which 13 (8.7%) had positive swabs for at least one respiratory virus, and 115 patients reported any respiratory symptom of which 10 (8.7%) had positive swabs for respiratory virus. Overall, 23 patients had positive swabs for at least one respiratory virus. Human rhinovirus (HRV) was the predominant virus (13 isolates) followed by enteroviruses (3), human metapneumovirus (2), human coronavirus OC43 (2), 229E virus (2) and human respiratory syncytial virus subtype B (1). Among the patients infected with HRV, 10 were collected during the same snapshot. CONCLUSIONS Although one half of the patients reported respiratory symptoms, the prevalence of respiratory viruses was within the range of that previously described in adult asymptomatic patients outside the homeless community. Most HRV-positive swabs were collected during the same snapshot suggesting a local outbreak. No influenza viruses were found despite the fact that one half of the patients were investigated during the peak of the seasonal influenza epidemic in Marseille.
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Affiliation(s)
| | | | | | | | | | - Philippe Brouqui
- Faculté de médecine, Institut Hospitalo-Universitaire des Maladies Infectieuses et Tropicales URMITE CNRS IRD UMR 6236/198, 27 bd Jean MOULIN, Marseille 13005, France.
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Goldberg TL. Altruism towards panhandlers: Who gives? HUMAN NATURE-AN INTERDISCIPLINARY BIOSOCIAL PERSPECTIVE 2013; 6:79-89. [PMID: 24202832 DOI: 10.1007/bf02734137] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/24/1994] [Accepted: 07/21/1994] [Indexed: 11/26/2022]
Abstract
This study investigates an example of human altruism which is neither kin-directed nor reciprocal: giving to a panhandler. Data were collected on the proportions of passers-by who gave to panhandlers in Boston and Cambridge, Massachusetts. Three hypotheses were tested, each predicting that passers-by should behave "selfishly," capitalizing on opportunities that, in an evolutionarily appropriate context, could increase mating success. Male passers-by, when alone, gave disproportionately to female panhandlers. Male passers-by, when in the company of a female partner, disproportionately avoided giving to female panhandlers. Male passers-by in the company of a female partner did not "show off" by giving disproportionately to male panhandlers.
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Affiliation(s)
- T L Goldberg
- Department of Anthropology, Harvard University, Peabody Museum, 11 Divinity Avenue, 02138, Cambridge, MA
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Zlotnick C, Zerger S, Wolfe PB. Health care for the homeless: what we have learned in the past 30 years and what's next. Am J Public Health 2013; 103 Suppl 2:S199-205. [PMID: 24148056 DOI: 10.2105/ajph.2013.301586] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
In the 1980s, the combined effects of deinstitutionalization from state mental hospitals and the economic recession increased the number and transformed the demographic profile of people experiencing homelessness in the United States. Specialized health care for the homeless (HCH) services were developed when it became clear that the mainstream health care system could not sufficiently address their health needs. The HCH program has grown consistently during that period; currently, 208 HCH sites are operating, and the program has become embedded in the federal health care system. We reflect on lessons learned from the HCH model and its applicability to the changing landscape of US health care.
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Affiliation(s)
- Cheryl Zlotnick
- Cheryl Zlotnick is with the Children's Hospital Oakland Research Institute, Oakland, CA, and the Department of Nursing, Faculty of Social Welfare and Health Sciences, University of Haifa, Mount Carmel, Israel. Suzanne Zerger is with the Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, Ontario. Phyllis B. Wolfe is with P. B. Wolfe & Associates, Washington, DC
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Tinland A, Fortanier C, Girard V, Laval C, Videau B, Rhenter P, Greacen T, Falissard B, Apostolidis T, Lançon C, Boyer L, Auquier P. Evaluation of the Housing First program in patients with severe mental disorders in France: study protocol for a randomized controlled trial. Trials 2013; 14:309. [PMID: 24063556 PMCID: PMC3850649 DOI: 10.1186/1745-6215-14-309] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2013] [Accepted: 09/10/2013] [Indexed: 11/30/2022] Open
Abstract
Background Recent studies in North American contexts have suggested that the Housing First model is a promising strategy for providing effective services to homeless people with mental illness. In the context of the highly generous French national health and social care system, which is easily accessible and does not require out-of-pocket payment, the French Health Ministry insists on rigorous techniques, including randomized protocols, to evaluate the impact of Housing First approaches in France. Method and design A prospective randomized trial was designed to assess the impact of a Housing First intervention on health outcomes and costs over a period of 24 months on homeless people with severe mental illness, compared to Treatment-As-Usual. The study is being conducted in four cities in France: Lille, Marseille, Paris and Toulouse. The inclusion criteria are as follows: over 18 years of age, absolutely homeless or in precarious housing, and possessing a ‘high’ level of need: diagnosis of schizophrenia or bipolar disorder and moderate to severe disability according to the Multnomah Community Ability Scale (score ≤ 62) and at least one of the following three criteria: 1) having been hospitalized for mental illness two or more times in any one year during the preceding five years; 2) co-morbid alcohol or substance use; and 3) having been recently arrested or incarcerated. Participants will be randomized to receiving the Housing First intervention or Treatment-As-Usual. The Housing First intervention provides immediate access to independent housing and community care. The primary outcome criterion is the use of high-cost health services (that is,, number of hospital admissions and number of emergency department visits) during the 24-month follow-up period. Secondary outcome measures include health outcomes, social functioning, housing stability and contact with police services. An evaluation of the cost-effectiveness and cost-utility of Housing First will also be conducted. A total of 300 individuals per group will be included. Discussion This is the first study to examine the impact of a Housing First intervention compared to Treatment-As-Usual in France. It should provide key information to policymakers concerning the cost-effectiveness and health outcomes of the Housing First model in the French context. Trial registration The current clinical trial number is NCT01570712
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Affiliation(s)
- Aurelie Tinland
- Aix-Marseille University, EA 3279 Research Unit, Marseille 13385, France.
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Vijayaraghavan M, Kushel MB, Vittinghoff E, Kertesz S, Jacobs D, Lewis CE, Sidney S, Bibbins-Domingo K. Housing instability and incident hypertension in the CARDIA cohort. J Urban Health 2013; 90:427-41. [PMID: 22752301 PMCID: PMC3665966 DOI: 10.1007/s11524-012-9729-z] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990-1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N = 5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N = 4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9-1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, <0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4-9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.
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Affiliation(s)
- M Vijayaraghavan
- Division of General Internal Medicine, San Francisco General Hospital, San Francisco, CA, USA
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Beyond the existence proof: ontological conditions, epistemological implications, and in-depth interview research. ACTA ACUST UNITED AC 2012. [DOI: 10.1007/s11135-012-9775-3] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Myrstol BA, Fitzpatrick KM. Risk Factors and the Duration of Homelessness among Drug-Using Arrestees: Evidence from 30 American Counties. JOURNAL OF DRUG ISSUES 2011. [DOI: 10.1177/002204261104100405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We examined risk factors influencing length of homelessness among a sample of drug-using adults booked into jails in 30 American counties during the years 2002–2003. Interviews were conducted with 30,634 arrestees. Multinomial logistic regression (MLR) explored the impact of arrestees’ drug use histories, prior experiences with alcohol and drug treatment, prior mental health experiences, and previous criminal justice experiences on membership in one of three housing stability categories. MLR results showed that, in comparison to the sporadic homeless, the persistent homeless were a demographically distinct group with significant social and human capital deficits and distinct health risk profiles, including drug use behavior, mental health status, and criminal offending. We argue that jails are well positioned to serve as a focal point for the delivery of public health and psychiatric services to homeless persons.
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Okunseri C, Girgis D, Self K, Jackson S, McGinley EL, Tarima SS. Factors associated with reported need for dental care among people who are homeless using assistance programs. SPECIAL CARE IN DENTISTRY 2010; 30:146-50. [DOI: 10.1111/j.1754-4505.2010.00145.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Episodic illness, chronic disease, and health care use among homeless persons in Metropolitan Atlanta, Georgia, 2007. South Med J 2010; 103:18-24. [PMID: 19996848 DOI: 10.1097/smj.0b013e3181c46f79] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Homeless persons are at higher risk for morbidity and mortality from both chronic and episodic illness than the general population. Few data are available on the prevalence of these conditions and uptake of vaccination for prevention. METHODS In March 2007, we administered a cross-sectional survey to a convenience sample of homeless persons in Atlanta. RESULTS Approximately half (46.2%) of the survey participants reported at least one chronic medical condition. Acute respiratory symptoms within the previous 30 days were reported by up to 57.7% of survey participants. Receipt of influenza vaccination was reported by 31.9% of survey participants, receipt of pneumococcal vaccine by 18.7%. Vaccination rates varied by age and risk group. DISCUSSION The survey demonstrated high rates of morbidity in this population. Influenza and pneumococcal vaccination rates were suboptimal. Culturally appropriate interventions must be developed to prevent respiratory and other diseases in this important group.
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Cronley C, Strand EB, Patterson DA, Gwaltney S. Homeless People who are Animal Caretakers: A Comparative Study. Psychol Rep 2009; 105:481-99. [DOI: 10.2466/pr0.105.2.481-499] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Data from a Homeless Management Information System (HMIS) were used to compare homeless people who report caring for animals with homeless people who do not report caring for animals, based on demographic variables and stated reasons for homelessness. Among homeless clients ( N = 4,100; M age = 39 yr., SD = 13.2), 5.5% reported animal caretaking; demographic differences between caretaking and not caretaking homeless clients and life factors related to homelessness were most often associated with animal caretaking. 41% of participants ( n = 1,664) were female, and 59% ( n = 2,436) were male. Findings suggest that first-time homeless, Euro-American women who were homeless due to domestic violence were the most likely to say they were caring for animals. The use of such an information system could aid in identifying this subpopulation and coordinating services for animal care.
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Rising inability to obtain needed health care among homeless persons in Birmingham, Alabama (1995-2005). J Gen Intern Med 2009; 24:841-7. [PMID: 19415393 PMCID: PMC2695531 DOI: 10.1007/s11606-009-0990-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2008] [Revised: 03/07/2009] [Accepted: 03/18/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Homeless persons depend disproportionately on the health-care safety net for medical services. National reports identify financial strains to this safety net. Whether this has affected homeless persons is unknown. OBJECTIVES We quantified changes in the proportion of homeless persons reporting unmet need for health care in Birmingham, Alabama, comparing two periods, 1995 and 2005. We assessed whether a period effect was independent of characteristics of persons surveyed. DESIGN Analysis of two surveys conducted with identical methods among representative samples of homeless persons in 1995 (n = 161) and 2005 (n = 161). MEASUREMENTS Report of unmet need (inability to obtain care when needed) was the dependent variable. Two survey periods (1995 and 2005) were compared, with multivariable adjustment for sociodemographic and health characteristics. Reasons for unmet need were determined among the subset of persons reporting unmet need. RESULTS Unmet need for health care was more common in 2005 (54%) than in 1995 (32%) (p < 0.0001), especially for non-Blacks (64%) and females (65%). Adjusting for individual characteristics, a survey year of 2005 independently predicted unmet need (odds ratio 2.68, 95% CI 1.49-4.83). Among persons reporting unmet need (87 of 161 in 2005; 52 of 161 in 1995), financial barriers were more commonly cited in 2005 (67% of 87) than in 1995 (42% of 52) (p = 0.01). CONCLUSION A rise in unmet health-care needs was reported among Birmingham's homeless from 1995 to 2005. This period effect was independent of population characteristics and may implicate a local safety net inadequacy. Additional data are needed to determine if this represents a national trend.
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Parrow NL, Abbott J, Lockwood AR, Battisti JM, Minnick MF. Function, regulation, and transcriptional organization of the hemin utilization locus of Bartonella quintana. Infect Immun 2009; 77:307-16. [PMID: 18981245 PMCID: PMC2612243 DOI: 10.1128/iai.01194-08] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2008] [Revised: 10/21/2008] [Accepted: 10/27/2008] [Indexed: 01/03/2023] Open
Abstract
Bartonella quintana is a gram-negative agent of trench fever, chronic bacteremia, endocarditis, and bacillary angiomatosis in humans. B. quintana has the highest known hemin requirement among bacteria, but the mechanisms of hemin acquisition are poorly defined. Genomic analyses revealed a potential locus dedicated to hemin utilization (hut) encoding a putative hemin receptor, HutA; a TonB-like energy transducer; an ABC transport system comprised of three proteins, HutB, HutC, and HmuV; and a hemin degradation/storage enzyme, HemS. Complementation analyses with Escherichia coli hemA show that HutA functions as a hemin receptor, and complementation analyses with E. coli hemA tonB indicate that HutA is TonB dependent. Quantitative reverse transcriptase PCR analyses show that hut locus transcription is subject to hemin-responsive regulation, which is mediated primarily by the iron response regulator (Irr). Irr functions as a transcriptional repressor of the hut locus at all hemin concentrations tested. Overexpression of the ferric uptake regulator (fur) represses transcription of tonB in the presence of excess hemin, whereas overexpression of the rhizobial iron regulator (rirA) has no effect on hut locus transcription. Reverse transcriptase PCR analyses show that hutA and tonB are divergently transcribed and that the remaining hut genes are expressed as a polycistronic mRNA. Examination of the promoter regions of hutA, tonB, and hemS reveals consensus sequence promoters that encompass an H-box element previously shown to interact with B. quintana Irr.
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Affiliation(s)
- Nermi L Parrow
- Division of Biological Sciences, The University of Montana, 32 Campus Drive, Missoula, MT 59812, USA
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Greenberg GA, Rosenheck RA. Homelessness in the state and federal prison population. CRIMINAL BEHAVIOUR AND MENTAL HEALTH : CBMH 2008; 18:88-103. [PMID: 18383201 DOI: 10.1002/cbm.685] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
AIMS This study sought to investigate the rates and correlates of homelessness (i.e. living on the street or in a homeless shelter), including mental illness, among US adult state and federal prison inmates (ASFPIs). METHOD Data from a national survey of ASFPIs based on a random sampling survey (N = 17,565) were used to compare the homelessness rate among AFSPIs with that in the general population. Logistic regression was then used to examine the association of homelessness among ASFPIs with factors including symptoms, treatment of mental illness, previous criminal justice involvement, specific crimes, and demographic characteristics. RESULTS Nine percent of ASFPIs reported an episode of homelessness in the year prior to arrest, 4-6 times the estimated rate in the general US adult population after allowing for age, race/ethnicity, and gender. In comparison to other inmates, these homeless inmates were more likely to be currently incarcerated for a property crime, but also to have had previous criminal justice system involvement for both property and violent crimes, to suffer from mental health and/or substance abuse problems, and to be more likely to have been unemployed and with a low income. CONCLUSIONS Recent homelessness is far more common among ASFPIs than the general population. Prior incarceration, mental illness, substance abuse and disadvantageous socio-demographic characteristics were all found to be associated with homelessness among prison inmates, suggesting that there are several important factors in addition to efforts to survive with limited resources through criminal acts that influence the rates of homelessness among incarcerated individuals.
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Affiliation(s)
- Greg A Greenberg
- VA New England Mental Illness, Research, Education and Clinical Center, VAMC West Haven, CT, USA.
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Dermatis H, Galanter M, Trujillo M, Rahman-Dujarric C, Ramaglia K, LaGressa D. Evaluation of a Model for the Treatment of Combined Mental Illness and Substance Abuse. J Addict Dis 2006; 25:69-78. [PMID: 16956871 DOI: 10.1300/j069v25n03_09] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The present study evaluated a model program at Bellevue Hospital Center incorporating a peer-led self-help (PLSH) approach which can be applied to bring about systems-level change in a variety of settings where persons with dual diagnosis are encountered. A total of 461 consecutive MICA inpatient admissions were evaluated to compare the PLSH unit with two standard psychiatric units. The PLSH program was associated with a higher rate of acceptance of aftercare referral (93% vs. 74%) and aftercare attendance (52% vs. 30%) among patients with no prior psychiatric hospitalizations (N = 111). In addition, the PLSH program appeared to benefit chronically impaired MICA patients (N = 350) or those with a history of prior psychiatric hospitalizations, as they were more likely to accept referral to aftercare treatment than were chronic patients discharged from the standard psychiatric units (96% vs. 81%). Such a program, when more widely applied, could yield decreased recidivism and considerably lower medical, psychiatric, and economic cost.
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Affiliation(s)
- Helen Dermatis
- Department of Psychiatry, New York University Medical Center, 550 First Ave, NY, NY 10016, USA
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Kim TW, Kertesz SG, Horton NJ, Tibbetts N, Samet JH. Episodic homelessness and health care utilization in a prospective cohort of HIV-infected persons with alcohol problems. BMC Health Serv Res 2006; 6:19. [PMID: 16504167 PMCID: PMC1421395 DOI: 10.1186/1472-6963-6-19] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2005] [Accepted: 02/27/2006] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Because individuals with HIV/AIDS often have complex medical and social needs, the impact of housing status on medical service utilization is difficult to isolate from the impact of conditions that may worsen during periods of homelessness such as depression and substance abuse. We examine whether episodes of homelessness are independently associated with suboptimal medical utilization even when accounting for concurrent addiction severity and depression. METHODS We used data from a 30-month cohort of patients with HIV/AIDS and alcohol problems. Housing status, utilization (ambulatory visits, emergency department (ED) visits, and hospitalizations) and other features were assessed with standardized research interviews at 6-month intervals. Multivariable longitudinal regression models calculated incidence rate ratios (IRR) comparing utilization rates during 6-month intervals (homeless versus housed). Additional models assessed whether addiction severity and depressive symptoms could account for utilization differences. RESULTS Of the 349 subjects, 139 (39%) reported homelessness at least once during the study period; among these subjects, the median number of nights homeless per 6-month interview period was 30. Homelessness was associated with higher ED utilization (IRR = 2.17; 95% CI = 1.72-2.74) and hospitalizations (IRR = 2.30; 1.70-3.12), despite no difference in ambulatory care utilization (IRR = 1.09; 0.89-1.33). These associations were attenuated but remained significant when adjusting for addiction severity and depressive symptoms. CONCLUSION In patients with HIV/AIDS and alcohol problems, efforts to improve housing stability may help to mitigate intensive medical utilization patterns.
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Affiliation(s)
- Theresa W Kim
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Stefan G Kertesz
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine and the Deep South Center on Effectiveness and the Birmingham Veterans' Affairs Medical Center, Birmingham, AL, USA
| | | | | | - Jeffrey H Samet
- Clinical Addiction Research and Education (CARE) Unit, Section of General Internal Medicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Social and Behavioral Sciences, Boston University School of Public Health, Boston, MA, USA
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Kertesz SG, Larson MJ, Horton NJ, Winter M, Saitz R, Samet JH. Homeless chronicity and health-related quality of life trajectories among adults with addictions. Med Care 2005; 43:574-85. [PMID: 15908852 DOI: 10.1097/01.mlr.0000163652.91463.b4] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND New federal initiatives target funds toward chronically homeless as distinct from other homeless persons. Few data exist, however, to substantiate the implications of chronic homelessness for major health outcomes. OBJECTIVES Using data from a 2-year cohort of addicted persons, we tested whether changes in mental and physical health-related quality of life (HRQOL) differed according to homeless chronicity. METHODS Using self-reported homelessness, we classified subjects as chronically homeless (CH; n = 60), transitionally homeless (TRANS; n = 108), or as housed comparison subjects (HSD; n = 106). The Short Form-36 Health Survey, administered at baseline and 2 follow-ups over a period of 2 years, provided a Mental Component Summary (MCS) and a Physical Component Summary (PCS) for HRQOL. Mixed model linear regression was used to test the association between housing status, MCS, and PCS. Additional models assessed whether medical, psychiatric, addiction, and social support measures could account for HRQOL differences. RESULTS All subjects had low MCS scores at study entry (mean, 31.2; SD, 12.6). However, there was a significant housing status-by-time interaction (P = 0.01). At final follow-up, CH and TRANS subjects had lower adjusted MCS scores than HSD subjects (33.4, 38.8, and 43.7 for the 3 groups, respectively; all P < or = 0.01). By contrast, housing status and PCS were not significantly associated (P = 0.19). Medical, psychiatric, addiction, and social support variables had significant associations with MCS, and their inclusion in the regression reduced the apparent effect of housing status on MCS. CONCLUSIONS Chronic homelessness was associated with especially poor mental but not physical HRQOL over time. These findings reinforce a new typology of homelessness.
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Affiliation(s)
- Stefan G Kertesz
- Department of Medicine, Division of Preventive Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama 35294, USA.
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Abstract
CONTEXT Tuberculosis (TB) rates among US homeless persons cannot be calculated because they are not included in the US Census. However, homelessness is often associated with TB. OBJECTIVES To describe homeless persons with TB and to compare risk factors and disease characteristics between homeless and nonhomeless persons with TB. DESIGN AND SETTING Cross-sectional analysis of all verified TB cases reported into the National TB Surveillance System from the 50 states and the District of Columbia from 1994 through 2003. MAIN OUTCOME MEASURES Number and proportion of TB cases associated with homelessness, demographic characteristics, risk factors, disease characteristics, treatment, and outcomes. RESULTS Of 185,870 cases of TB disease reported between 1994 and 2003, 11,369 were among persons classified as homeless during the 12 months before diagnosis. The annual proportion of cases associated with homelessness was stable (6.1%-6.7%). Regional differences occurred with a higher proportion of TB cases associated with homelessness in western and some southern states. Most homeless persons with TB were male (87%) and aged 30 to 59 years. Black individuals represented the highest proportion of TB cases among the homeless and nonhomeless. The proportion of homeless persons with TB who were born outside the United States (18%) was lower than that for nonhomeless persons with TB (44%). At the time of TB diagnosis, 9% of homeless persons were incarcerated, usually in a local jail; 3% of nonhomeless persons with TB were incarcerated. Compared with nonhomeless persons, homeless persons with TB had a higher prevalence of substance use (54% alcohol abuse, 29.5% noninjected drug use, and 14% injected drug use), and 34% of those tested had coinfection with human immunodeficiency virus. Compared with nonhomeless persons, TB disease in homeless persons was more likely to be infectious but not more likely to be drug resistant. Health departments managed 81% of TB cases in homeless persons. Directly observed therapy, used for 86% of homeless patients, was associated with timely completion of therapy. A similar proportion in both groups (9%) died from any cause during therapy. CONCLUSIONS Individual TB risk factors often overlap with risk factors for homelessness, and the social contexts in which TB occurs are often complex and important to consider in planning TB treatment. Nevertheless, given good case management, homeless persons with TB can achieve excellent treatment outcomes.
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Affiliation(s)
- Maryam B Haddad
- Surveillance, Epidemiology, and Outbreak Investigations Branch, Division of Tuberculosis Elimination, Centers for Disease Control and Prevention, Atlanta, Ga 30333, USA.
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Surratt HL, Inciardi JA. HIV risk, seropositivity and predictors of infection among homeless and non-homeless women sex workers in Miami, Florida, USA. AIDS Care 2004; 16:594-604. [PMID: 15223529 DOI: 10.1080/09540120410001716397] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Although homelessness has frequently been associated with substance abuse, and has been established as a predictor of HIV risk among substance abusers, little is known about the impact of homelessness on HIV risk among female sex workers. This analysis investigated the contribution of homelessness to sexual risk taking among a sample of 485 female sex workers recruited into an HIV prevention programme in Miami, Florida, 41.6% of whom considered themselves to be currently homeless. Findings indicated that in comparison to non-homeless sex workers, significantly more homeless sex workers were daily users of alcohol and crack, and their past month sex work reflected significantly more frequent vaginal and oral sex acts, higher levels of unprotected vaginal sex and more numerous sexual activities while 'high' on drugs. At the same time, a significantly greater proportion of homeless sex workers encountered customers that refused to use condoms than did the non-homeless sex workers. There were no significant differences in HIV seropositivity between the homeless and non-homeless women (22.5 and 24.9%, respectively), primarily because the majority of the women in the study cycled in and out of homelessness.
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Affiliation(s)
- H L Surratt
- Center for Drug and Alcohol Studies, University of Delaware, Coral Gables, FL 33134, USA.
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Toohey SM, Shinn M, Weitzman BC. Social networks and homelessness among women heads of household. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2004; 33:7-20. [PMID: 15055751 DOI: 10.1023/b:ajcp.0000014315.82860.d2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
To examine possible bidirectional relationships between homelessness and deficient social networks, we compared the networks of 251 mothers before, and approximately 5 years after, their families entered shelters with networks of 291 consistently housed poor mothers. At Time 1, more women on the verge of homelessness than housed women reported that they had mothers, grandmothers, friends, and relatives but fewer believed these network members were housing resources. At Time 2, after homeless women were rehoused, these network differences between consistently housed and formerly homeless women had largely disappeared. Contrary to prior research findings, formerly homeless mothers did not report smaller networks, more children or fewer partners. However, formerly homeless women did report fewer positive functions. Because of city policies, homeless mothers were frequently rehoused far from network members.
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North CS, Eyrich KM, Pollio DE, Spitznagel EL. Are rates of psychiatric disorders in the homeless population changing? Am J Public Health 2004; 94:103-8. [PMID: 14713706 PMCID: PMC1449834 DOI: 10.2105/ajph.94.1.103] [Citation(s) in RCA: 98] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the prevalence of psychiatric illness among 3 homeless populations in St. Louis, Mo, in approximately 1980, 1990, and 2000. The 3 studies were conducted with the same systemic research methodology. METHODS We compared selected demographics and lifetime substance abuse and dependence and other mental illness among the 3 populations. RESULTS Among the homeless populations we studied, the prevalence of mood and substance use disorders dramatically increased, and the number of minorities within these populations has increased. CONCLUSIONS The prevalence of psychiatric illness, including substance abuse and dependence, is not static in the homeless population. Service systems need to be aware of potential prevalence changes and the impact of these changes on service needs.
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Affiliation(s)
- Carol S North
- Department of Psychiatry, Washington University School of Medicine, St Louis, MO 63110, USA.
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Gibson G, Rosenheck R, Tullner JB, Grimes RM, Seibyl CL, Rivera-Torres A, Goodman HS, Nunn ME. A national survey of the oral health status of homeless veterans. J Public Health Dent 2003; 63:30-7. [PMID: 12597583 DOI: 10.1111/j.1752-7325.2003.tb03471.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES This study reports results from a survey designed to (1) assess the oral health needs of a national sample of homeless veterans and (2) compare the dental needs of homeless veterans participating in VA-sponsored rehabilitation programs with domiciled veterans in VA substance addiction programs. METHODS Homeless veterans enrolled in a nationwide rehabilitation program (n = 1,152) completed a survey including questions concerning patients' perceptions of their oral health, dental service needs and use, and alcohol and tobacco use. A sample of these veterans (n = 281) subsequently received dental exams. A comparison group of domiciled veterans enrolled in VA substance abuse programs (n = 339) completed a similar survey. A sample of these veterans (n = 150) also received dental exams. RESULTS Sociodemographic variables, patient-reported oral health information and risk behaviors, and findings from dental exams described two remarkably similar populations. CONCLUSIONS As expected, the homeless veterans exhibited poor oral health, but it was not different from domiciled veterans enrolled in substance addiction programs. Lifestyle choices, such as heavy drinking and smoking, may contribute more to poor oral health than living conditions.
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Affiliation(s)
- Gretchen Gibson
- National Homeless Veterans Dental Program, Veterans Affairs North Texas Health Care System, Dallas 75216, USA.
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Kertesz SG, Horton NJ, Friedmann PD, Saitz R, Samet JH. Slowing the revolving door: stabilization programs reduce homeless persons' substance use after detoxification. J Subst Abuse Treat 2003; 24:197-207. [PMID: 12810140 DOI: 10.1016/s0740-5472(03)00026-6] [Citation(s) in RCA: 55] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study examined whether homelessness predicted earlier resumption of substance use after detoxification, and sought evidence concerning the impact of post-detoxification stabilization programs among homeless and nonhomeless individuals. Kaplan-Meier plots and proportional hazards models were used to determine the association between homelessness, stabilization program use, and recurrent substance use in a prospective cohort of persons entering inpatient detoxification (n=470). Among 254 persons available at 6 months, 76% reported recurrent substance use. Homeless persons not using stabilization programs experienced the highest hazard of return to substance use after detoxification, Hazard Ratio (HR) 1.26, 95% CI (0.88, 1.80). Homeless persons using these programs had the lowest rate of return to substance use: HR 0.61, 95% CI (0.40, 0.94). A similar impact of stabilization programs was not seen among nonhomeless subjects. Post-detoxification stabilization programs were associated with improved outcomes for homeless addicted persons. This treatment modality may slow the "revolving door" phenomenon of relapse after detoxification among homeless persons.
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Affiliation(s)
- Stefan G Kertesz
- Divisions of Preventive Medicine and General Internal Medicine, Department of Medicine, University of Alabama at Birmingham, 1530 3rd Avenue South, MT608, Birmingham, AL 35294-4410, USA.
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Han OS, Lee HB, Ahn JH, Park JI, Cho MJ, Hong JP, Hahm BJ, Kim CY. Lifetime and current prevalence of mental disorders among homeless men in Korea. J Nerv Ment Dis 2003; 191:272-5. [PMID: 12695742 DOI: 10.1097/01.nmd.0000061151.19363.82] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Oh-Su Han
- Department of Psychiatry, College of Medicine, University of Ulsan, Asan Medical Center, 388-1 Poongnap-dong, Songpa-gu, Seoul 138-736, Republic of Korea
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Booth BM, Sullivan G, Koegel P, Burnam A. Vulnerability factors for homelessness associated with substance dependence in a community sample of homeless adults. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2003; 28:429-52. [PMID: 12211359 DOI: 10.1081/ada-120006735] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
We studied a community probability sample of 1185 homeless individuals to examine substance dependence in relationship to other personal and social vulnerabilities linked to homelessness, including sociodemographics, childhood/adolescent factors, prehomelessness factors, multiple episodes of homelessness, and the quality of shelter in their current episode of homelessness. These vulnerability factors were significantly concentrated in homeless individuals with lifetime and recent substance dependence, especially among those with both alcohol and drug dependence. In addition, the profiles of the homeless with alcohol dependence alone were distinct from those with drug dependence alone or both, with older age, more males, longer histories of homelessness, and significantly poorer quality shelter during the previous 30 days. Therefore, homeless individuals with substance dependence have many vulnerabilities beyond their substance dependence that should be dealt with in treatment or other service settings before lasting housing can be achieved.
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Affiliation(s)
- Brenda M Booth
- Department of Psychiatry, Centers for Mental Healthcare Research, University of Arkansas for Medical Sciences, Little Rock, USA.
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Lempens A, van de Mheen D, Barendregt C. Homeless drug users in Rotterdam, the Netherlands: profile, way of life, and the need for assistance. Subst Use Misuse 2003; 38:339-75. [PMID: 12747389 DOI: 10.1081/ja-120017377] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Decreasing the number of homeless drug users is one of the main characteristics of inner city drugs policy. The present study selected an urban-ethnographic perspective (the subculture theory) in order to explore why one drug user is homeless and another 7 not, and to attempt to describe and define the homeless and their immediate social environment. These issues were formulated into the following research questions: 1. What are the sociodemographic characteristics of homeless drug users in Rotterdam, and do they differ from domiciled drug users? 2. What are their living conditions? 3. What are the reasons for being homeless? 4. Does the period of homelessness play a role in the need to change one's lifestyle? Five research methods were employed for this study: a literature search, interviews with key persons, field notes from community fieldworkers, a survey among drug users (n = 204), and photographic reports from six homeless users. Data were collected in 1998/1999. The results document that in our study population there were more women, more illegal persons, and more foreigners than among domiciled drug users, and that the homeless group used heroin and cocaine on more days. A large proportion of the homeless users had no identity papers and no health insurance. This did not, however, lead to more self-reported sickness or a higher prevalence of infectious diseases compared with nonhomeless drug users. Easily accessible (low threshold) social care centers and assistance are very important. Few of the homeless had voluntarily chosen a homeless life-most describe an event that was a trigger for their homelessness. The average duration of being homeless was 17 months, and the longer someone had been homeless the less inclined they were to change their situation. This paper also discusses policymaking implications.
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Affiliation(s)
- Ankie Lempens
- Addiction Research Institute Rotterdam, Rotterdam, The Netherlands
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Abstract
In this article we examine the relationship between alcohol and drug misuse among the literally homeless (those living out of doors and in emergency shelters) in Hartford, Connecticut and Providence, Rhode Island, two northeastern U.S. cities of comparable size. We worked with homeless advocacy organizations in both cities, using a point-in-time census (N = 1058) and random sample (N = 66) in Hartford, and a sampling of clients (N = 82) of six shelters serving residents of Providence (N = 82). We found substance misuse relevant in 47.2% of the homeless in Hartford and in 45.1% of the homeless in Providence. We conclude that there is a great need for substance treatment services inside shelters, soup kitchens, and day centers so that homeless individuals have an opportunity to engage in treatment within their own milieu.
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Affiliation(s)
- Irene Glasser
- Center for Alcohol and Addiction Studies, Brown University, Providence, Rhode Island, USA.
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Lovisi GM, Coutinho E, Morgado A, Mann AH. Social disablement among residents of hostels for the homeless in Rio de Janeiro, Brazil. Int J Soc Psychiatry 2002; 48:279-89. [PMID: 12553408 DOI: 10.1177/002076402128783316] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Knowledge of the extent of social disablement among homeless people is very useful for policy-makers and mental health professionals who are involved in the delivery of community-based care. As there are few studies of this issue in Brazil or other developing countries, a cross-sectional study was carried out among homeless people from the Rio de Janeiro (RJ) metropolitan area. METHOD Data were collected on a random sample of 330 residents in the five public hostels using the 21-items Social Behaviour Scale (SBS) and the Composite International Development Interview (CIDI). RESULTS The mean age of the 330 people in the sample was 44.8, 75.8% of them were men, 78.9% were single, 79.2% unemployed. Ten percent of the 330 residents had more than five social behaviour problems, but 39.4% of them had no problem. Some 26.7% were scored as under-active, 23.0% with poor self-care, 13.3% with slowness, 12.7% with restlessness and 11.8% inappropriate social mixing. Those with schizophrenia were reported to have many more disabilities in almost all of the SBS areas. On the other hand, depression and hostility were more frequent in those with diagnoses of depression and substance abuse disorders. Women were more likely to be reported as having disablement than men, explained by their greater prevalence rate of schizophrenia. CONCLUSIONS In this population, social disablement was largely explained by those with schizophrenia. Active treatment strategies are needed for this group. Other residents had few behaviour problems, their most pressing problems come from their poor social circumstances.
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Assessing homeless population size through the use of emergency and transitional shelter services in 1998: results from the analysis of administrative data from nine US jurisdictions. Public Health Rep 2002. [PMID: 12037263 DOI: 10.1016/s0033-3549(04)50056-0] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES This study reports findings from the first-ever systematic enumeration of homeless population size using data previously collected from administrative records of homeless services providers in nine US jurisdictions over a one year period. As such, it provides the basis for establishing an ongoing measure of the parameters of the homeless population and for tracking related trends on the use of homeless services over time. METHODS Each participating jurisdiction collected data through its homeless services management information systems for persons and families who use emergency shelter and transitional housing. The jurisdictions organized the data by a standardized reporting format. These data form the basis for reporting homeless population size, both in raw numbers and as adjusted for each jurisdiction's overall population size, as well as the rate of turnover and average annual length of stay in emergency shelters and transitional housing. RESULTS Individual jurisdictions had annual rates of sheltered homelessness ranging from 0.1% to 2.1% of their overall population, and 1.3% to 10.2% of their poverty population. Annual population size was 2.5 to 10.2 times greater than the point-prevalent population size. Results are broken down for adults and families. CONCLUSIONS The prevalence of homelessness varies greatly among the jurisdictions included in this study, and possible factors for this diversity are discussed. Future reports of this nature will furnish similar series of homeless enumerations across a growing number of jurisdictions, thereby providing a basis for exploring the effects of different contextual factors on local prevalence rates of homelessness.
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Foucault C, Barrau K, Brouqui P, Raoult D. Bartonella quintana Bacteremia among Homeless People. Clin Infect Dis 2002; 35:684-9. [PMID: 12203165 DOI: 10.1086/342065] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2001] [Revised: 04/18/2002] [Indexed: 11/03/2022] Open
Abstract
Bartonella quintana infections have recently reemerged, predominantly among the homeless populations in cities in both Europe and the United States. B. quintana can cause trench fever, endocarditis, and chronic bacteremia; the human body louse is the only known vector. Homeless people who presented to the emergency departments of University Hospital in Marseilles, France, were studied, as were those who had been admitted to other medical facilities in the city since 1 January 1997. Samples of blood and body lice were collected for culture for B. quintana and for serological testing. Bartonella bacteremia was associated with sweats, evidence of louse infestation, serological tests that were positive for B. quintana, and high titers of B. quintana antibody. Bacteremia was also associated with being homeless for <3 years. Asymptomatic, prolonged bacteremia (duration, up to 78 weeks) and intermittent bacteremia were found to occur. Data obtained regarding antibiotic regimens showed that treatment with gentamicin and doxycycline was effective in preventing relapses of bacteremia.
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Affiliation(s)
- C Foucault
- Université de la Méditerranée, Faculté de Médecine, Centre National de la Recherche Scientifique, Unité Mixte de Recherche 6020, Unité des Rickettsies, 13006 Marseille, France
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Affiliation(s)
- John Song
- Center for Bioethics and Department of Medicine, University of Minnesota, N504 Boynton, 410 Church Street, Minneapolis, MN 55455, USA.
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Becker H, Kunstmann W. The Homeless Mentally Ill in Germany. INTERNATIONAL JOURNAL OF MENTAL HEALTH 2001. [DOI: 10.1080/00207411.2001.11449526] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
Homeless people in developed countries have specific problems predisposing them to infectious diseases. Respiratory infections and outbreaks of tuberculosis and other aerosol transmitted infections have been reported. Homeless intravenous drug users are at an increased risk of contracting HIV, and hepatitis B and C infections. Skin problems are the main reason the homeless seek medical attention, and these commonly include scabies, pediculosis, tinea infections, and impetigo. Many foot disorders are more prevalent in the homeless including ulcers, cellulitis, erysipelas, and gas gangrene. The louse transmitted bacteria Bartonella quintana has recently been found to cause clinical conditions in the homeless such as urban trench fever, bacillary angiomatosis, endocarditis, and chronic afebrile bacteraemia. Treatment of homeless people is complicated by financial constraints, self-neglect, and lack of adherence. Patients with serious and contagious illnesses should be hospitalised. Physicians should be aware of these specific issues to enhance care.
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Affiliation(s)
- D Raoult
- Unité des Rickettsies, Université de la Méditerranée, Faculté de Médecine, and Hĵpital Nord Service des Maladies Infectieuses et Tropicales, Marseille, France.
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