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Waddell CJ, Saldana CS, Schoonveld MM, Meehan AA, Lin CK, Butler JC, Mosites E. Infectious Diseases Among People Experiencing Homelessness: A Systematic Review of the Literature in the United States and Canada, 2003-2022. Public Health Rep 2024:333549241228525. [PMID: 38379269 DOI: 10.1177/00333549241228525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024] Open
Abstract
Homelessness increases the risk of acquiring an infectious disease. We conducted a systematic review of the literature to identify quantitative data related to infectious diseases and homelessness. We searched Google Scholar, PubMed, and SCOPUS for quantitative literature published from January 2003 through December 2022 in English from the United States and Canada. We excluded literature on vaccine-preventable diseases and HIV because these diseases were recently reviewed. Of the 250 articles that met inclusion criteria, more than half were on hepatitis C virus or Mycobacterium tuberculosis. Other articles were on COVID-19, respiratory syncytial virus, Staphylococcus aureus, group A Streptococcus, mpox (formerly monkeypox), 5 sexually transmitted infections, and gastrointestinal or vectorborne pathogens. Most studies showed higher prevalence, incidence, or measures of risk for infectious diseases among people experiencing homelessness as compared with people who are housed or the general population. Although having increased published data that quantify the infectious disease risks of homelessness is encouraging, many pathogens that are known to affect people globally who are not housed have not been evaluated in the United States or Canada. Future studies should focus on additional pathogens and factors leading to a disproportionately high incidence and prevalence of infectious diseases among people experiencing homelessness.
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Affiliation(s)
- Caroline J Waddell
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Carlos S Saldana
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Megan M Schoonveld
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Oak Ridge Institute for Science and Education, US Department of Energy, Oak Ridge, TN, USA
| | - Ashley A Meehan
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Christina K Lin
- Department of Medicine, School of Medicine, Emory University, Atlanta, GA, USA
| | - Jay C Butler
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Infectious Disease, School of Medicine, Emory University, Atlanta, GA, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
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Anthonj C, Stanglow SN, Grunwald N. Co-defining WASH (In)Security challenges among people experiencing homelessness. A qualitative study on the Human Right to Water and Sanitation from Bonn, Germany. Soc Sci Med 2024; 342:116561. [PMID: 38237319 DOI: 10.1016/j.socscimed.2024.116561] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Revised: 12/18/2023] [Accepted: 01/01/2024] [Indexed: 01/27/2024]
Abstract
INTRODUCTION Access to safe and affordable drinking water, sanitation and hygiene (WASH) for all is needed to safeguard human health, high on societal and political agendas. According to official estimates, populations in high-income countries (HICs) are well served. Vulnerable communities at the margins of rich societies, including people experiencing homelessness, however, are often underserved and overlooked. For them, safe WASH is often a dream rather than reality. To date, no study has been conducted in Germany - one of the countries most affected in Europe. METHODS We chose a qualitative mixed-method approach to understand WASH (in)security challenges that people experiencing homelessness are facing. Data were collected in Bonn, Germany, from 25 people experiencing homelessness (in-depth interviews, arts-based workshops, group discussions), their service providers (social workers), and (un)available public infrastructure (inspections), in 2023. Data were analyzed following the dimensions of the Human Right to Water and Sanitation (HRTWS): availability; accessibility; affordability; acceptability; quality and safety. RESULTS People experiencing homelessness largely lack available, accessible, affordable, acceptable and safe WASH. Open urination and defecation are often the only alternative, resulting in substantial health risks and diseases. Women face particular challenges, especially while menstruating. Extreme weather events complicate existing WASH insecurity further, creating additional hardships for unhoused people and their service providers. The missed realization of the HRTWS has far-reaching consequences, making it harder to transition out of homelessness. CONCLUSIONS Much remains to be done to serve unhoused people in HICs better with WASH. Their experiences shed light on the underlying complexities, and the implications of different often interconnected challenges, including instability, mobility, preexisting diseases, mental health conditions and substance use disorder. Different insecurities exist among different sub-groups (e.g. women, people with limited mobility). They are valuable key informants for targeted health messaging and interventions.
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Affiliation(s)
- C Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | | | - N Grunwald
- Verein für Gefährdetenhilfe Bonn, Bonn, Germany
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Anthonj C, Mingoti Poague KIH, Fleming L, Stanglow S. Invisible struggles: WASH insecurity and implications of extreme weather among urban homeless in high-income countries - A systematic scoping review. Int J Hyg Environ Health 2024; 255:114285. [PMID: 37925888 DOI: 10.1016/j.ijheh.2023.114285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 10/19/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
This paper aims to provide a deeper understanding of the water-, sanitation- and hygiene (WASH)-related insecurities that people experiencing homelessness in urban areas of high-income countries (HIC) are facing, and how these insecurities are further complicated during extreme weather events. While limited recent research has looked into WASH among people experiencing homelessness in HICs, and while some work has considering the implications of climate change on WASH and health, the nexus of WASH, extreme weather events and homelessness in HICs have not been studied thus far. We conducted the first systematic scoping review of peer-reviewed literature on this nexus, which is understudied and marked by complexity, involving a range of systems and forms of impact. A total of 50 publications were included in our analysis. We found that public facilities like drinking water fountains, toilets, handwashing facilities, and showers are scarce, frequently unavailable, often pose safety and cleanliness issues, and access to non-public facilities may be cost-prohibitive for homeless populations. Consequently, people experiencing homelessness, including those sleeping rough, in encampments, or shelters, are often forced to limit drinking water consumption, forego healthy hygiene behaviours, and resort to open urination and defecation, all of which carry health risks. Extreme weather events, like heatwaves, extreme cold, heavy rain and flooding exacerbate challenges for people experiencing homelessness, further complicating their access to WASH, and reducing the ability of service providers to deliver extra relief, creating a dual WASH and health burden. Our review highlights that the Human Right to Water and Sanitation is not met for people experiencing homelessness in urban areas of high-income countries, with women emerging as one of the most vulnerable subgroups. It reveals that the impact of certain WASH issues (e.g. drinking water) on homeless populations are better understood than others (e.g. waste), and, similarly, the effects of certain extreme weather events (e.g. heatwaves) on the health and WASH conditions of people experiencing homelessness are better understood than others (e.g. flooding). Data gaps and the lack of information on limited WASH access and health circumstances of people experiencing homelessness, further minimize their representation and consequently impose obstacles to improve their situation. Based on our analysis, we established a framework which operationalizes the nexus of WASH, extreme weather events and homelessness. This framework improves our understanding of the underlying complexities at the intersection of these three issues and provides a foundation for enhanced preparedness and health-oriented planning.
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Affiliation(s)
- Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, ITC, University of Twente, Enschede, the Netherlands.
| | | | - Lisa Fleming
- Independent Consultant, California, San Francisco, United States
| | - Sarah Stanglow
- Social Worker, Verein für Gefährdetenhilfe Bonn, Bonn, Germany
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Capone D, Bakare T, Barker T, Chatham AH, Clark R, Copperthwaite L, Flemister A, Geason R, Hoos E, Kim E, Manoj A, Pomper S, Samodal C, Smith S, Poole C, Brown J. Risk Factors for Enteric Pathogen Exposure among Children in Black Belt Region of Alabama, USA. Emerg Infect Dis 2023; 29. [PMID: 37987604 PMCID: PMC10683812 DOI: 10.3201/eid2912.230780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We collected stool from school-age children from 352 households living in the Black Belt region of Alabama, USA, where sanitation infrastructure is lacking. We used quantitative reverse transcription PCR to measure key pathogens in stool that may be associated with water and sanitation, as an indicator of exposure. We detected genes associated with > 1 targets in 26% of specimens, most frequently Clostridioides difficile (6.6%), atypical enteropathogenic Escherichia coli (6.1%), and enteroaggregative E. coli (3.9%). We used generalized estimating equations to assess reported risk factors for detecting > 1 pathogen in stool. We found no association between lack of sanitation and pathogen detection (adjusted risk ratio 0.95 [95% CI 0.55–1.7]) compared with specimens from children served by sewerage. However, we did observe an increased risk for pathogen detection among children living in homes with well water (adjusted risk ratio 1.7 [95% CI 1.1–2.5]) over those reporting water utility service.
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Poole C, Barker T, Bradbury R, Capone D, Chatham AH, Handali S, Rodriguez E, Qvarnstrom Y, Brown J. Cross-Sectional Study of Soil-Transmitted Helminthiases in Black Belt Region of Alabama, USA. Emerg Infect Dis 2023; 29:2461-2470. [PMID: 37987581 PMCID: PMC10683802 DOI: 10.3201/eid2912.230751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2023] Open
Abstract
We conducted a cross-sectional study to determine the prevalence of soil-transmitted helminthiases (STH) in areas of rural Alabama, USA, that have sanitation deficits. We enrolled 777 children; 704 submitted stool specimens and 227 a dried blood spot sample. We microscopically examined stool specimens from all 704 children by using Mini-FLOTAC for helminth eggs. We tested a subset by using molecular techniques: real-time PCR analysis for 5 STH species, TaqMan Array Cards for enteric helminths, and digital PCR for Necator americanus hookworm. We analyzed dried blood spots for Strongyloides stercoralis and Toxocara spp. roundworms by using serologic testing. Despite 12% of our cohort reporting living in homes that directly discharge untreated domestic wastewater, stool testing for STH was negative; however, 5% of dried blood spots were positive for Toxocara spp. roundworms. Survey data suggests substantial numbers of children in this region may be exposed to raw sewage, which is itself a major public health concern.
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Avelar Portillo LJ, Kayser GL, Ko C, Vasquez A, Gonzalez J, Avelar DJ, Alvarenga N, Franklin M, Chiang YY. Water, Sanitation, and Hygiene (WaSH) insecurity in unhoused communities of Los Angeles, California. Int J Equity Health 2023; 22:108. [PMID: 37264411 PMCID: PMC10233557 DOI: 10.1186/s12939-023-01920-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/20/2023] [Indexed: 06/03/2023] Open
Abstract
BACKGROUND Access to water and sanitation is a basic human right; however, in many parts of the world, communities experience water, sanitation, and hygiene (WaSH) insecurity. While WaSH insecurity is prevalent in many low and middle-income countries, it is also a problem in high-income countries, like the United States, as is evident in vulnerable populations, including people experiencing homelessness. Limited knowledge exists about the coping strategies unhoused people use to access WaSH services. This study, therefore, examines WaSH access among unhoused communities in Los Angeles, California, a city with the second-highest count of unhoused people across the nation. METHODS We conducted a cross-sectional study using a snowball sampling technique with 263 unhoused people living in Skid Row, Los Angeles. We calculated frequencies and used multivariable models to describe (1) how unhoused communities cope and gain access to WaSH services in different places, and (2) what individual-level factors contribute to unhoused people's ability to access WaSH services. RESULTS Our findings reveal that access to WaSH services for unhoused communities in Los Angeles is most difficult at night. Reduced access to overnight sanitation resulted in 19% of the sample population using buckets inside their tents and 28% openly defecating in public spaces. Bottled water and public taps are the primary drinking water source, but 6% of the sample reported obtaining water from fire hydrants, and 50% of the population stores water for night use. Unhoused people also had limited access to water and soap for hand hygiene throughout the day, with 17% of the sample relying on hand sanitizer to clean their hands. Shower and laundry access were among the most limited services available, and reduced people's ability to maintain body hygiene practices and limited employment opportunities. Our regression models suggest that WaSH access is not homogenous among the unhoused. Community differences exist; the odds of having difficulty accessing sanitation services is two times greater for those living outside of Skid Row (Adj OR: 2.52; 95% CI: 1.08-6.37) and three times greater for people who have been unhoused for more than six years compared to people who have been unhoused for less than a year (Adj OR: 3.26; 95% CI: 1.36-8.07). CONCLUSION Overall, this study suggests a need for more permanent, 24-h access to WaSH services for unhoused communities living in Skid Row, including toilets, drinking water, water and soap for hand hygiene, showers, and laundry services.
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Affiliation(s)
- Lourdes Johanna Avelar Portillo
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA.
- Benioff Homelessness and Housing Initiative, School of Medicine, University of California San Francisco, 2789 25th Street, San Francisco, CA, 94110, USA.
| | - Georgia L Kayser
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California (UCSD), 9500 Gilman Drive, La Jolla, CA, 92093, USA
| | - Charlene Ko
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Angelica Vasquez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Jimena Gonzalez
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Diego Jose Avelar
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Nayib Alvarenga
- Spatial Sciences Institute, University of Southern California (USC), 3616 Trousdale Parkway, Los Angeles, CA, 90089, USA
| | - Meredith Franklin
- Department of Statistical Sciences, University of Toronto, 700 University Ave., Toronto, ON, Canada
| | - Yao-Yi Chiang
- Department of Computer Science and Engineering, University of Minnesota, 200 Union St. SE, Minneapolis, MN, 55455, USA
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Brown J, Acey CS, Anthonj C, Barrington DJ, Beal CD, Capone D, Cumming O, Pullen Fedinick K, MacDonald Gibson J, Hicks B, Kozubik M, Lakatosova N, Linden KG, Love NG, Mattos KJ, Murphy HM, Winkler IT. The effects of racism, social exclusion, and discrimination on achieving universal safe water and sanitation in high-income countries. Lancet Glob Health 2023; 11:e606-e614. [PMID: 36925180 DOI: 10.1016/s2214-109x(23)00006-2] [Citation(s) in RCA: 14] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 03/17/2023]
Abstract
Drinking water and sanitation services in high-income countries typically bring widespread health and other benefits to their populations. Yet gaps in this essential public health infrastructure persist, driven by structural inequalities, racism, poverty, housing instability, migration, climate change, insufficient continued investment, and poor planning. Although the burden of disease attributable to these gaps is mostly uncharacterised in high-income settings, case studies from marginalised communities and data from targeted studies of microbial and chemical contaminants underscore the need for continued investment to realise the human rights to water and sanitation. Delivering on these rights requires: applying a systems approach to the problems; accessible, disaggregated data; new approaches to service provision that centre communities and groups without consistent access; and actionable policies that recognise safe water and sanitation provision as an obligation of government, regardless of factors such as race, ethnicity, gender, ability to pay, citizenship status, disability, land tenure, or property rights.
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Affiliation(s)
- Joe Brown
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Charisma S Acey
- Department of City and Regional Planning, University of California, Berkeley, CA, USA
| | - Carmen Anthonj
- Faculty of Geo-Information Science and Earth Observation, University of Twente, Enschede, Netherlands
| | - Dani J Barrington
- School of Population and Global Health, The University of Western Australia, Crawley, WA, Australia
| | - Cara D Beal
- School of Pharmacy and Medical Sciences and Cities Research Institute, Griffith University, Southport, QLD, Australia
| | - Drew Capone
- Department of Environmental and Occupational Health, School of Public Health, Indiana University, Bloomington, IN, USA
| | - Oliver Cumming
- Department of Disease Control, London School of Hygiene & Tropical Medicine, London, UK
| | - Kristi Pullen Fedinick
- Natural Resources Defense Council, Washington, DC, USA; Center for Earth, Energy, and Democracy, Minneapolis, MN, USA
| | - Jacqueline MacDonald Gibson
- Department of Civil, Construction, and Environmental Engineering, North Carolina State University, Raleigh, NC, USA
| | - Brittany Hicks
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Michal Kozubik
- Department of Social Work and Social Sciences, Faculty of Social Sciences and Health Care, Constantine the Philosopher University, Nitra, Slovakia; Department of Community & Occupational Medicine, University Medical Centre Groningen, University of Groningen, Groningen, Netherlands
| | | | - Karl G Linden
- Department of Civil, Environmental, and Architectural Engineering, University of Colorado Boulder, Boulder, CO, USA
| | - Nancy G Love
- Department of Civil and Environmental Engineering, University of Michigan, Ann Arbor, MI, USA
| | - Kaitlin J Mattos
- Department of Environment and Sustainability, Fort Lewis College, Durango, CO, USA
| | - Heather M Murphy
- Department of Pathobiology, Ontario Veterinary College, University of Guelph, Guelph, ON, Canada
| | - Inga T Winkler
- Central European University, Department of Legal Studies, Vienna, Austria
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Amato HK, Martin D, Hoover CM, Graham JP. Somewhere to go: assessing the impact of public restroom interventions on reports of open defecation in San Francisco, California from 2014 to 2020. BMC Public Health 2022; 22:1673. [PMID: 36058902 PMCID: PMC9441075 DOI: 10.1186/s12889-022-13904-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 07/28/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Open defecation due to a lack of access to sanitation facilities remains a public health issue in the United States. People experiencing homelessness face barriers to accessing sanitation facilities, and are often forced to practice open defecation on streets and sidewalks. Exposed feces may contain harmful pathogens posing a significant threat to public health, especially among unhoused persons living near open defecation sites. The City of San Francisco's Department of Public Works implemented the Pit Stop Program to provide the unhoused and the general public with improved access to sanitation with the goal of reducing fecal contamination on streets and sidewalks. The objective of this study was to assess the impact of these public restroom interventions on reports of exposed feces in San Francisco, California. METHODS We evaluated the impact of various public restroom interventions implemented from January 1, 2014 to January 1, 2020 on reports of exposed feces, captured through a 311 municipal service. Publicly available 311 reports of exposed feces were spatially and temporally matched to 31 Pit Stop restroom interventions at 27 locations across 10 San Francisco neighborhoods. We conducted an interrupted time-series analysis to compare pre- versus post-intervention rates of feces reports near the restrooms. RESULTS Feces reports declined by 12.47 reports per week after the installation of 13 Pit Stop restrooms (p-value = 0.0002). In the same restrooms, the rate of reports per week declined from the six-month pre-intervention period to the post-intervention period (slope change = -0.024 [95% CI = -0.033, -0.014]). In a subset of restrooms, where new installations were made (Mission and Golden Gate Park), and in another subset of restrooms where restroom attendants were provided (Mission, Castro/Upper Market, and Financial District/South Beach), feces reports also declined. CONCLUSIONS Increased access to public toilets reduced feces reports in San Francisco, especially in neighborhoods with people experiencing homelessness. The addition of restroom attendants also appeared to have reduced feces reports in some neighborhoods with PEH. These interventions should be audited for implementation quality, observed utilization data, and user experience at the neighborhood level in order to tailor sanitation interventions to neighborhood-specific needs.
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Affiliation(s)
- Heather K Amato
- Division of Environmental Health Sciences, Berkeley School of Public Health, University of California, Berkeley, USA.
| | - Douglas Martin
- Berkeley School of Public Health, University of California, Berkeley, USA
| | - Christopher M Hoover
- Division of Environmental Health Sciences, Berkeley School of Public Health, University of California, Berkeley, USA
| | - Jay P Graham
- Division of Environmental Health Sciences, Berkeley School of Public Health, University of California, Berkeley, USA
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Ballard AM, Cooper HLF, Young AM, Caruso BA. 'You feel how you look': Exploring the impacts of unmet water, sanitation, and hygiene needs among rural people experiencing homelessness and their intersection with drug use. PLOS WATER 2022; 1:e0000019. [PMID: 38742171 PMCID: PMC11090493 DOI: 10.1371/journal.pwat.0000019] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/16/2024]
Abstract
Existing literature attests to water, sanitation, and hygiene (WASH) inequities among people experiencing homelessness (PEH) in the United States, but there is a dearth of research on such issues in rural areas. Homelessness is an emerging public health concern in rural areas where homelessness is on the rise, infectious disease outbreaks are becoming increasingly common, and PEH face unique WASH-related challenges compared to their urban counterparts. We conducted an exploratory study to understand the impacts of unmet WASH needs among rural PEH and their intersection with drug use through in-depth interviews (n = 10). Eligible participants were 18 years or older, lived in one of five Central Appalachian counties, and had experienced homelessness in the previous six months. Using thematic analysis, we identified factors that inhibit WASH access, and adverse health and well-being outcomes that result from unmet WASH needs. We also explore how WASH experiences compare among rural PEH who self-reported drug use to those who did not. Our findings revealed that factors at multiple levels inhibited WASH access, including stigma and place-based characteristics, which contributed to the adverse physical, mental, and emotional health of PEH. Comparisons between PEH who used drugs to those that did not revealed the intricate relationship between WASH, homelessness, and substance use in communities impacted by the opioid epidemic. Expanded WASH facilities that are safe and available with no prerequisites can address inadequate access among rural PEH and collaboration with harm reduction services may be advantageous to reach those who inject drugs.
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Affiliation(s)
- April M. Ballard
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - Hannah L. F. Cooper
- Department of Behavioral, Social, and Health Education Sciences, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
| | - April M. Young
- Department of Epidemiology, University of Kentucky College of Public Health, Lexington, Kentucky, United States of America
- Center on Drug and Alcohol Research, Department of Behavioral Science, University of Kentucky College of Medicine, Lexington, Kentucky, United States of America
| | - Bethany A. Caruso
- Gangarosa Department of Environmental Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
- Hubert Department of Global Health, Emory University Rollins School of Public Health, Atlanta, GA, United States of America
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Verbyla ME, Calderon JS, Flanigan S, Garcia M, Gersberg R, Kinoshita AM, Mladenov N, Pinongcos F, Welsh M. An Assessment of Ambient Water Quality and Challenges with Access to Water and Sanitation Services for Individuals Experiencing Homelessness in Riverine Encampments. ENVIRONMENTAL ENGINEERING SCIENCE 2021; 38:389-401. [PMID: 34079210 PMCID: PMC8165467 DOI: 10.1089/ees.2020.0319] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 12/30/2020] [Indexed: 05/05/2023]
Abstract
Individuals experiencing unsheltered homelessness face significant barriers to accessing water, sanitation, and hygiene services, but the risks associated with this lack of access and barriers to service provision have been largely understudied. We analyzed water samples upstream and downstream of three homeless encampments in the San Diego River watershed and interviewed service providers from public and nonprofit sectors to assess local perceptions about challenges and potential solutions for water and sanitation service provision in this context. Water upstream from encampments contained detectable levels of caffeine and sucralose. Escherichia coli concentrations downstream of the encampments were significantly greater than concentrations upstream, but there was no significant change in the concentrations of other pollutants, including caffeine and sucralose. The HF183 marker of Bacteroides was only detected in one sample upstream of an encampment and was not detected downstream. Overall, there was insufficient evidence to suggest that the encampments studied here were responsible for contributing pollution to the river. Nevertheless, the presence of caffeine, sucralose, and HF183 indicated that there are anthropogenic sources of contamination in the river during dry weather and potential risks associated with the use of this water by encampment residents. Interviews with service providers revealed perceptions that the provision of water and sanitation services for this population would be prohibitively expensive. Interviewees also reported perceptions that most riverbank residents avoided contact with service providers, which may present challenges for the provision of water and sanitation service unless trust is first built between service providers and residents of riverine encampments.
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Affiliation(s)
- Matthew E. Verbyla
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
- Corresponding author: Department of Civil, Construction, and Environmental Engineering, MC-1324, San Diego State University, San Diego, CA 92182, USA. Phone: 619-594-0711; Fax: 619 594 8078;
| | - Jose S. Calderon
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Shawn Flanigan
- School of Public Affairs, San Diego State University, San Diego, California, USA
| | - Mireille Garcia
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Rick Gersberg
- School of Public Health, San Diego State University, San Diego, California, USA
| | - Alicia M. Kinoshita
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Natalie Mladenov
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Federick Pinongcos
- Department of Civil, Construction, and Environmental Engineering, San Diego State University, San Diego, California, USA
| | - Megan Welsh
- School of Public Affairs, San Diego State University, San Diego, California, USA
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11
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Abdel-Samad M, Calzo JP, Felner JK, Urada L, Verbyla ME, Madanat H, Adams BE, Alves T, Appleyard B, Chanin J, Flanigan S, Foad H, Ginsberg M, Higgins M, Ko E, Maher K, Mladenov N, Peattie P, Welsh M, Sleet D. Conceptualizing an Interdisciplinary Collective Impact Approach to Examine and Intervene in the Chronic Cycle of Homelessness. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042020. [PMID: 33669672 PMCID: PMC7921968 DOI: 10.3390/ijerph18042020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/04/2021] [Accepted: 02/09/2021] [Indexed: 11/16/2022]
Abstract
Homelessness is a persistent problem in the United States in general and in Southern California especially. While progress has been made in reducing the number of people experiencing homelessness in the United States from 2007 (647,000) to 2019 (567,000), it remains an entrenched problem. The purpose of this paper is to outline a novel, interdisciplinary academic-practice partnership model to address homelessness. Where singular disciplinary approaches may fall short in substantially reducing homelessness at the community and population level, our model draws from a collective impact model which coordinates discipline-specific approaches through mutually reinforcing activities and shared metrics of progress and impact to foster synergy and sustainability of efforts. This paper describes the necessary capacity-building at the institution and community level for the model, the complementary strengths and contributions of each stakeholder discipline in the proposed model, and future goals for implementation to address homelessness in the Southern California region.
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Affiliation(s)
- Mounah Abdel-Samad
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
- Correspondence:
| | - Jerel P. Calzo
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| | - Jennifer K. Felner
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| | - Lianne Urada
- School of Social Work, SDSU, San Diego, CA 92182, USA; (L.U.); (E.K.)
| | - Matthew E. Verbyla
- Department of Civil, Construction, and Environmental Engineering, SDSU, San Diego, CA 92182, USA; (M.E.V.); (T.A.); (N.M.)
| | - Hala Madanat
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
| | - Brian E. Adams
- Department of Political Science, SDSU, San Diego, CA 92182, USA; (B.E.A.); (K.M.)
| | - Thais Alves
- Department of Civil, Construction, and Environmental Engineering, SDSU, San Diego, CA 92182, USA; (M.E.V.); (T.A.); (N.M.)
| | - Bruce Appleyard
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - Joshua Chanin
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - Shawn Flanigan
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - Hisham Foad
- Department of Economics, SDSU, San Diego, CA 92182, USA;
| | - Maya Ginsberg
- School of Music and Dance, SDSU, San Diego, CA 92182, USA;
| | | | - Eunjeong Ko
- School of Social Work, SDSU, San Diego, CA 92182, USA; (L.U.); (E.K.)
| | - Kristen Maher
- Department of Political Science, SDSU, San Diego, CA 92182, USA; (B.E.A.); (K.M.)
| | - Natalie Mladenov
- Department of Civil, Construction, and Environmental Engineering, SDSU, San Diego, CA 92182, USA; (M.E.V.); (T.A.); (N.M.)
| | - Peggy Peattie
- School of Journalism and Media Studies, SDSU, San Diego, CA 92182, USA;
| | - Megan Welsh
- School of Public Affairs, San Diego State University (SDSU), San Diego, CA 92182, USA; (B.A.); (J.C.); (S.F.); (M.W.)
| | - David Sleet
- School of Public Health, SDSU, San Diego, CA 92182, USA; (J.P.C.); (J.K.F.); (H.M.)
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Ly TDA, Hadjadj L, Hoang VT, Goumbala N, Dao TL, Badiaga S, Tissot-Dupont H, Brouqui P, Raoult D, Rolain JM, Gautret P. Enteric pathogenic bacteria and resistance gene carriage in the homeless population in Marseille, France. Acta Microbiol Immunol Hung 2021; 68:7-13. [PMID: 33512334 DOI: 10.1556/030.2021.01346] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2020] [Accepted: 12/02/2020] [Indexed: 12/20/2022]
Abstract
We aimed to assess the prevalence of pathogenic bacteria and resistance genes in rectal samples collected among homeless persons in Marseille, France. In February 2014 we enrolled 114 sheltered homeless adults who completed questionnaires and had rectal samples collected. Eight types of enteric bacteria and 15 antibiotic resistance genes (ARGs) were sought by real-time polymerase chain reaction (qPCR) performed directly on rectal samples. ARG-positive samples were further tested by conventional PCR and sequencing. We evidenced a 17.5% prevalence of gastrointestinal symptoms, a 9.6% prevalence of enteric pathogenic bacteria carriage, including Escherichia coli pathotypes (8.7%) and Tropheryma whipplei (0.9%). Only 2 persons carried blaCTX-M-15 resistance genes (1.8%), while other genes, including carbapenemase-encoding genes and colistin-resistance genes, (mcr-1 to mcr-6, mcr-8) were not detected. Our results suggest that sheltered homeless persons in Marseille do not have a high risk of harbouring gastrointestinal antibiotic resistant bacteria.
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Affiliation(s)
- Tran Duc Anh Ly
- 1Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- 2IHU-Méditerranée Infection, Marseille, France
| | - Linda Hadjadj
- 2IHU-Méditerranée Infection, Marseille, France
- 3Aix Marseille University, MEPHI, Marseille, France
| | - Van Thuan Hoang
- 1Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- 2IHU-Méditerranée Infection, Marseille, France
- 6Pneumology Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Ndiaw Goumbala
- 1Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- 2IHU-Méditerranée Infection, Marseille, France
- 5VITROME, Campus International IRD-UCAD de l'IRD, Dakar, Senegal
| | - Thi Loi Dao
- 1Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- 2IHU-Méditerranée Infection, Marseille, France
- 4Family Medicine Department, Thai Binh University of Medicine and Pharmacy, Thai Binh, Viet Nam
| | - Sekene Badiaga
- 2IHU-Méditerranée Infection, Marseille, France
- 7Aix Marseille University, Service des urgences CHU Hôpital Nord, Marseille, France
| | - Herve Tissot-Dupont
- 2IHU-Méditerranée Infection, Marseille, France
- 3Aix Marseille University, MEPHI, Marseille, France
| | - Philippe Brouqui
- 2IHU-Méditerranée Infection, Marseille, France
- 3Aix Marseille University, MEPHI, Marseille, France
| | - Didier Raoult
- 1Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- 2IHU-Méditerranée Infection, Marseille, France
- 3Aix Marseille University, MEPHI, Marseille, France
| | - Jean-Marc Rolain
- 2IHU-Méditerranée Infection, Marseille, France
- 3Aix Marseille University, MEPHI, Marseille, France
| | - Philippe Gautret
- 1Aix Marseille University, IRD, AP-HM, SSA, VITROME, Marseille, France
- 2IHU-Méditerranée Infection, Marseille, France
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Capone D, Cumming O, Nichols D, Brown J. Water and Sanitation in Urban America, 2017-2019. Am J Public Health 2020; 110:1567-1572. [PMID: 32816545 DOI: 10.2105/ajph.2020.305833] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Objectives. To estimate the population lacking at least basic water and sanitation access in the urban United States.Methods. We compared national estimates of water and sanitation access from the World Health Organization/United Nations Children's Fund Joint Monitoring Program with estimates from the US Department of Housing and Urban Development on homelessness and the American Community Survey on household water and sanitation facilities.Results. We estimated that at least 930 000 persons in US cities lacked sustained access to at least basic sanitation and 610 000 to at least basic water access, as defined by the United Nations.Conclusions. After accounting for those experiencing homelessness and substandard housing, our estimate of people lacking at least basic water equaled current estimates (n = 610 000)-without considering water quality-and greatly exceeded estimates of sanitation access (n = 28 000).Public Health Implications. Methods to estimate water and sanitation access in the United States should include people experiencing homelessness and other low-income groups, and specific policies are needed to reduce disparities in urban sanitation. We recommend similar estimation efforts for other high-income countries currently reported as having near universal sanitation access.
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Affiliation(s)
- Drew Capone
- Drew Capone and Joe Brown are with Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta. Oliver Cumming is with the Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. Dennis Nichols is with the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
| | - Oliver Cumming
- Drew Capone and Joe Brown are with Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta. Oliver Cumming is with the Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. Dennis Nichols is with the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
| | - Dennis Nichols
- Drew Capone and Joe Brown are with Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta. Oliver Cumming is with the Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. Dennis Nichols is with the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
| | - Joe Brown
- Drew Capone and Joe Brown are with Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta. Oliver Cumming is with the Department of Disease Control, London School of Hygiene and Tropical Medicine, London, United Kingdom. Dennis Nichols is with the Department of Global Health, Rollins School of Public Health, Emory University, Atlanta
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Capone D, Berendes D, Cumming O, Knee J, Nalá R, Risk BB, Stauber C, Zhu K, Brown J. Analysis of fecal sludges reveals common enteric pathogens in urban Maputo, Mozambique. ENVIRONMENTAL SCIENCE & TECHNOLOGY LETTERS 2020; 7:889-895. [PMID: 38881628 PMCID: PMC11177333 DOI: 10.1021/acs.estlett.0c00610] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Sewage surveillance is increasingly used in public health applications: metabolites, biomarkers, and pathogens are detectable in wastewater and can provide useful information about community health. Work on this topic has been limited to wastewaters in mainly high-income settings, however. In low-income countries, where the burden of enteric infection is high, non-sewered sanitation predominates. In order to assess the utility of fecal sludge surveillance as a tool to identify the most prevalent enteric pathogens circulating among at-risk children, we collected 95 matched child stool and fecal sludge samples from household clusters sharing latrines in urban Maputo, Mozambique. We analyzed samples for 20 common enteric pathogens via multiplex real-time quantitative PCR. Among the 95 stools matched to fecal sludges, we detected the six most prevalent bacterial pathogens (Enteroaggregative E. coli, Shigella/Enteroinvasive E. coli, Enterotoxigenic E. coli, Enteropathogenic E. coli, shiga-toxin producing E. coli, Salmonella) and all three protozoan pathogens (Giardia duodenalis, Cryptosporidium parvum, Entamoeba histolytica) in the same rank order in both matrices. We did not observe the same trend for viral pathogens or soil-transmitted helminths, however. Our results suggest that sampling fecal sludges from onsite sanitation offers potential for localized pathogen surveillance in low-income settings where enteric pathogen prevalence is high.
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Affiliation(s)
- Drew Capone
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, 30332, United States of America
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7431, United States
| | - David Berendes
- Waterborne Disease Prevention Branch, Division of Foodborne, Waterborne, and Environmental Diseases, National Center for Emerging Zoonotic and Infectious Diseases, Centers for Disease Control and Prevention, Atlanta, Georgia, 30329, United States of America
| | - Oliver Cumming
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, United Kingdom
| | - Jackie Knee
- Department of Disease Control, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, WC1E 7HT, London, United Kingdom
| | - Rassul Nalá
- Ministério da Saúde, Instituto Nacional de Saúde Maputo, Maputo, Mozambique
| | - Benjamin B. Risk
- Department of Biostatistics and Bioinformatics, Emory University, Atlanta, Georgia, 30322, United States of America
| | - Christine Stauber
- School of Public Health, Georgia State University, Atlanta, Georgia, 30302, United States of America
| | - Kevin Zhu
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, 30332, United States of America
| | - Joe Brown
- Civil and Environmental Engineering, Georgia Institute of Technology, Atlanta, Georgia, 30332, United States of America
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina 27599-7431, United States
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15
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Moffa M, Cronk R, Fejfar D, Dancausse S, Padilla LA, Bartram J. A systematic scoping review of environmental health conditions and hygiene behaviors in homeless shelters. Int J Hyg Environ Health 2019; 222:335-346. [DOI: 10.1016/j.ijheh.2018.12.004] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Revised: 12/17/2018] [Accepted: 12/17/2018] [Indexed: 10/27/2022]
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