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Gleason K, Martin J, Bernier E. Community narratives on rural homelessness: Tales of terror and tales of compassion. J Prev Interv Community 2024:1-30. [PMID: 38411157 DOI: 10.1080/10852352.2024.2315367] [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: 02/28/2024]
Abstract
Homelessness is often assumed to be mostly confined to urban spaces, leaving experiences of homelessness in rural contexts largely unexamined. The present study aims to understand the discursive context, or public understanding, of homelessness in rural communities. We examined community narratives related to the idea of "homelessness" in rural spaces. Semi-structured qualitative interviews were conducted with 70 key stakeholders from four rural communities in the U.S. State of Maine. Participants were asked to give their impressions related to homelessness in their community. We conducted a systematic qualitative analysis of these interviews and our analysis was grounded in a critical discourse analysis perspective. Using Rappaport's framework for understanding helpful and harmful community narratives, we identified three community narratives that harm by stereotyping or erasing homelessness in rural communities: Not Here, That One Guy, and Mainly Outsiders. We also examined counter-narratives that worked against each of the three primary narratives: It Looks Different, It's More Hidden, and Local Struggle and Lack of Resources. The counter-narratives tell a different, more compassionate, story of homelessness in rural spaces. Our main goal was to analyze the "work" that each of these narratives were doing in terms of constructing different understandings of "rural homelessness." The implications for policy and practice are discussed.
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Affiliation(s)
- Kristen Gleason
- Psychology Department, University of Southern Maine, Portland, Maine, USA
| | - Jennifer Martin
- Psychology Department, University of New Haven, West Haven, Connecticut, USA
| | - Elizabeth Bernier
- Psychology Department, University of Southern Maine, Portland, Maine, USA
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2
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Schwartz GL, Leifheit KM, Arcaya MC, Keene D. Eviction as a community health exposure. Soc Sci Med 2024; 340:116496. [PMID: 38091853 DOI: 10.1016/j.socscimed.2023.116496] [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] [Received: 06/14/2023] [Revised: 11/30/2023] [Accepted: 12/03/2023] [Indexed: 01/23/2024]
Abstract
Evidence suggests that being evicted harms health. Largely ignored in the existing literature is the possibility that evictions exert community-level health effects, affecting evicted individuals' social networks and shaping broader community conditions. In this narrative review, we summarize evidence and lay out a theoretical model for eviction as a community health exposure, mediated through four paths: 1) shifting ecologies of infectious disease and health behaviors, 2) disruption of neighborhood social cohesion, 3) strain on social networks, and 4) increasing salience of eviction risk. We describe methods for parsing eviction's individual and contextual effects and discuss implications for causal inference. We conclude by addressing eviction's potentially multilevel consequences for policy advocacy and cost-benefit analyses.
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Affiliation(s)
- Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California San Francisco, San Francisco, CA, USA; Urban Health Collaborative & Department of Health Management and Policy, Drexel University Dornsife School of Public Health, Philadelphia, PA, USA.
| | - Kathryn M Leifheit
- Department of Pediatrics, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA
| | - Mariana C Arcaya
- Department of Urban Studies & Planning, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Danya Keene
- Department of Social & Behavioral Sciences, Yale School of Public Health, New Haven, CT, USA
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3
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Storholm ED, Siconolfi DE, Wagner GJ, Huang W, Nacht CL, Sallabank G, Felner JK, Wolf J, Lee SD, Stephenson R. Intimate Partner Violence and HIV Prevention Among Sexual Minority Men: Protocol for a Prospective Mixed Methods Cohort Study. JMIR Res Protoc 2022; 11:e41453. [PMID: 36378519 PMCID: PMC9709678 DOI: 10.2196/41453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 08/15/2022] [Accepted: 08/18/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Sexual minority men experience intimate partner violence (IPV) at rates similar to those reported by heterosexual women in the United States. Previous studies linked both IPV victimization and perpetration to HIV risk and seroconversion; however, less is known about the impact of IPV on HIV testing, sexually transmitted infection (STI) testing, pre-exposure prophylaxis (PrEP) uptake, and the persistence of PrEP use among sexual minority men experiencing IPV. Although prior work suggests that IPV may influence HIV prevention behavior, experiences of IPV are so highly varied among sexual minority men (eg, forms, frequency, and severity; steady vs casual partnerships; perpetration vs receipt; and sexual vs physical vs psychological violence) that additional research is needed to better understand the impact that IPV has on HIV risk and protective behaviors to develop more effective interventions for sexual minority men. OBJECTIVE This study aims to contribute to our understanding of the antecedents of IPV and the direct and indirect pathways between perpetration and receipt of IPV and HIV or STI risk behavior, STIs, and use of PrEP among sexual minority men experiencing IPV. METHODS This mixed methods study has 2 phases: phase 1 involved formative qualitative interviews with 23 sexual minority men experiencing IPV and 10 key stakeholders or providers of services to sexual minority men experiencing IPV to inform the content of a subsequent web-based cohort study, and phase 2 involves the recruitment of a web-based cohort study of 500 currently partnered HIV-negative sexual minority men who reside in Centers for Disease Control and Prevention-identified Ending the HIV Epidemic priority jurisdictions across the United States. Participants will be followed for 24 months. They will be assessed through a full survey and asked to self-collect and return biospecimen kits assessing HIV, STIs, and PrEP use at 0, 6, 12, 18, and 24 months. They will also be asked to complete abbreviated surveys to assess for self-reported changes in key study variables at 3, 9, 15, and 21 months. RESULTS Phase 1 was launched in May 2021, and the phase 1 qualitative interviews began in December 2021 and were concluded in March 2022 after a diversity of experiences and perceptions were gathered and no new ideas emerged in the interviews. Rapid analysis of the qualitative interviews took place between March 2022 and June 2022. Phase 2 recruitment of the full cohort began in August 2022 and is planned to continue through February 2024. CONCLUSIONS This mixed methods study will contribute valuable insights into the association that IPV has with HIV risk and protective behaviors among sexual minority men. The findings from this study will be used to inform the development or adaptation of HIV and IPV prevention interventions for sexual minority men experiencing IPV. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/41453.
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Affiliation(s)
- Erik D Storholm
- School of Public Health, San Diego State University, San Diego, CA, United States
- RAND Corporation, Santa Monica, CA, United States
| | | | | | | | - Carrie L Nacht
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Greg Sallabank
- School of Nursing, University or Michigan, Ann Arbor, MI, United States
| | - Jennifer K Felner
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Joshua Wolf
- RAND Corporation, Santa Monica, CA, United States
| | - Sarita D Lee
- RAND Corporation, Santa Monica, CA, United States
| | - Rob Stephenson
- School of Nursing, University or Michigan, Ann Arbor, MI, United States
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4
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Gleason KD, Dube M, Bernier E, Martin J. Using geographic information systems to assess community-level vulnerability to housing insecurity in rural areas. JOURNAL OF COMMUNITY PSYCHOLOGY 2022; 50:1993-2012. [PMID: 33969506 DOI: 10.1002/jcop.22589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 02/18/2021] [Accepted: 04/05/2021] [Indexed: 06/12/2023]
Abstract
Research examining homelessness in rural areas has been sparse. The current study aims to expand conceptions of rural homelessness by mapping community-level risk factors related to housing insecurity. Geographic information systems (GIS) techniques were used to map the distribution of select community-level risk indicators in the State of Maine. Three methodological choices related to this process are demonstrated: (1) selection and distribution of housing insecurity risk indicators; (2) use of location quotients; and (3) use of spatial lags. After examining and mapping selected risk factors against the location of homeless service supports, four areas in Maine were identified as communities of concern for housing insecurity. Better understanding the extent and location of areas of high need that are resource poor can help service and funding agencies to plan for the more efficient and effective distribution of homeless prevention and mitigation services. Implications for research in rural areas are discussed.
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Affiliation(s)
- Kristen D Gleason
- Department of Psychology, University of Southern Maine, Portland, Maine, USA
| | - Matthew Dube
- Department of Computer Information Systems and Data Science, University of Maine at Augusta, Augusta, Maine, USA
| | - Elizabeth Bernier
- Department of Psychology, University of Southern Maine, Portland, Maine, USA
| | - Jennifer Martin
- Department of Psychology, University of Southern Maine, Portland, Maine, USA
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5
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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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Byrne T, Baggett T, Land T, Bernson D, Hood ME, Kennedy-Perez C, Monterrey R, Smelson D, Dones M, Bharel M. A classification model of homelessness using integrated administrative data: Implications for targeting interventions to improve the housing status, health and well-being of a highly vulnerable population. PLoS One 2020; 15:e0237905. [PMID: 32817717 PMCID: PMC7446866 DOI: 10.1371/journal.pone.0237905] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 08/06/2020] [Indexed: 11/19/2022] Open
Abstract
Homelessness is poorly captured in most administrative data sets making it difficult to understand how, when, and where this population can be better served. This study sought to develop and validate a classification model of homelessness. Our sample included 5,050,639 individuals aged 11 years and older who were included in a linked dataset of administrative records from multiple state-maintained databases in Massachusetts for the period from 2011-2015. We used logistic regression to develop a classification model with 94 predictors and subsequently tested its performance. The model had high specificity (95.4%), moderate sensitivity (77.8%) for predicting known cases of homelessness, and excellent classification properties (area under the receiver operating curve 0.94; balanced accuracy 86.4%). To demonstrate the potential opportunity that exists for using such a modeling approach to target interventions to mitigate the risk of an adverse health outcome, we also estimated the association between model predicted homeless status and fatal opioid overdoses, finding that model predicted homeless status was associated with a nearly 23-fold increase in the risk of fatal opioid overdose. This study provides a novel approach for identifying homelessness using integrated administrative data. The strong performance of our model underscores the potential value of linking data from multiple service systems to improve the identification of housing instability and to assist government in developing programs that seek to improve health and other outcomes for homeless individuals.
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Affiliation(s)
- Thomas Byrne
- Boston University School of Social Work, Boston, Massachusetts, United States of America
| | - Travis Baggett
- Boston Health Care for the Homeless Program, Boston, Massachusetts, United States of America
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, United States of America
| | - Thomas Land
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Dana Bernson
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Maria-Elena Hood
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Cheryl Kennedy-Perez
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - Rodrigo Monterrey
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
| | - David Smelson
- University of Massachusetts Medical School, Worcester, Massachusetts, United States of America
| | - Marc Dones
- National Innovation Service, United States of America
| | - Monica Bharel
- Massachusetts Department of Public Health, Boston, Massachusetts, United States of America
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8
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Wright RS, Murphy JG. Homeless With a Heart Attack in America-A Double Whammy. Mayo Clin Proc 2020; 95:626-628. [PMID: 32200978 DOI: 10.1016/j.mayocp.2020.02.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 02/21/2020] [Indexed: 11/16/2022]
Affiliation(s)
- R Scott Wright
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN.
| | - Joseph G Murphy
- Department of Cardiovascular Diseases, Mayo Clinic, Rochester, MN
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9
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Cutuli JJ, Treglia D, Herbers JE. Adolescent Homelessness and Associated Features: Prevalence and Risk Across Eight States. Child Psychiatry Hum Dev 2020; 51:48-58. [PMID: 31270658 DOI: 10.1007/s10578-019-00909-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
This study utilizes data from the Youth Risk Behavior Survey to estimate the prevalence of adolescent homelessness and relations to five indicators of poor functioning among students attending public high school in eight states. About 3.27% of students experienced homelessness, and nearly 7% of teens who identified as lesbian, gay, or bisexual (LGB) experienced homelessness. Homelessness was related to higher rates of sexual/dating violence as well as having been bullied and feeling unsafe at school. Homelessness and LGB identification predicted higher rates of more-severe problems with alcohol, hard drug use, poor grades, suicidality, and risky sexual behavior, controlling for other factors. There was no interaction effect between homelessness and LGB status, suggesting that these risks are additive.
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Affiliation(s)
- J J Cutuli
- Department of Psychology, Rutgers University - Camden, 311 N Fifth Street, Rm 308, Camden, NJ, 08243, USA.
| | - Dan Treglia
- School of Social Policy and Practice, University of Pennsylvania, Philadelphia, PA, USA
| | - Janette E Herbers
- Department of Psychological and Brain Sciences, Villanova University, Villanova, PA, USA
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10
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Taylor O, Loubiere S, Tinland A, Vargas-Moniz M, Spinnewijn F, Manning R, Gaboardi M, Wolf JRLM, Bokszczanin A, Bernad R, Kallmen H, Toro P, Ornelas J, Auquier P. Lifetime, 5-year and past-year prevalence of homelessness in Europe: a cross-national survey in eight European nations. BMJ Open 2019; 9:e033237. [PMID: 31791966 PMCID: PMC6924844 DOI: 10.1136/bmjopen-2019-033237] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine the lifetime, 5-year and past-year prevalence of homelessness among European citizens in eight European nations. DESIGN A nationally representative telephone survey using trained bilingual interviewers and computer-assisted telephone interview software. SETTING The study was conducted in France, Ireland, Italy, the Netherlands, Poland, Portugal, Spain and Sweden. PARTICIPANTS European adult citizens, selected from opt-in panels from March to December 2017. Total desired sample size was 5600, with 700 per country. Expected response rates of approximately 30% led to initial sample sizes of 2500 per country. MAIN OUTCOME MEASURES History of homelessness was assessed for lifetime, past 5 years and past year. Sociodemographic data were collected to assess correlates of homelessness prevalence using generalised linear models for clustered and weighted samples. RESULTS Response rates ranged from 30.4% to 33.5% (n=5631). Homelessness prevalence was 4.96% for lifetime (95% CI 4.39% to 5.59%), 1.92% in the past 5 years (95% CI 1.57% to 2.33%) and 0.71% for the past year (95% CI 0.51% to 0.98%) and varied significantly between countries (pairwise comparison difference test, p<0.0001). Time spent homeless ranged between less than a week (21%) and more than a year (18%), with high contrasts between countries (p<0.0001). Male gender, age 45-54, lower secondary education, single status, unemployment and an urban environment were all independently strongly associated with lifetime homelessness (all OR >1.5). CONCLUSIONS The prevalence of homelessness among the surveyed nations is significantly higher than might be expected from point-in-time and homeless service use statistics. There was substantial variation in estimated prevalence across the eight nations. Coupled with the well-established health impacts of homelessness, medical professionals need to be aware of the increased health risks of those with experience of homelessness. These findings support policies aiming to improve health services for people exposed to homelessness.
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Affiliation(s)
- Owen Taylor
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
| | - Sandrine Loubiere
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France
| | - Aurelie Tinland
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France
| | - Maria Vargas-Moniz
- APPsyCI - Applied Psychology Research Center: Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, Lisboa, Lisboa, Portugal
| | - Freek Spinnewijn
- FEANTSA - European Federation of National Organisations Working with the Homeless, Brussels, Belgium
| | - Rachel Manning
- Department of Psychology, University of Limerick, Limerick, Ireland
| | - Marta Gaboardi
- Department of Developmental and Social Psychology, University of Padova School of Psychology, Padova, Veneto, Italy
| | - Judith R L M Wolf
- Impuls - Netherlands Center for Social Care Research, Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | | | - Hakan Kallmen
- Stockholm Center for Psychiatry Research and Education, Karolinska Institute, Stockholm, Stockholm County, Sweden
| | - Paul Toro
- Department of Psychology, Wayne State University, Detroit, Michigan, USA
| | - Jose Ornelas
- APPsyCI - Applied Psychology Research Center: Capabilities and Inclusion, Instituto Superior de Psicologia Aplicada, Lisboa, Lisboa, Portugal
| | - Pascal Auquier
- School of Medicine - La Timone Medical Campus, EA 3279: CEReSS, Aix-Marseille Universite, Marseille, France
- Department of Clinical Research and Innovation, Support Unit for Clinical Research and Economic Evaluation, APHM, Marseille, France
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11
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Fusaro VA, Levy HG, Shaefer HL. Racial and Ethnic Disparities in the Lifetime Prevalence of Homelessness in the United States. Demography 2019; 55:2119-2128. [PMID: 30242661 DOI: 10.1007/s13524-018-0717-0] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Homelessness in the United States is often examined using cross-sectional, point-in-time samples. Any experience of homelessness is a risk factor for adverse outcomes, so it is also useful to understand the incidence of homelessness over longer periods. We estimate the lifetime prevalence of homelessness among members of the Baby Boom cohort (n = 6,545) using the 2012 and 2014 waves of the Health and Retirement Study (HRS), a nationally representative survey of older Americans. Our analysis indicates that 6.2 % of respondents had a period of homelessness at some point in their lives. We also identify dramatic disparities in lifetime incidence of homelessness by racial and ethnic subgroups. Rates of homelessness were higher for non-Hispanic blacks (16.8 %) or Hispanics of any race (8.1 %) than for non-Hispanic whites (4.8 %; all differences significant with p < .05). The black-white gap, but not the Hispanic-white gap, remained significant after adjustment for covariates such as education, veteran status, and geographic region.
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Affiliation(s)
- Vincent A Fusaro
- Boston College School of Social Work, 140 Commonwealth Avenue, Chestnut Hill, MA, 02467, USA.
| | - Helen G Levy
- Institute for Social Research, University of Michigan, 426 Thompson Street, Ann Arbor, MI, 48104, USA
| | - H Luke Shaefer
- School of Social Work & Gerald R. Ford School of Public Policy, University of Michigan, 1080 South University Avenue, Ann Arbor, MI, 48109, USA
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12
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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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Stefanovics EA, Rosenheck RA. Prevalence and multi-morbid correlates of homelessness among veterans with HIV infection nationally in the veterans health administration. PSYCHOL HEALTH MED 2019; 24:1123-1136. [PMID: 30900465 DOI: 10.1080/13548506.2019.1595680] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
This study sought to evaluate the risk of homelessness among HIV positive users of Veterans Health Administration (VHA) services. National VHA administrative data from Fiscal Year (FY) 2012 (N = 5.4 million) were used to: (1) evaluate the unadjusted risk of homelessness among veterans with HIV; (2) identify common multi-morbid correlates of both HIV diagnosis and homelessness; and (3) to assess the independent risk of homelessness among veterans with HIV after adjusting for risk factors common to both conditions. Veterans with HIV were at substantial risk of homelessness (OR = 4.23 (95% CI 4.07-4.39)). However, with adjustment for shared co-variates (especially black race, low income, substance use, and psychiatric disorders) this risk declined substantially to 1.41 (95% CI 1.35-1.48). The high risk of homelessness among HIV positive veterans is largely attributable to multi-morbid risk factors common to both HIV and homelessness rather than to an independent effect of HIV, and requires multi-dimensional preventive psychosocial interventions.
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Affiliation(s)
- Elina A Stefanovics
- a Department of Psychiatry , Yale University School of Medicine, (YUSM) , New Haven , CT , USA.,b Department of Psychiatry , Veterans Affairs (VA) New England Mental Illness Research and Education Clinical Center (MIRECC) , West Haven , CT , USA
| | - Robert A Rosenheck
- a Department of Psychiatry , Yale University School of Medicine, (YUSM) , New Haven , CT , USA.,b Department of Psychiatry , Veterans Affairs (VA) New England Mental Illness Research and Education Clinical Center (MIRECC) , West Haven , CT , USA
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14
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Jetelina KK, Reingle Gonzalez JM, Brown CVR, Foreman ML, Field C. Acute Alcohol Use, History of Homelessness, and Intent of Injury Among a Sample of Adult Emergency Department Patients. VIOLENCE AND VICTIMS 2017; 32:658-670. [PMID: 28516838 DOI: 10.1891/0886-6708.vv-d-16-00069] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
BACKGROUND The literature is clear that adults who are currently homeless also have higher rates of intentional injuries, such as assault and suicide attempts. No study has assessed whether intentional injuries are exacerbated because of substance use among adults with a history of homelessness. METHODS Data were obtained from a cohort of adults admitted to 3 urban emergency departments (EDs) in Texas from 2007 to 2010 (N = 596). Logistic regression analyses were used to determine whether a history of homelessness was associated with alcohol use at time of injury in intentional violent injuries (gunshot, stabbing, or injury consistent with assault). RESULTS 39% adults with a history of homelessness who were treated at trauma centers for a violent injury. Bivariate analyses indicated that adults who had ever experienced homelessness have 1.67 increased odds, 95% confidence interval (CI) [1.11, 2.50], of any intentional violent injury and 1.95 increased odds (95% CI [1.12, 3.40]) of a stabbing injury than adults with no history of homelessness. CONCLUSIONS Adults who experienced homelessness in their lifetime were more likely to visit EDs for violencerelated injuries. Given our limited knowledge of the injuries that prompt ED use by currently homeless populations, future studies are needed to understand the etiology of injuries, and substance-related injuries specifically, among adults with a history of homelessness.
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15
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Tsai J. Lifetime and 1-year prevalence of homelessness in the US population: results from the National Epidemiologic Survey on Alcohol and Related Conditions-III. J Public Health (Oxf) 2017; 40:65-74. [DOI: 10.1093/pubmed/fdx034] [Citation(s) in RCA: 44] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/07/2017] [Indexed: 11/12/2022] Open
Affiliation(s)
- Jack Tsai
- Department of Psychiatry, Yale School of Medicine, New Haven, CT06510, USA
- Department of Veterans Affairs (VA) New England Mental Illness Research, Education, and Clinical Center, West Haven, CT06516, USA
- VA National Center on Homelessness Among Veterans, West Haven, CT06516, USA
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16
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Gleason K, Barile JP, Baker CK. Describing Trajectories of Homeless Service Use in Hawai'i Using Latent Class Growth Analysis. AMERICAN JOURNAL OF COMMUNITY PSYCHOLOGY 2017; 59:158-171. [PMID: 28295354 DOI: 10.1002/ajcp.12128] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The State of Hawai'i, like many other areas across the United States, has large numbers of individuals and families experiencing homelessness, many of whom seek support through statewide shelters and services. This study explored the diversity of ways in which individuals and families moved through Hawai'i's homeless service system. Using administrative data, a cohort of new service users was tracked across time to trace the developmental trajectories of their homeless service use. The sample consisted of adults who had entered the service system for the first time in the fiscal year (FY) of 2010 (N = 4655). These individuals were then tracked through the end of FY 2014, as they used emergency shelter, transitional shelter, and outreach services. A latent class growth analysis was conducted and identified four distinct patterns of service use: low service use (n = 3966, 85.2%); typical transitional shelter use (n = 452, 9.7%); atypical transitional use (n = 127, 2.7%), and potential chronic service use (n = 110, 2.4%). Multinomial logistic regression models were then used to determine if select demographic, family, background experience (e.g., education, employment), or health variables were associated with class membership. The distinct profiles for class membership are discussed.
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Affiliation(s)
- Kristen Gleason
- University of Hawai'i at Mānoa, Honolulu, HI, USA
- Center for Community Research, DePaul University, Chicago, IL, USA
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Murillo LG, Ramos-Olazagasti MA, Mannuzza S, Castellanos FX, Klein RG. Childhood Attention-Deficit/Hyperactivity Disorder and Homelessness: A 33-Year Follow-Up Study. J Am Acad Child Adolesc Psychiatry 2016; 55:931-936. [PMID: 27806860 PMCID: PMC5533180 DOI: 10.1016/j.jaac.2016.07.772] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2016] [Revised: 06/16/2016] [Accepted: 08/26/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine whether childhood attention-deficit/hyperactivity disorder (ADHD) predicts homelessness in adulthood, and whether the persistence of childhood ADHD through adolescence influences the likelihood of homelessness. METHOD A 33-year prospective, controlled, follow-up was performed of clinic-referred, 6- to 12-year-old boys of white ethnicity with ADHD (probands; mean = 8), at a mean age of 41 years (follow-up [FU] = 41). Comparisons, children without ADHD from the same medical center, were matched for age and socioeconomic status (SES). Both groups were evaluated at a mean age of 18 years (FU18). Homelessness was assessed at FU41 in 134 of 207 probands (65%) and 136 of 178 (76%) comparisons. We tested the following: the relationship between childhood ADHD and homelessness; whether adolescent dysfunctions (conduct disorder, non-alcohol substance use disorder, arrests, and school dropout) accounted for this relationship, if found; and whether ADHD that persisted through FU18 elevated probands' homelessness rate. RESULTS Probands had significantly higher rates of homelessness than comparisons (23.7% vs. 4.4%; χ21 = 21.15, df = 1, p < .001). In a multivariate analysis, including childhood ADHD and covariates, the probands' significant elevation of homelessness remained (odds ratio [OR] = 3.60, 95% CI = 1.32-9.76, p = .01). Probands with persistent ADHD through adolescence had significantly more homelessness than remitted probands (χ21 = 12.73, p < .001), but this relationship was no longer significant when conduct disorder at FU18 was controlled (OR = 1.97, 95% CI = 0.89-4.38, p = .09). CONCLUSION Among boys of white ethnicity who were followed into adulthood, childhood ADHD was associated with an elevated rate of homelessness. Findings point to the need for clinical monitoring of childhood ADHD through adolescence, even when ADHD does not persist, in hopes of mitigating a cascade of malfunction that includes homelessness.
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Affiliation(s)
| | | | | | - Francisco Xavier Castellanos
- The Child Study Center at New York University Langone Medical Center, New York. Nathan Kline Institute for Psychiatric Research, Orangeburg, NY
| | - Rachel G. Klein
- The Child Study Center at New York University Langone Medical Center, New York
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Tsai J, Link B, Rosenheck RA, Pietrzak RH. Homelessness among a nationally representative sample of US veterans: prevalence, service utilization, and correlates. Soc Psychiatry Psychiatr Epidemiol 2016; 51:907-16. [PMID: 27075492 DOI: 10.1007/s00127-016-1210-y] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2015] [Accepted: 03/16/2016] [Indexed: 11/30/2022]
Abstract
PURPOSE To examine the prevalence of lifetime homelessness among veterans and use of Veterans Affairs (VA) homeless services, as well as their association with sociodemographic and clinical characteristics. METHODS A nationally representative sample of 1533 US veterans was surveyed July-August 2015. RESULTS Among all veterans, 8.5 % reported any lifetime homelessness in their adult life, but only 17.2 % of those reported using VA homeless services. Prevalence of homelessness and VA homeless service use did not significantly differ by gender. Being low income, aged 35-44, and having poor mental and physical health were each independently associated with lifetime homelessness. Veterans who were White or lived in rural areas were significantly less likely to have used VA homeless services. CONCLUSIONS Homelessness remains a substantial problem across different generations of veterans. The low reported uptake of VA homeless services suggests there are barriers to care in this population, especially for veterans who live in rural areas. Governmental resources dedicated to veteran homelessness should be supported, and obtaining accurate prevalence estimates are important to tracking progress over time.
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Affiliation(s)
- Jack Tsai
- US Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA. .,Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA.
| | - Bruce Link
- Mailman School of Public Health, Columbia University, New York, NY, 10032, USA.,New York State Psychiatric Institute, New York, NY, 10032, USA
| | - Robert A Rosenheck
- US Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, 950 Campbell Ave., 151D, West Haven, CT, 06516, USA.,Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA
| | - Robert H Pietrzak
- Department of Psychiatry, Yale School of Medicine, New Haven, CT, 06511, USA.,US Department of Veterans Affairs National Center for Posttraumatic Stress Disorder, West Haven, CT, 06516, USA
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Heubner J, Tryssenaar J. Development of an Occupational Therapy Practice Perspective in a Homeless Shelter: A Fieldwork Experience. The Canadian Journal of Occupational Therapy 2016. [DOI: 10.1177/000841749606300104] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This paper describes the lived experience of a student occupational therapist at a homeless shelter. This phenomenological experience was captured through journal entries, used initially as a communication tool with the supervising therapist. Retrospective content analysis of the journal revealed a dual search for meaning: by the residents, as they sought for meaning in their chaotic lives; and the student as she searched for meaning in the role of the occupational therapist. Key themes included the importance of rapport, and the residents' innate drive towards purposeful activity. The student developed activity opportunities for people identified as lower functioning, with concommitant psychiatric difficulties. The restraints of the physical setting did not discourage people with significant dysfunction from involvement. Positive changes in psychosocial functioning also were observed. This lived experience indicates the potential of occupational therapy as an ideal profession for addressing the myriad of problems associated with the shelter population.
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A Literature Review of Homelessness and Aging: Suggestions for a Policy and Practice-Relevant Research Agenda. Can J Aging 2016; 35:28-41. [DOI: 10.1017/s0714980815000616] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
RÉSUMÉLe sans-abrisme chez les personnes âgées est une préoccupation croissante à travers le Canada et devrait augmenter avec le changement démographique (Crane & Warnes, 2010; Culhane, Métraux, Byrne, Stino, et Bainbridge, 2013). Pourtant, les connaissances actuelles, les politiques et les pratiques concernant le sans-abrisme ont tendance largement de se concentrer sur des populations plus jeunes. De même, la recherche et les politiques sur le vieillissement en général négligent le sans-abrisme. Les réponses au problème de sans-abrisme chez les personnes âgées doivent répondre aux besoins complexes liés à la santé, la sécurité du revenu et le logement. Basé sur un examen exhaustif de la littérature, cet article présente les domaines de recherche afin d'éclairer les politiques, les stratégies et les services pour les divers groupes des aînés sans-abri. Nous clarifions les intersections du vieillissement et du sans-abrisme; examinons les statistiques pertinentes, y compris la prévalence estimée; discutons des voies et des variations de l'expérience; et determinons les lacunes dans les connaissances. Nous concluons par un appel à un programme de recherche inclusive qui aidera à créér des politiques et des pratiques visant à réduire et finalement à éliminer le sans-abrisme chez les personnes âgées au Canada.
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Hasin DS, Saha TD, Kerridge BT, Goldstein RB, Chou SP, Zhang H, Jung J, Pickering RP, Ruan WJ, Smith SM, Huang B, Grant BF. Prevalence of Marijuana Use Disorders in the United States Between 2001-2002 and 2012-2013. JAMA Psychiatry 2015; 72:1235-42. [PMID: 26502112 PMCID: PMC5037576 DOI: 10.1001/jamapsychiatry.2015.1858] [Citation(s) in RCA: 702] [Impact Index Per Article: 78.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
IMPORTANCE Laws and attitudes toward marijuana in the United States are becoming more permissive but little is known about whether the prevalence rates of marijuana use and marijuana use disorders have changed in the 21st century. OBJECTIVE To present nationally representative information on the past-year prevalence rates of marijuana use, marijuana use disorder, and marijuana use disorder among marijuana users in the US adult general population and whether this has changed between 2001-2002 and 2012-2013. DESIGN, SETTING, AND PARTICIPANTS Face-to-face interviews conducted in surveys of 2 nationally representative samples of US adults: the National Epidemiologic Survey on Alcohol and Related Conditions (data collected April 2001-April 2002; N = 43,093) and the National Epidemiologic Survey on Alcohol and Related Conditions-III (data collected April 2012-June 2013; N = 36,309). Data were analyzed March through May 2015. MAIN OUTCOMES AND MEASURES Past-year marijuana use and DSM-IV marijuana use disorder (abuse or dependence). RESULTS The past-year prevalence of marijuana use was 4.1% (SE, 0.15) in 2001-2002 and 9.5% (SE, 0.27) in 2012-2013, a significant increase (P < .05). Significant increases were also found across demographic subgroups (sex, age, race/ethnicity, education, marital status, income, urban/rural, and region). The past-year prevalence of DSM-IV marijuana use disorder was 1.5% (0.08) in 2001-2002 and 2.9% (SE, 0.13) in 2012-2013 (P < .05). With few exceptions, increases in the prevalence of marijuana use disorder between 2001-2002 and 2012-2013 were also statistically significant (P < .05) across demographic subgroups. However, the prevalence of marijuana use disorder among marijuana users decreased significantly from 2001-2002 (35.6%; SE, 1.37) to 2012-2013 (30.6%; SE, 1.04). CONCLUSIONS AND RELEVANCE The prevalence of marijuana use more than doubled between 2001-2002 and 2012-2013, and there was a large increase in marijuana use disorders during that time. While not all marijuana users experience problems, nearly 3 of 10 marijuana users manifested a marijuana use disorder in 2012-2013. Because the risk for marijuana use disorder did not increase among users, the increase in prevalence of marijuana use disorder is owing to an increase in prevalence of users in the US adult population. Given changing laws and attitudes toward marijuana, a balanced presentation of the likelihood of adverse consequences of marijuana use to policy makers, professionals, and the public is needed.
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Affiliation(s)
- Deborah S Hasin
- Department of Psychiatry, College of Physicians and Surgeons, Columbia University, New York, New York2Mailman School of Public Health, Columbia University, New York, New York3New York State Psychiatric Institute, New York
| | - Tulshi D Saha
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bradley T Kerridge
- Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, New York
| | - Risë B Goldstein
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - S Patricia Chou
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Haitao Zhang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Jeesun Jung
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Roger P Pickering
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - W June Ruan
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Sharon M Smith
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Boji Huang
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
| | - Bridget F Grant
- Laboratory of Epidemiology and Biometry, Division of Intramural Clinical and Biological Research, National Institute on Alcohol Abuse and Alcoholism, National Institutes of Health, Rockville, Maryland
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Nayyar D, Hwang SW. Cardiovascular Health Issues in Inner City Populations. Can J Cardiol 2015; 31:1130-8. [DOI: 10.1016/j.cjca.2015.04.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2015] [Revised: 04/06/2015] [Accepted: 04/06/2015] [Indexed: 11/28/2022] Open
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Asgary R, Sckell B, Alcabes A, Naderi R, Adongo P, Ogedegbe G. Perceptions, Attitudes, and Experience Regarding mHealth Among Homeless Persons in New York City Shelters. JOURNAL OF HEALTH COMMUNICATION 2015; 20:1473-80. [PMID: 26313765 PMCID: PMC4654657 DOI: 10.1080/10810730.2015.1033117] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Mobile health may be an effective means of providing access and education to the millions of homeless Americans. We conducted semi-structured interviews with 50 homeless people from different shelters in New York City to evaluate their perceptions, attitudes, and experiences regarding mobile health. Participants' average age was 51.66 (SD = 11.34) years; duration of homelessness was 2.0 (SD = 3.10) years. The majority had a mobile phone with the ability to receive and send text messages. Most participants attempted to maintain the same phone number over time. The homeless were welcoming and supportive of text messaging regarding health care issues, including appointment reminders, health education, or management of diseases considering their barriers and mobility, and believed it would help them access necessary health care. Overwhelmingly they preferred text reminders that were short, positively framed, and directive in nature compared to lengthy or motivational texts. The majority believed that free cell phone plans would improve their engagement with, help them navigate, and ultimately improve their access to care. These positive attitudes and experience could be effectively used to improve health care for the homeless. Policies to improve access to mobile health and adapted text messaging strategies regarding the health care needs of this mobile population should be considered.
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Affiliation(s)
- Ramin Asgary
- Department of Population Health, New York University School of Medicine, New York, New York, USA
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Blanca Sckell
- Department of Community Medicine, Lutheran Family Health Centers, New York, New York, USA
| | - Analena Alcabes
- Department of Community Medicine, Lutheran Family Health Centers, New York, New York, USA
| | - Ramesh Naderi
- Department of Medicine, New York University School of Medicine, New York, New York, USA
| | - Philip Adongo
- School of Public Health, University of Ghana, Accra, Ghana
| | - Gbenga Ogedegbe
- Department of Population Health, New York University School of Medicine, New York, New York, USA
- Department of Medicine, New York University School of Medicine, New York, New York, USA
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Asgary R, Sckell B, Alcabes A, Naderi R, Ogedegbe G. Perspectives of cancer and cancer screening among homeless adults of New York City shelter-based clinics: a qualitative approach. Cancer Causes Control 2015. [DOI: 10.1007/s10552-015-0634-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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McVicar D, Moschion J, van Ours JC. From substance use to homelessness or vice versa? Soc Sci Med 2015; 136-137:89-98. [DOI: 10.1016/j.socscimed.2015.05.005] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Bernstein RS, Meurer LN, Plumb EJ, Jackson JL. Diabetes and hypertension prevalence in homeless adults in the United States: a systematic review and meta-analysis. Am J Public Health 2015; 105:e46-60. [PMID: 25521899 DOI: 10.2105/ajph.2014.302330] [Citation(s) in RCA: 67] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
We estimated hypertension and diabetes prevalence among US homeless adults compared with the general population, and investigated prevalence trends. We systematically searched 5 databases for published studies (1980-2014) that included hypertension or diabetes prevalence for US homeless adults, pooled disease prevalence, and explored heterogeneity sources. We used the National Health Interview Survey for comparison. We included data from 97366 homeless adults. The pooled prevalence of self-reported hypertension was 27.0% (95% confidence interval=23.8%, 29.9%; n=43 studies) and of diabetes was 8.0% (95% confidence interval=6.8%, 9.2%; n=39 studies). We found no difference in hypertension or diabetes prevalence between the homeless and general population. Additional health care and housing resources are needed to meet the significant, growing burden of chronic disease in the homeless population.
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Affiliation(s)
- Rebecca S Bernstein
- Rebecca S. Bernstein and Linda N. Meurer are with Department of Family and Community Medicine, Medical College of Wisconsin, Milwaukee. Ellen J. Plumb is with Department of Family and Community Medicine, Thomas Jefferson University Hospital, Philadelphia, PA. Jeffrey L. Jackson is with Medical College of Wisconsin and Department of Internal Medicine, Division of General Internal Medicine, Zablocki VA Medical Center, Milwaukee
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Furr SR, Johnson WD, Goodall CS. Grief and Recovery: The Prevalence of Grief and Loss in Substance Abuse Treatment. JOURNAL OF ADDICTIONS & OFFENDER COUNSELING 2015. [DOI: 10.1002/j.2161-1874.2015.00034.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Susan R. Furr
- Department of Counseling; University of North Carolina at Charlotte
| | - W. Derrick Johnson
- Department of Counseling; University of North Carolina at Charlotte
- Now in private practice in Charlotte; North Carolina
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Henwood BF, Katz ML, Gilmer TP. Aging in place within permanent supportive housing. Int J Geriatr Psychiatry 2015; 30:80-7. [PMID: 24737594 DOI: 10.1002/gps.4120] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2014] [Accepted: 03/10/2014] [Indexed: 01/17/2023]
Abstract
OBJECTIVES This study examined whether and how permanent supportive housing (PSH) programs are able to support aging in place among tenants with serious mental illness. DESIGN Investigators used a mixed-method approach known as a convergent parallel design in which quantitative and qualitative data are analyzed separately and findings are merged during interpretation. Quantitative analysis compared 1-year pre-residential and post-residential outcomes for PSH program enrollees, comparing adults aged 35-49 years (n = 3990) with those aged 50 years or older (n = 3086). Case study analysis using qualitative interviews with staff of a PSH program that exclusively served older adults identified challenges to providing support services. RESULTS Substantial declines in days spent homeless and in justice system settings were found, along with increases in days living independently in apartments and in congregate settings. Homelessness and justice system involvement declined less for older adults than younger adults. Qualitative themes related to working with older adults included increased attention to medical vulnerability, residual effects of institutional care, and perceived preference for congregate living. CONCLUSIONS PSH is an effective way to end homelessness, yet little is known about how programs can support housing stability among aging populations. Additional support and training for PSH staff will better promote successful aging in place.
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Affiliation(s)
- Benjamin F Henwood
- University of Southern California, School of Social Work, Los Angeles, CA, USA
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Quality of life after housing first for adults with serious mental illness who have experienced chronic homelessness. Psychiatry Res 2014; 220:549-55. [PMID: 25129560 DOI: 10.1016/j.psychres.2014.07.072] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2013] [Revised: 07/24/2014] [Accepted: 07/28/2014] [Indexed: 11/23/2022]
Abstract
This 1-year longitudinal study of adults who have recently transitioned from homelessness to Permanent Supportive Housing (PSH) focuses on quality of life as a primary outcome of interest. Eighty of 103 new tenants participated in structured interviews at the time of entry into their new home and at 12-months post-housing. t-tests assessed differences in community participation and quality of life measures at the 2 time points. Mixed effects models examined the impact of community participation on quality of life. Results show that time in independent housing was significantly associated with several domains of quality of life. Symptom severity was also significantly and negatively related to quality of life domains. Community participation was significantly related to frequency of social contacts only. These findings suggest that community participation is not critical to improving quality of life, and that despite concerns that individuals may feel isolated and lonely when living independently, satisfaction with one׳s living situation and family relationships nevertheless improves with housing tenure.
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Mental health correlates of past homelessness in Latinos and Asians. Community Ment Health J 2014; 50:953-9. [PMID: 24659183 DOI: 10.1007/s10597-014-9721-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2013] [Accepted: 03/11/2014] [Indexed: 10/25/2022]
Abstract
Mental illness and addiction are strongly associated with homelessness, yet few studies have shown how these relationships vary across ethnic categories that are underrepresented in the homeless population. This study draws from the National Latino and Asian American Survey to examine mental health and substance abuse correlates of homelessness amongst Latinos and Asians living in the United States. Clinical and institutional factors associated with homelessness varied by ethnicity. Among Latinos, alcohol abuse or dependence, conduct disorder and intermittent explosive disorder were risk factors for homelessness, while attending a religious service more than once a week was a protective factor. Among Asians, mood disorder was a risk factor as were health problems and receiving welfare in the past. Understanding ethnicity-specific correlates of homelessness may guide culturally nuanced mental health prevention and intervention efforts.
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Risk factors associated with recurrent homelessness after a first homeless episode. Community Ment Health J 2014; 50:505-13. [PMID: 23744291 DOI: 10.1007/s10597-013-9608-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2011] [Accepted: 05/19/2013] [Indexed: 10/26/2022]
Abstract
Alcohol and drug use are commonly associated with the experience of homelessness. In order to better understand this, we explored the prevalence of drug and alcohol use as it related to successful re-housing within a sample of first-time single homeless adults at municipal shelters. From within this sample, we compared the features of recurrent homelessness with those of chronic homelessness and of being stably housed. We interviewed 344 subjects upon shelter entry and followed each one every six months for 18 months using standardized social and mental health measures. We analyzed baseline assessments relative to housing experiences during follow-up using Chi square and multinomial logistic regression. Eighty-one percent (N = 278) obtained housing over 18 months, of which 23.7 % (N = 66) experienced homelessness again. Recurrent homelessness was more common among those with a high school education and if initially re-housed with family. Bivariate analysis resulted in the observation of the highest rate of alcohol and other drug use among this recurrent group and multinomial logistic regression supported this only with the coupling of arrest history and diagnosed antisocial personality disorder. With relatively high rates of recurrent homelessness, there were differences between subjects who experienced recurrent homelessness compared to those who were stably housed and with chronic homelessness. That alcohol and other substance use disorders were associated with recurrent homelessness only if they were linked to other risk factors highlights the complexity of causes for homelessness and a resultant need to organize them into constellations of causal risk factors. Consistent with this, there should be initiatives that span bureaucratic boundaries so as to flexibly meet multiple complex service needs, thus improving outcomes concerning episodes of recurrent homelessness.
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Abstract
We exploited an exogenous health shock-namely, the birth of a child with a severe health condition-to investigate the effect of a life shock on homelessness in large cities in the United States as well as the interactive effects of the shock with housing market characteristics. We considered a traditional measure of homelessness, two measures of housing instability thought to be precursors to homelessness, and a combined measure that approximates the broadened conceptualization of homelessness under the 2009 Homeless Emergency Assistance and Rapid Transition to Housing Act (2010). We found that the shock substantially increases the likelihood of family homelessness, particularly in cities with high housing costs. The findings are consistent with the economic theory of homelessness, which posits that homelessness results from a conjunction of adverse circumstances in which housing markets and individual characteristics collide.
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Affiliation(s)
- Marah A Curtis
- School of Social Work, University of Wisconsin-Madison, 1350 University Ave, Madison, WI, 53706, USA,
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Roos LE, Mota N, Afifi TO, Katz LY, Distasio J, Sareen J. Relationship between adverse childhood experiences and homelessness and the impact of axis I and II disorders. Am J Public Health 2013; 103 Suppl 2:S275-81. [PMID: 24148049 DOI: 10.2105/ajph.2013.301323] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
OBJECTIVES We investigated the links between homelessness associated with serious mental and physical healthy disparities and adverse childhood experiences (ACEs) in nationally representative data, with Axis I and II disorders as potential mediators. METHODS We examined data from the National Epidemiologic Survey of Alcohol and Related Conditions in 2001-2002 and 2004-2005, and included 34,653 participants representative of the noninstitutionalized US population who were 20 years old or older. We studied the variables related to 4 classes of Axis I disorders, all 10 Axis II personality disorders, a wide range of ACEs, and a lifetime history of homelessness. RESULTS Analyses revealed high prevalences of each ACE in individuals experiencing lifetime homelessness (17%-60%). A mediation model with Axis I and II disorders determined that childhood adversities were significantly related to homelessness through direct effects (adjusted odd ratios = 2.04, 4.24) and indirect effects, indicating partial mediation. Population attributable fractions were also reported. CONCLUSIONS Although Axis I and II disorders partially mediated the relationship between ACEs and homelessness, a strong direct association remained. This novel finding has implications for interventions and policy. Additional research is needed to understand relevant causal pathways.
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Affiliation(s)
- Leslie E Roos
- Leslie E. Roos is with the Department of Psychology, University of Oregon, Eugene. Natalie Mota is with the Department of Psychology, University of Manitoba, Winnipeg. Tracie O. Afifi is with the Departments of Psychiatry, Community Health Sciences, and Family Social Science, University of Manitoba. Laurence Y. Katz is with the Department of Psychiatry, University of Manitoba. Jino Distasio is with the Department of Geography, Institute of Urban Studies, University of Winnipeg, and the Department of Psychiatry, University of Manitoba. Jitender Sareen is with the Departments of Psychiatry, Psychology, and Community Health Sciences, University of Manitoba
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Henwood BF, Cabassa LJ, Craig CM, Padgett DK. Permanent supportive housing: addressing homelessness and health disparities? Am J Public Health 2013; 103 Suppl 2:S188-92. [PMID: 24148031 DOI: 10.2105/ajph.2013.301490] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Permanent supportive housing (PSH) is an intervention to address long-term homelessness. Evidence has resulted in a shift in US policy toward using PSH rather than shelters and transitional housing. Despite recognizing that individuals transitioning from homelessness to PSH experience a high burden of disease and health disparities, public health research has not considered whether and how PSH improves physical health outcomes. Based on diverse areas of research, we argue that in addition to improved access to quality health care, social determinants of health (including housing itself, neighborhood characteristics, and built environment) affect health outcomes. We identify implications for practice and research, and conclude that federal and local efforts to end long-term homelessness can interact with concurrent efforts to build healthy communities.
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Affiliation(s)
- Benjamin F Henwood
- Benjamin F. Henwood, is with the School of Social Work, University of Southern California, Los Angeles. Leopoldo J. Cabassa is with the School of Social Work, Columbia University, New York, NY. At the time of the study, Catherine M. Craig was with Community Solutions, Washington, DC. Deborah K. Padgett is with the Silver School of Social Work and the Global Institute of Public Health, New York University, New York, NY
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Elwood Martin R, Hanson D, Hemingway C, Ramsden V, Buxton J, Granger‐Brown A, Condello L, Macaulay A, Janssen P, Gregory Hislop T. Homelessness as viewed by incarcerated women: participatory research. Int J Prison Health 2012; 8:108-16. [DOI: 10.1108/17449201211284987] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Reback CJ, Peck JA, Fletcher JB, Nuno M, Dierst-Davies R. Lifetime substance use and HIV sexual risk behaviors predict treatment response to contingency management among homeless, substance-dependent MSM. J Psychoactive Drugs 2012; 44:166-72. [PMID: 22880545 DOI: 10.1080/02791072.2012.684633] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Homeless, substance-dependent men who have sex with men (MSM) continue to suffer health disparities, including high rates of HIV. One-hundred and thirty one homeless, substance-dependent MSM were randomized into a contingency management (CM) intervention to increase substance abstinence and health-promoting behaviors. Participants were recruited from a community-based, health education/risk reduction HIV prevention program and the research activities were also conducted at the community site. Secondary analyses were conducted to identify and characterize treatment responders (defined as participants in a contingency management intervention who scored at or above the median on three primary outcomes). Treatment responders were more likely to be Caucasian/White (p < .05), report fewer years of lifetime methamphetamine, cocaine, and polysubstance use (p < or = .05), and report more recent sexual partners and high-risk sexual behaviors than nonresponders (p < .05). The application of evidence-based interventions continues to be a public health priority, especially in the effort to implement effective interventions for use in community settings. The identification of both treatment responders and nonresponders is important for intervention development tailored to specific populations, both in service programs and research studies, to optimize outcomes among highly impacted populations.
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Affiliation(s)
- Cathy J Reback
- Friends Research Institute, University of California, Los Angeles, USA.
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Levitt AJ, Jost JJ, Mergl KA, Hannigan A, Degenova J, Chung SY. Impact of chronically street homeless tenants in congregate supportive housing. THE AMERICAN JOURNAL OF ORTHOPSYCHIATRY 2012; 82:413-20. [PMID: 22880979 DOI: 10.1111/j.1939-0025.2012.01164.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
New initiatives to house chronically street homeless (CSH) adults have led to increasing proportions of this population living in congregate supportive housing, but little is known about the impact of this shift on supportive housing programs. The present multisite, mixed-methods study examined service utilization and lease compliance among 52 chronically street homeless and 46 long-term shelter stayer (LTSS) adults during their first 12 months in congregate supportive housing. Quantitative analysis of administrative data revealed that CSH tenants used significantly more service resources than LTSS tenants, including more advocacy, escorting, and psychiatric treatment and more assistance with financial, housing, and mental and physical health issues. The 2 groups did not differ significantly on measures of lease compliance. Qualitative focus groups with CSH tenants, service provider staff, and property management staff all indicated that existing supportive housing services are suitable for this population, although some adjustments, additional resources, or both, may be indicated.
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Affiliation(s)
- A J Levitt
- Center for Urban Community Services, 198 E. 121st St., 5th floor, New York, NY 10035, USA.
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A prospective study of childhood and adolescent antecedents of homelessness among a community population of African Americans. J Urban Health 2012; 89:432-46. [PMID: 22234393 PMCID: PMC3368051 DOI: 10.1007/s11524-011-9641-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Much is known about contemporaneous correlates of homelessness from studies of homeless individuals. However, few studies have prospectively examined early antecedents and prevalence of homelessness in community populations. We use data from a 35-year study of a community population of African Americans to examine relationships between homelessness and prior structural, family, school, and behavioral influences. Nearly 22% of males and 16% of females reported homelessness between ages 15 and 42, providing a rare estimate within an African American urban community population. In bivariate analyses, lower school bonds, depressed mood, violent behavior, and running away in adolescence are predictive for both males and females. Teen parenting and angry mood are unique influences for females, while for males, poor first grade classroom conduct and adolescent substance use are unique risks. In multivariate analyses, poor classroom conduct and weaker school bonds predict homelessness among males, while teen parenting does so for females. Running away before age 15 is strongly predictive of later homelessness for both males and females. These results reveal the relative influence of multiple, interrelated early risks on homelessness and confirm our hypothesis that factors linked to other poor outcomes also relate to homelessness, underscoring another benefit to early prevention efforts.
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Edens EL, Kasprow W, Tsai J, Rosenheck RA. Association of Substance Use and VA Service-Connected Disability Benefits with Risk of Homelessness among Veterans. Am J Addict 2011; 20:412-9. [DOI: 10.1111/j.1521-0391.2011.00166.x] [Citation(s) in RCA: 95] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Jones CA, Perera A, Chow M, Ho I, Nguyen J, Davachi S. Cardiovascular disease risk among the poor and homeless - what we know so far. Curr Cardiol Rev 2011; 5:69-77. [PMID: 20066152 PMCID: PMC2803292 DOI: 10.2174/157340309787048086] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2008] [Revised: 08/26/2008] [Accepted: 08/26/2008] [Indexed: 11/22/2022] Open
Abstract
Homelessness [and poverty] is rapidly escalating across North America and is associated with dire implications for public health and our health care systems. Both are compelling states of existence affecting all ages, ethnicities and both genders. Homelessness frequently evolves through a complex interaction of factors that are both internal and external to the individual themselves. Once homeless, equitable access to both preventative and remedial health care is lacking and is associated with a higher than average burden of cardiovascular disease [CVD] risk factors, morbidity and mortality and is accompanied by disproportionately high health care costs. The emergence of limited, small scale programs aimed at addressing the unique health and social needs of the homeless is encouraging. However, there has been inadequate commitment at the National, State or Provincial and local levels to implement policies and dedicate funding and resources to the expansion of such “individual level” interventions into comprehensive programs that deliver sustainable, integrated prevention and services, especially with regard to CVD. The long-term solutions that address the links between homelessness and CVD lie in preventing homelessness and reversing the trends in our health care system that create disparities for lower socioeconomic status [SES] and homeless individuals.
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Abstract
BACKGROUND A total of 1.7 million youth are homeless in America and nearly half are lesbian, gay, bisexual, or transgender. The purpose of this study is to investigate survival strategies, anxiety, and self-esteem among male homeless adolescents. OBJECTIVES This study tested two hypotheses: (a) Survival strategies of homeless adolescents differ by sexual orientation/gender identity. (b) There is a relationship between survival strategies and sexual orientation/gender identity, amount of time homeless, self-esteem, and state/trait anxiety. DESIGN A comparative-descriptive study was conducted in six large cities. Seventy 16- to 20-year-old homeless male adolescents were recruited. RESULTS Survival strategies did not significantly vary by sexual orientation; however, some differences may be of clinical relevance. CONCLUSIONS Homeless youth of all sexual orientations/gender identities were using diverse strategies to survive. Psychiatric nurses are in a unique position to assist these youth.
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Affiliation(s)
- Laura C Hein
- University of South Carolina, Columbia, SC 29208, USA.
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Homelessness and Health Care: Considerations for Evaluation, Management, and Support Within the Primary Care Domain. Dis Mon 2010; 56:719-33. [DOI: 10.1016/j.disamonth.2010.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Hudson CG, Vissing YM. The geography of adult homelessness in the US: Validation of state and county estimates. Health Place 2010; 16:828-37. [PMID: 20471299 DOI: 10.1016/j.healthplace.2010.04.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Revised: 03/27/2010] [Accepted: 04/17/2010] [Indexed: 10/19/2022]
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O'Connell JJ, Oppenheimer SC, Judge CM, Taube RL, Blanchfield BB, Swain SE, Koh HK. The Boston Health Care for the Homeless Program: a public health framework. Am J Public Health 2010; 100:1400-8. [PMID: 20558804 DOI: 10.2105/ajph.2009.173609] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
During the past 25 years, the Boston Health Care for the Homeless Program has evolved into a service model embodying the core functions and essential services of public health. Each year the program provides integrated medical, behavioral, and oral health care, as well as preventive services, to more than 11 000 homeless people. Services are delivered in clinics located in 2 teaching hospitals, 80 shelters and soup kitchens, and an innovative 104-bed medical respite unit. We explain the program's principles of care, describe the public health framework that undergirds the program, and offer lessons for the elimination of health disparities suffered by this vulnerable population.
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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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Gordon AJ, Haas GL, Luther JF, Hilton MT, Goldstein G. Personal, Medical, and Healthcare Utilization Among Homeless Veterans Served by Metropolitan and Nonmetropolitan Veteran Facilities. Psychol Serv 2010; 7:65-74. [PMID: 21152352 DOI: 10.1037/a0018479] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This study assessed differences in personal, medical, and health care utilization characteristics of homeless veterans living in metropolitan versus nonmetropolitan environments. Data were obtained from a Veterans Health Administration (VHA) network sample of homeless veterans. Chi-square tests were used to assess differences in demographics, military history, living situation, medical history, employment status, and health care utilization. Moderator analyses determined whether predictors of health care utilization varied by metropolitan status. Of 3,595 respondents, 60% were residing in metropolitan areas. Age, sex, and marital status were similar between metropolitan and nonmetropolitan homeless. Metropolitan homeless were less likely to receive public financial support or to be employed, to have at least one medical problem, one psychiatric problem, or current alcohol dependency, but more likely to be homeless longer. Of the 52% of the sample who used VHA care in the last 6 months, 53% were metropolitan versus 49% nonmetropolitan (p = .01). Metropolitan status predicted at least one VHA visit within the prior 6 months (OR:1.3, CI:1.1, 1.6). Significant differences occur in the personal, medical, and health care utilization characteristics of homeless veterans in metropolitan versus nonmetropolitan areas.
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Affiliation(s)
- Adam J Gordon
- Mental Illness Research, Education, and Clinical Center and Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, and University of Pittsburgh School of Medicine
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Bharel M, Casey C, Wittenberg E. Disparities in cancer screening: acceptance of Pap smears among homeless women. J Womens Health (Larchmt) 2010; 18:2011-6. [PMID: 20044864 DOI: 10.1089/jwh.2008.1111] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
AIMS Cervical cancer is a preventable disease through screening and early treatment. Rates of cervical cancer are higher in impoverished women, including homeless women. This study assessed the acceptance of free and accessible Pap smears offered to homeless women in a respite care setting. METHODS A convenience sample of 205 adult women receiving respite care at a facility for homeless people in Boston, Massachusetts, between 2004 and 2007 were offered screening for cervical cancer during routine encounters with the medical staff during their stay. Rates of acceptance of screening as well as medical and sociodemographic information were collected on the women. RESULTS Of 205 women enrolled in the study, 129 (63%) were in need of screening and offered a Pap smear; 80 (62%) accepted and 49 (38%) declined. Of those who agreed to be tested, 56 (70%) had a Pap smear performed, resulting in 10 (18%) atypical results (atypical squamous cells of undetermined significance [ASCUS] or low-grade squamous intraepithelial lesion [LGSIL]) and 15 (27%) benign findings needing follow-up (e.g., vaginitis without evidence of malignancy). CONCLUSIONS A large proportion of homeless women receiving respite care decline a free Pap smear despite being in medical need of cervical cancer screening. Access and cost may not be the only barriers to screening among homeless women, and new and innovative approaches to screening in vulnerable populations need to be investigated in order to close the disparity gap.
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Affiliation(s)
- Monica Bharel
- Boston Health Care for the Homeless, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts 02118, USA.
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Messam T, McKay MM, Kalogerogiannis K, Alicea S. Adapting A Family-Based HIV Prevention Program for Homeless Youth and Their Families: The HOPE (HIV prevention Outreach for Parents and Early adolescents) Family Program. JOURNAL OF HUMAN BEHAVIOR IN THE SOCIAL ENVIRONMENT 2010; 20:303-318. [PMID: 20379348 PMCID: PMC2849102 DOI: 10.1080/10911350903269898] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
As rates of HIV infection increase in adolescents, it is important to provide prevention programs targeting this population. Homeless adolescents living with their families in shelters are at greater risk of participating in risky sexual behavior and incurring negative health outcomes. A family based HIV-prevention pilot study was conducted with eight homeless families in a New York City shelter to explore: 1) the perceived impact of family communication, parental monitoring, family understanding of puberty, STD's and HIV on preventing risky behavior for the participating youth, and 2) the feasibility of conducting such a program within the shelter system. Qualitative and quantitative results indicate increased family communication, parental monitoring and decreased parental depressive symptoms.
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