Permanent Supportive Housing With Housing First: Findings From a Community Guide Systematic Economic Review

INTRODUCTION

The annual economic burden of chronic homelessness in the U.S. is estimated to be as high as $3.4 billion. The Permanent Supportive Housing with Housing First (Housing First) program, implemented to address the problem, has been shown to be effective. This paper examines the economic cost and benefit of Housing First Programs.

METHODS

The search of peer-reviewed and gray literature from inception of databases through November 2019 yielded 20 evaluation studies of Housing First Programs, 17 from the U.S. and 3 from Canada. All analyses were conducted from March 2019 through July 2020. Monetary values are reported in 2019 U.S. dollars.

RESULTS

Evidence from studies conducted in the U.S. was separated from those conducted in Canada. The median intervention cost per person per year for U.S. studies was $16,479, and for all studies, including those from Canada, it was $16,336. The median total benefit for the U.S. studies was $18,247 per person per year, and it was $17,751 for all studies, including those from Canada. The benefit-to-cost ratio for U.S. studies was 1.80:1, and for all studies, including those from Canada, it was 1.06:1.

DISCUSSION

The evidence from this review shows that economic benefits exceed the cost of Housing First Programs in the U.S. There were too few studies to determine cost-benefit in the Canadian context.

Universal Motorcycle Helmet Laws to Reduce Injuries: A Community Guide Systematic Review

CONTEXT

Motorcycle crashes account for a disproportionate number of motor vehicle deaths and injuries in the U.S. Motorcycle helmet use can lead to an estimated 42% reduction in risk for fatal injuries and a 69% reduction in risk for head injuries. However, helmet use in the U.S. has been declining and was at 60% in 2013. The current review examines the effectiveness of motorcycle helmet laws in increasing helmet use and reducing motorcycle-related deaths and injuries.

EVIDENCE ACQUISITION

Databases relevant to health or transportation were searched from database inception to August 2012. Reference lists of reviews, reports, and gray literature were also searched. Analysis of the data was completed in 2014.

EVIDENCE SYNTHESIS

A total of 60 U.S. studies qualified for inclusion in the review. Implementing universal helmet laws increased helmet use (median, 47 percentage points); reduced total deaths (median, -32%) and deaths per registered motorcycle (median, -29%); and reduced total injuries (median, -32%) and injuries per registered motorcycle (median, -24%). Repealing universal helmet laws decreased helmet use (median, -39 percentage points); increased total deaths (median, 42%) and deaths per registered motorcycle (median, 24%); and increased total injuries (median, 41%) and injuries per registered motorcycle (median, 8%).

CONCLUSIONS

Universal helmet laws are effective in increasing motorcycle helmet use and reducing deaths and injuries. These laws are effective for motorcyclists of all ages, including younger operators and passengers who would have already been covered by partial helmet laws. Repealing universal helmet laws decreased helmet use and increased deaths and injuries.

A Community-Based Approach to Eliminating Racial and Health Disparities among Incarcerated Populations: The HIV Example for Inmates Returning to the Community

To underscore the public health risk involved, as well as the extent to which HIV infection rates disproportionately affect racial/ethnic populations in prison settings, the authors briefly review a current approach that is being implemented in four selected sites located in the southeastern region of the United States. Moreover, the authors present these observations in terms of HIV infection and how health professionals may be able to curb the spread of this and other infectious pathogens among primarily incarcerated African American and Latino male inmates. Based on a peer education model, the authors outline several practice implications for dealing with this population, which include (a) making provisions for case management, (b) building capacity and increasing the participatory role of community agencies, (c) focusing on the significance of ethnicity and cultural competency in prison culture, (d) implementing youth-specific models, and (e) applying a holistic approach.

Legislations and policies to expand mental health and substance abuse benefits in health insurance plans: a community guide systematic economic review

BACKGROUND

Health insurance plans have historically limited the benefits for mental health and substance abuse (MH/SA) services compared to benefits for physical health services. In recent years, legislative and policy initiatives in the U.S. have been taken to expand MH/SA health insurance benefits and achieve parity with physical health benefits. The relevance of these legislations for international audiences is also explored, particularly for the European context.

AIMS OF THE STUDY

This paper reviews the evidence of costs and economic benefits of legislative or policy interventions to expand MH/SA health insurance benefits in the U.S. The objectives are to assess the economic value of the interventions by comparing societal cost to societal benefits, and to determine impact on costs to insurance plans resulting from expansion of these benefits.

METHODS

The search for economic evidence covered literature published from January 1950 to March 2011 and included evaluations of federal and state laws or rules that expanded MH/SA benefits as well as voluntary actions by large employers. Two economists screened and abstracted the economic evidence of MH/SA benefits legislation based on standard economic and actuarial concepts and methods.

RESULTS

The economic review included 12 studies: eleven provided evidence on cost impact to health plans, and one estimated the effect on suicides. There was insufficient evidence to determine if the intervention was cost-effective or cost-saving. However, the evidence indicates that MH/SA benefits expansion did not lead to any substantial increase in costs to insurance plans, measured as a percentage of insurance premiums.

DISCUSSION AND LIMITATIONS

This review is unable to determine the overall economic value of policies that expanded MH/SA insurance benefits due to lack of cost-effectiveness and cost-benefit studies, predominantly due to the lack of evaluations of morbidity and mortality outcomes. This may be remedied in time when long-term MH/SA patient-level data becomes available to researchers. A limitation of this review is that legislations considered here have been superseded by recent legislations that have stronger and broader impacts on MH/SA benefits within private and public insurance: Mental Health Parity and Addiction Equity Act of 2008 (MHPAEA) and the Patient Protection and Affordable Care Act of 2010 (ACA).

IMPLICATIONS FOR FUTURE RESEARCH

Economic assessments over the long term such as cost per QALY saved and cost-benefit will be feasible as more data becomes available from plans that implemented recent expansions of MH/SA benefits. Results from these evaluations will allow a better estimate of the economic impact of the interventions from a societal perspective. Future research should also evaluate the more downstream effects on business decisions about labor, such as effects on hiring, retention, and the offer of health benefits as part of an employee compensation package. Finally, the economic effect of the far reaching ACA of 2010 on mental health and substance abuse prevalence and care is also a subject for future research.

Quality of life of African American cancer survivors. A review of the literature

African Americans are more likely to present with advanced stages of cancer at the time of diagnosis, and their survival rates continue to lag behind those of Caucasian survivors. Although the need to address the quality of life (QOL) of cancer survivors is well documented, little is known about the QOL of African American cancer survivors. A comprehensive literature search from 1990 to 2005 was conducted in 5 phases as outlined by Cooper. Inclusion criteria included the measurement of QOL as an outcome and the report and/or comparison of QOL for African Americans in the sample. The studies that met the criteria for inclusion focused on breast and prostate cancer. All were descriptive (quantitative or qualitative). Overall, the QOL of African American cancer survivors described in this research is poorer than for Caucasians, although in 1 study African American breast cancer survivors reported better emotional adjustment, sexual functioning, and lower symptom distress. Nonetheless, because of the limited and conflicting research as well as inconsistent measurements and methodologies, it is not possible to adequately describe the QOL of African American cancer survivors. Research is needed that uses consistent, culturally appropriate measures, theoretical frameworks, and definitions across studies. Cancer 2007. (c) 2006 American Cancer Society.

Enhancing knowledge of colorectal cancer among African Americans: why are we waiting until age 50?

Because of low rates of colorectal cancer screening among African Americans, it may be beneficial to begin educating persons about this disease before age 50. Using the Patient/Provider/System Theoretical Model for cancer screening, this study compared knowledge of colorectal cancer, sources of information, and awareness of programs among participants of age 20-29, 30-49, and 50-75 years. The majority (n = 354) were women and African American (mean age = 37 years, mean education = 12th grade). Younger participants tended to know less about the disease, but there were few differences in knowledge between the two older groups. Persons in the 40-49-year age group were more likely to be familiar with the role diet plays in the risk of colorectal cancer. Participants associated the need for screening with the presence of symptoms. Television and radio were listed as the most frequent source of information about cancer. The Internet was the least used. The majority were not familiar with selected national programs and services focused on increasing awareness of cancer. Findings suggest that colorectal cancer-related information should be targeted toward this population before age 50, using multiple sources such as TV/radio, providers, magazines, and cancer-related organizations. An estimated 104,950 colon and 40,340 rectal cancer cases will be diagnosed in 2005 with an estimated 56,290 deaths from the disease (American Cancer Society [ACS], 2005). Despite a stabilization of colorectal cancer (CRC) incidence rates since the 1980s, African American males and females have higher incidence and mortality rates associated with this disease compared to Whites. The 5-year survival rate for CRC among African Americans improved to 54% during the years 1995-2000, but lagged well behind the 64% survival rate for Whites during the same time period. Screening and early detection of CRC followed by effective treatment is crucial to reducing these mortality rates.

Comparing perceptions of cancer fatalism among African American patients and their providers

PURPOSE

To describe perceptions of cancer fatalism and identify demographic correlates; to explore whether providers believe their patients are fatalistic about cancer and compare these views to the patients' views.

DATA SOURCES

Both patients (n= 52) and providers (n= 35) were recruited at federally funded, community primary care centers. Data were collected using the Powe Fatalism Inventory, the Perceived Patient Fatalism Inventory, and a demographic data questionnaire. Data were analyzed using descriptive statistics, Pearson correlations, and t-test.

CONCLUSIONS

The majority of patients were African American women. The majority of providers were physicians and nurses. Patients indicated low perceptions of cancer fatalism, but providers believed patients were highly fatalistic. As the patients' educational level increased, perceptions of cancer fatalism decreased.

IMPLICATIONS FOR PRACTICE

The providers' belief that patients are fatalistic about cancer may influence patient-provider communication. They may be less likely to recommend screening, and patients may be less likely to initiate a discussion about cancer. Strategies are needed that target providers and their patients to address actual and/or perceived perceptions and their influence on cancer screening.

Perceptions about breast cancer among college students: implications for nursing education

Nurses are in a key position to enhance knowledge, correct misperceptions, and allay fears related to breast cancer. However, little attention is given to these psychosocial issues in nursing texts, and the extent to which they are covered within nursing curricula is unclear. This study, guided by the Powe Fatalism Model, compared perceptions about breast cancer and sources of cancer information among a random sample (n = 158) of nursing and non-nursing female students (mean age = 24). Data were collected using a Breast Cancer Perceptions and Knowledge Survey and a demographic questionnaire. A significant number of myths and misperceptions related to breast cancer were prevalent within both groups. Few nursing students reported obtaining information on common perceptions about cancer from their coursework. More research is needed to understand how the nursing students' perceptions about breast cancer influence their ability to provide patient care across the cancer continuum.

Perceptions about breast cancer among African American women: do selected educational materials challenge them?

Despite the availability of factual information about breast cancer, there continues to be an abundance of misperceptions about the disease. This study, guided by the Patient/Provider/System Model for cancer screening, describes perceptions about breast cancer among African American women (N = 179) at primary care centers. Data were collected using the Breast Cancer Perceptions and Knowledge Survey and a demographic questionnaire. Breast cancer pamphlets available at the centers were evaluated (readability, extent they challenged misperceptions). The average age of the women was 34 years with an average educational level of 12 years. A number of misperceptions were prevalent. The majority viewed breast self-examination as a form of early detection and some viewed pain as an indicator of cancer. Pamphlets did not explicitly challenge the misperceptions and the SMOG reading level was high. Intervention studies are needed to identify the effective methods to challenge and correct misperceptions about breast cancer for these women.

Meeting the public's cancer information needs: characteristics of callers to the National Cancer Information Center of the American Cancer Society

BACKGROUND

In this study, we describe the characteristics of the callers of the American Cancer Society's National Cancer Information Center (NCIC), why they called, how they learned about NCIC, and their satisfaction.

METHODS

A random sample of callers (N = 19,487) completed a telephone survey.

RESULTS

The majority were female, White, 45 to 74 years old, had incomes greater than 35,001 dollars, and were college educated. They learned about the NCIC through TV advertisements and requested information about specific cancers, local programs, or making donations.

CONCLUSIONS

These findings validate the usefulness of the NCIC and are helpful in identifying and targeting persons who do not routinely use this service.

Knowledge of oral cancer risk factors among african americans: do nurses have a role?

PURPOSE/OBJECTIVES

To assess the knowledge of oral cancer risk factors among African Americans.

DESIGN

Descriptive; guided by the Patient/Provider/System Theoretical Model for cancer screening.

SETTING

Community-based primary care center in a southern state.

SAMPLE

141 African Americans. The majority was female, had a 12th grade education, and had an income less than 10,000 dollars; 25% were smokers.

METHODS

Participants were asked to identify whether each of 15 factors (i.e., seven risk factors and eight nonrisk factors) increased risk for oral cancer. One point was added for each correct response; therefore, scores could range from 0-15 points. Demographic data were collected.

MAIN RESEARCH VARIABLES

Knowledge of and misconceptions about oral cancer.

FINDINGS

Only six participants correctly identified all of the risk factors. The majority recognized tobacco but was not as aware of the effects of the sun, alcohol, and diet. Many erroneously identified factors such as hot beverages, poor oral hygiene, spicy foods, dentures, and mouthwash as risk factors. Those with higher incomes and those who visited their dentists in the prior year had more knowledge of risk factors. No differences were found in knowledge based on age, gender, education, or smoking status.

CONCLUSIONS

Some patients are less likely to routinely visit a dentist and are less knowledgeable about the risk factors for oral cancer. Many of these risk factors are modifiable; therefore, patients need to be aware of the risks and have access to effective strategies to reduce risk.

IMPLICATIONS FOR NURSING

Assess risk factors, teach risk reduction, and correct misinformation. Refer patients to dental professionals. Develop community outreach to African American men at barbershops and fraternal organizations.

Cancer fatalism: the state of the science

Cancer fatalism--the belief that death is inevitable when cancer is present--has been identified as a barrier to participation in cancer screening, detection, and treatment. Yet this literature has not been reviewed in a comprehensive and systematic manner. Therefore, this literature review addressed (1) philosophical and theoretical underpinnings of cancer fatalism; (2) relationships among demographic factors, cancer fatalism, and cancer screening; (3) the role of cancer fatalism for patients diagnosed with cancer; and (4) intervention strategies. Most of the reviewed studies were descriptive or correlational, did not have an explicit theoretical framework, had varied definitions of fatalism, and reported screening as "intent to screen" or as "past screening behaviors." Review of the studies suggests that cancer fatalism develops over time and is most frequently reported among medically underserved persons and those with limited knowledge of cancer. Cancer fatalism may be modified through culturally relevant interventions that incorporate spirituality. Emphasis must be placed on recognizing the role of cancer fatalism when planning health promotion activities. Future studies should focus on the consistent measurement of cancer fatalism and testing intervention strategies.