Exploring housing insecurity in relation to student success

OBJECTIVES

The relative high rates of homelessness and housing insecurity among college students has become a public health concern within the U.S. This study explores the relationship between housing instability in relation to academic and mental health outcomes.

PARTICIPANTS

College students attending a larger public university (N = 1,416 students; M age = 22.54; 47.2% Pell Eligible; 54.6% racially/ethnically minoritized students) were surveyed employing cluster-sampling in the Fall Semester of 2019.

METHODS

Participants completed validated measures of housing instability, mental health outcomes, and demographics. Additional measures were matched with survey responses through the Office of Institutional Research (i.e., GPA, Pell Grant eligibility).

RESULTS

Students who experienced housing insecurity and homelessness were more likely to have a lower GPA as well as poorer mental health outcomes.

CONCLUSION

Findings highlight implications surrounding the need for housing programs and additional financial support in an effort to bolster students' academic performance and mental well-being.

Trapped in housing insecurity: Socioecological barriers to housing access experienced by intimate partner violence survivors from marginalized communities

Homelessness and intimate partner violence (IPV) do not impact all communities equally. Survivors from marginalized communities-that is communities that have been historically and structurally excluded from social, economic, and political resources-face additional challenges weathering IPV and housing crises. Understanding the housing experiences of marginalized survivors is necessary to achieve housing equity for all survivors. Community-based participatory research methods were utilized to convene 14 listening sessions (7 primary/7 validation) with Black and Latinx IPV survivors with intersectional identities (n = 92). Listening sessions were held in community-based locations including a church, health clinic, social service agency, and private residence. The last five validation sessions were conducted virtually on Zoom due to COVID pandemic protocols. All listening sessions were digitally recorded and transcribed verbatim. Latinx population listening sessions were conducted in Spanish and were implemented and translated with attention to linguistic justice principles. The research team used a modified constructivist grounded theory approach for data analysis. Four overarching themes (and seven subthemes) related to survivors' housing experiences emerged: (1) safety and healing challenges, including living in unhealthy physical environments, not being safe in their homes, and contending with community violence, sexual exploitation threats, and eviction fears; (2) formal service fragmentation/bureaucracy that hampered access to housing resource information and resources; (3) resource scarcity associated with limited affordable housing stock; and (4) systemic oppression resulting from discriminatory treatment and gentrification. Comprehensive multileveled approaches are needed to disrupt the cycle of housing insecurity for IPV survivors from marginalized communities.

Community narratives on rural homelessness: Tales of terror and tales of compassion

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.

College focused rapid rehousing: Deploying an existing community model to address homelessness on campus

Research indicates that financial and housing insecurity challenges are widespread on most college campuses throughout the U.S. However, there is wide variability in how campuses address these challenges. This study reports on a three-year implementation of the College-Focused Rapid Rehousing pilot; an initiative in California by which universities commissioned community providers to assist students in need via a modified Rapid Rehousing (RRH) intervention. RRH is a widely implemented intervention that combines move-in assistance, short-term rental subsidies, and ongoing case management, to help individuals quickly transition into stable housing. The mixed-methods evaluation included analyses of online surveys (n = 141), administrative records (n = 368), and focus groups conducted with staff across eight campuses (n = 35). Survey findings indicate that CFRR programs assisted a diverse group of students with similar histories of housing insecurity. Quantitative analyses also show that most participants experienced the intervention as designed, though with some inconsistencies in how quickly some were assisted. Qualitative findings highlight contextual factors that affected the consistency of the intervention, including tight rental markets and philosophical disagreements among administrators about the intervention's scope. Despite study limitations, findings provide insights into the applicability of the RRH model on campus settings and directions for future research.

Homelessness Among Acute Care Patients Within a Large Health Care System in Northern California

The impacts of homelessness on health and health care access are detrimental. Intervention and efforts to improve outcomes and increase availability of affordable housing have mainly originated from the public health sector and government. The role that large community-based health systems may play has yet to be established. This study characterizes patients self-identified as homeless in acute care facilities in a large integrated health care system in Northern California to inform the development of collaborative interventions addressing unmet needs of this vulnerable population. The authors compared sociodemographic characteristics, clinical conditions, and health care utilization of individuals who did and did not self-identify as homeless and characterized their geographical distribution in relation to Sutter hospitals and homeless resources. Between July 1, 2019 and June 30, 2020, 5% (N = 20,259) of the acute care settings patients had evidence of homelessness, among which 51.1% age <45 years, 66.4% males, and 24% non-Hispanic Black. Patients experiencing homelessness had higher emergency department utilization and lower utilization of outpatient and urgent care services. Mental health conditions were more common among patients experiencing homelessness. More than half of the hospitals had >5% of patients who identified as homeless. Some hospitals with higher proportions of patients experiencing homelessness are not located near many shelter resources. By understanding patients who self-identify as homeless, it is possible to assess the role of the health system in addressing their unmet needs. Accurate identification is the first step for the health systems to develop and deliver better solutions through collaborations with nonprofit organizations, community partners, and government agencies.

In-hospital outcomes in unhoused patients with cardiogenic shock in the United States: Insights from The National Inpatient Sample 2011-2019

BACKGROUND

Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in-hospital outcomes and resource utilization in the setting of cardiogenic shock (CS).

HYPOTHESIS

Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients.

METHODS

The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD-9 and ICD-10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05).

RESULTS

We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints.

CONCLUSIONS

These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under-diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long-term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.

An Exploratory Analysis of Domestic and Intimate Partner Violence Victimization Among Persons Experiencing Eviction

A paucity of research has examined the prevalence of domestic and intimate partner violence (DV/IPV) victimization among persons experiencing eviction. The current study uses administrative records for a random sample of evicted adults in Omaha, Nebraska from 2017 to 2019 (n = 306) to assess the prevalence of DV/IPV victimization among evicted persons and differences among the DV/IPV and no DV/IPV groups. Findings indicated over 20% of evicted persons experienced DV/IPV victimization, and DV/IPV often preceded the first eviction. DV/IPV disproportionately impacted Black women. Implications regarding the compounding consequences of eviction and DV/IPV victimization and recommendations for future research are discussed.

Association of Antenatal Housing Instability with Perinatal Care Utilization and Outcomes

Background: Social determinants of health are important contributors to maternal and child health outcomes. Limited existing research examines the relationship between housing instability during pregnancy and perinatal care utilization. Our objective was to evaluate whether antenatal housing instability is associated with differences in perinatal care utilization and outcomes. Materials and Methods: Participants who were surveyed during their postpartum hospitalization were considered to have experienced housing instability if they answered affirmatively to at least one of six screening items. The primary outcome was adequacy of prenatal care measured by the Adequacy of Prenatal Care Utilization index. Maternal, neonatal, and postpartum outcomes, including utilization and breastfeeding, were also collected as secondary outcomes. Multivariable logistic regression models were adjusted for sociodemographic and clinical covariates. Results: In this cohort (N = 490), 11.2% (N = 55) experienced housing instability during pregnancy. Participants with unstable housing were more likely to have inadequate prenatal care (17.3% vs. 3.9%; odds ratio [OR] 5.11, 95% confidence interval [CI] 2.15-12.14, p < 0.001), but findings were not significant after adjustment (aOR 1.72, 95% CI 0.55-5.41, p = 0.35). Similarly, postpartum visit attendance was lower for individuals with unstable housing (79.6% vs. 91.2%), but there was no difference in the odds of the postpartum visit attendance after adjustment (OR 0.69, 95% CI 0.29-1.66, p = 0.14). Conclusions: There were no statistically significant association with the maternal, neonatal, and other postpartum secondary outcomes. Housing instability appears to be a risk marker that is related to other social determinants of health. Given the range of housing instability experiences, future research must account for specific types and degrees of housing instability and their potential perinatal consequences.

Housing Insecurity and Other Syndemic Factors Experienced by Black and Latina Cisgender Women in Austin, Texas: A Qualitative Study

Austin, Texas emerged as one of the fastest-growing cities in the U.S. over the past decade. Urban transformation has exacerbated inequities and reduced ethnic/racial diversity among communities. This qualitative study focused on housing insecurity and other syndemic factors among Black and Latina cisgender women (BLCW). Data collection from 18 BLCW using in-depth interviews guided by syndemic theory was conducted three times over three months between 2018 and 2019. Four housing insecurity categories emerged: (a) very unstable, (b) unstable, (c) stable substandard, and (d) stable costly. Participants who experienced more stable housing, particularly more stable housing across interviews, reported fewer instances of intimate partner violence (IPV), less substance use, and a reduced risk of acquiring HIV. Results identified the importance of exploring housing insecurity with other syndemic factors among BLCW along with determining structural- and multi-level interventions to improve housing circumstances and other syndemic factors. Future research should explore these factors in other geographic locations, among other intersectional communities, and among larger sample sizes and consider using a mixed methods approach.

Social Model Hospice Residential Care Homes: Whom Do They Really Serve?

BACKGROUND

Most prefer to die at home, but the Medicare Hospice Benefit does not cover custodial care, making it difficult for terminally ill patients with housing insecurity and/or caregiver instability to access hospice care at home.

OBJECTIVES

To examine the characteristics of patients who received end-of-life care in community-run, residential care homes (RCHs) operating under the social model hospice.

METHODS

A retrospective chart review of 500 residents who were admitted to one of three RCHs in Upstate New York over a 15-year period (2004-2019).

RESULTS

Patients served by the RCHs included 318 (63.6%) women and 182 (36.4%) men aged 34-101 (M = 77.8). The majority (94.9%) were Caucasian and most had cancer diagnoses (71.6%). Prior to admission, most (93%) patients resided in a private residence, and nearly half (47%) lived alone, but most (81.7%) had full- or part-time caregivers. Nearly all patients were admitted either directly from a hospital (47.5%) or private home (47.2%). Over half (52%) were admitted to RCHs within a month of hospice enrollment, and 20.1% enrolled concurrent with admission. While the average length of stay was 21 days, 50% died within 10 days of admission.

CONCLUSIONS

Community-run RCHs represent a unique approach for improving access to hospice home care for patients with home insecurity and/or caregiver instability, yet most patients had prior caregiver coverage and were admitted from a hospital or home setting, suggesting there is a need for community care settings for patients unable to remain at home in the final weeks or days prior to death.

Struggling with the basics: food and housing insecurity among college students across twenty-two colleges and universities

OBJECTIVES

To quantify the number and type of students failing to secure basic needs.

PARTICIPANTS

Students attending 22 postsecondary schools in the United States in Fall 2019.

METHODS

The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities.

RESULTS

Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen.

CONCLUSIONS

High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels.

Housing insecurity and employment stability: An investigation of working mothers

Little evidence informs the relationship between housing insecurity and employment for working mothers. The present study aimed to identify variation in work schedules and supports, as well as the link from housing insecurity to employment experiences in a sample of at-risk mothers. Latent class analysis identified subtypes of employment stability; multinomial logistic regression estimated links from housing insecurity to class membership. Three subtypes of employment stability emerged, "Full-Time and Stable," "Full-Time and Unstable," and "Part-Time Weekend." Housing insecurity increased risk for being in the "Unstable" class relative to the other classes such that these mothers experienced stressful work schedules that offered little support or flexibility for family and child needs. Identifying and intervening on housing insecurity can promote stable employment. Increased workplace supports such as paid leave, flexible schedules, and antidiscrimination training can better enable mothers to juggle the competing demands of motherhood and work.

Racial/Ethnic Disparities in Financial Hardship During the First Year of the Pandemic

Introduction

The economic impact of the COVID-19 pandemic has been substantial, yet little is known about the financial effects resulting from lost employment or financial hardship racial-ethnic disparities.

Methods

We conducted a nationally representative, online survey of 5500 English- and Spanish-speaking American Indian/Alaska Native, Asian, Black/African American, Native Hawaiian/Pacific Islander, Latino, White, and multiracial adults, from December 2020 to February 2021. Six financial hardship domains were measured (lost income, debt, unmet expenses, unmet health care expenses, housing insecurity, and food insecurity). Prevalence of financial hardship among each racial-ethnic group was estimated using multivariable Poisson regression.

Results

Overall, 70.3% reported experiencing financial hardship; debt (57.6%), lost income (44.5%), and unmet expenses (33.7%) were most common. American Indian/Alaska Native (adjusted prevalence ratio [aPR]=1.19, 95% confidence interval [CI]=1.04 to 1.35), Black/African American (aPR=1.18, 95% CI=1.06 to 1.32), Latino (English-speaking: aPR=1.15, 95% CI=1.01 to 1.31; Spanish-speaking: aPR=1.27, 95% CI=1.12 to 1.45), and Native Hawaiian/Pacific Islander (aPR=1.21, 95% CI=1.06 to 1.38) adults were more likely to experience financial hardship, compared with White adults. American Indian/Alaska Native, Black/African American, Spanish-speaking Latino, and Native Hawaiian/Pacific Islander adults were also more likely to report hardship in almost all hardship domains (e.g., housing insecurity: aPRs=1.37-1.91).

Conclusions

Racial/ethnic minorities were more likely to experience financial hardship during the pandemic. The prevalence of lost income was similar across most racial/ethnic groups, suggesting that preexisting wealth disparities led to some groups being less able to handle the economic shocks caused by the COVID-19 pandemic. Financial hardship may be underestimated for communities without English or Spanish fluency. Without intervention, financial hardship will likely exacerbate wealth disparities in the United States.

The CARES Program: Improving Viral Suppression and Retention in Care Through a Comprehensive Team-Based Approach to Care for People with HIV and Complex Psychosocial Needs

Retention in HIV care and viral suppression rates remain suboptimal, especially among people with HIV (PWH) facing complex barriers to care such as mental health conditions, substance use disorders, and housing insecurity. The Center for Adherence, Retention, and Engagement Support (CARES) program utilizes an interdisciplinary team that delivers integrated services in a drop-in setting to provide individualized care to PWH with complex psychosocial needs. We describe the CARES program and evaluate its effectiveness in retaining patients in care to achieve virological suppression. We characterized 119 referrals of PWH experiencing homelessness, mental health conditions, and substance use disorders to CARES between 2011 and 2017, and collected data for a 24-month observation period through 2019. Outcomes of patients who participated in CARES were compared with those who were referred but did not participate. The primary outcome was viral suppression (<200 copies/mL) at least once during 2-year follow-up. Retention in care (≥2 completed medical visits ≥90 days apart in each year post-referral) was a secondary outcome. Of 119 PWH referred to CARES, 59 participated with ≥2 visits. Those who participated in CARES were more likely to achieve viral suppression [adjusted odds ratio (aOR) 3.50, 95% confidence interval (CI) 1.19-10.32] and to be retained in care (aOR 3.73, 95% CI 1.52-9.14) compared with those who were referred but did not participate. This analysis found that the CARES program improved retention in care and viral suppression among PWH with complex psychosocial needs and suggests that it may represent a useful model for future programming.

A Novel Framework to Address the Complexities of Housing Insecurity and Its Associated Health Outcomes and Inequities: "Give, Partner, Invest"

The association between housing insecurity and reduced access to healthcare, diminished mental and physical health, and increased mortality is well-known. This association, along with structural racism, social inequities, and lack of economic opportunities, continues to widen the gap in health outcomes and other disparities between those in higher and lower socio-economic strata in the United States and throughout the advanced economies of the world. System-wide infrastructure failures at municipal, state, and federal government levels have inadequately addressed the difficulty with housing affordability and stability and its associated impact on health outcomes and inequities. Healthcare systems are uniquely poised to help fill this gap and engage with proposed solutions. Strategies that incorporate multiple investment pathways and emphasize community-based partnerships and innovation have the potential for broad public health impacts. In this manuscript, we describe a novel framework, "Give, Partner, Invest," which was created and utilized by the University of Pittsburgh Medical Center (UPMC) Insurance Services Division (ISD) as part of the Integrated Delivery and Finance System to demonstrate the financial, policy, partnership, and workforce levers that could make substantive investments in affordable housing and community-based interventions to improve the health and well-being of our communities. Further, we address housing policy limitations and infrastructure challenges and offer potential solutions.

Patterns and predictors of material hardship among poor families with children

Experiences of material hardship vary across poor families, but little is understood about this variability. The present study aimed to distinguish subtypes of material hardship as well as which characteristics predict subtypes. Latent class analysis with data from a large, longitudinal study of families with youth children investigated subtypes of material hardship as well as predictors of subtypes. Multinomial logistic regression then predicted class membership used on known housing risk factors maternal IPV victimization, depression, and substance use. Analyses identified three distinct subtypes of material hardship: "Housing Insecure," "Food Insecure," and "Cost-Burdened but Managing." Maternal IPV victimization and depression reduced likelihood of membership in the "Managing" class, but no predictors distinguished families who become food versus housing insecure. Findings suggest widespread financial stress and complex tradeoffs for low-income families, who struggle to afford basic needs. Maternal safety and mental health prove crucial to families' coping abilities. Increased systemic supports targeting specific circumstances may promote stability and prevent more severe hardship.

The effect of a non-congregate, integrated care shelter on health: A qualitative study

OBJECTIVE

To describe the experiences of unstably housed, medically vulnerable residents living at the Haven, a novel, non-congregate integrated care shelter operating in a historic hotel during the COVID-19 pandemic.

DESIGN

A qualitative descriptive design.

SAMPLE/MEASUREMENT

Semi-structured qualitative interviews were conducted in February and March 2022 with a purposive sample of 20 residents living in the integrated care shelter. Data were analyzed in May and June 2022 using the thematic analysis methods described by Braun and Clarke.

RESULTS

Six women and 14 men, ages 23-71 (M = 50, SD = 14), were interviewed. Lengths of stay at the time of the interview ranged from 74 to 536 days (M = 311 days). Medical co-morbidities and substance use details were collected at baseline. Three themes were identified: (1) Autonomy, (2) supportive environments, and (3) stability and the need for permanent housing. Participants characterized the integrated care, non-congregate model as having multiple advantages over traditional shelter systems. Participants emphasized the role of nurses and case managers in providing a respectful, caring environment in the integrated shelter model.

CONCLUSION

Participants described acute physical and mental health needs which were largely met by the innovative integrated shelter care model. The effect of homelessness and housing insecurity on health is well documented, but few solutions exist that promote autonomy. Participants in this qualitative study emphasized the benefits of living in a non-congregate integrated care shelter and the services which promoted their self-management of chronic diseases.

PATIENT OR PUBLIC CONTRIBUTION

Patients were the participants in the study, but were not involved in the design, analysis of interpretation of the data, or preparation of the manuscript. Due to this project's small scope, we could not involve patients or the public after the study concluded data collection.

Neuropsychological functioning of homeless people in Paris: An exploratory study

Homelessness is a multifactorial issue, influenced by structural and individual factors. These factors include health status, which has been reported to be poorer among people experiencing homelessness. Although the somatic and mental health of homeless individuals has already been studied in France, to our knowledge, no research has been conducted on neuropsychological functioning in this country. Studies out with France have identified cognitive impairments as highly prevalent among homeless people, and these impairments are likely affected by local structural factors, such as healthcare access. Therefore, we conducted an exploratory study in Paris to evaluate cognition and associated factors in homeless adults. The second objective was to identify methodological specificities to consider in a future larger-scale study and for the application of the outcomes. For this exploratory phase, 14 individuals were recruited from specific services and were interviewed regarding their social, neurological, and psychiatric history, before completing a set of cognitive tests. The results showed a high diversity of profiles in terms of demographic characteristics, including being a migrant and/or illiterate. A high proportion of participants had signs of traumatic brain injury, anxiety, depressive disorders, and post-traumatic stress disorders. Most cognitive scores were in the low average of normative data. No statistical association was found between identified risk factors and cognitive performance. Future studies should consider the sociodemographic specificities of the homeless population and design appropriate measurement tools to improve the understanding of neuropsychological profiles.

Understanding social needs in pregnancy: Prospective validation of a digital short-form screening tool and patient survey

BACKGROUND

Social determinants of health significantly affect health outcomes, yet are infrequently addressed in prenatal care.

OBJECTIVE

This study aimed to improve the efficiency and experience of addressing social needs in pregnancy through: (1) testing a digital short-form screening tool; and (2) characterizing pregnant people's preferences for social needs screening and management.

STUDY DESIGN

We developed a digital short-form social determinants of health screening tool from PRAPARE (Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences), and a survey to query patients' preferences for addressing social needs. Instruments were administered online to peripartum participants, with equal representation of patients with public and private insurance. We calculated the sensitivity and specificity of the short-form tool vs PRAPARE. Quantitative responses were characterized using descriptive statistics. Free-text responses were analyzed with matrix and thematic coding. Survey data were analyzed by subgroups of historically marginalized populations.

RESULTS

A total of 215 people completed the survey. Participants were predominantly White (167; 77.7%) and multiparous (145; 67.4%). Unmet social needs were prevalent with both the short-form tool (77.7%) and PRAPARE (96.7%). The sensitivity (79.3%) and specificity (71.4%) of the short-form screener were high for detecting any social need. Most participants believed that it was important for their pregnancy care team to know their social needs (material: 173, 80.5%; support: 200, 93.0%), and over half felt comfortable sharing their needs through in-person or digital modalities if assistance was or was not available (material: 117, 54.4%; support: 122, 56.7%). Free-text themes reflected considerations for integrating social needs in routine prenatal care. Acceptability of addressing social needs in pregnancy was high among all groups.

CONCLUSION

A digital short-form social determinants of health screening tool performs well when compared with the gold standard. Pregnant people accept social needs as a part of routine pregnancy care. Future work is needed to operationalize efficient, effective, patient-centered approaches to addressing social needs in pregnancy.

Perceived Access to Contraception via Telemedicine Among Young Adults: Inequities by Food and Housing Insecurity

BACKGROUND

Telemedicine expanded rapidly during the COVID-19 pandemic, including for contraceptive services. Data are needed to understand whether young people can access telemedicine for contraception, especially in underserved populations.

OBJECTIVE

To compare young people's perceived access to telemedicine visits for contraception during the COVID-19 pandemic by food and housing insecurity.

DESIGN

Supplementary study to a cluster randomized controlled trial in 25 community colleges in California and Texas. Online surveys were administered May 2020 to April 2021. Mixed-effects logistic regression models with random effects for site were used to examine differences in access to contraception through telemedicine by food and housing insecurity status, controlling for key sociodemographic characteristics, including race/ethnicity, non-English primary language, health insurance status, and state of residence, and contraceptive method used.

PARTICIPANTS

1,414 individuals assigned female at birth aged 18-28.

MAIN MEASURES

Survey measures were used to capture how difficult it would be for a participant to have a telemedicine visit (phone or video) for contraception.

KEY RESULTS

Twenty-nine percent of participants were food insecure, and 15% were housing insecure. Nearly a quarter (24%) stated that it would be difficult to have a phone or video visit for contraception. After accounting for sociodemographic factors and type of method used, food insecure (adjusted odds ratio [aOR], 2.17; 95% confidence interval [CI], 1.62-2.91) and housing insecure (aOR, 1.62; 95% CI, 1.13-2.33) participants were significantly more likely to report that it would be difficult to use telemedicine for contraception during the pandemic.

CONCLUSIONS

Underserved patients are those who could benefit most from the expansion of telemedicine services, yet our findings show that young people experiencing basic needs insecurity perceive the greatest difficulty accessing these services for essential reproductive care.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT03519685.

How do childcare and pregnancy affect the academic success of college students?

OBJECTIVE

We examined socioeconomic, academic, and health-related factors associated with respondent reports that childcare interfered with academics.

PARTICIPANTS

176 undergraduate student parents.

METHODS

We administered a cross-sectional survey to a representative sample of students at a public university in New York City. Using a sub-set of those who reported being parents/guardians (n = 176), we conducted bivariate analyses to assess factors associated with childcare problems interfering with school.

RESULTS

About 30% of the sample reported that childcare interfered with school somewhat/moderately/a lot in the last year. Compared to those with no/little perceived interference, they were significantly more likely to need mental health treatment (30% vs. 13%; p < 0.01), worry that they would run out of food sometimes/often (32% vs. 16%; p < 0.01), and experience housing problems (26% vs. 9%; p < 0.01).

CONCLUSIONS

Offering mental healthcare and services addressing food and housing insecurity can help college students to navigate challenges inherent to being a student parent.

Risk of delivery complications among pregnant people experiencing housing insecurity

BACKGROUND

Housing insecurity is increasingly being recognized as an important social determinant of health. Pregnant individuals experiencing housing insecurity may represent a particularly vulnerable subset of this population, but few studies have examined this population nationally. In particular, racial and ethnic minority individuals may be at risk for poor outcomes within this group because of structural racism and discrimination. The introduction of the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis codes related to social determinants of health represent a new opportunity to identify patients with housing insecurity nationally.

OBJECTIVE

This study aimed to evaluate the prevalence of and delivery outcomes for pregnant people experiencing housing insecurity, both nationally and by race and ethnicity.

STUDY DESIGN

This was a retrospective cohort study using data from the 2016 to 2018 National Inpatient Sample. Delivery hospitalizations for people experiencing housing insecurity were identified using the International Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code Z59. Among hospitals that coded at least 1 delivery for a patient with housing insecurity, logistic regression models were used to assess the odds of severe maternal morbidity associated with housing insecurity, adjusting for clinical risk and pregnancy characteristics.

RESULTS

Of 539,950 delivery hospitalizations, 1820 hospitalizations (0.3%) were for patients with housing insecurity. Compared to deliveries for patients with housing security, deliveries for patients with housing insecurity were more likely for patients who identified as Black (34.8% vs 18.1%; P<.001) and who had Medicaid insurance (83.5% vs 46.2%; P<.001). People with housing insecurity were more likely to have comorbidities and higher-risk pregnancies, including higher rates of substance use disorders (54.0% vs 6.9%), major mental health disorders (37.5% vs 8.7%), preeclampsia with severe features (7.4% vs 4.3%), and preterm birth <37 weeks gestation (23.7% vs 11.6%) (all P<.001). In regression analyses, patients with housing insecurity had more than twice the odds of severe maternal morbidity than patients with housing security during the delivery hospitalization (odds ratio, 2.17; 95% confidence interval, 1.75-2.68). After adjusting for clinical risk and pregnancy characteristics, the differences were attenuated overall (adjusted odds ratio, 1.17; 95% confidence interval, 0.94-1.47) and among racial and ethnic groups (White patients: adjusted odds ratio, 1.39; 95% confidence interval, 0.95-2.03; Black patients: adjusted odds ratio, 1.05; 95% confidence interval, 0.73-1.52; Hispanic patients: adjusted odds ratio, 1.04; 95% confidence interval, 0.59-1.84; Asian or Pacific Islander or Native American or other race patients: adjusted odds ratio, 1.08; 95% confidence interval, 0.45-2.58).

CONCLUSION

Pregnant individuals experiencing housing insecurity were more likely to be from groups that have been marginalized historically, had higher rates of comorbidities, and worse delivery outcomes. After risk adjustment, differences in the odds of severe maternal mortality were attenuated. Screening for housing insecurity may identify these patients earlier and connect them to services that could improve disparities in outcomes.

Association between unmet social needs and healthy lifestyle parenting behaviors

Objective

To examine cross-sectional associations of food and housing security risks and healthy lifestyle parenting behaviors related to nutrition and physical activity among families with children with overweight/obesity.

Methods

We surveyed 407 parents of children ages 6-12 years with overweight/obesity. Exposures were measures of food and housing insecurity risk. Outcomes were healthy lifestyle parenting behaviors related to nutrition and physical activity. Logistic regression models for each exposure-outcome relationship were adjusted for parental educational attainment, parental cohabitation status, household size, and household income.

Results

In multivariable-adjusted models, food insecurity was associated with significantly lower odds of parent modeling exercise {aOR 0.60 [95% confidence interval (CI): 0.37, 0.96]} and parent modeling eating healthy foods [aOR 0.42 (95% CI: 0.24, 0.73)]. Housing insecurity was associated with significantly lower odds of parent modeling exercise [aOR 0.57 (95% CI: 0.35, 0.95)].

Conclusions

Food insecurity and housing insecurity may be barriers to parents adopting and modeling healthy lifestyle parenting behaviors related to physical activity and nutrition.

Racial and Gender Inequalities in Food, Housing, and Healthcare Insecurity Associated with Intimate Partner and Sexual Violence

The costs and consequences of intimate partner violence (IPV) and sexual violence (SV) are well-documented; however, little is known about how experiences of violence are connected to specific economic insecurities including food, healthcare, and housing insecurity among both men and women. This study investigates (1) the prevalence of food, healthcare, and housing insecurity across gender and racial groups exposed to IPV and SV and (2) associations between exposure to past-year IPV and SV and past-year food, healthcare, and housing insecurity controlling for confounding factors. A cross-sectional survey design was used in this study. Data from 2010 National Intimate Partner and Sexual Violence Survey (NISVS) were analyzed in a nationally representative sample of men (N = 8079) and women (N = 9970). Logistic regressions were used to model associations between past-year intimate partner and sexual violence and dependent variables of food, healthcare, and housing insecurity. Analyses were stratified by gender and included control variables of age, income, education, and race/ethnicity. Higher rates of food, housing, and healthcare insecurity were found among men and women of color exposed to violence, particularly among respondents who identified as Black/African American, Latinx, American Indian/Alaska Native, and other racial/ethnic minority groups. For men, IPV and SV was associated with higher odds for experiencing food (AOR = 2.40, p <.001), housing (AOR = 2.06, p <.001), and healthcare insecurity (AOR = 2.39, p <.001). For women, IPV and SV was also associated with higher odds for experiencing food (AOR = 2.16, p <.001), housing (AOR = 1.94, p <.001), and healthcare insecurity (AOR = 2.38, p <.001). Findings identify specific economic needs among survivors and suggest that the burdens of IPV and SV are not equitably shared across racial/ethnic populations. Findings can inform policy that aims to reduce inequalities in food, housing, and healthcare associated with IPV and SV.

Aging in the Right Place for Older Adults Experiencing Housing Insecurity: An Environmental Assessment of Temporary Housing Program

Research on programs offering senior-specific housing supports and enabling "aging in the right place" (AIRP) for "older persons with experiences of homelessness" (OPEH) is limited. This paper presents an environmental assessment of a "transitional housing program" (THP) in Metro Vancouver, Canada, for OPEH to AIRP. Data were collected using Aging in the Right Place Environmental (AIRP-ENV) and Secondary Observation (AIRP-ENV-SO) audit tools designed to evaluate multi-unit housing for OPEH. The 241-item AIRP-ENV tool was used to assess the built environmental features of four multi-unit buildings of the THP. The AIRP-ENV-SO tool was used to collect contextual data on the function, safety, and land use of the surrounding neighborhood. Findings identified built environment and urban design features that support THP residents' safety, security, accessibility, functionality, social activity, autonomy, and identity. The THP buildings were rated 'Good' for accessibility, functionality, autonomy and identity, while 'Satisfactory' or 'Poor' for safety, security, and social activity. Findings point to the built environmental features (e.g., size and layout of spaces) required in the THP to create opportunities for increased social engagement among residents and enhanced safety and security. The AIRP-ENV and AIRP-ENV-SO audit tools can help inform programs across the housing continuum to develop supportive built environments that promote AIRP for OPEH.

Intimate Partner Violence Exposure and Adolescent Mental Health Outcomes: The Mediating Role of Housing Insecurity

The present study investigated pathways from childhood exposure to mothers' intimate partner violence (IPV) to adolescent depression and anxiety. Further, the study examined whether housing insecurity mediated the link from IPV exposure to mental health outcomes. Data came from the Years 5, 9 and 15 interviews of the Fragile Families and Child Well-being Study; the analytic sample was limited to mothers with at least partial custody of children (N = 2,425). Structural equation modeling with latent variables investigated research questions. Confirmatory factor analysis (CFA) identified observed indicators for latent constructs, and a path analysis tested direct and indirect pathways from IPV exposure to adolescent depression and anxiety. IPV exposure at age five was associated with increased housing insecurity at age nine, which was associated with increased adolescent depression and anxiety at age 15. Although IPV exposure was not directly associated with either mental health outcome, housing insecurity mediated the link from IPV exposure to adolescent depression. Findings point to the long-term consequences of exposure to intimate partner violence in childhood, highlighting pathways to mental disorder in adolescence. The present study emphasizes the need for policies that protect survivors of IPV from eviction and homelessness, empower them to leave abusers without fear of losing their housing, and promote healthy child development in the wake of family violence.

Eviction as a social determinant of pregnancy health: County-level eviction rates and adverse birth outcomes in the United States

Access to housing is an important manifestation of structural racism and discrimination, and birth outcomes show wide health disparities, but few studies have examined eviction and birth outcomes. This multilevel study merged data from the Eviction Lab on 2015 eviction judgements and records with the National Center for Health Statistics natality dataset. The analytic sample included 2,950,965 births across 5924 counties in 45 states. Outcomes of interest were low birthweight (<2500 g; LBW) and preterm birth (<37 weeks gestation; PTB). We fit generalised estimating equations to account for clustering within county and a logistic distribution to estimate the odds ratio of LBW or PTB associated with the county-level eviction rate, with control for individual- and county-level characteristics. Results were calculated separately for non-Hispanic white, non-Hispanic black and Hispanic mothers. After adjustment for covariates, living in the counties in the highest quartile of eviction was associated with a 12-13% increased odds of LBW. The magnitude of association with PTB was not as large. Non-Hispanic black women were more likely to live in counties in the highest quartile of eviction rate (43%, vs. 23% for white women and 23% for Hispanic women) or filing rate (44%, vs. 23% for white and 18% for Hispanic). The association between eviction rate and LBW/PTB was strongest for black women, while there was essentially no association among Hispanic women. Housing instability may be a key social determinant of poor birth outcomes and should be considered in state and local maternal and child health policy and programming.

Housing Insecurity, Housing Conditions, and Breastfeeding Behaviors for Medicaid-Eligible Families in Urban Settings

BACKGROUND

Research exploring associations between exposure to social determinants of health and breastfeeding is needed to identify breastfeeding barriers. Housing insecurity and household conditions (chaos and crowding) may affect breastfeeding by increasing maternal stress and discomfort and decreasing time available to breastfeed.

RESEARCH AIM

We aimed to examine the relationships between housing insecurity, breastfeeding exclusivity intention during the early postnatal period, and breastfeeding exclusivity at 6 months postpartum among a sample "at risk" for suboptimal breastfeeding rates.

METHODS

This study is a secondary data analysis of a longitudinal study at two time periods. Data were collected from English- and Spanish-speaking, Medicaid-eligible mother-infant dyads (N = 361) at near-birth and child aged 6 months, in New York City and Pittsburgh. Structural equation modeling was used to examine direct and indirect effects of housing insecurity on breastfeeding exclusivity at child aged 6 months.

RESULTS

The path model showed that experiencing more markers of housing insecurity (i.e., foreclosure/eviction threat, history of homelessness, late rent) was predictive of significantly lower breastfeeding exclusivity at 6 months. This was partially mediated through less exclusive breastfeeding intention during the early postnatal period. Greater household crowding was associated with 6-month breastfeeding exclusivity when mediated by intention. Household crowding had differential effects by study site and participant race/ethnicity.

CONCLUSION

Refinement of housing insecurity as a multi-dimensional construct can lead to the development of standardized data collection instruments, inform future methodological decisions in research addressing social determinants of health, and can inform the development of responsive individual- and structural-level interventions.The data used in this study were collected as part of the SMART Beginnings Randomized Controlled Trial (NCT02459327 registered at ClinicalTrials.gov).

"Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City

OBJECTIVE

To identify consequences of unmet housing needs in the period following cancer diagnosis.

DESIGN

Qualitative descriptive design.

PARTICIPANTS

New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers).

METHODS

One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm.

FINDINGS

Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living.

CONCLUSION

The simultaneous experience of cancer and unmet housing needs is broadly burdensome.

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.

Informal supports, housing insecurity, and adolescent outcomes: Implications for promoting resilience

Adolescents in low-income, marginalized families are vulnerable to behavior problems that impede healthy functioning and threaten long-term well-being. Informal supports may fill an important gap for these households as they navigate financial and social stressors. Instrumental support from social networks and neighborhood cohesion may promote family stability and youth well-being; further, these informal supports may promote resilience to housing insecurity, which is linked with a range of adverse adolescent outcomes. The present study utilized data from a large sample of at-risk families with children (N = 2425) to investigate whether instrumental support and neighborhood cohesion predicted adolescent behavior problems over 10 years and whether these links were mediated by housing insecurity. Results of structural equation modeling with latent variables showed direct links from instrumental support to anxious/depressed behaviors and from neighborhood cohesion to aggressive behaviors, as well as an indirect link from instrumental support to aggressive behavior via housing insecurity. Findings suggest informal supports are an important source of resilience for low-income families who may be excluded from or are reluctant to engage with formal social systems. Further, stable, connected communities with highly embedded social networks can promote housing stability and youth well-being in a virtuous cycle.

Risk of food and housing insecurity among college students during the COVID-19 pandemic

The aim of this study was to assess college students' food and housing insecurity risk amidst the pandemic. Data were collected through an online survey in the summer of 2020 from 1956 graduate and undergraduate students attending a large, private, urban university in the Midwest, U.S. Food insecurity among students increased (25% before; 29% during COVID) with housing insecurity staying roughly the same (34% before; 36% during COVID). Results indicate certain student groups were at greater risk of basic needs insecurity during the pandemic compared to their counterparts. Results also suggest changes in food and housing insecurity trends. College students are burdened with basic needs insecurity, exacerbated during the pandemic. Institutions need to work toward solutions to address the needs of vulnerable populations disproportionately affected by basic needs insecurity. Recommendations on addressing the basic needs of college students are also provided.

Does resource insecurity drive HIV-related stigma? Associations between food and housing insecurity with HIV-related stigma in cohort of women living with HIV in Canada

INTRODUCTION

Women living with HIV across global contexts are disproportionately impacted by food insecurity and housing insecurity. Food and housing insecurity are resource insecurities associated with poorer health outcomes among people living with HIV. Poverty, a deeply stigmatized phenomenon, is a contributing factor towards food and housing insecurity. HIV-related stigma-the devaluation, mistreatment and constrained access to power and opportunities experienced by people living with HIV-intersects with structural inequities. Few studies, however, have examined food and housing insecurity as drivers of HIV-related stigma. This study aimed to estimate the associations between food and housing insecurity with HIV-related stigma among women living with HIV in Canada.

METHODS

This prospective cohort study of women living with HIV (≥16 years old) in three provinces in Canada involved three waves of surveys collected at 18-month intervals between 2013 and 2018. To understand associations between food and housing security and HIV-related stigma, we conducted linear mixed effects regression models. We adjusted for socio-demographic characteristics associated with HIV-related stigma.

RESULTS AND DISCUSSION

Among participants (n = 1422), more than one-third (n = 509; 36%) reported baseline food insecurity and approximately one-tenth (n = 152, 11%) housing insecurity. Mean HIV-related stigma scores were consistent across waves 1 (mean [M] = 57.2, standard deviation [SD] = 20.0, N = 1401) and 2 (M = 57.4, SD = 19.0, N = 1227) but lower at wave 3 (M = 52.8, SD = 18.7, N = 918). On average, across time, food insecure participants reported HIV-related stigma scores that were 8.6 points higher (95% confidence interval [CI]: 6.4, 10.8) compared with food secure individuals. Similarly, participants reporting insecure housing at wave 1 tended to experience greater HIV-related stigma (6.2 points, 95% CI: 2.7, 9.6) over time compared to stably housed participants. There was an interaction between time and housing insecurity, whereby baseline housing insecurity was no longer associated with higher HIV-related stigma at the third wave.

CONCLUSIONS

Among women living with HIV in Canada, experiencing food and housing insecurity was associated with consistently higher levels of HIV-related stigma. In addition to the urgent need to tackle food and housing insecurity among people living with HIV to optimize wellbeing, getting to the heart of HIV-related stigma requires identifying and dismantling resource insecurity-related stigma drivers.

Prevalence and Correlates of Violence Experienced by Trans Women

Objectives: To measure the prevalence and correlates of intimate partner, physical, and sexual violence experienced by trans women. Materials and Methods: A National HIV Behavioral Surveillance (NHBS) Study of 201 trans women was conducted in San Francisco from July 2019 to February 2020 using respondent-driven sampling. Prevalence ratio tests were used to test differences in the prevalence of violence by demographic characteristics including housing status. Results: Among 201 trans women interviewed, 26.9% were currently homeless. In the past year, 59.7% had been homeless, 34.3% changed housing, 60.7% had a housing situation other than renting or owning. Experiences of violence were common: 36.8% experienced any form of violence, including sexual (16.9%), intimate partner (14.9%), and other physical (25.4%) in the past year. Experiences of violence were significantly associated with multiple measures of housing insecurity. Younger age, being misgendered, and substance use were also associated with experiences of violence. Conclusions: Trans women face dual crises in housing and violence. Affordable, subsidized, and safe housing has the potential to reduce the exposure and vulnerability to violence faced by trans women.

Leveraging research to inform prevention and intervention efforts: Identifying risk and protective factors for rural and urban homeless families within transitional housing programs

This mixed method study spotlights hardships and supportive factors for unhoused families led by single mothers who have successfully graduated from two transitional housing programs, one rural and one urban. Data collection consisted of entry and exit surveys (n = 241) as well as qualitative interviews (n = 11). Binary logistic regression results indicated education and social support as significant predictors of successful program completion. Qualitative findings further illustrate narratives surrounding supportive factors and program supports (i.e., assistance securing employment, education courses, sense of community), as well as policy implications. Implications stress the need for enhancing supportive factors (i.e., education and social capital) in early prevention efforts (e.g., schools and community centers), as well as an intentional integration of addressing socio-emotional needs and resources within housing programs and services unique to rural and urban communities.

Using geographic information systems to assess community-level vulnerability to housing insecurity in rural areas

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.

Engagement in Care and Housing Instability Influence HIV Screening Among Transgender Individuals in South Florida

Purpose: HIV screening is a critical step in the HIV care continuum to lowering incidence and achieving viral load suppression among at-risk populations. Few studies assess factors associated with HIV screening among transgender individuals living in the southeast region of the United States. This study was conducted to determine factors that influence HIV screening among transgender individuals in South Florida. Methods: During Fall 2016, 68 participants were recruited to complete a questionnaire as part of a pilot pre-exposure prophylaxis study. Correlations were examined between sociodemographic factors, HIV risk, and access to and engagement in care. Significant correlations were entered into one logistic regression model to estimate predictors of HIV screening and knowledge of HIV status. Results: Almost half (48.5%) of the respondents were Latinx, 38.2% Black, 10.3% non-Latinx White, and 3% other. Seventy-eight percent reported access and routine engagement in care within the past year, 25% had not screened for HIV in the past year, and of those who knew their status, 16.7% reported living with HIV. Regression analysis revealed that participants with routine engagement in care were twice as likely to screen for HIV (p=0.02). Unstable housing was associated with no HIV screening in the past year (p=0.05). Conclusion: Stable housing is linked to engagement in routine care that can increase the likelihood of an at-risk transgender individual screening for HIV. Further research is needed to develop interventions to improve engagement in care among transgender individuals who do not have adequate housing or access to care.

Motherhood Together: Effects of an Adapted Prenatal Curriculum on Mother and Infant Outcomes

Background

Research shows that pregnant women experiencing housing insecurity are more likely to face barriers to prenatal care that can lead to negative health outcomes for both mother and infant. Previous studies have also shown that prenatal education programs provide pregnant mothers with the knowledge and resources that increase the likelihood of positive health outcomes. An interprofessional healthcare team in Central Arkansas modified an existing prenatal education program to create Motherhood Together, a program specifically tailored for pregnant women facing house insecurity.

Methods

The purpose of this initial evaluation of the Motherhood Together program was to identify the feasibility of the program and preliminary outcomes. This evaluation sought to better understand the demographic composition of the population participating in Motherhood Together (n = 19), as well as the effect of the program on infant outcomes, health literacy, and maternal self-care. The overall participant experience and feedback to enhance the program was also obtained.

Results

The average age of participants was 24.6 years old and 77.8% reported high school as their highest level of educational attainment. The majority of participants identified as Black/African American (77.8%) and 22.2% identified as White. Participants scored the experience of Motherhood Together sessions positively with an overall score of 3.75/4.00. Participants reported an average gestational age at delivery being 36.9 weeks with 25% reporting preterm births following the program. Multivitamins were reported as being taken by 100% of participants following participation.

Conclusion

Tailoring the pre-existing educational program to create the Motherhood Together program was clearly feasible and continues to serve as a critical resource for improving equity in infant and maternal outcomes in central Arkansas.

Prevalence of Alzheimer's disease and related dementias among veterans experiencing housing insecurity

INTRODUCTION

Housing insecure veterans are aging, but the prevalence of Alzheimer's disease and related dementias (AD/ADRD) in the population is unknown.

METHODS

We calculated the prevalence of AD/ADRD diagnoses in 2018 among veterans that experienced homelessness, were at-risk for homelessness, or were stably housed. We determined acute care (emergency department, hospitalizations, psychiatric hospitalizations), and any long-term care (nursing home, and community-based) use by housing status among veterans with an AD/ADRD diagnosis.

RESULTS

The overall prevalence of AD/ADRD diagnoses for homeless, at-risk, and stably housed veterans was 3.66%, 13.48%, and 3.04%, respectively. Housing insecure veterans with AD/ADRD used more acute care, and were more likely to have a nursing home admission compared to stably housed veterans. At risk, but not homeless veterans, were more likely to use US Department of Veterans Affairs-paid home and community-based care than stably housed veterans.

DISCUSSION

The prevalence of AD/ADRD diagnoses is greater among housing insecure veterans than stably housed veterans.

The effect of maternal food insecurity transitions on housing insecurity in a population-based sample of mothers of young children

BACKGROUND

Studies have shown a link between food insecurity and housing problems, including trouble paying rent. Additional research is needed to test the longitudinal effect of food insecurity on housing insecurity in a socio-demographically diverse, population-based sample. We tested whether food insecurity transitions predicted housing insecurity using a housing insecurity index consisting of housing and neighborhood factors. We also tested whether social cohesion or social support mediated the food/housing insecurity relationship.

METHOD

Data were analyzed from a sample of 2868 mothers of young children residing in California at two time points: the baseline Maternal and Infant Health Assessment (2003-2007) and follow-up Geographic Research on Wellbeing survey (2012-2013). Women were categorized as food insecure both times; became food insecure; became food secure; and food secure both times. We constructed linear regression models for housing insecurity: models regressing each variable separately; a model regressing sociodemographic covariates and food insecurity status; mediation models adding social cohesion or social support; and mediation models for each racial/ethnic group.

RESULTS

Food insecurity transitions were associated with housing insecurity in a gradient pattern. Compared to women who were food secure both times, housing insecurity was highest among women who were food insecure both times, followed by those who became food insecure, and then those who transitioned out of food insecurity (became food secure). Food insecurity remained a significant risk factor for housing insecurity even after adjusting sociodemographic covariates. While social support and social cohesion were negatively associated with housing insecurity, there was limited evidence that social support/cohesion mediated the food insecurity/housing insecurity relationships.

CONCLUSIONS

The lack of substantial mediation suggests that factors beyond social ties may explain the food and housing insecurity relationship. Efforts to reduce material hardship should consist of streamlined policy efforts that offer tangible supports for women and their families.

Incidence of Homelessness among Veterans Newly Diagnosed with Alzheimer's Disease and Related Dementias

BACKGROUND

To determine the incidence of homelessness among Veterans diagnosed with Alzheimer's disease and related dementias (ADRD).

METHODS

We used Veterans Affairs (VA) administrative records to identify Veterans with a new ADRD diagnosis anytime between 2010-2019. Among these Veterans, we calculated the incidence of homelessness, and estimated the association between demographics, comorbidities and hazard of homelessness.

RESULTS

The incidence rate of homelessness was highest for Veterans diagnosed with ADRD between 18-49 years of age (14.9 per 1,000 person-years; 95%CI: 13.6, 16.3) and lowest for Veterans diagnosed with ADRD at 90+ years (0.3 per 1,000 person-years; 95%CI: 0.2, 0.4). The adjusted hazard ratio of homelessness was higher for unmarried Veterans, and those with alcohol use disorder, substance use disorder, liver disease, depression, hypertension, lung disease, post-traumatic stress disorder and psychoses.

CONCLUSIONS

Younger age and being unmarried at the time of ADRD diagnosis are associated with a greater risk of experiencing homelessness.

Examining the Neighborhood Attributes of Recently Housed Partner Violence Survivors in Rapid Rehousing

Survivors’ considerations for re-housing following intimate partner violence (IPV) are understudied despite likely neighborhood-level influences on women’s safety. We assess housing priorities and predictors of re-housing location among recent IPV survivors (n = 54) in Rapid Re-housing (RRH) in the Baltimore-Washington Metropolitan Area. Choropleth maps depict residential location relative to census tract characteristics (neighborhood deprivation index (NDI) and residential segregation) derived from American Community Survey data (2013–2017). Linear regression measured associations between women’s individual, economic, and social factors and NDI and segregation. In-depth interviews (n = 16) contextualize quantitative findings. Overall, survivors re-housed in significantly more deprived and racially segregated census tracts within their respective regions. In adjusted models, trouble securing housing (B = 0.74, 95% CI: 0.13, 1.34), comfortability with proximity to loved ones (B = 0.75, 95% CI: 0.02, 1.48), and being unsure (vs unlikely) about IPV risk (B = −0.76, 95% CI: −1.39, −0.14) were significantly associated with NDI. Economic dependence on an abusive partner (B = −0.31, 95% CI: −0.56, −0.06) predicted re-housing in segregated census tracts; occasional stress about housing affordability (B = 0.39, 95% CI: 0.04, 0.75) predicted re-housing in less segregated census tracts. Qualitative results contextualize economic (affordability), safety, and social (familiarity) re-housing considerations and process impacts (inspection delays). Structural racism, including discriminatory housing practices, intersect with gender, exacerbating challenges among survivors of severe IPV. This mixed-methods study further highlights the significant economic tradeoffs for safety and stability, where the prioritization of safety may exacerbate economic devastation for IPV survivors. Findings will inform programmatic policies for RRH practices among survivors.

Redefining Basic Needs for Higher Education: It's More Than Minimal Food and Housing According to California University Students

PURPOSE

A student-specific definition of basic needs for higher education is warranted to inform programs and policies for underserved students. The purpose of this study was to: 1) explore how students define basic needs, 2) understand experiences of housing insecurity, and 3) understand experiences of food insecurity within the context of housing insecurity.

DESIGN

Qualitative research elicited student perceptions of basic needs and experiences of housing and food insecurity.

SETTING

Focus group discussions were conducted at 5 University of California campuses between February and March 2019.

PARTICIPANTS

Undergraduate (n = 37) and graduate (n = 21) students were recruited from campus basic needs centers.

METHODS

Each student completed a brief survey. Researchers conducted 11 focus groups using a semi-structured interview guide. Transcripts were coded to identify themes.

RESULTS

Students were female (76%), age 23.6 (SD = 5.8) years; 46% were Pell grant recipients; and 52% were first-generation college students. Most had experienced food insecurity (98%) and 26% had experienced homelessness. Eight themes were identified: 1) students define basic needs as more than minimal food and shelter and as the responsibility of students and the university, 2) students encounter multifaceted housing insecurity issues, 3) affording rent is a priority that most often leads to experiencing food insecurity, 4) transportation barriers interfere with meeting students' basic needs to succeed as students, 5) students with nontraditional characteristics, graduate students, and out-of-state students face unique challenges in meeting basic needs, 6) limited financial aid and lack of financial aid guidance are barriers to meeting basic needs, 7) fees contribute additional challenges to students meeting basic needs, and 8) additional university basic needs services are essential.

CONCLUSION

A student-informed definition of basic needs included food, housing, mental health, sleep, hygiene, and transportation. This understanding of basic needs can inform future research, programs, and policy to address housing insecurity in higher education.

Change of address as a measure of housing insecurity predicting rural emergency department revisits after asthma exacerbation

OBJECTIVE

Housing insecurity is an important socioeconomic factor that may impact emergency department (ED) use for children with asthma, but housing insecurity screening has primarily relied on patient surveys or linkage to external data sources. Using patient addresses recorded in the electronic medical record (EMR), we sought to correlate recent changes in address (as a proxy for housing insecurity) with ED revisit risk.

METHODS

We retrospectively identified patients age 2-17 years seen in our rural ED for asthma exacerbation during 2016-2018. We used EMR data from the 12 months before the earliest ED visit to compare patients with and without a recent change of address (over previous 12 months) on 30- and 90-day all-cause and asthma-specific ED revisits.

RESULTS

The study included 632 children, of whom 85 (13%) had a recent address change before the index ED visit. Moving was not associated with asthma-specific 30-day or 90-day revisits. Ninety-day all-cause revisits were more common among patients who had recently moved (36% vs. 25%; p = 0.019), although this difference was not statistically significant after multivariable adjustment for Medicaid insurance coverage and number of recent health system encounters (odds ratio: 1.49; 95% confidence interval: 0.91, 2.46; p = 0.114).

CONCLUSIONS

A history of recent address change in the EMR was not independently associated with repeat ED visits for asthma exacerbation. Many children presenting to the ED did not have recent encounters with our health system where address could be ascertained. This EMR-based proxy for housing insecurity may be more applicable to patients under continuous follow-up.

Prevalence and Social Determinants of Food Insecurity among College Students during the COVID-19 Pandemic

The coronavirus disease (COVID-19) pandemic has increased unemployment and food insecurity in the United States (US). Prior to the pandemic, college students exhibited higher rates of food insecurity than nonstudent households. The objectives of this study were to assess the prevalence and determinants of food insecurity among college students during the COVID-19 pandemic. We administered an online survey to 651 students on three diverse campuses at a state-funded university in Texas, US, in May 2020. Food security was assessed using a multistep approach that included the 2-item Food Sufficiency Screener and 6-Item USDA Food Security Survey Module (FSSM). Overall, 34.5% of respondents were classified as food insecure within the last 30 days. The strongest predictors of food insecurity were change in current living arrangement (OR = 2.70, 95% CI: 2.47, 2.95), being furloughed (OR = 3.22, 95% CI: 2.86, 3.64), laid off (OR = 4.07, 95% CI: 3.55, 4.66), or losing part-time work (OR = 5.73, 95% CI: 5.09, 6.46) due to the COVID-19 pandemic. These findings highlight the high prevalence of food insecurity among college students during the COVID-19 pandemic, with students who experienced housing insecurity and/or loss of income due to the pandemic being impacted the most.

[How does the employment status influence the effects of residential insecurity on health?]

OBJECTIVE

This study aims to analyze the effects of housing insecurity on health and if those are modified by employment status of people belonging to "Treball als Barris" program in Barcelona between 2015 and 2016.

METHODS

We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals attended by "Treball als Barris" at baseline and after one year of follow-up. Then, we carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them.

RESULTS

Among women, we found negative effects of housing insecurity on health (PR of poor self-reported health among women who stayed under housing insecurity was 2.29 [IC95%: 1.36-3.84] compared to those who stayed secured), while, among men, main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [IC95%: 1.02-6.15] compared to those who were employed after follow-up). In addition, results suggest an interaction between housing and employment status on mental health among.

DISCUSSION

Housing insecurity rates have increased in last years. It produces negatives effects on health and can interact with other social determinants such as employment, mainly on men's mental health.

Cumulative Adversity Profiles Among Youth Experiencing Housing and Parental Care Instability

This study applies cumulative adversity and stress proliferation theories to examine risk and protective resource profiles of youth with three different levels of housing and parental care instability. Data derive from a state representative sample (n=27,087) of school-based adolescent students. ANCOVA analyses identified significant differences in sociodemographic and psychosocial functioning variables for youth with 0, 1, or 2 forms of housing and parental care instability, with more deleterious functioning being observed among youth with greater levels of instability. Those experiencing either or both housing and parental care instability are more represented by males, sexual minorities, and youth of color; psychosocial risk and protective factors demonstrated consistent differences between instability groups. Dimensions of cumulative adversity operate with social marginalities (e.g., race, sexual minority status) relative to instability, with higher frequency of victimization, lower grades, diminished self-regulation capabilities and school engagement, weakened psychological health, and strained family and peer relationships. The paper discusses theorized mechanisms through which cumulative adversity conveys effects as well as implications for social work prevention and resilience-fostering strategies in schools and other youth-serving settings.