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Attwell K, Turvey J, Wood L. COVID-19 vaccination of at-risk and marginalised groups: recentering the state in vaccine uptake. Soc Sci Med 2024; 348:116812. [PMID: 38636209 DOI: 10.1016/j.socscimed.2024.116812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 03/11/2024] [Accepted: 03/20/2024] [Indexed: 04/20/2024]
Abstract
Recent studies have used the World Health Organization's new Behavioural and Social Drivers (BeSD) framework to analyse vaccine uptake. However, this study of COVID-19 vaccination among marginalised population groups highlights the framework's limitations regarding the centrality of the state in shaping people's vaccination intentions in high income countries. We conducted interviews and focus groups with service providers and community members to explore COVID-19 vaccination amongst Western Australians experiencing homelessness and/or from other marginalised populations (such as people with substance use dependence). Analysing this data iteratively to emphasise the state's role and functions, we elaborate how trauma and mistrust of government drive thoughts, feelings, and social interactions regarding vaccination programs, which are mutually reinforcing and which inhibit individuals' willingness to engage. Government systems that leave some populations behind increase those populations' susceptibility to misinformation. Policies may generate new unintended problems: social service providers worried about vaccine advocacy damaging clients' trust, especially in the context of vaccine mandates. Reframing the state's responsibility for designing culturally and socially appropriate services, we outline how end-users and trusted providers can lead this process. We share a new framework, "Recentering the State in Vaccine Uptake," arising from our analyses.
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Affiliation(s)
- Katie Attwell
- VaxPol Lab, Political Science and International Relations, School of Social Sciences, The University of Western Australia, Perth, WA, Australia.
| | - Jake Turvey
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
| | - Lisa Wood
- Institute for Health Research, University of Notre Dame, Fremantle, WA, Australia.
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Kerman N, Marshall CA, Polillo A, Voronov J, de Pass T, Easton C, Ward B, Noble A, Hwang SW, Kozloff N, Stergiopoulos V, Kidd SA. Service restrictions from emergency shelters among people experiencing homelessness: Uncovering pathways into unsheltered homelessness and institutional circuitry. Soc Sci Med 2024; 348:116831. [PMID: 38574591 DOI: 10.1016/j.socscimed.2024.116831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2023] [Revised: 03/13/2024] [Accepted: 03/22/2024] [Indexed: 04/06/2024]
Abstract
Service restrictions refer to temporary or permanent bans of individuals from a program or an organization's services, and are widely used in emergency shelter systems. Limited research exists on how service restrictions unfold and their impacts on people experiencing homelessness. This qualitative study used in-depth interviews with timeline mapping to examine the antecedents and consequences of service restrictions from emergency shelters among people experiencing homelessness in two cities in Ontario, Canada. A total of 49 people experiencing homelessness who had been restricted from an emergency shelter program in the past year were recruited and included in the study analysis. A pragmatic and integrative approach was used for data analysis that involved the development of meta-matrices to identify prominent and divergent perspectives and experiences with regard to service restriction antecedents and consequences. Study findings underscored that service restrictions were often the result of violence and aggression, primarily between service users. There were regional differences in other service restriction reasons, including substance use and possession. Service restrictions affected the shelter status of almost all participants, with many subsequently experiencing unsheltered homelessness, and cycling through institutional health, social, and criminal justice services (i.e., institutional circuitry). Other health and social consequences included substance use relapses and hospitalizations; cold-related injuries due to post-restriction unsheltered homelessness; suicidality; food insecurity; diminished contact with support network and connections; and intense feelings of anger, fear, and hopelessness. Overall, the study findings advance our understanding of the role of homeless services in pathways into unsheltered homelessness and institutional circuitry, which raise critical questions about how to mitigate the harms associated with service restrictions, while concurrently facilitating safety and upholding the rights of people experiencing homelessness and emergency shelter staff.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada.
| | - Carrie Anne Marshall
- Western University, School of Occupational Therapy, 1201 Western Road, London, Ontario, Canada
| | - Alexia Polillo
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Joseph Voronov
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Timothy de Pass
- Centre for Addiction and Mental Health, 60 White Squirrel Way, Toronto, Ontario, Canada
| | - Corinna Easton
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada
| | - Brooklyn Ward
- Western University, Faculty of Health Sciences, 1201 Western Road, London, Ontario, Canada; Ottawa Hospital Research Institute, Clinical Epidemiology Program, 1919 Riverside Drive, Ottawa, Ontario, Canada
| | - Amanda Noble
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Factor-Inwentash Faculty of Social Work, 246 Bloor Street West, Toronto, Ontario, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Unity Health Toronto, 30 Bond Street, Toronto, Ontario, Canada; University of Toronto, Division of General Internal Medicine, 1 King's College Circle, Toronto, Ontario, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1025 Queen Street West, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, 1051 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, 1025 Queen Street West, Toronto, Ontario, Canada; University of Toronto, Department of Psychiatry, 1051 Queen Street West, Toronto, Ontario, Canada
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Murnan AW, Keim SA, Klebanoff MA. Exploration of Differences between Women Who Do and Do Not Disclose Their Marijuana Use during Pregnancy. Am J Perinatol 2024; 41:902-908. [PMID: 35240705 PMCID: PMC10008515 DOI: 10.1055/a-1787-6889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study aimed to explore demographic and health-related factors that may differentiate women who do and do not disclose their marijuana use during pregnancy. STUDY DESIGN The current study is a secondary analysis of data from a prospective cohort of pregnant women identified as using marijuana during pregnancy via a variety of assessment tools including self-report, urine screen, and obstetrics record abstraction. The cohort included a convenience sample of women recruited from several antenatal clinics at The Ohio State University Wexner Medical Center (OSUWMC). To be eligible, women needed to be within the first or second trimester of their pregnancy, 16 to 50 years of age, able to communicate in English, and intended to deliver at OSUWMC. Chi-square, independent samples t-tests, and logistic regression analyses were used to explore differences between those who did and did not disclose their use in relation to physical and mental health diagnoses, adverse experiences, use of other substances, and demographics. RESULTS Women who used marijuana during their pregnancy and had mental/physical health data available comprised the current sample (n = 109). Women who attended college were more likely to disclose their marijuana use compared with women who did not attend college (p < 0.001). Women who experienced homelessness (p < 0.01) or self-reported alcohol use during pregnancy (p < 0.001) were significantly more likely to disclose their marijuana use. CONCLUSION Findings, suggesting disclosure of other substance use and adverse experiences, such as homelessness, may increase the likelihood that pregnant women will voluntarily disclose their marijuana use to providers. Findings did not reflect racial differences nor significant differences in mental/physical health status among women based on their disclosure. Future research with larger datasets is needed to build on these findings by confirming results, as well as exploring additional factors, that may more effectively differentiate women who are unlikely to disclose their prenatal marijuana use from those who do disclose their use. KEY POINTS · Women with higher education were more likely to self-disclose their prenatal marijuana use.. · Women who experienced homelessness were more likely to self-disclose their prenatal marijuana use.. · Self-disclosure of prenatal alcohol use was related to self-disclosure of prenatal marijuana use.
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Affiliation(s)
- Aaron W Murnan
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
| | - Sarah A Keim
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Division of Epidemiology, The Ohio State University College of Public Health, Columbus, Ohio
| | - Mark A Klebanoff
- Center for Biobehavioral Health, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, Ohio
- Center for Perinatal Research, The Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio
- Department of Obstetrics and Gynecology, The Ohio State University College of Medicine, Columbus, Ohio
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Diaz YDG, Palma D, Vargas-Leguás H, Rodrigo T, Molina-Pinargorte I, Casas X, Forcada N, Santiago J, Altet N, Millet JP. Factors associated with referrals for directly observed treatment and unsuccessful treatment. Int J Tuberc Lung Dis 2024; 28:237-242. [PMID: 38659139 DOI: 10.5588/ijtld.23.0396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To describe the characteristics of people indicated for directly observed treatment (DOT) in Spain, and the factors associated with unsuccessful treatment.METHODS This was a multicentre observational study based on a prospective follow-up of patients over 18 years old diagnosed with TB between 2006 and 2019 from the registry of the Programa Integrado de Investigación en Tuberculosis (PII-TB). Sociodemographic and clinical variables were collected. Adjusted odds ratios (aORs) were calculated for the indication of DOT and for having an unsuccessful treatment.RESULTS A total of 7,883 patients were included. The indication of DOT was associated with being homeless (aOR 5.93, 95% CI 3.03-11.59), inactivity status (aOR 2.55, 95% CI 2.02-3.23), alcohol consumption (aOR 1.94, 95% CI 1.51-2.48), parenteral drug use (aOR 1.77, 95% CI 1.06-2.95) and HIV diagnosis (aOR 1.96, 95% CI 1.16-3.29). Unsuccessful treatment was associated with having an HIV diagnosis (aPR 2.31, 95% CI 1.31-4.08), having a worse clinical and radiological evolution (clinical progression: APR 15.59, 95% CI 8.21-29.60; radiological progression: aPR 12.84, 95% CI 6.46-25.52), need for hospitalisation (aPR 1.73, 95% CI 1.10-2.73), unsatisfactory tolerability (aPR 2.82, 95% CI 1.49-5.29), the existence of difficulties in understanding the prescribed treatment (aPR 1.92, 95% CI 1.21-3.06), as well as worse treatment satisfaction (aPR 7.27, 95% CI 4.32-12.24).CONCLUSION The prioritisation of vulnerable populations is a key aspect to carry out the new Global Plan to End TB 2023-2030. In these groups DOT indication should be increased to ensure adherence and patient follow-up and outcomes..
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Affiliation(s)
| | - D Palma
- Agència de Salut Pública de Barcelona, Servei d'Epidemiologia, Barcelona, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid
| | - H Vargas-Leguás
- Serveis Clínics, Barcelona, Agència de Salut Pública de Barcelona, Servei d'Epidemiologia, Barcelona
| | - T Rodrigo
- Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, Spain
| | | | | | | | | | | | - J-P Millet
- Serveis Clínics, Barcelona, Agència de Salut Pública de Barcelona, Servei d'Epidemiologia, Barcelona, Centro de Investigación Biomédica en Red de Epidemiología y Salud Pública (CIBERESP), Madrid, Programa Integrado de Investigación en Tuberculosis (PII-TB) de la Sociedad Española de Neumología y Cirugía Torácica (SEPAR), Barcelona, Fundación Unidad de Investigación en Tuberculosis (fuiTB), Barcelona, Spain
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Rew L, Slesnick N, Kesler S, Rhee H. Mediation of Psychological Capital in Youth Experiencing Homelessness. Nurs Res 2024; 73:188-194. [PMID: 38652691 PMCID: PMC11047266 DOI: 10.1097/nnr.0000000000000722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND Youth who experience homelessness engage in behaviors that place them at high risk for disease and injury. Despite their health risk behaviors, these youth display psychological capital, positive attributes of hope, efficacy, resilience, and optimism that motivate them to engage in health-promoting behaviors such as safer sex. However, this array of positive psychological attributes has not been studied in this vulnerable population. OBJECTIVES The specific aim of this analysis was to determine whether factors of psychological capital mediated the relationship between background risk factors (e.g., race/ethnicity, educational attainment, reason for being homeless, sexual abuse history, and HIV status) and outcomes of condom intention, safer sex behaviors, and life satisfaction among youth who participated in a longitudinal intervention study. METHODS Using a Solomon four-group design, 602 youth were recruited from drop-in centers in two large cities (Columbus, Ohio, and Austin, Texas) to participate in a brief intervention that included outcomes of enhanced communication skills, goal setting, safer sex behaviors, drug refusal skills, and life satisfaction. Using an autoregressive, cross-lagged, longitudinal mediation model, we tested the direct and indirect effects of background factors, psychological capital, and intervention outcomes. Models were tested for the intervention group alone and the total sample. RESULTS There were no significant direct or indirect effects of background factors on intervention outcomes among the intervention group, and the model fit was poor. There were also no significant mediating paths via factors of psychological capital and poor model fit for the combined group. DISCUSSION Findings provide important information about intrinsic strengths of youth experiencing homelessness and psychological capital as a significant construct for understanding health behaviors among disadvantaged and underserved youth. The lack of significant mediation effects may have been due, in part, to the lack of a robust measure of psychological capital. Further study with various background factors and outcomes would contribute further to our understanding of how best to support this population.
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Choudhury S, Choi SL, Lee Y, Manser SS. Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas. Health Soc Work 2024; 49:87-94. [PMID: 38478764 DOI: 10.1093/hsw/hlae002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 08/17/2023] [Accepted: 09/08/2023] [Indexed: 04/30/2024]
Abstract
Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.
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Affiliation(s)
- Sumaita Choudhury
- MPH, is a doctoral candidate and research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, 1823 Red River Street, Austin, TX 78712, USA
| | - Sharon Lee Choi
- PhD, is a research associate, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Yehyang Lee
- MS, is a graduate research assistant, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
| | - Stacey Stevens Manser
- PhD, is a research scientist and associate director, Texas Institute for Excellence in Mental Health, Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, USA
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Meehan AA, Milazzo KE, Bien M, Nall SK, Vickery KD, Mosites E, Barocas JA. Involuntary displacement and self-reported health in a cross-sectional survey of people experiencing homelessness in Denver, Colorado, 2018-2019. BMC Public Health 2024; 24:1159. [PMID: 38664800 PMCID: PMC11044435 DOI: 10.1186/s12889-024-18681-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 04/22/2024] [Indexed: 04/29/2024] Open
Abstract
BACKGROUND The number of people experiencing unsheltered homelessness in the U.S. is increasing. Municipalities have responded with punitive responses such as involuntary displacement (i.e., encampment sweeps, move along orders), but little is known about the impact of involuntary displacement on health. The purpose of this study was to investigate the association between broadly defined experiences of involuntary displacement and self-reported health conditions among people experiencing homelessness. METHODS We used logistic regression models to generate odds ratios using publicly available data from a cross-sectional sample of people experiencing homelessness in Denver, Colorado, during September 2018-February 2019. Hosmer-Lemeshow Goodness of Fit tests were used to assess model fit. RESULTS Among 397 people experiencing homelessness, involuntary displacement was significantly associated with self-reported infectious diseases (adjusted odds ratio (aOR) 2.09, 95% CI 1.27, 3.41), substance and alcohol use (aOR 2.83; 95% CI 1.70, 4.73), climate-related conditions (aOR 2.27; 95% CI 1.35, 3.83), and worsening mental health (aOR 2.00; 95% CI 1.24, 3.24) after controlling for potential confounders. No statistically significant associations were identified between involuntary displacement and injuries, musculoskeletal issues, chronic conditions, and chronic mental and emotional issues. CONCLUSIONS This research quantifies the association between involuntary displacement and multiple infectious and non-infectious health outcomes. While city officials attempt to grapple with increasing unsheltered homelessness, it is important to understand what harms are occurring that are associated with current policies. Our research adds to the growing body of literature that involuntary displacement is a harmful response to unsheltered homelessness. Alternative approaches focused on connections to housing and social services should be prioritized.
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Affiliation(s)
- Ashley A Meehan
- Department of Health, Behavior, and Society, Johns Hopkins Bloomberg School of Public Health, 624 N. Broadway, Baltimore, MD, 21205, USA.
| | | | - Michael Bien
- National Foundation for the Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Samantha K Nall
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
| | - Katherine Diaz Vickery
- Health, Homelessness, & Criminal Justice Lab, Hennepin Health Care Research Institute, Minneapolis, MN, USA
| | - Emily Mosites
- Office of Readiness and Response, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Joshua A Barocas
- Divisions of General Internal Medicine and Infectious Diseases, University of Colorado School of Medicine, Aurora, CO, USA
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Ball MAZ, Sack DE, Druffner SA, Jones I, Wrenn JO, Sexton MM, Shinn M, Hess JJ. Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED. JAMA Netw Open 2024; 7:e248565. [PMID: 38669017 PMCID: PMC11053378 DOI: 10.1001/jamanetworkopen.2024.8565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2023] [Accepted: 02/28/2024] [Indexed: 04/29/2024] Open
Abstract
Importance Unstable housing and homelessness can exacerbate adverse health outcomes leading to increased risk of chronic disease, injury, and disability. However, emergency departments (EDs) have no universal method to identify those at risk of or currently experiencing homelessness. Objective To describe the extent of housing insecurity among patients who seek care in an urban ED, including chief concerns, demographics, and patterns of health care utilization. Design, Setting, and Participants This cross-sectional study included all adult patients presenting to the ED at Vanderbilt University Medical Center (VUMC), an urban tertiary care, level I trauma center in the Southeast US, from January 5 to May 16, 2023. Main Outcomes and Measures The primary outcome was the proportion of ED visits at which patients screened positive for housing insecurity. Secondary outcomes included prevalence of insecurity by chief concerns, demographics, and patterns of health care utilization. Results Of all 23 795 VUMC ED visits with screenings for housing insecurity (12 465 visits among women [52%]; median age, 47 years [IQR, 32-48 years]), in 1185 (5%), patients screened positive for current homelessness or housing insecurity (660 unique patients); at 22 610 visits (95%), the screening result was negative. Of visits with positive results, the median age of patients was 46 years (IQR, 36-55 years) and 829 (70%) were among male patients. Suicide and intoxication were more common chief concerns among visits at which patients screened positive (132 [11%] and 118 [10%], respectively) than among those at which patients screened negative (220 [1%] and 335 [2%], respectively). Visits with positive results were more likely to be among patients who were uninsured (395 [33%] vs 2272 [10%]) and had multiple visits during the study period. A higher proportion of positive screening results occurred between 8 pm and 6 am. The social work team assessed patients at 919 visits (78%) with positive screening results. Conclusions and Relevance In this cross-sectional study of 23 795 ED visits, at 5% of visits, patients screened positive for housing insecurity and were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. This analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity to achieve equitable health care.
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Affiliation(s)
| | - Daniel E. Sack
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Medicine, University of Pennsylvania, Philadelphia
| | | | - Ian Jones
- Department of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jesse O. Wrenn
- Department of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Mitchell M. Sexton
- Department of Emergency Medicine and Biomedical Informatics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Marybeth Shinn
- Vanderbilt University Peabody College, Nashville, Tennessee
| | - Jennifer J. Hess
- Vanderbilt University School of Medicine, Nashville, Tennessee
- Department of Emergency Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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Gilmore E, Duncan K, Ades V. Homelessness in Pregnancy and Increased Risk of Adverse Outcomes: A Retrospective Cohort Study. J Urban Health 2024; 101:383-391. [PMID: 38478248 PMCID: PMC11052971 DOI: 10.1007/s11524-024-00839-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/07/2024] [Indexed: 04/28/2024]
Abstract
Limited data indicates that homelessness during pregnancy is linked to adverse outcomes for both mothers and newborns, but there is an information gap surrounding pregnant individuals struggling with homelessness. In a landscape of increasing healthcare disparities, housing shortages and maternal mortality, information on this vulnerable population is fundamental to the creation of targeted interventions and outreach. The current study investigates homelessness as a risk factor for adverse obstetrical, neonatal, and postpartum outcomes. We reviewed more than 1000 deliveries over 1 year at a large public hospital in New York City, comparing homeless subjects to a group of age-matched, stably housed controls. Multiple outcomes were assessed regarding obstetrical, neonatal, and postpartum outcomes along with social stressors. Homeless pregnant individuals were more likely to experience numerous adverse outcomes, including cesarean delivery and preterm delivery. Their neonates were more likely to undergo an extended stay in the intensive care unit and evaluation by the Administration for Children's Services, suggesting that they may be at an increased risk for family separation. After delivery, patients were less likely to exclusively breastfeed or return for their postpartum visit. Regarding personal history, they were more likely to endorse a history of violence or abuse, use illicit substances, and carry a psychiatric diagnosis. These findings indicate that homelessness is linked to numerous adverse obstetrical, neonatal, and postpartum outcomes that worsen health indices and exacerbate pre-existing disparities. Initiatives must focus on improved outreach and care delivery for homeless pregnant individuals.
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Affiliation(s)
- Emma Gilmore
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA.
- Department of Obstetrics and Gynecology, University of Pennsylvania, 3737 Market Street, Philadelphia, PA, 19104, USA.
| | - Karen Duncan
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
| | - Veronica Ades
- Department of Obstetrics and Gynecology, New York University Grossman School of Medicine, 550 First Avenue, New York, NY, 10016, USA
- Department of Obstetrics, Gynecology and Women's Health, Albert Einstein College of Medicine, Jacobi Medical Center, 1400 Pelham Parkway South, Building 1, BS27, Bronx, NY, 10461, USA
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Tetzlaff EJ, Mourad F, Goulet N, Gorman M, Siblock R, Kidd SA, Bezgrebelna M, Kenny GP. " Death Is a Possibility for Those without Shelter": A Thematic Analysis of News Coverage on Homelessness and the 2021 Heat Dome in Canada. Int J Environ Res Public Health 2024; 21:405. [PMID: 38673318 PMCID: PMC11050128 DOI: 10.3390/ijerph21040405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Revised: 03/20/2024] [Accepted: 03/22/2024] [Indexed: 04/28/2024]
Abstract
Among the most vulnerable to the health-harming effects of heat are people experiencing homelessness. However, during the 2021 Heat Dome, the deadliest extreme heat event (EHE) recorded in Canada to date, people experiencing homelessness represented the smallest proportion of decedents (n = 3, 0.5%)-despite the impacted region (British Columbia) having some of the highest rates of homelessness in the country. Thus, we sought to explore the 2021 Heat Dome as a media-based case study to identify potential actions or targeted strategies that were initiated by community support agencies, individuals and groups, and communicated in the news during this EHE that may have aided in the protection of this group or helped minimize the mortality impacts. Using media articles collated for a more extensive investigation into the effects of the 2021 Heat Dome (n = 2909), we identified a subset which included content on people experiencing homelessness in Canada (n = 274, 9%). These articles were thematically analysed using NVivo. Three main themes were identified: (i) public warnings issued during the 2021 Heat Dome directly addressed people experiencing homelessness, (ii) community support services explicitly targeting this population were activated during the heat event, and (iii) challenges and barriers faced by people experiencing homelessness during extreme heat were communicated. These findings suggest that mass-media messaging and dedicated on-the-ground initiatives led by various organizations explicitly initiated to support individuals experiencing homelessness during the 2021 Heat Dome may have assisted in limiting the harmful impacts of the heat on this community.
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Affiliation(s)
- Emily J. Tetzlaff
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Farah Mourad
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
| | - Nicholas Goulet
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Melissa Gorman
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Rachel Siblock
- Climate Change and Innovation Bureau, Healthy Environments and Consumer Safety Branch, Safe Environments Directorate, Health Canada, 269 Laurier Avenue W., Ottawa, ON K1A 0P8, Canada; (M.G.); (R.S.)
| | - Sean A. Kidd
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, 1001 Queen Street W., Toronto, ON M6J 1H4, Canada; (S.A.K.); (M.B.)
- Department of Psychiatry, University of Toronto, 250 College Street, 8th Floor, Toronto, ON M5T 1R8, Canada
| | - Mariya Bezgrebelna
- Slaight Family Centre for Youth in Transition, Centre for Addiction and Mental Health, 1001 Queen Street W., Toronto, ON M6J 1H4, Canada; (S.A.K.); (M.B.)
| | - Glen P. Kenny
- Human and Environmental Physiology Research Unit, School of Human Kinetics, University of Ottawa, 125 University Private, Ottawa, ON K1N 6N5, Canada; (E.J.T.); (F.M.)
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON K1Y 4E9, Canada
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11
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So M, Davis L, Barnes AJ, Freese R, Atella J, Shlafer RJ. Health and care utilization among youth with a history of parental incarceration and homelessness. Fam Syst Health 2024; 42:90-100. [PMID: 37498706 DOI: 10.1037/fsh0000830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/29/2023]
Abstract
INTRODUCTION Despite widespread recognition of the health and social risks posed by parental incarceration (PI) and homelessness, these challenges are rarely considered in unison. We sought to (a) assess the experiences of homelessness among youth with and without a history of PI and (b) compare the health and healthcare utilization among youth with a combined history of PI and homelessness. METHOD Examining data from eighth-, ninth-, and 11th-grade public school participants in the 2019 Minnesota Student Survey (N = 110,904), we calculated univariate and multivariate analyses to characterize the health status and care utilization of youth who have experienced PI, past-year homelessness, or both. RESULTS We observed higher prevalence of homelessness among youth with a history of PI compared to those without. The group with dual PI-homelessness experience had a higher proportion of youth that were younger, male, and non-White; and living in poverty or urban areas compared to youth with PI history only. Even after accounting for demographic factors, the dual PI-homelessness group evidenced higher expected odds for several physical health conditions (e.g., asthma, diabetes), and differences in care utilization indicators relative to individual PI and homelessness groups. DISCUSSION Findings suggest that PI may be overrepresented among recently homeless youth and that youth with such dual experience possess distinct, and often elevated, health service needs. Health, education, housing, and other systems may need intersectoral strategies to better identify and support this at-risk subset of youth through clinical and policy approaches. (PsycInfo Database Record (c) 2024 APA, all rights reserved).
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Affiliation(s)
- Marvin So
- University of Minnesota Medical School
| | - Laurel Davis
- Department of Pediatrics, University of Minnesota Medical School
| | - Andrew J Barnes
- Department of Pediatrics, University of Minnesota Medical School
| | - Rebecca Freese
- Clinical and Translational Science Institute, University of Minnesota
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12
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Nambiar D, Mathew B, Dubey S, Moola S. Interventions addressing maternal and child health among the urban poor and homeless: an overview of systematic reviews. BMC Public Health 2023; 23:492. [PMID: 36918855 PMCID: PMC10015840 DOI: 10.1186/s12889-023-15410-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Accepted: 03/09/2023] [Indexed: 03/16/2023] Open
Abstract
BACKGROUND Inequalities in access to and utilization of maternal and child health (MCH) care are hampering progress on the path to achieving the Sustainable Development Goals. In a number of Low- and Middle-Income Countries (LMICs) population subgroups at disproportionate risk of being left behind are the urban poor. Within this neglected group is the further neglected group of the homeless. Concomitantly, a number of interventions from the antenatal period onward have been piloted, tested, and scaled in these contexts. We carried out an overview of systematic reviews (SRs) to characterize the evidence around maternal and child health interventions relevant to urban poor homeless populations in LMICs. METHODS We searched Medline, Cochrane Library, Health Systems Evidence and EBSCOhost databases for SRs published between January 2009 and 2020 (with an updated search through November 2021). Our population of interest was women or children from urban poor settings in LMICs; interventions and outcomes corresponded with the World Health Organization's (WHO) guidance document. Each SR was assessed by two reviewers using established standard critical appraisal checklists. The overview was registered in PROSPERO (ID: CRD42021229107). RESULTS In a sample of 33 high quality SRs, we found no direct relevant evidence for pregnant and lactating homeless women (and children) in the reviewed literature. There was a lack of emphasis on evidence related to family planning, safe abortion care, and postpartum care of mothers. There was mixed quality evidence that the range of nutritional interventions had little, unclear or no effect on several child mortality and development outcomes. Interventions related to water, sanitation, and hygiene, ensuring acceptability of community health services and health promotion type programs could be regarded as beneficial, although location seemed to matter. Importantly, the risk of bias reporting in different reviews did not match, suggesting that greater attention to rigour in their conduct is needed. CONCLUSION The generalizability of existing systematic reviews to our population of interest was poor. There is a clear need for rigorous primary research on MCH interventions among urban poor, and particularly homeless populations in LMICs, as it is as yet unclear whether the same, augmented, or altogether different interventions would be required.
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Affiliation(s)
- Devaki Nambiar
- The George Institute for Global Health, 308 Elegance Tower, Jasola District Centre, 110025, New Delhi, India.
| | | | - Shubhankar Dubey
- Indian Council of Medical Research- Regional Medical Research Center, Bhubaneswar, Odisha, India
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13
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Foster MA, Hofmeister MG, Yin S, Montgomery MP, Weng MK, Eckert M, Nelson NP, Mermin J, Wester C, Teshale EH, Gupta N, Cooley LA. Widespread Hepatitis A Outbreaks Associated with Person-to-Person Transmission — United States, 2016–2020. MMWR Morb Mortal Wkly Rep 2022; 71:1229-1234. [PMID: 36173747 PMCID: PMC9533732 DOI: 10.15585/mmwr.mm7139a1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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14
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Taparra K, Egan A, Kanagusuku L. Mental Health and Substance Use Among US Homeless Adolescents. JAMA 2022; 328:889-890. [PMID: 36066525 DOI: 10.1001/jama.2022.11622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Kekoa Taparra
- Department of Radiation Oncology, Stanford Health Care, Stanford, California
| | - Alana Egan
- Department of Clinical Psychology, University of Rhode Island, Kingston
| | - Leimomi Kanagusuku
- Department of Family Medicine and Community Health, University of Hawai'i, Aiea
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15
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Liu M, Wadhera RK. Mental Health and Substance Use Among US Homeless Adolescents-Reply. JAMA 2022; 328:890. [PMID: 36066522 DOI: 10.1001/jama.2022.11625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Michael Liu
- Harvard Medical School, Boston, Massachusetts
| | - Rishi K Wadhera
- Richard A. and Susan F. Smith Center for Outcomes Research, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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16
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Aranda-Díaz A, Imbert E, Strieff S, Graham-Squire D, Evans JL, Moore J, McFarland W, Fuchs J, Handley MA, Kushel M. Implementation of rapid and frequent SARS-CoV2 antigen testing and response in congregate homeless shelters. PLoS One 2022; 17:e0264929. [PMID: 35271622 PMCID: PMC8912252 DOI: 10.1371/journal.pone.0264929] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 02/20/2022] [Indexed: 11/18/2022] Open
Abstract
Background People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses. Methods We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation. Results Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study. Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters. Adoption: We offered testing to all eligible participants within weeks of the project’s initiation. Implementation: Adaptations made to increase reach and improve consistency were promptly implemented. Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot. Conclusion Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.
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Affiliation(s)
- Andrés Aranda-Díaz
- Department of Bioengineering, Stanford University, Stanford, California, United States of America
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- * E-mail:
| | - Elizabeth Imbert
- Division of HIV, ID and Global Medicine, University of California, San Francisco, California, United States of America
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
| | - Sarah Strieff
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Dave Graham-Squire
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jennifer L. Evans
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
| | - Jamie Moore
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Willi McFarland
- San Francisco Department of Public Health, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
| | - Jonathan Fuchs
- San Francisco Department of Public Health, San Francisco, California, United States of America
| | - Margaret A. Handley
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, United States of America
- UCSF PRISE Center: Partnerships for Research in Implementation Science for Equity, San Francisco, California, United States of America
| | - Margot Kushel
- UCSF Benioff Homelessness and Housing Initiative, San Francisco, California, United States of America
- UCSF Center for Vulnerable Populations, University of California, San Francisco, California, United States of America
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Abstract
IMPORTANCE There has been recent media attention on the risk of excess mortality among homeless individuals during the COVID-19 pandemic, yet data on these deaths are limited. OBJECTIVES To quantify and describe deaths among people experiencing homelessness in San Francisco during the COVID-19 pandemic and to compare the characteristics of these deaths with those in prior years. DESIGN, SETTING, AND PARTICIPANTS A cross-sectional study tracking mortality among people experiencing homelessness from 2016 to 2021 in San Francisco, California. All deceased individuals who were homeless in San Francisco at the time of death and whose deaths were processed by the San Francisco Office of the Chief Medical Examiner were included. Data analysis was performed from August to October 2021. EXPOSURE Homelessness, based on homeless living status in an administrative database. MAIN OUTCOMES AND MEASURES Descriptive statistics were used to understand annual trends in demographic characteristics, cause and manner of death (based on autopsy), substances present in toxicology reports, geographic distribution of deaths, and use of health and social services prior to death. Total estimated numbers of people experiencing homelessness in San Francisco were assessed through semiannual point-in-time counts. The 2021 point-in-time count was postponed owing to the COVID-19 pandemic. RESULTS In San Francisco, there were 331 deaths among people experiencing homelessness in the first year of the COVID-19 pandemic (from March 17, 2020, to March 16, 2021). This number was more than double any number in previous years (eg, 128 deaths in 2016, 128 deaths in 2017, 135 deaths in 2018, and 147 deaths in 2019). Most individuals who died were male (268 of 331 [81%]). Acute drug toxicity was the most common cause of death in each year, followed by traumatic injury. COVID-19 was not listed as the primary cause of any deaths. The proportion of deaths involving fentanyl increased each year (present in 52% of toxicology reports in 2019 and 68% during the pandemic). Fewer decedents had contacts with health services in the year prior to their death during the pandemic than in prior years (13% used substance use disorder services compared with 20% in 2019). CONCLUSIONS AND RELEVANCE In this cross-sectional study, the number of deaths among people experiencing homelessness in San Francisco increased markedly during the first year of the COVID-19 pandemic. These findings may guide future interventions to reduce mortality among individuals experiencing homelessness.
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Affiliation(s)
- Caroline Cawley
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Hemal K. Kanzaria
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
| | - Barry Zevin
- Street Medicine and Shelter Health, San Francisco Department of Public Health, San Francisco, California
| | - Kelly M. Doran
- Departments of Emergency Medicine and Population Health, New York University Grossman School of Medicine, New York
| | - Margot Kushel
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
| | - Maria C. Raven
- Department of Emergency Medicine, University of California, San Francisco
- Benioff Homelessness and Housing Initiative, Center for Vulnerable Populations, University of California, San Francisco
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco
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18
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Chun SY, Yoo JW, Park H, Hwang J, Kim PC, Park S, Shen JJ. Trends and age-related characteristics of substance use in the hospitalized homeless population. Medicine (Baltimore) 2022; 101:e28917. [PMID: 35212298 PMCID: PMC8878700 DOI: 10.1097/md.0000000000028917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/24/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.
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Affiliation(s)
- Sung-youn Chun
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ji W. Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV
| | - Hyeki Park
- Department of International Cooperation, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Pearl C. Kim
- Department of Healthcare Administration and Policy, University of Nevada Las Vegas School of Public Health, Las Vegas, NV
| | - Seong Park
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
| | - Jay J. Shen
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
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19
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Stone J, Artenie A, Hickman M, Martin NK, Degenhardt L, Fraser H, Vickerman P. The contribution of unstable housing to HIV and hepatitis C virus transmission among people who inject drugs globally, regionally, and at country level: a modelling study. Lancet Public Health 2022; 7:e136-e145. [PMID: 35012711 PMCID: PMC8848679 DOI: 10.1016/s2468-2667(21)00258-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2021] [Revised: 10/27/2021] [Accepted: 11/10/2021] [Indexed: 01/12/2023]
Abstract
BACKGROUND A considerable proportion of people who inject drugs are unstably housed. Although unstable housing is associated with HIV and HCV infection among people who inject drugs, its contribution to transmission is unknown. We estimated the global and national proportions of incident HIV and HCV infections among people who inject drugs attributed to housing instability from 2020 to 2029. METHODS In this modelling study, we developed country-level models of unstable housing and HIV and HCV transmission among people who inject drugs in 58 countries globally, calibrated to country-specific data on the prevalences of HIV and HCV and unstable housing. Based on a recently published systematic review, unstably housed people who inject drugs were assumed to have a 39% (95% CI 6-84) increased risk of HIV transmission and a 64% (95% CI 43-89%) increased risk of HCV transmission. We used pooled country-level estimates from systematic reviews on HCV and HIV prevalence in people who inject drugs. Our models estimated the transmission population attributable fraction (tPAF) of unstable housing to HIV and HCV transmission among people who inject drugs, defined as the percentage of infections prevented from 2020 to 2029 if the additional risk due to unstable housing was removed. FINDINGS Our models were produced for 58 countries with sufficient data (accounting for >66% of the global people who inject drugs population). Globally, we project unstable housing contributes 7·9% (95% credibility interval [CrI] 2·3-15·7) of new HIV infections and 11·2% (7·7-15·5) of new HCV infections among people who inject drugs from 2020 to 2029. Country-level tPAFs were strongly associated with the prevalence of unstable housing. tPAFs were greater in high-income countries (HIV 17·2% [95% CrI 5·1-30·0]; HCV 19·4% [95% CrI 13·8-26·0]) than in low-income or middle-income countries (HIV 6·6% [95% CrI 1·8-13·1]; HCV 8·3% [95% CrI 5·5-11·7]). tPAFs for HIV and HCV were highest in Afghanistan, Czech Republic, India, USA, England, and Wales where unstable housing contributed more than 20% of new HIV and HCV infections. INTERPRETATION Unstable housing is an important modifiable risk factor for HIV and HCV transmission among people who inject drugs in many countries. The study emphasises the importance of implementing initiatives to mitigate these risks and reduce housing instability. FUNDING National Institute for Health Research and National Institute of Allergy and Infectious Diseases and National Institute for Drug Abuse.
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Affiliation(s)
- Jack Stone
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Adelina Artenie
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Matthew Hickman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
| | - Natasha K Martin
- Division of Global Public Health, University of California San Diego, San Diego, CA, USA
| | - Louisa Degenhardt
- National Drug and Alcohol Research Centre, UNSW Sydney, Sydney, NSW, Australia
| | - Hannah Fraser
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Peter Vickerman
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; NIHR Health Protection Research Unit in Behavioural Science and Evaluation, University of Bristol, Bristol, UK
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Győrffy Z, Békási S, Döbrössy B, Bognár VK, Radó N, Morva E, Zsigri S, Tari P, Girasek E. Exploratory attitude survey of homeless persons regarding telecare services in shelters providing mid- and long-term accommodation: The importance of trust. PLoS One 2022; 17:e0261145. [PMID: 34990458 PMCID: PMC8735598 DOI: 10.1371/journal.pone.0261145] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 11/24/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND With the expansion of digital health, it is imperative to consider intervention techniques in order not to be the cause of even more social health inequalities in underserved populations struggling with chronic diseases. Telemedicine solutions for homeless persons might compensate for shortcomings in access to valuable health services in different settings. The main aim of our research was to examine the attitudes and openness of homeless persons regarding telecare on a Hungarian sample. METHODS Quantitative survey among homeless people (n = 98) was completed in 4 shelters providing mid- and long-term accommodation in Budapest, Hungary. Attitudes regarding healthcare service accessibility and telecare were measured by a self-developed questionnaire of the research team. Telecare attitude comparison was made with data of a Hungarian weighted reference group of non-homeless persons recruited from 2 primary care units (n = 110). RESULTS A significant fraction of homeless people with mid- or long-term residency in homeless shelters did not oppose the use of telecare via live online video consultation and there was no difference compared to the national reference group (averages of 3.09 vs. 3.15, respectively). Results of the homeless group indicate that those more satisfied with healthcare services, in general, manifest more openness to telecare. It is clearly demonstrated by the multivariate analysis that those participants in the homeless group who had problems getting health care in the last year definitely preferred in-person doctor-patient consultations. CONCLUSION Digital health technologies offer a potentially important new pathway for the prevention and treatment of chronic conditions among homeless persons. Based on the attitudes towards telecare, initiating an on-site telecare program for mid- and long-term residents of homeless shelters might enable better care continuity. Our results draw attention to the key factors including building trust in the implementation of such programs among underserved and other vulnerable patient groups.
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Affiliation(s)
- Zsuzsa Győrffy
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Sándor Békási
- Health Center, Hungarian Charity Service of the Order of Malta, Budapest, Hungary
- Telemedicine Workgroup, FitPuli Kft., Győr, Hungary
| | - Bence Döbrössy
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Virág Katalin Bognár
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Nóra Radó
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
| | - Emília Morva
- Regional Directorate, Hungarian Charity Service of the Order of Malta, Budapest, Hungary
| | | | | | - Edmond Girasek
- Faculty of Medicine, Institute of Behavioural Sciences, Semmelweis University, Budapest, Hungary
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Montgomery MP, Hong K, Clarke KEN, Williams S, Fukunaga R, Fields VL, Park J, Schieber LZ, Kompaniyets L, Ray CM, Lambert LA, D’Inverno AS, Ray TK, Jeffers A, Mosites E. Hospitalizations for COVID-19 Among US People Experiencing Incarceration or Homelessness. JAMA Netw Open 2022; 5:e2143407. [PMID: 35024835 PMCID: PMC8759002 DOI: 10.1001/jamanetworkopen.2021.43407] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
IMPORTANCE People experiencing incarceration (PEI) and people experiencing homelessness (PEH) have an increased risk of COVID-19 exposure from congregate living, but data on their hospitalization course compared with that of the general population are limited. OBJECTIVE To compare COVID-19 hospitalizations for PEI and PEH with hospitalizations among the general population. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional analysis used data from the Premier Healthcare Database on 3415 PEI and 9434 PEH who were evaluated in the emergency department or were hospitalized in more than 800 US hospitals for COVID-19 from April 1, 2020, to June 30, 2021. EXPOSURES Incarceration or homelessness. MAIN OUTCOMES AND MEASURES Hospitalization proportions were calculated. and outcomes (intensive care unit admission, invasive mechanical ventilation [IMV], mortality, length of stay, and readmissions) among PEI and PEH were compared with outcomes for all patients with COVID-19 (not PEI or PEH). Multivariable regression was used to adjust for potential confounders. RESULTS In total, 3415 PEI (2952 men [86.4%]; mean [SD] age, 50.8 [15.7] years) and 9434 PEH (6776 men [71.8%]; mean [SD] age, 50.1 [14.5] years) were evaluated in the emergency department for COVID-19 and were hospitalized more often (2170 of 3415 [63.5%] PEI; 6088 of 9434 [64.5%] PEH) than the general population (624 470 of 1 257 250 [49.7%]) (P < .001). Both PEI and PEH hospitalized for COVID-19 were more likely to be younger, male, and non-Hispanic Black than the general population. Hospitalized PEI had a higher frequency of IMV (410 [18.9%]; adjusted risk ratio [aRR], 1.16; 95% CI, 1.04-1.30) and mortality (308 [14.2%]; aRR, 1.28; 95% CI, 1.11-1.47) than the general population (IMV, 88 897 [14.2%]; mortality, 84 725 [13.6%]). Hospitalized PEH had a lower frequency of IMV (606 [10.0%]; aRR, 0.64; 95% CI, 0.58-0.70) and mortality (330 [5.4%]; aRR, 0.53; 95% CI, 0.47-0.59) than the general population. Both PEI and PEH had longer mean (SD) lengths of stay (PEI, 9 [10] days; PEH, 11 [26] days) and a higher frequency of readmission (PEI, 128 [5.9%]; PEH, 519 [8.5%]) than the general population (mean [SD] length of stay, 8 [10] days; readmission, 28 493 [4.6%]). CONCLUSIONS AND RELEVANCE In this cross-sectional study, a higher frequency of COVID-19 hospitalizations for PEI and PEH underscored the importance of adhering to recommended prevention measures. Expanding medical respite may reduce hospitalizations in these disproportionately affected populations.
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Affiliation(s)
- Martha P. Montgomery
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kai Hong
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristie E. N. Clarke
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Samantha Williams
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Rena Fukunaga
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Victoria L. Fields
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Joohyun Park
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyna Z. Schieber
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lyudmyla Kompaniyets
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Colleen M. Ray
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Lauren A. Lambert
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ashley S. D’Inverno
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tapas K. Ray
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Alexiss Jeffers
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emily Mosites
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia
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22
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Fine DR, Dickins KA, Adams LD, De Las Nueces D, Weinstock K, Wright J, Gaeta JM, Baggett TP. Drug Overdose Mortality Among People Experiencing Homelessness, 2003 to 2018. JAMA Netw Open 2022; 5:e2142676. [PMID: 34994792 PMCID: PMC8742197 DOI: 10.1001/jamanetworkopen.2021.42676] [Citation(s) in RCA: 34] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 11/09/2021] [Indexed: 11/14/2022] Open
Abstract
Importance Despite high rates of drug overdose death among people experiencing homelessness, patterns in drug overdose mortality, including the types of drugs implicated in overdose deaths, remain understudied in this population. Objective To describe the patterns in drug overdose mortality among a large cohort of people experiencing homelessness in Boston vs the general adult population of Massachusetts and to evaluate the types of drugs implicated in overdose deaths over a continuous 16-year period of observation. Design, Setting, and Participants This cohort study analyzed adults aged 18 years or older who received care at Boston Health Care for the Homeless Program (BHCHP) between January 1, 2003, and December 31, 2017. Individuals were followed up from the date of their initial BHCHP encounter during the study period until the date of death or December 31, 2018. Data were analyzed from December 1, 2020, to June 6, 2021. Main Outcomes and Measures Drug overdose deaths and the types of drugs involved in each overdose death were ascertained by linking the BHCHP cohort to the Massachusetts Department of Public Health death records. Results In this cohort of 60 092 adults experiencing homelessness (mean [SD] age at entry, 40.4 [13.1] years; 38 084 men [63.4%]), 7130 individuals died by the end of the study period. A total of 1727 individuals (24.2%) died of a drug overdose. Of the drug overdose decedents, 456 were female (26.4%), 194 were Black (11.2%), 202 were Latinx (11.7%), and 1185 were White (68.6%) individuals, and the mean (SD) age at death was 43.7 (10.8) years. The age- and sex-standardized drug overdose mortality rate in the BHCHP cohort was 278.9 (95% CI, 266.1-292.3) deaths per 100 000 person-years, which was 12 times higher than the Massachusetts adult population. Opioids were involved in 91.0% of all drug overdose deaths. Between 2013 and 2018, the synthetic opioid mortality rate increased from 21.6 to 327.0 deaths per 100 000 person-years. Between 2004 and 2018, the opioid-only overdose mortality rate decreased from 117.2 to 102.4 deaths per 100 000 person-years, whereas the opioid-involved polysubstance mortality rate increased from 44.0 to 237.8 deaths per 100 000 person-years. Among opioid-involved polysubstance overdose deaths, cocaine-plus-opioid was the most common substance combination implicated throughout the study period, with Black individuals having the highest proportion of cocaine-plus-opioid involvement in death (0.72 vs 0.62 in Latinx and 0.53 in White individuals; P < .001). Conclusions and Relevance In this cohort study of people experiencing homelessness, drug overdose accounted for 1 in 4 deaths, with synthetic opioid and polysubstance involvement becoming predominant contributors to mortality in recent years. These findings emphasize the importance of increasing access to evidence-based opioid overdose prevention strategies and opioid use disorder treatment among people experiencing homelessness, while highlighting the need to address both intentional and unintentional polysubstance use in this population.
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Affiliation(s)
- Danielle R. Fine
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kirsten A. Dickins
- Munn Center for Nursing Research, Massachusetts General Hospital, Boston
| | - Logan D. Adams
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Denise De Las Nueces
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | | | - Joseph Wright
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
| | - Jessie M. Gaeta
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
- Section of General Internal Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Travis P. Baggett
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
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Schwarz L, Castillo EM, Chan TC, Brennan JJ, Sbiroli ES, Carrasco-Escobar G, Nguyen A, Clemesha RES, Gershunov A, Benmarhnia T. Heat Waves and Emergency Department Visits Among the Homeless, San Diego, 2012-2019. Am J Public Health 2022; 112:98-106. [PMID: 34936416 PMCID: PMC8713618 DOI: 10.2105/ajph.2021.306557] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/18/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To determine the effect of heat waves on emergency department (ED) visits for individuals experiencing homelessness and explore vulnerability factors. Methods. We used a unique highly detailed data set on sociodemographics of ED visits in San Diego, California, 2012 to 2019. We applied a time-stratified case-crossover design to study the association between various heat wave definitions and ED visits. We compared associations with a similar population not experiencing homelessness using coarsened exact matching. Results. Of the 24 688 individuals identified as experiencing homelessness who visited an ED, most were younger than 65 years (94%) and of non-Hispanic ethnicity (84%), and 14% indicated the need for a psychiatric consultation. Results indicated a positive association, with the strongest risk of ED visits during daytime (e.g., 99th percentile, 2 days) heat waves (odds ratio = 1.29; 95% confidence interval = 1.02, 1.64). Patients experiencing homelessness who were younger or elderly and who required a psychiatric consultation were particularly vulnerable to heat waves. Odds of ED visits were higher for individuals experiencing homelessness after matching to nonhomeless individuals based on age, gender, and race/ethnicity. Conclusions. It is important to prioritize individuals experiencing homelessness in heat action plans and consider vulnerability factors to reduce their burden. (Am J Public Health. 2022;112(1):98-106. https://doi.org/10.2105/AJPH.2021.306557).
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Affiliation(s)
- Lara Schwarz
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Edward M Castillo
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Theodore C Chan
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Jesse J Brennan
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Emily S Sbiroli
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Gabriel Carrasco-Escobar
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Andrew Nguyen
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Rachel E S Clemesha
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Alexander Gershunov
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
| | - Tarik Benmarhnia
- Lara Schwarz and Gabriel Carrasco-Escobar are with the Herbert Wertheim School of Public Health and Longevity Science, University of California, San Diego, La Jolla. Edward M. Castillo, Theodore C. Chan, Jesse J. Brennan, and Emily S. Sbiroli are with the Department of Emergency Medicine, University of California, San Diego. Andrew Nguyen, Rachel E. S. Clemesha, Alexander Gershunov, and Tarik Benmarhnia are with Scripps Institution of Oceanography, University of California, San Diego
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Kwan A, Morris J, Barbic SP. Protocol: A mixed methods evaluation of an IPS program to increase employment and well-being for people with long-term experience of complex barriers in Vancouver's downtown and DTES. PLoS One 2021; 16:e0261415. [PMID: 34914771 PMCID: PMC8675668 DOI: 10.1371/journal.pone.0261415] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 12/02/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Employment improves mental health and well-being by providing financial security, daily structure, a sense of identity and purpose, and social engagement. However, securing and sustaining employment is exceptionally challenging for vulnerable populations who experience persistent and multiple barriers, such as mental illness, homelessness, food and housing insecurity, and marginalization. Evidence-based supported employment programs, most notably individual placement and support (IPS) are becoming a more common approach for addressing the needs of these high-risk individuals. The aim of this paper is to outline the protocol for evaluating an IPS program in Vancouver's downtown and Downtown Eastside (DTES). METHODS AND DESIGN This prospective quasi-experimental study of persons with persistent and multiple barriers to employment will use a mixed-methods approach for evaluating a novel IPS program. The evaluation will consist of survey packages and interviews that will capture outcomes related to employment and well-being, as well as the experiential process of receiving individualized and integrated supports through the IPS program. A mixed-methods approach is appropriate for this study as quantitative data will provide an objective assessment of program impacts on employment and well-being outcomes over time, while qualitative data will provide an in-depth understanding of continued barriers and experiences. DISCUSSION The results from this evaluation will contribute evidence within a local British Columbian (BC) context that may increase access to meaningful employment for those with long-term experience of complex barriers to employment. Further, the findings will support continued improvements, and guide decision-making around practices and policy for future implementation of IPS and employment supports across BC.
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Affiliation(s)
- Amanda Kwan
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- * E-mail:
| | - Jonny Morris
- Canadian Mental Health Association BC Division, Vancouver, BC, Canada
| | - Skye P. Barbic
- Department of Occupational Science and Occupational Therapy, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
- Providence Health Care Research Institute, Vancouver, BC, Canada
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25
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Montgomery MP, Meehan AA, Cooper A, Toews KA, Ghinai I, Schroeter MK, Gibbs R, Rehman N, Stylianou KS, Yeh D, Thomas-Campbell N, Washington NC, Brosnan HK, Chang AH, Gomih A, Ngo C, Vickery KD, Harrison B, Winkelman TN, Gerstenfeld A, Zeilinger L, Mosites E. Notes from the Field: COVID-19 Vaccination Coverage Among Persons Experiencing Homelessness - Six U.S. Jurisdictions, December 2020-August 2021. MMWR Morb Mortal Wkly Rep 2021; 70:1676-1678. [PMID: 34855724 PMCID: PMC8641566 DOI: 10.15585/mmwr.mm7048a4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
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Nicholas W, Greenwell L, Henwood BF, Simon P. Using Point-in-Time Homeless Counts to Monitor Mortality Trends Among People Experiencing Homelessness in Los Angeles County, California, 2015‒2019. Am J Public Health 2021; 111:2212-2222. [PMID: 34878861 PMCID: PMC8667842 DOI: 10.2105/ajph.2021.306502] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2021] [Indexed: 11/04/2022]
Abstract
Objectives. To report trends in mortality rates, mortality rate ratios (MRRs), and causes of death among people experiencing homelessness (PEH) in Los Angeles County, California, by using annual point-in-time homeless counts and to compare findings to published longitudinal cohort studies of homeless mortality. Methods. We enumerated homeless deaths and determined causes by using 2015-2019 medical examiner‒coroner data matched to death certificate data. We estimated midyear homeless population denominators by averaging consecutive January point-in-time homeless counts. We used annual demographic surveys of PEH to estimate age- and gender-adjusted MRRs. We identified comparison studies through a literature review. Results. Mortality rates increased from 2015 to 2019. Drug overdose was the leading cause of death. Mortality was higher among White than among Black and Latino PEH. Compared with the general population, MRRs ranged from 2.8 (95% confidence interval [CI] = 2.7, 3.0) for all causes to 35.1 (95% CI = 31.9, 38.4) for drug overdose. Crude mortality rates and all-cause MRRs from comparison cohort studies were similar to those in the current study. Conclusions. These methods can be adapted by other urban jurisdictions seeking to better understand and reduce mortality in their homeless populations. (Am J Public Health. 2021;111(12):2212-2222. https://doi.org/10.2105/AJPH.2021.306502).
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Affiliation(s)
- Will Nicholas
- Will Nicholas, Lisa Greenwell, and Paul Simon are with the Los Angeles County Department of Public Health, Los Angeles, CA. Benjamin F. Henwood is with the Suzanne Dworak-Peck School of Social Work, University of Southern California. Los Angeles
| | - Lisa Greenwell
- Will Nicholas, Lisa Greenwell, and Paul Simon are with the Los Angeles County Department of Public Health, Los Angeles, CA. Benjamin F. Henwood is with the Suzanne Dworak-Peck School of Social Work, University of Southern California. Los Angeles
| | - Benjamin F Henwood
- Will Nicholas, Lisa Greenwell, and Paul Simon are with the Los Angeles County Department of Public Health, Los Angeles, CA. Benjamin F. Henwood is with the Suzanne Dworak-Peck School of Social Work, University of Southern California. Los Angeles
| | - Paul Simon
- Will Nicholas, Lisa Greenwell, and Paul Simon are with the Los Angeles County Department of Public Health, Los Angeles, CA. Benjamin F. Henwood is with the Suzanne Dworak-Peck School of Social Work, University of Southern California. Los Angeles
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Rajan SS, Tsai J. Estimation of Utility Values for Computing Quality-adjusted Life Years Associated With Homelessness. Med Care 2021; 59:1115-1121. [PMID: 34629422 DOI: 10.1097/mlr.0000000000001647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND There is a lack of data-driven evidence about the burden of homelessness, and lack of a holistic measure of effectiveness for evaluating interventions targeting homelessness. Quality-adjusted life years (QALYs) can help holistically capture the burden of homelessness, and facilitate the valuation and comparison of interventions designed to address homelessness. OBJECTIVE This study estimated utility values required to compute the QALYs associated with homelessness, and also examined individual-level characteristics that affect these values. RESEARCH DESIGN The study is cross-sectional and derived from a large national survey conducted during the coronavirus disease 2019 pandemic. SUBJECTS A sample of 6607 middle- and low-income adults in the United States. MEASURES A self-completion standard gamble survey was used to estimate utility values associated with homelessness. Linear regression was used to analyze the association between individual-level characteristics and these utility values. RESULTS The study estimated the average utility value associated with homelessness as 43.4% among the study participants. This implies that 1 year of life as a homeless individual is perceived to be equivalent to less than half a year of life as a stably housed individual in good health. The study also found that individuals who have experienced homelessness and financial distress value life as a homeless person considerably less than those who have not had these experiences. CONCLUSIONS The method developed in this study can be used to estimate QALYs in studies evaluating homelessness interventions, thereby establishing the societal value of these interventions and informing policy and budgetary decision-making. Future studies estimating the utility values associated with homelessness in the general population, as well as specific homeless groups, are required to provide more generalizable evidence.
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Affiliation(s)
- Suja S Rajan
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
| | - Jack Tsai
- Department of Management, Policy and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX
- National Center on Homelessness among Veterans, US Department of Veterans Affairs Central Office, Tampa, FL
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Nyamathi A, Salem BE, Shin SS, Jones AA, Garfin DR, Yadav K, Chang AH, White K, Morisky D. Effect of a Nurse-Led Community Health Worker Intervention on Latent Tuberculosis Medication Completion Among Homeless Adults. Nurs Res 2021; 70:433-442. [PMID: 34380979 PMCID: PMC8563379 DOI: 10.1097/nnr.0000000000000545] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Tuberculosis (TB) disproportionately affects marginalized and impoverished homeless adults. Although active TB can be prevented by treating latent TB infection (LTBI), individual factors, such as high prevalence of depression and anxiety, drug and alcohol use, and unstable housing, lead to poor LTBI treatment adherence and completion among homeless adults. OBJECTIVES We hypothesized that the delivery of a tailored nurse-led, community health worker (RN/CHW) program across the LTBI continuum of care (e.g., screening, diagnosis, and treatment) that delivers 3HP treatment (3HP: rifapentine plus isoniazid) for homeless adults (e.g., sheltered and unsheltered) and is tailored to their health and social service needs will overcome existing treatment completion barriers. We also hypothesized that mental health symptoms (e.g., depression and anxiety), drug use score, and problematic alcohol use will decline over time among clients receiving this treatment. METHODS We assessed the effect of delivering a theoretically guided, RN/CHW-based, single-arm study among eligible LTBI-positive homeless adults (N = 50) on completion of a weekly, directly observed, 12-dose 3HP LTBI treatment in Central City East (Skid Row). Completing 3HP treatment was compared to the only known historical, clinic-based control that obtained 65% completion among homeless adults. Secondary outcomes included drug and alcohol use, depression, and anxiety. RESULTS The RN/CHW program achieved a 91.8% 3HP treatment completion rate among homeless adults. Younger homeless adults (<50 years old) were less likely to complete 3HP treatment compared to those who were older. Neither drug use, depression, nor anxiety was associated with 3HP treatment completion. Decrease in anxiety was observed at 3 months, but not at 6 months, compared to baseline. DISCUSSION To our knowledge, the pilot study is the first to evaluate an effective RN/CHW-delivered, community-based intervention, which can reduce the burden of active TB for homeless adults.
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Williams-Arya P, Vaughn LM, Nidey N, Sawyer M, Porter K, Froehlich TE. Striving for Structure and Stability in Cincinnati's Family Homeless Shelters: A Community-Based Participatory Research Approach. Fam Community Health 2021; 44:282-291. [PMID: 34269697 DOI: 10.1097/fch.0000000000000305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
Experiencing homelessness negatively impacts child health, development, and emotional-behavioral functioning, but there is limited knowledge regarding specific service priorities, as articulated by families themselves, to prevent or address these adverse sequelae. Thus, to elicit the service needs perspective of families in shelter and to translate these findings into real-world action, we undertook a community-based participatory research effort using Group-Level Assessment, a focus group methodology. An action-based participatory needs assessment called a Group-Level Assessment (GLA) was conducted in collaboration with parents currently experiencing homelessness. A total of 53 parents from 3 Cincinnati homeless shelters participated by responding to 17 to 20 open-ended prompts regarding their child's medical, developmental, learning, social, and behavioral needs. Using GLA methodology, we found that the needs expressed by families residing in shelters coalesced around the following themes: job and housing stability, education and skill development, emotional support, and improving shelter life. The GLA findings were then shared with shelter and community leaders, leading to a number of policy and practice enhancements in the shelters. This study demonstrates the power of the GLA approach to affect community action as a direct result of priorities generated by families experiencing homelessness.
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Affiliation(s)
- Pamela Williams-Arya
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio (Drs Williams-Arya and Froehlich); and Divisions of Developmental and Behavioral Pediatrics (Drs Williams-Arya, Nidey, and Froehlich and Mss Sawyer and Porter), Emergency Medicine (Dr Vaughn), and Biostatistics and Epidemiology (Dr Nidey), Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
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Mengistu Z, Ali A, Abegaz T. The pattern of orthopedic fractures and visceral injury in road traffic crash victims, Addis Ababa, Ethiopia. PLoS One 2021; 16:e0253690. [PMID: 34559808 PMCID: PMC8462740 DOI: 10.1371/journal.pone.0253690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 06/11/2021] [Indexed: 11/19/2022] Open
Abstract
Background Road Traffic crash injury is one of the main public health problems resulting in premature death and disability particularly in low-income countries. However, there is limited evidence on the crash fractures in Ethiopia. Objective The study was conducted to assess the magnitude of road traffic crash fractures and visceral injuries. Methods A hospital-based cross-sectional study was conducted on 420 fracture patients. Participants were randomly selected from Addis Ababa City hospitals. The study was carried out between November 2019 and February 2020. Data were collected using a questionnaire and record of medical findings. Multilevel logistic regression analysis was carried out. Ethical clearance was obtained from the Addis Ababa University, College of Health Sciences Institutional Review Board. Confidentiality of participants’ information was maintained. Results The study found out that the majority 265 (63. 1%) of fracture cases were younger in the age group of 18 to 34 years. Males were more affected—311(74.0%). The mortality rate was 59(14.1%), of those 50(85.0%) participants were males. The major road traffic victims were pedestrians—220(52.4%), mainly affected by simple fracture type -105(53.3%) and compound fracture type—92(46. 7%). Drivers mainly suffered from compound fracture type -23 (59.0%). One hundred eighty-two (43.3%) of fracture patients had a visceral injury. Homeless persons who sit or sleep on the roadside had a higher risk of thoracic visceral injury compared to traveler pedestrians (AOR = 4.600(95%CI: 1.215–17.417)); P = 0.025. Conclusion Visceral injury, simple and compound fractures were the common orthopedic injury types reported among crash victims. Males, pedestrians, and young age groups were largely affected by orthopedic fracture cases. Homeless persons who sited or slept on the roadside were significant factors for visceral injury. Therefore, preventing a harmful crash and growing fracture care should be considered to reduce the burden of crash fracture.
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Affiliation(s)
- Zuriyash Mengistu
- School of Nursing and Midwifery, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
- * E-mail:
| | - Ahmed Ali
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
| | - Teferi Abegaz
- School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia
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Abramovich A, Pang N, Moss A, Logie CH, Chaiton M, Kidd SA, Hamilton HA. Investigating the impacts of COVID-19 among LGBTQ2S youth experiencing homelessness. PLoS One 2021; 16:e0257693. [PMID: 34547037 PMCID: PMC8454954 DOI: 10.1371/journal.pone.0257693] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2021] [Accepted: 09/07/2021] [Indexed: 01/11/2023] Open
Abstract
Background LGBTQ2S youth are overrepresented among youth experiencing homelessness and experience significantly higher rates of mental health issues compared to heterosexual and cisgender youth. COVID-19 related challenges for LGBTQ2S youth experiencing homelessness remain unknown. To address this gap, this study aimed to understand the impacts of the COVID-19 pandemic on LGBTQ2S youth at risk of, and experiencing, homelessness in the Greater Toronto Area, Ontario, Canada and surrounding areas. Methods Utilizing a mixed-methods convergent parallel design, LGBTQ2S youth experiencing homelessness were recruited to participate in virtual surveys and in-depth one-on-one interviews. Surveys included standardized measures and were administered to measure mental health outcomes and collect information on demographic characteristics, and health service use. Survey data were analyzed with descriptive statistics and statistical tests for difference of proportions. Interviews were analyzed using an iterative thematic content approach. Results Sixty-one youth completed surveys and 20 youth participated in one-on-one interviews. Quantitative and qualitative data showed that youth have been significantly impacted by the COVID-19 pandemic in various ways, including experiencing poor mental health, such as suicidality, depression, anxiety, and increased substance use, and lack of access to health and social support services. Conclusion Our study highlights the need for LGBTQ2S inclusive and affirming health care and support services for precariously housed adolescents to address the pre-existing social and health issues that have been exacerbated by the pandemic.
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Affiliation(s)
- Alex Abramovich
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- * E-mail:
| | - Nelson Pang
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Amanda Moss
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Carmen H. Logie
- Factor Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
- Women’s College Research Institute, Women’s College Hospital, Toronto, Ontario, Canada
| | - Michael Chaiton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Sean A. Kidd
- Department of Psychiatry, University of Toronto, Toronto, Canada
| | - Hayley A. Hamilton
- Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Loubiere S, Monfardini E, Allaria C, Mosnier M, Allibert A, Ninove L, Bosetti T, Farnarier C, Hamouda I, Auquier P, Mosnier E, Tinland A. Seroprevalence of SARS-CoV-2 antibodies among homeless people living rough, in shelters and squats: A large population-based study in France. PLoS One 2021; 16:e0255498. [PMID: 34525096 PMCID: PMC8443066 DOI: 10.1371/journal.pone.0255498] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/17/2021] [Indexed: 11/18/2022] Open
Abstract
Background Overcrowded housing, as well as inadequate sanitary conditions, contribute to making homeless people particularly vulnerable to the SARS-CoV-2 infection. We aimed to assess the seroprevalence of the SARS-CoV-2 infection among people experiencing homelessness on a large city-wide scale in Marseille, France, taking into account different types of accommodation. Methods A consortium of outreach teams in 48 different locations including streets, slums, squats, emergency or transitional shelters and drop-in centres participated in the inclusion process. All participants consented to have a validated rapid antibody assay for immunoglobulins M (IgM) and G (IgG) and to answer a questionnaire on medical health conditions, comorbidities, and previous COVID-19 symptoms. Information on their housing conditions since the COVID-19 crisis was also collected from the participants. Results From June 01 to August 05, 2020, 1,156 homeless participants were enrolled in the study and tested. The overall seroprevalence of SARS-CoV-2 IgG/IgM antibodies was 5.6% (95%CI 2.3–7.0), ranging from 2.2% in people living on the streets to 8.1% in people living in emergency shelters (P = 0.009). Around one third of the seropositive participants reported COVID-19 symptoms. Compared to the general population in Marseille (3.6%), the homeless population living in the same urban area experienced a significantly increased risk of SARS-CoV-2 infection (|z| = 3.65 > 1.96). Conclusion These findings highlight the need for regular screening among the homeless to prevent clustering in overcrowded or inadequate accommodations. It is also necessary to provide essential resources to keep homeless people healthy, the vast majority of whom have cumulative risk factors for SARS-CoV-2 infection.
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Affiliation(s)
- Sandrine Loubiere
- Department of Research and Innovation, Assistance Publique Hôpitaux de Marseille - APHM, Marseille, France
- CEReSS: Health Service Research and Quality of Life Center, Aix Marseille University, Marseille, France
- * E-mail:
| | - Elisabetta Monfardini
- Department of Psychiatry, Sainte-Marguerite University Hospital, APHM, Marseille, France
- INSERM, U1028, CNRS UMR5292, Lyon Neuroscience Research Center, ImpAct Team, Bron, France
| | - Camille Allaria
- CEReSS: Health Service Research and Quality of Life Center, Aix Marseille University, Marseille, France
- LAMES – Laboratoire Méditerranéen de Sociologie, UMR 7305, MMSH – Maison Méditerranéenne des Sciences de l’Homme, Aix-en-Provence, France
| | | | - Agathe Allibert
- Department of Research and Innovation, Assistance Publique Hôpitaux de Marseille - APHM, Marseille, France
| | - Laetitia Ninove
- Unité des Virus Emergents (UVE), Aix-Marseille Univ – IRD 190 – Inserm 1207 –IHU Méditerranée Infection, Marseille, France
| | | | - Cyril Farnarier
- Projet ASSAb – Accès aux Soins pour les Personnes Sans Abri, Hôpital Européen, Marseille, France
- LaSSA – Laboratoire de Sciences Sociales Appliquées, Marseille, France
| | - Ilyes Hamouda
- Department of Research and Innovation, Assistance Publique Hôpitaux de Marseille - APHM, Marseille, France
| | - Pascal Auquier
- Department of Research and Innovation, Assistance Publique Hôpitaux de Marseille - APHM, Marseille, France
- CEReSS: Health Service Research and Quality of Life Center, Aix Marseille University, Marseille, France
| | - Emilie Mosnier
- INSERM, IRD, SESSTIM, Sciences Economiques & Sociales de la Santé & Traitement de l’Information Médicale, Aix Marseille University, Marseille, France
| | - Aurélie Tinland
- CEReSS: Health Service Research and Quality of Life Center, Aix Marseille University, Marseille, France
- Department of Psychiatry, Sainte-Marguerite University Hospital, APHM, Marseille, France
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Campbell RB, Larsen M, DiGiandomenico A, Davidson MA, Booth GL, Hwang SW, McBrien KA, Campbell DJT. Les défis de la gestion du diabète chez les personnes itinérantes : étude qualitative avec la méthode photovoix. CMAJ 2021; 193:E1184-E1192. [PMID: 34344778 PMCID: PMC8354642 DOI: 10.1503/cmaj.202537-f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/22/2021] [Indexed: 11/03/2022] Open
Abstract
CONTEXTE: La recherche sur les défis de la prise en charge du diabète chez les personnes itinérantes qui en sont atteintes n’a pas tendance à prendre en considération le point de vue des personnes touchées. Nous avons utilisé une approche de recherche participative avec la communauté pour explorer ces défis. MÉTHODES: Nous avons recruté des cochercheurs ayant une connaissance expérientielle de l’itinérance et du diabète. Les chercheurs principaux leur ont offert une formation en recherche et ont préparé le terrain avec eux pour ce projet. Les cochercheurs ont collectivement choisi d’utiliser la méthode photovoix pour illustrer la difficulté de bien s’alimenter quand on est en situation d’itinérance et explorer en quoi cet écueil affecte plus largement la gestion du diabète. Après une formation en photographie et en éthique, les cochercheurs ont pris des photos en lien avec les objectifs du projet et rédigé des récits connexes au moyen de techniques de rédaction inspirée par des photos. Les chercheurs principaux ont analysé les photos et les récits, et ils en ont dégagé des thèmes qui se sont précisés lors de discussions de groupe. RÉSULTATS: Les 8 cochercheurs étaient atteints de diabète de type 2 (diagnostiqué de 18 mois à 23 ans auparavant) et avaient vécu en situation d’itinérance pendant des périodes allant de 8 mois à 12 ans. Nous avons dégagé 4 thèmes à partir de 17 photos et récits produits. L’itinérance affecte grandement la santé émotionnelle et mentale des personnes, ce qui nuit à leur capacité de bien gérer leur diabète. Les aliments servis dans les refuges sont rarement nutritifs ou appétissants. L’obtention d’une forme de logement peut faciliter la prise en charge du diabète en créant un environnement stable qui favorise l’autonomie, mais les coûts et le manque de connaissances sont des obstacles à la préparation de repas sains. L’itinérance complique aussi l’accès aux professionnels de la prise en charge du diabète et aux médicaments d’ordonnance. INTERPRÉTATION: Les images et les récits associés permettent de dresser un tableau frappant, complet et fidèle des défis auxquels sont confrontées les personnes en situation d’itinérance qui essaient de gérer leur diabète. Comprendre ces défis est la première étape qui permettra aux intervenants et aux décideurs de répondre aux besoins de cette population.
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Affiliation(s)
- Rachel B Campbell
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Matthew Larsen
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Anna DiGiandomenico
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Marleane A Davidson
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Gillian L Booth
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Stephen W Hwang
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - Kerry A McBrien
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb
| | - David J T Campbell
- Département de médecine (R.B. Campbell, D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.; Clients with Diabetes Action Committee, MAP Centre for Urban Health Solutions (Larsen, DiGiandomenico, Davidson), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; MAP Centre for Urban Health Solutions (Booth, Hwang), Institut du savoir Li Ka Shing, Hôpital St. Michael, Unity Health Toronto; Département de médecine, Faculté de médecine (Booth, Hwang), Université de Toronto, Toronto, Ont.; Départements des sciences de la santé communautaire (McBrien, D.J.T. Campbell), de médecine familiale (McBrien) et de cardiologie (D.J.T. Campbell), Faculté de médecine Cumming de l'Université de Calgary, Calgary, Alb.
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Gutwinski S, Schreiter S, Deutscher K, Fazel S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS Med 2021; 18:e1003750. [PMID: 34424908 PMCID: PMC8423293 DOI: 10.1371/journal.pmed.1003750] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. METHODS AND FINDINGS We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. CONCLUSIONS Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018085216). TRIAL REGISTRATION PROSPERO CRD42018085216.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Biomedical Innovation Academy, Berlin Institute of Health, Berlin, Germany
| | - Karl Deutscher
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
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Grewal EK, Campbell RB, Booth GL, McBrien KA, Hwang SW, O’Campo P, Campbell DJT. Using concept mapping to prioritize barriers to diabetes care and self-management for those who experience homelessness. Int J Equity Health 2021; 20:158. [PMID: 34243783 PMCID: PMC8272311 DOI: 10.1186/s12939-021-01494-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Accepted: 06/08/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Diabetes is a chronic medical condition which demands that patients engage in self-management to achieve optimal glycemic control and avoid severe complications. Individuals who have diabetes and are experiencing homelessness are more likely to have chronic hyperglycemia and adverse outcomes. Our objective was to collaborate with individuals experiencing homelessness and care providers to understand the barriers they face in managing diabetes, as a first step in identifying solutions for enhancing diabetes management in this population. METHODS We recruited individuals with lived experience of homelessness and diabetes (i.e. clients; n = 32) from Toronto and health and social care providers working in the areas of diabetes and/or homelessness (i.e. providers; n = 96) from across Canada. We used concept mapping, a participatory research method, to engage participants in brainstorming barriers to diabetes management, which were subsequently categorized into clusters, using the Concept Systems Global MAX software, and rated based on their perceived impact on diabetes management. The ratings were standardized for each participant group, and the average cluster ratings for the clients and providers were compared using t-tests. RESULTS The brainstorming identified 43 unique barriers to diabetes management. The clients' map featured 9 clusters of barriers: Challenges to getting healthy food, Inadequate income, Navigating services, Not having a place of your own, Relationships with professionals, Diabetes education, Emotional wellbeing, Competing priorities, and Weather-related issues. The providers' map had 7 clusters: Access to healthy food, Dietary choices in the context of homelessness, Limited finances, Lack of stable, private housing, Navigating the health and social sectors, Emotional distress and competing priorities, and Mental health and addictions. The highest-rated clusters were Challenges to getting healthy food (clients) and Mental health and addictions (providers). Challenges to getting healthy food was rated significantly higher by clients (p = 0.01) and Competing priorities was rated significantly higher by providers (p = 0.03). CONCLUSIONS Experiencing homelessness poses numerous barriers to managing diabetes, the greatest of which according to clients, is challenges to getting healthy food. This study showed that the way clients and providers perceive these barriers differs considerably, which highlights the importance of including clients' insights when assessing needs and designing effective solutions.
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Affiliation(s)
- Eshleen K. Grewal
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Rachel B. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Gillian L. Booth
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Kerry A. McBrien
- Department of Family Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Stephen W. Hwang
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Patricia O’Campo
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Unity Health Toronto, Toronto, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - David J. T. Campbell
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
- Department of Cardiac Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
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Rowlands Snyder EC, Boucher LM, Bayoumi AM, Martin A, Marshall Z, Boyd R, LeBlanc S, Tyndall M, Kendall CE. A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada. PLoS One 2021; 16:e0253923. [PMID: 34197552 PMCID: PMC8248707 DOI: 10.1371/journal.pone.0253923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.
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Affiliation(s)
| | - Lisa M. Boucher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, Ontario, Canada
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
- Drug Users Advocacy League, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire E. Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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Maroko AR, Hopper K, Gruer C, Jaffe M, Zhen E, Sommer M. Public restrooms, periods, and people experiencing homelessness: An assessment of public toilets in high needs areas of Manhattan, New York. PLoS One 2021; 16:e0252946. [PMID: 34161351 PMCID: PMC8221515 DOI: 10.1371/journal.pone.0252946] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 05/25/2021] [Indexed: 11/18/2022] Open
Abstract
Access to safe, clean water and sanitation is globally recognized as essential for public health. Public toilets should be accessible to all members of a society, without social or physical barriers preventing usage. A public toilet facility's design and upkeep should offer privacy and safety, ensure cleanliness, provide required sanitation-related resources, and be gender equitable, including enabling comfortable and safe management of menstruation. Menstrual hygiene management (MHM) refers to the need to ensure that girls, women and all people who menstruate have access to clean menstrual products, privacy to change the materials as often as needed, soap and water for washing the body as required, and access to facilities to dispose of used materials. Challenges around menstruation faced by people experiencing homelessness, which tend to be greater than those facing the general population, include inadequate toilet and bathing facilities, affordability issues around menstrual products, and menstrual stigma. Public toilets are a vital resource for managing menstruation, particularly for vulnerable populations without reliable access to private, safe, and clean spaces and menstrual products. This mixed-methods study sought to: 1) understand the lived experiences of MHM among people experiencing homelessness in New York City with respect to public toilets; 2) describe general and MHM-related characteristics of public toilets in high need areas of Manhattan and analyze their interrelationships; and 3) examine the associations among neighborhood-level demographics and the public toilet characteristics in those areas. Qualitative methods included key informant interviews (n = 15) and in-depth interviews (n = 22) with people with experience living on the street or in shelters, which were analyzed using Malterud's 'systematic text condensation' for thematic cross-case analysis. Quantitative methods included audits and analyses of public toilet facilities (n = 25) using traditional statistics (e.g., Spearman's correlations) and spatial analyses (e.g., proximity buffers). Qualitative findings suggest cleanliness, access to restrooms, and availability of resources are critical issues for the participants or prospective users. Quantitative analyses revealed insufficiently provided, maintained, and resourced public toilets for managing menstruation in high-needs areas. Findings also suggest that toilets with more MHM-related resource availability, such as menstrual products and toilet stall disposal bins, were more difficult to access. Neighborhood-level characteristics showed a potential environmental injustice, as areas characterized by higher socioeconomic status are associated with more access to MHM-specific resources in public restrooms, as well as better overall quality.
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Affiliation(s)
- Andrew R. Maroko
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Kim Hopper
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Caitlin Gruer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Maayan Jaffe
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
| | - Erica Zhen
- Department of Environmental, Occupational, and Geospatial Health Sciences, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, United States of America
| | - Marni Sommer
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, United States of America
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Roland M, Ben Abdelhafidh L, Déom V, Vanbiervliet F, Coppieters Y, Racapé J. SARS-CoV-2 screening among people living in homeless shelters in Brussels, Belgium. PLoS One 2021; 16:e0252886. [PMID: 34129635 PMCID: PMC8205130 DOI: 10.1371/journal.pone.0252886] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 05/25/2021] [Indexed: 12/03/2022] Open
Abstract
Background Subgroups of precarious populations such as homeless people are more exposed to infection and at higher risk of developing severe forms of COVID-19 compared to the general population. Many of the recommended prevention measures, such as social distancing and self-isolation, are not feasible for a population living in shelters characterised by physical proximity and a high population density. The objective of the study was to describe SARS-CoV-2 infection prevalence in homeless shelters in Brussels (Belgium), and to identify risk factors and infection control practices associated with SARS-CoV-2 positivity rates. Methods A total of 1994 adults were tested by quantitative PCR tests in 52 shelters in Brussels (Belgium) between April and June, 2020, in collaboration with Doctors of the World. SARS-CoV-2 prevalence is here described site by site, and we identify risk factors associated with SARS-CoV-2 positivity rates. We also investigate associations between seropositivity and reported symptoms. Results We found an overall prevalence of 4.6% for the period, and a cluster of high rates of SARS-CoV-2 positivity (20–30% in two shelters). Among homeless people, being under 40 years of age (OR (CI95%) 2.3 (1.2–4.4), p = 0.02), having access to urgent medical care (AMU) (OR(CI95%): 2.4 (1.4–4.4)], p = 0.02), and sharing a room with someone who tested positive (OR(CI95%): 5.3 (2.9–9.9), p<0.0001) were factors associated with SARS-CoV-2 positivity rates. 93% of those who tested positive were asymptomatic. Conclusion This study shows high rates of SARS-COV-2 infection positive tests in some shelters, with a high proportion of asymptomatic cases. The survey reveals how important testing and isolation measures are, together with actions taken by medical and social workers during the outbreak.
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Affiliation(s)
| | | | | | | | - Yves Coppieters
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
| | - Judith Racapé
- Research Center in Epidemiology, Biostatistics and Clinical Research, School of Public Health, Université Libre de Bruxelles (ULB), Brussels, Belgium
- Chair of Health and Precarity, Faculty of Medicine, Université Libre de Bruxelles (ULB), Brussels, Belgium
- * E-mail:
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Husain M, Rachline A, Cousien A, Rolland S, Rouzaud C, Ferre VM, Gomez MV, Le Teurnier M, Wicky-Thisse M, Descamps D, Yazdanpanah Y, Charpentier C, Pasquet-Cadre A. Impact of the COVID-19 pandemic on the homeless: results from a retrospective closed cohort in France (March-May 2020). Clin Microbiol Infect 2021; 27:1520.e1-1520.e5. [PMID: 34111590 PMCID: PMC8182982 DOI: 10.1016/j.cmi.2021.05.039] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2021] [Revised: 05/17/2021] [Accepted: 05/25/2021] [Indexed: 11/30/2022]
Abstract
Objectives To evaluate severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, hospitalization and fatality rates in residents of homeless shelters run by Samusocial of Paris. Methods We conducted a retrospective serological study between July and August 2020 on all residents and staff members of three homeless shelters run by Samusocial of Paris: two centres providing healthcare accommodation (HCA) and one a women's dormitory. We included all adults present in the shelters or who died of a proven SARS-CoV-2 infection during the first wave (March–May). SARS-CoV-2 antibodies were detected in serum samples using the SARS-CoV-2 IgG Architect (Abbott) test. Any participant with a positive PCR or serology was defined as a confirmed SARS-CoV-2 case. Results We included 100 residents and 83 staff members. The confirmed SARS-CoV-2 rate by PCR or serology was 72/100 (72.0%) for residents and 17/83 (20.5%) for staff members. Women accommodated in the dormitory had the highest infection rate (90.6%). The hospitalization rate in residents was 17/72 (23.6%) and the death rate 4/72 (5.6%). All hospitalizations and deaths occurred among HCA residents. Among the residents of HCA shelters, 34/68 (50%) presented at least two comorbidity factors associated with being at high risk for severe SARS-CoV-2 infection. Conclusion The SARS-CoV-2 infection rate was high in residents of these homeless shelters (10.6% seroprevalence in the Île-de-France region during the first wave). Severe SARS-CoV-2 infection was highly associated with the prevalence of comorbidities. This population should be considered as a priority in vaccination campaigns and in access to individual housing units when at risk.
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Affiliation(s)
- Maya Husain
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France.
| | - Anne Rachline
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | | | - Simon Rolland
- INSERM CIC 1417 Cochin Pasteur, AP-HP, Hôpital Cochin, 75014, Paris, France; Department of Infectious and Tropical Diseases, Cavale Blanche University Hospital, 29200, Brest, France
| | - Claire Rouzaud
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Necker enfants malades, F-75015, Paris, France; Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | - Valentine Marie Ferre
- Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | | | - Maï Le Teurnier
- Samusocial de Paris, 35 avenue Courteline, 75012, Paris, France
| | | | - Diane Descamps
- Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
| | - Yazdan Yazdanpanah
- Department of Infectious and Tropical Diseases, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France
| | - Charlotte Charpentier
- Department of Virology, AP-HP, Hôpital Bichat-Claude Bernard, F-75018, Paris, France; Université de Paris, IAME, INSERM UMR1137, Paris, France
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Calvo F, Rived-Ocaña M, Font-Mayolas S, Carbonell X. [Homelessness and mental health diagnose during the Great Recession (2008-2017): the effect of immigration.]. Rev Esp Salud Publica 2021; 95:e202106079. [PMID: 34078851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 05/13/2021] [Indexed: 06/12/2023] Open
Abstract
OBJECTIVE Homelessness, which is a severe social problem across Europe and on the rise over the past decade, is closely linked to organic and mental health problems. In front of the lack of diagnostic analysis studies in the Spanish territory, this research aimed to determine the sociodemographic characteristics of a sample of individuals experiencing homelessness (IEH), to determine the prevalence of diagnoses of substance use disorders, dual pathology and other mental disorders and to analyze the existence of diagnostic differences between IEH born in the country and immigrant IEH. METHODS A transversal and observational study was carried out, based on the analysis of mental health diagnostics of the medical histories of a sample of 1,072 IEH (453 locals and 619 immigrants) assisted between 2008 and 2017 in mental health services in Girona, northeastern Spain. For the statistical analysis, Student's t test was used to compare means and the chi-squared test was used for the analysis of qualitative variables. A binary logistic regression analysis was carried out to establish the predictor variables for the diagnosis of drug addiction and dual pathology. RESULTS IEH showed high rates of mental disorders, especially psychoactive substances (82.6% of diagnosed people). 43.9% of IEH showed alcohol dependence as the reason for their diagnosis, followed by cocaine addiction and opiates. Foreign born IEH had more diagnoses for alcohol dependence and less for opiates or dual pathology than spanish born IEH. IEH born in Spain showed a higher vulnerability and received more mental health diagnoses than immigrant IEH. CONCLUSIONS Even though immigrant PESS show more diagnoses for alcohol dependence, PESS born in Spain show a higher vulnerability and receive more mental health diagnoses than immigrant PESS. The process of migrating seems to establish a difference in the kind of mental disorders and addictions the PESS collective is prone to.
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Affiliation(s)
- Fran Calvo
- Departament de Pedagogia. Institut de Recerca sobre Qualitat de Vida. Universitat de Girona. Girona. España
| | - Mercè Rived-Ocaña
- Escola Universitària d'Infermeria i Teràpia Ocupacional (EUIT). Universitat Autònoma de Barcelona. Barcelona. España
| | - Sílvia Font-Mayolas
- Departament de Psicologia. Institut de Recerca sobre Qualitat de Vida. Universitat de Girona. Girona. España
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Jones AL, Gordon AJ, Gabrielian SE, Montgomery AE, Blosnich JR, Varley AL, deRussy AJ, Austin EL, Hoge AE, Kim YI, Gelberg L, Kertesz SG. Perceptions of Care Coordination Among Homeless Veterans Receiving Medical Care in the Veterans Health Administration and Community Care Settings: Results From a National Survey. Med Care 2021; 59:504-512. [PMID: 33827108 PMCID: PMC8119353 DOI: 10.1097/mlr.0000000000001547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Initiatives to expand Veterans' access to purchased health care outside Veterans Health Administration (VHA) facilities ("community care") present care coordination challenges for Veterans experiencing homelessness. OBJECTIVE Among Veterans with homeless experiences, to evaluate community care use and satisfaction, and compare perceptions of care coordination among Veterans using VHA services and community care to those using VHA services without community care. RESEARCH DESIGN Cross-sectional analysis of responses to a 2018 mailed survey. SUBJECTS VHA outpatients with homeless experiences. MEASURES Self-reported use of community care, Likert-style ratings of satisfaction with that care, and Access/Coordination experiences from the Primary Care Quality-Homeless (PCQ-H) survey. RESULTS Of 4777 respondents, 1325 (26.7%) reported using community care; most of this subsample affirmed satisfaction with the community care they received (83%) and its timeliness (75%). After covariate adjustment, Veteran characteristics associated with greater community care use included female sex, being of retirement age and nonmarried, and having higher education, more financial hardship, ≥3 chronic conditions, psychological distress, depression, and posttraumatic stress disorder. Satisfaction with community care was lower among patients with travel barriers, psychological distress, and less social support. Compared with those using the VHA without community care, Veterans using VHA services and community care were more likely to report unfavorable access/coordination experiences [odds ratio (OR)=1.34, confidence interval (CI)=1.15-1.57]. This included hassles following referral (OR=1.37, CI=1.14-1.65) and perceived delays in receiving health care (OR=1.38, CI=1.19-1.61). CONCLUSIONS Veterans with homeless experiences value community care options. Potential access benefits are balanced with risks of unfavorable coordination experiences for vulnerable Veterans with limited resources.
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Affiliation(s)
- Audrey L Jones
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Health Care System
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Adam J Gordon
- Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center, Veterans Affairs Salt Lake City Health Care System
- Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT
| | - Sonya E Gabrielian
- VA Greater Los Angeles Health Care System
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | - John R Blosnich
- Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, University Drive (151C), Pittsburgh, PA
- Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA
| | | | | | - Erika L Austin
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
| | | | - Young-Il Kim
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System
- David Geffen School of Medicine, University of California-Los Angeles, Los Angeles, CA
| | - Stefan G Kertesz
- Birmingham VA Medical Center
- University of Alabama at Birmingham School of Public Health, Birmingham, AL
- University of Alabama at Birmingham School of Medicine, Birmingham, AL
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Fentress TSP, Wald S, Brah A, Leemon G, Reyes R, Alkhamees F, Kramer M, Taylor EM, Wildhood M, Frohe T, Duncan MH, Clifasefi SL, Collins SE. Dual study describing patient-driven harm reduction goal-setting among people experiencing homelessness and alcohol use disorder. Exp Clin Psychopharmacol 2021; 29:261-271. [PMID: 34264737 DOI: 10.1037/pha0000470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Two recent randomized controlled efficacy trials showed that harm-reduction treatment for alcohol use disorder (AUD)-or patient-driven treatment that does not require abstinence and instead supports decreased alcohol-related harm and improved quality of life (QoL)-is efficacious for adults experiencing homelessness and AUD. The present study provides qualitative and quantitative analysis of one component of harm-reduction treatment, participants' harm-reduction goal-setting, within these two trials. Aims of this secondary, dual-trial study (Trial 1 N = 208, Trial 2 N = 86) were to describe participant-generated harm-reduction goals and determine whether aspects of harm-reduction goal-setting predict treatment outcomes. Across both trials, qualitative findings indicated improving QoL, meeting basic needs, improving physical and mental health, and changing drinking behavior were participants' top four goals. Only 2%-6% of goals centered on attaining alcohol abstinence. Regarding quantitative findings, Trial 1 showed statistically significant increases in goals generation over the course of treatment, while proportion of achieved goals stayed constant. In Trial 2, number of goals generated remained constant, while proportion of goals achieved increased. Trial 2 findings showed greater goal generation over time was associated with better physical health-related QoL, and drinking-related goals predicted improved alcohol outcomes. Overall, this secondary, dual-trial study suggests patient-driven goal-setting in harm-reduction treatment is feasible: Participants generated diverse, personalized, and clinically relevant goals. This study built on positive efficacy trial findings, indicating participants' generation of goals was associated with improved treatment outcomes. More research is needed to further understand more nuanced relationships between harm-reduction goal-setting and treatment outcomes. (PsycInfo Database Record (c) 2021 APA, all rights reserved).
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Affiliation(s)
- Taurmini S P Fentress
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Sazi Wald
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Aaron Brah
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Griffin Leemon
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Rosemary Reyes
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Fatma Alkhamees
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Madeline Kramer
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Emily M Taylor
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Megan Wildhood
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Tessa Frohe
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Mark H Duncan
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Seema L Clifasefi
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
| | - Susan E Collins
- Department of Psychiatry and Behavioral Science, University of Washington School of Medicine
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Ingle TA, Morrison M, Wang X, Mercer T, Karman V, Fox S, Meyers LA. Projecting COVID-19 isolation bed requirements for people experiencing homelessness. PLoS One 2021; 16:e0251153. [PMID: 33979360 PMCID: PMC8115830 DOI: 10.1371/journal.pone.0251153] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 04/21/2021] [Indexed: 01/19/2023] Open
Abstract
As COVID-19 spreads across the United States, people experiencing homelessness (PEH) are among the most vulnerable to the virus. To mitigate transmission, municipal governments are procuring isolation facilities for PEH to utilize following possible exposure to the virus. Here we describe the framework for anticipating isolation bed demand in PEH communities that we developed to support public health planning in Austin, Texas during March 2020. Using a mathematical model of COVID-19 transmission, we projected that, under no social distancing orders, a maximum of 299 (95% Confidence Interval: 223, 321) PEH may require isolation rooms in the same week. Based on these analyses, Austin Public Health finalized a lease agreement for 205 isolation rooms on March 27th 2020. As of October 7th 2020, a maximum of 130 rooms have been used on a single day, and a total of 602 PEH have used the facility. As a general rule of thumb, we expect the peak proportion of the PEH population that will require isolation to be roughly triple the projected peak daily incidence in the city. This framework can guide the provisioning of COVID-19 isolation and post-acute care facilities for high risk communities throughout the United States.
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Affiliation(s)
- Tanvi A. Ingle
- Department of Integrative Biology, The University of Texas at Austin, Austin, Texas, United States of America
| | - Maike Morrison
- Department of Biology, Stanford University, Stanford, California, United States of America
| | - Xutong Wang
- Department of Integrative Biology, The University of Texas at Austin, Austin, Texas, United States of America
| | - Timothy Mercer
- Department of Population Health, The University of Texas at Austin Dell Medical School, Austin, Texas, United Staites of America
- Department of Internal Medicine, The University of Texas at Austin Dell Medical School, Austin, Texas, United States of America
- CommUnityCare Federally Qualified Health Centers, Austin, Texas, United States of America
| | - Vella Karman
- Homeless Services Division, Austin Public Health, Austin, Texas, United States of America
| | - Spencer Fox
- Department of Integrative Biology, The University of Texas at Austin, Austin, Texas, United States of America
| | - Lauren Ancel Meyers
- Department of Integrative Biology, The University of Texas at Austin, Austin, Texas, United States of America
- Santa Fe Institute, Santa Fe, New Mexico, United States of America
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Arum C, Fraser H, Artenie AA, Bivegete S, Trickey A, Alary M, Astemborski J, Iversen J, Lim AG, MacGregor L, Morris M, Ong JJ, Platt L, Sack-Davis R, van Santen DK, Solomon SS, Sypsa V, Valencia J, Van Den Boom W, Walker JG, Ward Z, Stone J, Vickerman P. Homelessness, unstable housing, and risk of HIV and hepatitis C virus acquisition among people who inject drugs: a systematic review and meta-analysis. Lancet Public Health 2021; 6:e309-e323. [PMID: 33780656 PMCID: PMC8097637 DOI: 10.1016/s2468-2667(21)00013-x] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 01/19/2023]
Abstract
BACKGROUND People who inject drugs (PWID) are at increased risk for HIV and hepatitis C virus (HCV) infection and also have high levels of homelessness and unstable housing. We assessed whether homelessness or unstable housing is associated with an increased risk of HIV or HCV acquisition among PWID compared with PWID who are not homeless or are stably housed. METHODS In this systematic review and meta-analysis, we updated an existing database of HIV and HCV incidence studies published between Jan 1, 2000, and June 13, 2017. Using the same strategy as for this existing database, we searched MEDLINE, Embase, and PsycINFO for studies, including conference abstracts, published between June 13, 2017, and Sept 14, 2020, that estimated HIV or HCV incidence, or both, among community-recruited PWID. We only included studies reporting original results without restrictions to study design or language. We contacted authors of studies that reported HIV or HCV incidence, or both, but did not report on an association with homelessness or unstable housing, to request crude data and, where possible, adjusted effect estimates. We extracted effect estimates and pooled data using random-effects meta-analyses to quantify the associations between recent (current or within the past year) homelessness or unstable housing compared with not recent homelessness or unstable housing, and risk of HIV or HCV acquisition. We assessed risk of bias using the Newcastle-Ottawa Scale and between-study heterogeneity using the I2 statistic and p value for heterogeneity. FINDINGS We identified 14 351 references in our database search, of which 392 were subjected to full-text review alongside 277 studies from our existing database. Of these studies, 55 studies met inclusion criteria. We contacted the authors of 227 studies that reported HIV or HCV incidence in PWID but did not report association with the exposure of interest and obtained 48 unpublished estimates from 21 studies. After removal of duplicate data, we included 37 studies with 70 estimates (26 for HIV; 44 for HCV). Studies originated from 16 countries including in North America, Europe, Australia, east Africa, and Asia. Pooling unadjusted estimates, recent homelessness or unstable housing was associated with an increased risk of acquiring HIV (crude relative risk [cRR] 1·55 [95% CI 1·23-1·95; p=0·0002]; I2= 62·7%; n=17) and HCV (1·65 [1·44-1·90; p<0·0001]; I2= 44·8%; n=28]) among PWID compared with those who were not homeless or were stably housed. Associations for both HIV and HCV persisted when pooling adjusted estimates (adjusted relative risk for HIV: 1·39 [95% CI 1·06-1·84; p=0·019]; I2= 65·5%; n=9; and for HCV: 1·64 [1·43-1·89; p<0·0001]; I2= 9·6%; n=14). For risk of HIV acquisition, the association for unstable housing (cRR 1·82 [1·13-2·95; p=0·014]; n=5) was higher than for homelessness (1·44 [1·13-1·83; p=0·0036]; n=12), whereas no difference was seen between these outcomes for risk of HCV acquisition (1·72 [1·48-1·99; p<0·0001] for unstable housing, 1·66 [1·37-2·00; p<0·0001] for homelessness). INTERPRETATION Homelessness and unstable housing are associated with increased risk of HIV and HCV acquisition among PWID. Our findings support the development of interventions that simultaneously address homelessness and unstable housing and HIV and HCV transmission in this population. FUNDING National Institute for Health Research, National Institute on Drug Abuse, National Institute of Allergy and Infectious Diseases, and Commonwealth Scholarship Commission.
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Affiliation(s)
- Chiedozie Arum
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Hannah Fraser
- Population Health Sciences, University of Bristol, Bristol, UK
| | | | - Sandra Bivegete
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Adam Trickey
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Michel Alary
- Centre de recherche du CHU de Québec, Université Laval, Quebec City, QC, Canada; Département de médecine sociale et préventive, Université Laval, Quebec City, QC, Canada; Institut national de santé publique du Québec, Québec, QC, Canada
| | - Jacquie Astemborski
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Jennifer Iversen
- Kirby Institute for Infection and Immunity, UNSW Sydney, NSW, Australia
| | - Aaron G Lim
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Louis MacGregor
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Meghan Morris
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Jason J Ong
- Population Health Sciences, University of Bristol, Bristol, UK; Department of Clinical Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Lucy Platt
- Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Rachel Sack-Davis
- Burnet Institute, Melbourne, VIC, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Daniela K van Santen
- Burnet Institute, Melbourne, VIC, Australia; Department of Infectious Disease Research and Prevention, Public Health Service of Amsterdam, Amsterdam, Netherlands
| | - Sunil S Solomon
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Vana Sypsa
- Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Jorge Valencia
- Harm Reduction Unit "SMASD", Department of Addictions and Mental Health, Madrid, Spain
| | | | | | - Zoe Ward
- Population Health Sciences, University of Bristol, Bristol, UK
| | - Jack Stone
- Population Health Sciences, University of Bristol, Bristol, UK.
| | - Peter Vickerman
- Population Health Sciences, University of Bristol, Bristol, UK
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Rottnek F, Laxton A. Homeless and COVID-19: Interventions for an Acute Exacerbation of a Chronic Condition. Mo Med 2021; 118:196-202. [PMID: 34149073 PMCID: PMC8210986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Affiliation(s)
- Fred Rottnek
- Professor and Director of Community Medicine, Department of Family and Community Medicine; Program Director, Addiction Medicine Fellowship, Saint Louis University (SLU) School of Medicine, St. Louis, Missouri
| | - Aaron Laxton
- Director of Behavioral Health and Therapist with Assisted Recovery Center of America, St. Louis, Missouri
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Montgomery MP, Paulin HN, Morris A, Cotton A, Speers A, Boyd AT, Buff AM, Mathews D, Wells A, Marchman C, Gaffga N, Bamrah Morris S, Cavanaugh SS. Establishment of Isolation and Noncongregate Hotels During COVID-19 and Symptom Evolution Among People Experiencing Homelessness-Atlanta, Georgia, 2020. J Public Health Manag Pract 2021; 27:285-294. [PMID: 33762544 PMCID: PMC10878749 DOI: 10.1097/phh.0000000000001349] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
CONTEXT Local agencies across the United States have identified public health isolation sites for individuals with coronavirus disease 2019 (COVID-19) who are not able to isolate in residence. PROGRAM We describe logistics of establishing and operating isolation and noncongregate hotels for COVID-19 mitigation and use the isolation hotel as an opportunity to understand COVID-19 symptom evolution among people experiencing homelessness (PEH). IMPLEMENTATION Multiple agencies in Atlanta, Georgia, established an isolation hotel for PEH with COVID-19 and noncongregate hotel for PEH without COVID-19 but at risk of severe illness. PEH were referred to the isolation hotel through proactive, community-based testing and hospital-based testing. Daily symptoms were recorded prospectively. Disposition location was recorded for all clients. EVALUATION During April 10 to September 1, 2020, 181 isolation hotel clients (77 community referrals; 104 hospital referrals) were admitted a median 3 days after testing. Overall, 32% of community referrals and 7% of hospital referrals became symptomatic after testing positive; 83% of isolation hotel clients reported symptoms at some point; 93% completed isolation. Among 302 noncongregate hotel clients, median stay was 18 weeks; 61% were discharged to permanent housing or had a permanent housing discharge plan. DISCUSSION Overall, a high proportion of PEH completed isolation at the hotel, suggesting a high level of acceptability. Many PEH with COVID-19 diagnosed in the community developed symptoms after testing, indicating that proactive, community-based testing can facilitate early isolation. Noncongregate hotels can be a useful COVID-19 community mitigation strategy by bridging PEH at risk of severe illness to permanent housing.
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Affiliation(s)
- Martha P Montgomery
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, Georgia (Drs Montgomery, Paulin, Boyd, Buff, Gaffga, Bamrah Morris, and Cavanaugh); Partners for HOME, Atlanta, Georgia (Mr Morris and Ms Marchman); Fulton County Board of Health, Atlanta, Georgia (Ms Cotton); Georgia Department of Public Health, Atlanta, Georgia (Ms Speers); Darlene Mathews, Incorporated, Atlanta, Georgia (Ms Mathews); and Mercy Care, Atlanta, Georgia (Ms Wells)
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47
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Linnemayr S, Zutshi R, Shadel W, Pedersen E, DeYoreo M, Tucker J. Text Messaging Intervention for Young Smokers Experiencing Homelessness: Lessons Learned From a Randomized Controlled Trial. JMIR Mhealth Uhealth 2021; 9:e23989. [PMID: 33792551 PMCID: PMC8050749 DOI: 10.2196/23989] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/04/2021] [Accepted: 02/23/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Smoking rates are significantly higher among young people experiencing homelessness than in the general population. Despite a willingness to quit, homeless youth have little success in doing so on their own, and existing cessation resources tailored to this population are lacking. Homeless youth generally enjoy the camaraderie and peer support that group-based programs offer, but continuous in-person support during a quit attempt can be prohibitively expensive. OBJECTIVE This study aimed to assess the feasibility and acceptability of an automated text messaging intervention (TMI) as an adjunct to group-based cessation counseling and provision of nicotine patches to help homeless youth quit smoking. This paper outlines the lessons learned from the implementation of the TMI intervention. METHODS Homeless youth smokers aged 18 to 25 years who were interested in quitting (n=77) were recruited from drop-in centers serving homeless youth in the Los Angeles area. In this pilot randomized controlled trial, all participants received a group-based cessation counseling session and nicotine patches, with 52% (40/77) randomly assigned to receive 6 weeks of text messages to provide additional support for their quit attempt. Participants received text messages on their own phone rather than receiving a study-issued phone for the TMI. We analyzed baseline and follow-up survey data as well as back-end data from the messaging platform to gauge the acceptability and feasibility of the TMI among the 40 participants who received it. RESULTS Participants had widespread (smart)phone ownership-16.4% (36/219) were ineligible for study participation because they did not have a phone that could receive text messages. Participants experienced interruptions in their phone use (eg, 44% [16/36] changed phone numbers during the follow-up period) but reported being able to receive the majority of messages. These survey results were corroborated by back-end data (from the program used to administer the TMI) showing a message delivery rate of about 95%. Participant feedback points to the importance of carefully crafting text messages, which led to high (typically above 70%) approval of most text messaging components of the intervention. Qualitative feedback indicated that participants enjoyed the group counseling session that preceded the TMI and suggested including more such group elements into the intervention. CONCLUSIONS The TMI was well accepted and feasible to support smoking cessation among homeless youth. Given high rates of smartphone ownership, the next generation of phone-based smoking cessation interventions for this population should consider using approaches beyond text messages and focus on finding ways to develop effective approaches to include group interaction using remote implementation. Given overall resource constraints and in particular the exigencies of the currently ongoing COVID-19 epidemic, phone-based interventions are a promising approach to support homeless youth, a population urgently in need of effective smoking cessation interventions. TRIAL REGISTRATION ClinicalTrials.gov NCT03874585; https://clinicaltrials.gov/ct2/show/NCT03874585. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) RR2-10.1186/s13722-020-00187-6.
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Affiliation(s)
| | | | | | - Eric Pedersen
- University of Southern California, Los Angeles, CA, United States
| | | | - Joan Tucker
- RAND Corporation, Santa Monica, CA, United States
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48
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Vincent W, Lin J, Veloso D, Miller D, McFarland W. Homelessness, HIV testing, and the reach of public health efforts for people who inject drugs, San Francisco, California. Drug Alcohol Depend 2021; 221:108560. [PMID: 33607498 PMCID: PMC8494070 DOI: 10.1016/j.drugalcdep.2021.108560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Revised: 12/20/2020] [Accepted: 01/02/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND There is a dearth of literature that explicitly examines associations between housing and HIV testing among people who inject drugs (PWID). Thus, the present study investigated the links between housing status and HIV testing for PWID. METHODS Respondent-driven sampling recruited 382 HIV-negative PWID, who completed structured interviews in San Francisco. Logistic regression determined whether housing statuses in the past 12 months ([1] owned/rented, [2] single-room occupancy hotels [SROs], [3] living with friends/family/partners, [4] shelters, [5] outdoors) were associated with getting HIV tested in the past 12 months while adjusting for sociodemographics and receptive sharing of injection paraphernalia in the past 12 months. RESULTS PWID who lived in SROs had greater odds of being tested for HIV than PWID who did not live in SROs (aOR = 1.95, CI.95: 1.06-3.60) while adjusting for covariates. Although bivariable analyses indicated that receptively sharing syringes was more common for PWID who lived with others (χ2[3] = 7.94, p = 0.047) or lived outdoors (χ2[3] = 9.50, p = 0.023) than those who did not, respectively, PWID who lived with others (aOR = 1.72, CI.95 = 0.95-3.14) or lived outdoors (aOR = 1.37, CI.95 = 0.74-2.53) did not show greater odds of HIV testing in multivariable analyses. CONCLUSIONS PWID who lived in SROs had greater odds of HIV testing than PWID who did not live in SROs. Although PWID who lived with others or outdoors showed greater HIV risk, they did not show greater odds of HIV testing. Public health efforts may be reaching PWID in SROs, but more work is needed to reach PWID who live with other people or outdoors.
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Affiliation(s)
- Wilson Vincent
- Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, United States.
| | - Jess Lin
- Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, United States
| | - Danielle Veloso
- Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, United States
| | - Desmond Miller
- Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, United States
| | - Willi McFarland
- Department of Psychology, Weiss Hall, 1701 N. 13th Street, Philadelphia, PA, 19122, United States
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49
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Luong L, Lachaud J, Kouyoumdjian FG, Hwang SW, Mejia-Lancheros C. The impact of a Housing First intervention and health-related risk factors on incarceration among people with experiences of homelessness and mental illness in Canada. Can J Public Health 2021; 112:270-279. [PMID: 33170496 PMCID: PMC7910327 DOI: 10.17269/s41997-020-00433-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 10/06/2020] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine the effect of a Housing First (HF) intervention and health-related risk factors on incarceration among adults with experiences of homelessness and mental illness. METHODS Participants (N = 508) were recruited at the Toronto site of the At Home/Chez Soi study. The outcome was incarceration in Ontario from 2009 to 2014. Exposures were intervention group (HF vs. treatment as usual), Axis I mental health diagnoses, emergency department (ED) visit, and history of traumatic brain injury (TBI). Logistic regression was used to examine the association between exposures and incarceration. RESULTS Of 508 participants, 220 (43.3%) were incarcerated at least once during the study period. Among those incarcerated, 81.9% were male, 52.7% had been diagnosed with alcohol dependence/abuse, 60.9% had been diagnosed with substance dependence/abuse, 65.1% reported having visited an ED within the last 6 months, and 66.4% had a history of TBI. After adjusting for demographic covariates, substance dependence/abuse (aOR: 2.06; 95% CI: 1.40, 3.03), alcohol dependence/abuse (aOR: 1.52, 95% CI: 1.04, 2.22), ED visit (aOR: 1.54; 95% CI: 1.02, 2.32), and history of TBI (aOR: 2.60; 95% CI: 1.75, 3.85) were associated with incarceration. We found no significant effect of the HF intervention on incarceration outcome (aOR: 1.08; 95% CI: 0.76, 1.55). CONCLUSIONS Among adults with experiences of homelessness and severe mental illness, those with substance and alcohol dependence/abuse disorders, history of TBI, and recent ED visits were at increased odds of incarceration. Strategies are needed to prevent and reduce incarceration for this population, including treatment of mental illness in the community.
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Affiliation(s)
- Linh Luong
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
| | - Fiona G Kouyoumdjian
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Department of Family Medicine, McMaster University, Hamilton, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada
- Division of General Internal Medicine, University of Toronto, Toronto, ON, Canada
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, 30 Bond Street, Toronto, ON, M5B 1W8, Canada.
- Research Group in Nursing Care and Practice, Family Health Nursing and Health Measures; Nursing Faculty, Universidad Nacional de Colombia, Bogotá, Colombia.
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50
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Roederer T, Mollo B, Vincent C, Nikolay B, Llosa AE, Nesbitt R, Vanhomwegen J, Rose T, Goyard S, Anna F, Torre C, Fourrey E, Simons E, Hennequin W, Mills C, Luquero FJ. Seroprevalence and risk factors of exposure to COVID-19 in homeless people in Paris, France: a cross-sectional study. Lancet Public Health 2021; 6:e202-e209. [PMID: 33556328 PMCID: PMC7993986 DOI: 10.1016/s2468-2667(21)00001-3] [Citation(s) in RCA: 68] [Impact Index Per Article: 22.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/14/2020] [Accepted: 12/21/2020] [Indexed: 01/20/2023]
Abstract
BACKGROUND During the COVID-19 lockdown period from March 17 to May 11, 2020, French authorities in Paris and its suburbs relocated people experiencing recurrent homelessness to emergency shelters, hotels, and large venues. A serological survey was done at some of these locations to assess the COVID-19 exposure prevalence in this group. METHODS We did a cross-sectional seroprevalence study at food distribution sites, emergency shelters, and workers' residences that were provided medical services by Médecins Sans Frontières in Paris and Seine-Saint-Denis in the Ile-de-France region. Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) antibody seropositivity was detected by Luciferase-Linked Immunosorbent Assay and Pseudo Neutralization Test. Sociodemographic and exposure related information was collected via a verbal questionnaire to analyse risk factors and associations with various COVID-19 symptoms. FINDINGS Between June 23 and July 2, 2020, 426 (52%) of 818 individuals recruited tested positive in 14 sites. Seroprevalence varied significantly by type of recruitment site (χ2 p<0·0001), being highest among those living in workers' residences (88·7%, 95% CI 81·8-93·2), followed by emergency shelters (50·5%, 46·3-54·7), and food distribution sites (27·8%, 20·8-35·7). More than two thirds of COVID-19 seropositive individuals (68%, 95% CI 64·2-72·2; 291 of 426) did not report any symptoms during the recall period. COVID-19 seropositivity was strongly associated with overcrowding (medium density: adjusted odds ratio [aOR] 2·7, 95% CI 1·5-5·1, p=0·0020; high density: aOR 3·4, 1·7-6·9, p<0·0001). INTERPRETATION These results show high exposure to SARS-CoV-2 with important variations between those at different study sites. Living in crowded conditions was the strongest factor associated with exposure level. This study underscores the importance of providing safe, uncrowded accommodation, alongside adequate testing and public health information. FUNDING Médecins Sans Frontières, Epicentre, Institut Pasteur's URGENCE nouveau coronavirus fund, Total Foundation.
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Affiliation(s)
| | | | | | | | | | | | - Jessica Vanhomwegen
- Environment and Infectious Risks Research and Expertise Unit, Global Health Department, Institut Pasteur, Paris, France
| | - Thierry Rose
- Unit of Lymphocyte Cell Biology, Immunology Department, Institut Pasteur, Paris, France
| | - Sophie Goyard
- Unit of Lymphocyte Cell Biology, Immunology Department, Institut Pasteur, Paris, France
| | - François Anna
- Unit of Molecular Virology and Vaccinology, Virology Department, Institut Pasteur, Paris, France; Theravectys, Paris, France
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