Precarious Work and Housing for Michigan Farmworkers During the COVID-19 Pandemic and Beyond

OBJECTIVES

Farmworkers in Michigan face precarious and exploitative labor conditions that affect their access to affordable, fair, and quality housing, which are key social determinants of health. We sought to assess the health, working conditions, and housing access, affordability, and quality of farmworkers living in and outside of employer-provided housing during the COVID-19 pandemic.

METHODS

We conducted a mixed methods cross-sectional study in collaboration with community partners from the Michigan Farmworker Project and the Michigan Department of Civil Rights. We assessed housing, labor conditions, and general health through in-depth phone interviews with seasonal, migrant, and H-2A farmworkers (n = 63) during the height of the COVID-19 pandemic (2020-2021) in Michigan. Descriptive analyses of these data included comparisons by type of farmworker and type of housing (employer-provided or other).

RESULTS

The majority of farmworkers interviewed were women and seasonal farmworkers and spoke primarily Spanish. A significant share of farmworker participants reported living in poverty (38.3%) and had low or very low food security (27.0%). Nearly half of farmworkers (47.6%) rated their health as "fair" or "poor" during the year prior to the interview, and more than a third reported 3 or more chronic conditions (39.6%) and lack of health insurance coverage (38.7%). Among the 43 workers tested, 25.6% reported testing positive for COVID-19. Farmworkers reported experiences of objectification and dehumanization. Three-quarters of workers reported feeling that they were treated as less than human by supervisors and one-third reported verbal abuse. Farmworkers also experienced challenges exacerbated by their social vulnerability that impeded them from finding affordable, quality housing. Regarding housing quality, the majority of workers (80.6%) reported one or more environmental hazards around their residence, and about a third reported not having air conditioning (33.%) and lacking a functioning washing machine (33.9%). Concerns about the quality of drinking water accessible to workers and exposure to chemicals were shared by participants.

CONCLUSION

This study adds valuable knowledge to the understanding of the systemic barriers to housing and work conditions for female and male seasonal, migrant, and H-2A farmworkers in Michigan. Shortcomings in the regulatory and policy environment result in precarious housing and work conditions, including exploitative labor practices. These conditions negate equality, fairness, and health equity, important tenants for public health.

National Overview of Nonprofit Hospitals' Community Benefit Programs to Address Housing

BACKGROUND

Housing is a critical social determinant of health that can be addressed through hospital-supported community benefit programming.

OBJECTIVES

To explore the prevalence of hospital-based programs that address housing-related needs, categorize the specific actions taken to address housing, and determine organizational and community-level factors associated with investing in housing.

RESEARCH DESIGN

This retrospective, cross-sectional study examined a nationally representative dataset of administrative documents from nonprofit hospitals that addressed social determinants of health in their federally mandated community benefit implementation plans. We conducted descriptive statistics and bivariate analyses to examine hospital and community characteristics associated with whether a hospital invested in housing programs. Using an inductive approach, we categorized housing investments into distinct categories.

MEASURES

The main outcome measure was a dichotomous variable representing whether a hospital invested in one or more housing programs in their community.

RESULTS

Twenty percent of hospitals invested in one or more housing programs. Hospitals that addressed housing in their implementation strategies were larger on average, less likely to be in rural communities, and more likely to be serving populations with greater housing needs. Housing programs fell into 1 of 7 categories: community partner collaboration (34%), social determinants of health screening (9%), medical respite centers (4%), community social determinants of health liaison (11%), addressing specific needs of homeless populations (16%), financial assistance (21%), and targeting high-risk populations (5%).

CONCLUSIONS

Currently, a small subset of hospitals nationally are addressing housing. Hospitals may need additional policy support, external partnerships, and technical assistance to address housing in their communities.

Housing and Long-Term Services and Supports for People With Intellectual or Developmental Disabilities From Racially and Culturally Minoritized Communities

This article describes research on the places people with intellectual and developmental disabilities (IDD) live and disparities in housing and long-term services and supports (LTSS) outcomes for people with IDD from racially and culturally minoritized groups. It also summarizes the conclusions and recommendations of the Housing and Long-Term Services and Supports strand of the 2022 State of the Science Conference on the Intersection of Diversity, Equity and Inclusion and Supports and Services for People with IDD, identifies limitations of the available research and recommends strategies to improve research, knowledge translation, and practices.

The construct validity of attitudes toward sex offenders (ATS) scale: ATS is more strongly linked to the acceptance of sex offenders than other offenders or non-offenders

Negative attitudes toward offenders may hinder the rehabilitation process. The present study examines the relationship between attitudes toward sex offenders and stated acceptance of offenders and non-offenders into various aspects of daily life. Sixty female members of the public (18-50 years old, UK residents, recruited by word of mouth and via social media) completed an attitudes towards sex offenders (ATS) scale and indicated for each of eight vignettes describing ex-offenders and non-offenders whether they would accept them in various situations (housing, employment, day-to-day activities). Results indicate that in this group of female participants, harsher attitudes toward sex offenders are associated with lower acceptance of sex offenders (around 50% less acceptance) and other offenders (around 25% less acceptance), but not non-offenders, suggesting a tight coupling between attitudes and acceptance. The observed coupling between attitudes toward sex offenders and acceptance of offenders suggests that it will be difficult to change one without changing the other.

The effect of enriched versus depleted housing on eucalyptus smoke-induced cardiovascular dysfunction in mice

Objectives: Living conditions play a major role in health and well-being, particularly for the cardiovascular and pulmonary systems. Depleted housing contributes to impairment and development of disease, but how it impacts body resiliency during exposure to environmental stressors is unknown. This study examined the effect of depleted (DH) versus enriched housing (EH) on cardiopulmonary function and subsequent responses to wildfire smoke. Materials and Methods: Two cohorts of healthy female mice, one of them surgically implanted with radiotelemeters for the measurement of electrocardiogram, body temperature (Tco) and activity, were housed in either DH or EH for 7 weeks. Telemetered mice were exposed for 1 h to filtered air (FA) and then flaming eucalyptus wildfire smoke (WS) while untelemetered mice, which were used for ventilatory assessment and tissue collection, were exposed to either FA or WS. Animals were continuously monitored for 5-7 days after exposure. Results: EH prevented a decrease in Tco after radiotelemetry surgery. EH mice also had significantly higher activity levels and lower heart rate during and after FA and WS. Moreover, EH caused a decreased number of cardiac arrhythmias during WS. WS caused ventilatory depression in DH mice but not EH mice. Housing enrichment also upregulated the expression of cardioprotective genes in the heart. Conclusions: The results of this study indicate that housing conditions impact overall health and cardiopulmonary function. More importantly, depleted housing appears to worsen the response to air pollution. Thus, non-chemical factors should be considered when assessing the susceptibility of populations, especially when it comes to extreme environmental events.

Residential mobility and persistently depressed voting among disadvantaged adults in a large housing experiment

This study examines the impact of residential mobility on electoral participation among the poor by matching data from Moving to Opportunity, a US-based multicity housing-mobility experiment, with nationwide individual voter data. Nearly all participants in the experiment were Black and Hispanic families who originally lived in high-poverty public housing developments. Notably, the study finds that receiving a housing voucher to move to a low-poverty neighborhood decreased adult participants' voter participation for nearly two decades-a negative impact equal to or outpacing that of the most effective get-out-the-vote campaigns in absolute magnitude. This finding has important implications for understanding residential mobility as a long-run depressant of voter turnout among extremely low-income adults.

Systematic Review: HIV, Aging, and Housing-A North American Perspective, 2012-2023

Advances in anti-retroviral therapy (ART) have decreased mortality rates and subsequently led to a rise in the number of HIV-positive people living longer. The housing experiences of this new population of interest-older adults (50 years and older) living with HIV-are under-researched. Understanding the housing experiences and unmet needs of older people with HIV can better provide comprehensive care services for them. This study's systematic review evaluated the peer-reviewed literature reporting housing access/insecurity/assistance/options, housing impact, and unmet needs of older individuals living with HIV in North America from 2012 to 2023. Furthermore, Latent Semantic Analysis (LSA), a text-mining technique, and Singular Value Decomposition (SVD) for text clustering were utilized to examine unstructured data from the abstracts selected from the review. The goal was to allow for a better understanding of the relationships between terms in the articles and the identification of emerging public health key themes affecting older adults living with HIV. The results of text clustering yielded two clusters focusing on (1) improvements to housing and healthcare services access and policies and (2) unmet needs-social support, mental health, finance, food, and sexuality insecurities. Topic modeling demonstrated four topics, which we themed to represent (1) a holistic care approach; (2) insecurities-food, financial, sexuality, and other basic needs; (3) access to housing and treatment/care; and (4) homelessness and HIV-related health outcomes. Stable housing, food, and healthcare services access and availability are critical elements to incorporating comprehensive, holistic healthcare for older adults living with HIV. The aging population requires high-priority policies for accessible and equitable healthcare. Clinicians and policymakers should address individual barriers, adopt a patient-centered approach, increase doctor visits, provide competency training, ensure long-term follow-up, involve families, and improve patient education in care management, contributing to HIV/AIDS geriatric care models.

Identifying Potential Determinants of Faecal Contamination on Domestic Floors in Three Settings in Rural Kenya: A Mixed Methods Analysis

Observational evidence suggests that household floors may be an important domain for the transmission of enteric and parasitic infections. However, little work has been done to investigate how household floors can become contaminated with human and animal faeces. This study uses a mixed methods approach to postulate the proximal and distal determinants of household floor contamination with faeces in groups of rural villages in 3 counties in Kenya (Bungoma, Kwale and Narok). Quantitative data was collected through a household census and analysed descriptively and using mixed effects logistic regression models. Qualitative data was collected through unstructured observations of daily routines and in-depth interviews. These data were analysed thematically with case memos produced for routine activities that were hypothesised to be determinants of floor contamination. Possible proximal determinants of floor contamination included; (1) animal contact with floors; (2) child faeces disposal, and; (3) floor cleaning routines. Distal determinants are suggested to be rooted in the socioeconomic, environmental, and cultural context in which households were located and included; (1) the type and number of animals owned by households; (2) presence/absence of dedicated shelters for housing animals at night, which impacted whether sleeping or cooking areas were exposed to animals; (3) Accessibility of inside spaces to poultry and other roaming animals; (4) ownership of an improved floor; (5) ability of animals to access neighbours compounds; (6) seasonal changes in weather. These results will be of use in identifying the contexts in which faecal contamination of domestic floors may be contributing towards transmission of enteric and parasitic infections and in designing effective interventions to prevent this exposure.

Subjective evaluation of home environment and levels of self-reported depression in middle to old age: Results from the HCHS study

OBJECTIVES

The immediate living environment might, like other lifestyle factors, be significantly related to mental well-being. The current study addresses the question whether five relevant subjective home environment variables (i.e., protection from disturbing nightlight, daylight entering the home, safety at home, quality of window views, and noise disturbance) are associated with levels of self-reported depression over and above well-known sociodemographic and common lifestyle variables.

METHODS

Data from the Hamburg City Health Study (HCHS) were analyzed. In N = 8757 with available PHQ-9 depression data, multiple linear regression models were computed, with demographic data, lifestyle variables, and variables describing the subjective evaluation of the home environment.

RESULTS

The model explained 15% of variance in depression levels, with ratings for the subjective evaluation of home environment accounting for 6%. Better protection from disturbing light at night, more daylight entering the home, feeling safer, and perceived quality of the window views, were all significantly associated with lower, while more annoyance by noise was associated with higher levels of self-reported depression. Results did not differ if examining a sample of the youngest (middle-aged participants: 46-50 years) versus oldest (70-78 years) participants within HCHS.

CONCLUSION

Beyond studying the role of lifestyle factors related to self-reported depression, people's homes may be important for subclinical levels of depression in middle and older age, albeit the direction of effects or causality cannot be inferred from the present study. The development of a consensus and tools for a standardized home environment assessment is needed.

Current and ideal living arrangements and supports for Canadian adults with fetal alcohol spectrum disorder (FASD)-Part I: Perspectives from adults with FASD

BACKGROUND

Adults with fetal alcohol spectrum disorder (FASD) can thrive with lifelong support in daily living activities. Previous research examining living support for adults with FASD has heavily relied on caregiver reports rather than lived experiences, which can undermine opportunities for self-determination. In this study, we examined the perspectives of adults with FASD to better understand: (1) the ways in which they are supported with daily life activities; and (2) their ideal future living arrangements and supports.

METHODS

This article presents findings from the perspective of adults with FASD as part of a broader project involving both adults with FASD and the caregivers who support them. Interviews were conducted with four Canadian adults with FASD who live in housing with supportive services and seven adults with FASD who live at home with the support of caregivers. Framework analyses, a structured approach to analyzing qualitative data, were used to examine participants' perspectives.

RESULTS

In addition to providing support for previous findings, participants provided novel information regarding: (1) their daily living supports; (2) positive and negative aspects of their arrangements; and (3) ideal living environments and supports.

CONCLUSIONS

This study offers insight into participants' perspectives regarding their living support, which is critical to inform housing and aid in self-determination. Areas of support outlined by participants can be used to begin conversations regarding the support required in housing arrangements for adults with FASD.

Current and ideal living arrangements and supports for Canadian adults with fetal alcohol spectrum disorder: Part II-Perspectives from caregivers

BACKGROUND

Caregivers supporting adults with fetal alcohol spectrum disorder (FASD) report concerns regarding living arrangements and services for their adult children with FASD. Best practices for living support for adults with FASD are under-researched, and few studies have explored the experiences of caregivers whose children are adults. This study examined the perspectives of caregivers who support adults (18+) with FASD regarding: (1) current ways adults with FASD are supported with daily life activities; and (2) ideal future living arrangements and supports.

METHODS

This article presents findings from the perspective of caregivers who support adults with FASD, as part of a broader project involving both adults with FASD and caregivers. Semi-structured interviews were conducted with 11 Canadian caregivers who live at home with an adult with FASD (aged 18+). Responses were examined using framework analysis, a structured approach to analyzing qualitative data.

RESULTS

Caregivers described their experiences and perspectives regarding: (1) current ways adults with FASD are supported in their daily activities; (2) strategies for successful support; (3) ideal future living arrangements and supports; and (4) concerns for the future. Notably, almost every participant raised pressing concerns regarding the future living arrangements for the person they support once they are no longer able to provide care.

CONCLUSIONS

This study explores caregivers' perspectives regarding living support needed by adults with FASD, which can inform support programs and housing services. Findings demonstrate an urgent need for policy change directed toward developing available, affordable, and appropriate housing for adults with FASD.

'We Were an Afterthought': Corona Virus Disease 2019 (COVID-19) Pandemic in Culturally and Linguistically Diverse (CALD) Communities in New South Wales, Australia

This paper investigates the impact on Culturally and Linguistically Diverse (CALD) communities in Australia of government and community responses to the coronavirus pandemic of 2019 in the domains of education, employment, housing, social connectedness, and public health communication. Most of the examples are drawn from the state of New South Wales. In Australia, CALD refers to people from countries not classified as main English speaking. Most CALD communities reported in this article are from refugee backgrounds, are recently arrived migrants or do not use English in most of their communication. Inadequate, and in some instances, inappropriate or absent support, adversely impacts CALD communities. We used a multidisciplinary bricolage approach that draws on media, government, and community support publications and concluded that CALD communities experienced heightened pressures due to lower resource availability and poor communication. This led to disruption of support services, exposing gaps and vulnerability. The results reported here challenge Australian government, schools, community agencies, researchers to include proactively CALD community perspectives when planning and responding to such crises in future. Improving communication, pandemic response planning, addressing needs and ensuring participation are key considerations.

Welfare Assessment on Different-Sized Dairy Goat Farms in the Northern Serbian Province of Vojvodina

This research aimed for the first time to identify the essential welfare problems on 46 goat dairy farms in Vojvodina,based on the goat AWIN welfare protocol. The study showed that space allowance per goat was 1.55, 1.86 and 2.50 m2/goat (large, medium, small-sized farms, respectively). Most farms possessed the soil floor and straw as a flooring material. The small and medium farms more allowed access to the outdoor area. Contrary, large-sized farms mostly kept goats in fully housed systems with reduced opportunities for the goats to express their natural behavior. Management procedures were significantly different (p < 0.05) between the investigated farms. Differences were mainly in bedding, feeding and culling strategies. Low productivity was the main cause of culling in all farm types. Small-sized farms carried out more often disbudding (42.9%) in comparison with medium (21.4%) and large-sized ones (14.3%). Group level observation showed that the main areas of concern were associated with hair coat condition and kneeling at the feeding rack (p < 0.05). Inadequate BCS, udder asymmetry and claw overgrowth were frequently recorded. The prevalence of thin and fat goats was highest in large-sized farms All farm size categories and management systems showed certain welfare weaknesses. Thus, the findings highlighted the need for higher implementation of animal welfare principles and improvement of management techniques to meet the welfare requirements of dairy goats.

The effect of the local economic context and local public services on financial satisfaction among youth in European cities

The post-2008 economic recovery period has seen varying degrees of improvement in the well-being of young individuals across different countries, regions, and cities of the EU. This study contributes to the literature on the geography of well-being by examining the impact of urban economic contexts on the subjective well-being of youth in Europe, a topic that has received limited attention so far. Specifically, we investigate how the local economic context has affected financial satisfaction among the young (15-35 age group) in European cities during the recovery period after the economic crisis. We study whether living in a city with better opportunities in the labor market, on the housing market, or with better local services (e.g., education or health care) affect financial satisfaction among the young. We carried out multilevel analysis of financial satisfaction among young adults on data from the Quality of Life in European Cities survey (years 2012, 2015, 2019), which asks about aspects of quality of life among a representative sample of the population in a large number of cities in EU Member States. Overall, the results suggest that a better labor market context (where it is in general easier to find a job) has a statistically significant positive effect on financial satisfaction among the young. Our results also show that satisfaction with the financial situation among young adults is significantly higher in cities with a higher quality of local social services. On the other hand, we have found only small (and statistically non-significant) contextual effect related to the local housing market.

Gentrification and access to housing in Mexico City during 2000 to 2022

We conducted a spatial and temporal analysis of housing patterns in Mexico City by utilizing an extensive database of 16,000 prices for flats and houses, covering the period from 2000 to 2022. Our findings reveal a striking trend: The average housing prices have quadrupled over a 20-y period, without considering inflation. In contrast, the per capita labor income of Mexican citizens has declined relative to inflation. As a result, the average family encountered four times greater challenges in accessing housing in 2015 as compared to 2005. Furthermore, our research demonstrates that areas that have undergone significant gentrification or super-gentrification contribute to a widespread increase in land value on neighboring zones, leading to the emergence of clusters of highly expensive neighborhoods.

Social Isolation and Safety Issues among Rural Older Adults Living Alone: Perspectives of Meals on Wheels Programs

Ensuring the safety and social well-being of rural populations, especially rural older adults living alone with complex medical conditions, is challenging, given large, sparsely populated communities and limited resources. Using qualitative data from surveys with 42 rural Meals on Wheels programs from across the U.S., we highlight particular challenges to meeting the social and safety needs of rural older adults living alone. Respondents described challenges, opportunities, and successes in meeting the needs of their clients. We describe these under four domains: main challenges, what can be done to address social isolation and loneliness, safety issues, improving safety, and current successes. We also identify cross-cutting themes related to programs' rural environment (long distances, inclement weather), infrastructure (housing quality, access to broadband Internet and technological connectivity, road conditions), funding and resource availability, and service provision (availability of health care and partner organizations.) We describe each of these in more detail and also share policy recommendations for improving health and safety of older adults living alone in rural areas, including funding nutrition programs as a health benefit and addressing aging, poor-quality housing stock.

Exploring Differences in Home Modification Strategies According to Household Location and Occupant Disability Status: 2019 American Housing Survey Analysis

Home modification is essential in helping older adults age in place safely and independently. The purpose of this study was to examine the impact of housing location and disability status on home modification projects among older adults using the 2019 American Housing Survey Data. The study found that recent home modification strategies were significantly different according to older adults' housing locations and health status. Older adults in non-metropolitan areas and with disability were less likely to make home modifications, and when they did so, they spent less money on the modifications. The findings highlight the importance of providing adequate home modification programs and resources for home modifications, as well as support and education from community organizations, particularly for older adults in non-metropolitan areas. The results of this study can assist in developing housing policies and guidelines to address these current and future challenges in home modification implementation for the aging population.

Rural/urban differences in receipt of governmental rental assistance: Relationship to health and disability

PURPOSE

Housing is essential to health. Governmental rental assistance is one way to increase access to affordable housing, but little is known about how it varies by rural/urban location. This paper seeks to address that gap by examining rural/urban and within-rural differences in receipt of rental assistance, with particular attention differences by health and disability.

METHODS

We used data from the 2021 National Health Interview Survey (n = 28,254) to conduct bivariate analyses to identify significant differences in receipt of rental assistance by rural/urban location. We then conducted logistic regression analyses to generate odds ratios of receiving rental assistance, adjusting for self-rated health, disability, sociodemographic characteristics, and the US Census region.

FINDINGS

When limiting the sample to those who rent (20.6% of rural residents and 29.6% of urban residents), rural residents were nearly 5 percentage points more likely to receive rental assistance (13.1% vs 8.2%, P<.001). Rural recipients of rental assistance were more likely to have a disability than urban residents (27.9% vs 20.3%, P<.05) and were more likely to report fair/poor health (41.6% vs 31.4%, P<.05).

CONCLUSIONS

Rural residents are less likely to rent their homes, but, among those who rent, they are more likely to receive governmental rental assistance. This may be reflective of the greater need for rental assistance among rural residents, who were in poorer health and of lower socioeconomic status than urban renters. As housing is essential to good health, policy attention must prioritize addressing a persistent and growing need for affordable housing in rural and urban areas alike.

'My pet can't come with me': Pets as a barrier against moving into supported accommodation

OBJECTIVE

To determine the impact of pet ownership on older people's decision to move to supported accommodation.

METHODS

Online survey.

RESULTS

Older Australians who were current or past pet owners were invited to complete an online survey, with 193 participants providing valid data. Almost two-thirds of the respondents who said they did not intend to move in the foreseeable future (n = 85) said their pet was an important reason. When asked to rate which factors would be hardest to come to terms with if they had to move because they needed more assistance in future, three groups emerged: the first group (37%) thought the impact on their pet of moving would not be difficult and the pet was not an important reason for staying in their current home. The second group (36%) were the opposite; they believed there would be a negative impact on their pet if they moved and the pet was an important reason for them to stay. The final group (27%) thought their pet was not an important reason to stay in their current location but if they did have to move, the impact on the pet would be quite difficult. No one fell into the category of identifying that their pet was an important reason to stay but having to move would have no impact on the animal.

CONCLUSIONS

Many older people think about their pets when making a decision to move house, including considering whether a move to supported accommodation will be difficult for their pet. A perceived absence of pet-friendly supported accommodation may be contributing to sub-optimal decision-making by older people.

Pandemic expertise: qualitative findings on the experiences of living with HIV during the COVID-19 pandemic

This qualitative study explored the experiences of people living with HIV (PLWH) in the San Francisco Bay Area, United States, during the COVID-19 pandemic and subsequent public health restrictions at a safety net HIV clinic. Patients (N = 30) were recruited for Spanish/English language semi-structured interviews (n = 30), translated when necessary, and analyzed thematically. The recurring theme of "pandemic expertise" emerged from the data: skills and attitudes developed through living with HIV helped PLWH cope with the COVID-19 pandemic, including effective strategies for dealing with anxiety and depression; appreciation for life; and practical experience of changing behavior to protect their health. A subset did not consider living with HIV helped them adapt to the COVID-19 pandemic, with some describing their lives as chaotic due to housing issues and/or ongoing substance use. Overall, interviewees reported finding trustworthy health information that helped them follow COVID-19 prevention strategies. Although living with HIV is associated with a higher prevalence of mental health concerns, substance use, and stigma, these challenges can also contribute to increased self-efficacy, adaptation, and resilience. Addressing structural issues such as housing appears to be key to responding to both pandemics.

Stopping the Vicious Cycle: Equitable Enforcement Strategies to Achieve Safe, Stable, and Accessible Housing for People with Disabilities

Policy Points People with disabilities experience a vicious cycle of poverty, poor health, and marginalization partly because of the inequitable implementation and enforcement of laws, including underenforcement of civil rights and housing laws and overenforcement of punitive nuisance and criminal laws. Inequitable enforcement reflects policy choices that prioritize powerful entities (e.g., landlords, developers) to the detriment of people who experience intersectional structural discrimination based on, for example, race, disability, and income. Equitable enforcement, a process of ensuring compliance with the law while considering and minimizing harms to marginalized people, can promote health and disability justice by increasing access to safe, stable, and accessible housing.

Housing Conditions and Health Implications for Migrant Agricultural Workers in Canada: A Scoping Review

Migrant agricultural workers face various health inequities that have led to preventable illness and death. This paper investigates how material housing conditions have shaped physical and mental health outcomes for temporary foreign workers in Canadian agriculture. We conducted a scoping review of literature on migrant agricultural worker housing in Canada published between 2000-2022, analysing insights on the physical quality of workers' housing in relation to international frameworks on housing quality. Our review revealed a range of housing-related health risks, including: (1) Sanitation, food security, and water; (2) Thermal safety, electricity, and utilities; (3) Habitability of structure, air quality, and exposure to hazards; (4) Spacing, privacy, and co-worker relations and; (5) Geographic proximity to necessary services and social opportunities. Although housing has been increasingly recognized as a social determinant of health, little research examines how migrant farmworkers' accommodations shape their health outcomes, particularly in Canada. This scoping review provides timely insights and recommendations to inform research, policy, and public health interventions.

'When the bedbugs come, that's another problem': exploring the lived experiences of bedbug infestations among low-income older adults and service providers who support them

AIMS

Older adults in low-income housing communities are more vulnerable to bedbug infestations. Prior research, however, has predominately focused on the effectiveness of integrated pest-management strategies, with little attention given to the lived experiences of tenants struggling with infestations. We used a qualitative approach to explore what it is like to live with and treat bedbug infestations from the perspectives of low-income older adults and service providers.

METHODS

Participants included low-income older adults (n = 58) and service providers (n = 58) who offer supports directly in the buildings. Semi-structured qualitative interviews and focus groups were used to explore the challenges of preparing and treating units for bedbugs, and examine how bedbugs impact access to support services.

RESULTS

Bedbugs were a widespread issue, and underlying physical, mental, social, and financial challenges made it difficult for older tenants to prepare their units and access treatment. Tenants also faced bedbug stigma from community services, as many were unwilling to provide services in infested units. Although some service providers utilized strategies to minimize exposure, many were concerned these strategies created additional stigma.

CONCLUSION

Our findings highlight an urgent need to increase public health funding to support older adults with the costs of bedbug elimination and to enhance pest-management strategies through partnerships with health and social service agencies to improve outcomes for older adults.

Family perspectives on provider conversations about housing needs for children with medical complexity

BACKGROUND

Children with medical complexity (CMC) have unique, and often unmet, housing needs that place them at risk for housing insecurity and poor health outcomes. Yet, little is known about how families with CMC discuss their housing needs with healthcare providers. We sought to understand: (1) how housing is currently discussed between CMC caregivers and healthcare providers, and (2) how CMC caregivers want such conversations to occur.

METHODS

From August to November 2020, we conducted semi-structured interviews with parents/guardians of CMC (<26 years old) in Maryland as part of a larger study to understand their housing experience. Four questions on communication with providers about housing were developed a priori and included in this analysis. Qualitative content analysis was applied to interview transcripts.

RESULTS

Among 31 completed interviews, most participants were female (90%), lived in single-family homes (68%) and were from a mix of neighbourhood types (urban 19%, suburban 58%, rural 22%). Their children ranged in age from 6 months to 22 years, had a mix of insurance types (public 65%, private 29%, both 6%) and nearly all required medical equipment or technology. Four themes emerged: (1) Current housing conversations are rare and superficial, (2) Ideal housing conversations would result in thoughtful care plans and concrete supports, (3) Frequency and initiation of housing conversations are best tailored to family preferences and (4) Value of housing conversations are limited by lack of provider knowledge and time.

CONCLUSIONS

Conversations about housing needs for CMC happen in limited ways with healthcare providers, despite a desire on the part of their caregivers. Such conversations can give meaningful insights into the family's specific housing challenges, allowing providers to appropriately tailor care plans and referrals. Future work is needed to capture provider perspectives, design CMC-specific housing screeners and develop interdisciplinary referral strategies.

Addressing Structural Racism Through Public Policy Advocacy: A Policy Statement From the American Heart Association

During the COVID-19 pandemic, the American Heart Association created a new 2024 Impact Goal with health equity at its core, in recognition of the increasing health disparities in our country and the overwhelming evidence of the damaging effect of structural racism on cardiovascular and stroke health. Concurrent with the announcement of the new Impact Goal was the release of an American Heart Association presidential advisory on structural racism, recognizing racism as a fundamental driver of health disparities and directing the American Heart Association to advance antiracist strategies regarding science, business operations, leadership, quality improvement, and advocacy. This policy statement builds on the call to action put forth in our presidential advisory, discussing specific opportunities to leverage public policy in promoting overall well-being and rectifying those long-standing structural barriers that impede the progress that we need and seek for the health of all communities. Although this policy statement discusses difficult aspects of our past, it is meant to provide a forward-looking blueprint that can be embraced by a broad spectrum of stakeholders who share the association's commitment to addressing structural racism and realizing true health equity.

Opioid-related overdose deaths among people experiencing homelessness, 2017 to 2021: A population-based analysis using coroner and health administrative data from Ontario, Canada

AIMS

To measure the change in proportion of opioid-related overdose deaths attributed to people experiencing homelessness and to compare the opioid-related fatalities between individuals experiencing homelessness and not experiencing homelessness at time of death.

DESIGN, SETTING AND PARTICIPANTS

Population-based, time-trend analysis using coroner and health administrative databases from Ontario, Canada from 1 July 2017 and 30 June 2021.

MEASUREMENTS

Quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness. We also obtained socio-demographic and health characteristics of decedents, health-care encounters preceding death, substances directly contributing to death and circumstances surrounding deaths.

FINDINGS

A total of 6644 individuals (median age = 40 years, interquartile range = 31-51; 74.1% male) experienced an accidental opioid-related overdose death, among whom 884 (13.3%) were identified as experiencing homelessness at the time of death. The quarterly proportion of opioid-related overdose deaths attributed to people experiencing homelessness increased from 7.2% (26/359) in July-September 2017 to 16.8% (97/578) by April-June 2021 (trend test P < 0.01). Compared with housed decedents, those experiencing homelessness were younger (61.3 versus 53.1% aged 25-44), had higher prevalence of mental health or substance use disorders (77.1 versus 67.1%) and more often visited hospitals (32.1 versus 24.5%) and emergency departments (82.6 versus 68.5%) in the year prior to death. Fentanyl and its analogues more often directly contributed to death among people experiencing homelessness (94.0 versus 81.4%), as did stimulants (67.4 versus 51.6%); in contrast, methadone was less often present (7.8 versus 12.4%). Individuals experiencing homelessness were more often in the presence of a bystander during the acute toxicity event that led to death (55.8 versus 49.7%); and where another individual was present, more often had a resuscitation attempted (61.7 versus 55.1%) or naloxone administered (41.2 versus 28.9%).

CONCLUSIONS

People experiencing homelessness account for an increasing proportion of fatal opioid-related overdoses in Ontario, Canada, reaching nearly one in six such deaths in 2021.

Resident Support for the Federally Mandated Smoke-Free Rule in Public Housing: 2018-2022

This study examines support for the Department of Housing and Urban Development's (HUD) mandatory smoke-free rule up to four years post-rule among smokers and non-smokers. A repeated cross-sectional design was used where District of Columbia public housing residents aged 18+ (n = 529) completed surveys during three time points: July 2018 (pre-rule), November 2018-March 2020 (post-rule), and September 2020-December 2022 (post-rule + COVID-19). Full support for the rule was indicated by agreeing that smoking should not be allowed in all indoor locations and within 25 feet of buildings. Descriptive statistics showed significant differences in support across time for smokers (5.3%, 30.7%, and 22.5%, respectively) and similar support across time for nonsmokers (48.2%, 52.2%, and 40.0%, respectively). In unstratified regression analysis, pre-rule support was lower than when the rule was in effect (aOR = 0.47, 95% CI = 0.25, 0.90), and tobacco users were less likely to support the rule (aOR = 0.34, 95% CI = 0.23, 0.50). Stratified logistic regression results showed that pre-rule support was lower among smokers compared to post-rule support (aOR = 0.14, 95% CI = 0.03, 0.59); support among nonsmokers did not vary by time. Findings overall indicate low support for the smoke-free rule up to 4 years post-implementation. Engaging residents with the rule and promoting health and well-being may further enhance policy effectiveness and acceptance.

Locally acquired strongyloidiasis in remote Australia: why are there still cases?

In Australia, strongyloidiasis primarily affects returned travellers, Vietnam veterans and refugees or asylum seekers, and First Nations people. Non-overseas acquired cases are seen almost exclusively in Australian First Nations remote communities. Australian First Nations communities have one of the highest rates of strongyloidiasis in the world. Our work has shown that strongyloidiasis is a disease of poverty. Acknowledging this is important-we need to shift the lens to socioeconomic factors, particularly environmental health hardware such as working toilets and sewerage systems, showers and laundries, and effective wastewater and rubbish removal. The rates of strongyloidiasis in First Nations communities is a result of decades of inadequate, poorly constructed and/or poorly maintained housing, and poor environmental health hardware (hereafter hardware). The solution lies in adequate funding, resulting in well designed and maintained housing and appropriate hardware. Governments need to allow First Nations communities themselves to take the lead role in funding allocation, and design, construction and maintenance of their housing and hardware. This will ensure housing and hardware fulfils cultural and physical needs and desires, and protects health. Improving housing and hardware will also improve other health outcomes. This article is part of the Theo Murphy meeting issue 'Strongyloides: omics to worm-free populations'.

My home-my castle? Self-reported anxiety varies in relation to the subjective evaluation of home environment

Introduction

Although people spend most of the day in their home environment, the focus of research in environmental psychology to date has been on factors outside the home. However, it stands to reason that indoor quality likewise has an impact on psychological well-being. Therefore, the present study addresses the question of whether the subjective evaluation of home environmental parameters are related to self-reported anxiety and whether they can additionally explain variance beyond the usual sociodemographic and general lifestyle variables.

Methods

Data from the Hamburg City Health Study (first 10,000 participants) was analyzed. A subsample of N = 8,886 with available GAD-7 anxiety data was selected, and hierarchical regression models were computed, with demographic data entered first, followed by variables concerning lifestyle/habits and finally variables of the subjective evaluation of home environment.

Results

Using the integrated model, we were able to explain about 13% of the variance in self-reported anxiety scores. This included both the demographic, lifestyle, and subjective evaluation of home environment variables. Protection from disturbing night lights, a greater sense of security, less disturbing noises, brighter accommodations, and a satisfactory window view explained almost 6% of the variance and was significantly associated with lower anxiety scores.

Conclusion

The home as a place of refuge plays an increasingly important role as home office hours rise. It is therefore crucial to identify domestic factors contributing to people's mental well-being. The subjective evaluation of one's home environment has proven influential over and above modifiable lifestyle variables.

How Housing, Employment, and Legal Precarity Affect the Sleep of Migrant Workers: A Mixed-Methods Study

In the United States, natural disasters have increased in frequency and intensity, causing significant damage to communities, infrastructure, and human life. Migrant workers form part of a growing occupational group that rebuilds in the aftermath of natural disasters like hurricanes and tornadoes. The work these migrant workers perform is essential but also unstable, exploitative, and dangerous, which stresses their health and well-being. This study focuses on the health and well-being of migrant roofers, a precarious occupational group who restores communities and helps the U.S. population adjust to a climate-changed world. Using surveys (N = 359) and in-depth interviews (n = 58) from a convenience sample of migrant roofers, we examine how precarity in terms of employment, housing, and legal status affect the sleep outcomes of these workers, who derive their income from an industry where instability is the norm, live in substandard and irregular housing, and lack workplace protections given their legal status.

Egg Quality, Yolk Fatty Acid Profiles from Laying Hens Housed in Conventional Cage and Cage-Free Production Systems in the Andean Tropics

Egg consumers worldwide have increased their concerns about laying hens' welfare and its impact on final egg product quality. This study compared the egg quality parameters under the conventional cage (CC) and cage-free (CF) egg production systems in the tropics. The study was conducted on a commercial farm in Colombia using Hy-Line Brown pullets, reared under the same conditions for the first 15 wks. At 16 wks, the hens were distributed into two housing systems, CC and CF, on the same farm. The hens were fed the same diet for each phase in both systems and feed intake varied slightly. Egg samples were collected every six wks, from 22 to 82 wks of age. A total of 3960 eggs were analyzed at 11 sampling times. Parameters such as albumen height, egg weight, yolk color, eggshell thickness, eggshell strength, and Haugh units were determined using a DET-6000 machine. At 22 and 82 wks, screening for Salmonella spp. status was conducted using environmental and egg samples. Additionally, at 34, 64, and 82 wks, yolk samples were obtained for fatty acid profiles and crude protein (CP) analysis. The data were analyzed in a completely randomized block design with repeated measures (11 times): mean separation by Student's t-test yolk pigmentation, Haugh Units, and albumen height (p < 0.001) were higher in the CF compared with the CC between 38 and 69 wks of age, and eggs at 63 and 82 wks (p < 0.05) were heavier in the CF compared to the CC. Likewise, eggs from the CC had better eggshell strength from 57 to 82 wks. In the egg yolk fatty acid profile at the 34th wk, the pentadecanoic, palmitic, and heptadecanoic acids had higher concentrations in the CF systems than the CC. At the 64th wk, the egg yolk fatty acids-lauric, myristic, and heptadecanoic-had higher concentrations in the CF; likewise, at the 82nd wk, egg yolks from the CC had higher concentrations of lauric, heptadecanoic, and nervonic fatty acids than the CF. The eggs and environmental samples were negative for Salmonella spp. throughout the whole production phase. These results indicated that the production system might impact internal and external egg quality measures, potentially due to various stressors, including environmental factors or behavior restrictions.

Healthcare Access Worsened for Women in Precarious Housing During the COVID-19 Pandemic: A Qualitative Study

This research aims to gain an in-depth understanding of precariously housed women's experiences related to health and access to health care during the COVID-19 pandemic using a grounded theory approach. Qualitative data were obtained through interviews with 17 precariously housed women from Izmir, Turkey. Poor health among most participants was primarily attributed to unfavorable living conditions and weakened community networks. The COVID-19 pandemic exacerbated existing health issues due to barriers in accessing basic needs. Food insecurity was widespread during the pandemic and the critical role of aid and the inadequacy of social assistance in securing food were emphasized. Women's health perceptions were significantly shaped by gender, and gendered caregiving duties have restricted women's healthcare access. Access to healthcare was also limited by financial challenges, with health insurance being a crucial determinant. Longer waiting times, often exacerbated by the appointment system, and language were significant barriers to healthcare access. The findings propose that the participants were precarized by the blindness of COVID-19 measures to vulnerabilities, which resulted in deeper inequalities in housing, food, employment, and healthcare access. This research addresses the political, commercial, and social determinants of precariously housed women's health. Improving precariously housed women's health and wellbeing requires implementation of public policies targeting to improve housing quality, provide targeted assistance to food insecurity, promote gender inclusiveness, and foster gender empowerment.

Are housing circumstances associated with faster epigenetic ageing?

BACKGROUND

Numerous aspects of housing are associated with health. However, the pathways between housing and health, particularly the psychosocial elements of housing, are less well understood. Epigenetic information alongside social survey data offers an opportunity to explore biological ageing, measured using DNA methylation, as a potential pathway through which housing affects health.

METHODS

We use data on housing and DNA methylation from the UK Household Longitudinal Study, linked with prior survey responses from the British Household Panel Survey, covering adults in Great Britain. We explore the association between epigenetic ageing and housing circumstances, both contemporary and historical, using hierarchical regression.

RESULTS

We find that living in a privately rented home is related to faster biological ageing. Importantly, the impact of private renting (coefficient (SE) 0.046 years (0.011) vs owned outright, p<0.001) is greater than the impact of experiencing unemployment (coefficient 0.027 years (0.012) vs employed, p<0.05) or being a former smoker (coefficient 0.021 years (0.005) vs never smoker, p<0.001). When we include historical housing circumstances in the analysis, we find that repeated housing arrears and exposure to pollution/environmental problems are also associated with faster biological ageing.

CONCLUSION

Our results suggest that challenging housing circumstances negatively affect health through faster biological ageing. However, biological ageing is reversible, highlighting the significant potential for housing policy changes to improve health.

Pathways to community living in practice: Local development and adaptation within an older peoples mental health service

OBJECTIVE

To describe the local adaptation of the Pathways to Community Living (PCLI) program in an Older Peoples Mental Health (OPMH) service to guide other services.

METHOD

A retrospective observational study was conducted. Data were obtained from service planning meetings and newly developed documents, Clinical Advisory Committee meetings, and OPMH PCLI database.

RESULTS

The PCLI program was adapted for the local OPMH service through development of an assessment template, creating a Memorandum of Understanding with a partner Residential Aged Care Facility (RACF) and establishing processes for collaboration and regular review. Between 2019 and March 2023, 20 mental health consumers were referred to the OPMH PCLI program. Their demographic and clinical characteristics are described.

CONCLUSIONS

Adaptation of the PCLI program for OPMH consumers required consideration of specific older adult needs to develop a bespoke plan for assessment and partnership with the PCLI-funded RACF. The development phase and ongoing processes for review facilitated engagement of key stakeholders across health and RACF sectors, highlighting issues with consumer engagement. Similar models could be used by other health services to implement the PCLI in their local context.

Residential Mobility and Reasons for Moving Among People Living With Spinal Cord Injury: Results of a Multisite Survey Study

Background

Residential mobility after spinal cord injury (SCI) has not been extensively examined despite a growing interest in investigating the relationship between neighborhood exposures and community living outcomes.

Objectives

This study explores residential mobility patterns, the annual move rate, and reasons for moving among a community-living sample of adults with SCI.

Methods

A survey was conducted with 690 people at six SCI Model Systems centers in the United States between July 2017 and October 2020. The outcomes included move status in the past 12 months, move distance, and the primary reason for moving. A sample from the 2019 American Community Survey (ACS) 5-year pooled estimates was obtained for comparative analysis. Descriptive statistics were used to summarize the distributions of the outcomes and differences between the samples.

Results

The annual move rate for adults with SCI was 16.4%, and most moves were within the same county (56.6%). Recent movers were more likely to be young adults, be newly injured, and have low socioeconomic status. Housing quality, accessibility, and family were more frequently reported motivations for moving compared to employment. Young adults more commonly moved for family and accessibility, whereas middle-aged adults more commonly moved for housing quality. No notable difference was observed in the annual move rate between the SCI and the general population samples.

Conclusion

These findings suggest an age-related pattern of residential relocation after SCI, which may be indicative an extended search for optimal living conditions that meet the housing and accessibility needs of this population.

Quality of hematology and clinical chemistry results in laboratory and zoo nonhuman primates: Effects of the preanalytical phase. A review

Most errors in clinical pathology originate in the preanalytical phase, which includes all steps from the preparation of animals and equipment to the collection of the specimen and its management until analyzed. Blood is the most common specimen collected in nonhuman primates. Other specimens collected include urine, saliva, feces, and hair. The primary concern is the variability of blood hematology and biochemistry results due to sampling conditions with the effects of capture, restraint, and/or anesthesia. Housing and diet have fewer effects, with the exception of food restriction to reduce obesity. There has been less investigation regarding the impact of sampling conditions of nonblood specimens.

An Affordable and Easy-to-Construct Zebrafish Housing System for Stable Long-Term Laboratory Research

Zebrafish have become a go-to model organism for in vivo studies, in part because of their reputation as being inexpensive to rear and house. Multiple do-it-yourself designs are currently available that provide laboratories with cost-effective housing systems. Unfortunately, these designs suffer from a range of issues ranging from poor water cycling rates and fragile housing tanks to inconsistent water conditions and designs that are prohibitively expensive for smaller laboratories to construct and maintain. These issues cause many of these housing systems to fall far short of the quality of commercially available zebrafish housing facilities. In this article, we present a novel, affordable, and easy-to-construct zebrafish housing system that improves upon previously published systems. The system utilizes three-dimensional printing technology to construct adaptable zebrafish tanks allowing for the housing of zebrafish at any stage of development. In addition, the water recirculation system utilizes multiple layers of filtration and no chemical adhesives, which allows for stable, long-term, housing of zebrafish in conditions suitable for research and teaching laboratories. The build described herein has been used by our laboratory to house zebrafish for over 3 years, representing multiple generations of housed fish.

"I can't remember the last time I was comfortable about being home": lived experience perspectives on thriving following homelessness

PURPOSE

Strategies for preventing and ending homelessness are frequently measured by their effectiveness on indices of tenancy sustainment. To shift this narrative, we conducted research to identify what is needed to "thrive" following homelessness from the perspectives of persons with lived experience in Ontario, Canada.

METHODS

Conducted in the context of a community-based participatory research study aimed at informing the development of intervention strategies, we interviewed 46 persons living with mental illness and/or substance use disorder [n = 25 (54.3%) unhoused; n = 21 (45.7%) housed following homelessness] using qualitative interviews. A subsample of 14 participants agreed to engage in photovoice interviews. We analysed these data abductively using thematic analysis informed by health equity and social justice.

RESULTS

Participants described experiences of "living in a state of lack" following homelessness. This essence was expressed through four themes: 1) housing as part one of the journey to home; 2) finding and keeping "my people"; 3) meaningful activity as critical for thriving following homelessness; and 4) struggling to access mental health supports in the context of challenging circumstances.

CONCLUSIONS

Individuals struggle to thrive following homelessness in the context of insufficient resources. There is a need to build on existing interventions to address outcomes beyond tenancy sustainment.

Housing, HIV outcomes, and related comorbidities in persons living with HIV in Washington, DC

Housing instability can hinder the ability of people with HIV (PWH) to maintain engagement in care, adhere to antiretroviral (ART) regimens, and achieve viral suppression. This analysis examined the association between housing instability and HIV outcomes, as well as the association between housing status and substance use disorders, mental health disorders, and sexually transmitted infections. Multivariable logistic regressions were performed using data from the DC Cohort, a longitudinal cohort of PWH. Among 8622 PWH, unstably housed PWH were significantly more likely to be prescribed ART (aOR: 1.4; 95%CI: 1.1, 1.8) yet were significantly less likely to be virally suppressed (aOR: 0.6; 95%CI: 0.5, 0.8). Unstably housed PWH were also significantly more likely to have a substance use or mental health disorder, which may inhibit PWH's ability to achieve viral suppression. Efforts to end the HIV epidemic should address housing to ensure treatment is optimized for key populations.

Race matters in addressing homelessness: A scoping review and call for critical research

Structural racism contributes to homelessness in the United States, as evidenced by the stark racial disparities in who experiences it. This paper reviews research at the intersections of race and homelessness to advance efforts to understand and address racial inequities. Part 1 offers a synthesis of homelessness research from the 1980s to 2015, where several scholars examined the role of race and racism despite mainstream efforts to present the issue as race-neutral. Part 2 presents the results of a systematic scoping review of research at the intersections of race and homelessness from 2016 to 2021. The 90 articles included demonstrate a growing, multidisciplinary body of literature that documents how needs and trajectories of people experiencing homelessness differ by race, examines how the racialized structuring of society contributes to homelessness risk, and explores how programs, policies, and grassroots action can address inequities. In addition to charting findings and implications, included studies are appraised against research principles developed by Critical Race Theory scholars, mapping the potential of existing research on race and homelessness to challenge racism.

Aboriginal peoples' lived experience of household overcrowding in the Kimberley and implications for research reciprocity in COVID-19 recovery

OBJECTIVE

Household overcrowding was identified early in the COVID-19 pandemic as a risk factor increasing transmission and worsening outcomes. Nirrumbuk Environmental Health and Services designed this project to deepen understanding of Aboriginal peoples' experiences of overcrowding in social housing.

METHODS

Our household survey explored overcrowding, capacity to respond to COVID-19 directives and the Canadian National Overcrowding Standard (CNOS).

RESULTS

For 219 participating Aboriginal households, usual number of residents per household ranged from 1 to 14, increasing with short- and long-term visitors. 17.8% had occupants who themselves were on waiting lists for their own home. Nearly one-third of houses had three generations under one roof. 53.4% indicated isolation of COVID-19 cases as 'extremely' difficult. 33.8% indicated their community could not manage COVID-19 at scale. Overcrowding was defined by interpersonal dynamics or consequences such as plumbing blockages or conflict rather than the number or people or ratio of people to bedrooms. 64.8% welcomed CNOS to determine acceptable and healthy occupancy levels. Participants encouraged research about environmental health in Aboriginal hands.

CONCLUSIONS

Cultural obligations, poverty and social housing waitlist management impose extreme demand on remote housing. CNOS relevance was endorsed but tempered by lived experience.

IMPLICATIONS FOR PUBLIC HEALTH

Aboriginal-led research is directly accountable to communities through reciprocity and kinship. Nirrumbuk has already modified service planning.

Youth-centered Recommendations to Address Social Stigma and Discrimination Against Unhoused Youth: An Integrative Literature Review

Youth between ages 13 and 25 who experience homelessness face numerous barriers to excellent health, including social stigma and discrimination. Applying socio-ecological model and intersectionality theory, an integrative literature review was conducted. Peer-reviewed studies (N = 29) representing 808,296 participants extracted from four databases (CINAHL, MEDLINE, PsychINFO, SocINDEX) were analyzed. The studies included sources of discrimination and stigma from interpersonal interactions with support services staff upwards to policy and systemic levels with housing and justice systems. Health outcomes include poorer physical and behavioral health status from increased likeliness of denied access to support services, prolonged time spent being homeless, and higher incidences of experiencing violence. School nursing has power to push for recommended changes and support unhoused youth towards excellent health. Proposed changes include adapting Housing First framework, engaging with unhoused youth in program planning, policy writing, and public education that address the causes of poverty.

The relationship between health and housing in low-income older adults: A secondary analysis of survey data

OBJECTIVE

To examine the health-housing relationship in low-income older adults, and differences by income and receipt of housing assistance.

DESIGN

Secondary analysis of longitudinal survey data.

SAMPLE

About 10,858 adults aged 62+ who completed at least one wave of the 2014 Survey of Income and Program Participation (SIPP) (n = 37,333 observations).

MEASUREMENTS

SIPP variables representing demographics and housing quality, affordability, stability, and neighborhood were analyzed. Low-income and higher-income participants were differentiated by the household income-to-poverty ratio.

RESULTS

Low-income participants were significantly more likely to be in poor health and report problems with housing quality, affordability, and neighborhood safety compared to higher-income participants (p < .001). Increased household size and problems with housing quality and neighborhood safety were associated with poor health in both groups (p < .05). Low-income participants who received housing assistance were significantly poorer, less healthy, and food insecure than participants not receiving assistance (p < .001); however, the health-housing relationship was not different in the two groups.

CONCLUSIONS

Results provide additional support for housing as a social determinant of older adult health. Though housing assistance programs reached a subset of low-income older adults, the results suggest a housing assistance shortfall. Implications for public health nurses and researchers are explored.

Review of housing and husbandry of anemonefishes for use in research

Anemonefishes of the genus Amphiprion are emerging as a model organism for marine science, so there is potentially a lot for the research community to gain by optimizing and standardizing housing and husbandry protocols. Here, we conducted a literature review and a questionnaire survey regarding the housing and husbandry of anemonefishes for use in research. The questionnaire survey was completed by 27 laboratories, with a 45% response rate, across 11 different countries in Europe, North America, Asia and Australia. Results from the literature review identified that housing and husbandry protocols varied widely in terms of tank volume, diet composition and lighting type for the housing of broodstock pairs. These results also emphasize the significant impacts that variation in housing and husbandry protocols have on fish. Results from the questionnaire survey confirmed this. We identified multiple opportunities for improvement of protocols, including the potential for exchange of larvae between laboratories to create strains and reduce pressure on natural populations. In conclusion, our research suggests that the anemonefish research community should be discussing the optimization and standardization of housing and husbandry or, minimally, recognizing that housing and husbandry influence a wide range of traits and will influence the results and conclusions drawn from experiments.

[Attitudes of neighbors about the treatment and community life of people with severe mental health disorders in Argentina]

A psychiatric reform is underway in Latin America and the Caribbean. Specifically in Argentina, a model of community mental health is being built, and prolonged psychiatric hospitalizations are still taking place, especially in neuropsychiatric hospitals. Therefore, it is necessary to closely monitor the psychiatric reform. One of the possible ways to monitor the reform is by analyzing society's attitudes towards prolonged psychiatric hospitalization as a mean of mental health treatment. Thus, an analytical observational study was conducted at the Buenos Aires Province, Argentina, in 2021, to analyze the behavior of neighbors of people who had prolonged psychiatric hospitalizations and who received housing support. Questionnaires were applied to neighbors and non-neighbors, addressing the behaviors toward prolonged psychiatric hospitalization as a mean of treatment, social distance toward people who were hospitalized, as well as specific interviews with key informants from neighborhoods where people with severe mental health disorders and who receive housing support live. Based on the answers of neighbors and non-neighbors, no statistically significant differences were identified in behaviors toward prolonged psychiatric hospitalization as a mean of treatment, nor for social distance in relation to people who were hospitalized. Key informants conditioned their assessment of prolonged hospitalization and valued the role of support teams in making community life viable.

A comprehensive demographic profile of the US evicted population

Millions of American renter households every year are threatened with eviction, an event associated with severe negative impacts on health and economic well-being. Yet we know little about the characteristics of individuals living in these households. Here, we link 38 million eviction court cases to US Census Bureau data to show that 7.6 million people, including 2.9 million children, faced the threat of eviction each year between 2007 and 2016. Overall, adult renters living with at least one child in their home were threatened with eviction at an annual rate of 10.4%, twice that of adults without children (5.0%). We demonstrate not only that the average evicted household includes one child, but that the most common age to experience eviction in America is during childhood. We also find that previous studies have underestimated racial disparities in eviction risk: Despite making up only 18.6% of all renters, Black Americans account for 51.1% of those affected by eviction filings and 43.4% of those evicted. Roughly one in five Black Americans living in a renter household is threatened with eviction annually, while one in ten is evicted. Black-White disparities persist across levels of income and vary by state. In providing the most comprehensive description to date of the population of US renters facing eviction, our study reveals a significant undercount of individuals impacted by eviction and motivates policies designed to stabilize housing for children and families.

Benefits of the PRISM Shelter-Based Program for Attainment of Stable Housing and Functional Outcomes by People Experiencing Homelessness and Mental Illness: A Quantitative Analysis

OBJECTIVE

To explore the housing trajectory, personal recovery, functional level, and quality of life of clients at discharge and 1 year after completing Projet Réaffiliation Itinérance Santé Mentale (PRISM), a shelter-based mental health and rehabilitation program intended to provide individuals experiencing homelessness and severe mental illness with transition housing and to reconnect them with mental health and social services.

METHOD

Housing status, psychiatric follow-up trajectory, personal recovery (Canadian Personal Recovery Outcome Measure), functional level (Multnomah Community Ability Scale), and quality of life (Lehman Quality of Life Interview) were assessed at program entry, at program discharge and 1 year later.

RESULTS

Of the 50 clients who participated in the study from May 31, 2018, to December 31, 2019, 43 completed the program. Of these, 76.7% were discharged to housing modalities and 78% were engaged with psychiatric follow-up at the program's end. Housing stability, defined as residing at the same permanent address since discharge, was achieved for 62.5% of participants at 1-year follow-up. Functional level and quality of life scores improved significantly both at discharge and at 1-year follow-up from baseline.

CONCLUSIONS

Admission to PRISM helped clients secure long-term stable housing and appropriate psychiatric follow-up. Stable housing was maintained for most clients at 1-year follow-up, and they benefited from sustained functional and quality of life outcomes in long-term follow-up.

Evaluation of a modernized supported housing intervention for individuals who experience severe and persistent mental illness in Ontario, Canada

WHAT IS KNOWN ON THE SUBJECT

Supported housing approaches that include case management and increased opportunities for independence and personal autonomy for people who are living with severe and persistent mental illness (SPMI) have been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services.

WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE

This study uncovered that individuals experiencing SPMI who lived in supported housing used more primary health care and specialist physician services, in the year following transition to this housing arrangement.

WHAT ARE THE IMPLICATIONS FOR PRACTICE

The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual residents, including increasing access to both primary health care and specialist services. This is important for nursing practice, as the findings of the study show that supported housing arrangements for people experiencing SPMI may assist in better supporting their complex health care needs.

ABSTRACT

INTRODUCTION: Supported housing for people who are living with severe and persistent mental illness (SPMI) has been found to help reduce hospitalizations and use of the emergency department. What is not fully clear is if these types of supported housing arrangements also influence the use of primary health care and other specialist services.

AIM/QUESTION

The aim of this study was to compare the use of health services use of individuals with SPMI, before and after transition to the new supported housing program.

METHOD

Using health care administrative databases, a pre-post cohort study was conducted examining the health system use of residents who transitioned from custodial to supported housing arrangements between 2017 and 2019.

RESULTS

Individuals with SPMI used more primary health care and specialist physician services after transition to the supported housing model.

DISCUSSION

The results suggest that a supported housing model may be associated with increased usage of outpatient person-centred health services in people experiencing SPMI.

IMPLICATIONS FOR PRACTICE

The findings of this study suggest that supported housing arrangements for people experiencing SPMI may help in improving the personalization of health services for individual. This is important for nursing practice, as the findings of the study show that supported housing arrangements may assist in better supporting complex health care needs of individuals.

Unmet Needs for Help With Mobility Limitations Among Older Adults Aging in Place: The Role of Rurality

OBJECTIVES

This study identifies differences in unmet mobility needs among older adults living in rural versus urban areas.

METHODS

We used data from Round 9 of the National Health and Aging Trends Study (NHATS), limiting our analyses to respondents who had not moved since baseline (average housing tenure of 27 years; n = 3343). We conducted bivariate and multivariate analyses to detect rural/urban differences in unmet mobility needs, adjusting for socio-demographics, health status, and housing characteristics.

RESULTS

Rural residence was associated with higher odds of any unmet mobility needs for older adults aging in place (adjusted odds ratio: 1.64, 95% confidence interval: 1.10-2.44, p < .05). The relationship between rurality and unmet needs for help with mobility limitations remained significant in fully adjusted models.

DISCUSSION

Rural older adults aging in place have greater unmet needs for help with mobility limitations. This study highlights several important gaps in supporting rural older adults aging in place.

Describing homelessness risk among people from culturally and linguistically diverse backgrounds in Western Australia: A cluster analysis approach

ISSUE ADDRESSED

Housing is a social determinant of health. Migrants are at an increased risk of insecure housing, overcrowding, and homelessness which can lead to poor quality of life and well-being. This study aimed to identify clustering patterns of homelessness risks among people from culturally and linguistically diverse (CaLD) backgrounds in Western Australia (WA).

METHODS

Participants from CaLD backgrounds (n = 143, 81.8% male) were identified from secondary cross-sectional data sourced from Vulnerability Index Service Prioritisation Decision Assistance Tool (VI-SPDAT) surveys conducted with people experiencing homelessness in Perth, WA, between 2012 and 2020. A two-step cluster analysis was used to identify subgroups within the data, and chi-square tests compared demographic characteristics and drivers of homelessness among the determined clusters.

RESULTS

Three distinct clusters were identified and labelled as 'high-risk group' (n = 50, 35.0%), 'medium-risk group' (n = 39, 27.3%) and 'low-risk group' (n = 47, 32.9%). The most vulnerable participants (with VI-SPDAT score ≥ 10) were all clustered in the 'high-risk group'.

CONCLUSION

The analysis identified subgroups within and between CaLD populations and highlighted limitations with data collection instruments for measuring homelessness among these groups. SO WHAT?: To prevent health issues associated with homelessness and improve social determinants of health, improvements in research and service provision are recommended to facilitate equitable access to secure housing for people from CaLD populations.