Hospitalization and Housing: A Qualitative Study Exploring the Perspectives of Hospitalized Patients Experiencing Housing Insecurity

Although housing insecurity has clear negative impacts on health, little is known about how it impacts patients' experience of hospitalization. In this qualitative study, we interviewed 22 hospitalized patients experiencing housing insecurity. The following three major themes emerged: 1) adverse social and environmental factors directly contribute to hospitalization, 2) lack of tailored care during hospitalization leaves patients unprepared for discharge, and 3) patients have difficulty recuperating after a hospital stay, leading to the risk of rehospitalization. Within these themes, participants described the roles of extreme physical and psychological hardship, chaotic interpersonal relationships, substance use, and stigma affecting participants' experiences before, during, and following hospitalization. Our results, based directly on the patient experience, suggest a need for hospital systems to invest in universal in-hospital screening for housing insecurity, incorporation of trauma-informed care, and robust partnerships with community organizations. Future research should explore the feasibility and impact of these interventions.

Hock Lesions in Dairy Cows in Cubicle Housing Systems in Germany: Prevalence and Risk Factors

Hock lesions in dairy cows are an important indicator of animal welfare, in particular housing conditions. The aim of this study was to assess the prevalence of hock lesions in dairy cows kept in cubicle housing systems in three structurally different regions of Germany and to derive recommendations from risk factor analyses. Lactating and dry cows kept in cubicle housing systems were assessed for hock lesions (north: 206 farms with 20,792 cows; south: 156 farms with 8050 cows; east: 192 farms with 37,839 cows). Risk factor analyses were conducted using multi-factorial logistic regression models. The median prevalence of hock lesions (hairless patches, wounds, and/or swelling) at farm level was 79.8% (SD: 25.0; north), 66.2% (SD: 31.0; south), and 78.5% (SD: 26.3; east). The mean prevalence of severe hock lesions (wounds and/or swelling) at farm level was 12.5% (SD: 11.3; north), 8.0% (SD: 13.5; south), and 14.4% (SD: 17.9; east). Cows kept in pens with rubber mats or mattresses (with or without a small amount of litter) had a particularly higher chance of hock lesions compared with cows kept in pens with deep-bedded cubicles (OR: north: 3.1 [2.3-4.2]; south: 8.7 [5.9-13.0], east: 2.0 [1.7-2.4]). The study showed that hock lesions are a widespread problem on German dairy farms with cubicle housing systems. Deep-bedded cubicles are likely to reduce hock lesions and increase cows' comfort.

Scientific and technical assistance on welfare aspects related to housing and health of cats and dogs in commercial breeding establishments

This Scientific Report addresses a mandate from the European Commission according to Article 31 of Regulation (EC) No 178/2002 on the welfare of cats and dogs in commercial breeding establishments kept for sport, hunting and companion purposes. The aim was to scrutinise recent recommendations made by the EU Platform on Animal Welfare Voluntary Initiative on measures to assist the preparation of policy options for the legal framework of commercial breeding of cats and dogs. Specifically, the main question addressed was if there is scientific evidence to support the measures for protection of cats and dogs in commercial breeding related to housing, health considerations and painful procedures. Three judgements were carried out based on scientific literature reviews and, where possible a review of national regulations. The first judgement addressed housing and included: type of accommodation, outdoor access, exercise, social behaviour, housing temperature and light requirements. The second judgement addressed health and included: age at first and last breeding, and breeding frequency. Judgement 3 addressed painful procedures (mutilations or convenience surgeries) and included: ear cropping, tail docking and vocal cord resections in dogs and declawing in cats. For each of these judgements, considerations were provided indicating where scientific literature is available to support recommendations on providing or avoiding specific housing, health or painful surgical interventions. Areas where evidence is lacking are indicated.

Intimate Partner Violence, Economic Insecurity, and Health Outcomes Among American Indian and Alaska Native Men and Women: Findings From a National Sample

Limited data are available on experiences of intimate partner violence (IPV) and sexual violence (SV) and health outcomes among American Indian and Alaska Native (AIAN) populations. This study explores the relationship between IPV and SV, food insecurity, housing insecurity, healthcare access, and self-reported physical and mental health status in a nationally representative sample of AIAN adults (N = 3,634). IPV and SV were associated with poorer physical and mental health at the bivariate level, but not in multivariate analyses. Economic inequalities are a salient predictor of health and may be compounded by demographic and geographic contexts.

Military Eligibility for the Supplemental Nutrition Assistance Program: Simulating the Exemption of the Basic Allowance for Housing from Gross Income

BACKGROUND

Twenty-four percent of active-duty service member households experienced food insecurity in 2020; however, limited data have suggested that few participate in the Supplemental Nutrition Assistance Program (SNAP). A potential reason for low SNAP participation among active-duty military households is that the basic allowance for housing (BAH) is considered countable income for SNAP eligibility determination.

OBJECTIVES

This study explores how many more service members' households, referred to as "SNAP units" (that is, a group of individuals who live together and regularly buy food and prepare meals together), would become eligible for SNAP benefits if the BAH is excluded from countable income in deciding eligibility.

METHODS

This study used 2016-2020 American Community Survey 5-y estimates to construct a sample of active-duty military households combined with data on military pay and allowances to simulate changes to SNAP eligibility and poverty status with a BAH exemption as well as impacts on federal spending on SNAP.

RESULTS

Eligibility for SNAP among military SNAP units increases from 0.4% to 1.5% (263% increase) if a service member's BAH was exempted from their gross income. The increase was driven by SNAP units whose highest-ranking service member was from the noncommissioned officer ranks without dependents. As more military SNAP units became eligible and chose to participate, annual SNAP disbursements (that is, amount of funds spent on SNAP) for the whole program increased by up to 1.3%, compared with FY16-20 SNAP disbursements. With an increase in SNAP participation, the poverty rate among military SNAP units decreases from 8.7% to 1.4% (83.9% decrease).

CONCLUSIONS

Exempting service members' BAH from their gross income would likely increase SNAP eligibility and participation among military households and, in turn, reduce poverty.

Preventing eviction during pregnancy: a cost-effectiveness analysis of a theoretical safety-net program

BACKGROUND

Eviction during pregnancy has been shown to be associated with adverse birth outcomes. A safety net program focused on covering the costs of rent during pregnancy may aid in preventing adverse complications.

OBJECTIVE

This study aimed to evaluate the cost-effectiveness of a program covering the cost of rent to prevent eviction during pregnancy.

STUDY DESIGN

A cost-effectiveness model using TreeAge software was designed to evaluate the cost, effectiveness, and incremental cost-effectiveness ratio associated with eviction compared to no eviction during pregnancy. The cost of eviction from a societal perspective was compared to the annual cost of housing in the no eviction group, which was estimated by the median contract rent in the United States from 2021 national census data. Birth outcomes included preterm birth, neonatal death, and major neurodevelopmental delay. Probabilities and costs were derived from the literature. The cost-effectiveness threshold was set at $100,000/QALY. We performed univariable and multivariable sensitivity analyses to assess the robustness of the results.

RESULTS

In our theoretical cohort of 30,000 pregnant individuals aged 15 to 44 years facing eviction annually, the no eviction during pregnancy strategy was associated with 1427 fewer preterm births, 47 fewer neonatal deaths, and 44 fewer cases of neurodevelopmental delay compared to eviction. At the median cost of rent in the United States, the no eviction strategy was associated with increased quality-adjusted life-years and decreased costs. Therefore, the no eviction strategy was the dominant strategy. In univariate sensitivity analysis varying the cost of housing, no eviction remained the cost-effective strategy and was cost-saving when rent was below $1016 per month.

CONCLUSION

The no eviction strategy is cost-effective and reduces cases of preterm birth, neonatal death, and neurodevelopmental delay. When rent is below the median of $1016 per month, no eviction is the cost-saving strategy. These findings suggest that policies supporting social programmatic implementation for rent coverage for pregnant people at risk of eviction have the potential to be highly beneficial in reducing costs and disparities in perinatal outcomes.

Establishing Academic Homes for Homelessness: A Call to Action

Although homelessness ranks as one of society's most pressing and visible health equity challenges, the academic community has not actively addressed its health impacts, root causes, and potential solutions. Few schools and programs of public health even offer a basic course for students. In the COVID-19 pandemic era, academia must demonstrate urgency to address homelessness and educate learners, motivate fledgling researchers, inform policy makers, offer community-engaged and evidence-based studies, and join in the growing national debate about best approaches. At a minimum, every public health student should understand the interdisciplinary challenges of homelessness, its implications for health equity, and opportunities to address the crisis. We call for academia, particularly schools and programs of public health, to engage more fully in national partnerships to care for members of society who are most marginalized, in terms of health and behavioral health outcomes, quality of life, and connectedness.

Representative Survey for Evaluating Housing and Manure Handling Technologies of the Hungarian Pig Sector

In Hungary, there is a lack of information on the pig production technologies in place in the base year of 2005 and changes since then, as well as a lack of information on the number of pigs kept in different age and production categories, which makes it difficult to calculate ammonia emissions and reductions in the national inventories. Our research team conducted a representative survey of pig farms to assess housing and manure management technologies in the Hungarian pig sector in 2005 and 2015. Novel expert-based calculation methods were developed to convert farm data on pig populations into daily average numbers (DAN) of animals in different statistical categories and feeding phases. The survey resulted in a representative database of housing, manure handling, storage and manure application practices in Hungarian pig production. The data and methodology from the survey helped to develop an ammonia emission calculator and knowledge transfer tool (AGEM-S) for use by farmers.

Barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families: a scoping review

PURPOSE

Accessible housing is a fundamental human right and yet many children and youth with disabilities live in inaccessible, insecure, unaffordable and poor quality housing. The aim of our study was to understand the barriers and facilitators to obtaining accessible housing among children, youth and young adults with disabilities and their families.

METHODS

We conducted a scoping review involving seven international literature databases from 2000 to 2022 that identified 38 studies meeting our inclusion criteria.

RESULTS

The reviewed studies involved 10 countries over a 22-year period. Our review emphasized the following key trends: (1) barriers to obtaining accessible homes (i.e. common types of accessibility barriers, rates of inaccessible housing, factors affecting home accessibility), and negative impacts of inaccessible housing; and (2) rates and facilitators to obtaining accessible housing (i.e., common types of home modifications, enablers of home modifications) and positive impacts of accessible housing.

CONCLUSIONS

Our findings highlight the barriers and enablers of obtaining accessible housing among children, youth and young adults with disabilities and their families and the critical need to support them in securing appropriate housing.

Household structure is independently associated with malaria risk in rural Sussundenga, Mozambique

Introduction

Mozambique has the fourth highest malaria cases and malaria mortality globally. Locally, malaria incidence increases from low in the southern region to high in the central and northern regions. Manica Province in central Mozambique has the fourth highest prevalence of malaria out of the 11 provinces, and the highest in the central region of the country. In this area where coverage of interventions has been limited, household level risk factors can be important for understanding the natural history of infection, as well as the implementation of current and future interventions. There has been indication that the relationship between household structure and malaria risk is actually a mediating one between the true relationship between household income and education and Plasmodium falciparum infection. The objective of this study was to determine and quantify these complex relationships.

Methods

We conducted a community-based cross-sectional study in Sussundenga village. Sussundenga is a rural village, located in Sussundenga District, Manica Province, Mozambique. We enrolled 303 participants from 83 randomly selected households. We collected information on demographics, household construction, and administered a P. falciparum rapid diagnostic test (RDT). We constructed several generalized estimating equations logistic regression models to determine the independent effects of housing construction on malaria risk. We also constructed models separate from generalized estimating equations logistic mediation models to determine the proportion of effects mediated by household construction material in the relationship between head of household occupation and education and malaria risk.

Results

The overall malaria prevalence among the study population by RDT was 30.8%. In the multivariable model adjusting for all individual and household factors as potential confounders, rudimentary roof structure was the only household structural variable that was statistically significantly associated with increased malaria risk [OR 2.41 (1.03-5.63)]. We found no evidence that household structure mediated the relationship between head of household education or employment and malaria risk in our study population.

Discussion

Household structure was a significant risk factor for malaria infection in our study population. These findings are consistent with malaria being a disease of poverty and an area that could be targeted for future interventions that could have long-term impacts.

Preparing Cities for Future Pandemics: Unraveling the Influence of Urban and Housing Variables on COVID-19 Incidence in Santiago de Chile

In this study, we analyzed how urban, housing, and socioeconomic variables are related to COVID-19 incidence. As such, we have analyzed these variables along with demographic, education, employment, and COVID-19 data from 32 communes in Santiago de Chile between March and August of 2020, before the release of the vaccines. The results of our Principal Component Analysis (PCA) confirmed that those communes with more economic, social, organizational, and infrastructural resources were overall less affected by COVID-19. As the dimensions affecting COVID-19 are based on structural variables, this study discusses to what extent our cities can be prepared for the next pandemic. Recommendations for local decision-makers in controlling illegal immigration and investing in housing and urban parks are drawn.

Modeling of Zebrafish Housing Temperatures During Power Outage and Instrument Failure

Power outages can happen anywhere and anytime for various reasons. This threat affects also scientific work of biologists. Especially problematic area is aquatic animal husbandry, where life support of the animals is dependent on continuous electricity supply and years of scientific work may depend on the well-being of these animal stocks. Therefore, tools to estimate and control these risks are needed. In this study, I have used modeling to estimate aquarium water temperature changes during power outages and constructed simplified models for zebrafish aquaria. A calculation worksheet is also provided to help to model kinetics of water temperature changes in zebrafish facilities.

Room size and offspring presence impact pair-bonded primate affiliation

Primates live in a variety of social groupings and vary in the expression of species-typical behaviors depending upon social conditions. Coppery titi monkeys (Plecturocebus cupreus) are pair-bonding, territorial primates often used to study neurobiology and social behavior in captivity at the California National Primate Research Center (CNPRC). At the center, titi monkeys are housed in cages of standardized size. However, the number of cages--and thus families--per room varies based upon the room size (small or large). Anecdotal evidence suggests titi monkeys behave differently in the two different room sizes. To empirically test this, we measured rates of pair-bonding related affiliation in 23 pairs of titi monkeys. We predicted that monkeys in small rooms would show higher rates of affiliation compared to large rooms. We used a between- and within- subjects design in which all subjects moved from either small to large or large to small rooms. Affiliative behavior was recorded via bihourly instantaneous scan samples. We found that titi monkey pairs affiliated significantly more in small rooms compared to large rooms (partial R2 = 0.1468, t(33) = -3.729, p-value < .0005). We also confirmed that the presence of offspring negatively impacts pair affiliation rates (partial R2 = 0.2240, t(33) = -0.181, p-value = 0.0011). The results of this study suggest that titi monkey pair behavior is influenced by room size, and thus the number of neighboring groups. Management decisions should consider the implications that housing may have on the results of social behavior research.

Childhood Residential Mobility and Mental and Physical Health in Later Life: Findings From the Reasons for Geographic and Racial Differences in Stroke (REGARDS) Study

The study objective was to investigate the effects of childhood residential mobility on older adult physical and mental health. In REasons for Geographic and Racial Differences in Stroke (REGARDS) Study, we used linear regression models to investigate if number of moves during childhood predicted mental and physical health (SF-12 MCS, PCS), adjusting for demographic covariates, childhood socioeconomic status (SES), childhood social support, and adverse childhood experiences (ACEs). We investigated interaction by age, race, childhood SES, and ACEs. People who moved more during childhood had poorer MCS scores, β = -0.10, SE = 0.05, p = 0.03, and poorer PCS scores, β = -0.25, SE = 0.06, p < 0.0001. Effects of moves on PCS were worse for Black people compared to White people (p = 0.06), those with low childhood SES compared to high childhood SES (p = 0.02), and high ACEs compared to low ACEs (p = 0.01). As family instability accompanying residential mobility, family poverty, and adversity disproportionately affect health, Black people may be especially disadvantaged.

Predictors and Consequences of Homelessness: Protocol for a Cohort Study Design Using Linked Routine Data

BACKGROUND

Homelessness is a global burden, estimated to impact more than 100 million people worldwide. Individuals and families experiencing homelessness are more likely to have poorer physical and mental health than the general population. Administrative data is being increasingly used in homelessness research.

OBJECTIVE

The objective of this study is to combine administrative health care data and social housing data to better understand the consequences and predictors associated with being homeless.

METHODS

We will be linking health and social care administrative databases from Northern Ireland, United Kingdom. We will conduct descriptive analyses to examine trends in homelessness and investigate risk factors for key outcomes.

RESULTS

The results of our analyses will be shared with stakeholders, reported at conferences and in academic journals, and summarized in policy briefing notes for policymakers.

CONCLUSIONS

This study will aim to identify predictors and consequences of homelessness in Northern Ireland using linked housing, health, and social care data. The findings of this study will examine trends and outcomes in this vulnerable population using routinely collected health and social care administrative data.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/42404.

Precarious Housing Associated with Unsuppressed Viral load, sub-optimal Access to HIV Treatment and Unmet Health care Needs, Among Women Living with HIV in Metro Vancouver, Canada

We investigated associations between (1) housing status (four categories measuring housing stability) and outcomes along the HIV care continuum (not currently on antiretroviral therapy [ART]; sub-optimal ART adherence [< 95% in the last 3-4 weeks]; unsuppressed viral load [> 200 copies/ml], median CD4 < 200 in the last six months), and (2) housing status and unmet primary, dental and mental health care needs in the last six months among WLWH. Housing status was defined according to the Canadian Definition of Homelessness and had four categories: unsheltered (i.e., living in ≥ 1 unsheltered location [e.g., street, abandoned buildings]), unstable (i.e., living in ≥ 1 unstable location [e.g., shelter, couch surfing]), supportive housing (i.e., only living in supportive housing), and stable housing (i.e., only living in one's own housing; reference). At baseline, in the last six months, 47.3% of participants reported unstable housing, followed by 24.4% unsheltered housing, 16.4% stable housing, and 11.9% supportive housing. Overall, 19.1% of the full sample (N = 336, 2010-2019) reported not currently on ART; among participants on ART, 28.0% reported sub-optimal ART adherence. Overall, 32.1% had recent unsuppressed viral load. Among a subsample (n = 318, 2014-2019), 15.7% reported unmet primary care needs, 26.1% unmet dental care needs, and 16.4% unmet mental health care needs. In adjusted models, being unsheltered (vs. stable housing) was associated with not currently on ART, unsuppressed viral load, and unmet primary and dental care needs. Housing and health services need to be developed with and for WLWH to address structural inequities and fulfill basic rights to housing and health.

Urban rhythms in a small home: COVID-19 as a mechanism of exception

The amount of living space we have access to is one manifestation of the unequal distribution of housing resources within societies. The COVID-19 pandemic has required most households to spend more time at home, unmasking inequalities and reigniting longstanding debates about the functionality and experience of smaller homes. Drawing on interviews across three UK cities, this article attends to the changing household routines of individuals living in different types of small home, exploring daily life before and during 'lockdown'. Using the concept of urban rhythms, the data show that the lockdown has intensified existing pressures of living in a smaller home - lack of space for different functions and household members - whilst constraining coping strategies, like spending time outside the home. Lockdown restrictions governing mobility and contact acted as a mechanism of exception, disrupting habitual patterns of life and sociability, and forcing people to spend more time in smaller homes that struggled to accommodate different functions, affecting home atmospheres. For some, the loss of normal strategies was so significant that they sought to challenge the new rules governing daily life to protect their wellbeing.

Transmission prevention behaviors in US households with SARS-CoV-2 cases in 2020

Introduction

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) transmission frequently occurs within households, yet few studies describe which household contacts and household units are most likely to engage in transmission-interrupting behaviors.

Methods

We analyzed a COVID-19 prospective household transmission cohort in North Carolina (April to October 2020) to quantify changes in physical distancing behaviors among household contacts over 14 days. We evaluated which household contacts were most likely to ever mask at home and to ever share a bedroom with the index case between days 7-14.

Results

In the presence of a household COVID-19 infection, 24% of household contacts reported ever masking at home during the week before study entry. Masking in the home between days 7-14 was reported by 26% of household contacts and was more likely for participants who observed their household index case wearing a mask. Participants of color and participants in high-density households were more likely to mask at home. After adjusting for race/ethnicity, living density was not as clearly associated with masking. Symptomatic household contacts were more likely to share a bedroom with the index case. Working individuals and those with comorbidities avoided sharing a bedroom with the index case.

Discussion

In-home masking during household exposure to COVID-19 was infrequent in 2020. In light of the ongoing transmission of SARS-CoV-2, these findings underscore a need for health campaigns to increase the feasibility and social desirability of in-home masking among exposed household members. Joint messaging on social responsibility and prevention of breakthrough infections, reinfections, and long COVID-19 may help motivate transmission-interruption behaviors.

From a Criminal to a Human-Rights Issue: Re-Imagining Policy Solutions to Homelessness

Criminalizing homelessness is ineffective, costly, and immoral; yet it remains a dominant feature in the management of this global social issue. There has been little analysis investigating why punitive homeless policies have remained popular despite their ineffectiveness. In applying Bacchi's What's the Problem Represented to Be (WPR) framework to a Canadian encampment bylaw, our analysis demonstrated that public policies criminalizing homelessness continue to prevail because homelessness is fundamentally understood as a problem of deviant, criminal individual behavior. We argue that reframing understandings of homelessness from one of criminality to a human rights issue gives way to more dignified, just, and effective solutions, such as the Housing First Model. We suggest that community health nurses can serve a key role in disrupting these criminalizing discourses across domains of policy, research, and practice by advocating for holistic, rights-based, and equity-oriented policy solutions related to homelessness.

Associations of self-reported chronic obstructive pulmonary disease with indicators of economic instability and stress - 16 states, 2017

OBJECTIVES

To examine the association between chronic obstructive pulmonary disease status and indicators of economic instability and stress to better understand the magnitude of these issues in persons with chronic obstructive pulmonary disease.

METHODS

Analyzed 2017 Behavioral Risk Factor Surveillance System data from 16 states that administered the 'Social Determinants of Health' module, which included economic instability and stress measures (N = 101,461). Associations between self-reported doctor-diagnosed chronic obstructive pulmonary disease status and each measure were examined using multinomial logistic models.

RESULTS

Adults with chronic obstructive pulmonary disease were more likely (p < 0.001) than adults without to report not having enough money at month end (21.0% vs. 7.9%) or just enough money (44.9% vs. 37.2%); being unable to pay mortgage, rent, or utility bills (19.2% vs. 8.8%); and that often or sometimes food did not last or could not afford to eat balanced meals (37.9% vs. 20.6%), as well as stress all or most of the time (27.3% vs. 11.6%). Associations were attenuated although remained significant after adjustments for sociodemographic and health characteristics.

DISCUSSION

Financial, housing, and food insecurity and frequent stress were more prevalent in adults with chronic obstructive pulmonary disease than without. Findings highlight the importance of including strategies to address challenges related to economic instability and stress in chronic obstructive pulmonary disease management programs.

Secondary Outcomes of a Brief Group Alcohol and Risky Sex Intervention for Emerging Adults Experiencing Homelessness

AWARE is a four-session group-based motivational enhancement intervention designed to reduce substance use and sexual risk behavior among emerging adults experiencing homelessness. Expanding on promising intervention effects on substance use and risky sex outcomes, this study explored intervention effects on changes in secondary outcomes from baseline to 12-month post-intervention: depression, physical health (general health ratings, physical symptoms), social functioning (satisfaction, quality of friendships), and housing stability. Among the 240 participants with baseline and 12-month follow-up data, we found small effect sizes generally favoring the intervention over usual care for all outcomes. Findings show promise that addressing substance use and risky sexual behavior through interventions in drop-in centers could benefit emerging adults experiencing homelessness in additional areas of their lives. More work is needed to understand how interventions could be tailored to more directly address these outcomes and sustain changes in the long-term.

Distribution of capitalized benefits from land conservation

Land conservation efforts throughout the United States sustain ecological benefits while generating wealth in the housing market through capitalization of amenities. This paper estimates the benefits of conservation that are capitalized into proximate home values and quantifies how those benefits are distributed across demographic groups. Using detailed property and household-level data from Massachusetts, we estimate that new land conservation led to $62 million in new housing wealth equity. However, houses owned by low-income or Black or Hispanic households are less likely to be located near protected areas, and hence, these populations are less likely to benefit financially. Direct study of the distribution of this new wealth from capitalized conservation is highly unequal, with the richest quartile of households receiving 43%, White households receiving 91%, and the richest White households receiving 40%, which is nearly 140% more than would be expected under equal distribution. We extend our analysis using census data for the entire United States and observe parallel patterns. We estimate that recent land conservation generated $9.8 billion in wealth through the housing market and that wealthier and White households benefited disproportionately. These findings suggest regressive and racially disparate incidence of the wealth benefits of land conservation policy.

Examining the effect of prison time on landlords' willingness to rent to exonerees: A test of the stigma-by-association framework

Researchers posit that stigma-by-association may account for the discrimination that exonerees experience post-release. Exonerees who serve a longer prison sentence may experience more stigma than exonerees who spent less time in prison. Across two studies, we examined whether criminal history (exoneree, releasee, or control) or prison time (5 or 25 years) impacted landlords' willingness to rent their apartment. Authors responded to one-bedroom apartment listings in the Greater Toronto Area, Canada, inquiring about unit availability. The rental inquiries were identical except for criminal history and prison time. Across both studies, results demonstrated that landlords were significantly less likely to respond, and indicate availability, to exonerees and releasees compared to control. Landlords discriminated against exonerees when the exoneree did not mention a formal exoneration (Study 1) and explicitly mentioned that he was exonerated by DNA evidence (Study 2). Prison time had no significant impact. A content analysis of landlords' replies revealed that exonerees and releasees experienced more subtle forms of discrimination compared to individuals without a criminal history. Together, our results demonstrate that individuals who were formerly incarcerated and associated with prison-whether it be for 5 years or 25 years or a rightful or wrongful conviction-experience housing discrimination upon their release.

Centering Home Care in Bioethics Scholarship, Education, and Practice

This commentary responds to "Home Care in America: The Urgent Challenge of Putting Ethical Care into Practice," by Coleman Solis and colleagues, in the May-June 2023 issue of the Hastings Center Report. More specifically, we respond to the authors' call for "inquiry into the nature, value, and practice" of home care. We argue that the most urgently needed normative reset for thinking about care work is the replacement of dominant individualistic thinking with systemic thinking. Deepening a focus on the social, economic, and historical forces that shape the state of contemporary care work will help bioethicists to argue more effectively for improvements to working conditions. In turn, better working conditions will ease the oppositional stance between caregivers and receivers that has been set up by the current system, enabling all parties involved to better pursue the feminist ethical ideal of care.

Socioeconomic status, race, and preadolescent acne: A population-based retrospective cohort analysis in a mixed rural-urban community of the United States (Olmsted County, Minnesota)

BACKGROUND/OBJECTIVE

There is limited information about the potential relationship of socioeconomic status (SES) with acne in preadolescents. Our objective was to assess the possible relationship between SES and preadolescent acne.

METHODS

A population-based retrospective cohort study was conducted to identify Olmsted County, Minnesota, residents with an initial acne diagnosis between 7 and ≤12 years old during 2010 to 2018 using the Rochester Epidemiology Project. For each acne case, we randomly selected 2 sex- and age-matched controls without an acne diagnosis from the county. Individual HOUsing-based SocioEconomic Status index (HOUSES) derived from real property data was used to evaluate SES, represented as four quartiles with higher quartile representing higher SES.

RESULTS

A total of 604 patients met the criteria. HOUSES distribution significantly differed between cases and controls (p = .001); a higher proportion of acne cases were in quartile 4 (42.2% vs. 32.7%), indicating higher SES. Race and ethnicity did not significantly differ between cases and controls. Among cases and controls, 74.5% and 72.3% were White, respectively. Study limitations include its retrospective design, only patients who visited a physician were included, and Olmsted County residents are largely non-Hispanic White.

CONCLUSION

Preadolescents diagnosed with acne have a higher SES than those without diagnosed acne, highlighting a potential disparity in access to care and appropriate diagnosis.

Investigating the Comparative Effectiveness of Place-Based and Scatter-Site Permanent Supportive Housing for People Experiencing Homelessness During the COVID-19 Pandemic: Protocols for a Mixed Methods, Prospective Longitudinal Study

BACKGROUND

Permanent supportive housing (PSH) is an evidence-based practice to address homelessness that is implemented using 2 distinct approaches. The first approach is place-based PSH (PB-PSH), or single-site housing placement, in which an entire building with on-site services is designated for people experiencing homelessness. The second approach is scatter-site PSH (SS-PSH), which uses apartments rented from a private landlord while providing mobile case management services.

OBJECTIVE

This paper describes the protocols for a mixed methods comparative effectiveness study of 2 distinct approaches to implementing PSH and the patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk.

METHODS

People experiencing homelessness who are placed in either PB-PSH or SS-PSH completed 6 monthly surveys after move-in using smartphones provided by the study team. A subsample of participants completed 3 qualitative interviews at baseline, 3 months, and 6 months that included photo elicitation interviewing. Two stakeholder advisory groups, including one featuring people with lived experience of homelessness, helped guide study decisions and interpretations of findings.

RESULTS

Study recruitment was supposed to occur over 6 months starting in January 2021 but was extended due to delays in recruitment. These delays included COVID-19 delays (eg, recruitment sites shut down due to outbreaks and study team members testing positive) and delays that may have been indirectly related to the COVID-19 pandemic, including high staff turnover or recruitment sites having competing priorities. In end-July 2022, in total, 641 people experiencing homelessness had been referred from 26 partnering recruitment sites, and 563 people experiencing homelessness had enrolled in the study and completed a baseline demographic survey. Of the 563 participants in the study, 452 had recently moved into the housing when they enrolled, with 272 placed in PB-PSH and 180 placed in SS-PSH. Another 111 participants were approved but are still waiting for housing placement. To date, 49 participants have been lost to follow-up, and 12% of phones (70 of the initial 563 distributed) were reported lost by participants.

CONCLUSIONS

Recruitment during the pandemic, while successful, was challenging given that in-person contact was not permitted at times either by program sites or the research institutions during COVID-19 surges and high community transmission, which particularly affected homelessness programs in Los Angeles County. To overcome recruitment challenges, flexible strategies were used, which included extending the recruitment period and the distribution of cell phones with paid data plans. Given current recruitment numbers and retention rates that are over 90%, the study will be able to address a gap in the literature by considering the comparative effectiveness of PB-PSH versus SS-PSH on patient-centered quality of life, health care use, and health behaviors that reduce COVID-19 risk, which can influence future public health approaches to homelessness and infectious diseases.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04769349; https://clinicaltrials.gov/ct2/show/NCT04769349.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/46782.

Risk Factors for Suicide Ideation Among Rhode Island College Students

OBJECTIVES

This study aimed to identify individual and relational risk factors for suicide ideation among students enrolled in 2- and 4-year colleges.

METHODS

A cross-sectional analysis was conducted using N=685 college students from the 2022 Rhode Island Young Adult Survey.

RESULTS

13.7% (N = 94) reported suicide ideation, 7.6% (N = 52) reported making a suicide plan, and 3.2% (N = 22) reported at least one suicide attempt. Sexual and gender minorities had 300% (95%CI: 47%, 987%) increased odds relative to cisgender heterosexual males, students living on campus had 56% (95%CI: 79%, 10%) lower odds compared to those living off campus with a parent, and students with insomnia had 156% (57%, 320%) increased odds of suicide ideation.

CONCLUSIONS

Interventions to 1) cultivate identity- affirming communities for sexual and gender minority students, 2) create a sense of belonging for students living off campus, and 3) improve sleep health are needed.

New Home, New You: A retrospective mixed-methods evaluation of a health-related behavioural intervention programme supporting social housing tenants

BACKGROUND

Social housing tenants are at greater risk of engaging in unhealthy behaviours than the general population. Housing association employees are in an ideal position to contribute positively to their tenants' health. 'New Home, New You' (NHNY) is a joint venture between a social housing association, a city council and a community healthcare provider in the South West of England. It was designed with the aim of improving the health and well-being of social housing tenants.

OBJECTIVES

The aim of this retrospective evaluation was to establish whether social housing tenants were benefiting from this health-related behavioural intervention in terms of their mental well-being and health-related behaviours.

METHODS

This was a mixed-methods evaluation. The outcome evaluation was a secondary analysis of quantitative data collected during the NHNY project. The process of delivering and receiving the intervention was evaluated using qualitative, semi-structured interviews with housing officers and tenants who had participated in the programme. The development of the intervention was evaluated through a focus group and additional semistructured interviews with key stakeholders. Quantitative data were analysed using the Statistical Package for the Social Sciences. Qualitative interviews were analysed using thematic analysis.

RESULTS

Six key stakeholders and a total of seven housing officers from several teams and seven tenants were interviewed. Of the 1016 tenants who were invited to participate in NHNY, 226 enroled in the programme. For participating tenants, the scope for health-related behaviour change was greatest in relation to eating and smoking. Small positive statistically significant changes in mental health were found between the 6- and 12-month mean score and between the baseline and the 12-month score.

CONCLUSIONS

The findings indicate that NHNY may have been beneficial for some participating tenants. Housing officers can have a significant role in promoting health messages and embedding behaviour change among their tenants. Although the programme was implemented as a service improvement rather than a controlled trial and focused on a particular intervention and geographical area, other housing associations may find this evaluation useful for considering whether to adopt some of the principles applied in NHNY in other settings.

PATIENT OR PUBLIC CONTRIBUTION

A social housing tenant representative provided input on the methodology and methods used to evaluate NHNY, as well as the information sheet.

Moving into new housing designed for people with disability: preliminary evaluation of outcomes

PURPOSE

To assess the change in individual outcomes for people with disability and complex needs after moving into newly built, individualised apartments in the community.

METHODS

People with disability (neurological disorder or cerebral palsy) and complex needs (n = 15, aged 18-65 years) completed quantitative self-report measures over two time-points (pre-move and 6-24 months post-move). Pre-move living arrangements included group homes, residential aged care, private rentals, and living with parents. Post-move living arrangements were individualised apartments built for people with disability. Health, wellbeing, community integration, and support needs were compared across pre- and post-move timepoints.

RESULTS

Paired sample t-tests showed significant improvements consistent with large effects in wellbeing (p = 0.031, Eta²=0.29) and community integration (p = 0.008, Eta²=0.41), particularly home integration, and a trend towards improved health (p = 0.077, Eta²=0.21). A Wilcoxon signed rank test demonstrated a trend towards reduced support needs (z= -1.941, p = 0.052) consistent with a medium effect (r = 0.35) and an average decrease of 2.4 support hours per participant per day.

CONCLUSIONS

Well-located housing with appropriate design, technology and support provision makes a positive contribution to wellbeing, community integration, and health for people with complex disability. Implications for rehabilitationPeople with disability who move into individualised apartments experience significant positive change in health, wellbeing, and participation.Findings highlight the benefits of housing that foster independence and enable personal choice and control.Evidence suggests that investment in appropriately designed and well-located housing has positive outcomes for people with disability.Evidence collected within this outcome framework has the potential to ensure models of housing and support that are responsive to the diverse and changing needs of people with disability.

A decade of research on housing and health: a systematic literature review

This paper provides a systematic review of the evidence linking housing and health. This involved a review of 59 peer-reviewed journal papers, that included case studies on the health impacts of housing and were published in English, in the past decade (2010-2020). Our systematic review of the literature suggested most of the research on the health impacts of housing employed quantitative methodology, were conducted in the Global North and were published in Medical and Health Sciences journals. Research findings demonstrated four key areas through which housing impacts health: neighbourhood or context, physical building, housing market and housing policy. This paper provides valuable information to researchers for future research directions on the associations between housing and health and to decision-makers and planners for planning healthy cities.

Pre-Weaned Calf Rearing on Northern Irish Dairy Farms-Part 2: The Impact of Hygiene Practice on Bacterial Levels in Dairy Calf Rearing Environments

Pre-weaned dairy calves are very susceptible to disease in the first months of life due to having a naïve immune system and because of the numerous physiological stressors they face. Hygiene management is a key element in minimizing enteric disease risk in calves by reducing their exposure to pathogens. Samples of milk, concentrate feed and drinking water, boot swabs of bedding and swabs of feed equipment were collected from 66 dairy farms as part of a survey of calf rearing practice and housing design. All the samples were cultured to determine total viable counts (TVC), total coliforms (TCC) and Escherichia coli as indicators of hygiene. Target ranges for levels of TVC, TCC and E. coli were defined from the literature and the sample results compared against them. The TVC targets in milk, MR and water were <4.0 log₁₀ CFU/mL. TCC and E. coli targets of <1.1 log₁₀ CFU/mL (the detection limit) were used for milk, MR, concentrate feed and feeding equipment. For water, the TCC and E. coli targets were <1.0 log₁₀ CFU/100 mL. The targets used for bedding boot swabs were <6.3 log₁₀ TVC CFU/mL and <5.7 log₁₀ TCC or E. coli CFU/mL. Farm management factors were included as fixed effects in a generalized linear mixed model to determine the probability of samples being within each hygiene indicator target range. Milk replacer samples obtained from automatic feeders were more likely to be within the TVC target range (0.63 probability) than those prepared manually (0.34) or milk samples taken from the bulk tank (0.23). Concentrate feed samples taken from buckets in single-calf pens were more likely to have E. coli detected (0.89) than samples taken from group pen troughs (0.97). A very small proportion of water samples were within the indicator targets (TVC 9.8%, TCC 6.0%, E. coli 10.2%). Water from self-fill drinkers had a lower likelihood of being within the TVC target (0.03) than manually filled buckets (0.14), and water samples from single pens were more likely to be within TCC target ranges (0.12) than those from group pens (0.03). However, all self-fill drinkers were located in group pens so these results are likely confounded. Where milk feeders were cleaned after every feed, there was a greater likelihood of being within the TVC target range (0.47, compared with 0.23 when not cleaned after every feed). Detection of coliforms in milk replacer mixing utensils was linked with reduced probability of TVC (0.17, compared with 0.43 when coliforms were not detected) and TCC (0.38, compared with 0.62), which was within target in feeders. Key factors related to increased probability of bedding samples being within TCC target range were use of group calf pens (0.96) rather than single-calf pens (0.80), use of solid floors (0.96, compared with 0.76 for permeable floors) and increased space allowance of calves (0.94 for pens with ≥2 m²/calf, compared with 0.79 for pens with <2 m²/calf). Bedding TVC was more likely to be within the target range in group (0.84) rather than in single pens (0.66). The results show that hygiene levels in the calf rearing environment vary across farms and that management and housing design impact hygiene.

Noncompliance with Hypertension Treatment and Related Factors among Kumamoto Earthquake Victims Who Experienced the COVID-19 Pandemic during Postearthquake Recovery Period

Survivors of the Kumamoto earthquake of 2016 experienced the coronavirus disease (COVID-19) outbreak while carrying additional burdens that might bring inadequate coping. This cross-sectional survey aimed to identify untreated and interrupted consultations among those with hypertension and related factors and to identify the disaster's long-term effects. Of the 19,212 earthquake survivors who had moved to permanent housing, 7367 (4196 women and 3171 men, mean age 61.8 ± 17.3 years) completed a self-administered questionnaire. The prevalence of hypertension was 41.4%. The results of the logistic regression analysis with the significant independent variables in the bivariate analysis were: reduced income due to COVID-19 (AOR = 3.23, 95%CI = 2.27-4.58) and poor self-rated health (AOR = 2.49, 95%CI = 1.72-3.61) were associated with a risk of untreated or discontinued treatment. Moreover, living in rental, public or restoration public housing was also significantly associated with a higher risk of hypertension noncompliance (AOR = 1.92, 95%CI = 1.20-3.07; AOR = 2.47, 95%CI = 1.38-4.42; AOR = 4.12, 95%CI = 1.14-14.90). These results suggest that changes due to COVID-19, the extent of self-rated health and the type of permanent housing influence the hypertension consulting behaviour of earthquake survivors during recovery. It is crucial to implement long-term public support for the mental health, income and housing concerns of the survivors.

Housing Insecurity among Black Women Surviving Intimate Partner Violence during the COVID-19 Pandemic: An Intersectional Qualitative Approach

Background

To investigate housing experiences during the COVID-19 pandemic among Black women experiencing intimate partner violence (IPV) who are also navigating racism, sexism, and classism.

Methods

From January to April 2021, we conducted in-depth interviews with 50 Black women experiencing IPV in the United States. Guided by intersectionality, a hybrid thematic and interpretive phenomenological analytic approach was used to identify sociostructural factors shaping housing insecurity.

Results

Our findings demonstrate the various ways in which the COVID-19 pandemic shaped Black women IPV survivors' ability to obtain and sustain safe housing. Five themes were derived to capture factors contributing to housing experiences: challenges with separate and unequal neighborhoods; pandemic-related economic inequalities; economic abuse limitations; mental toll of eviction; and strategies to maintain housing.

Conclusions

Obtaining and maintaining safe housing during the COVID-19 pandemic was difficult for Black women IPV survivors who were also navigating racism, sexism, and socioeconomic position. Structural-level interventions are needed to reduce the impact of these intersecting systems of oppression and power in order to facilitate the resources necessary for Black women IPV survivors to identify safe housing.

Synthesizing the links between secure housing tenure and health for more equitable cities

Millions of households in rich and poor countries alike are at risk of being unwilfully displaced from their homes or the land on which they live (i.e., lack secure tenure), and the urban poor are most vulnerable. Improving housing tenure security may be an intervention to improve housing and environmental conditions and reduce urban health inequalities. Building on stakeholder workshops and a narrative review of the literature, we developed a conceptual model that infers the mechanisms through which more secure housing tenure can improve housing, environmental quality, and health. Empirical studies show that more secure urban housing tenure can boost economic mobility, improve housing and environmental conditions including reduced exposure to pollution, create safer and more resourced communities, and improve physical and mental health. These links are shared across tenure renters and owners and different economic settings. Broader support is needed for context-appropriate policies and actions to improve tenure security as a catalyst for cultivating healthier homes and neighbourhoods and reducing urban health inequalities in cities.

Mamwi Gidaanjitoomin/Together We Build It: A Systematic Review of Traditional Indigenous Building Structures in North America and Their Potential Application in Contemporary Designs to Promote Environment and Well-Being

(1) Background: Housing has long been recognized as an essential determinant of health. Our sense of home goes beyond physical shelter and is associated with personal or collective connections with spaces and places. However, modern architecture has gradually lost its connections between people and places; (2) Methods: We examined traditional Indigenous architecture and how it can be utilized in contemporary settings to restore connections to promote the environment, health, and well-being. (3) Results: We found that traditional Indigenous building structures may be the best manifestation of the Indigenous interconnected and holistic worldviews in North America, containing thousands of years of knowledge and wisdom about the land and the connection between humans and the environment, which is the foundation of reciprocal well-being; (4) Conclusions: Learning from the traditional structures, we proposed that modern architects should consider the past, present, and future in every endeavor and design and to utilize traditional knowledge as a crucial source of inspiration in creating works that are beneficial for both current and future generations by taking collectivism, health and well-being, and the environment into consideration in designs.

Hepatitis C virus reinfection in a real-world cohort of homeless-experienced individuals in Boston

BACKGROUND

People experiencing homelessness are disproportionately affected by hepatitis C virus (HCV) infection compared to housed populations. Surveillance for HCV reinfection after successful treatment is a critical step in the care cascade, but limited data on reinfection are available among this highly marginalized group. This study assessed post-treatment reinfection risk in a real-world cohort of homeless-experienced individuals in Boston.

METHODS

Individuals receiving HCV direct-acting antiviral treatment through Boston Health Care for the Homeless Program during 2014-20 with post-treatment follow-up assessment were included. Reinfection was identified based on recurrent HCV RNA at 12 weeks post-treatment with HCV genotype switch or any recurrent HCV RNA following sustain virologic response.

RESULTS

A total of 535 individuals were included (81% male, median age 49 years, 70% unstably housed or homeless at treatment initiation). Seventy-four HCV reinfections were detected, including five second reinfections. HCV reinfection rate was 12.0/100 person-years (95%CI 9.5-15.1) overall, 18.9/100 person-years (95%CI 13.3-26.7) among individuals with unstable housing and 14.6/100 person-years (95%CI 10.0-21.3) among those experiencing homelessness. In adjusted analysis, experiencing homelessness (vs. stable housing, adjusted HR 2.14, 95% CI 1.09-4.20, p=0.026) and drug use within six months prior to treatment (adjusted HR 5.23, 95%CI 2.25-12.13, p<0.001) were associated with increased reinfection risk.

CONCLUSION

We found high HCV reinfection rates in a homeless-experienced population, with increased risk among those homeless at treatment. Tailored strategies to address the individual and systems factors impacting marginalized populations are required to prevent HCV reinfection and to enhance engagement in post-treatment HCV care.

Household Composition Under Strain: Regional Unemployment Rates and the Older American Housing Decision

This research explored the relationship between regional unemployment rates and the community-based housing configuration of older Americans. The analysis used the American Community Survey from 2006 to 2016 to examine regions experiencing high unemployment for differences in the likelihood of older adults to live alone, with a spouse or partner, or in a multigenerational household. Findings demonstrated that under the strain of higher regional unemployment, older adults were less likely to live alone and more likely to live in a multigenerational household. Additionally, older adults with a difficulty that could signify a need for support were less likely to live with a spouse or partner, while those without a difficulty were more likely to live with a spouse or partner. Recession-related safety-net policy should target supports to community-dwelling older adults, particularly those living alone, those with more support needs, with lower income, and older renters, because their housing arrangements may become vulnerable during regional economic contraction. Implications during COVID-19 are discussed.

Continuity of primary care among homeless adults with mental illness who received a housing and mental health intervention

BACKGROUND

Continuity of primary care (CPC) is associated with reduced mortality and improved health status. This study assessed the level of CPC and changes in CPC over 6 years among adults with experience of homelessness and mental illness who received a Housing First intervention.

METHODS

Participants were adults (≥18 years old) with a serious mental disorder and experiencing chronic homelessness enrolled between October 2009 and June 2011 in the Toronto site of the Canadian At Home/Chez Soi study and followed until March 2017. Participants were randomized to Housing First with intensive case management (HF-ICM), Housing First with assertive community treatment (HF-ACT), or treatment as usual. For this report, 280 intervention group participants (HF-ICM, n = 193 and HF-ACT, n = 87) were analysed using data from health records. The main outcome was CPC measured by the Continuity of Care Index as a continuous and categorical variable among participants during 3 consecutive 2-year periods.

RESULTS

Most HF-ICM participants had low levels of CPC, with 68%-74% of this group having low CPC across all time periods. Similarly, most HF-ACT participants had low levels of CPC, with 63%-78% of this group having low CPC across all time periods.

CONCLUSIONS

Among this group of individuals with mental illness who were experiencing homelessness, CPC remained low over 6 years of follow-up. This study highlights that housing and mental health interventions may need to place greater emphasis on improving CPC using effective strategies that are specifically geared towards this important goal among their clients.

Factors Associated with Sustained Virologic Response to Hepatitis C Treatment in a Homeless-Experienced Cohort in Boston, 2014-2020

BACKGROUND

Engaging people experiencing homelessness or unstable housing in hepatitis C virus (HCV) treatment is critical to achieving HCV elimination.

OBJECTIVE

To describe HCV treatment outcomes, including factors associated with retention through the treatment cascade, for a cohort of individuals treated in a homeless health center in Boston.

DESIGN

Retrospective cohort study.

PARTICIPANTS

All individuals who initiated HCV treatment with Boston Health Care for the Homeless Program's HCV treatment program between January 2014 and March 2020 (N = 867).

OUTCOME MEASURES

The primary outcome was sustained virologic response (SVR), defined as an HCV ribonucleic acid (RNA) level ≤ 15 IU/mL at least 12 weeks after treatment completion. We used multivariable logistic regression to examine the association between baseline variables and SVR. Process-oriented outcomes included treatment completion, assessment for SVR, and achievement of SVR.

RESULTS

Of 867 individuals who started HCV treatment, 796 (91.8%) completed treatment, 678 (78.2%) were assessed for SVR, and 607 (70.0%) achieved SVR. In adjusted analysis, residing in stable housing (OR 3.83, 95% CI 1.85-7.90) and age > 45 years old (OR 1.53, 95% CI 1.04-2.26) were associated with a greater likelihood of achieving SVR. Recent drug use (OR 0.63, 95% CI 0.41-0.95) was associated with a lower likelihood of SVR. Age, housing status, and drug use status impacted retention at every step in the treatment cascade.

CONCLUSION

A large proportion of homeless-experienced individuals engaging in HCV treatment in a homeless health center achieved SVR, but enhanced approaches are needed to engage and retain younger individuals, those with recent or ongoing substance use, or those experiencing homelessness or unstable housing. Efforts to achieve HCV elimination in this population should consider the complex and overlapping challenges experienced by this population and aim to address the fundamental harm of homelessness itself.

Impact of the Domestic Violence Housing First Model on Survivors' Safety and Housing Stability: 12-Month Findings

Intimate partner violence (IPV) is a widespread and devastating phenomenon resulting in a myriad of long-term consequences for survivors and their children. IPV victimization not only has negative health and economic consequences, it has also been linked to homelessness and housing instability. In response, the Domestic Violence Housing First (DVHF) model is being used in some domestic violence (DV) agencies to help survivors attain safe and stable housing. The model includes using individualized advocacy and/or flexible funding to help survivors meet these goals. Using a longitudinal, quasi-experimental design, the current study involved conducting interviews with survivors and examining agency records to investigate the effectiveness of this model. We hypothesized that survivors who received DVHF would experience less re-abuse and greater housing stability over 12 months compared to those who received services as usual (SAU). The sample included 345 IPV survivors who had been homeless or unstably housed when they approached one of five DV programs for help. Interviews were spaced 6 months apart (when survivors first sought services as well as 6 months and 12 months later). Longitudinal analyses showed that survivors who received the DVHF model reported greater improvements in housing stability at both the 6-month and 12-month time points compared to those receiving SAU. At the 12-month time point, survivors who had received DVHF reported decreased physical, psychological, and economic abuse, as well as the use of their children against them as a form of abuse. This study adds to a growing body of evidence supporting this model's effectiveness and adds to our understanding of factors impacting the long-term housing stability and safety for IPV survivors.

Aging in Place in Social Housing: A Scoping Review of Social Housing for Older Adults

Access to affordable housing is a rising concern, and social housing is one approach to support low-income, older renters. A scoping review was undertaken to understand the characteristics of older tenants and social housing services to identify strategies to promote aging in place. Seven peer review databases were searched to identify relevant articles. A total of 146 articles were included. Almost all examined socio-demographic and health characteristics of older tenants, while 72 per cent examined social housing services, including eligibility policies, staffing, and access to on-site services. This review points to a high vulnerability among older tenants and highlights the importance of co-locating services on-site with a tenant-facing support staff to identify vulnerable tenants and link them to services. More research on tenancy issues (e.g., unit condition, rental management) is needed to identify new opportunities for social housing landlords to help older tenants age in place.

Childhood Lead Poisoning 1970-2022: Charting Progress and Needed Reforms

CONTEXT

Childhood lead poisoning prevention in the United States was marked by a largely failed medical approach from 1971 to 1990; an emergent (but small) healthy housing primary prevention strategy from 1991 to 2015; and implementation of large-scale proven interventions since then.

PROGRAM

Childhood Lead Poisoning Prevention & Healthy Housing.

METHODS

Historic and recent health and housing data from the National Health and Nutrition Examination Survey (NHANES) and the American Healthy Homes Survey (AHHS) were retrieved to analyze trends and associated policy gaps.

EVALUATION

Approximately 590 000 US children aged 1 through 5 years had elevated blood lead levels of 3.5 μg/dL and greater in 2016, and 4.3 million children resided in homes with lead paint in 2019. Despite large improvements, racial and other disparities remain stubbornly and statistically significant. The NHANES and the AHHS require larger sample sizes. The Centers for Disease Control and Prevention has not published children's blood lead surveillance and NHANES data in several years; the Department of Housing and Urban Development (HUD) has no analogous housing surveillance system; and the Environmental Protection Agency (EPA) and the Occupational Safety and Health Administration (OSHA) have not updated training, Superfund, and occupational standards in decades.

DISCUSSION

The nation has been without a plan and an associated budget for more than 2 decades. Congress has not reformed the nation's main lead poisoning prevention laws in more than 30 years. Such reforms include stopping US companies from producing new residential lead paint in other countries; enabling the disclosure law to identify all residential lead hazards; closing loopholes in federally assisted housing regulations and mortgage insurance standards; harnessing tax policy to help homeowners mitigate lead hazards; streamlining training requirements; increasing the size of health and housing surveys and surveillance systems; and updating housing codes, medical guidance, dust lead standards, training, Superfund, and worker exposure limits. Congress and the president should reauthorize a cabinet-level task force (dormant since 2010) to develop a new strategic plan with an interagency budget to implement it. These reforms will scale and optimize markets, subsidies, enforcement, and other proven interventions to end ineffective, costly, harmful, and irrational cost shifting that threatens children, workers, and affordable housing.

Barriers, opportunities, and potential costs of expanding HIV support services

Experiencing housing instability, food insecurity, and financial stress can negatively impact retention in care and treatment adherence for people living with HIV. Expanding services that support socioeconomic needs could help improve HIV outcomes. Our objective was to investigate barriers, opportunities, and costs of expanding socioeconomic support programs. Semi-structured interviews were conducted with organizations serving U.S. Ryan White HIV/AIDS Program clients. Costs were estimated from interviews, organization documents, and city-specific wages. Organizations reported complex patient, organization, program, and system challenges as well as several opportunities for expansion. The average one-year per-person cost for engaging new clients was $196 for transportation, $612 for financial aid, $650 for food aid, and $2498 for short-term housing (2020 USD). Understanding potential expansion costs is important for funders and local stakeholders. This study provides a sense of magnitude for costs to scale-up programs to better meet socioeconomic needs of low-income patients living with HIV.

What is "determinant" in the social determinants of health? A case seen through multiple lenses

Social determinants of health are a subject of growing interest, yet criticisms have emerged about the way determinants are conceptualized in nursing. A tendency to focus on readily observable living conditions and measurable demographic characteristics can divert attention, it has been said, from the less visible underlying processes which shape social life and health. To illustrate how the analytic perspective determines what becomes visible or invisible as a "determinant" in health, this paper presents a case exemplar. Drawing from news reports and research in real estate economics and urban policy analysis, it explores a single local infectious illness outbreak through a series of progressively more abstract units of inquiry, considering mechanisms of lending and debt financing, housing supply, property valuation, tax policy, change in the structure of the financial industry, and international patterns of migration and capital flow, among other factors, which contributed in various ways to creating unsafe living conditions. An analytic exercise calling attention to dynamism and complexity in social processes, the paper offers a political-economy-based approach that serves as a cautionary note against oversimplification in discussions of health causality.

Comparison of environment quality measurements between 3 types of calf housing in the United Kingdom

Preweaning calves are kept in a range of housing types that offer variable protection against the weather and provide differing internal environments. This cross-sectional observational study assessed the effect of housing type (shed, polytunnel, or hutches) on internal environmental parameters, using 2 blocks of 8-wk measurements from 10 commercial dairy farms in the south of England, covering both summer and winter periods. Continuous measurements for internal and external temperature and humidity were recorded by data logger placed within the calf housing and used to calculate the temperature-humidity index (THI). Weekly point readings were also taken for temperature, humidity, light, air speed, ammonia level, and airborne particulate matter. Airborne bacterial levels were determined at wk 2, 5, and 8 by incubating air samples at 35°C for 24 h in aerobic conditions. Data were analyzed using linear mixed models. Housing type influenced THI significantly in both seasons. In summer, calves were exposed to heat stress conditions (THI ≥72) for 39, 31, and 14 of 46 d in polytunnel housing, hutches, and sheds, respectively. The maximum summer temperature (37.0°C) was recorded in both hutch and polytunnel housing, with sheds remaining consistently cooler (maximum 31.0°C). In winter, the lowest minimum internal temperature recorded was in hutches at -4.5°C, with both the sheds and polytunnel, but not hutches, providing a significant increase in temperature compared with the external environment. Hutches remained ≤ 10°C for 86% of the winter study period. Light levels were reduced in all housing types compared with the external environment. The particulate matter in air that is capable of reaching the lungs (particulate matter <10 μm) was highest in sheds, intermediate in hutches, and lowest in polytunnel housing (0.97 ± 3.75, 0.37 ± 0.44, and 0.20 ± 0.24 mg/m³, respectively). This was mirrored by airborne bacterial numbers, which were also highest in sheds (8,017 ± 2,141 cfu/m³), intermediate in hutches (6,870 ± 2,084 cfu/m³), and lowest in the polytunnel (3,357 ± 2,572 cfu/m³). Round, white, catalase-positive, and oxidase-negative colonies were most prevalent, likely indicating Staphylococcus species. This study demonstrated that UK calves are routinely exposed to either heat or cold stress, especially when housed in hutches or polytunnels. Sheds had the highest levels of particulate matter and airborne bacteria, both known contributory factors for respiratory disease. These findings demonstrate that all calf housing systems result in environmental compromises that could have long-term impacts on calf health and growth; therefore, further studies should identify husbandry and housing modifications to mitigate these factors.

Homelessness, Politics, and Policy: Predicting Spatial Variation in COVID-19 Cases and Deaths

When COVID-19 began to spread in the United States, the first public health orders were to hunker down at home. But for the vulnerable people experiencing homelessness, especially those sleeping outdoors, retreating to a private dwelling was not possible. This suggests that places with greater homelessness would also have elevated COVID-19 infections. This paper examines how spatial variation in unsheltered homelessness was related to the cumulative number of cases and deaths from COVID-19. Although Continuums of Care (CoCs) with more households receiving welfare, without internet service, and more disabled residents had a higher rate of COVID-19-related cases and deaths, CoCs with more unsheltered homelessness had fewer COVID-19-related deaths. More research is needed to explain this counterintuitive result, but it may reflect the bicoastal pattern of homelessness which is higher where government intervention, community sentiment, and compliance with rules to promote the common welfare are greater. In fact, local politics and policies mattered. CoCs with more volunteering and a higher share of votes for the 2020 Democratic presidential candidate also had fewer COVID-19 cases and deaths. Yet, other policies did not matter. Having more homeless shelter beds, publicly assisted housing units, residents in group quarters, or greater use of public transportation had no independent associations with pandemic outcomes.

The effect of the right care, right place, right time (R3) initiative on Medicare health service use among older affordable housing residents

OBJECTIVE

To determine the effect of an affordable housing-based supportive services intervention, which partnered with health and community service providers, on Medicare health service use among residents.

DATA SOURCES

Analyses used aggregated fee-for-service Medicare claims data from 2017 to 2020 for beneficiaries living in 34 buildings in eastern Massachusetts.

STUDY DESIGN

Using a quasi-experimental design, a "difference-in-differences" framework was employed to isolate changes in outcomes, focusing on changes in pre- and post-intervention health service use across two stages of the intervention. Phase 1 encompassed the initial implementation period, and Phase 2 introduced a strategy to target residents at high risk of poor health outcomes. Key health service outcomes included hospitalizations, 30-day hospital readmission, and emergency department use.

DATA COLLECTION

Medicare claims data for 10,412 individuals were obtained from a Quality Improvement Organization and aggregated at the building level.

PRINCIPAL FINDINGS

Analyses for Phase 1 found that hospital admission rates, emergency department admissions and payments, and hospital readmission rates grew more slowly for intervention sites than comparison sites. These findings were strengthened after the introduction of risk-targeting in Phase 2. Compared to selected control buildings, residents in intervention buildings experienced significantly lower rates of increases in inpatient hospitalization rates (-16% vs. +6%), hospital admission days (-25% vs. +29%), average hospital days (-12% vs. +14%), hospital admission payments (-22% vs. +33%), and 30-day hospital readmission rates (-22% vs. +54%). When accounting for the older age of the intervention residents, the size of the decline recorded in emergency department admissions was 6.7% greater for the intervention sites than the decline in comparison sites.

CONCLUSIONS

A wellness-focused supportive services intervention was effective in reducing select health service use. The introduction of risk-targeting further strengthened this effect. Age-friendly health systems would benefit from enhanced partnerships with affordable housing sites to improve care and reduce service use for older residents.

Housing: Fragile buffer to wildfire smoke in pregnancy

Living near or migrating to areas at high risk for wildfires may result in health consequences and increased disparities for pregnant people and their children.

Mental health and HIV risk differs by co-occurring structural vulnerabilities among women who sell sex

Female sex workers (FSW) experience many structural vulnerabilities (SV; e.g., violence, economic insecurity) which contribute to increased risk of HIV and mental distress. However, little research has examined how SV co-occur to shape HIV risk, and none have studied mental distress. Among FSW (n = 385) in Baltimore, Maryland, latent class analysis of five binary indicators (housing insecurity; financial dependence on others; client-perpetrated physical or sexual violence; food insecurity) determined classes of SV and differential HIV risk behavior and mental health outcomes. A 3-class model fit the data best: minimal SV (i.e., low probabilities of all indicators); material needs (i.e., housing, food insecurity); and high SV (i.e., high probability of all indicators). Compared to minimal SV, high SV and material needs had significantly greater adjusted probability of drug injection and poorer adjusted depression, post-traumatic stress disorder, and mental distress scores. The high SV class had significantly higher probability of reporting condomless sex with clients compared to material needs and minimal SV. Results show the deleterious effect of co-occurring SV on HIV risk behaviors among FSW with particular emphasis on co-occurring food and housing insecurities. This is the first study of co-occurring SV on mental health outcomes in this key population.

Instability in Housing and Medical Care Access: The Inequitable Impacts of the COVID-19 Pandemic on U.S. Transgender Populations

Purpose

To assess whether the COVID-19 pandemic has inequitably impacted key social determinants of health (SDoH), specifically employment, housing, and health care, for U.S. transgender populations.

Methods

Between April 13, 2020 and August 3, 2020, we conducted a national, cross-sectional online survey of sexual and gender minority individuals (N=870). We used logistic regression to calculate both unadjusted and adjusted odds of unemployment, homelessness/housing instability, and interruptions in medical care owing to the pandemic by gender and gender modality. Adjusted models controlled for age, race/ethnicity, and region.

Results

In adjusted models, transgender and gender diverse people had 2.12 times the odds of reporting homelessness/housing instability and 2.88 times the odds of reporting medical care interruptions compared with cisgender peers. Transgender men, women, and nonbinary people had 4.12, 3.29, and 3.48 times the adjusted odds of interruptions in medical care compared with cisgender men, respectively. We did not observe significant differences in employment.

Conclusions

Findings add empirical support to the hypothesis that socioeconomic consequences of COVID-19 are inequitably impacting transgender people. To contextualize our results and support future research in this area, we present a conceptual model of the short- and long-term impacts of COVID-19 on transgender populations using a framework of stigma as a fundamental cause of health inequities. Our findings emphasize that public health professionals must urgently consider-and intervene to address-the pandemic's SDoH-related impacts on transgender populations.