Individuals Experiencing Homelessness: A Systematic Review of Otolaryngology-Related Health Needs and Community-Based Interventions

OBJECTIVE

Access to and use of physician services is limited for those experiencing homelessness. Homelessness may predispose patients to several Otolaryngology-Head and Neck Surgery (OHNS) health conditions and barriers to care may leave these unaddressed. The aim of this review was to synthesize the literature on OHNS health needs and community-based interventions for patients experiencing homelessness.

DATA SOURCES

English literature was searched in MEDLINE, EMBASE, and CINAHL.

REVIEW METHODS

Studies were included if they reported on OHNS-related conditions in patients experiencing homelessness and/or interventions related to providing OHNS care to this patient population.

RESULTS

Twelve hundred and one articles were screened, and 12 articles were included. Most studies reported on otologic conditions (n = 8) and head and neck-related conditions (n = 6). Nasal trauma, chronic rhinosinusitis, dysphonia, hearing loss, and cancerous/precancerous head and neck lesions were common OHNS conditions reported in this patient population. Identified barriers to care included lack of transportation, financial considerations, and lower health literacy. Three articles on community-based interventions were included. Most of these interventions were single visits to shelters, and ensuring adequate follow-up was identified as a challenge.

CONCLUSION

The current literature brings attention to certain OHNS diseases that are prevalent in this unique patient population and identifies unique barriers these patients experience when accessing care. Future studies should focus on further delineating the impact of OHNS diseases in patients experiencing homelessness and screening interventions that can be employed to mitigate the impact of diseases of the head and neck.

Canadian Older Adults' Intention to Use an Electronic Decision Aid for Housing Decisions: Cross-sectional Web-Based Survey

BACKGROUND

Older adults with disabilities such as loss of autonomy face the decision of whether to stay at home or move to a health care facility such as a nursing home. Therefore, they may need support for this difficult decision.

OBJECTIVE

We assessed the intention of Canadian older adults to use an electronic decision aid (eDA) to make housing decisions and identified the factors that influenced their intention.

METHODS

We conducted a cross-sectional study using a web-based survey targeting older adults across 10 Canadian provinces and 3 territories. We included respondents from a web-based panel who were aged ≥65 years, understood English or French, had access to an electronic device with an internet connection, and had made a housing decision over the past few months or were planning to make a decision in the coming year. We based the web-based survey on the Unified Theory of Acceptance and Use of Technology (UTAUT). We adapted 17 UTAUT items to measure respondents' intention to use the eDA for housing decisions, as well as items measuring 4 intention constructs (performance expectancy, effort expectancy, social influence, and facilitating conditions). We also assessed eHealth literacy using both subjective and objective scales. We used descriptive statistics and multivariable linear regression analyses to identify the factors influencing the intention to use the eDA.

RESULTS

Of the 11,972 invited panelists, 1176 (9.82%) met the eligibility criteria, and 1000 (85.03%) respondents completed the survey. The mean age was 72.5 (SD 5.59) years. Most respondents were male (548/1000, 54.8%), White (906/1000, 90.6%), English speakers (629/1000, 62.9%), and lived in Ontario or Quebec (628/1000, 62.8%) and in urban areas (850/1000, 85%). The mean scores were 27.8 (SD 5.88) out of 40 for subjective eHealth literacy and 3.00 (SD 0.97) out of 5 for objective eHealth literacy. In our sample, the intention score was 4.74 (SD 1.7) out of 7. The mean scores of intention constructs out of 7 were 5.63 (SD 1.28) for facilitating conditions, 4.94 (SD 1.48) for performance expectancy, 5.61 (SD 1.35) for effort expectancy, and 4.76 (SD 1.59) for social influence. In the final model, the factors associated with intention included mother tongue (β=.30; P<.001), objective eHealth literacy (β=-.06; P=.03), performance expectancy (β=.55; P<.001), social influence (β=.37; P<.001), and facilitating conditions (β=.15; P<.001).

CONCLUSIONS

Findings from this pan-Canadian web-based survey on Canadian older adults suggest that their intention to use the eDA to make housing decisions is similar to the findings in other studies using UTAUT. The factors identified as influencing intention were mother tongue, objective eHealth literacy, performance expectancy, social influence, and facilitating conditions. These will guide future strategies for the implementation of the eDA.

Stress Evaluation of Mouse Husbandry Environments for Improving Laboratory Animal Welfare

Animal welfare is recognized as essential for the coexistence of humans and animals. Considering the increased demand and interest in animal welfare, many methods for improving animal welfare are being devised, but which method reduces animal stress has not been scientifically verified. Therefore, reducing animal stress by providing a proper breeding environment and environmental enrichment can be the basis for animal study. In this study, stress levels were assessed based on the mouse-breeding environment. We considered that the higher the body weight and the lower the corticosterone concentration, the lower the stress. According to the results, animals in the individual ventilation cages were determined to have lower serum cortisol concentrations, while the body weight of the animals was increased when in individual ventilation cages compared with individual isolated cages and when providing environmental enrichment compared with group breeding or not providing environmental enrichment. The results provide appropriate guidelines for improving laboratory animal welfare.

Longer trips to court cause evictions

Studying ∼200,000 evictions filed against ∼300,000 Philadelphians from 2005 to 2021, we focus on the role of transit to court in preventing tenants from asserting their rights. In this period, nearly 40% of tenants facing eviction were ordered to leave their residences because they did not show up to contest cases against them and received a default judgment. Controlling for a variety of potential confounds at the tenant and landlord level, we find that residents of private tenancies with longer transit travel time to the courthouse were more likely to default. A 1-h increase in estimated travel time increases the probability of default by between 3.8% and 8.6% points across different model specifications. The effect holds after adjusting for direct distance to the court, unobserved landlord characteristics, and even baseline weekend travel time. However, it is absent in public housing evictions, where timing rules are significantly laxer, and during the COVID-19 pandemic, when tenants had the opportunity to be present virtually. We estimate that had all tenants been equally able to get to the court in 10 min, there would have been 4,000 to 9,000 fewer default evictions over the sample period. We replicate this commuting effect in another dataset of over 800,000 evictions from Harris County, Texas. These results open up a new way to study the physical determinants of access to justice, illustrating that the location and accessibility of a courthouse can affect individual case outcomes. We suggest that increased use of video technology in court may reduce barriers to justice.

Using Sensor Data to Identify Factors Affecting Internal Air Quality within 279 Lower Income Households in Cornwall, South West of England

(1) Background: Poor air quality affects health and causes premature death and disease. Outdoor air quality has received significant attention, but there has been less focus on indoor air quality and what drives levels of diverse pollutants in the home, such as particulate matter, and the impact this has on health; (2) Methods: This study conducts analysis of cross-sectional data from the Smartline project. Analyses of data from 279 social housing properties with indoor sensor data were used to assess multiple factors that could impact levels of particulate matter. T-Tests and Anova tests were used to explore associations between elevated PM2.5 and building, household and smoking and vaping characteristics. Binary logistic regression was used to test the association between elevated particulate matter and self-reported health; (3) Results: Of the multiple potential drivers of the particulate matter investigated, smoking and vaping were significantly associated with mean PM2.5. Following multivariate analysis, only smoking remained significantly associated with higher mean concentrations. Properties in which <15 cigarettes/day were smoked were predicted to have PM2.5 concentrations 9.06 µg/m3 higher (95% CI 6.4, 12.82, p ≤ 0.001) than those in which residents were non-smokers and 11.82 µg/m3 higher (95% CI 7.67, 18.19, p ≤ 0.001) where >15 cigarettes were smoked; (4) Conclusions: A total of 25% of social housing properties in this study experienced levels of indoor PM greater than WHO guideline levels for ambient air pollution. Although there are many factors that impact air quality, in this study the main driver was smoking. This highlights the importance of targeting smoking in indoor environments in future smoking cessation and control policy and practice and of understanding how pollutants interact in the home environment. There is also a need for further research into the impact on indoor air quality of vaping, particularly due to the rise in use and uncertainty of its long-term impact.

A Matched Analysis of the Association Between Federally Mandated Smoke-Free Housing Policies and Health Outcomes Among Medicaid-Enrolled Children in Subsidized Housing, New York City, 2015-2019

Smoke-free housing policies are intended to reduce the deleterious health effects of secondhand smoke exposure, but there is limited evidence regarding their health impacts. We examined associations between implementation of a federal smoke-free housing rule by the New York City Housing Authority (NYCHA) and pediatric Medicaid claims for asthma, lower respiratory tract infections, and upper respiratory tract infections in the early post-policy intervention period. We used geocoded address data to match children living in tax lots with NYCHA buildings (exposed to the policy) to children living in lots with other subsidized housing (unexposed to the policy). We constructed longitudinal difference-in-differences models to assess relative changes in monthly rates of claims between November 1, 2015, and December 31, 2019 (the policy was introduced on July 30, 2018). We also examined effect modification by baseline age group (≤2, 3-6, or 7-15 years). In New York City, introduction of a smoke-free policy was not associated with lower rates of Medicaid claims for any outcomes in the early postpolicy period. Exposure to the smoke-free policy was associated with slightly higher than expected rates of outpatient upper respiratory tract infection claims (incidence rate ratio = 1.05, 95% confidence interval: 1.01, 1.08), a result most pronounced among children aged 3-6 years. Ongoing monitoring is essential to understanding long-term health impacts of smoke-free housing policies.

Invited Commentary: Use of Epidemiologic Methods to Guide Comprehensive and Equitable Approaches to Policy

Despite a dramatic reduction in the prevalence of commercial cigarette smoking in the United States, children are still commonly exposed to secondhand smoke (SHS), which is a cause of various pediatric health problems. Further, SHS exposure is patterned by race and class, exacting an inequitable toll on children from families with lesser social and economic advantage. In this issue of the Journal, Titus et al. (Am J Epidemiol. 2023;192(1):25-33) use natural experiment evaluation methods (difference-in-differences) to test whether the recently implemented US Department of Housing and Urban Development policy that forbade smoking in and around New York City Housing Authority buildings affected child respiratory health. The results from their work remind us that policies do not always impact outcomes as we might expect. Given that policy is one of the most potent tools for population health promotion, this work underlines the need for epidemiologists to engage in policy evaluation at all stages of the policy life cycle, in order to discover comprehensive approaches to policy development and implementation that prioritize equity and address structural racism.

University housing reinforces the negative relationship between interpersonal violence, psychological distress, and suicidality in undergraduates, particularly among gender diverse students

OBJECTIVE

To compare academic and mental health outcomes across diverse gender identities in the context of interpersonal violence and campus housing.

PARTICIPANTS

45,549 students from 124 self-selected post-secondary institutions.

METHODS

Various academic and health measures from the National College Health Assessment Spring 2017 dataset were analyzed for differences across five gender identities (cis women, cis men, transwomen, transmen, and genderqueer students), and two housing categories (university housing and non-university housing).

RESULTS

When compared to cisgender peers, gender diverse students reported greater experiences of interpersonal violence and higher levels of negative academic and mental health outcomes. Living in university housing was associated with an increase in these disparities.

CONCLUSIONS

University housing, which usually reinforces fixed gender binaries, is associated with worse outcomes for gender diverse students. These data can help higher education institutions better understand and address problems that disproportionately impact transgender and gender diverse students, who represent a growing demographic.

A National Study of Homelessness, Social Determinants of Health, and Treatment Engagement Among Outpatient Medication for Opioid Use Disorder-Seeking Individuals in the United States

BACKGROUND

Homelessness is an important social determinant of health (SDOH), impacting health outcomes for many medical conditions. Although homelessness is common among people with opioid use disorder (OUD), few studies systematically evaluate homelessness and other SDOH among people enrolled in standard of care treatment for OUD, medication for opioid use disorder (MOUD), or examine whether homelessness affects treatment engagement.

METHODS

Using data from the 2016 to 2018 U.S. Treatment Episode Dataset Discharges (TEDS-D), patient demographic, social, and clinical characteristics were compared between episodes of outpatient MOUD where homelessness was reported at treatment enrollment versus independent housing using pairwise tests adjusted for multiple testing. A logistic regression model examined the relationship between homelessness and treatment length and treatment completion while accounting for covariates.

RESULTS

There were 188 238 eligible treatment episodes. Homelessness was reported in 17 158 episodes (8.7%). In pairwise analysis, episodes involving homelessness were significantly different from those involving independent living on most demographic, social, and clinical characteristics, with significantly greater social vulnerability in most SDOH variables (P's < .05). Homelessness was significantly and negatively associated with treatment completion (coefficient = -0.0853, P < 0.001, 95% CI = [-0.114, -0.056], OR = 0.918) and remaining in treatment for greater than 180 days (coefficient = -0.3435, P < 0.001, 95% CI = [-0.371, -0.316], OR = 0.709) after accounting for covariates.

CONCLUSIONS

Patients reporting homelessness at treatment entry in outpatient MOUD in the U.S. represent a clinically distinct and socially vulnerable population from those not reporting homelessness. Homelessness independently predicts poorer engagement in MOUD confirming that homelessness may be an independent predictor for MOUD treatment discontinuation nationally.

Designing and Implementing a New Seniors Services Coordinator Role for Low-Income Housing: A Qualitative Study

Older adults living in social housing are disproportionally impacted by poverty, social isolation, and chronic health conditions that negatively impact their housing stability. In response, service coordination models of care that provide proactive case management have seen widespread adoption across low-income seniors housing communities. We examined the design and implementation of a new "seniors services coordinator" (SSC) role that was introduced by a social housing provider in Toronto, Canada. We conducted qualitative focus groups with tenants (n = 16), housing and policy staff (n = 16), and government-funded care coordinators (n = 16) to understand how the new SSC position formed relationships with tenants, assessed tenant needs and coordinated services, and built partnerships with government-funded system navigators. Since staff were assigned to specific buildings and had smaller caseloads, stakeholders felt that the SSC would be well positioned to build relationships of trust with tenants. Histories of mistrust, boundaries and time management, role conflicts, and system-level barriers, however, made it difficult for SSCs to fully carry out their role. Our findings highlight several design and implementation considerations that may impact the success of tenant-facing support staff such as SSCs, which can serve as a roadmap for other housing providers looking to implement similar initiatives.

An Empirical Analysis of the Effectiveness of Daycare Centers in Improving the Well-Being of Older People

In 2021 the State Council set out a plan to address the challenges posed by China's aging population, particularly through the consolidation of community home care services, including the provision of daycare centers. This study focuses on the provision of daycare centers in Dalian, a key city in Northeast China, and utilizes Mary Shaw's "housing and health" model to conceptualize daycare centers as elements in a network that encompasse home and neighborhood. Furthermore, the study considers how daycare centers may affect this network, particularly when it comes to contributing to the well-being of older people and how they adapt to the local culture. A survey was conducted across 19 daycare centers to determine the services they provide. Semi-structured interviews were conducted with 8 older people living in Dalian, and their homes were surveyed using the EVOLVE Tool. Additional interviews were conducted with 11 people in outdoor neighborhood spaces and daycare centers. The interviewees were asked to provide insights about their homes, neighborhoods, and daycare centers. The interview and survey data uncovered themes around socialization, nutrition, and personal hygiene by employing the thematic analysis method. The results revealed that daycare centers theoretically compensated for the missing functions in the community; however, residents' cultural awareness and consumption habits prevented daycare centers from being used optimally, thereby failing to improve the well-being of older people. Thus, in the process of improving the socialist market economy, the government should enhance the publicity of these facilities and retain welfare as much as possible. Funds should also be allocated to protect older people's basic needs.

From Philosophy to Practice: Designing a Multi-Method, Multi-Stage Program Evaluation of the Wisconsin Domestic Violence Housing First Pilot Program

Safe and secure housing is a pressing concern for survivors of domestic violence (DV). Domestic Violence Housing First (DVHF) is a policy that serves DV survivors' needs by removing barriers to housing stability via flexible financial assistance, mobile advocacy, trauma-informed practice, and partnerships with community housing providers. In this paper, we outline a study protocol developed to evaluate the efficacy of the Wisconsin Domestic Violence Housing First Pilot Program (WI-DVHF). Funding was provided to 9 social service programs across the state and implemented in novel ways. We develop a multi-site, multi-level, longitudinal analysis of WI-DVHF at the individual, site, and community levels. WI-DVHF includes 4 elements differentiating it from previous studies, including analysis of DVHF in rural and urban locations, unique implementation across different sites, and access to a WI rental education program. We also include data from comparable non-WI-DVHF sites and clients served during the study period. This will address concerns about comparing survivors within a site as DVHF funding may free up funds that can benefit other survivors at that site and to better understand the general challenges and trends these organizations face during the study period. The US housing crisis emphasizes the importance of identifying unique and flexible ways to meet the housing needs of DV survivors. This study highlights the potential for DVHF to improve the lives of survivors, and its adaptability to previously understudied cultural groups and across the rural-urban divide. Further, WI-DVHF funds may positively benefit other programs and participants within a site by freeing up valuable space in DV shelters and other resources.

Psychosocial Attributes of Housing and Their Relationship With Health Among Refugee and Asylum-Seeking Populations in High-Income Countries: Systematic Review

Objectives: Housing as a social determinant of health should provide not only shelter, but also a feeling of home. We explored psychosocial pathways creating a sense of home and influencing the relationship between housing and health among asylum seekers and refugees (ASR) in high-income countries. Methods: We performed a systematic review. To be included, studies had to be peer-reviewed, published between 1995 and 2022, and focus on housing and health of ASR in high-income countries. We conducted a narrative synthesis. Results: 32 studies met the inclusion criteria. The psychosocial attributes influencing health most often identified were control, followed by expressing status, satisfaction, and demand. Most attributes overlap with material/physical attributes and have an impact on ASR's mental health. They are closely interconnected with each other. Conclusion: Psychosocial attributes of housing play an essential role in the health of ASR; they are closely associated with material/physical attributes. Therefore, future research on housing and health of ASR should routinely study psychosocial attributes, but always in association with physical ones. The connections between these attributes are complex and need to be further explored. Systematic Review Registration: https://www.crd.york.ac.uk/prospero/, identifier CRD42021239495.

The Effects of Owner-Occupied Housing on Student Outcomes: Evidence from NYC

The view of owning a home as integral to the "American dream" is enshrined in numerous policies designed to promote homeownership. Whether or not these policies are worth their cost is unclear and depends, in part, on the extent to which owner-occupied housing (OOH) confers socially important benefits. Yet identifying the effects of OOH is complicated, not only due to standard concerns about selection, but also because OOH tends to be located in neighborhoods with better amenities (including schools) and is often synonymous with living in a single-family home. In this paper we use rich, longitudinal student-level data to examine whether students in OOH have better academic and health outcomes than those in renter occupied housing (ROH). We address concerns about selection using student fixed effects and a rich set of individual, building, and neighborhood controls. We find that that there is notable variation in both the characteristics and size of OOH and the types of students who live in OOH in NYC. While raw differences show that students who live in OOH have better outcomes-they are less likely to be chronically absent, obese, or overweight and have higher standardized test scores-much of this disparity is explained by differences in the students who select into OOH. In models where we account for selection into OOH and building type with rich controls and student fixed effects, we find small positive effects of moving into OOH on attendance and math scores with no consistent evidence of any impacts of OOH on BMI or obesity, suggesting that policies that promote homeownership might be oversold.

Delivering Services to Older Persons Experiencing Homelessness: Providers' Perspectives of What Does and Does Not Work

Older people with experiences of homelessness (OPEH) tend to experience more complex health, social, and psychological issues than people experiencing homelessness at younger ages. Simultaneously, many housing resources (e.g., shelters, temporary housing) are often ill equipped to meet the needs of OPEH. As such, OPEH are often unable to age in the right place (AIRP) - that is, in a place that supports unique needs and vulnerabilities. However, several promising practices exist that deliver housing and services tailored to OPEH. To investigate the aspects of housing and shelter that both promote and impede AIRP for OPEH, this study examines the delivery of services in three such promising practices from the perspective of service providers. Findings from fifteen qualitative interviews revealed three overarching themes: 1) barriers to providing individualized support (e.g., staff turnover); 2) shifting contexts and structures (e.g., housing market changes); and 3) mechanisms of success (e.g., facilitating smooth transitions into permanent housing). These findings provide evidence to support the refinement of service delivery to promote AIRP for OPEH. In doing so, these insights can help to elevate promising practices to the level of best practice.

The missing link: creating opportunities for older people to participate in academic conferences

Including people with lived experience in knowledge co-creation and sharing processes is critical for enhancing the value and quality of health and social care research. In this brief report, we reflect on a collaboration between researchers and older people to judge a student poster competition at a virual seniors housing conference. We describe the steps taken to facilitate the judging process and present five recommendations to foster meaningful partnerships with older people at academic conferences and increase opportunities for emerging and established gerontological researchers to involve older people in their work.

Environmental factors and building conditions for risk of cutaneous leishmaniasis in the northeast of Iran: a population-based case-control study

BACKGROUND

Leishmaniasis is a tropical disease that significantly affects countries in the developing world. This study evaluated the environmental factors and building conditions associated with cutaneous leishmaniasis (CL) in northeast Iran.

METHODS

A population-based case-control study was performed between 1 July 2018 and 1 March 2021 in northeast Iran; two controls were selected for each case. Patients and controls were compared for environmental factors, building conditions and demographic characteristics.

RESULTS

There were 170 confirmed leishmaniasis cases during the study period. Familiarity with people with active leishmaniasis in open areas of the body increased the odds of getting the disease (odds ratio [OR] 2.41 [95% confidence interval {CI} 1.18 to 4.93]). In the case group, the history of contact with animals such as sheep, goats, cows, mice and camels was significantly higher. Housewives (OR 0.08 [95% CI 0.02 to 0.27]) and self-employed people (OR 0.22 [95% CI 0.07 to 0.70]) were less likely to become infected. The individuals who lived in houses with asbestos cement roofs were more likely to become infected (OR 4.77 [95% CI 1.34 to 16.91]) compared with those who lived in houses with bituminous roofs.

CONCLUSIONS

The most significant risk factor identified in the present study was the type and condition of the home's roof. Housing construction improvement is vital to prevent leishmaniasis in northeast Iran.

The external housing environment of participants in the Avon Longitudinal Study of Parents and Children (ALSPAC): a resource for studies of influences on health

Background: Early life environmental health exposures related to housing can have a significant impact on an individual's physical and mental health and physical development. Housing exposures can fall into two main areas - a representation of social circumstances and physical conditions. Methods: During pregnancy and post-delivery, self-completion questionnaires concerning the housing environment were administered to the ALSPAC (Avon Longitudinal Study of Parents & Children) study mothers and their partners until the study offspring were aged 18. Data collected included types of housing, housing tenure, numbers of rooms in the home, whether shared or sole use of kitchen and indoor flushing toilet, household moves, Council Tax band, difficulties in affording rent/mortgage and becoming homeless. Here we also describe the historic development of housing in the Bristol and surrounding Avon areas. Results: Data collected included the tenure (e.g., owned/rented) of the home, its size (indexed by the number of rooms), the presence of over-crowding (measured by the number of residents per room), presence of amenities, and frequency of household moves. This information was collected on over 13,000 women during pregnancy >8000 at age 10 and >4000 at 18 years. Council Tax bands were asked at 10 and 18 years. Conclusions: This is the first of two Data Notes on the housing type and housing circumstances of the families enrolled in ALSPAC. The second Data Note will detail their internal housing conditions. The data provides an excellent resource for researchers when considering the influences of housing on physical and mental health and development.

The Happy Home: Ageing, Migration, and Housing in Relation to Older Migrants' Subjective Wellbeing

(1) Background: With an increasingly diversifying ageing population, it is important to understand what 'ageing well' means to older adults with a migration background. Given older adults' preference to age in place and declining mobility, housing is a significant place in later life. Therefore, this paper explores the influence of housing, migration, and age on older migrants' subjective wellbeing, with attention to immaterial aspects such as a sense of home as well. (2) Methods: In-depth interviews with older migrants from various ethnicities (N = 22) were conducted. The data collection and analysis were led by an inductive and deductive approach through thematic analysis. (3) Results: The results point to the dynamic nature of age(ing) and the role of migration background in the subjective wellbeing of older migrants. The need for preserving one's housing situation and environmental mastery in later life is highlighted. Furthermore, the relation and mutual influence of subjective wellbeing and sense of home is uncovered. (4) Conclusions: This study highlights the intersection of age, migration, and housing to the subjective wellbeing and sense of home of older migrants. In addition, influences on older migrants' subjective wellbeing concern both a material (i.e., housing) and immaterial (i.e., sense of home, age, migration) base.

Public Health Interventions to Address Housing and Mental Health amongst Migrants from Culturally and Linguistically Diverse Backgrounds Living in High-Income Countries: A Scoping Review

Migrants from culturally and linguistically diverse (CaLD) backgrounds experience factors that may increase health inequities related to a range of determinants of health including housing and mental health. However, the intersection between mental health and housing for migrants is poorly understood. A scoping review searched four academic databases for concepts related to cultural and linguistic diversity, housing conditions, and public health interventions to address homelessness. A total of 49 articles were included and seven key themes identified: housing provision; mental health intersections and interventions; complexity and needs beyond housing; substance use; service provider and policy issues; the role of cultural and linguistic diversity; and consumer experience. The intersection of ethnicity with other social determinants of health and housing was highlighted though there were limited interventions tailored for migrants. Studies generally pointed to the positive impacts of Housing First. Other sub-themes emerged: social connection and community; shame, stigma, and discrimination; health and support requirements; and employment, financial assistance, and income. Consumer choice was identified as vital, along with the need for systemic anti-racism work and interventions. To support secure housing for migrants and mitigate mental health impacts, closer attention is required towards migration factors along with broader, tailored services complementing housing provision.

Structural Home Defects Are the Leading Cause of Mold in Buildings: The Housing and Health Service Experience

The study aimed to evaluate the contribution of building problems to mold proliferation in dwellings. We investigated 503 dwellings of patients suffering from respiratory diseases, whose attending physicians had requested a home inspection if the area of mold was equal to at least one square meter. After careful visual evaluation and basic environmental measurements performed by a trained technician, environmental issues were classified into building defects, accidental water damage, and condensation. Data analysis demonstrated that building defects were the pre-eminent cause of mold proliferation. Among the building defects, water infiltration through leaks in roofs or walls was the leading cause. These results highlight the need for health professionals managing patients with respiratory diseases to be able to request a home inspection, and for city health authorities to commission professionals who can focus on building problems and find ways to address them.

Pathways Linking Housing Inequalities and Health Outcomes among Migrant and Refugee Populations in High-Income Countries: A Protocol for a Mixed-Methods Systematic Review

Several high-income countries are currently experiencing an unprecedented and multifaceted housing crisis. The crisis is escalating rapidly, and its negative ramifications are shared disproportionately by migrant and refugee communities. Although housing is often cited as an important social determinant of health, the relationship between housing inequalities and health outcomes in the context of migrant and refugee populations remain under-explored, particularly in high-income countries. This paper presents a protocol for a mixed-methods systematic review which will synthesize the evidence on the key housing and health inequalities faced by migrant and refugee populations in high-income countries. It will inform the identification of pathways linking housing inequalities to health outcomes. The protocol for this systematic review was developed with guidance from the Joanna Briggs Institute (JBI) methodology for mixed-methods systematic reviews using a convergent integrated approach to synthesis and integration, and the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA-P) statement. Quantitative, qualitative and mixed-methods studies reporting the association of housing inequalities with physical and mental health outcomes among refugee and migrant populations in high-income countries will be included. Medline, Web of Science, Embase, PsycINFO, Scopus and CINAHL will be searched for peer-reviewed literature. This will be supplemented by gray literature searches using Google Scholar, MedNar and WHOLIS. Two reviewers will independently screen and select studies, assess the methodological quality and conduct data extraction. This systematic review will elucidate the different pathways linking housing inequalities and health outcomes, which may guide the development of targeted housing and public health interventions to improve the health and wellbeing of migrant and refugee populations. The review is registered with PROSPERO (CRD42022362868).

An examination of housing interventions among youth experiencing homelessness: an investigation into racial/ethnic and sexual minority status

OBJECTIVES

The purpose of this study is to explore main and interaction effects of minority and multiple minority statuses on exits from homelessness and the stability of homelessness exits overtime.

METHODS

This study utilized the Homeless Management Information System administrative data of 10 922 youth experiencing homelessness collected from a convenience sample of 16 geographically diverse communities across the USA between 2015-17. Using multinomial logistic regression analyses and logistic regression, main effects and interaction effects of racial/ethnic minority identity and sexual/gender minority identity were examined on various homelessness exits (n = 9957) and housing sustainability (n = 5836).

RESULTS

Black youth, relative to White youth, were disproportionately exiting homelessness through incarceration (P < 0.001). Black and Latinx youth were less likely to successfully self-resolve their homelessness (both P < 0.05). Black heterosexual and Black and Latinx non-heterosexual youth were most frequently lost to the homeless system (all P < 0.01). Black youth, relative to White youth, were approximately half as likely to remain stably housed after returning to family (P < 0.01).

CONCLUSIONS

With respect to housing exits and exit stability, Black and Latinx heterosexual youth are consistently at a disadvantage. Homelessness/housing systems and programs need to conduct a deeper investigation into how they implement and develop equitable outreach and engagement practices.

Home-built environment interventions and inflammation biomarkers: a systematic review and meta-analysis protocol

BACKGROUND

Inflammation control is a fundamental part of chronic care in patients with a history of cancer and comorbidity. As the risk-benefit profile of anti-inflammatory drugs is unclear in survivors of cancer, GPs and patients could benefit from alternative non-pharmacological treatment options for dysregulated inflammation. There is a potential for home-built environment (H-BE) interventions to modulate inflammation; however, discrepancies exist between studies.

AIM

To evaluate the effectiveness of H-BE interventions on cancer-associated inflammation biomarkers.

DESIGN & SETTING

A systematic review and meta-analysis of randomised and non-randomised trials in community-dwelling adults.

METHOD

PubMed and MEDLINE, Embase, Web of Science, and Google Scholar will be searched for clinical trials published in January 2000 onwards. The study will include H-BE interventions modifying air quality, thermal comfort, non-ionising radiation, noise, nature, and water. No restrictions to study population will be applied to allow deriving expectations for effects of the interventions in cancer survivors from available source populations. Outcome measures will be inflammatory biomarkers clinically and physiologically relevant to cancer. The first reviewer will independently screen articles together with GPs and extract data that will be verified by a second reviewer. The quality of studies will be assessed using the Cochrane risk-of-bias tools. Depending on the clinical and methodological homogeneity of populations, interventions, and outcomes, a meta-analysis will be conducted using random-effects models.

CONCLUSION

Findings will determine the effectiveness of H-BE interventions on inflammatory parameters, guide future directions for its provision in community-dwelling survivors of cancer and support GPs with safer anti-inflammatory treatment options in high-risk patients for clinical complications.

"People say you're going home, but I don't have a home": Housing After Prison

Recidivism in Australia is high, especially in the Australian Capital Territory (ACT). While high-quality stable housing has been shown to reduce recidivism, people released from prison face many barriers in obtaining housing. This paper reports on a qualitative study exploring the housing experiences of 11 people released from prison in the ACT. Participants felt the importance of housing for reintegration and avoiding recidivism, but reported many challenges, including issues relating to lack of pre-release planning, income and employment, drug use, difficulties and delays with accessing social housing, and complying with parole or bail conditions. We recommend increased investment in services to assist people in prison with organizing housing before release. Furthermore, as housing is a foundational need for reintegration and drug use is high among the prison population in the ACT, Housing First initiatives may be the most appropriate model for providing accommodation and reducing recidivism.

Effect of Local Annealing on Magnetic Flux Distribution and Noise in a Micro-Generator with Amorphous Shell

This study examined micro-alternators with two different housing structures--an uncoated shell and a shell coated with an iron-based amorphous-alloy soft magnetic material. The electromagnetic power and noise characteristics of generators with these shell structures were measured and analyzed. The material used for the shell coating was the SA1 amorphous alloy. The magnetic property of the SA1 material was evaluated, including its hysteresis expansion, hysteresis-loop parameters, α-Fe crystal formation, thermogravimetric transfer, and Curie temperature. The center point of the casing was subjected to flame local-heating annealing to attain ferromagnetism and paramagnetism material characteristics. The experimental shell was between these magnetic-phase-transition properties and was used to observe the magnetic power and noise characteristics of the microgenerator. The measured magnetic flux at the center of the amorphous shell was 1.2-2.4 mT, and the magnetic flux distributed around the shell was 0.6-1.0 mT. The generator with the amorphous-alloy shell had the lowest demagnetization rate in the permanent magnet region, which was close to the bottom of the pole piece, and the magnetic flux leakage of the pole-piece side frame changed the magnetic flux path, thus affecting the demagnetization performance. For the noise experiment, the flame-annealing temperature of the local center point of the amorphous casing reached the Curie temperature, and the noise characteristics of the casing can be reduced by 15 dB compared to those of the generator without the casing. However, the overall performance of generator harmonics and power were not fully improved.

The Impact of the COVID-19 Pandemic and Associated Societal Restrictions on People Experiencing Homelessness (PEH): A Qualitative Interview Study with PEH and Service Providers in the UK

People experiencing homelessness (PEH) faced unique challenges during the COVID-19 pandemic, including changes to accommodation availability, societal restrictions impacting access to essentials like food, and services moving to online and remote access. This in-depth qualitative research aims to add to the existing, but limited research exploring how the pandemic affected PEH. 33 semi-structured qualitative interviews (22 with PEH during the pandemic and 11 with homelessness sector service providers) were undertaken in the United Kingdom between April 2021 and January 2022. Interviews were audio-recorded, transcribed and analysed using reflexive thematic analysis. To ensure consistency of coding, 10% of interviews were coded by two researchers. The PEH sample was 50% female, aged 24-59 years, 59% white British, and included people who had lived in hostels/hotels, with friends/family, and on the streets during the COVID-19 pandemic. Providers came from varied services, including support charities, housing, and addiction services. Five key themes were identified: (i) the understanding of and adherence to public health guidance and restrictions; (ii) the experience of people accommodated by the 'Everyone In' initiative; (iii) the impact of social distancing guidelines on PEH experiences in public spaces; (iv) the importance of social support and connections to others; and (v) how homelessness services adapted their provision. Policy makers and public health communicators must learn from PEH to maximize the effectiveness of future public health strategies. Housing providers and support services should recognize the implications of imposing a lack of choice on people who need accommodation during a public health emergency. The loss of usual support for PEH triggered a loss of ability to rely on usual 'survival strategies', which negatively influenced their health. This research highlights successes and difficulties in supporting PEH during the COVID-19 pandemic and informs planning for similar public health events.

Colonization with extended-spectrum beta-lactamase-producing Enterobacteriaceae in unaccompanied refugee minors on arrival in France

In a prospective observational study, we recorded that 25.7% of 139 unaccompanied migrant minors arriving in Angers, Western France were colonized with extended-spectrum β-lactamase producing Enterobacteriaceae (ESBL-PE). Concurrently, we highlighted that some minors had acquired ESBL-PE after their arrival in France.

Council tenancies and hoarding behaviours: A study with a large social landlord in England

Hoarding behaviours are highly stigmatised and often hidden. People with problematic hoarding behaviours have a higher rate of mental health and other healthcare and social services utilisation. Hoarding is a community health problem, one factor being housing insecurity. Hoarding behaviours represent significant burden to housing providers, impact the community and dealing with it involves multiple community agencies. This study with a city council in England with a large housing stock (over 14,000 properties) in summer 2021 sought to understand the nature, circumstances and extent that hoarding presents. We developed a reporting system and conducted 11 interviews with housing officers in which they described a case to explain their involvement. Our report details the nature of 38 people who hoard: 47% had a known disability or vulnerability, 34% presented a fire and environmental risk, 87% lived alone and 60% were resident in flats. Our qualitative themes are: Working with others, Balancing an enforcement approach, Feeling conflicted, Complex needs of people who hoard and Staff needs. The cases described by the housing officers are combined into six case studies and illustrate the complex, multi-agency circumstances around decision making and risk stratification. Our findings point to housing officers as frontline professionals dealing with a public health and social care issue which is often the manifestation of complex life histories and mental health conditions. We suggest a greater focus on risk stratification and a more holistic approach to hoarding cases to effectively deal with this most complex of community health and social care issues.

New approaches for mental health of social minorities

Mental health of social minorities is a challenge of modern psychiatry. It is largely described that people reporting sexual, cultural, religious variations are exposed to an amount of social stress deriving from the contrast between their minority status and the dominant societal norms and values. Minority stress leads to higher level of psychosocial distress and mental illness among these vulnerable populations. This conceptual research paper reports on evidences regarding the mental health issues related to the minority social condition and proposes a set of actions to address these challenges in a global perspective. Specifically, political, social and educational interventions are discussed in order to contrast stigma, discrimination, promote integration and health services for vulnerable populations. Policymakers are invited to deliver ad-hoc policies on minorities and homeless people with specific funding to address related public mental health issues. Educational programs are encouraged in the school setting as well as in the training of health care professionals in order to improve the level of acceptance and competencies in the treatment of minorities' health needs. We firmly believe there is no healthy society without healthy minorities.

Trauma-Informed Design of Supported Housing: A Scoping Review through the Lens of Neuroscience

There is growing recognition of the importance of the design of the built environment in supporting mental health. In this context, trauma-informed design has emerged as a new field of practice targeting the design of the built environment to support wellbeing and ameliorate the physical, psychological and emotional impacts of trauma and related pathologies such as Post Traumatic Stress Disorder (PTSD). With high levels of prevalence of PTSD among people escaping homelessness and domestic violence, a priority area is the identification and application of evidence-based design solutions for trauma-informed supported housing. This study sought to examine the scope of existing evidence on the relationship between trauma, housing and design and the correlation of this evidence with trauma-informed design principles, and to identify gaps and opportunities for future research. In response to the commonly articulated limitations of the evidence-base in built environment design research, we combined a scoping review of literature on trauma, housing and design with insights from neuroscience to focus and extend understanding of the opportunities of trauma-informed design. We found that while limited in scope, there is strong alignment between existing evidence and the principles of trauma-informed design. We also identify three areas of future research related to the key domains of safety and security; control; and enriched environments.

Effects of voluntary adolescent intermittent alcohol exposure and social isolation on adult alcohol intake in male rats

Initiating alcohol use in adolescence significantly increases the likelihood of developing adult alcohol use disorder (AUD). However, it has been difficult to replicate adolescent alcohol exposure leading to increased adult alcohol intake across differing preclinical models. In the present study, differentially housed male rats (group vs. single cages) were used to determine the effects of voluntary intermittent exposure of saccharin-sweetened ethanol during adolescence on adult intake of unsweetened 20% ethanol. Adolescent male rats were assigned to group- or isolated-housing conditions and underwent an intermittent 2-bottle choice in adolescence (water only or water vs. 0.2% saccharin/20% ethanol), and again in adulthood (water vs. 20% ethanol). Intermittent 2-bottle choice sessions lasted for 24 h, and occurred three days per week, for five weeks. Rats were moved from group or isolated housing to single-housing cages for 2-bottle choice tests and returned to their original housing condition on off days. During adolescence, rats raised in isolated-housing conditions consumed significantly more sweetened ethanol than rats raised in group-housing conditions, an effect that was enhanced across repeated exposures. In adulthood, rats raised in isolated-housing conditions and exposed to sweetened ethanol during adolescence also consumed significantly higher levels of unsweetened 20% ethanol compared to group-housed rats. The effect was most pronounced over the first five re-exposure sessions. Housing conditions alone had little effect on adult ethanol intake. These preclinical results suggest that social isolation stress, combined with adolescent ethanol exposure, may play a key role in adult AUD risk.

Associations between Homelessness and Alzheimer's Disease and Related Dementia: A Systematic Review

The homeless population in the United States is rapidly aging, with a parallel increase in Alzheimer's disease and related dementia (ADRD). During an evolving pandemic that jeopardizes employment and housing, assessing the relationship between ADRD and homelessness is critical since the latter is potentially intervenable. The objective of this study is to review the literature and determine whether there is an association between homelessness and dementia risk. A systematic review of existing studies was conducted through PubMED, SCOPUS, and EMBASE among others. Of the 228 results found, nine met inclusion criteria. Homeless studies mainly centered on veteran populations (n = 6/9). There is a complex relationship suggesting homelessness as a risk for and consequence of ADRD but also co-occurrence with psychiatric disorders, substance abuse, and traumatic injuries. Future studies should employ enumeration surveys with modular longitudinal tracking and measure social determinants of health, discrimination, chronic stress, and mood disorders.

"A right place for everybody": Supporting aging in the right place for older people experiencing homelessness

While policies and practices that promote aging in place have risen in prominence over the last two decades, marginalised older adults have largely been overlooked. 'Aging in the right place' is a concept that recognises the importance of adequate and appropriate age-related health and psychosocial supports in shelter/housing settings and their impact on the ability of older people to age optimally. To understand the unique shelter/housing challenges and solutions that affect aging in the right place for older people experiencing homelessness (OPEH), we conducted three World Café workshops in three Canadian cities-Montreal, Calgary, and Vancouver. In total, 89 service providers and OPEH engaged in the workshops, which involved guided, small-table discussions with the goal of stimulating creative ideas and fostering a productive atmosphere. Findings revealed two overarching themes 1) Discrepancies, between the need and availability of housing options and community supports for OPEH, such as affordable transportation, case management, access to healthcare, and system navigation; and 2) Desires, for more peer support, participatory planning, service-enriched housing, social programming, and policies that promote agency, independence, and choice for OPEH. These findings provide evidence to inform the development or modification of housing and supports for OPEH that promote aging in the right place.

Enhanced supported living for people with severe and persistent mental health problems: A qualitative investigation

Supported living has been shown to improve functioning and social inclusion in people with severe and persistent mental health problems, reduce hospitalisation and provide secure accommodation in a population where housing needs are often unmet. Conversely, living in supported accommodation has been depicted by some as depersonalising, marginalising and an ordeal to survive. Discussions regarding housing and support often lack a thorough consideration of individual experiences, with a reliance on quantitative surveys. The question remains how to assure that supported accommodations actually are supportive of the residents' ongoing recovery process. The present study sought to shed light on the experiences of residents in an enhanced supported living service in the United Kingdom. Semi-structured interviews were conducted with nine residents of the service between July 2020 and February 2021. Transcripts were analysed using thematic analysis and indicated three superordinate themes of experiences considered valuable to residents: (1) support from care staff which was readily available; (2), a sense of community and daily activity offered by the residence and on-site activities; and (3) the experience of supported living as a stepping-stone in an ongoing recovery process. Findings indicate the power of comprehensive care with supportive staff, peer-relations, autonomy and fostering hope in empowering individuals in their ongoing recovery.

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

OBJECTIVE

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

DESIGN

Qualitative descriptive design.

PARTICIPANTS

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

METHODS

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

FINDINGS

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

CONCLUSION

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

IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS

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

Microbiota and Serum Metabolic Profile Changes in Korean Native Hanwoo Steer in Response to Diet Feeding Systems

The diversity of bacteria and their function in cattle gastrointestinal tracts can influence animal welfare. Next-generation sequencing (NGS) was used to investigate microbial diversity in the feces of Hanwoo steers reared under natural grazing (GS) and housing (HS) systems. Additionally, serum metabolic parameters, such as liver and kidney markers and mineral and lipid content changes, as well as their correlation with pyrotags, were studied. A total of 6468 ± 87.86 operational taxonomic units (OTUs) were identified in both steer groups, of which 3538 ± 38.17 OTUs were from grazing steer and 2930 ± 94.06 OTUs were from GS. Chao1 index analysis revealed a higher bacterial richness in GS. The dominant bacterial taxa were Bacteroidetes and Firmicutes. GS showed lower Bacteroidetes and higher Firmicutes abundance than HS. The serum of HS showed consistent increases in gamma-glutamyl transpeptidase (γGTP), glucose (GLU), total cholesterol (T-CHO), and triglyceride (TG) levels. The impact of GS on animal health and serum metabolic markers was strongly correlated with microbiota. As shown in this study, grazing has a significant impact on the fecal microbiota at the phylum and family levels, as well as the serum biochemical metabolites of Hanwoo steers.

The Impact of Supportive Housing on Liver-Related Outcomes Among Persons With Hepatitis C Virus Infection

BACKGROUND

Hepatitis C virus (HCV) infection disproportionately impacts people experiencing homelessness. Hepatitis C virus can lead to negative health outcomes, including mortality. We evaluated the impact of a permanent supportive housing (PSH) program (ie, "treatment") on liver-related morbidity and mortality among persons with chronic homelessness and HCV infection.

METHODS

We matched records for persons eligible for a New York City PSH program (2007-2014) with Heath Department HCV and Vital Statistics registries and Medicaid claims. Among persons diagnosed with HCV before or 2 years posteligibility, we added stabilized inverse probability of treatment weights to negative binomial regression models to compare rates for liver disease-related emergency department visits and hospitalizations, and hazard ratios for mortality, by program placement 2 and 5 years posteligibility.

RESULTS

We identified 1158 of 8783 placed and 1952 of 19 019 unplaced persons with laboratory-confirmed HCV infection. Permanent supportive housing placement was associated with significantly reduced liver-related emergency department visits (adjusted rate ratio [aRR] = 0.76, 95% confidence interval [CI] = .61-.95), hospitalizations (aRR = 0.62, 95% CI = .54-.71), and all-cause (adjusted hazard ratio [aHR] = 0.65, 95% CI = .46-.92) and liver-related mortality (aHR = 0.72, 95% CI = .09-.83) within 2 years. The reduction remained significant for hospitalizations after 5 years.

CONCLUSIONS

Placement into PSH was associated with reduced liver-related morbidity and mortality among persons with HCV infection and chronic homelessness.

Exploring the Interactions between Housing and Neighbourhood Environments for Enhanced Child Wellbeing: The Lived Experience of Parents Living in Areas of High Child Poverty in England, UK

Children's health can be affected by the interrelated characteristics of the physical and social environment where they live, including housing quality, neighbourhood characteristics and the local community. Following a systems-based approach, this exploratory project sought to understand how the needs and aspirations associated with the home environment can work in synergy with, or be exacerbated by, other aspects of the local area. The study recruited parents of children aged 2-12 years old from two local authorities in England with high levels of child poverty: Tower Hamlets in East London, and Bradford District in West Yorkshire. Thematic analysis of participant interviews highlighted ten themes and opportunities for improvements. The evidence presented in this research emphasises how environmental quality issues within and outside the home, compounded further by delays in repairs and reduction in service standards, as well as affordability issues, are likely to deeply affect the wellbeing of an entire generation of disadvantaged children whose parents can feel disempowered, neglected and often isolated when attempting to tackle various dimensions of inequalities. Interventions which can improve the quality of housing, and access to space and services, are urgently needed, including initiatives to support and empower families and local communities, especially those prioritising opportunities for action.

Housing-related challenges during COVID-19 pandemic among urban poor in low- and middle-income countries: A systematic review and gap analysis

The abysmal health of the urban poor or slum dwellers was attributed to structural inequities such as inadequate housing, water, and sanitation. This review aimed to assess housing-related opportunities and challenges during the COVID-19 pandemic among urban poor in low-and middle-income countries. For study identification, a comprehensive search was performed in 11 databases that yielded 22 potential studies. The inadequate housing infrastructure makes the lives of the urban poor more precarious during COVID-19. Typically, the houses lacked lighting, ventilation, and overcrowding. This review reflected that it is crucial to reimagine housing policy for the urban poor with an emphasis on pandemic/epidemic guidelines.

Parental Perceptions Regarding the Impact of Housing on Child Health

Introduction Childhood poverty has life-long adverse impacts. We aimed to assess perceptions of parents of a cohort of children attending a paediatric emergency department regarding the impact of their housing on their child and family Methods From 01/11/2020 - 08/01/2021 a cross-sectional study was performed in a paediatric emergency department in Dublin Results Of 312 parents who completed a questionnaire, 4.5% (n = 14) reported themselves to be homeless. Homeless children were less likely to be registered with general practitioners (78.6% vs. 97.5%, p = .009) or be fully vaccinated (71.4% vs. 92.4%, p = .024). Homeless parents were more likely to feel unsafe at home (35.7% vs. 3.4%, p &lt;.001), and to report that their housing negatively impacted their child's education (58.3% vs 10.7%, p &lt;.001), physical health (45.5% vs 11.7, p = .007), and mental health (61.5% vs 12.6%, p &lt;.001). Ten percent of non-homeless parents were concerned about losing their home. A lack of landlord permission to install child safety measures in the home was reported by 28% of all parents. Conclusion Homeless parents were more likely to report that their living situation negatively impacted their child's play, development, education, safety, and health.

Comparison of Locomotor and Feeding Rhythms between Indoor and Outdoor Cats Living in Captivity

The plastic nature of cat behaviour allows this “friendly symbiont” of humans to adapt to various housing conditions. Beyond daylight, one could wonder if other environmental factors affect its patterns. Yet, how its activity and feeding rhythms are impacted by its environment is rarely studied in standardised conditions between populations. We compared the behaviour of cats living in a 29 m2 indoor room and cats living in a 1145 m2 outdoor enclosure, tracking them simultaneously in summer for 21 days, with advanced technologies. Both populations received daylight but weather fluctuations only occurred outdoors. Bimodality was detected in the activity and feeding rhythms of both groups, while twilight triggered crepuscular peaks. Daily, the outdoor population covered more distance (4.29 ± 0.27 km; p < 0.001) and consumed more food (67.44 ± 2.65 g; p < 0.05) than the indoor population (2.33 ± 0.17 km, 57.75 ± 2.85 g, respectively), but displayed less rhythmic behaviours, assumedly because of rhythm disruptors met only in outdoor conditions. Finally, outdoor housing seemed to promote the exploratory behaviour of the cats at night, while indoor housing increased both meal frequency (p = 0.063) and the impact of human interactions on the feeding rhythms of the cats.

Evictions and tenant-landlord relationships during the 2020-2021 eviction moratorium in the US

This study provisionally examined the effects of the US eviction moratorium instituted in response to the Coronavirus Disease 2019 (COVID-19) pandemic. Three waves of data collected May 2020-April 2021 from a nationally representative sample of middle- and low-income US tenants (n = 3393 in Wave 1, n = 1311 in Wave 2, and 814 in Wave 3) were analyzed. Across three waves, 4.3% of tenants reported experiencing an eviction during the moratorium and 6%-23% of tenants reported delaying paying rent because of the moratorium. Multivariable analyses found that tenants who delayed paying their rent, were female, or had a history of mental illness or substance use disorder were more likely to report the eviction moratorium had a negative effect on their landlord relationship. COVID-19 infection was not predictive of eviction but tenants with a history of homelessness were more than nine times as likely to report an eviction than those without such a history. Together, these findings suggest the eviction moratorium may have had some unintended consequences on rent payments and tenant-landlord relationships that need to be considered with the end of the federal eviction moratorium.

The mediation effect of indoor air quality on health: A comparison of homeowners and renters

This research aims to explore whether there is a health disparity between homeowners and renters affected by the indoor air quality of their dwellings. By proxying the presence of mold and smoke as conjoint facilitators of poor indoor air quality, we design a mediation model that previously has not been explored empirically. The structural path model in this study shows that there is indeed a disparity in health between homeowners and renters by demography, socioeconomic status, and dwelling condition. Our study argues that renters whose living conditions are generally worse off than homeowners are also unequal in their health status due to exacerbating effects from poor indoor air quality, which is endogenous to the state of the renter. The originality of this study is that it is the first study that empirically tests the mediation effect of poor indoor air quality of homeowners and renters using a structural equation path model.

Competing perspectives on rural homelessness: Findings from a qualitative study in Ontario, Canada

Rural homelessness in Canada has only recently been acknowledged, and several gaps remain in our understanding of the phenomenon and how it is influenced by the rural context. This qualitative exploratory study aimed to help understand the experience of housing insecurity, factors that lead to rural homelessness, and potential solutions to the housing crisis in a rural Ontario community. Interviews were conducted with 27 participants: 16 individuals who were housing insecure and 11 key informants who had knowledge of the local homelessness situation. Data collection took place between August 2020 and May 2021 and inductive analysis was concurrent. Findings revealed competing perspectives on the magnitude of the crisis, its root causes, and potential solutions to rural homelessness. The invisible nature of rural homelessness and values of individualism that assign responsibility for homelessness to poor choices rather than structural factors may account for these different perspectives. Stigma also played an important role in how homelessness was understood, particularly for individuals who were homeless and perceived to be using substances. The lack of privacy, limited services, and low housing stock in the rural environment contributed to challenges with overcoming homelessness. Strategies to help improve supports for individuals facing homelessness include anti-stigma education, capacity building, and inclusion of people with lived experience of homelessness in decision and policymaking. Prevention should also be incorporated into the response to rural homelessness through intersectoral collaboration and upstream policies that target the structural drivers of homelessness.

Treating people where they are: Nurse-led micro-elimination of hepatitis C in supported housing sites for networks of people who inject drugs in Victoria, Canada

To achieve the World Health Organization's goal of eliminating hepatitis C (HCV) by 2030 requires enhanced HCV testing and treatment among people who use drugs (PWUD). Micro-elimination of HCV is a strategy to target HCV testing and treatment efforts to specific segments of the population. From February to December 2018 nurses initiated a "seek & treat" micro-elimination approach, increasing outreach and removing barriers to accessing HCV treatment in a clinic setting by testing and treating individuals, including PWUD, where they live. The aim of this study was to evaluate the proportion of clients with HCV antibodies and HCV RNA and the response to direct acting agent (DAA therapy) among people who live at or have social connections to local supportive housing sites through this nurse-led micro-elimination project in Victoria, Canada. A chart review of electronic medical records and case management documentation was used to collect relevant data of participants treated with DAA therapy, identified through specific housing site testing and outreach interventions. In total, 180 people were tested for HCV antibodies, 72 (40%) were antibody positive: 51 (28%) were RNA positive, 13 (7%) had spontaneously cleared and 8 (4%) had been previously treated. Of the 51 that were currently living with HCV, 43 people were started on treatment, 39 have achieved sustained virologic response (SVR). By providing treatment to clients in their homes and with their friends, clinicians have been able to treat clients, including those with limited contact with the health care system.

Prison Visitation and Concerns about Reentry: Variations in Frequency and Quality of Visits are Associated with Reentry Concerns among People Incarcerated in Prison

Prior studies suggest that visitation may have an impact on successful reentry. At the same time, the impact of visitation on incarcerated people's concerns about reentry has received little empirical attention. Understanding how factors such as visitation affect concerns about reentry can provide correctional officials with policy directions on how to reduce strains and enhance successful reintegration. Further, while some studies have evaluated frequency of visitation far fewer have examined the impact of quality of visitation. Using a sample of males and females incarcerated in five correctional facilities (n = 3,084), this study examines how frequency and quality of visitation impact incarcerated people's concerns about employment, housing, debt, and recidivism upon reentry. Findings suggest that more visits reduce concerns, while negative visits increase concerns about reentry.

Housing and Support for People with Disability: Perspectives of Motor Accident, Disability and Injury Insurers across Australia and New Zealand

Housing is a critical enabler of a dignified life, civic participation and the achievement of human rights. Providing appropriate housing for people who experience neurotrauma as a result of road or workplace injury, with both the assistive technology and human support required, continues however to be a policy and practice challenge. Australian and New Zealand motor accident, disability and injury insurers have high and enduring liability in this area, and their under-researched perspectives are needed to strengthen the evidence base for policy and practice development. This qualitative study utilised focus group methodology with representatives from government injury and disability insurers across Australia and New Zealand (n = 8). The study aimed to identify (a) issues and trends; (b) factors for decision making; and (c) service impacts relating to housing and support for people with disability and high daily support needs. Thematic analysis generated results across four key areas: influences on the decision to fund housing and/or support; identifying 'good' housing solutions; evaluating cost-benefit of housing and support investments; and developing future investment in housing and support. Findings such as those regarding decision-making, and investment, attest to the value of capturing the perspectives of this key group of stakeholders to assist to envision better housing and support for people with disability.