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Jouzi Z, San Diego L, Lewis NA, Leak TM. How Can Transitional Housing Be Improved? Insights from Residents' Experiences and Perceptions in New York City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:829. [PMID: 39063406 PMCID: PMC11277256 DOI: 10.3390/ijerph21070829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Revised: 06/14/2024] [Accepted: 06/22/2024] [Indexed: 07/28/2024]
Abstract
Homelessness, affecting over half a million Americans, significantly elevates the risks of mental and physical health issues, consequently diminishing life expectancy when compared with the general population. Homelessness is a critical public health issue, and efforts are needed to address lack of housing as a social determinant of health. Transitional housing (TH) programs emerge as vital interventions, offering a place to stay with various support services to facilitate the transition to permanent residency. Nearly half of the unhoused population in the country and over 90% in New York live in TH or shelters. Despite the high utilization rates of TH, engagement with support services and opportunities for improvement remain poorly understood. This study aimed to fill this gap by examining the factors influencing support service usage and opportunities for enhancement through semi-structured interviews with TH residents in New York City to capture their lived experiences and perspectives. Analysis of the interviews (n = 20) revealed five main factors affecting service engagement that aligned with constructs of the socioecological model: intrapersonal (self-efficacy, chronic health conditions, mental health), interpersonal (parenthood and well-being of children with special needs, individual staff interactions, and communication), institutional (bureaucratic challenges, administrative burden, and living facilities), community (social isolation and educational opportunity), and policy (challenge meeting basic needs and undocumented status). Recommendations for bridging service gaps primarily arose at the institutional and community levels, offering critical insights for administrators to tailor services more effectively to TH residents' needs, thus contributing to the broader goal of advancing health equity among the unhoused.
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Affiliation(s)
- Zeynab Jouzi
- Action Research Collaborative (ARC), Cornell University, Ithaca, NY 14853, USA; (N.A.L.J.); (T.M.L.)
| | - Lauren San Diego
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA;
| | - Neil A. Lewis
- Action Research Collaborative (ARC), Cornell University, Ithaca, NY 14853, USA; (N.A.L.J.); (T.M.L.)
- Department of Communication, Cornell University, Ithaca, NY 14853, USA
| | - Tashara M. Leak
- Action Research Collaborative (ARC), Cornell University, Ithaca, NY 14853, USA; (N.A.L.J.); (T.M.L.)
- Division of Nutritional Sciences, Cornell University, Ithaca, NY 14853, USA;
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Jose R, D’Amico EJ, Klein DJ, Rodriguez A, Pedersen ER, Tucker JS. In flux: Associations of substance use with instability in housing, employment, and income among young adults experiencing homelessness. PLoS One 2024; 19:e0303439. [PMID: 38739626 PMCID: PMC11090355 DOI: 10.1371/journal.pone.0303439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Accepted: 04/24/2024] [Indexed: 05/16/2024] Open
Abstract
Young adults experiencing homelessness (YAEH) are faced with instabilities in many areas of their lives, including their living situation, employment, and income. Little is known about how the experience of instability in these different domains might be associated with substance use. Leveraging data collected on 276 YAEH in Los Angeles County, regression analyses examine associations between three distinct types of instability (housing, employment, income) and participants' self-reported alcohol use, alcohol consequences, non-cannabis drug use, and substance use symptoms. Results indicated that recent instability in income, employment, and secure housing for those with access to it (but not housing in general or non-secure housing) were significantly associated with greater alcohol/drug use or substance use symptoms. Depression was also found to moderate the association between employment instability and alcohol use. Our findings suggest that efforts to reduce instability in income, employment, and secure housing may have positive benefits for substance using YAEH, especially those with depressive symptoms.
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Affiliation(s)
- Rupa Jose
- RAND Corporation, Arlington, Virginia, United States of America
| | | | - David J. Klein
- RAND Corporation, Santa Monica, California, United States of America
| | | | - Eric R. Pedersen
- Department of Psychiatry and Behavioral Sciences, University of Southern California, Los Angeles, California, United States of America
| | - Joan S. Tucker
- RAND Corporation, Santa Monica, California, United States of America
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3
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Manson D, Fast D. "They are always focusing on the person who is doing the worst": Exploring how crisis shapes young people's pathways in and out of supportive housing in Vancouver, Canada. Soc Sci Med 2023; 331:116091. [PMID: 37473541 DOI: 10.1016/j.socscimed.2023.116091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 06/30/2023] [Accepted: 07/10/2023] [Indexed: 07/22/2023]
Abstract
Housing instability, homelessness, and mental health among young people who use drugs in Vancouver, Canada, and elsewhere have increasingly been framed through a language of crisis. The declaration of overlapping housing, mental health, and addictions crises in our own setting has prompted a wide range of interventions, including the rapid expansion of supportive housing programs that include integrated housing-based substance use and mental health care. There is growing evidence demonstrating that these models are effective at stabilizing people who are experiencing protracted housing instability, mental health, and substance use related health concerns. We recount stories of three young people who have lived in supportive housing to argue that achieving the relative stability afforded by these interventions is partially contingent on maintaining a delicate balance between being in a state of "too much" or "too little" in crisis. These stories demonstrate two key findings. First, being in crisis has made these young people visible to housing, substance use, and mental health programs that may not otherwise be available to them. Secondly, entering periods of protracted or intense mental health crisis may reopen pathways into unstable housing and homelessness by activating undesirable institutional responses that conflict with young people's desire for self-determination in relation to their care. This study underscores that supportive housing should be part of a broader youth focused system of housing and care that seeks to address the needs of young people before they enter states of crisis.
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Affiliation(s)
- Daniel Manson
- Department of Medicine, University of British Columbia, Vancouver, Canada; British Columbia Centre on Substance Use, Vancouver, Canada.
| | - Danya Fast
- Department of Medicine, University of British Columbia, Vancouver, Canada; British Columbia Centre on Substance Use, Vancouver, Canada
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Nasmith TE, Gadermann A, Jaworsky D, Norena M, To MJ, Hwang SW, Palepu A. Clinically significant substance use and residential stability among homeless or vulnerably housed persons in Canada: a longitudinal cohort study. J Public Health (Oxf) 2021; 43:532-540. [PMID: 32076717 DOI: 10.1093/pubmed/fdaa018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Revised: 12/14/2019] [Accepted: 01/12/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND We examined clinically significant substance use among homeless or vulnerably housed persons in three Canadian cities and its association with residential stability over time using data from the Health and Housing in Transition study. METHODS In 2009, 1190 homeless or vulnerably housed individuals were recruited in three Canadian cities and followed for 4 years. We collected information on housing and incarceration history, drug and alcohol use, having a primary care provider at baseline and annually for 4 years. Participants who screened positive for substance use at baseline were included in the analyses. We used a generalized logistic mixed effect regression model to examine the association between clinically significant substance use and residential stability, adjusting for confounders. RESULTS Initially, 437 participants met the criteria for clinically significant substance use. The proportion of clinically significant substance use declined, while the proportion of participants who achieved residential stability increased over time. Clinically significant substance use was negatively associated with achieving residential stability over the 4-year period (AOR 0.7; 95% CI 0.57, 0.86). CONCLUSIONS In this cohort of homeless or vulnerably housed individuals, clinically significant substance use was negatively associated with achieving residential stability over time, highlighting the need to better address substance use in this population.
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Affiliation(s)
- Trudy E Nasmith
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Anne Gadermann
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Denise Jaworsky
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada
| | - Monica Norena
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
| | - Matthew J To
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada
| | - Stephen W Hwang
- Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, ON M5B 1W8, Canada.,Department of Medicine, University of Toronto, Toronto, ON M5G 2C4, Canada
| | - Anita Palepu
- Department of Medicine, University of British Columbia, Vancouver, BC V5Z 1M9, Canada.,Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC V6Z 1Y6, Canada
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Rowlands Snyder EC, Boucher LM, Bayoumi AM, Martin A, Marshall Z, Boyd R, LeBlanc S, Tyndall M, Kendall CE. A cross-sectional study of factors associated with unstable housing among marginalized people who use drugs in Ottawa, Canada. PLoS One 2021; 16:e0253923. [PMID: 34197552 PMCID: PMC8248707 DOI: 10.1371/journal.pone.0253923] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 06/15/2021] [Indexed: 11/23/2022] Open
Abstract
Introduction Housing affects an individual’s physical and mental health, particularly among people who use substances. Understanding the association between individual characteristics and housing status can inform housing policy and help optimize the care of people who use drugs. The objective of this study was to explore the factors associated with unstable housing among people who use drugs in Ottawa. Methods This is a cross-sectional analysis of data from 782 participants in the Participatory Research in Ottawa: Understanding Drugs (PROUD) Study. PROUD is a prospective cohort study of people who use drugs in Ottawa. Between March and December 2013, participants were recruited through peer-based recruitment on the streets and in social services settings and completed a peer-administered questionnaire that explored socio-demographic information, drug use patterns, community integration, experiences with police and incarceration, and access to health care and harm reduction services. Eligibility criteria included age of 16 years or older, self-reported illicit drug use within the past 12 months and having lived in Ottawa for at least 3 months. Housing status was determined by self-report. “Stable housing” was defined as residence in a house or apartment and “unstable housing” was defined as all other residence types. Exploratory multivariable logistic regression analyses of the association between characteristics of people who use drugs and their housing status were conducted. Results Factors that were associated with unstable housing included: recent incarceration; not having a regular doctor; not having received support from a peer worker; low monthly income; income source other than public disability support payments; and younger age. Gender, language, ethnicity, education level, opioid use and injection drug use were not independently associated with housing status. Conclusions People who use drugs face significant barriers to stable housing. These results highlight key areas to address in order to improve housing stability among this community.
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Affiliation(s)
| | - Lisa M. Boucher
- School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada
| | - Ahmed M. Bayoumi
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Toronto, Ontario, Canada
- Division of General Internal Medicine, St. Michael’s Hospital, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Alana Martin
- Somerset West Community Health Centre, Ottawa, Ontario, Canada
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
| | - Zack Marshall
- School of Social Work, McGill University, Montreal, Quebec, Canada
| | - Rob Boyd
- Sandy Hill Community Health Centre, Ottawa, Ontario, Canada
| | - Sean LeBlanc
- PROUD Community Advisory Committee, Ottawa, Ontario, Canada
- Drug Users Advocacy League, Ottawa, Ontario, Canada
| | - Mark Tyndall
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Claire E. Kendall
- C.T. Lamont Primary Health Care Research Centre, Bruyère Research Institute, Ottawa, Ontario, Canada
- * E-mail:
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Tiderington E. "I achieved being an adult": A Qualitative Exploration of Voluntary Transitions from Permanent Supportive Housing. ADMINISTRATION AND POLICY IN MENTAL HEALTH AND MENTAL HEALTH SERVICES RESEARCH 2020; 48:9-22. [PMID: 32232704 DOI: 10.1007/s10488-020-01036-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This study examined how individuals voluntarily leaving permanent supportive housing (PSH) through a Moving On initiative experienced the transition from PSH services to mainstream housing. Participants (N = 25) were purposively sampled from five supportive housing agencies in a Moving On initiative. A modified grounded theory approach was used to analyze semi-structured, post-move interviews. Participants described the transition from PSH as a process that involved gaining freedom from negative aspects of the PSH environment and a stagnation in services, adjusting to a new environment and the loss of familiar supports, taking on new responsibilities of self-advocacy and managing new financial burdens, and feeling empowered to move on to next steps, which ultimately, led to achievement of independence. Various contextual conditions, including PSH- and postmove housing type, influenced participants' experience of this process. Findings can inform future Moving On initiatives, implementation of PSH programs, as well as the design of the larger homeless service system.
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Affiliation(s)
- Emmy Tiderington
- Rutgers School of Social Work, The State University of New Jersey, 360 Dr. Martin Luther King Blvd., Hill Hall, Suite 401C, Newark, NJ, 07102-1801, USA.
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Food insecurity among formerly homeless youth in supportive housing: A social-ecological analysis of a structural intervention. Soc Sci Med 2019; 245:112724. [PMID: 31838336 DOI: 10.1016/j.socscimed.2019.112724] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/03/2019] [Accepted: 12/04/2019] [Indexed: 01/02/2023]
Abstract
A growing body of research indicates that structural interventions to provide permanent supportive housing (PSH) to homeless adults within a Housing First approach can improve their health. However, research is lacking regarding the impact of PSH on youth experiencing homelessness. This article seeks to understand how PSH for youth impacts a basic health need-food security- across multiple levels of the social-ecological environment. In January of 2014, San Francisco, California opened the city's first municipally-funded PSH building exclusively designated for transition-aged youth (ages 18-24). We conducted 20 months of participant observation and in-depth interviews with 39 youth from April 2014 to December 2015. Ethnographic fieldnotes and interview transcripts were analyzed using grounded theory. We present our social-ecological assessment regarding food insecurity for formerly homeless youth in supportive housing. We found that although housing removes some major sources of food insecurity from their lives, it adds others. Many of the participating youth were frequently hungry and went without food for entire days. Mechanisms across multiple levels of the social-ecological model contribute to food insecurity. Mechanisms on the structural level include stigma, neighborhood food resources, and monthly hunger cycles. Mechanisms on the institutional level include the transition into housing and housing policies regarding kitchen use and food storage. Interpersonal level mechanisms include food sharing within social networks. Individual level mechanisms include limited cooking skills, equipment, and coping strategies to manage hunger. Although supportive housing provides shelter to youth, effective implementation of the Housing First/PSH model for youth must ensure their access to an affordable nutritious diet.
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8
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Thulien NS, Gastaldo D, Hwang SW, McCay E. The elusive goal of social integration: A critical examination of the socio-economic and psychosocial consequences experienced by homeless young people who obtain housing. Canadian Journal of Public Health 2019; 109:89-98. [PMID: 29981071 DOI: 10.17269/s41997-018-0029-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The objective of this study was to provide an insider perspective on the experiences of nine formerly homeless young people as they transitioned into independent (market rent) housing and attempted to achieve meaningful social integration. METHODS The study was conducted in Toronto, Canada, and guided by the conceptual framework developed for the World Health Organization by the Commission on Social Determinants of Health. A critical ethnographic methodology was used. Over the course of 10 months, the lead author met every other week with nine formerly homeless young people who had moved into their own homes within 30 days prior to study recruitment. RESULTS Unaffordable housing, limited education, inadequate employment opportunities, poverty-level income, and limited social capital made it remarkably challenging for the young people to move forward. As the study progressed, the participants' ability to formulate long-range plans was impeded as they were forced to focus on day-to-day existence. Over time, living in a perpetual state of poverty led to feelings of "outsiderness," viewing life as a game of chance, and isolation. CONCLUSION Rather than a secure, linear path from the streets to the mainstream, study participants were forced to take a precarious path full of structural gaps that left them stuck, spinning, and exhausted by the day-to-day struggle to meet basic needs. Despite their remarkable agency, it was almost impossible for the participants to achieve meaningful social integration given the structural inequities inherent in society. These observations have implications for practice, policy, and research.
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Affiliation(s)
- Naomi S Thulien
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada. .,Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.
| | - Denise Gastaldo
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada.,The Centre for Critical Qualitative Health Research, University of Toronto, Toronto, ON, Canada
| | - Stephen W Hwang
- Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute of St. Michael's Hospital, Toronto, ON, M5B 1W8, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Elizabeth McCay
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Gaetz S, Ward A, Kimura L. Youth homelessness and housing stability: What outcomes should we be looking for? Healthc Manage Forum 2019; 32:73-77. [PMID: 30722701 DOI: 10.1177/0840470418817333] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In North America, the key performance indicator of success in community strategies to address homelessness is whether a homeless person is housed or not. In this article, we argue that for young people experiencing homelessness, we need to advance a broader consideration of outcomes to include a range of well-being indicators designed to understand the needs of developing adolescents and young adults and contribute to housing stability. We articulate that the positive outcomes of young people across life domains that include housing stability as well as their safety and security, health and well-being, social connections to peers, family and meaningful adults, connections to groups/neighbourhoods/communities, interests and recreation and leisure, and school and career/work aspirations and goals must be at the centre of these efforts. The Making the Shift project is designed to test this outcomes framework in order to enhance service and measurement capacity and ultimately improve outcomes for youth.
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Affiliation(s)
- Stephen Gaetz
- 1 Faculty of Education, Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
| | - Ashley Ward
- 2 Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
| | - Lauren Kimura
- 2 Canadian Observatory on Homelessness, York University, Toronto, Ontario, Canada
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10
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Cheng T, Small W, Dong H, Nosova E, Hayashi K, DeBeck K. An age-based analysis of nonmedical prescription opioid use among people who use illegal drugs in Vancouver, Canada. Subst Abuse Treat Prev Policy 2018; 13:41. [PMID: 30482215 PMCID: PMC6260714 DOI: 10.1186/s13011-018-0180-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2018] [Accepted: 11/13/2018] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Nonmedical prescription opioid use (NMPOU) is a serious public health problem in North America. At a population-level, previous research has identified differences in the prevalence and correlates of NMPOU among younger versus older age groups; however, less is known about age-related differences in NMPOU among people who use illegal drugs. METHODS Data were collected between 2013 and 2015 from two linked prospective cohort studies in Vancouver, Canada: the At-Risk Youth Study (ARYS) and the Vancouver Injection Drug Users Study (VIDUS). Factors independently associated with NMPOU among younger (ARYS) and older (VIDUS) participants were examined separately using bivariate and multivariate generalized estimating equations. RESULTS A total of 1162 participants were included. Among 405 eligible younger participants (Median age = 25; Inter-Quartile Range [IQR]: 22-28), 40% (n = 160) reported engaging in NMPOU at baseline; among 757 older participants (Median age = 48, IQR: 40-55), 35% (n = 262) reported engaging in NMPOU at baseline. In separate multivariate analyses of younger and older participants, NMPOU was positively and independently associated with heroin use (younger: Adjusted Odds Ratio [AOR] = 3.12, 95% Confidence Interval [CI]: 2.08-4.68; older: AOR = 2.79, 95% CI: 2.08-3.74), drug dealing (younger: AOR = 2.22, 95% CI: 1.58-3.13; older: AOR = 1.87, 95% CI: 1.40-2.49), and difficulty accessing services (younger: AOR = 1.47, 95% CI: 1.04-2.09; older: AOR = 1.74, 95% CI: 1.32-2.29). Among the youth cohort only, NMPOU was associated with younger age (AOR = 1.12, 95% CI: 1.05-1.19), crack use (AOR = 1.56, 95% CI: 1.06-2.30), and binge drug use (AOR = 1.41, 95% CI: 1.00-1.97); older participants who engaged in NMPOU were more likely to report crystal methamphetamine use (AOR = 1.97, 95% CI: 1.46-2.66), non-fatal overdose (AOR = 1.76, 95% CI: 1.20-2.60) and sex work (AOR = 1.49, 95% CI: 1.00-2.22). DISCUSSION The prevalence of NMPOU is similar among younger and older people who use drugs, and independently associated with markers of vulnerability among both age groups. Adults who engage in NMPOU are at risk for non-fatal overdose, which highlights the need for youth and adult-specific strategies to address NMPOU that include better access to health and social services, as well as a range of addiction treatment options for opioid use. Findings also underscore the importance of improving pain treatment strategies tailored for PWUD.
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Affiliation(s)
- Tessa Cheng
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Will Small
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- Centre for Applied Research in Mental Health and Addiction, SFU Faculty of Health Sciences, 515 W. Hastings Street, Vancouver, BC V6B 5K3 Canada
| | - Huiru Dong
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC V6T 1Z3 Canada
| | - Ekaterina Nosova
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC V5A 1S6 Canada
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
| | - Kora DeBeck
- British Columbia Centre on Substance Use, Providence Health Care, 400-1045 Howe St, Vancouver, BC V6Z 2A9 Canada
- School of Public Policy, Simon Fraser University, 515 West Hastings Street, Suite 3271, Vancouver, BC V6B 5K3 Canada
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11
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Leibler JH, Nguyen DD, León C, Gaeta JM, Perez D. Personal Hygiene Practices among Urban Homeless Persons in Boston, MA. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14080928. [PMID: 28820454 PMCID: PMC5580630 DOI: 10.3390/ijerph14080928] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/17/2017] [Revised: 08/07/2017] [Accepted: 08/16/2017] [Indexed: 01/03/2023]
Abstract
Persons experiencing homelessness in the United States experience significant barriers to self-care and personal hygiene, including limited access to clean showers, laundry and hand washing facilities. While the obstacles to personal hygiene associated with homelessness may increase risk of infectious disease, hygiene-related behaviors among people experiencing homelessness has received limited attention. We conducted a cross-sectional study of individuals experiencing homelessness in Boston, MA (n = 194) to identify hygiene-related self-care practices and risk factors for reduced hygiene in this population. Most participants (72%) reported taking a daily shower. More than 60% reported hand washing with soap five or more times each day, and use of hand sanitizer was widespread (89% reported using sanitizer in the last week). A majority (86%) used a laundromat or laundry machine to wash clothing, while 14% reported washing clothing in the sink. Heavy drinking, injection drug use, and sleeping outdoors were identified as significant risk factors for reduced hygiene practices. People experiencing homelessness who also engage in these activities may be among the most difficult to reach for intervention, yet targeted efforts may decrease illness risk associated with reduced hygiene. Housed friends and family play a critical role in assisting homeless individuals maintain hygiene by providing showers and laundry facilities.
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Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, T430W, Boston, MA 02118, USA.
| | - Daniel D Nguyen
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, T430W, Boston, MA 02118, USA.
| | - Casey León
- Boston Health Care for the Homeless Program, 780 Albany St. Boston, MA 02118, USA.
| | - Jessie M Gaeta
- Boston Health Care for the Homeless Program, 780 Albany St. Boston, MA 02118, USA.
- Department of Medicine, Boston University School of Medicine, 72 E. Concord St. Boston, MA 02118, USA.
| | - Debora Perez
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, T430W, Boston, MA 02118, USA.
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12
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Linton SL, Cooper HLF, Kelley ME, Karnes CC, Ross Z, Wolfe ME, Friedman SR, Jarlais DD, Semaan S, Tempalski B, Sionean C, DiNenno E, Wejnert C, Paz-Bailey G. Cross-sectional association between ZIP code-level gentrification and homelessness among a large community-based sample of people who inject drugs in 19 US cities. BMJ Open 2017; 7:e013823. [PMID: 28637724 PMCID: PMC5541298 DOI: 10.1136/bmjopen-2016-013823] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Housing instability has been associated with poor health outcomes among people who inject drugs (PWID). This study investigates the associations of local-level housing and economic conditions with homelessness among a large sample of PWID, which is an underexplored topic to date. METHODS PWID in this cross-sectional study were recruited from 19 large cities in the USA as part of National HIV Behavioral Surveillance. PWID provided self-reported information on demographics, behaviours and life events. Homelessness was defined as residing on the street, in a shelter, in a single room occupancy hotel, or in a car or temporarily residing with friends or relatives any time in the past year. Data on county-level rental housing unaffordability and demand for assisted housing units, and ZIP code-level gentrification (eg, index of percent increases in non-Hispanic white residents, household income, gross rent from 1990 to 2009) and economic deprivation were collected from the US Census Bureau and Department of Housing and Urban Development. Multilevel models evaluated the associations of local economic and housing characteristics with homelessness. RESULTS Sixty percent (5394/8992) of the participants reported homelessness in the past year. The multivariable model demonstrated that PWID living in ZIP codes with higher levels of gentrification had higher odds of homelessness in the past year (gentrification: adjusted OR=1.11, 95% CI=1.04 to 1.17). CONCLUSIONS Additional research is needed to determine the mechanisms through which gentrification increases homelessness among PWID to develop appropriate community-level interventions.
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Affiliation(s)
- Sabriya L Linton
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Hannah LF Cooper
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Mary E Kelley
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Conny C Karnes
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Zev Ross
- ZevRoss Spatial Analysis, Ithaca, New York, USA
| | - Mary E Wolfe
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Samuel R Friedman
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, New York, USA
| | - Don Des Jarlais
- Baron Edmond de Rothschild Chemical Dependency Institute, Mount Sinai Beth Israel, New York, USA
| | - Salaam Semaan
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | - Barbara Tempalski
- Institute for Infectious Disease Research, National Development and Research Institutes, New York, New York, USA
| | - Catlainn Sionean
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
| | | | - Cyprian Wejnert
- Centers for Disease Control and Prevention, Atlanta, Georgia, USA
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Dombrowski K, Sittner K, Crawford D, Welch-Lazoritz M, Habecker P, Khan B. Network Approaches to Substance Use and HIV/Hepatitis C Risk among Homeless Youth and Adult Women in the United States: A Review. Health (London) 2016; 8:1143-1165. [PMID: 28042394 PMCID: PMC5193114 DOI: 10.4236/health.2016.812119] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
During the United States economic recession of 2008-2011, the number of homeless and unstably housed people in the United States increased considerably. Homeless adult women and unaccompanied homeless youth make up the most marginal segments of this population. Because homeless individuals are a hard to reach population, research into these marginal groups has traditionally been a challenge for researchers interested in substance abuse and mental health. Network analysis techniques and research strategies offer means for dealing with traditional challenges such as missing sampling frames, variation in definitions of homelessness and study inclusion criteria, and enumeration/population estimation procedures. This review focuses on the need for, and recent steps toward, solutions to these problems that involve network science strategies for data collection and analysis. Research from a range of fields is reviewed and organized according to a new stress process framework aimed at understanding how homeless status interacts with issues related to substance abuse and mental health. Three types of network innovation are discussed: network scale-up methods, a network ecology approach to social resources, and the integration of network variables into the proposed stress process model of homeless substance abuse and mental health. By employing network methods and integrating these methods into existing models, research on homeless and unstably housed women and unaccompanied young people can address existing research challenges and promote more effective intervention and care programs.
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Affiliation(s)
- Kirk Dombrowski
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Kelley Sittner
- Department of Sociology, Oklahoma State University, Stillwater, USA
| | | | | | - Patrick Habecker
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
| | - Bilal Khan
- Department of Sociology, University of Nebraska-Lincoln, Lincoln, USA
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Hepburn K, Barker B, Nguyen P, Dong H, Wood E, Kerr T, DeBeck K. Initiation of drug dealing among a prospective cohort of street-involved youth. THE AMERICAN JOURNAL OF DRUG AND ALCOHOL ABUSE 2016; 42:507-512. [PMID: 27315200 PMCID: PMC5055453 DOI: 10.1080/00952990.2016.1186684] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2015] [Revised: 04/28/2016] [Accepted: 05/03/2016] [Indexed: 10/21/2022]
Abstract
BACKGROUND Street-involved youth who use drugs may have limited income-generation options and are known to commonly become immersed in illicit drug markets to generate funds. However, little attention has been given to factors that may drive drug dealing initiation among this vulnerable population. OBJECTIVES This longitudinal study examines drug dealing initiation among street-involved youth. METHODS Data were derived from the At-Risk Youth Study from September 2005 to November 2014; a prospective cohort of 194 street-involved youth who use drugs aged 14-26, in Vancouver, Canada. Extended Cox model was used to identify factors independently associated with time to first drug dealing. RESULTS Among street-involved youth who had never dealt drugs at baseline, 56 (29%) individuals initiated drug dealing during the study period for an incidence density of 13.0 per 100 person-years (95% confidence interval [CI]: 9.9-17.2). In multivariable Cox regression analysis, male gender (adjusted hazard ratio [AHR] = 1.90, 95% CI: 1.06-3.42), homelessness (AHR = 1.88, 95% CI: 1.05-3.35), crystal methamphetamine use (AHR = 2.48, 95% CI: 1.47-4.20), and crack cocaine use (AHR = 2.35, 95% CI: 1.38-4.00) were positively and independently associated with initiating drug dealing. CONCLUSION Homelessness and stimulant drug use were key risk factors for drug dealing initiation among street-involved youth. Findings indicate that evidence-based and innovative interventions, including youth-centric supportive housing, low threshold employment programs, and stimulant addiction treatment should be implemented and evaluated as strategies to help prevent this vulnerable population from engaging in risky illegal income generation practices.
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Affiliation(s)
- Kirk Hepburn
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b School of Public Policy , Simon Fraser University , Vancouver , Canada
| | - Brittany Barker
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- c Interdisciplinary Studies Graduate Program , University of British Columbia , Vancouver , Canada
| | - Paul Nguyen
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Huiru Dong
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
| | - Evan Wood
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Thomas Kerr
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- d Division of AIDS, Department of Medicine , University of British Columbia , Vancouver , Canada
| | - Kora DeBeck
- a Urban Health Research Initiative, British Columbia Centre for Excellence in HIV/AIDS , Vancouver , Canada
- b School of Public Policy , Simon Fraser University , Vancouver , Canada
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Roy É, Robert M, Fournier L, Laverdière É, Berbiche D, Boivin JF. Predictors of residential stability among homeless young adults: a cohort study. BMC Public Health 2016; 16:131. [PMID: 26860995 PMCID: PMC4746879 DOI: 10.1186/s12889-016-2802-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2015] [Accepted: 02/01/2016] [Indexed: 11/20/2022] Open
Abstract
Background Homelessness episodes have been shown to be associated with serious health outcomes among youth. This study was undertaken to estimate the probability of reaching residential stability over time and to identify predictors of residential stability among homeless young adults aged 18 to 25 years. Methods A prospective cohort study was carried out in Montréal, Canada, between April 5th 2006 and January 21th 2009. Interviews conducted every three months included questions on life conditions and social and mental health factors that are known to influence residential trajectories. Residential status was determined, starting on the first day after recruitment; each follow-up day was classified as a homeless day or a housed day. A period of 90 days was used to define residential stability; therefore the main study outcome was the occurrence of the first consecutive 90 housed days during the follow-up period. Kaplan-Meier and Cox proportional-hazards regression analyses were conducted. Results Of the 359 participants, 284 reached 90 days of residential stability over the study period, representing an annual probability of 80.5 %. In multivariate analysis, youth who had a high school degree, had a formal sector activity, and those who had sought psychological help were more likely to reach residential stability. Being a man, injecting substances, and having an informal sector activity were associated with a decreased probability to reach residential stability. Conclusion Exposure to factors related to opportunities that promote social integration increases the chance of reaching residential stability. On the other hand, factors related to high level of street entrenchment seem to interfere with stabilization. Maximum efforts should be made to prevent chronic homelessness among youth, targeting not only individual impairments but also hinging on services adapted to foster social connections among the youth.
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Affiliation(s)
- Élise Roy
- Addiction Research and Study Program, Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, room 200, Longueuil, QC, J4K 0A8, Canada.
| | - Marie Robert
- Département de Psychoéducation et de Psychologie, Université du Québec en Outaouais, 283, boul. Alexandre-Taché, bureau 3712, C.P. 1250, Succursale Hull, Gatineau, QC, J8X 3X7, Canada
| | - Louise Fournier
- École de Santé Publique, Université Montréal, 7101 Avenue du Parc, 3ième étage, Montréal, QC, H3N 1X9, Canada
| | - Émélie Laverdière
- Faculty of Medicine and Health Sciences, Université de Sherbrooke, 150, Place Charles-Le Moyne, room 200, Longueuil, QC, J4K 0A8, Canada
| | - Djamal Berbiche
- Charles-LeMoyne Hospital Research Centre, 150, Place Charles-Le Moyne, room 200, C.P. 11, Longueuil, QC, J4K 0A8, Canada
| | - Jean-François Boivin
- Lady Davis Institute for Medical Research, Jewish General Hospital, 3755, Côte Ste-Catherine, Montréal, QC, H3T 1E2, Canada
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Tozer K, Tzemis D, Amlani A, Coser L, Taylor D, Van Borek N, Saewyc E, Buxton JA. Reorienting risk to resilience: street-involved youth perspectives on preventing the transition to injection drug use. BMC Public Health 2015; 15:800. [PMID: 26286577 PMCID: PMC4545775 DOI: 10.1186/s12889-015-2153-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2014] [Accepted: 08/14/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Youth Injection Prevention (YIP) project aimed to identify factors associated with the prevention of transitioning to injection drug use (IDU) among street-involved youth (youth who had spent at least 3 consecutive nights without a fixed address or without their parents/caregivers in the previous six months) aged 16-24 years in Metro Vancouver, British Columbia. METHODS Ten focus groups were conducted by youth collaborators (peer-researchers) with street-involved youth (n = 47) from November 2009-April 2010. Audio recordings and focus group observational notes were transcribed verbatim and emergent themes identified by open coding and categorizing. RESULTS Through ongoing data analysis we identified that youth produced risk and deficiency rather than resiliency-based answers. This enabled the questioning guide to be reframed into a strengths-based guide in a timely manner. Factors youth identified that prevented them from IDU initiation were grouped into three domains loosely derived from the risk environment framework: Individual (fear and self-worth), Social Environment (stigma and group norms - including street-entrenched adults who actively discouraged youth from IDU, support/inclusion, family/friend drug use and responsibilities), and Physical/Economic Environment (safe/engaging spaces). Engaging youth collaborators in the research ensured relevance and validity of the study. CONCLUSION Participants emphasized having personal goals and ties to social networks, supportive family and role models, and the need for safe and stable housing as key to resiliency. Gaining the perspectives of street-involved youth on factors that prevent IDU provides a complementary perspective to risk-based studies and encourages strength-based approaches for coaching and care of at-risk youth and upon which prevention programs should be built.
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Affiliation(s)
- Kira Tozer
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Despina Tzemis
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Ashraf Amlani
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Larissa Coser
- Faculty of Health Sciences, Simon Fraser University, 8888 University Drive, Burnaby, BC, V5A1S6, Canada.
| | - Darlene Taylor
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada.
| | - Natasha Van Borek
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada.
| | - Elizabeth Saewyc
- University of British Columbia School of Nursing, T201-2211 Westbrook Mall, Vancouver, BC, V6T2B5, Canada.
| | - Jane A Buxton
- British Columbia Centre for Disease Control, 655 West 12th Avenue, Vancouver, BC, V5Z4R4, Canada. .,School of Population and Public Health, University of British Columbia, 2206 East Mall, Vancouver, BC, V6T1Z3, Canada.
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Barriers to health and social services for street-involved youth in a Canadian setting. J Public Health Policy 2015; 36:350-63. [PMID: 25811385 DOI: 10.1057/jphp.2015.8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although street-involved youth contend with many health and social problems, the extent to which vulnerable youth engage with supportive services has not been well described. This study sought to examine the prevalence and correlates associated with having difficulty accessing health and social services among a prospective cohort of street-involved youth in Vancouver, Canada. Among 1019 street-involved youth, 650 (64 per cent) reported having difficulty accessing services during the study period. In a multivariate analysis, youth who reported having difficulty accessing services were significantly more likely to be socially and economically vulnerable. Specifically, they were more likely to report severe housing instability, high-intensity drug use, recent interactions with law enforcement, drug dealing, and histories of violence and physical abuse. Study findings point to opportunities to improve access to services among vulnerable youth through removal of blanket age restrictions for youth services, establishing youth-centric social housing, and supporting peer-driven, low-threshold services.
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Delany-Moretlwe S, Cowan FM, Busza J, Bolton-Moore C, Kelley K, Fairlie L. Providing comprehensive health services for young key populations: needs, barriers and gaps. J Int AIDS Soc 2015; 18:19833. [PMID: 25724511 PMCID: PMC4344539 DOI: 10.7448/ias.18.2.19833] [Citation(s) in RCA: 118] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2014] [Revised: 01/08/2015] [Accepted: 01/21/2015] [Indexed: 12/18/2022] Open
Abstract
INTRODUCTION Adolescence is a time of physical, emotional and social transitions that have implications for health. In addition to being at high risk for HIV, young key populations (YKP) may experience other health problems attributable to high-risk behaviour or their developmental stage, or a combination of both. METHODS We reviewed the needs, barriers and gaps for other non-HIV health services for YKP. We searched PubMed and Google Scholar for articles that provided specific age-related data on sexual and reproductive health; mental health; violence; and substance use problems for adolescent, youth or young sex workers, men who have sex with men, transgender people, and people who inject drugs. RESULTS YKP experience more unprotected sex, sexually transmitted infections including HIV, unintended pregnancy, violence, mental health disorders and substance use compared to older members of key populations and youth among the general population. YKP experience significant barriers to accessing care; coverage of services is low, largely because of stigma and discrimination experienced at both the health system and policy levels. DISCUSSION YKP require comprehensive, integrated services that respond to their specific developmental needs, including health, educational and social services within the context of a human rights-based approach. The recent WHO Consolidated Guidelines on HIV Prevention, Diagnosis, Treatment and Care for Key Populations are an important first step for a more comprehensive approach to HIV programming for YKP, but there are limited data on the effective delivery of combined interventions for YKP. Significant investments in research and implementation will be required to ensure adequate provision and coverage of services for YKP. In addition, greater commitments to harm reduction and rights-based approaches are needed to address structural barriers to access to care.
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Affiliation(s)
- Sinead Delany-Moretlwe
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;
| | - Frances M Cowan
- CeSHHAR Zimbabwe, Harare, Zimbabwe
- Department of Infection and Population Health, University College London, London, United Kingdom
| | - Joanna Busza
- Department of Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | | | - Karen Kelley
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Lee Fairlie
- Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Hossain R, Coren E. Service Engagement in Interventions for Street-Connected Children and Young People: A Summary of Evidence Supplementing a Recent Cochrane–Campbell Review. CHILD & YOUTH CARE FORUM 2014. [DOI: 10.1007/s10566-014-9286-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Long C, DeBeck K, Feng C, Montaner J, Wood E, Kerr T. Income level and drug related harm among people who use injection drugs in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2014; 25:458-64. [PMID: 24380808 PMCID: PMC4040344 DOI: 10.1016/j.drugpo.2013.11.011] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2013] [Revised: 11/12/2013] [Accepted: 11/22/2013] [Indexed: 11/19/2022]
Abstract
BACKGROUND Higher income is generally associated with better health outcomes; however, among people who inject drugs (IDU) income generation frequently involves activities, such as sex work and drug dealing, which pose significant health risks. Therefore, we sought to examine the relationship between level of income and specific drug use patterns and related health risks. METHODS This study involved IDU participating in a prospective cohort study in Vancouver, Canada. Monthly income was categorized based on non-fixed quartiles at each follow-up with the lowest level serving as the reference category in generalized linear mixed-effects regression. RESULTS Among our sample of 1032 IDU, the median average monthly income over the study follow-up was $1050 [interquartile range=785-2000]. In multivariate analysis, the highest income category was significantly associated with sex work (adjusted odds ratio [AOR]=7.65), drug dealing (AOR=5.06), daily heroin injection (AOR=2.97), daily cocaine injection (AOR=1.65), daily crack smoking (AOR=2.48), binge drug use (AOR=1.57) and unstable housing (AOR=1.67). The high income category was negatively associated with being female (AOR=0.61) and accessing addiction treatment (AOR=0.64), (all p<0.05). In addition, higher income was strongly associated with higher monthly expenditure on drugs (>$400) (OR=97.8). CONCLUSION Among IDU in Vancouver, average monthly income levels were low and higher total monthly income was linked to high-risk income generation strategies as well as a range of drug use patterns characteristic of higher intensity addiction and HIV risk. These findings underscore the need for interventions that provide economic empowerment and address high intensity addiction, especially for female IDU.
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Affiliation(s)
- Cathy Long
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Dalla Lana School of Public Health, University of Toronto, Canada
| | - Kora DeBeck
- British Columbia Centre for Excellence in HIV/AIDS, Canada; School of Public Policy, Simon Fraser University, Canada
| | - Cindy Feng
- School of Public Health, University of Saskatchewan, Canada
| | - Julio Montaner
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada
| | - Evan Wood
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada
| | - Thomas Kerr
- British Columbia Centre for Excellence in HIV/AIDS, Canada; Department of Medicine, University of British Columbia, Canada.
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