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Decker HC, Graham LA, Titan A, Hawn MT, Kanzaria HK, Wick E, Kushel MB. Housing Status Changes Are Associated With Cancer Outcomes Among US Veterans. Health Aff (Millwood) 2024; 43:234-241. [PMID: 38315919 DOI: 10.1377/hlthaff.2023.01003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Cancer is a leading cause of death in older unhoused adults. We assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. We examined all-cause survival in more than 100,000 veterans diagnosed with lung, colorectal, and breast cancer during the period 2011-20. Five percent were unhoused at the time of diagnosis, of whom 21 percent gained housing over the next year; 1 percent of veterans housed at the time of diagnosis lost housing. Continuously unhoused veterans and veterans who lost their housing had poorer survival after lung and colorectal cancer diagnosis compared with those who were continuously housed. There was no survival difference between veterans who gained housing after diagnosis and veterans who were continuously housed. These findings support policies to prevent and end homelessness in people after cancer diagnosis, to improve health outcomes.
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Affiliation(s)
- Hannah C Decker
- Hannah C. Decker , University of California San Francisco, San Francisco, California
| | - Laura A Graham
- Laura A. Graham, Veterans Affairs Palo Alto Healthcare System, Palo Alto, California
| | - Ashley Titan
- Ashley Titan, Stanford University, Stanford, California
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Su KY, Feldman BJ, Feldman CT, Saluja S, Coulourides Kogan AM, Cousineau MR. Behavioral Health Care Delivery Through Street Medicine Programs in California. Community Ment Health J 2024; 60:283-291. [PMID: 37526807 PMCID: PMC10822007 DOI: 10.1007/s10597-023-01169-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/08/2023] [Indexed: 08/02/2023]
Abstract
Mental health and substance use disorders are prevalent among people experiencing homelessness. Street Medicine can reach unhoused people who face barriers to accessing healthcare in more traditional medical settings including shelter-based clinics. However, there is little guidance on best practices for mental health and substance use treatment through Street Medicine. The aim of the study was to describe behavioral health care through Street Medicine by analyzing data from the California Street Medicine Landscape survey and follow-up qualitative interviews. Most street medicine programs utilize non-psychiatrists to diagnose and treat mental health and substance use disorders, though the capacity to provide the level of care needed varies. There is a lack of street-based psychiatric clinicians and programs have difficulty making referrals to mental health and addiction services. This report shows that Street Medicine could serve as a strategy to expand access to behavioral health care for the unhoused.
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Affiliation(s)
- Kimberly Y Su
- Keck School of Medicine of USC, Los Angeles, CA, USA.
| | | | | | - Sonali Saluja
- Keck School of Medicine of USC, Los Angeles, CA, USA
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Fine DR, Dickins KA, Adams LD, Horick NK, Critchley N, Hart K, Gaeta JM, Lewis E, Looby SE, Baggett TP. Mortality by Age, Gender, and Race and Ethnicity in People Experiencing Homelessness in Boston, Massachusetts. JAMA Netw Open 2023; 6:e2331004. [PMID: 37651141 PMCID: PMC10472188 DOI: 10.1001/jamanetworkopen.2023.31004] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/20/2023] [Indexed: 09/01/2023] Open
Abstract
Importance People experiencing homelessness (PEH) face disproportionately high mortality rates compared with the general population, but few studies have examined mortality in this population by age, gender, and race and ethnicity. Objective To evaluate all-cause and cause-specific mortality in a large cohort of PEH by age, gender, and race and ethnicity. Design, Setting, and Participants An observational cohort study was conducted from January 1, 2003, to December 31, 2018. All analyses were performed between March 16, 2021, and May 12, 2022. A cohort of adults (age ≥18 years) seen at the Boston Health Care for the Homeless Program (BHCHP), a large federally funded Health Care for the Homeless organization in Boston, Massachusetts, from January 1, 2003, to December 31, 2017, was linked to Massachusetts death occurrence files spanning January 1, 2003, to December 31, 2018. Main Outcomes and Measures Age-, gender-, and race and ethnicity-stratified all-cause and cause-specific mortality rates were examined and compared with rates in the urban Northeast US population using mortality rate ratios (RRs). Results Among the 60 092 adults included in the cohort with a median follow-up of 8.6 (IQR, 5.1-12.5) years, 7130 deaths occurred. The mean (SD) age at death was 53.7 (13.1) years; 77.5% of decedents were men, 21.0% Black, 10.0% Hispanic/Latinx, and 61.5% White. The all-cause mortality rate was 1639.7 deaths per 100 000 person-years among men and 830 deaths per 100 000 person-years among women. The all-cause mortality rate was highest among White men aged 65 to 79 years (4245.4 deaths per 100 000 person-years). Drug overdose was a leading cause of death across age, gender, and race and ethnicity groups, while suicide uniquely affected young PEH and HIV infection and homicide uniquely affected Black and Hispanic/Latinx PEH. Conclusions and Relevance In this large cohort study of PEH, all-cause and cause-specific mortality varied by age, gender, and race and ethnicity. Tailored interventions focusing on those at elevated risk for certain causes of death are essential for reducing mortality disparities across homeless-experienced groups.
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Affiliation(s)
- Danielle R. Fine
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Kirsten A. Dickins
- Community, Systems and Mental Health Nursing Department, Rush University Medical Center, Chicago, Illinois
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston
| | - Logan D. Adams
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
| | - Nora K. Horick
- Biostatistics Center, Massachusetts General Hospital, Boston
| | - Natalia Critchley
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Katherine Hart
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
| | - Jessie M. Gaeta
- The Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
- Boston University School of Medicine, Boston, Massachusetts
| | - Elizabeth Lewis
- The Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
- Boston University School of Public Health, Boston, Massachusetts
| | - Sara E. Looby
- Harvard Medical School, Boston, Massachusetts
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston
- Metabolism Unit, Endocrinology Division, Department of Medicine, Massachusetts General Hospital, Boston
| | - Travis P. Baggett
- Division of General Internal Medicine, Department of Medicine, Massachusetts General Hospital, Boston
- Harvard Medical School, Boston, Massachusetts
- The Institute for Research, Quality, and Policy in Homeless Health Care, Boston Health Care for the Homeless Program, Boston, Massachusetts
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Weldrick R, Canham SL, Sussman T, Walsh CA, Cormier É, Mahmood A. Delivering Services to Older Persons Experiencing Homelessness: Providers' Perspectives of What Does and Does Not Work. JOURNAL OF GERONTOLOGICAL SOCIAL WORK 2023; 66:29-42. [PMID: 35678024 DOI: 10.1080/01634372.2022.2087128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Revised: 06/03/2022] [Accepted: 06/04/2022] [Indexed: 06/15/2023]
Abstract
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.
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Affiliation(s)
- Rachel Weldrick
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
| | - Sarah L Canham
- College of Social Work, University of Utah, Salt Lake City, UT, USA
- College of Architecture and Planning, University of Utah, Salt Lake City, UT, USA
| | - Tamara Sussman
- School of Social Work, McGill University, Montreal, QC, Canada
| | | | | | - Atiya Mahmood
- Department of Gerontology, Simon Fraser University, Vancouver, BC, Canada
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Alcohol, tobacco and drug use among adults experiencing homelessness in Accra, Ghana: A cross-sectional study of risk levels and associated factors. PLoS One 2023; 18:e0281107. [PMID: 36877700 PMCID: PMC9987824 DOI: 10.1371/journal.pone.0281107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 01/16/2023] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Substance use contributes to poor health and increases the risk of mortality in the homeless population. This study assessed the prevalence and risk levels of substance use and associated factors among adults experiencing homelessness in Accra, Ghana. METHODS 305 adults currently experiencing sheltered and unsheltered homelessness in Accra aged ≥ 18 years were recruited. The World Health Organization's (WHO) Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to assess substance use risk levels. Association of high-risk substance use with sociodemographic, migration, homelessness, and health characteristics were assessed using logistic regression. RESULTS Nearly three-quarters (71%, n = 216) of the sample had ever used a substance, almost all of whom engaged in ASSIST-defined moderate-risk (55%) or high-risk (40%) use. Survivors of physical or emotional violence (AOR = 3.54; 95% confidence interval [CI] 1.89-6.65, p<.001) and sexual violence (AOR = 3.94; 95%CI 1.85-8.39, p<.001) had significantly higher odds of engaging in high-risk substance use, particularly alcohol, cocaine, and cannabis. The likelihood of engaging in high-risk substance use was higher for men than women (AOR = 4.09; 95%CI 2.06-8.12, p<.001) but lower for those in the middle-income group compared to low-income (AOR = 3.94; 95%CI 1.85-8.39, p<.001). CONCLUSIONS Risky substance use was common among adults experiencing homelessness in Accra, and strongly associated with violent victimisation, gender, and income levels. The findings highlight the urgent need for effective and targeted preventive and health-risk reduction strategies to address risky substance use in the homeless population in Accra and similar cities within Ghana and sub-Sahara Africa with a high burden of homelessness.
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Surgical Care of Patients Experiencing Homelessness: A Scoping Review Using a Phases of Care Conceptual Framework. J Am Coll Surg 2022; 235:350-360. [PMID: 35839414 PMCID: PMC9668043 DOI: 10.1097/xcs.0000000000000214] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Abstract
Homelessness is a growing concern across the world, particularly as individuals experiencing homelessness age and face an increasing burden of chronic health conditions. Although substantial research has focused on the medical and psychiatric care of patients experiencing homelessness, literature about the surgical care of these patients is sparse. Our objective was to review the literature to identify areas of concern unique to patients experiencing homelessness with surgical disease. A scoping review was conducted using a comprehensive database for studies from 1990 to September 1, 2020. Studies that included patients who were unhoused and discussed surgical care were included. The inclusion criteria were designed to identify evidence that directly affected surgical care, systems management, and policy making. Findings were organized within a Phases of Surgical Care framework: preoperative care, intraoperative care, postoperative care, and global use. Our search strategy yielded 553 unique studies, of which 23 met inclusion criteria. Most studies were performed at public and/or safety-net hospitals or via administrative datasets, and surgical specialties that were represented included orthopedic, cardiac, plastic surgery trauma, and vascular surgery. Using the Surgical Phases of Care framework, we identified studies that described the impact of housing status in pre- and postoperative phases as well as global use. There was limited identification of barriers to surgical and anesthetic best practices in the intraoperative phase. More than half of studies (52.2%) lacked a clear definition of homelessness. Thus, there is a marked gap in the surgical literature regarding the impact of housing status on optimal surgical care, with the largest area for improvement in the intraoperative phase of surgical and anesthetic decision making. Consistent use of clear definitions of homelessness is lacking. To promote improved care, a standardized approach to recording housing status is needed, and studies must explore vulnerabilities in surgical care unique to this population.
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Smith-Bernardin SM, Suen LW, Barr-Walker J, Cuervo IA, Handley MA. Scoping review of managed alcohol programs. Harm Reduct J 2022; 19:82. [PMID: 35879719 PMCID: PMC9311344 DOI: 10.1186/s12954-022-00646-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 06/01/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Internationally, strategies focusing on reducing alcohol-related harms in homeless populations with severe alcohol use disorder (AUD) continue to gain acceptance, especially when conventional modalities focused on alcohol abstinence have been unsuccessful. One such strategy is the managed alcohol program (MAP), an alcohol harm reduction program managing consumption by providing eligible individuals with regular doses of alcohol as a part of a structured program, and often providing resources such as housing and other social services. Evidence to the role of MAPs for individuals with AUD, including how MAPs are developed and implemented, is growing. Yet there has been limited collective review of literature findings. METHODS We conducted a scoping review to answer, "What is being evaluated in studies of MAPs? What factors are associated with a successful MAP, from the perspective of client outcomes? What are the factors perceived as making them a good fit for clients and for communities?" We first conducted a systematic search in PubMed, Embase, PsycINFO, CINAHL, Sociological Abstracts, Social Services Abstracts, and Google Scholar. Next, we searched the gray literature (through focused Google and Ecosia searches) and references of included articles to identify additional studies. We also contacted experts to ensure relevant studies were not missed. All articles were independently screened and extracted. RESULTS We included 32 studies with four categories of findings related to: (1) client outcomes resulting from MAP participation, (2) client experience within a MAP; (3) feasibility and fit considerations in MAP development within a community; and (4) recommendations for implementation and evaluation. There were 38 established MAPs found, of which 9 were featured in the literature. The majority were located in Canada; additional research works out of Australia, Poland, the USA, and the UK evaluate potential feasibility and fit of a MAP. CONCLUSIONS The growing literature showcases several outcomes of interest, with increasing efforts aimed at systematic measures by which to determine the effectiveness and potential risks of MAP. Based on a harm reduction approach, MAPs offer a promising, targeted intervention for individuals with severe AUD and experiencing homelessness. Research designs that allow for longitudinal follow-up and evaluation of health- and housing-sensitive outcomes are recommended.
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Affiliation(s)
- Shannon M Smith-Bernardin
- School of Nursing, Department of Social and Behavioral Sciences, University of California, San Francisco, San Francisco, CA, USA. .,UCSF Benioff Homelessness and Housing Initiative at ZSFG Hospital and Trauma Center, San Francisco, CA, USA.
| | - Leslie W Suen
- National Clinician Scholars Program, Philip R. Lee Institute of Health Policy Studies, University of California, San Francisco, San Francisco, CA, USA.,San Francisco Veterans Affairs Medical Center, San Francisco, CA, USA
| | - Jill Barr-Walker
- ZSFG Library, University of California, San Francisco, San Francisco, CA, USA
| | | | - Margaret A Handley
- UCSF Benioff Homelessness and Housing Initiative at ZSFG Hospital and Trauma Center, San Francisco, CA, USA.,Department of Epidemiology and Biostatistics, University of California, San Francisco, CA, USA.,PRISE Center: Partnerships for Research in Implementation Science for Equity, University of California, San Francisco, CA, USA
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Alves da Costa F, Verschuuren M, Andersen Y, Stürup-Toft S, Lopez-Acuña D, Ferreira-Borges C. The WHO Prison Health Framework: a framework for assessment of prison health system performance. Eur J Public Health 2022; 32:565-570. [PMID: 35373832 PMCID: PMC9341673 DOI: 10.1093/eurpub/ckac020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The Health in Prisons European Database (HIPED) aims to periodically collect data on prison health systems, services and health outcomes to inform equivalence of care for people living in prison. Recognized as the United Nations hub for health data in prisons, HIPED lacked an established framework to define its domains and indicators to measure progress. Therefore, the objectives of developing this framework were to inform surveillance systems at prison, local, regional, national and international level and to use it to guide improvement of prison health systems and cross-country comparison. METHODS The framework was conceptualized through identification of policy priorities and existing frameworks, notably the WHO Health System Framework. A consultation with a range of WHO stakeholders was conducted evaluating the components of existing frameworks and their relevance to the prison health context, as well as identifying areas needing further emphasis. The final stage identified the structure of the framework. RESULTS The framework consists of three main building blocks. The first captures the system-level aspects of prison health care (or inputs) whilst the second captures delivery aspects of prison health care (or outputs). These building blocks are in turn modified by two influencing factors. Ultimately, all these elements impact on the third building block, health outcomes. In addition, two cross-cutting principles associated with all these building blocks and influencing factors are included. CONCLUSIONS A new framework for assessing prison health system performance is now available, crucial to support informed decision-making for policy design and implementation for prisons and other places of detention.
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Affiliation(s)
- Filipa Alves da Costa
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Marieke Verschuuren
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | - Yanina Andersen
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
| | | | - Daniel Lopez-Acuña
- Department of International Health, Andalusian School of Public Health, Granada, Spain
| | - Carina Ferreira-Borges
- WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
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Chun SY, Yoo JW, Park H, Hwang J, Kim PC, Park S, Shen JJ. Trends and age-related characteristics of substance use in the hospitalized homeless population. Medicine (Baltimore) 2022; 101:e28917. [PMID: 35212298 PMCID: PMC8878700 DOI: 10.1097/md.0000000000028917] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Accepted: 01/24/2022] [Indexed: 01/04/2023] Open
Abstract
We aimed to examine trends and characteristics of substance use (opioid, cocaine, marijuana, and heroin) among hospitalized homeless patients in comparison with other hospitalized patients in 3 states.This was a cross-sectional study, based on the 2007 to 2015 State Inpatient Data of Arizona, Florida, and Washington (n = 32,162,939). Use of opioid, cocaine, marijuana, heroin, respectively, was identified by the International Classification of Diseases, 9th Revision. Multi-level multivariable regressions were performed to estimate relative risk (RR) and 95% confidence intervals (CI). Dependent variables were the use of substances (opioid, cocaine, marijuana, and heroin), respectively. The main independent variable was homeless status. The subgroup analysis by age group was also conducted.Homeless patients were associated with more use of opioid (RR [CI]), 1.23 [1.20-1.26], cocaine 2.55 [2.50-2.60], marijuana 1.43 [1.40-1.46], and heroin 1.57 [1.29-1.91] compared to other hospitalized patients. All hospitalized patients including those who were homeless increased substance use except the use of cocaine (RR [CI]), 0.57 [0.55-0.58] for other patients and 0.60 [0.50-0.74] for homeless patients. In all age subgroups, homeless patients 60 years old or older were more likely to be hospitalized with all 4 types of substance use, especially, cocaine (RR [CI]), 6.33 [5.81-6.90] and heroin 5.86 [2.08-16.52] in comparison with other hospitalized patients.Homeless status is associated with high risks of substance use among hospitalized patients. Homeless elderly are particularly vulnerable to use of hard drugs including cocaine and heroin during the opioid epidemics.
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Affiliation(s)
- Sung-youn Chun
- Research and Analysis Team, National Health Insurance Service Ilsan Hospital, Goyang, Republic of Korea
| | - Ji W. Yoo
- Department of Internal Medicine, University of Nevada School of Medicine, Las Vegas, NV
| | - Hyeki Park
- Department of International Cooperation, Health Insurance Review & Assessment Service, Wonju, Republic of Korea
| | - Jinwook Hwang
- Department of Thoracic and Cardiovascular Surgery, Korea University Ansan Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Pearl C. Kim
- Department of Healthcare Administration and Policy, University of Nevada Las Vegas School of Public Health, Las Vegas, NV
| | - Seong Park
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
| | - Jay J. Shen
- Department of Criminal Justice, University of Nevada Greenspun College of Urban Affairs, Las Vegas, NV
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Alexander AC, Waring JJ, Olurotimi O, Kurien J, Noble B, Businelle MS, Ra CK, Ehlke SJ, Boozary LK, Cohn AM, Kendzor DE. The relations between discrimination, stressful life events, and substance use among adults experiencing homelessness. Stress Health 2022; 38:79-89. [PMID: 34137166 PMCID: PMC9629914 DOI: 10.1002/smi.3073] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 05/31/2021] [Accepted: 06/04/2021] [Indexed: 02/03/2023]
Abstract
The current study investigated whether stressful life events and everyday discrimination experiences were associated with using one or more substances in the past 30-days and substance use disorder (SUD) among adults experiencing homelessness. We obtained survey data from adults (N = 501) seeking services at a day shelter. Participants self-reported whether they used cigarettes, other tobacco products, cannabis, alcohol, opioids, amphetamine, and cocaine/crack in the past 30-days, and the total number of substances used were also calculated. We measured stressful life events and everyday discrimination using validated scales. We used multivariable logistic and negative binomial regression analyses to evaluate hypothesised associations. Results indicated that reporting a higher number of stressful life events was associated with past 30-days cannabis, tobacco, alcohol, and other substance use, screening positive for a SUD, and using a greater number of substances in the past 30 days. After accounting for stressful life events, everyday discrimination was associated with only past 30-days cannabis use. Overall, we found that reporting stressful life events was related to current substance use and screening positive for a SUD. Findings suggest that life stressors, and discrimination to a lesser extent, were associated with substance use and SUD among adults experiencing homelessness.
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Affiliation(s)
- Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph J.C. Waring
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Oluwakemi Olurotimi
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Jasmin Kurien
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Bishop Noble
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Chaelin K. Ra
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States
| | - Laili K. Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, Norman, OK
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Pediatrics, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, United States.,Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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Lee J, Salloum RG, Lindstrom K, Kathryn McHugh R. Benzodiazepine misuse and cigarette smoking status in US adults: Results from the National Survey on Drug Use and Health, 2015-2018. Addict Behav 2021; 123:107058. [PMID: 34315094 DOI: 10.1016/j.addbeh.2021.107058] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Revised: 06/25/2021] [Accepted: 07/16/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Benzodiazepines are the third most commonly misused drugs in the U.S. POPULATION There is a growing public health concern related to recent increases in benzodiazepine-related overdose deaths, emergency department visits, and treatment admissions. Although benzodiazepine misuse often occurs along with other drug use, little is known about the association between benzodiazepine and cigarette smoking. METHODS We used a pooled dataset from the National Survey on Drug Use and Health (NSDUH) for 2015-2018 (N = 171,766). We estimated a multivariable logistic regression model of past-year benzodiazepine misuse as a function of past-year tobacco use (cigarette smoking, other tobacco use), controlling for survey years, sociodemographics, past-year substance use, and psychiatric comorbidities. RESULTS Among the analytic sample (N = 171,766), 2.1% (weighted; unweighted n = 4,942) reported they misused benzodiazepines in the past 12 months. In the multivariable logistic regression model, correlates of past-year benzodiazepine misuse were past-year cigarette smoking (aOR = 1.85, 95% CI = 1.67, 2.06) and other tobacco use (e.g., cigars and smokeless tobacco) (aOR = 1.17, 95% CI = 1.03, 1.34), female (aOR = 1.14, 95% CI = 1.04, 1.26), uninsured (aOR = 1.26, 95% CI = 1.12, 1.42), past-year use of alcohol (aOR = 1.48, 95% CI = 1.21, 1.80), cannabis (aOR = 2.76, 95% CI = 2.46, 3.10), and other drugs (aOR = 7.92, 95% CI = 7.08, 8.86), as well as, past-year distress (aOR = 1.84, 95% CI = 1.61, 2.10), and depressive symptoms (aOR = 1.32, 95% CI = 1.16, 1.51). CONCLUSION Nicotine is independently associated with benzodiazepine misuse, even after controlling for other drug use and psychiatric variables. Future studies examining potential mechanisms linking nicotine and benzodiazepine use are necessary.
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Affiliation(s)
- Juhan Lee
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, United States; Department of Psychiatry, Yale School of Medicine, United States.
| | - Ramzi G Salloum
- Department of Health Outcomes and Biomedical Informatics, College of Medicine, University of Florida, United States
| | - Katie Lindstrom
- Department of Health Education and Behavior, College of Health and Human Performance, University of Florida, United States
| | - R Kathryn McHugh
- Division of Alcohol, Drugs and Addiction, McLean Hospital, Belmont, MA, United States; Harvard Medical School, Boston, MA, United States
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Gadermann AM, Hubley AM, Russell LB, Thomson KC, Norena M, Rossa-Roccor V, Hwang SW, Aubry T, Karim ME, Farrell S, Palepu A. Understanding subjective quality of life in homeless and vulnerably housed individuals: The role of housing, health, substance use, and social support. SSM - MENTAL HEALTH 2021. [DOI: 10.1016/j.ssmmh.2021.100021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
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13
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Tong MS, Kaplan LM, Guzman D, Ponath C, Kushel MB. Persistent Homelessness and Violent Victimization Among Older Adults in the HOPE HOME Study. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:8519-8537. [PMID: 31135255 PMCID: PMC8715865 DOI: 10.1177/0886260519850532] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
The homeless population is aging; older homeless adults may be at high risk of experiencing violent victimization. To examine whether homelessness is independently associated with experiencing physical and sexual abuse, we recruited 350 adults, aged 50 and older in Oakland, California, who met criteria for homelessness between July 2013 and June 2014. We interviewed participants at 6-month intervals for 3 years in Oakland about key variables, including housing status. Using generalized estimating equations, we examined whether persistent homelessness in each follow-up period was independently associated with having experienced physical or sexual victimization, after adjusting for known risk factors. The majority of the cohort was men (77.4%) and Black American (79.7%). At baseline, 10.6% had experienced either physical or sexual victimization in the prior 6 months. At 18-month follow-up, 42% of the cohort remained homeless. In adjusted models, persistent homelessness was associated with twice the odds of victimization (adjusted odds ratio [AOR] = 2.01; 95% confidence interval [CI]: [1.41, 2.87]). Older homeless adults experience high rates of victimization. Re-entering housing reduces this risk. Policymakers should recognize exposure to victimization as a negative consequence of homelessness that may be preventable by housing.
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Affiliation(s)
- Michelle S. Tong
- University of California, Berkeley, USA
- University of California, San Francisco, USA
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14
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Zeng X, Lu M, Chen M. The relationship between family intimacy and relapse tendency among people who use drugs: a moderated mediation model. Subst Abuse Treat Prev Policy 2021; 16:48. [PMID: 34103061 PMCID: PMC8185318 DOI: 10.1186/s13011-021-00386-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/28/2021] [Indexed: 01/29/2023] Open
Abstract
BACKGROUND Drug addiction is difficult to overcome. The relapse rate is high, and the negative impact on individuals, families and society is severe, therefore exploring social psychological mechanisms to reduce relapse has very important theoretical and practical value. However, the underlying mechanism by which the interaction between family and individual factors influences the tendency to relapse remain unclear. Thus, the purpose of this paper is to discuss the relationship between family intimacy and relapse tendency of people who use drugs, as well as the mediating effect of psychological capital and the role of self-efficacy in it. METHODS A total of 817 male who use drugs were investigated via the Family Intimacy and Adaptability Scale, General Self-Efficacy Scale, Positive Psychological Capital Questionnaire and Relapse Tendency Questionnaire. Using Hayes's process macro carried out moderated mediation analysis. RESULTS (1) The average family intimacy score of people who use drugs was low. (2) Family intimacy negatively predicted relapse tendency in people who use drugs. (3) Psychological capital mediated the relationship between family intimacy and relapse tendency. (4) The first half of the indirect effect of family intimacy on relapse tendency was regulated by self-efficacy, compared with the low level of self-efficacy, the psychological capital level with high self-efficacy is higher. CONCLUSION The results of this study suggest that the intimacy between the people who use drugs and their family members should be improved, and the rehabilitation center should take various measures to enhance the psychological capital level and the level of self-efficacy of the people who use drugs, which will be helpful to reduce their relapse tendency.
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Affiliation(s)
- Xiaoqing Zeng
- School of Psychology, Institute of Psychology, Jiangxi Normal University, Nanchang, China.
| | - Mengyao Lu
- School of Psychology, Institute of Psychology, Jiangxi Normal University, Nanchang, China
| | - Meirong Chen
- Department of Education, Nanchang Normal University, Nanchang, China
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15
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Mabhala M, Esealuka WA, Nwufo AN, Enyinna C, Mabhala CN, Udechukwu T, Reid J, Yohannes A. Homelessness Is Socially Created: Cluster Analysis of Social Determinants of Homelessness (SODH) in North West England in 2020. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18063066. [PMID: 33809704 PMCID: PMC8002255 DOI: 10.3390/ijerph18063066] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 03/11/2021] [Accepted: 03/12/2021] [Indexed: 11/18/2022]
Abstract
Poverty creates social conditions that increase the likelihood of homelessness. These include exposure to traumatic life experiences; social disadvantages such as poor educational experiences; being raised in a broken family, care homes or foster care; physical, emotional, and sexual abuse; and neglect at an early age. These conditions reduce people’s ability to negotiate through life challenges. This cross-sectional study documents the clustering and frequency of adverse social conditions among 152 homeless people from four cities in North West England between January and August 2020. Two-step cluster analysis showed that having parents with a criminal record, care history, and child neglect/abuse history was predictive of homelessness. The cluster of indicator variables among homeless people included sexual abuse (χ2 (N = 152) = 220.684, p < 0.001, Cramer’s V = 0.7), inappropriate sexual behaviour (χ2 (N = 152) = 207.737, p < 0.001, Cramer’s V = 0.7), emotional neglect (χ2 (N = 152) = 181.671, p < 0.001, Cramer’s V = 0.7), physical abuse by step-parent (χ2 (N = 152) = 195.882, p < 0.001, Cramer’s V = 0.8), and physical neglect (χ2 (N = 152) = 205.632, p < 0.001, Cramer’s V = 0.8). Poverty and homelessness are intertwined because of the high prevalence of poverty among the homeless. Poverty sets up a chain of interactions between social conditions that increase the likelihood of unfavourable outcomes: homelessness is at the end of the interaction chain. Interventions supporting families to rise out of poverty may also reduce entry into homelessness.
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Affiliation(s)
- Mzwandile Mabhala
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester CH1 1SL, UK; (W.A.E.); (A.N.N.); (C.E.); (J.R.)
- Correspondence:
| | - Winifred Adaobi Esealuka
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester CH1 1SL, UK; (W.A.E.); (A.N.N.); (C.E.); (J.R.)
| | - Amanda Nkolika Nwufo
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester CH1 1SL, UK; (W.A.E.); (A.N.N.); (C.E.); (J.R.)
| | - Chinwe Enyinna
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester CH1 1SL, UK; (W.A.E.); (A.N.N.); (C.E.); (J.R.)
| | - Chelsea Nonkosi Mabhala
- Faculty of Sciences, School of Pharmacy, University of East Anglia, Norwich, Norfolk NR4 7TJ, UK;
| | | | - John Reid
- Faculty of Health and Social Care, Department of Public Health and Wellbeing, University of CHESTER, Riverside Campus, Chester CH1 1SL, UK; (W.A.E.); (A.N.N.); (C.E.); (J.R.)
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16
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Ayano G, Belete A, Duko B, Tsegay L, Dachew BA. Systematic review and meta-analysis of the prevalence of depressive symptoms, dysthymia and major depressive disorders among homeless people. BMJ Open 2021; 11:e040061. [PMID: 33622940 PMCID: PMC7907847 DOI: 10.1136/bmjopen-2020-040061] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To assess the global prevalence estimates of depressive symptoms, dysthymia and major depressive disorders (MDDs) among homeless people. DESIGN Systematic review and meta-analysis. DATA SOURCES Databases including PubMed, Scopus and Web of Science were systematically searched up to February 2020 to identify relevant studies that have reported data on the prevalence of depressive symptoms, dysthymia and MDDs among homeless people. ELIGIBILITY CRITERIA Original epidemiological studies written in English that addressed the prevalence of depressive problems among homeless people. DATA EXTRACTION AND SYNTHESIS A random-effect meta-analysis was performed to pool the prevalence estimated from individual studies. Subgroup and sensitivity analyses were employed to compare the prevalence across the groups as well as to identify the source of heterogeneities. The Joanna Briggs Institute's quality assessment checklist was used to measure the study quality. Cochran's Q and the I2 test were used to assess heterogeneity between the studies. RESULTS Forty publications, including 17 215 participants, were included in the final analysis. This meta-analysis demonstrated considerably higher prevalence rates of depressive symptoms 46.72% (95% CI 37.77% to 55.90%), dysthymia 8.25% (95% CI 4.79% to 11.86%), as well as MDDs 26.24% (95% CI 21.02% to 32.22%) among homeless people. Our subgroup analysis showed that the prevalence of depressive symptoms was high among younger homeless people (<25 years of age), whereas the prevalence of MDD was high among older homeless people (>50 years of age) when compared with adults (25-50 years). CONCLUSION This review showed that nearly half, one-fourth and one-tenth of homeless people are suffering from depressive symptoms, dysthymia and MDDs, respectively, which are notably higher than the reported prevalence rates in the general population. The findings suggest the need for appropriate mental health prevention and treatment strategies for this population group.
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Affiliation(s)
- Getinet Ayano
- Ethiopia Ministry of Health, Addis Ababa, Ethiopia
- Department of Public Health, Curtin University, Perth, Western Australia, Australia
| | - Asmare Belete
- Department of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia
| | - Bereket Duko
- School of Public Health, Hawassa University College of Medicine and Health Sciences, Hawassa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | - Berihun Assefa Dachew
- Department of Public Health, Curtin University Faculty of Health Sciences, Perth, Western Australia, Australia
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17
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Dickins KA, Philpotts LL, Flanagan J, Bartels SJ, Baggett TP, Looby SE. Physical and Behavioral Health Characteristics of Aging Homeless Women in the United States: An Integrative Review. J Womens Health (Larchmt) 2020; 30:1493-1507. [PMID: 33290147 DOI: 10.1089/jwh.2020.8557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The average age of the homeless population is and will continue to rise. Although women comprise a significant and growing percentage of this vulnerable population, their age- and sex-specific health characteristics are poorly understood. Materials and Methods: This integrative review appraises published research addressing the physical and behavioral health characteristics of aging homeless women (≥50 years) in the United States (2000-2019). The authors searched six electronic databases to identify eligible studies. Studies were screened for methodological quality by using the Johns Hopkins Nursing Evidence-Based Practice model. The review is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Results: Ten primary studies met the review eligibility criteria. All were level III (non-experimental); nine appraised as "good" quality (level B), and one as "lower" quality (level C). Aging homeless women demonstrate elevated rates of physical health conditions, related to suboptimal nutrition, lower than expected preventive health screening uptake, and geriatric concerns. Disproportionate rates of mental health conditions are compounded by substance use and interpersonal trauma. Familial and social dynamics and socioeconomic disadvantage contribute to social health concerns. Spiritual health is a critically important yet underexplored protective factor. Conclusions: Studies are limited, though collective findings suggest that aging homeless women endure a disproportionate physical, behavioral, and social health burden compared with aging non-homeless women and aging homeless men. Implications for research on early aging, preventative health strategies, and homelessness among women, and clinical practice in the context of geriatric and women's health are described.
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Affiliation(s)
- Kirsten A Dickins
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Lisa L Philpotts
- Treadwell Library, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Jane Flanagan
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- William F. Connell School of Nursing, Boston College, Boston, Massachusetts, USA
| | - Stephen J Bartels
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Travis P Baggett
- Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
- Boston Health Care for the Homeless Program, Boston, Massachusetts, USA
| | - Sara E Looby
- Yvonne L. Munn Center for Nursing Research, Massachusetts General Hospital, Boston, Massachusetts, USA
- Metabolism Unit, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
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18
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Ayano G, Solomon M, Tsegay L, Yohannes K, Abraha M. A Systematic Review and Meta-Analysis of the Prevalence of Post-Traumatic Stress Disorder among Homeless People. Psychiatr Q 2020; 91:949-963. [PMID: 32415465 DOI: 10.1007/s11126-020-09746-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Post-traumatic stress disorder (PTSD) is common among homeless people and is associated with an increased risk of mortality from suicide, medical causes, and drug-related problems. However, there are no previous systematic review and meta-analysis studies that reported the consolidated magnitude of PTSD among homeless people. A literature search was conducted on PubMed, Embase, and Scopus to discover pertinent studies that determined the prevalence of PTSD among the homeless. Articles were evaluated by titles, abstracts, and full-text. Comprehensive meta-analysis software was used to conduct the meta-analysis. Subgroup and sensitivity analysis were performed and Cochran's Q- and the I2 test were used to assess heterogeneity. The evidence of publication bias was evaluated by using Egger's test and visual inspection of the symmetry in funnel plots. From the total, 19 studies with 20,364 participants across seven countries were included in the final analysis. Our meta-analysis revealed that the pooled prevalence of PTSD among homeless people was 27.38% (95% CI; 21.95-33.57). In our subgroup analysis, we found that the prevalence of PTSD was considerably high as measured by the screening instrument (35.93%) than the diagnostic instrument (23.57% %). The prevalence of PTSD among homeless showed a significant variation by the location of the studies, the instruments used to measure PTSD as well as the quality of the included studies. This review showed that the pooled prevalence estimate of PTSD among homeless peoples was remarkably high (27.38%). Early screening and treatment of PTSD among homeless peoples are warranted to alleviate suffering.
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Affiliation(s)
- Getinet Ayano
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia.
- School of public health, Curtin University, Kent Street, Bentley, Perth, Western Australia, 6102, Australia.
| | - Melat Solomon
- Research and Training Department, Amanuel Mental Specialized Hospital, Addis Ababa, Ethiopia
| | - Light Tsegay
- Department of Psychiatry, Aksum University, Aksum, Ethiopia
| | | | - Mebratu Abraha
- Department of Psychiatry, Paulo's millennium medical college, Addis Ababa, Ethiopia
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19
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Garfin DR, Morisky D, Shin SS, Salem B, Yadav K, Deguzman R, Harvey G, Adams I, Halas K, Chang A, White K, Wu J, Nyamathi AM. Correlates of depression and anxiety among homeless adults with latent tuberculosis infection. J Health Psychol 2020; 27:494-501. [PMID: 32951464 DOI: 10.1177/1359105320956693] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Homeless persons have disproportionate rates of latent tuberculosis infection (LTBI). LTBI treatment can prevent and reduce active tuberculosis spread. We examined associations between mental health, social support, and perceptions of general health in 50 LTBI-positive, homeless adults enrolled in LTBI treatment. Depression and anxiety prevalence were 40% and 48%, respectively. Depression was negatively associated with general health, positive social interaction, and tangible, emotional/informational, and total social support, and positively associated with severe substance use (ps < 0.05). Anxiety was negatively associated with emotional/informational, tangible and total social support, and positively associated with severe substance use (ps < 0.05). Mental health services may help improve LTBI interventions.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Alicia Chang
- Los Angeles County Department of Public Health, USA
| | | | - Jesse Wu
- Los Angeles County Department of Public Health, USA
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20
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Cournoyer Lemaire E, Loignon C, Bertrand K. A critical scoping review about the impact of music in the lives of young adults who use drugs. Drug Alcohol Rev 2020; 40:135-154. [PMID: 32808319 DOI: 10.1111/dar.13136] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 06/25/2020] [Accepted: 06/29/2020] [Indexed: 01/24/2023]
Abstract
ISSUES Music is among the most frequently used medium to promote young adults' well-being. To that aim, the efficiency of music is explained by its capacity to modulate emotions through its effect on the brain's reward pathways. Hence, music could help individuals suffering from dysregulations in these pathways, whose experience of positive emotions is often inhibited. Such dysregulations are particularly present in individuals with problematic psychoactive substance (PAS) use, who are overrepresented in the context of homelessness. While few of them initiate treatment, they successfully rely on their own resources to promote their well-being, including music, though its impact in this context remains under-studied. APPROACH This scoping review describes the impact of music on the well-being, PAS use and addictive trajectory of young housed and homeless individuals with problematic PAS use. Eleven French and English databases were screened for peer-reviewed articles using concepts and keywords related to music, PAS and well-being. From the 3697 results, 39 were reviewed. Results were organised according to the observed impact of music and analysed critically. KEY FINDINGS Literature shows that PAS users value the impact of music in meeting emotional, psychological and social needs, especially when they experience homelessness. Yet, research has been highly limited to the harmful consequences of music, limiting our knowledge of its potential benefits. IMPLICATIONS AND CONCLUSION To deepen our understanding about the impact of music, future research should endorse a broader perspective and consider the personal and contextual experiences accompanying the involvement in music, factors that were traditionally overlooked.
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Affiliation(s)
| | - Christine Loignon
- Family Medicine Department, University of Sherbrooke, Longueuil, Canada
| | - Karine Bertrand
- Community Health Sciences Department, University of Sherbrooke, Longueuil, Canada
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21
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Abbs E, Brown R, Guzman D, Kaplan L, Kushel M. Risk Factors for Falls in Older Adults Experiencing Homelessness: Results from the HOPE HOME Cohort Study. J Gen Intern Med 2020; 35:1813-1820. [PMID: 31965522 PMCID: PMC7280424 DOI: 10.1007/s11606-020-05637-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Revised: 11/13/2019] [Accepted: 01/03/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND More than half of homeless adults are of age ≥ 50 years. Falls are a common cause of morbidity in older adults in the general population. Risk factors for falls in the general population include poor health, alcohol use, and exposure to unsafe environments. Homeless adults aged ≥ 50 have a high prevalence of known risk factors and face additional potential risks. OBJECTIVES To examine the prevalence of and risk of falling in a cohort of older homeless adults. DESIGN Longitudinal cohort study with participant interviews every 6 months for 3 years; data were analyzed using generalized estimating equations (GEEs). PARTICIPANTS Three hundred fifty adults aged ≥ 50, homeless at study entry, recruited via population-based sampling. MEASURES The dependent variable is any falls in prior 6 months; independent variables include individual (i.e., illness, behaviors) and social/environmental (i.e., social support, experiencing violence, living unsheltered) factors. RESULTS Over three quarters of participants were men (77.1%) and Black (79.7%). The median age was 58 (IQR 54, 61). At baseline, one third (33.7%) reported a fall in the prior 6 months. At follow-up visits, 23.1% to 31.2% of participants reported having fallen. In GEE models, individual risk factors (non-Black race, being a women, older age, functional impairment, urinary incontinence, history of stroke, and use of assistive devices, opioid, and marijuana) were associated with increased odds of falls. Environmental and social factors (spending any nights unsheltered (adjusted odds ratio (AOR) = 1.42, CI = 1.10-1.83) and experiencing physical assault (AOR = 1.67, CI = 1.18-2.37) were also associated. CONCLUSIONS Older homeless adults fall frequently. Likely contributors include having a high prevalence of conditions that increase the risk of falls, compounded by heightened exposure to unsafe environments. Fall prevention in this population should target those at highest risk and address modifiable environmental conditions. Providing shelter or housing and addressing substance use could reduce morbidity from falls in homeless older adults.
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Affiliation(s)
- Elizabeth Abbs
- School of Medicine, University of California, San Francisco, San Francisco, CA, USA
| | - Rebecca Brown
- Division of Geriatrics, University of California, San Francisco, San Francisco, CA, USA.,Division of Geriatric Medicine, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA.,Corporal Michael J. Crescenz Veterans Affairs Medical Center, San Francisco, CA, USA
| | - David Guzman
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143, USA
| | - Lauren Kaplan
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA.,Center for Vulnerable Populations, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143, USA
| | - Margot Kushel
- UCSF Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, CA, USA. .,Center for Vulnerable Populations, University of California, San Francisco, UCSF Box 1364, San Francisco, CA, 94143, USA.
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22
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Riggs KR, Hoge AE, DeRussy AJ, Montgomery AE, Holmes SK, Austin EL, Pollio DE, Kim YI, Varley AL, Gelberg L, Gabrielian SE, Blosnich JR, Merlin J, Gundlapalli AV, Jones AL, Gordon AJ, Kertesz SG. Prevalence of and Risk Factors Associated With Nonfatal Overdose Among Veterans Who Have Experienced Homelessness. JAMA Netw Open 2020; 3:e201190. [PMID: 32181829 PMCID: PMC7078753 DOI: 10.1001/jamanetworkopen.2020.1190] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
IMPORTANCE Individuals with a history of homelessness are at increased risk for drug or alcohol overdose, although the proportion who have had recent nonfatal overdose is unknown. Understanding risk factors associated with nonfatal overdose could guide efforts to prevent fatal overdose. OBJECTIVES To determine the prevalence of recent overdose and the individual contributions of drugs and alcohol to overdose and to identify characteristics associated with overdose among veterans who have experienced homelessness. DESIGN, SETTING, AND PARTICIPANTS This survey study was conducted from November 15, 2017, to October 1, 2018, via mailed surveys with telephone follow-up for nonrespondents. Eligible participants were selected from the records of 26 US Department of Veterans Affairs medical centers and included veterans who had received primary care at 1 of these Veterans Affairs medical centers and had a history of experiencing homelessness according to administrative data. Preliminary analyses were conducted in October 2018, and final analyses were conducted in January 2020. MAIN OUTCOMES AND MEASURES Self-report of overdose (such that emergent medical care was obtained) in the previous 3 years and substances used during the most recent overdose. All percentages are weighted according to propensity to respond to the survey, modeled from clinical characteristics obtained in electronic health records. RESULTS A total of 5766 veterans completed the survey (completion rate, 40.2%), and data on overdose were available for 5694 veterans. After adjusting for the propensity to respond to the survey, the mean (SD) age was 56.4 (18.3) years; 5100 veterans (91.6%) were men, 2225 veterans (38.1%) were black, and 2345 veterans (40.7%) were white. A total of 379 veterans (7.4%) reported any overdose during the past 3 years; 228 veterans (4.6%) reported overdose involving drugs, including 83 veterans (1.7%) who reported overdose involving opioids. Overdose involving alcohol was reported by 192 veterans (3.7%). In multivariable analyses, white race (odds ratio, 2.44 [95% CI, 2.00-2.98]), self-reporting a drug problem (odds ratio, 1.66 [95% CI, 1.39-1.98]) or alcohol problem (odds ratio, 2.54 [95% CI, 2.16-2.99]), and having witnessed someone else overdose (odds ratio, 2.34 [95% CI, 1.98-2.76]) were associated with increased risk of overdose. CONCLUSIONS AND RELEVANCE These findings suggest that nonfatal overdose is relatively common among veterans who have experienced homelessness. While overdose involving alcohol was more common than any specific drug, 1.7% of veterans reported overdose involving opioids. Improving access to addiction treatment for veterans who are experiencing homelessness or who are recently housed, especially for those who have experienced or witnessed overdose, could help to protect this population.
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Affiliation(s)
- Kevin R. Riggs
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | | | | | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham
| | | | - Erika L. Austin
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Public Health, Birmingham
| | | | - Young-il Kim
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Allyson L. Varley
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
| | - Sonya E. Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, California
- David Geffen School of Medicine at University of California, Los Angeles, Los Angeles
| | | | | | - Adi V. Gundlapalli
- University of Utah School of Medicine, Salt Lake City
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Audrey L. Jones
- University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Adam J. Gordon
- University of Utah School of Medicine, Salt Lake City
- VA Salt Lake City Health Care System, Salt Lake City, Utah
| | - Stefan G. Kertesz
- Birmingham VA Medical Center, Birmingham, Alabama
- University of Alabama at Birmingham School of Medicine, Birmingham
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23
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Paul DW, Knight KR, Olsen P, Weeks J, Yen IH, Kushel MB. Racial Discrimination in the Life Course of Older Adults Experiencing Homelessness: Results from the HOPE HOME Study. JOURNAL OF SOCIAL DISTRESS AND THE HOMELESS 2019; 29:184-193. [PMID: 33727778 PMCID: PMC7958187 DOI: 10.1080/10530789.2019.1702248] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 11/17/2019] [Accepted: 12/02/2019] [Indexed: 05/12/2023]
Abstract
Over 2.5 million people experience homelessness yearly in the United States. Black persons are overrepresented by three-fold among those experiencing homelessness but little research has examined the relationship between race and homelessness. We aimed to understand the relationship between race and the experience of homelessness for older adults. We used grounded theory methodology to analyze in-depth qualitative interviews (n = 65) of persons experiencing homelessness. We recruited participants who were enrolled in two sub-studies of the Health Outcomes of People Experiencing Homelessness in Older Middle AgE (HOPE HOME) Study in Oakland California. We identified two major themes within interviews with Black participants (n=52) related to race: (1) participants experienced overt racial discrimination in early life and (2) structural racism precipitated and perpetuated adult homelessness. Further, we identified sub-themes of structural racism that contributed to participants becoming or staying homeless: criminal justice discrimination, employment discrimination, exposure to violence, premature death, and limited family wealth. We developed a theoretical model of how these elements of structural racism may increase susceptibility to homelessness. These relationships between racial discrimination and homelessness may serve as targets for policies aimed at preventing homelessness.
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Affiliation(s)
- Dereck W. Paul
- School of Medicine, University of California, San Francisco, San Francisco, CA
| | - Kelly R. Knight
- Department of Anthropology, History, and Social Medicine, University of California, San Francisco, San Francisco, CA
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
| | - Pamela Olsen
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine, Department of Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
| | - John Weeks
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine, Department of Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
| | - Irene H. Yen
- Public Health, School of Social Sciences, Humanities and Arts, University of California, Merced, Merced, CA
| | - Margot B. Kushel
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
- Division of General Internal Medicine, Department of Internal Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA
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Hudgins JD, Porter JJ, Monuteaux MC, Bourgeois FT. Prescription opioid use and misuse among adolescents and young adults in the United States: A national survey study. PLoS Med 2019; 16:e1002922. [PMID: 31689290 PMCID: PMC6830740 DOI: 10.1371/journal.pmed.1002922] [Citation(s) in RCA: 115] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2019] [Accepted: 09/25/2019] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Prescription opioid misuse has become a leading cause of unintentional injury and death among adolescents and young adults in the United States. However, there is limited information on how adolescents and young adults obtain prescription opioids. There are also inadequate recent data on the prevalence of additional drug abuse among those misusing prescription opioids. In this study, we evaluated past-year prevalence of prescription opioid use and misuse, sources of prescription opioids, and additional substance use among adolescents and young adults. METHODS AND FINDINGS This was a retrospective analysis of the National Survey on Drug Use and Health (NSDUH) for the years 2015 and 2016. Prevalence of opioid use, misuse, use disorder, and additional substance use were calculated with 95% confidence intervals (CIs), stratified by age group and other demographic variables. Sources of prescription opioids were determined for respondents reporting opioid misuse. We calculated past-year prevalence of opioid use and misuse with or without use disorder, sources of prescription opioids, and prevalence of additional substance use. We included 27,857 adolescents (12-17 years of age) and 28,213 young adults (18-25 years of age) in our analyses, corresponding to 119.3 million individuals in the extrapolated national population. There were 15,143 respondents (27.5% [95% CI 27.0-28.0], corresponding to 32.8 million individuals) who used prescription opioids in the previous year, including 21.0% (95% CI 20.4-21.6) of adolescents and 32.2% (95% CI 31.4-33.0) of young adults. Significantly more females than males reported using any prescription opioid (30.3% versus 24.8%, P < 0.001), and non-Hispanic whites and blacks were more likely to have had any opioid use compared to Hispanics (28.9%, 28.1%, and 25.8%, respectively; P < 0.001). Opioid misuse was reported by 1,050 adolescents (3.8%; 95% CI 3.5-4.0) and 2,207 young adults (7.8%; 95% CI 7.3-8.2; P < 0.001). Male respondents using opioids were more likely to have opioid misuse without use disorder compared with females (23.2% versus 15.8%, respectively; P < 0.001), with similar prevalence by race/ethnicity. Among those misusing opioids, 55.7% obtained them from friends or relatives, 25.4% from the healthcare system, and 18.9% through other means. Obtaining opioids free from friends or relatives was the most common source for both adolescents (33.5%) and young adults (41.4%). Those with opioid misuse reported high prevalence of prior cocaine (35.5%), hallucinogen (49.4%), heroin (8.7%), and inhalant (30.4%) use. In addition, at least half had used tobacco (55.5%), alcohol (66.9%), or cannabis (49.9%) in the past month. Potential limitations of the study are that we cannot exclude selection bias in the study design or socially desirable reporting among participants, and that longitudinal data are not available for long-term follow-up of individuals. CONCLUSIONS Results from this study suggest that the prevalence of prescription opioid use among adolescents and young adults in the US is high despite known risks for future opioid and other drug use disorders. Reported prescription opioid misuse is common among adolescents and young adults and often associated with additional substance abuse, underscoring the importance of drug and alcohol screening programs in this population. Prevention and treatment efforts should take into account that greater than half of youths misusing prescription opioids obtain these medications through friends and relatives.
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Affiliation(s)
- Joel D. Hudgins
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
| | - John J. Porter
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Michael C. Monuteaux
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
| | - Florence T. Bourgeois
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts, United States of America
- Departments of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts, United States of America
- Pediatric Therapeutics and Regulatory Science Initiative, Computational Health Informatics Program, Boston Children’s Hospital, Boston, Massachusetts, United States of America
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25
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Kaplan LM, Vella L, Cabral E, Tieu L, Ponath C, Guzman D, Kushel MB. Unmet mental health and substance use treatment needs among older homeless adults: Results from the HOPE HOME Study. JOURNAL OF COMMUNITY PSYCHOLOGY 2019; 47:1893-1908. [PMID: 31424102 PMCID: PMC7046319 DOI: 10.1002/jcop.22233] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 06/19/2019] [Accepted: 07/25/2019] [Indexed: 05/04/2023]
Abstract
AIMS To examine the prevalence of and factors associated with unmet need for mental health and substance use treatment in older homeless adults. METHODS Among 350 homeless adults aged ≥50, we examined prevalence of mental health and substance use problems and treatment. Using logistic regression, we examined factors associated with unmet treatment need. RESULTS Among those with a mental health problem, being aged ≥65 was associated with an increased odds, while having a regular healthcare provider and case manager were associated with a decreased odds of having unmet need for mental health treatment. A first homelessness episode at age ≥50 was associated with increased, while spending time in jail/prison or having a case manager was associated with decreased odds of unmet needs for substance use treatment. CONCLUSION Older homeless adults have a high prevalence of unmet behavioral health treatment need. There is a need for targeted services for this population.
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Affiliation(s)
- Lauren M Kaplan
- Division of General Internal Medicine, University of California, San Francisco, CA Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Lea Vella
- San Francisco Veteran Affairs Medical Center, San Francisco, California and Division of Geriatrics, University of California, San Francisco, California
- Department of Quality, University of California San Francisco Medical Center, San Francisco, California
| | - Elise Cabral
- Department of Medicine, School of Medicine, University of California, San Francisco, California
| | - Lina Tieu
- Division of General Internal Medicine, University of California, San Francisco, CA Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Claudia Ponath
- Division of General Internal Medicine, University of California, San Francisco, CA Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - David Guzman
- Division of General Internal Medicine, University of California, San Francisco, CA Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
| | - Margot B Kushel
- Division of General Internal Medicine, University of California, San Francisco, CA Zuckerberg San Francisco General Hospital and Trauma Center, San Francisco, California
- UCSF Center for Vulnerable Populations at Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, California
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Leibler JH, Liebschutz JM, Keosaian J, Stewart C, Monteiro J, Woodruff A, Stein MD. Homelessness, Personal Hygiene, and MRSA Nasal Colonization among Persons Who Inject Drugs. J Urban Health 2019; 96:734-740. [PMID: 31493182 PMCID: PMC6814663 DOI: 10.1007/s11524-019-00379-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Methicillin-resistant Staphylococcus aureus (MRSA) infection is a leading cause of hospitalization and medical visits among individuals experiencing homelessness and also among persons who inject drugs (PWID), populations with significant overlap in urban centers in the USA. While injection drug use is a risk factor for MRSA skin infections, MRSA is also known to transmit easily in crowded, public locations in which individuals have reduced personal hygiene. Individuals in urban centers who experience homelessness or drug addiction may spend significant amounts of time in environments where MRSA can be easily transmitted, and may also experience reduced access to facilities to maintain personal hygiene. We assessed the relationship between homelessness, personal hygiene, and MRSA nasal colonization, a proxy for MRSA infection risk, in a study of PWID in Boston, MA (n = 78). Sleeping in a homeless shelter for at least one night in the last 3 months was significantly associated with MRSA nasal colonization (OR 3.0; p = 0.02; 95% CI 1.2, 7.6). Sleeping at more than one place during the last week (considered a metric of elevated housing instability) was also associated with a threefold increase in odds of MRSA nasal colonization (OR 3.1; p = 0.01; 95% CI 1.3, 7.6). MRSA nasal colonization was strongly associated with use of public showers (OR 13.7; p = 0.02; 95% CI 1.4, 132.8), although few people in this study (4 of 78) reported using these public facilities. Sharing bedding with other people was also associated with increased risk of MRSA colonization (OR 2.2; p = 0.05; 95% CI 1.0-4.7). No associations between hand hygiene, frequency of bathing or clothes laundering, or street sleeping were observed. Use of public facilities supporting persons experiencing homelessness and housing instability, including shelters and public showers, is associated with an increased risk of MRSA nasal colonization in this study. Personal hygiene behaviors appear less associated with MRSA nasal colonization. Environmental assessments of MRSA contamination in homeless shelters and public sanitation facilities are warranted so as to inform appropriate intervention activities.
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Affiliation(s)
- Jessica H Leibler
- Department of Environmental Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Jane M Liebschutz
- Department of Medicine, Division of General Internal Medicine, Center for Research on Health Care, University of Pittsburgh, Pittsburgh, PA, USA
| | - Julia Keosaian
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Catherine Stewart
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Jordanna Monteiro
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Alexander Woodruff
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
| | - Michael D Stein
- Department of Health Law, Policy and Management, Boston University School of Public Health, Boston, MA, USA
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Scholes G. Problematic alcohol consumption in homeless Australians: A narrative review of the causes, barriers to receiving help and possible solutions. Health Promot J Austr 2019; 31:279-286. [PMID: 31446632 DOI: 10.1002/hpja.289] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Accepted: 08/19/2019] [Indexed: 11/06/2022] Open
Abstract
ISSUE ADDRESSED Problematic alcohol consumption (PAC) affects one-third of homeless Australians, and it is expected that the rates will increase as the population ages. However, current policy does not recognise the importance of this problem. The aim of this narrative review was to examine the social determinants and other risk factors contributing to PAC in homeless Australians, the barriers to receiving help and possible solutions for the Australian context. METHODS PubMed and PsycINFO databases and Australian government websites were examined for the keywords "alcohol" and "homeless," and pertinent articles were selected for inclusion and for citation tracking of further relevant articles. RESULTS The causes of PAC in homeless Australians are multifactorial, and multidirectional, and include risk factors such as low socio-economic status, mental illness and having experienced trauma. There is significant stigma associated with both homelessness and PAC, which further isolates this group. Current policies to address PAC in the homeless are inadequate; however, there are a range of possible programs to reduce PAC in this group, and international harm reduction strategies have also shown success in improving outcomes for this group. CONCLUSION There are numerous social risk factors that influence the development of PAC in the homeless. The introduction of harm reduction strategies, programs to enhance motivation and personal skills, as well as better mental health treatment, would all fill important gaps in services for homeless Australians with PAC. SO WHAT?: Health professionals can be advised that there are many social determinants that influence PAC in homeless Australians. There are important structural barriers to providing this marginalised group with the services they require; however, there is scope for the introduction of new programs, including harm reduction strategies, to meet the fundamental needs of this group.
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Smith L, Veronese N, López-Sánchez GF, Moller E, Johnstone J, Firth J, Grabovac I, Yang L, Soysal P, Jackson SE. Health behaviours and mental and physical health status in older adults with a history of homelessness: a cross-sectional population-based study in England. BMJ Open 2019; 9:e028003. [PMID: 31203244 PMCID: PMC6585828 DOI: 10.1136/bmjopen-2018-028003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVES This study compared (1) levels of engagement in lifestyle risk behaviours and (2) mental and physical health status in individuals who have previously been homeless to those of individuals who have not. DESIGN Cross-sectional. PARTICIPANTS Data were from participants (n=6931) of the English Longitudinal Study of Ageing. : Measures : Participants reported whether they had ever been homeless. We used regression models to analyse associations between homelessness and (1) cigarette smoking, daily alcohol consumption and physical inactivity, adjusting for sociodemographic covariates (age, sex, ethnicity, highest level of education, marital status and household non-pension wealth) and (2) self-rated health, limiting long-standing illness, depressive symptoms, life satisfaction, quality of life and loneliness, adjusting for sociodemographics and health behaviours. RESULTS 104 participants (1.5%) reported having been homeless. Individuals who had been homeless were significantly more likely to be physically inactive (OR 1.62, 95% CI 1.44 to 2.52), report fair/bad/very bad self-rated health (OR 1.75, 95% CI 1.07 to 2.86), have a limiting long-standing illness (OR 2.66, 95% CI 1.65 to 4.30) and be depressed (OR 3.06, 95% CI 1.85 to 5.05) and scored lower on measures of life satisfaction (17.34 vs 19.96, p<0.001) and quality of life (39.02 vs 41.21, p=0.013). Rates of smoking (20.2% vs 15.4%, p=0.436), daily drinking (27.6% vs 22.8%, p=0.385) and loneliness (27.1% vs 21.0%, p=0.080) were also elevated. CONCLUSIONS Those who were once homeless have poorer mental and physical health outcomes and are more likely to be physically inactive. Interventions to improve their health and quality of life are required.
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Affiliation(s)
- Lee Smith
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy
| | | | | | - James Johnstone
- The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Joseph Firth
- NICM Health Research Institute, Western Sydney University, Sydney, Australia
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Vienna, Austria
| | - Lin Yang
- Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
| | - Pinar Soysal
- Department of Geriatric Medicine, Faculty of Medicine, Bezmialem Vakif University, Istanbul, Turkey
| | - Sarah E Jackson
- Department of Behavioural Science and Health, University College London, London, UK
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Rosendale N, Guterman EL, Betjemann JP, Josephson SA, Douglas VC. Hospital admission and readmission among homeless patients with neurologic disease. Neurology 2019; 92:e2822-e2831. [PMID: 31127074 DOI: 10.1212/wnl.0000000000007645] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Accepted: 02/07/2019] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To characterize the most common neurologic diagnoses leading to hospitalization for homeless compared to housed individuals and to assess whether homelessness is an independent risk factor for 30-day readmission after an admission for a neurologic illness. METHODS We performed a retrospective serial cross-sectional study using data from the Healthcare Cost and Utilization Project California State Inpatient Database from 2006 to 2011. Adult patients with a primary neurologic discharge diagnosis were included. The primary outcome was 30-day readmission. We used multilevel logistic regression to examine the association between homelessness and readmission after adjustment for patient factors. RESULTS We identified 1,082,347 patients with a neurologic primary diagnosis. The rate of homelessness was 0.37%. The most common indications for hospitalization among homeless patients were seizure and traumatic brain injury, both of which were more common in the homeless compared to housed population (19.3% vs 8.1% and 31.9% vs 9.2%, respectively, p < 0.001). A multilevel mixed-effects model controlling for patient age, sex, race, insurance type, comorbid conditions, and clustering on the hospital level found that homelessness was associated with increased 30-day readmission (odds ratio 1.5, 95% confidence interval 1.4-1.6, p < 0.001). This association persisted after this analysis was repeated within specific diagnoses (patients with epilepsy, trauma, encephalopathy, and neuromuscular disease). CONCLUSION The most common neurologic reasons for admission among homeless patients are seizure and traumatic brain injury; these patients are at high risk for readmission. Future interventions should target the drivers of readmissions in this vulnerable population.
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Affiliation(s)
- Nicole Rosendale
- From the Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco.
| | - Elan L Guterman
- From the Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco
| | - John P Betjemann
- From the Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco
| | - S Andrew Josephson
- From the Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco
| | - Vanja C Douglas
- From the Department of Neurology and Weill Institute for Neurosciences, University of California, San Francisco
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30
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Raven MC, Kaplan LM, Rosenberg M, Tieu L, Guzman D, Kushel M. Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study. JMIR Mhealth Uhealth 2018; 6:e10049. [PMID: 30530464 PMCID: PMC6305882 DOI: 10.2196/10049] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 09/20/2018] [Accepted: 09/25/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The median age of single homeless adults is approximately 50 years. Older homeless adults have poor social support and experience a high prevalence of chronic disease, depression, and substance use disorders. Access to mobile phones and the internet could help lower the barriers to social support, social services, and medical care; however, little is known about access to and use of these by older homeless adults. OBJECTIVE This study aimed to describe the access to and use of mobile phones, computers, and internet among a cohort of 350 homeless adults over the age of 50 years. METHODS We recruited 350 participants who were homeless and older than 50 years in Oakland, California. We interviewed participants at 6-month intervals about their health status, residential history, social support, substance use, depressive symptomology, and activities of daily living (ADLs) using validated tools. We performed clinical assessments of cognitive function. During the 6-month follow-up interview, study staff administered questions about internet and mobile technology use. We assessed participants' comfort with and use of multiple functions associated with these technologies. RESULTS Of the 343 participants alive at the 6-month follow-up, 87.5% (300/343) completed the mobile phone and internet questionnaire. The median age of participants was 57.5 years (interquartile range 54-61). Of these, 74.7% (224/300) were male, and 81.0% (243/300) were black. Approximately one-fourth (24.3%, 73/300) of the participants had cognitive impairment and slightly over one-third (33.6%, 100/300) had impairments in executive function. Most (72.3%, 217/300) participants currently owned or had access to a mobile phone. Of those, most had feature phones, rather than smartphones (89, 32.1%), and did not hold annual contracts (261, 94.2%). Just over half (164, 55%) had ever accessed the internet. Participants used phones and internet to communicate with medical personnel (179, 64.6%), search for housing and employment (85, 30.7%), and to contact their families (228, 82.3%). Those who regained housing were significantly more likely to have mobile phone access (adjusted odds ratio [AOR] 3.81, 95% CI 1.77-8.21). Those with ADL (AOR 0.53, 95% CI 0.31-0.92) and executive function impairment (AOR 0.49; 95% CI 0.28-0.86) were significantly less likely to have mobile phones. Moderate to high risk amphetamine use was associated with reduced access to mobile phones (AOR 0.27, 95% CI 0.10-0.72). CONCLUSIONS Older homeless adults could benefit from portable internet and phone access. However, participants had a lower prevalence of smartphone and internet access than adults aged over 65 years in the general public or low-income adults. Participants faced barriers to mobile phone and internet use, including financial barriers and functional and cognitive impairments. Expanding access to these basic technologies could result in improved outcomes.
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Affiliation(s)
- Maria C Raven
- Department of Emergency Medicine, School of Medicine, University of California, San Francisco, San Francisco, CA, United States.,Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States
| | - Lauren M Kaplan
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
| | - Marina Rosenberg
- School of Public Health, University of California, Berkeley, Berkeley, CA, United States
| | - Lina Tieu
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
| | - David Guzman
- Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
| | - Margot Kushel
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, San Francisco, CA, United States.,Center for Vulnerable Populations, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States.,Division of General Internal Medicine, Department of Medicine, Zuckerberg San Francisco General Hospital and Trauma Center, University of California, San Francisco, San Francisco, CA, United States
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