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Conard PL, Keller MJ, Armstrong ML. The Risks, Invisibility, and Health Issues Facing Women Veterans Who Are Homeless. Nurs Womens Health 2021; 25:471-481. [PMID: 34736917 DOI: 10.1016/j.nwh.2021.09.007] [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] [Received: 03/14/2021] [Revised: 04/26/2021] [Accepted: 09/28/2021] [Indexed: 11/19/2022]
Abstract
Women veterans may experience a variety of traumatizing events and conditions before, during, and after their military service, such as intimate partner violence, military sexual trauma, moral injury, and posttraumatic stress disorder. These experiences put them at greater risk for significant behavioral and physical health sequelae, which can be associated with difficulty with civilian reintegration and complexities around homelessness. Homeless women military veterans are often uncounted, undergo different environmental situations than their male counterparts, and are vulnerable to sexual violence and unintended pregnancies. Identifying homeless women military veterans is an important first step; otherwise, they remain "invisible." Comprehensive, collaborative, interdisciplinary health care in which trust is established and care is holistic and individualized will produce the most optimal outcomes.
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Iwundu CN, Agrawal P, Businelle MS, Kendzor DE, Reitzel LR. Predictors of Overnight and Emergency Treatment among Homeless Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E4271. [PMID: 32549281 PMCID: PMC7345623 DOI: 10.3390/ijerph17124271] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/31/2020] [Accepted: 06/10/2020] [Indexed: 12/02/2022]
Abstract
High usage of emergency treatment and hospitalization has been reported among homeless individuals. Hence, this study aimed to identify the sociodemographic predictors associated with overnight and emergency hospital treatment among a sample of homeless adults. Participants were recruited from a shelter in Dallas, Texas (N = 354; Mage = 43.7 ± 11.7) and were predominantly uninsured, low-income men from various racial groups. The outcome variables were: (a) stayed overnight for treatment in a hospital; and (b) treated in a hospital emergency room. In logistic regression models, sex emerged as the only predictor of overnight treatment in a hospital (OR = 2.68, 95% CI = 1.61-4.47), and treatment in an emergency room (OR = 2.21, 95% CI = 1.34-3.65), such that women were more likely than men to be treated overnight and use emergency care. Targeted interventions and policies are needed to address homeless women's primary care needs and reduce costlier treatment.
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Affiliation(s)
- Chisom N. Iwundu
- Department of Rehabilitation and Health Services, College of Public and Health, University of North Texas Services, Denton, TX 76203, USA
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (P.A.); (L.R.R.)
| | - Pooja Agrawal
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (P.A.); (L.R.R.)
- School of Medicine, University of Texas Medical Branch, Galveston, TX 78701, USA
| | - Michael S. Businelle
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Darla E. Kendzor
- Oklahoma Tobacco Research Center, The University of Oklahoma Health Sciences Center, 655 Research Parkway, Suite 400, Oklahoma City, OK 73104, USA; (M.S.B.); (D.E.K.)
| | - Lorraine R. Reitzel
- Department of Psychological, Health, and Learning Sciences, College of Education, University of Houston, Houston, TX 77204, USA; (P.A.); (L.R.R.)
- HEALTH Research Institute, University of Houston, 4849 Calhoun Rd., Houston, TX 77204, USA
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Guillén AI, Marín C, Panadero S, Vázquez JJ. Substance use, stressful life events and mental health: A longitudinal study among homeless women in Madrid (Spain). Addict Behav 2020; 103:106246. [PMID: 31838444 DOI: 10.1016/j.addbeh.2019.106246] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/23/2019] [Accepted: 11/23/2019] [Indexed: 10/25/2022]
Abstract
The objectives of this study were: (1) to assess the prevalence of substance use among homeless women; (2) to examine the correlates for drug abuse; (3) to analyze paths between early stressful life events, drug abuse and mental health. The methodology was a longitudinal study of women homeless in Madrid (Spain), who were followed for a 24 months period. There were 138 participants interviewed at baseline and 73 participants interviewed at follow-up. We ran bivariate and multivariate analysis to examine the correlates for drug abuse. We also performed path analysis to test the interconnections between stressful life events, drug abuse and mental health. Results at baseline showed that 83.3% of participants had consumed at least one substance in the previous month. Tobacco was the most common substance consumed (70.1%), followed by sedatives (48.6%), alcohol (36.2%), methadone (13.7%), cocaine (7.2%), cannabis (6.5%) and heroin (5.1%). In addition, women who met criteria for drug abuse (19.6% of the sample) were more likely to be younger, have suffered adverse experiences during childhood, have engaged in prostitution, and have ever attempted suicide, in comparison with women who did not meet criteria for drug abuse. Path analysis supported that early stressful life events increased the vulnerability for subsequent negative outcomes among homeless women. These findings have significant implications for understanding how to implement programs for homeless women in Spain.
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Neisler J, Shree S, Reitzel LR, Chen TA, Kendzor DE, Obasi EM, Wrighting Q, Businelle MS. Characterizing Alcohol Use Behaviors among Homeless Men and Women. Am J Health Behav 2019; 43:37-49. [PMID: 30522565 PMCID: PMC6296245 DOI: 10.5993/ajhb.43.1.4] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Objectives: In this study, we characterized alcohol use behaviors by sex among sheltered homeless adults and explored associations with health and readiness to change drinking behaviors. Methods: Participants (N = 581; 63.7% men; Mage = 43.6, 29.4% white) self-reported alcohol use and readiness to change drinking behaviors. Sex differences were analyzed via Wilcoxon ranksum, chi-square tests, logistic regression, and ANCOVAs. Results: Overall, 38.5% of the sample met criteria for current at-risk drinking, 39.7% self-reported a history of alcohol problems, and 22.9% reported having a formal alcohol use disorder (AUD) diagnosis. Among current alcohol users, 83.8% reported at-risk drinking. Men had more drinks per drinking day, more drinks per week, and more drinking days per week when compared to women. No sex differences were found for at-risk drinking, self-reported alcohol problems, probable alcohol abuse/dependence, AUD diagnosis, readiness to change drinking, or recent alcohol/substance abuse counseling. Conclusions: High rates of at-risk drinking were found among alcohol users. Homeless men and women did not exhibit differences in several manifestations of problematic alcohol use. Alcohol use interventions might be equally appealing to both sexes given equivalent readiness to change drinking; however, rates of recent treatment receipt were low.
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Affiliation(s)
- Julie Neisler
- Graduate Student, University of Houston, Department of Psychological, Health, & Learning Sciences, Houston, TX
| | - Sonakshee Shree
- Research Assistant, University of Houston, Department of Psychological, Health, & Learning Sciences, Houston, TX
| | - Lorraine R Reitzel
- Associate Professor, University of Houston, Department of Psychological, Health, & Learning Sciences, Houston, TX;,
| | - Tzu-An Chen
- Assistant Professor, University of Houston HEALTH Research Institute, Houston, TX
| | - Darla E Kendzor
- Associate Professor, University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Oklahoma City, OK
| | - Ezemenari M Obasi
- Professor, University of Houston, Department of Psychological, Health, & Learning Sciences, Houston, TX
| | - Quentaxia Wrighting
- Research Data Coordinator, MD Anderson Cancer Center, Department of Behavioral Sciences, Houston, TX
| | - Michael S Businelle
- Associate Professor, University of Oklahoma Health Sciences Center, Oklahoma Tobacco Research Center, Oklahoma City, OK
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Biederman DJ, Forlan N. Desired Destinations of Homeless Women: Realizing Aspirations Within the Context of Homelessness. Creat Nurs 2016; 22:196-203. [DOI: 10.1891/1078-4535.22.3.196] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Despite recent decreases, homelessness remains a substantial problem in the United States. Homelessness is associated with poor health, and homeless women experience earlier mortality than their housed counterparts. Understanding the aspirations of homeless women may offer service providers avenues for intervention to increase well-being among this vulnerable population. This study, a secondary analysis of transcribed interviews (n = 20), provides insight into the aspirations of homeless women. Opportunities for service providers to intervene on these aspirations within the context of homelessness are offered.
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Upshur C, Weinreb L, Bharel M, Reed G, Frisard C. A randomized control trial of a chronic care intervention for homeless women with alcohol use problems. J Subst Abuse Treat 2014; 51:19-29. [PMID: 25488504 DOI: 10.1016/j.jsat.2014.11.001] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2013] [Revised: 09/26/2014] [Accepted: 11/10/2014] [Indexed: 10/24/2022]
Abstract
A clinician-randomized trial was conducted using the chronic care model for disease management for alcohol use problems among n = 82 women served in a health care for the homeless clinic. Women with problem alcohol use received either usual care or an intervention consisting of a primary care provider (PCP) brief intervention, referral to addiction services, and on-going support from a care manager (CM) for 6 months. Both groups significantly reduced their alcohol consumption, with a small effect size favoring intervention at 3 months, but there were no significant differences between groups in reductions in drinking or in housing stability, or mental or physical health. However, intervention women had significantly more frequent participation in substance use treatment services. Baseline differences and small sample size limit generalizability, although substantial reductions in drinking for both groups suggest that screening and PCP brief treatment are promising interventions for homeless women with alcohol use problems.
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Affiliation(s)
- Carole Upshur
- Department of Family Medicine and Community Health, University of Massachusetts Medical School.
| | - Linda Weinreb
- Department of Family Medicine and Community Health, University of Massachusetts Medical School
| | - Monica Bharel
- Departments of Medicine, Boston University Medical Center and Massachusetts General Hospital, Boston Health Care for the Homeless Program
| | - George Reed
- Department of Quantitative Health Sciences, University of Massachusetts Medical School
| | - Christine Frisard
- Department of Medicine, Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School
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