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Dadras O, Diaz E. Perceived discrimination and its association with self-rated health, chronic pain, mental health, and utilization of health services among Syrian refugees in Norway: a cross-sectional study. Front Public Health 2024; 12:1264230. [PMID: 38406500 PMCID: PMC10884245 DOI: 10.3389/fpubh.2024.1264230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 01/22/2024] [Indexed: 02/27/2024] Open
Abstract
Background There is a scarcity of research on discriminatory experiences and their association with health outcomes among Syrian Refugees in Norway. Thus, this study aims to examine the relationship between perceived discrimination, self-rated health (SRH), chronic pain, poor mental health, and healthcare utilization among Syrian refugees resettled in Norway. Methods Cross-sectional data from the Integration for Health project were analyzed, including 154 Syrian refugees who resettled in Norway in 2018-19. Perceived discrimination, SRH, chronic pain, psychological distress, post-traumatic stress symptoms, and healthcare visits were assessed. Statistical analyses, including Poisson regression and multinomial logistic regression, were conducted. The significant statistical level was set at 0.05. Results Approximately 30% of participants reported experiencing discrimination, with no significant associations between sociodemographic factors and perceived discrimination. Perceived discrimination was significantly associated with psychological distress (adjusted PR: 2.07, 95%CI: 1.21-3.55), post-traumatic stress symptoms (adjusted PR: 11.54, 95%CI: 1.25-106.16), and 4 or more psychologist visits (adjusted OR: 12.60, 95%CI: 1.72-92.16). However, no significant associations were found between perceived discrimination and SRH; pain symptoms, or general healthcare utilization. Conclusion Experienced discrimination is highly prevalent and seems to be associated with mental health outcomes, but not clearly with SRH, pain, or general healthcare visits among Syrian refugees living in Norway. Efforts should focus on reducing discrimination, promoting social inclusion, and improving access to mental health services for refugees. Public awareness campaigns, anti-discrimination policies, and cultural training for healthcare professionals are recommended to address these issues and improve the well-being of Syrian refugees in Norway.
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Affiliation(s)
- Omid Dadras
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
| | - Esperanza Diaz
- Department of Addiction Medicine, Haukeland University Hospital, Bergen, Norway
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Sifat MS, Ehlke SJ, Ogunsanya M, Frank-Pearce SG, Boozary LK, Alexander AC, Businelle MS, Kendzor DE. Greater Discrimination Frequency and Lower Distress Tolerance Are Associated with Mental Health Problems Among Racially Privileged and Minoritized Adults Accessing an Urban Day Shelter. J Racial Ethn Health Disparities 2024; 11:45-61. [PMID: 36607564 PMCID: PMC10699794 DOI: 10.1007/s40615-022-01496-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] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 11/29/2022] [Accepted: 12/15/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Discrimination experiences may be a contributing factor to the elevated prevalence of mental health problems among adults experiencing homelessness. METHODS Using survey data (N = 552) collected from adults seeking services at an urban day shelter, the relationships between everyday and major discrimination experiences, distress tolerance, and mental health problems (depression, anxiety, post-traumatic stress disorder, poor mental health days) were characterized. Distress tolerance was examined as a moderator of the relationship between discrimination and mental health problems. RESULTS Participants were predominantly from racially minoritized groups (59.6%), non-Hispanic (88.7%), and male (70.9%), with an average age of 45.7 years old (SD = 11.7). Descriptive analyses indicated that the main reason for discrimination differed between racially privileged (i.e., White participants) and racially minoritized participants (i.e., participants who identified as Black, American Indian/Alaska Native, Asian, Native Hawaiian/Pacific Islander, or multi-race), such that homelessness was most commonly endorsed among racially privileged participants while racial discrimination was most commonly reported among racially minoritized participants. Multivariate logistic regression analyses revealed associations between everyday discrimination, major discrimination, and distress tolerance with mental health problems. Distress tolerance did not moderate the relations between discrimination and mental health problems in most analyses. Notably, major discrimination was no longer associated with all mental health variables when both everyday and major discrimination were included in all models. CONCLUSION Findings suggest that reducing everyday discrimination and addressing the adverse impact of everyday discrimination experiences may have a beneficial impact on mental health.
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Affiliation(s)
- Munjireen S Sifat
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA.
| | - Sarah J Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
| | - Motolani Ogunsanya
- College of Pharmacy, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Summer G Frank-Pearce
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Laili Kharazi Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Cellular and Behavioral Neurobiology, Psychology, University of Oklahoma, Norman, OK, USA
| | - Adam C Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Michael S Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Darla E Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
- Department of Family and Preventive Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Alang SM, Letcher AS, Mitsdarffer ML, Kieber-Emmons A, Rivera J, Moeller C, Biery N, Batts H. The Radical Welcome Engagement Restoration Model and Assessment Tool for Community-Engaged Partnerships. Health Promot Pract 2024:15248399231223744. [PMID: 38293773 DOI: 10.1177/15248399231223744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
People experiencing addiction, houselessness, or who have a history of incarceration have worse health outcomes compared with the general population. This is due, in part, to practices and policies of historically White institutions that exclude the voices, perspectives, and contributions of communities of color in leadership, socio-economic development, and decision-making that matters for their wellbeing. Community-based participatory research (CBPR) approaches hold promise for addressing health inequities. However, full engagement of people harmed by systemic injustices in CBPR partnerships is challenging due to inequities in power and access to resources. We describe how an Allentown-based CBPR partnership-the Health Equity Activation Research Team of clinicians, researchers, and persons with histories of incarceration, addiction, and houselessness-uses the Radical Welcome Engagement Restoration Model (RWERM) to facilitate full engagement by all partners. Data were collected through participatory ethnography, focus groups, and individual interviews. Analyses were performed using deductive coding in a series of iterative meaning-making processes that involved all partners. Findings highlighted six defining phases of the radical welcome framework: (a) passionate invitation, (b) radical welcome, (c) authentic sense of belonging, (d) co-creation of roles, (e) prioritization of issues, and (f) individual and collective action. A guide to assessing progression across these phases, as well as a 32-item radical welcome instrument to help CBPR partners anticipate and overcome challenges to engagement are introduced and discussed.
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Affiliation(s)
- Sirry M Alang
- Lehigh University, Bethlehem, PA, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | | | | | | | - Jose Rivera
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
- Pinebrook Family Answers, Allentown, PA, USA
| | | | - Nyann Biery
- Lehigh Valley Health Network, Allentown, PA, USA
| | - Hasshan Batts
- Promise Neighborhoods of the Lehigh Valley, Allentown, PA, USA
- Prison Survivor Network, Allentown, PA, USA
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O'Neill M, Michalski C, Hayman K, Hulme J, Dube S, Diemert LM, Kornas K, Schoffel A, Rosella LC, Boozary A. "Whatever journey you want to take, I'll support you through": a mixed methods evaluation of a peer worker program in the hospital emergency department. BMC Health Serv Res 2024; 24:147. [PMID: 38287378 PMCID: PMC10826204 DOI: 10.1186/s12913-023-10532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 12/27/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND People who are unhoused, use substances (drugs and/or alcohol), and who have mental health conditions experience barriers to care access and are frequently confronted with discrimination and stigma in health care settings. The role of Peer Workers in addressing these gaps in a hospital-based context is not well characterized. The aim of this evaluation was to 1) outline the role of Peer Workers in the care of a marginalized populations in the emergency department; 2) characterize the impact of Peer Workers on patient care, and 3) to describe how being employed as a Peer Worker impacts the Peer. METHODS Through a concurrent mixed methods evaluation, we explore the role of Peer Workers in the care of marginalized populations in the emergency department at two urban hospitals in Toronto, Ontario Canada. We describe the demographic characteristics of patients (n = 555) and the type of supports provided to patients collected through a survey between February and June 2022. Semi-structured, in-depth interviews were completed with Peer Workers (n = 7). Interviews were thematically analyzed using a deductive approach, complemented by an inductive approach to allow new themes to emerge from the data. RESULTS Support provided to patients primarily consisted of friendly conversations (91.4%), discharge planning (59.6%), tactics to help the patient navigate their emotions/mental wellbeing (57.8%) and sharing their lived experience (50.1%). In over one third (38.9%) of all patient interactions, Peer Workers shared new information about the patient with the health care team (e.g., obtaining patient identification). Five major themes emerged from our interviews with Peer Workers which include: (1) Establishing empathy and building trust between the patient and their care team through self-disclosure; (2) Facilitating a person-centered approach to patient care through trauma-informed listening and accessible language; (3) Support for patient preferences on harm reduction; (4) Peer worker role facilitating self-acceptance and self-defined recovery; and (5) Importance of supports and resources to help Peer Workers navigate the emotional intensity of the emergency department. CONCLUSIONS The findings add to the literature on Peer Worker programs and how such interventions are designed to best meet the needs of marginalized populations.
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Affiliation(s)
- Meghan O'Neill
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Camilla Michalski
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kate Hayman
- University Health Network, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Jennifer Hulme
- University Health Network, Toronto, ON, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Sané Dube
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Lori M Diemert
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathy Kornas
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Alice Schoffel
- University Health Network, Toronto, ON, Canada
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada
| | - Laura C Rosella
- Population Health Analytics Lab, Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Laboratory Medicine and Pathobiology, Temerty Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
- Institute for Better Health, Trillium Health Partners, Mississauga, ON, Canada
| | - Andrew Boozary
- University Health Network, Toronto, ON, Canada.
- Gattuso Centre for Social Medicine and Population Health, University Health Network, Toronto, ON, Canada.
- Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Jones-Patten A, Shin SS, Nyamathi A, Bounds D. "Cigarettes play the equalizer": discrimination experiences and readiness to quit cigarette smoking among African Americans experiencing homelessness: a qualitative analysis. Addict Sci Clin Pract 2024; 19:1. [PMID: 38163885 PMCID: PMC10759568 DOI: 10.1186/s13722-023-00432-8] [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: 04/17/2023] [Accepted: 12/15/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Approximately 70-80% of people experiencing homelessness in the United States use tobacco. Smoking cessation programs specifically for this population have been found to be less effective for African American participants. The purpose of this study was to explore discrimination experiences and their impact on smoking habits and readiness to quit cigarette smoking while experiencing homelessness. METHODS In the qualitative phase of this mixed methods study, five focus groups were conducted for African Americans residing in a homeless shelter in Skid Row, Los Angeles, CA. Using a semi-structured interview guide, we asked participants about discrimination experiences, how smoking habits were impacted by these experiences, and tools needed to successfully abstain from cigarette smoking. Qualitative descriptive content analysis was used to explore discrimination experiences and its association with readiness to quit cigarette smoking. RESULTS Of the 17 participants, 14 (82.4%) were male, and the average age was 46.8 years. Using a qualitative In Vivo coding method, three themes were revealed: "Experiencing Discrimination while Black", "The Psychosocial Fabric-Why Quitting Cigarette Smoking is a Challenge", and "The Lesser of Two Evils-Choosing to Smoke over More Harmful Options." Participants discussed working in the blue-collar workforce while Black, identifying as a double minority, smoking to cope with stress, early exposure to cigarettes, smoking being a central part of one's belonging to a group, and the legality of cigarette smoking. DISCUSSION Our findings show that African Americans experiencing homelessness (1) may experience discrimination in multiple settings, regardless of housing status, (2) could have grown up around cigarette smoking and remain surrounded by it while experiencing homelessness, and (3) may experience a calming effect with smoking, which slows some from reacting negatively to adverse situations. CONCLUSION Barriers to successfully abstaining from smoking are multifactorial among African Americans experiencing homelessness and should be addressed individually. Future research should explore the cultural tailoring of interventions that support cessation efforts unique to minoritized populations to improve smoking cessation programs offered to this population.
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Affiliation(s)
- Alexandria Jones-Patten
- Columbia University School of Nursing, Center for Research On People of Color, 560 W 168Th St, New York, NY, 10032, USA.
- Columbia University Irving Medical Center New York, New York, NY, USA.
| | - Sanghyuk S Shin
- Irvine School of Nursing Berk Hall, University of California, 802 West Peltason Drive, Irvine, CA, 92617, USA
| | - Adeline Nyamathi
- Irvine School of Nursing Berk Hall, University of California, 802 West Peltason Drive, Irvine, CA, 92617, USA
| | - Dawn Bounds
- Irvine School of Nursing Berk Hall, University of California, 802 West Peltason Drive, Irvine, CA, 92617, USA
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Namata C, Hatzidimitriadou E. Strategies for improving access to primary care services for homeless immigrants in England: a Delphi study. Prim Health Care Res Dev 2023; 24:e70. [PMID: 38093561 PMCID: PMC10790723 DOI: 10.1017/s1463423623000646] [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: 06/27/2023] [Revised: 09/22/2023] [Accepted: 11/05/2023] [Indexed: 12/18/2023] Open
Abstract
AIM The aim of the study was to identify the most prioritized strategies in improving access to primary care services (PCS) for homeless immigrants. BACKGROUND The issue of improving access to PCS for homeless immigrants is a complex and multifaceted one, and yet there is limited research on the strategies aimed at improving these services. Hence, the need for more studies that directly engage homeless immigrants and service providers in understanding their barriers to accessing PCS and their preferences for improving access to these services. METHODS The study used a two round Delphi method to elicit the views of stakeholders. The Delphi process utilized a web-based questionnaire. The stakeholders included healthcare providers and voluntary sector providers. The first round had a total of 58 items belonging to 14 categories. The second round comprised a total of 25 items belonging to 12 categories which were preselected based on participants' ranking of their importance in the first round. Participants were required to rank the relative importance of all the items on a 5-point Likert scale. Data were analysed using the STATA-15 software package. FINDINGS A total of 12 stakeholders participated in both rounds of the Delphi survey. The top three strategies encompassed fighting against discrimination and prejudice, improving and promoting mental health services, and empowering homeless immigrants. These evidence-based strategies hold the potential to support the implementation of healthcare interventions aimed at improving access to PCS and healthcare outcomes for homeless immigrants. However, it is crucial to conduct further research that includes homeless immigrants in the Delphi study to gain insights into the strategies that are most important to them in enhancing access to PCS, as they are the primary target users. Such research will contribute to the development of comprehensive and effective interventions tailored to the specific needs of homeless.
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Affiliation(s)
- Carol Namata
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
| | - Eleni Hatzidimitriadou
- Faculty of Medicine, Health and Social Care, Canterbury Christ Church University, Canterbury, Kent, England
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Meehan AA, Cox SN, Thuo NB, Rogers JH, Link AC, Martinez MA, Lo NK, Manns BJ, Rolfes MA, Chow EJ, Chu HY, Mosites E, Al Achkar M. Previous Health Care Experiences' Influence on Health Care Perceptions Among Residents of Six Homeless Shelters in Seattle, Washington, July-October 2021. J Patient Cent Res Rev 2023; 10:111-120. [PMID: 37483554 PMCID: PMC10358972 DOI: 10.17294/2330-0698.2012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Purpose The study purpose was to learn and describe 1) where homeless shelter residents receive health care, 2) what contributes to positive or negative health care experiences among shelter residents, and 3) shelter resident perceptions toward health care. Methods Semi-structured interviews (SSIs) utilizing purposive sampling and focus group discussions (FGDs) utilizing convenience sampling were conducted at 6 homeless shelters in Seattle-King County, Washington, during July-October 2021. All residents (age ≥18) were eligible to participate. SSIs were conducted with 25 residents, and 8 FGDs were held. Thematic analysis was conducted using Dedoose. Results Participants received health care in settings ranging from no regular care to primary care providers. Four elements emerged as contributing positively and negatively to health care experiences: 1) ability to access health care financially, physically, and technologically; 2) clarity of communication from providers and staff about appointment logistics, diagnoses, and treatment options; 3) ease of securing timely follow-up services; and 4) respect versus stigma and discrimination from providers and staff. Participants who felt positively toward health care found low- or no-cost care to be widely available and encouraged others to seek care. However, some participants described health care in the United States as greedy, classist, discriminatory, and untrustworthy. Participants reported delaying care and self-medicating in anticipation of discrimination. Conclusions Findings demonstrate that while people experiencing homelessness can have positive experiences with health care, many have faced negative interactions with health systems. Improving the patient experience for those experiencing homelessness can increase engagement and improve health outcomes.
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Affiliation(s)
- Ashley A. Meehan
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Sarah N. Cox
- Department of Epidemiology, University of Washington, Seattle, WA
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Nicholas B. Thuo
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Julia H. Rogers
- Department of Epidemiology, University of Washington, Seattle, WA
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Amy C. Link
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Miguel A. Martinez
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Natalie K. Lo
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Brian J. Manns
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Melissa A. Rolfes
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Eric J. Chow
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
- Public Health – Seattle & King County, Seattle, WA
| | - Helen Y. Chu
- Division of Allergy & Infectious Diseases, Department of Medicine, University of Washington, Seattle, WA
| | - Emily Mosites
- COVID-19 Emergency Response, Centers for Disease Control and Prevention, Atlanta, GA
| | - Morhaf Al Achkar
- Department of Family Medicine, University of Washington, Seattle, WA
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Nolen S, Wilson T, Jacka BP, Li Y, Beaudoin FL, Marshall BD. Prevalence and correlates of experiencing drug-related discrimination among people who use drugs presenting at emergency department at high risk of opioid overdose. Addict Behav Rep 2023; 17:100496. [PMID: 37249941 PMCID: PMC10213175 DOI: 10.1016/j.abrep.2023.100496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2023] [Revised: 05/08/2023] [Accepted: 05/13/2023] [Indexed: 05/31/2023] Open
Abstract
Objectives Our objective is to determine if specific sociodemographic characteristics were associated with perceived drug-related discrimination among people who use drugs (PWUD) presenting for care in the emergency department (ED). Methods We conducted a secondary analysis of data from the Navigator trial, a randomized control trial of two behavioral interventions in the ED for people at risk of an opioid overdose. Participants included adult patients presenting to two Rhode Island EDs. Eligible participants included those high risk for an opioid overdose, resided or received most of their healthcare in Rhode Island, and were able to provide consent. The primary outcome of this analysis was self-reported feelings of drug-related discrimination by the medical community. The independent variables of interest included race/ethnicity, gender identity, and sexual orientation. Log-binomial multivariable regression models were constructed with all three independent variables of interest and a selection of sociodemographic covariates. Results Of 620 eligible participants, 251 (40.5%) reported ever experiencing drug-related discrimination in their lifetime. In the adjusted model, participants who identified as women and participants who identified as LGBQIA+ were more likely to report experiencing drug-related discrimination from the medical community in EDs. Racial/ethnic minority groups were less likely than White (non-Hispanic) participants to report drug-related discrimination. Discussion In this study population, White participants reported more drug-related discrimination than their minority counterparts, although female and LGBQIA+ patients reported more discrimination. Future studies should further assess the significance of these intersecting identities on self-reported discrimination. This knowledge could improve ED-based interventions, policies, and services for PWUD.
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Affiliation(s)
- Shayla Nolen
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Taneisha Wilson
- Department of Emergency Medicine, Warren Alpert Medical School of Brown University, Providence, RI 02903, USA
| | - Brendan P. Jacka
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Yu Li
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Francesca L. Beaudoin
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
| | - Brandon D.L. Marshall
- Department of Epidemiology, Brown University School of Public Health, 121 South Main St, Box G-S-121-2, Providence, RI 02912, USA
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Canham SL, Rose JN, Weldrick R, Siantz E, Casucci T, McFarland MM. Understanding discrimination towards persons experiencing homelessness: A scoping review protocol. BMJ Open 2022; 12:e066522. [PMID: 36521892 PMCID: PMC9756145 DOI: 10.1136/bmjopen-2022-066522] [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: 07/11/2022] [Accepted: 12/07/2022] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION Given the increasing rates of homelessness in recent years, there is an urgent need to address the ongoing discrimination and societal disinterest in preventing, reducing and ending homelessness. There is no systematic review of experiences of stigma and discrimination among persons experiencing homelessness or interventions to combat this discrimination. The objective for the proposed study is to identify ways in which persons experiencing homelessness have been stigmatised and discriminated against, the results of these experiences, and interventions to reduce stigma and discrimination towards persons experiencing homelessness. METHODS AND ANALYSIS We are conducting a scoping review with guidance from the JBI Manual for Evidence Synthesis and Arksey and O'Malley's framework. From 15 to 19 July 2022, we searched the following databases from our institutional licensed years of coverage: Medline, Embase, CINAHL Complete, Academic Search Ultimate, APA PsycINFO, Science Citation Index Expanded, Social Sciences Citation Index, Arts & Humanities Citation Index, Emerging Sources Citation Index, Left, PAIS International, PILOTS, Psychology & Behavioral Sciences Collection, Sociological Abstracts, and Dissertations and Theses Global. Two independent reviewers are screening study titles/abstracts and will independently screen the full texts. Study inclusion criteria include any study type reporting primary findings of English-language research on non-refugee persons experiencing homelessness in any type of setting or service worldwide. Three reviewers will then chart data of our included studies. Data will be extracted and organised into categories and subthemes in tabular form. To understand the validity of the scoping review findings in the local context and to gather additional perspectives on the topic, we will conduct an 'expert consultation' workshop. ETHICS AND DISSEMINATION This study has ethics approval from the University of Utah Institutional Review Board. Review findings will be disseminated through a peer-reviewed journal and at conferences. We plan to preregister this protocol with Open Science Framework.
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Affiliation(s)
- Sarah L Canham
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
- Department of City and Metropolitan Planning, The University of Utah, Salt Lake City, Utah, USA
| | - Jeffrey N Rose
- Department of Parks, Recreation, and Tourism, College of Health, University of Utah, Salt Lake City, Utah, USA
| | - Rachel Weldrick
- Department of Gerontology, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Elizabeth Siantz
- College of Social Work, University of Utah, Salt Lake City, Utah, USA
| | - Tallie Casucci
- J. Willard Marriott Library, University of Utah, Salt Lake City, Utah, USA
| | - Mary M McFarland
- Eccles Health Sciences Library, University of Utah, Salt Lake City, Utah, USA
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Darby A, Cleveland Manchanda EC, Janeway H, Samra S, Hicks MN, Long R, Gipson KA, Chary AN, Adjei BA, Khanna K, Pierce A, Kaltiso SAO, Spadafore S, Tsai J, Dekker A, Thiessen ME, Foster J, Diaz R, Mizuno M, Schoenfeld E. Race, racism, and antiracism in emergency medicine: A scoping review of the literature and research agenda for the future. Acad Emerg Med 2022; 29:1383-1398. [PMID: 36200540 DOI: 10.1111/acem.14601] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 01/25/2023]
Abstract
OBJECTIVES The objective was to conduct a scoping review of the literature and develop consensus-derived research priorities for future research inquiry in an effort to (1) identify and summarize existing research related to race, racism, and antiracism in emergency medicine (EM) and adjacent fields and (2) set the agenda for EM research in these topic areas. METHODS A scoping review of the literature using PubMed and EMBASE databases, as well as review of citations from included articles, formed the basis for discussions with community stakeholders, who in turn helped to inform and shape the discussion and recommendations of participants in the Society for Academic Emergency Medicine (SAEM) consensus conference. Through electronic surveys and two virtual meetings held in April 2021, consensus was reached on terminology, language, and priority research questions, which were rated on importance or impact (highest, medium, lower) and feasibility or ease of answering (easiest, moderate, difficult). RESULTS A total of 344 articles were identified through the literature search, of which 187 met inclusion criteria; an additional 34 were identified through citation review. Findings of racial inequities in EM and related fields were grouped in 28 topic areas, from which emerged 44 key research questions. A dearth of evidence for interventions to address manifestations of racism in EM was noted throughout. CONCLUSIONS Evidence of racism in EM emerged in nearly every facet of our literature. Key research priorities identified through consensus processes provide a roadmap for addressing and eliminating racism and other systems of oppression in EM.
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Affiliation(s)
- Anna Darby
- Department of Emergency Medicine, Los Angeles County and University of Southern California Medical Center, Los Angeles, California, USA
| | | | - Hannah Janeway
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Shamsher Samra
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Marquita Norman Hicks
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Ruby Long
- Department of Emergency Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA
| | - Katrina A Gipson
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anita N Chary
- Department of Emergency Medicine, Baylor College of Medicine, Houston, Texas, USA
| | - Brenda A Adjei
- National Cancer Institute Division of Cancer Control and Population Sciences, Bethesda, Maryland, USA
| | - Kajal Khanna
- Department of Emergency Medicine, Stanford University School of Medicine, Palo Alto, California, USA
| | - Ava Pierce
- Department of Emergency Medicine, University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Sheri-Ann O Kaltiso
- Department of Emergency Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sophia Spadafore
- Department of Emergency Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jennifer Tsai
- Department of Emergency Medicine, Yale University School of Medicine, New Haven, Connecticut, USA
| | - Annette Dekker
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Molly E Thiessen
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver, Colorado, USA
| | - Jordan Foster
- Department of Emergency Medicine, Columbia University Medical Center, New York, New York, USA
| | - Rose Diaz
- Department of EM, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, California, USA
| | - Mikaela Mizuno
- University of California, Riverside School of Medicine, Riverside, California, USA
| | - Elizabeth Schoenfeld
- Department of Emergency Medicine, University of Massachusetts Medical School-Baystate, Springfield, Massachusetts, USA
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11
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Kerman N, Wang R, Aubry T, Distasio J, Gaetz S, Hwang SW, Latimer E, O'Grady B, Schwan K, Somers JM, Stergiopoulos V, Kidd SA. Shelter Bans Among People Experiencing Homelessness: an Exploratory Study of Predictors in Two Large Canadian Datasets. J Urban Health 2022; 99:842-854. [PMID: 36070045 PMCID: PMC9561502 DOI: 10.1007/s11524-022-00680-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/05/2022] [Indexed: 10/14/2022]
Abstract
Emergency shelters are a core component of homeless service systems that address immediate basic needs. Service bans, which refer to temporary or permanent disallowances from a program or organization, are an underresearched phenomenon that can leave people experiencing homelessness without needed supports. This exploratory study examined the factors associated with shelter bans among people experiencing homelessness using secondary data from two Canadian studies: (1) a multisite randomized controlled trial of Housing First (At Home/Chez Soi Demonstration Project) and (2) a cross-sectional survey of youth experiencing homelessness across Canada (2019 Without a Home-National Youth Homelessness Survey). The two datasets were analyzed separately using logistic regression models with similar predictors to maximize the comparability of the results. Participants who experienced homelessness at an earlier age and had recent criminal justice system involvement were more likely to have shelter bans in both datasets. Impaired impulse control, more chronic medical conditions and living in Toronto were associated with increased likelihood of shelter bans in the At Home/Chez Soi dataset, whereas more adverse childhood experiences, physical violence victimization, engagement in survival sex behaviours and longer current episodes of homelessness were significant predictors of bans in the Without A Home dataset. Overall, the findings suggest that victimization and criminalization during homelessness may increase the risk of shelter loss from bans and further exclusion. The observed regional differences also highlight the potential limits of individual-level predictors. Further research is needed on shelter ban outcomes, as well as how capacity limits and organizational policies affect banning decisions.
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Affiliation(s)
- Nick Kerman
- Centre for Addiction and Mental Health, Toronto, ON, Canada.
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Tim Aubry
- School of Psychology and Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
| | - Jino Distasio
- Department of Geography, University of Winnipeg, Winnipeg, MB, Canada
| | - Stephen Gaetz
- Canadian Observatory on Homelessness and Faculty of Education, York University, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Eric Latimer
- Douglas Research Centre and Department of Psychiatry, McGill University, Montreal, QC, Canada
| | - Bill O'Grady
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Kaitlin Schwan
- Women's National Housing & Homelessness Network, Toronto, ON, Canada
| | - Julian M Somers
- Centre for Applied Research in Mental Health and Addiction, Vancouver, BC, Canada
- Simon Fraser University, Burnaby, BC, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Sean A Kidd
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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12
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Grudniewicz A, Peckham A, Rudoler D, Lavergne MR, Ashcroft R, Corace K, Kaluzienski M, Kaoser R, Langford L, McCracken R, Norris WC, O'Riordan A, Patrick K, Peterson S, Randall E, Rayner J, Schütz CG, Sunderji N, Thai H, Kurdyak P. Primary care for individuals with serious mental illness (PriSMI): protocol for a convergent mixed methods study. BMJ Open 2022; 12:e065084. [PMID: 36127095 PMCID: PMC9490567 DOI: 10.1136/bmjopen-2022-065084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
INTRODUCTION People with serious mental illness (SMI) have poor health outcomes, in part because of inequitable access to quality health services. Primary care is well suited to coordinate and manage care for this population; however, providers may feel ill-equipped to do so and patients may not have the support and resources required to coordinate their care. We lack a strong understanding of prevention and management of chronic disease in primary care among people with SMI as well as the context-specific barriers that exist at the patient, provider and system levels. This mixed methods study will answer three research questions: (1) How do primary care services received by people living with SMI differ from those received by the general population? (2) What are the experiences of people with SMI in accessing and receiving chronic disease prevention and management in primary care? (3) What are the experiences of primary care providers in caring for individuals with SMI? METHODS AND ANALYSIS We will conduct a concurrent mixed methods study in Ontario and British Columbia, Canada, including quantitative analyses of linked administrative data and in-depth qualitative interviews with people living with SMI and primary care providers. By comparing across two provinces, each with varying degrees of mental health service investment and different primary care models, results will shed light on individual and system-level factors that facilitate or impede quality preventive and chronic disease care for people with SMI in the primary care setting. ETHICS AND DISSEMINATION This study was approved by the University of Ottawa Research Ethics Board and partner institutions. An integrated knowledge translation approach brings together researchers, providers, policymakers, decision-makers, patient and caregiver partners and knowledge users. Working with this team, we will develop policy-relevant recommendations for improvements to primary care systems that will better support providers and reduce health inequities.
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Affiliation(s)
- Agnes Grudniewicz
- Telfer School of Management, University of Ottawa, Ottawa, Ontario, Canada
| | - Allie Peckham
- Edson College of Nursing and Health Innovation, Arizona State University, Tempe, Arizona, USA
| | - David Rudoler
- Faculty of Health Sciences, Ontario Tech University, Oshawa, Ontario, Canada
- Ontario Shores Centre for Mental Health Sciences, Whitby, Ontario, Canada
| | - M Ruth Lavergne
- Department of Family Medicine, Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Rachelle Ashcroft
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, Ontario, Canada
| | - Kimberly Corace
- Substance Use and Concurrent Disorders Program, The Royal, Ottawa, Ontario, Canada
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Mark Kaluzienski
- Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Department of Mental Health, The Ottawa Hospital, Ottawa, Ontario, Canada
| | - Ridhwana Kaoser
- Faculty of Health Sciences, Simon Fraser University, Vancouver, British Columbia, Canada
| | - Lucie Langford
- Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Rita McCracken
- Department of Family Practice, The University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Anne O'Riordan
- Patient and Family Centred Care, Kingston Health Sciences Centre, Kingston, Ontario, Canada
| | - Kevin Patrick
- Client and Family Relations, The Royal, Ottawa, Ontario, Canada
| | - Sandra Peterson
- Centre for Health Services and Policy Research, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Ellen Randall
- School of Population and Public Health, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Jennifer Rayner
- Research and Evaluation Department, Alliance for Healthier Communities, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Christian G Schütz
- Department of Psychiatry, The University of British Columbia, Vancouver, British Columbia, Canada
- BC Mental Health and Substance Use Service, Provincial Health Services Authority, Vancouver, British Columbia, Canada
| | - Nadiya Sunderji
- Waypoint Research Institute, Penetanguishene, Ontario, Canada
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Helen Thai
- Department of Psychology, McGill University, Montreal, Québec, Canada
| | - Paul Kurdyak
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
- Centre for Addiction and Mental Health, Toronto, Ontario, Canada
- ICES, Toronto, Ontario, Canada
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13
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Del Buono BC, Salhi BA, Kimmel AE, Santen SA, Jarrell KL, White MH, Brown CK, Moll JL. Prioritizing homelessness in emergency medicine education: A concept paper. AEM EDUCATION AND TRAINING 2022; 6:S85-S92. [PMID: 35774356 PMCID: PMC9222893 DOI: 10.1002/aet2.10753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 03/03/2022] [Accepted: 03/25/2022] [Indexed: 06/15/2023]
Abstract
Patients experiencing homelessness visit the emergency department (ED) often and have worse clinical outcomes. Caring for this patient population is complex, challenging, and resource-intensive. Emergency medicine (EM) education is lacking in formal curricula on the topic of homelessness, despite benefits for resident morale and patient care. Our goals were to identify a gap in EM education and training of the intersection of housing and health and propose educational topics and teaching methods to be included in residency curricula. Methodology was based on the development of a didactic session at the 2021 SAEM Annual Meeting. A needs assessment was performed through a review of medical education literature, a national survey of EM residency curricula, the individual curricula utilized by respective team members, and perspective from the team's own individual experiences with teaching about homelessness. Topics presented were chosen through discussion between the authors and determined to be common and relevant and cover a broad spectrum of content. The four presented topics included the intersection of COVID-19 and housing, the impact of LGBTQIA+ status on homelessness, housing status related to health system utilization and health outcomes, and housing inequity as a means of perpetuating structural racism. Suggestions for education of these topics included case-based learning, journal clubs, simulation, collaboration with social work, quality improvement projects, and engagement with community leaders. The ED is uniquely positioned to encounter the impacts of homelessness on health. Emergency physicians should be prepared to effectively care for these patients with complex social needs. Structured learning on this topic would benefit EM resident growth and lead to better patient care through improved screening, recognition of risk factors, and use of social resources.
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Affiliation(s)
- Benedict C. Del Buono
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Bisan A. Salhi
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Alexis E. Kimmel
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Sally A. Santen
- Virginia Commonwealth University School of MedicineProfessor, Emergency Medicine and Medical EducationUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Kelli L. Jarrell
- Department of Emergency MedicineUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
| | - Melissa H. White
- Department of Emergency MedicineEmory University School of MedicineAtlantaGeorgiaUSA
| | - Christopher K. Brown
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
| | - Joel L. Moll
- Department of Emergency MedicineVirginia Commonwealth University School of MedicineRichmondVirginiaUSA
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14
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Ehlke SJ, Cohn AM, Boozary LK, Alexander AC, Waring JJC, Businelle MS, Kendzor DE. Discrimination, Substance Use, and Mental Health among Sexual and Gender Minority Adults Accessing Day Shelter Services. Subst Use Misuse 2022; 57:1237-1247. [PMID: 35603487 PMCID: PMC10428822 DOI: 10.1080/10826084.2022.2076874] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Sexual and gender minority (SGM) adults are overrepresented in the population of individuals experiencing homelessness, and high rates of substance use are common in this group. Plausibly, poor mental health and discrimination may contribute to substance use among SGM adults experiencing homelessness. This study described participant characteristics, and the interrelations among sociodemographic variables, substance use, mental health, and discrimination experiences among 87 SGM adults seeking services at a day shelter in Oklahoma City, OK. Discrimination experiences were characterized by race (White vs. non-White), sex (female vs. male), sexual identity (heterosexual vs. sexual minority), and gender identity (gender conforming vs. gender minority). METHODS Participants reported their past 30-day tobacco (cigarette/cigarillos, alternative tobacco products [ATP]), alcohol, and marijuana use, as well as everyday and lifetime major discrimination experiences, substance use problems, depression, anxiety, and post-traumatic stress disorder (PTSD). Independent samples t-tests examined differences in discrimination based on substance use and mental health. RESULTS Participants had high rates of tobacco and marijuana use, substance use problems, depression, anxiety, and PTSD. Over 80% reported experiencing everyday or lifetime major discrimination. Depression and PTSD were associated with ATP use, and anxiety was associated with alcohol use. All mental health variables were associated with substance use problems and everyday discrimination. Depression was associated with lifetime major discrimination. CONCLUSIONS SGM adults accessing shelter services frequently experienced discrimination and poor mental health, and substance use was common. Future research should examine the causal impact of discrimination on mental health and substance use among SGM adults experiencing homelessness.
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Affiliation(s)
- Sarah J. Ehlke
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Amy M. Cohn
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Pediatrics, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Laili K. Boozary
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Psychology, Cellular and Behavioral Neurobiology, The University of Oklahoma, Norman, OK
| | - Adam C. Alexander
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Joseph J. C. Waring
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
| | - Michael S. Businelle
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Darla E. Kendzor
- TSET Health Promotion Research Center, Stephenson Cancer Center, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma, USA
- Department of Family and Preventive Medicine, The University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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15
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Flores J, Emory K, Santos X, Mashford-Pringle A, Barahona-Lopez K, Bozinovic K, Adams J, Chen C, Zuo Y, Nguyen D. "I Think the Mental Part Is the Biggest Factor": An Exploratory Qualitative Study of COVID-19 and Its Negative Effects on Indigenous Women in Toronto, Canada. FRONTIERS IN SOCIOLOGY 2022; 7:790397. [PMID: 35586263 PMCID: PMC9108416 DOI: 10.3389/fsoc.2022.790397] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 03/17/2022] [Indexed: 06/15/2023]
Abstract
This article explores the unique and understudied experiences of Indigenous women living in Toronto, Canada during the first year of the COVID-19 pandemic. The purpose of this study is to better document the impacts of COVID-19 on the mental health and wellbeing of Indigenous women in Toronto, Canada to better understand unmet needs, as well as lay the groundwork for more targeted research and potential interventions based on these needs. Using in-depth semi-structured interviews with thirteen Indigenous women, we shed light on the negative effects this pandemic has had on this population. We find that COVID-19 has negatively affected people's mental health, substance use and access to health services. This research speaks to the growing body of work that discusses the harmful effects of COVID-19 generally and how this pandemic has specifically affected Indigenous peoples.
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Affiliation(s)
- Jerry Flores
- Department of Sociology, University of Toronto, Mississauga, ON, Canada
| | - Kristen Emory
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Xuan Santos
- Department of Sociology and Criminology and Justice Studies, California State University San Marcos, San Marcos, TX, United States
| | | | - Kati Barahona-Lopez
- Department of Sociology, University of Wisconsin-Eau Claire, Eau Claire, WI, United States
| | - Keston Bozinovic
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Jennifer Adams
- School of Public Health, San Diego State University, San Diego, CA, United States
| | - Coco Chen
- Department of Sociology, University of Toronto, Mississauga, ON, Canada
| | - Yandy Zuo
- Department of Sociology, University of Toronto, Mississauga, ON, Canada
| | - Diana Nguyen
- School of Public Health, San Diego State University, San Diego, CA, United States
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16
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Essien UR, McCabe ME, Kershaw KN, Youmans QR, Fine MJ, Yancy CW, Khan SS. Association Between Neighborhood-Level Poverty and Incident Atrial Fibrillation: a Retrospective Cohort Study. J Gen Intern Med 2022; 37:1436-1443. [PMID: 34240286 PMCID: PMC9086074 DOI: 10.1007/s11606-021-06976-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 06/09/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND Atrial fibrillation (AF) is a leading cause of cardiovascular morbidity and mortality. While neighborhood-level factors, such as poverty, have been related to prevalence of AF risk factors, the association between neighborhood poverty and incident AF has been limited. OBJECTIVE Using a large cohort from a health system serving the greater Chicago area, we sought to determine the association between neighborhood-level poverty and incident AF. DESIGN Retrospective cohort study. PARTICIPANTS Adults, aged 30 to 80 years, without baseline cardiovascular disease from January 1, 2005, to December 31, 2018. MAIN MEASURES We geocoded and matched residential addresses of all eligible patients to census-level poverty estimates from the American Community Survey. Neighborhood-level poverty (low, intermediate, and high) was defined as the proportion of residents in the census tract living below the federal poverty threshold. We used generalized linear mixed effects models with a logit link function to examine the association between neighborhood poverty and incident AF, adjusting for patient demographic and clinical AF risk factors. KEY RESULTS Among 28,858 in the cohort, patients in the high poverty group were more often non-Hispanic Black or Hispanic and had higher rates of AF risk factors. Over 5 years of follow-up, 971 (3.4%) patients developed incident AF. Of these, 502 (51.7%) were in the low poverty, 327 (33.7%) in the intermediate poverty, and 142 (14.6%) in the high poverty group. The adjusted odds ratio (aOR) of AF was higher for the intermediate poverty compared with that for the low poverty group (aOR 1.23 [95% CI 1.01-1.48]). The point estimate for the aOR of AF incidence was similar, but not statistically significant, for the high poverty compared with the low poverty group (aOR 1.25 [95% CI 0.98-1.59]). CONCLUSION In adults without baseline cardiovascular disease managed in a large, integrated health system, intermediate neighborhood poverty was significantly associated with incident AF. Understanding neighborhood-level drivers of AF disparities will help achieve equitable care.
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Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA. .,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.
| | - Megan E McCabe
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kiarri N Kershaw
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Quentin R Youmans
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Michael J Fine
- Division of General Internal Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, PA, USA
| | - Clyde W Yancy
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Sadiya S Khan
- Division of Cardiology, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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17
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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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18
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Lei L, Guo S. Beyond multiculturalism: revisioning a model of pandemic anti-racism education in post-Covid-19 Canada. INTERNATIONAL JOURNAL OF ANTHROPOLOGY AND ETHNOLOGY 2022; 6:1. [PMID: 35106365 PMCID: PMC8795931 DOI: 10.1186/s41257-021-00060-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Accepted: 12/26/2021] [Indexed: 05/31/2023] Open
Abstract
Canada was the first country in the world to establish multiculturalism as its official policy for the governance of diversity. Canadian multiculturalism has gained much popularity in political and public discourses in the past 50 years, and it has also received no less criticism as to its effectiveness in addressing issues of racism. There have also been ambiguities over the meaning and intention of multiculturalism, leading to divergent understandings of multiculturalism as an ideal of inclusion and equity, on the one hand, and a mere political rhetoric, on the other. On the occasion of celebrating the 50th anniversary of Canada’s official multiculturalism policy, this article re-visits Canada’s multiculturalism by reviewing its history and ethos and critically examining its actual effects as manifested during the Covid-19 pandemic in Canada. The rise of anti-Asian racism, anti-Black racism, and anti-Indigenous racism incidents in the pandemic reveals that multiculturalism has in effect, sustained a racist and unequal society of Canada with racism entrenched in its history and ingrained in every aspect of its social structure. Multiculturalism tolerates cultural difference but does not challenge an unjust society premised on white supremacy. The anti-racism movement mobilized by racialized communities in Canada indicates that multiculturalism has failed to respond to racialized communities’ pressing demand for social change and action for social justice. The article concludes with a proposed alternative framework to multiculturalism, that is, pandemic anti-racism education model, to centre the issue of race and racism in an action-oriented, inclusive, and empowering approach toward a future of a just society.
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19
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Xiong M, Johnson W. Perceived discrimination and relative deprivation in Chinese migrant adolescents: the mediating effect of locus of control and moderating effect of duration since migration. Child Adolesc Psychiatry Ment Health 2022; 16:1. [PMID: 34998401 PMCID: PMC8742458 DOI: 10.1186/s13034-021-00436-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Accepted: 12/27/2021] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Associations between perceived discrimination and relative deprivation have been observed among both general and migrant populations. However, it is unclear how, and under what conditions, perceived discrimination relates to relative deprivation, a subjective cognition and affective experience in which individuals or groups perceive themselves as disadvantaged, compared to their peers. Therefore, this study aimed to construct a moderated mediation model to examine the roles of locus of control and duration since migration in the relationship between perceived discrimination and relative deprivation among Chinese rural-to-urban migrant adolescents. METHODS We conducted a cross-sectional study using a convenience sampling method in three coastal cities in southeast China. We recruited 625 Chinese rural-to-urban migrant adolescents, who completed a battery of questionnaires assessing perceived discrimination, relative deprivation, locus of control, and demographic variables. Regression-based statistical mediation and moderation were conducted using the PROCESS macro for SPSS. RESULTS After controlling for sex and age, perceived discrimination was positively associated with migrant adolescents' relative deprivation, and external locus of control partially mediated this connection. Furthermore, the mediating effect was moderated by the duration of the migration. In relatively recently migrated adolescents, perceived discrimination was significantly related to relative deprivation through a greater external locus of control; however, this indirect association was not significant for adolescents with long-term migratory duration. CONCLUSION The results of our analysis expand our understanding of the link between perceived discrimination and relative deprivation. Moreover, these findings may provide practical guidance for interventions among Chinese rural-to-urban migrant adolescents to raise their social status and improve their mental health by addressing the macro-social psychological causes of relative deprivation.
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Affiliation(s)
- Meng Xiong
- Department of Psychology, Yangtze University, Jingzhou, 434023, Hubei, China. .,Department of Psychology, University of Edinburgh, Edinburgh, UK.
| | - Wendy Johnson
- grid.4305.20000 0004 1936 7988Department of Psychology, University of Edinburgh, Edinburgh, UK
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20
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A longitudinal cross-sectional analysis of substance use treatment trends for individuals experiencing homelessness, criminal justice involvement, both, or neither - United States, 2006-2018. LANCET REGIONAL HEALTH. AMERICAS 2022; 7:100174. [PMID: 35382494 PMCID: PMC8979492 DOI: 10.1016/j.lana.2021.100174] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Background Individuals experiencing homelessness or criminal justice involvement (CJI) have higher rates of substance use than the general public. Despite documented barriers to accessing treatment, few studies have compared substance use treatment patterns between these groups. Methods This paper uses data from the Treatment Episode Dataset-Admissions between 2006 to 2018 to describe characteristics and trends in substance use treatment admissions indicating homelessness (n=2,524,413), CJI (4,764,750), both (509,902), or neither (8,950,797) in the United States. We used multivariable logistic regression to examine trends independent of demographic differences between groups. Findings Between 2006 and 2018, the proportion of treatment admissions related to heroin increased across all groups. Methamphetamine-related admissions rose substantially for individuals experiencing homelessness, CJI, or both. By 2018, 27·8% (95% CI: 27·4-28·2%) of admissions for individuals experiencing both were methamphetamine-related and 16·7% (95% CI: 16·3-17·0%) were heroin-related. Conversely, among individuals experiencing neither, 7·5% (95% CI: 7·4-7·5%) of admissions were methamphetamine-related and 33·6% (95% CI: 33·4-33·7%) were heroin-related. Individuals experiencing both homelessness and CJI received lower rates of medications for opioid use disorder (OUD) (8·3%; 95% CI: 8·2-8·3%) compared to individuals experiencing neither (36·4%; 95% CI: 36·4-36·4%). Interpretation Community treatment facilities should be supported to provide medications for OUD and accommodate rising rates of methamphetamine and polysubstance-related treatment admissions in populations experiencing complex social drivers of health such as homelessness, CJI, or both. Funding National Institute of General Medical Sciences and National Institute of Diabetes and Digestive and Kidney Diseases.
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21
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Reid N, Mason J, Kurdyak P, Nisenbaum R, de Oliveira C, Hwang S, Stergiopoulos V. Evaluating the Impact of a Critical Time Intervention Adaptation on Health Care Utilization among Homeless Adults with Mental Health Needs in a Large Urban Center. CANADIAN JOURNAL OF PSYCHIATRY. REVUE CANADIENNE DE PSYCHIATRIE 2022; 67:57-66. [PMID: 33611924 PMCID: PMC8811242 DOI: 10.1177/0706743721996114] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE This study evaluated the impact of a critical time intervention (CTI) adaptation on health care utilization outcomes among adults experiencing homelessness and mental health needs in a large urban center. METHODS Provincial population-based administrative data from Ontario, Canada, were used in a pre-post design for a cohort of 197 individuals who received the intervention between January 2013 and May 2014 and were matched to a cohort of adults experiencing homelessness who did not receive the intervention over the same time period. Changes in health care utilization outcomes in the year pre- and postintervention were evaluated using generalized estimating equations, and post hoc analyses evaluated differences between groups. RESULTS Pre-post analyses revealed statistically significant changes in health care utilization patterns among intervention recipients, including reduced inpatient service use and increased outpatient service use in the year following the intervention compared to the year prior. However, the matched cohort analysis found nonsignificant differences in health service use changes between a subgroup of intervention recipients and their matched counterparts. CONCLUSIONS An adapted CTI model was associated with changes in health care utilization among people experiencing homelessness and mental health needs. However, changes were not different from those observed in a matched cohort. Rigorous study designs with adequate samples are needed to examine the effectiveness of CTI and local adaptations in diverse health care contexts.
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Affiliation(s)
- Nadine Reid
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Joyce Mason
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada
| | - Paul Kurdyak
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rosane Nisenbaum
- Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Claire de Oliveira
- Mental Health and Addictions Research Program, ICES, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Institute for Mental Health Policy Research, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Centre for Health Economics, Hull York Medical School, University of York, York, UK
| | - Stephen Hwang
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.,Populations and Public Health Research Program, ICES, Toronto, Ontario, Canada
| | - Vicky Stergiopoulos
- 7978Centre for Addiction and Mental Health, Toronto, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.,Li Ka Shing Knowledge Institute, 10071St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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22
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Homelessness in pregnancy: perinatal outcomes. J Perinatol 2021; 41:2742-2748. [PMID: 34404925 PMCID: PMC9507167 DOI: 10.1038/s41372-021-01187-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/03/2021] [Accepted: 08/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Investigate the association between maternal homelessness at the time of delivery and perinatal outcomes, with a focus on neonatal health outcomes. STUDY DESIGN Population-based cohort using California's statewide database included 1,520,253 women with linked birth and maternal discharge data, 2008-2012. Multivariable analysis assessed homelessness at time of delivery on perinatal outcomes, preterm delivery, and neonatal intensive care unit admission. RESULT A total of 672 women (0.05%) were homeless at the time of delivery. Homelessness was associated with premature delivery at multiple gestational age cutoffs (34w0d-36w6d; 32w0d-33w6d; 28w0d-31w6d; <28w0d) (range of aORs:1.62-2.19), and neonatal intensive care unit admission (aOR = 1.66, 95% CI:1.31-2.09). Among term infants, homelessness remained associated with increased odds of neonatal intensive care unit admission (aOR = 1.84, 95% CI:1.34-2.53), low birthweight (aOR = 1.99, 95% CI:1.36-2.90), neonatal abstinence syndrome (aOR = 2.13, 95% CI:1.35-2.53), hypoxic-ischemic encephalopathy (aOR = 14.38, 95% CI:3.90-53.01), and necrotizing enterocolitis (aOR = 14.94, 95% CI:2.68-83.20). CONCLUSION Homelessness in pregnancy was associated with adverse perinatal outcomes including increased odds of preterm delivery across all gestational ages, and increased risk of neonatal intensive care unit admission and low birth weight independent of preterm delivery.
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23
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Bulgarelli AF, Dos Santos CM, Rech RS, Baumgarten A, Goulart BN. Tooth Loss Condition and Social Discrimination in Brazilian Healthcare Services. Int J Public Health 2021; 66:586597. [PMID: 34744559 PMCID: PMC8565290 DOI: 10.3389/ijph.2021.586597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 02/24/2021] [Indexed: 01/16/2023] Open
Abstract
Objective: To explore factors associated with social discrimination against users of health services regarding dental aesthetic conditions. Methods: Based on a Brazilian National Survey, multivariate Poisson regressions with robust variance were used to explore the association of outcome discrimination related to different motivations in health services and exposure to sociodemographic and dental variables. Effect modification by complete prosthesis wearing was assessed. Results: Among the 60,200 people interviewed, 11.5% reported being discriminated against in health services. For women, a higher prevalence of discrimination was found among those in the age group of 30–44 years. For both sexes, discrimination was associated with black and brown skin color. Regarding dental characteristics, the higher the tooth loss was, the higher the prevalence of discrimination; however, complete prosthesis wearing presented as a protective factor. Social discrimination was the major motivation for reported discrimination and presented higher prevalence in edentulous individuals who did not wear prosthesis. Conclusion: Dental loss may lead to self-reported discrimination in health care services. The prevalence of discrimination increases when tooth loss increases, and the major reason associated is social discrimination.
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Affiliation(s)
- Alexandre F Bulgarelli
- Graduate Program in Collective Health, Federal University of Rio Grande do Sul, Porto Alegre, Brazil.,Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Camila M Dos Santos
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Rafaela S Rech
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Alexandre Baumgarten
- Department of Preventive and Social Dentistry, Faculty of Dentistry, Federal University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Bárbara N Goulart
- Psychology Institute, Department of health and human communication, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
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24
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Moczygemba LR, Thurman W, Tormey K, Hudzik A, Welton-Arndt L, Kim E. GPS Mobile Health Intervention Among People Experiencing Homelessness: Pre-Post Study. JMIR Mhealth Uhealth 2021; 9:e25553. [PMID: 34730550 PMCID: PMC8600433 DOI: 10.2196/25553] [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] [Received: 11/06/2020] [Revised: 05/27/2021] [Accepted: 08/06/2021] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND People experiencing homelessness are at risk for gaps in care after an emergency department (ED) or hospital visit, which leads to increased use, poor health outcomes, and high health care costs. Most people experiencing homelessness have a mobile phone of some type, which makes mobile health (mHealth) interventions a feasible way to connect a person experiencing homelessness with providers. OBJECTIVE This study aims to investigate the accuracy, acceptability, and preliminary outcomes of a GPS-enabled mHealth (GPS-mHealth) intervention designed to alert community health paramedics when people experiencing homelessness are in the ED or hospital. METHODS This study was a pre-post design with baseline and 4-month postenrollment assessments. People experiencing homelessness, taking at least 2 medications for chronic conditions, scoring at least 10 on the Patient Health Questionnaire-9, and having at least 2 ED or hospital visits in the previous 6 months were eligible. Participants were issued a study smartphone with a GPS app programmed to alert a community health paramedic when a participant entered an ED or hospital. For each alert, community health paramedics followed up via telephone to assess care coordination needs. Participants also received a daily email to assess medication adherence. GPS alerts were compared with ED and hospital data from the local health information exchange (HIE) to assess accuracy. Paired t tests compared scores on the Patient Health Questionnaire-9, Medical Outcomes Study Social Support Survey, and Adherence Starts with Knowledge-12 adherence survey at baseline and exit. Semistructured exit interviews examined the perceptions and benefits of the intervention. RESULTS In total, 30 participants were enrolled; the mean age was 44.1 (SD 9.7) years. Most participants were male (20/30, 67%), White (17/30, 57%), and not working (19/30, 63%). Only 19% (3/16) of the ED or hospital visit alerts aligned with HIE data, mainly because of patients not having the smartphone with them during the visit, the smartphone being off, and gaps in GPS technology. There was a significant difference in depressive symptoms between baseline (mean 16.9, SD 5.8) and exit (mean 12.7, SD 8.2; t19=2.9; P=.009) and a significant difference in adherence barriers between baseline (mean 2.4, SD 1.4) and exit (mean 1.5, SD 1.5; t17=2.47; P=.03). Participants agreed that the app was easy to use (mean 4.4/5, SD 1.0, with 5=strongly agree), and the email helped them remember to take their medications (mean 4.6/5, SD 0.6). Qualitative data indicated that unlimited smartphone access allowed participants to meet social needs and maintain contact with case managers, health care providers, family, and friends. CONCLUSIONS mHealth interventions are acceptable to people experiencing homelessness. HIE data provided more accurate ED and hospital visit information; however, unlimited access to reliable communication provided benefits to participants beyond the study purpose of improving care coordination.
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Affiliation(s)
- Leticia R Moczygemba
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Whitney Thurman
- School of Nursing, University of Texas at Austin, Austin, TX, United States
| | - Kyler Tormey
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Anthony Hudzik
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Lauren Welton-Arndt
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
| | - Elizabeth Kim
- Health Outcomes Division, College of Pharmacy, University of Texas at Austin, Austin, TX, United States
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25
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Abstract
As states move beyond simply managing their homelessness crises to looking for ways to reduce and ultimately end homelessness, broad-scale efforts to prevent homelessness are lacking. Experiences of homelessness are often harmful, traumatic, and costly, making a compelling case for why homelessness prevention should be prioritized. In recent years, countries such as Australia, Finland, and Wales have shifted their focus to prevention, but there remains a conceptual and systematic gap in our collective knowledge about what precisely homelessness prevention is, what policies, programs, and interventions are captured in a homelessness prevention strategy, and how to build a framework for orienting our response to homelessness towards prevention. This article begins to fill that gap by providing a definition and typology of homelessness prevention (THP). Our definition offers a schema to clarify the nature of homelessness prevention and to develop a collective response between various policies and practices that can and should be framed as homelessness prevention. Building off of the public health model of prevention and pre-existing homelessness prevention classification systems, our THP complements the definition by specifying the pragmatic nature of prevention initiatives and the range of sectors, stakeholders, and levels of government required to respond to the causes of homelessness. Our typology is made up of five interrelated elements: structural, systems, early intervention, evictions prevention, and housing stabilization. Each of these elements contains actionable strategies that cut across primary, secondary, and tertiary prevention to ensure that people at various levels of risk have access to the tools and resources necessary to find and maintain safe, appropriate, and suitable housing. Together the definition and THP are useful tools to envision a new way forward in how we respond to homelessness.
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Affiliation(s)
- Erin Dej
- Department of Criminology, Wilfrid Laurier University, 171 Colborne St., Brantford, ON, N3T 6C9, Canada.
| | - Stephen Gaetz
- Faculty of Education, York University, Toronto, ON, Canada.,Canadian Observatory on Homelessness, York University, Toronto, ON, Canada
| | - Kaitlin Schwan
- Canadian Observatory on Homelessness, York University, Toronto, ON, Canada
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26
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D'Souza MS, Mirza NA. Towards Equitable Health Care Access: Community Participatory Research Exploring Unmet Health Care Needs of Homeless Individuals. Can J Nurs Res 2021; 54:451-463. [PMID: 34387510 PMCID: PMC9605994 DOI: 10.1177/08445621211032136] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Community and health services often overlook health care needs of persons experiencing homelessness, which leads to deterioration in health and increased utilization of emergency services. Since homeless people are underrepresented in health service research, little is known about their unmet health care needs, particularly in smaller cities where resources are limited. This community-based participatory research explored the experiences of small-city homeless service users (HSUs) with unmet health care needs and community service providers (CSPs) who work with them to determine barriers to health care access affecting them. Structured interviews were conducted with 65 HSUs and 15 CSPs in interior British Columbia, Canada. These interviews were audio-recorded, and the retrieved data were analyzed thematically. The three themes uncovered included: a lack of access to health care and risk of stigma, a lack of trust and fear of discrimination, and a need for community navigation and social support. The findings indicate that HSUs do not receive equitable care and face challenges in accessing appropriate and timely foot care, which contributes to increased foot-related emergency visits, loss of trust in the health care system, and disabilities due to worsening foot conditions. Various social determinants of health also impact HSUs, such as low socioeconomic status, lack of housing, decreased social support, unhealthy behaviors, and inequitable access to health services. By collaborating with HSUs, community and health services need to develop innovative outreach programs that provide better community resources as the first step toward equitable access to health care.
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Affiliation(s)
| | - Noeman Ahmad Mirza
- Faculty of Nursing, 8637University of Windsor, Toldo Health Education Centre, Windsor, ON, Canada
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27
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Gutwinski S, Schreiter S, Deutscher K, Fazel S. The prevalence of mental disorders among homeless people in high-income countries: An updated systematic review and meta-regression analysis. PLoS Med 2021; 18:e1003750. [PMID: 34424908 PMCID: PMC8423293 DOI: 10.1371/journal.pmed.1003750] [Citation(s) in RCA: 98] [Impact Index Per Article: 32.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Revised: 09/07/2021] [Accepted: 08/02/2021] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Homelessness continues to be a pressing public health concern in many countries, and mental disorders in homeless persons contribute to their high rates of morbidity and mortality. Many primary studies have estimated prevalence rates for mental disorders in homeless individuals. We conducted a systematic review and meta-analysis of studies on the prevalence of any mental disorder and major psychiatric diagnoses in clearly defined homeless populations in any high-income country. METHODS AND FINDINGS We systematically searched for observational studies that estimated prevalence rates of mental disorders in samples of homeless individuals, using Medline, Embase, PsycInfo, and Google Scholar. We updated a previous systematic review and meta-analysis conducted in 2007, and searched until 1 April 2021. Studies were included if they sampled exclusively homeless persons, diagnosed mental disorders by standardized criteria using validated methods, provided point or up to 12-month prevalence rates, and were conducted in high-income countries. We identified 39 publications with a total of 8,049 participants. Study quality was assessed using the JBI critical appraisal tool for prevalence studies and a risk of bias tool. Random effects meta-analyses of prevalence rates were conducted, and heterogeneity was assessed by meta-regression analyses. The mean prevalence of any current mental disorder was estimated at 76.2% (95% CI 64.0% to 86.6%). The most common diagnostic categories were alcohol use disorders, at 36.7% (95% CI 27.7% to 46.2%), and drug use disorders, at 21.7% (95% CI 13.1% to 31.7%), followed by schizophrenia spectrum disorders (12.4% [95% CI 9.5% to 15.7%]) and major depression (12.6% [95% CI 8.0% to 18.2%]). We found substantial heterogeneity in prevalence rates between studies, which was partially explained by sampling method, study location, and the sex distribution of participants. Limitations included lack of information on certain subpopulations (e.g., women and immigrants) and unmet healthcare needs. CONCLUSIONS Public health and policy interventions to improve the health of homeless persons should consider the pattern and extent of psychiatric morbidity. Our findings suggest that the burden of psychiatric morbidity in homeless persons is substantial, and should lead to regular reviews of how healthcare services assess, treat, and follow up homeless people. The high burden of substance use disorders and schizophrenia spectrum disorders need particular attention in service development. This systematic review and meta-analysis has been registered with PROSPERO (CRD42018085216). TRIAL REGISTRATION PROSPERO CRD42018085216.
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Affiliation(s)
- Stefan Gutwinski
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefanie Schreiter
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
- Biomedical Innovation Academy, Berlin Institute of Health, Berlin, Germany
| | - Karl Deutscher
- Department of Psychiatry and Psychotherapy, Charité–Universitätsmedizin Berlin, Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Seena Fazel
- Department of Psychiatry, University of Oxford, Oxford, United Kingdom
- * E-mail:
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28
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Gabrielian S, Jones AL, Hoge AE, deRussy AJ, Kim YI, Montgomery AE, Blosnich JR, Gordon AJ, Gelberg L, Austin EL, Pollio D, Holmes SK, Varley AL, Kertesz SG. Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey. J Prim Care Community Health 2021; 12:2150132721993654. [PMID: 33543675 PMCID: PMC7871055 DOI: 10.1177/2150132721993654] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Objectives: Patients experiencing homelessness (PEH) with serious mental illness (SMI) have poor satisfaction with primary care. We assessed if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs)) provide this population with superior experiences than mainstream primary care and explored whether integrated behavioral health and social services were associated with favorable experiences. Methods: We surveyed VA PEH with SMI (n = 1095) to capture the valence of their primary care experiences in 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs). We surveyed clinicians (n = 52) from 29 H-PACTs to elucidate if their clinics had embedded mental health, addiction, social work, and/or housing services. We counted these services in each H-PACT (0-4) and classified H-PACTs as having high (3-4) versus low (0-2) service integration. We controlled for demographics, housing history, and needs in comparing H-PACT versus mainstream experiences; and experiences in high versus low integration H-PACTs. Results: Among respondents, 969 (91%) had complete data and 626 (62%) were in H-PACTs. After covariate adjustment, compared to mainstream respondents, H-PACT respondents were more likely (P < .01) to report favorable experiences (AORs = 1.7-2.1) and less likely to report unfavorable experiences (AORs = 0.5-0.6) in all 4 domains. Of 29 H-PACTs, 27.6% had high integration. High integration H-PACT respondents were twice as likely as low integration H-PACT respondents to report favorable access/coordination experiences (AOR = 1.7). Conclusions: Homeless-tailored clinics with highly-integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients.
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Affiliation(s)
- Sonya Gabrielian
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Audrey L Jones
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - April E Hoge
- Birmingham VA Medical Center, Birmingham, AL, USA
| | | | - Young-Il Kim
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Ann Elizabeth Montgomery
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - John R Blosnich
- VA Pittsburgh Healthcare System, Pittsburgh, PA, USA.,University of Southern California, Los Angeles, CA, USA
| | - Adam J Gordon
- VA Salt Lake City Health Care System, Salt Lake City, UT, USA.,University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Lillian Gelberg
- VA Greater Los Angeles Health Care System, Los Angeles, CA, USA.,University of California Los Angeles, Los Angeles, CA, USA
| | - Erika L Austin
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Public Health, Birmingham, AL, USA
| | - David Pollio
- University of Alabama at Birmingham College of Letters and Sciences, Birmingham, AL, USA
| | | | | | - Stefan G Kertesz
- Birmingham VA Medical Center, Birmingham, AL, USA.,University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
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29
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Lu T, Guo Z, Li H, Zhang X, Ren Z, Yang W, Wei L, Huang L. Effects of Wise Intervention on Perceived Discrimination Among College Students Returning Home From Wuhan During the COVID-19 Outbreak. Front Psychol 2021; 12:689251. [PMID: 34163414 PMCID: PMC8215144 DOI: 10.3389/fpsyg.2021.689251] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 05/10/2021] [Indexed: 12/23/2022] Open
Abstract
At the beginning of the coronavirus disease 2019 (COVID-19) outbreak, college students returning home from Wuhan, Hubei Province, experienced various degrees of discrimination. This study first investigates perceived discrimination among college students returning home from Wuhan. Then, an experimental method is used to investigate the effectiveness of an intervention designed to reduce the perceived discrimination among those who returned to towns outside of Hubei Province. A total of 63 college students participated in the experiment. In the experimental group (N = 31), a wise intervention based on reading and writing was adopted to intervene in perceived discrimination among the participants. The results showed that the perceived discrimination among students returning from Wuhan to towns outside of Hubei Province was significantly higher than that among students returning to towns within Hubei Province. The wise intervention reduced the perceived discrimination in the experimental group but not in the control group. Further analysis found that perceived social support fully mediated the relationship between the intervention and perceived discrimination. These results provide insights on how the content of intervention (perceived social support) and the form of intervention (wise intervention) can prevent the occurrence of psychological problems in epidemic situations.
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Affiliation(s)
- Ting Lu
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Zihan Guo
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Hao Li
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Xinyu Zhang
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Zhihong Ren
- Key Laboratory of Adolescent Cyberpsychology and Behavior, Key Laboratory of Human Development and Mental Health of Hubei Province, Ministry of Education, School of Psychology at Central China Normal University, Wuhan, China
| | - Weiping Yang
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Liuqing Wei
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
| | - Ling Huang
- Department of Psychology, Faculty of Education, Hubei University, Wuhan, China
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Kertesz SG, deRussy AJ, Kim YI, Hoge AE, Austin EL, Gordon AJ, Gelberg L, Gabrielian SE, Riggs KR, Blosnich JR, Montgomery AE, Holmes SK, Varley AL, Pollio DE, Gundlapalli AV, Jones AL. Comparison of Patient Experience Between Primary Care Settings Tailored for Homeless Clientele and Mainstream Care Settings. Med Care 2021; 59:495-503. [PMID: 33827104 PMCID: PMC8567819 DOI: 10.1097/mlr.0000000000001548] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND More than 1 million Americans receive primary care from federal homeless health care programs yearly. Vulnerabilities that can make care challenging include pain, addiction, psychological distress, and a lack of shelter. Research on the effectiveness of tailoring services for this population is limited. OBJECTIVE The aim was to examine whether homeless-tailored primary care programs offer a superior patient experience compared with nontailored ("mainstream") programs overall, and for highly vulnerable patients. RESEARCH DESIGN National patient survey comparing 26 US Department of Veterans Affairs (VA) Medical Centers' homeless-tailored primary care ("H-PACT"s) to mainstream primary care ("mainstream PACT"s) at the same locations. PARTICIPANTS A total of 5766 homeless-experienced veterans. MEASURES Primary care experience on 4 scales: Patient-Clinician Relationship, Cooperation, Accessibility/Coordination, and Homeless-Specific Needs. Mean scores (range: 1-4) were calculated and dichotomized as unfavorable versus not. We counted key vulnerabilities (chronic pain, unsheltered homelessness, severe psychological distress, and history of overdose, 0-4), and categorized homeless-experienced veterans as having fewer (≤1) and more (≥2) vulnerabilities. RESULTS H-PACTs outscored mainstream PACTs on all scales (all P<0.001). Unfavorable care experiences were more common in mainstream PACTs compared with H-PACTs, with adjusted risk differences of 11.9% (95% CI=6.3-17.4), 12.6% (6.2-19.1), 11.7% (6.0-17.3), and 12.6% (6.2-19.1) for Relationship, Cooperation, Access/Coordination, and Homeless-Specific Needs, respectively. For the Relationship and Cooperation scales, H-PACTs were associated with a greater reduction in unfavorable experience for patients with ≥2 vulnerabilities versus ≤1 (interaction P<0.0001). CONCLUSIONS Organizations that offer primary care for persons experiencing homelessness can improve the primary care experience by tailoring the design and delivery of services.
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Affiliation(s)
- Stefan G. Kertesz
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL 35233
| | - Aerin J. deRussy
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
| | - Young-il Kim
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
| | - April E. Hoge
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
| | - Erika L. Austin
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL 35233
| | - Adam J. Gordon
- VA Salt Lake City Health Care System, 500 Foothill Dr, Salt Lake City, UT 84148
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Lillian Gelberg
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073
- University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Sonya E. Gabrielian
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073
- University of California Los Angeles, 10833 Le Conte Ave, Los Angeles, CA 90095
| | - Kevin R. Riggs
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
| | - John R. Blosnich
- University of Southern California, Los Angeles CA 90089
- VA Pittsburgh Healthcare System, 4100 Allequippa St, Pittsburgh, PA 15219
| | - Ann Elizabeth Montgomery
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Public Health, 1665 University Blvd, Birmingham, AL 35233
| | - Sally K. Holmes
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
| | - Allyson L. Varley
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham School of Medicine, 1670 University Blvd, Birmingham, AL 35233
| | - David E. Pollio
- Birmingham Veterans Affairs Medical Center, 700 19th Street S., Birmingham, AL 35233
- University of Alabama at Birmingham College of Arts and Sciences, 1720 2 Ave. S., Birmingham AL 35294
| | - Adi V. Gundlapalli
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
| | - Audrey L. Jones
- University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132
- VA Greater Los Angeles Healthcare System, 11301 Wilshire Blvd, Los Angeles, CA 90073
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Amin M, Schumacher C, Bohlouli B. Perceived social support and discrimination and oral health behaviors in adolescents. Clin Exp Dent Res 2021; 7:1183-1189. [PMID: 34014043 PMCID: PMC8638274 DOI: 10.1002/cre2.443] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Revised: 05/05/2021] [Accepted: 05/05/2021] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The aims of this study were to examine the associations between perceived social support and oral health behaviors among adolescents and if this perception had a protective effect against the influence of perceived racial discrimination on oral health behaviors in this population. MATERIAL AND METHODS Participants of this cross-sectional study were adolescents aged 12-18 years recruited from University dental clinic. They completed a questionnaire comprising three sections: demographics (14 items), oral health behaviors (6 items), and validated Personal Resource Questionnaire (25 items). Perceived discrimination was evaluated by a question asking if the adolescent had ever experienced discrimination based on their race. RESULTS Of 252 participants, mean (SD) age of 14 (1.8) years, 60% were girls, 56% were self-identified as White, and 81% were born in Canada. Discrimination was reported by 21%. Frequency of toothbrushing and self-rated oral health were significantly associated with increased levels of perceived social support. Sugar consumption was significantly different for participants with and without perceived racial discrimination (p-value = 0.002). Perceived social support did not act as a buffer against perceived racial discrimination for sugar consumption (OR = 1.00; 95% CI: 0.98-1.01). CONCLUSIONS Adolescents' perceived social support affected some aspects of their oral health but did not moderate the influence of perceived racial discrimination.
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Affiliation(s)
- Maryam Amin
- Division of Pediatric Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | | | - Babak Bohlouli
- Department of Emergency Medicine, University of Alberta, Edmonton, Alberta, Canada
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Clinical Presentation and Outcome of Patients Experiencing Homelessness Presenting with ST-Elevation Myocardial Infarction. Can J Cardiol 2021; 37:1555-1561. [PMID: 34004281 DOI: 10.1016/j.cjca.2021.05.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/22/2021] [Accepted: 05/07/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cardiovascular disease remains a major cause of morbidity and mortality among homeless adults. Despite major advances in the management of ST elevation myocardial infarction (STEMI), limited information is available for the clinical presentation and management and outcome of STEMI among patients experiencing homelessness (PEH). METHODS All patients presenting with STEMI between January 1, 2008 and December 31, 2017 at a PCI capable STEMI network inner city hospital comprised the study population. Baseline characteristics, homeless status and clinical outcomes were determined from hospital records. The primary outcome of in-hospital mortality was compared between PEH and non-homeless patients using a log-binomial regression model with propensity score adjusted standardized mortality ratio weighting (SMRW). RESULTS Among 2854 STEMI admissions during the study period, 75 (2.6%) patients were identified as PEH. The PEH group was younger (58 vs. 63 years, p=0.0002), predominantly male (96% vs. 76%, p<0.0001) and more likely to present with cardiogenic shock or cardiac arrest (17% vs. 6%, p=0.0004) compared to non-homeless cohort. The in-hospital mortality remained significantly higher among PEH (RR: 3.83; 95% CI: 1.27, 11.60) after propensity score adjustment. CONCLUSIONS Despite universal health care and contemporary STEMI management, PEH presenting with STEMI experienced a 4-fold higher in-hospital mortality compared to non-homeless cohort. Targeted interventions are needed to improve STEMI outcomes in this high risk group.
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Lachaud J, Mejia-Lancheros C, Liu M, Wang R, Nisenbaum R, Stergiopoulos V, Hwang SW, O'Campo P. Severe Psychopathology and Substance Use Disorder Modify the Association Between Housing Trajectories and Food Security Among Homeless Adults. Front Nutr 2021; 8:608811. [PMID: 34055849 PMCID: PMC8152664 DOI: 10.3389/fnut.2021.608811] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Accepted: 03/15/2021] [Indexed: 11/13/2022] Open
Abstract
Purpose: We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association. Materials and Methods: We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project-a randomized trial of Housing First. Food security data were collected seven times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modeling. Logistic regression was used to estimate the association between housing trajectory groups and food security. Results: Three housing trajectory groups were identified: rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared with those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3-6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the never moved to stable housing group had the lowest food security status. Discussion: Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. International Standard Randomized Control Trial Number Register (ISRCTN42520374).
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Affiliation(s)
- James Lachaud
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Michael Liu
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Harvard Medical School, Boston, MA, United States
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Patricia O'Campo
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
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Gil-Salmeron A, Smith L, Yang L, Rieder A, Grabovac I. Differences in health status, health behaviour and healthcare utilisation between Immigrant and native homeless people in Spain: An exploratory study. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:856-866. [PMID: 33586224 DOI: 10.1111/hsc.13313] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 12/09/2020] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Few studies have examined the differences between immigrant and native-born homeless populations. Our aim was to conduct an exploratory study to examine the differences in health status, health behaviour and healthcare utilisation in a sample of Spanish immigrant and native homeless people. Study was conducted in eight different temporary accommodations in the Valencia region in August 2018. Overall, 86 participants were included in the analysis who answered questionnaires concerning socio-demographic characteristics, immigration status, health status and behaviour, healthcare utilisation and experienced discrimination in healthcare and health literacy. In total, 76.7% were men with a mean age of 41.91 (14.17) years, with 60.4% having immigration background with an average of 4.8 (4.2) years since arrival in Spain. No differences were found in the subjective health status, however, native homeless participants reported significantly higher prevalence of heart disease (87.5% vs. 12.5%), hypertension (84.6% vs. 15.4%), psychological illness (63.6% vs. 36.4%) and were also more often smokers (73.5% vs. 28.8%), reported smoking more cigarettes per day (12.0 vs. 7.4) and were more often illegal drug users (17.6% vs. 2.0%). Immigrant participants were significantly more often not insured, reported more problems in healthcare access and had lower rates of visits to general practitioners and less hospital admissions. Differences were also observed in social status with the native homeless more often reporting receiving income, and living in less crowded accommodations. Our results show a variety of issues that the immigrant homeless population in Spain is confronted with that also prevents adequate social inclusion and achieving good health. However, the immigrant population engaged less often in risky health behaviour. More, and continuous, monitoring of social, mental and physical health of the homeless population is necessary. Public health interventions aiming at health promotion in the immigrant homeless populations need to focus on increasing overall social integration.
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Affiliation(s)
- Alejandro Gil-Salmeron
- Polibenestar Research Institute, University of Valencia, Valencia, Spain
- International Foundation for Integrated Care, Oxford, UK
| | - Lee Smith
- The Cambridge Center for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge, UK
| | - Lin Yang
- Department of Cancer Epidemiology and Prevention Research, Alberta Health Services, Calgary, Canada
- Departments of Oncology and Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - Anita Rieder
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
| | - Igor Grabovac
- Department of Social and Preventive Medicine, Center for Public Health, Medical University of Vienna, Vienna, Austria
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Developing an Embedded Nursing Service within a Homeless Shelter: Client's Perspectives. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18094719. [PMID: 33925216 PMCID: PMC8125392 DOI: 10.3390/ijerph18094719] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 04/26/2021] [Accepted: 04/27/2021] [Indexed: 11/20/2022]
Abstract
This phenomenological case study of a newly developed nursing service, embedded within a homeless shelter in the South East of England, uses semi-structured to elicit experiences and perceptions of clients within the service. Participants (n = 6) were interviewed using a semi-structured approach and identified three broad themes: impact of previous healthcare experiences, benefits of embedding healthcare within the shelter, and future service development. The study illuminates the diversity and complexity of healthcare needs of homeless people, as well as offers a unique insight into the service user’s perception of the service.
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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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Loeb TB, Ebor MT, Smith-Clapham AM, Chin D, Novacek DM, Hampton-Anderson JN, Norwood-Scott E, Hamilton AB, Brown AF, Wyatt GE. How Mental Health Professionals Can Address Disparities in the Context of the COVID-19 Pandemic. TRAUMATOLOGY 2021; 27:60-69. [PMID: 34025223 PMCID: PMC8132617 DOI: 10.1037/trm0000292] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The Coronavirus 2019 (COVID-19) pandemic is an unparalleled crisis, yet also a unique opportunity for mental health professionals to address and prioritize mental and physical health disparities that disproportionately impact marginalized populations. Black, Indigenous, and People of Color (BIPOC) have long experienced structural racism and oppression, resulting in disproportionately high rates of trauma, poverty, and chronic diseases that span generations and are associated with increased COVID-19 morbidity and mortality rates. The current pandemic, with the potential of conferring new trauma exposure, interacts with and exacerbates existing disparities. To assist mental health professionals in offering more comprehensive services and programs for those who have minimal resources and the most profound barriers to care, four critical areas are highlighted as being historically problematic and essential to address: (a) recognizing psychology's role in institutionalizing disparities; (b) examining race/ethnicity as a critical variable; (c) proactively tackling growing mental health problems amidst the COVID-19 crisis; and (d) understanding the importance of incorporating historical trauma and discrimination in research and practice. Recommendations are provided to promote equity at the structural (e.g., nationwide, federal), professional (e.g., the mental health professions), and individual (e.g., practitioners, researchers) levels.
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Affiliation(s)
- Tamra Burns Loeb
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Megan T Ebor
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Amber M Smith-Clapham
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Dorothy Chin
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Derek M Novacek
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
- Desert Pacific Mental Illness Research, Education, and Clinical Center, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Joya N Hampton-Anderson
- Department of Psychiatry and Behavioral Sciences, Emory University School of Medicine, Atlanta, GA, USA, 30322
| | - Enricka Norwood-Scott
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
| | - Alison B Hamilton
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
- Center for the Study of Healthcare Innovation, Implementation, and Policy, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA, 90073
| | - Arleen F Brown
- Division of General Internal Medicine and Health Services Research (GIM and HSR), University of California Los Angeles, CA, USA, 90095
- Division of GIM and HSR, Olive View-UCLA Medical Center, Sylmar, CA, USA, 91342
| | - Gail E Wyatt
- Department of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, CA, USA, 90095
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Polillo A, Gran-Ruaz S, Sylvestre J, Kerman N. The use of eHealth interventions among persons experiencing homelessness: A systematic review. Digit Health 2021; 7:2055207620987066. [PMID: 33598308 PMCID: PMC7863153 DOI: 10.1177/2055207620987066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 12/15/2020] [Indexed: 11/16/2022] Open
Abstract
Objective eHealth interventions are being developed to meet the needs of diverse populations. Despite these advancements, little is known about how these interventions are used to improve the health of persons experiencing homelessness. The aim of this systematic review was to examine the feasibility, effectiveness, and experience of eHealth interventions for the homeless population. Methods Following PRISMA guidelines, a systematic search of PsycINFO, PubMed, Web of Science, and Google Scholar was conducted along with forward and backward citation searching to identify relevant articles. Results Eight articles met eligibility criteria. All articles were pilot or feasibility studies that used modalities, including short message service, mobile apps, computers, email, and websites, to deliver the interventions. The accessibility, flexibility, and convenience of the interventions were valued by participants. However, phone retention, limited adaptability, a high level of human involvement, and preference for in-person communication may pose future implementation challenges. Conclusions eHealth interventions are promising digital tools that have the potential to improve access to care and service delivery. eHealth interventions are feasible and usable for persons experiencing homelessness. These interventions may have health benefits by augmenting existing services and if implementation challenges are addressed. Further evaluation of the effectiveness of eHealth interventions is needed before widespread implementation. Those with lived experience should also be engaged in developing and evaluating these interventions.
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Affiliation(s)
- Alexia Polillo
- Centre for Addiction and Mental Health, University of Toronto, Toronto, Canada
| | | | - John Sylvestre
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, Canada
| | - Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, Canada
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Mejia-Lancheros C, Lachaud J, Woodhall-Melnik J, O'Campo P, Hwang SW, Stergiopoulos V. Longitudinal interrelationships of mental health discrimination and stigma with housing and well-being outcomes in adults with mental illness and recent experience of homelessness. Soc Sci Med 2021; 268:113463. [DOI: 10.1016/j.socscimed.2020.113463] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 09/03/2020] [Accepted: 10/16/2020] [Indexed: 02/06/2023]
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Durbin A, Nisenbaum R, Wang R, Hwang SW, Kozloff N, Stergiopoulos V. Recovery Education for Adults Transitioning From Homelessness: A Longitudinal Outcome Evaluation. Front Psychiatry 2021; 12:763396. [PMID: 34880792 PMCID: PMC8645597 DOI: 10.3389/fpsyt.2021.763396] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 10/26/2021] [Indexed: 11/13/2022] Open
Abstract
Objective: Grounded in principles of adult education, Recovery Education Centres (RECs) hold promise in promoting recovery for adults with mental health challenges, but research on recovery outcomes for hard-to-reach populations participating in RECs is scant. This quasi-experimental study compares 12-month recovery outcomes of adults with histories of homelessness and mental health challenges enrolled in a REC, to those of participants of other community services for this population. Methods: This pre-post quasi-experimental study compared participants enrolled in a REC for people with histories of homelessness and mental health challenges (n = 92) to an age-and-gender frequency matched control group participating in usual services (n = 92) for this population in Toronto, Ontario. Changes from program enrollment to 12 months in personal empowerment (primary outcome), disease specific quality of life, recovery, health status, health related quality of life, and mastery were assessed. Post-hoc analyses compared subgroups with 1-13 h (n = 37) and 14+ h (n = 37) of REC participation during the study period to the control group. Linear mixed models estimated mean changes and differences in mean changes and 95% confidence intervals. Results: Mean change in perceived empowerment from program enrollment to 12 months in the intervention group [0.10 (95% CI: 0.04, 0.15)] was not significantly different from the control group [0.05 (-0.01, 0.11)], mean difference, 0.05 [(-0.03, 0.13), P = 0.25]. In the post-hoc analysis, the mean change in perceived empowerment for the intervention subgroup with 14+ h of REC participation [0.18 (0.10, 0.26)] was significantly different than in the control group [0.05 (-0.01, 0.11)] mean difference, 0.13 [(0.03, 0.23), P < 0.01]. Mean change in mastery was also significantly different for the intervention subgroup with 14+ h of REC participation [2.03 (1.04, 3.02)] vs. controls [0.60 (-0.15, 1.35)], mean difference, 1.43 [(0.19, 2.66), P = 0.02]. There were no significant differences in other outcomes. Conclusion: With sufficient hours of participation, recovery education may be a helpful adjunct to health and social services for adults with mental health challenges transitioning from homelessness.
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Affiliation(s)
- Anna Durbin
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluatives Sciences, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada
| | - Stephen W Hwang
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Clinical Evaluatives Sciences, Toronto, ON, Canada.,Slaight Centre for Youth in Transition, Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Centre for Addiction and Mental Health, Toronto, ON, Canada
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[The anesthetist's view on Jethro Tull's Aqualung]. Anaesthesist 2020; 70:237-246. [PMID: 33165627 PMCID: PMC7650578 DOI: 10.1007/s00101-020-00882-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Im Jahre 1971 veröffentlichte die britische Rockgruppe Jethro Tull ihr Meilensteinalbum Aqualung. Darauf ist ein Lied gleichen Titels zu hören, das die Geschichte eines Wohnungslosen namens „Aqualung“ erzählt, der einen kalten Tag auf einer Bank in einem Londoner Park verbringt. Es passiert nicht wirklich viel: Er schaut jungen Mädchen beim Spielen zu, bückt sich, um eine Zigarettenkippe aufzuheben, geht einen kurzen Weg zu einer öffentlichen Toilette, die Heilsarmee bietet ihm eine Tasse Tee an, er wird durch die junge Prostituierte „cross-eyed Mary“ erschreckt und flüchtet vor ihr und stirbt schließlich mit rasselnden letzten Atemzügen, die an Tiefseetauchergeräusche erinnern. Offensichtlich ist Aqualung schwer krank. Möglicherweise leidet er an einem Lungenödem, peripherer arterieller Verschlusskrankheit, posttraumatischer Belastungsstörung und vielleicht noch an weiteren der vielen, für Wohnungslose typischen Erkrankungen. Die Beschreibung seiner letzten Atemzüge mag den Anästhesisten an das Todesrasseln erinnern. Eine Möglichkeit, medizinisches Fachwissen an Ärzte zu vermitteln, besteht darin, Daten und Fakten über Erkrankungen mit Elementen der Popkultur zu verknüpfen. Dieser Essay möchte einen bis heute berühmten Rocksong als Vehikel nutzen, um Anästhesisten und Intensivmediziner für intensivmedizinisch relevante Erkrankungen von Wohnungslosen zu sensibilisieren und den Wissensstand zu verbessern.
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Kerman N, Lem M, Witte M, Kim C, Rhoades H. A Multilevel Intervention Framework for Supporting People Experiencing Homelessness with Pets. Animals (Basel) 2020; 10:ani10101869. [PMID: 33066290 PMCID: PMC7602009 DOI: 10.3390/ani10101869] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Revised: 10/03/2020] [Accepted: 10/06/2020] [Indexed: 01/01/2023] Open
Abstract
Simple Summary Approximately one in 10 people experiencing homelessness have pets. Despite pets having psychosocial benefits for their owners, pets can also present challenges for people experiencing homelessness related to meeting their basic needs and obtaining housing. This article proposes a framework of policy, public, and service interventions for improving the health and well-being of pet owners experiencing homelessness. At the policy level, the framework proposes an increase of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. At the service delivery level, direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support this vulnerable group. Abstract Approximately one in 10 people experiencing homelessness have pets. Despite the psychosocial benefits derived from pet ownership, systemic and structural barriers can prevent this group from meeting their basic needs and exiting homelessness. A multilevel framework is proposed for improving the health and well-being of pet owners experiencing homelessness. Informed by a One Health approach, the framework identifies interventions at the policy, public, and direct service delivery levels. Policy interventions are proposed to increase the supply of pet-friendly emergency shelters, access to market rental housing and veterinary medicine, and the use of a Housing First approach. At the public level, educational interventions are needed to improve knowledge and reduce stigma about the relationship between homelessness and pet ownership. Direct service providers can support pet owners experiencing homelessness by recognizing their strengths, connecting them to community services, being aware of the risks associated with pet loss, providing harm reduction strategies, documenting animals as emotional support animals, and engaging in advocacy. By targeting policies and service approaches that exacerbate the hardships faced by pet owners experiencing homelessness, the framework is a set of deliberate actions to better support a group that is often overlooked or unaccommodated in efforts to end homelessness.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON K1N 6N5, Canada
- Correspondence:
| | - Michelle Lem
- Community Veterinary Outreach, Carp, ON K0A 1L0, Canada; (M.L.); (M.W.)
| | - Mike Witte
- Community Veterinary Outreach, Carp, ON K0A 1L0, Canada; (M.L.); (M.W.)
| | | | - Harmony Rhoades
- USC Suzanne Dworak-Peck School of Social Work, University of South California, Los Angeles, CA 90089, USA;
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Lane DA. Homelessness: a ‘cause of the causes’ of cardiovascular disease? BRITISH HEART JOURNAL 2020; 106:1456-1457. [DOI: 10.1136/heartjnl-2020-317224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Gabet M, Grenier G, Perrottet D, Fleury MJ. Le soutien postlogement transitoire auprès des femmes en situation d’itinérance : besoins, implantation et impact d’une étude pilote. SANTE MENTALE AU QUEBEC 2020. [DOI: 10.7202/1070242ar] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectifs Les dispositifs de soutien en logement sont parmi les solutions soutenues pour contrer l’itinérance. Le logement transitoire (LT) offre une trajectoire séquentielle d’accès à la stabilité résidentielle : des refuges au LT, au logement permanent avec ou sans soutien. Le suivi post-LT permettrait d’améliorer la stabilité résidentielle et l’intégration communautaire. Néanmoins, peu d’informations sont disponibles sur les conditions de succès et la capacité du suivi post-LT à améliorer la stabilité résidentielle et l’intégration communautaire des personnes itinérantes, en particulier les femmes. Cette étude de cas pilote visait à identifier les besoins de femmes recevant du suivi post-LT, l’implantation des activités de suivi et ses conditions de succès, ainsi que son impact en réponse aux besoins exprimés.
Méthode Deux organismes à but non lucratif ont été sélectionnés à Montréal. Une étude de cas à partir de méthodes mixtes a permis de trianguler les données provenant de femmes en situation d’itinérance, de leurs intervenantes et des gestionnaires de ressources de suivi post-LT. Deux entretiens ont été menés à un intervalle de 6 mois avec ces femmes (n = 10). Les besoins et l’impact du suivi post-LT ont été mesurés grâce à un questionnaire (questions ouvertes et fermées). Pour documenter l’implantation du suivi, des informations ont été colligées auprès des intervenantes (n = 2) sur les activités et l’intensité des services offerts à l’aide de fiches de contact. Des facteurs facilitant et entravant le suivi post-LT ont également été identifiés lors d’une entrevue de groupe avec les intervenantes (n = 2) et les gestionnaires (n = 4).
Résultats Les usagères ont identifié des besoins liés à la santé, aux activités quotidiennes et à l’intégration sociale. La plupart des femmes étaient satisfaites des activités et de la fréquence du suivi, de la facilité d’accès des intervenantes et de la capacité du suivi à répondre à leurs besoins. L’intensité du suivi, l’alliance thérapeutique usagère/intervenante et la motivation des usagères ont été identifiées comme des facteurs facilitants. Les facteurs entravants comprenaient : la durée limitée de l’insertion préalable en LT, particulièrement chez les usagères ayant subi un traumatisme majeur ; les comportements réfractaires ; la réticence à prendre des médicaments et la dépendance à des substances psychoactives ; les problèmes d’accès aux services, dont les services de santé mentale spécialisés ; et pour les intervenantes, les contraintes de temps, les difficultés logistiques, et le manque de logements permanents abordables adéquats. Après six mois, 80 % des usagères avaient conservé le même logement, et leur intégration communautaire n’avait pas changé.
Conclusion Le suivi post-LT semble adapté pour promouvoir la stabilité résidentielle chez les femmes en situation d’itinérance chronique et ayant des problèmes de santé mentale ou de dépendance, première étape essentielle vers l’intégration communautaire. L’étude a souligné l’importance d’offrir des modalités de services adaptés aux besoins des usagères. Un meilleur financement du suivi post-LT, une collaboration plus étroite avec d’autres services publics, une formation accrue des intervenantes et une augmentation du nombre de logements permanents abordables et adéquats favoriseraient un déploiement plus efficace du suivi post-LT.
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Affiliation(s)
- Morgane Gabet
- M. Sc., Ph. D. (c), Assistante de recherche, Centre de recherche de l’Institut universitaire en santé mentale Douglas, Montréal
| | - Guy Grenier
- Ph. D., Associé de recherche, Centre de recherche de l’Institut universitaire en santé mentale Douglas, Montréal
| | - Daniela Perrottet
- M. Sc., Coordonnatrice de recherche, Centre de recherche de l’Institut universitaire en santé mentale Douglas, Montréal
| | - Marie-Josée Fleury
- Ph. D., Professeure titulaire, Département de psychiatrie, Université McGill ; chercheuse, Centre de recherche de l’Institut universitaire en santé mentale Douglas, Montréal
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Essien UR, Paul DW, Kushel M. Database Inaccuracies and Disparities in Care Among Homeless Adults Hospitalized for Cardiovascular Conditions. JAMA Intern Med 2020; 180:613-614. [PMID: 32250398 DOI: 10.1001/jamainternmed.2020.0027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Affiliation(s)
- Utibe R Essien
- Division of General Internal Medicine, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.,Center for Health Equity Research and Promotion, VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania
| | - Dereck W Paul
- University of California, San Francisco School of Medicine, San Francisco
| | - Margot Kushel
- University of California, San Francisco School of Medicine, San Francisco.,University of California, San Francisco Center for Vulnerable Populations, San Francisco
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Kerman N, Sylvestre J. Surviving versus living life: Capabilities and service use among adults with mental health problems and histories of homelessness. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:414-422. [PMID: 31577380 DOI: 10.1111/hsc.12873] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 09/17/2019] [Accepted: 09/19/2019] [Indexed: 06/10/2023]
Abstract
The capabilities approach is a framework that can be applied to marginalised populations, including people with mental health problems and histories of homelessness, to measure well-being. Although a range of health and social services exist to address the many challenges associated with mental health problems and homelessness, the extent to which these services impact capabilities is unknown. This qualitative study explored the perspectives of people with mental health problems and histories of homelessness to understand how they perceived their service use as affecting their capabilities. In-depth interviews were conducted over a 1-year period beginning in October 2016 with 52 adults with mental health problems who were currently or formerly homeless and living in Ottawa, Canada. Data were analysed using first and second cycle coding, which involved line-by-line, descriptive coding followed by focused coding to categorise the data within a broadly applied capabilities framework. Findings showed that participants perceived many capability impairments in their lives, including nutritious food scarcities, limited material rights, social role deprivations, social isolation and insufficient income to participate in recreational activities. Services used by participants had mixed, for better and worse, and limited effects on their capabilities (e.g., unable to overcome affordable housing shortages or financial barriers associated with some capability impairments). Furthermore, service use could promote one capability while hindering another, forcing people to choose between competing needs when using services. Overall, the capabilities approach offers a comprehensive, human rights-based framework that is relevant to people with mental health problems and histories of homelessness but the services used by this population primarily help people to survive life but not necessarily live life.
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Affiliation(s)
- Nick Kerman
- School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - John Sylvestre
- Centre for Research on Educational and Community Services, University of Ottawa, Ottawa, ON, Canada
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Mejia-Lancheros C, Lachaud J, O’Campo P, Wiens K, Nisenbaum R, Wang R, Hwang SW, Stergiopoulos V. Trajectories and mental health-related predictors of perceived discrimination and stigma among homeless adults with mental illness. PLoS One 2020; 15:e0229385. [PMID: 32106225 PMCID: PMC7046214 DOI: 10.1371/journal.pone.0229385] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 02/04/2020] [Indexed: 12/27/2022] Open
Abstract
Stigma and discrimination toward individuals experiencing homelessness and mental disorders remain pervasive across societies. However, there are few longitudinal studies of stigma and discrimination among homeless adults with mental illness. This study aimed to identify the two-year group trajectories of stigma and discrimination and examine the predictive role of mental health characteristics among 414 homeless adults with mental illness participating in the extended follow-up phase of the Toronto At Home/Chez Soi (AH/CS) randomized trial site. Mental health-related perceived stigma and discrimination were measured at baseline, one, and two years using validated scales. Group-based-trajectory modelling was used to identify stigma and discrimination group trajectory memberships and the effect of the Housing First treatment (rent supplements and mental health support services) vs treatment as usual on these trajectories. The associations between mental health-related characteristics and trajectory group memberships were also assessed using multinomial logistic regression. Over two-years, three group trajectories of stigma and discrimination were identified. For discrimination, participants followed a low, moderate, or increasingly high discrimination group trajectory, while for stigma, participants followed a low, moderate or high stigma group trajectory. The Housing First treatment had no significant effect on discrimination or stigma trajectories groups. For the discrimination trajectories, major depressive episode, mood disorder with psychotic features, alcohol abuse, suicidality, severity of mental health symptoms, and substance use severity in the previous year were predictors of moderate and increasingly high discrimination trajectories. History of discrimination within healthcare setting was also positively associated with following a moderate or high discrimination trajectory. For the stigma trajectories, substance dependence, high mental health symptoms severity, substance use severity, and discrimination experiences within healthcare settings were the main predictors for the moderate trajectory group; while substance dependence, suicidality, mental health symptom severity, substance use severity and discrimination experiences within health care setting were also positive predictors for the high stigma trajectory group. Ethno-racial status modified the association between having a major depression episode, alcohol dependence, and the likelihood of being a member of the high stigma trajectory group. This study showed that adults experiencing mental illness and homelessness followed distinct stigma and discrimination group trajectories based on their mental health-problems. There is an urgent need to increase focus on strategies and policies to reduce stigma and discrimination in this population.
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Affiliation(s)
- Cilia Mejia-Lancheros
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - James Lachaud
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Patricia O’Campo
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Kathryn Wiens
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Rosane Nisenbaum
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
| | - Stephen W. Hwang
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Division of General Internal Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- MAP Centre for Urban Health Solutions, St Michael’s Hospital, Li Ka Shing Knowledge Institute, Toronto, ON, Canada
- Centre for Addiction and Mental Health, Toronto, ON, Canada
- Department of Psychiatry, University of Toronto, Toronto, ON, Canada
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Khan BM, Reid N, Brown R, Kozloff N, Stergiopoulos V. Engaging Adults Experiencing Homelessness in Recovery Education: A Qualitative Analysis of Individual and Program Level Enabling Factors. Front Psychiatry 2020; 11:779. [PMID: 32848944 PMCID: PMC7424067 DOI: 10.3389/fpsyt.2020.00779] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2020] [Accepted: 07/22/2020] [Indexed: 01/25/2023] Open
Abstract
PURPOSE Recovery Education Centres (REC) in mental health offer a new model of providing recovery supports through emancipatory adult education and recovery-oriented service principles. Despite the widespread adoption of RECs, there is limited evidence regarding factors enabling engagement and participation, particularly for unique subpopulations or service delivery contexts. The Supporting Transitions and Recovery Learning Centre (STAR) in Toronto, Ontario is the first REC in Canada and one of few worldwide supporting adults transitioning out of homelessness. This research aimed to investigate individual and program level enablers of engagement and participation in a REC for this population. METHODS Qualitative methods were used to explore the experiences of 20 service user participants through semi-structured interviews exploring their experiences of REC participation and perceived key program features. Interviews were conducted between July 2017 and June 2018, six to 14 months following REC enrollment, and analyzed using inductive thematic analysis. RESULTS In contrast to past experiences with health and social services, participants described a welcoming and respectful physical and interpersonal environment with low-barrier seamless access facilitating their engagement and participation. Although the realities of homelessness presented barriers for some, participants described that the involvement of peers, as role models, and the self-directed, strengths, and skills-based curriculum, co-produced and co-delivered by peers and professionals, were instrumental in activating the process of recovery through education. CONCLUSIONS/IMPLICATIONS Findings are consistent with the growing evidence base of the defining features of RECs and suggest this model can be successfully extended to support recovery among adults transitioning out of homelessness. This unique examination of Canada's first REC for adults exiting homelessness can help guide program and policy development to better support this disadvantaged population.
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Affiliation(s)
- Bushra M Khan
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada
| | - Nadine Reid
- Centre for Addiction and Mental Health, Toronto, ON, Canada
| | - Rebecca Brown
- Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada
| | - Nicole Kozloff
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Vicky Stergiopoulos
- Centre for Addiction and Mental Health, Toronto, ON, Canada.,Department of Psychiatry, University of Toronto, Toronto, ON, Canada.,Centre for Urban Health Solutions, St. Michael's Hospital, Unity Health Toronto, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
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Moore-Nadler M, Clanton C, Roussel L. Storytelling to Capture the Health Care Perspective of People Who Are Homeless. QUALITATIVE HEALTH RESEARCH 2020; 30:182-195. [PMID: 31274048 DOI: 10.1177/1049732319857058] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Utilizing a hermeneutic philosophical approach, the researchers explored the perceptions and experiences of people who are homeless in Mobile, Alabama, receiving health care and interacting with health care providers. Using the voice of the participants, discussions among the researchers, and supporting literature reinforcing key concepts, a framework was created illustrating the lived experience. The following themes were identified: social determinants of health, compromised systems, professionalism, dehumanization, engagement, and downward trajectory. The experiences described and themes identified indicate a breakdown in therapeutic relationships between homeless individuals and health care providers, contributing to the continuing destabilization common in this population.
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Affiliation(s)
| | - Clista Clanton
- College of Nursing, University of South Alabama, Mobile, Alabama, USA
| | - Linda Roussel
- College of Nursing, Texas Woman's University, Denton, Texas, USA
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Mabhala MA, Yohannes A. Being at the Bottom Rung of the Ladder in an Unequal Society: A Qualitative Analysis of Stories of People without a Home. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:E4620. [PMID: 31766338 PMCID: PMC6926508 DOI: 10.3390/ijerph16234620] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/12/2019] [Accepted: 11/18/2019] [Indexed: 11/17/2022]
Abstract
Background: Homelessness is rising in the United Kingdom, despite investment in measures to eradicate it made by the government and charity organisations. Aim: The aim is to examine the stories of homeless people in order to document their perceptions of their social status, the reasons that led to their homelessness, and propose a conceptual explanation. Method: We conducted 26 semi-structured interviews in three centres for homeless people in Cheshire, North West of England. Results: Three categories-education, employment, and health-emerged from the data and provided a theoretical explanation for the reasons that led to their homelessness. These are vital not only for the successful negotiation of one's way out of homelessness, but also for achieving other social goods, including social connections, social mobility, and engaging in positive social relationships. Conclusion: Participants catalogued the adverse childhood experiences, which they believe limited their capacity to meaningfully engage with the social institution for social goods, such as education, social services, and institutions of employment. Since not all people who have misfortunes of poor education, poor health, and loss of job end up being homeless, we contend that a combination of these with multiple adverse childhood experiences may have weakened their resilience to traumatic life changes, such as loss of job and poor health.
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Affiliation(s)
- Mzwandile A. Mabhala
- Department of Public Health and Wellbeing, Faculty of Health and Social Care, University of Chester, Riverside Campus, Chester CH1 1SL, UK
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