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Wu S, Ta L, Vieira J, Schwartz K, Perez J, Zeien J, Li D, Hartmark-Hill J. Adverse Childhood Experiences and Depression among Homeless Young Adults: A Social Determinants of Health Perspective. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:81. [PMID: 38248544 PMCID: PMC10815729 DOI: 10.3390/ijerph21010081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/02/2024] [Accepted: 01/08/2024] [Indexed: 01/23/2024]
Abstract
Homelessness is a pervasive issue in the United States that presents significant challenges to public health. Homeless young adults (HYAs) are at particular risk for increased incidence and severity of depression. Using primary survey data (n = 205) collected in the Phoenix Metropolitan Area, Arizona, from June to August 2022, this study aims to examine the relationship between adverse childhood experiences (ACEs) and depression among HYAs. We adopted the ACEs 10-item scale to measure childhood traumatic experiences, whereas depression was measured by using a PHQ-4 depression scale and diagnosed depression. Regression models were conducted to test the relationships between ACEs and depression outcomes while controlling for the covariates at the individual, interpersonal, and socioeconomic/living environment levels. The average PHQ-4 score was 5.01 (SD = 3.59), and 59.69% of HYAs reported being diagnosed previously with depression. The mean ACEs score was 5.22 out of 10. Other things being equal, for every one unit increase in ACEs scores, the odds of being diagnosed with depression increased by 11.5%, yet it was not statistically significant, while the PHQ-4 score increased by 0.445 (p < 0.001). Overall, HYAs were disproportionately affected by depression. This study elucidates the complex relationship between ACEs and depression among HYAs.
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Affiliation(s)
- Shiyou Wu
- School of Social Work, Arizona State University, Phoenix, AZ 85004, USA
| | - Lac Ta
- College of Medicine–Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (L.T.); (J.V.); (K.S.); (J.P.); (J.H.-H.)
| | - Jaime Vieira
- College of Medicine–Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (L.T.); (J.V.); (K.S.); (J.P.); (J.H.-H.)
| | - Kendall Schwartz
- College of Medicine–Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (L.T.); (J.V.); (K.S.); (J.P.); (J.H.-H.)
| | - Joshua Perez
- College of Medicine–Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (L.T.); (J.V.); (K.S.); (J.P.); (J.H.-H.)
| | - Justin Zeien
- Walter Reed National Military Medical Center, Bethesda, MD 20814, USA;
| | - Danyi Li
- Keck School of Medicine Preventive Medicine, University of Southern California, Los Angeles, CA 90032, USA;
| | - Jennifer Hartmark-Hill
- College of Medicine–Phoenix, University of Arizona, Phoenix, AZ 85004, USA; (L.T.); (J.V.); (K.S.); (J.P.); (J.H.-H.)
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Silberg C, Likindikoki S, Mbwambo J, Mmari K, Saleem HT. Housing instability and violence among women who use drugs in Dar es Salaam, Tanzania. Harm Reduct J 2022; 19:68. [PMID: 35761376 PMCID: PMC9237973 DOI: 10.1186/s12954-022-00649-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 06/10/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Women who use heroin and other drugs (WWUD) are a key population with elevated risk of physical and sexual violence perpetrated by intimate partners and non-partners. While housing instability has been shown to be associated with violence in high-income settings, this is an underexplored topic in sub-Saharan Africa. In this research, we aimed to assess the relationship between housing instability and various forms of violence within a sample of WWUD in Dar es Salaam. METHODS This analysis uses data from a parent study from 2018. A total of 200 WWUD were recruited through respondent-driven sampling methods and administered a survey. Two multivariable logistic regression models were built to assess the relationship between housing instability and physical violence (Model 1) and housing instability and sexual violence (Model 2) while controlling for a number of sociodemographic characteristics. RESULTS Approximately 35% of participants were classified as housing unstable. More than half of participants (62%) reported experiencing physical violence in the past 12 months, and more than a third (36%) reported sexual violence in the same time period. Housing instability was found to be independently associated with both physical and sexual violence victimization in the past year when adjusting for covariates (Model 1 adjusted odds ratio [AOR]: 2.40, 95% CI 1.22-4.46; Model 2 AOR: 1.93. 95% CI 1.02-3.67). CONCLUSION To our knowledge, this is the first study to document a significant association between housing instability and violence among WWUD communities in sub-Saharan Africa. This analysis adds to the growing body of literature on the relationship between stable housing and livelihood and health outcomes across differing populations. The cyclical nature of housing instability and violence may be disrupted through housing programming that provides safety, security, and stability for WWUD.
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Affiliation(s)
- Claire Silberg
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Samuel Likindikoki
- grid.25867.3e0000 0001 1481 7466Department of Epidemiology and Biostatistics, School of Public Health and Social Sciences, Muhimbili University of Health and Allied Sciences, P.O. Box 65015, Dar es Salaam, Tanzania ,grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Jessie Mbwambo
- grid.25867.3e0000 0001 1481 7466Department of Psychiatry and Mental Health, School of Medicine, Muhimbili University of Health and Allied Sciences, P.O. Box 65001, Dar es Salaam, Tanzania
| | - Kristin Mmari
- grid.21107.350000 0001 2171 9311Department of Population, Family and Reproductive Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Baltimore, MD 21205 USA
| | - Haneefa T. Saleem
- grid.21107.350000 0001 2171 9311Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, 615 North Wolfe Street, Room E5033, Baltimore, MD 21205 USA
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Embleton L, Di Ruggiero E, Logie CH, Ayuku D, Braitstein P. Improving livelihoods and gender equitable attitudes of street-connected young people in Eldoret, Kenya: Results from a pilot evidence-based intervention. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:227-240. [PMID: 32633059 DOI: 10.1111/hsc.13086] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/06/2020] [Revised: 06/12/2020] [Accepted: 06/16/2020] [Indexed: 06/11/2023]
Abstract
Street-connected young people (SCY) in Eldoret, Kenya, experience substantial gender inequities, economic marginalization and are highly vulnerable to acquiring HIV. This study sought to explain and explore how participation in a pilot-adapted evidence-based intervention, Stepping Stones and Creating Futures, integrated with matched savings, changed SCY's economic resources, livelihoods and gender equitable attitudes. We piloted our adapted intervention using a convergent mixed-methods design measuring outcomes pre- and post-intervention with 80 SCY in four age- and gender-stratified groups of 20 participants per group (young women aged 16-19 years and 20-24 years, young men aged 16-19 years and 20-24 years). The pilot occurred at MTRH-Rafiki Centre for Excellence in Adolescent Health in Eldoret, Kenya, from September 2017 to January 2018. Through street outreach, Peer Facilitators created four age- and gender-stratified sampling lists of SCY whom met the eligibility criteria and whom indicated their interest in participating in the intervention during outreach sessions. Simple random sampling was used to select eligible participants who indicated their interest in participating in the intervention. The adapted intervention, Stepping Stones ya Mshefa na Kujijenga Kimaisha, included 24 sessions that occurred over 14 weeks, focused on sexual and reproductive health, gender norms in society, livelihoods and included a matched-savings programme conditional on attendance. The primary outcome of interest was gender equitable attitudes measured using the Gender Equitable Men scale and secondary outcomes included economic resources and livelihoods. Participants had a significant change in gender equitable attitudes from pre- to post-intervention from 43 (IQR 38-48) to 47 (IQR 42-51) (p < .001). Quantitatively and qualitatively participants reported increases in daily earnings, changes in street involvement, housing and livelihood activities. Overall, this study demonstrated that the adapted programme might be effective at changing gender equitable attitudes and improving livelihood circumstances for SCY in Kenya.
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Affiliation(s)
- Lonnie Embleton
- Institute of Medical Science, Faculty of Medicine, University of Toronto, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Erica Di Ruggiero
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Carmen H Logie
- Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada
| | - David Ayuku
- Department of Behavioural Science, College of Health Science, Moi University, Eldoret, Kenya
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
| | - Paula Braitstein
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
- Academic Model Providing Access to Healthcare, Eldoret, Kenya
- School of Medicine, College of Health Sciences, Moi University, Eldoret, Kenya
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Pan Y, Metsch LR, Wang W, Philbin M, Kyle TL, Gooden LK, Feaster DJ. The Relationship Between Housing Status and Substance Use and Sexual Risk Behaviors Among People Currently Seeking or Receiving Services in Substance Use Disorder Treatment Programs. J Prim Prev 2020; 41:363-382. [PMID: 32617888 PMCID: PMC7384551 DOI: 10.1007/s10935-020-00597-x] [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] [Indexed: 10/23/2022]
Abstract
Although HIV risk behaviors such as substance use and condomless sex are prevalent among people currently seeking or receiving services at substance use disorder (SUD) treatment programs, associations with housing status in this population have not been well studied. We examined the associations between housing status, substance use and HIV-related sexual risk behaviors among 1281 participants from 12 US community-based SUD programs. In addition, substance use was examined as a potential mediator of the relationship between housing status and sexual risk behaviors. We conducted Chi-square, univariate and multivariate logistic regression models on data from the National Drug Abuse Treatment Clinical Trials Network HIV Rapid Testing and Counseling study. Path analysis was used to test the mediation and indirect effects. Unstable housing was significantly associated with having multiple concurrent condomless sex partners, condomless sex with non-primary partners, and partners of unknown HIV serostatus. Homelessness was significantly associated with condomless vaginal sex and condomless sex with any substance use. The path between unstable housing and sexual risk behaviors was mediated by problematic drug use, particularly by cocaine, opioids, and marijuana use. Because housing status impacts HIV risk behaviors for individuals in SUD treatment programs, both housing status and substance use behaviors should be assessed upon program entry in order to identify and mitigate risk behaviors.
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Affiliation(s)
- Yue Pan
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA.
| | - Lisa R Metsch
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Weize Wang
- Department of Biostatistics, Center for Research on US Latino HIV/AIDS and Drug Abuse, Robert Stempel College of Public Health & Social Work, Florida International University, Miami, FL, USA
| | - Morgan Philbin
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
- The HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tiffany L Kyle
- Aspire Health Partners, 5151 Adanson Street, Orlando, FL, USA
| | - Lauren K Gooden
- Department of Sociomedical Sciences, Mailman School of Public Health, Columbia University, New York, NY, USA
| | - Daniel J Feaster
- Department of Public Health Sciences, University of Miami Miller School of Medicine, Clinical Research Building, Room 1034, 1120 N.W. 14th ST, Miami, FL, 33136, USA
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Glick JL, Lopez A, Pollock M, Theall KP. Housing insecurity and intersecting social determinants of health among transgender people in the USA: A targeted ethnography. INTERNATIONAL JOURNAL OF TRANSGENDER HEALTH 2020; 21:337-349. [PMID: 34993513 PMCID: PMC8726680 DOI: 10.1080/26895269.2020.1780661] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Abstract
Background: Housing is an important social determinant of health (SDOH). Transgender people face a unique blend of discrimination and compromised social services, putting them at risk for housing insecurity and associated public health concerns. Aims: This targeted ethnography explores housing insecurity as a SDOH among transgender people in the U.S. Methods: In-depth interviews were conducted with transgender people (n = 41) throughout the U.S.A., identified through purposive sampling. A semi-structured guide was used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes. Results: Responses revealed pervasive housing insecurity and inter-related challenges. Respondents discussed how intersecting identities create unique constellations of vulnerability, which "intersect like a star." Financial insecurity and interpersonal rejection were lead housing insecurity causes, often resulting in psychological strain, which was sometimes addressed with substances and sexual risk-taking. These factors were cyclically accompanied by financial and employment insecurity and a cascade of unmet social needs. Social support facilitated coping. Discussion: Findings support increasing transgender housing security intervention resources that address intersecting and cyclical discrimination, trauma, housing, employment, and health issues.
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Affiliation(s)
- Jennifer L. Glick
- Department of Health Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Alex Lopez
- Global Community Health and Behavioral Sciences, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
| | - Miranda Pollock
- School of Medicine, Section of Community and Population Medicine, Louisiana State University Health Sciences Center – New Orleans, New Orleans, Louisiana, USA
| | - Katherine P. Theall
- Global Community Health and Behavioral Sciences and LSUHSC Comprehensive Alcohol and HIV Research Center (CARC), Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana, USA
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Emerson AM. Narrative Inquiry Into Shelter-Seeking by Women With a History of Repeated Incarceration: Research and Nursing Practice Implications. ANS Adv Nurs Sci 2019; 41:260-274. [PMID: 29901467 PMCID: PMC6070403 DOI: 10.1097/ans.0000000000000216] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Nurses who provide care in the community to women with a history of repeated incarceration may struggle to understand the full extent of the barriers faced by this population and as a result risk giving suboptimal care to an already underserved group. This narrative inquiry study of stories told by 10 women with histories of repeated incarceration fulfilled 2 purposes: to demonstrate how women's shelter-seeking stories exposed uniquely complex patterns of health opportunity and risk and to demonstrate how storytelling might serve as an informative mode of nursing health assessment for this population.
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Condomless Sex and Psychiatric Comorbidity in the Context of Constrained Survival Choices: A Longitudinal Study Among Homeless and Unstably Housed Women. AIDS Behav 2019; 23:802-812. [PMID: 30267368 DOI: 10.1007/s10461-018-2280-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
We sought to identify the prevalence and independent correlates of condomless sex within a cohort of community-recruited homeless and unstably housed cisgender adult women who were followed biannually for 3 years (N = 143 HIV+ , N = 139 HIV-). Nearly half (44%) of participants reported condomless sex in the 6 months before baseline, which increased to 65% throughout the study period. After adjusting for having a primary partner, longitudinal odds of condomless sex among women with HIV were significantly higher among those reporting < daily use of alcohol or cannabis (AOR = 2.09, p =.002, and 1.88, p =.005, respectively) and PTSD (AOR = 1.66, p =.034). Among women without HIV, adjusted longitudinal odds of condomless sex were significantly higher for those reporting < daily methamphetamine use (AOR = 2.02, p =.012), panic attack (AOR = 1.74, p =.029), and homelessness (AOR = 1.67, p = .006). Associations were slightly attenuated when adjusting for sex exchange. Targeted HIV/STI programs for unstably housed women should address anxiety and trauma disorders, infrequent substance use, and housing challenges.
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Anderson-Carpenter KD, Fletcher JB, Swendeman D, Reback CJ. Associations between sociodemographic characteristics and substance use disorder severity among methamphetamine-using men who have sex with men. Subst Use Misuse 2019; 54:1763-1773. [PMID: 31075997 PMCID: PMC6644069 DOI: 10.1080/10826084.2019.1610445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: Men who have sex with men (MSM) have elevated rates of substance use disorders (SUDs) and differences across sociodemographic sub-groups of MSM are associated with a greater risk of deleterious outcomes. Although studies have shown that MSM report greater rates of polysubstance use relative to other adult populations, the associations between sociodemographic characteristics and both acute substance use and substance use severity among methamphetamine-using MSM are unknown. Objectives: The present study examines associations between sociodemographic characteristics and (a) recent substance use and (b) SUD severity. Method: From March 2014 to January 2016, 286 methamphetamine-using MSM were recruited to complete a baseline Audio Computer-Assisted Self-Interview (ACASI) assessment and the SCID MINI. Multivariable analyses employed generalized structural equation modeling given the non-continuous nature of the endogenous variables. Results: All measured sociodemographic characteristics except gay self-identification were significantly associated with recent substance use (all ps ≤ .05), and all characteristics except current homelessness were significantly associated with diagnostic SUD severity (all ps ≤ .05). However, nuanced risks were observed in participants' use of specific substances regarding recent substance use and substance use severity. Conclusion: These results suggest that multiple factors contribute to the risks of SUD severity among methamphetamine-using MSM. As such, these results are useful in the tailoring of clinical and psychosocial intervention strategies that serve this and other high-risk populations.
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Affiliation(s)
- Kaston D Anderson-Carpenter
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,b Department of Psychology , Michigan State University , East Lansing , MI , USA
| | | | - Dallas Swendeman
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,d Development Core, Center for HIV Identification, Prevention, and Treatment Services, University of California , Los Angeles , CA , USA
| | - Cathy J Reback
- a David Geffen School of Medicine , Semel Institute for Neuroscience and Human Behavior, University of California , Los Angeles , CA , USA.,c Friends Research Institute, Inc ., Los Angeles , CA , USA.,e Center for HIV Identification, Prevention and Treatment Services, University of California , Los Angeles , CA , USA
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Campeau L, Blouin K, Leclerc P, Alary M, Morissette C, Blanchette C, Serhir B, Roy E. Impact of sex work on risk behaviours and their association with HIV positivity among people who inject drugs in Eastern Central Canada: cross-sectional results from an open cohort study. BMJ Open 2018; 8:e019388. [PMID: 29391367 PMCID: PMC5829837 DOI: 10.1136/bmjopen-2017-019388] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES The objectives of this study were: (1) to examine the correlates of HIV positivity among participants who injected drugs and engaged in sex work (PWID-SWs) in the SurvUDI network between 2004 and 2016, after stratification by sex, and (2) to compare these correlates with those of sexually active participants who did not engage in sex work (PWID non-SWs). DESIGN AND SETTING This biobehavioural survey is an open cohort of services where participants who had injected in the past 6 months were recruited mainly through harm reduction programmes in Eastern Central Canada. PARTICIPANTS Data from 5476 participants (9223 visits in total; 785 not included in multivariate analyses due to missing values) were included. METHODS Participants completed an interviewer-administered questionnaire and provided saliva samples for anti-HIV antibody testing. Generalised estimating equations taking into account multiple participations were used. RESULTS Baseline HIV prevalence was higher among SWs compared with non-SWs (women: 13.0% vs 7.7%; P<0.001, and men: 17.4% vs 10.8%; P<0.001). PWID-SWs were particularly susceptible to HIV infection as a result of higher levels of vulnerability factors and injection risk behaviours. They also presented different risk-taking patterns than their non-SWs counterparts, as shown by differences in correlates of HIV positivity. Additionally, the importance of sex work for HIV infection varies according to gender, as suggested by a large proportion of injection risk behaviours associated with HIV among women and, conversely, a stronger association between sexual behaviours and HIV positivity observed among men. CONCLUSION These results suggest that sex work has an impact on the risk of HIV acquisition and that risk behaviours vary according to gender. Public health practitioners should take those specificities into account when designing HIV prevention interventions aimed at PWIDs.
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Affiliation(s)
- Laurence Campeau
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
- École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Karine Blouin
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
| | - Pascale Leclerc
- École de santé publique, Université de Montréal, Montréal, Québec, Canada
- Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Michel Alary
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec – Université Laval, Québec City, Quebec, Canada
- Département de médecine sociale et préventive, Université Laval, Québec City, Québec, Canada
| | - Carole Morissette
- Direction régionale de Santé Publique - CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, Québec, Canada
| | - Caty Blanchette
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche du CHU de Quebec – Université Laval, Québec City, Quebec, Canada
| | - Bouchra Serhir
- Sérologie, Virologie et biologie moléculaire, Laboratoire de santé publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne de Bellevue, Québec, Canada
| | - Elise Roy
- Unité sur les Infections Transmissibles Sexuellement et par le Sang, Institut National de Santé Publique du Québec, Montréal, Québec, Canada
- Département des Sciences de la Santé Communautaire, Université de Sherbrooke - Campus de Longueuil, Longueuil, Québec, Canada
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Expanded Medicaid Provides Access to Substance Use, Mental Health, and Physician Visits to Homeless and Precariously Housed Persons. J Community Health 2017; 43:207-211. [DOI: 10.1007/s10900-017-0405-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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11
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The Effects of Housing Status, Stability and the Social Contexts of Housing on Drug and Sexual Risk Behaviors. AIDS Behav 2017; 21:2079-2092. [PMID: 28243936 DOI: 10.1007/s10461-017-1738-1] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Research on the relationship between housing instability and HIV risk has often focused on two different conceptions of stability. In one conceptualization, housing stability is defined according to physical location with homeless or unstably housed individuals defined as those who reside in places not meant for human habitation or in emergency shelters. The other conceptualization has defined housing stability as individuals' degree of transience, often operationalized as the number of moves or evictions a person has had within a specified amount of time. Less studied has been the social context of living situation, e.g. living with other drug users, conflict over living expenses, or having to have sex in order to stay. This paper uses data from 392 low-income residents in Hartford, CT to explore how people in different housing situations-including those who are housed and homeless-experience housing stability, feelings of security in their homes, and the social context of their housing. We then explore how these varied measures of housing context affect drug use frequency and sexual risk. Results show that participants who are homeless feel more overall housing instability in terms of number of moves and negative reasons for moving. Those who were doubled up with family or friends were more likely to experience conflict over household expenses and more likely to live with drug users. Among homeless and housed, hard drug use was associated with experiencing violence in the place where they lived, perceiving greater housing stability, having moved for a positive reason, doubling up, and longer periods of homelessness, while number of moves and longer prison sentence predicted sexual risk. Among the housed, living with other drug users was associated with more hard drug use, while contributing money toward household expenses was associated with less hard drug use. Two significant interactions were associated with sexual risk among the housed. Those with longer prison sentences who lived with drug users had more sexual partners, and those with longer prison sentences who doubled up had more sex partners. Results of this study indicate that measures of housing status not often considered in the literature such as the social context of housing have significant effects on HIV risk.
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Vásquez-Vera H, Palència L, Magna I, Mena C, Neira J, Borrell C. The threat of home eviction and its effects on health through the equity lens: A systematic review. Soc Sci Med 2017; 175:199-208. [DOI: 10.1016/j.socscimed.2017.01.010] [Citation(s) in RCA: 81] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 11/22/2016] [Accepted: 01/06/2017] [Indexed: 10/20/2022]
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Bowen EA, Mitchell CG. Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents. SOCIAL WORK IN PUBLIC HEALTH 2016; 31:387-397. [PMID: 27167535 DOI: 10.1080/19371918.2015.1137518] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.
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Affiliation(s)
- Elizabeth A Bowen
- a School of Social Work, University at Buffalo, State University of New York , Buffalo , New York , USA
| | - Christopher G Mitchell
- b Jane Addams College of Social Work, University of Illinois at Chicago , Chicago , Illinois , USA
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The relationship between housing subsidies and supportive housing on neighborhood distress and housing satisfaction: does drug use make a difference? SUBSTANCE ABUSE TREATMENT PREVENTION AND POLICY 2016; 11:20. [PMID: 27233496 PMCID: PMC4884364 DOI: 10.1186/s13011-016-0064-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Accepted: 05/12/2016] [Indexed: 11/10/2022]
Abstract
Background Since the 1970s, the dominant model for U.S. federal housing policy has shifted from unit-based programs to tenant-based vouchers and certificates. Because housing vouchers allow recipients to move to apartments and neighborhoods of their choice, such programs were designed to improve the ability of poor families to move into neighborhoods with less concentrated poverty. However, little research has examined whether housing voucher recipients live in less distressed neighborhoods than those without housing vouchers. There is much reason to believe that drug users may not be able to access or keep federal housing subsidies due to difficulties drug users, many of whom may have criminal histories and poor credit records, may have in obtaining free market rental housing. In response to these difficulties, permanent supportive housing was designed for those who are chronically homeless with one or more disabling condition, including substance use disorders. Little research has examined whether residents of permanent supportive housing units live in more or less economically distressed neighborhoods compared to low-income renters. Methods This paper uses survey data from 337 low-income residents of Hartford, CT and geospatial analysis to determine whether low-income residents who receive housing subsidies and supportive housing live in neighborhoods with less concentrated poverty than those who do not. We also examine the relationships between receiving housing subsidies or supportive housing and housing satisfaction. Finally, we look at the moderating effects of drug use and race on level of neighborhood distress and housing satisfaction. Results Results show that low-income residents who receive housing subsidies or supportive housing were not more or less likely to live in neighborhoods with high levels of distress, although Black residents with housing subsidies lived in more distressed neighborhoods. Regarding housing satisfaction, those with housing subsidies perceived significantly more choice in where they were living while those in supportive housing perceived less choice. In addition, those with rental subsidies or supportive housing reported living closer to needed services, unless they also reported heavy drug use. Conclusions Housing subsidies and supportive housing have little impact on the level of neighborhood distress in which recipients live, but some effects on housing satisfaction.
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Ruiz Y, Guilamo-Ramos V, McCarthy K, Muñoz-Laboy MA, de Lourdes Rosas López M. Exploring migratory dynamics on HIV transmission: the case of Mexicans in New York City and Puebla, Mexico. Am J Public Health 2014; 104:1036-44. [PMID: 24825203 DOI: 10.2105/ajph.2013.301770] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Migration and population movement are increasingly viewed as important factors associated with HIV transmission risk. With growing awareness of the potential impact of migration on HIV transmission, several perspectives have emerged that posit differing dynamics of risk. We considered available data on the role of migration on HIV transmission among Mexican migrants in New York City and Puebla, Mexico. Specifically, we examined 3 distinct models of migratory dynamics of HIV transmission-namely, the structural model, the local contextual model, and the interplay model. In doing so, we reframed current public health perspectives on the role of migration on HIV transmission.
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Affiliation(s)
- Yumary Ruiz
- Yumary Ruiz is with The Center for Latino Adolescent and Family Health and Steinhardt's Department of Nutrition, Food Studies, and Public Health at New York University, New York, NY. Vincent Guilamo-Ramos and Katharine McCarthy are with The Center for Latino Adolescent and Family Health, Silver School of Social Work, New York University. Miguel A. Muñoz-Laboy is with the College of Health Professions and Social Work, Temple University, Philadelphia, PA. Maria de Lourdes Rosas López is with the Departamento de Ciencias Sociales (Department of Political Science), Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
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Hsu LC, Truong HHM, Vittinghoff E, Zhi Q, Scheer S, Schwarcz S. Trends in early initiation of antiretroviral therapy and characteristics of persons with HIV initiating therapy in San Francisco, 2007-2011. J Infect Dis 2013; 209:1310-4. [PMID: 24218501 DOI: 10.1093/infdis/jit599] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
In 2010, the San Francisco Department of Public Health offered antiretroviral therapy (ART) to all its patients with human immunodeficiency virus (HIV) regardless of CD4 count. We assessed trends in time from diagnosis to ART initiation and factors associated with ART initiation among San Francisco residents living with HIV between 2007 and 2011. Time to ART initiation decreased among those diagnosed with higher CD4 count. ART initiation rate was significantly higher in recent years and lower among African Americans, men who have sex with men who also inject drugs, and persons aged ≥50 years. We found a trend toward early treatment. However, racial and social disparities persist.
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Dual HIV risk: receptive syringe sharing and unprotected sex among HIV-negative injection drug users in New York City. AIDS Behav 2013; 17:2501-9. [PMID: 23640654 DOI: 10.1007/s10461-013-0496-y] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
HIV-negative injection drug users (IDUs) who engage in both receptive syringe sharing and unprotected sex ("dual HIV risk") are at high risk of HIV infection. In a cross-sectional study conducted in New York City in 2009, active IDUs aged ≥18 years were recruited using respondent-driven sampling, interviewed, and tested for HIV. Participants who tested HIV-negative and did not self-report as positive were analyzed (N = 439). Adjusted odds ratios (aOR) and 95 % confidence intervals (95 % CI) were estimated using multinomial logistic regression. The sample was: 77.7 % male; 54.4 % Hispanic, 36.9 % white, and 8.7 % African-American/black. Dual risk was engaged in by 26.2 %, receptive syringe sharing only by 3.2 %, unprotected sex only by 49.4 %, and neither by 21.2 %. Variables independently associated with engaging in dual risk versus neither included Hispanic ethnicity (vs. white) (aOR = 2.0, 95 % CI = 1.0-4.0), married or cohabiting (aOR = 6.3, 95 % CI = 2.5-15.9), homelessness (aOR = 3.4, 95 % CI = 1.6-7.1), ≥2 sex partners (aOR = 8.7, 95 % CI = 4.4-17.3), ≥2 injecting partners (aOR = 2.9, 95 % CI = 1.5-5.8), and using only sterile syringe sources (protective) (aOR = 0.5, 95 % CI = 0.2-0.9). A majority of IDUs engaged in HIV risk behaviors, and a quarter in dual risk. Interventions among IDUs should simultaneously promote the consistent use of sterile syringes and of condoms.
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