Housing instability: Exploring socioecological influences on the health of birthing people

STUDY AIM

To describe how socioecological influences of housing instability affect pregnancy health among birthing and postpartum people.

DESIGN

We used the socioecological framework to guide this exploratory descriptive study using semi-structured, in-depth interviews.

METHODS

We purposively recruited birthing people in the southern mid-Atlantic region. Seventeen one-time, semi-structured interviews were conducted between February 2020 and December 2021 with English-speaking unstably housed participants ≥18 years old, currently pregnant, or recently postpartum. Qualitative and quantitative content approaches were used to analyse transcribed interviews. Dedoose software was used to identify code patterns and refine the codebook until group consensus. The team examined code patterns, explored meaning in text and codified code-generated categories to describe experiences.

RESULTS

Majority (82.4%) of participants were African Americans between 22 and 41 years, and most were postpartum (76.5%). Participants described multiple forms of housing instability, reasons for losing housing, challenges with finding housing and strategies for finding housing. Participants did not describe housing instability as a barrier to receiving prenatal care. Building and sustaining individual relationships and social support were prominent factors affecting their housing challenges. Participants also reported a lack of obstetric provider inquiry about housing status during pregnancy. Many reported that challenges with housing triggered mental health issues, especially depression.

CONCLUSION

Nurses and other obstetric providers are key points of contact in the prenatal care setting for assessing housing stability. Additionally, refining social structures and funding support services within communities and prenatal health systems should be a strategy for future programme and policy planning improvement.

IMPACT

This study highlights critical areas for consideration when addressing social determinants for birthing people and reinforces the need for more comprehensive assessment in the prenatal setting.

PATIENT OR PUBLIC CONTRIBUTION

Members of the public participated in this study as key informants for study interviews.

Assessing food system vulnerabilities: a fault tree modeling approach

BACKGROUND

Food system function is vulnerable to disruption from a variety of sources. Disruption of the processes required for food provision may result in decreases in food security in affected communities. Currently, there are few tools that quantitatively predict or analyze food system vulnerabilities to contribute to food system resilience analysis. This work presents a prototype version of one such tool, a fault tree, which can be used conceptually and for future modeling work. Fault tree analysis is an engineering tool used to illustrate basic and intermediate factors that can cause overall system failures.

METHODS

The fault tree defines food system functioning as food security at the community level and maps the components of the food system onto three main tenets of food security - accessibility, availability, and acceptability. Subtrees were populated using a top down approach guided by expertise, extant literature, and 36 stakeholder interviews.

RESULTS

The food system is complex, requiring 12 subtrees to elaborate potential failures. Subtrees comprising accessibility include physical accessibility of the vending point and economic accessibility among community members. Food availability depends on the functioning of the food supply chain, or, in the case of individuals who rely on donated food, the food donation system. The food supply chain includes processing, wholesale operations, distribution systems, and retail center subtrees. Elements of acceptability include the medical appropriateness, nutritional adequacy, and cultural acceptability of food. Case studies of the effects of Winter Storm Jonas of 2016 and the 2013-2017 California drought in Baltimore City illustrate the utility of the fault tree model.

CONCLUSION

FTA of potential routes to food system failure provides a tool that allows for consideration of the entirety of the food system; has potential to provide a quantitative assessment of food system failure and recovery; and is able to capture short-term and long-term hazards in a single framework. This systems modeling approach highlights an extensive list of vulnerability points throughout the food system, and underscores the message that reducing food system vulnerabilities requires action at all levels to protect communities from the risks of short-term and long-term threats to food security.