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Objectives: To examine the prevalence and severity of alcohol's harm to children in the US and the relationship of the harmer to the child, and to examine caregivers' sociodemographic characteristics, alcohol use, and exposure to harm due to a drinking spouse/partner or other family member as risk factors for alcohol's harm to children.Study Design: We report data on 764 caregivers (defined as persons with parental responsibility for at least 1 child aged ≤17 years) from the 2015 National Alcohol's Harm to Others Survey, a dual-frame national sample of US adults.Results: Overall 7.4% of caregivers reported alcohol's harm to children in the past year. Risk factors for alcohol's harm to children included the caregiver's own experience of alcohol's harm from a spouse/partner or other family member. Caregivers with a heavy drinker in the household were significantly more likely to report harm to children. A caregiver's own heavy drinking was not a significant risk factor for children in his or her care.Conclusions: Alcohol places a substantial burden on children in the US. Although a caregiver's own drinking can harm children, other drinkers also increase the risk of alcohol's harm to children. Screening caregivers to determine whether there is a heavy drinker in the household may help reduce alcohol's harm in the family without stigmatizing caregivers, who themselves may not be heavy drinkers. [ABSTRACT FROM AUTHOR]

Context: The homeless population is aging. Older homeless adults experience premature development of age-related conditions and an elevated symptom burden. Little is known about symptom experience among older homeless adults.Objectives: To characterize the experience, understanding, and management of physical, psychological, social (e.g., loneliness), and existential (e.g., regret, loss of dignity) symptoms among older homeless adults.Methods: We conducted semistructured interviews from June 2016 to March 2017 with a purposive sample of participants from the Health Outcomes of People Experiencing Homelessness in Older Middle Age cohort, a longitudinal study of homeless adults aged 50 and older. We analyzed data between June 2016 and December 2017 using thematic analysis.Results: We found four main themes: 1) nonphysical symptoms are interwoven with, and as distressing as, physical symptoms; 2) individuals attribute symptoms to childhood abuse, manual labor, the conditions of homelessness, and aging; 3) symptoms interfere with daily functioning, causing negative changes in personality, energy, and motivation; and 4) individuals cope with symptoms through religion, social support, and substance use.Conclusion: Homelessness causes and exacerbates physical and psychological distress. Interventions should address multiple interconnected dimensions of suffering. Health systems that care for homeless patients should adapt palliative care practices using a stepwise approach. Homeless shelters should adopt policies and modifications that increase privacy and autonomy while promoting community building. Housing interventions should promote community building. All who work with people experiencing homelessness should avoid stigmatizing language and recognize homeless individuals' sources of strength and coping. [ABSTRACT FROM AUTHOR]