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ObjectiveTo contrast sociodemographic characteristics, physical and mental health status, substance use, sexual behaviors, victimization, and utilization of health services between homeless women residing in sheltered and non-sheltered environments.DesignCross-sectional survey. A structured scale was used to measure mental health status. Physical health status, substance use, sexual behavior, history of adult victimization, and health services utilization were measured by content-specific items.SettingShelters (N = 47) and outdoor locations in Los Angeles.ParticipantsOne thousand fifty-one homeless women.ResultsHomeless women living on the streets were more likely than sheltered women to be white and longer-term homeless. Controlling for sociodemographic characteristics, multiple logistic regression analyses revealed that unsheltered women had over 3 times greater odds of fair or poor physical health, and over 12 times greater odds of poor mental health than sheltered homeless women. They were also more likely than sheltered women to report using alcohol or noninjection drugs, to have multiple sexual partners, and to have a history of physical assault. About half of the overall sample reported utilization of a variety of health services; however, unsheltered homeless women were less likely to utilize all of the health services that were assessed, including drug treatment.ConclusionsThere is a critical need for aggressive outreach programs that provide mental health services and substance abuse treatment for homeless women on the streets. Comprehensive services that also include medical care, family planning, violence prevention, and behavioral risk reduction may be particularly valuable for homeless women, especially those living in unsheltered environments.

A qualitative research approach was used to explore the factors that influence the initiation of drug and alcohol use among homeless women and the health and social consequences of drug and alcohol use. The sample consisted of 238 women; of whom 209 women reported drug and/or alcohol use in the past month and 29 women reported no history of drug or alcohol use. Findings of the study revealed homeless women who currently used drugs and alcohol, homeless women who currently used drugs only, and to a lesser extent current alcohol users only, had suffered traumatic childhood events and family dysfunction and had to cope with low self-esteem, emotional distress, and poor physical health. The initiation of drug and/or alcohol use was strongly affected by the social influence of other users. In comparison, homeless women who did not use drugs or alcohol reported a positive self-image, few traumatic events, and chose partners who did not use drugs or alcohol. Common among current drug and/or alcohol users were the reported social benefits of drug use. Quantitative analyses revealed homeless women who were current drug users were significantly more likely to have experienced childhood and adult victimization as compared with women in the other groups. Thus, the need for social interventions and positive social support early in the lives of these women are strongly implicated in these findings.

The long-term effects of two culturally competent AIDS education programs with different content on the risk behavior and AIDS-related knowledge of 410 homeless African American women 2 years after program completion were examined. Participants were members of a larger cohort of impoverished African American and Latina women recruited in Los Angeles from 1989 to 1991. Of a subsample of 527 African American women selected randomly for a 2-year follow-up interview, 410 (78%) were located and agreed to participate. Women participating in both AIDS education programs reported reduced HIV risk behaviors and demonstrated greatly improved AIDS knowledge at 2-year follow-up (p < .001). Women in a specialized program were less likely than those in a traditional program to report noninjection drug use at 2 years. Women in the traditional program had significantly better AIDS knowledge at follow-up (p < .001). These findings suggest that educational programs can produce sustained benefits among impoverished women.

The researchers sought to explore and describe the demographic, cognitive, psychosocial, and behavioral factors associated with the continued risky behavior of a convenience sample of homeless and drug-addicted women two to four weeks after they had completed an AIDS education program. The sample included 942 crack users and 767 women who had multiple sex partners. Analyses revealed that impoverished women who maintained multiple sexual partners were less likely to be in drug recovery programs than in homeless shelters. They were more likely to share needles and be involved sexually with male injection drug users compared with impoverished women who did not maintain multiple sexual partners. Persistent crack users were older than those who reported cessation of crack use, were more often African American, and were more likely to have sex partners who were injecting drug users. Women who demonstrated less improvement in depression and distress scores, concerns, use of affective coping, appraisal of threat, and social support were more likely to maintain crack use and multiple partners. The study's implications for the design of intervention programs aimed at risk reduction based on ethnicity are discussed.

This study was undertaken to describe sexual behaviors and drug use and other factors that inhibit condom use and needle cleaning among impoverished women who are injection drug users (IDUs) or sexual partners of IDUs. This study also investigated whether risky sexual behavior or barriers to risk reduction differ with ethnicity and level of acculturation. Survey instruments to assess drug and sexual activity were administered to 378 African American and Latina women recruited primarily from homeless shelters and drug recovery programs. The most commonly cited barriers to condom use were belief that partners did not have acquired immunodeficiency syndrome (AIDS), lack of knowledge about where to get and how to use condoms, and discomfort discussing condom use with partners. African American women were more likely to report having multiple partners and unprotected sex, and more likely to report barriers in using, discussing, and obtaining condoms. Latina women were more likely to report partners' dislike of condoms. African American and highly acculturated Latina women were more likely to be IDUs than less acculturated Latina women. The most pervasive barriers for needle cleaning were not having personal needles, being high and not interested in needle cleaning, and not having disinfectant available. In a multiple logistic regression analysis for engaging in unprotected sex and cleaning needles, not ethnic or acculturation differences were found after controlling for selected demographic characteristics and risk factors. The data indicate a need to increase the supply of free or low cost condoms, to provide easily accessible sites for obtaining condoms, to supply clean needles,and to focus counseling for women on negotiating condom use with partners and the skillful and correct placement of the condom.

Abstract Background Stone mining is one of the main livelihood activities in areas close to major cities in Ethiopia. Mining tends to make a notable impact on woody plant species and soil properties. Information regarding the effect of stone mining on woody plant species diversity and soil properties is limited in Ethiopia. It is also less known how people perceive the impact of stone mining on existing natural resource in the watershed after mining. Therefore, this paper analyzed the effect of stone mining on woody plant species diversity, selected soil properties and perception of nearby community on mining in northern Ethiopia. Methods Vegetation and soil sampling were conducted using 6.32 ha sample plots. Samples were randomly selected from mining and adjacent unmined areas. Species abundance, density, basal area, selected soil physical and chemical properties were analyzed. The differences in species diversity and soil physical and chemical properties between the mined and unmined areas were analyzed using independent t test. Household survey was also conducted to assess the view of the local people regarding the effect of mining on ecology. Results A total of 35 species representing 19 families in the mining site were recorded while 43 species representing 27 families were recorded in the unmined site. Abundance and density of species were higher in unmined than in mining areas. The most abundant species in the mining and unmined sites were Euclea racemosa subsp. schimperi, Senna singueana, Maytenus arbutifolia, Calpurnia aurea and Buddleja polystachya. Woody species diversity at mining (1.97) was significantly different from that unmined (2.49) site (p = 0.0005). Bulk density significantly varied between the mined (1.9 g cm−3) and unmined (1.38 g cm−3) sites (p

OBJECTIVE: The purpose of this study was to determine the health status of adults with developmental disabilities residing in community settings and the quality of the preventive, medical, dental, and psychiatric services they receive. METHODS: Data were collected on a sample of 353 adults residing in Los Angeles, California, in 1997. Historical data were obtained from study subjects or caregivers, physical and dental examinations were performed, blood was drawn for analysis, and a psychiatrist reviewed medical records for reports of psychiatric diagnoses and consultations. RESULTS: Health markers, such as rates of obesity, and laboratory test results of routine screening panels including blood cell counts, hemoglobin, and hematocrits; blood concentrations of liver enzymes and other enzymes, cholesterol, and tryglycerides; and urinalyses were within normal limits for an adult population. However, preventive services were notably lacking, especially for individuals living at home. Fewer than half of the study subjects had received influenza vaccine; only a third of those living alone or with family or friends had received this vaccination. Chart audits revealed that about a third received psychotropic medications, but only 24% of these individuals had psychiatric consultations noted in their record. Further, 36% of this medicated group received psychotropic drugs without any identifiable diagnosis, and simultaneous receipt of two or more antipsychotics was not uncommon. CONCLUSIONS: Given that the U.S. health care system fails to ensure the provision of preventive services for all people, including the developmentally disabled, a systematic overhaul is necessary to establish an effective quality assurance program that will provide preventive medical, dental, and psychiatric services for people with developmental disabilities. [ABSTRACT FROM AUTHOR]

Objective: To contrast sociodemographic characteristics, physical and mental health status, substance use, sexual behaviors, victimization, and utilization of health services between homeless women residing in sheltered and non-sheltered environments.Design: Cross-sectional survey. A structured scale was used to measure mental health status. Physical health status, substance use, sexual behavior, history of adult victimization, and health services utilization were measured by content-specific items.Setting: Shelters (N = 47) and outdoor locations in Los Angeles.Participants: One thousand fifty-one homeless women.Results: Homeless women living on the streets were more likely than sheltered women to be white and longer-term homeless. Controlling for sociodemographic characteristics, multiple logistic regression analyses revealed that unsheltered women had over 3 times greater odds of fair or poor physical health, and over 12 times greater odds of poor mental health than sheltered homeless women. They were also more likely than sheltered women to report using alcohol or noninjection drugs, to have multiple sexual partners, and to have a history of physical assault. About half of the overall sample reported utilization of a variety of health services; however, unsheltered homeless women were less likely to utilize all of the health services that were assessed, including drug treatment.Conclusions: There is a critical need for aggressive outreach programs that provide mental health services and substance abuse treatment for homeless women on the streets. Comprehensive services that also include medical care, family planning, violence prevention, and behavioral risk reduction may be particularly valuable for homeless women, especially those living in unsheltered environments. [ABSTRACT FROM AUTHOR]

There is limited understanding of the physical health, mental health, and substance use or abuse correlates of sexual violence against homeless women. This study documents the association of rape with health and substance use or abuse characteristics reported by a probability sample of 974 homeless women in Los Angeles. Controlling for potential confounders, women who reported rape fared worse than those who did not on every physical and mental health measure and were also more likely to have used and abused drugs other than alcohol. Results should serve to alert clinicians about groups of homeless women who may benefit from rape screening and treatment interventions. [ABSTRACT FROM AUTHOR]

Objectives: (1) To present the Behavioral Model for Vulnerable Populations, a major revision of a leading model of access to care that is particularly applicable to vulnerable populations; and (2) to test the model in a prospective study designed to define and determine predictors of the course of health services utilization and physical health outcomes within one vulnerable population: homeless adults. We paid particular attention to the effects of mental health, substance use, residential history, competing needs, and victimization.Methods: A community-based probability sample of 363 homeless individuals was interviewed and examined for four study conditions (high blood pressure, functional vision impairment, skin/leg/foot problems, and tuberculosis skin test positivity). Persons with at least one study condition were followed longitudinally for up to eight months.Principal Findings: Homeless adults had high rates of functional vision impairment (37 percent), skin/leg/foot problems (36 percent), and TB skin test positivity (31 percent), but a rate of high blood pressure similar to that of the general population (14 percent). Utilization was high for high blood pressure (81 percent) and TB skin test positivity (78 percent), but lower for vision impairment (33 percent) and skin/leg/foot problems (44 percent). Health status for high blood pressure, vision impairment, and skin/leg/foot problems improved over time. In general, more severe homeless status, mental health problems, and substance abuse did not deter homeless individuals from obtaining care. Better health outcomes were predicted by a variety of variables, most notably having a community clinic or private physician as a regular source of care. Generally, use of currently available services did not affect health outcomes.Conclusions: Homeless persons are willing to obtain care if they believe it is important. Our findings suggest that case identification and referral for physical health care can be successfully accomplished among homeless persons and can occur concurrently with successful efforts to help them find permanent housing, alleviate their mental illness, and abstain from substance abuse. [ABSTRACT FROM AUTHOR]

To determine the characteristics and childbearing histories of women whose infants entered foster care in Los Angeles County, we examined the cases of 1,155 drug-using women whose infants were removed from them at birth and 236 non-drug-using women whose infants were also removed at birth by court order (July 1989 through March 1991). All of the women were indigent, and less than half had graduated from high school. The drug-using women frequently had criminal records, and more than a quarter were homeless. Many comparison women had mental health problems, and some (16.7%) were teenagers under court custody. Overall, 80% of all the children born to both groups of women were under court jurisdiction. Data obtained after study infants' births on 926 drug-using women observed for 18 months revealed that 22% had borne another infant who was placed in foster care; half of these infants had a positive drug immunoassay. Of the 185 non-drug-using women with 18-month follow-ups, 7.6% had borne another child who was in foster care. The magnitude of the repeated childbearing recorded among both groups of women in this study shows that preventive programs including family planning, mental health services, and drug prevention or rehabilitation programs have not reached this population. [ABSTRACT FROM AUTHOR]

Objective: To document the prevalence of tuberculosis (TB) skin test positivity among homeless adults in Los Angeles and determine whether certain characteristics of homelessness were risk factors for TB.Design: Cross-sectional study.Setting: Shelters, soup lines, and outdoor locations in the Skid Row and Westside areas of Los Angeles.Participants: A representative sample of 260 homeless adults.Measurements and Main Results: Tuberculosis tine test reactivity was measured. The overall prevalence of TB skin test positivity was 32%:40% in the inner-city Skid Row area and 14% in the suburban Westside area. Using multiple logistic regression, TB skin test positivity was found to be associated with living in crowded or potentially crowded shelter conditions, long-term homelessness, geographic area, history of a psychiatric hospitalization, and age.Conclusions: Homeless adults living in congested inner-city areas are at high risk of both latent and active TB. Endemic risk factors and limited access to medical care support the need for aggressive treatment of active TB cases and innovative programs to ensure completion of prophylactic regimens by homeless individuals with latent infection. [ABSTRACT FROM AUTHOR]