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The need for a safe, stable, and suitable place of residence is fundamental for human beings. Nevertheless, having such a place, particularly in a city, remains unattainable for too many people. This study aims to examine how “the others” are metaphorically represented in contemporary South Korean films that portray city dwellers struggling to find a place of residence in urban areas and fighting for their existence. The multimodal analysis of conceptual metaphors enabled us to comprehend how the metaphor of EXISTENCE IS A LOCATION emphasized the significance of physical space for one’s being. Furthermore, the vertical movements in visual representations, such as GOOD IS UP, BAD IS DOWN, connect to more abstract meanings of precarious existence, social hierarchy, and otherness. [ABSTRACT FROM AUTHOR]

The US is facing a severe affordable rental housing crisis that contributes to multiple forms of housing insecurity including homelessness, crowded and poor quality housing conditions, unstable housing arrangements, and cost burdens. A considerable body of evidence finds that housing insecurity is an important determinant of health. However, the existing literature may fall short of conceptualizing and measuring the full impact of housing insecurity on population health and on racial health equity. In this paper, we seek to expand the conceptualization of housing as a determinant of population health equity by considering housing insecurity as a manifestation of structural racism that intersects with other manifestations and impacts of structural racism to affect, not only the health of housing insecure individuals, but also the health of the networks and communities in which these individuals live. First, we situate the current housing crisis within larger systems of structural racism. We extend prior work documenting the confluence of ways that racist policies and practices have created unequal burdens of housing insecurity to also discuss the ways that the meanings and impacts of housing insecurity may be shaped by racism. Next, we consider how the health impacts of this unequal burden of housing insecurity can extend beyond individual households to affect networks and communities. Ultimately, we provide a multilevel framework that can inform research, policy, and practice to address housing and health equity. [ABSTRACT FROM AUTHOR]

Social needs, such as social isolation and food insecurity, are important individual-level social determinants of health, especially for adults ages 65 years and older. These needs may be associated with future health care utilization, but this research area has not been studied extensively. The objective of this study was to examine the independent association of 5 individual social needs with future (1) emergency department (ED) visits and (2) hospital admissions. This observational study included 9649 Kaiser Permanente Northwest (KPNW) Medicare members who completed the Medicare Total Health Assessment (MTHA) quality improvement survey between August 17, 2020 and January 31, 2022. The 5 social needs assessed by the MTHA, defined as binary measures (yes/no), included (1) financial strain, (2) food insecurity, (3) housing instability, (4) social isolation, and (5) transportation needs. ED utilization (yes/no) and hospitalization (yes/no), the current study outcome measures, were measured in the 12 months after MTHA assessment. In multivariable analyses, 3 of the 5 social needs were significantly associated with higher ED utilization: financial strain (odds ratio [OR] = 1.40, 95% confidence interval [CI] = 1.11–1.76, P < 0.05), housing instability (OR = 1.43, 95% CI = 1.02–1.99, P < 0.05), and social isolation (OR = 1.19, 95% CI = 1.05–1.34, P < 0.05), and 1, financial strain, was significantly associated with hospital admissions (OR = 1.66, 95% CI = 1.23–2.23, P < 0.05). The study results identified which social needs are most strongly associated with future ED utilization and hospital admissions. Further research is needed to better understand whether addressing social needs is associated with improved patient-level health outcomes over time. [ABSTRACT FROM AUTHOR]

As health care systems invest significant resources to address social needs associated with poor health such as food, financial, and housing insecurity, many eligible patients are still not obtaining the resources they need. The recently initiated PURPLE Project (Promoting Understanding in Social Needs Research Projects by Listening and Engaging) engages stakeholder advisors to help address 2 challenges: (1) many patients do not accept offered assistance, and (2) of patients who accept assistance, less than half have their needs addressed. This article presents the team's engagement with local advisors, garnering real-life insights from patients with social needs, staff and leadership in public health, health care, and community service organizations. The team shares these organizations' priorities and recommendations and how these can be applied to these major challenges. This article can assist others in the social care arena who seeks to involve local partners as advisors to improve practices and policies in addressing social needs. [ABSTRACT FROM AUTHOR]

To provide effective care physicians must attend, not just to medical issues, but also to the social determinants of health — racial factors, food insecurity, housing instability, transportation barriers and beyond. Social determinants also include a largely underrecognized dimension: legal vulnerabilities such as rental evictions and debt adjudications. Yet rarely do medical trainees have an opportunity to witness legal vulnerabilities, firsthand. [ABSTRACT FROM AUTHOR]

This study aimed to identify the prevalence of substance use before and during COVID-19; and examined its association with depression and social factors among 437 residents from the neighborhood of Harlem in Northern Manhattan, New York City. Over a third of respondents reported using any substance before COVID-19, and initiating/increasing substance use during COVID-19. The most common substances used before COVID-19 and initiated/increased during COVID-19 were smoking (20.8% vs. 18.3%), marijuana (18.8% vs. 15.3%), and vaping (14.2% and 11.4%). The percentages of any hard drug use were 7.3% and 3.4%, respectively. After adjustment, residents with mild (Prevalence Ratio [PR] = 2.86, 95% CI 1.65, 4.92) and moderate (PR = 3.21, 95% CI 1.86, 5.56) symptoms of depression, and housing insecurity (PR = 1.47, 95% CI 1.12, 1.91) had at least a 47% greater probability of initiating and/or increasing substance use. Conversely, respondents with employment insecurity (PR = 0.71, 95% CI 0.57, 0.88) were 29% less likely to report such patterns. No association was found between substance use initiation and/or increase and food insecurity. High prevalence of substance use during COVID-19 may lead residents to turn to substance use as a coping mechanism for psychosocial stressors. Thus, it is essential to provide accessible and culturally sensitive mental health and substance use services. [ABSTRACT FROM AUTHOR]

In the United States, there has been a long history of environmental injustice that disproportionately affects racial and ethnic minorities and low-income communities due to racially targeted policies and widespread discrimination. Environmental racism can be revealed in housing discrimination that perpetuates inequities in exposure to environmental pollutants. Biased credit and mortgaging practices such as redlining have led to housing segregation of racial and ethnic minorities in the USA, permitting policymakers to diminish and disinvest in these communities. The COVID-19 pandemic has amplified housing instability for families of color, including Black and Hispanic/Latinx communities, putting them at increased risk for COVID-19 exposure. There is a need to investigate how environmental injustice intensifies the COVID-19 pandemic, illuminates racial and ethnic inequities in exposure to environmental contaminants, and fuels disparities in COVID-19 outcomes. The aims of this paper are to analyze and discuss environmental injustice and racial and ethnic disparities related to COVID-19 and housing. We also propose recommendations to address this pervasive issue. [ABSTRACT FROM AUTHOR]

Low-barrier care is one model of a differentiated service delivery approach for people with HIV (PWH) who are not engaged in conventionally-organized HIV care. Although psychiatric and substance use disorders are common among patients in low-barrier clinics, approaches to behavioral health service delivery within this context have not been well-described. We conducted a descriptive analysis using retrospective review of medical records to evaluate substance use and psychiatric comorbidities and receipt of behavioral health services among patients in the Max Clinic in Seattle, Washington. Among 227 patients enrolled from 2015 to mid-2020, most had a history of hazardous substance use (85%), a psychiatric diagnosis (69%) or unstable housing (69%) documented in the medical record. Less than half of patients referred for depression treatment (33%) or for opioid use disorder treatment (40%) completed even one specialty care visit. More effective approaches are needed to engage patients in behavioral health services within the context of low-barrier HIV care. [ABSTRACT FROM AUTHOR]

Background The poor health status of underserved populations is compounded by low vaccination uptake, leading to a greater risk of epidemics. On October 2017, a measles outbreak started in the southwest of France among under-vaccinated social groups, including Travellers. We aimed to describe the health status, healthcare use and child measles–mumps–rubella (MMR) vaccination coverage in Travellers according to their environmental and living conditions. Methods A cross-sectional study with a three-stage random sample design was conducted between October 2019 and March 2022 in the Nouvelle-Aquitaine region in France. Trained social workers administered face-to-face questionnaires to collect data on adults and children. Anthropometric measurements, vaccination records and data using an environmental exposure questionnaire were also collected. Results The participation rate was high (73.6%), with 1030 adults and 337 children included. Concerning the adults, 36.6% had obesity, 14.4% reported diabetes, 24.7% hypertension and 14.4% major depression. The prevalence of major depression was significantly higher in adults living in precarious and unauthorized housing than in those with adequate housing (19.8 vs. 14.7%, P  = 0.03). With regard to children, 45.3% had full (i.e. 2-dose) MMR vaccination coverage at 24 months and 17.9% had obesity. Finally, 74.5% of the households experienced housing insecurity, and 22.2% did not have a supply of drinking water. Conclusion Traveller children and adults faced deleterious environmental and living conditions potentially affecting their health, healthcare use and vaccination coverage. These results demonstrate the need for urgent interventions for underserved populations which take into account their specific needs. [ABSTRACT FROM AUTHOR]

Objective: Social determinants of health (SDoH), such as poverty, are associated with increased burden and severity of rheumatic and musculoskeletal diseases. This study was undertaken to study the prevalence and documentation of SDoH‐related needs in electronic health records (EHRs) of individuals with these conditions. Methods: We randomly selected individuals with ≥1 International Classification of Diseases, Ninth/Tenth Revision (ICD‐9/10) code for a rheumatic/musculoskeletal condition enrolled in a multihospital integrated care management program that coordinates care for medically and/or psychosocially complex individuals. We assessed SDoH documentation using terms for financial needs, food insecurity, housing instability, transportation, and medication access according to EHR note review and ICD‐10 SDoH billing codes (Z codes). We used multivariable logistic regression to examine associations between demographic factors (age, gender, race, ethnicity, insurance) and ≥1 (versus 0) SDoH need as the odds ratio (OR) with 95% confidence interval (95% CI). Results: Among 558 individuals with rheumatic/musculoskeletal conditions, 249 (45%) had ≥1 SDoH need documented in EHR notes by social workers, care coordinators, nurses, and physicians. A total of 171 individuals (31%) had financial insecurity, 105 (19%) had transportation needs, 94 (17%) had food insecurity; 5% had ≥1 related Z code. In the multivariable model, the odds of having ≥1 SDoH need was 2.45 times higher (95% CI 1.17–5.11) for Black versus White individuals and significantly higher for Medicaid or Medicare beneficiaries versus commercially insured individuals. Conclusion: Nearly half of this sample of complex care management patients with rheumatic/musculoskeletal conditions had SDoH documented within EHR notes; financial insecurity was the most prevalent. Only 5% of patients had representative billing codes suggesting that systematic strategies to extract SDoH from notes are needed. [ABSTRACT FROM AUTHOR]

Housing instability can hinder the ability of people with HIV (PWH) to maintain engagement in care, adhere to antiretroviral (ART) regimens, and achieve viral suppression. This analysis examined the association between housing instability and HIV outcomes, as well as the association between housing status and substance use disorders, mental health disorders, and sexually transmitted infections. Multivariable logistic regressions were performed using data from the DC Cohort, a longitudinal cohort of PWH. Among 8622 PWH, unstably housed PWH were significantly more likely to be prescribed ART (aOR: 1.4; 95%CI: 1.1, 1.8) yet were significantly less likely to be virally suppressed (aOR: 0.6; 95%CI: 0.5, 0.8). Unstably housed PWH were also significantly more likely to have a substance use or mental health disorder, which may inhibit PWH's ability to achieve viral suppression. Efforts to end the HIV epidemic should address housing to ensure treatment is optimized for key populations. [ABSTRACT FROM AUTHOR]

There is ample evidence that homelessness is associated with high rates of morbidity and mortality. Street Medicine seeks to eliminate these disparities by providing healthcare on the streets to people who are unsheltered. While extant research describes health disparities for the unsheltered and programmatic approaches to addressing housing instability, there are few published studies describing how healthcare providers build and maintain relationships with patients on the street. This insight is central to specifying how street medicine differs from traditional forms of care and defining aspects of street medicine that contribute to successful patient engagement. Through a collaboration between Operation Safety Net (OSN), a street medicine provider in Pittsburgh, Pennsylvania, and [name redacted], an exploratory qualitative study was designed and implemented using harm reduction principles as a guiding framework. Qualitative interviews were conducted with eleven OSN street medicine providers and a thematic analysis using a deductive approach was used to analyze the data. Findings identified the ways that relational harm reduction was central to all aspects of patient care provided through this program. Major themes included: (1) individualism, or meeting patients where they are figuratively and literally; (2) humanism, which refers to valuing and holding true regard for patients; and (3) nonjudgmental care, in which providers do not hold negative attitudes toward patients and their decisions. These themes are consistent with relational principles of harm reduction. Challenges that were discussed also aligned with these principles and included frustration with systems providing care that did not meet patients' individualized needs, and pain and trauma experienced by providers upon losing patients for whom they genuinely cared. Understanding these relational principles of harm reduction may help providers operationalize ways to effectively engage and maintain homeless patients in care and subsequently bridge the gap to traditional models of care. This study may provide valuable insights to expand the street medicine field in research and applied clinical and community settings. [ABSTRACT FROM AUTHOR]

Introduction: Notable inequities in patient experiences exist in the healthcare system. Communities with a large concentration of blacks and immigrants are often marginalized rather than centralized in the healthcare system. These inequities may fuel distrust and exacerbate adverse outcomes, thereby widening the health gap. Addressing differences in patients' experiences of care is paramount for reducing health inequities. Methods: In this qualitative study, we used a purposive sampling method to recruit 62 participants to conduct 10 FGs (44 participants total) and 18 key informant interviews with stakeholders across Central Brooklyn. Results: The data revealed three primary themes: Trust, Discrimination, and Social Determinants of Health (SDOHs). Each theme comprised subthemes as follows: For Trust, the subthemes included (1) confidence in the healthcare professional, (2) provider empathy, and (3) active participation in healthcare decisions. Regarding Discrimination, the subthemes involved (1) racism and identity, as well as (2) stigma related to diagnosis, disease state, and pain management. Lastly, for Social Determinants of Health, the key subtheme was the acknowledgment by providers that patients encounter competing priorities acting as barriers to care, such as housing instability and food insecurity. For the first theme, participants' interactions with the healthcare system were prompted by a necessity for medical attention, and not by trust. The participants reported that experiences of discrimination resulting from identity and stigma associated with diagnosis, disease state, and pain management amplified the disconnect between the community, the patients, and the healthcare system. This also exacerbated the poor healthcare experiences suffered by many people of color. For SDOHs, the participants identified housing, food security, and other various social factors that may undermine the effectiveness of the healthcare that patients receive. Conclusions: Improvements in the health system, based on feedback from patients of color regarding their unique care experiences, are important initiatives in combating inequities in healthcare. [ABSTRACT FROM AUTHOR]

Purpose: The transition from pediatric to adult care can be complex and difficult to navigate for adolescents with cerebral palsy (CP). We aimed to assess the current state of transitional care for young persons with CP and delineate guidelines for best practice with opportunities for intervention. Methods: A systematic review was conducted using PRISMA guidelines to search PubMed, Embase, and Scopus databases. Articles were screened for relevance via title and abstract prior to full-text review. Results: Of 3151 resultant articles, 27 observational studies were included. Fourteen (52%) studies assessed clinical outcomes of patients with CP during and post-transition. Transition-associated poor outcomes included housing instability, unemployment, difficulty forming relationships, increased hospital admission rates, and decreased use of rehabilitation services. Factors associated with improved outcomes included family participation, promotion of self-efficacy, and meeting the adult team before transition. Nine (33%) studies conducted interviews with transition-age persons with CP. Key themes were a lack of transition preparedness, difficulty navigating the adult system, gaps in seamless care, and limited accessibility to specialists and environments suitable for patients with complex care needs. Four (15%) studies examined features of current transition services. Perceived barriers included poor communication within health service teams, limited adult providers accepting CP patients, and the lack of financial resources for specialized care. There was no standardized transition tool or approach. Conclusion: These findings underscore the importance of a planned transition process in optimizing long-term medical and psychosocial outcomes for persons with CP. Further research, including translational, team-based, and community-engaged research, are needed. [ABSTRACT FROM AUTHOR]

Veteran community engagement is an evolving discipline informed by traditional community-based participatory research, veteran studies, and veterans themselves. This Special Issue suggests that research collaborations including military veterans, soldiers, and their families as co-researchers is a critical next step toward a design thinking perspective in social and healthcare systems for this population. This Special Issue was conceptualized through a veteran community-academic partnership formed over a decade ago. This partnership hosted several Warrior Summit conferences from 2013 to present, with the last of this series calling for academic contributions. The resulting papers drawn from the conference and other authors form this issue, and include a wide range of topics: veteran microdosing and psychedelic self-medication; a historical view of the impact of education exchange between U.S. and South Korean military nurses; strategies for engaging veterans in research of a theater-based intervention for PTSD; interprofessional approaches to addressing veteran identity considerations through collaborations between chaplain service and psychologists in the VA Healthcare System; an international perspective exploring a community collaborative with veterans in Montréal, Canada; efforts to build long-term and sustainable models for veteran engagement in health services research; community-engaged strategies to address veteran homelessness within broader housing stability efforts; and examining the role of veteran peer mentorship programs in alcohol recovery. These projects represent an emerging movement and offer a multidisciplinary roadmap toward honoring veterans voices in research, clinical services, and program development. [ABSTRACT FROM AUTHOR]

Veterans with histories of incarceration are at greater risk for poor physical and mental health outcomes, yet prior research in this population has focused on specific subsets of veterans or a narrow range of predictors. We utilized the Bronfenbrenner Socioecological Model as the framework to evaluate correlates of incarceration history in a large sample of Iraq and Afghanistan-era veterans at four levels: demographic, historical, clinical, and contextual. Participants were 2,904 veterans (76.9% male; 49.5% White and 46.5% Black; mean age 38.08, SD = 10.33), 700 of whom reported a history of incarceration. Four logistic regression models predicting history of incarceration were tested, adding demographic, historical, clinical, and contextual variables hierarchically. In the final model, younger age (OR = 0.99, 95% CI = 0.98–1.00), male gender (OR of being female = 0.28, 95% CI = 0.21–0.38), belonging to a historically marginalized group (OR of being White = 0.69, 95% CI = 0.56–0.84), family history of incarceration (OR = 1.47, 95% CI = 1.10–1.94), adult interpersonal trauma (OR = 1.39, 95% CI = 1.28–1.51), problematic alcohol use (OR = 1.03, 95% CI = 1.02–1.05), drug abuse (OR = 1.15, 95% CI = 1.11–1.19), and unemployment (OR for being employed = 0.76, 95% CI = 0.62–0.92) were significantly associated with a history of incarceration. Implications of these findings for developing interventions and supporting systems to effectively target this high-risk population of veterans are discussed. [ABSTRACT FROM AUTHOR]

Housing First (HF) addresses chronic homelessness by admitting individuals into permanent shelter regardless of their situation. Studies using self-reported data suggest that HF can potentially decrease justice system use, but they are limited by inaccurate measurement of police contacts. This study uses administrative data from police to measure the change in number of police interactions, change in average crime weight (or importance of crime), and change in the distribution of crime weight, before and after HF. Six hundred and two chronically homeless individuals with a history of criminal involvement and who were accommodated by an HF shelter between three months to a year were eligible for this study. We use unconditional quantile regression to observe HF's effect on changes in the distribution of crime weights over time. While the average crime weight increased during the study period (57–79.1), the average number of police interactions decreased. Statistically significant decreases of approximately 5 crime weight units were observed between percentiles 0.54 and 0.65 and decreases of approximately 15 crime weight units occurred at percentiles 0.73 and 0.81. HF is effective at reducing minor crimes at the highest end of the distribution and helping those experiencing homelessness to avoid the warrant cycle. [ABSTRACT FROM AUTHOR]

Aims/objectives: Through interviews with clinical service providers, we explored stigma's impact on HIV service provision for African Americans during COVID‐19. Background: African Americans experience disproportionate rates of HIV and COVID‐19. We explored COVID‐19's impact on HIV services for African American adults in a Southern city. Design: The study was qualitative and observational. Methods: Key informant interviews were conducted (n = 11) across two healthcare centres and two community‐based organisations and thematically analysed using phenomenological approaches by two coders. Interviews explored pre‐ and post‐COVID‐19 service provision and parallels between COVID‐19 and HIV, particularly as related to stigma. The COREQ checklist was utilised to ensure research quality. Results: According to the providers interviewed, all providers offered HIV prevention/treatment, but PrEP and preventive services diminished greatly early in the COVID‐19 pandemic. Successful transition to telehealth depended on existing telehealth use. Challenges exacerbated by COVID‐19 included food/housing insecurity and physical distancing constraints. Clients' COVID‐19 informational needs shifted from concerns to vaccine requests over time. Interviewees stated HIV and COVID‐19 both carry 'risk taking'; however, HIV risk was more physically intimate than COVID‐19. Notably, some providers used stigmatising language referring to clients with HIV/COVID and omitted person‐centred language. Conclusions: Findings suggest need to address challenges in telehealth to improve client experiences now and for future pandemics. More research is needed to examine intersectional stigmatisation of COVID‐19 and HIV for African Americans to design person‐centred counselling interventions. Relevance to Clinical Practice: Results demonstrate need for provider training to reframe stigma discussions using client centeredness, educating African Americans on HIV and COVID‐19 prevention, and coordination with local organisations to address multiple care needs. Patient/Public Contribution: This research highlights needs of clients based on the views of healthcare providers caring for predominantly African American communities in a Southern city. However, no patients, service users, caregivers or members of the public were directly involved in this study. [ABSTRACT FROM AUTHOR]

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. [ABSTRACT FROM AUTHOR]

In this article, I discuss social housing tenants' experiences of tenure security and freedom in a housing regime characterized by strong market-orientation and means-testing. Based on thematic analysis of qualitative interviews, I argue that some tenants experience social housing as a haven of stability, whereas others regard it as a source of insecurity that prevents the realization of real personal freedom. These divergent personal experiences reflect the ambiguity of social rented housing in Oslo, a form of housing that for all its market-orientation and means-testing still provides relatively stable long-term homes for many social tenants. By highlighting the link between security and freedom this paper contributes to ongoing theoretical debates in housing studies. The main argument of the paper is that there is a strong connection between the dominant power of landlords in means-tested social housing, restricted tenure security, and the limited positive freedom of social housing tenants. [ABSTRACT FROM AUTHOR]

This article explores the significance of material basics for the health and well-being of children and young people. It emphasizes the importance of stable housing, nutritious food, clean water and air, school supplies, technology, social activities, and access to transportation and open spaces. Children who grow up in families facing material deprivation, such as poverty or housing instability, are more likely to experience psychological, behavioral, and educational challenges, as well as poor mental health. The article also highlights the need for measurement and data on material basics, as well as policies that address material deprivation alongside traditional measures of poverty. It provides data from the Australian census, focusing on poverty, housing stress, overcrowding, homelessness, and young people not in education, employment, or training. The article specifically addresses the issue of poverty and housing stress among Aboriginal and/or Torres Strait Islander children, noting higher poverty rates in remote and disadvantaged areas. It also discusses the prevalence of housing stress, overcrowding, and homelessness among children and young people. Lastly, the article emphasizes the importance of addressing these issues and suggests that investing in childhood can lead to healthier societies. [Extracted from the article]

Some populations have increased risks of experiencing chronic homelessness related to complex health and social needs combined with system failures. Permanent supportive housing (PSH) may improve housing and health outcomes for this population. To understand the scope of the literature on PSH, this scoping review uses Arksey and O'Malley's methodological framework enhanced by Levac and the Joanna Briggs Institute. A search was conducted across multiple databases for existing research on PSH. Forty-one studies were included, and five themes were generated: PSH sustains housing for most people; PSH is costly to implement, but costs can be recouped; PSH facilitates belonging and safety; single-site programs have social challenges but also provide efficiency and improve social networks; and visible on-site staff fundamentally helps those with highest support needs. Permanent supportive housing has been shown to be effective for those with the highest health and social support needs and is required to help prevent and end homelessness. [ABSTRACT FROM AUTHOR]

Couch hopping is a significant feature of youth homelessness in the United States. Every year, half of youth ages 18 to 25 who experience housing instability report couch hopping—also known as couch surfing or doubling up. Emerging work suggests that in some intergenerational informal hosting arrangements, youth and their adult hosts can form meaningful and supportive relationships. However, hosts also navigate material challenges that could threaten the stability of these arrangements. Based on in-depth interviews with nine youth ages 17 to 23 in informal hosting arrangements and 10 informal hosts, we describe how increased household costs and lease and benefits restrictions can impact stability, and the strategies hosts and youth mobilized to address them. We place hosts' instability in the context of intergenerational poverty and structural racism, reframing material challenges as opportunities to strengthen the village of support youth need to make sustained exits from homelessness. [ABSTRACT FROM AUTHOR]

Objectives: To quantify the number and type of students failing to secure basic needs. Participants: Students attending 22 postsecondary schools in the United States in Fall 2019. Methods: The Adult Food Security Module and part of the #RealCollege Survey were used to measure food and housing insecurity, respectively. Logistic and linear regression models were used to assess the relationship between selected factors and basic needs insecurities. Results: Participants (n = 22,153) were classified as 44.1% and 52.3% food insecure and housing insecure, respectively. Homeless students or those who experienced childhood food insecurity were at the greatest odds of college food insecurity. Year in school was the largest contributor to being housing insecure, with PhD or EdD students being 1,157% more likely to experience housing insecurity compared to freshmen. Conclusions: High prevalence of basic needs insecurities remain. Current campus initiatives may be insufficient, calling for a more holistic approach at the campus, state, and national levels. [ABSTRACT FROM AUTHOR]

Women experiencing housing insecurity are at an elevated risk for adverse reproductive health outcomes due to the prevalence of chronic health conditions and higher risk behaviors. Social service and healthcare providers are front line in addressing women's needs when they seek support. Thus, we sought to explore reproductive healthcare barriers using in-depth interviews with 17 providers at 11 facilities serving housing-insecure women in Salt Lake County, Utah, USA from April to July 2018. Providers noted a number of system-, provider-, and individual-level barriers. Dominant themes include reliance on unstable funding, lack of provider training on reproductive health, and perceived logistical challenges to care. Due to the prevalence of immediate needs among housing-insecure women, providers attest that reproductive health needs often do not emerge as their urgent concern. Our findings suggest that addressing policy and funding challenges to prioritizing reproductive needs among housing-insecure women can help mitigate the potential for long-term adverse reproductive outcomes. [ABSTRACT FROM AUTHOR]

Human trafficking occurs in a cycle of coercion and exploitation of vulnerable people; yet, little is known about those who are trafficked more than one time (re-trafficked). Our study sought to describe the trafficking experiences and explore vulnerabilities to re-trafficking in an urban, majority immigrant, population. This study is part of a parent cohort study that enrolls patients at the EMPOWER Center in New York City, which provides trauma-informed obstetric and gynecologic services to victims of sexual- and gender-based violence. Retrospective chart review was conducted on patients with a history of sex trafficking who were evaluated at the EMPOWER Center from February 2013 to January 2021. A total of 87 patients were enrolled in this study, 23 (26.4%) of whom had been re-trafficked. All were women. Most (88.5%) were victims of international trafficking, most often from Mexico or the Caribbean/Central America. Nine (10.3%) reported contraceptive use and six (6.9%) experienced forced substance use while trafficked. The most reported barriers that women faced in escaping trafficking were threat of violence (28.7%) and financial dependence (19.5%). Re-trafficked patients were more likely to have a history of being undocumented (odds ratio [OR] = 5.29; 95% confidence intervals [CI] [1.34, 20.94]) and experienced childhood sexual abuse (OR = 2.99; 95% CI [1.10, 8.16]), experienced childhood physical abuse (OR = 3.33; 95% CI [1.18, 9.39]), and lived with a non-parent family member (OR = 6.56; 95% CI [1.71, 25.23]). Although these vulnerabilities were no longer significant when analyzed in a parsimonious multivariate logistic regression model adjusting for the other significant variables, likely due to the limited sample size. Almost half (46.0%) reported ongoing emotional effects from being trafficked, which did not vary by re-trafficking status. Our study highlights potential pre-trafficking vulnerabilities, illustrates the complexity of the trafficking experience, and presents potential risk factors for being re-trafficked. [ABSTRACT FROM AUTHOR]

Justice‐involved people experience high levels of housing instability and residential mobility, making the housing search a recurrent part of life. Little is known, however, regarding how criminal record stigma functions in the rental housing market. This article examines how housing providers use criminal records to screen tenants in the rental housing market and whether it varies by type of neighborhood. I conduct an online correspondence audit to test discriminatory behaviors and find an adverse criminal record effect on housing opportunities. Many housing providers disqualify all tenants with a criminal record, even without information about the severity or timing of offenses. The criminal record effect is significantly stronger in gentrifying neighborhoods and in neighborhoods where the proportion of Black residents is dwindling. Tenant screening emerges as a central obstacle faced by the justice‐involved population, vital to understanding the web of disadvantages that traps so many in the wake of the carceral state. [ABSTRACT FROM AUTHOR]

Background: Research conducted in urban areas has highlighted the impact of housing instability on people who inject drugs (PWID), revealing that it exacerbates vulnerability to drug-related harms and impedes syringe service program (SSP) use. However, few studies have explored the effects of houselessness on SSP use among rural PWID. This study examines the relationship between houselessness and SSP utilization among PWID in eight rural areas across 10 states. Methods: PWID were recruited using respondent-driven sampling for a cross-sectional survey that queried self-reported drug use and SSP utilization in the prior 30 days, houselessness in the prior 6 months and sociodemographic characteristics. Using binomial logistic regression, we examined the relationship between experiencing houselessness and any SSP use. To assess the relationship between houselessness and the frequency of SSP use, we conducted multinomial logistic regression analyses among participants reporting any past 30-day SSP use. Results: Among 2394 rural PWID, 56.5% had experienced houselessness in the prior 6 months, and 43.5% reported past 30-day SSP use. PWID who had experienced houselessness were more likely to report using an SSP compared to their housed counterparts (adjusted odds ratio [aOR] = 1.24 [95% confidence intervals [CI] 1.01, 1.52]). Among those who had used an SSP at least once (n = 972), those who experienced houselessness were just as likely to report SSP use two (aOR = 0.90 [95% CI 0.60, 1.36]) and three times (aOR = 1.18 [95% CI 0.77, 1.98]) compared to once. However, they were less likely to visit an SSP four or more times compared to once in the prior 30 days (aOR = 0.59 [95% CI 0.40, 0.85]). Conclusion: This study provides evidence that rural PWID who experience houselessness utilize SSPs at similar or higher rates as their housed counterparts. However, housing instability may pose barriers to more frequent SSP use. These findings are significant as people who experience houselessness are at increased risk for drug-related harms and encounter additional challenges when attempting to access SSPs. [ABSTRACT FROM AUTHOR]

The UK food system affects social, economic and natural environments and features escalating risk of food insecurity. Yet it should provide access to safe, nutritious, affordable food for all citizens. Disadvantaged UK communities [individuals and families at risk of food and housing insecurity, often culturally diverse] have often been conceptualised in terms of individual behaviour which may lead to findings and conclusions based on the need for individual change. Such communities face public health challenges and are often treated as powerless recipients of dietary and health initiatives or as 'choiceless' consumers within food supply chains. As transforming the UK food system has become a national priority, it is important a diverse range of evidence is used to support understanding of the diets of disadvantaged communities to inform food systems transformation research. A scoping review of UK peer reviewed qualitative literature published in MEDLINE, CINAHL Plus with Full Text, EMBASE, PsycINFO and Web of Science between January 2010 and May 2021 in English. Eligibility criteria were applied, a data extraction table summarised data from included studies, and synthesis using social practice theory was undertaken. Forty-five qualitative studies were reviewed, which included the views of 2,434 community members aged between 5 and 83. Studies used different measures to define disadvantage. Synthesis using social practice theory identified themes of food and dietary practices shaped by interactions between 'material factors' (e.g. transport, housing and money), 'meanings' (e.g. autonomy and independence), and 'competencies' (e.g. strategies to maximise food intake). These concepts are analysed and critiqued in the context of the wider literature to inform food systems transformation research. This review suggests to date, qualitative research into diets of UK disadvantaged communities provides diverse findings that mainly conceptualise disadvantage at an individual level. Whilst several studies provide excellent characterisations of individual experience, links to 'macro' processes such as supply chains are largely missing. Recommendations are made for future research to embrace transdisciplinary perspectives and utilise new tools (e.g., creative methods and good practice guides), and theories (e.g., assemblage) to better facilitate food systems transformation for disadvantaged communities. [ABSTRACT FROM AUTHOR]

Homelessness and caregiver insecurity are barriers to accessing hospice for end-of-life care. Some communities have implemented a community-based social model of hospice care, and reports of its characteristics and outcomes are growing in hospice and homeless literature. This case report explored the experiences of social model hospice recipients using photovoice, a community-based participatory method to photograph meaningful aspects of care. Participants (n = 3) took photos (n = 93), journaled, and participated in semistructured interviews as co-analyzers. Through deductive codes from the literature and inductive analysis of data, 6 themes were identified: having a physical location to receive care, involving the community, having spiritual needs attended to, acknowledging family/family of choice, connecting with animals, and feeling cared for. Participants offered few suggestions to improve care. Social model hospice provided a location for care, funding, and social support to address housing and caregiver insecurity. Results corroborated the social model hospice concept (antecedents, attributes, consequences). Findings add to the growing literature with implications for communities and leaders looking to start or improve care. Results suggest that photovoice may be a feasible method for eliciting firsthand experiences of residents. Findings may guide discussions about patient-reported aspects of care for a more accurate understanding of meaningful social model hospice care. [ABSTRACT FROM AUTHOR]

Purpose: Health care professionals want to solve problems. When health disparities are observed, the solution often rests on expanding access to clinical services. However, what are the varied paths that persons with communication disorders might take to access speech, language, and hearing care? Where are these paths successful and where does a well-intended initiative have an absent or limited effect in altering disparities? Multiple, complex factors affect access to health care in underserved communities. However, current practice tends to frame the goals and metrics of outreach programs in terms of access to health care services, which risks privileging the perspective of the providers who want to increase the volume of services accessed over the voices of the community members for whom access to health care is only part of the larger course of their lives. Solutions that do not reflect those community strengths outside the service provision framework likely yield minimal impact on quality of life, since the community members are less likely to fully embrace the solution. Method: In this clinical focus, we describe a community-informed strengths-based framework for clinicians and clinical researchers whose work is designed to reach underserved communities by employing mutual trust, empathy, active listening, and patient-centered care planning. Through case scenarios, we exemplify key tenets of the framework. Conclusions: The community-informed strengths-based framework detailed in this clinical focus supports a paradigm shift from a biomedically-informed strengths-based framework to a model of health care service provision that focuses on individual or community strengths. Eliciting guidance from those receiving care and framing the totality of encounters in terms of the process of responding to community strengths can build a collaborative and sustainable path forward toward achieving health goals. [ABSTRACT FROM AUTHOR]

Discharges against medical advice, or self-discharges, account for nearly 2% of US hospital discharges.[[1]] Self-discharged patients have higher readmission, morbidity, and mortality rates.[[1]] In addition to $800 million in annual readmission costs,[[3]] self-discharges result in patient care disruptions and lower rates of follow-up.[[4]] Moreover, self-discharges are higher among patients experiencing housing instability, substance use disorders, mental illness, and other socioeconomic vulnerabilities.[[1]] Although common reasons for self-discharge include fear of losing housing, employment, and public benefits during hospitalization,[[2]] the association between housing status and self-discharges is unclear. This study examined the association between discharge type and housing instability, then identified primary reasons for hospitalization among self-discharged patients with housing instability. RESULTS We excluded 21,342,124 of 106,744,955 total hospitalizations from the analysis ( I n i = 15,845,919 hospitalizations of patients under 18 or over 99 years of age; I n i = 2,038,440 hospitalizations of patients who died during hospitalization; and I n i = 3,457,765 hospitalizations with missing data, including 2,445,836 missing race/ethnicity data). [Extracted from the article]

Background: The Department of Veterans Affairs (VA) healthcare system routinely screens Veterans for food insecurity, housing instability, and intimate partner violence, but does not systematically screen for other health-related social needs (HRSNs). Objectives: To (1) develop a process for systematically identifying and addressing Veterans' HRSNs, (2) determine reported prevalence of HRSNs, and (3) assess the acceptability of HRSN screening among Veterans. Design: "Assessing Circumstances and Offering Resources for Needs" (ACORN) is a Veteran-tailored HRSN screening and referral quality improvement initiative. Veterans were screened via electronic tablet for nine HRSNs (food, housing, utilities, transportation, legal needs, social isolation, interpersonal violence, employment, and education) and provided geographically tailored resource guides for identified needs. Two-week follow-up interviews with a purposive sample of Veterans explored screening experiences. Participants: Convenience sample of Veterans presenting for primary care at a VA urban women's health clinic and suburban community-based outpatient clinic (October 2019–May 2020). Main Measures: Primary outcomes included prevalence of HRSNs, Veteran-reported acceptability of screening, and use of resources guides. Data were analyzed using descriptive statistics, chi-square tests, and rapid qualitative analysis. Key Results: Of 268 Veterans screened, 50% reported one or more HRSNs. Social isolation was endorsed most frequently (29%), followed by educational needs (19%), interpersonal violence (12%), housing instability (9%), and utility concerns (7%). One in five Veterans reported at least one form of material hardship. In follow-up interviews (n = 15), Veterans found screening acceptable and felt VA should continue screening. No Veterans interviewed had contacted recommended resources at two-week follow-up, although several planned to use resource guides in the future. Conclusion: In a VA HRSN screening and referral program, Veterans frequently reported HRSNs, felt screening was important, and thought VA should continue to screen for these needs. Screening for HRSNs is a critical step towards connecting patients with services, identifying gaps in service delivery, and informing future resource allocation. [ABSTRACT FROM AUTHOR]

This article will be presented the stages of making a two‐component housing, for the protection and stability of a system that is implemented on an Arduino data acquisition and acquisition board. The housing has the actual body and cover, implicitly four inner pillars, which will present the stability in the housing of the system. The design and printing stages of this element of the mechatronic system will be identified. The design will be done with the help of the Solidworks program, and the printing will be done with the Prusa I3 printer. [ABSTRACT FROM AUTHOR]

Housing insecurity is endemic among low-income families. Caregiver mental health is an important factor for predicting family housing risk, but less is known about how it impacts subtypes of housing insecurity. The present study investigates two research questions for a sample of families with adolescent children: (1) Do distinct subtypes of housing insecurity exist based on affordability and instability? (2) Does caregiver depression or substance misuse predict housing insecurity subtypes? Data came from a large sample of low-income families (N = 2955). Missing data were handled using multiple imputation with chained equations. Latent class analysis estimated housing subtypes and longitudinal predictors of class membership using mixture modeling. Results showed a three-class solution that suggested a continuum of risk was the best fit to the data. The majority of families ("Low Housing Risk" class; 82.9%) experienced low levels of housing insecurity, whereas one in six families "Cost-Burdened but Housed," (14.5%) reported difficulty affording rent but maintained housing. The smallest, highest-risk class ("Housing Insecure," 2.7%) reported recent doubling up, evictions, and/or homelessness. Caregiver substance use quadrupled the likelihood that families would fall into the smallest ("Housing Insecure") class. Policies limiting access to housing assistance for households with a history of drug convictions may perpetuate ongoing risk for housing instability. Highlights: Families with children experience a range of diverse housing problems that threaten well-being. Latent class analysis indicated three subgroups of housing insecurity indicating a continuum of risk among families with adolescents. Caregiver substance use quadrupled the likelihood that families would fall into the highest risk class. Caregiver depression increased risk for experiencing housing cost burden. Failure to address caregiver mental health threatens family housing stability. [ABSTRACT FROM AUTHOR]

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Social risks are patient-level effects of social determinants of health. Cumulative social risk, the total of multiple risks, predicts health outcomes such as cancer mortality. Current measures of cumulative social risk count the number of domains in which a patient has risks. We tested whether an item response theory (IRT) model could be an alternative method for measuring cumulative social risk. A population-based sample (n = 1118) was recruited from 13 counties of western Washington State. Participants completed a one-time survey online. Questions on social risk included two on housing instability, two on food insecurity, one on affording medical care and one on general financial health. Additional measures to test the construct validity of the cumulative social risk score included perceived discrimination, perceived stress, smoking status and having a usual place for healthcare. The IRT model fit the six social risk items. Social risk items ranged in severity from just above the mean (0.18 standard deviations) to substantially above the mean (4.18 standard deviations). IRT scores were positively and significantly associated with perceived discrimination (p < 0.001), perceived stress (p < 0.001), being a current smoker vs. a never (p < 0.001) or former smoker (p = 0.006) and not having a usual place for healthcare vs. having a usual place of care (p = 0.033). Cumulative social risk can be measured and assessed using IRT models. Weighted IRT cumulative social risk scores were associated with multiple health markers, indicating promise for this type of measure. Future research is needed to compare IRT-based and count-based cumulative social risk scores. [ABSTRACT FROM AUTHOR]

In this paper, for the first time, we provide monthly estimates of multidimensional hardships experienced by Americans during the COVID-19 pandemic. We compile data from the Census's Household Pulse Survey on job insecurity, food insufficiency, housing insecurity, and mental health. Our analysis covers two years of the pandemic, beginning in April 2020 and ending in March 2022. We find that during these two years, 16.3% of adults, on average, experienced two or more hardships simultaneously. At the peaks of the hardship crises in July and December 2020, approximately 20% or one in five adults experienced two or more hardships. The most common hardships experienced by Americans during the pandemic were job insecurity and mental health. Multidimensional hardships were more prevalent among Black and Hispanic adults and less among White and Asian adults. Our results underscore the fact that the pandemic compounded hardships experienced by Americans and left a long-lasting impact on their well-being. [ABSTRACT FROM AUTHOR]

How school districts measure homelessness among their students has implications for accountability and funding, as well as for supporting student success. Yet, measuring homelessness among high school students is challenging because students move in and out of experiencing it. Using administrative student-level data from a mid-sized public school district in the southern United States, we show that different commonly used procedures to measure which students are considered homeless can yield markedly different estimates of high school graduation rates for these students. This is largely because of differences in how districts classify students who experience homelessness but later become housed. To address the potentially negative effects of housing insecurity on academic achievement, it is important to first identify a common way to diagnose the problem. [ABSTRACT FROM AUTHOR]

This mixed methods study explores predictive factors for housing insecurity (HI) and homelessness. Using multi-variable analyses with data from an original survey (48% response rate, n = 1,416 students), we found that income, race/ethnicity, awareness of services and being impacted by a natural disaster, all significantly impact HI and homelessness. Focus groups and interviews corroborate the quantitative results. Implications for practice are discussed. [ABSTRACT FROM AUTHOR]

Abstract Background We describe the rationale and study design for “TRUsted rEsidents and Housing Assistance to decrease Violence Exposure in New Haven (TRUE HAVEN),” a prospective type 1 hybrid effectiveness/implementation study of a multi-level intervention using a stepped wedge design. TRUE HAVEN aims to lower rates of community gun violence by fostering the stability, wealth, and well-being of individuals and families directly impacted by incarceration through the provision of stable housing and by breaking the cycle of trauma. Design TRUE HAVEN is an ongoing, multi-level intervention with three primary components: financial education paired with housing support (individual level), trauma-informed counseling (neighborhood level), and policy changes to address structural racism (city/state level). Six neighborhoods with among the highest rates of gun violence in New Haven, Connecticut, will receive the individual and neighborhood level intervention components sequentially beginning at staggered 6-month steps. Residents of these neighborhoods will be eligible to participate in the housing stability and financial education component if they were recently incarcerated or are family members of currently incarcerated people; participants will receive intense financial education and follow-up for six months and be eligible for special down payment and rental assistance programs. In addition, trusted community members and organization leaders within each target neighborhood will participate in trauma-informed care training sessions to then be able to recognize when their peers are suffering from trauma symptoms, to support these affected peers, and to destigmatize accessing professional mental health services and connect them to these services when needed. Finally, a multi-stakeholder coalition will be convened to address policies that act as barriers to housing stability or accessing mental healthcare. Interventions will be delivered through existing partnerships with community-based organizations and networks. The primary outcome is neighborhood rate of incident gun violence. To inform future implementation and optimize the intervention package as the study progresses, we will use the Learn As You Go approach to optimize and assess the effectiveness of the intervention package on the primary study outcome. Discussion Results from this protocol will yield novel evidence for whether and how addressing structural racism citywide leads to a reduction in gun violence. Trial registration ClinicalTrials.gov Identifier: NCT05723614. Registration date: February 01, 2023. Please refer to https://clinicaltrials.gov/ct2/show/NCT05723614 for public and scientific inquiries.

The article focuses on the development and implementation of a curriculum for pediatric residents addressing childhood homelessness and housing insecurity. Topics include the background highlighting the impact of housing instability on child health, the educational approach using a six-step curriculum development model, and positive outcomes revealing improved knowledge, comfort, and identification of housing issues among pediatric interns who underwent the curriculum.

Permanent supportive housing is an effective intervention for stably housing most people experiencing homelessness and mental illness who have complex support needs. However, high-risk behaviours and challenges are prevalent among this population and have the potential to seriously harm health and threaten housing tenures. Yet, the research on the relationship between high-risk issues and housing stability in permanent supportive housing has not been previously synthesized. This rapid review aimed to identify the housing-related outcomes of high-risk behaviours and challenges in permanent supportive housing settings, as well as the approaches used by agencies and residents to address them. A range of high-risk behaviours and challenges were examined, including risks to self (overdose, suicide/suicide attempts, non-suicidal self-injury, falls/fall-related injuries), and risks to multiple parties and/or building (fire-setting/arson, hoarding, apartment takeovers, physical/sexual violence, property damage, drug selling, sex trafficking). The search strategy included four components to identify relevant academic and grey literature: (1) searches of MEDLINE, APA PsycINFO, and CINAHL Plus; (2) hand searches of three journals with aims specific to housing and homelessness; (3) website browsing/searching of seven homelessness, supportive housing, and mental health agencies and networks; and (4) Advanced Google searches. A total of 32 articles were eligible and included in the review. Six studies examined the impacts of high-risk behaviours and challenges on housing tenancies, with overdose being identified as a notable cause of death. Twenty-six studies examined approaches and barriers to managing high-risk behaviours and challenges in PSH programs. These were categorized into eight types of approaches: (1) clinical, (2) relational/educational, (3) surveillant, (4) restrictive, (5) strategic, (6) design-based, (7) legal, and (8) self-defence. Consistent across all approaches was a lack of rigorous examination of their effectiveness. Further, some approaches that are legal, restrictive, surveillant, or strategic in nature may be used to promote safety, but may conflict with other program objectives, including housing stability, or resident empowerment and choice. Research priorities were identified to address the key evidence gaps and move toward best practices for preventing and managing high-risk behaviours and challenges in permanent supportive housing. [ABSTRACT FROM AUTHOR]

Background: In the UK, the population of homelessness and housing insecurity is increasing among families headed by mothers. The unique stressors of housing insecurity and living in accommodations ill-suited to long-term dwellings increase mental distress for mothers and children. Community engagement interventions present a public health opportunity to alleviate adverse outcomes for vulnerable families. Aim: To synthesise and evaluate evidence of the impact of community engagement interventions in supporting the mental well-being of mothers and children living under housing insecure conditions. To synthesise the components of community engagement interventions as a public health intervention in alleviating mental well-being and non-health outcomes of mothers and children living under housing insecurity. Methods: A systematic search of five online bibliographic databases (MEDLINE, EMBASE, PsychINFO, Global Health and Child Development & Adolescent Studies) and grey literature (Carrot2) was conducted in May 2022. Primary studies with community engagement components and housing-insecure single-mother families were included. Intervention data was extracted using the TIDieR checklist and a community engagement keywording tool. The studies' quality was critically appraised using the MetaQAT framework. Results: Ten studies meeting inclusion criteria were identified, across two countries (USA & UK). Data from the studies reported positive significant effects for health and personal maternal outcomes in addition to higher positive effects for child health outcomes (e.g., decrease in depression symptoms). Interventions targeting social support and self-efficacy demonstrated potential to improve maternal and child outcomes via the maternal-child relationship. Community engagement at the design, delivery and evaluation intervention stages increased the level of community engagement, however there were tentative links to directly improving mental well-being outcomes. Conclusion: There is evidence to suggest that community engagement may be applied as an effective intervention in supporting the mental well-being of mothers and children living under housing insecurity. Proposed intervention effectiveness may be achieved via psychosocial pathways such as improved maternal self-efficacy and social support. However, more embedded long-term process evaluations of these interventions are needed to establish maintenance of these observed benefits and to understand to what extent the findings apply to the UK context. [ABSTRACT FROM AUTHOR]

Sickle cell disease (SCD) is a life-threatening condition. Given the nature of the disease and associated complications with high mortality and morbidity rates, it is imperative that patients are diagnosed in early infancy, are established with specialists and general pediatric care immediately, and receive continuity in care. A percentage of patients diagnosed with SCD fall within a vulnerable, at-risk population. This population may face greater social barriers that lead to missed or late diagnosis and therefore delayed management, significantly increasing the risk of morbidity and mortality. Screening tools such as state newborn screens help to identify the diagnosis early. However, patients in vulnerable, at-risk populations who are not established in the health care system may not receive timely communication about their illness and necessary next steps for care. We present a case of a 12-month-old female who is an example of one of the many patients who despite having undergone newborn screening, fell through the cracks due to social barriers including housing instability, food insecurity, and lack of access to transportation. This paper emphasizes the need for and provides a real example of the benefit of access to longitudinal primary care for vulnerable patients. We also demonstrate the role of primary care in clearing the care gaps and coordinating services quickly to ultimately prevent life-threatening complications specifically for children with previously undiagnosed chronic illnesses. [ABSTRACT FROM AUTHOR]

Background: While health care payers are increasingly considering approaches that help support stable and affordable housing for their beneficiaries, experience with these initiatives is limited. Through its §1115 HealthChoice waiver, Maryland Medicaid has begun experimenting with programs designed to pay for housing and tenancy support/case management services. This study investigates barriers and facilitators to the success of Maryland's pilot program initiative — Assistance in Community Integration Services (ACIS). Methods: The study focused on key stakeholders employed by the four Lead Entities that currently participate in the ACIS program. The stakeholders included members of each Lead Entity's administration, direct service providers, state and local government officials, and case managers from local hospitals. The convenience sample was selected through an initial list of stakeholders and was supplemented using snowball sampling methods. Interviews were audio recorded and turned into transcripts via Otter.ai and then analyzed using NVivo by two independent reviewers. Results: A total of 23 interviews were conducted between February 2022 and May 2022, representing a broad range of stakeholders across different Maryland geographies. A total of 4 themes were identified through the course of the interviews. Stakeholders identified difficulty finding housing for the target population in a tight housing market, challenges with communication within the program and with its clients, and problems with non-healthcare providers documenting services for reimbursement. At the same time, ACIS was seen as creating opportunities for organizations to work together across siloes in meeting client needs. Conclusions: The findings of this study helps to highlight Medicaid §1115 waivers as a novel approach to using Medicaid funds to support tenancy-based services, such as ACIS and to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized. The program also highlights the growing need to address root causes of housing insecurity including the limited supply of affordable housing. [ABSTRACT FROM AUTHOR]

Introduction: People experiencing homelessness have high rates of social needs when presenting for emergency department (ED) services, but less is known about patients with housing instability who do not meet the established definitions of homelessness. Methods: We surveyed patients in an urban, safety-net ED from June-August 2018. Patients completed two social needs screening tools and responded to additional questions on housing. Housing status was determined using validated questions about housing stability. Results: Of the 1,263 eligible patients, 758 (60.0%) completed the survey. Among respondents, 40% identified as Latinx, 39% Black, 15% White, 5% Asian, and 8% other race/ethnicities. The median age was 42 years (interquartile range [IQR]: 29-57). and 54% were male. Of the 758 patients who completed the survey, 281 (37.1%) were housed, 213 (28.1%) were unstably housed, and 264 (34.8%) were homeless. A disproportionate number of patients experiencing homelessness were male (63.3%) and Black (54.2%), P <0.001, and a disproportionate number of unstably housed patients were Latinx (56.8%) or were primarily Spanish speaking (49.3%), P <0.001. Social needs increased across the spectrum of housing from housed to unstably housed and homeless, even when controlling for demographic characteristics. Conclusion: Over one in three ED patients experience homelessness, and nearly one in three are unstably housed. Notable disparities exist by housing status, and there is a clear increase of social needs across the housing spectrum. Emergency departments should consider integrating social screening tools for patients with unstable housing. [ABSTRACT FROM AUTHOR]

The prevalence of HIV/HCV (hepatitis C virus) co-infection is high particularly in persons who inject drugs (PWID) and is increasing because of the evolving opioid epidemic in the United States. The introduction of effective antiviral medications for HCV has raised the strategic goal of HCV micro-elimination, and efforts to understand the barriers to treatment are critical. In this study, we explored the provider perspective of factors that inhibit HCV micro-elimination efforts in people with HIV (PWH), including the role of implicit bias and related stigma in providers' health care decision making. We used the mixed-methods approach of nominal group technique (NGT) with 14 participants from 11 different clinics engaged in two virtual focus group sessions (n = 5 and n = 9). Responses from the NGTs were rank ordered during the sessions to identify providers' perspectives of major barriers and facilitators, then identified possible implicit bias after the NGTs concluded. There were 12 responses given for micro-elimination barriers with the three most prioritized being housing instability, medication nonadherence concerns, and inability to motivate patients. Of these, eight were categorized as potential implicit biases. Among the 14 responses given for facilitators of treatment, the three major solutions included distributive models of care, improved provider knowledge, and increased patient engagement. Although the solutions offered were insightful, there was consensus that the individual lives of patients were the root cause of most barriers to care. We recommend further research on behavioral design interventions that promote patients' involvement in decision making and focus on patients' eligibility criteria for HCV treatment as opposed to providers' perceived barriers to treatment. [ABSTRACT FROM AUTHOR]

Policy PointsHealth and civic engagement are reciprocally and longitudinally linked: Poor health is associated with less civic engagement. Well‐established social drivers of health and health inequality such as inadequate access to health care, poverty, racism, housing instability, and food insecurity are also drivers of lower civic engagement.A robust primary care system can play a key role in advancing civic engagement (e.g., voting, volunteerism, community service, and political involvement) at the population level but has received little attention.Policy and practice solutions at the individual and structural levels should support and leverage potential synergies among health equity, civic engagement, and primary care. Context: Health and civic engagement are linked. Healthier people may be able to participate more fully in civic life, although those with poorer health may be motivated to address the roots of their health challenges using collective action. In turn, civically active people may experience better health, and societies with more equitable health and health care may experience healthier civic life. Importantly, a robust primary care system is linked to greater health equity. However, the role of primary care in advancing civic engagement has received little study. Methods: We synthesize current literature on the links among health, civic engagement, and primary care. We propose a conceptual framework to advance research and policy on the role of primary care in supporting civic engagement as a means for individuals to actualize their health and civic futures. Findings: Current literature supports relationships between health equity and civic engagement. However, this literature is primarily cross‐sectional and confined to voting. Our integrative conceptual framework highlights the interconnectedness of primary care structures, health equity, and civic engagement and supports the crucial role of primary care in advancing both civic and health outcomes. Primary care is a potentially fruitful setting for cultivating community and individual health and power by supporting social connectedness, self‐efficacy, and collective action. Conclusions: Health and civic engagement are mutually reinforcing. Commonalities between social determinants of health and civic engagement constitute an important convergence for policy, practice, and research. Responsibility for promoting both health and civic engagement is shared by providers, community organizations, educators, and policymakers, as well as democratic and health systems, yet these entities rarely work in concert. Future work can inform policy and practice to bolster primary care as a means for promoting health and civic engagement. [ABSTRACT FROM AUTHOR]

The growing practice of community-engaged research (CER) creates new opportunities for practitioners, both to affirm the importance of critical approaches to CER and to strengthen our work by reflecting on the concepts and practices of our research. We offer reflections on the meanings of "community," "engagement," and "research" in the context of on-the-ground community–university collaborations conducted by the Blum Center on Poverty, Social Enterprise, and Participatory Governance, a campus-based research center at the University of California, Santa Cruz. This account is provided in the spirit of sharing observations, insights, and lessons learned about CER, generated through its practice in a range of community-based research projects. [ABSTRACT FROM AUTHOR]