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Background Estimated hepatitis C prevalence within the Veterans Health Administration is higher than the general population and is a risk factor for advanced liver disease and subsequent complications. We describe the hepatitis C care continuum within the Veterans Health Administration 1 January 2014 to 31 December 2022. Methods We included individuals in Veterans Health Administration care 2021–2022 who were eligible for direct-acting antiviral treatment 1 January 2014 to 31 December 2022. We evaluated the proportion of Veterans who progressed through each step of the hepatitis C care continuum, and identified factors associated with initiating direct-acting antivirals, achieving sustained virologic response, and repeat hepatitis C viremia. Results We identified 133 732 Veterans with hepatitis C viremia. Hepatitis C treatment was initiated in 107 134 (80.1%), with sustained virologic response achieved in 98 136 (91.6%). In those who achieved sustained virologic response, 1097 (1.1%) had repeat viremia and 579 (52.8%) were retreated for hepatitis C. Veterans of younger ages were less likely to initiate treatment and achieve sustained virologic response, and more likely to have repeat viremia. Stimulant use and unstable housing were negatively associated with each step of the hepatitis C care continuum. Conclusions The Veterans Health Administration has treated 80% of Veterans with hepatitis C in care 2021–2022 and achieved sustained virologic response in more than 90% of those treated. Repeat viremia is rare and is associated with younger age, unstable housing, opioid use, and stimulant use. Ongoing efforts are needed to reach younger Veterans, and Veterans with unstable housing or substance use disorders. [ABSTRACT FROM AUTHOR]

Adverse maternal and infant health outcomes among African Americans are increasingly recognized as indicators of a critical public health crisis in the United States. Research has found that stress is related to structural racism and the social determinants of health (SDOH) that cause avoidable, unfair inequities in resources, education, power, and opportunities across ethnic groups. This paper describes the SDOH needs and experiences of pregnant Black women from the perspective of doulas and Birthing Beautiful Communities (BBC) clients. The design was a qualitative description, using data collected over time (2017–2018, 2020–2021, and 2023). This study took place in Cleveland and Akron, Ohio and the sample included 58 clients, 26 doulas, and 2 resource intake specialist assistants (RISAs). Qualitative data included individual client interviews, three doula focus groups, and one interview with two BBC RISAs. Three coders used content analysis to deductively identify SDOHs and calculate the number of interviews that contained information about specific SDOHs. Although the sample reported issues with all SDOH, particular ones caused a cascade of SDOH effects. Transportation issues, for example, impeded women from being able to make it to work, doctor's appointments, and to purchase essential baby items (e.g., food, infant supplies). An inability to work—whether because of transportation challenges or pregnancy-related health complications—led to unstable housing and an inability to deal with transportation challenges. Many clients mentioned that housing was a major issue, with many clients experiencing housing instability. Implications include ensuring SDOH information is collected from a trusted source who can advocate and ensure access to a wide range of local resources, ensuring policies protect pregnant women from experiencing a cascade of SDOH that may contribute to continuing health disparate infant and maternal health outcomes in African American women. [ABSTRACT FROM AUTHOR]

Supportive housing programs such as the Community Homes for Opportunity (CHO) that provide combined formal (off-site healthcare providers) and informal (on-site supports are effective in reducing erratic housing and homelessness. This study explored the views of the Community Mental Health Agency staff on their experiences with the CHO and related changes for further improvement of the program. We applied focused ethnographic techniques to recruit 47 agency staff from 28 group homes in Southwestern Ontario, Canada. Focus group discussions were conducted at two-time points (baseline–spring 2018 and post-implementation – winter 2019). Data analysis guided by Leininger's ethnographic qualitative analysis techniques produced three main themes and 11 subthemes themes. The main themes include facilitators of CHO, challenges to the CHO implementation, and strategies for improving the CHO program. Overall, supportive housing models have been found to constitute an effective pathway to reducing precarious housing and ending chronic homelessness for those in need while enhancing their social integration. [ABSTRACT FROM AUTHOR]

Background: Women Veterans have unique health care utilization patterns; however, video-based primary care utilization among and between women and men has not been well examined. Methods: In a retrospective cohort study, we calculated gender-stratified video visit adoption (i.e., likelihood) and frequency (i.e., rate of use among users) between April 1, 2020, and March 31, 2022, by demographic and clinical characteristics known to impact health care utilization. Results: Among 5,389,139 Veterans (9.2% women), 32% of women and 18.6% of men had a video-based primary care visit over the 2-year study period. Gender interacted with Veteran characteristics and the likelihood of any video care. Men often had associations stronger in magnitude (both positive and negative) than women, including by age, rurality, history of housing instability, mental health conditions, and marital status. The direction of effect never diverged by gender. A positive association among women always coincided with a positive association among men, and vice versa, across all characteristics assessed. Only the risk ratio for video care use comparing Veterans of Black race with White race was stronger among women. In contrast to the video care adoption differences by gender, we found few differences in the frequency of video-based care by gender. Conclusions: The findings suggest there are fewer disparities by demographic and clinical characteristics in any video care use among women compared with men and little to no disparities in the frequency of video care use by gender. Understanding the variation in video care utilization by gender could help improve acceptance, appropriate utilization, and uptake of video-based visits for all. [ABSTRACT FROM AUTHOR]

In this manuscript, the authors examined the rates of food and housing insecurity experienced by student‐veterans enrolled at community colleges in fall 2020. The results of a multi‐institutional survey of student‐veterans at 113 community colleges suggested that 37.6% of community college student‐veterans experienced food insecurity and 52.5% of community college student‐veterans experienced housing insecurity. Additionally, 17.8% of community college student‐veterans experienced homelessness in the past year. The results also suggest that community college student‐veterans who experienced food and housing insecurity had lower grade point averages, higher rates of clinically significant generalized anxiety disorder, and higher rates of clinically significant major depressive disorder. Examples of strategies to support community college student‐veterans experiencing food and housing insecurity are included. [ABSTRACT FROM AUTHOR]

Background: Social risks are common among cancer survivors who have the fewest financial resources; however, little is known about how prevalence differs by age at diagnosis, despite younger survivors' relatively low incomes and wealth. Methods: The authors used data from 3703 participants in the Detroit Research on Cancer Survivors (ROCS) cohort of Black cancer survivors. Participants self‐reported several forms of social risks, including food insecurity, housing instability, utility shut‐offs, not getting care because of cost or lack of transportation, and feeling unsafe in their home neighborhood. Modified Poisson models were used to estimate prevalence ratios and 95% confidence intervals (CIs) of social risks by age at diagnosis, controlling for demographic, socioeconomic, and cancer‐related factors. Results: Overall, 35% of participants reported at least one social risk, and 17% reported two or more risks. Social risk prevalence was highest among young adults aged 20–39 years (47%) followed by those aged 40–54 years (43%), 55–64 years (38%), and 65 years and older (24%; p for trend <.001). Compared with survivors who were aged 65 years and older at diagnosis, adjusted prevalence ratios for any social risk were 1.75 (95% CI, 1.42–2.16) for survivors aged 20–39 years, 1.76 (95% CI, 1.52–2.03) for survivors aged 40–54 years, and 1.41 (95% CI, 1.23–1.60) for survivors aged 55‐64 years at diagnosis. Similar associations were observed for individual social risks and experiencing two or more risks. Conclusions: In this population of Black cancer survivors, social risks were inversely associated with age at diagnosis. Diagnosis in young adulthood and middle age should be considered a risk factor for social risks and should be prioritized in work to reduce the financial effects of cancer on financially vulnerable cancer survivors. This report evaluates associations between age at diagnosis and the prevalence of social risks, such as food insecurity, housing instability, and forgoing care because of lack of transportation in a population‐based cohort of Black cancer survivors. Age at diagnosis was inversely associated with social risks, and young adult survivors reported the highest prevalence of any social risks, multiple social risks, and several individual social risks. [ABSTRACT FROM AUTHOR]

Aims: US hospitals are focussing more than ever on meeting important patient social needs. Patients often make multiple trips to hospitals related to nonmedical issues that could likely be averted through the increased integration of case management strategies. Although the percentage of hospitals using advanced practice nurses (APNs) in this role is still relatively low, we explore the idea that employing APN case managers improves hospitals' abilities to alleviate hospital overusage. Design: The study used a cross‐sectional design. Methods: We used the 2021 American Hospital Association data set, which includes 5855 hospitals, of which 4315 were general medical hospitals. Results: Using descriptive statistics and Poisson regression, we discovered that employing APN case managers in US acute care hospitals is associated with an increased likelihood that hospitals will implement strategies addressing patient social needs. Conclusions: When hospitals screen patients for social needs and formulate and implement internal and external strategies designed to meet patient social needs, many stakeholders stand to benefit. Should more hospitals observe such benefits when utilizing an APN case manager model, it will likely proliferate, and demand for APNs could accelerate further. Impact: Following the reduction in unnecessary patient visits and readmissions, hospitals' scarce resources are freed up to offer timely care to patients that are truly medically in need. Furthermore, financial performance improves under this scenario. APNs play a critical role in enabling hospitals to realize such benefits. Patient or Public Contribution: No patient or public contribution. We used archival data in this study. [ABSTRACT FROM AUTHOR]

Much progress has been made in advancing antiretroviral (ART) adherence, yet disparities remain. To explore relationships of syndemic conditions – co-occurring health conditions caused by combinations of biological, social, and structural factors – to ART adherence among African American men, we used data from longitudinal assessments of 302 African American men enrolled in a study designed to increase physical activity and healthy eating. Syndemic conditions included alcohol dependency, drug dependency, depression, post-traumatic stress disorder, and unstable housing. A syndemic conditions variable was operationalized to indicate the presence of 0–5 conditions. About 55% of participants had 1 or more syndemic conditions. Age and marriage were positively associated with ART adherence, whereas number of syndemic conditions was negatively associated with adherence during the 12-month period. The interaction of being married and the syndemic conditions variable significantly predicted greater adherence. Similarly, the interaction of more education and the syndemic conditions variable predicted greater adherence. In multiple regression models, the syndemic conditions variable remained significant (−0.018) in predicting adherence; however, there was no significant interaction among the 5 conditions. This study lends evidence to syndemics literature indicating deleterious consequences of negative life experiences on health outcomes. [ABSTRACT FROM AUTHOR]

Young adults experiencing homelessness (YAEH) are faced with instabilities in many areas of their lives, including their living situation, employment, and income. Little is known about how the experience of instability in these different domains might be associated with substance use. Leveraging data collected on 276 YAEH in Los Angeles County, regression analyses examine associations between three distinct types of instability (housing, employment, income) and participants' self-reported alcohol use, alcohol consequences, non-cannabis drug use, and substance use symptoms. Results indicated that recent instability in income, employment, and secure housing for those with access to it (but not housing in general or non-secure housing) were significantly associated with greater alcohol/drug use or substance use symptoms. Depression was also found to moderate the association between employment instability and alcohol use. Our findings suggest that efforts to reduce instability in income, employment, and secure housing may have positive benefits for substance using YAEH, especially those with depressive symptoms. [ABSTRACT FROM AUTHOR]

Evidence suggests that reductions in healthcare utilization, including forgone care, during the COVID-19 pandemic may be contributing towards excess morbidity and mortality. The objective of this study was to describe individual and community-level correlates of forgone care during the COVID-19 pandemic. We conducted a cross-sectional, secondary data analysis of participants (n = 2,003) who reported needing healthcare in two population-representative surveys conducted in Baltimore, MD in 2021 and 2021–2022. Abstracted data included the experience of forgone care, socio-demographic data, comorbidities, financial strain, and community of residence. Participant's community of residence were linked with data acquired from the Baltimore Neighborhood Indicators Alliance relevant to healthcare access and utilization, including walkability and internet access, among others. The data were analyzed using weighted random effects logistic regression. Individual-level factors found to be associated with increased odds for forgone care included individuals age 35–49 (compared to 18–34), female sex, experiencing housing insecurity during the pandemic, and the presence of functional limitations and mental illness. Black/African American individuals were found to have reduced odds of forgone care, compared to any other race. No community-level factors were significant in the multilevel analyses. Moving forward, it will be critical that health systems identify ways to address any barriers to care that populations might be experiencing, such as the use of mobile health services or telemedicine platforms. Additionally, public health emergency preparedness planning efforts must account for the unique needs of communities during future crises, to ensure that their health needs can continue to be met. Finally, additional research is needed to better understand how healthcare access and utilization practices have changed during versus before the pandemic. [ABSTRACT FROM AUTHOR]

In 2020, thousands of international students found themselves stranded in Sydney, Australia, with the suspension of international travel and closure of borders. While many lost their livelihoods due to lockdowns, the Australian government excluded international students and other temporary visa holders from all forms of income support and disaster relief—resulting in food and housing insecurity and social isolation. This article describes and analyses the forms of mutual aid and support that international students organised to address their situation. In providing an account of their efforts, we consider them as forms of care infrastructure and draw particular attention to the institutional relationships that were involved: interfaces with faith, community and labour organising; confrontations with state agencies and the higher education sector; and institutionalisation into a formalised and state‐funded community organising initiative—the Oz International Student Hub. We examine the evolution of these relationships as responses to a series of strategic dilemmas, as students sought simultaneously to care for one another and to confront the forces that produced their precarity and isolation. And we draw out a series of lessons we can learn from their efforts about how mutual aid can avoid the pitfalls of charity and state welfare, while institutionalising more durable political spaces that do not have to be invented anew with each fresh crisis. [ABSTRACT FROM AUTHOR]

Nurse informaticists (NIs) play a pivotal role in addressing health-related social needs through integrating technology into electronic health records. NIs navigate regulatory landscapes, emphasizing screening for social determinants of health during hospital encounters. This article underscores NIs’ strategic contributions to optimizing data collection, supporting health equity, and utilizing innovative technologies to bridge gaps in healthcare outcomes. [ABSTRACT FROM AUTHOR]

Background and aims: Psychological and social status, and environmental context, may mediate the likelihood of experiencing overdose subsequent to illicit drug use. The aim of this systematic review was to identify and synthesise psychosocial factors associated with overdose among people who use drugs. Methods: This review was registered on Prospero (CRD42021242495). Systematic record searches were undertaken in databases of peer-reviewed literature (Medline, Embase, PsycINFO, and Cinahl) and grey literature sources (Google Scholar) for work published up to and including 14 February 2023. Reference lists of selected full-text papers were searched for additional records. Studies were eligible if they included people who use drugs with a focus on relationships between psychosocial factors and overdose subsequent to illicit drug use. Results were tabulated and narratively synthesised. Results: Twenty-six studies were included in the review, with 150,625 participants: of those 3,383–4072 (3%) experienced overdose. Twenty-one (81%) studies were conducted in North America and 23 (89%) reported polydrug use. Psychosocial factors associated with risk of overdose (n = 103) were identified and thematically organised into ten groups. These were: income; housing instability; incarceration; traumatic experiences; overdose risk perception and past experience; healthcare experiences; perception of own drug use and injecting skills; injecting setting; conditions with physical environment; and social network traits. Conclusions: Global rates of overdose continue to increase, and many guidelines recommend psychosocial interventions for dependent drug use. The factors identified here provide useful targets for practitioners to focus on at the individual level, but many identified will require wider policy changes to affect positive change. Future research should seek to develop and trial interventions targeting factors identified, whilst advocacy for key policy reforms to reduce harm must continue. [ABSTRACT FROM AUTHOR]

Background. There is a high prevalence of homeless people with psychotic disorders and supported housing is often required. However, there is little evidence about supported housing services, especially in low-middle income countries. This rapid review synthesizes evidence about the experiences of users and providers of community-based accommodation services for people living with serious mental illness internationally to understand priorities for policy and practice. Methods. PubMed, PsycINFO, Google Scholar, and reference lists were searched to identify 1344 studies. The inclusion criteria specified qualitative studies about users' and/or providers' views of the accommodation services for adults aged 18+ years with serious mental illness. Title, abstract, and full-text screening were conducted in duplicate, and quality appraisal was conducted using the standard for reporting qualitative research tool. Data extraction was conducted using both Excel and Word documents, and we used thematic analysis to report findings. Results. Only 43 studies were identified for inclusion. Service users' and providers' experiences of accommodation services from high income countries and low-middle income countries were similar. Both the service providers and users appreciated housing, and service providers mentioned it was not a sufficient step towards independent living. Shortage of resources in low-middle income countries made it challenging for some service providers to provide care because they had to choose between buying medicine or food. While service users needed greater availability of service providers, providers were at risk of burnout. Although some service providers were trained to respond to stigmatizing events, some users continued to experience stigma from their family members, society, and service providers. Conclusions. People living with serious mental illness and service providers value the housing provision but globally their experience of this provision is relatively poor compared to mainstream society, suggesting people living with serious mental illness remain disadvantaged. Further research should explore low-cost housing options that will provide quality person-centered care for people living with serious mental illness. [ABSTRACT FROM AUTHOR]

Background: Health outcomes are strongly impacted by social determinants of health, including social risk factors and patient demographics, due to structural inequities and discrimination. Primary care is viewed as a potential medical setting to assess and address individual health-related social needs and to collect detailed patient demographics to assess and advance health equity, but limited literature evaluates such processes. Methods: We conducted an analysis of cross-sectional survey data collected from n = 507 Maryland Primary Care Program (MDPCP) practices through Care Transformation Requirements (CTR) reporting in 2022. Descriptive statistics were used to summarize practice responses on social needs screening and demographic data collection. A stepwise regression analysis was conducted to determine factors predicting screening of all vs. a targeted subset of beneficiaries for unmet social needs. Results: Almost all practices (99%) reported conducting some form of social needs screening and demographic data collection. Practices reported variation in what screening tools or demographic questions were employed, frequency of screening, and how information was used. More than 75% of practices reported prioritizing transportation, food insecurity, housing instability, financial resource strain, and social isolation. Conclusions: Within the MDPCP program there was widespread implementation of social needs screenings and demographic data collection. However, there was room for additional supports in addressing some challenging social needs and increasing detailed demographics. Further research is needed to understand any adjustments to clinical care in response to identified social needs or application of data for uses such as assessing progress towards health equity and the subsequent impact on clinical care and health outcomes. [ABSTRACT FROM AUTHOR]

Access to safe and stable housing has both a direct and indirect effect on health. Homeless persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfil one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of homeless populations. Access to safe and stable housing has both a direct and indirect effect on health. Experiencing homelessness and housing instability can induce stress and trauma, worsening behavioral health and substance use. The absence of safe and stable living conditions can make it challenging to rest, recuperate, and recover from health ailments and can pose barriers to treatment adherence. Homelessness and housing instability is associated with high rates of numerous diseases and chronic conditions. Its cyclical relationship with other social drivers of health can exacerbate health disparities. As a result, unhoused persons experience unique health challenges and require a health care system and professionals designed to meet their distinct needs. Physicians and other health professionals have a role in educating themselves about the needs of unhoused patients as well as making themselves aware of community and government resources available to these populations. Policymakers must support health professionals in these efforts by supporting the data infrastructure needed to facilitate these referrals to resources, supporting research into best practices for caring for these populations, and investing in community-based organization capacity. Policy action is needed to address the underlying drivers of homelessness, including a dearth of affordable housing, while also addressing the short-term need for safe shelter now. In this position paper, the American College of Physicians (ACP) recognizes the need to address universal access to housing to fulfill one's right to health. ACP offers several recommendations to prevent homelessness and promote the necessary health care and social needs of unhoused populations. [ABSTRACT FROM AUTHOR]

The relative high rates of homelessness and housing insecurity among college students has become a public health concern within the U.S. This study explores the relationship between housing instability in relation to academic and mental health outcomes. College students attending a larger public university (N = 1,416 students; M age = 22.54; 47.2% Pell Eligible; 54.6% racially/ethnically minoritized students) were surveyed employing cluster-sampling in the Fall Semester of 2019. Participants completed validated measures of housing instability, mental health outcomes, and demographics. Additional measures were matched with survey responses through the Office of Institutional Research (i.e., GPA, Pell Grant eligibility). Students who experienced housing insecurity and homelessness were more likely to have a lower GPA as well as poorer mental health outcomes. Findings highlight implications surrounding the need for housing programs and additional financial support in an effort to bolster students' academic performance and mental well-being. [ABSTRACT FROM AUTHOR]

Homelessness and intimate partner violence (IPV) do not impact all communities equally. Survivors from marginalized communities—that is communities that have been historically and structurally excluded from social, economic, and political resources—face additional challenges weathering IPV and housing crises. Understanding the housing experiences of marginalized survivors is necessary to achieve housing equity for all survivors. Community‐based participatory research methods were utilized to convene 14 listening sessions (7 primary/7 validation) with Black and Latinx IPV survivors with intersectional identities (n = 92). Listening sessions were held in community‐based locations including a church, health clinic, social service agency, and private residence. The last five validation sessions were conducted virtually on Zoom due to COVID pandemic protocols. All listening sessions were digitally recorded and transcribed verbatim. Latinx population listening sessions were conducted in Spanish and were implemented and translated with attention to linguistic justice principles. The research team used a modified constructivist grounded theory approach for data analysis. Four overarching themes (and seven subthemes) related to survivors' housing experiences emerged: (1) safety and healing challenges, including living in unhealthy physical environments, not being safe in their homes, and contending with community violence, sexual exploitation threats, and eviction fears; (2) formal service fragmentation/bureaucracy that hampered access to housing resource information and resources; (3) resource scarcity associated with limited affordable housing stock; and (4) systemic oppression resulting from discriminatory treatment and gentrification. Comprehensive multileveled approaches are needed to disrupt the cycle of housing insecurity for IPV survivors from marginalized communities. [ABSTRACT FROM AUTHOR]

Housing insecurity is associated with co-occurring depression and pain interfering with daily activities. Network analysis of depressive symptoms along with associated risk or protective exposures may identify potential targets for intervention in patients with co-occurring bodily pain. In a community-based sample of adults (n = 408) living in precarious housing or homelessness in Vancouver, Canada, depressive symptoms were measured by the Beck Depression Inventory; bodily pain and impact were assessed with the 36-item Short Form Health Survey. Network and bootstrap permutation analyses were used to compare depressive symptoms endorsed by Low versus Moderate-to-Severe (Mod + Pain) groups. Multilayer networks estimated the effects of risk and protective factors. The overall sample was comprised of 78% men, mean age 40.7 years, with 53% opioid use disorder and 14% major depressive disorder. The Mod + Pain group was characterized by multiple types of pain, more persistent pain, more severe depressive symptoms and a higher rate of suicidal ideation. Global network connectivity did not differ between the two pain groups. Suicidal ideation was a network hub only in the Mod + Pain group, with high centrality and a direct association with exposure to lifetime trauma. Antidepressant medications had limited impact on suicidal ideation. Guilt and increased feelings of failure represented symptoms from two other communities of network nodes, and completed the shortest pathway from trauma exposure through suicidal ideation, to the non-prescribed opioid exposure node. Interventions targeting these risk factors and symptoms could affect the progression of depression among precariously housed patients. [ABSTRACT FROM AUTHOR]

Objectives: Video-based telehealth may expand access to mental health services among older veterans with alcohol use disorder (AUD). We examined the modalities through which mental health services were rendered, and predictors of video visits before and after video-enabled tablet receipt from the Veterans Health Administration. Method: 11,210 veterans aged 60 or older with a diagnosis of AUD who received a tablet between 1 April 2020 and 25 October 2021 were identified. The electronic health record was used to characterized encounters by modality of mental health care delivery in the six months pre/post tablet receipt. Logistic regression examined predictors of a video visit for mental health. Results: Phone was the most common modality; however, the proportion of video encounters increased from 8.7% to 26.2% after tablet receipt. Individuals who were older, male, and had more physical health conditions, were less likely to have a video visit. Individuals who were married, resided in urban areas, had a history of housing instability, and had more mental health conditions, were more likely to have a video visit. Conclusion: Video-enabled tablets may help older adults with AUD overcome access barriers to mental health services, although targeted support for certain groups may be necessary. [ABSTRACT FROM AUTHOR]

Objective: We use the case of housing insecurity to examine how romantic partner incarceration results in increased and prolonged surveillance of women at home. Background: Romantic partner incarceration prompts surveillance from the criminal legal system while simultaneously eroding women's finances, health, and family relationships. Less is known about how these symbiotic harms of romantic partner incarceration enable surveillance beyond the criminal legal system. Method: We use longitudinal interviews with 35 (previously coresident) romantic partners of incarcerated men, showing how incarceration prompts unwanted moves for partners, how women manage housing insecurity following partner incarceration, and how they become embedded into living arrangements where they are monitored, evaluated, and controlled. Results: We identify three primary findings. First, women experiencing housing insecurity after romantic partner incarceration relied heavily on their social ties (and, to a lesser extent, institutional housing providers) while enduring stressful and prolonged housing searches. Second, the homes that women move into expose them to increased surveillance. Women encounter domestic, caregiving, romantic, and financial surveillance. Romantic partner incarceration prompts large changes in surveillance among women who left independent homes, moderate changes in surveillance among women who left comparatively desirable doubled‐up homes, and prolonged surveillance among nonmovers. Finally, women respond to surveillance by monitoring burdens on hosts and reframing stays in shared homes as temporary. Conclusion: Taken together, these findings extend prior research on the symbiotic harms of romantic partner incarceration, how women attached to incarcerated men experience surveillance, and how doubled‐up families sustain shared homes. [ABSTRACT FROM AUTHOR]

Gendered understandings of housing transitions amongst women and especially amongst those in substance use disorder recovery are under-researched. To address this gap, this study explores the multifaceted challenges and pathways to housing stability amongst women in substance use disorder recovery in the UK. Through qualitative analysis of life course interviews with 15 women in recovery, it becomes evident that housing insecurity, instability, and frequent transitions are common experiences. The women in the sample faced housing instability, ranging from temporary supported accommodations to homelessness. Notably, escaping negative relationships with male partners emerged as a primary cause of homelessness among these women. What this article highlights, which has not been found elsewhere to date, is that housing transitions are essentially a social process for women in recovery. This study highlights the social dimension of housing transitions. The potency of social capital and social networks in determining housing stability and security amongst women is emphasised as they exchange negative forms of social capital for positive forms of social capital. Recommendations stemming from this study include the need for drug recovery and housing policies to integrate gender-specific strategies to adequately support women in recovery. Further, they need to adopt a broader perspective, emphasizing the importance of fostering positive social connections and networks when considering housing options for individuals in recovery. For women who have spent a long time in supported residential and therapeutic environments, there is a need to develop a scaffolded support system to help women transition to independent living. The utilisation of recovery capital (and CHIME) as frameworks may provide a basis upon which to map out holistic and sustainable pathways to housing stability and security for women in recovery due to their acknowledgement of interconnected and related life domains that produce change and transformation. [ABSTRACT FROM AUTHOR]

Existing research indicates an association between the introduction of Universal Credit in the UK and increased financial hardship among claimants. This policy change embodies key changes in welfare policy and ideology taking place across Europe and worldwide. This study investigates the association between housing insecurity and claiming Universal Credit in comparison to Housing Benefit and Jobseeker's Allowance. To examine changes in housing insecurity trajectories before and after the introduction of Universal Credit, we apply a difference-in-differences fixed effects logistic regression research design to Understanding Society data (2009–2020) on benefit claimants in England. We compare how Universal Credit claimants' likelihood of housing insecurity changes over time compared to other benefit claimants. We find that claiming Universal Credit does indeed have a significant effect on increasing housing insecurity in comparison to claiming Housing Benefit or Jobseeker's Allowance. This effect varied across different scenarios, including a larger effect for people with disabilities and claimants moving from Housing Benefit to Universal Credit. These findings demonstrate that the Universal Credit system negatively impacts particular population groups more than others, placing these claimants at disproportionate risk of experiencing housing insecurity. [ABSTRACT FROM AUTHOR]

Background: Children with intellectual disabilities are at heightened risk for traumatization, though underserved due to silos of care, diagnostic overshadowing, and lack of adapted treatment. Trauma‐Focused Cognitive Behavioural Therapy (TF‐CBT), an evidence‐based childhood trauma therapy, is described with recommended adaptations for use with children who have intellectual disabilities. Method: We present a suggested theoretical and clinical guide for treating children with mild to moderate intellectual disabilities. We explicate key functional domains of intellectual disabilities—comprehension, executive functions, and generalization—as the basis for tailoring the treatment model. Results: Therapy recommendations are organized into a heuristic 'matrix' of resources and adaptations to TF‐CBT components, based on clinical experience and research literature, illustrated with composite case vignettes. Conclusion: Children with intellectual disabilities are a uniquely vulnerable population historically excluded from clinical trauma interventions and research but can respond to adapted care. Considerations for future research and dissemination are discussed. [ABSTRACT FROM AUTHOR]

The study is focused on the reentry/resettlement problems that are faced by ex-prisoners in the Czech Republic (CR). Findings are based on semi-structured interviews with 26 ex-prisoners and 30 social workers who provide social services in prisons and after the release. Based on the data, which were coded inductively employing qualitative content analysis, several post-prison issues emerged: (1) material deprivation and insecurity regarding housing, subsistence, and stable employment; (2) debts and enforcement proceedings; (3) prisonisation effect; (4) health issues; (5) relationships with family and significant others; (6) drug abuse; (7) meaningful leisure time. Particularly, more attention was given to housing, subsistence, stable employment, and debts and enforcement proceedings because, compared to other countries, these issues have their specifics in the CR. Findings, interpreted through the optics of intersectionality, suggest that the Czech social policies regarding ex-prisoners are focused on a one or selection of factors, instead on the complex interplay of them, as well as not properly targeted and delivered in the right time. To improve the situation, the better system of social services financing that would address the ex-prisoners' complex needs must be implemented along with the housing first policy and more accessible personal bankruptcy. [ABSTRACT FROM AUTHOR]

• On average, adolescent housing insecurity led to a 6.4% increase in later CRP. • Increases in CRP levels due to adolescent housing insecurity accumulate over time. • Adolescent housing insecurity in mid-adolescence had the strongest effect on CRP. • Impact of one episode of adolescent housing insecurity on CRP may last 3 + years. • Effect of adolescent housing insecurity on CRP held when controlling for poverty. Adolescent housing insecurity is a dynamic form of social adversity that impacts child health outcomes worldwide. However, the means by which adolescent housing insecurity may become biologically embedded to influence health outcomes over the life course remain unclear. Therefore, we aimed to utilize life course perspectives and advanced causal inference methods to evaluate the potential for inflammation to contribute to the biological embedding of adolescent housing insecurity. Using prospective data from the Great Smoky Mountains Study, we investigated the relationship between adolescent housing insecurity and whole-blood spot samples assayed for C-reactive protein (CRP). Adolescent housing insecurity was created based on annual measures of frequent residential moves, reduced standard of living, forced separation from the home, and foster care. Annual measures of CRP ranged from 0.001 mg/L to 13.6 mg/L (median = 0.427 mg/L) and were log 10 transformed to account for positively skewed values. We used g-estimation of structural nested mean models to estimate a series of conditional average causal effects of adolescent housing insecurity on CRP levels from ages 11 to 16 years and interpreted the results within life course frameworks of accumulation, recency, and sensitive periods. Of the 1,334 participants, 427 [44.3 %] were female. Based on the conditional average causal effect, one exposure to adolescent housing insecurity from ages 11 to 16 years led to a 6.4 % (95 % CI = 0.69 – 12.4) increase in later CRP levels. Exposure at 14 years of age led to a 27.9 % increase in CRP levels at age 15 (95 % CI = 6.5 – 53.5). Recent exposures to adolescent housing insecurity (<3 years) suggested stronger associations with CRP levels than distant exposures (>3 years), but limited statistical power prevented causal conclusions regarding recency effects at the risk of a Type II Error. These findings highlight inflammation—as indicated by increased CRP levels—as one potential mechanism for the biological embedding of adolescent housing insecurity. The results also suggest that adolescent housing insecurity—particularly recent, repeated, and mid-adolescent exposures—may increase the risk of poor health outcomes and should be considered a key intervention target. [ABSTRACT FROM AUTHOR]

Across many countries, increases in inequality driven by rising top incomes and wealth have not been accompanied by growing popular concern. In fact, citizens in unequal societies are less concerned than those in more egalitarian societies. Understanding how the general public perceive richness is an essential step towards resolving this paradox. We discuss findings from focus group research in London, UK, a profoundly and visibly unequal city, which sought to explore public perceptions of richness and the rich. Participants from diverse socio-economic backgrounds discussed their views of the 'wealthy' and the 'super rich' with reference to both vast economic resources and more intangible aspects, including, crucially, security. High levels of wealth and income were perceived to be necessary for achieving security for oneself and one's family. The security of the rich was discussed in contrast to participants' own and others' insecurity in the context of a (neo)liberal welfare regime – specifically, insecurity about housing, personal finances, social security, health care and the future of the welfare state. In unequal countries, where insecurity is widespread, lack of confidence in collective welfare state provision may serve in the public imagination to legitimate private wealth accumulation and richness as a form of self-protection. [ABSTRACT FROM AUTHOR]

Objective: The purpose of this paper was to examine variables associated with food insecurity among community college caregivers during the COVID-19 pandemic. Methods: We used data from a multi-institutional survey of 15,051 caregivers enrolled at 130 community colleges in 42 states in fall 2020. We used a logistic regression to examine whether demographic, academic, caregiving-related, financial, or COVID-19-related variables were associated with caregivers' food insecurity. Results: Over half (52%) of community college caregivers experienced food insecurity. Transgender caregivers, first-generation caregivers, and caregivers who were divorced or single, had multiple disabilities, were previously in foster care, and had a family that experienced trouble making ends meet growing up had significantly (p <.05) higher probabilities of experiencing food insecurity. Community college caregivers who used childcare and those with at least one child up to 12 years old also had increased probabilities of experiencing food insecurity. Moreover, caregivers who felt childcare was not affordable and believed that they did not earn enough money to make employment worthwhile after paying for childcare expenses had higher probabilities of experiencing food insecurity, as did those who experienced housing insecurity and used Pell grants, student loans, and support from friends or family to pay for college. Losing a job, experiencing cuts to work hours or wages, employment as a frontline worker, and contracting COVID were associated with higher probabilities of food insecurity. Contributions: Community college caregivers experienced high rates of food insecurity during the pandemic and some caregivers were at greater risk of exacerbated probabilities of food insecurity. We advocate for targeted interventions, wraparound services, and increased advocacy for legislation to support student caregivers. [ABSTRACT FROM AUTHOR]

Research Question: A sizable portion of college students experience food and housing insecurity, which poses a roadblock to fully and successfully engaging in higher education. In light of these complex challenges, we ask: How do Florida College System (FCS) institutions meet the basic needs of their students? Methods: To answer the question at hand, we conducted an embedded single case study of the FCS. Between 2014 and 2019, researchers traveled to 21 Florida colleges on one or more occasions to speak with college presidents, administrators, faculty members, advisors, academic support staff, and students. In total, we gathered data from 1,379 people through 213 focus group sessions and 20 individual interviews. Results: From these data emerged evidence of the extensive services and support programs provided by FCS institutions, ranging from food and housing assistance to clothing, transportation, and childcare. Such initiatives aim to meet the chronic, daily needs of students and their families, as well as acute needs that arise out of local disasters and crises. Contributions: The findings of this study contribute to the literature on the mission of community colleges. While these support programs address needs traditionally considered non-academic, participants suggest that they are essential to fostering student success. By meeting students' physiological and safety needs, institutions can better accomplish their academic goals of remediation, transfer, vocational training, and contract education, particularly among students who have been traditionally excluded from higher education. The findings also highlight the importance of acknowledging the needs of students' families when providing support. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic posed numerous obstacles to psychosocial wellbeing for children. We conducted a longitudinal study to evaluate child mental health and social risks during the pandemic. Methods: Participants were 172 caregivers of children aged 6–11 years old who attended well child visits within 6 months before pandemic onset at an urban safety net hospital in the US. Prepandemic data was extracted from the electronic medical record, and surveys were administered at three time points between August 2020 and July 2021. We measured mental health symptoms with the Pediatric Symptom Checklist-17, social risks (e.g., food and housing insecurity) with the THRIVE questionnaire, and school modality (in-person, hybrid, remote). Results: Compared to pre-pandemic, children had significantly higher PSC-17 total scores (overall mental health symptoms) and THRIVE total scores (total burden of social risks) at all three mid-pandemic waves. Using longitudinal mixed models accounting for time, social risks, and school modality, both social risks (B = 0.37, SE = 0.14, p < 0.01) and school modality were significantly associated with PSC-17 scores (B = − 1.95, SE = 0.63, p < 0.01). Children attending in-person school had fewer mental health symptoms than those attending remote or hybrid school. Conclusion: Mental health symptoms and social risks remained significantly higher fifteen months after the onset of the COVID-19 pandemic compared to prepandemic. In-person attendance at school appeared protective against persistently elevated mental health symptoms. [ABSTRACT FROM AUTHOR]

This study explores foster care outcomes among youth by race and gender/sexuality. The findings reveal significant correlations between educational attainment and high school diploma acquisition for LGBTQ youth of color. Discrepancies in employment outcomes suggest systemic barriers for these youth. Additionally, LGBTQ youth of color face high instability and low availability of support networks. Housing stability, physical and mental health, financial capability, social capital, and the impacts of COVID-19 further highlight demographic disparities. [ABSTRACT FROM AUTHOR]

Northern New Mexico was uniquely vulnerable to the COVID‐19 pandemic and its fallout. Its Hispanic majority, aging population, and decreased access to healthcare put many of the communities in this area of the United States at risk. Taos County was particularly at increased risk of impact from COVID‐19. The county was also more vulnerable to the economic consequences of a pandemic due to reliance on tourism; this meant major impacts for individual households. As unemployment and poverty increased—and pandemic relief program rollouts floundered—the consequences meant precarity for many families. One of the most visible impacts of the pandemic was the inability to access affordable housing. This paper, based on 58 in‐depth interviews and 5 months of participant observation, explores experiences of homelessness and housing insecurity among an already vulnerable population during the pandemic, illustrating the ways in which many people struggled. Importantly, this paper explores differences in patterns of housing insecurity among rural White and rural Hispanic participants during the COVID‐19 pandemic. In addition, this paper advocates the importance of looking at nuanced patterns of dealing with housing precarity in the rural setting as the ways in which different populations cope impact the forms of help that are needed when housing becomes a problem. [ABSTRACT FROM AUTHOR]

This study reports on 54 homeless and 53 stably housed veterans who received battlefield acupuncture (BFA) between September 2018 and October 2022. Linear mixed-effects regressions were used to examine change in overall pain score and how pain impacted four areas: (1) activity, (2) sleep, (3) mood, and (4) stress over the course of 8 weeks from the baseline visit at one BFA clinic. Results indicated significant reductions in the impact of pain on activity, sleep, and stress among both homeless and housed veterans. Although overall pain levels were not significantly impacted, further research on the impact of BFA on homeless populations is warranted. [ABSTRACT FROM AUTHOR]

Women affected by the criminal legal system disproportionately experience economic hardship and have, over time, reported difficulties in securing basic needs, including income and employment, food and other tangible items, and housing. Women often describe assistance in acquiring these necessities as high priorities. Based on consistency of women's testimonies, we explored whether and how research aligns with women's priorities. We examined existing research by conducting a systematic review following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) 2020 guidelines. Despite extensive documentation of women's unmet needs, we found limited research focused on addressing and improving women's economic status, identifying mechanisms that ensure women have their basic needs met, and promoting housing stability for women. We contend that the dynamics in current research align with aspects of epistemic neglect and create a form of research-based slow violence. We discuss new research actions to change these dynamics. [ABSTRACT FROM AUTHOR]

Weapon carrying among White rural populations is understudied although evidence suggests that rural White boys have high rates of carriage. This study delineated patterns of weapon use and pro‐gun beliefs using a latent class analysis on a sample of 32,916 White rural adolescents. Five groups were identified (i.e., Low Gun Risk, Naïve, Social Contagion, Independent, Unsupervised) using pro‐gun beliefs, peer risk factors, and weapon carrying items. Multinomial logistic regression analyses revealed that identifying as male, age, housing instability, and victimization consistently differentiated group membership between different classes. These results suggest that rural White adolescents vary in their belief systems about guns and weapon carrying behavior and that this heterogeneity can be differentiated by lived experiences of these adolescents. [ABSTRACT FROM AUTHOR]

In 2019, North Dakota accounted for 11% of American oil production. Rural counties like Williams County, ND experienced rapid in-migration of oilfield workers and, consequently, acute housing shortages. Williams County provides an excellent opportunity to study the relationship between commodity booms and housing instability because its housing market is tied so tightly to the production of a single commodity. While fracking is often presented as an economic boon to these communities, we show that Williams County has experienced "rural gentrification," in which long-term residents are displaced by higher-income workers linked to the oilfields. To explore housing instability in an oil boomtown, this project links oil production statistics with evictions data and individual-level address histories. By showing how housing instability increased during the oil boom, this study contributes to our understanding of how rural communities are affected by extractive industry and how housing markets respond to rapid economic changes. [ABSTRACT FROM AUTHOR]

Traumatic brain injuries, mental illnesses and neurodevelopmental disorders are established risk factors for housing instability. Further, these brain‐associated conditions may result in additional barriers to accessing services. We explored perspectives of front‐line housing support workers concerning the neuroscience of housing instability to co‐create a knowledge translation (KT) activity. Interviews were conducted with front‐line workers (participant‐researchers) about the impacts of brain‐associated conditions in individuals experiencing housing instability. We combined interview results with existing neuroscience research to develop a KT activity. We collaboratively planned improvements to the KT activity via a focus group. The participant‐researchers found statistics about the overrepresentation of brain‐associated conditions among individuals experiencing housing instability compelling. They expressed that the greatest impact may arise if we target politician and policymaker audiences. Improved awareness of the neuroscience of housing instability may provide motivation for addressing systemic factors that perpetuate the violence of living unhoused. [ABSTRACT FROM AUTHOR]

Housing instability remains a persistent problem in the United States. While physical and gun violence negatively affect communities, little is known about whether and how they are associated with the risk of housing instability. This study uses structural equation modelling to explore these relationships and examine how they may be mediated by other neighbourhood social and physical factors. Using data from the Fragile Families and Child Wellbeing Study, a sample of mostly low-income urban women, we find that witnessing violence is positively associated with the risk of experiencing housing instability. Also, having a deadly gun shooting in proximity of the home was only indirectly associated with housing instability. These findings underlie links between neighbourhood violence and housing instability that were previously understudied. This exploratory study provides some potential new avenues of investigation regarding neighbourhood safety, urban housing policy, and social inequity reduction. [ABSTRACT FROM AUTHOR]

This qualitative study explored the experiences of people living with HIV (PLWH) in the San Francisco Bay Area, United States, during the COVID-19 pandemic and subsequent public health restrictions at a safety net HIV clinic. Patients (N = 30) were recruited for Spanish/English language semi-structured interviews (n = 30), translated when necessary, and analyzed thematically. The recurring theme of "pandemic expertise" emerged from the data: skills and attitudes developed through living with HIV helped PLWH cope with the COVID-19 pandemic, including effective strategies for dealing with anxiety and depression; appreciation for life; and practical experience of changing behavior to protect their health. A subset did not consider living with HIV helped them adapt to the COVID-19 pandemic, with some describing their lives as chaotic due to housing issues and/or ongoing substance use. Overall, interviewees reported finding trustworthy health information that helped them follow COVID-19 prevention strategies. Although living with HIV is associated with a higher prevalence of mental health concerns, substance use, and stigma, these challenges can also contribute to increased self-efficacy, adaptation, and resilience. Addressing structural issues such as housing appears to be key to responding to both pandemics. [ABSTRACT FROM AUTHOR]

The article explores the issue of housing insecurity among Native Hawaiians in Hawai'i County. It identifies factors such as high living costs, limited economic opportunities, and historical underfunding and delayed assignment of home lands as contributing to the problem. This housing unaffordability negatively impacts Native Hawaiian health, leading to higher rates of depression, high blood pressure, childhood hospitalization, and poor child health. The article suggests potential solutions, including regulating short-term rentals, improving economic opportunities, and pursuing home lands distribution through litigation. It also discusses the impact of housing unaffordability on Native Hawaiian health, particularly in relation to mental health disorders, substance abuse, chronic health problems, and challenges in accessing healthcare. The COVID-19 pandemic has further exacerbated the financial instability of Native Hawaiian households. The article highlights the need for urgent action to address housing insecurity and improve the well-being of Native Hawaiians. [Extracted from the article]

Key Points: Question: What were the patterns of excess mortality associated with the COVID-19 pandemic among renters who received eviction filings? Findings: In this retrospective study of 282 000 renters who received an eviction filing between January 1, 2020, and August 31, 2021, an excess mortality analysis found that observed mortality was 106% higher than expected. By comparison, observed mortality among similar renters was 25% higher than expected and among the general population was 9% higher than expected. Meaning: Housing instability, as measured by eviction filings, was associated with significantly increased risk of death over the first 20 months of the COVID-19 pandemic. Eviction prevention efforts may have reduced excess mortality for renters during this period. Importance: Residential evictions may have increased excess mortality associated with the COVID-19 pandemic. Objective: To estimate excess mortality associated with the COVID-19 pandemic for renters who received eviction filings (threatened renters). Design, Setting, and Participants: This retrospective cohort study used an excess mortality framework. Mortality based on linked eviction and death records from 2020 through 2021 was compared with projected mortality estimated from similar records from 2010 through 2016. Data from court records between January 1, 2020, and August 31, 2021, were collected via the Eviction Lab's Eviction Tracking System. Similar data from court records between January 1, 2010, and December 31, 2016, also collected by the Eviction Lab, were used to estimate projected mortality during the pandemic. We also constructed 2 comparison groups: all individuals living in the study area and a subsample of those individuals living in high-poverty, high-filing tracts. Exposures: Eviction filing. Main Outcomes and Measures: All-cause mortality in a given month. The difference between observed mortality and projected mortality was used as a measure of excess mortality associated with the pandemic. Results: The cohort of threatened renters during the pandemic period consisted of 282 000 individuals (median age, 36 years [IQR, 28-47]). Eviction filings were 44.7% lower than expected during the study period. The composition of threatened renters by race, ethnicity, sex, and socioeconomic characteristics during the pandemic was comparable with the prepandemic composition. Expected cumulative age-standardized mortality among threatened renters during this 20-month period of the pandemic was 116.5 (95% CI, 104.0-130.3) per 100 000 person-months, and observed mortality was 238.6 (95% CI, 230.8-246.3) per 100 000 person-months or 106% higher than expected. In contrast, expected mortality for the population living in similar neighborhoods was 114.6 (95% CI, 112.1-116.8) per 100 000 person-months, and observed mortality was 142.8 (95% CI, 140.2-145.3) per 100 000 person-months or 25% higher than expected. In the general population across the study area, expected mortality was 83.5 (95% CI, 83.3-83.8) per 100 000 person-months, and observed mortality was 91.6 (95% CI, 91.4-91.8) per 100 000 person-months or 9% higher than expected. The pandemic produced positive excess mortality ratios across all age groups among threatened renters. Conclusions and Relevance: Renters who received eviction filings experienced substantial excess mortality associated with the COVID-19 pandemic. This cohort study of renters who received eviction filings, similar renters who did not, and the general population across the study area compares rates of excess mortality associated with the COVID-19 pandemic. [ABSTRACT FROM AUTHOR]

Background: Current guidelines recommend HCV screening by 18 months of age for those exposed to HCV in utero; yet, screening occurs in the minority of children. Objectives: To evaluate the association between maternal neighbourhood‐level social determinants of health (SDOH) and paediatric HCV screening in the general population in a publicly funded healthcare system in Canada. Methods: Retrospective cohort study using administrative healthcare data held at ICES. Children born to individuals positive for HCV RNA in pregnancy from 2000 to 2016 were identified and followed for 2 years. Major SDOH were identified, and the primary outcome was HCV screening in exposed children (HCV antibody and/or RNA). Associations between SDOH and HCV screening were determined using multivariate Poisson regression models adjusting for confounding. Results: A total of 1780 children born to persons with +HCV RNA were identified, and 29% (n = 516) were screened for HCV by age two. Most mothers resided in the lowest income quintile (42%), and most vulnerable quintiles for material deprivation (41%), housing instability (38%) and ethnic diversity (26%) with 11% living in rural locations. After adjustment for confounding, maternal rural residence (risk ratio [RR] 0.82, 95% confidence interval [CI] 0.62, 1.07) and living in the highest dependency quintile (RR 0.83, 95% CI 0.65, 1.07) were the SDOH most associated with paediatric HCV screening. Younger maternal age (RR 0.98 per 1‐year increase, 95% CI 0.97, 0.99), HIV co‐infection (RR 1.69, 95% CI 1.16, 2.48) and GI specialist involvement (RR 1.18, 95% CI 1.00, 1.39) were associated with higher probabilities of screening. Conclusions: Among children exposed to HCV during pregnancy, rural residences and living in highly dependent neighbourhoods showed a potential association with a lower probability of HCV screening by the age of 2. Future work evaluating barriers to paediatric HCV screening among rural residing and dependent residents is needed to enhance the screening. [ABSTRACT FROM AUTHOR]

This study examines pathways from gender-based, racialized violence to health outcomes among formerly incarcerated Black women. We frame violence as gender-based and racialized, with a theoretical stance that we live in a male-dominated society characterized by historic and contemporary race-based oppression. This secondary analysis focused on a subsample of Black women (N = 288) from three U.S. cities (Oakland, CA; Kansas City, KS, MO; and Birmingham, AL) from March 2019 to June 2020 for the Tri-City Cervical Cancer Prevention Study among Women in the Justice System. Confirmatory factor analysis evaluated psychometric properties of hypothesized latent variables—violence victimization, living conditions, and healthcare access—and their observed indicators. Structural equation modeling estimated their relationships with physical, mental, and sexual health, controlling for sampling location. Violence victimization was associated with mental (β = 0.37, p =.000) and sexual health concerns (β = 0.31, p =.000). Healthcare access was associated with physical health concerns (β = 0.45, p =.004). Although there were no direct relationships between living conditions and health concerns, mediation analysis indicated worse living conditions were associated with more violence victimization and less healthcare access, with violence victimization fully mediating a relationship with mental and physical health concerns. Regarding control variables, women in Kansas City reported more sexual health concerns (β = 0.19, p =.005). Findings have important implications for treatment and care for Black women with incarceration and violence victimization histories. [ABSTRACT FROM AUTHOR]

The objective of this study was to analyze temporal changes in social needs (SN), comparing those who received routine annual in-person care to those receiving SN screenings through a combination of tele-social care and in-person care biannually. Our prospective cohort study used a convenience sample of patients from primary care practices. Baseline data were collected from April 2019 to March 2020. The intervention group (n = 336) received SN screening and referral telephone outreach from June 2020 to August 2021. The control group (n = 2890) was screened, in person, during routine visits at baseline and summer 2021. We used a repeated-measures logistic regression with general estimating equations to assess incremental change in individual SN for the intervention group. Food, housing, legal and benefit needs increased and peaked at the beginning of the pandemic and decreased after interventions (P < 0.001). There was a 32% decrease in the odds of food insecurity for those in the intervention group compared to the control group (adjusted OR 0.668, 95% confidence interval 0.444–1.004, P = 0.052), and a 75% decrease in the odds of housing insecurity (adjusted OR 0.247, 95% confidence interval 0.150–0.505, P < 0.001). During COVID-19, there was an increase in SN followed by a decrease after interventions were offered. Those who completed tele-social care showed greater improvements in social needs than those in routine care, with the greatest improvements in food and housing needs. [ABSTRACT FROM AUTHOR]

Background: In the United States, nearly 85,000 Veterans experienced homelessness during 2020, and thousands more are experiencing housing instability, representing a significant proportion of the population.1 Many Veterans experiencing homelessness are aging and have complex co‐occurring medical, psychiatric, and substance use disorders. Homelessness and older age put Veterans at greater risk for age‐related disorders, including Alzheimer's disease and related dementias (ADRD). Methods: We examined the rate of ADRD diagnosis for Veterans experiencing homelessness and housing instability compared to a matched cohort of stably housed Veterans over a nine‐year period using cox proportional hazard models. Results: In the matched cohort, 95% (n = 88,811) of Veterans were men, and 67% (n = 59,443) were White and were on average 63 years old (SD = 10.8). Veterans with housing instability had a higher hazard of 1.53 (95% confidence interval (CI) 1.50, 1.59) for ADRD compared to Veterans without housing instability. Conclusions: Veterans experiencing housing instability have a substantially higher risk of receiving an ADRD diagnosis than a matched cohort of stably housed Veterans. Health systems and providers should consider cognitive screening among people experiencing housing insecurity. Existing permanent supportive housing programs should consider approaches to modify wraparound services to support Veterans experiencing ADRD. [ABSTRACT FROM AUTHOR]

Background: While certain socioeconomic factors have been studied in relation to suicide, housing-price-related indexes have rarely been investigated. Aims: This article aims to examine the impact of housing-price-related indexes on suicide rates in the general population of Taiwan, a country with high housing costs and suicide rates. Methods: The study utilized three national housing-price-related indexes from 2012 to 2019: (1) housing price index, (2) housing price to income ratio, and (3) housing rental index. Cause of Death Data was employed to calculate suicide rate. A linear regression model with autoregressive errors was used to analyze the association between housing-price-related indexes and suicide rates among different sex and age groups. Results: The findings revealed that higher housing rental index values were associated with increased suicide rates in young and middle-aged adults compared to the elderly population, regardless of sex. However, this association was not observed with the other two housing-price-related indexes (i.e. housing price index and housing price to income ratio). Conclusion: These results offer valuable insights for policymakers, mental health professionals, and housing advocates to improve housing affordability and reduce the burden of suicide in the general population, particularly among younger generations. [ABSTRACT FROM AUTHOR]

The riverine region of Bayelsa State, Nigeria, faces a critical issue as the impacts of climate change, including rising sea levels, extreme weather events, and disruptions to traditional livelihoods, disproportionately affect women. This qualitative study aimed to fill a gap in understanding by exploring the nuanced ways in which these environmental challenges influence the migration decisions of women who have fled floods, remain displaced, and have opted not to return to prevent potential negative experiences linked to future flooding in the region. The research delves into the interplay between climate change, gender dynamics, and community resilience. Employing an exploratory research design with purposive and snowball sampling techniques, the study selected 51 female participants. Through 24 in-depth interviews and three focus group discussions, the research captured the nuanced experiences of women grappling with the challenges posed by climate change. Thematic analysis was applied to analyze the collected data. The study unveiled that climate change significantly shapes the migration decisions of women in the riverine area of Bayelsa State. This influence manifests through disrupted livelihoods, flooding, water scarcity, diseases and health challenges, housing insecurity, increased environmental vulnerabilities, and uncertain future prospects. These findings underscore the pressing need for gender-responsive policies and community-based strategies to address the complex interplay between climate change impacts and women's migration experiences. [ABSTRACT FROM AUTHOR]

Background: Access to palliative care is often limited for challenging and vulnerable groups, including persons with substance use disorders. However, with optimized healthcare options and liberal substitution policies, this patient group is likely to increase over the upcoming years, and comorbidities will also influence the need for palliative support. Here, we aim at analyzing characteristics and specific challenges associated with substance use disorders (SUD) in palliative care. Methods: We retrospectively reviewed all patients diagnosed with substance use disorder that were treated at our Competence Center Palliative Care within the University Hospital Zurich, Switzerland between 2015 and 2021. Patient characteristics, including age, gender, duration of hospitalization, as well as specific metrics like body mass index, distinct palliative care assessment scores, and in-hospital opioid consumption were retrieved from the electronic patient files. Demographics and clinical data were analyzed by descriptive statistics, and compared to those of a control group of palliative care patients without SUD. An opioid calculator was used to standardize opioid intake based on morphine equivalents for meaningful comparisons. Results: The primary characteristics revealed that the majority of individuals were single (56%), had no children (83%), lived alone (39%), and were either unemployed or recipients of a disability pension (in total 50%). Nicotine (89%), opioids (67%), and alcohol (67%) were the most used substances. We identified various comorbidities including psychiatric illnesses alongside SUD (56%), hepatitis A, B, or C (33%), and HIV infection (17%). Patients with SUD were significantly younger (p < 0.5), predominantly male (p < 0.05), and reported a higher prevalence of pain (p < 0.5) compared to the standard cohort of palliative patients. Regarding the challenges most frequently reported by healthcare practitioners, non-compliance, multimorbidity, challenging communication, biographical trauma, lack of social support, and unstable housing situations played a key role. Conclusion: Patients with SUD represent a complex and vulnerable group dealing with multiple comorbidities that profoundly affect both their physical and psychological well-being. Understanding their unique characteristics is pivotal in providing precise and suitable palliative care. [ABSTRACT FROM AUTHOR]

While women living with HIV (WLWH) are twice as likely to report severe or undertreated chronic pain compared to men, little is known about pain among WLWH. Our goal was to characterize the correlates of pain as well as its impact on quality-of-life outcomes among women enrolled in the Sexual Health and HIV/AIDS Women's Longitudinal Needs Assessment (SHAWNA), an open longitudinal study of WLWH accessing care in Metro Vancouver, Canada. We conducted logistic regression analyses to identify associations between self-reported major or persistent pain with sociostructural and psychosocial correlates and with quality-of-life outcomes. Data are presented as adjusted odds ratios (aORs) with 95% confidence intervals. Among 335 participants, 77.3% reported pain at ≥ 1 study visit, with 46.3% experiencing any undiagnosed pain and 53.1% managing pain with criminalized drugs. In multivariable analysis, age (aOR 1.04[1.03–1.06] per year increase), food and housing insecurity (aOR 1.54[1.08–2.19]), depression diagnosis (aOR 1.34[1.03–1.75]), suicidality (aOR 1.71[1.21–2.42]), and non-daily, non-injection opioid use (aOR 1.53[1.07–2.17]) were associated with higher odds of pain. Daily non-injection opioid use (aOR 0.46[0.22–0.96]) and health services access (aOR 0.63[0.44–0.91]) were associated with lower odds of pain. In separate multivariable confounder models, pain was associated with reduced odds of good self-rated health (aOR 0.64[0.48–0.84] and increased odds of health interference with social activities (aOR 2.21[1.63–2.99]) and general function (aOR 3.24[2.54–4.13]). In conclusion, most WLWH in our study reported major or persistent pain. Pain was commonly undiagnosed and associated with lower quality of life. We identified structural and psychosocial factors associated with pain in WLWH, emphasizing the need for low-barrier, trauma-informed, and harm reduction-based interventions. [ABSTRACT FROM AUTHOR]