Effect Of Homelessness Research Articles

The Effect of Homelessness on Management of Menstruation and Dysmenorrhea in Pomona, California [ID 2683481

INTRODUCTION: Given the challenges to menstrual hygiene many women face and the high rate of homelessness in Pomona, California, we suspected women without housing would have increased difficulty managing their menstrual hygiene and dysmenorrhea primarily due to resource inaccessibility. METHODS: After IRB approval and beta testing, we partnered with local homeless shelters and a student-run clinic to screen for eligible participants, obtain verbal consent, and conduct anonymous interviews. Each interview lasted 15 minutes with 26 questions spanning demographics, menstrual hygiene and dysmenorrhea management, and history of homelessness. RESULTS: Analysis of 50 surveys (96% response rate) revealed that 37% of participants reportedly relied on shelter pantries for access to menstrual hygiene products, 27% of participants admitted to stealing their preferred products, and almost 10% of participants reported resorting to using alternate methods such as free bleeding and old clothes to catch their menstrual flow. For management of dysmenorrhea-associated painful cramping, 96% of participants reported preferring medication management but not having access to it when homeless so instead their only option was to “just deal with it” (60%). CONCLUSION: The results of this study illuminate the gap in existing literature regarding the specific struggles that homeless people face when managing their menstrual hygiene and dysmenorrhea. The discrepancies in management of hygiene and pain when housed versus unhoused come down to lack of access to essential resources. Shelter pantries do not have enough funding to effectively support the size and demand of the growing menstruating homeless population.

The effect of a non-congregate, integrated care shelter on health: A qualitative study.

To describe the experiences of unstably housed, medically vulnerable residents living at the Haven, a novel, non-congregate integrated care shelter operating in a historic hotel during the COVID-19 pandemic. A qualitative descriptive design. Semi-structured qualitative interviews were conducted in February and March 2022 with a purposive sample of 20 residents living in the integrated care shelter. Data were analyzed in May and June 2022 using the thematic analysis methods described by Braun and Clarke. Six women and 14 men, ages 23-71 (M=50, SD=14), were interviewed. Lengths of stay at the time of the interview ranged from 74 to 536 days (M=311 days). Medical co-morbidities and substance use details were collected at baseline. Three themes were identified: (1) Autonomy, (2) supportive environments, and (3) stability and the need for permanent housing. Participants characterized the integrated care, non-congregate model as having multiple advantages over traditional shelter systems. Participants emphasized the role of nurses and case managers in providing a respectful, caring environment in the integrated shelter model. Participants described acute physical and mental health needs which were largely met by the innovative integrated shelter care model. The effect of homelessness and housing insecurity on health is well documented, but few solutions exist that promote autonomy. Participants in this qualitative study emphasized the benefits of living in a non-congregate integrated care shelter and the services which promoted their self-management of chronic diseases. Patients were the participants in the study, but were not involved in the design, analysis of interpretation of the data, or preparation of the manuscript. Due to this project's small scope, we could not involve patients or the public after the study concluded data collection.

Housing Status as a Predictor for Outpatient Care Following an Emergency or Urgent Care Encounter with a Behavioral Health Diagnosis: A Multivariable Analysis.

Individuals without stable housing experience high rates of mental illness and seek behavioral health care in emergency care settings. Little is known about the effect of homelessness on outpatient follow-up after utilizing emergency or urgent care for behavioral health care. Patient encounters with behavioral health diagnoses among 7 emergency department (ED) or urgent care (UC) locations over 4 years were used to determine the correlation between housing status and outpatient follow-up within 90 days. Of 1,160,386 visits by 269,615 unique patients, 55,738 (23%) encounters included a behavioral health diagnosis. Patients with stable housing were twice as likely to follow up with a primary care provider (PCP) and with an outpatient behavioral health provider than patients without housing (aOR 2.60; aOR 2.00, p < 0.0001). Homelessness is associated with difficulty in accessing follow-up behavioral health care. UCs and EDs may use specific interventions to improve outpatient follow-up.

The effect of homelessness on viral suppression in an underserved metropolitan area of middle Tennessee: potential implications for ending the HIV epidemic

BackgroundA wealth of scientific evidence supports the effectiveness of HIV prophylaxis and treatment. Homelessness is strongly associated with the health status and viral suppression among underserved populations and can undermine the national plan to eliminate HIV by 2030. This retrospective observational study examined the extent in which homelessness affects HIV treatment in an underserved urban area of Middle Tennessee in 2014–2019.ResultsAmong 692 HIV-seropositive patients, the proportion of homeless patients increased from 13.5% in 2014 to 27.7% in 2019, thrice the national average for HIV-seropositive people (8.4%) and twice that of HIV positive patients who are participating in Ryan White programs nationwide (12.9%). Our findings suggest that homeless patients were half as likely to achieve viral suppression as compared to those who had a permanent/stable home [OR 0.48 (0.32–0.72), p-value < 0.001].ConclusionOur study indicates that homelessness may play an important role in viral suppression among persons living with HIV/AIDS in Middle Tennessee.

Abstract 11280: Effect of Homelessness on Incidence of Autopsy-Defined Causes of Presumed Sudden Cardiac Death: Insights from the San Francisco Postmortem Systematic Investigation of Sudden Cardiac Death (POST SCD) Study

Introduction: Prior studies report higher cardiovascular mortality in persons experiencing homelessness (PEH), but presume cardiac cause of death (COD) from EMS records or death certificates. The effect of homelessness on autopsy-defined SCD is unknown. In this prospective postmortem study of all SCDs in San Francisco (SF) County, we hypothesized a greater incidence of presumed SCD in PEH, but more non-cardiac COD on autopsy. Methods: Between 2/2011 - 3/2014, all incident World Health Organization-defined (presumed) SCDs ages 18-90 were autopsied via active surveillance of out of hospital deaths in the POST SCD Study. A multidisciplinary committee adjudicated COD. Autopsy-defined SCDs had no extra-cardiac COD (e.g., overdose, pulmonary embolism, stroke). Homeless status was determined from medical records; rates of presumed and autopsy-defined SCD were compared to those for housed individuals. The countywide homeless population was determined from the 2013 SF Homeless Count and Survey. Results: We identified 525 presumed SCDs over 37 months: 36 (7%) were PEH and 489 (93%) were housed. Presumed SCDs in PEH were younger than housed subjects (56.5 ± 9.9 v. 63.2 ± 14.6 years), more often male (97% v. 67%), less likely to be Asian (0% v. 22%) or have dyslipidemia (3% v. 32%), but more likely to have alcohol (58% v. 21%) and substance use disorder (44% v. 13%, p&lt;0.01 for all). The presence of psychiatric disorders was similar between groups. Among presumed SCDs, PEH had a lower proportion of autopsy-defined SCDs than housed individuals (9/36 [25%] v. 306/489 [63%]), with more non-cardiac COD including aspiration, aortic dissection, occult overdose, and infection (p&lt;0.05 for all). Observed incidence rates for presumed SCD were 181.4 v. 22.7 per 100,000 person-years (IRR 8.01, p&lt;0.01) in PEH v. housed individuals, and 45.4 v. 14.2 per 100,000 person-years (IRR 3.20, p&lt;0.01) for autopsy-defined SCD. Conclusion: In this 3-year comprehensive postmortem study of all incident SCDs in a diverse urban setting, homelessness was associated with &gt;3-fold higher risk of autopsy-confirmed SCD and 8-fold higher risk of sudden mortality overall. Only one-fourth of presumed SCDs in PEH were autopsy-confirmed SCDs, while one-third of non-cardiac causes were due to occult drug overdose.

The Effect of Homelessness on Patient Wait Times in the Emergency Department.

Prolonged emergency department (ED) wait times could potentially lead to increased morbidity and mortality. While previous work has demonstrated disparities in wait times associated with race, information about the relationship between experiencing homelessness and ED wait times is lacking. The purpose of this study was to explore the relationship between residence status (undomiciled vs. domiciled) and ED wait times. We hypothesized that being undomiciled would be associated with longer wait times. We obtained data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2017. We compared wait times in each triage category using t tests. We used multivariate linear regression to explore associations between residence status and wait times while controlling for other patient- and hospital-level variables. On average, undomiciled patients experienced significantly longer mean ED wait times than domiciled patients (53.4 vs. 38.9min; p<0.0001). In the multivariate model, undomiciled patients experienced significantly different wait times by 15.5min (p=0.0002). Undomiciled patients experienced increasingly longer waits vs. domiciled patients for the emergent and urgent triage categories (+33.5min, p<0.0001, and +22.7min, p<0.0001, respectively). Undomiciled patients experience longer ED wait times when compared with domiciled patients. This disparity is not explained by undomiciled patients seeking care in the ED for minor illness, because the disparity is more pronounced for urgent and emergent triage categories.

“How I was then and how I am now”: an evaluation of the effects of being housed upon the Anxiety of Homeless persons in Regional Australia

ABSTRACT Homelessness is universally regarded as an aversive condition, to be remedied by the provision of appropriate housing. However, although there are many reports of the negative effect of homelessness upon the mental health of homeless persons, relatively little has been reported regarding the change in mental health that might accompany being housed. To further understand that change, 71 previously-homeless persons from Regional Australia completed a series of questionnaires about their anxiety states when they were homeless and when they were housed. Results indicated that, although there was a major reduction in anxiety over that period, some participants did not change in their self-reported anxiety, and others reported that their anxiety had increased after being housed. Analysis of specific symptoms of anxiety revealed which aspects of anxiety had increased in some participants, and which had decreased in others. Implications for the matching of “person-to-housing-setting” are discussed, plus avenues for future research.

The Effect of Homelessness on Employment Entry and Exits: Evidence from the Journeys Home Survey

This paper provides new insights into the association between homelessness and poor employment outcomes by examining how homelessness affects employment transitions. The study uses longitudinal data from the Journeys Home survey and methods that address concerns related to reverse causality and endogenous selection into homelessness. The findings reveal that low levels of employment among homeless people can be attributed primarily to their higher probabilities of exiting employment. The negative association between homelessness and employment entry is much weaker in both magnitude and significance. This finding contrasts with what one would expect given the perception in the literature, i.e. that the difficulty of finding employment is a major contributing factor behind the poor rates of employment among homeless people. The significant positive association between homelessness and the probability of exiting employment seems to be mainly driven by unobserved person-specific characteristics, which increase a person’s chances of being homeless and of leaving employment. Once the effect of these unobserved confounding characteristics is considered, homelessness per se has no significant impact on either employment entry or exit.

The impact of being homeless on the unsuccessful outcome of treatment of pulmonary TB in São Paulo State, Brazil.

BackgroundTuberculosis (TB) is a major public health problem requiring complex treatment, the success of which depends on biological, social, and institutional factors. São Paulo State (SPS), in Brazil, has a high TB burden. Because of high socioeconomic heterogeneity and chaotic urbanisation, homelessness might play an important role in the TB burden in SPS. Our aim was to determine the association between homelessness and outcome of treatment of pulmonary TB (PTB) in SPS.MethodsA historical cohort from the routine SPS TB database for 2009-2013 was analysed. The study population was newly diagnosed adult patients with PTB. Homelessness was ascertained at notification or when treatment started. Our outcome was unsuccessful outcome of treatment. We used logistic regression to adjust for potential confounders and multiple imputation for missing data.ResultsWe analysed 61,817 patients; 1726 (2.8 %, 95%CI 2.7-2.9 %) were homeless. Homeless patients were concentrated in bigger cities, were more frequently middle-aged males, had black/brown skin colour, and had received less education (P < 0.001, for all). Alcohol and drug use was three times more frequent in homeless patients (43.2 % vs 14.4 %, 30.2 % vs. 9.4 %, P < 0.001, respectively). HIV testing was less common among the homeless, of whom 17.3 % were HIV positive compared with 8.5 % among the not homeless population (P < 0.001). Microbiologic confirmation was more frequent among the homeless (91.6 % vs. 84.8 %, P < 0.001). Unsuccessful outcome of treatment was 57.3 % among the homeless and 17.5 % among the not homeless (OR = 6.32, 95%CI 5.73-6.97, P < 0.001), mainly due to loss to follow-up (39 %) and death (10.5 %). After full-adjustment for potential confounders, homelessness remained strongly associated with lower treatment success (aOR = 4.96, 95 % CI 4.27-5.76, P < 0.001). HIV status interacted with homelessness: among HIV-infected patients, the aOR was 2.45 (95%CI 1.90-3.16, Pinteraction < 0.001). The population attributable fraction for the joint effect of homelessness, alcohol and drug use was almost 20 %.ConclusionsConfirming our hypothesis, homelessness led to a marked reduction in the successful treatment of newly diagnosed pulmonary tuberculosis. Homelessness and associated conditions were important contributors to lack of treatment success in pulmonary tuberculosis in São Paulo. A multifaceted intervention must be implemented to target this vulnerable population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-016-0584-8) contains supplementary material, which is available to authorized users.

The role of compassion and ‘Tough Love’ in caring for and supporting the homeless: experiences from ‘Catching Lives’ Canterbury, UK

Homelessness is a wide-spread problem which can lead to high vulnerability and social exclusion. There are many reasons why a person may become homeless, with relationship breakdown being reported as a common cause. Homeless people often encounter a number of other problems such as mental and physical health issues and problems with drugs and alcohol which might represent either a cause or an effect of homelessness. A compassionate approach towards the homeless is crucial, whether this be explicit in taking action to deal with basic needs, or implicit with more of a ‘tough love’ approach in encouraging motivation and independence to help people re-build their lives. This paper takes recent experiences from a local homeless charity ‘Catching Lives’ in Canterbury, UK, and discusses these in the light of recent literature. Drawing on such experiences, the paper aims to draw attention to the issue of homelessness and the importance of a compassionate approach. The paper concludes by summarizing the findings, and encouraging the importance of a compassionate approach towards addressing the needs of the homeless. With the correct support and understanding, individuals can learn to take control and re-build their lives.

Predictors of employment among sheltered homeless women

The effect of homelessness on the psychological and physical health of women is damaging and long lasting. Understanding of the personal factors that enable homeless women to secure employment and re-enter mainstream society is of utmost importance. A sample of homeless women residing in a US Midwestern nonprofit treatment and transitional living shelter for homeless women and their children were surveyed regarding the extent to which life satisfaction, social self-efficacy, and hopeful thinking predicted women's expected capabilities to obtain employment above and beyond social support provisions, while controlling for participants' age, ethnicity, and education level. Findings failed to reveal that social psychological (i.e., life satisfaction and social self-efficacy) and intrapersonal (i.e., hope) variables predicted homeless women's job procurement self-efficacy above and beyond perceived social support. The social support provision of social integration and younger age significantly predicted women's self-efficacy to secure employment. Implications of results for social justice initiatives and interventions are discussed.

The nature and prevalence of chronic pain in homeless persons: an observational study

Background: Homeless people are known to suffer disproportionately with health problems that reduce physical functioning and quality of life, and shorten life expectancy. They suffer from a wide range of diseases that are known to be painful, but little information is available about the nature and prevalence of chronic pain in this vulnerable group. This study aimed to estimate the prevalence of chronic pain among homeless people, and to examine its location, effect on activities of daily living, and relationship with alcohol and drugs. Methods: We conducted face-to-face interviews with users of homeless shelters in four major cities in the United Kingdom, in the winters of 2009-11. Participants completed the Brief Pain Inventory, Short Form McGill Pain questionnaire, Leeds Assessment of Neuropathic Symptoms and Signs, and detailed their intake of prescribed and unprescribed medications and alcohol. We also recorded each participant’s reasons for homelessness, and whether they slept rough or in shelters. Findings: Of 168 shelter users approached, 150 (89.3%) participated: 93 participants (63%) reported experiencing pain lasting longer than three months; the mean duration of pain experienced was 82.2 months. The lower limbs were most frequently affected. Opioids appeared to afford a degree of analgesia for some, but whilst many reported symptoms suggestive of neuropathic pain, very few were taking anti-neuropathic drugs. Interpretation: The prevalence of chronic pain in the homeless appears to be substantially higher than the general population, is poorly controlled, and adversely affects general activity, walking and sleeping. It is hard to discern whether chronic pain is a cause or effect of homelessness, or both. Pain is a symptom, but in this challenging group it might not always be possible to treat the underlying cause. Exploring the diagnosis and treatment of neuropathic pain may offer a means of improving the quality of these vulnerable people’s lives.

A personal reflection on researching and writing my dissertation: "The effect of homelessness on information access, identity formation and social interaction".

This is a brief account of research undertaken for a dissertation, The effect of homelessness on information access, identity formation and social interaction, submitted to the University of Strathclyde in 2010 for the degree of M.Sc. Information and Library Studies. The dissertation aimed to add to the information science literature on homelessness, which often focuses on practical information needs, by considering access to information sources – specifically newspapers, television, radio, books and the internet – that may affect ‘higher-level’ needs. The findings contradicted initial expectations regarding the extent to which homelessness would restrict access to these information sources, but the decision to address higher-level information needs proved well-founded, since participants clearly pursued these alongside more basic physiological needs. The research has implications for the provision of information and services within both organisations serving the homeless and public libraries. This paper presents the research and its findings from a personal perspective.

The Effect of Homelessness, Housing Type, Functioning, and Community Reintegration Supports on Mental Health Court Completion and Recidivism

Although mental health court has been found to increase quality of life and functioning, it is unknown whether community stability indicators predict program completion and delay re-arrest for homeless versus non-homeless mental health court participants. Self-reported quality of life and social support, chart diagnosis, and administrative housing, services and criminal justice data were collected for 589 Bronx Mental Health Court participants for 12 months following diversion. Individuals who were homeless (n = 89) versus housed (n = 500) during the 12 months prior to diversion were compared to determine predictors of court graduation and re-arrest. Homeless status did not predict graduation or re-arrest, and quality of life, social support, functioning and housing type were not predictive of re-arrest. Housing instability negatively affected outcomes for both homeless and non-homeless individuals. An increase in functioning and a slight improvement in social support were predictive of successful graduation for homeless individuals, whereas a large increase in social support and lower functioning had a negative impact. In contrast, positive life satisfaction was predictive of successful graduation in non-homeless participants. Those who did not complete mental health court, whether homeless or not, were more likely to be re-arrested, particularly for felony and drug-related offenses than those who graduated. Mental health court was generally beneficial to mental health court participants. However, for those previously homeless, functioning and social support may play a unique and interconnected role in court graduations, whereas general life satisfaction may be a better indicator for program completion for non-homeless individuals.

The effect of homelessness on hospitalisation among patients with HIV/AIDS

The purpose of this study was to determine the effect of homelessness on the costs and patterns of hospitalisation in patients with HIV/AIDS. A retrospective longitudinal study design, based on medical records data covering 2,768 person-years of observation between 1997 and 2003 on patients with HIV/AIDS, was employed. A contextual measure of neighbourhood socioeconomic status (SES) was also used to uncover differences among low- and high-SES neighbourhood dwellers. The association of homelessness and neighbourhood SES with total annual hospitalisation costs, length of stay, numbers of hospital and emergency department admissions and the probability of an operating room procedure, controlling for other covariates, was assessed using multivariate regression analysis. Our results suggest that the homeless and low-SES neighbourhood residents had a large proportion of total costs attributable to admissions for acute events related to the progression of disease. Hospitalisations for planned operating room procedures comprised a relatively larger proportion of hospitalisation costs for high-SES neighbourhood residents. One implication of our findings is that improvements in the continuity of care and cost savings on inpatient care may be realised through further development of social assistance programs aimed at reaching the homeless and residents of low-SES neighbourhoods.

Changes in the Social Skills and Behavior Problems of Homeless and Housed Children During the Preschool Year

This study examined the social competence and mental health of homeless and permanently housed preschool children enrolled in the Head Start program. Mothers and Head Start teachers rated the social skills and behavior problems of 38 homeless and 46 housed preschoolers twice during the school year. The researchers compared the behavior of the homeless and housed preschoolers soon after they entered Head Start, as well as changes in children's behavior six months after their initial assessment. Both parents and teachers reported that homeless children exhibited more behavioral problems than housed children at the beginning of the study, but perceived no significant differences in the two groups' social skills. Mothers reported significant declines in homeless children's compliance relative to their housed peers at the conclusion of the study, while teachers noted significant declines in homeless children's compliance and expressive skills. Both mothers and teachers reported that homeless children exhibited significantly greater increases in behavior problems than their housed peers over the study period. Findings indicate the need for Head Start and other early childhood programs to develop interventions designed to moderate the negative effect of homelessness on young children's social-emotional development.