Homeless Adults Research Articles

Housing and Social Connection: Older Formerly Homeless Veterans Living in Subsidized Housing and Receiving Supportive Services

ABSTRACT Objectives: The purpose of this study was to (Aim 1) describe United States military veterans’ experiences and attitudes about project-based housing (PBH) and tenant-based housing (TBH), including perceptions of their new environment, self‐sufficiency, and social integration. We identified (Aim 2) features of program design and housing facilities associated with self‐sufficiency and social integration including describing differences in veterans’ experiences of housing (PBH vs. TBH). Methods: Interviews were conducted with 30 Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program (25 male and 5 female; average age 63). Thirteen lived in PBH and 17 in TBH in the Greater Boston Metro Area. Results: Social isolation may be a particular challenge of older formerly homeless adults. Veterans in both types of supportive housing struggled with social isolation despite social engagement opportunities available in PBH. Healthcare and transportation issues were important for veterans living in TBH while behavioral health issues were a major factor for those living in both types of housing. Both groups of veterans relied on their case management teams as a means of support and social engagement. Conclusions: To reduce social isolation and loneliness, more attention is needed by program staff to provide varied social engagement opportunities, from one-on-one to group activities. Clinical Implications: These findings can help providers recognize issues inhibiting formerly homeless veterans from being successful in supportive housing. Clinicians should consider how veterans’ behavioral health impacts their ability to engage in social activities. Substance use disorder remains a challenge for many veterans interviewed. Its effects impact their perceptions of fellow residents, perceptions of housing, and recovery.

Enteric pathogenic bacteria and resistance gene carriage in the homeless population in Marseille, France.

We aimed to assess the prevalence of pathogenic bacteria and resistance genes in rectal samples collected among homeless persons in Marseille, France. In February 2014 we enrolled 114 sheltered homeless adults who completed questionnaires and had rectal samples collected. Eight types of enteric bacteria and 15 antibiotic resistance genes (ARGs) were sought by real-time polymerase chain reaction (qPCR) performed directly on rectal samples. ARG-positive samples were further tested by conventional PCR and sequencing. We evidenced a 17.5% prevalence of gastrointestinal symptoms, a 9.6% prevalence of enteric pathogenic bacteria carriage, including Escherichia coli pathotypes (8.7%) and Tropheryma whipplei (0.9%). Only 2 persons carried blaCTX-M-15 resistance genes (1.8%), while other genes, including carbapenemase-encoding genes and colistin-resistance genes, (mcr-1 to mcr-6, mcr-8) were not detected. Our results suggest that sheltered homeless persons in Marseille do not have a high risk of harbouring gastrointestinal antibiotic resistant bacteria.

Development of a foot care model to determine the risk of foot problems among homeless adults in Canada.

Foot care is a common problem for homeless adults in cities, who often receive fragmented foot care services, resulting in increased foot problems, health complications, hospitalisation, limb removal and disabilities. Among the health factors that negatively affect the homeless, foot health is essential, but often neglected. This study employed a descriptive, cross-sectional research design to assess the foot care of homeless people and develop recommendations for clinical practice. Using Inlow's 60-s foot screening method, the foot conditions of a purposive sample of 65 homeless adults were examined in British Columbia, Canada, in 2019-2020. Descriptive and inferential statistics were used to analyse the data. Determinants, such as sex and years of homelessness significantly contributed to homeless individuals' risk of developing foot problems. Differences in perceived and observed foot problems were influenced by equitable access to social health and healthcare services. Foot assessment is not well-covered by homeless health services and should be implemented as part of the standard medical review of homeless patients. Furthermore, foot assessment should be conducted by healthcare professionals, rather than relying on the standard practice of service users' self-report. Finally, foot care should be based on tailoring assessments and interventions for the individualised needs of homeless service users. Future research must seek ways to integrate homeless individuals' voices in the development, implementation and evaluation of foot care services.

Climbing the ‘scaffolded city’: tactics used by homeless young adults to navigate employment barriers

ABSTRACT Homeless young adults face a complex set of challenges as they navigate life and work. This study aims to guide scholarly and activist understandings of homelessness, communication, and employment by exploring homeless young adults’ struggles and tactics regarding work. Specifically, we argue that homeless young adults experience a ‘scaffolded city’ phenomenon, where regulated employment is all but out of reach due to the mutually reinforcing structures undergirding work and home. These built, imagined, and discursive structures manifest as domestic, bureaucratic, social support, and health barriers. We also highlight various tactics used by homeless young adults to navigate life and work despite these barriers, including communicating intentionally, coordinating nonprofit organizational resources, connecting to a higher purpose, maintaining motivation, and seeking entrepreneurial opportunities. We frame these findings to be used as a set of practical tools to design and evaluate homeless young adult employment programs.

Characteristics of Emergency Department Visits by Homeless Young Adults in the U.S.

PurposeHomeless young adults often seek health care at emergency departments (EDs) after they are no longer able to ignore a pressing health problem. However, a dearth of literature examines homeless young adults' ED visits. This study aimed to increase understanding of ED visits among homeless young adults within the U.S. MethodsData for this study were obtained from the 2011–2015 National Hospital Ambulatory Medical Care Survey. The sample for this study included all ED visits made by homeless and housed young adults aged 18–29 years (unweighted N = 25,068). ResultsED visits by homeless young adults were distinguished in terms of gender, region, payment sources, and triage level. Furthermore, ED visits made by homeless young adults were more likely related to mental health and suicide. Homeless young adults' ED visits were characterized by a longer average length of stay and were less likely to be referred to a physician or clinic for follow-up, given medication, or have a procedure performed in the ED. ConclusionsThis study highlighted differences in ED utilization for homeless young adults. The findings of this study suggest a need to further examine the characteristics of ED services received by homeless young adults to better understand differences in ED service receipt related to housing status. This knowledge can inform efforts to reduce costs through improving access to housing and outpatient mental health care and reducing stigma among health care professionals to ensure continuity of care.

Congregations Serving Homeless Populations: Examining Predictive Factors and Policy Implications

AbstractIn this study, authors analyzed data from the 2012 National Congregations Study (NCS) to explore what factors are predictive of a congregation’s engagement in programs serving people experiencing homelessness. Using a cross-sectional sample of 1,328 congregations derived from the third wave of the NCS, authors applied multivariate logistic regression to identify congregational characteristics associated with programming for homeless adults. Approximately one-fourth of all congregations in our sample reported some type of homeless programming. The authors’ final model indicates that 10 variables predict greater likelihood of congregations having programs serving the homeless, which include factors such as larger annual spending and lower percentage low-income congregants; recent formation of a nonprofit entity; collaboration with another organization; certain religious traditions; and the presence of other sponsored programs such as (a) services targeting a specific gender, (b) services helping sexual assault and domestic violence victims, and (c) services for older adults. Given the ongoing U.S. homelessness crisis, this study may help housing authorities and local continuums of care identify congregations for potential partnership to help achieve the Housing First policy priorities and meet specific homeless subpopulation needs.

Moving to Better Healthcare? Estimating the Causal Impact of Medicaid Expansion on Homelessness

Recent homelessness figures in the United States show a puzzling trend of aggregate decline but lopsided changes across states. This study examines the puzzle through healthcare access and provides the first causal evidence of the Medicaid expansion’s impact on homeless adults’ location. Using the state and county-level data on the homeless population from 2010-2017, the estimates from a difference-in-differences model show a significant 10 % post-expansion increase in homeless individuals per capita in states that adopted Medicaid expansion. Furthermore, utilizing the difference in homeless individuals’ coverage status vis-a-vis homeless people in families, estimates from a triple difference (DDD) model also confirm the post-expansion increase in homelessness in expansion states. This study contributes further by uniquely utilizing county-level data to provide subsample analysis on metropolitan counties and counties located at state borders. Results from the state, county, and border-county-discontinuity design reveal the evidence of homeless individuals’ migration from non-expansion to expansion states. Two mechanisms explain the migration process: post-expansion coverage eligibility of previously uninsured homeless individuals and the increased ability of homeless service providers in expansion states in offering healthcare and housing-related services. This paper concludes by measuring the state spending on Medicaid to demonstrate the implications of these findings on state welfare policymaking and fiscal expenditure.

Objective assessment of dietary exposure and cardiometabolic risk in homeless adults

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The Long-Term Effects of a Housing First Intervention on Primary Care and Non-Primary Care Physician Visits Among Homeless Adults with Mental Illness: A 7-Year RCT Follow-Up.

Background:Housing First (HF)-based interventions have been implemented in North America and beyond to help people exit homelessness. The effect of these interventions on access to primary and specialist care services is not well-defined. This study assesses the long-term effects of an HF intervention for homeless adults with mental illness on primary care physician (PCP) and non-primary care physician (non-PCP) visits.Methods:This is a secondary analysis of the At Home/Chez Soi study, a randomized trial of HF for homeless adults with mental illness in Toronto, Canada. High-need (HN) participants were randomized to HF with assertive community treatment (HF-ACT) or treatment as usual (TAU). Moderate needs (MN) participants were randomized to HF with intensive case management (HF-ICM) or TAU. The primary outcomes were the incidence and the number of visits to a PCP and non-PCP over 7-years post-randomization, compared to the 1-year pre-randomization.Results:Of 575 enrolled participants, 527 (80 HN and 347 MN) participants were included in the analyses. HN participants who received HF-ACT had a significant reduction in the number of visits to a PCP compared to TAU participants (ratio of rate ratios (RRR): 0.66, 95% CI: 0.48-0.93) and a significant reduction in the number of non-PCP visits compared with TAU participants (RRR: 0.64, 95% CI: 0.42-0.97) in the 7-years post-randomization compared to the 1-year pre-randomization. MN participants who received HF-ICM had a significant increase in incident visits to a PCP compared to TAU participants (RRR: 1.66, 95% CI: 1.10-2.50). No effect of HF-ICM was observed on the incidence or number of non-PCP visits.Conclusion:HF has differing effects on visits to PCPs and non-PCPs among homeless people with high and moderate needs for mental health supports. HF does not result in a consistent increase in PCP and non-PCP visits over a 7-year follow-up period. The At Home/Chez Soi study is registered with ISRCTN (ISRCTN, ISRCTN42520374).

Cumulative Incidence of SARS-CoV-2 Infection Within the Homeless Population: Insights From a Citywide Longitudinal Study

Background: Studies showed high prevalence of SARs-CoV-2 among homeless people in shelters, but no longitudinal studies confirmed these findings, put them into perspective, or considered homeless populations beyond shelters. Methods: All homeless adults sleeping rough, in slums or squats, in emergency shelters or transitional accommodation in Marseille were eligible. There were two testing sessions, 3 months apart, during which each participant was tested for anti-SARS-CoV-2 antibodies and completed a face-to-face surveys. The primary outcome was the occurrence of a seroconversion event defined as a biologically confirmed SARS-CoV-2 infection. Cox proportional hazards regression models and Kaplan-Meier survival analysis with log-rank test were performed to evaluate risk factors associated with seroconversion. Local data from a national seroprevalence survey were used for comparison between homeless people and the general population.Findings: A total of 1249 people were included. SARS-CoV-2 seroprevalence increased from 6.0% [4.7-7.3] during the first session to 18.9% [16.0-21.7] during the second one, compared to 3.0% [1.9-4.2] and 6.5% [4.5-8.7] in the general population. Factors significantly associated with an increased risk of COVID-19 infection were: having stayed in emergency shelters (1.93 [1.18 – 3.15]), being an isolated parent (1.64 [1.07-2.52]) and having contact with more than 5-15 people per day (1.84 [1.27 – 2.67]). By contrast, smoking (0.46 (0.32 – 0.65)), having financial resources (0.70 (0.51 – 0.97)) and psychiatric or addictive comorbidities (0.52 (0.32 – 0.85)) were associated with a lower risk.Interpretation: We confirm that homeless people have higher infection rates than the general population, with increased risk in emergency shelters.Funding Information: French Directorate of Health care facilities (DGOS) – research grant PHRC COVID-19 (COVID-homeless 0047)Declaration of Interests: The authors declare that they have no competing interests. Ethics Approval Statement: All participants provided a written informed consent. The COVIDHomeless study was designed and carried out in compliance with the Declaration of Helsinki and with legal and regulatory provisions. It was approved by the ethics committee on May 28, 2020 (CPP IDF VI - number 44-20; ID: 2020-AO1398-31). The database was anonymized and declared to the French data protection commission (Commission Nationale de l’Informatique et des Libertés, CNIL, n°2018172v0).

Clinical Outcomes, Costs, and Cost-effectiveness of Strategies for Adults Experiencing Sheltered Homelessness During the COVID-19 Pandemic

Approximately 356 000 people stay in homeless shelters nightly in the United States. They have high risk of contracting coronavirus disease 2019 (COVID-19). To assess the estimated clinical outcomes, costs, and cost-effectiveness associated with strategies for COVID-19 management among adults experiencing sheltered homelessness. This decision analytic model used a simulated cohort of 2258 adults residing in homeless shelters in Boston, Massachusetts. Cohort characteristics and costs were adapted from Boston Health Care for the Homeless Program. Disease progression, transmission, and outcomes data were taken from published literature and national databases. Surging, growing, and slowing epidemics (effective reproduction numbers [Re], 2.6, 1.3, and 0.9, respectively) were examined. Costs were from a health care sector perspective, and the time horizon was 4 months, from April to August 2020. Daily symptom screening with polymerase chain reaction (PCR) testing of individuals with positive symptom screening results, universal PCR testing every 2 weeks, hospital-based COVID-19 care, alternative care sites (ACSs) for mild or moderate COVID-19, and temporary housing were each compared with no intervention. Cumulative infections and hospital-days, costs to the health care sector (US dollars), and cost-effectiveness, as incremental cost per case of COVID-19 prevented. The simulated population of 2258 sheltered homeless adults had a mean (SD) age of 42.6 (9.04) years. Compared with no intervention, daily symptom screening with ACSs for pending tests or confirmed COVID-19 and mild or moderate disease was associated with 37% fewer infections (1954 vs 1239) and 46% lower costs ($6.10 million vs $3.27 million) at an Re of 2.6, 75% fewer infections (538 vs 137) and 72% lower costs ($1.46 million vs $0.41 million) at an Re of 1.3, and 51% fewer infections (174 vs 85) and 51% lower costs ($0.54 million vs $0.26 million) at an Re of 0.9. Adding PCR testing every 2 weeks was associated with a further decrease in infections; incremental cost per case prevented was $1000 at an Re of 2.6, $27 000 at an Re of 1.3, and $71 000 at an Re of 0.9. Temporary housing with PCR every 2 weeks was most effective but substantially more expensive than other options. Compared with no intervention, temporary housing with PCR every 2 weeks was associated with 81% fewer infections (376) and 542% higher costs ($39.12 million) at an Re of 2.6, 82% fewer infections (95) and 2568% higher costs ($38.97 million) at an Re of 1.3, and 59% fewer infections (71) and 7114% higher costs ($38.94 million) at an Re of 0.9. Results were sensitive to cost and sensitivity of PCR and ACS efficacy in preventing transmission. In this modeling study of simulated adults living in homeless shelters, daily symptom screening and ACSs were associated with fewer severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections and decreased costs compared with no intervention. In a modeled surging epidemic, adding universal PCR testing every 2 weeks was associated with further decrease in SARS-CoV-2 infections at modest incremental cost and should be considered during future surges.

Prevalence of Hypertension in Homeless Adults: An Interprofessional Education Community-Based Health Fairs Cross-Sectional Study in Urban Long Beach, California.

IntroductionHypertension (SBP/DBP > 130/80 mmHg) is a leading risk factor for cardiovascular disease worldwide.AimTo determine the prevalence of hypertension in a homeless community during an interprofessional education (IPE)-based health fair.MethodsHomeless participants were recruited between August 2019–September 2019. Faculty, nursing, and pharmacist students, educated 477 participants, aged 18–80 years, on the risk factors associated with untreated hypertension. Then, participants self-completed the consented demographic survey questionnaire. Finally, the sitting blood pressure (BP) was recorded three times based on a standardized procedure, using Omron BPN monitor with cuff.ResultsSeven pharmacy students, nine nursing students, two registered nurses, five registered pharmacists, and two medical doctors collaboratively provided health education to the homeless community and screened their sitting BP. 390/477 (81.8%) of participants satisfied the inclusion criteria. Participants (54.7%) of the reported education level was at the high School level or less. More than the half of the participants (average age of 51 ± 13 years) had hypertension (median SBP/DBP ≥ 130/82.7 mmHg), respectively. The prevalence of hypertension for the overall cohort was 61.52% (95% CI, 56.59–66.35). Age (p value = 0.000) was significantly associated with hypertension based on the binary logistic analysis.ConclusionThis study demonstrated a high prevalence of hypertension in the homeless community in Long Beach, California with high risk of cardio-vascular events or strokes. This works sheds new light on an issue of major public health significance and points to the need for fostering IPE community-based health fairs intervention program for the US homeless population.

Conceptualizing the Shelter and Housing Needs and Solutions of Older People Experiencing Homelessness

Newly and chronically homeless older adults have unique pathways into homelessness and distinct physical, mental, and social needs. Using a five-step process, we conducted a scoping review of primary research to investigate the needs and solutions for sheltering/housing older people experiencing homelessness (OPEH). Thematic analysis of data from 19 sources revealed 1) shelter/housing needs and challenges of newly vs. chronically homeless older adults; 2) existing shelter/housing solutions addressing the needs of OPEH, including Housing First, permanent supportive housing, and multiservice homelessness intervention programs; and 3) outcomes of rehousing OPEH. Following, we developed a conceptual model which outlines how unique health and psychosocial needs of newly and chronically homeless older adults can be met through appropriately-designed shelter/housing solutions with individualized levels of senior-specific support. Future shelter/housing initiatives and strategies should use a rights-based approach and prioritize matching diverse OPEH needs to appropriate shelter/housing options that will support their ability to age-in-the-right-place. Part of a symposium sponsored by the Environmental Gerontology Interest Group.

Homeless on Main Street: Using Photovoice to Highlight Older Adults Among the Hidden Homeless

Homelessness is a reality for a growing number of Americans living in small towns and rural areas. However, unlike in cities, housing instability may be less visible. Using a photo-elicitation method (i.e., Photovoice), this study explores the meaning of place and obscured visibility to currently and formerly homeless older adults living in a small town in central Connecticut.Participants (N = 27) were recruited from a local service agency, given cameras and asked to photograph areas around town that were meaningful to them. Photographs were developed and followed by in-person, semi-structured interviews with participants in which photos and experiences during the project were discussed. Primary themes included belonging, generativity, social isolation, and place-making as meaning-making. The study culminated in a community photography exhibition in which photographs from the project were displayed in public spaces around town. Implications for community-based interventions to reach homeless groups in rural areas are discussed. Part of a symposium sponsored by the Qualitative Research Interest Group.

Through Their Lens: Using Visual Methods to Illuminate the Lived Experiences of Diverse Older Adults

Visual methods, like photovoice and photo-elicitation, have attracted modest attention in gerontological inquiry with diverse and vulnerable community-dwelling older adults. Visual methods are based on the idea of inserting images, produced by informants or not, into research interviews, allowing informants to be the experts of knowledge and meaning-making while the researcher becomes the student. The empowerment of informants as subject-collaborators in the research process is a distinctive feature of visual methods. Benefits include revealing unique insights into diverse phenomena by evoking elements of human consciousness, feelings, and memories that words may not easily express and surveys may not easily capture. This symposium presents qualitative research using visual methods to illuminate the lived experiences, voices, and perspectives of diverse and vulnerable older adults living in New Jersey, Connecticut, and California. Reyes’ research critiques how the operationalization of mainstream notions of civic participation becomes exclusionary and provides a more inclusive understanding of how civic participation is enacted and performed through the practices of Latinx and African American older adults living in New Jersey. Versey’s research with homeless older adults subverts the attention often focused within cities by interrogating the meaning of place with informants whose needs and desires are often overlooked or obscured by residing in a small, rural town in central Connecticut. Yeh’s research on aging in place inequalities chronicles the everyday lives of housed and unhoused older San Franciscans to reveal their tactics for negotiating a moving tension between the daily interiority of identity and contingencies of a changing environment. Qualitative Research Interest Group Sponsored Symposium.

Reframing Aging-in-the-Right-Place for Housing Insecure Older Adults

Amidst rising costs of housing and changing personal needs, considerations of the availability of appropriate and accessible housing are becoming increasingly salient for older adults. While it has been widely acknowledged that older adults would prefer to age-in-place, recent reframing of this trend promotes the ideal as aging-in-the-right-place. This symposium will provide an updated understanding of how to support older adults’ ability to age-in-the-right-place, regardless of income or physical, mental, or social status. Presenters include international and interdisciplinary researchers representing perspectives from gerontology, social work, community planning, and health sciences. The symposium will begin with Wada examining resilience scholarship, with a focus on older people who are experiencing homelessness, which has been largely neglected. In the next presentation, Humphries will outline distinct, senior-specific needs and shelter/housing solutions for newly and chronically homeless older adults. Following, Canham will describe promising practices of shelter/housing to support aging-in-the-right-place for older people experiencing homelessness in Montréal, Calgary, and Vancouver identified through an environmental scan. Extending these efforts to an international scale, Mahmood will outline findings from a scoping review of supportive shelter/housing options, supports, and interventions. A final presentation will report on how community development practices implemented by a not-for-profit affordable housing provider promote older tenants’ food security and social support needs. Stephen Golant, a leading expert on housing, geography, and long-term needs on older adults, will discuss implications of these studies for policy and practice for supporting housing insecure older adults while advancing scholarship on aging-in-the-right-place for this marginalized population. Environmental Gerontology Interest Group Sponsored Symposium.

Examining moment to moment affective determinants of smoking rate following a quit attempt among homeless daily smokers

BackgroundCigarette smoking disproportionately affects homeless individuals, who have a higher smoking prevalence, fewer resources, and increased stressors compared to domiciled smokers. Little is known about how to facilitate smoking cessation among this population although some findings support focusing efforts on affective variables as well as alternate outcomes in order to optimize interventions for this group. MethodsParticipants were homeless adults recruited from a Dallas, TX, shelter (N = 57, 61.4% male, Mage = 48.8 ± 9.0) to participate in tobacco cessation classes using an American Cancer Society-based therapy and support group with nicotine replacement therapy. Moment-to-moment changes in affect [e.g., negative affect (NA), positive affect (PA), and stress] were recorded via Ecological Momentary Assessments to assess whether they were associated with concurrent changes in cigarettes smoked per day (CPD) following a specific quit attempt. Separate generalized linear models (GLM) were evaluated for each predictor to examine the associations between affective variables and CPD in covariate-adjusted analyses. ResultsSignificant interaction effects of time and affect were found for all variables (NA: p = 0.0011, PA: p = 0.0006, stress: p = 0.0259), whereby the association of affect and CPD were significant in the early part of the week but the effects faded as time progressed. With regard to main effects, only increases in PA during the post-quit week significantly predicted fewer CPD (adjusted incidence rate ratio = 0.924, SE = 0.027, p = 0.0032). ConclusionsHomeless smokers may be more likely to decrease their cigarette consumption during periods of greater PA throughout the post-quit week. Relationship between positive affect and reduction in CPD suggest focus on affective variables with homeless smokers may be an effective avenue for change in smoking behaviors, particularly in the days immediately following a quit attempt. Time effects should be further investigated to determine when these interventions might best be implemented.

Oral health perceptions and client satisfaction among homeless adults attending a community-centred dental clinic.

The homeless face significant barriers accessing dental care. Community-centred dental clinics might provide more accessible care to this group. This descriptive epidemiological study aimed to measure oral health perceptions and client satisfaction among homeless and similarly disadvantaged adults receiving community-centred dental care. A sample of 79 clients attending St Patrick's Oral Health Clinic completed Locker's Global Oral Health Item, the Oral Health Impact Profile 14 and the Client Satisfaction Questionnaire 4. High levels of satisfaction with St Patrick's Oral Health Clinic were based on positive staff attitudes, low cost, time effectiveness and staff sensitivity to anxiety. Ideas for improvement included shorter treatment waiting lists, offering additional treatment types and better communication and advertisement of the service. Compared to the general Australian population, participants reported a relatively poor self-perception of oral health and a high prevalence and severity of oral health impacts. Participants experienced significant personal and social impacts due to their oral conditions. High levels of client satisfaction reflect the value of community-centred dental care for this group. An understanding of factors influencing satisfaction might be useful for similar services providing oral care to homeless and similarly disadvantaged groups.

Epidemiological serosurvey and molecular characterization of sexually transmitted infections among 1890 sheltered homeless people in Marseille: Cross-sectional one day-surveys (2000–2015)

ObjectivesWe observed the prevalence and distribution of potential risk factors for sexually transmitted infections (STIs) among Marseille homeless population. MethodsOver the 2000-2015 period, we enrolled 1890 sheltered homeless adults and collected serum samples. Markers of hepatitis B and C viruses (HBV, HCV) and Treponema pallidum were searched using the CMIA testing. Positive HBsAg or anti-HCV samples underwent sequencing; positive anti-T. pallidum sera were subjected to the RPR test. ResultsThe overall prevalence of HBsAg, anti-HBs, anti-HBc, anti-HCV and anti-T. pallidum (by CMIA and RPR) was 4.1%, 22.9%, 35.5%, 5.3% and (6.8%, 1.0%), respectively. We found a significantly higher prevalence of HBsAg and anti-T. pallidum among individuals born in sub-Saharan Africa (or Asia) compared to those born in Europe. Being older (>42 years), toxicomania status, cannabis use and underweight status (compared to normal status) were independent factors associated with HCV seropositivity. Using sequencing, we obtained a substantial diversity of HBV and HCV genotypes. One HCV sequence harbouring a L31M substitution in the NS5a protein may be associated with reduced drug sensitivity. ConclusionsThe positive relationship between toxicomania and HCV suggests the need for effective prevention programmes including health education activities and addiction treatment.

Electronic cigarette use patterns and chronic health conditions among people experiencing homelessness in MN: a statewide survey

BackgroundAdults experiencing homelessness have higher rates of disease and premature morbidity compared to the general population. Tobacco use is a primary contributing factor to these disparities; however, less is known regarding e-cigarette use patterns among adults experiencing homelessness and whether e-cigarettes are used in a manner that is narrowing or widening health disparities. This study aimed to describe the 1) prevalence and trends in e-cigarette use, 2) correlates of e-cigarettes use, and 3) rates of chronic health conditions by product use pattern in a community-based sample of adults experiencing homelessness.MethodsAdults experiencing homelessness in Minnesota were surveyed by self-report in 2015 (n = 3672) and 2018 (n = 4181) regarding e-cigarette and combustible cigarette use, potential correlates of e-cigarette use, and self-reported chronic health conditions (i.e., asthma, hypertension, diabetes, and cancer).ResultsFrequency of use increased from 2015 to 2018 for combustible cigarettes (66.9% vs. 72.3%), e-cigarettes (11.4% vs. 14.5%), and dual combustible/e-cigarette use (10.2% vs. 12.9%). The strongest bivariate correlates of past 30-day e-cigarette use were younger age, non-binary gender identification, non-heterosexual orientation, identification as White/Caucasian, greater frequency of lifetime homelessness, substance use, lack of regular place for medical care, mental health diagnosis, criminal justice involvement, and combustible cigarette smoking. Dual users had significantly higher rates of asthma and cancer than both those using combustible cigarettes and those using neither combustible nor e-cigarettes.ConclusionsDuring a time when cigarette smoking, e-cigarette use, and dual use were decreasing in the general population in Minnesota, rates increased in the homeless population. We observed that the rates of dual use were more than five times greater among homeless adults compared to the general population in 2018. Correlates of e-cigarette use were identified and should be used to identify subpopulations for intervention targeting. Mechanisms of the relationship between dual use and increased risks of health conditions deserve further study.