Stable Housing Research Articles

Is federal housing assistance associated with earlier-stage cancer diagnosis? Evidence from the new SEER-Medicare and US Department of Housing and Urban Development data linkage.

85 Background: Despite growing awareness that stable and affordable housing is a key social determinant of health, little research has examined the role of federal housing assistance in cancer outcomes. This study uses a novel data linkage to examine the association of federal housing assistance (i.e. various rent subsidy programs) on stage at diagnosis for the 4 most common cancers in the US. Methods: Individuals aged 66-95 years newly diagnosed with breast, colorectal, non-small cell lung (NSCLC) or prostate cancer in 2006-2019 with fee-for-service coverage were selected from SEER-Medicare Housing and Urban Development (HUD) administrative data. After identifying individuals with housing assistance at diagnosis, controls without housing assistance at diagnosis were propensity score matched in a 3:1 ratio by cancer site, age, sex, race/ethnicity, marital status, registry, year of diagnosis, area-level Yost socioeconomic status index, dual Medicaid eligibility, rural/urban residence, reason for Medicare entitlement, and pre-diagnosis comorbidity. Associations of housing assistance and diagnosis stage (SEER summary stage: localized vs. regional/distant) were examined with separate logistic regression models by cancer type. Results: A total of 7335 individuals with breast, 5660 with colorectal, 7399 with NSCL and 4309 with prostate cancer received housing assistance at diagnosis (Table). Compared to matched controls, a smaller percentage of individuals with housing assistance were diagnosed with regional/distant breast (36% vs. 33%), colorectal (59% vs. 57%), and NSCL (71% vs. 69%) cancers. Individuals receiving housing assistance were less likely to be diagnosed with later-stage breast (OR: 0.87; 95% CI: 0.83, 0.92) and NSCL (OR: 0.93; 95% CI: 0.88, 0.99) cancers. Housing assistance was not significantly associated with stage for individuals with colorectal or prostate cancers. Conclusions: Federal housing assistance is associated with earlier-stage breast and NSCL cancer diagnosis, highlighting its potential role in mitigating the adverse effects of housing insecurity on cancer outcomes. Housing assistance and cancer diagnosis stage. No Housing Assistance at Dx,N (%) Housing Assistance at Dx,N (%) OR [95% CI], P Breast Localized 14291 (64) 4890 (67) 1.0 (ref) Regional/Distant 8179 (36) 2445 (33) 0.87 [0.83, 0.92] P<0.001 Colorectal Localized 7046 (42) 2422 (43) 1.0 (ref) Regional/Distant 9934 (59) 3238 (57) 0.95 [0.89, 1.01] P=0.09 NSCLC Localized 6572 (30) 2298 (31) 1.0 (ref) Regional/Distant 15625 (71) 5101 (69) 0.93 [0.88, 0.99] P=0.02 Prostate Localized 10293 (80) 3401 (79) 1.0 (ref) Regional/Distant 2634 (20) 908 (21) 1.04 [0.96, 1.14] P=0.33 Dx=Diagnosis; OR=Odds Ratio; CI=Confidence Interval.

Using youth participatory action research to explore the impacts of structural violence on LGBTQIA + youth health.

Queerphobia is defined as society's negative attitude towards LGBTQIA + people, translating into structures that marginalise LGBTQIA + people and contribute to health inequities that cause real harm and can be understood as structural violence. The purpose of this article is to explore what historically marginalised youth in a youth participatory action research (YPAR) project characterise as the big picture issues affecting the lives of LGBTQIA + youth. We used participatory arts-based methods to conduct community and identity building, define research questions and photo prompts, conduct data collection, engage in group thematic analysis, and make recommendations at the state policy level. We also conducted individual semi-structured interviews with participants. Our findings can be grouped into three main themes: LGBTQIA + youth may feel it is safer to remain closeted; queerphobia perpetuates housing instability; and queerphobia functions as a structural barrier to social services. Youth also developed state level policy recommendations to address the structural issues causing harm to LGBTQIA + youth health. Recommendations included increasing access to affordable housing and LGBTQIA + inclusive foster and group homes, and advocating for government-funded LGBTQIA + specific healthcare practices for LGBTQIA + youth. More youth-driven data are needed that centre those directly impacted by structural violence and associated health outcomes.

Association between Homelessness and Temperature-Related Health Emergencies in the United States

Abstract Temperature-related illness (TRI) encompasses heat-related illness, such as heat exhaustion and heatstroke, and cold-related illness, such as frostbite and hypothermia. TRI is typically the result of exposure to ambient weather conditions; because of this, unhoused individuals are hypothesized to have higher risk of TRI. However, no national epidemiological studies have been completed to determine this risk. The objective of this study was to determine the association between homelessness and emergency department (ED) diagnosis of TRI in the United States. We conducted a cross-sectional study of adult ED visits in the United States from 2005 through 2020 using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS), a nationally representative sample of nonfederal ED patient visits. Housing status (housed versus unhoused) was measured using NHAMCS patient residence category, with blank responses excluded. TRI was defined as ED clinician diagnosis of heat- or cold-related illness using International Classification of Disease, versions 9 and 10 (ICD-9 and ICD-10) codes. Multivariable logistic regression was used to determine adjusted odds of TRI by housing status. There were 323 606 nonpediatric ED visits in the NHAMCS sample. TRI diagnosis was present in 288 (0.09%) visits. 4099 visits (0.9%) were categorized as unhoused. After adjusting for sex, mental health diagnosis, and alcohol or substance use or use disorder, the odds ratio of TRI diagnosis in unhoused individuals was 4.08 (95% CI 2.09, 7.95) compared to housed individuals. We found a higher adjusted odds ratio of TRI diagnosis at an ED visit among unhoused individuals compared with housed individuals. Significance Statement Temperature-related health emergencies, or illnesses caused by exposure to ambient weather conditions, affect numerous Americans each year and are expected to become more common as climate change continues. We wanted to understand whether unhoused individuals are at higher risk of these health emergencies. We used a national sample of emergency department visits in the United States to study this and found out that unhoused individuals are at more than four times the risk of these illnesses than housed individuals. Our work highlights the need for prevention of homelessness, stable housing for housing insecure populations, and heating and cooling centers during weather emergencies.

Health impacts of excessive heat in Multnomah County, OR, 2021

Abstract Human-induced climate change is leading to increased extreme weather events, such as the heat dome that occurred in Multnomah County, OR, in June 2021. Certain groups are at increased risk from excessive heat events, such as the very young and very old, persons without stable housing, and persons with certain health comorbidities. Our review of three data sources (deaths, hospitalizations, and emergency department visits) showed large increases in all three measures in the summer of 2021. Further, two-thirds of identified heat deaths occurred in or near neighborhoods that ranked among the most vulnerable to extreme heat. Despite thoughtful planning, a recently updated heat response plan, and an unprecedented mobilization of resources, we documented severe health impacts due to this heat event. We recommend that local health jurisdictions and emergency responders increase readiness for such events by interrogating existing plans and tailoring them not to events of expected severity, but to a worst case scenario that exceeds historic experiences.

1인 가구 가정생활 실태 및 요구 조사: 2023년 가족센터 이용자를 중심으로

This study examined the family life, program engagement, and policy support demands of single-person households associated with family centers across South Korea. Participants were recruited from 48 family centers, and the current study included 105 adults who met the criteria for single-person households. The assessment of family life focused on satisfaction, community participation, availability of support, and daily living challenges. The investigation of program engagement and demands for policy support included awareness of, and satisfaction with, diverse programs tailored for single-person households, and their expressed demands for support. Data were analyzed using descriptive statistics, t-tests, and F-tests. Results indicated that the family life satisfaction of single-person households scored an average of 7.7 out of 10. Community engagement and perceived availability of help were slightly above the median value. The greatest challenge for single-person households was maintaining a balanced diet. Overall, no significant differences in these features of family life across gender or age groups. Regarding program engagement, awareness of support programs for single-person households was higher among women than men, and satisfaction with these programs was higher among those in their 20s and 50s compared to those in their 40s. In terms of demands for policy support, housing stability support was the top priority for those in 20s to 40s, while family leisure/cultural activity support was most demanded by those in their 50s. This study highlights the importance of understanding the characteristics of single-person households using family centers nationwide and offers direction for the management and enhancement of support programs.

Factors Related to the Rise of Congenital Syphilis From the Perspectives of Prenatal Providers and Birthing Parents in Chicago, IL, USA.

Rates of congenital syphilis (CS) in the United States have risen sharply in recent years. There has been sparse research centering the voices and experiences of birthing parents who have delivered infants with CS and prenatal providers in Chicago or the surrounding Midwestern United States to date. Additionally, there has been little research on the role of extrinsic factors, such as stigma and attitudes surrounding CS in an individual's community, in their entry into and retention in the CS prevention cascade. Semistructured interviews seeking to gather perspectives and factors related to the rise of CS were conducted with birthing parents who delivered infants with CS at a major academic medical institution (AMI) and the prenatal providers who served them. This was supplemented by retrospective data of birthing parent outcomes. Barriers elicited during the interviews included insufficient penicillin uptake, limited transportation, poor communication between providers and patients, gaps in patient understanding or knowledge around CS contraction and treatment, missed appointments, appointment burden for patients, life stressors of patients, housing instability, childcare difficulties, and stigma related to the CS diagnosis. The quantitative data revealed differing proportions of CS outcomes and care between those with care within the AMI, those with care outside the AMI, and those who had no prenatal care. This study found numerous perspectives and factors that may explain the rise of CS along various stages of the syphilis care continuum through in-depth interviews of prenatal providers and birthing parents.

Housing Insecurity and Older Adults' Health and Well-Being in a Gentrifying City: Results from the EPIPorto Cohort Study.

Using 2022 data from 600 adults (≥ 60years) in Porto, Portugal, we explored the association between housing insecurity and various health outcomes. We examined housing conditions, affordability, and stability in relation to loneliness, quality of life, cognitive function, perception of healthy ageing, and sleep using regression models. Older adults without house heating (β = 2.293; 95%CI = 0.753, 3.833), with leaks/dampness/rot (β = 3.741; 1.818, 5.664), insufficient daylight (β = 2.787; 0.095, 5.479), living in neighborhoods with noise (β = 1.793, 0.280 to 3.305), pollution/grime (β = 2.580; 0.746, 4.414), and violence/crime/vandalism (β = 3.940; 1.723, 6.157), who faced housing cost overburden (β = 2.001; 0.426, 3.577), eviction (β = 12.651; 0.852, 24.450), and moved frequently (β = 4.129; 1.542, 6.716) exhibited higher levels of loneliness. Similarly, lack of house heating (β = - 1.942; - 3.438, - 0.445), leaks/dampness/rot (β = - 4.157; - 5.999, - 2.316), insufficient daylight (β = - 3.124; - 5.714, - 0.534), noise (β = - 2.143; - 3.600, - 0.686), pollution/grime (β= - 2.093; - 3.860, - 0.325), violence/crime/vandalism (β= - 2.819; - 4.948, - 0.691), and those with housing cost overburden (β= - 2.435; - 3.930, - 0.940) reported lower quality of life.Those with no toilet (β = - 1.891; - 3.760, - 0.021) or shower (β = - 1.891; - 3.760, - 0.021) and who faced forced displacement (β = - 2.179; - 3.516, - 0.842) presented lower cognitive function. Furthermore, those living in neighborhoods with pollution/grime (OR = 0.494; 0.322, 0.756) and violence/crime/vandalism (OR = 0.477; 0.284, 0.801), those in social housing (OR = 0.728; 0.575, 0.922), and those who moved frequently (OR = 0.475; 0.257, 0.879) reported lower levels of perceived healthy ageing. Insufficient sleep was more common among residents in social housing (OR = 2.155; 1.102, 4.213), while poor sleep quality was least likely both among those living in social housing (OR = 0.445; 0.220, 0.900) and affordable housing (OR = 0.381; 0.162, 0.896). Good quality, stable, and affordable housing seems crucial for healthy ageing.

Caring for dementia caregivers: How well does social risk screening reflect unmet needs?

Unmet social and caregiving needs can make caregiving for a person with dementia more difficult. Although national policy encourages adoption of systematic screening for health-related social risks (HRSRs) in clinical settings, the accuracy of these risk-based screening tools for detecting unmet social needs is unknown. We used baseline data from dementia caregivers (N = 343) enrolled in a randomized controlled trial evaluating CommunityRx-Dementia, a social care intervention conducted on Chicago's South Side. We assessed caregivers' (1) unmet social and caregiving needs by querying need for 14 resource types and (2) HRSRs using the Center for Medicare & Medicaid Services (CMS) Accountable Health Communities (AHC) screening tool. Using unmet social needs as the reference, we examined the sensitivity of the AHC tool to detect food, housing, and transportation needs. Analyses were stratified by gender. Most caregivers were women (78%), non-Hispanic (96%), Black (81%), partnered (58%) and had an annual household income ≥$50K (64%). Unmet social and caregiving needs were similarly prevalent among women and men caregivers (87% had ≥1 need, 43% had ≥5 needs). HRSRs were also prevalent. The most common HRSR was lack of social support (45%). Housing instability, difficulty with utilities and having any HRSRs were significantly more prevalent among women (all p < 0.05). The AHC screener had low sensitivity for detecting unmet food (39%, 95% confidence interval [CI]: 27%-53%), housing (42%, 95% CI: 31%-53%), and transportation (22%, 95% CI: 14%-31%) needs. Sensitivity did not differ by gender for food (41% for women and 30% for men, p = 0.72) or housing (44% for women and 29% for men, p = 0.37) needs. For transportation needs, sensitivity was 27% for women versus 0% for men (p = 0.01). Men and women caregivers have high rates of unmet social needs that are often missed by the CMS-recommended risk-based screening method. Findings indicate a role for need-based screening in implementing social care.

A systematic comparison of additive and interaction approaches to modeling the effects of syndemic problems on HIV outcomes in South Africa.

Much of the research on the effects of syndemics on HIV outcomes has utilized an additive approach. However, interaction effects may better account for syndemic synergy than an additive approach, but it remains difficult to specify interaction effects without empirical guidance. We sought to systematically compare additive and interaction effects approaches to modeling the effects of syndemic problems on antiretroviral therapy (ART) using empirically specified interaction terms. Participants were 194 people with HIV (PWH) who received HIV care in Khayelitsha, South Africa. In a series of linear regression models, we examined ten syndemic problems: depression, alcohol use, intimate partner violence (IPV), post-traumatic stress, social anxiety, substance use, food insecurity, poverty, housing instability, and structural barriers to care. Depression, substance use, and food insecurity were selected for interaction terms based on a prior network analysis, which found these problems to be most central. The additive models did not produce statistically significant findings. However, the interaction effects models yielded significant interaction terms in both the full model and a parsimonious model. There was a statistically significant effect of the interaction between depression and food insecurity on ART adherence (b = 0.04, Robust SE = 0.02, 95%CI [0.001-0.08], p = .012). This pattern of results was replicated in the parsimonious model. Findings suggest that when feasible, interaction effects approaches may be a helpful syndemic modeling technique. Results may inform future intervention targets, such as depression and food insecurity, and the importance of addressing both structural and psychosocial syndemic problems.

Abstract C131: Understanding the impact of social risk factors on cancer care delivery: A scoping review

Abstract In recent years, there has been a growing emphasis on understanding the relationship between individual-level social determinants of health, which include social risks and social needs, within the realm of cancer care delivery. Social risks include food insecurity, housing instability, and transportation barriers, leading to adverse health outcomes. These social risks become social needs when patients identify a desire for assistance in addressing them. As the number of cancer survivors increases and disparities in the burden of cancer persist, there is a critical need to focus efforts on ensuring all survivors experience high-quality and equitable care across the cancer continuum, from diagnosis to end-of-life care. To inform research activities and intervention development, we aim to summarize and describe cancer care delivery research focused on three social risk factors: food insecurity, housing insecurity, and transportation barriers. To achieve our research objectives, we conducted a scoping review using Covidence software to examine published research assessing and addressing housing insecurity, food insecurity, and transportation barriers among individuals diagnosed with cancer. Six databases were searched: PubMed, Scopus, Cochrane Library, CINAHL Plus, EMBASE, and PsycINFO. Inclusion criteria for this review included original research in English published between 2010 and 2023 that focused on cancer patients and survivors in the United States and included social risk factors and cancer care delivery data. Data selection and screening were performed in two phases: (1) title and abstract and (2) full text, which required two independent reviewers. Discrepancies and disagreements between the two reviewers for inclusion of studies were resolved through weekly discussions at team meetings. A data abstraction tool that contains nine general variable categories was developed. We identified 10,032 studies, of which 76 were duplicates, and 9,368 were irrelevant at the title and abstract levels. We are currently finishing the full-text screening for the 563 studies deemed potentially eligible for inclusion at the title abstract level. To date, 164 of the 335 studies screened have met our eligibility criteria. We will extract data from all eligible studies once the full-text screening is completed. Across eligible studies, transportation barriers (91.5%) were the most common social risk factor of focus, followed by studies focusing on food insecurity (6.7%) and housing insecurity (3.7%). Our scoping review findings will provide us with a wide spectrum of knowledge regarding the most prominent relationships between social risk factors and cancer care delivery, gaps in current work, and existing interventions targeting these efforts. The results of this work will enhance our understanding of how social-structural disadvantages influence cancer outcomes and inform the development of concerted efforts aimed at addressing the social factors contributing to the unequal burden of cancer among survivors. Citation Format: Carol Y. Ochoa-Dominguez, Victoria M. Telles, Janeth I. Sanchez, Brenda A. Adjei, Avertson Worthy, Daniel Sabater-Minarim, Angel Arizpe, Matthew P. Banegas. Understanding the impact of social risk factors on cancer care delivery: A scoping review [abstract]. In: Proceedings of the 17th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2024 Sep 21-24; Los Angeles, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2024;33(9 Suppl):Abstract nr C131.

Trends in Contacts Made by Immigrants to the National Domestic Violence Hotline, Before and During the COVID-19 Pandemic.

Immigrants in the United States are more likely than nonimmigrants to experience risk factors for intimate partner violence (IPV) and problems in getting support. The COVID-19 pandemic and recent incidents of xenophobia and anti-immigrant sentiment may have exacerbated exposure to IPV risk factors. We examined immigrant experiences of IPV before and during the COVID-19 pandemic. This study identified changes in characteristics of abuse, services used, referrals, and barriers to services among those who contacted the National Domestic Violence Hotline (NDVH) and identified as immigrants, reported immigration status as a concern, needed immigration support, and/or identified immigration status as a barrier to accessing services (N = 49 817). We used joinpoint regressions to examine whether the rate of change differed significantly from 2016-2019 (before the pandemic) to 2019-2021 (during the pandemic). The number of immigrant contacts to NDVH peaked in 2017 (n = 9333) and declined 25% to 6946 in 2021. During 2016-2019, the percentage of contacts reporting the following increased significantly: technology-facilitated violence (+12.7 percentage points), economic/financial abuse (+10.8 percentage points), and involvement of firearms (+4.8 percentage points); during 2019-2021, these trends reversed. The percentage of contacts reporting separation or divorce was relatively flat until 2019 and then increased from 14.6% in 2019 to 19.9% in 2021 (+5.2 percentage points). Housing instability increased during 2017-2020 (+9.3 percentage points), but requests for shelters decreased (-4.5 percentage points). Immigration status and personal finances were commonly reported barriers to services; both decreased during 2016-2019 but then increased during 2019-2021. This study can inform prevention and response strategies relevant for immigrants experiencing or reporting IPV.

From conceptualising to modelling structural determinants and interventions in HIV transmission dynamics models: a scoping review and methodological framework for evidence-based analyses

Abstract Background Including structural determinants (e.g. criminalisation, stigma, inequitable gender norms) in dynamic HIV transmission models is important to help quantify their population-level impacts and guide implementation of effective interventions that reduce the burden of HIV and inequalities thereof. However, evidence-based modelling of structural determinants is challenging partly due to a limited understanding of their causal pathways and few empirical estimates of their effects on HIV acquisition and transmission. Methods We conducted a scoping review of dynamic HIV transmission modelling studies that evaluated the impacts of structural determinants, published up to August 28, 2023, using Ovid Embase and Medline online databases. We appraised studies on how models represented exposure to structural determinants and causal pathways. Building on this, we developed a new methodological framework and recommendations to support the incorporation of structural determinants in transmission dynamics models and their analyses. We discuss the data and analyses that could strengthen the evidence used to inform these models. Results We identified 17 HIV modelling studies that represented structural determinants and/or interventions, including incarceration of people who inject drugs (number of studies [n] = 5), violence against women (n = 3), HIV stigma (n = 1), and housing instability (n = 1), among others (n = 7). Most studies (n = 10) modelled exposures dynamically. Almost half (8/17 studies) represented multiple exposure histories (e.g. current, recent, non-recent exposure). Structural determinants were often assumed to influence HIV indirectly by influencing mediators such as contact patterns, condom use, and antiretroviral therapy use. However, causal pathways’ assumptions were sometimes simple, with few mediators explicitly represented in the model, and largely based on cross-sectional associations. Although most studies calibrated models using HIV epidemiological data, less than half (7/17) also fitted or cross-validated to data on the prevalence, frequency, or effects of exposure to structural determinants. Conclusions Mathematical models can play a crucial role in elucidating the population-level impacts of structural determinants and interventions on HIV. We recommend the next generation of models reflect exposure to structural determinants dynamically and mechanistically, and reproduce the key causal pathways, based on longitudinal evidence of links between structural determinants, mediators, and HIV. This would improve the validity and usefulness of predictions of the impacts of structural determinants and interventions.

Homelessness During the Pandemic: The Use of Arts to Mobilize Knowledge

The following is a review of three arts-based research projects developed to mobilize knowledge in understandable ways for diverse populations regarding the stories of people who are homeless. All three projects were carried out in Canada – each with a different focus. The first research project created a film – Walking Through Wonderland (2010) - that captured the daily lived experiences of many street youths, such as being unable to find places to sleep, as well as not having food, or access to health care and social services, particularly for mental health care. Additionally, the film highlighted that many youths had become homeless because of major family trauma. The second research project created a Book of Images (2018) that visually portrayed the stories regarding housing stability among young people – in Halifax, Nova Scotia, and Toronto, Ontario – who had previously experienced homelessness. The third research project created an arts-based film production, Homelessness During the Pandemic (2022), with visual images and classical, almost haunting, music for the background to illustrate the experiences of homelessness during the coronavirus disease of 2019 (COVID-19) in two communities of Nova Scotia –Cape Breton Regional Municipality (CBRM) and Halifax Regional Municipality (HRM).

A descriptive study of the connections between social risk and healthcare utilization with supportive oncology care

Objective This study utilized social risk data in the electronic heath record collected as part of routine clinical practice and examined relationships with supportive oncology care contacts and healthcare utilization. Methods A total of 2,807 cancer patients were screened for four social determinants of health (SDOH) domains (financial resource strain, housing instability, food insecurity, and transportation need) and categorized to low or high risk SDOH groups. The number of patient contacts with supportive oncology was compared amongst the groups. The data were analyzed for demographic and outcome differences including emergency department visits, inpatient admissions, and appointment adherence. Results Heightened social risk was associated with more total contacts with supportive oncology care. Patients with high SDOH risk had more contacts across all outcomes examined including emergency department visits (M = 13), inpatient admissions (M = 14), and missed appointments (M = 11). Conclusions Patients with both greater social risks and acute care utilization are associated with more psychosocial interventions in supportive oncology follow-up. These findings highlight the need for comprehensive action to respond to social risk factors identified in SDOH screening.

Impact of the COVID-19 pandemic on Canadian performing and creative artists: An interpretive descriptive study using the social-ecological model.

Public health restrictions during the Coronavirus-2019 (COVID-19) pandemic in Canada have substantially reduced the work and income of performing and creative artists. We aimed to understand how factors at the public policy, community, organizational, interpersonal and individual levels affected Canadian performing and creative artists' health and livelihood during the pandemic. We interviewed 14 creative and performing artists from an academic hospital-based healthcare center in Toronto, Canada. In addition, we conducted secondary data analysis on an existing set of 17 transcribed interviews from a quality improvement study that included relevant information to answer the present study's research question. We applied an interpretive descriptive approach to our qualitative inquiry and used the social-ecological model (SEM) as our analytic framework. We identified factors at all levels of the SEM that tended to synergistically affect the health and livelihood of artists during the COVID-19 pandemic. Public health restrictions and government financial assistance programs have downstream effects on other levels. During the pandemic, many artists sensed an overwhelming loss of community, financial instability, and limited access to healthcare; which in turn affected their health. For those who accessed financial assistance programs, the stability of income afforded time for rest without the stress of food insecurity or housing instability. Use of the SEM as an analytic framework reflects the multidirectional intricacy and dynamic interplay among factors operating within and across all five levels, bringing to light potential areas of improvement at various levels to strengthen resilience and reduce risk factors associated with artists' health and healthcare access. Findings also accentuated the fragility of precarious work that inundates the performing arts industry, which emphasizes the need for interventions and policies to address this issue. Such interventions might include financial support programs for artists, access to affordable healthcare services, and efforts to strengthen social support networks within the arts community.

A qualitative investigation into the effectiveness of a housing navigator program linking justice-involved clients with recovery housing

BackgroundRoughly 24–36% of people who are incarcerated in the U.S. are formally diagnosed with opioid use disorder (OUD). Once released, individuals involved with the criminal legal system (CLS) face increased risks of return to use and fatality and are 129 times more likely to die from an overdose within the first two weeks of release compared to those without CLS involvement. People who are CLS-involved and who are seeking a recovery living environment can access temporary stable housing through recovery homes. However, entering a recovery home can be difficult due to fragmentation among recovery housing organizations and their non-uniform application and screening procedures. A navigation pilot program was implemented to provide clients with recovery home placement advice, pre-screening, and referrals in Cook County, IL. Existing research on recovery homes has rarely examined the importance of recovery housing navigation for enhancing service engagement among CLS-involved individuals receiving medications for OUD.MethodsSemi-structured qualitative interviews were conducted with 22 clients and three recovery housing navigators as part of a program evaluation of the navigation program pilot. Qualitative software was used to organize and qualitatively analyze transcripts through several rounds of coding producing emergent themes, which were then triangulated, and expanded using navigator data.ResultsClients seeking recovery home services reported multiple prior challenges securing safe and supportive recovery living environments. Despite low initial expectations, clients described their interactions with housing navigators in favorable terms and felt navigators worked with them effectively to identify and meet their housing and substance use needs in a timely manner. Clients also commented on their partnerships with the navigator throughout the process. Interactions with navigators also calmed fears of rejection many clients had previously experienced and still harbored about the process, which bolstered client-navigator relationships and client motivation to engage with additional services.ConclusionEvidence from this study suggests recovery home navigation can improve the speed and efficiency with which clients are connected to appropriate services that are tailored to their specific needs as well as increase client motivation to engage with a myriad of recovery services.

Poor housing conditions in adolescence and housing hardship in adulthood: A longitudinal mediation analysis

Despite a growing body of literature on housing and its immediate effects on various life outcomes, little is known whether poor housing conditions in adolescence are related to housing outcomes in adulthood. This study examined the association between poor housing conditions in adolescence and housing hardship in adulthood, as well as the potential mechanisms underlying this association. We utilized data from the National Longitudinal Study of Adolescent to Adult Health to investigate whether poor housing conditions in adulthood are longitudinally associated with housing hardship in adulthood. Moreover, we conducted formal mediation analyses, considering financial, educational, health, and behavioral factors to elucidate the mechanisms involved. Poor housing conditions in adolescence were positively associated with housing hardship in adulthood. Although the association appeared more pronounced for women than for men, this gender difference was not statistically significant. Educational attainment was the most significant mediator for both men and women. Financial, health, and behavioral factors played minimal or no mediating roles. The findings of this study suggest that improving housing conditions during adolescence and addressing the educational implications of poor housing conditions emerge as potential strategies for interventions aimed at promoting housing stability in later life.

Housing instability patterns among low-income, urban Black young adults in California and associations with mental health outcomes: baseline data from a randomized waitlist-controlled trial

BackgroundDeep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes.MethodsUsing baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18–24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope.ResultsWe found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns.ConclusionsHigh prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.

Voices from the Frontline: Insights on Aboriginal and Torres Strait Islander Housing Advocacy

ABSTRACT Homelessness is a significant issue in Australia, particularly for Aboriginal and Torres Strait Islander people, who are disproportionally affected compared to non-Indigenous Australians. In this article, we present new findings into the barriers and enablers of housing stability for Aboriginal and Torres Strait Islander people in the Brisbane and Logan areas of Queensland. The aim of the study was to document workers perceptions of barriers and enablers faced by Aboriginal and Torres Strait Islander people in Queensland when seeking to access housing. We drew on extensive interview data with front-line staff from an Aboriginal Community-Controlled Health Organisation (ACCHO) and in doing so identified five key themes: Bureaucratic Barriers and Inaccessibility of Services; Experiences of Discrimination; Impact of Family Dynamics on Housing Stability; Geographic Location; Comprehensive Support Needs. We demonstrated that consistent with the scholarly literature the interplay of systemic, structural, and cultural factors continues to impact housing stability. These findings suggest more work is required if governments are to address housing stability for Aboriginal and Torres Strait Islander individuals and families. IMPLICATIONS Presenting original data from social workers at an Aboriginal Community-Controlled Health Organisation (ACCHO) contributes to available understandings. In addressing housing challenges, cultural connection and competency are of vital importance. Voices from social workers can provide guidance for policymakers aiming to address homelessness for Aboriginal and Torres Strait Islander people.

Going straight home? Housing stability and post-prison reoffending in Aotearoa New Zealand

ABSTRACT International research has found that post-release stable accommodation is associated with reduced recidivism, however, research exploring this relationship in Aotearoa New Zealand and its potential causal nature is limited. Drawing on quantitative pre- and post-release interviews with people released from prison in Aotearoa New Zealand, this article examines their housing situations and the relationship between two measures of recidivism (re-sentencing and re-imprisonment) and two measures of housing stability (stable housing and residential mobility). Whilst stable housing is associated with a reduced risk of re-imprisonment, after controlling for confounding variables using inverse probability of treatment weighting, a direct causal relationship between housing stability and recidivism could not be found. We conclude that housing stability is therefore likely to be indicative of broader stability post-release and supports other factors related to successful reintegration, including the development of social capital.