Stable Housing Research Articles

Association Between Social Determinants of Health and Cancer Treatment Delay in an Urban Population.

Delays in oncologic time to treatment initiation (TTI) independently and adversely affect disease-specific mortality. Social Determinants of Health (SDoH) are increasingly recognized as significant contributors to patients' disease management and health outcomes. Our academic center has validated a 10-item SDoH screener, and we elucidated which specific needs may be predictive of delayed TTI. This is a retrospective cohort study at an urban academic center of patients with a SDoH screening and diagnosis of breast, colorectal, endocrine/neuroendocrine, GI, genitourinary, gynecologic, head and neck, hematologic, hepatobiliary, lung, or pancreatic cancer from 2018 to 2022. Variables of interest included household income, tumor stage, and emergency department (ED) or inpatient admission 30 days before diagnosis. Factors associated with delayed TTI ≥45 days were assessed using multivariable logistic regression. Among 2,328 patients (mean [standard deviation] age, 64.0 (12.8) years; 66.6% female), having >1 unmet social need was associated with delayed TTI (odds ratio [OR], 1.68; 95% CI, 1.54 to 1.82). The disparities most associated with delay were legal help, transportation, housing stability, and needing to provide care for others. Those with ED (OR, 0.49; 95% CI, 0.44 to 0.54) or inpatient (OR, 0.54; 95% CI, 0.50 to 0.58) admission 30 days before diagnosis were less likely to experience delay. Delays in oncologic TTI ≥45 days are independently associated with unmet social needs. ED or inpatient admissions before diagnosis increase care coordination, leading to improved TTI. Although limitations included the retrospective nature of the study and self-reporting bias, these findings more precisely identify targets for intervention that may more effectively decrease delay. Patients with SDoH barriers are at higher risk of treatment delay and could especially benefit from legal, transportation, caregiver, and housing assistance.

Retrospective narratives of challenges experienced during adolescence and young adulthood after child welfare-involvement

ABSTRACT This qualitative, narrative, retrospective study of adults (N = 21; mean age 27.8 years) with child welfare involvement in young adolescence explored the participants’ challenges in childhood and young adulthood. The sample had positive psychosocial functioning at age 18 years. Analysis identified three areas of challenges: Individual Challenges including mental health problems and shame/isolation; Family Challenges including child maltreatment by family members, lack of family support, and parentification; and System Challenges including housing instability, child welfare/case worker issues, and lack of a safety net. Even though these individuals had positive psychosocial functioning entering adulthood, their challenges were significant and required supportive services.

The Cumulative Impact of Unmet Essential Needs on Indicators of Attrition: Findings from a Public University Population-Based Sample of Students in the Bronx, NY.

In recent decades, a growing proportion of college students have experienced financial stress, resulting in unmet essential needs including food insecurity, housing instability, lack of healthcare access, and inadequate mental health treatment. Given that urban-based public universities constitute a substantial proportion of the US college student population, understanding how unmet needs affect academic achievement in this population is crucial for developing strategies that alleviate college failure and dropout. We examined the cumulative impact of unmet essential needs (scored from 0 to 4) on indicators of college attrition (dropout, leave of absence, risk of academic probation). The sample comprised a college population-representative sample of 1833 students attending one of three urban public colleges in the Bronx, NY. Employing adjustedmultinomial and binomial logistic regression models, we assessed how total unmet essential needs predict any indicator of college attrition. Each unit increase in unmet need increased the odds of having any attrition indicator by 29% (p < 0.01). Students with two unmet needs had 43% greater odds (p < 0.01), students with three unmet needs had 57% greater odds (p < 0.01), and students with four unmet needs had 82% greater odds (p < 0.01) of having any attrition indicator compared to those without unmet needs. Findings revealed a modest dose-response relationship between the number of unmet needs and the likelihood of experiencing indicators of attrition, suggesting a cumulative impact of unmet needs onstudents' abilityto persist to graduation.Designing interventions aimed at college students with multiple unmet essential needs, and addressing these needs holistically, may assist student retention and graduation.

Optimizing ankle-brachial index measurement for peripheral arterial disease screening in mobile clinics

ObjectiveMultidisciplinary mobile clinics (MMCs) provide a robust venue to provide health care access and peripheral arterial disease (PAD) screening to underserved populations. The ankle-brachial index (ABI) can facilitate PAD diagnosis; however, traditional supine ABI measurements may be challenging technically in a mobile outreach clinic with limited infrastructure, whereas seated ABI offers technical ease. In this study, the usefulness and feasibility of performing supine ABI, seated ABI, and seated ABI with a calculation to account for seated hydrostatic pressure (seated-adjusted ABI) were compared in a mobile outreach setting. MethodsProspective data were collected from patients at five independent MMCs focused on diabetic foot and PAD screening with ABI for underserved communities. Three techniques were used to measure the ABI: seated ABI, seated-adjusted ABI using a formula to account for hydrostatic ankle pressure, and traditional supine ABI using a foldable massage table that is 5% of the cost of a medical stretcher. Comparative analysis was performed using the Student t test analysis and one-way analysis of variance. The frequency of completed seated ABI, seated-adjusted ABI, and supine ABI examinations performed at independent MMCs was quantified to determine feasibility. ResultsIn 166 individuals experiencing homelessness or housing instability who were screened over the course of five MMCs, 89 underwent PAD screening with ABI. Of the patients screened, 38 patients had seated, seated-adjusted, and supine ABIs measured (43% of total number of patients undergoing any ABI measurement). PAD (ABI < 0.9) was identified in one patient using all three ABI methods. Noncompressible ABI (ABI ≥ 1.3) were identified in 32 patients (32/38 [84%]) screened with seated ABI. Of these 32 patients, 24 (75%) continued to have noncompressible ABIs using seated-adjusted ABI. Of these 24 patients, 4 (17%) continued to have noncompressible ABI using supine ABI. The average seated ABI significantly differed from supine ABI (1.34 vs 1.14; P < .0001). The average seated ABI also significantly differed from seated-adjusted ABI (1.34 vs 1.29; P = .026). The average seated-adjusted ABI significantly differed from supine ABI (1.29 vs 1.14; P = .0204). ConclusionsWe found that seated and seated-adjusted ABI are grossly inaccurate and more often lead to falsely elevated noncompressible ABI (32/38 [84%] and 24/38 [75%], respectively) compared with supine ABI (6/38 [16%]). We recommend using supine ABI on patients for PAD screening. Supine measurement is technically feasible in outreach mobile clinics using a transportable folding massage table and is a more accurate tool for PAD screening.

Evaluating Access and Outcomes in Gender-affirming Breast Augmentation: A Comparative Study of a County Hospital and an Academic Center.

Research on the diverse patient population undergoing gender-affirming breast augmentation remains scarce. We compared patients undergoing this procedure at San Francisco General Hospital (ZSFG), a county hospital, and the University of California, San Francisco (UCSF), an academic medical center. This was a retrospective cohort study of patients who underwent primary gender-affirming breast augmentation at ZSFG (August 2019 to June 2023) and UCSF (March 2015 to June 2023). Differences in sociodemographic characteristics, surgical access, and outcomes between sites were assessed. Of 195 patients, 122 patients had surgery at UCSF and 73 patients at ZSFG. ZSFG patients were more likely to be unstably housed (P < 0.001), Spanish-speaking (P = 0.001), and to have obesity (P = 0.011) and HIV (P = 0.004). Patients at ZSFG took hormones for longer before surgical consultation (P < 0.001) but had shorter referral-to-surgery intervals (P = 0.024). Patients at ZSFG more frequently underwent a subglandular approach (P = 0.003) with longer operative times (P < 0.001). Major surgical complications were uncommon (2.1%) with no differences between sites. Aesthetically, implant malposition/rotation occurred more often in patients at UCSF (P = 0.031), but revision rates were similar at both sites. Patients at UCSF had longer follow-up periods (P = 0.008). County hospital patients seeking gender-affirming breast augmentation have distinct sociodemographic profiles and more comorbidities than academic medical center patients. County patients might experience greater barriers that delay surgical eligibility, such as stable housing. Nevertheless, this procedure can be safely and effectively performed in both patient populations.

Housing, Homelessness, and Mental Health

Homelessness is one of the most significant humanitarian, policy, and public health issues in the United States. People experiencing homelessness are at a heightened risk of various health issues, including severe mental illness, and face a life expectancy up to 30 years shorter than those with stable housing. The US Department of Housing and Urban Development (HUD) defines homelessness as lack of a fixed, regular, and adequate nighttime residence and reports that there has been a steady rise in the number of individuals with mental illness lacking stable housing, far outpacing the capacity of available services. Despite the importance of housing for mental health, psychiatrists are often ill-equipped to intervene on this key social determinant of health. This article reviews underlying factors contributing to homelessness for individuals with mental illness, details clinical ramifications of homelessness, and outlines evidence-based interventions for supporting people experiencing homelessness and psychiatric illness. [ Psychiatr Ann. 2024;54(7):e202–e208.]

How Should Harm Reduction Be Included in Care Continua for Patients With Opioid Use Disorder?

Practices and interventions that aim to slow progression or reduce negative consequences of substance use are harm reduction strategies. Often described as a form of tertiary prevention, harm reduction is key to caring well for people who use drugs. Evidence-based harm reduction interventions include naloxone and syringe service programs. Improving equitable outcomes for those with opioid use disorder (OUD) requires access to the continuum of evidence-based OUD care, including harm reduction interventions, as well as dismantling policies that undermine mental health and substance use disorder treatment continuity, housing stability, and education and employment opportunities.

Shelter from the storm: The growing threats from climate change to housing in the United States

AbstractClimate change and its related impacts are fast becoming the dominant force in the housing market. The fundamental role that housing plays in people's lives makes these effects particularly pernicious, often impacting employment, school attendance, undermining physical and mental health, disrupting social networks, and contributing to food insecurity. The complexity of addressing these issues is compounded by the cyclical and reciprocal relationships among these factors, with housing inequalities frequently lying at the core and climate change impacts percolating throughout. I introduce the framework of acute, secondary, and pre‐emptive/reactive impacts to help understand these mechanisms. To understand and contextualize these connections, I provide a brief overview racial segregation in the United States and related inequalities that place some individuals, groups, and communities at greater risk. Other key sources of housing instability in the United States that are often closely related to housing segregation include lack of affordable housing, growing income inequality, housing discrimination, evictions, and foreclosures, all of which contribute to unequal housing outcomes. These factors are explored using the temporal framework to discuss their connection to climate change, which is in and of itself a major force of housing instability.

Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments

PurposeWe aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. MethodsEnglish-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. Results282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. ConclusionFinancial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.

Effects of housing stability and contemporary mortgage lending bias on breast cancer stage at diagnosis among older women in the United States.

Interventions aimed at upstream factors contributing to late-stage diagnoses could reduce disparities and improve breast cancer outcomes. This study examines the association between measures of housing stability and contemporary mortgage lending bias on breast cancer stage at diagnosis among older women in the United States. We studied 67,588 women aged 66-90 from the SEER-Medicare linked database (2010-2015). The primary outcome was breast cancer stage at diagnosis. Multinomial regression models adjusted for individual and neighborhood socio-economic factors were performed using a three-category outcome (stage 0, early stage, and late stage). Key census tract-level independent variables were residence in the same house as the previous year, owner-occupied homes, and an index of contemporary mortgage lending bias. In models adjusted for individual factors, higher levels of mortgage lending bias were associated with later stage diagnosis (RR = 1.10, 95% CI 1.02-1.20; RR = 1.31, 95% CI 1.16-1.49; RR = 1.41, 95% CI 1.24-1.60 for least to high, respectively). In models adjusted for individual and neighborhood socio-economic factors, moderate and high levels of mortgage lending bias were associated with later stage diagnosis (RR = 1.16, 95% CI 1.02-1.33 for moderate and RR = 1.18, 95% CI 1.02-1.37 for high). Owner occupancy and tenure were not associated with later stage diagnosis in adjusted models. Contemporary mortgage lending bias demonstrated a significant gradient relationship with later stage at diagnosis of breast cancer. Policy interventions aimed at reducing place-based mortgage disinvestment and its impacts on local resources and opportunities should be considered as part of an overall strategy to decrease late-stage breast cancer diagnosis and improve prognosis.

장년세대 노년생활 주거선택에 관한 연구

1. CONTENTS (1) RESEARCH OBJECTIVES The purpose of this study is to find out what characteristics the elderly generation exhibits when choosing a residence to live in their old age after retirement. In other words, we tried to analyze what was an effective response strategy from the perspective of housing policy to minimize the mismatch between demand and supply in the housing market as well as housing stability by appropriately supplying the most preferred housing in the location they prefer. (2) RESEARCH METHOD As a tool for empirical analysis, frequency analysis was first conducted using the SPSS 26.0 statistical program, and response distribution and sample characteristics for all questionnaires were identified. Based on the evaluation data on the matters to be considered when choosing a place of residence after retirement, variables were classified through factor analysis and reliability analysis for each factor, and significant differences in the general characteristics of the sample were found and verified through chi-square analysis. (3) RESEARCH FINDINGS About 80% of the population of the elderly generation hope to move to the Gyeonggi-do area or the outskirts of Seoul within 5 years after retirement and live in a country house, apartment, or residential complex with an area of 20 to 30 pyeong(66~99㎡) or less. It was also found that they wanted to live independently around their children. There is a need for housing policies that respond to their needs to be quickly established in the short and long term. 2. RESULTS Analysis of what is an effective response strategy from the perspective of housing policy to minimize the mismatch between demand and supply in the housing market as well as stable housing for the elderly by appropriately supplying the most preferred housing in the location most preferred by the elderly. In addition, by analyzing housing preference according to general characteristics, the type of housing desired after retirement and the desired area were derived, and the residential area preferred and desired by the elderly generation was identified and presented as basic data for policy establishment.

매입임대주택 주거만족도 영향 요인의 우선순위 연구

This study aims to contribute to the improvement and revitalization of purchased rental housing by comparing perceptions between consumers and providers. Housing providers perceive 'external factors' (external noise and odor), 'administrative factors' (completeness of defect repair, ease of receiving defect repair, and connections and support from welfare services), and 'social factors' (opportunities to participate in neighborhood social gatherings) as relatively less important than tenants. Therefore, it seems that housing providers need to actively shift their priorities to customize their work in order to improve the housing satisfaction of tenants in purchased rental housing.. The policy implications are as follows: First, the government and the Incheon Metropolitan Government need to improve the system to realize the per-unit support price of purchased rental housing. Second, the significant impact of exterior noise on residents of rental housing requires a paradigm shift from the current policy of focusing on areas where housing is available for purchase. Third, public housing operators should make efforts to keep effective rents below a certain level, such as flexibly adjusting the conversion rate between security deposits and monthly rents to ensure housing stability. Fourth, it is possible to improve residents' housing satisfaction by improving 'external factors' that public housing operators can control. Fifth, iH needs to improve its management system, which is currently categorized into two regions based on the volume of goods per region, to one that can be visited once a week. Finally, iH's residential welfare service program needs to be improved, as it is mostly conducted in apartment complexes based on convenience and efficiency.

Addressing the Sleep Deprivation Epidemic in Adolescents: Findings from the Youth Risk Behavior Survey 2021

ABSTRACT Background Millions of U.S. youths do not get adequate sleep. Healthy People 2030 has prioritized sleep and identified an objective to increase the proportion of students in grades 9 through 12 who get sufficient sleep. Purpose This study investigated the predictors of severe sleep deprivation in adolescents. Methods Data were obtained from the 2021 Youth Risk Behavior Survey (YRBS), a school-based survey, conducted by the Centers for Disease Control (CDC). Severe sleep deprivation was defined as 6 hours or less sleep per night on school nights. Binary logistic regressions were used to estimate the associations. Results Among the 17,232 youth surveyed, 48.2% experienced severe sleep deprivation. Self reported overweight and poor mental health status, limited physical activity, excessive screen time, smoking/vaping, lacking school connectedness, parental monitoring, school, and neighborhood safety as well as not having stable housing were statistically significant predictors of adolescents’ severe sleep deprivation. Discussion Scaling up sleep health programs in schools, neighborhoods, and subpopulations of adolescents could be a fundamental step toward achieving health equity. Translation to Health Education Practice Educators, health professionals, and social workers should be informed about the risk and protective factors of sleep health, and adolescents’ vulnerabilities to sleep deprivation.

“It feels like I’m a step closer to my ultimate goal of stable housing:” a qualitative study of unhoused people’s experiences in alternative shelters in Portland

ABSTRACT In recent years, alternatives to congregate shelters have emerged, including tiny home villages and motel conversions. Existing research indicates that these alternative shelter modalities are associated with positive outcomes for shelter guests. This qualitative study was conducted with 11 participants staying in three alternative shelters tailored to support specific groups: lesbian, bisexual, gay, transgender, queer, intersex, and asexual (LGBTQIA+) people, women, and medically vulnerable people. Participants reported a number of facilitators and barriers to meeting their personal goals (e.g., permanent housing, medical care). Key facilitators included the relative privacy, autonomy, and safety of alternative shelters, and support for guests with marginalized identities. Barriers included difficulty navigating housing systems, and lack of internet and mail access. Given the drawbacks of congregate shelters, these new models are promising options to support unhoused people when permanent housing is not yet available.

Challenges and Implications for Substance Use and Mental Healthcare Among Under-Resourced Women in the COVID-19 Era.

The COVID-19 pandemic exacerbated disparities in mental healthcare and substance use disorder (SUD) treatment access, especially in under-resourced communities. This study aimed to comprehend the experiences of under-resourced women with SUD during the pandemic, their knowledge and attitudes towardit, and its impact on substance use and treatment access. A cross-sectional study included 66 under-resourced women receiving medically managed withdrawal treatment at a community residential SUD center. Data collection occurred between November 2021 and August 2022, utilizing a 75-item instrument covering COVID-19 exposure and its impact on health, substance use, treatment access, vaccination status, beliefs, and knowledge. Descriptive analyses summarized the data. Participants faced various challenges during the pandemic. Many reported increased substance use, especially alcohol, opioids, benzodiazepines, and nicotine. Mental health stability was negatively affected, exacerbating existing disorders and limiting mental healthcare access.A majority (56.1%) reported that their chronic mental health disorder was less stable during the pandemic. Twenty (30.3%) participants reported that they had been diagnosed with a new mental health disorder since the pandemic, and 28.8% reported that it was harder for them to access mental healthcare during the pandemic. Job loss, housing instability, and financial strain were prevalent. Half (n=33, 50%) received a COVID-19 vaccine dose, while 27.3% (n=18) declined vaccination due to knowledge gaps and religious beliefs. The majority (n=41, 62.1%) worried about securing basic needs such as groceries and medication, with 64.6% (n=42) expressing a desire to cope using alcohol or drugs. This study expands upon previous research by examining the effect of the COVID-19 pandemic on mental health in the context of substance use disorder treatment. Unlike previous data, which focused solely on substance use behaviors, our study delves into the impact of the pandemic on co-occurring mental health disorders. Findings underscore the need for gender-responsive and culturally appropriate SUD treatment. Vaccine hesitancy, as reflected in the study, necessitates more effective, tailored evidence-based informational campaigns. Efforts must focus on enhancing mental healthcare access, reducing stigma, and supporting individuals with co-occurring conditions amidst this evolving COVID-19 health crisis.

Disparities Associated with Decision to Undergo Oncologic Surgery: A Prospective Mixed-Methods Analysis

BackgroundUnderrepresented minority patients with surgical malignancies experience disparities in outcomes. The impact of provider-based factors, including communication, trust, and cultural competency, on outcomes is not well understood. This study examines modifiable provider-based barriers to care experienced by patients with surgical malignancies.MethodsA parallel, prospective, mixed-methods study enrolled patients with lung or gastrointestinal malignancies undergoing surgical consultation. Surveys assessed patients’ social needs and patient-physician relationship. Semi-structured interviews ascertained patient experiences and were iteratively analyzed, identifying key themes.ResultsThe cohort included 24 patients (age 62 years; 63% White and 38% Black/African American). The most common cancers were lung (n = 18, 75%) and gastroesophageal (n = 3, 13%). Survey results indicated that food insecurity (n = 5, 21%), lack of reliable transportation (n = 4, 17%), and housing instability (n = 2, 8%) were common. Lack of trust in their physician (n = 3, 13%) and their physician’s treatment recommendation (n = 3, 13%) were identified. Patients reported a lack of empathy (n = 3, 13%), lack of cultural competence (n = 3, 13%), and inadequate communication (n = 2, 8%) from physicians. Qualitative analysis identified five major themes regarding the decision to undergo surgery: communication, trust, health literacy, patient fears, and decision-making strategies. Five patients (21%) declined the recommended surgery and were more likely Black (100% vs. 21%), lower income (100% vs. 16%), and reported poor patient-physician relationship (40% vs. 5%; all p < 0.05).ConclusionsFactors associated with declining recommended cancer surgery were underrepresented minority race and poor patient-physician relationships. Interventions are needed to improve these barriers to care and racial disparities.

The Influence of Housing Status and Food Insecurity on a Behavioral HIV/STI Prevention Intervention for Black Women under Community Supervision in New York City: A Moderation Analysis.

Black women in community supervision programs (CSPs) are disproportionately affected by HIV and other sexually transmitted infections (STIs). A randomized controlled trial of a group intervention titled Empowering African-American Women on the Road to Health (E-WORTH) demonstrated effectiveness in reducing sexual risk behaviors and STI incidence among Black women in CSPs. This secondary analysis aimed to assess the moderating effects of housing status and food security on E-WORTH effectiveness in reducing sexual risk behaviors and cumulative incidence of STIs over a 12-month period which were found significant in the original trial among a sample of 351 Black women in CSPs in New York City who use drugs and/or engage in binge drinking who reported engaging in HIV risk behaviors or testing positive for HIV. We examined the moderating effects of housing stability, housing independence, and food insecurity on reducing cumulative STI incidence and number of unprotected sex acts using mixed-effects negative binomial regression and logistic regression models that controlled for age, high school education, employment status, and marital status. Findings indicate that the intervention effect was moderated by housing stability, but not housing independence or food security. Compared to the control group, E-WORTH participants who were housing insecure had 63% fewer acts of condomless sex. Our findings highlight the importance of interventions designed for women in CSPs that account for upstream determinants of health and include service linkages to basic needs provisions. Further research is needed to unpack the cumulative impacts of multiple experiences of poverty faced by this population.

Is the Risk of Alzheimer's Disease and Related Dementias Among U.S. Veterans Influenced by the Intersectionality of Housing Status, HIV/AIDS, Hepatitis C, and Psychiatric Disorders?

Homelessness and housing instability disproportionately affect U.S. veterans with psychiatric disorders, human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), hepatitis C, and Alzheimer's disease and related disorders (ADRD). We examined housing status and/or HIV/AIDS in relation to ADRD risk and evaluated hepatitis C, substance use, and mental health disorders as mediators and/or moderators of hypothesized relationships, among U.S. veterans ≥50 years of age seeking Department of Veterans Affairs (VA) healthcare services. A retrospective cohort study was conducted using linked VA Homeless Operations Management and Evaluation System and Corporate Data Warehouse databases (2017-2023) on 3 275 098 eligible veterans yielding 133 388 ADRD cases over 5 years of follow-up. Multivariable regression and causal mediation analyses were performed, controlling for demographic and clinical characteristics. Taking stably housed veterans without HIV/AIDS as referent, ADRD risk was higher among veterans with homelessness/housing instability alone (adjusted hazard ratio [aHR] = 1.67, 95% confidence interval [CI]: 1.63,1.72), lower among veterans with HIV/AIDS alone (aHR = 0.65, 95% CI: 0.58,0.73), but similar to veterans with homelessness/housing instability and HIV/AIDS (aHR = 1.01, 95% CI: 0.79,1.29). In adjusted models, hepatitis C and psychiatric disorders were positively related to homelessness/housing instability and ADRD risk, but negatively related to HIV/AIDS. Statistically significant mediation and/or moderation of hepatitis C and psychiatric disorders were observed, although <10% of total effects were explained by these characteristics, controlling for confounders. Among older veterans, ADRD diagnoses over 5 years were less among those with HIV/AIDS, but more among those with homelessness/housing instability, and these relationships were partly explained by hepatitis C and psychiatric disorders.

Factors associated with housing stability for Aboriginal families in South Australia: a prospective cohort study

Stable, affordable and safe housing is a key determinant of health and wellbeing. Evidence from an Australian population-based cohort of 344 Aboriginal mothers and children aged 5-9 years shows that tenure type, financial difficulties and women’s experience of partner violence are key drivers to housing stability. Stable housing was defined as moving house ≤ two times in the previous five years. Women had higher odds of stable housing if they had not reported partner violence in the last year (Adj. OR = 2.2, 95%CI 1.1–4.3) and reported fewer financial difficulties (Adj. OR= 2.2, 95%CI 0.9–5.4). Women in private rental had lower odds of stable housing (Adj. OR = 0.4, 95%CI 0.2–0.7) compared to women in government subsidised rental housing. Understanding factors that support housing stability is crucial to ensure the best outcomes for young Aboriginal children and families at a critical period in the life course.

‘Moving, moving, moving’: the social forces that perpetuate housing instability for women experiencing intimate partner violence

Housing scholars have demonstrated that intimate partner violence (IPV) is a key driver of housing instability. Contributing to existing housing literature that foregrounds the importance of material and psychological housing instability, our empirical research focuses on a novel programme providing supportive housing for women, the majority of whom are allocated housing to protect them from IPV. Our data includes in-depth interviews with the supportive housing tenants and practitioners, as well as administrative data. Our findings illuminate the close interrelation between material and psychological housing instability, and demonstrate how problems inherent in the private rental market interact with issues caused by perpetrators’ ongoing use of violence in ways that make it impossible for women to achieve either form of stability. The implication for housing scholars is to understand that although affordable housing is a protective measure, supportive housing models that rely on the private rental market, face profound limitations in achieving material and psychological housing stability for women who experience IPV.