Housing Security Research Articles

Abstract 4976: Examining the association between chronic inflammation, stress, and resilience factors among diverse breast cancer survivors using the NIH All of Us dataset

Abstract Breast cancer disparities exist by race and ethnicity, including disparities in age at diagnosis, quality of life, and health outcomes. These disparities may be influenced by chronic stress, exacerbated by unique challenges that extend beyond disease management, such as the effects of psychosocial stress and social determinants of health (SDOH) on chronic inflammation. Elevated C-reactive protein (CRP) levels, a marker of chronic inflammation, are implicated in worse health outcomes. Understanding how stress and SDOH interact to influence CRP and other inflammatory biomarkers is critical for addressing disparities in survivorship care. However, most studies lack adequate representation of racial and ethnic minorities; thus, factors associated with chronic inflammation among diverse breast cancer survivors remain unknown. This study aims to investigate factors associated with chronic inflammation among diverse breast cancer survivors using the NIH All of Us research dataset. Using Python, a programming language available within the NIH All of Us research program dataset, we examined CRP and additional inflammatory biomarkers and their relationships with stress, economic, social, and environmental factors. Economic and environmental factors included income, housing security, and neighborhood characteristics. Social and psychological factors included social support, the Perceived Stress Scale (PSS), and the Everyday Discrimination Scale (EDS). Multivariate analyses were conducted to evaluate associations between stress, resilience, SDOH, and inflammation, with stratification by age, BMI, and allostatic load. Preliminary findings reveal significant racial and ethnic disparities in CRP levels. Black and Hispanic breast cancer survivors exhibited the highest CRP levels. We identified 3,110 participants with breast cancer in the All of Us research program dataset. Of those, 7.2% were African American or Black, 2.2% were Asian, and 6.7% were Hispanic. We hypothesize that inflammation will be higher among racial and ethnic minorities, as well as among women with higher levels of stressors, such as low income and increased PSS and EDS scores. Furthermore, we expect inflammation to be negatively associated with resilience factors, such as increased social support and greater neighborhood safety. This study will identify factors associated with chronic inflammation among diverse breast cancer survivors and provide a deeper understanding of the biological mechanisms driving breast cancer health inequities. Citation Format: Bathsheba Aklilu, Erica Tate, Cathy Samayoa. Examining the association between chronic inflammation, stress, and resilience factors among diverse breast cancer survivors using the NIH All of Us dataset [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2025; Part 1 (Regular Abstracts); 2025 Apr 25-30; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2025;85(8_Suppl_1):Abstract nr 4976.

Ensuring Housing Security Through Farmer Apartments: A Social–Ecological System Framework Analysis of Operational Mechanisms in L Village

This study employs the social–ecological system (SES) framework to investigate the operational mechanisms of farmer apartment housing in Village L, demonstrating how such mechanisms ensure housing security for villagers in land-constrained contexts. Through a case analysis of Village L, we reveal that the effective implementation of farmer apartments relies on four interconnected elements: socio-political and economic conditions, homestead resource allocation within the resource system, institutional governance rules, and collaborative interactions among the government, village collectives, villagers, and enterprises. By integrating fragmented resources, optimizing participatory governance, and fostering multi-stakeholder cooperation, Village L has established a closed-loop operational model of “resource intensification–democratic decision-making–synergistic co-construction”. This model preserves villagers’ homestead entitlements and addresses housing demands through centralized construction, striking a balance between equity and efficiency in land-scarce areas. The findings underscore that farmer apartment housing represents a viable pathway for achieving “housing-for-all” in resource-limited areas, contingent upon institutionalizing village collectives’ self-governance capabilities and incentivizing broader societal participation (e.g., NGOs and enterprises) to form a diversified investment framework. Policy refinements should prioritize scaling context-specific governance innovations while safeguarding farmers’ land rights during urbanization transitions, offering replicable insights for regions facing similar land use challenges.

Housing Insecurity Among College Students: Associations with Interpersonal Violence Victimization.

One of the most significant economic impacts of sexual and dating violence across the lifespan is housing insecurity and homelessness. However, research on the association between housing instability and interpersonal violence among college students is limited. As such, the purpose of this study is to better understand the association between sexual and dating violence victimization and housing security among college students using data from a campus climate assessment administered on two campuses of a large, urban public university in the northeast. To reduce response burden there were rotating survey modules used so participants were assigned to either the sexual violence (n = 2,672) or dating violence (n = 1,645) module. Bivariate and multivariate logistic regression analyses were used to examine the association between sexual violence victimization or dating violence victimization since coming to college and past year housing insecurity among college students and which types of housing insecurity were associated with sexual violence victimization. Student-survivors who experienced sexual violence had 2.5 times greater odds of experiencing housing insecurity compared to students who had not experienced sexual violence since coming to the university. Similarly, students who experienced physical or psychological dating violence since entering college had four times greater odds respectively of experiencing housing insecurity compared to students who did not experience dating violence. Campus and community-based services for college students are impactful at addressing academic and safety concerns and should incorporate supportive services related to housing.

Considerations for equitable distribution of digital healthcare for people who use drugs

BackgroundTelehealth holds the potential to expand healthcare access for people who use drugs (PWUD). However, limited data exist on their digital infrastructure access, a prerequisite for telehealth participation. We studied digital healthcare accessibility among PWUD.MethodsWe employed respondent-driven sampling to recruit 162 PWUD in Athens, Greece to assess current internet and computer access and telemedicine experience via a structured questionnaire. Participants were at least 18 years with an injection drug use (IDU) history. We utilized logistic regression to evaluate sociodemographic associations.ResultsParticipants’ mean (SD) age was 45.9 (8.8) years, 84.0% were male, 90.1% Greek, 77.8% reported IDU within the past year, 85.2% were not linked to opioid treatment, and 50.0% were experiencing homelessness. Only 1.9% had telemedicine experience. Internet and computer access were reported by 66.0% and 31.5%, respectively. Most (77.9%) used mobile phones for internet access. Compared to participants with secure housing, those experiencing homelessness reported decreased internet (50.6% vs. 81.5%, p < 0.001) and computer access (11.1% vs. 51.9%, p < 0.001). Multivariable analyses revealed that older age (per 1-year increase: OR = 0.94, 95% CI [0.89, 0.99], p = 0.03)), IDU within the past year (0.29 [0.10, 0.88], p = 0.03), and homelessness (0.29, [0.13, 0.65], p = 0.003) were associated with lower odds of internet access.ConclusionsTwo-thirds of PWUD accessed the internet, mainly via mobile phones, while only one-third gained access through a computer. Very few PWUD used telemedicine. Homelessness, recent IDU, and older age may further limit digital infrastructure access and should be considered when designing equitable digital healthcare solutions for PWUD.Trial registrationRegistered on ClinicalTrials.gov (ID: NCT05794984, Protocol: STUDY00007088, Date: 2023-04-03)

Ontological security and permanent supportive housing in San Diego, California: connecting lived experience to policy

Although permanent supportive housing (PSH) improves housing stability for individuals emerging from homelessness, some residents see improvements in their mental health, while others do not. This study sought to understand how PSH characteristics can support or undermine a sense of ontological security: a sense of permanence, safety, and control within one’s material and social environments. Drawing on interviews with 30 residents residing across four PSH buildings in San Diego, California that varied in size, location, and populations served, this study discovered that, while the indefinite nature of PSH and communal spaces support ontological security, many residents find that their small and inaccessible apartments make it difficult to feel safe or in control of their lives. Furthermore, many residents expressed concerns over other residents and the perceived dangers of their surrounding neighbourhoods. This was especially true for senior residents in mixed-age buildings. Findings support policy recommendations including increasing the availability of seniors-only buildings and targeting zoning restrictions that limit building locations.

Pregnant and Homeless in the UK: A Qualitative Analysis of Maternal Experiences in Temporary Accommodation

ABSTRACTBackgroundIn the UK, families in temporary accommodation reached record numbers in 2023. Pregnant mothers experiencing homelessness are at risk of poor health outcomes, yet little is known about their experiences. Most biomedical research emphasizes obstetric outcomes rather than maternal experiences. Our study aimed to explore maternal experiences of pregnancy while living in temporary accommodation in the UK.MethodsUsing an interpretivist paradigm and critical feminist theory, we collected and analyzed semi‐structured interview narratives from pregnant and postnatal mothers experiencing homelessness. Interviews with key workers from relevant Third Sector Organisations provided complementary insights. Study planning included Patient and Public Involvement. Data were analyzed using reflexive thematic analysis.ResultsFourteen mothers and six keyworkers were interviewed. Reflexive thematic analysis generated three themes. Theme one, Pregnant/postnatal bodies in unsafe spaces, described participants' experiences with unsafe accommodations, exposure to environmental hazards, and frequent moves which affected physical and mental health. In Undermining mothers, participants explained how the constant struggle to meet basic needs eroded opportunities to engage with caring roles and destabilized their sense of being “good” mothers. Together these contributed to pregnancy disengagement and feeling unprepared for birth. The third key theme, Feeling unseen in midwifery blind spots, describes barriers to accessing maternity services, as well as interactions with midwives that often reinforced feelings of being invisible.DiscussionLiving in temporary accommodations whilst pregnant negatively impacts physical, mental, and emotional well‐being. Improving care for pregnant mothers experiencing homelessness requires systemic change within housing and maternity services to acknowledge housing security as an essential need for pregnant and parenting mothers.

Prevalence of food and housing insecurity among direct support professionals in New York.

Prevalence of food and housing insecurity among direct support professionals in New York.

Navigating Displacement: The Ukrainian Refugee Crisis in Europe

ABSTRACTRussia's full‐scale invasion of Ukraine in 2022 triggered one of the most significant displacement crises in modern European history, with over 6.3 million Ukrainians fleeing to Europe. The European Union's activation of the Temporary Protection Directive facilitated immediate access to housing, employment, and social security benefits for Ukrainian refugees, setting a stark contrast to past refugee crises. This Special Issue of Global Networks critically examines the European Union's response, the solidarity shown towards Ukrainian migrants, and the evolving nature of forced migration governance. It highlights the innovative practices in housing and support provision and the challenges faced by social workers. The issue also explores refugee experiences and the motivations behind volunteer engagement. It contributes to discussions on migration policy, resilience, and the long‐term implications of temporary protection measures for future migration governance and refugee protection in Europe.

Screening and Referral for Health-Related Social Needs and Financial Distress: Current Processes Among National Cancer Institute Community Oncology Research Program Practices.

Health-related social needs (HRSNs) are associated with adverse cancer health outcomes. We assessed the processes for screening and responding to both HRSNs and financial distress and described the methods used across National Cancer Institute Community Oncology Research Program (NCORP) practices. The NCORP 2022 Landscape Assessment survey focused on services to screen for and respond to HRSNs and financial distress within a national network of community oncology practices. We calculated the proportions of oncology practices that screened for and responded to HRSNs and financial distress, separately, and described the staff, tools, and methods used for each process. Multivariable logistic regression models estimated the associations between oncology practice characteristics and screening for HRSNs and financial distress. The majority of community oncology practices reported screening for HRSNs (79%), and of those, most inquired about transportation (96%), family and social support (93%), housing (80%), and food security (80%). Most oncology practices reported screening for financial distress (78%). Social worker evaluation was the most common method used to screen for both HRSNs (77%) and financial distress (65%). Most oncology practices reported social work referral as the method for responding to HRSNs (89%) and financial distress (96%). Oncology practice characteristics such as having a survivorship clinic and geographic region were associated with screening for HRSNs and financial distress. Research is needed to understand the impact of different HRSN screening and referral approaches on care delivery, clinic costs, care quality, and health outcomes of patients with cancer. These efforts are critical to generate evidence to inform best practices, clinical guidelines, and novel interventions aimed to improve cancer health equity.

Analysis of factors influencing attrition among clinical traditional Chinese medical major graduates: based on a discrete choice experiment

BackgroundTraditional Chinese Medicine (TCM) is essential for promoting health worldwide. Despite governmental support, TCM faces critical challenges, including workforce shortages and high attrition rates, with many clinical TCM graduates pursuing non-clinical careers. This study aims to explore the employment preferences of these graduates and to propose strategies for retaining TCM professionals, optimizing the input–output ratio of TCM education, and supporting the sustainable development of the TCM industry.MethodsA stratified sampling method was used to select clinical TCM major graduates from 16 universities of Chinese medicine. A Discrete Choice Experiment (DCE) was conducted to investigate the factors influencing the attrition of clinical TCM professionals, including monthly income, work location, housing security, workload, work environment, and promotion opportunities. A mixed logit model was applied to analyze the DCE data.ResultsA total of 273 clinical TCM major graduates were included in the primary DCE analysis. The monthly income was more important than other attributes (RAI = 48.03%). Among non-economic factors, participants expressed the strongest willingness to decrease workload, being willing to forgo 3,370.312 yuan (approximately $500.3) in monthly income to reduce heavy workloads to moderate levels. Other significant factors included work environment (RAI = 13.64%), housing security (RAI = 9.47%), and promotion opportunities (RAI = 5.33%), with work location being the least important (RAI = 3.3%). Subgroup analysis showed that rural graduates were more willing than urban graduates to forgo monthly income for promotion opportunities. Graduates from the central region of China valued work environment and housing security more than those from the eastern and western regions. Postgraduates were more likely than undergraduates to give up monthly income for housing security.ConclusionIn addition to economic factors, non-economic factors are also critical considerations for clinical TCM major graduates in their employment decisions. A combination of measures, including offering lower workloads, better work environments, housing security, and promotion opportunities, should be adopted to stabilize the employment environment for clinical TCM graduates.

Housing First for Youth Who Experience Homelessness: A Systematic Review

Housing First programs are widely used to house adults with histories of chronic homelessness. Recently, Housing First for Youth (HF4Y) emerged as a targeted response to youth homelessness and is presently cited as the ideal model; however, researchers have yet to synthesize the evidence on which this claim is made. Through a systematic review of literature, the present authors fill this gap by offering a thematic synthesis of available peer-reviewed evidence on the impacts of HF4Y on a variety of outcomes for youth who experience homelessness. Five databases were searched from inception to April 2023 and reference lists of relevant articles were hand searched for additional studies. This search finds seven studies that specifically measure outcomes associated with HF4Y enrollment. Findings indicate that HF4Y can improve housing security, but additional research is needed to develop a more robust evidence base. There is a need for longitudinal studies, randomized controlled trials, and rich qualitative studies of HF4Y.

Housing Vulnerability in Times of Crisis. Impact of the COVID-19 Pandemic on Service Needs and Implementation for Individuals Experiencing Housing Instability in Three Urban Areas of Quebec, Canada

ABSTRACT People experiencing housing instability were particularly vulnerable during the pandemic, with a limited capacity to meet their own needs and to implement public health measures mandated by public authorities. Community organizations had to adapt their social services in response. Based on qualitative research conducted in 2020 and 2021 with individuals experiencing housing instability (n = 35) and community workers (n = 20) in three urban areas of the province of Quebec, this paper analyzes not only the impact of COVID-19 on the daily lives of people experiencing housing instability, but also the ways in which community organizations have taken up the issue and reorganized their interventions. Using the Actor-network theory framework, the findings suggest that the pandemic increased housing vulnerability. COVID-19 further destabilized the primary needs of many service users, including food distribution and access to emergency shelter. While meeting these needs is essential, people also reported difficulties with social isolation and a lack of direct support from community workers. This suggests that housing security goes beyond simply having a home. Community organizations suggested solutions, including developing additional sites to support services outside of central areas.

Examining the nexus between housing conditions and health outcomes in Palestinian society: a mixed-method investigation

BackgroundPalestinian health conditions are exacerbated by high housing density, overcrowding, moisture issues, poor air circulation, poverty, limited health services, and housing insecurity, leading to chronic illnesses and mental health challenges. This study aims to explore the intricate connection between housing conditions and health outcomes, particularly focusing on the psychological, mental, and physical well-being of Palestinians.MethodsThe study employs a mixed-method approach, combining quantitative surveys and qualitative interviews. A structured questionnaire, developed based on expert discussions and previous research, assesses health indicators across the three domains. Descriptive statistics and Stepwise Multiple Regression techniques are used for data analysis. Additionally, ten structured interviews are conducted to provide qualitative insights into the detrimental impacts of housing conditions on health.ResultsThe quantitative analysis reveals significant associations between housing characteristics and health outcomes. Participants residing in smaller households, with higher family incomes, and in private homes report better health across all domains. Urban residents generally exhibit better health outcomes compared to rural or refugee camp dwellers, highlighting disparities in resource accessibility. Moreover, stability in residential environments positively correlates with overall well-being. Qualitative findings underscore the negative impact of cramped living conditions, poor building supplies, and military occupation/ conflict on mental and physical health.ConclusionThe study emphasizes the interconnectedness of socio-demographic factors with health outcomes among Palestinians. It highlights the crucial role of family dynamics, socioeconomic status, housing type, residential environment, and the political situation—particularly its impact on housing security and stress levels—in determining physical, mental, and psychological well-being. Addressing structural inequalities and promoting equitable access to resources and opportunities are essential steps towards improving health outcomes in Palestinian society. The study’s findings can inform policy development for Palestinians, addressing structural inequalities and improving healthcare, housing affordability, and socioeconomic opportunities, with future research utilizing longitudinal designs and cross-cultural comparisons.

Beyond survival: Understanding the social dimensions of prostate cancer.

28 Background: Prostate cancer carries one of the highest burdens of racial disparities in outcomes in oncology. Understanding social determinants of health (SDOH), which measure inequities in healthcare, could give us insight into quality improvement strategies. We aimed to study the impact of key SDOH measures (everyday discrimination, supportive relationships, neighborhood characteristics, and food and housing security) on the perception of overall health in prostate cancer survivors using a publicly available database. Methods: A cross-sectional study was conducted using overall health and SDOH survey data collected by the National Institutes of Health All of Us Research Program from June 2017 to June 2022. Ordinal logistic regression was utilized to assess associations between overall perception of health and each specific SDOH survey domain. All statistical tests were two-sided, and a p-value less than 0.05 was statistically significant; multiplicity adjustments were not made. The Statistical package (0.13.5) of Python (Version 3.1) was used for all statistical analyses. Results: 5,909 male participants with prostate cancer met the inclusion criteria. 2,280 (38.58%) had completed the SDOH surveys and were considered for analysis. Of those, 1,966 (86%) were White, 5.88% Black or African American, and 3.55% Hispanic in ethnicity. In the ordinal logistic regression models, for every unit increase in the SDOH neighborhood characteristics score, the odds of having a higher perception of general health increased by 3% (OR 1.03, 95% CI = [1.02, 1.04], p &lt; 0.0001). For every unit increase in the SDOH day-to-day discrimination score, the odds of having a higher perception of general health increased by 3% (OR 1.03, 95% CI = [1.02, 1.04], p &lt; 0.0001). For every unit increase in the score of the supportive relationships SDOH domain, participants were 4% (OR = 1.04, 95% CI = [1.035, 1.053]) more likely to have a higher perception of general health. Controlling for all other variables, Black race, Hispanic ethnicity, a history of mental health disorders, smokers, and age less than 65 years were independently significant for poor perception of overall health (p &lt; 0.05). Conclusions: While SDOH have been linked with prostate cancer-specific mortality, this is one of the first studies evaluating the role of each component of SDOH on the perception of overall health. We highlighted that factors including neighborhood, discrimination, and supportive relationships have a quantifiable impact on health. Our study provides objective predictive changes in the overall perception of health. Using our variables as a model to predict the effect of changes in these determinants and tailor support to individual needs could ultimately improve quality of life.

The impact of social vulnerability on perceived health in individuals with bladder cancer.

678 Background: Bladder cancer is the sixth most common malignancy in the United States. Social determinants of health (SDOH) have been increasingly recognized as drivers of disparities in cancer care. Improved understanding of the role of social vulnerabilities could better inform the cancer care delivery interventions towards equitable cancer care for bladder cancer patients. We aimed to study the impact of key SDOH measures (everyday discrimination, supportive relationships, neighborhood characteristics, and food and housing security) on the perception of overall health in bladder cancer patients using a publicly available database. Methods: A cross-sectional study was conducted using overall health and SDOH survey data collected by the National Institutes of Health All of Us Research Program from June 2017 to June 2022. Ordinal logistic regression was utilized to assess associations between overall perception of health and each specific SDOH survey domain. All statistical tests were two-sided, and a p-value less than 0.05 was statistically significant; multiplicity adjustments were not made. The Statistical package (0.13.5) of Python (Version 3.1) was used for all statistical analyses. Results: 1,796 participants with bladder cancer met the inclusion criteria. 640 (38.58%) had completed the SDOH surveys and were considered for analysis. Of the total population, there was a significant male preponderance (66.1% vs 31%). 559 (87.3%) were White, 3.4% Black or African American, and 3.6% with Hispanic ethnicity. In the ordinal logistic regression models. for every unit increase in the score of the supportive relationships SDOH domain (more supportive relationships), participants were 4% (OR = 1.04, 95% CI = [1.018, 1.053], p&lt;0.0001) more likely to have a higher perception of general health. Similarly for every unit increase in the food and housing security domain (more secure food and housing status), participants are 19% ((OR =1.19, 95%CI= [1.06,1.34], p 0.004) more likely to have a higher perception of general well-being. Controlling for all other variables, Black race, Hispanic ethnicity, smokers, and age less than 65 years were independently significant for poor perception of overall health (p &lt; 0.05). Conclusions: This is one of the first studies evaluating the role of each component of SDOH on the perception of overall health in bladder cancer patients. Our study demonstrates a clear predictive link between social determinants of health and the perceived overall health of bladder cancer patients. Specifically, stronger social support networks and secure access to food and housing were significantly associated with a more positive perception of health. These findings suggest that future directions in bladder cancer care should prioritize the development and implementation of comprehensive care models that address these social needs.

Towards a relational understanding of youth lifestyles and wellbeing in climate resilient urban development: insights from a seven-city study of young people

ABSTRACT Supporting youth wellbeing in low carbon ways is a crucial challenge in cities. Seventy percent of youth will live in urban areas by 2050 and urban sites account for 67–72% of the global share of carbon emissions. Young people’s consumption behaviour including energy use is increasingly identified as a key driver of urban emissions. This paper expands beyond dominant individualised approaches to examining urban youth wellbeing and consumption to interrogate the relational contexts in which young people live, their wellbeing aspirations, and the conditions that enable or lock-in lifestyle emissions. Applying a relational lens and thematic analysis to focus group data collected from 332 youth aged 12–24 years in seven cities of the global South and North, the paper examines experiences shaping youth wellbeing in the context of urban consumption activities. Findings emphasised the complexities of “linked lives”, foregrounding family, peer and community relationships as critical in shaping youth wellbeing and consumption. Home was highlighted as a significant relational context, where family relationships impact wellbeing and energy use, through connection, comfort, conflict and compromise. Public space was also valued, but findings highlighted issues of identity and inequality that impact access. Findings also underscored the significance of beyond-human relationships. This cross-cultural research highlights underacknowledged complexities in youth wellbeing and consumption activities. Discussion proposes ways local government can adopt relational perspectives to advance climate resilient urban development, including cultivating meaningful relationships with youth and prioritising secure housing, access to green space, and care and integration of nature within urban landscapes.

Breastfeeding Among First-Time Mothers Reporting Housing Insecurity and Food Insecurity.

Background: Despite health benefits to both infants and mothers, many are not breastfeeding as recommended by national guidelines. Prior studies examining the effects of housing insecurity and food insecurity on breastfeeding intention and duration have been limited and yielded mixed findings. Methods: To assess the relationship among housing insecurity, food insecurity, and breastfeeding, we conducted a secondary analysis of a cohort of nulliparous U.S.-born pregnant individuals with a singleton gestation of ≥28 weeks who completed web-based surveys on five occasions over their infant's first year of life. Upon enrollment, we screened participants for housing and food insecurity and participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). We examined variations in breastfeeding intentions and practice by housing insecurity and food insecurity, controlling for demographic factors, using multivariable logistic regression. Results: Of 411 participants, 67 (16%) reported housing insecurity, and 48 (12%) reported food insecurity. Participants with housing insecurity were less likely to report exclusive breastfeeding at 6 months (17.9% versus 29.1%, p = 0.06) and significantly less likely to report any breastfeeding at 12 months (34.3% versus 56.9%, p = 0.003) compared to those with secure housing. In both bivariate and multivariable models, housing insecurity was significantly associated with cessation of breastfeeding before 12 months. Food insecurity was not significantly associated with breastfeeding duration or exclusivity. Conclusions: Housing insecurity is associated with and may adversely impact infant feeding, highlighting the need for screening and accessible and affordable family housing, with further investment in food assistance programs such as WIC.

To cool or not to cool: understanding and improving cooling centre use in metro vancouver through community-based participatory action research

Abstract Extreme heat events present significant health risks, particularly for populations facing systemic marginalization. Through interviews and focus groups with 63 (n=60 residents; n=3 service providers) participants, this paper explores the barriers and opportunities related to access and use of cooling centres from both user and provider perspectives, as well as broader implications for addressing vulnerability to extreme heat in the metro Vancouver region of British Columbia, Canada. Initially focused on cooling centres, our research expanded to include the complexities of individual and systemic responses to heat, highlighting the complex interplay between personal preferences and structural barriers. Key barriers to cooling centre usage reported by participants included concerns over safety, hygiene, stigma, lack of information, and infrastructural challenges such as transportation. Service providers faced constraints with staffing, limited hours, and underutilization of additional services. Tensions emerged between individual, do-it-yourself (DIY) approaches and collective solutions, with participants seeking agency in their choices while acknowledging the need for improved, community-based interventions. The study also uncovered the unintended effects of inclusivity, as the presence of individuals who use substances or are unhoused in cooling spaces deterred some potential users, underscoring the challenges of designing universally accessible services. Broader systemic issues, such as housing security and the quality of indoor environments, further intersected with vulnerability to extreme heat, exacerbating risks for those opting to stay at home. The paper recommends leveraging existing public spaces, enhancing social networks, improving tenant protections, and fostering ‘right to cool’ initiatives to balance immediate relief with long-term systemic reform, particularly around the rental housing crisis and tenant insecurity. By addressing both individual and collective needs, this approach can mitigate the health impacts of extreme heat while promoting greater equity and resilience.

What About the Kids? Identifying Children in the Housing Support System in Aotearoa, New Zealand

ABSTRACTIn Aotearoa New Zealand (henceforth referred to as Aotearoa) a range of housing supports are aimed at improving homeownership rates and making both private rental and public housing more available. Despite these “supports”, a large number of children, adolescents and young people are experiencing housing insecurity or severe housing deprivation. Housing intersects with health, education, state care and welfare to influence a range of outcomes for children, therefore this paper addresses the critical issue of access to housing supports for children and adolescents. Through Official Information Act requests and a review of existing housing sector data, we found 323,257 children within the housing support system in Aotearoa New Zealand, with Māori (Indigenous People of Aotearoa) children disproportionately represented. We describe how children are largely unaccounted for in housing support system data, and this invisibility therefore challenges the understanding of the extent, inequities, and impact of the housing sector on children. We argue the urgent need for transformative policies centred on children, embedded in Te Tiriti o Waitangi (the Treaty of Waitangi), to ensure all children have access to stable, healthy, and secure housing for a brighter future.

Social Risks and Nonadherence to Recommended Cancer Screening Among US Adults

Research indicates that social drivers of health are associated with cancer screening adherence, although the exact magnitude of these associations remains unclear. To investigate the associations between individual-level social risks and nonadherence to guideline-recommended cancer screenings. This cross-sectional study used 2022 Behavioral Risk Factor Surveillance System data from 39 US states and Washington, DC. Analyses for each specific cancer screening subsample were limited to screening-eligible participants according to the latest US Preventive Services Task Force (USPSTF) guidelines. Data were analyzed from February 22 to June 5, 2024. Ten social risk items, including life satisfaction, social and emotional support, social isolation, employment stability, food security (2 questions), housing security, utility security, transportation access, and mental well-being. Up-to-date status (adherence) was assessed using USPSTF definitions. Adjusted risk ratios (ARRs) and 95% CIs were estimated using modified Poisson regression with robust variance estimator. A total of 147 922 individuals, representing a weighted sample of 78 784 149 US adults, were included in the analysis (65.8% women; mean [SD] age, 56.1 [13.3] years). The subsamples included 119 113 individuals eligible for colorectal cancer screening (CRCS), 7398 eligible for lung cancer screening (LCS), 56 585 eligible for cervical cancer screening (CCS), and 54 506 eligible for breast cancer screening (BCS). Findings revealed slight differences in effect size magnitude and in some cases direction; therefore results were stratified by sex, although precision was reduced for LCS. For the social contextual variables, life dissatisfaction was associated with nonadherence for CCS (ARR, 1.08; 95% CI, 1.01-1.16) and BCS (ARR, 1.22; 95% CI, 1.15-1.29). Lack of support was associated with nonadherence in CRCS in men and women and BCS, as was feeling isolated in CRCS in women and BCS. An association with feeling mentally distressed was seen in BCS. Under economic stability, food insecurity was associated with increased risk of nonadherence in CRCS in both men and women, CCS, and BCS; the direction of effect sizes for LCS were the same, but were not statistically significant. Under built environment, transportation insecurity was associated with nonadherence in CRCS in women and BCS, and cost barriers to health care access were associated with increased risk of nonadherence in CRCS for both men and women, LCS in women, and BCS, with the greatest risk and with reduced precision seen in LCS in women (ARR, 1.54; 95% CI, 1.01-2.33). In this cross-sectional study of adults eligible for cancer screening, findings revealed notable variations in screening patterns by both screening type and sex. Given that these risks may not always align with patient-centered social needs, further research focusing on specific target populations is essential before effective interventions can be implemented.