Haunted houses: Using photovoice to understand emotional geographies in single room occupancy housing.

For nearly 20 years, the ‘Housing Subsidy 690’ programme has provided economic aid to those experiencing homelessness in the city of Buenos Aires. In practice, it bridges two precarious housing situations: living on the street and living in the city’s single-room occupancy (SRO) hotels. Although it was initially created as a housing programme that was intended to address the shortcomings of previous policies towards homelessness and solve a complex issue, nearly 20 years after its creation a certain inertia around the policy can be perceived, as well as fractures in its functioning. Drawing on interviews with beneficiaries and professionals involved in the administration of the subsidy, as well as a review of secondary data, this article describes the functioning of the programme and suggests that it constitutes a form of policy inertia that contributes to perpetuating housing instability and homelessness. We argue that receiving the subsidy does not resolve housing vulnerability, as it contributes to an intermittent cycle between these unstable housing conditions, thereby reproducing this vulnerability.

Abstract Single-room occupancy hotels (SROs) in San Francisco’s Tenderloin provide crucial affordable housing for low-income, formerly unhoused, and marginalized populations. As residents age, these buildings are transforming into naturally occurring retirement communities, posing complex challenges for aging in place. Despite their important role, SROs frequently have neglected maintenance, deteriorating conditions, and safety concerns, and are often located in neighborhoods with higher rates of noise, crime, and substance use. While research has explored characteristics of older SRO residents, their experiences of aging in place remain understudied. This qualitative project used participatory methods to amplify the contributions of SRO residents. We formed an Advisory Council of SRO residents with lived expertise and established a partnership with two community stakeholders: a nonprofit specializing in home adaptations and a senior center. Through human-centered design activities and culturally responsive bilingual facilitation, the Advisory Council examined intersecting impacts of ageism and racism across socioecological levels, leading to a co-created action plan for future collaborative projects. Our subsequent photovoice study engaged twelve diverse participants in documenting their environments with cameras, producing rich visual and narrative data that highlighted the multifaceted social, spatial, cultural, and temporal dynamics of daily life in and around SROs. This approach revealed both resistance and vulnerabilities among residents while assessing systems of oppression from internalized to structural levels. By prioritizing the perspectives of marginalized older adults, this project fostered community empowerment and enhanced capacity for civic engagement. Findings offer insights for co-developing resident-centered approaches to support aging in place within these vital housing communities.

Street sweeps, involving the state-enforced removal of makeshift residences and confiscation of personal belongings from people in public spaces, are a common tool employed by urban governments to address public health and safety concerns. Amidst the ongoing housing and toxic drug poisoning crises in Vancouver, Canada, we sought to characterize experiences of confiscation of personal belongings by city workers among unstably-housed people who use drugs people who use drugs. Cohort study. We used multivariable generalized estimating equations models to longitudinal data derived from unstably-housed people who use drugs (including those reporting homelessness and living in single room occupancy hotels) participating in three harmonized cohort studies of community-recruited people who use drugs in Vancouver in 2021-2023. In total, 13.6% of 691 eligible participants (and 23.6% of 233 reporting homelessness) reported municipal government-enforced belonging confiscation in the past six months at least once. In multivariable analyses, violent victimization (adjusted odds ratio [AOR]=2.14; 95% confidence interval [CI]: 1.27, 3.60) and inability to access health/social services (AOR=2.19, 95% CI: 1.32, 3.65) were significantly and positively associated with belonging confiscation, and so was non-fatal overdose (AOR=1.94, 95% CI: 1.01, 3.74) among those reporting homelessness. Findings underscore that confiscation of belongings was relatively widespread among our cohort of people who use drugs and concentrated among individuals who are structurally marginalized, emphasizing the need to end street sweeps and prioritize development of dignified housing and harm reduction policies involving affected communities in decision-making.

"It's something we're connected to": Acceptability and adoption of overdose detection technologies implemented in San Francisco permanent supportive housing.

Reimagining subjectivities in place: Necropolitical logics of safer supply and housing in Vancouver's Downtown Eastside.

Homelessness adversely impacts continuity of care for people with HIV (PWH). The POP-UP program is a low-barrier drop-in care model embedded within an HIV clinic in San Francisco and is designed to serve PWH experiencing homelessness. We conducted a pilot study of mobile outreach for PWH in POP-UP who remain out-of-care despite the drop-in program. We conducted a mixed-methods study to evaluate the effectiveness of mobile outreach through a retrospective cohort of PWH eligible for this outreach and semistructured interviews. Patients with POP-UP were eligible for outreach if they had (1) HIV viral load ≥200 copies/mL and no visit in ≥30 days, (2) no clinic visit in ≥180 days, or (3) urgent re-engagement need identified by the clinic team. We report the proportion of patients re-engaging in clinic-based care within 30 days and thematic findings from semistructured interviews with patients who experienced mobile outreach. Of 74 patients eligible for outreach, 55 were outreached, 48 located, and 30 returned to clinic within 30 days. Most were currently housed in a single-room occupancy hotel (39%) or permanent supportive housing (25%), 87% had a substance use disorder, and 51% had a mental health diagnosis. Qualitative findings highlighted the value of mobile outreach in terms of interpersonal relationships with the clinical team and the perception that outreach was a helpful nudge to return to clinic. Among PWH with housing instability who are out-of-care despite access to drop-in clinic-based services, mobile outreach was acceptable and promising for locating patients and facilitating care re-engagement.

Residents of single room occupancy units (SROs) in San Diego, California, USA who were formerly homeless employed Photovoice (Wang & Burris, 1997) to describe how they feel about their current living situations and were then interviewed about this experience as well as the significance of the images they captured. A visual critical ethnographic approach (Bloomberg & Volpe, 2016; Peattie, 2022) was used to analyze interview transcripts from 14 participants. Interviews revealed three primary themes related to the images themselves: Photovoice allowed participants to produce liberatory insights about their housing and themselves; visually documenting aspects of their living spaces enabled participants to critically analyze housing management systems; and engaging in photography allowed participants to reflect on pivotal moments in their life journeys. Interviews additionally revealed three themes related to engagement with Photovoice: Photovoice empowered participants to create emancipatory narratives; inspired civic engagement; and provided a therapeutic means of communication. This study lends credence to Photovoice as a tool of empowerment and offers valuable information for providers and policymakers in their quest to design more supportive and affirming assistance for individuals re-entering housing through SROs.

Association between homelessness and PrEP uptake among men who have sex with men: Results from the American Men's Internet Survey, 2017-2021.

BackgroundPeople experiencing homelessness (PEH) are disproportionately affected by infectious diseases compared to people who are housed (non-PEH). In the western U.S., 9–25% of invasive pneumococcal disease (IPD) and group A Streptococcus (IGAS) cases are among PEH; disparities in IPD and IGAS by housing status are not well-documented in other regions.MethodsHospitalized IPD and IGAS cases among residents of 3 metro Atlanta counties (Fulton, DeKalb, & Cobb) ≥18 years occurring during 2010–2022 and their housing status at diagnosis were ascertained from the CDC-funded Georgia Emerging Infections Program. Recurrent cases ≤12 months apart were excluded. During 2010–2018, homelessness was defined by medical record documentation or residence in a shelter, mission, or medical respite. In 2019, the definition expanded to "unstable housing," which included transitional and single-room occupancy housing. Person-level case characteristics by housing status were calculated. Annual age-adjusted incidence per 100,000 population by housing status and incidence rate ratios with 95% confidence intervals were estimated using Poisson regression. Point-in-Time counts (PEH) and 2020 US Census data (non-PEH) were used as population denominators.ResultsDuring 2010–2022, 2,202 IPD cases in 2,119 people and 989 IGAS cases in 981 people were identified. Among people with IPD and IGAS, 88 (4%) and 55 (6%) were PEH, respectively (Tables 1–2). IPD and IGAS incidence rates were higher among PEH than non-PEH (Table 3). Among PEH with IPD, 65 (74%) were men and 81 (92%) were < 65 years (vs. 1019 [50%] and 1320 [65%] in non-PEH). Among PEH with IGAS, 40 (73%) were men and 52 (95%) were < 65 years (vs. 473 [51%] and 658 [71%] in non-PEH). PEH with IPD or IGAS were more likely to lack insurance. Both IPD and IGAS incidence among PEH increased before and after the homeless definition change; among non-PEH, incidence decreased (IPD) or was stable (IGAS) (Fig 1).ConclusionThe rate of IPD and GAS cases was higher among PEH than non-PEH and increased during 2010–2022. IPD and IGAS cases among PEH occurred more frequently in men and people < 65 years compared to non-PEH. Disparities in IPD and IGAS incidence by housing status exist within metro Atlanta and may be increasing. PEH should be prioritized in IPD and IGAS prevention efforts.DisclosuresAll Authors: No reported disclosures

Single room isolation with contact precautions is widely regarded as a fundamental strategy to prevent the transmission of multidrug-resistant organisms (MDROs). However, its implementation demands substantial resources, limiting its universal application to all MDROs. In this study, we assessed the effect of discontinuing single room isolation for vancomycin-resistant Enterococcus (VRE). This is a retrospective, observational study conducted at a single 750-bed tertiary center. We conducted an interrupted time series analysis to compare incidence rates and trends of new-onset VRE colonization and bacteremia during the one year before and after the strategy change on January 1, 2023. Single-room occupancy decreased from 79.7% pre-intervention to 23.6% post-intervention (P < 0.001). The incidence rate of new-onset VRE colonization was 0.452 and 0.535 per 1,000 patient-days in the pre- and post-intervention periods, respectively, with no statistically significant difference (P = 0.202). However, there was a slightly increasing trend (0.036 [95% confidence interval, -0.002, 0.074] increase per month, P = 0.066). The new-onset VRE bacteremia incidence rate was not differed in incidence (0.060 and 0.055, P = 0.571) or trend (P = 0.720). Our study suggests that discontinuing single-room isolation for VRE patients may not affect the incidence of new-onset VRE bacteremia, but caution is needed due to the potential increase in colonization.

BackgroundBurn injuries are a significant public health concern, closely linked to housing conditions and socioeconomic status. Residents in socioeconomically deprived neighbourhoods are at increased risk of exposure to hazards due to older and poorer housing conditions and limited access to fire protection measures. Individual behaviours such as substance use, smoking, and hoarding are often highlighted as primary causes of residential fires, overshadowing the broader socioeconomic and structural factors that also play a significant role in housing safety. This paper explores the correlation between inadequate housing conditions and heightened fire risks leading to burn injuries, focusing on the contextual factors shaping everyday urban fire risks, experiences, and responses of residents living in Single-Room Occupancy (SRO) housing in Vancouver’s Downtown East Side (DTES) and staff working in the fire, health, housing (social and private), and non-profit sectors.MethodsAs part of an ongoing ethnographic study, we partnered with the Vancouver Fire Rescue Services (VFRS) to conduct participant observations in private, non-profit, and government-owned SROs, modular homes, and a temporary shelter. This paper synthesizes insights from participant observations from the first author’s self-reflexive journals, including informal conversations with approximately fifty-nine individuals such as SRO tenants, SRO managers/caretakers, health workers, burn survivors, municipal staff, not-for-profit staff, and firefighters.ResultsUrgent housing-related issues contributing to inequitable everyday urban fire risks were identified, such as structural deficiencies in SRO buildings and systems, inadequate waste management and storage, and inequitable approaches to addressing hoarding. Additionally, disparities in access to information and the interaction between interpersonal and structural stigmas were significant factors, underscoring the pressing need for intervention.ConclusionCommunities like DTES, facing precarious housing conditions, disadvantaged neighbourhoods, and complex health and social challenges, necessitate a comprehensive and holistic approach to fire prevention and safety. Recognizing the interplay between housing instability, mental and physical health issues, unregulated toxic drug supply, drug criminalization, and structural inequities allows practitioners from various sectors to develop contextually driven fire prevention strategies. This multifaceted approach transcends individual-level behaviour change and is crucial for addressing the complex issues contributing to fire risks in underserved communities.

The implementation of isolation precautions for patients with suspected Coronavirus Disease 2019 (COVID-19) and pending test results is resource intensive. Due to the limited availability of single-bed rooms at our institution, we isolated patients with suspected COVID-19 together with patients without suspected COVID-19 on-site in multiple-bed rooms until SARS-CoV-2-test results were available. We evaluated the likelihood of SARS-CoV-2 transmission to individuals sharing the room with patients isolated on-site. This observational study was performed at the University Hospital Basel, Switzerland, from 03/20 − 11/20. Secondary attack rates were compared between patients hospitalized in multiple-bed rooms and exposed to individuals subjected to on-site isolation precautions (on-site isolation group), and patients exposed to individuals initially not identified as having COVID-19, and not placed under isolation precautions until the diagnosis was suspected (control group). Transmission events were confirmed by whole-genome sequencing. Among 1,218 patients with suspected COVID-19, 67 (5.5%) tested positive for SARS-CoV-2. Of these, 21 were isolated on-site potentially exposing 27 patients sharing the same room. Median contact time was 12 h (interquartile range 7–18 h). SARS-CoV-2 transmission was identified in none of the patients in the on-site isolation group vs. 10/63 (15.9%) in the control group (p = 0.03). Isolation on-site of suspected COVID-19-patients in multiple-bed rooms avoided single-room occupancy and subsequent in-hospital relocation for many patients without confirmed SARS-CoV-2-infection. The absence of secondary transmission among the exposed patients in the on-site isolation group allows for assessment of the risk/benefit ratio of this strategy given the limitation of a small sample size.

Individuals with a substance use disorder (SUD) often face barriers to accessing health care, resulting in unmet needs and delayed care. Hospital-based services have the potential to engage individuals with a SUD in ongoing treatment, but there is limited literature characterising this population. The Outcomes for Patients Accessing Addiction Care study was a prospective hospital-based cohort study conducted at St. Paul's Hospital in Vancouver, Canada. Participants were recruited from January 2018 to March 2020. Data were collected through an interviewer-administered questionnaire, including socio-demographic information, substance use history and mental health screening. The cohort included 536 participants, with 31% aged 30-39 years, 63% identifying as White and 74% reporting male sex at birth. Nearly half of the participants were either homeless or living in single room occupancy. Use of substances more than once per week was reported for tobacco/nicotine (86%), marijuana (43%), non-medical use of prescription drugs (29%), illicit stimulants (52%) and illicit opioids (61%). This preliminary report provides a description of a hospital-based cohort of individuals with a SUD accessing addiction care. The findings highlight demographic characteristics, mental health issues, substance use patterns and barriers to accessing services. Understanding these factors can inform the development of patient-centred interventions and improve engagement and retention in addiction care. Further research is needed to explore interventions and program effectiveness in this population.

Using drugs alone in single room occupancy housing: Understanding environmental drivers of overdose risk

Exploring COVID-19 vaccine uptake and hesitancy among vulnerable populations in inner city Vancouver, Canada: Insights into characteristics and clinical outcomes

With the expanding rental sector and rising housing expenses, this research aims to compare the socio-demographic, economic, and housing statuses of renters burdened by housing costs in four regions, and also to explore predictors affecting their residential assessment. Using data from the 2020 Korean Housing Survey, this cross-sectional study identified 245 cost-burdened households whose housing expenses accounted for more than 25% of their total gross income and living expenses. The results revealed that the majority of renters were single-person households residing in single-room occupancy units of multifamily housing, primarily comprising unemployed older adults aged 50 and over. While earning less than half of the minimum wage, the renters’ living expenses fell well below the minimum cost of living, and more than 40% of the expenditure was spent on housing costs, resulting in cost-overburdened households. With the correlation between income, deposit, and rent, the burden of housing costs and the quality of the residential environment varied among regions. Indeed, the residential assessment of the renters was significantly influenced by urban amenities, and both income deficits and excessive housing cost burdens required inclusive and prompt housing interventions including housing assistance, provision of affordable public housing, income transfer, and transitions from renting to Chonsei arrangements.

This article works with a definition of care that encompasses expansive models of kinship and collective and communal life. Specifically, it explores representations of such interdependencies in the liminal space of the single‐room occupancy hotel (SRO) through the literary and artistic creations of two understudied African American artists. Fiction writer Robert Deane Pharr and visual artist Frederick Weston created their work in SROs in New York City beginning in the 1960s, during a time of massive transformation of the city's built environment in the name of urban renewal. Their novels and artwork, respectively, provide some of the only uncovered (to date) literary and cultural representations of New York City's SROs. Pharr's and Weston's works memorialize rituals of survival that center care and interdependencies over and against competitive individualism and a climate of uncare. Further, both explicitly articulate this vision by working with conceptual and material waste. Trash is their literal and metaphoric medium. These artists relied upon what is seen as surplus value by the city. But as Pharr and Weston use it, trash offers a critique of negative assumptions about the lives of SRO residents. The pandemic has shocked us into awareness of our inescapable interdependencies. Therefore, it behooves us to revisit these understudied, early proponents of care—an ethics that today's mutual aid and other liberation movements often center. Pharr's and Weston's documentation and interpretation of care offer us ways to survive within our current environments in crisis without repeating the death‐making logic and history of urban renewal.

Objective:Precariously housed individuals are exposed to multiple adverse factors negatively impacting neurocognitive functioning. Additionally, this population is subjected to poor life outcomes, such as impaired psychosocial functioning. Neurocognitive functioning plays an important role in psychosocial functioning and may be especially critical for precariously housed individuals who face numerous barriers in their daily lives. However, few studies have explicitly examined the cognitive determinants of functional outcomes in this population. Cognitive intraindividual variability (IIV) involves the study of within-person differences in neurocognitive functioning and has been used as marker of frontal system pathology. Increased IIV has been associated with worse cognitive performance, cognitive decline, and poorer everyday functioning. Hence, IIV may add to the predictive utility of commonly used neuropsychological measures and may serve as an emergent predictor of poor outcomes in at-risk populations. The objective of the current study was to examine IIV as a unique index of the neurocognitive contributions to functional outcomes within a large sample of precariously housed individuals. It was hypothesized that greater IIV would be associated with poorer current (i.e., baseline) and long-term (i.e., up to 12 years) psychosocial functioning.Participants and Methods:Four hundred and thirty-seven adults were recruited from single-room occupancy hotels located in the Downtown Eastside of Vancouver, Canada (Mage = 44 years, 78% male) between November 2008 and November 2021. Baseline neurocognitive functioning was assessed at study enrolment. Scores from the Social and Occupational Functioning Assessment Scale (SOFAS), the Role Functioning Scale (RFS), the physical component score (PCS) and the mental component score (MCS) of the 36-Item Short Form Survey Instrument were obtained at participants’ baseline assessments and at their last available follow-up assessment to represent baseline and long-term psychosocial functioning, respectively. Using an established formula, an index of IIV was derived using a battery of standardized tests that broadly assessed verbal learning and memory, sustained attention, mental flexibility, and cognitive control. A series of multiple linear regressions were conducted to predict baseline and long-term social and role functioning (average across SOFAS and RFS scores), and PCS and MCS scores from IIV. In each of the models, we also included common predictors of functioning, including a global cognitive composite score, age, and years of education.Results:The IIV index and the global composite score did not explain a significant proportion of the variance in baseline and long-term social and role functioning (p &gt; .05). However, IIV was a significant predictor of baseline (B = -3.84, p = .021) and long-term (B = -3.58, p = .037) PCS scores, but not MCS scores (p &gt; .05). The global composite score did not predict baseline or long-term PCS scores.Conclusions:IIV significantly predicted baseline and long-term physical functioning, but not mental functioning or social and role functioning, suggesting that IIV may be a sensitive marker for limitations in everyday functioning due to physical health problems in precariously housed individuals. Critically, the present study is the first to show that IIV may be a useful index for predicting poor long-term health-related outcomes in this population compared to traditional neuropsychological measures.

Objective:In persons with severe psychiatric disorders, distinct neurocognitive profiles hold differential associations to positive, negative and disorganized symptom dimensions of psychosis. These patterns portend specific functional outcomes, treatment efficacy, and prognoses. Similar associations have not been established in multimorbid samples in which persons present with a complex array of psychiatric symptoms. The objective of this study was to (1) establish neurocognitive profiles in a multimorbid, marginalized sample and (2) investigate their pattern(s) of association with psychiatric symptom dimensions and psychosocial outcomes.Participants and Methods:Participants (n=370; Mage = 45 years; 74% male) were precariously housed, substance-using adults with multimorbidity, recruited from Single-Room Occupancy hotels and a community court within the Downtown Eastside of Vancouver, BC, Canada. Data were collected as part of a longitudinal examination consisting of annual, bi-annual, and monthly neurocognitive, psychosocial, and psychiatric assessments. Neurocognitive scores were combined into five cognitive domains (Attentional Control [AC]; Processing Speed [PS]; Fluid Reasoning [Problem Solving and Reversal Learning; Gf]; Encoding and Retrieval [ER]; and Decision Making [DM]) and submitted to a latent profile analysis. The resulting profiles capturing neurocognition were validated on sociodemographic and clinical variables. Finally, the profiles were compared across previously validated, population-distinct factors derived from the Positive and Negative Syndrome Scale (PANSS), as well as on measures of psychosocial functioning.Results:An optimal goodness-of-fit was reached for a three-profile model (BLRT=127.86, p=.01). Profile 1 (n=207, 55.9%) showed stronger neurocognition (all p&lt;.05), with a within-profile strength in Gf (p&lt;.001). With the exception of ER, Profile 2 (n=109, 29.5%) exhibited inferior neurocognition across all indicators compared to Profile 1 (all p &lt;.05); yet showed a relative, within-profile strength in Gf (p &lt; .01). Profile 3 (n=54, 14.6%) generally displayed comparable impairments to Profile 2. Additionally, their performance on Gf was remarkably low compared to Profiles 1 and 2 (p&lt;.001). Psychiatrically, compared to Profile 1, Profile 2 exhibited more positive/disorganized symptoms and general psychopathology, as well as higher total PANSS (all p &lt;.05), whereas Profile 3 showed the poorest insight/awareness (p&lt;.01). Profiles 2 and 3 had lower levels of adaptive functioning and work productivity compared to Profile 1 (all p&lt;.01).Conclusions:Three neurocognitive profiles were detected in a sample of precariously housed adults with multimorbidity: one profile of comparatively higher neurocognitive capacity, with less symptoms of psychosis and better psychosocial functioning; a second profile of comparatively poorer neurocognition and psychosocial functioning, with more symptoms of psychosis; and a third profile with a severe deficit in fluid reasoning and poor insight and awareness. Given their poor insight, the third profile may be comprised of particularly vulnerable persons at greater risk of unmet healthcare needs. Interventions to improve these individuals' understanding of their personal health risks might facilitate their capacity to access services. Conversely, individuals from Profile 2 may benefit from outreach programs focusing on medication access and adherence to address their symptoms of psychosis. In sum, our findings suggest that the confluence of neurocognition and psychiatric symptoms may implicate unique treatment approaches and outcomes in precariously-housed persons with multimorbid conditions.