Socioeconomic Difficulty Research Articles

Flexible work: Does it really mean more autonomy? Time poverty in flexible time-space working arrangements

This research explores various dimensions of time poverty within flexible time-space working arrangements and enriches the concept through the application of power-chronography. By using qualitative research methods, such as semi-structured interviews, the study explores the multifaceted nature of time poverty and examines how it is experienced and produced in the everyday lives of individuals with flexible working arrangements in the Czech Republic. The paper sheds light on uneven temporalities and reveals how time poverty relates to temporal acceleration and technological changes in communication. Specifically, time poverty is observed as it relates to constant availability pressures, the need to recalibrate with the dominant socioeconomic rhythm and difficulty planning due to general temporal unpredictability. The reproduction of time poverty is further done via the internalization of sociocultural norms and self-discipline as regards work, temporality and the digital environment. The constant juggling of multiple responsibilities and the pressure to be available for work obligations often spill over into personal relationships, leading to a blurring of boundaries between work and leisure. Consequently, time poverty can be redistributed in relational practices, which means that time poverty becomes a shared experience, impacting not only individuals but also their social networks – family, friends, colleagues. Flexible time-space working arrangements, thus, rather than providing greater autonomy over one's time-space, may reinforce the expectation of constant work availability, consequently time poverty. Finally, the study argues that these aspects – acceleration, constant availability, temporal unpredictability and sociocultural norm internationalization – should be understood as broader aspects of sociocultural and material-discursive practices rather than solely individual responsibilities.

Current Prospects in Rheumatoid Arthritis: Pathophysiology, Genetics, and Treatments.

An autoimmune inflammatory disease, rheumatoid arthritis (RA), predominantly affects the synovium joint lining, augmenting disability, early mortality, and socioeconomic difficulty. Therefore, current updates on pharmacological therapies are crucial for developing drugs to treat the disease at each stage. This review attempts to compile a thorough analysis of current developments in our knowledge of RA pathogenesis and disease-modifying drugs, with the aim of providing insights for next-generation RA therapeutics. According to the literature, the most successful drugs for treatment techniques described so far in this include (cs) DMARDs (sub-class of DMARDs), tsDMARDS (targeted synthetic DMARDS), and bDMARDs (biological DMARDs). However, current pharmacologic therapy (consisting of biological, conventional, and creative views of small molecule anti-rheumatic drugs that treat the disease or DMARD) remains the cornerstone of rheumatoid arthritis treatment with which significant progress toward disease remission has been accomplished. The pathobiology of RA involves cytokine messengers such as B and T-cells, and an intricate interplay of pro-inflammatory cytokines responsible for activating and developing effector cells, in turn, accountable for local disease and systemic symptoms. Despite the fact that the cause of rheumatoid arthritis is not known, new treatments have been created as a result of better approaches towards the biology of the disease. As they target molecules directly implicated in the genesis of rheumatoid arthritis, these drugs may be more effective, targeted, and less harmful in the short and long term than standard therapies.

The socioeconomic context of stigma: examining the relationship between economic conditions and attitudes towards people with mental illness across European countries.

Efforts to reduce the stigma associated with mental illness have intensified over the past 30 years with a particular focus on improving public attitudes. Difficult economic circumstances can be harmful to intergroup relations, but little is known about whether there is a relationship between socioeconomic conditions and attitudes towards people with mental illnesses. Random effects logistic regression modelling was employed to explore the relationship between individual financial circumstances, contextual socioeconomic factors and difficulty speaking to a person with a significant mental illness across European countries. Lower GDP per capita and higher income inequality at the country level, alongside individual financial difficulties, were each associated with a greater likelihood of reporting difficulty speaking to a person with a significant mental illness. Micro and macro-economic factors are associated with public attitudes towards people with mental illness across Europe. With prolonged economic instability predicted over the coming years in Europe it is important that these findings are taken into consideration when designing mental health and social policies, in order to safeguard the progress that has been made in reducing mental health stigma to date.

Eat or heat: fuel poverty and childhood respiratory health

When people cannot afford to adequately heat their home, they are experiencing fuel poverty. The drivers of fuel poverty are socioeconomic: low household income, high fuel prices, and energy-inefficient homes. Fuel poverty hits households with children hardest, unsurprisingly, as this demographic is especially susceptible to socioeconomic difficulty. In 2019, 3·2 million households (13·4%) in England were fuel-poor; 40·3% of these included children. Lone-parent families have the highest rates (28% in 2019). When living costs are not met by income or benefits, the choice between necessities (“eat or heat”) is stark. Adequately sized accommodation, with sufficient bedrooms, is expensive and in high demand. It is a vicious cycle: the cheapest accommodation is poor quality and energy-inefficient, so families struggling the most get the least value for money on energy. This winter brought a perfect storm, just as families are spending further periods of enforced time at home. Extreme weather has been frequent and severe, bringing colder homes and property damage. Home energy costs soared, reflecting increased global gas prices. To protect energy suppliers from folding, the UK Government raised the Energy Price Cap (a national regulatory price limit). This financial hit to families is on the backdrop of economic recession, high inflation, and austerity. Temporary increases in Universal Credit, instigated during the pandemic, are being rescinded, rendering households £1040 poorer per year. Children in cold houses are at increased risk of asthma attacks, and respiratory infections including bronchiolitis, in a year of disrupted viral epidemiology. As the temperature drops, circulation of viruses increases (particularly in overcrowded homes), and immunity is impaired. Furthermore, to keep heat in, windows and doors stay closed, and subsequent poor ventilation causes damp, mould, and proliferation of house dust mites, contributing to chronic and acute respiratory ill health. Infants in the coldest houses expend calories trying not to be hypothermic and hypoglycaemic, rather than using energy for growth and organ development. Lung maturation takes a hit at a vulnerable stage, with risks of lifelong pulmonary function deficit. The solution must be systemic. Current government schemes, including a £140 rebate from the Warm Home Discount Scheme and cold weather payments of £25 for each 7-day period below 0°C, are insufficient. Housing agencies, councils, landlords, and health services must work to help families with children. The ultimate aim must be to end child poverty by reducing living costs, and ensuring families have sufficient income and housing rights; in the meantime, Universal Credit cuts must be halted. Health-care services, from bedside to boardroom, must also address socioeconomic causes of illness. Health professionals must be educated, informed by meaningful research around respiratory impacts of cold housing. Consultations should reflect that substandard accommodation is a modifiable factor in child mortality. In the UK, the harms of fuel poverty to children remain unaddressed, because children are not considered a priority. Climate-emergency activists this year glued themselves to motorways to advocate for home insulation for environmental reasons—we have never fought this vociferously for warmer houses for children. Poverty kills children, and the substandard, cold housing in which they live is one reason for this. We declare no competing interests. CB and ARL contributed equally and share first authorship. DBH and IPS are joint senior authors.

Adverse Childhood Experiences: Are They Associated With Greater Risk of Elder Abuse Victimization?

Though a growing number of studies have examined the associations between adverse childhood experiences (ACEs) and negative later-life health outcomes, the effects of these early life-course factors on elder abuse victimization have yet to be fully investigated. Using a life-course perspective, this study examines the associations between ACEs and elder abuse victimization. We used data from a cross-sectional survey conducted in Beijing, China. A total of 1,002 older adults were included in this study. Retrospective self-report items were used to measure ACEs and elder abuse victimization in later life. Univariate and multivariate logistic regressions were performed to examine the associations between ACEs and elder abuse victimization. Five types of ACEs (i.e., socio-economic difficulty of the original family, parental divorce, frequent quarrels between parents, frequent physical punishment by parents, and starvation) were associated with a higher risk of elder abuse victimization. After controlling for participants' socio-demographic characteristics and adding these five types of ACEs simultaneously in the multivariate regression model, the poor socio-economic status of the original family (OR = 1.759, p < .05) and suffering frequent physical punishment inflicted by parents (OR = 2.288, p < .05) were found to be significantly associated with elder abuse victimization. To have multiple (at least 4) ACEs is a risk factor for elder abuse victimization as well (OR = 3.06, p < .001). This study provides evidence for ACEs as risk factors for elder abuse victimization. The findings highlight the importance of strengthening our understanding of the impacts of ACEs in both research and practice.

Assessing prevalence and predictors of depression in Type 2 Diabetes Mellitus (DM) patients – The DEPDIAB study

ObjectivesDepression is common in diabetes and has significant impact on health outcomes. Suicidal ideation also forms a part of the spectrum of diabetes and coexistent depression. To assess the predictors of depression as well as its prevalence in Type 2 Diabetes Mellitus (T2DM) patients, we conducted a cross sectional study entitled “DEPression in DIABetes” (DEPDIAB). Material and methodsA cohort of consecutive 1371 T2DM patients from Eastern India suffering from diabetes greater than 1 year was assessed in a cross- sectional survey in 9 different hospitals and medical polyclinics in Kolkata, India for depression by administering the 9-item PHQ – 9 and Beck depression scales. Socioeconomic status was assessed by the “Revised Kuppuswamy and B G Prasad socio-economic scales for 2016”, a validated scoring system for assessing the socioeconomic status of Indian patients. ResultsIn our study 836 patients (60.9%) were male and 535 (39.02%) were female. 56 patients (4.1%) met the criteria for major depression and 494 patients (36.16%) for minor depression. No sign of depression was found in 816 patients (59.74%). Depression was strongly associated with younger age (18–40 years vs. >60 years) [OR-2.09; 95% CI 1.11–3.96], female sex [OR-1.31; 95% CI 1.11–2.01], low socioeconomic status [OR-2.69; 95% CI 1.34–3.79], poor compliance [OR- 5.05; 95% CI 2.79–8.13], hypoglycemia [OR 1.466; 95% CI 1.076–1.999] and difficulty in managing day-to-day activities [OR- 4.648; 95% CI 3.450–6.262] Suicidal ideation was detected in 201 patients (14.8%). Among patients who had repeated attacks of hypoglycemia (>1 episode per month), 22% experienced suicidal ideation. This was significantly higher than in patients who had not suffered from hypoglycemia (12%) (p < 0.0001). Patients with HbA1C of 7% or lower experienced statistically significantly lesser suicidal ideation than patients with a higher HbA1C (12% vs. 16.8% {p = 0.016}). Suicidal ideation did not correlate withbody mass index (BMI), fasting plasma glucose (FPG) or insulin usage. ConclusionsWe found a high prevalence of depression in T2DM patients in Eastern India. Younger age, female sex, lower socio-economic status, poor compliance, hypoglycemia, and difficulty in managing day to day activities emerged as significant predictors of depression in this study. Recurrent episodes of hypoglycemia were an independent risk factor for suicidal ideation in patients with depression. Depression was not significantly associated with co morbidities associated with T2D and surprisingly insulin usage was not associated with increased depression.

Holes in the wall: Examining gaps in knowledge in child and adolescent mental health in Tanzania - Scoping review.

To perform scoping review of the existing literature available specific to child and adolescent mental health in Tanzania. An extensive literature search of PubMed, Scopus, MEDLINE and EMBASE was undertaken to identify studies that focussed specifically on mental illness in children and young people in Tanzania. This included neurological and functional disorders, affective disorders, psychosis, epidemiological, intervention and treatment-based studies. Qualitative analysis of the studies was then undertaken to assess what is currently known about the subject and how reliable this information is and to identify areas for further research. Of 23 studies were included in the final synthesis, which could be broadly split into studies focussing on the prevalence and incidence of child and adolescent mental illness, hypothesised causes and correlations, identified treatments and interventions and qualitative studies of human experience. There is a dearth of published research regarding child and adolescent mental health in Tanzania. Although some high-quality studies allow us good insight into the epidemiology of mental illness, interventional studies are often small and low-power, and significant correlational relationships are yet to be drawn. There is significant scope for further child and adolescent mental health research in Tanzania.

Psychosocial correlates of risky sexual behaviour amongst students in Niger Delta University, Bayelsa.

Introductionglobally young people constitute one quarter of the population. They are the most vibrant and productive sector, but they are also prone to more risky sexual behaviour (RSB) with attendant negative consequences. In the Niger Delta Region of Nigeria, persistent conflicts and socioeconomic difficulty predisposes young people to risky conducts including RSB. The aim of this study is to explore the psychosocial correlates of risky sexual behaviour amongst students in the Niger Delta University, Bayelsa.Methodswe undertook a descriptive cross-sectional survey of students in the university. A multistage random sampling technique was used to recruit 400 students who completed a self-administered questionnaire. The data collected was analyzed using SPSS version 20.0.Resultsout of the 400 students, 64.3% (257) engaged in RSB and 46.8% (187) were currently engaging in RSB. Rates of self-reported depression, suicidal ideation and attempt were 62.3% (249), 18.0% (72) and 14.3% (54) respectively. Independent correlates of RSB include being older than 19 years (aOR. 2.82; 95% C.I. 1.44 -5.51), male gender (aOR. 1.70; 95% C.I. 1.08-2.66), having depression (aOR. 1.83; 95% C.I. 1.15-2.92), being diagnosed with a sexually transmitted disease (STD)/HIV (aOR. 2.08; 95% C.I. 1.12-3.86), and having been taught about condoms (aOR. 1.80; 95% C.I. 1.13-2.86).Conclusionrisky sexual behaviours have negative psychosocial and health implications. Regular and continuous health education targeted at young people is essential to reduce the social and health effects associated with RSB.

“A Touch of Sugar”: A Qualitative Study of the Impact of Health Beliefs on Type 1 and Type 2 Diabetes Self-Management Among Black Canadian Adults

ObjectivesBlack Canadians have higher rates of diabetes and complications compared with White Canadians. However, research on diabetes self-management in this community is lacking. We conducted a qualitative study to explore diabetes self-management in the Black Canadian community using the lens of the Health Belief Model. MethodsForty-three individuals who identify as Black Canadians, living with or caring for a person with diabetes, were recruited. Data were collected through focus groups and interviews, and then analyzed using content analysis. ResultsWe found that participants appreciated they are susceptible to diabetes based on family or peer experiences. Perceived severity is variable for which some believe that diabetes is only a “sugar problem,” and the majority highlighted a perceived lack of knowledge about diabetes complications. Perceived benefits to treatment included prolonging life and cleansing one’s body. Perceived barriers included lack of culturally appropriate dietary advice, lack of shared decision-making driven by a language barrier and cultural mismatch between patient and provider, socioeconomic status and difficulty navigating and accessing the Canadian health-care system. Peers, family members, churches and online platforms served as the main information sources and cues to action, influencing each of the 4 aforementioned categories. A number of solutions were proposed by the participants to address the barriers from patient, health-care delivery and health advocacy perspectives. ConclusionsBlack Canadians face unique barriers to diabetes self-management, some of which are rooted within health belief systems. Avenues for intervention include peer education through narratives and a renewed focus on providing culturally appropriate care.

Reintroducing Dyslexia: Early Identification and Implications for Pediatric Practice.

Dyslexia is a common learning disorder that renders children susceptible to poor health outcomes and many elements of socioeconomic difficulty. It is commonly undiagnosed until a child has repeatedly failed to learn to read in elementary school; this late diagnosis not only places the child at an academic disadvantage but also can be a precursor to psychiatric comorbidities such as anxiety and depression. Genetic and neuroimaging research have revealed that dyslexia is heritable and that it is undergirded by brain differences that are present even before reading instruction begins. Cognitive-behavioral research has revealed that there are early literacy skill deficits that represent red flags for dyslexia risk and can be measured at a preschool age. Altogether, this evidence points to dyslexia as a disorder that can be flagged by a pediatrician before school entry, during a period of heightened brain plasticity when interventions are more likely to be effective. In this review, we discuss the clinical implications of the most recent advances in dyslexia research, which converge to indicate that early identification and screening are crucial to the prevention or mitigation of adverse secondary consequences of dyslexia. We further highlight evidence-based and practical strategies for the implementation of early risk identification in pediatric practice so that physicians can be empowered in their ability to treat, educate, and advocate for their patients and families with dyslexia.

Breastfeeding and Marijuana Use: Medical and Ethical Policy Analysis [10I

INTRODUCTION: U.S. guidelines recommend breastfeeding women avoid marijuana given concerns about infant neurodevelopment. Unfortunately, this has resulted in many physicians and hospitals prohibiting women who use marijuana from breastfeeding despite inconclusive evidence of harm and well-known benefits of breastfeeding. Meanwhile, marijuana use is increasing among reproductive-aged women, and complex personal/socioeconomic factors affect feeding choices. We assess evidence and ethical justification for current practice. METHODS: We review: (1) Harm to infants from breastmilk marijuana exposure vs. avoiding breastfeeding, (2) Maternal health and psychosocial considerations, and (3) Current practices in light of principles of beneficence, justice, and autonomy. RESULTS: (1) Limited data suggests neurobehavioral changes among infants whose mothers use marijuana during breastfeeding, though socioeconomic confounders and difficulty of distinguishing in utero from breastmilk exposure hinder interpretation. Avoiding breastfeeding increases infants' risk of sudden infant death syndrome, sepsis, necrotizing enterocolitis, diabetes, asthma, and obesity. (2) Without breastfeeding, women have increased risk of cardiovascular disease, reproductive cancers, diabetes, depression and unintended pregnancy. Marijuana use is highest among underserved minority women who disproportionately suffer these health consequences and are especially vulnerable to punitive damages. (3) Benefits of breastfeeding for infants and women should be considered alongside risks of marijuana exposure through breastmilk. Lack of these considerations may exacerbate health disparities. Unbiased, culturally-informed counseling would promote open patient-provider communication and shared decision-making, and may improve long-term health. CONCLUSION: Restrictive breastfeeding policies for women who use marijuana which do not utilize an individualized, shared decision-making approach are not ethically justified, and may disproportionately undermine health of underserved women and infants.

Causes of Death in HIV-Infected Individuals with Immunovirologic Success in a National Prospective Survey.

This prospective multi-center observational survey describes causes of death and their trends from 2000 to 2010 among treated HIV-infected patients with immunovirologic success (PIVS) in France. In 90 clinical sites providing HIV care and treatment, representing a cohort of 82,000 patients in 2010, the underlying causes of death and characteristics of deceased patients were prospectively recorded in 2000, 2005, and 2010 by using a standardized form. We provide data on PIVS, define as patients with a CD4+ T cell value above 500/mm3 and a plasma HIV-1 RNA below 50 copies/ml at their last periodic checkup before death, compare them with immunovirologic uncontrolled patients, and describe trends in these data from 2000 onward. The main underlying causes of death of the 120 PIVS recorded in 2010 were: a non-AIDS/nonviral hepatitis-related malignancy (19%), suicide (12.5%), cardiovascular disease (11.5%), and liver disease (11%). Only three PIVS died of an AIDS-related event. Socioeconomic difficulty was identified in 41% of PIVS in 2010. This percentage had constantly grown since 2000 (p < .001). Median age at death also increased (40, 46, and 52 years in 2000, 2005, and 2010, respectively; p < .001). The distribution of the main causes of death of PIVS was statistically different from that of uncontrolled patients (p < .001). Although immunovirologic control is fundamental, a parallel multidisciplinary approach to care is essential to accurately detect and treat comorbidities, particularly cancer, psychiatric disorders, and cardiovascular disease. Psychosocial aspects must be considered.

Association Between Lipid Biomarkers, Physical Activity, and Socioeconomic Status in a Population-Based Cross-Sectional Study in the UK.

BackgroundCardiovascular disease (CVD) is the leading cause of global death. Physical activity can help individuals reduce their CVD risk. However, the biological mechanisms explaining the link between physical activity and CVD risk and how they may be mediated by socioeconomic status are not well understood.MethodsWe use cross-sectional data from 2010/2011 of the Understanding Society Survey, UK, to investigate the association between two biomarkers for CVD risk: cholesterol ratio and triglyceride levels and four different measures of physical activity: moderate, mild, self-reported activity rating, and walking 30 min or more a week using multivariate logistic regression. The analysis investigates if this association is mediated by socioeconomic status and difficulty accessing sports facilities.ResultsResults from multivariate regressions show that moderate and self-reported activity rating are significantly associated with cholesterol ratio and triglycerides for both men and women. A weaker association was found for walking 30 min or more a week. No association was found between mild physical activity and the two biomarkers. There is some evidence that socioeconomic status mediates the relationship between the biomarkers and physical activity. A significant association between socioeconomic status variables and the biomarkers was found only for women.ConclusionsWe provide some evidence of the mechanisms explaining the link between CVD risk and physical activity by finding an association with traditional lipid biomarkers. We also find that intensity of physical activity matters. Socioeconomic status especially for women is important which may explain some of the inequalities in CVD risk.

Maqasid al-Shari’ah as a Framework for Economic Development Theorization

Development studies has so far created a huge intellectual resource, including theories, models and policy prescriptions that have been implemented in most developing economies. However, development theorization has been generally dominated by the western materialist paradigm which is antithetical to the very philosophical foundations of Islam. Muslims, constituting at least a quarter of the world population, mostly live in the less developed economies and are therefore among the largest consumers of these materialist theories. Based on the premises that the Muslim world cannot address its multifarious development challenges by relying only on imported theories and models, and that as important stakeholders in the world, Muslims need to contribute to the global development discourse; this paper presents an Islamic alternative approach to the analysis of development based on the theory of maqasid al-Shari’ah. The paper proposes a maqasid-based development approach which sees development from the perspective of drawing benefit and removing harm, which require promoting things that make life easy, meaningful and prosperous and blocking all means to harm, socio-economic difficulty and underdevelopment. The three-stages development approach focuses on promoting wellbeing through the preservation and enhancement of five essential components; faith, life, intellect, offspring and wealth. The paper submits that maqasid al-Shari’ah is a veritable framework for, inter alia, formulating development policies and prioritizing development projects. The strength of the approach lies in the proper place it accords to faith, spirituality, and moral ethics as trigger mechanisms for sustained moderate development in addition to its emphasis on all-encompassing but moderate material progress. The paper calls for an extensive study of the science of maqasid al-Shari’ah as it pertains to economic development discourse.

Social capital and job satisfaction: The case of Europe in times of economic crisis

This study uses data for 23 countries elicited from the 2010/11 wave of the European Social Survey to examine the stability of social capital as a predictor of job satisfaction at a time of economic crisis. The analysis reveals a remarkably resilient impact of social capital and its constituent components during the economic downturn. However, this resilience is much less pronounced when the focus is on countries where the crisis was most severe, suggesting an economic development threshold below which certain social capital components lose their associational impact. However, religious activity is significantly associated with workers’ job satisfaction in these economies, providing comfort during times of socio-economic difficulty. The extent of organizational trust, measured by proxy variables for participative decision-making, has by far the strongest association with job satisfaction. This suggests that employers need to think again about the way they treat their employees to maximize the benefits of social capital and, ultimately, improve the job satisfaction scores of their workers.

Rheumatic heart disease in Egypt: Gloomy past and promising future

Abstract Rheumatic fever (RF) and rheumatic heart disease (RHD) have decreased in prevalence in the advanced industrialized nation. In the developing world, RF and RHD although less prevalent than they were 30 to 50 years ago, are still a major health problem. Poor socio-economic standards and difficulty of reaching proper primary health care facilities are the main causes of the still relatively high prevalence. This article will discuss in brief the epidemiology of group A beta hemolytic streptococci (GAS) and RF/RHD as well as their global burden. The gloomy past of RF/RHD will hopefully give way to the promising future we all strive to achieve through better social standards, sanitation and hygiene, and availability of better health care for all.

Why food in health security (FIHS)?

Health is intrinsic to human security (HumS) although it is somewhat anthropocentric and about our own psychosocial and biomedical status more than various external threats. The 1994 United Nations Development Program definition of HumS includes economic, food, environmental, personal, community and political security with freedom from fear and want. Environmental factors are critical for health security (HealS), especially with widespread socio-economic difficulty, and health systems less affordable or accessible. The nexus between nutritionally-related disorders and infectious disease is the most pervasive world health problem. Most if not all of the Millennium Development Goals are food-linked. Maternal nutrition has life-long health effects on the yet-to-be born child. The mix of essential nutrient deprivation and energy imbalance is rife across many societies. Food systems require deeper understanding and governance to overcome these food-related health risks which are matters of food security (FoodS). Nutritionally-related Disability Adjusted Life Years (DALYS) are improving markedly in many parts of the world, along with poverty and hunger reduction and health system advances. But recent economic, energy, food, water, climate change and health crises along with conflict are limiting. It is time for international and regional understanding of how households and communities can collectively manage these threats in affordable and sustainable ways. There is untapped problem-solving capacity at the international local level if supported by combined food--health systems expertise, innovation, infrastructure and governance. Principles of equity and ethics must apply. The Food in Health Security (FIHS) roundtable aims to develop a Network to facilitate this process.

Risk Factors for Homelessness: Evidence From a Population-Based Study

This study examined factors associated with lifetime experience of homelessness among young adults. Data were analyzed for 14,888 young adults (mean+/-SD age 21.97+/-1.77; 7,037 men and 7,851 women) who participated in the National Longitudinal Study of Adolescent Health (Add Health), a U.S. nationally representative, population-based sample. Data were collected from young adults through computer-assisted interviews six years after they had enrolled in the study as adolescents. Variables that have been associated with lifetime homelessness in at least one service sample were mapped to Add Health survey items. Data were analyzed by logistic regression. A total of 682 respondents (4.6%) were classified as ever being homeless. Several factors related to childhood experiences of poor family functioning, socioeconomic disadvantage, and separation from parents or caregivers were independently associated with ever being homeless. Other significant independent factors included current socioeconomic difficulty, mental health problems, and addiction problems. Indicators of involvement in crime and addiction problems with gambling and alcohol were not independently associated with homelessness. The findings underscore the relationship between specific indicators of adversity in childhood and risk of homelessness and point to the importance of early intervention efforts. Consistent with the extant research literature, mental health problems also appear to be associated with homelessness, highlighting the potentially complex service needs of this population.

Risk Factors for Homelessness: Evidence From a Population-Based Study

This study examined factors associated with lifetime experience of homelessness among young adults. Data were analyzed for 14,888 young adults (mean+/-SD age 21.97+/-1.77; 7,037 men and 7,851 women) who participated in the National Longitudinal Study of Adolescent Health (Add Health), a U.S. nationally representative, population-based sample. Data were collected from young adults through computer-assisted interviews six years after they had enrolled in the study as adolescents. Variables that have been associated with lifetime homelessness in at least one service sample were mapped to Add Health survey items. Data were analyzed by logistic regression. A total of 682 respondents (4.6%) were classified as ever being homeless. Several factors related to childhood experiences of poor family functioning, socioeconomic disadvantage, and separation from parents or caregivers were independently associated with ever being homeless. Other significant independent factors included current socioeconomic difficulty, mental health problems, and addiction problems. Indicators of involvement in crime and addiction problems with gambling and alcohol were not independently associated with homelessness. The findings underscore the relationship between specific indicators of adversity in childhood and risk of homelessness and point to the importance of early intervention efforts. Consistent with the extant research literature, mental health problems also appear to be associated with homelessness, highlighting the potentially complex service needs of this population.

Patients' Perception of Possible Child Custody or Visitation Loss for Nonadherence to Psychiatric Treatment

This study explored whether parents treated in public mental health settings perceived that they might lose child custody or visitation if they were not adherent to treatment. Interview data were gathered from 1,011 adult outpatients from five community mental health centers located in five states in different U.S. regions. Among parents with children younger than 16 (N=187), 19% perceived in the past six months that they might lose child custody or visitation if they were not adherent to treatment. Two-thirds of the identified sources of this perception were family, themselves, or individuals outside the treatment, welfare, or legal systems. These preliminary data indicate that the perception of possible loss of child custody or visitation for nonadherence to treatment is not uncommon among patients treated in these public mental health settings and that "informal" sources are often the perceived source. Further study regarding the effects of this perception on patient and family outcomes is needed.