Homeless Status Research Articles

The Association of Homelessness With Rates of Diabetes Complications: A Population-Based Cohort Study.

To estimate the rates of diabetes complications and revascularization procedures among people with diabetes who have experienced homelessness compared with a matched cohort of nonhomeless control subjects. A propensity-matched cohort study was conducted using administrative health data from Ontario, Canada. Inclusion criteria included a diagnosis of diabetes and at least one hospital encounter between April 2006 and March 2019. Homeless status was identified using a validated administrative data algorithm. Eligible people with a history of homelessness were matched to nonhomeless control subjects with similar sociodemographic and clinical characteristics. Rate ratios (RRs) for macrovascular complications, revascularization procedures, acute glycemic emergencies, skin/soft tissue infections, and amputation were calculated using generalized linear models with negative binomial distribution and robust SEs. Of 1,076,437 people who were eligible for inclusion in the study, 6,944 were identified as homeless. A suitable nonhomeless match was found for 5,219 individuals. The rate of macrovascular complications was higher for people with a history of homelessness compared with nonhomeless control subjects (RR 1.85, 95% CI 1.64-2.07), as were rates of hospitalization for glycemia (RR 5.64, 95% CI 4.07-7.81) and skin/soft tissue infections (RR 3.78, 95% CI 3.31-4.32). By contrast, the rates of coronary revascularization procedures were lower for people with a history of homelessness (RR 0.76, 95% CI 0.62-0.94). These findings contribute to our understanding of the impact of homelessness on long-term diabetes outcomes. The higher rates of complications among people with a history of homelessness present an opportunity for tailored interventions to mitigate these disparities.

Correlates of Homelessness Among Adults with Personality Disorder.

Although personality disorders (PDs) are more common among persons experiencing homelessness than the general population, few studies have investigated the risk of experiencing homelessness among persons with PDs. This study seeks to identify the demographic, socioeconomic, and behavioral health correlates of past-year homelessness among persons with antisocial, borderline, and schizotypal PDs. Nationally representative data of the civilian, noninstitutionalized population of the United States was used to identify correlates of homelessness. Descriptive statistics and bivariate associations between variables and homeless status were summarized prior to conducting several multivariate logistic regression models to identify correlates of homelessness. Main findings revealed positive associations between poverty, relationship dysfunction, and lifetime suicide attempt with homelessness. In the antisocial PD (ASPD) and borderline PD (BPD) models, comorbid BPD and ASPD, respectively, were associated with higher odds of past-year homelessness. Findings underscore the importance of poverty, interpersonal difficulties, and behavioral health comorbidities on homelessness among persons with ASPD, BPD, and schizotypal PD. Strategies to promote economic security, stable relationships, and interpersonal functioning may buffer against the effects of economic volatility and other systemic factors that could contribute to homelessness and persons with PD.

Identifying Predictors of Homelessness Among Adults in a Large Integrated Health System in Northern California.

Introduction Homelessness contributes to worsening health and increased health care costs. There is little published research that leverages rich electronic health record (EHR) data to predict future homelessness risk and inform interventions to address it. The authors' objective was to develop a model for predicting future homelessness using individual EHR and geographic data covariates. Methods This retrospective cohort study included 2,543,504 adult members (≥ 18 years old) from Kaiser Permanente Northern California and evaluated which covariates predicted a composite outcome of homelessness status (hospital discharge documentation of a homeless patient, medical diagnosis of homelessness, approved medical financial assistance application for homelessness, and/or "homeless/shelter" in address name). The predictors were measured in 2018-2019 and included prior diagnoses and demographic and geographic data. The outcome was measured in 2020. The cohort was split (70:30) into a derivation and validation set, and logistic regression was used to model the outcome. Results Homelessness prevalence was 0.35% in the overall sample. The final logistic regression model included 26 prior diagnoses, demographic, and geographic-level predictors. The regression model using the validation set had moderate sensitivity (80.4%) and specificity (83.2%) for predicting future cases of homelessness and achieved excellent classification properties (area under the curve of 0.891 [95% confidence interval = 0.884-0.897]). Discussion This prediction model can be used as an initial triage step to enhance screening and referral tools for identifying and addressing homelessness, which can improve health and reduce health care costs. Conclusions EHR data can be used to predict chance of homelessness at a population health level.

Easy to use and validated predictive models to identify beneficiaries experiencing homelessness in Medicaid administrative data.

To develop easy to use and validated predictive models to identify beneficiaries experiencing homelessness from administrative data. We pooled enrollment and claims data from enrollees of the California Whole Person Care (WPC) Medicaid demonstration program that coordinated the care of a subset of Medicaid beneficiaries identified as high utilizers in 26 California counties (25 WPC Pilots). We also used public directories of social service and health care facilities. Using WPC Pilot-reported homelessness status, we trained seven supervised learning algorithms with different specifications to identify beneficiaries experiencing homelessness. The list of predictors included address- and claims-based indicators, demographics, health status, health care utilization, and county-level homelessness rate. We then assessed model performance using measures of balanced accuracy (BA), sensitivity, specificity, positive predictive value, negative predictive value, and area under the receiver operating characteristic curve (area under the curve [AUC]). We included 93,656 WPC enrollees from 2017 to 2018, 37,441 of whom had a WPC Pilot-reported homelessness indicator. The random forest algorithm with all available indicators had the best performance (87% BA and 0.95 AUC), but a simpler Generalized Linear Model (GLM) also performed well (74% BA and 0.83 AUC). Reducing predictors to the top 20 and top five most important indicators in a GLM model yields only slightly lower performance (86% BA and 0.94 AUC for the top 20 and 86% BA and 0.91 AUC for the top five). Large samples can be used to accurately predict homelessness in Medicaid administrative data if a validated homelessness indicator for a small subset can be obtained. In the absence of a validated indicator, the likelihood of homelessness can be calculated using county rate of homelessness, address- and claim-based indicators, and beneficiary age using a prediction model presented here. These approaches are needed given the rising prevalence of homelessness and the focus of Medicaid and other payers on addressing homelessness and its outcomes.

Implementation of an integrated infectious disease and substance use disorder team for injection drug use-associated infections: a qualitative study

BackgroundHospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment intervention for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. We conducted a qualitative study to identify patient- and clinician-level perceived implementation barriers and facilitators to the SIRI team intervention.MethodsParticipants were patients with history of SIRIs (n = 7) and healthcare clinicians (n = 8) at one implementing hospital (Jackson Memorial Hospital). Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Research (CFIR). Interviews were transcribed, double coded, and categorized by study team members using CFIR constructs.ResultsImplementation barriers to the SIRI team intervention identified by participants included: (1) complexity of the SIRI team intervention; (2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; (3) clinician-level stigma and lack of knowledge around addiction and medications for opioid use disorder (OUD); and (4) concerns about underinvestment in the intervention. Implementation facilitators of the intervention included: (1) a non-judgmental, harm reduction-oriented approach; (2) the team’s advocacy for PWID as a means of institutional culture change; (3) provision of close post-hospital follow-up that is often inaccessible for PWID; (4) strong communication with patients and their hospital physicians; and (5) addressing diverse needs such as housing, insurance, and psychological wellbeing.ConclusionIntegration of infectious disease and SUD treatment is a promising approach to managing patients with SIRIs. Implementation success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction across multilevel (inner and outer) implementation contexts.

Inferred networks, machine learning, and health data.

This paper presents a network science approach to investigate a health information dataset, the Sexual Acquisition and Transmission of HIV Cooperative Agreement Program (SATHCAP), to uncover hidden relationships that can be used to suggest targeted health interventions. From the data, four key target variables are chosen: HIV status, injecting drug use, homelessness, and insurance status. These target variables are converted to a graph format using four separate graph inference techniques: graphical lasso, Meinshausen Bühlmann (MB), k-Nearest Neighbors (kNN), and correlation thresholding (CT). The graphs are then clustered using four clustering methods: Louvain, Leiden, and NBR-Clust with VAT and integrity. Promising clusters are chosen using internal evaluation measures and are visualized and analyzed to identify marker attributes and key relationships. The kNN and CT inference methods are shown to give useful results when combined with NBR-Clust clustering. Examples of cluster analysis indicate that the methodology produces results that will be relevant to the public health community.

Gender Minority Youth Experiencing Homelessness and Corresponding Health Disparities

PurposePediatricians and youth service providers frequently interface with vulnerable populations, including gender minority youth (e.g., transgender, nonbinary, gender questioning, and other gender diverse individuals) and youth experiencing homelessness. The purposes of this study are to estimate the prevalence of homelessness and types of homelessness experienced among gender minority youth and their corresponding health outcomes. MethodsData for this study came from gender minority (n = 3,194) and cisgender (n = 93,337) high school students who answered questions on transgender status and homelessness status in the 2017 and 2019 Youth Risk Behavior Survey (YRBS). We compared the prevalence of homelessness between gender minority and cisgender youth and assessed where youth experiencing homelessness had slept in the prior month: shelters, nonparental homes, streets, hotel, or other locations. Finally, logistic regression models and marginal effects (ME) were used to examine health outcomes at the intersection of gender minority status and homelessness. Results22% of gender minority youth reported homelessness during the prior month. Cisgender youth were significantly less likely to report being homeless (3%). Transgender youth experiencing homelessness were significantly more likely to live on the streets than cisgender youth experiencing homelessness (ME = 0.20; 95% CI = 0.10–0.30; p < .001). Gender minority youth experiencing homelessness reported elevated health-risk behaviors in excess of nonhomeless gender minority youth and cisgender youth experiencing homelessness. DiscussionPublic health campaigns, housing interventions, and youth service providers should consider and create tailored programs to secure housing and to promote the health of gender minority youth experiencing homelessness.

Palliative care, homelessness, and restricted or uncertain immigration status.

People experiencing homelessness have limited access to palliative care support despite high levels of ill health and premature mortality. Most research exploring these challenges in the United Kingdom has focused on people living in hostels or temporary accommodation. People with uncertain or restricted immigration status are often unable to access this accommodation due to lack of entitlement to benefits. There is little research about the experiences of those in the United Kingdom who cannot access hostels or temporary accommodation due to restricted or uncertain immigration status with regards to palliative and end-of-life care access. To explore the barriers to palliative and end-of-life care access for people with uncertain or restricted immigration status, who are experiencing homelessness and have advanced ill health, and the experiences of UK hospices of supporting people in this situation. A multi-method cross-sectional study. An online survey for hospice staff followed by online focus groups with staff from inclusion health, homelessness and palliative care services, charities and interviews with people experiencing homelessness. Fifty hospice staff responded to the online survey and 17 people participated in focus groups and interviews (focus groups: n = 10; interviews: n = 7). The survey demonstrated how hospices are not currently supporting many people with restricted or uncertain immigration status who are homeless and that hospice staff have received limited training around eligibility for entitlements or National Health Service (NHS) care. Interview and focus group data demonstrated high levels of unmet need. Reasons for this included a lack of consistency around eligibility for support from local authorities, issues relating to NHS charging, and mistrust and limited knowledge of the UK health and social care system. These barriers leave many people unable to access care toward the end of their lives. To advocate for and provide compassionate palliative and end-of-life care for people with uncertain immigration status, there is need for more legal literacy, with training around people's entitlement to care and support, as well as easier access to specialist legal advice.

1984. Implementation of an integrated infectious disease and substance use disorder team for the treatment of severe injection-related infections

Abstract Background Hospitalizations for severe injection drug use-related infections (SIRIs) are characterized by high costs, frequent patient-directed discharge, and high readmission rates. Beyond the health system impacts, these admissions can be traumatizing to people who inject drugs (PWID), who often receive inadequate treatment for their substance use disorders (SUD). The Jackson SIRI team was developed as an integrated infectious disease/SUD treatment team for patients hospitalized at a public safety-net hospital in Miami, Florida in 2020. In order to facilitate implementation of this team, we conducted a qualitative study of patients and providers to identify barriers and facilitators to the team’s success. Methods Participants were patients with history of SIRIs (n=7) at the Jackson Memorial Hospital (JMH) and healthcare providers (HCPs) (n=8) at JMH. Semi-structured qualitative interviews were performed with a guide created using the Consolidated Framework for Implementation Science (CFIR). Interviews were transcribed and double coded by study team members using determinants adapted from the CFIR. Results Key barriers to SIRI team success included: 1) complexity of SIRI and SUD care requiring multidisciplinary teams and resources; 2) lack of resources for PWID experiencing homelessness, financial insecurity, and uninsured status; 3) stigma and lack of knowledge around addiction and medications for SUD; and 4) suspected understaffing and underfunding for the team. Facilitators of team success included: 1) holistic, integrated care being more efficient and effective than fragmented care; 2) the team’s advocacy for PWID as a means of institutional culture change; 3) provision of close post-hospital follow-up for an often-abandoned population; 4) non-judgmental, harm reduction-oriented approach; and 5) addressing diverse needs such as housing, insurance, and psychological wellbeing. Conclusion Integration of infectious disease and substance use disorder treatment is a promising approach to managing patients with SIRIs; however, success depends on institutional buy-in, holistic care beyond the medical domain, and an ethos rooted in harm reduction. Disclosures Susanne Doblecki-Lewis, MD, MSPH, Gilead Sciences: Grant/Research Support.

Perceived interpersonal competence as a predictor of clinical outcomes in a randomized controlled trial for social anxiety and employment

ABSTRACT This study explored relationships among perceived interpersonal competence and demographic and work history variables in a randomized control trial for social anxiety disorder (SAD) that compared work-related group cognitive behavioral therapy plus vocational services (WCBT+VSAU) to vocational services only (VSAU-alone). Intervention effects of perceived interpersonal competence on treatment outcomes over 12 weeks were also examined. Data from 250 job seekers with SAD (59.2% Female; 40.8% Black/African American; 82.4% Non-Hispanic/non-Latino/a) were analyzed. We predicted negative relationships between perceived interpersonal competence and symptoms/impairment and that individuals with lower perceived interpersonal competence would benefit more quickly in WCBT+VSAU relative to VSAU-alone. Results indicated that perceived interpersonal competence did not vary by gender, race, ethnicity, homeless status, or employment history. There were no intervention effects of perceived interpersonal competence regarding social anxiety or overall functional impairment, but results supported negative relationships between perceived interpersonal competence and lower social anxiety and overall functional impairment in both conditions. Separately, perceived interpersonal competence moderated effects in the depression model such that there were faster declines in depression at lower perceived interpersonal competence levels in WCBT+VSAU, but not in VSAU-alone. Results indicate the value of attending to perceived interpersonal competence in interventions, which may result in mood benefits.

A Community-Based Study of Level and Determinants of Substance Use: Findings from Children Experiencing Homelessness in Major Cities of Northern Ethiopia.

Homelessness among children is a significant problem in most nations of the world. Children who experienced homelessness are most often unable to get secured and adequate housing. Such problems expose them to a range of destructive practices such as substance use. This study, therefore, was designed to evaluate the level and determinants of substance use by children who experienced homelessness in major cities of Northern Ethiopia. This cross-sectional study was undertaken from October 1, 2019 to February 30, 2020. We conducted street-based outreach searching to get a representative sample of the city's children who experienced homelessness and a total of 422 were recruited. The collected data were analyzed using SPSS version 20. Regression analysis was done to identify factors associated with substance use and statistical significance was declared at p < 0.05 and 95% confidence interval. More than 80% of the children who experienced homelessness use alcohol, cigarette or chat. Marriage status of parents before the child experiences homelessness being divorce (AOR = 8.53, 95% CI: 1.87-38.89), occupational status of mother being a daily laborer (AOR = 2.78, 95% CI: 0.83, 9.31), child relationship status with parents before child experiences homelessness (AOR = 0.08, 95% CI: 0.02-0.30) and parents' residential status before child experiences homelessness being rural (AOR = 5.63, 95% CI: 1.77-17.89) are the independent variables that established statistically significant association with the outcome variable, substance use. The majority of the children who experienced homelessness are exposed to substance use, particularly alcohol and cigarette. Efforts are needed by concerned bodies of the region to work on factors that predispose to homelessness and strategically safeguard the health and wellbeing of the children.

Critical windows of susceptibility for the effects of prenatal exposure to heat and heat variability on gestational growth

BackgroundStudies have shown that prenatal heat exposure may impact fetal growth, but few studies have examined the critical windows of susceptibility. As extreme heat events and within season temperature variability is expected to increase in frequency, it is important to understand how this may impact gestational growth. ObjectivesWe investigated associations between various measures of weekly prenatal heat exposure (mean and standard deviation (SD) of temperature and heat index (HI), derived using temperature in °C and dew point) and term birthweight or odds of being born small for gestational age (SGA) to identify critical windows of susceptibility. MethodsWe analyzed data from mother-child dyads (n = 4442) in the Boston-based Children's HealthWatch cohort. Birthweights were collected from survey data and electronic health records. Daily temperature and HI values were obtained from 800 m gridded spatial climate datasets aggregated by the PRISM Climate Group. Distributed lag-nonlinear models were used to assess the effect of the four weekly heat metrics on measures of gestational growth (birthweight, SGA, and birthweight z-scores). Analyses were stratified by child sex and maternal homelessness status during pregnancy. ResultsHI variability was significantly associated with decreased term birthweight during gestational weeks 10–29 and with SGA for weeks 9–26. Cumulative effects for these time periods were −287.4 g (95% CI: −474.1 g, −100.8 g for birthweight and 4.7 (95% CI: 1.6, 14.1) for SGA. Temperature variability was also significantly associated with decreased birthweight between weeks 15 and 26. The effects for mean heat measures on term birthweight and SGA were not significant for any gestational week. Stratification by sex revealed a significant effect on term birthweight in females between weeks 23–28 and in males between weeks 9–26. Strongest effects of HI variability on term birthweight were found in children of mothers who experienced homelessness during pregnancy. Weekly HI variability was the heat metric most strongly associated with measures of gestational growth. The effects observed were largest in males and those who experienced homelessness during pregnancy. DiscussionGiven the impact of heat variability on birthweight and risk of SGA, it is important for future heat warnings to incorporate measure of heat index and temperature variability.

300 Understanding the Relationship of Key Demographic Indicators on COVID-19 Rates in Emergency Department Settings During Surges

300 Understanding the Relationship of Key Demographic Indicators on COVID-19 Rates in Emergency Department Settings During Surges

Coronavirus vaccination coverage and timeliness among people experiencing homelessness in Wales, UK: A population-level analysis of linked healthcare and substance use services data.

ObjectivesPeople experiencing homelessness (PEH) have higher incidence of underlying health conditions that increase the risk of COVID-19 related complications. Achieving high vaccination coverage in a timely manner was therefore important for this group. We aimed to quantify the coverage and the timeliness of coronavirus vaccination among PEH in Wales. ApproachAnalysis was conducted using a population spine of people ≥ 18 years old continuously resident in Wales, UK, between July 2020 and November 2021. Data from health and substance use services were used to flag people who had experienced homelessness. The percentage of people receiving at least one dose of the coronavirus vaccination between 2nd December 2020 and 30th November 2021 was derived and logistic regression used to estimate the effect of experiencing homelessness on the odds of vaccination. Cumulative incidence plots and Restricted Meant Survival Time analysis were used to examine the timeliness of vaccination by homelessness status. ResultsThe proportion of people vaccinated by 30th November 2021 was roughly 26% points lower among PEH than ‘not-homeless’ people. Adjusted logistic regression found that people experiencing homelessness had lower odds of having received a first vaccine dose by 30th November 2021 (OR = 0.4, p &lt; 0.01). Since the start of the mass vaccination programme in Wales in December 2020, PEH went unvaccinated for on average 90 days longer than the general ‘not-homeless’ population, and 55 days longer than an exact match ‘not-homeless’ group. Visual analysis of the cumulative incidence plots found that at all points during the mass vaccination programme in Wales, the probability of being vaccinated was lower for PEH than ‘not-homeless’ groups. ConclusionPEH appear to have been under-engaged as part of the mass vaccination programme in Wales. This has led to lower overall vaccination rates and more time unvaccinated, potentially exposing PEH to greater risk of COVID-19 complications and mortality.

Triage and length of stay in emergency department visits due to alcohol intoxication: A retrospective chart review

BackgroundPatients with alcohol intoxication are screened and treated at emergency departments (EDs), at the cost of alcohol-related ED visit resource consumption. The purposes of this study were to identify characteristics of patients with alcohol intoxication, in terms of triage, blood alcohol concentration (BAC), and ED length of stay (LOS) and to compare these characteristics by homelessness status. MethodsWe conducted a retrospective chart review of all visits and referrals to one drunken center in an ED between January and December 2019. Adults aged over 18 years admitted to the drunken center with a blood alcohol concentration (BAC) of 100 mg/dl or higher were included. ResultsApproximately 89 % were male, around 30.4 % of the patients with acute alcohol intoxication were homeless. Approximately 46 % of patients were Medicaid or non-insured. Approximately 74.2 % of the patients were classified as KTAS 4 (less urgent) and 5 (nonurgency) upon initial KTAS evaluation. Both BAC and ED LOS were significantly higher in the homeless group. ConclusionsAbout half of alcohol intoxicated patients who visited ED were vulnerable, and they visited the ED due to the problem of less urgent or non-urgent status of triage. Sobering places, not ED, and connecting patients with social work programs is important.

Incidence of COVID-19 Among Persons Experiencing Homelessness in the US From January 2020 to November 2021

A lack of timely and high-quality data is an ongoing challenge for public health responses to COVID-19 among people experiencing homelessness (PEH). Little is known about the total number of cases of COVID-19 among PEH. To estimate the number of COVID-19 cases among PEH and compare the incidence rate among PEH with that in the general population. This cross-sectional study used data from a survey distributed by the Centers for Disease Control and Prevention to all US state, district, and territorial health departments that requested aggregated COVID-19 data among PEH from January 1, 2020, to September 30, 2021. Jurisdictions were encouraged to share the survey with local health departments. The primary study outcome was the number of cases of COVID-19 identified among PEH. COVID-19 cases and incidence rates among PEH were compared with those in the general population in the same geographic areas. Participants included a population-based sample of all 64 US jurisdictional health departments. Overall, 25 states, districts, and territories completed the survey, among which 18 states (72.0%) and 27 localities reported COVID-19 data among PEH. A total of 26 349 cases of COVID-19 among PEH were reported at the state level and 20 487 at the local level. The annual incidence rate of COVID-19 among PEH at the state level was 567.9 per 10 000 person-years (95% CI, 560.5-575.4 per 10 000 person-years) compared with 715.0 per 10 000 person-years (95% CI, 714.5-715.5 per 10 000 person-years) in the general population. At the local level, the incidence rate of COVID-19 among PEH was 799.2 per 10 000 person-years (95% CI, 765.5-834.0 per 10 000 person-years) vs 812.5 per 10 000 person-years (95% CI, 810.7-814.3 per 10 000 person-years) in the general population. These results provide an estimate of COVID-19 incidence rates among PEH in multiple US jurisdictions; however, a national estimate and the extent of under- or overestimation remain unknown. The findings suggest that opportunities exist for incorporating housing and homelessness status in infectious disease reporting to inform public health decision-making.

A Review of Basic Needs (Food Security, Housing Security, and Homelessness) of US College Students’ During the COVID-19 Pandemic

ObjectivesTo assess the basic needs (food security, housing security, and homelessness) status of U.S. college students during the COVID-19 pandemic. MethodsPubMed, CINAHL, Academic Search Premier, and OVID were searched for articles published in 2020–2021 that assessed housing/food security and/or homelessness in US college students during the COVID-19 pandemic. Of the 10,771 hits, 4 articles met the criteria, and data was extracted and summarized. ResultsAll four studies utilized cross-sectional online surveys and reported response rates between 4–23%. Three of the studies offered incentives to participants. All studies assessed food security (using 2, 6, or 10 item USDA tools); two assessed housing security, and no studies assessed homelessness. Thirty-one to 65.5% of college students were found to have some form of food insecurity. Three studies showed an increase in food insecurity in college students during the pandemic. While the fourth did not evaluate food insecurity before the pandemic, 84.7% of students reported that the pandemic reduced their ability to buy food. Additionally, one study reported a decrease in housing security during the pandemic while a second study reported 49.8% of students being very or somewhat worried about losing housing as a result of the pandemic. No studies were found that assessed the incidence of homelessness in college students during the pandemic. Changes in living arrangements, loss of employment, being an international student, disability status, gender, ethnicity, and race were associated with food insecurity. ConclusionsOur findings suggest that among US college students, food and housing insecurity worsened during the pandemic. Colleges and universities should enhance their student screening methods and provide resources to those who need assistance with food or housing. Future studies should assess homelessness in college students to add to the literature available. Funding SourcesNo funding.

COVID-19 public health data reporting and homelessness: challenges and future directions

ABSTRACT Data on COVID-19 among people experiencing homelessness has been extremely limited, despite known unique risks faced by this population. Gaps in data collection, monitoring, and reporting across multiple systems and government levels create challenges to understanding how COVID-19 is impacting people experiencing homelessness. This article examines these challenges and gaps in public health data on homelessness, presents examples of best practices, and offers policy recommendations for data collection, sharing, and dissemination of pandemic-related health metrics by homelessness status.

Suicide, Homicide, and Other Violent Deaths Among People Experiencing Homelessness in the United States: A Cross-sectional Study.

Limited information exists about violent deaths among people experiencing homelessness (PEH) across the United States. Using data from a national reporting system, we describe characteristics of suicides, homicides, and other deaths classified as violent among PEH in the United States. We obtained data on demographic characteristics, mechanisms of injury, and circumstances surrounding violent deaths from January 1, 2016, through December 31, 2018, in 31 states from the National Violent Death Reporting System. Of 122 113 violent deaths in 31 states during 2016-2018, 1757 (1.4%) occurred among PEH and 3952 (3.2%) occurred among people for whom homelessness status was unknown or missing. Of all violent deaths among PEH, 878 were suicides (1.1% of all suicides), 458 were homicides (1.6% of all homicides), 352 were of undetermined intent (2.8% of all deaths of undetermined intent), and 59 were the result of legal interventions (3.8% of all deaths due to legal interventions). Hanging/suffocation/strangulation was the most common mechanism of suicide among PEH (44.4%), followed by deaths due to firearms (21.6%). Firearms were the most common mechanism of homicide deaths among PEH (48.0%). Black PEH were more likely to die by homicide than by suicide, and White PEH were more likely to die by suicide than by homicide. Among the 843 suicide victims for whom additional information was known, 345 (40.9%) had a history of suicidal thoughts or plans, 245 (29.1%) had disclosed intent to die by suicide, and 183 (21.7%) were receiving treatment for a mental health condition. Efforts to reduce mortality and improve health outcomes among PEH should consider the high rates of violent deaths in this population.

Measurement of stigma and associated characteristics in people with tuberculosis in Medellín, Colombia: a cross-sectional study.

Stigma towards tuberculosis (TB) delays diagnosis and compromises adherence to treatment. We measured the degree of stigma and identified the sociodemographic and clinical characteristics that were associated with a higher degree of stigma in patients with pulmonary and extrapulmonary TB in Colombia. We conducted a cross-sectional study with 232 participants included in the TB control program in 2017. Sociodemographic and clinical variables were measured. The stigma component was measured through a validated scale and a multiple linear regression was used. The study analysed 232 patients, of which 52.2% were men, 53.5% were between 27 and 59y of age and 66.8% had a basic-medium education level. Two characteristics were significantly related to a higher stigma score: the basic-medium education level and homeless status. Homeless status increased the stigma score by 0.27. In contrast, the adjusted stigma score decreased by 0.07 if the patient's health status was perceived as 'healthy'. Stigma is maximized in homeless patients and patients with a low education level. It is minimized in patients who perceive their state of health as 'healthy'.