Occurrence of anxiety and depression among homeless individuals with pulmonary tuberculosis.

BACKGROUND: Tuberculosis and mental health issues are global health concern. Homelessness is a serious public health issue. There has been a relationship established between homelessness and mental illnesses. In this study, we see the mental health problems in homeless people with Pulmonary Tuberculosis (PTB). METHODS: PTB patients who were homeless living in shelter in Delhi, aged 22 years and above, were asked questions related to Anxiety and Depression. The tools used were PHQ-2 (patient health questionnaire), GAD-7 (general anxiety disorder), and CESD-R-10 (centre for epidemiologic studies depression scale revised). RESULTS: Out of 47 PTB patients screened, 4.2% (2, n = 47) had Minimal Anxiety, 51% (24, n = 47) had Mild Anxiety, 40.4% (19, n = 47) had Moderate Anxiety, 4.2% (2, n = 47) had Severe Anxiety, and 95.7% (45/47) had Depression. 78% (37, n = 47) were symptomatic for TB at the time of screening before being diagnosed with PTB and 22% (10, n = 47) were asymptomatic for PTB at the time of screening before being diagnosed with PTB. 34% (16/47) had history of PTB and 66% (31/47) had no history of PTB. CONCLUSION: There is a strong occurrence of Anxiety and Depression in homeless people with PTB. Patients who were symptomatic without history of PTB is more than half (53.19%). 22% of the people were asymptomatic at the time of screening, so it can be assumed that people were unaware that they have been suffering from PTB. In India, there is need to assess mental health issues among homeless TB patients on larger sample size. As the burden of mental illnesses is increasing and homeless population remains an unnoticed population.

Mortality and Suicide Among Persons Experiencing Homelessness: A Seven-Year Follow-up Study.

BACKGROUND: There is a significant gap in scientific understanding about suicide among people experiencing homelessness (PEHs). METHOD: This seven-year longitudinal study examined a cohort of 154 PEHs. In 2015, clinical assessments were conducted, including an evaluation of suicide risk, with data on causes of death collected from public health service records in 2022. RESULTS: Over the course of seven years, 14.3% of the sample passed away at an average age of 52.6 years. The leading causes of death were cancer, suicide, and accidental overdose. Participants who experienced violence had a higher number of suicide attempts and scored higher on the suicidal ideation scale. The most significant factors associated with mortality were prior suicide attempts and suicidal ideation. CONCLUSIONS: This study underscores the importance of suicide risk scale scores as the primary predictor of mortality. It emphasizes the need for further longitudinal research on suicide among PEHs and the development of specific programs to prevent suicide within this population. An approach combining structural and individual perspectives is suggested, considering appropriate housing policies and mental health care.

Health Status of People Who Are and Are Not Experiencing Homelessness: Opportunities for Improvement.

This study assessed the physical and psychological health parameters of adults experiencing homelessness to inform the development and delivery of health services by comparing with a housed population in the same South Australian city. Adults experiencing homelessness, known to existing support services, were invited to participate in a comprehensive assessment of their physical and mental health using questionnaires and objective assessments. Descriptive analyses using the percentage of participants failing to attain recommended published thresholds and accumulated health deficits for 16 health assessments were compared for the young group of people experiencing homelessness (18-40 years), the middle aged and older people experiencing homelessness (40-75 years), and a housed population of the middle aged and older people (40-75 years). Those experiencing homelessness had multiple and potentially inter-related health deficits compared with a population of people not experiencing homelessness in the same city. They were significantly less likely to meet healthy population norms for clinical frailty (p < 0.001), psychological distress (p < 0.001), grip strength (p < 0.001), lung function (p < 0.001), sleep quality (p < 0.001), and pelvic floor bother (p = 0.002). Significantly more accumulated health deficits were found for people experiencing homelessness when compared with the same ages for those who were not (mean 6.5 (SD 2.4) compared with 5.0 (SD 2.1)). This considerably increased for people experiencing homelessness aged less than 40 years (mean 8.7 (1.7)). Priorities for health service provision for people of different ages experiencing homelessness, when compared with housed community dwellers, have been described. The provision of targeted health assessments and service provision that specifically address healthcare needs among people experiencing homelessness are likely to have the biggest impacts across multiple health domains.

Pathways to social integration among homeless-experienced adults with serious mental illness: a qualitative perspective.

BACKGROUND: Social integration (i.e., reciprocal interactions with peers and community members) is a notable challenge for many homeless-experienced adults with serious mental illness (SMI). In this study, we examine a range of housing services offered to homeless-experienced adults with SMI and identify the impacts of supportive services on participants' social integration outcomes, with the goal of improving services in transitional and permanent housing settings for homeless-experienced adults with SMI. METHODS: Through semi-structured interviews with homeless-experienced adults with SMI (n = 30), we examine the impacts of housing and service settings on participants' social integration. Participants received services in a variety of housing settings, including transitional housing with congregate/shared living (n = 10), transitional housing with individual quarters (n = 10), and permanent supportive housing (n = 10). RESULTS: Participants expressed caution in developing social relationships, as these could pose barriers to recovery goals (e.g., substance use recovery). For many, social integration was secondary to mental and physical health and/or housing stability goals. Individual quarters gave individuals a place of respite and a sense of control regarding when and with whom they socialized. Meeting recovery goals was strongly related to connecting to and receiving a range of supportive services; interviews suggest that proximity to services was critical for engagement in these resources. CONCLUSIONS: Programs serving homeless experienced adults with SMI should seek to understand how individuals conceptualize social integration, and how social relationships can either support or hinder participants' recovery journey.

Hostel support workers' experiences navigating healthcare alongside people experiencing homelessness: a qualitative study in the UK.

OBJECTIVES: This study aimed to explore how hostel support workers (HSWs) experience navigating healthcare alongside people experiencing homelessness (PEH). PEH experience poor health outcomes, increased mortality and face many barriers when accessing healthcare. HSWs have a dynamic and holistic role, working with PEH to navigate access to health and social care, whilst facilitating independence. HSWs have been described as important in addressing barriers to access and linking healthcare and PEH. However, HSWs' experiences navigating this role across sectors remains underexplored. DESIGN: In this qualitative study, semistructured interviews were conducted, and phenomenological thematic analysis was performed. SETTING: Interviews were conducted with participants from 13 hostels across four UK counties. PARTICIPANTS: 17 HSWs were interviewed, with experience in their role ranging from 3 months to over 10 years. RESULTS: Three themes were identified.HSWs feeling stigmatised by healthcare staff (HCS), including power inequalities between HSWs and HCS, and the impact of stigma against PEH in healthcare on HSWs.Working across sectors, including both collaborative and disconnected experiences.In-reach and its role in linking PEH and healthcare. This included the contrasting subthemes of in-reach as an effective link versus in-reach being an impractical and unsustainable solution. CONCLUSIONS: Cross-sector collaboration has been recognised as an effective way to increase healthcare access and improve outcomes for Inclusion Health Groups, including PEH. This has been further highlighted by the formation of Integrated Care Systems, which strive to bring sectors together to tackle inequalities in outcomes, experience and access. Collaborative relationships between sectors, that is, hostels and healthcare, are vital for increasing healthcare access for PEH. We explored the experiences of HSWs navigating healthcare access for this marginalised population. Recognising and understanding these experiences are the first steps in building collaborative cross-sector relationships to improve healthcare accessibility, experiences and outcomes for PEH.

Belonging through meaningful activity in the transition from unhoused to housed.

BACKGROUND: Belonging is closely associated with well-being, yet individuals with experiences of being unhoused are likely to experience social exclusion and challenges with developing a sense of belonging. Engagement in meaningful activity has been linked to belonging; however, there are no focused studies exploring experiences of how engaging in meaningful activities influences belonging. Meaningful activities are things we do that bring value to our lives. PURPOSE: To explore how engaging in meaningful activities may influence experiences of belonging following homelessness through a secondary analysis of qualitative interviews. METHOD: Using interviews conducted in a community-based participatory action study exploring the transition to housing following homelessness (n = 19), we conducted a thematic analysis using the method described by Braun and Clarke. Participants were recruited through communication with local organizations supporting individuals with lived and living experiences of being unhoused as well as through presentations at drop-in organizations. An intentional effort was made to recruit diverse participants regarding housing status, age, and gender. Inductive analysis was used to conduct initial coding, focusing on belonging and engaging in meaningful activities. We then analyzed the codes abductively, using Bourdieu's Social Capital Theory to inform this analysis. FINDINGS: The overarching essence generated in our analysis was: "I don't feel like I belong…everything in the world is not for me…it's for people with…enough money to…enjoy those things". Within this overall essence, we generated three themes: 1) Human connection: "being where I am with people who care about me, I actually feel good"; 2) Social exclusion: being a "regular member of society"; and 3) Non-human connection: "my cats…are like my kids to me." Participants described numerous contextual factors that challenged them as they sought belonging following homelessness, including financial limitations and other societal factors. CONCLUSION: Our findings suggest that meaningful activity was an important pathway to belonging for participants in this study.

Exploring the Perspectives of Unhoused Adults and Providers Across the HCV Care Continuum.

Hepatitis C virus (HCV), the most common blood-borne infection, disproportionately affects people experiencing homelessness (PEH); however, HCV interventions tailored for PEH are scarce. This study utilized a community-based participatory approach to assess perceptions of HCV treatment experiences among HCV-positive PEH, and homeless service providers (HSP) to develop and tailor the "I am HCV Free" intervention which integrates primary, secondary, and tertiary care to attain and maintain HCV cure. Four focus groups were conducted with PEH (N = 30, Mage = 51.76, standard deviation 11.49, range 22-69) and HSPs (n = 10) in Central City East (Skid Row) in Los Angeles, California. An iterative, thematic approach was used to ensure the trustworthiness of the data. Barriers and facilitators emerged from the data which have the potential to impact initiating HCV treatment and completion across the HCV care continuum. Understanding and addressing barriers and strengthening facilitators to HCV treatment will aid in HCV treatment completion and cure for PEH.

Accessibility to prenatal care at the Street Outreach Office: nurse perceptions in northern Brazil.

OBJECTIVES: to understand nurse perspectives regarding homeless pregnant women's accessibility to prenatal care. METHODS: a qualitative study, with analysis based on the concept of accessibility. Semi-structured interviews were carried out with 11 nurses who work at the Street Outreach Office in northern Brazil. RESULTS: nurses are faced with geographic barriers and dangerous situations in border regions, recognizing that there is a context of physical, sexual and psychological violence that involves homeless pregnant women who seek care at the Street Outreach Office. Street Outreach Office nurses' work occurs in conjunction with other services in the Health Care Network. The implementation of educational measures is a powerful strategy, as is establishing links with women. FINAL CONSIDERATIONS: the Street Outreach Office's work provides meetings with pregnant women on site in the territory, which can provide geographic and socio-organizational accessibility to prenatal care.

Health-related issues of people experiencing homelessness in Thailand: a scoping review.

Introduction: Homelessness is a significant global challenge affecting people worldwide. In Thailand, the health-related issues of people experiencing homelessness have not been a major research focus. This scoping review aims to explore the scope of research on health-related issues among people experiencing homelessness in Thailand. Methods: Eight databases (ACI, AMED, Embase, PsycINFO, PubMed, Scopus, TCI, and Web of Science) were searched from inception of each database to August 2022. The search terms consisted of terms related to people experiencing homelessness in Thailand. Research articles published in Thai or English were included. Results: Of 186 articles, 167 were excluded during duplicate removal (n = 45), title and abstract screening (n = 106), seeking for full-text articles (n = 2), and full-text screening (n = 14). Nineteen articles were included for extraction and synthesis. Three topics (health status, causes of homelessness and effects of homelessness on health, healthcare and social services) were summarised. The included studies described mental health (e.g., depression, suicide, alcohol and drug dependence), physical health (e.g., poor self-hygiene, injuries, accidents), and health behaviours (e.g., alcohol drinking, substance use, unsafe sex). Social behaviours and health problems linked to homelessness, and several factors related to health and living conditions (e.g., stigma, discrimination) were reported. People experiencing homelessness had some barriers to access to healthcare and social services (e.g., health insurance, social welfare, financial difficulties). Conclusions: The majority of studies on health-related issues in people experiencing homelessness in Thailand are descriptive studies. Future studies should focus on the interactions and mechanisms between homelessness and health.

"Like an umbrella, protecting me from the rain until I get to my destination": Evaluating the implementation of a tailored primary care model for urban marginalized populations.

BACKGROUND: Improving health equity and access to the highest possible standard of health care is a key issue of social accountability. Centretown Community Health Centre in Ottawa, Canada has iteratively developed a program to target and serve marginalized and complex populations since 1999. The program implementation was evaluated using a validated implementation framework. METHODS: Quantitative and qualitative data were collected through a health records extraction (n = 570), a client complexity assessment tool (n = 74), semi-structured interviews with clients and key stakeholders (n = 41), and a structured client satisfaction survey (n = 30). Data were analyzed using descriptive statistics and inductive thematic analysis. RESULTS: Five hundred and seventy unique clients were seen between November 1-30, 2021. A third of clients (34%) did not have a provincial health card for access to universal health care services, and most (68%) were homeless or a resident of rooming houses. Most clients who reported their income (92%) were at or below Canada's official poverty line. The total mean complexity score for clients seen over a one-month period (n = 74) was 16.68 (SD 6.75) where a total score of at least 13 of 33 is perceived to be a threshold for client biopsychosocial complexity. Clients gained the majority of their total score from the Social support assessment component of the tool. Clients (n = 31) and key informants (n = 10) highlighted the importance of building relationships with this population, providing wrap-around care, and providing low-barrier care as major strength to the Urban Health program (UH). Key areas for improvement included the need to: i) increase staff diversity, ii) expand program hours and availability, and iii) improve access to harm reduction services. Clients appeared to be highly satisfied with the program, rating the program an average total score of 18.50 out of 20. CONCLUSIONS: The program appears to serve marginalized and complex clients and seems well-received by the community. Our findings have relevance for other health care organizations seeking to better serve marginalized and medically and socially complex individuals and families in their communities.

Remote Parenting in Families Experiencing, or at Risk of, Homelessness: A Study Based on Grounded Theory.

The situation/risk of family homelessness presents multiple interrelated issues. It has considerable negative consequences, namely the deterioration of the family members' health and well-being, and alterations in the family's dynamics, with parents sometimes being separated from their children. The aim of this research was to understand how parenting takes place in families experiencing, or at risk of, homelessness. The conducted study falls within the qualitative paradigm, using Strauss and Corbin's version of the Grounded Theory methodology. Three main categories emerged, supported by all the participating families: "Meaning of Parenthood", "Key Events", and "Transition Circumstances". These categories were translated into facilitating/inhibiting factors, within the following dimensions: "Individual", "Family", and "Society". We were able to conclude that, in the population under study, parenting is restricted, being mostly exerted in a remote manner. Furthermore, it takes on different forms, depending on the specific homelessness situation/risk. In families at risk of homelessness, we identified "Remote Parenting with Maintained Parental Authority", as well as "Restricted Parenting", when the children still lived with their parents. On the other hand, in families experiencing homelessness, we identified "Remote Parenting with Maintained Parental Authority", "Unilateral Remote Parenting", "Interrupted Parenting", and the "Total Disruption of Parenting".

Housing instability patterns among low-income, urban Black young adults in California and associations with mental health outcomes: baseline data from a randomized waitlist-controlled trial.

BACKGROUND: Deep-rooted racial residential segregation and housing discrimination have given rise to housing disparities among low-income Black young adults in the US. Most studies have focused on single dimensions of housing instability, and thus provide a partial view of how Black young adults experience multiple, and perhaps overlapping, experiences of housing instability including homelessness, frequent moves, unaffordability, or evictions. We aimed to illuminate the multiple forms of housing instability that Black young adults contend with and examine relationships between housing instability and mental health outcomes. METHODS: Using baseline data from the Black Economic Equity Movement (BEEM) guaranteed income trial with 300 urban low-income Black young adults (aged 18-24), we conducted a three-stage latent class analysis using nine housing instability indicators. We identified distinct patterns by using fit indices and theory to determine the optimal number of latent classes. We then used multinomial logistic regression to identify subpopulations disproportionately represented within unstable housing patterns. Finally, we estimated associations between housing experience patterns and mental health outcomes: depression, anxiety, and hope. RESULTS: We found high prevalence of housing instability with 27.3% of participants reporting experiences of homelessness in the prior year and 39.0% of participants reporting multiple measures of housing instability. We found the 4-class solution to be the best fitting model for the data based on fit indices and theory. Latent classes were characterized as four housing experience patterns: 1) more stably housed, 2) unaffordable and overcrowded housing, 3) mainly unhoused, and 4) multiple dimensions of housing instability. Those experiencing unaffordable and overcrowded housing and being mainly unhoused were more than four times as likely to have symptoms of depression (Unaffordable: aOR = 4.57, 95% CI: 1.64, 12.72; Unhoused: aOR = 4.67, 95% CI:1.18, 18.48) and more than twice as likely to report anxiety (Unaffordable: aOR = 2.28, 95% CI: 1.03, 5.04; Unhoused: aOR = 3.36, 95% CI: 1.12, 10.05) compared to the more stably housed pattern. We found that hope scores were similarly high across patterns. CONCLUSIONS: High prevalence of housing instability and mental health challenges among low-income Black young adults demands tailored interventions to reduce instability, given widening racial disparities and implications for future well-being into adulthood.

Social isolation and loneliness among people living with experience of homelessness: a scoping review.

Social isolation and loneliness (SIL) are public health challenges that disproportionally affect individuals who experience structural and socio-economic exclusion. The social and health outcomes of SIL for people with experiences of being unhoused have largely remained unexplored. Yet, there is limited synthesis of literature focused on SIL to appropriately inform policy and targeted social interventions for people with homelessness experience. The aim of this scoping review is to synthesize evidence on SIL among people with lived experience of homelessness and explore how it negatively impacts their wellbeing. We carried out a comprehensive literature search from Medline, Embase, Cochrane Library, PsycINFO, CINAHL, Sociological Abstracts, and Web of Science's Social Sciences Citation Index and Science Citation Index for peer-reviewed studies published between January 1st, 2000 to January 3rd, 2023. Studies went through title, abstract and full-text screening conducted independently by at least two reviewers. Included studies were then analyzed and synthesized to identify the conceptualizations of SIL, measurement tools and approaches, prevalence characterization, and relationship with social and health outcomes. The literature search yielded 5,294 papers after removing duplicate records. Following screening, we retained 27 qualitative studies, 23 quantitative studies and two mixed method studies. SIL was not the primary objective of most of the included articles. The prevalence of SIL among people with homelessness experience varied from 25 to 90% across studies. A range of measurement tools were used to measure SIL making it difficult to compare results across studies. Though the studies reported associations between SIL, health, wellbeing, and substance use, we found substantial gaps in the literature. Most of the quantitative studies were cross-sectional, and only one study used health administrative data to ascertain health outcomes. More studies are needed to better understand SIL among this population and to build evidence for actionable strategies and policies to address its social and health impacts.

Maternity and motherhood in street situation: integrative review. / Maternidade e maternagem em situação de rua: revisão integrativa.

The objective was to identify through integrative review the approach on maternity and motherhood in street situation. This is an integrative review performed in the databases PubMed, BIREME, Medline, and SciELO search portal, in Portuguese, English and Spanish. The survey was conducted between October and December 2021, following the recommendations of the Prisma flowchart and support of the Mendeley software, submitted to content analysis by Minayo. Eighteen articles were selected. The reading allowed the identification of two thematic categories: "Maternity and mothering in the streets" and "Main challenges experienced in maternity and mothering in street situation". Address about motherhood and mothering as a field of knowledge production creates a tension of the social constructions that do not have effecting rights for lack of programs and forceful intersectoral policies. In addition to the stigmatization for use of psychoactive substances, as well as the patriarchal structure attributed to motherhood. The responsibility for care entails several issues that cross the motherhood and mothering in the streets, namely: concern with the health of children, the fear of losing custody of their loved ones.

Objetivou-se identificar através da revisão integrativa a abordagem sobre a maternidade e maternagem em situação de rua. Trata-se de uma revisão integrativa realizada nas bases de dados PubMed, BIREME, Medline, e portal de buscas SciELO, em português, inglês e espanhol. A pesquisa foi realizada entre os meses de outubro a dezembro de 2021, seguindo às recomendações do fluxograma Prisma e suporte do software Mendeley, submetidos à análise de conteúdo de Minayo. Foram selecionados 18 artigos. A partir da leitura foi possível identificar duas categorias temáticas: "Maternidade e maternagem nas ruas" e "Principais desafios vivenciados na maternidade e maternagem em situação de rua". Abordar sobre a maternidade e maternagem enquanto um campo de produção de saberes cria-se um tensionamento das construções sociais que não possuem efetivação de direitos por falta de programas e políticas intersetoriais contundentes. Além da estigmatização por uso de substâncias psicoativas como também a estrutura patriarcal atribuída à maternidade. A responsabilidade pelo cuidado acarreta diversas questões que atravessam a maternidade e maternagem nas ruas, são elas: preocupação com a saúde dos filhos, a criação da prole, bem como, o temor pela perda da custódia de seus entes.

Beyond the margins: antenatal health and healthcare behaviours among homeless women in Kolkata Municipal Corporation, India.

Despite high childbearing rates among homeless women in India, the antenatal health and healthcare behaviours among such population remain poorly understood. To address this research gap, a mixed-methods approach was employed in the present study, involving interviews with a sample of 400 women aged 15-49 years, utilising time and location sampling techniques. Additionally, a purposeful sample of 52 women from the same age group participated in in-depth interviews. The respondents exhibited rampant socio-economic backwardness, including chronic homelessness (36%), no formal education (54%), engagement in rag picking (31%), and low income levels. About 56% of the women reported poor self-rated health (SRH), notably higher among those aged 35 and above and those living alone (68%). Poor SRH was also prevalent among the ever married (61%), ragpickers (61%), beggars (62%), chronic homeless individuals (62%), tobacco (60%) and alcohol consumers (61%), and those with chronic diseases (61%). Common health issues included depression or anxiety (56%) and iron deficiency anaemia (35%). The level of unmet healthcare needs was 41%, with significant variation across diseases. Lack of reproductive health rights and awareness, socio-cultural beliefs, stigma, socio-economic poverty, poor quality of public healthcare services, irregularity in charity-run healthcare, and time constraints hindered antenatal care visits. The study underscores the urgent need for population-centric programmes and policies aimed at promoting reproductive health to achieve Sustainable Development Goal 3 of 'Good health and wellbeing' by 2030.

Health status and self-perception of health among homeless people in Spain: a mixed-methods study.

Introduction: Homelessness is a phenomenon of social exclusion and poverty that has increased alarmingly during recent years. Homeless people (HP) experience violations of several basic human rights or needs that impact their well-being. Therefore, the aim of this research was to assess the health status and self-perceived health of HP and examining the impact of homelessness on their health. Methods: We used an explanatory sequential mixed-methods approach that integrated a quantitative cross-sectional study within critical social and ethno-sociological qualitative frameworks. Data were collected in Palma, Spain, from December 1, 2020, to January 1, 2023. A total of 198 HP were recruited from the streets and public areas. Basic human needs (Virginia Henderson model), medical diagnoses, substance abuse (DAST-10), diet quality (IASE), depression (PHQ-9), and social support (SSQ-6) were assessed. Then, 17 semi-structured interviews were conducted and were analyzed using thematic content and discourse analysis. Quantitative and qualitative data were integrated and jointly analyzed. Results: The 79.3% of the participants were men, mean age of 47.8 ± 12.2 years. The 76.4% were Spanish. The participants reported severe difficulties in accessing the labor market, and that this greatly affected their self-esteem and mental health. The 48.9% of the participants suffered from one or more chronic diseases, and 50.3% were diagnosed with a mental health disorder. The participants generally did not consider health problems as a central concern. The health needs that most affected the participants were related to food, safety, and social support. HP frequently felt unsafe, fearfully, and anxious. Conclusion: Homelessness, unemployment, and social exclusion have significant negative impacts on the health and wellbeing of HP. Precarious work conditions and deficiencies in the welfare system contribute significantly to homelessness. These results highlight the need for systemic solutions that extend beyond short-term housing initiatives.

Homes of substance: Drugs and the making of home/lessness for 2S/LGBTQ+ youth.

Two-Spirit, lesbian, gay, bisexual, transgender, queer, and other sexual minority (2S/LGBTQ+) youth between the ages of 14 and 29 experience inequities in homelessness and substance use. Research in this area has explored substance use as a determinant of homelessness and/or as a coping mechanism, yet far less attention has been directed to the potentially generative role of drugs in this marginalizing context. This community-based photovoice study leverages data from 61 semi-structured interviews with 32 2S/LGBTQ+ youth experiencing homelessness and unstable housing to examine how drugs shape their practices and contexts of homemaking. Analysis followed a reflexive thematic approach and was informed theoretically by perspectives on home- and place-making, a momentum-stagnation analytical frame, and a narcofeminist ethics of care. This framing centred attention on the possibilities of what drugs can do for 2S/LGBTQ+ youth in terms of shaping selves, homes, and worlds while homeless. We inductively derived three themes: (i) chasing comforts, (ii) striking down stagnation, and (iii) producing precarity. 2S/LGBTQ+ youth consumed substances in chasing comforts including warmth, relief, and a sense of clarity and being more at ease within the context of homelessness and social and material inequity. Their substance use was also a means for striking down stagnation and engendering momentum as they worked to carve out better homes and futures for themselves. Youth frequently drew attention to the temporality and limits of these benefits, however, cautioning that drugs could also turn to producing new forms of precarity that limited what they expected and experienced as possible with respect to their homemaking projects. Findings highlight the generative potential of drugs in the making of home/lessness and provide critical direction for policy and service delivery, including for supports to further consider and attend to the social contexts, meanings, and effects of 2S/LGBTQ+ youths' substance use in connection with homelessness.

Are social supports always protective? A seven-city study on heavy drinking among sexual and gender minority young adults experiencing homelessness.

PURPOSE: Sexual and gender minority (SGM) young adults are disproportionately impacted by homelessness and heavy drinking (i.e., having five or more drinks of alcohol in a row within a couple of hours). Social support, in general, is protective in reducing individuals' risk of heavy drinking. However, whether and how support from different sources may have different implications on heavy drinking among SGM young adults experiencing homelessness (SGM-YAEH) remains unclear. Informed by the risk amplification and abatement model (RAAM), this study examined the associations between support sources and heavy drinking among SGM-YAEH. METHODS: A purposive sample of SGM-YAEH (N=425) recruited in homeless service agencies from seven major cities in the U.S. completed a self-administered computer-assisted anonymous survey. This survey covered heavy drinking behaviors and social network properties. Logistic regression models were conducted to identify social support sources associated with SGM-YAEH's heavy drinking. RESULTS: Over 40 % of SGM-YAEH were involved in heavy drinking in the past 30 days. Receiving support from street-based peers (OR=1.9; 95 % CI=1.1, 3.2) and home-based peers (OR=1.7; 95 % CI=1.0, 2.8) were each positively associated with SGMYAEH heavy drinking risks. CONCLUSION: This study was not able to identify the protective role social supports may play in reducing SGM-YAEH's heavy drinking. Furthermore, receiving support from network members was correlated with elevated heavy drinking risks among this population. As heavy drinking prevention programs develop interventions: they should use affirming and trauma approaches to promote protective social ties, as research points to its association in reducing alcohol use disparities among SGM-YAEH.

Why some homeless individuals are unsheltered: A narrative review of self-reported reasons.

The rising rate of unsheltered homelessness is a troubling and important public health issue. This narrative review sought to answer the question: What are the reasons that homeless individuals report for being unsheltered? To identify studies, systematic search methods were applied to PubMed, Google Scholar, and PsycINFO databases using the following eligibility criteria: English-written, peer-reviewed studies published from 2000 to 2023 that reported qualitative or quantitative data related to reasons why homeless individuals in a Western country were unsheltered. After duplicates were removed, 14,690 studies were screened and filtered to 10 final studies that fit all eligibility criteria and were included in the review. Eight of the 10 studies reported qualitative data from interviews and focus groups; the two quantitative studies reported data from interviewer-administered surveys. Across studies, eight thematic categories were identified as barriers to staying in shelters or other sheltered locations: lack of safety, triggers for substance use, strict shelter rules, triggers for substance use, perceived inadequate care, unsanitary conditions, required treatment to participate in housing program, no pet or family accommodations, and lack of accessibility for individuals with disabilities. Together, these findings indicate the delicate balance needed in homeless shelters to have both an inclusive/permissive and structured/safe environment for homeless individuals. Attention to the design and operation of homeless shelters, as well as staff training and accommodation for clients with special needs may improve some of these issues.

Stressful Life Events Among Women Suffering Homelessness and Prostitution in Spain.

The aim of the study was to analyze the differences in suffering stressful life events (SLE) among women experiencing homelessness who had or had not been in prostitution. Data were collected from a sample of 135 women experiencing homelessness in Madrid. A total of 81% of the women interviewed had never been in prostitution, while 19% had been in prostitution at some point in their lives. Participants were recruited from shelters, drop-in centers, and public spaces. The information was collected using a structured interview. The results showed that women experiencing homelessness who had been in prostitution suffered a greater number of SLE, both in childhood and adolescence and throughout life. The interviewed who had been in prostitution were between two and nine times more likely to have experienced during their childhood and adolescence violence in their family, as well as to have run away from home, experienced abuse, attempted suicide, and used drugs excessively. Furthermore, during their lifetime, the interviewed who had been in prostitution were between two and four times more likely to suffer from serious physical and mental health issues, excessive alcohol consumption, intimate partner violence, physical violence from others, suicide attempts, police reporting, and unwanted pregnancies. Additionally, they were four to six times more likely to have been sexually assaulted or convicted/imprisoned for a crime, seven times more likely to have been arrested, and a striking 32 times more likely to have used drugs excessively.