Correction: The impact of pet ownership on healthcare access and utilization among people with HIV.

[This corrects the article DOI: 10.1371/journal.pone.0292658.].

Pet ownership is associated with harmful alcohol use among a cohort of people with HIV: a brief research report.

Research suggests that people with HIV (PWH), who are at high risk for alcohol and substance use, may rely on relationships with pets for companionship and stress relief. There may be common mechanisms underlying both substance use and attachment to pets. The purpose of this brief research report was to compare alcohol and substance use behaviors between pet owners and non-owners among a cohort of PWH. Participants (n = 735) in a survey study of PWH in Florida were asked about their alcohol and substance use behaviors, whether they owned a pet, and their sociodemographic characteristics. We used bivariate analyses and logistic regression to examine differences in alcohol and substance use behaviors between pet owners and non-owners. Pet owners had higher mean AUDIT scores than non-owners (Mpet = 5, Mnopet = 4, z = -3.07, p = 0.002). Pet owners were more likely than non-owners to use alcohol in a harmful or hazardous way (AUDIT score ≥ 8), above and beyond sociodemographic characteristics (OR = 1.65, p = 0.052). Pet owners were more likely to have ever used most substances than non-owners, and more likely to currently use alcohol (X2(1) = 12.97, p = 0.000), marijuana or hashish (X2(1) = 6.82, p = 0.009), and amyl nitrate/poppers (X2(1) = 11.18, p = 0.001). Pet owners may be more likely to use alcohol and other substances at higher rates than non-owners. Reasons for owning a pet and using substances may be similar, such as coping with stress.

The impact of pet ownership on healthcare access and utilization among people with HIV.

Though bonds with pets can be health-promoting for people with HIV (PWH), recent studies indicate that owning pets may complicate healthcare access, especially for those with fewer economic resources, poorer social support, and a strong human-animal bond. In this study, we make a case for considering pets to be an important element of the social environment that can influence healthcare access and utilization among PWH. Pet-owning PWH (n = 204) were recruited at healthcare and community sites throughout Florida as part of a larger survey study (the "Florida Cohort"). We developed a 12-item index of pet-related barriers to healthcare, which was designed to assess whether the participants experienced or anticipated any barriers to accessing and/or utilizing timely healthcare or health-related services due to pet caregiving or concerns about pet welfare. We estimated a series of regression models (negative binomial, logistic regression) to assess the effects of comfort from companion animals, human social support, healthcare needs, and sociodemographic characteristics on 1) the total number of pet-related healthcare barriers endorsed, 2) previously experienced pet-related healthcare barriers, and 3) anticipated pet-related healthcare barriers. Thirty-six percent of the sample reported at least one experienced or anticipated pet-related barrier to their healthcare; 17% reported previous healthcare barriers and 31% anticipated future healthcare barriers. Greater comfort from companion animals, greater healthcare needs, and poorer social support were associated with a greater probability of experiencing or anticipating any pet-related healthcare barriers. Those who identified racially as Black were less likely to anticipate future healthcare barriers than those who were White. Income was associated with pet-related healthcare barriers in all models. Given the importance of health maintenance for PWH and previous research suggesting pets may be an important emotional support for this population, social safety net programs and community partnerships that support multispecies families are strongly recommended.

"Whoever takes the dog gets the house": How older adults negotiate, budget, and deploy resources for multispecies family health and well-being.

In this study, we interrogate the ways that older adult pet owners exercise their agency within the limits of their social statuses to allocate their resources for the management of the health needs of their multispecies families. Guided by fundamental cause theory, we consider how the participants' memberships in socially constructed categories can impact their experiences with household health management. We conducted focus groups with 30 community-dwelling older adults who owned pets. Using a thematic analytic approach, we found that the participants' bonds with their pets led them to negotiate priorities and make concessions for the benefit of the household.

Longitudinal associations between allostatic load, pet ownership, and socioeconomic position among U.S. adults aged 50.

It is hypothesized that pets provide benefits to human health by buffering the deleterious effects of stress, but varying exposure to chronic stress via social position is rarely considered in these conceptual and empirical models. Allostatic load is an index of biological and physical measures that represents cumulative wear and tear on the body via chronic stress exposure. In this study, we use the 2006-2016 waves of the Health and Retirement Study, a nationally representative, longitudinal panel survey of adults aged 50+ in the United States, to test whether and to what extent pet ownership has an impact on allostatic load, and whether pet ownership moderates the effects of socioeconomic position on allostatic load. Linear mixed effects regression models revealed that pet owners had significantly lower allostatic load scores than those who do not own pets; however, after adjusting for socioeconomic position (i.e., wealth, education, race, ethnicity, gender, marital status), the effect of pet ownership was no longer significant. We estimated a series of models stratified by sociodemographic groups to test moderation effects. Among those who had a high school education, pet owners had lower allostatic load scores, whereas among those who had attended some college, pet owners had higher scores. Among those who were aged 80+, pet owners had higher scores than those who did not own pets. These findings suggest that the magnitude of the effect of pet ownership on allostatic load may not be sufficient to counteract experiences of high chronic stress as experienced by lower-status groups. Supporting the human-animal bond may contribute to improving older adult population health if paired with efforts to address the underlying causes of population health disparities.

The Impact of Sustained Ownership of a Pet on Cognitive Health: A Population-Based Study.

Objectives: To examine associations between sustained ownership of a pet and cognitive outcomes among a national sample of U.S. adults. Methods: Weighted linear mixed models were estimated using the Health and Retirement Study (2010-2016, n = 1369) to compare repeated measures of cognitive function between respondents who endorsed owning a pet in a sustained manner (>5 years), versus those who owned a pet ≤5 years, and non-pet owners. Results: Respondents aged 65+ who owned a pet >5 years demonstrated higher composite cognitive scores, compared to non-pet owners (ß = .76, p = .03). Sustained pet ownership was associated with higher immediate (ß = .3, p = .02) and delayed (ß = .4, p = .007) word recall scores. There were no significant differences in cognitive scores between pet owners and non-owners aged < 65. Discussion: Sustained ownership of a pet could mitigate cognitive disparities in older adults. Further studies are needed to examine potential causal pathways, including physical activity and stress buffering, versus selection effects.

Positive Engagement with Pets Buffers the Impact of Intimate Partner Violence on Callous-Unemotional Traits in Children.

Childhood exposure to intimate partner violence (IPV) is associated with serious psychological outcomes including increased odds of developing callous-unemotional (CU) traits and behaviors. Recent studies suggest that concomitant exposure to animal cruelty (AC) may increase this risk. However, even under these circumstances, bonds with companion animals may still be a protective factor that buffers the deleterious impact of IPV on child adjustment. This cross-sectional study evaluates whether, and to what extent, the association between exposure to IPV and children's CU and empathic-prosocial (EP) traits vary as a function of children's positive engagement with pets and exposure to AC. Participants included 204 children (aged 7-12 years; 57% Latinx) and their maternal caregiver who were recruited from domestic violence agencies in a western US state. We conducted multiple moderation analyses to evaluate each outcome individually (i.e., CU traits, EP traits), adjusting for the effects of child age, gender, and Hispanic ethnicity. Positive engagement with pets significantly moderated the relationship between IPV and CU traits, ∇R = 0.03, F (1, 195) = 7.43, ß = -0.17, t(195) = -2.73, p = .007. Specifically, when high levels of positive engagement with pets is present, IPV is negatively associated with CU traits, whereas the reverse was true at low levels of positive engagement with pets. Evidence of moderation by AC was not supported. Our findings suggest that children who form close relationships with their pets in the context of IPV appear to derive important support from these animals; safeguarding the well-being of these animals may be critical to their long-term emotional health.

Pet-Friendly for Whom? An Analysis of Pet Fees in Texas Rental Housing.

Previous studies have underscored the difficulty low-income pet owners often face when attempting to secure affordable rental housing. Further exacerbating this housing disparity are fees charged on top of normal monthly rent to pet owners in "pet-friendly" rental housing. In this study, we aggregated rental housing listings from the twenty most populous cities in Texas, USA from a popular online rental database. We paired the rental listings with census tract information from the American Community Survey in order to investigate economic and racial/ethnic patterns in the spatial distribution of the properties. We find that less expensive pet-friendly listings were more likely to have pet fees charged on top of rent than rental units that were more expensive. Additionally, when pet fee burden was defined as a function of average income by census tract, low-income communities and communities of color were more likely than higher income and predominantly White communities to pay disproportionately higher fees to keep pets in their homes. We also find patterns of spatial inequalities related to pet fee burden by a metric of income inequality by city. The burden of pet rental fees may contribute to both housing insecurity and companion animal relinquishment. We discuss these findings as they relate to inequalities in housing, with particular attention to marginalized and disadvantaged people with pets. We conclude with recommendations for policy and practice.

The Impact of Pet Care Needs on Medical Decision-Making among Hospitalized Patients: A Cross-Sectional Analysis of Patient Experience.

Hospital-based protocols to support pet care needs for hospitalized patients may have potential to benefit patient health and wellbeing, but must be informed by experiences of hospitalized pet owners. The aim of this study was to determine the scope and need for pet care services among hospitalized patients. A panel of prior inpatients and their family members at a tertiary care center were surveyed about preferences, experiences, and need for assistance with pet care during hospitalization. Respondents (n = 113) expressed interest in a low/no-cost pet-boarding or foster program for adult patients struggling to find pet care assistance. The majority of respondents (n = 71; 63%) reported challenges securing pet care during a prior hospitalization, and/or knew someone who encountered similar challenges. Respondents also indicated that these challenges had a negative impact on health, recovery, or their own decision to receive medical care. Pet care challenges during hospitalization are likely common and have the potential to hamper medical decision-making and health outcomes of inpatients.

Human-Animal Interaction and Perinatal Mental Health: A Narrative Review of Selected Literature and Call for Research.

There is a paucity of research exploring how relationships with household pets may impact maternal mental health. We are unaware of any study to date that has examined associations between individuals' relationships with their pets and psychological adjustment in the perinatal period. Using a biobehavioral lens, this paper provides a narrative overview of the literature on perinatal mental health and human-animal interaction (HAI). We focus on the role of social relationships, stress, and stress reduction in relation to perinatal mental health; the role of HAI in perceptions of social support, stressors, and stress reduction; and gaps in empirical knowledge concerning the role of HAI in perinatal mental health. Finally, we integrate contemporary biobehavioral models of perinatal mental health and HAI (i.e., Comprehensive Model of Mental Health during the Perinatal Period and the HAI-HPA Transactional Model) to propose a new conceptual framework that depicts ways in which HAI during the perinatal period may influence maternal and child health and wellbeing. To our knowledge, this is the first paper to consider the role of HAI in biobehavioral responses and mental health during the perinatal period. We conclude with recommendations for future research and improved perinatal care.

Love, fear, and the human-animal bond: On adversity and multispecies relationships.

Love and strong social bonds are known buffers in the experience of adversity. Humans often form strong bonds with non-human animals. The human-animal bond refers to a mutually beneficial and dynamic relationship between humans and non-human animals. Previous research suggests that strong bonds with pets may promote resilience in the experience of adversity, but a strong bond with a pet can also complicate this very experience of adversity, particularly among low-resourced and disadvantaged populations. What is the role of the human-animal bond in adversity, and what is the role of adversity in the bond between a human and a non-human animal? In this article we outline the state of research on the role of various types and sources of adversities in multispecies households (i.e., families, relationships) to consider this overarching question. We focus specifically on intimate partner violence, housing discrimination, LGBTQ+ identity-based discrimination, racism, neighborhood disadvantage, and economic inequality. We then outline an agenda for future research about love, adversity, and multispecies relationships, and discuss implications for public policy and community-based interventions.

Child and Pet Care-Planning During COVID-19: Considerations for the Evolving Family Unit.

OBJECTIVE: Using a mixed-methods design, we aimed to understand household dynamics and choices in hypothetical planning for child and pet care if an individual is faced with hospitalization for COVID-19. BACKGROUND: As the COVID-19 public health crisis persists, children and pets are vulnerable to caregiver hospitalization. METHODS: Bivariate associations from a large-scale survey explore hypothetical options for dependent care-planning. An open-ended question regarding pet-child interactions is coded applying a grounded theory framework. RESULTS: Caregivers expect to rely on family and friends to care for children, especially young children, and pets if hospitalized. The presence of pets in the home has been predominately positive for children during the pandemic, suggesting benefits of alternative care options that keep children and pets together. CONCLUSIONS: Relying on one's social network to care for dependents if caregivers become ill from COVID-19 could place loved ones at risk for contracting the virus, which could present obstacles to arranging care plans, especially inclusive of pets and children. IMPLICATIONS: The changing information regarding COVID-19 warrants that families establish concrete care plans for dependent children and pets. The spread of COVID-19 to the most vulnerable, such as grandparents and other family who may be expected to care for dependents, could create additional public health concerns.

The Impact of Pets on Everyday Life for Older Adults During the COVID-19 Pandemic.

Purpose: The social and behavioral health of older adults is of particular concern during the COVID-19 pandemic. It is estimated that at least 50% of older adults in the U.S. have pets; while pets may be a source of support, they could also pose unique challenges during an already trying time. We aimed to investigate how pets impacted the everyday lives of older adults in the early stages of the COVID-19 pandemic. Methods: A large survey of U.S. pet owners (n = 2,068) was administered to assess the impact of relationships with pets during COVID-19 on human health and well-being. We conducted bivariate analyses to compare levels of social support, loneliness, pet attachment, and family income for a subset of older adults (ages 65 and older) with a younger comparison group (ages 18-64). Using thematic and content analysis, we analyzed two open-ended prompts from age 65+ respondents (n = 122): (1) the pros and cons of living with pets during the pandemic, and (2) advice for those living with pets in future pandemics. Results: Older adults, on average, reported lower levels of social support and less loneliness than respondents below age 65. There were no significant differences in strength of attachment to pets nor income between the younger and older respondents. For the open-ended prompt regarding pros and cons, we coded three emerging themes and related sub-themes: (1) pros (company; more time together; life purpose or meaning; love; support; stress relief; routine; distraction; exercise), (2) cons (general worry; potential for illness; limited participation; veterinary care access; obtaining supplies; difficulty meeting pet needs; financial concerns), and (3) no difference. Advice shared was coded into 13 themes/sub-themes: pets' health and welfare; make plans; veterinary information; treat pets like family; don't abandon pets; human health and well-being; stay calm; enjoy pets; keep routine; be careful of transmission; seek community resources; keep supplies stocked; and finances. Conclusions: Pets may fulfill some social and emotional needs for older adults during this particularly isolating event; equally important to consider are the challenges that may be precipitated by and/or exacerbated by this public health emergency.

Attachment to Pets Moderates Transitions in Latent Patterns of Mental Health Following the Onset of the COVID-19 Pandemic: Results of a Survey of U.S. Adults.

This cross-sectional study examined whether, and to what extent, attachment to pets was associated with changes in latent patterns of adults' perceived mental health symptoms during the COVID-19 pandemic (n = 1942). We used latent transition analysis to determine the stability of subgroup membership pre- and post-COVID and the effect of attachment to pets on transition probabilities. Mental health before COVID-19 was measured retrospectively. Five subgroups were identified: low symptoms, mild symptoms, moderate symptoms, high symptoms, and severe symptoms. Among individuals in the moderate and high symptoms subgroups, those who reported high attachment to pets generally had greater odds of transitioning to a less severe symptom profile (OR = 2.12) over time than those with low attachment to pets (OR = 1.39). However, those who had a severe symptom profile and high attachment to pets had lower odds of transitioning to a less severe symptom profile (OR = 0.30) and higher odds of maintaining a severe symptom profile (OR = 3.33) than those with low attachment to pets. These findings suggest that the protective and risk effects of attachment to pets differ based on individuals' psychological symptom patterns across multiple indicators. We discuss the implications of these findings for research, policy, and practice.

How pets factor into healthcare decisions for COVID-19: A One Health perspective.

There is evidence that prioritizing pets' welfare can impact the health and well-being of their owners, especially when pet owners have a strong bond with their pet. This carries public health implications, particularly in a global public health emergency such as COVID-19. The study objective was to understand pet owners' consideration of their pets' welfare when making personal healthcare decisions specific to COVID-19. A large sample (n = 1356) of adult pet owners in the U.S. completed an online survey in April and May of 2020, coinciding with the onset of social distancing measures to prevent the spread of COVID-19. Respondents were asked if they would delay or avoid testing or treatment for COVID-19 due to concern for their pets' welfare, and a follow-up question asked them to elaborate. Multinomial logistic regression models showed that attachment to pets and socioeconomic resources were important factors in pet owners' hypothetical decisions regarding testing and treatment for COVID-19. Qualitative analysis of responses to the follow-up question revealed explanations across three themes: (1) the need to find pet accommodation prior to seeking healthcare; (2) pet-related concerns; and, (3) human-related concerns. Pet owners often cited concern for their pets' welfare as a factor contributing to their decision making; participants' lack of a concrete plan for pet care was most commonly cited as the reason for their delay in seeking healthcare. Results from this study indicate that pet owners experience unique obstacles to accessing healthcare related to COVID-19, which has implications for future public health emergencies. Increased disease spread and prevalence of poor health outcomes could result if pet owners delay or avoid testing or treatment. Communities can benefit from a One Health/One Welfare approach to collaboration between human and animal health and service providers to reduce COVID-19 spread and secure the well-being of people and their pets.

The Concerns, Difficulties, and Stressors of Caring for Pets during COVID-19: Results from a Large Survey of U.S. Pet Owners.

Pets may be a positive presence for their owners during the Coronavirus Disease 2019 (COVID-19) pandemic. However, it is pertinent to identify the hardships associated with pet ownership. We conducted a large-scale survey of U.S. pet owners (n = 2254) in spring and summer 2020 to assess the ways that relationships with pets impacted life during COVID-19. We used thematic analysis to analyze 3671 open-ended responses to three prompts. Reported concerns fell into three major categories: (1) pet-focused (meeting needs of pets; procuring supplies; accessing veterinary care; new and emerging behavioral issues; fate of the pet if owner becomes ill; general safety and well-being), (2) human-focused (issues with working from home; well-being and mental health; balancing responsibilities), and (3) household-focused (disease spread; economic issues). Quantitative analyses showed that the owner's strength of attachment to their pet, economic resources, and relationship status were associated with the types of concerns expressed. Results from this study indicate that pet owners experienced unique hardships related to changes in everyday life from the COVID-19 pandemic. These hardships should be considered alongside the potential benefits found in other studies in order to manage pet owner expectations, prevent pet relinquishment, and more fully understand multifaceted human-companion animal relationships.

Animal cruelty as an indicator of family trauma: Using adverse childhood experiences to look beyond child abuse and domestic violence.

Youth who engage in animal cruelty are known to be at increased risk of perpetrating violence on other people in their lives including peers, loved ones, and elder family members. These youths have often been exposed to family violence, including animal cruelty perpetrated on their beloved pets by violent adults. The current study utilizes a data set of 81,000 juvenile offenders whose adverse childhood experiences are known and includes 466 youth who self-report engaging in animal cruelty. Compared to the larger group of juvenile offenders, the children admitting to engaging in animal cruelty are younger at time of first arrest, more likely to be male, and more likely to be White. When looking at their reports of adverse childhood experiences (ACEs), they are more likely than other juvenile offenders to have an array of adverse experiences beyond family violence and to have four or more ACEs. Although the youth who are cruel to animals are already troubled, the fact that they present to law enforcement at early ages provides early opportunities for intervention. Service providers outside the law enforcement field, such as teachers, physicians, veterinarians and animal control officers may be able to identify these vulnerable youth, and refer them to needed services before violence is visited on other humans.

Factors that Influence Intake to One Municipal Animal Control Facility in Florida: A Qualitative Study.

This qualitative study identified a study area by visualizing one year of animal intake from a municipal animal shelter on geographic information systems (GIS) maps to select an area of high stray-dog intake to investigate. Researchers conducted semi-structured interviews with residents of the selected study area to elucidate why there were high numbers of stray dogs coming from this location. Using grounded theory, three themes emerged from the interviews: concerns, attitudes, and disparities. The residents expressed concerns about animal welfare, personal safety, money, and health. They held various attitudes toward domestic animals in the community, including viewing them as pets, pests, or useful commodities (products). Residents expressed acceptance as well as some anger and fear about the situation in their community. Interviewees revealed they faced multiple socioeconomic disparities related to poverty. Pet abandonment can result when pet owners must prioritize human needs over animal needs, leading to increased shelter intake of stray dogs. Community-specific strategies for reducing local animal shelter intake should address the issue of pet abandonment by simultaneously targeting veterinary needs of animals, socioeconomic needs of residents, and respecting attitude differences between residents and shelter professionals.