Females and Housing First: An analysis of 18-month outcomes in a randomized controlled trial.

The main objective of this research was to qualitatively examine the impacts of Housing First (HF) specifically on those participants who identified themselves as female in response to question asking what their gender was. The data analyzed are from a larger, muti-site, randomized controlled trial. χ2 analysis was used to compare the life changes (coded as positive, neutral, or negative) experienced by 64 females (42 HF and 22 TAU). An in-depth qualitative analysis was conducted on 45 of these participants (23 HF and 22 TAU). Significantly more female HF participants reported making positive life changes from baseline to 18-month than those in TAU. Relative to females in TAU, female HF participants reported a number of specific positive changes, including enhanced safety, improved recovery in mental illness, greater reductions in drug use, and individual changes. The implications of findings for strengthening HF programs to meet the unique needs of female participants are discussed.

Prevalence of Problem Gambling Among Women Using Shelter and Drop-in Services.

People experiencing poverty/homelessness have higher rates of problematic gambling than the general population. Yet, research on gambling among this population is sparse, notably among women. This study examined prevalence of problematic gambling among women using shelter and drop-in services in Ontario, Canada. The NORC Diagnostic Screen for Disorders was administered to women during visits to 15 sites using time/location methodology. Within a sample of 162 women, the prevalence of at-risk (6.2%), problem (9.3%), and pathological gambling (19.1%) was higher than the general population. Among women who scored at-risk or higher, 55.4% met criteria for pathological gambling. The findings suggest that women seeking shelter and drop-in services are vulnerable to problematic gambling. Creating awareness of this vulnerability within the shelter and drop-in service sector is an important first step to support women with gambling problems who face financial and housing precarity.

Associations of resilience with quality of life levels in adults experiencing homelessness and mental illness: a longitudinal study.

BACKGROUND: Homelessness constitutes a traumatic period that adversely impacts health and quality of life outcomes. The potential mitigating effects of resilience on quality of life levels in people experiencing homelessness are underresearched. This study assesses the longitudinal associations between resilience and quality of life scores among adults experiencing homelessness and mental illness. METHODS: This study is a secondary analysis of longitudinal data collected over 6 years from participants (N = 575) of the At Home/Chez Soi study on Housing First, Toronto site. Repeatedly measured resilience scores are the primary exposure and repeatedly measured global quality of life scores and mental health-specific quality of life scores are the primary outcomes. Mixed effect models were used to assess the association between the exposures and the outcomes. RESULTS: The majority of the participants were men (69.2%) and were on average 40.4 (± 11.8) years old at baseline. The average resilience score ranged between 5.00 to 5.62 over 8 data collection points across the 6-year follow-up period. After adjusting for gender, age, ethno-racial background, Housing First intervention, physical and mental comorbidities, and lifetime homelessness, higher resilience scores were positively associated with higher Global quality of life (Adjusted-coefficient: 0.23, 95% CI 0.19-0.27) and mental health-related quality of life values (Adjusted-coefficient: 4.15, 95% CI 3.35-4.95). CONCLUSION: In homeless adults with mental illness, higher resilience levels were positively associated with higher global and mental health related quality of life values. Further interventions and services aimed to enhance resilience mechanisms and strategies are warranted to enhance better mental health and quality of life outcomes of this population group. TRIAL REGISTRATION: At Home/Chez Soi trial was registered with ISRCTN, ISRCTN42520374. Registered 18 September 2009, http://www.isrctn.com/ISRCTN42520374.

Longitudinal interrelationships of mental health discrimination and stigma with housing and well-being outcomes in adults with mental illness and recent experience of homelessness.

RATIONALE: Stigma and discrimination are negatively associated with social and health status. People who are homeless often experience systemic stigma and discrimination. OBJECTIVE: In this study, we analyze the longitudinal interrelationships between the trajectories of housing (housing stability) and well-being outcomes (i.e., recovery, quality of life, and community functioning) and the trajectories of discrimination and stigma in a sample of adults with mental illness and recent experiences of homelessness in Toronto, Canada. We also examined the effect of the Housing First (HF) intervention on these interrelationships. METHOD: The Group-Based Trajectory Model was used to estimate the interrelationship (or intersections) between discrimination and stigma with housing stability, recovery, quality of life, and community functioning in 274 participants of the At Home/Chez Soi, phase 2, Toronto site randomized trial over a two-year follow-up period. RESULTS: Three distinct trajectory groups were observed for discrimination (Low,Moderate decrease, and moderate increase), stigma (Low, Moderate, and High), recovery (Low, Moderate, and High), and the quality of life (Low, Moderate, and High). Two-trajectory groups (Low and High) were identified for housing stability and community functioning. The analyses showed that the trajectory groups for discrimination and stigma are strongly and contemporaneously interrelated with thetrajectory groups for housing stability, recovery, quality of life, and community functioning ability. The HF intervention had a mitigating effect on the changes across select trajectory groups, particularly for members of the Low and High discrimination and stigma trajectories group. CONCLUSION: Persistent mental health-related discrimination and stigma trajectories are longitudinally and contemporaneously interrelated with housing and well-being outcomes in persons experiencing mental illness and recent homelessness. These findings indicate the need for interventions and actions to reduce stigma toward thispopulation. Such interventions may improve housing stability, quality of life, mental health recovery, and community functioning.

Perceptions of Mental Health and Wellbeing Following Residential Displacement and Damage from the 2018 St. John River Flood.

Climate change has spurred an increase in the prevalence and severity of natural disasters. Damage from natural disasters can lead to residential instability, which negatively impacts mental health and wellbeing. However, research on the mental health of residents who are displaced after natural disasters is relatively novel and needs more study. This study investigates experiences of mental health in residents in New Brunswick, Canada, who experienced residential damage and/or displacement during the 2018 spring flood. Lived experiences were studied through focus groups with 20 residents and perceptions of community mental health and wellbeing were captured during key informant interviews with 10 local community leaders. Data collection and analysis employed grounded theory. Findings indicate that those who had residential displacement or damage due to the flooding experienced negative mental health impacts, both during and following the flood. While natural disasters have devastating impacts on mental health, the data also indicate that the communities were positively impacted by a collective and collaborative response to the flood. This paper argues for the utility of communal coping as a concept to describe the experiences of communities following residential damage and/or displacement following natural disasters.

SPECT-CT localization of axillary sentinel lymph nodes for radiotherapy of early breast cancer.

PURPOSE: To evaluate the opportunities of single photon emission tomography/computerized tomography (SPECT-CT) for localization of axillary sentinel lymph nodes (ASLNs) and subsequent radiotherapy planning in women with early breast cancer. MATERIAL AND METHODS: Individual topography of ASLN was determined in 151 women with clinical T1-2N0M0 breast cancer. SPECT-CT visualization of ASLNs was initiated 120 min after intra-peritumoral injection of 99mTc-radiocolloids. Doses absorbed by virtual ASLNs after the whole breast irradiation with standard and extended tangential fields were calculated on a treatment planning station. RESULTS: SPECT-CT demonstrated a large variability of ASLN localization. They were detected in the central subgroup in 94 (61%) patients, in pectoral - in 77 (51%), and in interpectoral - in 4 (3%) patients. Sentinel lymph nodes "lying on the chest" were revealed in 35 (23%) cases.We found that with standard tangential fields coverage of ASLNs was obtained only in 20% of evaluated women. Extended tangential fields can effectively irradiate ASLNs localized in all axillary sub-regions with the exception of ASLNs "lying on the chest". CONCLUSION: SPECT-CT mapping of ASLNs in women with cT1-2N0M0 breast cancer reveals their variable localization. This information can be important for planning of radiation treatment in women that underwent breast conserving surgery without an axillary surgery.

Men's experiences of early life trauma and pathways into long-term homelessness.

Previous studies that have explored the association between childhood trauma and homelessness indicate that traumatic events can lead to survivor distrust of interpersonal relationships and institutions, prolonged homelessness and poor health and social outcomes. The majority of this literature relies on quantitative data and fails to investigate the personal experiences of childhood trauma that are found to impact housing status later in life. Semi-structured, qualitative interviews were conducted with 25 men living in an urban area in Ontario who had spent more than 30 consecutive nights in an emergency shelter over the course of their housing histories. During data analysis, it was observed that all of the men had experienced some form of trauma or neglect in childhood which contributed to their entries into homelessness. Using a case study approach, three entry pathways into long term homelessness are described: 1) youth; 2) emerging or early adulthood; and 3) middle adulthood. Participants are classified into the pathways by the developmental period at which they first entered homelessness. These findings have implications for policy makers and service providers, as key intervention points are identified. Establishing effective interventions that address crises experienced at these points could assist with homelessness prevention across the life course.

Strategizing Safety: Theoretical Frameworks to Understand Women's Decision Making in the Face of Partner Violence and Social Inequities.

Women in physically and psychologically abusive relationships face numerous decisions related to their safety: decisions that historically have been viewed by researchers and human service practitioners as related to individual or interpersonal factors, such as how they feel about their partner, what they (or those they are close to) think is best for their children, or whether they have a safe place to go to. Social and structural factors, such as poverty, sexism, and barriers related to disability, are either left out or viewed at their individual-level consequence, such as a woman's employment status. Using interview data and case studies from a larger study on housing instability, partner violence, and health, the authors apply ecological and macro-level theoretical models that go beyond the individual level to the stories of women who struggled with partner violence, arguing that it is critical to examine the large social and structural forces that impact women's lives if we are to understand the decisions women make when facing a violent partner.

Establishing stability: exploring the meaning of 'home' for women who have experienced intimate partner violence.

There is evidence that involuntary housing instability may undermine health and well-being. For women who have experienced intimate partner violence (IPV), achieving stability is likely as important for other groups, but can be challenging. Through our analysis of 41 interviews with women who have experienced low income and IPV, we argue that definitions of housing stability are multifaceted and for many centred on a shared understanding of the importance of creating an environment of "home". We found that obtaining housing that satisfied material needs was important to women. However, in asking women to define what housing stability meant to them, we found that other factors related to ontological security and the home, such as safety, community, and comfort, contributed to women's experiences of stability. Through our discussion of the importance these women placed on establishing stable homes, we argue that future research on women's experiences with housing stability and IPV should include definitions of stability that capture both material security and women's experiences with building emotionally stable homes.

Gambling in the Landscape of Adversity in Youth: Reflections from Men Who Live with Poverty and Homelessness.

Most of the research on gambling behaviour among youth has been quantitative and focused on measuring prevalence. As a result, little is known about the contextual experiences of youth gambling, particularly among those most vulnerable. In this paper, we explore the previous experiences of youth gambling in a sample of adult men experiencing housing instability and problem gambling. We present findings from a qualitative study on problem gambling and housing instability conducted in Toronto, Canada. Thirty men with histories of problem or pathological gambling and housing instability or homelessness were interviewed. Two thirds of these men reported that they began gambling in youth. Five representative cases were selected and the main themes discussed. We found that gambling began in early life while the men, as youth, were also experiencing adversity (e.g., physical, emotional and/or sexual abuse, neglect, housing instability, homelessness, substance addiction and poverty). Men reported they had access to gambling activity through their family and wider networks of school, community and the streets. Gambling provided a way to gain acceptance, escape from emotional pain, and/or earn money. For these men problematic gambling behaviour that began in youth, continued into adulthood.

"Talk with me": perspectives on services for men with problem gambling and housing instability.

BACKGROUND: Problem gambling and homelessness are recognized as important public health concerns that significantly impact individuals, their friends and families, communities and broader society. We aimed to explore the experiences with health and social services of men who had histories of problem gambling and housing instability in Toronto, Ontario. METHODS: We used a community-based participatory approach with a multi-service agency serving low-income individuals. We conducted qualitative interviews with men (n = 30) who had experienced problem gambling and housing instability. Our interviews employed open-ended questions to elicit men's perceptions of services related to housing instability, problem gambling and other comorbid conditions (e.g., mental illness, substance use). We reviewed relevant themes related to experiences with services (e.g., Use of and feedback on: health and social services, housing services, justice/legal aid services, substance use services, gambling services; stigma; goals; triggers; physical health; coping strategies; finances; relationships; barriers to services and recommendations for services). RESULTS: The concept of person-centred engagement was identified as a main overarching theme, and seemed to be lacking in most of the men's experiences of services. Person-centred engagement for these men entailed empowerment and autonomy; empathy, compassion and sincerity; respectful communication; and tailored and holistic life plans. While there was a strong emphasis placed on independence, the men identified the importance of positive therapeutic relationships as being critical aspects of the recovery process. Based on our analyses, several recommendations were identified: 1) Increasing general awareness of services for problem gambling; 2) Delivering integrated services in a one-stop-shop; 3) Addressing mental health with psychotherapy and pharmacotherapy; 4) Providing timely access to prevention and recovery services; and 5) Enhancing life skills with peer support. CONCLUSIONS: Our study highlighted that most of the men we interviewed were not having their health and social needs met. Services need to address the intersection of problem gambling, housing instability, and other comorbidities. Ensuring services are grounded in person-centred engagement appears to be critical for optimal service delivery.

Persisting Barriers to Employment for Recently Housed Adults with Mental Illness Who Were Homeless.

Adults with mental illness who are homeless experience multiple barriers to employment, contributing to difficulties securing and maintaining housing. Housing First programs provide quick, low-barrier access to housing and support services for this population, but their success in improving employment outcomes has been limited. Supported employment interventions may augment Housing First programs and address barriers to employment for homeless adults with mental illness. The present paper presents data from qualitative interviews to shed light on the persisting barriers to employment among people formerly homeless. Once housed, barriers to employment persisted, including the following: (1) worries about disclosing sensitive information, (2) fluctuating motivation, (3) continued substance use, and (4) fears about re-experiencing homelessness-related trauma. Nevertheless, participants reported that their experiences of homelessness helped them develop interpersonal strength and resilience. Discussing barriers with an employment specialist helps participants develop strategies to overcome them, but employment specialists must be sensitive to specific homelessness-related experiences that may not be immediately evident. Supported housing was insufficient to help people return to employment. Supported employment may help people return to work by addressing persisting barriers.

The Impact of a 24 Month Housing First Intervention on Participants' Body Mass Index and Waist Circumference: Results from the At Home / Chez Soi Toronto Site Randomized Controlled Trial.

UNLABELLED: Research suggests that individuals experiencing homelessness have high rates of overweight and obesity. Unhealthy weights and homelessness are both associated with increased risk of poor health and mortality. Using longitudinal data from 575 participants at the Toronto site of the At Home/Chez Soi randomized controlled trial, we investigate the impact of receiving a Housing First intervention on the Body Mass Index (BMI) and waist circumference of participants with moderate and high needs for mental health support services. The ANCOVA results indicate that the intervention resulted in no significant change in BMI or waist circumference from baseline to 24 months. The findings suggest a need for a better understanding of factors contributing to overweight, obesity, and high waist circumference in populations who have histories of housing precarity and experience low-income in tandem with other concerns such as mental illness and addictions. TRIAL REGISTRATION: International Standard Randomized Control Trial Number Register ISRCTN42520374.

Serving the food nation: Exploring Body Mass Index in food service workers.

BACKGROUND: Obesity is a public health concern in North America. Consumption of food prepared outside of the home is often discussed as a contributing factor. OBJECTIVE: To determine whether or not Canadian food service workers are more likely to have high Body Mass Indices (BMIs) as compared with the general population, and to examine factors that contribute to BMI in this population. METHODS: Analyses of secondary survey data from Cycle 5.1 of the Canadian Community Health Survey were performed. Descriptive statistics were generated to examine food service workers' risk of having above normal BMI compared to other Canadians. Logistic regression analysis was used to identify factors contributing to variation in BMI among food service workers. Analyses were stratified by age. RESULTS: Canadian food service workers are less likely to have BMIs in the overweight and obese ranges than the general population. Stratification by age demonstrated that this decreased risk can be attributed to the fact that food service workers tend to be younger than the general population. As age increases among food service workers, the odds of having a BMI in the overweight and obese ranges increases. CONCLUSIONS: Food service workers in general were not at higher risk for high BMI, but those between the ages of 41 and 64 are at higher risk of having a BMI in the overweight or obese ranges. The findings suggest that proximity to food service outlets may not be the most salient factor in explaining BMI.