Tenant-Based Housing Voucher Programs: A Community Guide Systematic Review.

CONTEXT: Unaffordable or insecure housing is associated with poor health in children and adults. Tenant-based housing voucher programs (voucher programs) limit rent to 30% or less of household income to help households with low income obtain safe and affordable housing. OBJECTIVE: To determine the effectiveness of voucher programs in improving housing, health, and other health-related outcomes for households with low income. DESIGN: Community Guide systematic review methods were used to assess intervention effectiveness and threats to validity. An updated systematic search based on a previous Community Guide review was conducted for literature published from 1999 to July 2019 using electronic databases. Reference lists of included studies were also searched. ELIGIBILITY CRITERIA: Studies were included if they assessed voucher programs in the United States, had concurrent comparison populations, assessed outcomes of interest, were written in English, and published in peer-reviewed journals or government reports. MAIN OUTCOME MEASURES: Housing quality and stability, neighborhood opportunity (safety and poverty), education, income, employment, physical and mental health, health care use, and risky health behavior. RESULTS: Seven studies met inclusion criteria. Compared with low-income households not offered vouchers, voucher-using households reported increased housing quality (7.9 percentage points [pct pts]), decreased housing insecurity or homelessness (-22.4 pct pts), and decreased neighborhood poverty (-5.2 pct pts).Adults in voucher-using households had improved health care access and physical and mental health. Female youth experienced better physical and mental health but not male youth. Children who entered the voucher programs under 13 years of age had improved educational attainment, employment, and income in their adulthood; children's gains in these outcomes were inversely related to their age at program entry. CONCLUSION: Voucher programs improved health and several health-related outcomes for voucher-using households, particularly young children. Research is still needed to better understand household's experiences and contextual factors that influence achievement of desired outcomes.

Permanent Supportive Housing With Housing First to Reduce Homelessness and Promote Health Among Homeless Populations With Disability: A Community Guide Systematic Review.

CONTEXT: Poor physical and mental health and substance use disorder can be causes and consequences of homelessness. Approximately 2.1 million persons per year in the United States experience homelessness. People experiencing homelessness have high rates of emergency department use, hospitalization, substance use treatment, social services use, arrest, and incarceration. OBJECTIVES: A standard approach to treating homeless persons with a disability is called Treatment First, requiring clients be "housing ready"-that is, in psychiatric treatment and substance-free-before and while receiving permanent housing. A more recent approach, Housing First, provides permanent housing and health, mental health, and other supportive services without requiring clients to be housing ready. To determine the relative effectiveness of these approaches, this systematic review compared the effects of both approaches on housing stability, health outcomes, and health care utilization among persons with disabilities experiencing homelessness. DESIGN: A systematic search (database inception to February 2018) was conducted using 8 databases with terms such as "housing first," "treatment first," and "supportive housing." Reference lists of included studies were also searched. Study design and threats to validity were assessed using Community Guide methods. Medians were calculated when appropriate. ELIGIBILITY CRITERIA: Studies were included if they assessed Housing First programs in high-income nations, had concurrent comparison populations, assessed outcomes of interest, and were written in English and published in peer-reviewed journals or government reports. MAIN OUTCOME MEASURES: Housing stability, physical and mental health outcomes, and health care utilization. RESULTS: Twenty-six studies in the United States and Canada met inclusion criteria. Compared with Treatment First, Housing First programs decreased homelessness by 88% and improved housing stability by 41%. For clients living with HIV infection, Housing First programs reduced homelessness by 37%, viral load by 22%, depression by 13%, emergency departments use by 41%, hospitalization by 36%, and mortality by 37%. CONCLUSIONS: Housing First programs improved housing stability and reduced homelessness more effectively than Treatment First programs. In addition, Housing First programs showed health benefits and reduced health services use. Health care systems that serve homeless patients may promote their health and well-being by linking them with effective housing services.

Expanded In-School Instructional Time and the Advancement of Health Equity: A Community Guide Systematic Review.

Expanded in-school instructional time (EISIT) may reduce racial/ethnic educational achievement gaps, leading to improved employment, and decreased social and health risks. When targeted to low-income and racial/ethnic minority populations, EISIT may thus promote health equity. Community Guide systematic review methods were used to search for qualified studies (through February 2015, 11 included studies) and summarize evidence of the effectiveness of EISIT on educational outcomes. Compared with schools with no time change, schools with expanded days improved students' test scores by a median of 0.05 standard deviation units (range, 0.0-0.25). Two studies found that schools with expanded day and year improved students' standardized test scores (0.04 and 0.15 standard deviation units). Remaining studies were inconclusive. Given the small effect sizes and a lack of information about the use of added time, there is insufficient evidence to determine the effectiveness of EISIT on academic achievement and thus health equity.

Examining the Effectiveness of Year-Round School Calendars on Improving Educational Attainment Outcomes Within the Context of Advancement of Health Equity: A Community Guide Systematic Review.

Students may lose knowledge and skills achieved in the school year during the summer break, with losses greatest for students from low-income families. Community Guide systematic review methods were used to summarize evaluations (published 1965-2015) of the effectiveness of year-round school calendars (YRSCs) on academic achievement, a determinant of long-term health. In single-track YRSCs, all students participate in the same school calendar; summer breaks are replaced by short "intersessions" distributed evenly throughout the year. In multi-track YRSCs, cohorts of students follow separate calendar tracks, with breaks at different times throughout the year. An earlier systematic review reported modest gains with single-track calendars and no gains with multi-track calendars. Three studies reported positive and negative effects for single-track programs and potential harm with multi-track programs when low-income students were assigned poorly resourced tracks. Lack of clarity about the role of intersessions as simple school breaks or as additional schooling opportunities in YRSCs leaves the evidence on single-track programs insufficient. Evidence on multi-track YRSCs is also insufficient.

Hospitality Invites Sociability, Which Builds Cohesion: a Model for the Role of Main Streets in Population Mental Health.

The aim of this study was to investigate the contribution of main streets to community social cohesion, a factor important to health. Prior work suggests that casual contact in public space, which we call "sociability," facilitates more sustained social bonds in the community. We appropriate the term "hospitality" to describe a main street's propensity to support a density of such social interactions. Hospitality is a result of the integrity and complex contents of the main street and surrounding area. We examine this using a typology we term "box-circle-line" to represent the streetscape (the box), the local neighborhood (the circle), and the relationship to the regional network of streets (the line). Through field visits to 50 main streets in New Jersey and elsewhere, and a systematic qualitative investigation of main streets in a densely interconnected urban region (Essex County, New Jersey), we observed significant variation in main street hospitality, which generally correlated closely with sociability. Physical elements such as street wall, neighborhood elements such as connectivity, inter-community elements such as access and perceived welcome, and socio-political elements such as investment and racial discrimination were identified as relevant to main street hospitality. We describe the box-circle-line as a theoretical model for main street hospitality that links these various factors and provides a viable framework for further research into main street hospitality, particularly with regard to geographic health disparities.

Early Childhood Education to Promote Health Equity: A Community Guide Systematic Review.

CONTEXT: Children in low-income and racial and ethnic minority families often experience delays in development by 3 years of age and may benefit from center-based early childhood education. DESIGN: A meta-analysis on the effects of early childhood education by Kay and Pennucci best met Community Guide criteria and forms the basis of this review. RESULTS: There were increases in intervention compared with control children in standardized test scores (median = 0.29 SD) and high school graduation (median = 0.20 SD) and decreases in grade retention (median = 0.23 SD) and special education assignment (median = 0.28 SD). There were decreases in crime (median = 0.23 SD) and teen births (median = 0.46 SD) and increases in emotional self-regulation (median = 0.21 SD) and emotional development (median = 0.04 SD). All effects were favorable, but not all were statistically significant. Effects were also long-lasting. CONCLUSIONS: Because many programs are designed to increase enrollment for high-risk students and communities, they are likely to advance health equity.

Out-of-School-Time Academic Programs to Improve School Achievement: A Community Guide Health Equity Systematic Review.

CONTEXT: Low-income and minority status in the United States are associated with poor educational outcomes, which, in turn, reduce the long-term health benefits of education. OBJECTIVE: This systematic review assessed the extent to which out-of-school-time academic (OSTA) programs for at-risk students, most of whom are from low-income and racial/ethnic minority families, can improve academic achievement. Because most OSTA programs serve low-income and ethnic/racial minority students, programs may improve health equity. DESIGN: Methods of the Guide to Community Preventive Services were used. An existing systematic review assessing the effects of OSTA programs on academic outcomes (Lauer et al 2006; search period 1985-2003) was supplemented with a Community Guide update (search period 2003-2011). MAIN OUTCOME MEASURE: Standardized mean difference. RESULTS: Thirty-two studies from the existing review and 25 studies from the update were combined and stratified by program focus (ie, reading-focused, math-focused, general academic programs, and programs with minimal academic focus). Focused programs were more effective than general or minimal academic programs. Reading-focused programs were effective only for students in grades K-3. There was insufficient evidence to determine effectiveness on behavioral outcomes and longer-term academic outcomes. CONCLUSIONS: OSTA programs, particularly focused programs, are effective in increasing academic achievement for at-risk students. Ongoing school and social environments that support learning and development may be essential to ensure the longer-term benefits of OSTA programs.

Systems that promote mental health in the teeth of oppression.

Emotional distress can disproportionately disable individuals from minoritized groups, such as Black Americans, due to multiple intersecting factors. Addressing these challenges requires a comprehensive, culturally sensitive approach to mental health care that promotes inclusivity, accessibility, and representation within the field, to foster empowerment and resilience among minoritized communities. Given the weight of negative factors that can lead to psychological distress and mental illness, the wellness of Black Americans and how they support their mental health is important to acknowledge. In this Series paper, we propose that Black Americans have developed systems for managing many of these threats to their survival and wellbeing.

Too Many Deaths, Too Many Left Behind: A People's External Review of the U.S. Centers for Disease Control and Prevention's COVID-19 Pandemic Response.

The U.S. population has suffered worse health consequences owing to COVID-19 than comparable wealthy nations. COVID-19 had caused more than 1.1 million deaths in the U.S. as of May 2023 and contributed to a 3-year decline in life expectancy. A coalition of public health workers and community activists launched an external review of the Centers for Disease Control and Prevention's pandemic management from January 2021 to May 2023. The authors used a modified Delphi process to identify core pandemic management areas, which formed the basis for a survey and literature review. Their analysis yields 3 overarching shortcomings of the Centers for Disease Control and Prevention's pandemic management: (1) Centers for Disease Control and Prevention leadership downplays the serious impacts and aerosol transmission risks of COVID-19, (2) Centers for Disease Control and Prevention leadership has aligned public guidance with commercial and political interests over scientific evidence, and (3) Centers for Disease Control and Prevention guidance focuses on individual choice rather than emphasizing prevention and equity. Instead, the agency must partner with communities most impacted by the pandemic and encourage people to protect one another using layered protections to decrease COVID-19 transmission. Because emerging variants can already evade existing vaccines and treatments and Long COVID can be disabling and lacks definitive treatment, multifaceted, sustainable approaches to the COVID-19 pandemic are essential to protect people, the economy, and future generations.

Ministers' perceptions of church-based programs to provide depression care for African Americans.

African Americans, compared with white Americans, underutilize mental health services for major depressive disorder. Church-based programs are effective in reducing racial disparities in health; however, the literature on church-based programs for depression is limited. The purpose of this study was to explore ministers' perceptions about depression and the feasibility of utilizing the church to implement evidence-based assessments and psychotherapy for depression. From August 2011 to March 2012, data were collected from three focus groups conducted with adult ministers (n = 21) from a black mega-church in New York City. Using consensual qualitative research to analyze data, eight main domains emerged: definition of depression, identification of depression, causal factors, perceived responsibilities, limitations, assessment, group interpersonal psychotherapy, and stigma. A major finding was that ministers described depression within a context of vast suffering due to socioeconomic inequalities (e.g., financial strain and unstable housing) in many African American communities. Implementing evidence-based assessments and psychotherapy in a church was deemed feasible if principles of community-based participatory research were utilized and safeguards to protect participants' confidentiality were employed. In conclusion, ministers were enthusiastic about the possibility of implementing church-based programs for depression care and emphasized partnering with academic researchers throughout the implementation process. More research is needed to identify effective, multidisciplinary interventions that address social inequalities which contribute to racial disparities in depression treatment.

Escaping the Catastrophic Logic of Separation.

In the philosophical system of American Apartheid, "race" is a fact, racial hierarchy a key corollary, and "separation of races" in status, rights, and geography a logical inference. The concept of racial hierarchy proved useful in the early colonial period in Virginia and elsewhere, first begun in the 1600s to keep indentured servants and enslaved people from joining together and overthrowing the plantation oligarchy. The discourse of separation has continued to be a key tactic for gaining and maintaining power, with profound harmful consequences for the nation. This article will explore three themes that are important for these times: (1) the ongoing "redlining system" that continues to ensnare us in a geography of apartheid; (2) the paradox of apartheid that "separation" binds the parts more firmly together; and (3) the "new racism" that attacks progress with the use of such farfetched ideas as the "replacement theory." From these explorations, I propose ways in which TRUTH and RECONCILIATION can be mobilized to put us on a new path.

Mindfulness Reminds Us What Health Care Is For.

Could clinicians help people more if they were buddhas? This article considers what the late Thích Nhâ't Hanh meant in his call to "become buddhas" and applies Nhâ't Hanh's mindfulness practices to managing crises and anxiety in health care settings. This article also considers recovery strategies, techniques for becoming calm, and reminders about why stillness matters for compassionate practice in health care.

Serial forced displacement in American cities, 1916-2010.

Serial forced displacement has been defined as the repetitive, coercive upheaval of groups. In this essay, we examine the history of serial forced displacement in American cities due to federal, state, and local government policies. We propose that serial forced displacement sets up a dynamic process that includes an increase in interpersonal and structural violence, an inability to react in a timely fashion to patterns of threat or opportunity, and a cycle of fragmentation as a result of the first two. We present the history of the policies as they affected one urban neighborhood, Pittsburgh's Hill District. We conclude by examining ways in which this problematic process might be addressed.

I used to cry every day: a model of the family process of managing displacement.

Community displacing events, natural or human made, are increasing in frequency. By the end of 2009, over 36 million people were known to be displaced worldwide. Displacement is a traumatic experience with significant short- and long-term health consequences. The losses and costs associated with displacement-social connections, employment, property, and economic capital-are felt not only by the displaced individuals but also the communities they have left behind, and the communities that receive displaced individuals. Many researchers have explored the link between health and reduced social, cultural, and economic capital. Most of the displacement literature focuses on the effect of displacement on the displaced individual; however, many families move as a group. In this study, we examined the family process of managing displacement and its associated capital losses by conducting interviews with 20 families. We found that families undergo a four-phase process of displacement: antecedent, uprooting, transition, and resettlement. The losses families experience impact the health and well-being of individuals, families, and communities. The degree to which the displacement process ends successfully, or ends at all, can be affected by efforts to both create connections within the new communities and rebuild economic and social capital.

What We "Cannot Not Know in America": 400 Years of Inequality and Seven Sins.

The 400 Years of Inequality Project was created to call organizations to observe the 400th anniversary of the first Africans landing in Jamestown in 1619. The project focused on the broad ramifications of inequality. Used as a justification of chattel slavery, structures of inequality continue to condition the lives of many groups in the US. Over 110 organizations joined this observance and held 150 events. The highlight of the year was the homily given by Reverend William Barber II, co-chair of the Poor People's Campaign, who described the "seven sins" that link the concept of inequality to every aspect of national life, from politics to militia. These "seven sins" help us to analyze and address crises, such as the COVID pandemic.