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1.
BMJ Open ; 12(4): e058580, 2022 Apr 13.
Article in English | MEDLINE | ID: covidwho-1788965

ABSTRACT

OBJECTIVES: COVID-19 lockdown measures have challenged people's mental health, especially among economically vulnerable households. The objective of this study was to investigate the impact of exposure to COVID-19 shocks (defined as job loss, living cost pressures and changing housing conditions throughout the lockdown period) and double precarity (defined as precarity in housing and employment) on mental health outcomes for members of share households as well as the mediating effects of a range of resources. DESIGN: We conducted a two-wave survey of occupants of share housing in June and October 2020 during a prolonged period of population lockdown. Research design involved fixed effects ordered logit regression models to assess the mental health consequences of baseline precarity and COVID-related shocks. SETTING: Victoria, Australia. PARTICIPANTS: We surveyed 293 occupants of share houses (mean age 34 SD 11.5, 56% female). Members of share houses (where individuals are unrelated adults and not in a romantic relationship) are more likely to be young, casually employed, visa-holders and low-income. OUTCOME MEASURES: We measured household composition, housing and employment precarity, access to government support, household crowding, social networks and COVID-19 shocks. We used a self-reported measure of mental health. RESULTS: Those exposed to COVID-19 shocks reported a 2.7 times higher odds of mental health deterioration (OR 2.7, 95% CI 1.53 to 4.85). People exposed to double precarity (precarity in both housing and employment) reported 2.4 times higher odds of mental health deterioration (OR 2.4, 95% CI 0.99 to 5.69). Housing inadequacy and lack of access to sufficient government payments explained 14.7% and 7% of the total effect of double precarity on mental health, respectively. CONCLUSIONS: Results indicate that residents of group households characterised by pre-existing precarity were vulnerable to negative mental health effects during lockdown. Access to sufficient government payments and adequate housing buffered this negative effect.


Subject(s)
COVID-19 , Shock , Adult , COVID-19/epidemiology , Communicable Disease Control , Crowding , Family Characteristics , Female , Housing , Humans , Male , Mental Health , Victoria/epidemiology
2.
BMC Res Notes ; 15(1): 126, 2022 Apr 05.
Article in English | MEDLINE | ID: covidwho-1779670

ABSTRACT

OBJECTIVES: Overcrowded housing is a sociodemographic variable associated with increased infection and mortality rates from communicable diseases. It is not well understood if this association exists for COVID-19. Our objective was hence to determine the association between household overcrowding and risk of mortality from COVID-19, and this was done by performing bivariable and multivariable analyses using COVID-19 data from cities in Los Angeles County. RESULTS: Bivariate regression revealed that overcrowded households were positively associated with COVID-19 deaths (standardized ß = 0.863, p < 0.001). COVID-19 case totals, people aged 60+, and the number of overcrowded households met conditions for inclusion in the backwards stepwise linear regression model. Analysis revealed all independent variables were positively associated with mortality rates, primarily for individuals 60 + (standardized ß1 = 0.375, p = 0.001), followed by overcrowded households (standardized ß2 = 0.346, p = 0.014), and total COVID-19 cases (standardized ß3 = 0.311, p < 0.001). Our findings highlight that residing in overcrowded households may be an important risk factor for COVID-19 mortality. Public health entities should consider this population when allocating resources for prevention and control of COVID-19 mortality and future disease outbreaks.


Subject(s)
COVID-19 , COVID-19/epidemiology , Family Characteristics , Housing , Humans , Middle Aged , Risk Factors , SARS-CoV-2
3.
Front Public Health ; 10: 855671, 2022.
Article in English | MEDLINE | ID: covidwho-1776080

ABSTRACT

Healthy housing can set its occupants completely in good physical, mental and social conditions, but there is a lack of research in China on the public's willingness to pay (WTP) for healthy housing. From the perspective of cognitive psychology, this study constructs an analytical framework based on the model of "theory of planned behavior" (TPB), the theory of selective information exposure, and the model of "emotions as social information," while exploring the effect mechanism of the online reviews on the public's WTP for healthy housing during COVID-19 pandemic. In combination with eye-tracking experiments and subjective reports, physiological, psychological and behavioral multimodal data on WTP of 65 participants for healthy housing are collected. Partial least squares structural equation modeling (PLS-SEM) is adopted to analyze the formation effect mechanism of the public's WTP for healthy housing. This study acquires the following results: (i) Information attentiveness to online reviews on different valence information of healthy housing as obtained in eye tracking experiments delivers significant effect on attitude, subjective norm (SN) and perceived behavioral control (PBC), but has no direct effect on the public's WTP for healthy housing; (ii) Hypotheses from TPB model are verified. attitude, PBC and SN can all make significant effect on WTP for healthy housing, with attitude showcasing the most prominent effect; and (iii) In terms of the mediating effect, information attentiveness can deliver significant indirect effect on WTP through attitude.


Subject(s)
COVID-19 , Eye-Tracking Technology , COVID-19/epidemiology , China , Housing , Humans , Intention , Pandemics , Surveys and Questionnaires
4.
Sci Rep ; 12(1): 5612, 2022 Apr 04.
Article in English | MEDLINE | ID: covidwho-1773993

ABSTRACT

Many studies have investigated the impact of the COVID-19 pandemic on mental health. Throughout the pandemic, time spent at home increased to a great extent due to restrictive measures. Here we set out to investigate the relationship between housing conditions and the mental health of populations across European countries. We analyzed survey data collected during spring 2020 from 69,136 individuals from four cohorts from Denmark, France, and the UK. The investigated housing conditions included household density, composition, and crowding, access to outdoor facilities, dwelling type, and urbanicity. The outcomes were loneliness, anxiety, and life satisfaction. Logistic regression models were used, and results were pooled using random-effects meta-analysis. In the meta-analysis, living alone was associated with higher levels of loneliness (OR = 3.08, 95% CI 1.87-5.07), and lower life satisfaction (OR = 1.27, 95% CI 1.05-0.55), compared to living with others. Not having access to an outdoor space and household crowding were suggestively associated with worse outcomes. Living in crowded households, living alone, or lacking access to outdoor facilities may be particularly important in contributing to poor mental health during a lockdown. Addressing the observed fundamental issues related to housing conditions within society will likely have positive effects in reducing social inequalities, as well as improving preparedness for future pandemics.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Communicable Disease Control , Crowding , Family Characteristics , Housing , Humans , Mental Health
5.
Sci Rep ; 11(1): 22055, 2021 11 11.
Article in English | MEDLINE | ID: covidwho-1758325

ABSTRACT

THE AIMS: (i) analyze connectivity between subgroups of university students, (ii) assess which bridges of relational contacts are essential for connecting or disconnecting subgroups and (iii) to explore the similarities between the attributes of the subgroup nodes in relation to the pandemic context. During the COVID-19 pandemic, young university students have experienced significant changes in their relationships, especially in the halls of residence. Previous research has shown the importance of relationship structure in contagion processes. However, there is a lack of studies in the university setting, where students live closely together. The case study methodology was applied to carry out a descriptive study. The participation consisted of 43 university students living in the same hall of residence. Social network analysis has been applied for data analysis. Factions and Girvan-Newman algorithms have been applied to detect the existing cohesive subgroups. The UCINET tool was used for the calculation of the SNA measure. A visualization of the global network will be carried out using Gephi software. After applying the Girvan-Newman and Factions, in both cases it was found that the best division into subgroups was the one that divided the network into 4 subgroups. There is high degree of cohesion within the subgroups and a low cohesion between them. The relationship between subgroup membership and gender was significant. The degree of COVID-19 infection is related to the degree of clustering between the students. College students form subgroups in their residence. Social network analysis facilitates an understanding of structural behavior during the pandemic. The study provides evidence on the importance of gender, race and the building where they live in creating network structures that favor, or not, contagion during a pandemic.


Subject(s)
COVID-19/epidemiology , Social Network Analysis , Social Networking , Female , Housing , Humans , Male , Pandemics , Public Health , SARS-CoV-2/isolation & purification , Students , Universities
6.
PLoS One ; 17(3): e0264929, 2022.
Article in English | MEDLINE | ID: covidwho-1736512

ABSTRACT

BACKGROUND: People experiencing homelessness who live in congregate shelters are at high risk of SARS-CoV2 transmission and severe COVID-19. Current screening and response protocols using rRT-PCR in homeless shelters are expensive, require specialized staff and have delays in returning results and implementing responses. METHODS: We piloted a program to offer frequent, rapid antigen-based tests (BinaxNOW) to residents and staff of congregate-living shelters in San Francisco, California, from January 15th to February 19th, 2021. We used the Reach-Effectiveness-Adoption-Implementation-Maintenance (RE-AIM) framework to evaluate the implementation. RESULTS: Reach: We offered testing at ten of twelve eligible shelters. Shelter residents and staff had variable participation across shelters; approximately half of eligible individuals tested at least once; few tested consistently during the study. Effectiveness: 2.2% of participants tested positive. We identified three outbreaks, but none exceeded 5 cases. All BinaxNOW-positive participants were isolated or left the shelters. Adoption: We offered testing to all eligible participants within weeks of the project's initiation. Implementation: Adaptations made to increase reach and improve consistency were promptly implemented. Maintenance: San Francisco Department of Public Health expanded and maintained testing with minimal support after the end of the pilot. CONCLUSION: Rapid and frequent antigen testing for SARS-CoV2 in homeless shelters is a viable alternative to rRT-PCR testing that can lead to immediate isolation of infectious individuals. Using the RE-AIM framework, we evaluated and adapted interventions to enable the expansion and maintenance of protocols.


Subject(s)
COVID-19 Serological Testing/methods , COVID-19/diagnosis , Homeless Persons/statistics & numerical data , COVID-19/immunology , COVID-19 Testing/methods , California , Disease Outbreaks/prevention & control , Housing , Humans , Immunologic Tests/methods , Mass Screening/methods , Pilot Projects , SARS-CoV-2/immunology , SARS-CoV-2/pathogenicity , San Francisco
8.
JAMA Pediatr ; 176(2): 119-120, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1718216
9.
Soc Sci Med ; 298: 114839, 2022 04.
Article in English | MEDLINE | ID: covidwho-1692870

ABSTRACT

Housing deprivation is a key determinant of the capacity to prevent infection and to recover from a disease because poor housing prevents adequate sheltering during a quarantine. We analyze the degree of housing deprivation faced by households in European countries when COVID-19 lockdown measures were enacted. To do so, we propose a synthetic measure that includes more dimensions than the official Eurostat indicator of severe housing deprivation. We use a fuzzy set approach to measure housing deprivation so that, unlike traditional deprivation approaches, based on a dichotomous variable, we can identify different degrees of housing deprivation for each household in the population. We find similar orderings of housing deprivation dimensions by country with the highest degree of deprivation in the living space dimension and the lowest one in the standard housing or technology deprivation dimension. Nonetheless, housing deprivation levels differ across countries, with Eastern European households being significantly more housing deprived than the rest when the lockdown began. This result shows that the effects of the lockdown on social well-being have not affected all Europeans equally and emphasizes the need for government measures that promote decent housing.


Subject(s)
COVID-19 , Housing , COVID-19/epidemiology , Communicable Disease Control , Europe/epidemiology , Humans , Quarantine
10.
BMC Infect Dis ; 22(1): 143, 2022 Feb 10.
Article in English | MEDLINE | ID: covidwho-1690954

ABSTRACT

BACKGROUND: COVID-19 is thought to be more prevalent among ethnic minorities and individuals with low socioeconomic status. We aimed to investigate the prevalence of SARS-CoV-2 antibodies during the COVID-19 pandemic among citizens 15 years or older in Denmark living in social housing (SH) areas. METHODS: We conducted a study between January 8th and January 31st, 2021 with recruitment in 13 selected SH areas. Participants were offered a point-of-care rapid SARS-CoV-2 IgM and IgG antibody test and a questionnaire concerning risk factors associated with COVID-19. As a proxy for the general Danish population we accessed data on seroprevalence from Danish blood donors (total Ig ELISA assay) in same time period. RESULTS: Of the 13,279 included participants, 2296 (17.3%) were seropositive (mean age 46.6 (SD 16.4) years, 54.2% female), which was 3 times higher than in the general Danish population (mean age 41.7 (SD 14.1) years, 48.5% female) in the same period (5.8%, risk ratios (RR) 2.96, 95% CI 2.78-3.16, p > 0.001). Seropositivity was higher among males (RR 1.1, 95% CI 1.05-1.22%, p = 0.001) and increased with age, with an OR seropositivity of 1.03 for each 10-year increase in age (95% CI 1.00-1.06, p = 0.031). Close contact with COVID-19-infected individuals was associated with a higher risk of infection, especially among household members (OR 5.0, 95% CI 4.1-6.2 p < 0,001). Living at least four people in a household significantly increased the OR of seropositivity (OR 1.3, 95% CI 1.0-1.6, p = 0.02) as did living in a multi-generational household (OR 1.3 per generation, 95% CI 1.1-1.6, p = 0.003). Only 1.6% of participants reported not following any of the national COVID-19 recommendations. CONCLUSIONS: Danish citizens living in SH areas of low socioeconomic status had a three times higher SARS-CoV-2 seroprevalence compared to the general Danish population. The seroprevalence was significantly higher in males and increased slightly with age. Living in multiple generations households or in households of more than four persons was a strong risk factor for being seropositive. Results of this study can be used for future consideration of the need for preventive measures in the populations living in SH areas.


Subject(s)
COVID-19 , SARS-CoV-2 , Adult , Antibodies, Viral , Denmark/epidemiology , Female , Housing , Humans , Male , Middle Aged , Pandemics , Seroepidemiologic Studies
11.
Br J Community Nurs ; 27(2): 99, 2022 Feb 02.
Article in English | MEDLINE | ID: covidwho-1687498
12.
J Hazard Mater ; 430: 128475, 2022 05 15.
Article in English | MEDLINE | ID: covidwho-1676810

ABSTRACT

Vertical transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) along a vertical column of flats has been documented in several outbreaks of coronavirus disease 2019 (COVID-19) in Guangdong and Hong Kong. We describe an outbreak in Luk Chuen House, involving two vertical columns of flats associated with an unusually connected two-stack drainage system, in which nine individuals from seven households were infected. The index case resided in Flat 812 (8th floor, Unit 12), two flats (813, 817) on its opposite side reported one case each (i.e., a horizontal sub-cluster). All other flats with infected residents were vertically associated, forming a vertical sub-cluster. We injected tracer gas (SF6) into drainage stacks via toilet or balcony of Flat 812, monitored gas concentrations in roof vent, toilet, façade, and living room in four of the seven flats with infected residents and four flats with no infected residents. The measured gas concentration distributions agreed with the observed distribution of affected flats. Aerosols leaking into drainage stacks may generate the vertical sub-cluster, whereas airflow across the corridor probably caused the horizontal sub-cluster. Sequencing and phylogenetic analyses also revealed a common point-source. The findings provided additional evidence of probable roles of drainage systems in SARS-CoV-2 transmission.


Subject(s)
COVID-19 , Aerosols , COVID-19/epidemiology , Disease Outbreaks , Housing , Humans , Phylogeny , SARS-CoV-2
13.
Int J Environ Res Public Health ; 19(4)2022 02 09.
Article in English | MEDLINE | ID: covidwho-1674653

ABSTRACT

Gated communities constitute an important component of the contemporary city in many countries, and the adequacy of such communities as a housing option has attracted the attention of researchers and policy makers from various backgrounds. However, it is unclear how gated communities will be perceived and reconsidered following the COVID-19 pandemic and whether this type of community will become more common. Thus, this study aims to investigate housing experience of gated community residents during the pandemic with reference to the urban context of Saudi Arabia. To this end, the residents of a selected gated community were surveyed using a structured questionnaire to identify the urban and architectural design factors that have affected their housing experience during the pandemic compared to that of the residents of non-gated communities. It was concluded that despite the criticism gated communities have received, they offered a safer and more controlled housing environment during the pandemic from the residents' point of view, which may create additional housing demands for this type of residential community in the future. This requires further investigation for ascertaining how this may affect the housing market dynamics and strategies.


Subject(s)
COVID-19 , Pandemics , COVID-19/epidemiology , Housing , Humans , SARS-CoV-2 , Surveys and Questionnaires
14.
Healthc (Amst) ; 10(1): 100608, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1670527

ABSTRACT

Patients experiencing homelessness are among the most disadvantaged in our society, suffering from poor health outcomes and exhibiting disproportionately high hospital utilization and spending. However, to date, hospitals have only scantily devoted time or resources to the housing coordination aspect of homelessness. Implementing better systems to coordinate housing for patients experiencing homelessness may improve health outcomes and reduce health care utilization for this population. This objective is now more important than ever as the economic impact of COVID-19 is expected to exacerbate the homelessness crisis. Ensuring that patients are properly connected to temporary or permanent housing is valuable to patient health, health care system metrics such as excess spending and utilization, and provider performance under Accountable Care Organizations or other risk-bearing payment models. Here, we propose a health systems-based housing coordination framework that may improve care delivery for patients experiencing homelessness. This framework relies on the coordination between dedicated hospital-based housing navigators who can identity patients experiencing homelessness and outpatient housing navigators equipped to coordinate short- and long-term housing specifically for patients experiencing homelessness who frequently interact with the health care system.


Subject(s)
COVID-19 , Homeless Persons , Housing , Humans , Patient Acceptance of Health Care , SARS-CoV-2
15.
J Urban Health ; 99(1): 146-163, 2022 02.
Article in English | MEDLINE | ID: covidwho-1653711

ABSTRACT

Housing is a key social determinant of health with implications for both physical and mental health. The measurement of healthy housing and studies characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study described a methodological approach employed in the assessment and characterization of healthy housing in SSA using the Demographic and Health Survey (DHS) data for 15 countries and explored healthy housing determinants using a multiple survey-weighted logistic regression analysis. For all countries, we demonstrated that the healthy housing index developed using factor analysis reasonably satisfies both reliability and validity tests and can therefore be used to describe the distribution of healthy housing across different groups and in understanding the linkage with individual health outcomes. We infer from the results that unhealthy housing remains quite high in most SSA countries. Having a male head of the household was associated with decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68-0.95), Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64-0.78), and Senegal (OR = 0.62, CI = 0.51-0.74). Further, increasing household size was associated with reducing odds of healthy housing in Kenya (OR = 0.53, CI = 0.44-0.65), Namibia (OR = 0.34, CI = 0.24-0.48), Nigeria (OR = 0.57, CI = 0.46-0.71), and Uganda (OR = 0.79, CI = 0.67-0.94). Across all countries, household wealth was a strong determinant of healthy housing, with middle and rich households having higher odds of residing in healthy homes compared to poor households. Odds ratios ranged from 3.63 (CI = 2.96-4.44) for households in the middle wealth group in the DRC to 2812.2 (CI = 1634.8-4837.7) in Namibia's wealthiest households. For other factors, the analysis also showed variation across countries. Our findings provide timely insights for the implementation of housing policies across SSA countries, drawing attention to aspects of housing that would promote occupant health and wellbeing. Beyond the contribution to the measurement of healthy housing in SSA, our paper highlights key policy and program issues that need further interrogation in the search for pathways to addressing the healthy housing deficit across most SSA countries. This has become critical amid the COVID-19 pandemic, where access to healthy housing is pivotal in its control.


Subject(s)
COVID-19 , Housing , Humans , Kenya , Male , Pandemics , Reproducibility of Results , SARS-CoV-2
17.
JAMA Netw Open ; 4(12): e2140602, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1597867

ABSTRACT

Importance: During the 2020-2021 academic year, many institutions of higher education reopened to residential students while pursuing strategies to mitigate the risk of SARS-CoV-2 transmission on campus. Reopening guidance emphasized polymerase chain reaction or antigen testing for residential students and social distancing measures to reduce the frequency of close interpersonal contact, and Connecticut colleges and universities used a variety of approaches to reopen campuses to residential students. Objective: To characterize institutional reopening strategies and COVID-19 outcomes in 18 residential college and university campuses across Connecticut. Design, Setting, and Participants: This retrospective cohort study used data on COVID-19 testing and cases and social contact from 18 college and university campuses in Connecticut that had residential students during the 2020-2021 academic year. Exposures: Tests for COVID-19 performed per week per residential student. Main Outcomes and Measures: Cases per week per residential student and mean (95% CI) social contact per week per residential student. Results: Between 235 and 4603 residential students attended the fall semester across each of 18 institutions of higher education in Connecticut, with fewer residential students at most institutions during the spring semester. In census block groups containing residence halls, the fall student move-in resulted in a 475% (95% CI, 373%-606%) increase in mean contact, and the spring move-in resulted in a 561% (95% CI, 441%-713%) increase in mean contact compared with the 7 weeks prior to move-in. The association between test frequency and case rate per residential student was complex; institutions that tested students infrequently detected few cases but failed to blunt transmission, whereas institutions that tested students more frequently detected more cases and prevented further spread. In fall 2020, each additional test per student per week was associated with a decrease of 0.0014 cases per student per week (95% CI, -0.0028 to -0.00001). Conclusions and Relevance: The findings of this cohort study suggest that, in the era of available vaccinations and highly transmissible SARS-CoV-2 variants, colleges and universities should continue to test residential students and use mitigation strategies to control on-campus COVID-19 cases.


Subject(s)
COVID-19 Testing/statistics & numerical data , COVID-19/epidemiology , COVID-19/transmission , Universities , Adolescent , COVID-19/diagnosis , Connecticut/epidemiology , Female , Housing , Humans , Male , Mass Screening/methods , Retrospective Studies , SARS-CoV-2 , Social Interaction , Young Adult
18.
Asian J Psychiatr ; 69: 102987, 2022 Mar.
Article in English | MEDLINE | ID: covidwho-1588384

ABSTRACT

We examined the impact of telehealth on appointment retention among individuals with substance use disorder (SUD) by housing status. We evaluated appointment status using multivariate logistic regression with primary predictor variables of visit modality, patient's housing status and interaction between these two variables. Between March 1 and September 30, 2020, there were 18,206 encounters among 1,626 clients with SUD. For telehealth encounters, the probability of an appointment no-show was significantly higher for persons experiencing homelessness compared to stably housed (37% versus 25%, p < 0.001). Housing status influences the effectiveness of telehealth as a modality of healthcare delivery for individuals with SUD.


Subject(s)
COVID-19 , Homeless Persons , Substance-Related Disorders , Telemedicine , Housing , Humans , SARS-CoV-2 , Substance-Related Disorders/therapy
20.
JAMA Netw Open ; 4(12): e2138464, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1567894

ABSTRACT

Importance: Persons experiencing homelessness (PEH) are at higher risk for SARS-CoV-2 infection and severe illness due to COVID-19 because of a limited ability to physically distance and a higher burden of underlying health conditions. Objective: To describe and assess a hotel-based protective housing intervention to reduce incidence of SARS-CoV-2 infection among PEH in Chicago, Illinois, with increased risk of severe illness due to COVID-19. Design, Setting, and Participants: This retrospective cohort study analyzed PEH who were provided protective housing in individual hotel rooms in downtown Chicago during the COVID-19 pandemic from April 2 through September 3, 2020. Participants were PEH at increased risk for severe COVID-19, defined as (1) aged at least 60 years regardless of health conditions, (2) aged at least 55 years with any underlying health condition posing increased risk, or (3) aged less than 55 years with any underlying health condition posing substantially increased risk (eg, HIV/AIDS). Exposures: Participants were housed in individual hotel rooms to reduce the risk of SARS-CoV-2 infection; on-site health care workers provided daily symptom monitoring, regular SARS-CoV-2 testing, and care for chronic health conditions. Additional on-site services included treatment of mental health and substance use disorders and social services. Main Outcomes and Measures: The main outcome measured was SARS-CoV-2 incidence, with SARS-Cov2 infection defined as a positive upper respiratory specimen using any polymerase chain reaction diagnostic assay authorized for emergency use by the Food and Drug Administration. Secondary outcomes were blood pressure control, glycemic control as measured by hemoglobin A1c, and housing placements at departure. Results: Of 259 participants from 16 homeless shelters in Chicago, 104 (40.2%) were aged at least 65 years, 190 (73.4%) were male, 185 (71.4%) were non-Hispanic Black, and 49 (18.9%) were non-Hispanic White. There was an observed reduction in SARS-CoV-2 incidence during the study period among the protective housing cohort (54.7 per 1000 people [95% CI, 22.4-87.1 per 1000 people]) compared with citywide rates for PEH residing in shelters (137.1 per 1000 people [95% CI, 125.1-149.1 per 1000 people]; P = .001). There was also an adjusted change in systolic blood pressure at a rate of -5.7 mm Hg (95% CI, -9.3 to -2.1 mm Hg) and hemoglobin A1c at a rate of -1.4% (95% CI, -2.4% to -0.4%) compared with baseline. More than half of participants (51% [n = 132]) departed from the intervention to housing of some kind (eg, supportive housing). Conclusions and Relevance: This cohort study found that protective housing was associated with a reduction in SARS-CoV-2 infection among high-risk PEH during the first wave of the COVID-19 pandemic in Chicago. These findings suggest that with appropriate wraparound supports (ie, multisector services to address complex needs), such housing interventions may reduce the risk of SARS-CoV-2 infection, improve noncommunicable disease control, and provide a pathway to permanent housing.


Subject(s)
COVID-19 , Delivery of Health Care/methods , Homeless Persons , Housing , Noncommunicable Diseases , Program Evaluation , Adult , Aged , Blood Pressure , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/virology , COVID-19 Testing , Chicago , Chronic Disease , Female , Glycated Hemoglobin A/metabolism , Health Status Disparities , Humans , Incidence , Male , Middle Aged , Noncommunicable Diseases/epidemiology , Noncommunicable Diseases/therapy , Retrospective Studies , SARS-CoV-2 , Social Problems
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