Intensified discrimination against tenants and its health effects during the COVID-19 pandemic in large Chinese cities.

The COVID-19 pandemic in many senses reconstructs social norms and reshapes social behaviour, which typically assumes a close correlation between mobility with a higher risk of COVID-19 infection. This may intensify the pre-existing discrimination against tenants and widen tenure-based health inequalities. Drawing on an online questionnaire survey conducted in five major cities in China in 2020, we employ multi-level regression models to examine the intensified discrimination against tenants during COVID-19 and its impacts on residents' physical and mental health inequalities. Results show that the pre-existing inequalities have been intensified during COVID-19 and the perceived discrimination has rendered worsened self-rated health and mental health and enlarged health inequalities. The discrimination particularly affected tenants with better economic profiles or worse health conditions; by contrast, despite being exposed to more tenant-related discriminatory experiences, rural hukou holders suffered from less severe health inequalities. A clear linkage is found between renting in poorly-managed and larger health gaps generated by discrimination. The negative health impact of intensified discrimination is found to be more significant in communities with lower infection risk, which points to the necessity of understanding the long-term health impact of discrimination against tenants in a more holistic way. In terms of community environment, we discover a positive effect of community social capital, i.e., higher level social capital helps mitigate the health threat of discrimination against tenants during COVID-19. Besides, public housing tenants reported better health outcomes and were less exposed to intensified discrimination during COVID-19 than private housing tenants. These findings provide a nuanced understanding of variations determined by individual and territorial factors, thus present timely policy implications for promoting healthy and inclusive urban development in the post-pandemic era.

Patterns of homelessness and housing instability and the relationship with mental health disorders among young people transitioning from out-of-home care: Retrospective cohort study using linked administrative data.

OBJECTIVES: The study examined the relationship between mental health, homelessness and housing instability among young people aged 15-18 years old who transitioned from out-of-home in 2013 to 2014 in the state of Victoria, Australia with follow-up to 2018. We determined the various mental health disorders and other predictors that were associated with different levels of homelessness risk, including identifying the impact of dual diagnosis of mental health and substance use disorder on homelessness. METHODOLOGY: Using retrospective de-identified linked administrative data from various government departments we identified various dimensions of homelessness which were mapped from the European Topology of Homelessness (ETHOS) framework and associated mental health variables which were determined from the WHO ICD-10 codes. We used ordered logistic regression and Poisson regression analysis to estimate the impact of homelessness and housing instability respectively. RESULTS: A total homelessness prevalence of 60% was determined in the care-leaving population. After adjustment, high risk of homelessness was associated with dual diagnosis of mental health and substance use disorder, intentional self-harm, anxiety, psychotic disorders, assault and maltreatment, history of involvement with the justice system, substance use prior to leaving care, residential and home-based OHC placement and a history of staying in public housing. CONCLUSIONS: There is clearly a need for policy makers and service providers to work together to find effective housing pathways and integrated health services for this heterogeneous group of vulnerable young people with complex health and social needs. Future research should determine longitudinally the bidirectional relationship between mental health disorders and homelessness.

Using Mindfulness-Informed Photovoice to Explore Stress and Coping in Women Residing in Public Housing in a Low-Resourced Community.

The setting of the current study was an urban city where the majority of public housing residents are single females living in poverty. An adapted women's mindfulness program, including a Photovoice exercise, was offered to this vulnerable population. Stress contributes to poor mental/physical health. A Photovoice research method was used to elucidate the stressors and coping facilitators used by participants. Eleven participants took a digital photography workshop and then photographed stressors and coping facilitators. All 275 photographic submissions were analyzed thematically. Coping themes were: Aesthetics: Man-Made and Natural; Relationships: Pets and People; Self-Esteem and Cultural Identity; and Inspiration Through Religion and Social Media Messaging. Stress themes were: Urban Disarray and Existential Threat/Danger. Results showed that social connectedness, spirituality, improving neighborhood aesthetics, use of social media, and access to nature could support coping. [Journal of Psychosocial Nursing and Mental Health Services, 60(7), 23-31.].

In the Eyes of Those Who Were Randomized: Perceptions of Disadvantaged Older Adults in a Tai Chi Trial.

BACKGROUND AND OBJECTIVES: Older adults living in subsidized housing have typically been excluded from exercise intervention studies. We conducted a qualitative study to explore the perceived physical, psychological, social, and economic factors that influenced participation in and adherence to a year-long Tai Chi intervention within an ongoing cluster-randomized controlled trial (RCT) for older adults living within subsidized housing facilities. RESEARCH DESIGN AND METHODS: Focus groups were held with participants of the RCT who were allocated to the trial's Tai Chi intervention. Individual phone interviews were conducted with those allocated to Tai Chi who had low adherence or who had withdrawn their participation from the study. Emergent themes were extracted using grounded-theory methods. RESULTS: In this qualitative study, we enrolled 41 participants who were allocated to the RCT's Tai Chi intervention: 38 completed and 3 withdrew from the study. Average Tai Chi class attendance was 64.3%. Pragmatic factors that led to higher adherence and retention included: locating classes within each facility; providing programs at no cost; and deployment of a skilled research support team. In addition, the use of an accessible, simplified Tai Chi program improved confidence, social support, self-efficacy, and self-reported improvements in physical and psychological well-being. DISCUSSION AND IMPLICATIONS: Perceived physical, psychological, social benefits, and self-efficacy likely enhance adherence and retention to research-based Tai Chi interventions for older adults. Delivering an on-site, no cost, and supportive program appears critical to overcoming financial and environmental barriers to participation for those living within subsidized housing.

"We have a roof over our head, but we have to eat too:" Exploring shifting foodscapes from homelessness into Housing First in Kingston, Ontario.

BACKGROUND: People facing extended periods of homelessness exhibit a remarkable degree of agency and resilience in procuring food. The literature on foodscapes considers the sociospatial contexts of food procurement, finding that what happens within and along the way to sites of food acquisition and consumption are important considerations in fully understanding and realizing food security. PURPOSE: This study explores the shift in foodscapes of people who are transitioning from homelessness into scattered-site independent housing via a municipal Housing First program and considers implications for health and wellbeing. METHODS: Our mixed-method approach included observational research at 11 local food providers and drop-in centres that provided context for semi-structured interviews with 10 Housing First clients in Kingston, Ontario between November 2016 and March 2017. RESULTS: The findings confirm that the provision of stable housing makes it possible for people to store, prepare, and consume food at home. An increased ability to have control over when, where, and what is eaten had a positive impact on people's sense of health and wellbeing. However, other effective markers of wellbeing were enacted along people's everyday routines and activities that had negative impacts. Interviewees remained heavily dependent on charitable food programs, including increased use of foodbanks. Others reported increasing detachment and social isolation from previously established food routines. Finally, the structured transition perpetuated a circuit of dependence and marginalization that fell short of contributing to improved food security as well as health and wellbeing. IMPLICATIONS: Understanding the relational geography of foodscape transitions is critical to the design of effective Housing First programs. Addressing the root causes of homelessness and poverty requires investments in comprehensive housing strategies including adequate social assistance and community supports that take a sociospatially holistic approach to wellbeing.

Integrated Service Delivery and Health-Related Quality of Life of Individuals in Permanent Supportive Housing Who Were Formerly Chronically Homeless.

OBJECTIVES: To investigate the impact of an integrated care model on the health-related quality of life (HRQOL) of formerly chronically homeless individuals in permanent supportive housing. METHODS: From 2014 to 2017, eligible individuals in Houston, Texas (n = 323), were placed in 1 of 2 permanent supportive housing service delivery models. Both models included coordinated care teams. In the intervention group, teams had a single plan of care with the partnering clinic. The 9-item Patient Health Questionnaire and 36-item Short Form Survey were administered at baseline and every 6 months for 30 months. We assessed intervention group emergency department use at 2 years. We evaluated change by using hierarchical linear growth models. RESULTS: There was a significant and clinically meaningful increase in HRQOL in the intervention group, with the intervention group reporting improvement over the comparison group. Intervention group emergency department use decreased by 70% (no comparison group). CONCLUSIONS: Those in the intervention group with a single, coordinated plan of care reported significant and clinically meaningful increases in their HRQOL. Public Health Implications. Coordinated care models have potential to reduce societal costs and increase HRQOL, providing a financial and humanitarian justification for the continued investment in collaborative care in permanent supportive housing.

Reducing 9-1-1 Emergency Medical Service Calls By Implementing A Community Paramedicine Program For Vulnerable Older Adults In Public Housing In Canada: A Multi-Site Cluster Randomized Controlled Trial.

Objective: Older adults account for 38-48% of emergency medical service (EMS) calls, have more chronic diseases, and those with low income have lower quality of life. Mobile integrated health and community paramedicine may help address these health inequalities and reduce EMS calls. This study examines the effectiveness of the Community Paramedicine at Clinic (CP@clinic) program in decreasing EMS calls and improving health outcomes in low-income older adults. Methods: This was an open-label, pragmatic, cluster-randomized controlled trial conducted within subsidized public housing buildings for older adults in 5 paramedic services across Ontario, Canada. A total of 30 apartment buildings were eligible (>50 units, >60% of units occupied by older adults, unique postal code, available match for pairing). Paired buildings were randomly allocated to intervention (CP@clinic for one year) or control (usual care) via computer-generated randomization. The CP@clinic intervention is a community-based, paramedic-led, health promotion and disease prevention program held weekly in building common rooms. CP@clinic includes risk assessment with validated tools, decision support, health promotion, referrals to resources, and reports back to family doctors. All residents could participate, but only older adults (55 years and older) were included in analyses. The primary outcome was building-level EMS calls from paramedic service databases. Secondary outcomes were individual-level changes in chronic disease risk factors and quality-adjusted-life-years (QALYs). Data were analyzed using Generalized Estimating Equations to account for clustering by sites. Results: Intention-to-treat analysis showed no significant difference in EMS calls (mean difference = -0.37/100 apartment units/month, 95%CI: -0.98 to 0.24). Sensitivity analysis excluding data from 2 building pairs with eligibility changes after intervention initiation revealed a significant difference in EMS calls in favor of the intervention buildings (mean difference = -0.90/100 apartment units/month, 95%CI: -1.54 to -0.26). At the individual level, there was a significant QALY increase (mean difference = 0.06, 95%CI: 0.02 to 0.10) and blood pressure decrease (systolic mean change = 3.65 mmHg, 95%CI: 2.37 to 4.94; diastolic mean change = 2.03 mmHg, 95%CI: 1.00 to 3.06). Conclusions: CP@clinic showed a significant decrease in EMS calls, decrease in BP, and improvement in QALYs among older adults in subsidizing public housing, suggesting this simple program should be replicated in other communities with public housing. Trial Registration: Clinicaltrials.gov, Registration no. NCT02152891.

Health-related quality of life of patients with inflammatory bowel disease in Singapore

BACKGROUND/AIMS: Inflammatory bowel disease (IBD) is associated with considerable impairment of patients’ health-related quality of life (HRQoL). Knowledge of factors that significantly affect IBD patients’ HRQoL can contribute to better patient care. However, the HRQoL of IBD patients in non-Western countries are limited. Hence, we assessed the HRQoL of Singaporean IBD patients and identified its determinants. METHODS: A prospective, cross-sectional study was conducted at Singapore General Hospital outpatient IBD Centre. The HRQoL of IBD patients was assessed using the short IBD questionnaire (SIBDQ), Short Form-36 physical and mental component summary (SF-36 PCS/MCS) and EuroQol 5-dimensions 3-levels (EQ-5D-3L) and visual analogue scale (VAS). Independent samples t-test was used to compare HRQoL between Crohn’s disease (CD) and ulcerative colitis (UC). Determinants of HRQoL were identified through multiple linear regression. RESULTS: A total of 195 IBD patients (103 UC, 92 CD) with a mean disease duration of 11.2 years were included. There was no significant difference in HRQoL between patients with UC and CD. Factors that significantly worsened HRQoL were presence of active disease (b=−6.293 [SIBDQ], −9.409 [PCS], −9.743 [MCS], −7.254 [VAS]), corticosteroids use (b=−7.392 [SIBDQ], −10.390 [PCS], −8.827 [MCS]), poor medication adherence (b=−4.049 [SIBDQ], −1.320 [MCS], −8.961 [VAS]), presence of extraintestinal manifestations (b=−13.381 [PCS]), comorbidities (b=−4.531 [PCS]), non-employment (b=−9.738 [MCS], −0.104 [EQ-5D-3L]) and public housing (b=−8.070 [PCS], −9.207 [VAS]). CONCLUSIONS: The HRQoL is impaired in this Asian cohort of IBD. The magnitude of HRQoL impairment was similar in UC and CD. Clinical characteristics were better determinants of patients’ HRQoL than socio-demographic factors. Recognizing the factors that impact patients’ HRQoL would improve the holistic management of IBD patients.

Homeless No More: A Christ-Centered, Comprehensive Homeless Recovery Program.

Caring for vulnerable and marginalized populations is a central tenet of professional nursing, and of Christian service. Due to the scope and complexities of problems associated with homelessness, nurses may feel overwhelmed and ill-equipped to serve homeless individuals. Strategies for ending homelessness largely include resource-intensive, publicly supported housing and comprehensive physical and mental health services. The role of spirituality in recovery from homelessness has not been widely examined. This article describes one homeless shelter's successful Christ-centered, comprehensive approach to helping individuals recover from homelessness. The integral role of the nurse in the multidisciplinary team and practical nursing interventions are described.

The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study: Design and rationale of a cluster randomized controlled trial of Tai Chi in senior housing.

Supporting the health of growing numbers of frail older adults living in subsidized housing requires interventions that can combat frailty, improve residents' functional abilities, and reduce their health care costs. Tai Chi is an increasingly popular multimodal mind-body exercise that incorporates physical, cognitive, social, and meditative components in the same activity and offers a promising intervention for ameliorating many of the conditions that lead to poor health and excessive health care utilization. The Mind Body-Wellness in Supportive Housing (Mi-WiSH) study is an ongoing two-arm cluster randomized, attention-controlled trial designed to examine the impact of Tai Chi on functional indicators of health and health care utilization. We are enrolling participants from 16 urban subsidized housing facilities (n=320 participants), conducting the Tai Chi intervention or education classes and social calls (attention control) in consenting subjects within the facilities for one year, and assessing these subjects at baseline, 6months, and 1year. Physical function (quantified by the Short Physical Performance Battery), and health care utilization (emergency visits, hospitalizations, skilled nursing and nursing home admissions), assessed at 12months are co-primary outcomes. Our discussion highlights our strategy to balance pragmatic and explanatory features into the study design, describes efforts to enhance site recruitment and participant adherence, and summarizes our broader goal of post study dissemination if effectiveness and cost-effectiveness are demonstrated, by preparing training and protocol manuals for use in housing facilities across the U.S.

Integrating the Integrated: Merging Integrated Dual Diagnosis Treatment (IDDT) with Housing First.

This study reports on a housing program that merged two evidence-based practices frequently applied in tandem: Integrated Dual Diagnosis Treatment and Housing First. Quantitative measures show that consumers in the program were receptive to supportive housing and core services. These quantitative measures, when considered alongside qualitative interviews, suggest that in order for more consumers to move through the IDDT stages of educational and vocational advancement, the staff will need to emphasize the permanence of supportive housing. Thus, the study also demonstrates the importance of integrating results of qualitative evaluations with quantitative data to strengthen a program's evidence base.

Factors Associated With Veterans' Access to Permanent Supportive Housing.

OBJECTIVE: The objective of this study was to identify individual- and program-level characteristics associated with veterans' ability to move into permanent housing following receipt of a housing voucher and to identify factors associated with more rapid placement into housing. METHODS: This study used secondary quantitative and primary quantitative and qualitative data collected from veterans participating in the U.S. Department of Housing and Urban Development and U.S. Department of Veterans Affairs Supportive Housing program at four locations between 2008 and 2014 (N=9,967). Interviewers conducted in-person surveys with a subsample of the cohort (N=508). The study assessed two outcomes: whether a veteran accessed permanent supportive housing and the number of days required for veterans to move in. A logistic regression analysis identified predictors of becoming housed and a multiple regression model determined factors that influenced the time required for veterans to move into housing after admission to the program. RESULTS: Most (85%) veterans who received a permanent housing subsidy identified and moved into permanent housing. Receipt of outpatient behavioral health care in the 90 days before program admission and use of outpatient medical, behavioral health, or substance use care in the 90 days after increased the odds of becoming housed. CONCLUSIONS: Program-level policies may contribute to enhanced access to housing among veterans seeking permanent supportive housing, specifically a holistic approach to the frequent provision of supportive services-including both health care and case management-immediately after program admission.

Formerly Homeless People Had Lower Overall Health Care Expenditures After Moving Into Supportive Housing.

The provision of supportive housing is often recognized as important public policy, but it also plays a role in health care reform. Health care costs for the homeless reflect both their medical complexity and psychosocial risk factors. Supportive housing attempts to moderate both by providing stable places to live along with on-site integrated health services. In this pilot study we used a mixture of survey and administrative claims data to evaluate outcomes for formerly homeless people who were living in a supportive housing facility in Oregon between 2010 and 2014. Results from the claims analysis showed significantly lower overall health care expenditures for the people after they moved into supportive housing. Expenditure changes were driven primarily by reductions in emergency and inpatient care. Survey data suggest that the savings were not at the expense of quality: Respondents reported improved access to care, stronger primary care connections, and better subjective health outcomes. Together, these results indicate a potential association between supportive housing and reduced health care costs that warrants deeper consideration as part of ongoing health care reforms.

Nurse-midwives in federally funded health centers: understanding federal program requirements and benefits.

Midwives are working in federally funded health centers in increasing numbers. Health centers provide primary and preventive health care to almost 20 million people and are located in every US state and territory. While health centers serve the entire community, they also serve as a safety net for low-income and uninsured individuals. In 2010, 93% of health center patients had incomes below 200% of the Federal Poverty Guidelines, and 38% were uninsured. Health centers, including community health centers, migrant health centers, health care for the homeless programs, and public housing primary care programs, receive grant funding and enjoy other benefits due to status as federal grantees and designation as federally qualified health centers. Clinicians working in health centers are also eligible for financial and professional benefits because of their willingness to serve vulnerable populations and work in underserved areas. Midwives, midwifery students, and faculty working in, or interacting with, health centers need to be aware of the regulations that health centers must comply with in order to qualify for and maintain federal funding. This article provides an overview of health center regulations and policies affecting midwives, including health center program requirements, scope of project policy, provider credentialing and privileging, Federal Tort Claims Act malpractice coverage, the 340B Drug Pricing Program, and National Health Service Corps scholarship and loan repayment programs.

Effectiveness of herbal and fluoridated toothpaste on plaque and gingival scores among residents of a working women's hostel - a randomised controlled trial.

PURPOSE: To determine the effectiveness of herbal and fluoridated toothpastes on plaque and gingival scores among 18- to 25-year-old female participants residing in a working women's hostel. MATERIALS AND METHODS: Sixty participants residing in a working women's hostel in Belgaum city, aged between 18 and 25 years, comprised the study population. The 60 participants were randomly allocated to the experimental and control groups. The experimental group was asked to use a herbal toothpaste (Himalaya Herbal Healthcare) and the control group a fluoridated toothpaste (Colgate Dental Cream) twice a day for 6 weeks. The plaque and gingival indices were recorded according to Silness and Löe (1964) and Löe and Silness (1963), respectively, at baseline, 3 weeks and 6 weeks of usage of the toothpastes. RESULTS: Baseline plaque and gingival scores were 1.53 ± 0.9 and 1.22 ± 0.13 for the control group and 1.30 ± 0.15 and 1.19 ± 0.12 for the experimental group, respectively. At 6 weeks, plaque and gingival scores were 0.86 ± 0.18 and 0.80 ± 0.2 for the control group and 0.99 ± 0.14 and 0.9 ± 0.21 for the experimental group, respectively. Statistically significant differences were obtained before and after the intervention in both groups (P < 0.001). CONCLUSION: The herbal toothpaste was as effective as the conventionally formulated dentifrice in controlling plaque and gingivitis.

Pathways to translating experiential knowledge into mental health policy.

OBJECTIVE: This research explored the pathways through which the experiential knowledge of people who need and use mental health and social housing services (citizen-users) gains access to policymaking. METHODS: Qualitative instrumental case study methodology focused the study on the policy field of mental health and social housing in Manitoba, Canada. Data collection included interviews with 21 key informants from four policy actor groups: citizen-users, service providers, advocacy organization representatives, and government officials. Relevant policy-related documents were also reviewed. Data were analyzed using inductive qualitative methods. RESULTS: Key informants described diverse pathways through which the experiential knowledge of citizen-users has been communicated to policy decision makers. Pathways have involved direct discourse between citizen-users and decision makers. Alternatively, indirect pathways were ones in which experiential knowledge was translated by other policy actors. Informants identified factors that could influence the integrity of the indirect pathways: the length and complexity of the pathways, the motivations and interests of the translators, and strategies to enhance the pathways. The pathways could be strengthened by developing the culture, leadership, knowledge, skills and attitudes supportive of engaging citizen-users and by accurately translating their experiential knowledge. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: If citizen-users are to be included in policymaking in a recovery-oriented mental health system, action must be taken to enhance the pathways through which their experiential knowledge reaches policymaking processes. Service providers, advocacy organization representatives and government officials can all take action to promote social policymaking that is informed by citizen-users' ideas and experiences.

Using a wellness program in public housing for community nursing clinical experiences.

A group of senior baccalaureate nursing students have been working with elderly and disabled residents in public housing as part of a Wellness Program for more than 5 years. This placement is an alternative to traditional Visiting Nurse Association placements, and encourages students to expand outreach and develop interventions for vulnerable populations while fulfilling nursing educational objectives.

Contested visions of American democracy: citizenship, public housing, and the international arena.

This essay reexamines the history of public housing and the controversy it generated from the Great Depression to the Cold War. By recasting that history in the global arena, it demonstrates that the debate over public housing versus homeownership was also a debate over the meaning of American citizenship and democracy, pointing up starkly divergent notions about what was and was not American. Through an examination of national conflicts and neglected local struggles, this article further shows that the fight over public housing was far more meaningful and volatile than traditionally assumed. Both critics and advocates of public housing drew from international experiences and imagery in positioning the home as a constitutive feature of citizenship in American democracy. Fears of Bolshevism, fascism, and communism served to internationalize issues of race, space, and housing and together shaped the decision of whether a decent home was an American right or privilege.

The perceived consequences of safer injection: an exploration of qualitative findings and gender differences.

Injection drug users (IDUs) are at a risk for HIV and other bloodborne pathogens via syringe and paraphernalia sharing, with females being at elevated risk. Consequences of injection risk behavior such as the risk of becoming infected with HIV have been relatively well studied, though less is known about the consequences of refusing to share injection equipment. We conducted indepth qualitative interviews with 26 IDUs recruited from a syringe exchange program in Los Angeles, California, USA, to understand the consequences of refusing to share injection equipment and to determine whether these perceived consequences differ by gender. Perceived consequences were organized into four domains using a social ecological framework: microsystem (perceived risk for HIV, drug withdrawal or forgoing drug use), exosystem (trust and social norms), mesosystem (precarious housing and shelter policies), and macrosystem (syringe access/inconvenience, economic and legal consequences). Gender differences were identified in some, but not in all areas. Effective public health interventions among IDUs will benefit from a holistic perspective that considers the environmental and social rationality (Kowalewski, M., Henson, K.D., & Longshore, D. (1997). Rethinking perceived risk and health behavior: A critical review of HIV prevention research. Health Education and Behavior, 24(3), 313-325) of decisions regarding injection risk behavior and assists individuals in addressing the consequences that they perceive to be the most salient.

Exploring the meaning and role of spirituality for women survivors of intimate partner abuse.

Literature on trauma, coping and spirituality has introduced new questions about protective factors in the healing process for intimate partner abuse survivors (IPA). This qualitative study explores the relationship between spirituality and IPA with three focus groups of twenty-two women IPA survivors residing in a shelter. A content analysis revealed central themes that explicate the meaning and role spirituality plays for participants. Viewed as a salient dimension, spirituality provides strength, influences outcomes and assists in the regulation of behavioral responses in a positive manner in terms of participants' traumatic IPA victimization. Practice implications are discussed.