Elizabeth A. Bowen

Prevalence and covariates of food insecurity among residents of single-room occupancy housing in Chicago, IL, USA.

OBJECTIVE Emerging evidence suggests that food insecurity is a significant public health concern among people who are homeless or marginally housed. The present study assessed prevalence of food insecurity and its covariates among a group of marginally housed individuals living in single-room occupancy (SRO) dwellings, a population for which there is little extant health or nutrition research. DESIGN Cross-sectional survey incorporating the Household Food Insecurity Access Scale. SETTING Ten private SRO residences in the Uptown neighbourhood of Chicago, IL, USA, 2013. SUBJECTS SRO residents over 18 years of age who were able to communicate verbally in English (n 153). RESULTS Food insecurity was widespread among SRO residents, with 75 % of the sample considered food insecure and 52 % meeting criteria for severe food insecurity. Bivariate analyses indicated that female gender, eating most meals at a soup kitchen, having a mental health condition, problem drinking, having at least one chronic health condition, and diabetes were all significantly associated with food insecurity. In the multivariate ordered logistic regression model, eating most meals at a soup kitchen remained as the only significant correlate of food insecurity (OR=10·13). CONCLUSIONS SRO residents and other marginally housed populations face unique food access challenges. Although targeted assistance in the form of food stamps and congregate meal programmes remains critical, efforts to prevent and address food insecurity among homeless and marginally housed individuals should include policy interventions that recognize poverty as the root cause of food insecurity and aim to increase overall income and improve housing conditions.

A Multilevel Ecological Model of HIV Risk for People Who Are Homeless or Unstably Housed and Who Use Drugs in the Urban United States

Elevated HIV prevalence has been observed among urban U.S. individuals who use drugs and who lack stable housing. This article synthesizes extant research on this population and situates it in a multilevel, ecologically based model of HIV risk. Based on a multidisciplinary review of the literature, the model applies social-ecological theory on human development to identify factors shaping the HIV risk context for individuals who use drugs and who are unstably housed at global, societal, neighborhood, household, and individual levels of influence. At the global level, the model includes neoliberal ideologies contributing to the social inequalities that frame the HIV epidemic. U.S. housing and drug policy, including urban renewal, HOPE VI, and the War on Drugs, is the focus of the societal level. At the neighborhood level, mechanisms of the built environment and psychosocial mechanisms are explored for their salience to HIV risk. Research on the association between housing instability and HIV risk is reviewed at the household level. At the last level, relevant individual differences in biology, psychology, and cognition are discussed. Modeling risk at multiple levels of the environment underscores the need to expand the focus of research, treatment, and prevention interventions for HIV/AIDS and addictions beyond individuals and their risk behaviors to address facets of structural violence and incorporate the broader social, political, and economic contexts of risk and health.

Predictors of CD4 health and viral suppression outcomes for formerly homeless people living with HIV/AIDS in scattered site supportive housing

ABSTRACT Stable housing is key to improving health outcomes for people living with HIV/AIDS. Though many formerly homeless HIV positive individuals reside in supportive housing, little research has examined biometric HIV health outcomes for residents of these programs. Through a community-based research partnership, this study analyzed secondary data from a Shelter Plus Care supportive housing program in Cincinnati, Ohio to examine the likelihood of participants achieving a healthy CD4 count (>500 cells/mm3) and viral suppression (viral load <200 copies/mL) while in supportive housing and to identify participant characteristics associated with these outcomes. The study sample was 86 participants who entered the program between 2008 and 2016, including 50 current residents and 36 exited participants. Participants’ average length of stay in Shelter Plus Care was 35.2 months (range 3.2–108.1 months) during the study period. Bivariate analysis indicated statistically significant improvements on both outcome variables, with 45% of participants achieving a healthy CD4 count and 79% achieving viral suppression by program exit or most recent time point. Participants who had health insurance at intake and who had never been incarcerated were more likely to achieve viral suppression, and longer length of stay in the program was also positively associated with viral suppression. These results add to the literature on the relationship between housing conditions and HIV health outcomes by demonstrating that residence in supportive housing is associated with improvements in CD4 count and viral load for a sample of formerly homeless persons living with HIV/AIDS, two-thirds of whom had co-occurring physical health, mental health, or substance abuse problems. Further research collaborations should expand on these findings to examine the service packages that are associated with optimal HIV health outcomes for supportive housing residents.

Community Practice in the Bulldozer’s Shadow: The History and Legacy of Social Work in Urban Renewal

Social work has a long history of involvement in urban development policy, dating to the settlement house movement. This article explores a neglected part of this history by analyzing the role of social work in urban renewal programs. The functions of social work in urban renewal—including relocating families displaced by slum clearance and community organizing to foster resident input in planning—reflect enduring tensions in practice between social justice and social control. Implications for current practice are explored as the profession continues to define its part in urban redevelopment policies.

The Relative Influence of Injunctive and Descriptive Social Norms on Methamphetamine, Heroin, and Injection Drug Use Among Homeless Youths: The Impact of Different Referent Groups:

The current study assessed the relative influence of both injunctive and descriptive norms in the context of different referent groups (i.e., family, street peers, home-based peers, and staff members) on past 30-day methamphetamine, heroin, and injection drug use behaviors of homeless youth. Cross-sectional data (N = 911) were collected from three drop-in centers in Los Angeles, California. The study consisted of two parts: a social network interview and a computerized self-administered survey. Multivariate logistic regression models examined the association of objection to drug use from referent groups (injunctive norms; that is, street-based peers, home-based peers, relatives, staff members) and drug use of referent groups (descriptive norms) with youths’ substance use behaviors. Multivariate results indicated that the role of injunctive and descriptive norms varied across the three substance use behaviors and by referent group. Findings indicate the need to carefully consider the diversity of homeless youths’ networks in designing substance use interventions.

A trauma-informed examination of the hardships experienced by abortion fund patients in the United States

ABSTRACT Researchers describe hardships experienced by abortion patients, examining administrative health cases from 2010 to 2015 in the United States. All patients received financial assistance from an abortion fund to help pay for abortion. Case data were analyzed to assess types and numbers of hardships experienced by age, race, and geographic origin. Hardships ranged from homelessness to parenting multiple children. Patients from the geographic South experienced the most hardships, followed by those from the Midwest. Hardships experienced by abortion fund patients are like those reported in other samples of abortion patients; hardships potentially cause or exacerbate trauma. Results are discussed in the context of a trauma-informed perspective.

Striving and Dreaming: A Grounded Theory of the Transition to Adulthood for Cross-Systems Youth:

The transition to adulthood is an underresearched topic for cross-systems youth, defined as young people who have experienced homelessness, child welfare system involvement, and educational challenges. This qualitative study explored processes of resilience in the transition to adulthood for cross-systems youth aged 18 to 24 (n = 20). Analysis of in-depth interviews using a grounded theory open coding process revealed two thematic concepts, striving and dreaming. As illustrated in two case studies, striving was characterized by participants having specific educational and career goals and making strategic choices about programs and resources. In contrast, the dreaming concept indicated participants having little understanding of the steps and resources needed to achieve their goals. Implications for practice include the importance of helping cross-systems youth maintain supportive relationships with families of origin and peers to enhance striving, and the use of motivational interviewing to assist emerging adults in gauging their readiness and motivation to set and pursue goals.

Housing as a Social Determinant of Health: Exploring the Relationship between Rent Burden and Risk Behaviors for Single Room Occupancy Building Residents

A growing body of health determinants research recognizes that housing and health are intimately linked. This study explores the relationship between rent burden (the ratio of rent to income) and health risk behaviors among a sample of single room occupancy (SRO) building residents. Cross-sectional data were gathered from a sample of 162 residents living in privately owned, for-profit SROs in Chicago. Findings indicated that participants who had full rental subsidies and thus were designated in a no-rent-burden category were more likely to engage in risk behaviors including illicit drug use, having multiple sexual partners, and having sex without a condom, in comparison to participants with moderate or high-rent burdens. These findings suggest that interventions to increase housing stability and affordability and bolster reliable income sources (in addition to rental subsidies) may be key in reducing risk behaviors and improving health for vulnerably housed populations such as SRO residents.

Homelessness and residential instability as covariates of HIV risk behavior among residents of single room occupancy housing

ABSTRACT Homeless and unstably housed individuals are at increased risk for contracting HIV. This study examined multiple indicators of housing instability and their association with HIV risk for a sample of low-income residents living in single room occupancy (SRO) buildings in Chicago (n = 163). In the multivariate analysis, prior homelessness was associated with recent illicit drug use (adjusted odds ratio = 3.14) and self-identifying as homeless was associated with having multiple sexual partners (adjusted odds ratio = 2.99). The number of months participants had lived at the SRO was not significantly associated with any risk behaviors. Results suggest that residential stability and housing histories vary considerably among SRO residents, and that it is critical to use precise definitions to capture multiple dimensions of housing to better understand their potential relationship with HIV risk.

What the MAYSI-2 Can Tell Us About Anger–Irritability and Trauma

The rate of experiencing trauma can be quite high for juvenile offenders and those experiences can lead to feelings of anger and irritability. This study uses Massachusetts Youth Screening Instrument–Version 2 (MAYSI-2) data to examine the relationship between the Traumatic Experiences (TE) and Angry–Irritable (AI) scales for juvenile offenders (N = 1,348) from a Midwest detention center. Chi-square analyses revealed statistically significant relationships between the AI scale and gender, race, and the TE scale. In addition, ordinal logistic regression results showed that as the number of traumatic experiences increased, so did the odds of scoring Caution or Warning on the AI scale. Recommendations are that juvenile justice systems utilize a trauma-informed process throughout the adjudicatory process and there be improved efforts to coordinate services across multiple systems, such as child welfare and special education, where juvenile offenders are often engaged.