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1.
Medicine (Baltimore) ; 101(7): e28816, 2022 Feb 18.
Article in English | MEDLINE | ID: covidwho-1799411

ABSTRACT

BACKGROUND: Homelessness is a more complex problem than the simple lack of a place to live. Homeless people (HP) often suffer from poor health and premature death due to their limited access healthcare, and are also deprived of basic human and social rights. The study protocol described here aims to evaluate the complex relationship between homelessness and health, and identify the barriers and facilitators that impact access to healthcare by HP. METHODS: This is a mixed-methods study that uses an explanatory sequential design. The first phase will consist of a cross-sectional study of 300 HP. Specific health questionnaires will be used to obtain information on health status, challenges during the COVID-19 pandemic, self-reported use of healthcare, diagnoses and pharmacologic treatments, substance abuse (DAST-10), diet quality (IASE), depression (PHQ-9), and human basic needs and social support (SSQ-6). The second phase will be a qualitative study of HP using the "life story" technique with purposive sampling. We will determine the effects of different personal, family, and structural factors on the life and health status of participants. The interviews will be structured and defined using Nussbaum's capability approach. DISCUSSION: It is well-known that HP experience poor health and premature death, but more information is needed about the influence of the different specific social determinants of these outcomes and about the barriers and facilitators that affect the access of HP to healthcare. The results of this mixed methods study will help to develop global health strategies that improve the health and access to healthcare in HP.


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , Cross-Sectional Studies , Health Services Accessibility , Humans , Pandemics
2.
Healthc Policy ; 17(3): 34-41, 2022 02.
Article in English | MEDLINE | ID: covidwho-1761265

ABSTRACT

Among those visiting a testing centre in Toronto, ON, between March and April 2020, people experiencing homelessness (n = 214) were more likely to test positive for COVID-19 compared with those not experiencing homelessness (n = 1,836) even after adjustment for age, sex and medical co-morbidity (15.4% vs. 6.7%, p < 0.001; odds ratio [OR] 2.41, 95% confidence interval [CI: 1.51, 3.76], p < 0.001).


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , Cross-Sectional Studies , Humans , Odds Ratio , Social Problems
3.
Int J Environ Res Public Health ; 19(6)2022 03 19.
Article in English | MEDLINE | ID: covidwho-1760604

ABSTRACT

Staff working in homelessness services often find the work rewarding yet challenging, and the sector experiences high levels of staff burnout and staff turnover. During the COVID-19 pandemic, staff working in these services faced particularly stressful working conditions. This study explored the experiences of stress and wellbeing among those working in frontline homelessness service roles during the early stages of the pandemic in Scotland. Semi-structured interviews were conducted with 18 participants, 11 of whom completed the Maslach Burnout Inventory (MBI). Qualitative data were analysed using Framework Analysis in NVivo, informed by the Revised Transactional Model of occupational stress and coping. MBI data were analysed using descriptive statistics. The COVID-19 pandemic positively and negatively impacted participants' lives and roles. Organisational culture acted as a magnifying glass for pre-pandemic practices: for some, the pandemic brought teams and staff closer together, creating a better working environment. For others, it led to fragmentation and frustration. Participants discussed coping strategies and recommendations for the future to protect staff wellbeing. Quantitative data suggested that participants were not experiencing burnout, although some were at heightened risk. Future research should explore the longer-term impact of the pandemic on homelessness service staff outcomes.


Subject(s)
Burnout, Professional , COVID-19 , Homeless Persons , Burnout, Professional/epidemiology , COVID-19/epidemiology , Humans , Pandemics , Scotland/epidemiology
5.
Am J Public Health ; 112(4): 633-637, 2022 04.
Article in English | MEDLINE | ID: covidwho-1760044

ABSTRACT

The point-in-time (PIT) homeless count conducted annually in communities across the United States is a major metric reported to the federal government that has a number of limitations. With the PIT count in 2021 being optional because of the COVID-19 pandemic and potential increases in homeless-related needs in the aftermath of the pandemic, there are opportunities for renewed efforts to improve how the United States enumerates homelessness, determines needs of communities, and tracks progress in ending homelessness throughout the nation. This article describes 2 divergent solutions: (1) improve the PIT by standardizing methodologies across jurisdictions and supplementing counts with other data sources or (2) replace the PIT with a new system. There are strengths and limitations of both solutions. Advocates for either solution agree that there are important funding considerations to take into account and advancing technologies to utilize. As the nation continues to ramp up public health efforts, homelessness is a public health crisis that could benefit from improved epidemiological and data science methods. (Am J Public Health. 2022;112(4):633-637. https://doi.org/10.2105/AJPH.2021.306640).


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , Humans , Pandemics , Public Health , Social Problems , United States
7.
Int J Environ Res Public Health ; 19(6)2022 03 15.
Article in English | MEDLINE | ID: covidwho-1742462

ABSTRACT

People experiencing homelessness have higher rates of mental ill-health and substance use and lower access to health services compared to the general population. The COVID-19 pandemic led to changes in service delivery across health and social care services, with many adopting virtual or telephone support for service users. This paper explores the experiences of access to community-based mental health and substance use support for people experiencing homelessness during the COVID-19 pandemic. Qualitative telephone interviews were conducted with 10 women and 16 men (ages 25 to 71) who self-identified as experiencing homelessness in North East England between February and May 2021. With five individuals with lived experience, results were analysed using inductive reflexive thematic analysis. Reactive changes to support provision often led to inadvertent exclusion. Barriers to access included: physical locations, repetition of recovery stories, individual readiness, and limited availability. Participants suggested creating services reflective of need and opportunities for choice and empowerment. Community mental health and substance use support for people experiencing homelessness should ensure the support is personalised, responsive to need, inclusive, and trauma-informed. The findings of this research have important implications for mental health and substance use policy and practice for individuals who experience homelessness during a public health crisis.


Subject(s)
COVID-19 , Homeless Persons , Substance-Related Disorders , Adult , Aged , COVID-19/epidemiology , Female , Homeless Persons/psychology , Humans , Male , Mental Health , Middle Aged , Pandemics , Social Work , Substance-Related Disorders/epidemiology , Substance-Related Disorders/psychology
8.
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
10.
JAMA Netw Open ; 5(3): e221870, 2022 03 01.
Article in English | MEDLINE | ID: covidwho-1733815

ABSTRACT

Importance: There has been recent media attention on the risk of excess mortality among homeless individuals during the COVID-19 pandemic, yet data on these deaths are limited. Objectives: To quantify and describe deaths among people experiencing homelessness in San Francisco during the COVID-19 pandemic and to compare the characteristics of these deaths with those in prior years. Design, Setting, and Participants: A cross-sectional study tracking mortality among people experiencing homelessness from 2016 to 2021 in San Francisco, California. All deceased individuals who were homeless in San Francisco at the time of death and whose deaths were processed by the San Francisco Office of the Chief Medical Examiner were included. Data analysis was performed from August to October 2021. Exposure: Homelessness, based on homeless living status in an administrative database. Main Outcomes and Measures: Descriptive statistics were used to understand annual trends in demographic characteristics, cause and manner of death (based on autopsy), substances present in toxicology reports, geographic distribution of deaths, and use of health and social services prior to death. Total estimated numbers of people experiencing homelessness in San Francisco were assessed through semiannual point-in-time counts. The 2021 point-in-time count was postponed owing to the COVID-19 pandemic. Results: In San Francisco, there were 331 deaths among people experiencing homelessness in the first year of the COVID-19 pandemic (from March 17, 2020, to March 16, 2021). This number was more than double any number in previous years (eg, 128 deaths in 2016, 128 deaths in 2017, 135 deaths in 2018, and 147 deaths in 2019). Most individuals who died were male (268 of 331 [81%]). Acute drug toxicity was the most common cause of death in each year, followed by traumatic injury. COVID-19 was not listed as the primary cause of any deaths. The proportion of deaths involving fentanyl increased each year (present in 52% of toxicology reports in 2019 and 68% during the pandemic). Fewer decedents had contacts with health services in the year prior to their death during the pandemic than in prior years (13% used substance use disorder services compared with 20% in 2019). Conclusions and Relevance: In this cross-sectional study, the number of deaths among people experiencing homelessness in San Francisco increased markedly during the first year of the COVID-19 pandemic. These findings may guide future interventions to reduce mortality among individuals experiencing homelessness.


Subject(s)
Homeless Persons/statistics & numerical data , Adult , Aged , Aged, 80 and over , COVID-19/epidemiology , Cause of Death/trends , Cross-Sectional Studies , Female , Humans , Male , Middle Aged , Mortality/trends , SARS-CoV-2 , San Francisco
11.
Int J Environ Res Public Health ; 19(6)2022 03 09.
Article in English | MEDLINE | ID: covidwho-1732056

ABSTRACT

Persons experiencing homelessness (PEH) are at heightened risk for infection, morbidity, and mortality from COVID-19. However, health consequences of the pandemic extend far beyond those directly caused by the virus. This scoping review aimed to explore the impacts of the COVID-19 pandemic on the health and well-being of PEH in North America and Europe. A systematic search of academic and grey literature was conducted in September 2021. To be included, studies had to include primary data related to the impact of the pandemic on health or well-being of PEH and be written in English. All potentially relevant references were independently screened by two reviewers, and minor conflicts were settled with input of a third reviewer. A total of 96 articles met criteria for inclusion. Data extraction was completed for all included studies, and findings synthesised and presented thematically. Numerous health impacts of the pandemic on PEH were identified, including SARS-CoV-2 infection, morbidity, mortality, and hospitalisation, fear of infection, access to housing, hygiene, PPE, food, as well as mental health, substance use, other health-related outcomes and treatment services. Gaps in the literature relating to persons using alcohol, access to mental health support, and violence were also identified. Implications for future research are discussed.


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , Homeless Persons/psychology , Humans , North America/epidemiology , Pandemics , SARS-CoV-2
12.
Int J Environ Res Public Health ; 19(5)2022 Mar 07.
Article in English | MEDLINE | ID: covidwho-1732040

ABSTRACT

Most vulnerable individuals are particularly affected by the COVID-19 pandemic. This study takes place in a large city in France. The aim of this study is to describe the mobility of the homeless population at the beginning of the health crisis and to analyze its impact in terms of COVID-19 prevalence. From June to August 2020 and September to December 2020, 1272 homeless people were invited to be tested for SARS-CoV-2 antibodies and virus and complete questionnaires. Our data show that homeless populations are sociologically different depending on where they live. We show that people that were living on the street were most likely to be relocated to emergency shelters than other inhabitants. Some neighborhoods are points of attraction for homeless people in the city while others emptied during the health crisis, which had consequences for virus circulation. People with a greater number of different dwellings reported became more infected. This first study of the mobility and epidemiology of homeless people in the time of the pandemic provides unique information about mobility mapping, sociological factors of this mobility, mobility at different scales, and epidemiological consequences. We suggest that homeless policies need to be radically transformed since the actual model exposes people to infection in emergency.


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , Humans , Pandemics , Population Dynamics , SARS-CoV-2
13.
Lancet Public Health ; 7(4): e366-e377, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1730182

ABSTRACT

BACKGROUND: People experiencing homelessness face a high risk of SARS-CoV-2 infection and transmission, as well as health complications and death due to COVID-19. Despite being prioritised for receiving the COVID-19 vaccine in many regions, little data are available on vaccine uptake in this vulnerable population. Using population-based health-care administrative data from Ontario, Canada-a region with a universal, publicly funded health system-we aimed to describe COVID-19 vaccine coverage (ie, the estimated percentage of people who have received a vaccine) and determinants of vaccine receipt among individuals with a recent history of homelessness. METHODS: We conducted a retrospective, population-based cohort study of adults (aged ≥18 years) with a recent experience of homelessness, inadequate housing, or shelter use as recorded in routinely collected health-care databases between June 14, 2020, and June 14, 2021 (a period within 6 months of Dec 14, 2020, when COVID-19 vaccine administration was initiated in Ontario). Participants were followed up from Dec 14, 2020, to Sept 30, 2021, for the receipt of one or two doses of a COVID-19 vaccine using the province's real-time centralised vaccine information system. We described COVID-19 vaccine coverage overall and within predefined subgroups. Using modified Poisson regression, we further identified sociodemographic factors, health-care usage, and clinical factors associated with receipt of at least one dose of a COVID-19 vaccine. FINDINGS: 23 247 individuals with a recent history of homelessness were included in this study. Participants were predominantly male (14 752 [63·5%] of 23 247); nearly half were younger than 40 years (11 521 [49·6%]) and lived in large metropolitan regions (12 123 [52·2%]); and the majority (18 226 [78·4%]) visited a general practitioner for an in-person consultation during the observation period. By Sept 30, 2021, 14 271 (61·4%; 95% CI 60·8-62·0) individuals with a recent history of homelessness had received at least one dose of a COVID-19 vaccine and 11 082 (47·7%; 47·0-48·3) had received two doses; in comparison, over the same period, 86·6% of adults in the total Ontario population had received a first dose and 81·6% had received a second dose. In multivariable analysis, factors positively associated with COVID-19 uptake were one or more outpatient visits to a general practitioner (adjusted risk ratio [aRR] 1·37 [95% CI 1·31-1·42]), older age (50-59 years vs 18-29 years: 1·18 [1·14-1·22], ≥60 years vs 18-29 years: 1·27 [1·22-1·31]), receipt of an influenza vaccine in either of the two previous influenza seasons (1·25 [1·23-1·28]), being identified as homeless via a visit to a community health centre versus exclusively a hospital-based encounter (1·13 [1·10-1·15]), receipt of one or more SARS-CoV-2 tests between March 1, 2020, and Sept 30, 2021 (1·23 [1·20-1·26]), and the presence of chronic health conditions (one condition: 1·05 [1·03-1·08]; two or more conditions: 1·11 [1·08-1·14]). By contrast, living in a smaller metropolitan region (aRR 0·92 [95% CI 0·90-0·94]) or rural location (0·93 [0·90-0·97]) versus large metropolitan regions were associated with lower uptake. INTERPRETATION: In Ontario, COVID-19 vaccine coverage among adults with a recent history of homelessness has lagged and, as of Sept 30, 2021, was 25 percentage points lower than that of the general adult population in Ontario for a first dose and 34 percentage points lower for a second dose. With high usage of outpatient health services among individuals with a recent history of homelessness, better utilisation of outpatient primary care structures might offer an opportunity to increase vaccine coverage in this population. Our findings underscore the importance of leveraging existing health and service organisations that are accessed and trusted by people who experience homelessness for targeted vaccine delivery. FUNDING: The Public Health Agency of Canada. TRANSLATION: For the French translation of the abstract see Supplementary Materials section.


Subject(s)
COVID-19 , Homeless Persons , Vaccines , Adolescent , Adult , COVID-19/prevention & control , COVID-19 Vaccines , Cohort Studies , Humans , Male , Ontario/epidemiology , Retrospective Studies , SARS-CoV-2
14.
J Adolesc Health ; 70(3): 504-506, 2022 03.
Article in English | MEDLINE | ID: covidwho-1683229

ABSTRACT

PURPOSE: This study provides information on COVID-19 vaccination and attitudes among young adults with recent experiences of homelessness. METHODS: Participants (n = 134) from a clinical trial of a risk reduction program for youth experiencing homelessness in Los Angeles completed survey items about COVID-19 vaccinations between March and October 2021. RESULTS: A total of 29% of respondents were vaccinated, and 50% were not interested in getting vaccinated. Among the unvaccinated, 58% had not been offered the vaccine; furthermore, 38%-45% had strong distrust of the vaccine and were worried about its harmfulness. Vaccination status was generally unrelated to demographics, housing instability, service use, substance use, or mental health. DISCUSSION: Our data suggest that vaccination rates are lower among young adults with recent experiences of homelessness than those in the general US population. The results suggest a need for greater direct outreach that includes both offering the vaccine and addressing misconceptions about its safety to increase vaccination rates in this population.


Subject(s)
COVID-19 , Homeless Persons , Adolescent , Attitude , COVID-19 Vaccines , Humans , SARS-CoV-2 , Vaccination/psychology , Young Adult
15.
Can J Public Health ; 113(1): 117-125, 2022 02.
Article in English | MEDLINE | ID: covidwho-1675363

ABSTRACT

OBJECTIVES: People experiencing homelessness are at increased risk of SARS-CoV-2 infection. This study reports the point prevalence of SARS-CoV-2 infection during testing conducted at sites serving people experiencing homelessness in Toronto during the first wave of the COVID-19 pandemic. We also explored the association between site characteristics and prevalence rates. METHODS: The study included individuals who were staying at shelters, encampments, COVID-19 physical distancing sites, and drop-in and respite sites and completed outreach-based testing for SARS-CoV-2 during the period April 17 to July 31, 2020. We examined test positivity rates over time and compared them to rates in the general population of Toronto. Negative binomial regression was used to examine the relationship between each shelter-level characteristic and SARS-CoV-2 positivity rates. We also compared the rates across 3 time periods (T1: April 17-April 25; T2: April 26-May 23; T3: May 24-June 25). RESULTS: The overall prevalence of SARS-CoV-2 infection was 8.5% (394/4657). Site-specific rates showed great heterogeneity with infection rates ranging from 0% to 70.6%. Compared to T1, positivity rates were 0.21 times lower (95% CI: 0.06-0.75) during T2 and 0.14 times lower (95% CI: 0.04-0.44) during T3. Most cases were detected during outbreak testing (384/394 [97.5%]) rather than active case finding. CONCLUSION: During the first wave of the pandemic, rates of SARS-CoV-2 infection at sites for people experiencing homelessness in Toronto varied significantly over time. The observation of lower rates at certain sites may be attributable to overall time trends, expansion of outreach-based testing to include sites without known outbreaks, and/or individual site characteristics.


RéSUMé: OBJECTIFS: Les personnes en situation d'itinérance courent un risque accru de contracter une infection par le SRAS-CoV-2. Notre étude rend compte de la prévalence ponctuelle des infections par le SRAS-CoV-2 au cours de tests de dépistage menés dans des lieux de services aux personnes en situation d'itinérance de Toronto au cours de la première vague de la pandémie de COVID-19. Nous avons aussi exploré l'association entre les caractéristiques de ces lieux et les taux de prévalence. MéTHODE: L'étude a inclus les personnes séjournant dans des refuges, des campements, des lieux de distanciation physique et des centres d'accueil et de répit et ayant subi un test de dépistage de proximité du SRAS-CoV-2 entre le 17 avril et le 31 juillet 2020. Nous avons examiné les taux de positivité des tests au fil du temps et nous les avons comparés aux taux dans la population générale de Toronto. Des analyses de régression binomiales négatives ont été effectuées pour étudier la relation entre chaque caractéristique au niveau des refuges et les taux de positivité au SRAS-CoV-2. Nous avons aussi comparé les taux de trois intervalles (I1: 17 au 25 avril; I2: 26 avril au 23 mai; I3: 24 mai au 25 juin). RéSULTATS: La prévalence globale des infections par le SRAS-CoV-2 était de 8,5 % (394/4 657). Les taux d'infection spécifiques aux lieux de services ont présenté une grande hétérogénéité, soit de 0 % à 70,6 %. Comparés au 1er intervalle (I1), les taux de positivité ont été 0,21 fois plus faibles (IC de 95% : 0,06 ­ 0,75) durant l'I2 et 0,14 fois plus faibles (IC de 95% : 0,04 ­ 0,44) durant l'I3. La plupart des cas ont été détectés lors d'un dépistage en cours d'éclosion (384/394 [97,5%]) et non lors d'une recherche active de cas. CONCLUSION: Au cours de la première vague de la pandémie, les taux d'infection par le SRAS-CoV-2 dans les lieux de services aux personnes en situation d'itinérance de Toronto ont varié de façon significative au fil du temps. L'observation de taux plus faibles dans certains lieux pourrait s'expliquer par les tendances temporelles globales, par l'expansion des activités de dépistage de proximité pour inclure les lieux sans éclosion connue et/ou par les caractéristiques individuelles des lieux.


Subject(s)
COVID-19 , Homeless Persons , Humans , Pandemics , Prevalence , SARS-CoV-2
16.
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
17.
Lancet Planet Health ; 5(11): e763, 2021 11.
Article in English | MEDLINE | ID: covidwho-1665606
18.
Eur Rev Med Pharmacol Sci ; 26(1): 340-344, 2022 01.
Article in English | MEDLINE | ID: covidwho-1631708

ABSTRACT

In Italy COVID-19 pandemic had a severe impact. The homeless live in situations aggravating their poor health conditions and comorbidities. Although homeless people are a fragile category, no dedicated measures by public health departments seem to be applied infrequently to this population. For these reasons, they are probably one of the categories most affected by the global spread of the SARS-CoV-2. Moreover, the current vaccination campaign against COVID-19 can represent an important opportunity for health and social integration also for the homeless. This scoping review performed a map to describe strategies and interventions adopted to protect the homeless population during the COVID-19 pandemic in Italy. The methodology adheres to the PRISMA statement (extension for purpose revision) and follows the framework of Arksey and O'Malley. At the end of the selection process, 7 studies deemed relevant were included. Many strategies have been adopted to counter the spread of the virus to the homeless population, such as rapid and molecular tests with swabs or rapid blood tests. All the tests for diagnosing the infection currently in use have also been used for the homeless.


Subject(s)
COVID-19/diagnosis , COVID-19/prevention & control , Communicable Disease Control/methods , Homeless Persons , COVID-19/transmission , Humans , Italy , Pandemics/prevention & control , Public Health/methods , Social Determinants of Health
19.
BMC Public Health ; 22(1): 122, 2022 01 18.
Article in English | MEDLINE | ID: covidwho-1629368

ABSTRACT

OBJECTIVES: The COVID-19 pandemic has disproportionately impacted 2SLGBTQ+ youth experiencing homelessness. Little is known about vaccine attitudes and uptake among this population. To address this, the objectives of this study were to explore this group's COVID-19 vaccine attitudes, and facilitators and barriers impacting vaccine uptake. METHODS: 2SLGBTQ+ youth experiencing homelessness in the Greater Toronto Area were recruited to participate in online surveys assessing demographic characteristics, mental health, health service use, and COVID-19 vaccine attitudes. Descriptive statistics and statistical tests were used to analyze survey data to explore variables associated with vaccine confidence. Additionally, a select group of youth and frontline workers from youth serving organizations were invited to participate in online one-on-one interviews. An iterative thematic content approach was used to analyze interview data. Quantitative and qualitative data were merged for interpretation by use of a convergent parallel analytical design. RESULTS: Ninety-two youth completed surveys and 32 youth and 15 key informants participated in one-on-one interviews. Quantitative and qualitative data showed that the majority of 2SLGBTQ+ youth experiencing homelessness were confident in the COVID-19 vaccine; however, numerous youth were non-vaccine confident due to mistrust in the healthcare system, lack of targeted vaccine-related public health information, concerns about safety and side effects, and accessibility issues. Solutions to increase vaccine confidence were provided, including fostering trust, targeted public health messaging, and addressing accessibility needs. CONCLUSION: Our study highlights the need for the vaccine strategy and rollouts to prioritize 2SLGBTQ+ youth experiencing homelessness and to address the pervasive health disparities that have been exacerbated by the pandemic.


Subject(s)
COVID-19 , Homeless Persons , Adolescent , Attitude , COVID-19 Vaccines , Humans , Pandemics , SARS-CoV-2
20.
AMA J Ethics ; 23(11): E840-846, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1625866

ABSTRACT

The COVID-19 pandemic underscores long-standing challenges to the health of persons experiencing homelessness. This case commentary considers primary care clinicians' response to a patient who declines COVID-19 testing and isolation. This article also considers other outbreaks in the United States in which the autonomy of persons with low income or persons of color was neglected and calls for community engagement, policies that center interests of marginalized groups, and economic relief, including supportive housing.


Subject(s)
COVID-19 , Homeless Persons , COVID-19 Testing , Humans , Pandemics , Public Health , SARS-CoV-2 , United States
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