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1.
Harm Reduct J ; 19(1): 43, 2022 05 04.
Article in English | MEDLINE | ID: covidwho-2139312

ABSTRACT

Vancouver, Canada, and Lisbon, Portugal, are both celebrated for their world-leading harm reduction policies and programs and regarded as models for other cities contending with the effects of increasing levels of drug use in the context of growing urban poverty. However, we challenge the notion that internationally celebrated places like Lisbon and Vancouver are meeting the harm reduction needs of young people who use drugs (YPWUD; referring here to individuals between the ages of 14 and 29). In particular, the needs of YPWUD in the context of unstable housing, homelessness, and ongoing poverty-a context which we summarize here as "street involvement"-are not being adequately met. We are a group of community and academic researchers and activists working in Vancouver, Lisbon, and Pittsburgh. Most of us identify as YPWUD and have lived and living experience with the issues described in this comment. We make several calls to action to support the harm reduction needs of YPWUD in the context of street involvement in and beyond our settings.


Subject(s)
Homeless Persons , Substance-Related Disorders , Adolescent , Adult , Harm Reduction , Housing , Humans , Public Policy , Substance-Related Disorders/prevention & control , Young Adult
2.
JMIR Public Health Surveill ; 7(1): e24320, 2021 01 11.
Article in English | MEDLINE | ID: covidwho-2141293

ABSTRACT

BACKGROUND: Many studies have focused on the characteristics of symptomatic patients with COVID-19 and clinical risk factors. This study reports the prevalence of COVID-19 in an asymptomatic population of a hospital service area (HSA) and identifies factors that affect exposure to the virus. OBJECTIVE: The aim of this study is to measure the prevalence of COVID-19 in an HSA, identify factors that may increase or decrease the risk of infection, and analyze factors that increase the number of daily contacts. METHODS: This study surveyed 1694 patients between April 30 and May 13, 2020, about their work and living situations, income, behavior, sociodemographic characteristics, and prepandemic health characteristics. This data was linked to testing data for 454 of these patients, including polymerase chain reaction test results and two different serologic assays. Positivity rate was used to calculate approximate prevalence, hospitalization rate, and infection fatality rate (IFR). Survey data was used to analyze risk factors, including the number of contacts reported by study participants. The data was also used to identify factors increasing the number of daily contacts, such as mask wearing and living environment. RESULTS: We found a positivity rate of 2.2%, a hospitalization rate of 1.2%, and an adjusted IFR of 0.55%. A higher number of daily contacts with adults and older adults increases the probability of becoming infected. Occupation, living in an apartment versus a house, and wearing a face mask outside work increased the number of daily contacts. CONCLUSIONS: Studying prevalence in an asymptomatic population revealed estimates of unreported COVID-19 cases. Occupational, living situation, and behavioral data about COVID-19-protective behaviors such as wearing a mask may aid in the identification of nonclinical factors affecting the number of daily contacts, which may increase SARS-CoV-2 exposure.


Subject(s)
Asymptomatic Diseases , COVID-19/epidemiology , Employment , Housing , Infection Control , Masks , Contact Tracing , Cross-Sectional Studies , Hospitals/statistics & numerical data , Humans , Risk Factors , SARS-CoV-2
3.
Front Public Health ; 10: 902576, 2022.
Article in English | MEDLINE | ID: covidwho-2123463

ABSTRACT

Housing safety and health problems threaten owners' and occupiers' safety and health. Nevertheless, there is no systematic review on this topic to the best of our knowledge. This study compared the academic and public opinions on housing safety and health and reviewed 982 research articles and 3,173 author works on housing safety and health published in the Web of Science Core Collection. PRISMA was used to filter the data, and natural language processing (NLP) was used to analyze emotions of the abstracts. Only 16 housing safety and health articles existed worldwide before 1998 but increased afterward. U.S. scholars published most research articles (30.76%). All top 10 most productive countries were developed countries, except China, which ranked second (16.01%). Only 25.9% of institutions have inter-institutional cooperation, and collaborators from the same institution produce most work. This study found that most abstracts were positive (n = 521), but abstracts with negative emotions attracted more citations. Despite many industries moving toward AI, housing safety and health research are exceptions as per articles published and Tweets. On the other hand, this study reviewed 8,257 Tweets to compare the focus of the public to academia. There were substantially more housing/residential safety (n = 8198) Tweets than housing health Tweets (n = 59), which is the opposite of academic research. Most Tweets about housing/residential safety were from the United Kingdom or Canada, while housing health hazards were from India. The main concern about housing safety per Twitter includes finance, people, and threats to housing safety. By contrast, people mainly concerned about costs of housing health issues, COVID, and air quality. In addition, most housing safety Tweets were neutral but positive dominated residential safety and health Tweets.


Subject(s)
COVID-19 , Social Media , Cluster Analysis , Housing , Humans , Natural Language Processing , Sentiment Analysis
4.
J Addict Med ; 16(5): 592-594, 2022.
Article in English | MEDLINE | ID: covidwho-2116973

ABSTRACT

BACKGROUND: Self-isolation is critical in preventing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. However, people who use drugs face significant barriers in adhering to the regulations. As a response, several supportive measures have been introduced in British Columbia, including temporary housing access and "risk mitigation" prescribing, in which health care providers prescribe pharmaceutical alternatives to the unregulated drug supply to prevent withdrawal and reduce overdose risk. CASE SUMMARY: We present a case of a 39-year-old male with a history of polysubstance use and frequent overdoses, who had tested positive for SARS-CoV-2 and was able to successfully self-isolate. "Risk mitigation" prescribing, supportive housing, and harm reduction services were initiated for his self-isolation and connection to community outreach teams for ongoing support. DISCUSSION: This case illustrates how "risk mitigation" prescribing supported patient's self-isolation, reduced his illicit drug use, and offered an opportunity for healthcare engagement. Access to safer alternatives to the toxic drug supply should continue beyond COVID-19 pandemic to address the persistent issues of contaminated drug supply and the overdose crisis in North America.


Subject(s)
COVID-19 , Drug Overdose , Illicit Drugs , Adult , COVID-19/prevention & control , Drug Overdose/epidemiology , Drug Overdose/prevention & control , Housing , Humans , Male , Pandemics/prevention & control , Pharmaceutical Preparations , SARS-CoV-2
5.
Health Aff (Millwood) ; 41(11): 1583-1589, 2022 11.
Article in English | MEDLINE | ID: covidwho-2109346

ABSTRACT

In response to the COVID-19 pandemic, many US states implemented eviction moratoriums in 2020. Evidence from eviction filings from that year shows short-term declines in eviction filings. This study examined the short-term effects of these state eviction moratoriums in 2020 on the mental health status of renters. It employed nationally representative data from the Behavioral Risk Factor Surveillance System and a triple-difference design that compared renters with homeowners while leveraging state differences in moratoriums over time. During 2020 forty-three states and Washington, D.C., implemented eviction moratoriums of varying scope and enforcement. Some moratoriums targeted the whole eviction process, including early stages, whereas others focused on the later stages of eviction. We found that state moratoriums were associated with an improvement in mental health, including fewer days not in good mental health in the past thirty days and a lower likelihood of frequent mental distress (fourteen or more days not in good mental health in the past thirty days). Overall, there is some evidence from this study pointing to potential short-term benefits from state eviction moratoriums in 2020 to the mental health and well-being of renters, which would be important to consider when formulating policies that affect residential stability.


Subject(s)
COVID-19 , Mental Disorders , Humans , Mental Health , Housing , Pandemics/prevention & control , Mental Disorders/epidemiology
6.
Prev Med ; 164: 107287, 2022 Nov.
Article in English | MEDLINE | ID: covidwho-2106177

ABSTRACT

Black and Latino populations have been disproportionately burdened by COVID-19 morbidity and mortality. Subsidized housing, crowding, and neighborhood poverty might be associated with increased COVID-19 transmission and play a role in observed racial and ethnic disparities, yet research is limited. Our study investigated whether these housing variables mediate the relationship between race and ethnicity and SARS-CoV-2 antibody seropositivity among New York City (NYC) adults. We analyzed data from a SARS-CoV-2 serosurvey (n = 1074), nested within the 2020 cross-sectional NYC Community Health Survey (June-October 2020). We defined SARS-CoV-2 seropositivity as either a positive blood test for SARS-CoV-2 antibodies or a self-reported positive test result. We used causal mediation analyses to test whether subsidized housing, crowding, and neighborhood poverty mediate a relationship between race and ethnicity and seropositivity. After controlling for potential confounding, we found elevated prevalence ratios of SARS-CoV-2 seropositivity among Black (APR = 1.74, 95% CI = 1.10-2.73) and Latino (APR = 1.58, 95% CI = 1.05-2.37) residents compared with White residents and for those living in crowded housing (APR = 1.48, 95% CI = 1.03-2.12) and high-poverty neighborhoods (APR = 1.54, 95% CI = 1.12-2.11) but not for subsidized housing. We observed statistically significant natural direct effects for all three mediators. While living in crowded housing and high-poverty neighborhoods contributed to racial and ethnic disparities in seropositivity the estimated contribution from living in subsidized housing was -9% (Black) and - 14% (Latino). Our findings revealed racial and ethnic disparities in seropositivity of SARS-CoV-2 antibodies among NYC adults. Unlike crowding and neighborhood poverty, living in subsidized housing did not explain racial and ethnic disparities in COVID-19.


Subject(s)
COVID-19 , Ethnicity , Adult , Humans , New York City/epidemiology , SARS-CoV-2 , Housing , Cross-Sectional Studies
8.
Indoor Air ; 32(10): e13136, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2088235

ABSTRACT

Appropriate knowledge and actions of residents in housing are expected to reduce health effects, defined as "living literacy." With the spread of COVID-19 and the diversification of lifestyles, a quantitative evaluation of a comprehensive model that includes living literacy in the housing environment is required. In this study, the author conducted two web-based surveys of approximately 2000 different households in Japan during the summer of 2020 and winter of 2021, and a statistical analysis based on the survey results. As a result, ventilation by opening windows was observed as a new resident behavior trend under COVID-19. In addition, structural equation modeling using the survey samples confirmed the certain relationship between living literacy and subjective evaluation of the indoor environment and health effects in both periods.


Subject(s)
COVID-19 , Health Literacy , Life Style , Models, Theoretical , Humans , Air Pollution, Indoor/analysis , COVID-19/epidemiology , Housing , Japan/epidemiology , Surveys and Questionnaires , Behavior , Seasons
9.
Sensors (Basel) ; 22(20)2022 Oct 14.
Article in English | MEDLINE | ID: covidwho-2071710

ABSTRACT

The reduction in face-to-face contact and the increase in time spent at home during the ongoing coronavirus disease pandemic have resulted in increasing interest and demand for smart homes. Further, the rapid increase in the number of one-person and two-person households in Korea recently has led to these becoming representative household types. This study identifies the wellness characteristics of such households and proposes a direction for smart home development to help them lead healthy, happy lives. It focuses on mapping residents' perceptions and experiences to scenarios and on identifying the functions required in smart homes and the technologies needed to provide these functions. It uses data from a survey to investigate and analyze the wellness characteristics of one- and two-person households in five dimensions and develops five scenarios of representative household types. By analyzing the developed scenarios, this study proposes smart homes that support the wellness of such households in six categories: exercise/sports, hobby/entertainment, social communications, occupation/work, self-development/education, and energy conservation. These households are exposed to digital environments from an early age and are familiar with the internet and technologies. Therefore, they are likely to adopt innovative technologies in housing. Thus, the smart home development proposed in this study is a promising strategic approach to housing planning.


Subject(s)
Health Status , Housing , Humans , Technology , Longitudinal Studies , Republic of Korea
10.
Int J Environ Res Public Health ; 19(19)2022 Oct 01.
Article in English | MEDLINE | ID: covidwho-2066008

ABSTRACT

Children's health can be affected by the interrelated characteristics of the physical and social environment where they live, including housing quality, neighbourhood characteristics and the local community. Following a systems-based approach, this exploratory project sought to understand how the needs and aspirations associated with the home environment can work in synergy with, or be exacerbated by, other aspects of the local area. The study recruited parents of children aged 2-12 years old from two local authorities in England with high levels of child poverty: Tower Hamlets in East London, and Bradford District in West Yorkshire. Thematic analysis of participant interviews highlighted ten themes and opportunities for improvements. The evidence presented in this research emphasises how environmental quality issues within and outside the home, compounded further by delays in repairs and reduction in service standards, as well as affordability issues, are likely to deeply affect the wellbeing of an entire generation of disadvantaged children whose parents can feel disempowered, neglected and often isolated when attempting to tackle various dimensions of inequalities. Interventions which can improve the quality of housing, and access to space and services, are urgently needed, including initiatives to support and empower families and local communities, especially those prioritising opportunities for action.


Subject(s)
Child Health , Housing , Child , Child Poverty , Child, Preschool , England , Humans , Residence Characteristics
11.
Front Public Health ; 10: 1029394, 2022.
Article in English | MEDLINE | ID: covidwho-2065654

ABSTRACT

The abysmal health of the urban poor or slum dwellers was attributed to structural inequities such as inadequate housing, water, and sanitation. This review aimed to assess housing-related opportunities and challenges during the COVID-19 pandemic among urban poor in low-and middle-income countries. For study identification, a comprehensive search was performed in 11 databases that yielded 22 potential studies. The inadequate housing infrastructure makes the lives of the urban poor more precarious during COVID-19. Typically, the houses lacked lighting, ventilation, and overcrowding. This review reflected that it is crucial to reimagine housing policy for the urban poor with an emphasis on pandemic/epidemic guidelines.


Subject(s)
COVID-19 , Housing , COVID-19/epidemiology , Developing Countries , Humans , Pandemics , Urban Population , Water
12.
Pediatrics ; 150(5)2022 11 01.
Article in English | MEDLINE | ID: covidwho-2065207

ABSTRACT

BACKGROUND AND OBJECTIVES: Children in families facing energy insecurity have greater odds of poor health and developmental problems. In this study of families who requested and received medical certification for utility shut-off protection and were contacted by our Medical Legal Partnership (MLP), we aimed to assess concurrent health-related social needs related to utilities, housing, finances, and nutrition. METHODS: After medical certificates were completed at our academic pediatric center, our MLP office contacted families and assessed utility concerns as well as other health, social, and legal needs. In this observational study, we present descriptive analyses of patients who received certificates from September 2019 to May 2020 via data collected through the MLP survey during the coronavirus disease 2019 pandemic (June 2020-December 2021). RESULTS: Of 167 families who received utility shut-off protection from September 2019 to May 2020, 84 (50.3%) parents and guardians were successfully contacted. Most (93%) found the medical certificate helpful. Additionally, 68% had applied for Energy Assistance, and 69% reported they were on utility company payment plans. Most (78%) owed arrearages, ranging from under $500 to over $20 000, for gas, electric, and/or water bills. Food, housing, and financial insecurity screening positivity rates were 65%, 85%, and 74%, respectively. CONCLUSIONS: Patients who were contacted by an MLP after receiving medical certification for utility shutoff protection were found to have challenges paying for utilities and faced multiple food, housing, and financial stressors. Through consultation and completion of medical forms for utility shutoff protection, pediatricians and MLPs can provide resources and advocacy to support families' physical, emotional, and psychosocial needs.


Subject(s)
COVID-19 , Child , Humans , COVID-19/prevention & control , Housing , Pediatricians , Nutritional Status , Certification
13.
J Infect Dis ; 226(Supplement_3): S327-S334, 2022 Oct 07.
Article in English | MEDLINE | ID: covidwho-2062915

ABSTRACT

BACKGROUND: Variable and incomplete reporting of housing status creates challenges in the surveillance of coronavirus disease 2019 (COVID-19) among the homeless population in Los Angeles County (LA County) and nationwide. METHODS: We developed standard investigation procedures to assess the housing status of LA County COVID-19 patients. Using data sharing procedures, we matched COVID-19 patients to Homeless Management Information System (HMIS) client profiles and supplemented with additional data sources for contributory data points and to further housing status ascertainment. RESULTS: We identified 10 586 COVID-19 patients among people experiencing homelessness (PEH) between 30 March 2020 and 30 December 2021; 2801 (26.5%) patients were first identified from HMIS profile matches, 1877 (17.7%) from quarantine/isolation housing intake rosters, 573 (5.4%) from hospital records, 749 (7.1%) from case and contact interviews, 3659 (34.6%) directly from PEH medical and service providers, and 927 (8.8%) had unknown sources. Among COVID-19 patients matched to HMIS profiles, 5351 (42.5%) were confirmed to be PEH at the time of COVID-19 diagnosis. CONCLUSIONS: Interoperability between public health data, HMIS, and external partners have been critical components in evaluating the impact of COVID-19 among the LA County homeless population. No one data source was complete for COVID-19 surveillance in this population.


Subject(s)
COVID-19 , Homeless Persons , Management Information Systems , COVID-19/epidemiology , COVID-19 Testing , Housing , Humans
14.
J Gerontol Nurs ; 48(10): 33-39, 2022 Oct.
Article in English | MEDLINE | ID: covidwho-2055511

ABSTRACT

In the current study, a smart speakers-based system (Amazon® Echo Dot device, a safety pendant, and facility tailored functionalities) for supporting aging in place was implemented in one low-income senior housing property. We aimed to explore perceived benefits, concerns, and expectations about this system among three stakeholder groups (older adults, housing staff, and technology developers) to identify facilitators of and barriers to system implementation. A qualitative analysis of individual interviews using inductive coding methods was performed to identify emerging themes. All stakeholder groups perceived smart speakers as valuable for convenience in daily living and safety. Older adults and system developers identified user difficulty with setting up functions they wanted to use, suggesting the need for user-centered technology support. There were differences in priorities for smart speaker use among three stakeholder groups. This work contributes to the identification of factors affecting smart speaker adoption and use among low-income older adults who often have limited technology experience and support. [Journal of Gerontological Nursing, 48(10), 33-39.].


Subject(s)
Housing , Independent Living , Aged , Humans , Qualitative Research , Technology
15.
Transbound Emerg Dis ; 69(5): e2111-e2121, 2022 Sep.
Article in English | MEDLINE | ID: covidwho-2053006

ABSTRACT

Viral respiratory diseases, such as avian influenza, Newcastle disease, infectious bronchitis and infectious laryngotracheitis, have considerable negative economic implications for poultry. Ensuring the virus-free status of premises by environmental sampling after cleaning and disinfection is essential for lifting a quarantine and/or safely restocking the premises following an outbreak. The objectives of this study were to identify optimal sample collection devices and to determine the locations in poultry housing which are best for poultry respiratory virus sample collection. Chickens exposed to infectious bronchitis virus, which was used as a representative virus for enveloped poultry respiratory viruses, were housed in floor-pens in either a curtain-sided wood framed house or a cement block house. Foam swabs, cellulose sponges, polyester swabs, dry cotton gauze and pre-moistened cotton gauze were evaluated for comparative efficiency in recovering viral RNA. Cotton gauze pre-moistened with the viral transport media had the highest sensitivity among the devices (wood-framed house: 78% positive, geometric mean titre [GMT] of 2.6 log10 50% egg infectious doses [EID50 ] equivalents/ml; cement block houses: 55% positive, GMT of 1.7 log10 EID50 equivalents/ml). Targeting virus deposition sites is also crucial for efficient virus elimination procedures and subsequent testing; therefore, 10 locations within the houses were compared for virus detection. In both housing types, the highest viral RNA loads were recovered from the tops of drinker lines within the pen. Places the chickens could contact directly (e.g., feeder rim) or were contacted by caretaker feet (hallway floor) also yielded higher levels of viral RNA more consistently. These results will facilitate the establishment of efficient environmental sampling procedures for respiratory viruses of poultry.


Subject(s)
Influenza in Birds , Poultry Diseases , Animals , Cellulose , Chickens , Housing , Newcastle disease virus/genetics , Poultry , RNA, Viral
16.
Bol. malariol. salud ambient ; 62(2): 280-287, 2022. ilus, tab, graf
Article in Spanish | WHO COVID, LILACS (Americas) | ID: covidwho-2040760

ABSTRACT

El síndrome respiratorio agudo severo coronavirus 2 (SARS-CoV-2) ha causado una pandemia. Se han encontrado muchos grupos infectados dentro de los hogares familiares, pero los datos sobre la transmisión secundaria entre los contactos del hogar son limitados. La evolución de la situación epidemiológica ha demostrado que el distanciamiento social, la aplicación de equipos de protección personal y las actividades remotas en los hogares son medidas eficaces para frenar la transmisión del virus; y la última de estas gana cada vez mayor importancia por el hecho del aislamiento en los hogares de los pacientes positivos a SARS-CoV-2. El objetivo de este estudio es comparar el efecto de la integración de elementos domóticos en casas con pacientes positivos asilados con Covid-19 y casas convencionales sin ningún elemento remoto, entendiendo que el menor contacto con superficies, objetos y áreas son importantes para evitar la propagación. En relación al Aislamiento Social y a la Actividad Remota los porcentajes de frecuencia fueron muy similares; mientras que en las Medidas de Protección, la casa inteligente con adulto mayor presentó un porcentaje de frecuencia inferior en comparación con la casa convencionl y la inteligente con adultos contemporáneos. Nuestros datos brindan información sobre la tasa de transmisión secundaria de SARS-CoV-2 en el hogar y el efecto de la inclusión de elementos domóticos para prevenir los contagios(AU)


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused a pandemic. Many infected clusters have been found within family households, but data on secondary transmission among household contacts are limited. The evolution of the epidemiological situation has shown that social distancing, the application of personal protective equipment and remote activities at home are effective measures to stop the transmission of the virus; and the last of these is gaining increasing importance due to the isolation of SARS-CoV-2 positive patients in their homes. The objective of this study is to compare the effect of the integration of home automation elements in houses with positive patients in isolation with Covid-19 and conventional houses without any remote element, understanding that the least contact with surfaces, objects and areas are important to prevent the spread. In relation to Social Isolation and Remote Activity, the frequency percentages were very similar; while in the Protection Measures, the smart house with older adults presented a lower percentage of frequency compared to the conventional house and the smart house with contemporary adults. Our data provide information on the rate of secondary transmission of SARS-CoV-2 in the home and the effect of the inclusion of home automation elements to prevent contagion(AU)


Subject(s)
Security Measures , Social Isolation , Personal Protective Equipment , Physical Distancing , COVID-19/epidemiology , Family Characteristics , Communicable Diseases , Severe Acute Respiratory Syndrome , Pandemics , Housing
17.
Indoor Air ; 32(8): e13097, 2022 08.
Article in English | MEDLINE | ID: covidwho-2008742

ABSTRACT

In a virus pandemic context, buildings ventilation has been recognized as a solution for preventing transmission of the virus in aerosolized form. The impact of the widespread recommendation of window opening and sealing door on ventilation circuits needs to be considered with a multizone approach. We modeled the airflow distribution in a building where people are isolating in a pandemic context, including one infected person. We analyzed the impact of opening the window and sealing the door in the quarantine room on exposures and probability of infection for occupants of the flat and of adjacent flats. In order to study the sensitivity of the results, we tested three ventilation systems: balanced, exhaust-only, and humidity-based demand-controlled, and several window- and door-opening strategies. When the door of the quarantine room is sealed, we observe that opening the window in the quarantine room always results in increased exposure and probability of infection for at least one other occupant, including in neighbors' apartments. When all internal doors are opened, we observe moderate impacts, with rather an increase of exposure of the occupants of the same apartments and of their probability of infection, and a decrease for the occupants located in other apartments. Based on the analysis on the airflows distribution in this case study, we conclude that sealing the internal door has more influence than opening the window of the quarantine room, whatever the ventilation system. We observe that this widespread recommendation to open the window of a quarantine room and to seal the door is based on the consideration of a single zone model. We illustrate the importance of moving from such a single zone approach to a multizone approach for quantifying ventilation and airing impacts in multizone buildings as residences in order to prevent epidemics of viruses such as SARS-CoV-2. It highlights the need of air leakage databases.


Subject(s)
Air Pollution, Indoor , COVID-19 , Housing , Humans , SARS-CoV-2 , Ventilation/methods
18.
BMC Public Health ; 22(1): 1597, 2022 08 22.
Article in English | MEDLINE | ID: covidwho-2002157

ABSTRACT

BACKGROUND: Persons experiencing homelessness (PEH) suffer a high burden of chronic diseases and multi-morbidity, yet face significant barriers in accessing healthcare services. These health inequalities were further aggravated during the COVID-19 pandemic. While there is a lack of comprehensive health data on PEH, even less is known about populations experiencing housing exclusion, a hidden form of homelessness. This study examines and compares chronic diseases and multi-morbidity in PEH, persons experiencing housing exclusion, and persons with secure housing who lacked access to regular healthcare services in the wake of the COVID-19 pandemic in Germany. METHODS: Study participants were adults who sought medical care at clinics of the humanitarian organisation "Ärzte der Welt" in Munich, Hamburg and Berlin in 2020. The patients were categorised into three housing groups according to the ETHOS classification of homelessness and housing exclusion. Socio-demographic characteristics, self-rated health, chronic diseases and multi-morbidity were described in each group. Logistic regression analysis was used to identify socio-demographic factors associated with higher odds of chronic diseases and multi-morbidity in each housing group. RESULTS: Of the 695 study participants, 333 experienced homelessness, 292 experienced housing exclusion and 70 had secure housing. 92.3% of all patients had either no or limited health coverage, and 96.7% were below the poverty line. Males and EU/EEA citizens were highly represented among PEH (74.2% and 56.8% respectively). PEH had lower self-rated health (47.8%, p = 0.04), and a higher prevalence of psychiatric illness (20.9%, p = 0.04). In adjusted analyses, belonging to the age group 35-49 and ≥ 50 years were associated with greater odds of chronic disease (AOR = 2.33, 95% CI = 1.68-3.24; AOR = 3.57, 95% CI = 2.55-5.01, respectively) while being ≥ 50 years old was associated with multi-morbidity (AOR = 2.01, 95% CI = 1.21, 3.33). Of the 18 participants tested for SARS-COV-2, 15 were PEH, 1 of whom tested positive. CONCLUSIONS: Housing status was not an independent risk factor for chronic disease and multi-morbidity in our study population. However, PEH reported poorer self-rated and psychiatric health. Strategies to improve access to healthcare services amongst persons experiencing homelessness and housing exclusion are needed in Germany.


Subject(s)
COVID-19 , Homeless Persons , Adult , COVID-19/epidemiology , Chronic Disease , Cross-Sectional Studies , Homeless Persons/psychology , Housing , Humans , Male , Middle Aged , Multimorbidity , Pandemics , SARS-CoV-2
19.
J Epidemiol Community Health ; 76(9): 833-838, 2022 09.
Article in English | MEDLINE | ID: covidwho-1993048

ABSTRACT

Recent crises have underscored the importance that housing has in sustaining good health and, equally, its potential to harm health. Considering this and building on Howden-Chapman's early glossary of housing and health and the WHO Housing and Health Guidelines, this paper introduces a range of housing and health-related terms, reflecting almost 20 years of development in the field. It defines key concepts currently used in research, policy and practice to describe housing in relation to health and health inequalities. Definitions are organised by three overarching aspects of housing: affordability (including housing affordability stress (HAS) and fuel poverty), suitability (including condition, accessibility and sustainable housing) and security (including precarious housing and homelessness). Each of these inter-related aspects of housing can be either protective of, or detrimental to, health. This glossary broadens our understanding of the relationship between housing and health to further promote interdisciplinarity and strengthen the nexus between these fields.


Subject(s)
Health Status , Housing , Costs and Cost Analysis , Homeless Persons , Housing/economics , Humans , Poverty
20.
BMJ Open ; 12(8): e064225, 2022 08 17.
Article in English | MEDLINE | ID: covidwho-1993031

ABSTRACT

INTRODUCTION: People experiencing homelessness are at high risk for COVID-19 and poor outcomes if infected. Vaccination offers protection against serious illness, and people experiencing homelessness have been prioritised in the vaccine roll-out in Toronto, Canada. Yet, current COVID-19 vaccination rates among people experiencing homelessness are lower than the general population. This study aims to characterise reasons for COVID-19 vaccine uptake and hesitancy among people experiencing homelessness, to identify strategies to overcome hesitancy and provide public health decision-makers with information to improve vaccine confidence and uptake in this priority population. METHODS AND ANALYSIS: The Ku-gaa-gii pimitizi-win qualitative study (formerly the COVENANT study) will recruit up to 40 participants in Toronto who are identified as experiencing homelessness at the time of recruitment. Semistructured interviews with participants will explore general experiences during the COVID-19 pandemic (eg, loss of housing, social connectedness), perceptions of the COVID-19 vaccine, factors shaping vaccine uptake and strategies for supporting enablers, addressing challenges and building vaccine confidence. ETHICS AND DISSEMINATION: Approval for this study was granted by Unity Health Toronto Research Ethics Board. Findings will be communicated to groups organising vaccination efforts in shelters, community groups and the City of Toronto to construct more targeted interventions that address reasons for vaccine hesitancy among people experiencing homelessness. Key outputs will include a community report, academic publications, presentations at conferences and a Town Hall that will bring together people with lived expertise of homelessness, shelter staff, leading scholars, community experts and public health partners.


Subject(s)
COVID-19 , Homeless Persons , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19 Vaccines/therapeutic use , Housing , Humans , Pandemics
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