Examining the Role of Self-Harm in the Relationship between Emergency Department Service Utilization and Trauma-Induced Homelessness among Homeless Individuals in Texas.

Homelessness is a complex public health problem in the United States. Current or ongoing history of trauma among individuals adds to the complexity and challenges of homelessness. Our study assessed the moderating role of self-harm in the association between emergency department (ED) service utilization and trauma-induced homelessness (TIH) among adults in Texas. Homeless adults (N = 282) who completed their baseline Vulnerability Index Service Prioritization Decision Assistance Prescreen Tool survey between February 2021 and February 2022 at a Local Mental Health Authority in Texas were selected. The outcome variable, TIH, was assessed by current period of homelessness due to experiencing trauma or abuse. The main independent variable was ED utilization, while self-harm in the past year was assessed as the moderating variable. A multivariate logistic regression with a moderation analysis was conducted while adjusting for the covariates. Individuals who utilized ED services and engaged in self-harm and risky behaviors had greater odds of experiencing current period of TIH. Male respondents were less likely to experience TIH. Finally, engaging in self-harm significantly moderated the association between ED service use and TIH. This study may help inform efforts to develop tailored interventions and promote resilience-based approaches to improve health outcomes among individuals experiencing homelessness due to TIH.

Exploring Sexual Orientation Disparities Regarding the Interplay of Childhood Sexual Abuse, Self-Reported Diabetes Status, and Depression Among Adults in the United States.

Previous research has revealed a strong link between the experience of childhood sexual abuse (CSA) and diabetes in adulthood. Moreover, research has shown that sexual minorities (SM) are exposed to adverse childhood experiences (ACEs) (i.e. CSA) and experience depression at higher rates than their heterosexual counterparts. Thus, it is imperative to further investigate the role of depression and the differential associations of exposure to ACEs with diabetes prevalence by sexual orientation. We explored sexual orientation disparities regarding the relationship between CSA and diabetes and examined the moderating role of depression. A total of 29,903 participants from the 2021 Behavioral Risk Factor Surveillance System (BRFSS) were included in this study. Secondary data analysis was conducted using the survey data, and weighted logistic regression and moderation analysis were performed. Heterosexuals who experienced CSA (AOR = 1.25; p < .05) and SM who experienced CSA (AOR = 2.13; p < .05) reported higher odds of having diabetes. Among heterosexuals, depression (AOR = 1.38; p < .001) was significantly associated with having diabetes. Additionally, depression was a significant moderator among heterosexuals with and without CSA. Further understanding of the impact of ACEs on diabetes among specific subgroups of SM should be assessed in future studies.

Self-perceived disaster preparedness in minority older adults: A cross-sectional study.

OBJECTIVE: Evidence suggests that people of color, especially African Americans and non-White Hispanics, residing in low-income communities are the most vulnerable to natural disasters. This study assessed individual level of self-perceived disaster preparedness, disaster response actions, and sociodemographic predictors of disaster preparedness among older minority adults in Houston, Texas. METHOD: Working with Houston-area community-based organizations and senior-living centers, a cross-sectional survey, available in English and Spanish, was disseminated between November 2020 and January 2021. PARTICIPANTS: Five hundred and twenty-two older minority adults aged 55+ completed the electronic survey. MAIN OUTCOME MEASURE(S): The main outcome measure was the level of self-perceived preparedness regarding emergencies and disastersie, prepared vs not prepared-among the study participants. RESULTS: Overall, about 58 percent of older minority adults did not perceive themselves to be prepared. Compared to individuals reporting annual incomes below $25,000, individuals reporting annual incomes between $25,000 and $74,999 were more likely to report being prepared [odds ratio (OR) = 2.28, 95 percent confidence interval (CI) = 1.29, 4.05]. Individuals who tested positive or had a close family member test positive for COVID-19 experienced 2.16 times higher odds of having self-perceived disaster preparedness than those who did not [OR = 2.16, 95 percent CI = 1.37, 3.42]. None of the other covariates were statistically significant. CONCLUSIONS: While we observed no differences in self-perceived disaster preparedness between African American and Hispanic older adults, our findings suggest the importance of prior experience/exposure to previous disasters and the role of socioeconomic status in self-perceived disaster preparedness in minority older adults.

Coping with adverse childhood experiences during the COVID-19 pandemic: Perceptions of mental health service providers.

Background: Adverse Childhood Experiences (ACEs) have been associated with long-term physical and mental health conditions, toxic stress levels, developing unstable interpersonal relationships, and substance use disorders due to unresolved childhood adversities. Aims: This study assessed the perspectives of mental health providers (MHPs) regarding their adult patients' coping with ACEs during COVID-19 in Houston, Texas. Specifically, we explored how individuals with ACEs are coping with the increased stresses of the pandemic, how MHPs may provide therapeutic support for individuals with ACEs during this pandemic, pandemic-related challenges of accessing and utilizing mental health services for individuals with ACEs, and the awareness and treatment of ACEs among MHPs. Methods: Ten in-depth semi-structured virtual interviews were conducted with licensed MHPs from November 2021 to April 2022 in Houston, Texas. Interviews were coded and analyzed for emerging themes through an inductive open coding approach to discover insights regarding coping with ACEs during COVID-19. Results: Four key themes experienced by individuals with ACEs emerged from the MHP interviews: (1) Maladaptive emotional dissonance and coping outlets during the pandemic, (2) Difficulties with social connectedness and significance of social support, (3) Heightened daily life stressors and coping with the ongoing disruption of the pandemic, and (4) Changing interactions with the mental health system. Themes from this study highlighted that resilience, seeking treatment, and strong social support can help develop healthy coping strategies among individuals with ACEs. Conclusion: This study may help inform best clinical practices to develop interventions and policies regarding ACEs such as a resilience-promotion approach that targets all the socio-ecological levels. In addition, findings highlight the synergy of psychotherapeutic and pharmacological management via tele-health modalities, in helping individuals with ACEs continue receiving the care they deserve and need during a persistent pandemic and an uncertain future.

Health Disparities and Climate Change: The Intersection of Three Disaster Events on Vulnerable Communities in Houston, Texas.

Although evidence suggests that successive climate disasters are on the rise, few studies have documented the disproportionate impacts on communities of color. Through the unique lens of successive disaster events (Hurricane Harvey and Winter Storm Uri) coupled with the COVID-19 pandemic, we assessed disaster exposure in minority communities in Harris County, Texas. A mixed methods approach employing qualitative and quantitative designs was used to examine the relationships between successive disasters (and the role of climate change), population geography, race, and health disparities-related outcomes. This study identified four communities in the greater Houston area with predominantly non-Hispanic African American residents. We used data chronicling the local community and environment to build base maps and conducted spatial analyses using Geographic Information System (GIS) mapping. We complemented these data with focus groups to assess participants' experiences in disaster planning and recovery, as well as community resilience. Thematic analysis was used to identify key patterns. Across all four communities, we observed significant Hurricane Harvey flooding and significantly greater exposure to 10 of the 11 COVID-19 risk factors examined, compared to the rest of the county. Spatial analyses reveal higher disease burden, greater social vulnerability, and significantly higher community-level risk factors for both pandemics and disaster events in the four communities, compared to all other communities in Harris County. Two themes emerged from thematic data analysis: (1) Prior disaster exposure prepared minority populations in Harris County to better handle subsequent disaster suggesting enhanced disaster resilience, and (2) social connectedness was key to disaster resiliency. Long-standing disparities make people of color at greater risk for social vulnerability. Addressing climate change offers the potential to alleviate these health disparities.