Using Geocoding to Identify COVID-19 Outbreaks in Congregate Residential Settings: San Francisco's Outbreak Response in Single-Room Occupancy Hotels.

More than 500 single-room occupancy hotels (SROs), a type of low-cost congregate housing with shared bathrooms and kitchens, are available in San Francisco. SRO residents include essential workers, people with disabilities, and multigenerational immigrant families. In March 2020, with increasing concerns about the potential for rapid transmission of COVID-19 among a population with disproportionate rates of comorbidity, poor access to care, and inability to self-isolate, the San Francisco Department of Public Health formed an SRO outbreak response team to identify and contain COVID-19 clusters in this congregate residential setting. Using address-matching geocoding, the team conducted active surveillance to identify new cases and outbreaks of COVID-19 at SROs. An outbreak was defined as 3 separate households in the SRO with a positive test result for COVID-19. From March 2020 through February 2021, the SRO outbreak response team conducted on-site mass testing of all residents at 52 SROs with outbreaks identified through geocoding. The rate of positive COVID-19 tests was significantly higher at SROs with outbreaks than at SROs without outbreaks (12.7% vs 6.4%; P < .001). From March through May 2020, the rate of COVID-19 cases among SRO residents was higher than among residents of other settings (ie, non-SRO residents), before decreasing and remaining at an equal level to non-SRO residents during later periods of 2020. The annual case fatality rate for SRO residents and non-SRO residents was similar (1.8% vs 1.5%). This approach identified outbreaks in a setting at high risk of COVID-19 and facilitated rapid deployment of resources. The geocoding surveillance approach could be used for other diseases and in any setting for which a list of addresses is available.

Therapy or threat? Inadvertent exposure to alcohol and illicit drug cues in the neighbourhoods of sober living homes.

Alcohol retail outlets and other environmental cues can contribute to relapse among individuals recovering from substance abuse. Sober living homes are residences designed to strengthen abstinence from substances, in part by helping residents develop skills for coping with cues and other stressors. Between January 2009 and March 2010, we conducted 10 focus groups with 68 adults aged 18 and over who lived in or operated any of 35 sober living homes in Los Angeles County, California. A stratified purposive sampling strategy was used to recruit sober living home residents and operators. The study aim was to assess how residents responded to the neighbourhood alcohol and drug cues they encountered in their daily lives. The focus group transcripts were analysed using the constructs of 'approach coping' and 'avoidance coping'. Findings suggest that the sober living homes helped residents cope with cue exposure through social rules and processes such as chaperones and evening curfews, as well as the presence of peer support for managing the conflictive thoughts and emotions that result from cue exposure. The examples of 'avoidance coping' and 'approach coping' identified in the transcripts were more often behavioural than cognitive. For example, residents described efforts they made to increase their physical distance from (i.e. avoid) neighbours who used substances. Whereas some participants believed that living in areas with high levels of drug use and trafficking was 'a time bomb' for relapse, others suggested that cue exposure could actually strengthen their ability to remain abstinent ('approach coping'). The approach/avoidance coping construct did not account for the experiences of all residents. Several participants expressed indifference towards cues while performing daily routines and pursuing important recovery goals. The threat of alcohol and drug cues may be mitigated by recovery-oriented homes that support coping on an individualised, as-needed basis.

From personal tragedy to personal challenge: responses to stigma among sober living home residents and operators.

Sober living homes for people attempting to maintain abstinence from alcohol and drugs can act as a buffer against the high rates of substance misuse that are endemic to many urban environments. Sober living homes and other group homes for people with disabilities have faced persistent opposition from neighbourhood associations, which raises the question of stigma. This article describes the responses of sober living home residents and operators to the threat of stigma across a diverse set of neighbourhoods. Ten focus groups were conducted with 68 residents and operators of 35 sober living homes in Los Angeles County, California, between January 2009 and March 2010. Results showed that few residents reported experiences of blatant stigmatisation by neighbours; however, they were well aware of the stereotypes that could be ascribed to them. Despite this potential stigma, residents developed valued identities as helpers in their communities, providing advice to neighbours whose family or friends had substance use problems, and organising community service activities to improve the appearance of their neighbourhoods. With their attention to local context, sober living home residents and operators challenge the personal tragedy approach of much traditional advocacy on health-related stigma.

Alternative families in recovery: fictive kin relationships among residents of sober living homes.

Sober living homes are group residences for people attempting to maintain abstinence from alcohol and drugs in a mutually supportive setting. Residents typically develop strong psychological and economic ties and have been referred to as "alternative families," thus evoking the anthropological concept of fictive kinship. We analyzed data from seven focus groups with sober living home residents to assess the prevalence and functions of fictive kinship in these settings. Results suggest that residents created kinship by exchanging various types of support, and by incorporating other residents into existing family relationships, particularly in homes where there were children. Residents perceived fictive kin as more supportive than actual kin, encouraging them toward greater individuation, in contrast with family backgrounds that were sometimes described as stifling. These accounts of the therapeutic qualities of fictive kin in sober living homes could inform the work of fair housing advocates and other community stakeholders.