Interventions for Health: Why and How Health Care Systems Provide Programs to Benefit Unhoused Patients.

Individuals experiencing homelessness have poorer health than housed individuals, while also utilizing more emergency department care and fewer preventive services. Several interventions - including permanent supportive housing, medical respite, and mobile medical clinics - are cost-effective means to improve health outcomes for homeless populations, yet few health systems have invested in such programs. This study aimed to determine the reasons some health systems initiated these interventions, and the early experience of those health systems that did. Quantitative analyses of health systems in 4 states with high levels of homelessness showed that interventions to improve the health of homeless populations were more common in larger hospitals, teaching hospitals, religious hospitals, network-affiliated hospitals, and hospitals in California. Interviews confirmed that health systems typically were moved to implement these interventions by more than 1 factor, including financial goals, mission-driven motives, a desire to improve care quality, and recognition of local need. Interviewees reported collaborations with community service providers, and some reported targeting services to specific subpopulations. Health systems reported success with some initiatives but noted that success was contingent on overcoming barriers including funding, opposition from the local community, challenges building true partnerships with service providers, and the reluctance of some homeless patients to receive services. Health systems may be encouraged by the results reported by early adopters who navigated these obstacles, while policy makers might consider incentivizing health systems to engage in these interventions by providing a dedicated funding stream.

A longitudinal study of overweight, elevated blood pressure, and acanthosis nigricans among low-income middle school students.

This longitudinal study examined the rates of overweight, elevated blood pressure, acanthosis nigricans, and their associated factors in third through fifth grade students over 4 years. Participants consisted of 279 students who participated in health screenings in 2002 and 2006. Hispanic students had significantly higher rates of overweight and acanthosis nigricans compared to White students. There was a sharp increase in elevated blood pressure from 2002 to 2006 among obese children. While 20% of the matched obese students were above the 90th percentile in 2002, 82% of the same students were above the 90th percentile in 2006. After controlling for sex, ethnicity, and grade, preadolescent obesity in 2002 continued to be a significant factor associated with elevated blood pressure and acanthosis nigricans in 2006. These findings demonstrate that prevention and treatment of obesity during preadolescence is critical for the prevention of elevated high blood pressure in early adolescence.