Experimental Evidence Shows That Housing Vouchers Provided Measurable Benefits, Including Parent Stress Reduction.

This article presents early findings on the causal effects of a housing voucher on family stress, which plays an important role in children's healthy development. Using the Housing and Children's Healthy Development study, which is the only randomized controlled trial of housing vouchers (conducted in the Cleveland, Ohio, and Dallas, Texas, metropolitan areas), we found measurable health and related benefits accruing to families who received vouchers even though half of those who leased housing with vouchers only lived in that dwelling for roughly one year or less. Vouchers also substantially improved cost burdens, sufficiency of space, adequacy of heat, and daytime neighborhood safety. Our analysis shows that the affordability secured by the voucher (reduction of cost burden) played the most important role in reducing parent stress. One policy implication of the affordability findings is the need to keep families' housing cost burden affordable.

The Integrating Medications for Addiction Treatment (IMAT) Index: A measure of capability at the organizational level.

Primary care provides a treatment opportunity for many persons with opioid use disorder (OUD). The push to integrate and expand reach and adoption of medications for opioid use disorder (MOUD) within primary care has been a major focus of national, state and health systems endeavors. To guide high capability MOUD practice, we introduce the Integrating Medications for Addiction Treatment (IMAT) Index. The research team has developed IMAT along similar lines to other organizational measures of integrated services capability. We present the development and validation of the measure, and suggest its applicability for systems and organizations, as well as for process improvement and implementation research. Forty-one primary care clinics completed the IMAT at two time points: baseline and 9-month follow-up. Findings support the IMAT Index as psychometrically acceptable and pragmatically useful. It has good internal consistency, as well as concurrent and predictive validity. Changes in IMAT scores between baseline and follow-up significantly predicted increases in proportion of patients on MOUD. The IMAT has the potential to support both scientific and public health care activities.

The Benefits of Rental Assistance for Children's Health and School Attendance in the United States.

Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.

COVID-19 Adaptations in the Care of Patients with Opioid Use Disorder: a Survey of California Primary Care Clinics.

BACKGROUND: With the onset of the COVID-19 crisis, many federal agencies relaxed policies regulating opioid use disorder treatment. The impact of these changes has been minimally documented. The abrupt nature of these shifts provides a naturalistic opportunity to examine adaptations for opioid use disorder treatment in primary care. OBJECTIVE: To examine change in medical and behavioral health appointment frequency, visit type, and management of patients with opioid use disorder in response to COVID-19. DESIGN: A 14-item survey queried primary care practices that were enrolled in a medications for opioid use disorder statewide expansion project. Survey content focused on changes in service delivery because of COVID-19. The survey was open for 18 days. PARTICIPANTS: We surveyed 338 clinicians from 57 primary care clinics located in California, including federally qualified health centers and look-alikes. A representative from all 57 clinics (100%) and 118 staff (34.8% of all staff clinicians) participated in the survey. MAIN MEASURES: The survey consisted of seven dimensions of practice: medical visits, behavioral health visits, medication management, urine drug screenings, workflow, perceived patient demand, and staff experience. KEY RESULTS: A total of 52 of 57 (91.2%) primary care clinics reported practice adaptations in response to COVID-19 regulatory changes. Many clinics indicated that both medical (40.4%) and behavioral health visits (53.8%) were now exclusively virtual. Two-thirds (65.4%) of clinics reported increased duration of buprenorphine prescriptions and reduced urine drug screenings (67.3%). The majority (56.1%) of clinics experienced an increase in patient demand for behavioral health services. Over half (56.2%) of clinics described having an easier or unchanged experience retaining patients in care. CONCLUSIONS: Many adaptations in the primary care approach to patients with opioid use disorder may be temporary reactions to COVID-19. Further evaluation of the impact of these adaptations on patient outcomes is needed to determine whether changes should be maintained post-COVID-19.

Association of Childhood Asthma With Federal Rental Assistance.

Importance: Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes. Objectives: To examine whether participation in the US Department of Housing and Urban Development's (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers). Design, Setting, and Participants: This survey study used data from the nationally representative National Health Interview Survey linked to administrative housing assistance records from January 1, 1999, to December 31, 2014. A total of 2992 children aged 0 to 17 years who were currently receiving rental assistance or would enter a rental assistance program within 2 years of survey interview were included. Data analysis was performed from January 15, 2018, to August 31, 2019. Exposures: Participation in rental assistance provided by HUD. Main Outcomes and Measures: Ever been diagnosed with asthma, 12-month history of asthma attack, and 12-month history of visiting an emergency department for the treatment of asthma among program participants vs those waiting to enter a program. Overall participation was examined, and participation in public or multifamily housing was compared with participation in housing choice vouchers. Results: This study included 2992 children who were currently participating in a HUD program or would enter a program within 2 years. Among children with an asthma attack in the past year, participation in a rental assistance program was associated with a reduced use of emergency departments for asthma of 18.2 percentage points (95% CI, -29.7 to -6.6 percentage points). Associations were only found after entrance into a program, suggesting that they were not confounded by time-varying factors. Statistically significant results were found for participation in public or multifamily housing (percentage point change, -36.6; 95% CI, -54.8 to -18.4) but not housing choice vouchers (percentage point change, -7.2; 95% CI, -24.6 to 10.3). No statistically significant evidence of changes in asthma attacks was found (percentage point change, -2.7; 95% CI, -12.3 to 7.0 percentage points). Results for asthma diagnosis were smaller and only significant at the 10% level (-4.3; 95% CI, -8.8 to 0.2 percentage points). Conclusions and Relevance: Among children with a recent asthma attack, rental assistance was associated with less emergency department use. These results may have important implications for the well-being of low-income families and health care system costs.

Residential mobility and long-term exposure to neighborhood poverty among children born in poor families: A U.S. longitudinal cohort study.

One in four Americans lives in a poor neighborhood - defined by a poverty rate of 20% or higher. The effects of neighborhood poverty on children's health and development depend on the timing and duration of the exposure. Focusing on children born in poor families, we examined the timing and persistence of their exposure to neighborhood poverty from birth to age 17. We also examined family characteristics associated with exposure to neighborhood poverty. Study data are from a national cohort of 634 children born in poor families in the Panel Study of Income Dynamics. Neighborhood poverty was defined by census tract using residential addresses reported in annual/biennial interviews. Approximately half of the children lived in a poor neighborhood at any age. More than a third lived in a poor neighborhood both at birth and in their last follow-up in adolescence, spending most of their childhood and adolescence in such neighborhoods. Many family demographic and socioeconomic characteristics were significantly associated with entering and exiting poor neighborhoods, but only non-white head of household, being born in a poor neighborhood, and parents' tenure in poor neighborhoods before the child's birth were significantly positively associated with cumulative exposure to poor neighborhoods (in years). Among children born in poor families, exposure to neighborhood poverty is persistent throughout childhood and adolescence. Children from non-white families and families with a history living in poor neighborhoods are disproportionately exposed to poor neighborhoods. Policies are needed to address structural conditions such as neighborhood racial and income segregation to reduce prolonged exposure to neighborhood poverty among children born into poverty.

The Impact of Housing Assistance on the Mental Health of Children in the United States.

Housing assistance policies may lead to improved mental health for children and adolescents by improving housing quality, stability, and affordability. We use a unique data linkage of the National Health Interview Survey and U.S. Department of Housing and Urban Development administrative data to examine the impact of housing assistance on parent-reported mental health outcomes for children ages 2 to 17 (N = 1,967). We account for selection into housing assistance using a pseudo-waitlist method that compares children receiving assistance to those who will enter housing assistance within two years of their interview. Compared to those in the pseudo-waitlist group, we find that children living in public housing have better mental health outcomes. We do not find similar benefits for children receiving vouchers. Our results suggest that housing assistance policies can have a positive impact on mental health among disadvantaged children.

Housing Assistance and Child Health: A Systematic Review.

CONTEXT: Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in promoting the health of disadvantaged children. OBJECTIVE: To summarize and evaluate research in which authors examine housing assistance and child health. DATA SOURCES: PubMed, Web of Science, PsycInfo, and PAIS (1990-2017). STUDY SELECTION: Eligible studies were required to contain assessments of public housing, multifamily housing, or vouchers in relation to a health outcome in children (ages 0-21); we excluded neighborhood mobility interventions. DATA EXTRACTION: Study design, sample size, age, location, health outcomes, measurement, program comparisons, analytic approach, covariates, and results. RESULTS: We identified 14 studies, including 4 quasi-experimental studies, in which authors examined a range of health outcomes. Across studies, the relationship between housing assistance and child health remains unclear, with ∼40% of examined outcomes revealing no association between housing assistance and health. A sizable proportion of observed relationships within the quasi-experimental and association studies were in favor of housing assistance (50.0% and 37.5%, respectively), and negative outcomes were less common and only present among association studies. LIMITATIONS: Potential publication bias, majority of studies were cross-sectional, and substantial variation in outcomes, measurement quality, and methods to address confounding. CONCLUSIONS: The results underscore a need for rigorous studies in which authors evaluate specific housing assistance programs in relation to child outcomes to establish what types of housing assistance, if any, serve as an effective strategy to reduce disparities and advance equity across the lifespan.

The Effects of Assisted Housing on Child Well-Being.

The most rigorous research on the causal effects of assisted housing on children's outcomes finds no such effects. The present study uses rich longitudinal data from the Panel Study of Income Dynamics, augmented with Census, American Community Survey and U.S. Department of Housing and Urban Development administrative data, to unpack these nil effects. Analyses include 194 children ( X¯ age = 6.2 years) living in assisted housing in 1995 or later who were 13-17 years old in 2002 or 2007, and an unassisted comparison group of 215 children who were income-eligible for, but never received, housing assistance. Results suggested no mean effects of living in assisted housing during childhood on adolescent cognitive, behavior, and health outcomes, addressing selection through propensity score matching and instrumental variables. However, quantile regressions suggest assisted housing provides an added boost for children with the best cognitive performance and fewest behavior problems but has opposite effects on children with the lowest cognitive scores and most behavior problems. Further tests indicate that these differences are not explained either by neighborhood effects or housing quality. A potentially fruitful avenue for future research investigates differences in how parents take advantage of the housing affordability provided by assisted housing to benefit their children.

Housing Affordability And Children's Cognitive Achievement.

Housing cost burden-the fraction of income spent on housing-is the most prevalent housing problem affecting the healthy development of millions of low- and moderate-income children. By affecting disposable income, a high burden affects parents' expenditures on both necessities for and enrichment of their children, as well as investments in their children. Reducing those expenditures and investments, in turn, can affect children's development, including their cognitive skills and physical, social, and emotional health. This article summarizes the first empirical evidence of the effects of housing affordability on children's cognitive achievement and on one factor that appears to contribute to these effects: the larger expenditures on child enrichment by families in affordable housing. We found that housing cost burden has the same relationship to both children's cognitive achievement and enrichment spending on children, exhibiting an inverted U shape in both cases. The maximum benefit occurs when housing cost burden is near 30 percent of income-the long-standing rule-of-thumb definition of affordable housing. The effect of the burden is stronger on children's math ability than on their reading comprehension and is more pronounced with burdens above the 30 percent standard. For enrichment spending, the curve is "shallower" (meaning the effect of optimal affordability is less pronounced) but still significant.

Challenges of drug discovery in novel target space. The discovery and evaluation of PF-3893787: a novel histamine H4 receptor antagonist.

We describe the development of novel benzimidazoles as small molecule histamine H4 receptor (H4R) antagonists and their profiling in rat early toxicity studies. The discovery and optimisation of a second series of pyrimidine based antagonists is then described culminating in the identification of the clinical development candidate 13 (PF-3893787). The pre-clinical profile of 13 (PF-3893787) is presented including the development of a translatable biomarker. Our pragmatic approach to target selection, safety assessment, and testing for efficacy faced numerous challenges and we share a number of lessons which the team learned and which will assist us and others in future drug discovery projects.

Comparison of the non-nucleoside reverse transcriptase inhibitor lersivirine with its pyrazole and imidazole isomers.

Lersivirine is a potent non-nucleoside reverse transcriptase inhibitor with exceptional mutant resilience. Here, we compare the pharmacological and pharmacokinetic profile of lersivirine with its pyrazole and imidazole isomers and briefly explore the profile of these series. This work establishes lersivirine as the outstanding molecule in this set.

Inhalation by design: dual pharmacology ß-2 agonists/M3 antagonists for the treatment of COPD.

This paper describes the successful design and development of dual pharmacology ß-2 agonists-M3 antagonists, for the treatment of chronic obstructive pulmonary disorder using the principles of 'inhalation by design'. A key feature of this work is the combination of balanced potency and pharmacodynamic duration with desirable pharmacokinetic and material properties, whilst keeping synthetic complexity to a minimum.

Communicating health information to disadvantaged populations.

Interest in the communication of health information among disadvantaged populations has increased in recent years with the shift from a model of patient-provider communication to one of a more empowered healthcare consumer; with the use of new communication technologies that increase the number of channels through which health information may be accessed; and with the steadily increasing number of people without health insurance. Three separate research literatures contribute to our current understanding of this issue. In the medicine and public health literature, disparities in health access and outcomes among socioeconomic, ethnic, and racial groups are now well documented. In the information sciences literature, scholars note that on a continuum of health information behaviors, ranging from information avoidance and nonseeking to active seeking, nonseeking behaviors are associated with disadvantaged populations. In the communication literature, enthusiasm over the technology-driven growth of online health information seeking is tempered by evidence supporting the knowledge gap hypothesis, which indicates that as potential access to health information increases, systematic gaps in health knowledge also increase as groups with higher socioeconomic status acquire this information at a faster rate than those with lower socioeconomic status. A number of diverse strategies show promise in reducing information and health disparities, including those that focus on technology, such as programs to increase computer and Internet access, skills, and comprehension; those that focus on interpersonal communication, such as the community health worker model; and those that focus on mass media channels, such as entertainment education.

The relationship between a statewide preceptorship program and family medicine residency selection.

OBJECTIVE: The purpose of this study was to investigate the extent to which participation in the California Academy of Family Physicians Foundation Family Medicine (FM) Preceptorship Program, as well as medical school, degree earned, gender, and match year predicted FM residency match. METHODS: Allopathic and osteopathic students who applied to the preceptorship program from 1996 to 2002 were followed until residency match. Chi-square (chi(2)) analysis was used to compare preceptorship participants, nonparticipants (students who applied but did not complete the preceptorship), and nonapplicants (students who did not apply to the preceptorship) for FM match rates and to compare participants to nonparticipants for primary care match rates. FM match data for California schools from 1999 to 2005 were used to perform a logistic regression predicting FM match. RESULTS: Twenty-four percent of participants matched into FM residency programs whereas only 13% of nonparticipants and 13% of nonapplicants selected FM (chi(2) = 24.97; P < .001). There was not a statistically significant difference between the proportion of participants and nonparticipants who matched into primary care (chi(2) = 0.12; P = .73). Odds ratio results of logistic regression for participants compared with nonapplicants matching into FM was 2.7 (95% CI, 2.0-3.6; P < .001). CONCLUSION: Preceptorship program participants were more likely than both nonparticipants and nonapplicants to select a FM residency.

Optimization of 5-aryloxyimidazole non-nucleoside reverse transcriptase inhibitors.

A major problem associated with non-nucleoside reverse transcriptase inhibitors (NNRTIs) for the treatment of HIV is their vulnerability to mutations in the allosteric binding site of reverse transcriptase that can result in the development of a resistant virus. Herein we present the optimization of a series of 5-aryloxy imidazoles, which possess a balanced pharmacological profile against both wild-type enzyme and the clinically relevant mutations K103N and Y181C. Subtle structural changes were used to probe structure-activity relationships relating to both potency and metabolic stability, which led to an imidazole derivative with an impressive overall profile.

Preliminary experiences of the states in implementing the National Family Caregiver Support Program: a 50-state study.

Despite increased attention to policy choices to support family and informal caregivers, relatively little is known about states' experiences in providing caregiver support services. This article reports on the first nationwide survey of all 50 states and the District of Columbia in providing caregiver services since the passage of the National Family Caregiver Support Program. State program administrators reported that their program differs from other home and community-based services because of the explicit focus on the family or informal caregiver. Results suggest that despite an increasing availability of caregiver supports in all 50 states, there is also a great unevenness in services and service options for family caregivers across the states and within states.

A concise and selective synthesis of novel 5-aryloxyimidazole NNRTIs.

[reaction: see text] A concise and efficient route to the construction of a 5-aryloxyimidazole has been developed. The key step was the selective O-arylation of a 2,4-dimethoxybenzyl-protected imidazolone. The final compound is a potent inhibitor of HIV reverse transcriptase.

Structure-activity relationships of 1-alkyl-5-(3,4-dichlorophenyl)-5-{2-[3-(substituted)-1-azetidinyl]-ethyl}-2-piperidones. Part 2: Improving oral absorption.

A series of piperidone analogues of 1b-q, seeking replacements for the polar sulfamide moiety in clinical candidate UK-224,671 1a, possessing reduced H-bonding potential as a strategy to improve oral absorption, were prepared. These studies led to the successful identification of 1n, which demonstrated equivalent pharmacology and metabolic stability to 1a, and greatly improved oral absorption as assessed in rat PK studies.