Search Results (508)

Homelessness is a major public health concern, and successful rehousing is an important outcome for people experiencing homelessness (PEH). However, limited evidence exists on which individual factors are associated with rehousing after transitional care; this study examined characteristics associated with being rehoused at discharge from Durham Homeless Care Transitions (DHCT). We analyzed data from DHCT, a transitional care program serving PEH. Independent variables included demographic characteristics, self-efficacy, mental healthcare status, and unmet identity and communication access (ICA) needs, including lack of personal identification documentation and technology access. We performed bivariate analyses and multivariable regression to assess associations with being rehoused at discharge. In both bivariate and multivariable analyses, non-White PEH were less likely to be rehoused at discharge than White PEH. Greater unmet ICA needs were also significantly associated with lower likelihood of rehousing. These findings add to the mixed prior literature regarding racial inequities in rehousing among PEH. The concept of ICA needs has not previously been studied and may offer an actionable target for transitional care programs seeking to improve rehousing outcomes and advance equity. Full article

Objectives: This study aimed to identify the oral health conditions of homeless individuals in Rome, the most frequently required dental treatments, and to describe a standardized, replicable clinical protocol tailored to the specific needs and access barriers of this vulnerable population. Methods: Five hundred homeless individuals received comprehensive dental examinations at the Primary Care Services of the Dicastery for the Charity Services (Vatican City) between September 2023 and January 2026. Clinical assessments included oral hygiene status, periodontal health, caries prevalence, and degree of edentulism. Treatment interventions were programmed by scheduling subsequent appointments. For patients requiring prosthetic rehabilitation, treatment was sequenced into distinct steps: preparatory treatments (hygiene, extractions, conservative procedures), impression taking, prosthesis try-in, and delivery. Results: Oral health assessment revealed poor or absent hygiene (85.4%), high DMFT scores (63.0%), and root residues (22.4%). Periodontal disease affected 94.0% of participants (gingivitis 73.0%, periodontitis 21.0%). Tooth loss patterns included partial edentulism (12.0%) and complete edentulism (24.0%). A total of 440 appointments were scheduled, with an attendance rate of 78.4%. Prosthetic rehabilitation was completed in 150 patients: 50 received partial dentures (33.3%) and 100 complete dentures (66.7%). Conclusions: The examined homeless individuals experienced severe oral health deterioration characterized by extensive tooth loss and advanced periodontal disease. A substantial prosthetic rehabilitation was needed in this sample. The proposed sequential treatment protocol demonstrated high feasibility and patient adherence in this vulnerable population. Comprehensive dental services that address both immediate emergency needs and long-term rehabilitative care are crucial for improving oral health-related quality of life and facilitating social reintegration. Patient-reported outcomes indicated meaningful improvements in digestive function, aesthetic satisfaction, and employment opportunities following prosthetic rehabilitation. Full article

Access to primary care services is essential for promoting mental health, yet immigrants experiencing homelessness face significant barriers to care. This study explores factors that influence access to primary care services in the UK. A qualitative design was employed, involving in-depth semi-structured interviews with 30 immigrants experiencing homelessness and 30 stakeholders across healthcare, voluntary, and local authority sectors. Data were analysed using thematic analysis, guided by the Levesque framework of healthcare access and an intersectionality lens. Findings reveal that access is influenced by intersecting structural barriers, including fear of detention and deportation, cultural stigma surrounding mental health, digital exclusion, and financial hardship. These barriers delay help-seeking and shift care-seeking toward emergency services. Increasing reliance on digital systems in primary care further excludes individuals with limited access to devices, connectivity, or digital skills. These findings indicate that barriers to accessing primary care services may hinder the early identification and preventive management of mental health needs among homeless immigrants. Improving access requires structural reforms that address legal, financial, and digital barriers, alongside more culturally responsive and trust-based care. Without such changes, digital health innovations risk reinforcing existing inequalities and limiting the role of primary care in early mental health intervention and prevention. Full article

This paper discusses emerging findings from a large-scale, ongoing UKRI-funded study (2024–2027) undertaken in twelve diverse areas of England. While the main project focuses on reducing health inequalities for refugees, asylum seekers and migrant populations, this interim paper focuses on emerging evidence related to the question of how perceptions of deservingness and route of entry link to access to housing and support services available to the four main refugee, asylum seeking and migrant groups who are the predominant focus within the wider research study. We argue that the level and type of support received and access to housing have a direct impact on the wellbeing of the populations. Housing is one of the key social determinants of health, with impacts on both mental health and broader wellbeing. Our findings show that nationality, together with route of entry, legal status and eligibility for statutory support (or lack thereof), clearly affects housing pathways. This, in turn, impacts on the likelihood of being housed in temporary/dispersal accommodation, as well as experiencing homelessness and longer-term housing precarity. These are factors which are widely recognised as affecting mental health and wellbeing, as well as the ability to receive uninterrupted health care for other conditions. This study explores how vulnerability, desirability, and deservingness shape different trajectories of refugee housing and resettlement and the resultant impacts on different migrant populations. Full article

Objective: To examine the association between Life Essential 8 (LE8) and incident T2D in the Women’s Health Initiative (WHI), and to assess whether associations varied by race and ethnicity. Research Design and Methods: Prospective cohort study of 19,403 postmenopausal women enrolled in the WHI without T2D at baseline. Data were analyzed from 1993 through 2024. The LE8 score (range, 0–100), comprising blood glucose, blood lipids, blood pressure, smoking, physical activity, diet, sleep, and body mass index (BMI), categorized as high (80–100), moderate (50–79), and low (0–49) according to AHA definitions. Incident treated T2D was self-reported during follow-up. Cox proportional hazards models estimated hazard ratios (HRs) and 95% CIs for LE8 categories and continuous scores. Results: During a mean follow-up of 16.3 years, 3921 women developed T2D. Compared with the lowest category, women in the highest LE8 category had a 57% lower risk of T2D (HR, 0.43; 95% CI, 0.38–0.49). A 20-point increase in LE8 score was associated with a 43% lower risk (HR, 0.57; 95% CI, 0.54–0.60). Among individual domains, BMI and glucose were most strongly associated with T2D. Subgroup analyses by 20-point increase in LE8 showed greater risk reduction among Hispanic/Latina women (HR, 0.46; 95% CI, 0.41–0.53) compared with non-Hispanic women (HR, 0.58; 95% CI, 0.55–0.62), but no significant association with race was observed. Conclusions: Higher LE8 scores are associated with a reduced risk of T2D in postmenopausal women, supporting LE8 as a useful framework for lifestyle-based diabetes prevention strategies. Full article

Two-spirit, lesbian, gay, bisexual, transgender, queer, and questioning (2SLGBTQ+) youth disproportionately experience homelessness compared to cisgender and heterosexual youth; however, there is a distinct lack of population-based housing programs designed to meet their specific needs, particularly in suburban contexts. This study applies the socio-ecological model to examine the multi-level factors shaping the experiences, needs, and housing trajectories of 2SLGBTQ+ youth residing at the Blue Door INNclusion program—one of the first population-based housing programs for 2SLGBTQ+ youth in a suburban region of Ontario, Canada. Drawing on semi-structured interviews and survey data with residents of the Blue Door INNclusion program, we explore youths’ pathways into homelessness, their experiences during program participation, and their transitions toward independent living. Analysis focuses on how intrapersonal, interpersonal, organizational, and structural factors shape youths’ experiences of safety, belonging, and access to supports, as well as changes in mental health, social connections, employment, and education over time. Findings indicate that pre-entry experiences, including family rejection and housing instability, shaped youths’ needs and engagement within the program. Across socio-ecological levels, affirming relationships, inclusive organizational practices, and access to tailored supports were central to fostering safety and belonging. Over time, youth described improvements in mental health and social connectedness, alongside increased engagement in education and employment, while structural challenges such as financial precarity continued to influence their transitions toward independence. By situating youths’ experiences within a socio-ecological framework, this study offers theoretically grounded insights into the multi-level conditions that support housing stability and well-being among 2SLGBTQ+ youth in suburban transitional housing contests. Full article

The Street Clinic (Consultório na Rua—CnR) is a strategic component of Primary Health Care in Brazil, aimed at populations experiencing homelessness, a group characterized by high levels of social and health vulnerability. This study critically analyzes the experiences of healthcare professionals working within a CnR team, identifying the meanings attributed to their work, the challenges encountered, and the strategies developed within the territory. This is an exploratory study with a qualitative approach, grounded in health narratives and the philosophical hermeneutics of Hans-Georg Gadamer. Four professionals participated, representing the totality of eligible members of a team in a medium-sized municipality in Southern Brazil, with between one and eleven years of experience in the service. Hermeneutic analysis revealed that the CnR functions as an entry point to Primary Health Care and Psychosocial Care, with the bond between team and users serving as the primary mechanism for overcoming barriers to access. Professionals report ethical suffering arising from the tension between their commitment to comprehensive care and the structural limitations of the service, including shortages of supplies, institutional instability, and precarious employment arrangements. It is concluded that strengthening the CnR requires not only investment in infrastructure and expansion of the teams, but also policies that recognize and support the complexity of street-based work, including care for the caregivers themselves. Full article

Language is social, as it is used by individuals to communicate and exchange ideas in society. Language is also cognitive, as the primary function of language, even before communicating and exchanging ideas, is to think. This article connects the social representations of what bilingualism is in the United States and how transnational youth are talked about in U.S. society with how both of these social representations create cognitive representations (e.g., thoughts, ideas, and beliefs) about transnational youth that result in negative educational policies and practices and shameful psychological and behavioral experiences for these youth. We begin with an ethnosemantic analysis of the word “bilingual” in the U.S. and then use the cognitive linguistic phenomena of conceptual metaphor and conceptual metonymy to explain how bilingualism is cognitively viewed as a “shameful problem” in society for transnational youth. We link linguistic shame, brought on by the social cognitive representations of bilingualism as transnational youth metonymically being incomplete, broken, in disrepair, fractured, unsettled, displaced, lacking fully built linguistic structures, not fully in possession of any language, to the phenomenon of and conceptual metaphor of TRANSNATIONAL YOUTH’S BILINGUALISM IS LINGUISTIC HOMELESSNESS. We conclude by putting forth a new metaphor, TRANSNATIONAL YOUTH FUNDS OF KNOWLEDGE ARE MYCELIAL NETWORKS, that rejects the concept of linguistic homelessness by pointing to these youth’s expanding networks of fluid languaging practices, transnational academic skills, and ever adapting identities. Through this new discourse, we advocate for new ways of socially talking about transnational youth and their languaging practices that may lead to different cognitive representations of these students; reorienting bilingualism from a problem to a resource and a right. Full article

Across California, the seven largest cities—Los Angeles, San Diego, San Jose, San Francisco, Fresno, Sacramento, and Long Beach—carry a disproportionate share of the state’s homelessness crisis, even though they operate under the same statewide policy framework. Each city’s homelessness system reflects its own history, political climate, and housing market conditions, and this study shows that a common set of structural forces especially severe housing scarcity, fragmented behavioral–health systems, and uneven local capacity shapes homelessness across these urban areas while producing different outcomes on the ground. Drawing on multidisciplinary research, statewide policy analyses, and municipal data, the analysis compares how cities interpret and implement key interventions, including permanent supportive housing, interim shelter expansion, prevention strategies, and enforcement-oriented responses. The findings make clear that California’s homelessness crisis cannot be reduced to a single cause; instead, understanding it requires a systems-oriented perspective that accounts for the intertwined economic, social, and policy forces shaping conditions in each community. By situating city-level strategies within broader statewide patterns, the study identifies points of convergence and divergence, as well as persistent structural constraints that limit the effectiveness of current responses, underscoring the need for coordinated, scalable, and context-responsive policy solutions. Full article

Background: Drug use settings are critical determinants of overdose risk and other drug-related harms. Although sex differences in drug use patterns are well documented, less is known about sex differences in the types of locations where people use drugs. This study examined sex differences in drug use settings among people who use opioids. Methods: Data were from the baseline survey of the OASIS project, a community-based study conducted in Baltimore, Maryland (N = 869), focusing on 9 specific types of locations where participants reported drug use in the past 30 days: their own residence, someone else’s residence, street, alley, park, abandoned building, public restroom, car, and other locations. Bivariate and multivariable logistic regression models examined associations between sex and drug use settings, adjusting for age, race, education, homelessness, and frequency of drug use. Results: The sample included 346 women and 523 men. In adjusted models, women had significantly lower odds than men of using drugs on the street (aOR = 0.49, 95% CI 0.35–0.70), in alleys (aOR = 0.50, 95% CI 0.35–0.69), parks (aOR = 0.57, 95% CI 0.42–0.78), abandoned buildings (aOR = 0.53, 95% CI 0.38–0.75), cars (aOR = 0.55, 95% CI 0.41–0.73), and other locations (aOR = 0.59, 95% CI 0.37–0.94). Sex was not significantly associated with drug use at one’s own residence or someone else’s residence. Conclusions: Women who use opioids were significantly less likely than men to use drugs in public and semi-public settings, which may reflect gendered patterns of stigma, interpersonal violence, and safety concerns. Harm reduction programs should focus on making current drug use settings safer and developing additional safer settings with an emphasis on addressing barriers for women to access harm reduction services, including women-centered overdose prevention centers and household-based overdose response training. Full article

The harms associated with substance use continue to disproportionately affect marginalized populations. This study presents a retrospective program evaluation of a mobile health unit that delivers integrated clinical and harm reduction services to marginalized populations in Eastern Puerto Rico. Methods: A secondary data analysis was conducted using administrative data from a mobile health unit, capturing client encounters, service utilization (e.g., mental health support, health screenings, safe injection counseling, and case management), visit frequency, and demographic characteristics. This study is framed as an implementation-focused program evaluation. Descriptive and exploratory analyses were conducted to assess service delivery, program reach, utilization patterns, and selected program outcomes over a 1.5-year period. Results: Between January 2022 and October 2023, the mobile health unit served 279 participants across eight municipalities. Participants exhibited higher rates of intravenous drug use, mental health disorders, homelessness, and incarceration history compared with previously published estimates for the general Puerto Rican population, although these comparisons are indirect. The program delivered multidisciplinary services and facilitated referrals addressing key social determinants of health, including housing, nutritional assistance, identification services, in-patient treatment, and medication-assisted treatment. Model-based estimates using the Mobile Health Map Impact Tracker tool suggest that, in 2023, mobile health screenings may be associated with a return on investment of approximately 6:1, 259 avoided emergency department visits, 29 life-years saved, and approximately USD 2.4 million in healthcare cost savings. Conclusions: This evaluation demonstrates the feasibility of a mobile health model integrating harm reduction and clinical services to reach highly marginalized populations and facilitate connections to health and social services. Findings reflect program implementation, service reach, and engagement rather than causal effectiveness. Mobile health approaches may represent a feasible and potentially beneficial strategy for expanding access to care, although further research incorporating patient-level outcomes is needed to assess effectiveness. Full article

Domestic and family violence (DFV) is a key driver of women’s homelessness and financial insecurity. In Australia, Safe at Home (SAH) programs have emerged as an innovative, wrap-around service response that increases victim-survivors’ safety by implementing a range of strategies and tools that enables them to remain in their home or a home of their choice. SAH responses represent one strategy that effectively prevents homelessness and mitigates the financial, social, and emotional disruption associated with housing relocation after leaving a violent and abusive relationship. This paper examines the implementation of SAH responses in Australia through a critical synthesis of national policy documents and published literature. The paper outlines the four nationally endorsed pillars of SAH (maximising safety, integrated responses, homelessness prevention, and economic security) and examines how these pillars shape service design and outcomes. Evidence from evaluations and outcome studies indicate that SAH can enhance women’s sense of safety, support housing stability, and reduce the financial burden of leaving a violent partner. Access and effectiveness vary depending on the design of the response and location. Challenges include limited affordable housing supply, inconsistent perpetrator accountability, and structural barriers to long-term economic security. Sustained investment in SAH programs, robust data collection mechanisms, and stronger integration of housing and economic supports are ultimately needed to ensure SAH can fulfil its potential as a core component of Australia’s DFV service system. Full article

This research draws from participant interviews at baseline, midpoint, and conclusion of a two-year Basic Income program designed to lift 76 families, with at least one child under the age of six, above the California poverty line by supplying a guaranteed monthly cash stipend (average: $1289 per month). Theoretically, we bring the Family Stress Model into the conversation with the Theory of Change that underpins Guaranteed Income programming, namely that freedom and choice empower families to mitigate stress, manage funding, and better navigate the multifactorial aspects of living in poverty. Participants report that the Basic Income program offered a much-appreciated reprieve from poverty and reported using the funds to stabilize their housing and support the health and development of themselves and their children. Participants also highlighted how guaranteed cash programming can pair with traditional social service case management to better benefit recipients. Full article

Background: Diabetes mellitus is a global health challenge, especially among homeless people. Early prediction of diabetes can reduce treatment costs and improve interventions. This study aimed to identify predictors of diabetes among homeless adults by utilizing artificial intelligence and providing recommendations for diabetes prevention. Methods: A case-control study of 150 homeless adults in Giza, Egypt (99 diabetes cases and 51 controls), analyzed 43 variables collected through interviews and physiological measures, with missing data imputed. Feature selection using recursive feature elimination and univariate and correlation analyses reduced the predictors to 13 variables. The class imbalance was addressed using synthetic minority over-sampling on the training set. Six models and a stacking ensemble with XGBoost as a meta-learner were evaluated using 5-fold cross-validation and performance metrics, including the accuracy, precision, recall, F1-score, and AUC-ROC. Results: The key predictors included BMI, systolic blood pressure, triceps skinfold thickness, waist circumference, lifestyle factors, comorbidities, diastolic blood pressure, age, medication adherence, educational level, marital status, duration of residence, and diabetes knowledge. Individual classifiers achieved a moderate performance (accuracy: 56.7–70.0%, F1-score: 0.686–0.781). The stacking ensemble substantially outperformed individual models, achieving a 95.45% accuracy, a 100% precision, a 93.75% recall, a 0.968 F1-score, and a 0.979 AUC-ROC on the test set. Conclusions: Machine learning models can reliably predict diabetes. The proposed hybrid stacking model outperformed conventional classifiers in terms of the prediction performance, highlighting the benefits of ensemble learning and sophisticated resampling strategies in dealing with imbalanced medical data. It is recommended that healthcare institutions integrate AI-powered diagnostic assistance technology into clinical processes to aid in the early detection and treatment of diabetes. Full article

Background: Antimicrobial resistance is a threat that increases morbidity and mortality. This cross-sectional study aimed to describe the profile of priority antimicrobial-resistant pathogens and to analyze the behavior of multidrug-resistant tuberculosis (MDR-TB) in the Santiago de Cali District, Colombia. Methods: researchers compiled information from data provided by healthcare institutions, the National Public Health Surveillance System, and laboratory-based surveillance using the World Health Organization’s WHONET v.5.6 software. Univariate statistical analysis described trends in pathogen resistance, and multivariate analysis analyzed the behavior of MDR-TB. Results: Among Gram-negative bacteria, high levels of carbapenem resistance were observed in A. baumannii (84% aztreonam resistance) and in K. pneumoniae (63%). P. aeruginosa exhibited elevated multidrug resistance, consistent with extensive antimicrobial selective pressure. MDR-TB exhibited a high burden of resistance, reaching 96%, with projections indicating a potential increase driven by monoresistance and resistance to rifampicin. Patients with drug-resistant tuberculosis who were HIV-positive or experiencing homelessness had a significantly higher likelihood of hospitalization (OR 5.59; 95% CI 3.09–10.11 and OR 2.94; 95% CI 1.48–5.81, respectively) and mortality (OR 3.34; 95% CI 1.72–6.49 and OR 2.59; 95% CI 1.16–5.79, respectively). Conclusions: The expansion of resistance mechanisms suggests sustained selective pressure, underscoring the need for strategies to optimize antibiotics. Full article