Creating a Regional Model to Coordinate and Prioritize Access to Permanent Supportive Housing

Demand for supportive housing outstrips availability in metropolitan regions around the country. Individuals who are homeless with serious mental illnesses, substance abuse, and other debilitating health conditions are often heavy users of publicly financed services and institutions, such as jails, emergency departments, psychiatric and medical hospitals, and sobering and detoxification services. King County, in collaboration with community partners, has developed a regional system for coordinating and prioritizing access to this limited resource based on utilization of publicly financed services/institutions and/or vulnerability. In this paper, the model, key implementation steps, preliminary results, and lessons learned are described.     

Stakeholder Perspectives on Implementation Challenges and Strategies for Moving On Initiatives in Permanent Supportive Housing

The Journal of Behavioral Health Services & Research - Moving On Initiatives (MOIs) assist individuals with the transition from permanent supportive housing to mainstream housing without the...     

Differences in Health and Social Support between Homeless Men and Women Entering Permanent Supportive Housing

BackgroundPermanent supportive housing (PSH) is the leading intervention to end chronic homelessness. Little is known, however, about gender differences, including potential disparities in physical and mental health and social support, that might inform services available through PSH.MethodsThis study included 421 homeless adults, at least 39 years old, English- or Spanish-speaking, who were moving into PSH through 26 different agencies in the Los Angeles area.ResultsCompared with men entering PSH, homeless women (28% of the sample) were younger (p < .01), less likely to have achieved at least a high school education (p < .05), and had lower incomes (p < .01). Women had more chronic physical health conditions (p < .01), were more likely to have any chronic mental health condition (odds ratio, 2.5; p < .01), and had more chronic mental health conditions than men (p < .01). Women had more relatives in their social networks (Coefficient, 0.79, p < .01) and more relatives who provided support (coefficient, 0.38; p < .05), but also more relatives with whom they had conflict (coefficient, 0.19; p < .01). Additionally, women were less likely to have caseworkers (coefficient, −0.59; p < .001) or physical and mental health care providers in their networks (coefficient, −0.23 [p < .01]; coefficient, −0.37 [p < .001], respectively). However, after correcting for multiple testing, three outcomes lost significance: number of chronic physical health conditions, number of relatives who provided any support, and number of relatives with whom there was conflict.ConclusionsThere is evidence of gender differences in mental health and social support among homeless adults moving into PSH. PSH cannot be a one-size-fits-all approach. Supportive services within housing should be tailored based on gender and other individual needs.     

The Effects of Message Framing Within the Stages of Change on Smoking Cessation Intentions and Behaviors

This study examines two commonly used and accepted theoretical models in health communication—the stages of change and message framing—to determine whether gain- or loss-framed messages are more effective at getting people to intend to quit smoking depending on their current stage of change (precontemplation, contemplation, or preparation). One hundred forty-eight current smokers were exposed to one of four gain- or loss-framed messages that emphasized the benefits of cessation or the costs of smoking. Message believability, message processing, and stage movement were measured to see if any differences existed as a function of the individual's base stage of change and message frame exposure. Overall, results indicated that all participants, regardless of stage and frame, engaged in more central than peripheral message processing. However, those in the precontemplation/loss frame and preparation/gain frame conditions engaged in significantly less cognitive processing than those in all other conditions. Additionally, gain-framed messages were most influential at getting individuals to progress from the contemplation to the preparation stage. Implications and future directions for research are also discussed.     

Overdose Prevention and Housing: a Qualitative Study Examining Drug Use,Overdose Risk,and Access to Safer Supply in Permanent Supportive Housing in Vancouver,Canada

The majority of overdose deaths in British Columbia (BC) occur among people using illicit substances alone in private residences. Some supportive housing in BC includes on-site access to a variety of health and substance use–related services. More recently, a number of supportive housing locations have started offering prescribed safer supply medications to people at high overdose risk, though these remain limited and under-evaluated. In this study, we describe the drug use practices — including access to and use of on-site supervised consumption, OAT, and prescribed safer supply medications — of study participants living in permanent supportive housing with integrated primary care, substance use treatment services, and supervised consumption spaces. Qualitative interviews were conducted with 30 residents of a permanent supportive housing site in Vancouver, Canada. Data were analyzed using a sequential process to identify both a priori (e.g., low-barrier substance use treatment, pandemic effects on service access) and emerging themes (e.g., using alone). Most (N = 27) study participants reported using alone in their rooms, despite having access to an on-site supervised consumption area. Reasons for using alone include the following: preference for being alone, discretion/stigma, and restrictive housing policies. Less than half (N = 12) of the study participants accessed on-site prescribed safer supply medications. Participants receiving on-site prescribed safer supply described positive benefits including reduced use of illicit opioids, and less reliance on illicit income generation activities. On-site prescribed safer supply programs within supportive housing environments are an important tool in addressing overdose risk.Keywords : Housing, Overdose, Safer supply, Qualitative methods     

深圳市常住居民吸烟、戒烟与被动吸烟现状分析

目的 了解深圳市15岁以上常住居民吸烟、戒烟与被动吸烟的分布和流行情况,为控制烟草使用、创建无烟环境提供依据.方法 采用多阶段整群随机抽样的方法,对深圳市8 782名15岁以上常住居民进行问卷调查.结果 调查人群吸烟率为16.47％,现在吸烟率为16.34％,常吸烟率为14.30％,重型吸烟率为7.74％,被动吸烟率为...     

Supportive Housing in Foster Care: The Views of Young People

This study investigated Finnish young people's experiences of supportive housing. Supportive housing is an after-care programme that should support the transition from foster care to independent adulthood. It is directed mainly at young people who have been taken into foster care by social workers. The sample consisted of 39 young people (23 males, 16 females) aged 17–26 who had been residents in supportive care in Helsinki for 3–36 months. Their experiences were collected by use of a quantitative questionnaire. The data indicate that most of the participants felt their needs were met in supportive housing. Despite the overall positivity, two important issues should be noted. First, the results reveal some gender differences, indicating that boys had a somewhat more positive experience of supportive housing than girls. The second key issue is that many respondents did not get much support for acquiring hard skills such as managing financial, employment or health care issues, or for planning life after supportive housing.     

Promoting Responsive Bottle-Feeding Within WIC: Evaluation of a Policy,Systems, and Environmental Change Approach

BackgroundBottle-fed infants are at greater risk for overfeeding and rapid weight gain (RWG); evidence-based strategies for promoting healthy bottle-feeding practices are needed.ObjectiveOur aim was to assess whether policy, systems, and environmental (PSE) strategies for promoting responsive bottle-feeding practices within the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) were associated with lower risk for RWG.DesignWe conducted a matched-pair cluster randomized trial. PSE strategies were implemented at 3 WIC clinics in Los Angeles County. PSE clinics were compared with 3 matched control clinics. Mothers and infants were assessed when infants were newborn and 3 months and 6 months of age.Participants/settingParticipants were mothers (n = 246) who enrolled their newborn infants (younger than 60 days) into WIC between May and August 2019.Main outcome measuresInfant weight was assessed and standardized to sex- and age-specific z scores. RWG was defined as weight-for-age z score change > 0.67. Mothers completed questionnaires assessing responsive and pressuring feeding styles, breast- and bottle-feeding patterns, and perceptions of WIC experiences.Statistical analyses performedLogistic regression with estimation via generalized estimating equations and linear mixed models with repeated measures assessed effects of PSE strategies on categorical and continuous outcomes, respectively.ResultsInfants in PSE clinics had significantly lower likelihood of exhibiting RWG (P = .014) than infants in control clinics. Mothers in PSE and control clinics reported similar levels of responsive and pressuring feeding style and similar prevalence of breastfeeding and bottle-feeding. Mothers in PSE clinics trended toward feeling better supported with respect to their decision to bottle-feed (P = .098) and had more stable intentions to stay in the WIC program (P = .002) compared with mothers in control clinics.ConclusionsPSE strategies focused on promoting more inclusive assessment of infant feeding, tailored bottle-feeding counseling, and increased education and support for responsive bottle-feeding were associated with lower risk for RWG among WIC infants.     

Smoking,Weight Change,and Age

This study examined a cohort of healthy white veterans during a five-year period in order to determine the effects of age and of change in smoking status on change in body weight. In general, regardless of age cohort, a greater number of excigarette smokers gained weight, more weight than did other men. However, excigarette smokers between the ages of 40 and 54 years old showed a substantial weight gain when, according to National Health Survey statistics, men in that age span normally gain little weight. While both chronological age and cigarette smoking change were significantly related to weight change, together they accounted for only 7.5% of the variance in weight change, suggesting the importance of other factors in explaining the weight change over a five-year period.     

US Health Policy Related to Hookah Tobacco Smoking

Objectives. Although US cigarette smoking is decreasing, hookah tobacco smoking (HTS) is an emerging trend associated with substantial toxicant exposure. We assessed how a representative sample of US tobacco control policies may apply to HTS.Methods. We examined municipal, county, and state legal texts applying to the 100 largest US cities. We developed a summary policy variable that distinguished among cities on the basis of how current tobacco control policies may apply to HTS and used multinomial logistic regression to determine associations between community-level sociodemographic variables and the policy outcome variable.Results. Although 73 of the 100 largest US cities have laws that disallow cigarette smoking in bars, 69 of these cities have exemptions that allow HTS; 4 of the 69 have passed legislation specifically exempting HTS, and 65 may permit HTS via generic tobacco retail establishment exemptions. Cities in which HTS may be exempted had denser populations than cities without clean air legislation.Conclusions. Although three fourths of the largest US cities disallow cigarette smoking in bars, nearly 90% of these cities may permit HTS via exemptions. Closing this gap in clean air regulation may significantly reduce exposure to HTS.A hookah, also known as a water pipe, consists of a head, body, bowl, and hose. Moist, sweetened, flavored tobacco is placed in the head, and lit charcoal is placed on it. Users inhale through the mouthpiece, drawing smoke through the hookah. This practice is associated with substantial inhalation of smoke. For example, the World Health Organization1 has estimated that a hookah smoker may inhale as much smoke during 1 standard hookah tobacco smoking (HTS) session as a cigarette smoker would from 100 cigarettes. Other studies have suggested that, compared with a single cigarette, 1 hookah smoking session may expose the user to more inhaled tar, carbon monoxide, nicotine, and polycyclic aromatic hydrocarbons.1–5 In vivo studies have shown HTS to be associated with plasma nicotine concentrations comparable to those seen with cigarette smoking and increases in carbon monoxide levels that are much higher than those typically observed with cigarette smoking.6 Secondhand smoke exposure from a hookah may also be a concern. Although more study is needed, a published report7 has suggested that expired air from nonsmokers in a hookah tobacco café had a higher concentration of carbon monoxide than expired air from nonsmokers in a regular bar allowing cigarette smoking.The increase in HTS in the United States8–13 has coincided with a decrease in the rate of cigarette smoking to its lowest level in nearly 60 years.14,15 The rate of HTS is highest among young people, with 30% of college students having ever used and 10% having used in the past 30 days, making HTS nearly as common as cigarette use.8,9,11,16 The rate of HTS has also increased substantially among high school students and noncollege populations,10,13,17 and it is popular across gender, age, race, geographic location, and socioeconomic status.9,11,16,18 Although some hookah users also smoke cigarettes, as many as half of users would have otherwise been naïve to nicotine.12,13Clean air policies have successfully curbed cigarette smoking in certain regions of the United States. As of July 1, 2011, 35 states and thousands of local municipalities had passed smoke-free laws. Whether HTS is affected by laws such as these or whether provisions included in these laws may have intentionally or unintentionally exempted HTS is, however, not known.19,20 Because of the importance of HTS establishments in promoting use of these products, these exemptions are likely to contribute to the prevalence of HTS.15,16Thus, a systematic assessment of extant clean air laws, with special attention paid to implications for HTS, would be valuable. Moreover, determining what community factors are associated with HTS policy status may be valuable; this information may ultimately help focus interventions on communities in which the need is greatest. The purposes of this study were to assess how a representative sample of US tobacco control policies may apply to HTS and to determine associations between community-level sociodemographic factors and HTS policy status.     

中国青少年吸烟相关政策因素分析

引　　言中国作为世界人口大国 ,也是世界上最大的烟草生产及消费国 ,吸烟人数 3 2亿 ,占全球总数的 1 / 3 [1 ] 。估计到 2 0 5 0年每年将有 3 0 0万人死于与吸烟有关的疾病[2 ] 。烟草使用与其说是一种成年人的健康祸首 ,莫如说是一种“青少年的流行病” ,大多数吸烟者是在青少年时期即开始使用烟草的。有关研究表明 ,1 / 3～ 1 / 2青少年尝试吸烟后会养成吸烟习性并成瘾 ,如果 2 0岁以前不吸烟 ,成人后吸烟的可能性大大降低[3] 。令人堪忧的是 ,我国青少年吸烟率近年来有上升趋势 ,开始吸烟的年龄大大提前 ,1 996年全国吸烟行为流行病学…