The Hidden Work of Exiting Homelessness: Challenges of Housing Service Use and Strategies of Service Recipients

This study explored the experiences of parents attempting to re-attain housing after a shelter stay. 

Eighty parents participated in semistructured face-to-face interviews approximately six months after being recruited from shelters in four states across the U.S. Qualitative analyses identified common challenges of service use, strategies of service recipients, and characteristics of positive and negative service experiences.

Challenges of service use included "catch-22s" resulting from incongruity between service policies/procedures and participants' contexts and/or requirements of other services, confusion and uncertainty resulting from absent or insufficient communication about services, and long waitlists. 

Participants demonstrated persistence and determination, networked with service providers, and activated formal resources. Positive service experiences were tailored to families' needs and marked by clear and consistent communication between providers and with service recipients. 

Findings suggest effective health communication tactics should be applied to housing services. Providers should collaborate to ensure service attainment does not impede other pathways to stability.

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By:  Mayberry LS1.

• 1Division of General Internal Medicine & Public Health, Vanderbilt University Medical Center Nashville, TN. 
• J Community Psychol. 2016 Apr 1;44(3):293-310. Epub 2016 Mar 9.

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Public Housing Relocations and Partnership Dynamics in Areas with High Prevalences of Sexually Transmitted Infections

BACKGROUND:

We investigated the implications of one structural intervention-public housing relocations-for partnership dynamics among individuals living areas with high sexually transmitted infection (STI) prevalence. High-prevalence areas fuel STI endemicity and are perpetuated by spatially assortative partnerships.

METHODS:

We analyzed 7 waves of data from a cohort of black adults (n = 172) relocating from 7 public housing complexes in Atlanta, Georgia. At each wave, data on whether participants' sexual partners lived in the neighborhood were gathered via survey. Participant addresses were geocoded to census tracts, and measures of tract-level STI prevalence, socioeconomic conditions, and other attributes were created for each wave. "High-prevalence tracts" were tracts in the highest quartile of STI prevalence in Georgia. Descriptive statistics and hierarchical generalized linear models examined trajectories of spatially assortative partnerships and identified predictors of assortativity among participants in high-prevalence tracts.

RESULTS:

All 7 tracts containing public housing complexes at baseline were high-prevalence tracts; most participants relocated to high-prevalence tracts. Spatially assortative partnerships had a U-shaped distribution: the mean percent of partners living in participants' neighborhoods at baseline was 54%; this mean declined to 28% at wave 2 and was 45% at wave 7. Participants who experienced greater postrelocation improvements in tract-level socioeconomic conditions had a lower odds of having spatially assortative partnerships (adjusted odds ratio, 1.55; 95% confidence interval [95% CI], 1.06-2.26).

CONCLUSIONS:

Public housing relocation initiatives may disrupt high-prevalence areas if residents experience significant postrelocation gains in tract-level socioeconomic conditions.

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By:  Cooper HL1, Bonney L, Luo R, Haley DF, Linton S, Hunter-Jones J, Ross Z, Wingood GM, Adimora AA, Rothenberg R.

• 1From the *Department of Behavioral Sciences and Health Education, Rollins School of Public Health at Emory University, Atlanta, GA; †Division of General Medicine, Emory University School of Medicine, Atlanta, GA; ‡Institute of Public Health at Georgia State University, Atlanta, GA; §ZevRoss Spatial Analysis, Ithaca, New York; 
• Department of Sociomedical Sciences, Columbia University School of Public Health, New York, NY; and ∥University of North Carolina Schools of Medicine and Gillings School of Global Public Health, Chapel Hill, NC. 
• Sex Transm Dis. 2016 Apr;43(4):222-30. doi: 10.1097/OLQ.0000000000000419.

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High Tuberculosis Strain Diversity among New York City Public Housing Residents

OBJECTIVES:

We sought to better understand tuberculosis (TB) epidemiology among New York City Housing Authority (NYCHA) residents, after a recent TB investigation identified patients who had the same TB strain.

METHODS:

The study population included all New York City patients with TB confirmed during 2001 through 2009. Patient address at diagnosis determined NYCHA residence. We calculated TB incidence, reviewed TB strain data, and identified factors associated with TB clustering.

RESULTS:

During 2001 to 2009, of 8953 individuals in New York City with TB, 512 (6%) had a NYCHA address. Among the US-born, TB incidence among NYCHA residents (6.0/100 000 persons) was twice that among non-NYCHA residents (3.0/100 000 persons). Patients in NYCHA had high TB strain diversity. US birth, younger age, and substance use were associated with TB clustering among NYCHA individuals with TB.

CONCLUSIONS:

High TB strain diversity among residents of NYCHA with TB does not suggest transmission among residents. These findings illustrate that NYCHA's higher TB incidence is likely attributable to its higher concentration of individuals with known TB risk factors.

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By:  Dawson P1, Perri BR1, Ahuja SD1.

• 1All authors are with the New York City Department of Health and Mental Hygiene Bureau of Tuberculosis Control, Queens, NY. Patrick Dawson is also with Columbia University Mailman School of Public Health Department of Epidemiology, New York, NY. 
• Am J Public Health. 2016 Mar;106(3):563-8. doi: 10.2105/AJPH.2015.302910. Epub 2015 Dec 21.

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Willingness of Housing First Participants to Consider Supported-Employment Services

OBJECTIVE:

People who had a recent history of homelessness and had mental illness were studied to determine how many wished to be employed and were willing to accept supported-employment services and the factors associated with a decision to decline services.

METHODS:

People (N=194) with mental illness receiving Housing First were assessed at three-month intervals over 24 months. Analyses determined variables that were associated with accepting or declining randomization to supported-employment services. A regression model was used to determine the odds of obtaining employment.

RESULTS:

Of the 133 (69%) participants who wanted work, 75 (56%) accepted and 58 (44%) declined randomization to services. Those who declined had lower odds of obtaining employment (OR=.42, p=.022), less education, and fewer arrests and had spent less time homeless.

CONCLUSIONS:

People with a recent history of homelessness who have a mental illness want work. People who declined randomization to supported-employment services had fewer barriers to employment but had reduced odds of obtaining employment.

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By:   Poremski D1, Hwang SW1.

• 1The authors are with the Centre for Research on Inner City Health, St. Michael's Hospital, Toronto, Ontario, Canada (e-mail: daniel.poremski@mail.mcgill.ca ). Dr. Poremski is also with the Department of Psychiatry, Douglas Mental Health University Institute, Montreal, Quebec, Canada. Dr. Hwang is also with the Department of Medicine, University of Toronto, Toronto, Ontario. 
• Psychiatr Serv. 2016 Jan 4:appips201500140

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Correlates of the Sex Trade among African–American Youth Living in Urban Public Housing: Assessing the Role of Parental Incarceration and Parental Substance Use

African–American youth are disproportionately affected by parental incarceration and the consequences of parental substance use. Many adapt to the loss of their parents to prison or drug addiction by engaging in sex-risk behavior, particularly the sex trade. These youth may engage in this risky behavior for a number of reasons. Although previous research has examined this issue, most of these studies have focused on runaway or street youth or youth in international settings. Empirical evidence on correlates of trading sex for money among urban African–American youth is practically missing. Using a sample of 192 African–American youth living in urban public housing, this paper attempts to rectify this gap in knowledge by assessing how individual and parental factors are related to the likelihood of a youth trading sex for money. The sample for this study reported a mean age of 19; 28 % reported having traded sex for money; 30 % had a father currently in prison; and 7 % reported having a mother currently in prison. Maternal incarceration and paternal substance use were associated with a higher likelihood of trading sex for money. Given the potential health risks associated with trading sex for money, understanding correlates of this behavior has important implications for the health of this vulnerable population of youth and urban health in general...

The study provides partial support for hypothesized relationship. Unlike previous research, individual level factors, age and gender, were not related to the dependent variable.^13–15 The fact that individual (i.e., age and gender) differences were not detected is an important finding, however. This unique none significant findings could be explained by males experiencing significantly more maternal alcohol and drug problems and also more maternal incarceration. Given the central role of maternal hardships in exchanging sex for money, this noted disparity in maternal hardship could have nullified gender differences that have been reported in other explorations. Conversely, in line with observations made in previous research (see²⁶), a youth’s behavior, e.g., ever tried alcohol was related to the likelihood of trading sex for money.^15,26 Having ever tried marijuana, in this sample, was not associated with the likelihood of having traded sex for money. Furthermore, mother’s presence in the home was inversely related to the likelihood of having had sex for money while father’s presence in the home had no significant effect on the behavior. It could be that for youth in compromised environments, a mother presence serves as a stabilizing factor, curbing involvement in health risk behavior. This observation is, in fact, in line with the premises of Family Stress Theory.⁴⁰ The same rationale could help explain the effect of mother’s current incarceration on the likelihood of trading in sex.

With respect to maternal alcohol problems, this behavior was not related to trading sex in sex. Conversely, father’s alcohol problem was related to having had sex for money. It could be that for youth in challenging environment, such as public housing, a mother’s alcohol problems may be seen as part of the daily routine, and hence may have little/no effect on functioning. A father’s alcohol problems, on the other hand, may be connected to other predicaments including marital discord and domestic violence, disrupting the home environment. Both maternal and paternal drug use were associated with a lower likelihood of having had sex for money. This observation is counterintuitive. Indeed, existing evidence suggests that substance use has potential to compromise a parent’s ability/capacity to supervise and support offspring, or to maintain a good home environment.⁴² The expectation, therefore, is that parental drug use would lead to a higher likelihood of trading in sex. Conversely, a youth adjusting to life in a challenging environment may assume roles parents are incapable of playing—adultification. Adultification may serve as a protective factor...⁴³

Table 3

Binary logistic regression—criterion: sex for money (n = 186)

	B	Wald	OR	p value
Demographic
Age	−.083	1.36	.920	.242
Gendera	−.617	1.49	.539	.221
Mother currently live in home	−.966	4.10	.381	.043
Father currently live in home	−.800	2.83	.449	.092
Individual factors
Have tried alcohol	1.63	6.66	5.14	.010
Have tried marijuana	.403	.532	1.49	.466
Family factors
Father has drug problem	−2.27	12.49	.103	.000
Father has alcohol problem	2.33	10.28	10.28	.001
Father currently incarcerated	.155	.091	1.16	.764
Mother has drug problem	−1.22	3.88	.292	.049
Mother has alcohol problem	−.508	.520	.603	.471
Mother currently incarcerated	2.32	4.68	10.21	.031
Chi-square (df)	58.37 (12)
−2 Log likelihood	162.058
Nagelkerke pseudo R 2	.388
Overall percentage correctly classified	83.3

aFemale reference group

  

Full article at: http://goo.gl/7DSzfe

By: Von Nebbitt, Taqi M. Tirmazi, Margaret Lombe, Qiana Cryer-Coupet, and Shelby French

University of Illinois at Chicago, Chicago, IL USA

Morgan State University, Baltimore, MD USA

Boston College, Boston, MA USA

The International Organization for Adolescents, Chicago, IL USA

Von Nebbitt, Email: ude.ciu@ttibbenv.

Corresponding author.

   

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