Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages

Housing instability has been shown to be related to poorer health outcomes in various studies, mainly in the USA and UK. Affected individuals are more prone to psychiatric (e.g., major depression, anxiety) and physical disorders (e.g., hypertension). This situation has deteriorated with the onset of the economic crisis. One of the most affected countries is Spain, which has high rates of foreclosure and eviction that continue to rise. In response, a civil movement, The Platform for People Affected by Mortgages (PAH), works to provide solutions to its members affected by foreclosure and advocates for the right to decent housing. 

The aims of this study ware to describe and compare the health status of PAH members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We conducted a cross-sectional study using a self-administered online questionnaire (2014) administered to 905 PAH members in Catalonia (>18 years; 559 women and 346 men). Results were compared with health indicators from The Health Survey of Catalonia 2013 (n = 4830). The dependent variables were poor mental health (GHQ 12 ≥ 3), and poor self-reported health (fair or poor). All analyses were stratified by sex. We computed age-standardized prevalence and prevalence ratios of poor mental and self-reported health in both samples. We also analyzed health outcomes among PAH members according to mortgage status (mortgage holders or guarantors), stage of foreclosure, and other socioeconomic variables by computing prevalence ratios from robust Poisson regression models. 

The prevalence of poor mental health among PAH members was 90.6 % in women and 84.4 % in men, and 15.5 and 10.2 % in the general population, respectively. The prevalence of poor self-reported health was 55.6 % in women and 39.4 % in men from the PAH, and 19.2 and 16.1 % in the general population, respectively. These health inequalities were independent of socioeconomic status. The prevalence of poor mental health was higher among individuals in the non-payment stage of foreclosure than among those who were up to date with their payments. 

In contrast, self-reported poor health was more prominent in later stages of foreclosure, such as in post-eviction without dation in payment stage in men. 

We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population. Public policies that tackle housing instability and its consequences are urgently needed in Spain.

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By:  Vásquez-Vera H1,2,3, Rodríguez-Sanz M1,2,4,5, Palència L2,4, Borrell C6,7,8,9,10.

• 1Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
• 2Agència de Salut Pública de Barcelona, Barcelona, Spain.
• 3Centro de Estudios para la Equidad en Salud, Universidad de La Frontera, Temuco, Chile.
• 4CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.
• 5Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain.
• 6Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. cborrell@aspb.cat.
• 7Agència de Salut Pública de Barcelona, Barcelona, Spain. cborrell@aspb.cat.
• 8CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain. cborrell@aspb.cat.
• 9Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. cborrell@aspb.cat.
• 10Agència de Salut Pública de Barcelona, Avinguda Lesseps 1, ES-08023, Barcelona, Spain. cborrell@aspb.cat. 
• J Urban Health. 2016 Mar 3.

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Eviction & Loss of Income Assistance among Street-Involved Youth in Canada

Loss of housing and income assistance among vulnerable youth has not been well described in the literature, yet it is a crucial issue for public health. 

This study examines the prevalence and correlates of loss of income assistance as well as eviction among street-involved youth. We collected data from a prospective cohort of street-involved youth aged 14-26. 

Among 770 participants, 64.3 per cent reported having housing and 77.1 per cent reported receiving income assistance at some point during the study period. Further, 28.6 and 20.0 per cent of youth reported having been evicted and losing income assistance, respectively. 

In multivariable generalized estimating equations analysis, heavy alcohol use, unprotected sex, being a victim of violence, and homelessness were all independently associated with eviction. 

Separately, homelessness, recent incarceration, and drug dealing were independently associated with loss of income assistance. 

Eviction and loss of income assistance are common experiences among street-involved youth with multiple vulnerabilities. Our findings highlight the importance of improving continued engagement with critical social services.

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By:  Zivanovic R1,2, Omura J2, Wood E2,3, Nguyen P2, Kerr T2,3, DeBeck K2,4.

• 1University of British Columbia's (UBC) MD program, Vancouver, Canada.
• 2Urban Health Research Initiative, BC Centre of Excellence in HIV/AIDS, St. Paul's Hospital, 613-1081 Burrard St., Vancouver, Canada V6Z 1Y6.
• 3Department of Medicine, University of British Columbia, Vancouver, Canada V5Z 1M9.
• 4School of Public Policy, Simon Fraser University, Vancouver, Canada V6B 5K3.
• J Public Health Policy. 2016 Mar 10. doi: 10.1057/jphp.2016.12. 

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Residential Eviction and Risk of Detectable Plasma HIV-1 RNA Viral Load among HIV-Positive People Who Use Drugs

We examined the relationship between residential eviction and exhibiting detectable plasma HIV-1 RNA viral load (VL) among a prospective cohort of antiretroviral therapy (ART)-exposed HIV-seropositive people who use illicit drugs (PWUD) in Vancouver, Canada. 

We used multivariable generalized estimating equations to estimate the effect of residential eviction on detectable VL and examine ART adherence as a mediating variable. 

Between June 2007 and May 2014, 705 ART-exposed participants were included in the study, among whom 500 (70.9 %) experienced at least one period of detectable VL. In a time-updated multivariable model, eviction independently increased the odds of detectable VL among those who were homeless as well as not homeless post eviction. The results of mediation analyses suggest that this association was mediated by incomplete ART adherence. 

These findings suggest the need for further development and evaluation of interventions to prevent evictions and promote ART adherence among PWUD facing eviction.

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By:  Kennedy MC^1,2, Kerr T^1,3, McNeil R¹, Parashar S¹, Montaner J^1,3, Wood E^1,3, Milloy MJ^4,5.

¹British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada.

²School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC, V6T 1Z9, Canada.

³Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada.

⁴British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, 608-1081 Burrard Street, Vancouver, BC, V6Z 1Y6, Canada. uhri-mjsm@cfenet.ubc.ca.

⁵Department of Medicine, University of British Columbia, 2775 Laurel Street, Vancouver, BC, V5Z 1M9, Canada. uhri-mjsm@cfenet.ubc.ca.

AIDS Behav. 2016 Feb 23.

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Pathways and Trajectories Linking Housing Instability and Poor Health among Low-Income Women Experiencing Intimate Partner Violence (IPV): Towards a Conceptual Framework

We used grounded theory to understand pathways and trajectories to housing instability (HI) and poor health among low-income women with experiences of intimate partner violence (IPV). We conducted in-depth interviews during 2010-11 with 41 women (ages 18-45 years) living in Ontario, Canada. 

All women reported depressive symptoms in combination with other health problems. In addition to the direct pathway of IPV to poor health, thematic analysis revealed an indirect multi-tiered pathway with complex trajectories among IPV, HI and poor health. These trajectories included material HI (homelessness, high mobility, evictions, problems paying rent, hiding and landlord discrimination), psychological HI (feeling unsafe, low self-esteem, and poor control) and social trajectories (financial problems, loss of employment, income or social networks and leaving school). 

These trajectories elevated stress and decreased self-care (unhealthy behaviors, substance abuse, and reduced medical compliance) and exacerbated poor health already compromised by IPV. Depending on her specific context, each woman experienced these pathways and trajectories differently. Moreover, the women's experiences differed across three time periods: before, immediately after, and long after leaving an abusive relationship. Finally, we found that for these women, achieving stable housing was crucial for stabilizing their health.

Via: http://ht.ly/SaGQS 

By: Daoud N1,2, Matheson FI1,3,4, Pedersen C1, Hamilton-Wright S1, Minh A1, Zhang J1, O'Campo P1,4.

• 1a Centre for Research on Inner City Health , The Keenan Research Centre in the Li Ka Shing Knowledge Institute, St. Michael's Hospital , Toronto , Ontario , Canada.
• 2b Department of Public Health, Faculty of Health Sciences , Ben-Gurion University , Beer Sheva , Israel.
• 3c Institute for Clinical Evaluative Sciences.
• 4d Dalla Lana School of Public Health , University of Toronto , Toronto , Ontario , Canada.