This is the protocol for an updated Campbell systematic review. The objectives are as follows: To evaluate the effect of behavioral interventions on smoking cessation among homeless individuals.

There are growing concerns about the homeless and mental health issues globally. This study aims to examine the mental health situation of homelessness and the determinants of anxiety and depression of them in Hong Kong.
The data from the largest territory-wide study of the homeless population in 2021 was analyzed. Descriptive statistics and logistic regressions were used to investigate the association between mental health and socioeconomic variables, including demographic background, economic indicators, COVID-19 worries, government measures, and respect by others. The symptoms of depression and anxiety were assessed using Patient Health Questionnaire (PHQ) and General Anxiety Disorder (GAD).
The results showed that being female, food insecurity, and chronic diseases were the risk factors for anxiety and depression. A high level of respect by others was the protective factor for depression (adjusted OR 0.37, 95% CI [0.23, 0.61]) and anxiety (adjusted OR 0.40, 95% CI [0.24, 0.68]), compared to a low level of respect in the multivariate model.
Providing medical outreach services, additional resources for social services, implementation of homeless-friendly policies, and a progressive supply of public and transitional housing would help enhance the well-being of the homeless population.

This study aimed to describe the sociodemographic characteristics, social support received, and quality of life of chronically homeless patients with schizophrenia in China. A self-prepared sociodemographic questionnaire, the Social Support Rating Scale (SSRS), European Five-dimensional Health Scale (EQ-5D), and Eysenck Personality were administrated to 3,967 chronically homeless and 3,724 non-homeless patients from the Department of Xiangtan Fifth People\'s Hospital, Hunan, China, between April 2011 and October 2016. Results indicated that the homeless patients were more likely to live outside the city and be ethnic minorities compared with non-homeless patients. Although the married proportion was higher among homeless patients, they had a higher rate of being divorced or widowed. Notably, the homeless patients had higher employment rates before illness, despite significantly lower education (P < 0.001). Chronically homeless patients with schizophrenia showed a lower score in the SSRS (30.29 ± 7.34 vs. 26.16 ± 10.04, p < 0.001); they had significantly lower objective support, subject support, social support, and EQ-Visual Analog Scale, Eysenck Personality Questionnaire-Psychoticism, and Eysenck Personality-Neuroticism scores (p < 0.001). Homeless patients may be worse off, and could be assisted by providing accommodation, family intervention, medical services (such as pain medication), and other comprehensive measures.

BACKGROUND: Homelessness is associated with an increased risk of cardiometabolic morbidities. However, few studies have been performed to evaluate the racial differences on these morbidities commonly seen in the homeless.
METHODS: A retrospective chart review was conducted to examine the racial differences in the prevalence of cardiometabolic morbidities among the homeless men served at a local health care screening clinic. Medical information was extracted and collated into a single Excel spreadsheet. Racial differences in cardiometabolic morbidities were evaluated using multivariable binary or ordinal logistic regression analyses, adjusting for age, body mass index, and smoking status.
RESULTS: Of the 551 homeless men, 377 (68.4%) were Black, and 174 (31.6%) were White. The mean age (47.8±11.9 years) of Black homeless men was significantly older than that (45.4±13.0 years) of White homeless men (p=0.03). Blacks were 2.7 (95% CI = 1.75, 4.16) times more likely to be in the less desirable HbA1c categories than Whites. By contrast, Blacks were less likely to have non-desirable lipid profile than Whites. Blacks were 0.42 (95% CI = 0.29, 0.62) times and 0.51 (95% CI = 0.28, 0.94) times likely to be in the non-desirable high-density lipoprotein (HDL) and low-density lipoprotein (LDL) categories than Whites, respectively.
CONCLUSIONS: Black homeless men are more likely to have pre-diabetes or diabetes than White counterparts. On the other hand, Black homeless men have better lipid profiles of HDL or LDL than their White counterparts. Our findings reveal the health challenges of the homeless men and can provide guidance on policy changes related to diet and nutrition of meal programs provided by homeless shelters and congregate meal program to address the health disparities by race in this population.

BACKGROUND: Cardiovascular diseases are increasingly important in China, but the prevalence of risk factors for cardiovascular diseases in the indigent mentally ill are unknown.
OBJECTIVE: Assess the prevalence of four key risk factors for cardiovascular disease -- hypertension, hyperglycemia, hyperlipidemia and smoking - among homeless patients with schizophrenia and identify factors associated with the presence of these risk factors.
METHODS: We reviewed medical charts of 181 homeless and 181 non-homeless patients with schizophrenia or schizophreniform disorder admitted to the Shanghai Jiading Mental Health Center between May 2007 and April 2013. Demographic characteristics and risk factors of cardiovascular events were compared between the two groups. Logistic regression models identified the factors that were associated with the presence of one or more of the four risk factors.
RESULTS: The prevalence of hypertension and hyperlipidemia were 19 to 20% in both males and females in the two groups; these rates are similar to those reported in the general population. The prevalence of hyperglycemia ranged from 11 to 15% among males and females in the two groups. Smoking was highly prevalent in male patients (82% in homeless males and 78% in non-homeless males) but, like in China generally, much less prevalent in female patients (7% in homeless females and 5% in non-homeless females). The logistic regression analysis found that male gender, older age, and urban (vs. rural) residence were independently associated with the presence of one or more of the four cardiovascular risk factors. Homelessness was not associated with the presence of cardiovascular risk factors.
CONCLUSIONS: This study is the first known report on cardiovascular risk factors among homeless mentally ill in China. The study did not assess several important factors (such as the type, dose and duration of use of antipsychotic medication) but it was, nevertheless, able to show that, unlike in high-income countries, homelessness is not related to elevated risk of cardiovascular disease in Chinese individuals with mental illnesses. Prospective studies with the growing number of homeless individuals in China will be needed to get a clearer picture of the best ways to provide them with the health care services they need.
心血管疾病在中国日益增长，但是贫困精神病患者心血管疾病的危险因素患病率尚不明确。
评估无家可归的精神分裂症患者中心血管疾病四个主要危险因素的患病率 - 高血压，高血糖，高血脂及吸烟 - 并确定与这些危险因素相关的因素。
我们回顾了从2007年5月到2013年4月期间，在上海嘉定精神卫生中心住院的精神分裂症以及分裂样精神病患者病历，包括181名无家可归的患者和181非无家可归的患者。比较了两组间人口学特征和心血管事件的危险因素。使用逻辑回归模型确定了与四个风险因素中一种或多种存在关联的因素。
两组患者的高血压和高血脂症的患病率范围为19%到20%（男性和女性的患病率范围相同）；这些比率和一般人群报道的相似。两组患者的高血糖患病率介于11%和15%之间（男性和女性的患病率范围相同）。在男性患者中吸烟是非常普遍的（无家可归男性吸烟率82%，非无家可归男性吸烟率78％），但是在中国女性患者吸烟远没有那么普遍（无家可归女性吸烟率7%，非无家可归女性吸烟率5%）。 Logistic回归分析发现，男性，年龄，城市（与农村相比）与四大心血管危险因素中的一种或多种独立相关。无家可归与心血管危险因素的患病率不相关。
本研究是对中国流浪精神病患者的心血管危险因素的第一个研究报告。这项研究有几个重要因素没有评估（如抗精神病药物的类型、剂量和使用时间），尽管如此，该研究还是能表明在中国，流浪与精神疾病患者心血管疾病风险增高无关，与高等收入国家不同。对于中国不断增多的流浪者而言，还需要进一步的前瞻性研究来探索他们所需的最佳医疗服务模式。