UNASSIGNED: Homelessness during pregnancy contributes to adverse pregnancy and infant outcomes from birth through early childhood. Washington, DC, a microcosm of structural inequities in the United States, has persistent racial disparities in perinatal outcomes and housing insecurity.
UNASSIGNED: Grounded in a reproductive justice framework, we explored the lived experience of navigating homelessness assistance while pregnant to inform recommendations for a collaborative policy and practice change effort. We conducted 20 individual interviews with DC residents who experienced homelessness during pregnancy. We analyzed the data using thematic analysis and an action-oriented approach.
UNASSIGNED: Our analysis resulted in three main recommendation areas for policy and practice change: (1) timely and meaningful access to safe and stable housing in pregnancy; (2) care coordination for services and referrals that support physical, mental, and social well-being; and (3) access to a living wage and affordable housing.
UNASSIGNED: Access to stable housing is critical to ensure that pregnant and parenting people can have and raise children in a safe and sustainable environment-key tenets of reproductive justice. Housing support must be meaningfully accessible, including service delivery that accommodates the complex social histories and competing demands that accompany housing insecurity.
UNASSIGNED: This study informed the development of strategic recommendations, catalyzed a new model for multisector collaboration, and influenced a system-wide practice change to expand access to robust housing supports for pregnant people. Policy and practice change require sustained leveraging of political will to promote economic justice and ensure that residents can achieve safe, sustainable, and affordable housing.

In recent decades, a growing proportion of college students have experienced financial stress, resulting in unmet essential needs including food insecurity, housing instability, lack of healthcare access, and inadequate mental health treatment. Given that urban-based public universities constitute a substantial proportion of the US college student population, understanding how unmet needs affect academic achievement in this population is crucial for developing strategies that alleviate college failure and dropout. We examined the cumulative impact of unmet essential needs (scored from 0 to 4) on indicators of college attrition (dropout, leave of absence, risk of academic probation). The sample comprised a college population-representative sample of 1833 students attending one of three urban public colleges in the Bronx, NY. Employing adjusted multinomial and binomial logistic regression models, we assessed how total unmet essential needs predict any indicator of college attrition. Each unit increase in unmet need increased the odds of having any attrition indicator by 29% (p < 0.01). Students with two unmet needs had 43% greater odds (p < 0.01), students with three unmet needs had 57% greater odds (p < 0.01), and students with four unmet needs had 82% greater odds (p < 0.01) of having any attrition indicator compared to those without unmet needs. Findings revealed a modest dose-response relationship between the number of unmet needs and the likelihood of experiencing indicators of attrition, suggesting a cumulative impact of unmet needs on students\' ability to persist to graduation. Designing interventions aimed at college students with multiple unmet essential needs, and addressing these needs holistically, may assist student retention and graduation.

One in three children in the United States is exposed to insecure housing conditions, including unaffordable, inconsistent, and unsafe housing. These exposures have detrimental impacts on youth mental health. Delineating the neurobehavioral pathways linking exposure to housing insecurity with children\'s mental health has the potential to inform interventions and policy. However, in approaching this work, carefully considering the lived experiences of youth and families is essential to translating scientific discovery to improve health outcomes in an equitable and representative way. In the current paper, we provide an introduction to the range of stressful experiences that children may face when exposed to insecure housing conditions. Next, we highlight findings from the early-life stress literature regarding the potential neurobehavioral consequences of insecure housing, focusing on how unpredictability is associated with the neural circuitry supporting cognitive and emotional development. We then delineate how community-engaged research (CEnR) approaches have been leveraged to understand the effects of housing insecurity on mental health, and we propose future research directions that integrate developmental neuroscience research and CEnR approaches to maximize the impact of this work. We conclude by outlining practice and policy recommendations that aim to improve the mental health of children exposed to insecure housing.

This article examines the factors shaping longitudinal patterns of housing insecurity in the wake of the Great Recession, with a focus on whether housing assistance helped renters who received it. We use data from the first two waves (2009-10 and 2011) of the Michigan Recession and Recovery Study, a population-representative sample of working-aged adults from Southeast Michigan. We use detailed reports from renters and other non-homeowners to construct measures of instability and cost-related housing problems at both waves, and we compare the changes in these over follow-up between housing assistance recipients and their income-eligible but non-recipient counterparts. Our findings suggest that receiving housing assistance reduced the chance of experiencing housing insecurity problems over follow-up regardless of baseline housing insecurity.

Emerging evidence suggests that psychosocial stress ages the immune system. Accordingly, immune aging may be an important potential mechanism linking psychosocial stress to aging-related decline and disease. Incarceration and housing insecurity represent severe and complex experiences of a multitude of psychosocial stressors, including discrimination, violence, and poverty. In this study, we investigated the association between incarceration and/or housing insecurity and advanced immune age in adults aged 55 and older. Our sample was derived from the Health and Retirement Survey (HRS), with n = 7003 individuals with valid housing insecurity data and n = 7523 with valid incarceration data. From 2016 Venous Blood Study data, we assessed immune aging using a comprehensive set of immune markers including inflammatory markers (IL-6, CRP, s-TNFR1), markers of viral control (CMV IgG antibodies), and ratios of T cell phenotypes (CD8+:CD4+, CD+ Memory: Naïve, CD4+ Memory: Naïve, CD8+ Memory: Naïve ratios). We found that both incarceration and housing insecurity were strongly associated with more advanced immune aging as indicated by increased inflammation, reduced viral control, and reduction in naïve T cells relative to memory T cells. Given that those who experienced incarceration, housing insecurity, and/or are racialized minorities were less likely to be included in this study, our results likely underestimated these associations. Despite these limitations, our study provided strong evidence that experiencing incarceration and/or housing insecurity may accelerate the aging of the immune system.

BACKGROUND: Unhoused patients face significant barriers to receiving health care in both the inpatient and outpatient settings. For unhoused patients with heart failure who are in extremis, there is a lack of data regarding in-hospital outcomes and resource utilization in the setting of cardiogenic shock (CS).
OBJECTIVE: Unhoused patients hospitalized with CS have increased mortality and decreased use of invasive therapies as compared to housed patients.
METHODS: The National Inpatient Sample (NIS) database was queried from 2011 to 2019 for relevant ICD-9 and ICD-10 codes to identify unhoused patients with an admission diagnosis of CS. Baseline characteristics and in-hospital outcomes between patients were compared. Binary logistic regression was used to adjust outcomes for prespecified and significantly different baseline characteristics (p < .05).
RESULTS: We identified a weighted sample of 1 202 583 adult CS hospitalizations, of whom 4510 were unhoused (0.38%). There was no significant difference in the comorbidity adjusted odds of mortality between groups. Unhoused patients had lower odds of receiving mechanical circulatory support, left heart catheterization, percutaneous coronary intervention, or pulmonary artery catheterization. Unhoused patients had higher adjusted odds of infectious complications, undergoing intubation, or requiring restraints.
CONCLUSIONS: These data suggest that, despite having fewer traditional comorbidities, unhoused patients have similar mortality and less access to more aggressive care than housed patients. Unhoused patients may experience under-diuresis, or more conservative care strategies, as evidenced by the higher intubation rate in this population. Further studies are needed to elucidate long-term outcomes and investigate systemic methods to ameliorate barriers to care in unhoused populations.

UNASSIGNED: To assess the association of Long COVID with housing insecurity in the United States.
UNASSIGNED: To compare the prevalence of 3 binary indicators of housing insecurity between people with Long COVID (symptoms >3 months) and COVID-19 survivors who did not report long-term symptoms, we used survey-weighted regression models on 206,969 responses from the Household Pulse Survey, a representative cross-sectional survey of US households collected September 2022-April 2023. Among people with Long COVID, we additionally assessed whether functional impairment, current COVID-19 related symptoms, and symptom impact on day-to-day life were associated with a higher prevalence of housing insecurity.
UNASSIGNED: During the study period, 56,353 respondents with prior COVID-19 experienced symptoms lasting 3 months or longer (27%), representing an estimated 28 million US adults. After adjusting for demographic factors, people with Long COVID were 1.5-2 times as likely to experience significant difficulty with household expenses (Prevalence ratio [PR] 1.48, 95% CI 1.42-1.55), be behind on housing payments (PR 1.48, 95% CI 1.36-1.60), and face likely eviction or foreclosure (PR 1.86, 95% CI 1.58-2.18). The risk of housing insecurity was highest among low-income adults with Long COVID. Among people with Long COVID, functional limitation and current symptoms which impact day-to-day life were associated with higher prevalence of housing insecurity.
UNASSIGNED: Compared with COVID-19 survivors who do not experience long-term symptoms, people with Long COVID are more likely to report indicators of housing insecurity, particularly those of lower socio-economic status, and those with functional limitations or long-term COVID-19 related symptoms impacting day-to-day life. Policies are needed to support people living with chronic illnesses following SARS-CoV-2 infection.

UNASSIGNED: The novel coronavirus 2019 (COVID-19) pandemic impacted everyday life for most individuals, including students. Unique COVID-19 stressors among students may include virtual learning, mental stress, and being socially distanced from classmates. Studies examining the impact of COVID-19 on stress and lifestyle changes among pharmacy students are limited.
UNASSIGNED: The primary purpose of this study was to compare stress and food or housing insecurity changes associated with COVID-19 in U.S. Doctor of Pharmacy (PharmD) students pre-COVID vs. during-COVID.
UNASSIGNED: A 23-item survey was administered via Qualtrics® to multiple PharmD programs across the U.S. in pre-COVID-19 (spring 2019) and during-COVID-19 (spring 2021). Participants were recruited via e-mail. The survey included questions related to demographics, lifestyle (sleep, exercise, work hours, extracurricular activities), and food and housing insecurities. The survey also included a validated instrument to measure stress (Cohen-Perceived Stress Scale). Results from 2021 were compared to a similar national survey serendipitously administered prior to COVID-19 in Spring 2019.
UNASSIGNED: Pre- and COVID-19 analytical cohorts included 278 and 138 participants, respectively. While pre-COVID-19 students were slightly older (29.9 ± 4.7 vs. 27.7 ± 4.2, p ≤0.001), relative to COVID-19 students, other demographic factors were similar. No significant difference was observed in reported stress levels (PSS = 20.0 ± 6.3 vs. 19.7 ± 6.2, p = 0.610) between time periods. Significant differences in food (53.2% vs. 51.4%, p = 0.731) and housing (45.0% vs. 47.1%, p = 0.680) insecurity were also not seen.
UNASSIGNED: These findings highlight that PharmD students\' perceived stress and food and housing insecurities due to COVID-19 may have been minimal. Additional studies on pharmacy students should be conducted to validate these results. These results may help inform policymakers and stakeholders during the early stages of any future pandemics.

Austin, Texas emerged as one of the fastest-growing cities in the U.S. over the past decade. Urban transformation has exacerbated inequities and reduced ethnic/racial diversity among communities. This qualitative study focused on housing insecurity and other syndemic factors among Black and Latina cisgender women (BLCW). Data collection from 18 BLCW using in-depth interviews guided by syndemic theory was conducted three times over three months between 2018 and 2019. Four housing insecurity categories emerged: (a) very unstable, (b) unstable, (c) stable substandard, and (d) stable costly. Participants who experienced more stable housing, particularly more stable housing across interviews, reported fewer instances of intimate partner violence (IPV), less substance use, and a reduced risk of acquiring HIV. Results identified the importance of exploring housing insecurity with other syndemic factors among BLCW along with determining structural- and multi-level interventions to improve housing circumstances and other syndemic factors. Future research should explore these factors in other geographic locations, among other intersectional communities, and among larger sample sizes and consider using a mixed methods approach.

Those experiencing houselessness rely on obtaining food from community organizers and donations. Simultaneously, the houseless face disproportionally high rates of medical conditions that may be affected by diet including diabetes, hypertension, and hyperlipidemia. There is limited literature on the resources and barriers of the houseless community regarding optimal nutrition from an actionable perspective. Further, less data is available on how street medicine organizations may best impact the nutrition of the unhoused they serve. Elucidating this information will inform how organizational efforts may best support the nutrition of the houseless community.
In partnership with the medical student-run organization, Chicago Street Medicine, at Northwestern University Feinberg School of Medicine, twenty adults experiencing houselessness in Chicago, Illinois participated in the cross-sectional study. A 10-item survey was verbally administered to characterize the participants\' daily food intake, food sources, barriers, resources, and nutritional preferences and needs. All data was directly transcribed into REDCap. Descriptive statistics were generated.
Individuals consumed a median of 2 snacks and meals per day (IQR: 1-3). No participant consumed adequate servings of every food group, with only one participant meeting the dietary intake requirements for one food group. Participants most often received their food from donations (n = 15), purchasing themselves (n = 11), food pantries (n = 4), and shelters (n = 3). Eleven of nineteen participants endorsed dental concerns as a major barrier to consuming certain foods. Twelve participants had access to a can opener and twelve could heat their meals on a stove or microwave. Seven had access to kitchen facilities where they may prepare a meal. Approximately half of participants had been counseled by a physician to maintain a particular diet, with most related to reducing sugar intake.
Most houseless participants were unable to acquire a balanced diet and often relied on organizational efforts to eat. Organizations should consider the chronic health conditions, dentition needs, and physical resources and barriers to optimal nutrition when obtaining food to distribute to the unhoused.