housing instability

住房不稳定
  • 文章类型: Journal Article
    由于生活安排,无家可归(YEH)以及性和性别少数群体(SGM)YEH的青年患传染病的风险可能会增加,风险行为,以及与无家可归的青年和老年人不同的医疗保健障碍。为了更好地了解YEH人群中的传染病,我们综合了2012年至2020年间发表的12篇同行评审文章的结果,这些文章列举了美国或加拿大各地的YEH或SGMYEH传染病负担.研究中出现的病原体仅限于性传播感染(STIs)和血源性感染(BBI)。只有三项研究列举了SGMYEH中的传染病。缺乏按住房状况划分的比较数据(例如。,庇护青年与不庇护青年),SGM身份,或确定的研究中的其他相关反事实群体。我们还介绍了三个公开可用的,来自美国或加拿大的国家级监测数据集,用于量化某些性传播感染,BBIs,YEH中的结核病,可用于未来的疾病负担评估。我们的审查呼吁更全面的以YEH为中心的研究,包括多模式数据收集和及时的疾病监测,以改善这一弱势群体中传染病的估计。
    Youth experiencing homelessness (YEH) and sexual and gender minority (SGM) YEH may be at increased risk for infectious diseases due to living arrangements, risk behaviors, and barriers to healthcare access that are dissimilar to those of housed youth and older adults experiencing homelessness. To better understand infectious diseases among YEH populations, we synthesized findings from 12 peer-reviewed articles published between 2012 to 2020 which enumerated YEH or SGM YEH infectious disease burden in locations across the U.S. or Canada. Pathogens presented in the studies were limited to sexually transmitted infections (STIs) and bloodborne infections (BBI). Only three studies enumerated infectious diseases among SGM YEH. There was a dearth of comparison data by housing status (ex., sheltered versus unsheltered youth), SGM identity, or other relevant counterfactual groups in the identified studies. We also introduce three publicly available, national-level surveillance datasets from the U.S. or Canada that quantify certain STIs, BBIs, and tuberculosis among YEH, which may be used for future disease burden assessments. Our review calls for more comprehensive YEH-centered research that includes multimodal data collection and timely disease surveillance to improve estimates of infectious diseases among this vulnerable population.
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  • 文章类型: Journal Article
    背景:围产期心理健康与2019年冠状病毒病(COVID-19)大流行之间的交集仍然具有重要的公共卫生重要性。当前的研究调查了COVID-19大流行期间孕妇的情绪和财务状况以及抑郁症状升高的预测因素。
    方法:这项在线调查是对2118名在调查时怀孕并居住在美国或波多黎各的18岁以上女性进行的。使用流行病学研究中心抑郁量表评估抑郁症状,得分≥10表示抑郁症状升高。最终的逻辑回归模型包括住房不安全,财务困境,COVID-19诊断,暴露于COVID-19和人口统计学协变量。
    结果:超过一半的样本(53.8%)有抑郁症状升高。在逻辑回归分析中,对于报告住房不安全的参与者,抑郁症状升高的几率显著更高(调整后的优势比[AOR],1.56;95%CI,1.22-2.01),财务困境(AOR,1.57;95%CI,1.17-2.12),COVID-19诊断(aOR,2.53;95%CI,1.53-4.17),和COVID-19暴露(AOR,1.41;95%CI,1.07-1.86),在调整协变量后。在经历过COVID-19的人群中,抑郁症状升高与住房不安全的关联特别强(aOR,6.04;95%CI,2.15-17.0)。
    结论:我们的发现与以前的文献一致,暴露,关心家庭,对金融稳定的影响与大流行期间的抑郁症状有关。金融和住房问题与抑郁症状升高之间的关系,独立于对家庭成员感染的担忧,这表明大流行可能对心理健康产生直接和间接影响。
    BACKGROUND: The intersection between perinatal mental health and the coronavirus disease 2019 (COVID-19) pandemic remains of significant public health importance. The current study examined the emotional and financial well-being and predictors of elevated depressive symptoms among pregnant women during the COVID-19 pandemic.
    METHODS: This online survey was conducted with 2118 women ≥18 years old who were pregnant at the time of the survey and living in the United States or Puerto Rico. Depressive symptoms were assessed with the Center for Epidemiologic Studies Depression Scale, with scores ≥10 indicative of elevated depressive symptoms. The final logistic regression model included housing insecurity, financial distress, COVID-19 diagnosis, exposure to COVID-19, and demographic covariates.
    RESULTS: More than half the sample (53.8%) had elevated depressive symptoms. In logistic regression analyses, the odds of having elevated depressive symptoms were significantly higher for participants reporting housing insecurity (adjusted odds ratio [aOR], 1.56; 95% CI, 1.22-2.01), financial distress (aOR, 1.57; 95% CI, 1.17-2.12), COVID-19 diagnosis (aOR, 2.53; 95% CI, 1.53-4.17), and COVID-19 exposure (aOR, 1.41; 95% CI, 1.07-1.86), after adjusting for covariates. The association of elevated depressive symptoms with housing insecurity was especially strong among those who experienced COVID-19 (aOR, 6.04; 95% CI, 2.15-17.0).
    CONCLUSIONS: Our findings are consistent with previous literature revealing that diagnosis, exposure, concerns about family, and effects on financial stability were related to depressive symptoms during the pandemic. The relationships between financial and housing concerns with elevated depressive symptoms, independent of concerns about infection in family members, suggest that there may be direct and indirect effects of the pandemic on mental health.
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  • 文章类型: Journal Article
    尽管人们越来越重视审查影响住房不稳定和无家可归的因素的重要性,该领域缺乏经过验证的住房不稳定量表。当前的研究检查了衡量住房不稳定性的七个项目量表的信度和效度。数据来自一项更大的研究,该研究在太平洋西北地区的五个家庭暴力机构中实施了家庭暴力住房优先模型。在两年的时间里,每六个月共采访406名参与者。西班牙语版本的比额表适用于讲西班牙语的参与者。结果概述了量表的心理功能,并支持其在评估住房不稳定和无家可归方面的效用。具体来说,该量表显示了并发和预测有效性,并显示了随着时间的推移以及跨语言和局部性的标量等价的证据。因此,目前的量表是住房不稳定的简洁和心理上合理的衡量标准,可用于跟踪英语和西班牙语使用者的住房不稳定,以及在城市和农村环境中。
    Despite increasing attention to the importance of examining factors that impact housing instability and homelessness, the field lacks a validated scale of housing instability. The current study examined the reliability and validity of a seven-item scale that measures housing instability. Data were taken from a larger study which implemented the Domestic Violence Housing First model across five domestic violence agencies in the Pacific Northwest. A total of 406 participants were interviewed every six months over a period of two years. A Spanish version of the scale was administered to Spanish-speaking participants. Results provide an overview of the psychometric functioning of the scale and support its utility in assessing housing instability and homelessness. Specifically, the scale demonstrated concurrent and predictive validity, and showed evidence of scalar equivalence over time and across both language and locality. The current scale is therefore a succinct and psychometrically sound measure of housing instability which can be used moving forward to track housing instability in English and Spanish speakers, as well as in urban and rural settings.
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  • 文章类型: Journal Article
    目的:了解现有的护理实践和政策,和潜在的增强,提高美国退伍军人事务部(VA)退伍军人家庭支持服务(SSVF)医疗保健导航器(HCN)的有效性,将农村地区住房不稳定的退伍军人与医疗保健服务联系起来。
    方法:我们使用了2022年春季在美国农村地区服务的HCN(n=21)的半结构化访谈中收集的主要数据。
    方法:我们将2009年实施研究综合框架(CFIR)和社会生态模型(SEM)应用于定性数据的收集和分析,以了解HCN如何在SSVF和更大的社区中管理服务。
    方法:我们使用快速定性方法来总结和分析数据。模板矩阵摘要确定了将退伍军人与医疗保健服务以及政策和实践含义联系起来的促进者和障碍。
    结果:使用CFIR2009,我们确定了影响在SSVF中成功实施HCN服务的上下文因素;我们提供了CFIR2009和2022年更新的版本之间的人行横道。SEM内部的框架促进者和障碍提供了有关是否应在社区解决实施策略的见解,人际关系,或SEM内的内部水平。调解人包括足够的知识,培训,以及HCN的指导机会,以及他们在组织内以及与其他社区组织合作的能力。障碍包括缺乏当地技术和住房资源,对退伍军人的服务资格和获得这些服务的途径了解不足,与退伍军人管理局的合作不足。
    结论:了解HCN在将农村地区居住不稳定的退伍军人与医疗保健服务联系起来时遇到的促进因素和障碍可以为未来的策略提供信息,包括政策变化,例如增加培训以支持HCN对资格的理解,好处,和权利,以及改善VA和社区合作伙伴之间的沟通和合作。
    OBJECTIVE: To understand existing care practices and policies, and potential enhancements, to improve the effectiveness of the US Department of Veterans Affairs (VA) Supportive Services for Veteran Families (SSVF) Health Care Navigators (HCN) in linking Veterans experiencing housing instability in rural areas with health care services.
    METHODS: We used primary data collected during semistructured interviews with HCNs (n = 21) serving rural areas across the United States during Spring 2022.
    METHODS: We applied the Consolidated Framework for Implementation Research (CFIR) 2009 and the Social Ecological Model (SEM) to the collection and analysis of qualitative data to understand how HCNs administer services within SSVF and the larger community.
    METHODS: We used rapid qualitative methods to summarize and analyze data. Templated matrix summaries identified facilitators and barriers to linking Veterans with health care services and policy and practice implications.
    RESULTS: Using CFIR 2009, we identified contextual factors affecting successful implementation of HCN services within SSVF; we offer a crosswalk between CFIR 2009 and the version updated in 2022. Framing facilitators and barriers within the SEM provided insight into whether implementation strategies should be addressed at a community, interpersonal, or intrapersonal level within the SEM. Facilitators included sufficient knowledge, training, and mentorship opportunities for HCNs and their capacity to collaborate within their organization and with other community-based organizations. Barriers included lack of local technology and housing resources, inadequate understanding of Veterans\' service eligibilities and pathways to access those services, and deficient collaboration with the VA.
    CONCLUSIONS: Understanding facilitators and barriers experienced by HCN when linking unstably housed Veterans in rural areas with health care services can inform future strategies, including policy changes such as increased training to support HCNs\' understanding of eligibility, benefits, and entitlements as well as improving communication and collaboration between VA and community partners.
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  • 文章类型: Case Reports
    每一年,在美国,估计有4,200,000名13至25岁的无人陪伴的年轻人无家可归。年轻人在住房危机中面临的威胁很多,以及它们的潜在影响,令人痛心.青少年身体和性受害的风险很高,精神和身体疾病,参与刑事法律制度,教育面临严重威胁,他们未来的经济稳定,和他们的生活。尽管有这些危险的后果,美国对这一问题的反应仍然缺乏紧迫性,有意义的投资,和经验支持。本文严格审查了当前在美国无家可归的情况下为青年提供服务的方法。直接了解年轻人的生活经历,它要求改变对问题的性质和范围的理解,因此,为解决这一问题而实施的做法和政策战略。具体来说,美国住房和城市发展部对无家可归的定义,以及进一步限制服务访问的相应程序,在呼吁改变路线以应对青年无家可归的情况下进行了审查。
    Each year, an estimated 4,200,000 unaccompanied youth ages 13 to 25 experience homelessness in the United States. The threats facing young people in housing crisis are many, and their potential impacts, harrowing. Youth are at high risk for physical and sexual victimization, mental and physical illness, and involvement with the criminal legal system and face serious threats to their education, their future economic stability, and their lives. Despite these dangerous consequences, the response to this issue in the United States continues to lack urgency, meaningful investment, and empirical support. This article critically examines the current approach to services for youth in situations of homelessness in the United States. Directly informed by the lived experiences of young people, it calls for a shift in understanding of the nature and scope of the problem and, consequently, the practice and policy strategies being implemented to address it. Specifically, the U.S. Department of Housing and Urban Development\'s definition of homelessness, along with corresponding procedures that further limit access to services, is examined in a call to change course in response to youth homelessness.
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  • 文章类型: Journal Article
    背景:酒精是美国发病率和死亡率的主要原因,居住不稳定的人不成比例地受到酒精相关的不良健康结果的影响。解决高强度酒精使用不稳定住房的人的需求(即,重度间歇性使用或暴饮暴食),包括那些目标不是禁欲的人,对减少这些人群的危害至关重要。这项研究探讨了酒精相关的治疗和支持需求不稳定的人谁使用酒精。
    方法:数据收集包括参与者观察和半结构化访谈(n=25),这些访谈对象居住不稳定且使用高强度酒精的人。数据进行了主题分析,关注结构性脆弱性和社会结构性力量,以塑造人们对酒精治疗的看法和经验。
    结果:参与者强调了住房不稳定对促使和维持大量饮酒的关键,经常使用酒精来管理与住房不稳定有关的压力和焦虑。虽然参与者经常参与酒精治疗计划,方案设计和访问障碍削弱了这些服务对参与者的有效性。参与者描述了需要在连续的护理中实施一系列计划和服务选项,以支持参与者满足他们的多样化需求和确定的酒精使用目标。
    结论:需要修改酒精治疗和支持,以便它们包括一系列减少伤害和禁欲的模式,以更好地满足人们的多样化需求。此外,治疗必须与永久性和负担得起的住房配对,以解决不稳定住房的人与酒精相关伤害的潜在驱动因素。
    BACKGROUND: Alcohol is a leading cause of morbidity and mortality in the United States and people who are unstably housed are disproportionately impacted by adverse alcohol-related health outcomes. Addressing the needs of unstably housed people with high-intensity alcohol use (i.e., heavy episodic use or binge drinking), including those whose goal is not abstinence, is critical to reducing harms among this population. This study explores the alcohol-related treatment and support needs among unstably housed people who use alcohol.
    METHODS: Data collection included participant observation and semi-structured interviews (n = 25) with unstably housed people with high-intensity alcohol use. Data were analysed thematically, with attention to structural vulnerability and social-structural forces at shaping perceptions of and experiences with alcohol treatment.
    RESULTS: Participants underscored how housing instability was critical in precipitating and maintaining heavy alcohol use, with alcohol often used to manage the stress and anxiety related to housing instability. While participants regularly engaged with alcohol treatment programs, program design and barriers to access undermined the effectiveness of these services for participants. Participants described the need for a range of program and service options across a continuum of care to be implemented to support participants in meeting their diverse needs and identified goals regarding alcohol use.
    CONCLUSIONS: Alcohol treatment and supports need to be modified so that they include a range of harm reduction and abstinence-based models to better meet people\'s diverse needs. Furthermore, treatment must be paired with permanent and affordable housing to address underlying drivers of alcohol-related harm for unstably housed people.
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  • 文章类型: Preprint
    背景。怀孕期间的粮食不安全与母亲及其新生儿的结局较差有关。鉴于美国持续的阿片类药物危机,在怀孕期间服用阿片类药物的母亲可能面临食物不安全的特别风险。方法。这项研究利用了254名婴儿生物母亲的数据,进行了阿片类药物暴露婴儿(OBOE)研究的新生儿阿片类药物戒断综合征(ACTNOW)结局的临床试验。我们研究了产前阿片类药物暴露婴儿的母亲及其未暴露(对照)的母亲与食物不安全相关的因素。卡方检验和逻辑回归用于通过社会人口统计学特征比较粮食不安全,阿片类药物的使用,以前的创伤经历,住房不稳定。进行了类似的分析,以检查怀孕期间粮食不安全与接受适当的产前护理之间的关系。结果。总的来说,58(23%)的母亲对粮食不安全进行了阳性筛查。在怀孕期间服用阿片类药物的母亲中,粮食不安全更为普遍(28%与14%;p=0.007),有公共保险(25%与8%;p=0.027),住房不稳定(28%与11%,p=0.002),在他们的童年经历了三次或更多的不良经历(37%vs.17%;p<0.001),并报告在怀孕期间遭受身体或情感虐待(44%vs.17%;p<0.001)。怀孕期间粮食不安全的母亲接受足够的产前护理的可能性较小(78%vs.90%;p=0.020)。在控制人口统计学特征后,这种差异仍然存在(AOR(95%CI)=0.39(0.16,1.00),p=0.049)。Conclusions.这项研究增加了大量证据,支持筛查和制定干预措施以解决怀孕期间的粮食不安全问题。特别是在产前阿片类药物暴露的婴儿的母亲中,可获得的数据有限。研究结果表明,粮食不安全经常与住房不稳定和先前的创伤同时发生,这表明需要结合创伤知情医疗保健原则的多方面干预。尽管粮食不安全的人怀孕结局差的风险增加,尽管研究参与者的公共保险覆盖率很高,但他们不太可能接受足够的产前护理,建议需要采取其他策略来解决该人群中的医疗保健障碍。试用登记。阿片类药物暴露婴儿(OBOE)研究的结果在临床试验(NCT04149509)(2019年4月11日)注册。
    UNASSIGNED: Food insecurity during pregnancy is associated with poorer outcomes for both mothers and their newborns. Given the ongoing opioid crisis in the United States, mothers who take opioids during pregnancy may be at particular risk of experiencing food insecurity.
    UNASSIGNED: This research utilized data from 254 biological mothers of infants in the Advancing Clinical Trials in Neonatal Opioid Withdrawal Syndrome (ACT NOW) Outcomes of Babies with Opioid Exposure (OBOE) Study. We examined factors associated with food insecurity among mothers of infants with antenatal opioid exposure and their unexposed (control) counterparts. Chi-square tests and logistic regression were used to compare food insecurity by sociodemographic characteristics, opioid use, prior traumatic experiences, and housing instability. Similar analyses were conducted to examine the relationship between food insecurity during pregnancy and receipt of adequate prenatal care.
    UNASSIGNED: Overall, 58 (23%) of the mothers screened positive for food insecurity. Food insecurity was more common among mothers who took opioids during pregnancy (28% vs. 14%; p =0.007), had public insurance (25% vs. 8%; p = 0.027), had housing instability (28% vs. 11%, p = 0.002), experienced three or more adverse experiences in their childhood (37% vs. 17%; p < 0.001), and reported physical or emotional abuse during their pregnancy (44% vs. 17%; p < 0.001). Mothers with food insecurity during pregnancy were less likely to have received adequate prenatal care (78% vs. 90%; p = 0.020). This difference remained after controlling for demographic characteristics (AOR (95% CI) = 0.39 (0.16, 1.00), p = 0.049).
    UNASSIGNED: This study adds to the body of evidence supporting the need for screening and development of interventions to address food insecurity during pregnancy, particularly among mothers of infants with antenatal opioid exposure, for which limited data are available. The findings revealed that food insecurity frequently co-occurs with housing instability and prior trauma, indicating that a multifaceted intervention incorporating principles of trauma-informed health care is needed. Although those with food insecurity are at increased risk for poor pregnancy outcomes, they were less likely to have received adequate prenatal care despite high levels of public insurance coverage among study participants, suggesting additional strategies are needed to address barriers to health care among this population.
    UNASSIGNED: The Outcomes of Babies with Opioid Exposure (OBOE) Study is registered at Clinical Trials.gov (NCT04149509) (04/11/2019).
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  • 文章类型: Journal Article
    人们越来越认识到心理健康的社会决定因素(SDoMHs)对人们的影响,或者有风险,发展严重的精神疾病。然而,尚不清楚单个SDoMHs与重度抑郁症(MDD)风险的关联如何变化,并大致相互比较。按照PRISMA准则,这篇综述包括26项荟萃分析和系统综述,报告了比值比,效果大小,和/或有与无指定SDoMHs的样本中MDD的合并患病率。童年的情感,物理,或性虐待和忽视;女性亲密伴侣暴力;粮食不安全与MDD风险增加显著相关,具有中等效果尺寸。自然灾害,恐怖主义行为,部署期间的军事战斗产生了小规模的不利影响,无家可归,监禁,迁移与MDD患病率显著升高相关。相反,较高水平的父母照护与中等效应大小的MDD风险降低显著相关.证据支持在个人和社区层面使用某些干预措施,可以减少这些因素的影响并促进健康,尽管在这一领域需要更多的研究以及有意义的医疗保健和社会政策来实现这一目标。
    There is a growing recognition of the impact of social determinants of mental health (SDoMHs) on people with, or at risk of, developing serious mental illnesses. Yet it is not known how associations of individual SDoMHs with risk for major depressive disorder (MDD) vary and roughly compare with one another. Following PRISMA guidelines, this umbrella review included 26 meta-analyses and systematic reviews that reported odds ratios, effect sizes, and/or pooled prevalence rates of MDD in samples with versus without specified SDoMHs. Childhood emotional, physical, or sexual abuse and neglect; intimate partner violence in females; and food insecurity were significantly associated with increased risk of MDD, with medium effect sizes. Natural disasters, terrorist acts, and military combat during deployment had small-size adverse effects, and homelessness, incarceration, and migration were associated with significantly elevated prevalence of MDD. Conversely, higher levels of parental care were significantly associated with reduced risk of MDD with medium effect sizes. Evidence supports the use of certain interventions at the individual and community level that can reduce the impact of these factors and promote health, although much more research is warranted in this area along with meaningful healthcare and societal policies to accomplish this goal.
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  • 文章类型: Journal Article
    在9/11后的美国退伍军人中,对食物和/或住房不稳定(FHI)的检查很少。从9/11后美国退伍军人人口中随机选择的具有全国代表性的男女退伍军人样本(n=38,633)被邮寄邀请函,以完成有关健康和福祉的调查。主成分分析和多变量逻辑回归被用来确定FHI的关键结构和相关关系15166名男性和女性受访者(9524名男性,5642名妇女)。三分之一的退伍军人报告了FHI;女性的可能性明显高于男性(粗比值比=1.31,95%CI:1.21-1.41)和最普遍的离职后(64.2%)。“心理健康/压力/创伤”,“身体健康”,和“物质使用”是FHI的主要结构。在两性中,FHI和无家可归者之间存在显著的调整相关性(p<0.01),抑郁症,不利的童年经历,社会支持低,入伍,未部署,与重病/残疾人一起生活,住在危险的街区.只有男人,创伤后应激障碍(调整比值比(AOR)=1.37,95%CI:1.14-1.64),胆固醇水平(升高与正常,AOR=0.79,95%CI:0.67-0.92),高血压(AOR=1.25,95%CI:1.07-1.47),非法/街头吸毒(AOR=1.28,95%CI:1.10-1.49)显着(p<0.01)。只有女性,病态肥胖(AOR=1.90,95CI:1.05-3.42)和糖尿病(AOR=1.53,95%CI:1.06-2.20)差异有统计学意义(p<0.05)。需要采取共同针对不良食品和住房的干预措施,特别是9/11后的退伍军人和入伍人员。
    Food and/or housing instability (FHI) has been minimally examined in post-9/11 US veterans. A randomly selected nationally representative sample of men and women veterans (n = 38,633) from the post-9/11 US veteran population were mailed invitation letters to complete a survey on health and well-being. Principal component analysis and multivariable logistic regression were used to identify FHI\'s key constructs and correlates for 15,166 men and women respondents (9524 men, 5642 women). One-third of veterans reported FHI; it was significantly more likely among women than men (crude odds ratio = 1.31, 95% CI:1.21-1.41) and most prevalent post-service (64.2%). \"Mental Health/Stress/Trauma\", \"Physical Health\", and \"Substance Use\" were FHI\'s major constructs. In both sexes, significant adjusted associations (p < 0.01) were found between FHI and homelessness, depression, adverse childhood experiences, low social support, being enlisted, being non-deployed, living with seriously ill/disabled person(s), and living in dangerous neighborhoods. In men only, posttraumatic stress disorder (adjusted odds ratio (AOR) = 1.37, 95% CI:1.14-1.64), cholesterol level (elevated versus normal, AOR = 0.79, 95% CI:0.67-0.92), hypertension (AOR = 1.25, 95% CI:1.07-1.47), and illegal/street drug use (AOR = 1.28, 95% CI:1.10-1.49) were significant (p < 0.01). In women only, morbid obesity (AOR = 1.90, 95%CI:1.05-3.42) and diabetes (AOR = 1.53, 95% CI:1.06-2.20) were significant (p < 0.05). Interventions are needed that jointly target adverse food and housing, especially for post-9/11 veteran women and enlisted personnel.
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  • 文章类型: Editorial
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