Search Results (85)

Background: Incarcerated men experience disproportionately high levels of health inequities shaped by social determinants, including poverty, violence, family adversity, trauma, and limited access to healthcare. These long-standing disadvantages, added to the adverse conditions experienced in prisons, may be associated with elevated rates of suicidality in this population. This study examined the prevalence of suicidal ideation and lifetime suicide attempts among men deprived of liberty in Southern Brazil and investigated the role of cumulative adversities and current protective factors in these outcomes. Methods: A cross-sectional study was conducted with 496 incarcerated men. Participants completed a sociodemographic and background questionnaire assessing lifetime adversity (e.g., hunger, homelessness, sexual abuse, domestic violence, family substance dependence) and current protective factors in prison (e.g., family visits, education, leisure, physical activity, religion, positive self-perception). Cumulative adversity and protective factors were operationalized as composite indices. Logistic regression models tested whether cumulative adversities and protective factors were independently associated with suicidal ideation and suicide attempts. Results: Lifetime prevalence was 9.6% for suicidal ideation and 10.8% for suicide attempts. Cumulative adversities were associated with higher odds of both suicidal ideation (OR = 1.43; 95% CI = 1.11–1.84; p = 0.006) and suicide attempts (OR = 1.94; 95% CI = 1.50–2.52; p < 0.001). Protective factors were associated with lower likelihood of suicidal ideation (OR = 0.74; 95% CI = 0.58–0.96; p = 0.020) but were not significantly associated with suicide attempts. No significant interaction effects were observed, indicating that protective factors did not moderate the impact of adversity. Conclusions: Suicidal tendencies among incarcerated men were associated with cumulative structural and psychosocial adversities. Protective factors in prison were associated with lower odds of ideation but not attempts. These associations may inform person-centered and equity-oriented approaches and are consistent with the relevance of social determinants to mental health, although causal inferences are not supported by this project. Full article

Introduction: People experiencing homelessness (PEH) often live in adverse and changing environments and have high rates of mental illness and social exclusion, factors that could influence information processing. However, it is unknown whether these conditions could be related to sensory processing problems. Objectives: Analyse sensory processing in PEH. Methodology: A descriptive cross-sectional study was conducted with 150 participants (mean age of 47.43 ± 10.94 years), using the Adult/Adolescent Sensory Profile and a sociodemographic questionnaire. Results. PEH aged 18–64 showed significantly higher scores in low registration (M = 36.9), sensory sensitivity (M = 41.1) and sensation avoiding (M = 45.5) compared to the control group (p < 0.001), suggesting a distinct form of sensory processing in this population. Discussion: These results may be linked to factors such as chronic exposure to unpredictable and stressful situations, as well as to the presence of diverse mental health issues. Conclusion: It is important to consider the sensory characteristics of this population when designing person-centered interventions, in order to reduce social isolation and promote self-regulation strategies, environmental adaptation and greater occupational participation. Full article

Background and Objectives: People experiencing homelessness (PEH) face a disproportionately high burden of vision impairment, most commonly from uncorrected refractive error (RE), and encounter significant barriers to accessing care. Despite these challenges, there is limited knowledge about effective approaches to providing ophthalmic services to this population. This review aims to categorize and evaluate existing models of eye care delivery for PEH in North America. Materials and Methods: A literature search was conducted for publications between 2013 and 2023. Eligible studies included those describing direct ophthalmic interventions for PEH in North America. Identified studies were reviewed and classified into distinct models of care delivery. Results: Four models of care emerged: office-based, shelter-based, mobile/temporary-based, and street medicine-based. Each model demonstrated unique strengths and limitations related to accessibility, continuity of care, and resource intensity. Across models, on-site correction of RE, particularly through provision of eyeglasses at the point of care, led to documented improvement of vision. However, referral completion and follow-up rates to tertiary care centers were low, especially in programs where services were fragmented across multiple locations. Strategies that emphasize same-location diagnosis and treatment for RE increase service delivery rates. Further studies are needed to evaluate referral pathways, long-term outcomes, and policy strategies to reduce vision-related disparities in this underserved population. Conclusions: No single model of care proved universally superior. Instead, hybrid approaches that integrate multiple models tailored to community infrastructure and patient needs appear most effective for expanding access to ophthalmic services among PEH. Full article

Achieving sustainable development (SD) and enhancing urban quality of life are undermined by the systemic exclusion of marginalized groups. Despite the global expansion of welfare systems, a welfare paradox persists, wherein universal policies often reinforce exclusion. This study investigates this paradox through a mixed-methods analysis of welfare inequity among homeless individuals in Khon Kaen, Thailand. Combining a quantitative survey (n = 202) with in-depth interviews of homeless persons and state officials, we model the structural nature of this exclusion. Results reveal systemic disparities by gender, age, and displacement causes. Critically, a predictive model identifies housing and education access as foundational determinants, collectively explaining 89.9% of the variance in economic inclusion (R² = 0.899, p < 0.001). Qualitative data elucidate the mechanisms behind these statistics, highlighting how the lack of official documentation and institutional stigma sever access to the broader welfare system. We conceptualize these interdependencies as a foundational capability cascade, where deficits in core domains trigger compounding exclusion. By integrating statistical modeling with narrative evidence, this research provides a robust framework for social exclusion and offers an evidence-based roadmap for designing equity-focused policy reforms that are essential for inclusive urban sustainability. Full article

Community-based organisations (CBOs) play a crucial role supporting clients during emergencies yet often lack adequate preparation. This study examined how Australian CBOs perceived and enacted dual responsibilities: ensuring service continuity during emergencies and facilitating person-centred preparedness for high-risk populations. A national cross-sectional online survey of community-based health and social care organisations was conducted between December 2021 and April 2022, employing strategic outreach and snowball sampling. Among 244 respondents, disability services (69%) and housing and homelessness services (27%) were the most common providers. Many organisations showed strong emergency preparedness, including comprehensive insurance, staff empowerment, and adaptive service delivery. Barriers to business continuity plans (BCPs) included resource constraints and limited emergency information access. Organisations with established networks and collaborations with emergency services demonstrated greater capacity for sustained service delivery (p < 0.001). Logistic regression analysis revealed local networking with emergency service agencies was positively associated with CBOs’ ability to support client preparedness (p < 0.001), while lack of tools (p = 0.007) and training (p = 0.037) limited capacity to facilitate person-centred emergency planning for high-risk populations. Embedding business continuity planning within operations and strengthening cross-sector collaboration can enable CBOs to fulfil their aforementioned dual responsibilities, while advancing sustainable organisational resilience and inclusive disaster risk reduction. Full article

Background: People experiencing homelessness (PEH) face significant health disparities and systemic barriers to healthcare, elevating their risk for cancer and other chronic diseases. To tackle PEHs’ challenges in accessing cancer preventive care, the CANCERLESS project implemented the Health Navigator Model (HNM)—a person-centered intervention that utilizes trained Health Navigators to provide tailored support and facilitate service access. Recognizing housing as a key determinant of health, this analysis assessed changes in housing status associated with participation in the HNM among CANCERLESS participants in Austria, Greece, Spain, and the UK. Methods: This was a secondary analysis of cross-national data collected during a single-arm interventional study. Of 652 enrolled PEH, 277 (42.5%) completed the HNM intervention follow-up and were included in the analysis. Changes in housing status from baseline to follow-up were categorized using the European Typology of Homelessness and Housing Exclusion (ETHOS) and treated as an ordered outcome. Descriptive statistics were complemented by a cumulative link mixed model with a participant random intercept to estimate the association between time (follow-up vs. baseline) and housing transitions among completers, adjusting for age, residence/legal status, and daily smoking. Results: Participants had a mean age of 47.4 (SD 13.8), primarily identified as male (64.1%), reported upper secondary education (33.9%), and were from Western European countries (39.7%), with varying housing situations. Among intervention completers, time (follow-up vs. baseline) was associated with higher odds of being in a higher ETHOS category (OR = 1.49, 95% CI = 1.02–2.20, p = 0.042), consistent with a modest improvement in housing status. Larger estimates were observed among migrants without legal documents (OR = 24.13, 95% CI = 6.41–90.89, p < 0.001), while daily smoking was associated with lower odds (OR = 0.33, 95% CI = 0.11–0.96, p = 0.041); other residence status categories were not statistically significant. Conclusions: Suggesting that tailored, navigation-based models, such as the HNM, may be linked to improved housing stability for PEH, these findings can inform piloting and context-aligned integration of the HNM within public health strategies as an alternative approach to address the complex, interconnected health and social needs of PEH. However, the lack of a comparison group and high attrition limit the results’ conclusiveness, and future evaluations should aim to include assessments of housing-associated contextual factors. Full article

Care-experienced young people often face considerable challenges due to a personal history of trauma and disruption and have a higher risk of homelessness, mental ill health, and involvement with the criminal justice system. A stubborn trend of achieving fewer qualifications than non-care-experienced peers persists, with greater likelihood of becoming NEET (Not in Education, Employment or Training). Accessible and sustainable pre-employment programmes should be a priority for national initiatives designed to generate improved outcomes for vulnerable youth. The I-CAN (Initiating and Supporting Care Leavers into Apprenticeships in Nursing) programme offers young people in England (aged 18–30) a person-focussed pathway to training and employment. However, robust research is needed to evidence the effectiveness of this type of small-scale and short-term funded programme. The current paper reports qualitative findings from a pilot study exploring the perceptions and experiences of (N = 27) young people who attended the 8-week I-CAN programme delivered at a Higher Education Institution. Data were collected from four focus groups and thematically analysed. The findings captured young people’s personal trajectories and exposed underpinning processes as well as unique, shared, and intersectional factors that can either facilitate or impede progression to education, employment and training. Crucially, care-experienced young people are not a homogenous group and capturing their authentic, diverse voices in evaluation research is essential for not only assessing if a programme works but for whom, and why. Furthermore, findings can help to inform meaningful strategies and socially valid interventions to support care-experienced young people navigate the transition ‘cliff edge’. Full article

This study uses a public health approach to identify the comorbid risk factors and protective factors that influence the likelihood of an officer-involved shooting (OIS). Methods: We analyzed 7.5 years of hospital inpatient data obtained from the state of Texas. The OIS subjects (n = 177) were civilians who were shot during a legal intervention involving law enforcement. The control group (n = 33,539) included persons who were hospitalized due to injuries from a car accident. Logistic regression models were used to identify the predictors of an OIS incident. The data included information on chronic diseases, vulnerable population status, health insurance, mental health diagnoses, substance use disorders, and recent trauma. Results: About one-fourth (24.3%) of OIS subjects had a diagnosed mental illness, compared to 8.4% of control subjects (p < 0.001). Factors that greatly increased the risk for an OIS included the following: schizophrenia (AOR = 2.7; CI: 1.6, 4.6), methamphetamine use disorder (AOR = 3.5; CI: 2.2, 5.5), and recent family bereavement (AOR = 8.5; CI: 1.8, 39.6). Six subjects (3.4%) were persons experiencing homelessness (PEH). Protective factors that lowered the risk for an OIS included commercial health insurance (AOR = 0.27; CI: 0.17, 0.45) and Medicaid insurance (AOR = 0.61; CI: 0.11, 0.93). Conclusions: These findings underscore the preventable nature of many OIS incidents, especially those that involve untreated mental illness, homelessness, substance use disorders, and recent trauma. Addressing the root causes of these incidents will likely require interdisciplinary collaboration among law enforcement, public health agencies, and social services. Full article

Although engineering institutional bodies uphold public welfare and the impact of engineering on people and society, engineering curricula rarely scaffold students to connect their technical learning with sociotechnical perspectives. This paper describes a project-based learning approach where engineering students engaged with issues faced by people experiencing homelessness to better understand the sociotechnical nature of effective, user-centered, engineering design. We conducted a quantitative assessment to determine how well and in what ways the project-based learning curriculum shifted students’ perceptions about homelessness. We collected pre-/post-survey data from students on 21 statements about their perceptions and attitudes about homelessness prior to and after an engineering project with a focus on homelessness in San Diego, CA, USA. The study aimed to measure the effectiveness of the course/project on shifting students’ perceptions from myths about homelessness towards reality, which supported the course objectives regarding diversity, inclusion, and social justice. We found that, from data from 166 students over 8 semesters, students’ perceptions had statistically significant (p < 0.05) shifts in five survey statements, which regarded beliefs about the personal choices or perceived moral decisions of those experiencing homelessness, and that students were able to more strongly identify with an engineer’s duty to care for those experiencing homelessness. Full article

Introduction: Social sustainability is deeply connected to the well-being of marginalized groups, and it is important to highlight how mental health impacts the social inclusion of homeless individuals, particularly veterans. Homelessness is a growing global issue, disproportionately affecting U.S. veterans, with mental health challenges playing a significant role in its onset and perpetuation. Purpose: This study aims to compare the sociodemographic and clinical characteristics of homeless veterans and non-veterans in the U.S. Method: Using public data (N = 6295), this quantitative study applies descriptive and inferential statistical analyses. Results: Homeless veterans are more likely than non-veterans to be older, male, and identify as Caucasian or African American. They are more frequently high school graduates or have higher education, and report being divorced, widowed, married, or in varied employment statuses (full-time, part-time, or unemployed). Veterans exhibit higher rates of severe mental illnesses, schizophrenia, trauma- and stressor-related disorders, ADHD, bipolar disorder, personality disorders, depression, anxiety, and substance or alcohol use disorders. However, they are less likely than non-veterans to report substance-induced disorders, intoxication, dependence, or abuse involving cocaine, cannabis, opioids, and other substances. Conclusions: Psychosocial interventions for homeless veterans should prioritize mental health-related concerns, whereas efforts for homeless non-veterans should focus on addressing substance use. Future research should develop tailored interventions, explore the sociodemographic factors influencing homelessness, and investigate the interplay between trauma, mental health, and substance use. Addressing these issues can contribute to a more resilient, inclusive, and sustainable society by providing long-term support and integration opportunities for those most affected. The novelty of this study lies in distinguishing between mental health issues prevalent in veterans and substance use disorders more common in non-veterans, offering insights for tailored interventions. It also connects these findings to social sustainability, suggesting that addressing these issues can promote a more inclusive and resilient society. Full article

Differences in the lifestyle and health-service-seeking behavior of persons experiencing homelessness (PEH) are well known. However, a comprehensive estimation of the resulting healthcare utilization differences and health outcome impacts are so far under-researched, especially at the national level. We aim to close this gap of evidence for lung cancer within the Hungarian universal healthcare system. We analyzed lung cancer-related information for the PEH population in the Hungarian national central health insurance register dataset and a matched control population between 2015 and 2021. In this period, 11,857 people were registered as homeless for the majority of at least one year. To capture the effect of homelessness, we created a categorical “homelessness length index” (HLI) according to the proportion of time an individual experienced homelessness during the investigation period (HLI 0: 0; HLI 1: >0–1/3; HLI 2: >1/3–2/3; HLI 3: >2/3). PEH individuals were matched 1:5 with a non-PEH control sample adjusted for age, sex and region. We conducted Kaplan–Meier survival analysis and Cox proportional hazards (CPH) regression adjusted for age, sex, HLI and average lung cancer-related healthcare costs. Our final analysis sample consisted of 641 patients (233 PEH, 408 control) who were newly diagnosed with lung cancer during the observation period. The lung cancer prevalence in the PEH group was 1.97% as opposed to 0.69% in the control group. The Kaplan–Meier curve showed lower average survival times for the PEH group, compared to the control group. Lung cancer associated costs between diagnosis and death/censoring were substantially different with average per patient cumulative costs of EUR 3668 in the PEH group compared to EUR 6827 in the control group (2018 prices). This translated to an average 47% lower annual lung cancer-related healthcare cost per PEH patient. CPH analysis showed that after disease severity, the degree of time spent in homelessness had the most significant effect on mortality, with a HR of 1.47 associated with both HLI 2 and 3 (95% CI: 1.08–2.00 and 1.01–2.14, respectively). We find that in Hungary, homelessness is associated with a much higher lung cancer burden linked to a three-times-higher prevalence, lower overall survival and almost 50% lower annualized disease-specific healthcare costs. Worse outcomes are mainly driven by long-term homelessness. Results could not be further refined according to lifestyle-related factors due to data availability limitations. Full article

Marginalized populations face significant barriers to mental health care, such as stigma, poverty, and limited access to adapted services, with conventional psychiatric approaches often falling short. This study aimed to explore how psychiatric care can be adapted to better meet the needs of vulnerable populations. Data were collected from psychiatry residents, psychiatrists, and community organization staff during a course on vulnerable populations, using semi-structured discussions and analyzed through grounded theory with iterative coding. Seven main themes emerged: (1) barriers and needs of vulnerable populations, highlighting challenges like homelessness and stigma; (2) psychiatric interventions and flexible approaches, emphasizing tailored care; (3) collaboration with community organizations, focusing on partnerships to improve care access; (4) ethical approach and respect for rights, ensuring dignity in treatment; (5) specific populations and associated challenges, addressing the needs of groups like LGBTQ+ youth and migrants; (6) intervention and support models, such as proximity-based care and post-hospitalization follow-up; (7) innovation and evolution of practices, focusing on research and institutional adaptations. This study emphasizes the need for personalized, intersectoral care, recommending improved collaboration, flexible models, and greater clinical exposure, with future research exploring how psychiatric education can better prepare clinicians to work with marginalized groups. Full article

Jack the Ripper fictions tend to be realist in mode, making frequent use of the Victorian press and archives to depict the 1888 murders. At the same time, they marginalise and exploit the victims, defining them as silent testimonies to the power of the elusive perpetrator. In contrast, Alan M. Clark’s Jack the Ripper Victims Series (2011–2018), consisting of five novels devoted to one canonical victim each, shifts the focus and depicts their lives. This article outlines the way the fictionalisations of the five women’s lives bring to the fore five other ‘crimes’ or transgressions: addiction, domestic violence, unemployment, sex work, and homelessness, but also the way these texts replace what is sensational and formulaic in Ripperature with something more than mundane and gritty in the lived experience of everyday people, such as moments of personal joy or professional accomplishments. Drawing on Kate Mitchell’s approach to history, cultural memory, and neo-Victorian fiction, it argues that pre-dating the publication of The Five (2019), Clark managed to realistically re-present (make present) and represent (create a portrayal of) the late-Victorian crime of dismissing the women who were murdered. Full article

For people experiencing homelessness (PEH), the provision of affordable housing has been recognized as the most crucial intervention for improving housing stability and facilitating substance abuse treatment. However, evidence indicates that providing housing does not significantly improve substance abuse, mental health, or physical health outcomes. Optimal participation in essential daily activities has been shown to improve health outcomes and support independent living, but there is limited research that identifies activity performance priorities among PEH living in transitional housing. The present study investigates activity performance priorities using the focus group methodology. Management and staff from a transitional housing facility participated in a focus group discussion (90 min) and a follow-up (member checking) session (75 min), to deliberate on this topic. Emerging priorities for activity performance include activities of daily living [personal hygiene]; instrumental activities of daily living [house maintenance, meal preparation, and transportation]; health management [mental health, physical health, medical appointments]; social participation [building healthy relationships]; work [seeking and/or maintaining]; sleep; and leisure [recreational] activities. Community members and other stakeholders can support PEH in transitional housing by facilitating participation in these activities, and researchers should evaluate the effects of specific activity-focused interventions on health. Full article

Introduction: Individuals experiencing homelessness have higher rates of chronic disease and face challenges accessing primary care. Virtual health care can reduce health inequity but needs user acceptance. A virtual health hub (VHH) for people experiencing homelessness in Sydney provided virtual GP and psychologist care within a crisis accommodation service. This included nursing assistance. Method: The VHH evaluation assessed the feasibility of the service specifically examining accessibility, efficiency, costs, technology, quality, and outcomes through attendance data, patient measures, stakeholder interviews, and case studies. Findings: Data indicated 40% client utilisation with high attendance for GPs and/or psychologists. All clients reported a high quality of care, appointment benefits, understanding clinicians, and treatment help, and that privacy was maintained. If the VHH was not available, one-third would not have sought treatment. The majority agreed that virtual care was the same or better than in-person care. Only a few experienced technical issues. Service provider interviews indicated the benefits of accessible and affordable care, perceived reduced hospital presentations, staff time saved, and reduced client costs. Limitations were the lack of physical examinations and lack of follow-up due to temporary accommodation. Strong stakeholder partnerships enabled implementation success. Conclusions: The VHH service is feasible and replicable with on-site assistance and stakeholder commitment. Full article