Trauma, Mental Health, and Substance Use Among Homeless Families: The Importance of Shelter Environment

Homelessness is at historical levels in the United States and New York City has not been immune to this nationwide trend. Homeless populations are not only increasing in number but are remaining in the shelter for longer periods of time. Homelessness, itself has been shown to have negative consequences on mental health and physical health, but its effects are particularly significant for families with children who have greater needs and who are more susceptible to negative experiences at early ages that can have lifelong impact. Despite this recent data there has been very little to no research on the potential impact of the shelter environment on the mental or physical well-being of homeless families. Thus, this dissertation research aims to fill this gap in the current literature by conducting a secondary analysis of the HIV Prevention Outreach for Parents and Early Adolescents (HOPE) study to test: 1) the association between three shelter related variables (i.e., time in the shelter, the perceived social environment of the shelter, and difficulty following shelter rules) and psychosocial outcomes for caregivers (i.e., mental health, parental stress, and substance use among caregivers), 2) the association between three shelter related variables (i.e., time in the shelter, the perceived social environment of the shelter, and difficulty following shelter rules) and psychosocial outcomes for youth (i.e., depressive symptoms, and substance use among caregivers), 3) the potential moderating effect of this perceived social environment of the shelter and difficulty following rules on the association between trauma and psychosocial outcomes for both youth residents and their caregivers. The sample for this research consisted of youth (ages 11 - 14) and their caregivers (n = 452) residing in 10 shelters in New York City. Hierarchical regressions were employed to test various models within the three aims of the study. In addition, sampling of residents within shelters and youth within families was accounted for in the analysis. Results of the analysis conducted indicate that the length of time in the shelter was not significantly associated with psychosocial outcomes for youth and caregivers with two exceptions, namely caregiver mental health and parenting stress. Perception of the shelter environment was strongly associated with all psychosocial outcomes for caregivers and their youth, with the exception of caregiver substance use. Difficulty following shelter rules was significantly associated with all psychosocial outcomes for both youth and caregivers (although the youth substance use finding was counter to what was initially hypothesized). Trauma was also significantly associated with all psychosocial outcomes as well with the exception of parenting stress, and caregiver substance use. The findings from the third aim of the study revealed that his perceived social environment of the shelter did not prove to be a significant moderator of the association between trauma and psychosocial outcomes for youth and caregivers with the exception of youth substance use. Difficulty following rules was also not found to be as significant moderator with the exception of parenting stress and youth substance use. However both findings are counter-intuitive and discussed further in the concluding chapter. Thus, the findings support a more direct-effect relationship between the perceived social environment of the shelter and psychosocial outcomes as well as direct effects of difficulty following shelter rules and may also be indicative of a buffering effect. In addition, the findings of all three aims suggest an importance in the manner in which shelter is provided above and beyond providing a temporary residence

Lessons Learned from A Student-Led Breastfeeding Support Initiative At A US Urban Public University

Despite US laws requiring most workplaces to provide reasonable unpaid break time and a private space for female employees to express breast milk, much of the statutory language is vague and open to interpretation, potentially leading to suboptimal implementation. College and university campuses in the US represent a particular concern, as students are typically not employed by their school and thus not protected by state and federal labor laws. This article describes the work of 2 graduate students to successfully establish a dedicated space at their US urban public university for the purpose of expressing breast milk. A 3-pronged strategy was implemented to create a dedicated lactation space: (1) collecting data to support the establishment of the room, (2) raising awareness of legislation related to protection of breastfeeding, and (3) community organizing and advocacy. After nearly 18 months of advocacy and planning, the campus\u27 dedicated lactation room was opened for use in March 2012. Two years later, the room remains a valuable resource and is used, on average, 8.4 times per weekday during a typical school week. Several lessons learned are described, and the strategies employed can be tested and applied in other US academic settings to assist in advocating for more supports for breastfeeding mothers. However, it is also imperative that US legislation be amended to include language that explicitly protects students so that women do not need to make the choice between continuing their education and continuing to breastfeed

Fentanyl Preference Among People who use Opioids in New York City

BACKGROUND: Several studies have pointed to a sub-sample of people who use drugs (PWUD) who prefer the use of non-pharmaceutical fentanyl (NPF) and, as such, pose a unique challenge for public health initiatives amidst the continued rise in overdose mortality. However, matters of drug preference and autonomy of choice remain under-studied and often misunderstood. This paper examined the experiences of PWUD reporting a preference for NPF or an NPF-heroin mixture, specifically how they navigate the perceived benefits of NPF and its established risks. METHODS: 22 in-depth interviews were conducted in New York City between March 2018 and August 2019 with PWUD who self-reported a preference for NPF or an NPF-heroin mix. Interviews were audio-recorded, and the resulting transcripts analyzed using a thematic approach. RESULTS: Participants highlighted various factors that contributed to expressed preference for NPF or an NPF-heroin mix, including a desire to feel good, financial resources, drug availability, decreased consumer autonomy, and physiological demand. Participants reported practicing several risk reduction strategies; however, they highlighted that many, particularly carrying naloxone and always using with someone else, were difficult to implement in the context of illicit drug use. CONCLUSIONS: Our results demonstrate participants\u27 decreased consumer agency and greater exposure to systemic factors in the illicit markets, highlighting the need for expansion of various services, including drug checking resources and systems of outreach for PWUD who do not use intravenously. To promote tailored interventions, continued efforts in overdose prevention ought to more thoughtfully consider the context, perceptions, preferences, and behaviors of PWUD

Understanding Vaccine Perceptions and Willingness to Receive COVID-19 Vaccination: Opportunities to Strengthen Public Health Responses and COVID-19 Services for People Who Use Drugs

Background: People who use drugs (PWUD) are at high risk for COVID-19 infection, morbidity, and mortality. COVID-19 vaccines are safe and effective at reducing serious illness and death from COVID-19. There are sparse data on the perceptions and willingness of PWUD to receive COVID-19 vaccination. Materials and Methods: In order to assess the perceptions of, and willingness to receive, COVID-19 vaccination among PWUD, we conducted a rapid survey-based assessment of 100 PWUD in NYC (Spring 2021) who reported not having received COVID-19 vaccination and who reported past 30-day illicit drug use. Results: More than 80% of respondents agreed that personally receiving a COVID-19 vaccine was important for the health of others in the community, and endorsing this belief was significantly associated with COVID-19 vaccine willingness reflecting a high prevalence of altruistic beliefs (p-value: 0.01). Other reported perceptions that were significantly associated with COVID-19 vaccine willingness were believing that COVID-19 vaccines are safe for PWUD and trusting COVID-19 information from their healthcare providers (p-values < 0.05). That said, 62% reported being unwilling to receive a COVID-19 vaccine, and 70–83% had concerns about general vaccine safety/efficacy. Examining pairs of questions to explore potential ambivalence between vaccine endorsement and vaccine concerns identified that 56–65% simultaneously reported vaccine safety/efficacy concerns and beliefs that vaccination was an important intervention. Of the 75 respondents who reported past 30-day use of harm reduction and/or substance use disorder (SUD) programs, nearly 90% reported these programs as trusted sources of COVID-19 information. Conclusion: Most participants reported altruistic beliefs about the role of vaccines for community health, including COVID-19 vaccines, and this altruism was associated with willingness to be vaccinated against COVID-19. These findings suggest a complex relationship between beliefs about the role of vaccination in community health and the safety/efficacy of vaccines; this ambivalence suggests that COVID-19 vaccine willingness may not be firmly fixed, indicating potential opportunities to address questions and build vaccine confidence. Harm reduction and SUD programs could be leveraged to further engage PWUD in receipt of COVID-19 information and/or vaccination. Recognizing vaccine ambivalence, emphasizing collective and individual benefits of vaccination, and messaging from trusted sources may be promising approaches to increase vaccination in this population

Society of Behavioral Medicine (SBM) position statement: Restore CDC funding for firearms and gun violence prevention research

The Society for Behavioral Medicine (SBM) urges restoration of Centers for Disease Control and Prevention (CDC) funding for firearms and gun violence prevention research. Gun violence in the United States is an important and costly public health issue in need of research attention. Unfortunately, there have been no concerted CDC-funded research efforts in this area since 1996, due to the passage of the Dickey Amendment. To remedy the information-gathering restrictions caused by the Dickey Amendment bans, it is recommended that Congress remove â € policy riders\u27 on federal appropriations bills that limit firearms research at the CDC; expand NVDRS firearms-related data collection efforts to include all fifty states; fund CDC research on the risk and protective factors of gun use and gun violence prevention; fund research on evidence-based primary, secondary, and tertiary prevention and treatment initiatives for communities that are seriously impacted by the effects of gun violence; and support the development of evidence-based policy and prevention recommendations for gun use and ownership