Systematic Surveys in Informal Settlements: Challenges in Moving Toward Health Equity

Perceived Discrimination Based on Criminal Record in Healthcare Settings and Self-Reported Health Status among Formerly Incarcerated Individuals Abstract Perceived discrimination based on criminal record is associated with social determinants of health such as housing and employment. However, there is limited data on discrimination based on criminal record within health care settings. We examined how perceived discrimination based on criminal record within health care settings, among individuals with a history of incarceration, was associated with self-reported general health status. We used data from individuals recruited from 11 sites within the Transitions Clinic Network (TCN) who were released from prison within the prior 6 months, had a chronic health condition and/or were age 50 or older, and had complete information on demographics, medical history, self-reported general health status, and self-reported perceived discrimination (n = 743). Study participants were mostly of minority racial and ethnic background (76%), and had a high prevalence of self-reported chronic health conditions with half reporting mental health conditions and substance use disorders (52% and 50%, respectively), and 85% reporting one or more chronic medical conditions. Over a quarter (27%, n = 203) reported perceived discrimination by health care providers due to criminal record with a higher proportion of individuals with fair or poor health reporting discrimination compared to those in good or excellent health (33% vs. 23%; p = .002). After adjusting for age and reported chronic conditions, participants reporting discrimination due to criminal record had 43% increased odds of reporting fair/poor health (AOR 1.43, 95% CI 1.01–2.03). Race and ethnicity did not modify this relationship. Participants reporting discrimination due to criminal record had increased odds of reporting fair/poor health. The association between perceived discrimination by health care providers due to criminal record and health should be explored in future longitudinal studies among individuals at high risk of incarceration. Clinical Trial Registration: NCT01863290

Correction to: Extending Data for Urban Health Decision-Making: a Menu of New and Potential Neighborhood-Level Health Determinants Datasets in LMICs Readers should note an additional Acknowledgment for this article: Dana Thomson is funded by the Economic and Social Research Council grant number ES/5500161/1.

The Last Link: from Gun Acquisition to Criminal Use Abstract Guns that are used in crime and recovered by the police typically have changed hands often since first retail sale and are quite old. While there is an extensive literature on “time to crime” for guns, defined as the elapsed time from first retail sale to known use in a crime, there is little information available on the duration of the “last link”—the elapsed time from the transaction that actually provided the offender with the gun in question. In this article, we use data from the new Chicago Inmate Survey (CIS) to estimate the duration of the last link. The median is just 2 months. Many of the gun-involved respondents to the CIS (42%) did not have any gun 6 months prior to their arrest for the current crime. The CIS respondents were almost all barred from purchasing a gun from a gun store because of their prior criminal record—as a result, their guns were obtained by illegal transactions with friends, relatives, and the underground market. We conclude that more effective enforcement of the laws governing gun transactions may have a quick and pervasive effect on gun use in crime.

Homelessness, Personal Hygiene, and MRSA Nasal Colonization among Persons Who Inject Drugs Abstract Methicillin-resistant Staphylococcus aureus (MRSA) infection is a leading cause of hospitalization and medical visits among individuals experiencing homelessness and also among persons who inject drugs (PWID), populations with significant overlap in urban centers in the USA. While injection drug use is a risk factor for MRSA skin infections, MRSA is also known to transmit easily in crowded, public locations in which individuals have reduced personal hygiene. Individuals in urban centers who experience homelessness or drug addiction may spend significant amounts of time in environments where MRSA can be easily transmitted, and may also experience reduced access to facilities to maintain personal hygiene. We assessed the relationship between homelessness, personal hygiene, and MRSA nasal colonization, a proxy for MRSA infection risk, in a study of PWID in Boston, MA (n = 78). Sleeping in a homeless shelter for at least one night in the last 3 months was significantly associated with MRSA nasal colonization (OR 3.0; p = 0.02; 95% CI 1.2, 7.6). Sleeping at more than one place during the last week (considered a metric of elevated housing instability) was also associated with a threefold increase in odds of MRSA nasal colonization (OR 3.1; p = 0.01; 95% CI 1.3, 7.6). MRSA nasal colonization was strongly associated with use of public showers (OR 13.7; p = 0.02; 95% CI 1.4, 132.8), although few people in this study (4 of 78) reported using these public facilities. Sharing bedding with other people was also associated with increased risk of MRSA colonization (OR 2.2; p = 0.05; 95% CI 1.0–4.7). No associations between hand hygiene, frequency of bathing or clothes laundering, or street sleeping were observed. Use of public facilities supporting persons experiencing homelessness and housing instability, including shelters and public showers, is associated with an increased risk of MRSA nasal colonization in this study. Personal hygiene behaviors appear less associated with MRSA nasal colonization. Environmental assessments of MRSA contamination in homeless shelters and public sanitation facilities are warranted so as to inform appropriate intervention activities.

Individual-Level Predictors for Becoming Homeless and Exiting Homelessness: a Systematic Review and Meta-analysis Abstract Homelessness remains a societal problem. Compiled evidence of predictors for becoming homeless and exiting homelessness might be used to inform policy-makers and practitioners in their work to reduce homeless-related problems. We examined individual-level predictors for becoming homeless and exiting homelessness by searching PubMed, EMBASE, PsycINFO, and Web of Science up to January 2018. Becoming homeless and exiting homelessness were the outcomes. Observational studies with comparison groups from high-income countries were included. The Newcastle Ottawa Quality Assessment Scale was used for bias assessment. Random effects models were used to calculate pooled odds ratios (ORs) with 95% confidence intervals (CIs). We included 116 independent studies of risk factors for becoming homeless and 18 for exiting homelessness. We found evidence of adverse life events as risk factors for homelessness, e.g., physical abuse (OR 2.9, 95% CI 1.8–4.4) and foster care experiences (3.7, 1.9–7.3). History of incarceration (3.6, 1.3–10.4), suicide attempt (3.6, 2.1–6.3), and psychiatric problems, especially drug use problems (2.9, 1.5–5.1), were associated with increased risk of homelessness. The heterogeneity was substantial in most analyses (I2 > 90%). Female sex (1.5, 1.1–1.9; I2 = 69%) and having a partner (1.7, 1.3–2.1; I2 = 40%) predicted higher chances whereas relationship problems (0.6, 0.5–0.8), psychotic disorders (0.4, 0.2–0.8; I2 = 0%), and drug use problems (0.7, 0.6–0.9; I2 = 0%) reduced the chances for exiting homelessness. In conclusion, sociodemographic factors, adverse life events, criminal behaviour, and psychiatric problems were individual-level predictors for becoming homeless and/or exiting homelessness. Focus on individual-level vulnerabilities and early intervention is needed. PROSPERO registration number: CRD42014013119.

“Housing Insecurity Seems to Almost Go Hand in Hand with Being Trans”: Housing Stress among Transgender and Gender Non-conforming Individuals in New Orleans Abstract Housing is an important social determinant of physical and mental health. Transgender and gender non-conforming individuals (T/GNCI) face a unique constellation of discrimination and compromised social services, putting them at risk for housing insecurity, homelessness, and its associated public health concerns. This study explores housing insecurity among T/GNCI in New Orleans, LA, where the infrastructural landscape is marked by an underinvestment in housing stock and disaster capitalism. In-depth interviews were conducted with T/GNCI (n = 17) living in New Orleans, identified through purposive sampling. Semi-structured guides were used to elicit personal stories and peer accounts of insecure housing experiences and coping strategies. Interviews were audio recorded and transcribed. Data was coded, sorted, and analyzed for key themes using NVIVO 11. Respondents discussed an array of circumstances that contribute to housing insecurity, including intersectional stigma and discrimination coupled with gentrification and a changing housing landscape in the city. Housing was intricately intertwined with employment and other structural issues; vulnerability in one realm was closely tied to insecurity in the others. Social support and queer family structures emerged as a key source of resilience, coping, and survival. The study supports an increase of resources for T/GNC housing access and interventions that address the cyclical discrimination, housing, and employment issues this population faces with a consideration of the historical and current structural barriers impeding their access to safe, stable, long-term housing.

Urban Green Space Is Spatially Associated with Cardiovascular Disease Occurrence in Women of Mashhad: a Spatial Analysis of Influential Factors on their Presence in Urban Green Spaces Abstract Chronic diseases have spread around the world. Cardiovascular diseases (CVD), the most important of the chronic diseases and the leading cause of death in women of Mashhad, are impacted by environmental factors. Urban green spaces (UGSs) are important environmental factors playing a critical role in the prevention and control of CVD. Spatial analysis is useful in understanding the application of UGSs in CVD prevention. To identify the spatial distribution of CVD in Mashhad, Moran’s index was used and 7539 home addresses of female patients with CVD were imported into ArcMap. Moran’s coefficient was estimated to be 0.34, revealing a clustered distribution of CVD. The spatial autocorrelation between CVD and UGSs was analyzed using Moran’s I. Moran’s I index value was calculated to be − 0.15, and four types of clusters were identified in eight sub-districts of Mashhad municipality. To find the factors influencing the presence in UGSs among women affected by CVD, 607 female patients living in the selected sub-districts were asked to take part in a telephone survey. Data were analyzed using ordinary least squares (OLS) and geographically weighted regression (GWR) at block level (343 statistical blocks in total). Accordingly, the spatial diversity and effects of three variables of income, level of education, and access to UGSs among female patients with CVD were measured. According to OLS results and the standard residual, two clusters were removed. Finally, vulnerable blocks were identified that could be helpful in the development of prevention policies and place-based interventions.

“You Do Not Think of Me as a Human Being”: Race and Gender Inequities Intersect to Discourage Police Reporting of Violence against Women Abstract Intimate partner violence (IPV) and sexual violence (SV) are drivers of women’s morbidity and mortality in urban environments yet remain among the most underreported crimes in the USA. We conducted 26 in-depth interviews with women who experienced past-year IPV or SV, to explore structural and community influences on police contact in Baltimore, MD. Results indicate that gender-based and race-based inequities intersected at the structural and community levels to discourage women from police contact following IPV/SV. Structural influences on police reporting included police discriminatory police misconduct, perceived lack of concern for citizens, power disparities, fear of harm from police, and IPV/SV-related minimization and victim-blaming. Community social norms of police avoidance discouraged police contact, enforced by stringent sanctions. The intersectional lens contextualizes a unique paradox for Black women: the fear of unjust harm to their partners through an overzealous and racially motivated police response and the simultaneous sense of futility in a justice system that may not sufficiently prioritize IPV/SV. This study draws attention to structural race and gender inequities in the urban public safety environment that shape IPV/SV outcomes. Race-based inequity undermines women’s safety and access to justice and pits women’s safety against community priorities of averting police contact and disproportionate incarceration. A social determinants framework is valuable for understanding access to justice for IPV/SV. Enhancing access to justice for IPV/SV requires overcoming deeply entrenched racial discrimination in the justice sector, and historical minimization of violence against women.

Structural Characteristics of Tree Cover and the Association with Cardiovascular and Respiratory Health in Tampa, FL Abstract Urban tree cover can provide several ecological and public health benefits. Secondary datasets for Tampa, FL, including sociodemographic variables (e.g., race/ethnicity), health data, and interpolated values for features of tree cover (e.g., percent canopy and leaf area index) were analyzed using correlation and regression. Percent canopy cover and leaf area index were inversely correlated to respiratory and cardiovascular outcomes, yet only leaf area index displayed a significant association with respiratory conditions in the logistic regression model. Percent racial/ethnic minority residents at the block group level was significantly negatively correlated with median income and tree density. Leaf area index was also significantly lower in block groups with more African-American residents. The percentage of African Americans (p = 0.101) and Hispanics (p < 0.001) were positively associated with respiratory outcomes while population density (p < 0.001), percent canopy (p < 0.01), and leaf area index (p < 0.01) were negatively associated. In multivariate models, higher tree density, leaf area index, and median income were significantly negatively associated with respiratory cases. Block groups with a higher proportion of African Americans had a higher odds of displaying respiratory admissions above the median rate. Tree density and median income were also negatively associated with cardiovascular cases. Home ownership and tree condition were significantly positively associated with cardiovascular cases.