Youth Homelessness in Denver, Colorado: 2017-2021.

Objectives: Homelessness is a public health crisis in the United States, yet homelessness prevalence, especially among children and youth, is not well understood. In this study, we use an indirect estimation method known as multiple systems estimation to further evaluate prevalence of youth experiencing homelessness in Denver, Colorado.

Methods: We performed a multiple systems estimation ("capture-recapture") analysis to estimate annual homelessness among youth aged 14 to 17 years in the city and county of Denver, Colorado from 2017 to 2021.

The Built Environment, PTSD Symptoms, and Tobacco Use among Permanent Supportive Housing Residents.

Introduction: 50% of permanent supportive housing (PSH) residents in the U.S. smoke cigarettes, and tobacco-related mortality is their number one cause of death.

Novel methods to construct a representative sample for surveying California's unhoused population: the California Statewide Study of People Experiencing Homelessness.

Existing literature on people experiencing homelessness (PEH) draws on non-representative samples from service providers, populations with comorbidities, or areas with disproportionately high sheltered homelessness, leading to bias. Nearly a third of PEH in the US and over half of unsheltered PEH live in California. We designed a rigorous state-representative survey of PEH to investigate the antecedents of homelessness, understand health, and inform policy solutions.

Association of housing status and cancer diagnosis, care coordination and outcomes in a public hospital: a retrospective cohort study.

Objectives: Cancer is a leading cause of death in unhoused adults. We sought to examine the association between housing status, stage at diagnosis and all-cause survival following cancer diagnosis at a public hospital.

Design: Retrospective cohort study examining new cancer diagnoses between 1 July 2011 and 30 June 2021.

Continued Homelessness and Depressive Symptoms in Older Adults.

Importance: Depression is common in adults experiencing homelessness. It is unclear whether continued homelessness is associated with more depressive symptoms.

Objective: To examine the association between residential status and depressive symptoms in adults aged 50 years or older experiencing homelessness at study entry.

The Impact of Intimate Partner Violence on Homelessness and Returns to Housing: A Qualitative Analysis From the California Statewide Study of People Experiencing Homelessness.

Homelessness is a public health concern in California and throughout the United States. Intimate partner violence (IPV) is a risk factor for experiencing homelessness. Few studies have examined the interplay between IPV, homelessness, and housing.

"We Remember the Pain": A qualitative study of intergenerational trauma among older adults experiencing homelessness in the HOPE HOME study.

Rates of homelessness among adults aged 50 and over are rising. Common strategies for exiting homelessness rely on social and family support. However, intergenerational trauma may disrupt these social support networks and contribute to homelessness.

Accounting for the interplay of interpersonal and structural trauma in the treatment of chronic non-cancer pain, opioid use disorder, and mental health in urban safety-net primary care clinics.

While the epidemiological literature recognizes associations between chronic non-cancer pain (CNCP), opioid use disorder (OUD), and interpersonal trauma stemming from physical, emotional, sexual abuse or neglect, the complex etiologies and interplay between interpersonal and structural traumas in CNCP populations are underexamined. Research has documented the relationship between experiencing multiple adverse childhood experiences (ACEs) and the likelihood of developing an OUD as an adult. However, the ACEs framework is criticized for failing to name the social and structural contexts that shape ACE vulnerabilities in families.

Loneliness among homeless-experienced older adults with cognitive or functional impairments: qualitative findings from the HOPE HOME study.

Background: Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging in the United States; now, 48% of single homeless adults are 50 and older. We know little about loneliness among older adults who have experienced homelessness.

Homelessness And Health: Factors, Evidence, Innovations That Work, And Policy Recommendations.

On a single night in 2023, more than 653,000 people experienced homelessness in the United States. In this overview, we highlight structural and individual risk factors that can lead to homelessness, explore evidence on the relationship between homelessness and health, discuss programmatic and policy innovations, and provide policy recommendations. Health system efforts to address homelessness and improve the health of homeless populations have included interventions such as screening for social needs and medical respite programs.

Housing Status Changes Are Associated With Cancer Outcomes Among US Veterans.

Cancer is a leading cause of death in older unhoused adults. We assessed whether being unhoused, gaining housing, or losing housing in the year after cancer diagnosis is associated with poorer survival compared with being continuously housed. We examined all-cause survival in more than 100,000 veterans diagnosed with lung, colorectal, and breast cancer during the period 2011-20.

Barriers and Facilitators to Resolving Older Adult Homelessness through Stays with Family: Qualitative findings from the HOPE HOME Study.

Living with family and friends is a common strategy used to prevent or exit homelessness, but little is known about structural barriers that impede family and friends' ability to provide temporary or permanent housing for older homeless adults. We conducted semi-structured interviews with 46 homeless participants from the HOPE HOME study, a cohort of 350 community-recruited homeless adults age 50 or older in Oakland, CA, who reported having stayed with housed family/friends for 1 or more nights in the prior 6 months. We conducted semi-structured interviews with 19 hosts of homeless participants and 11 stakeholders in housing and homelessness.

Housing Status, Cancer Care, and Associated Outcomes Among US Veterans.

Importance: Cancer is a leading cause of death among older people experiencing homelessness. However, the association of housing status with cancer outcomes is not well described.

Objective: To characterize the diagnosis, treatment, surgical outcomes, and mortality by housing status of patients who receive care from the US Department of Veterans Affairs (VA) health system for colorectal, breast, or lung cancer.

Loneliness among older adults who have experienced homelessness: qualitative findings from the HOPE HOME study.

Background: Loneliness is more common in older adults and those who face structural vulnerabilities, including homelessness. The homeless population is aging. We know little about loneliness among older adults who have experienced homelessness.

Sleep Quality among Homeless-Experienced Older Adults: Exploratory Results from the HOPE HOME Study.

Background: Sleep is essential to health and affected by environmental and clinical factors. There is limited longitudinal research examining sleep quality in homeless older adults.

Objective: To examine the factors associated with poor sleep quality in a cohort of older adults in Oakland, California recruited while homeless using venue-based sampling and followed regardless of housing status.

The intersection of drug use discrimination and racial discrimination in the management of chronic non-cancer pain in United States primary care safety-net clinics: Implications for healthcare system and clinic-level changes.

Background: Clinicians' bias related to patients' race and substance use history play a role in pain management. However, patients' or clinicians' understandings about discriminatory practices and the structural factors that contribute to and exacerbate these practices are underexamined. We report on perceptions of discrimination from the perspectives of patients with chronic non-cancer pain (CNCP) and a history of substance use and their clinicians within the structural landscape of reductions in opioid prescribing in the United States.

"I Needed for You to See What I'm Talking About": Experiences With Telehealth Among Homeless-Experienced Older Adults.

Little is known about how older adults with a current or recent experience of homelessness navigated the switch to telehealth during the COVID-19 pandemic. We examined the perceptions and use of telehealth in a purposive sample of 37 homeless-experienced older adults in mid-late 2020 through semi-structured qualitative interviews. We purposively recruited participants from a larger longitudinal study on homeless-experienced older adults in Oakland, CA.

Telehealth for management of chronic non-cancer pain and opioid use disorder in safety net primary care.

Background: The SARS-CoV-2 (COVID-19) pandemic increased use of telehealth for the management of opioid use disorder and chronic non-cancer pain in primary care safety net clinical systems. Significant barriers to telehealth exist, little is known about how these barriers impact urban safety net, primary care providers and their patients. The objective of this study was to qualitatively assess the benefits and challenges of telehealth for management of chronic non-cancer pain, opioid use disorder, and multi-morbidity in primary care, safety net clinical systems.

Using behavioral theory to adapt advance care planning for homeless-experienced older adults in permanent supportive housing.

Background: Older adults experiencing chronic homelessness (i.e., prolonged homelessness and a disabling condition) have low rates of advance care planning (ACP) despite high rates of morbidity and mortality.