Background and Objectives
Screening for alcohol use in primary care is underutilized, especially for women. The current study implemented systematic women's alcohol use screening in a health care for ...the homeless primary care program.
Methods
All women (n = 541) seeking care over 12 months were screened.
Results
Of the 541 screening forms returned, 80 women refused to answer the alcohol use questions. Of 461 completed screens, over 40% reported no alcohol use, while 43.8% reported hazardous drinking. Hazardous drinking was significantly associated with younger age, African American race, and living on the street or in a shelter.
Discussion and Conclusions
High rates of drinking were identified among women in different housing situations and use of systematic screening was beneficial to providers.
Scientific Significance and Future Directions
Health care settings are important sites to identify hazardous drinking as well as alcohol disorders among women with unstable housing histories. The growing integration of behavioral health care into primary care, and the medical home concept, both provide opportunities for brief interventions for at‐risk drinkers, as well as treatment options for those with alcohol use disorders that may be particularly appealing to women. Findings support further investigation of the relationship of housing stability to drinking, and suggest African American women may need special attention. (Am J Addict 2014;23:117–122)
Cervical cancer is a preventable disease through screening and early treatment. Rates of cervical cancer are higher in impoverished women, including homeless women. This study assessed the acceptance ...of free and accessible Pap smears offered to homeless women in a respite care setting.
A convenience sample of 205 adult women receiving respite care at a facility for homeless people in Boston, Massachusetts, between 2004 and 2007 were offered screening for cervical cancer during routine encounters with the medical staff during their stay. Rates of acceptance of screening as well as medical and sociodemographic information were collected on the women.
Of 205 women enrolled in the study, 129 (63%) were in need of screening and offered a Pap smear; 80 (62%) accepted and 49 (38%) declined. Of those who agreed to be tested, 56 (70%) had a Pap smear performed, resulting in 10 (18%) atypical results (atypical squamous cells of undetermined significance ASCUS or low-grade squamous intraepithelial lesion LGSIL) and 15 (27%) benign findings needing follow-up (e.g., vaginitis without evidence of malignancy).
A large proportion of homeless women receiving respite care decline a free Pap smear despite being in medical need of cervical cancer screening. Access and cost may not be the only barriers to screening among homeless women, and new and innovative approaches to screening in vulnerable populations need to be investigated in order to close the disparity gap.
A large body of evidence connects access to greenspace with substantial benefits to physical and mental health. In urban settings where access to greenspace can be limited, park access and use have ...been associated with higher levels of physical activity, improved physical health, and lower levels of markers of mental distress. Despite the potential health benefits of urban parks, little is known about how park usage varies across locations (between or within cities) or over time.
We estimated park usage among urban residents (identified as residents of urban census tracts) in 498 US cities from 2019 to 2021 from aggregated and anonymised opted-in smartphone location history data. We used descriptive statistics to quantify differences in park usage over time, between cities, and across census tracts within cities, and used generalised linear models to estimate the associations between park usage and census tract level descriptors.
In spring (March 1 to May 31) 2019, 18·9% of urban residents visited a park at least once per week, with average use higher in northwest and southwest USA, and lowest in the southeast. Park usage varied substantially both within and between cities; was unequally distributed across census tract-level markers of race, ethnicity, income, and social vulnerability; and was only moderately correlated with established markers of census tract greenspace. In spring 2019, a doubling of walking time to parks was associated with a 10·1% (95% CI 5·6–14·3) lower average weekly park usage, adjusting for city and social vulnerability index. The median decline in park usage from spring 2019 to spring 2020 was 38·0% (IQR 28·4–46·5), coincident with the onset of physical distancing policies across much of the country. We estimated that the COVID-19-related decline in park usage was more pronounced for those living further from a park and those living in areas of higher social vulnerability.
These estimates provide novel insights into the patterns and correlates of park use and could enable new studies of the health benefits of urban greenspace. In addition, the availability of an empirical park usage metric that varies over time could be a useful tool for assessing the effectiveness of policies intended to increase such activities.
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Although older homeless adults have high rates of geriatric syndromes, risk factors for these syndromes are not known. We used multivariable regression models to estimate the association of subject ...characteristics with the total number of geriatric syndromes in 250 homeless adults aged 50 years and older. Geriatric syndromes included falls, cognitive impairment, frailty, major depression, sensory impairment, and urinary incontinence. A higher total number of geriatric syndromes was associated with having less than a high school education, medical comorbidities (diabetes and arthritis), alcohol and drug use problems, and difficulty performing one or more activities of daily living. Clinicians who care for older homeless patients with these characteristics should consider screening them for geriatric syndromes. Moreover, this study identifies potentially modifiable risk factors associated with the total number of geriatric syndromes in older homeless adults. This knowledge may provide targets for clinical interventions to improve the health of older homeless patients.
Research demonstrates that homelessness is associated with frequent use of emergency department (ED) services, yet prior studies have not adequately examined the relationship between frequent ED use ...and utilization of non-ED health care services among those experiencing homelessness. There has also been little effort to assess heterogeneity among homeless individuals who make frequent use of ED services. To address these gaps, the present study used Medicaid claims data from 2010 to estimate the association between the number of ED visits and non-ED health care costs for a cohort of 6,338 Boston Health Care for the Homeless Program patients, and to identify distinct subgroups of persons in this cohort who made frequent use of ED services based on their clinical and demographic characteristics. A series of gamma regression models found more frequent ED use to be associated with higher non-ED costs, even after adjusting for demographic and clinical characteristics. Latent class analysis was used to examine heterogeneity among frequent ED users, and the results identified 6 characteristically distinct subgroups among these persons. The subgroup of persons with trimorbid illness had non-ED costs that far exceeded members of all 5 other subgroups. Study findings reinforce the connection between frequent ED use and high health care costs among homeless individuals and suggest that different groups of homeless frequent ED users may benefit from interventions that vary in terms of their composition and intensity.
The prescription opioid crisis has involved all sectors of U.S. society, affecting every community, socioeconomic group, and age group. While federal and state agencies are actively working to deal ...with the epidemic, medical and dental providers have been tasked to increase their awareness of the issues and consider ways to safely prescribe opioids and, at the same time, effectively treat their patients’ pain. The Commonwealth of Massachusetts, under the leadership of Governor Charles D. Baker and his administration, challenged the state's four medical schools and three dental schools to improve their curricula to prepare the next generation of clinicians to deal with this crisis in an evidence‐based, effective, and sympathetic way. This Perspectives article outlines the national prescription opioid crisis, details its effects in Massachusetts, and describes the interdisciplinary collaboration among the Commonwealth, the three dental schools, the Massachusetts Dental Society, and a concerned student group. The article also describes the efforts each dental school is undertaking as well as an assessment of the challenges and limitations in implementing the initiative. The authors hope that the Massachusetts model will be a useful resource for dental schools in other states.
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