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School Disengagement as a Predictor of Dropout, Delinquency, and Problem Substance Use During Adolescence and Early Adulthood
Over the past 5 years, a great deal of attention has been paid to the development of early warning systems for dropout prevention. These warning systems use a set of indicators based on official school records to identify youth at risk for dropout and then appropriately target intervention. The current study builds on this work by assessing the extent to which a school disengagement warning index predicts not only dropout but also other problem behaviors during middle adolescence, late adolescence, and early adulthood. Data from the Rochester Youth Development Study (N = 911, 73% male, 68% African American, and 17% Latino) were used to examine the effects of a school disengagement warning index based on official 8th and 9th grade school records on subsequent dropout, as well as serious delinquency, official offending, and problem substance use during middle adolescence, late adolescence, and early adulthood. Results indicate that the school disengagement warning index is robustly related to dropout as well as serious problem behaviors across the three developmental stages, even after controlling for important potential confounders. High school dropout mediates the effect of the warning index on serious problem behaviors in early adulthood.
Journal Article
Beyond a Moment — Reckoning with Our History and Embracing Antiracism in Medicine
To go beyond declarations and move forward with fighting racism in medicine, we must understand the racial biases in our responses to past and present public health issues and plot an ethically and structurally different path to a new future.
Journal Article
Teaching Structure: A Qualitative Evaluation of a Structural Competency Training for Resident Physicians
BackgroundThe influence of societal inequities on health has long been established, but such content has been incorporated unevenly into medical education and clinical training. Structural competency calls for medical education to highlight the important influence of social, political, and economic factors on health outcomes.AimThis article describes the development, implementation, and evaluation of a structural competency training for medical residents.SettingA California family medicine residency program serving a patient population predominantly (88 %) with income below 200 % of the federal poverty level.ParticipantsA cohort of 12 residents in the family residency program.Program DescriptionThe training was designed to help residents recognize and develop skills to respond to illness and health as the downstream effects of social, political, and economic structures.Program EvaluationThe training was evaluated via qualitative analysis of surveys gathered immediately post-training (response rate 100 %) and a focus group 1 month post-training (attended by all residents not on service).DiscussionResidents reported that the training had a positive impact on their clinical practice and relationships with patients. They also reported feeling overwhelmed by increased recognition of structural influences on patient health, and indicated a need for further training and support to address these influences.
Journal Article
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. We aimed to describe the loneliness experience among homeless-experienced older adults with cognitive and functional impairments and the individual, social, and structural conditions that shaped these loneliness experiences.
Methods
We purposively sampled 22 older adults from the HOPE HOME study, a longitudinal cohort study among adults aged 50 years or older experiencing homelessness in Oakland, California. We conducted in-depth interviews about participants perceived social support and social isolation. We conducted qualitative content analysis.
Results
Twenty participants discussed loneliness experience, who had a median age of 57 and were mostly Black (80%) and men (65%). We developed a typology of participants’ loneliness experience and explored the individual, social, and structural conditions under which each loneliness experience occurred. We categorized the loneliness experience into four groups: (1) “lonely– distressed”, characterized by physical impairment and severe isolation; (2) “lonely– rather be isolated”, reflecting deliberate social isolation as a result of trauma, marginalization and aging-related resignation; (3) “lonely– transient”, as a result of aging, acceptance and grieving; and (4) “not lonely”– characterized by stability and connection despite having experienced homelessness.
Conclusions
Loneliness is a complex and heterogenous social phenomenon, with homeless-experienced older adults with cognitive or functional impairments exhibiting diverse loneliness experiences based on their individual life circumstances and needs. While the most distressing loneliness experience occurred among those with physical impairment and mobility challenges, social and structural factors such as interpersonal and structural violence during homelessness shaped these experiences.
Journal Article
Using alone at home: What’s missing in housing-based responses to the overdose crisis?
Background
Against the backdrop of North America’s overdose crisis, most overdose deaths are occurring in housing environments, largely due to individuals using drugs alone. Overdose deaths in cities remain concentrated in marginal housing environments (e.g., single-room occupancy housing, shelters), which are often the only forms of housing available to urban poor and drug-using communities. This commentary aims to highlight current housing-based overdose prevention interventions and to situate them within the broader environmental contexts of marginal housing. In doing so, we call attention to the need to better understand marginal housing as sites of overdose vulnerability and public health intervention to optimize responses to the overdose crisis.
Harm reduction and overdose prevention in housing
In response to high overdose rates in marginal housing environments several interventions (e.g., housing-based supervised consumption rooms, peer-witnessed injection) have recently been implemented in select jurisdictions. However, even with the growing recognition of marginal housing as a key intervention site, housing-based interventions have yet to be scaled up in a meaningful way. Further, there have been persistent challenges to tailoring these approaches to address dynamics within housing environments. Thus, while it is critical to expand coverage of housing-based interventions across marginal housing environments, these interventions must also attend to the contextual drivers of risks in these settings to best foster enabling environments for harm reduction and maximize impacts.
Conclusion
Emerging housing-focused interventions are designed to address key drivers of overdose risk (e.g., using alone, toxic drug supply). Yet, broader contextual factors (e.g., drug criminalization, housing quality, gender) are equally critical factors that shape how structurally vulnerable people who use drugs navigate and engage with harm reduction interventions. A more comprehensive understanding of these contextual factors within housing environments is needed to inform policy and programmatic interventions that are responsive to the needs of people who use drugs in these settings.
Journal Article
Does Maltreatment Beget Maltreatment? A Systematic Review of the Intergenerational Literature
In this article, the authors critically review the literature testing the cycle of maltreatment hypothesis which posits continuity in maltreatment across adjacent generations. That is, the authors examine whether a history of maltreatment victimization is a significant risk factor for the later perpetration of maltreatment. The authors begin by establishing 11 methodological criteria that studies testing this hypothesis should meet. They include such basic standards as using representative samples, valid and reliable measures, prospective designs, and different reporters for each generation. The authors identify 47 studies that investigated this issue and then evaluate them with regard to the 11 methodological criteria. Overall, most of these studies report findings consistent with the cycle of maltreatment hypothesis. Unfortunately, at the same time, few of them satisfy the basic methodological criteria that the authors established; indeed, even the stronger studies in this area only meet about half of them. Moreover, the methodologically stronger studies present mixed support for the hypothesis. As a result, the positive association often reported in the literature appears to be based largely on the methodologically weaker designs. Based on this systematic methodological review, the authors conclude that this small and methodologically weak body of literature does not provide a definitive test of the cycle of maltreatment hypothesis. The authors conclude that it is imperative to develop more robust and methodologically adequate assessments of this hypothesis to more accurately inform the development of prevention and treatment programs.
Journal Article
How Anti-Immigrant Policies Impact Research Among Latinx and Undocumented People Who Use Drugs
Since January 2025, anti-immigrant policies, criminalization, and xenophobic rhetoric have rapidly intensified, threatening the health and well-being of Latinx communities. Under new executive orders, funding and research related to racial health disparities and equity is being scaled back or halted. The negative effects of immigration enforcement on the health of Latinx communities have been well documented. Less is known about how the implementation of these policies and associated anti-immigrant rhetoric impacts researchers’ ability to conduct health equity science among vulnerable Latinx communities. The current anti-immigrant political climate is likely to have detrimental effects on health equity research and lead to increases in morbidity and mortality among Latinx people who use drugs (PWUD). This analytic essay draws on data from 4 case studies of research with Latinx PWUD residing in 3 US states. We discuss how anti-immigration policies and xenophobic rhetoric affect the ability to conduct research with Latinx PWUD. We offer strategies to support the continuation of health equity research in the context of an increasingly hostile sociopolitical landscape. ( Am J Public Health. 2025;115(11):1877–1886. https://doi.org/10.2105/AJPH.2025.308234 )
Journal Article
Recent Violence in a Community-Based Sample of Homeless and Unstably Housed Women With High Levels of Psychiatric Comorbidity
Objectives. We determined associations between co-occurring psychiatric conditions and violence against homeless and unstably housed women. Methods. Between 2008 and 2010, we interviewed homeless and unstably housed women recruited from community venues about violence, socioeconomic factors, and psychiatric conditions. We used multivariable logistic regression to determine independent correlates of violence. Results. Among 291 women, 97% screened positive for 1 or more psychiatric conditions. Types of violence perpetrated by primary partners and persons who were not primary partners (non–primary partners) included emotional violence (24% vs 50%; P < .01), physical violence (11% vs 19%; P < .01), and sexual violence (7% vs 22%; P < .01). The odds of primary partner and non–primary partner violence increased with each additional psychiatric diagnosis and decreasing levels of social isolation. Conclusions. All types of violence were more commonly perpetrated by non–primary partners, suggesting that an exclusive focus on domestic violence screening in health care or social service settings will miss most of the violence in this population. Contrary to some previous studies, the odds of violence decreased as social isolation increased, suggesting that social isolation may be protective in homeless and unstably housed communities with high levels of comorbidity and limited options.
Journal Article
Structural Adaptations to Methadone Maintenance Treatment and Take-Home Dosing for Opioid Use Disorder in the Era of COVID-19
Societal disruption from the COVID-19 pandemic has accelerated the opioid overdose epidemic. Given the drastic increase in opioid overdose deaths during the pandemic, particularly within Black communities,1 it is important to reflect on the state of opioid addiction treatment in the United States. When COVID-19 was declared a public health emergency, more than 400 000 individuals were receiving methadone maintenance treatment (MMT) for opioid use disorder (OUD) across the 50 states, the District of Columbia, and US territories including Puerto Rico.2 Individuals receiving MMT, a gold standard for OUD treatment, have lower rates of death and nonprescribed opioid use than those not receiving treatment and exhibit better treatment retention.3Despite these benefits, many structural barriers exist in accessing MMT, in large part because of decades of racist policies and political scapegoating (e.g., criminalizing those with substance use disorders and being \"tough on crime\" through harsh drug policies for political gain).4 Methadone dispensing is tightly regulated, and the medication can be dispensed only at opioid treatment programs (OTPs) overseen by the Substance Abuse and Mental Health Services Administration (SAMHSA), the Drug Enforcement Administration, and state governments. When used in the treatment of OUD, no other prescription medication is as tightly regulated as methadone.
Journal Article