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The main objective of this study was to examine how homelessness and housing instability is captured across data sources in the Veterans Health Administration (VHA). Data from 2021 were extracted from three data repositories, including the Corporate Data Warehouse (CDW), the Homeless Operations Management System (HOMES), and the Homeless Management Information System (HMIS). Using these three data sources, we identified the number of homeless and unstably housed veterans across a variety of indicators. The results showed that the use of diagnostic codes and clinic stop codes identified a large number of homeless and unstably housed veterans, but the use of HOMES and HMIS data identified additional homeless and unstably housed veterans to provide a complete count. A total of 290,431 unique veterans were identified as experiencing homelessness or housing instability in 2021 and there was regional variability in how homelessness and housing stability were captured across data sources, supporting the need for more uniform ways to operationalize these conditions. Together, these findings highlight the and encourage use of all available indicators and data sources to identify homelessness and housing instability in VHA. These methodologies applied to the largest healthcare system in the U.S. demonstrate their utility and possibilities for other healthcare systems. Transparent practices about data sources and indicators used to capture homelessness and housing instability should be shared to increase uniform use.

Place-based health interventions may help reach underserved populations. This scoping review summarizes the peer-reviewed literature on the type and effects of place-based health interventions in unconventional public-facing business settings (e.g., retail and services). A literature search was conducted in PubMed, Google Scholar, and APA PsycNet for studies from 1990–2023. Inclusion criteria for studies were: conducted in the United States, delivered a health intervention, based on an unconventional business setting, and targeted a specific health condition. An initial search yielded 2,727 unduplicated studies, which was filtered to 42 studies included in this review. These 42 studies were categorized based on health conditions of focus, including cardiovascular health (12 studies); HIV (6 studies); diabetes (5 studies); cancers (13 studies); and all other conditions (14 studies). The most common unconventional public-facing business settings for health interventions included barbershops or beauty salons; interventions included health education, preventative screenings, pharmacy services, and connections to local healthcare providers and resources. Notably, 34 (81%) of the studies targeted Black populations. Studies reported positive responses from participants for place-based interventions, increased awareness and screening of health conditions, more referrals to healthcare services, and improved health outcomes. While there have been 9 randomized trials conducted across various health conditions, these trials are limited to focus on a few select settings and lack of objective health outcome measures. These findings highlight the need for more rigorously designed studies in diverse settings that can effectively evaluate the impact of place-based health interventions. The existing literature suggests health interventions delivered in public-facing business settings may be a promising strategy to reach underserved populations.

[This corrects the article DOI: 10.1371/journal.pone.0279973.].

Housing can be an important social determinant of mental health, which is why it is important to understand how mental health disorders (MHDs) and substance use disorders (SUDs) cluster and vary by housing instability. This study examined rates of comorbid MHDs and SUDs among three groups of U.S. veterans: those experiencing homelessness, those in supported housing, and those independently housed. Administrative data on a national cohort of 5,402,062 veterans (including 181,131 homeless veterans and 29,166 veterans in supported housing) enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system from 2021 to 2023 were analyzed. Among homeless veterans, 28.3% had a SUD diagnosis, 62.9% a MHD diagnosis, and 24.7% comorbid MHD/SUD. Among veterans in supported housing, 38.2% had a SUD diagnosis, 67.3% a MHD diagnosis, and 32.0% comorbid MHD/SUD diagnoses. Among independently housed veterans, 7.9% had a SUD diagnosis, 41.6% a MHD diagnosis, and 5.8% comorbid MHD/SUD diagnoses. Homeless veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than veterans in supported housing; in turn, supported housing veterans with comorbid MHD/SUD used significantly more outpatient, inpatient, and emergency department care than independently housed veterans. Among homeless veterans with comorbid MHD/SUD diagnoses, those with addiction to central nervous system (CNS) stimulants used more outpatient, inpatient, and emergency department care than those with addiction to CNS depressants. In conclusion, the psychiatric epidemiology and comorbidity of veterans varies by housing situation, and there is continued need for psychiatric treatment among homeless veterans who enter supported housing.

For more than two decades since the development of the Housing First model, there have been debates about the model's effectiveness in serving individuals experiencing homelessness. Although the Housing First model has various fidelity standards, its hallmark feature is the provision of immediate access to permanent, subsidized, independent housing with no prerequisites such as mandating treatment participation or requiring sobriety. This feature is theorized to provide an effective pathway for homeless individuals to achieve positive outcomes. Various time-trend analyses have been conducted showing that increases and decreases in homelessness have coincided with increases and decreases in housing vouchers, housing units, or implementation of the Housing First model during the same period. However, the old adage remains true that \"correlation does not equal causation,\" and these analyses are subject to threats to internal validity, such as history effects or other confounding factors occurring concurrently. Instead, one should look to the gold standard of research designs-the randomized controlled trial. I provide a brief synthesis of the evidence (or lack thereof) from randomized controlled trials for the Housing First model to further discussions and inform policymaking.

Abstract Background Homelessness remains a major public health problem in the USA but there have been few recent epidemiological studies in the general population. Methods Using data from structured interviews with a nationally representative sample of 36 299 US adults from the 2012–13 Wave 3 of the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC-III), this study examined the lifetime and 1-year prevalence of homelessness, and its correlates. Results Lifetime and 1-year prevalence of homelessness in the US population was found to be 4.2 and 1.5%, respectively. Low income, debt, borderline personality disorder (PD), past-year tobacco use disorder, any history of suicidal attempts and being a victim of crime in the past year were all independently strongly associated with past-year homelessness (all OR > 1.5). Low income, debt, history of incarceration, antisocial PD and any history of suicidal attempts were all independently strongly associated with lifetime homelessness (all OR > 1.5). Conclusions These findings provide an update to the original NESARC, suggesting a possible increase in lifetime homelessness (2.7–4.2%) in the past decade. Along with known economic and behavioral health conditions, special attention should be paid to PDs in efforts to prevent and end homelessness.

Few studies have examined heterogeneous associations of risk factors with Coronavirus Disease-2019 (COVID-19) symptoms by type. The objectives of this study were to estimate the prevalence of and risk factors associated with COVID-19 symptoms and to investigate whether the associations differ by the type of symptoms. This study obtained longitudinal data over 6 months from laboratory-confirmed COVID-19 cases in a citywide sample in San Antonio. Sixteen symptoms of COVID-19 infection, measured at baseline and three follow-up times (1, 3, and 6 months), were analyzed using generalized estimating equations (GEE) to investigate potential risk factors while accounting for the repeated measurements. The risk factors included time in months, sociodemographic characteristics, and past or current medical and psychiatric conditions. To obtain interpretable results, we categorized these sixteen symptoms into five categories (cardiopulmonary, neuro-psychological, naso-oropharyngeal, musculoskeletal, and miscellaneous). We fitted GEE models with a logit link using each category as the outcome variable. Our study demonstrated that the associations were heterogeneous by the categories of symptoms. The time effects were the strongest for naso-oropharyngeal symptoms but the weakest for neuro-psychological symptoms. Female gender was associated with increased odds of most of the symptoms. Hispanic ethnicity was also associated with higher odds of neuro-psychological, musculoskeletal, and miscellaneous symptoms. Depression was the most robust psychiatric condition contributing to most of the symptoms. Different medical conditions seemed to contribute to different symptom expressions of COVID-19 infection.

ObjectivesFunctional limitations may be associated with firearm ownership among veterans by amplifying perceptions of vulnerability and the need for security, yet their role remains underexplored despite emerging research on health-related factors influencing firearm acquisition in this group. This study examines the relationship between the number of functional limitations and recent firearm purchasing among a sample of low-income US military veterans.MethodsData are from the National Veteran Homeless and Other Poverty Experiences (NV-HOPE) study, which surveyed US veterans in households under 300% of the US federal poverty level. The survey was conducted in December 2022 and January 2023 (n = 1,008). Functional limitations were assessed based on self-reported assistance needed in daily tasks. Multiple logistic regression was used to analyze the association between functional limitations and firearm purchases in the past year, adjusting for demographic and socioeconomic factors. Analyses were conducted in Stata v. 18, and statistical significance was determined at the p < 0.05 threshold.Results5.5% of respondents reported purchasing a firearm in the past year. Increased functional limitations were positively associated with recent firearm purchases (Adjusted Odds Ratio [aOR] = 1.14, 95% Confidence Interval [CI] = 1.03, 1.26). Sensitivity using Firth Logit for rare events confirmed the robustness of this finding.DiscussionVeterans experiencing a greater number of functional limitations are more likely to report recently purchasing a firearm. These findings underscore the importance of addressing health needs among firearm-owning veterans through VA programs that support disabled veterans and their caregivers.

Background The high prevalence of substance use disorders (SUDs) among incarcerated adults in the U.S. is well-known, but there has been less examination of SUD treatment and rates of incarceration among the population of adults with SUDs as the denominator. The current study uses a population-based sample to address three questions: (1) What is the rate of lifetime incarceration among the population of U.S. adults with SUDs?; (2) Among adults with SUDs, what proportion of those with incarceration histories use SUD treatment compared to those without incarceration histories?; and (3) What individual characteristics are associated with utilization of SUD treatment among adults with incarceration histories? Methods Data were based on the National Epidemiologic Survey on Alcohol and Related Conditions-III which surveyed a nationally representative sample of U.S. adults through structured interviews. This study focused on the 10,853 respondents who had any lifetime SUD, including 2670 (weighted 22.4%) who reported a lifetime history of incarceration. Results In the total weighted sample of respondents with SUDs, 22% had been incarcerated before but only 37% had used any alcohol use disorder treatment and 18% had used drug use disorder treatment. Controlling for confounding variables, respondents with SUDs and incarceration histories had 3.1 times the odds of using alcohol use disorder treatment and 1.6 times the odds of using drug use disorder treatment compared to their counterparts with SUDs and no incarceration histories. Having an opioid use disorder, especially heroin use disorder, and a stimulant use disorder, such as cocaine use disorder, had strong associations with any SUD treatment use. Conclusions Many U.S. adults with SUDs have histories of incarceration but only a minority use any SUD treatment. Public health approaches that increase access and incentives to engage in and complete SUD treatment may help resolve problems of both incarceration and SUDs in the population.

BackgroundThe Coronavirus Aid, Relief, and Economic Security Act of 2020 provided ‘economic impact payments’ (EIPs) of $1200 to US adults with annual personal income of $75 000 or less. This study examined the prospective association between EIP receipt and mental health outcomes.MethodsA nationally representative sample of 3169 middle-income and low-income US adults completed a baseline assessment of their health and well-being in May–June 2020 and a 3-month follow-up assessment during the period of the COVID-19 pandemic when EIPs were distributed.ResultsControlling for sociodemographic characteristics, EIP recipients had higher odds of reporting a positive COVID-19 test, endorsing a history of post-traumatic stress disorder and reporting any illicit drug use in the past month than participants who did not receive EIP. Participants who did not receive EIP were more likely to report a history of anxiety disorder or alcohol use disorder and recent suicidal ideation than EIP recipients. There was no association between EIP receipt and financial distress, although over one-third to over half of EIP recipients were not employed at baseline. Between baseline and 3-month follow-up, receipt of EIP was significantly associated with reduced medical conditions and alcohol use problems, but increased depression, suicidal ideation and COVID-19 era-related stress.ConclusionThe EIP provided a brief income stimulus to many adults in need but was not associated with improvements in financial distress or mental health among middle-income and low-income recipients. Long-term income security and employment may be more important to improving and sustaining positive mental health outcomes.