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Drawing on more than 150 in-depth interviews, Becoming Strong: Impoverished Women and the Struggle to Overcome Violence explores the diverse effects of trauma in the lives of homeless female victims of violence. Laura Huey and Ryan Broll closely examine the negative patterns common to cases of homeless female victims of violence and develop informed solutions for responding to issues that perpetuate cycles of female homelessness. Becoming Strong offers not only a comprehensive examination of trauma and the role it can play in shaping homeless women’s lives, but it also explores how women may recover and develop strategies for coping with traumatic experiences.

There is little doubt among scientists and the general public that homelessness, mental illness, and addiction are inter-related. InOf Others Inside, Darin Weinberg examines how these inter-relations have taken form in the United States. He links the establishment of these connections to the movement of mental health and addiction treatment from redemptive processes to punitive ones and back again, and explores the connection between social welfare, rehabilitation, and the criminal justice system.Seeking to offer a new sociological understanding of the relationship between social exclusion and mental disability,Of Others Insideconsiders the general social conditions of homelessness, poverty, and social marginality in the U.S. Weinberg also explores questions about American perceptions of these conditions, and examines in great detail the social reality of mental disability and drug addiction without reducing people's suffering to simple notions of biological fate or social disorder.

In the United States, adverse pregnancy outcomes, including hypertension before pregnancy (HTN), pregnancy-induced hypertension (PIH) [gestational hypertension and preeclampsia] and gestational diabetes mellitus (GDM) continue to increase. Stressful life events (SLEs) such as serious illness, divorce, are known to impact adverse birth outcomes, e.g., preterm birth, especially among Black women, low-income women, and other minority women than White women. However, there is limited evidence on SLEs adverse pregnancy outcomes. Therefore, the objective of this study is to provide an overview of trends in stressful life events from 2009 to 2020 and their impacts on hypertension before pregnancy, pregnancy-induced hypertension, and gestational diabetes mellitus in the United States and to understand these effects by race/ethnicity. A secondary analysis of Centers for Disease Control and Prevention national Pregnancy Risk Assessment Monitoring System data from 2009 to 2020 was performed. SLEs, HTN before pregnancy, PIH, and GDM, were examined with data visualizations and multivariable weighted log-binomial modeling. Any SLE prevalence was 66% to 72%, with Black women having higher SLEs than White women. SLE was associated with HTN before pregnancy (ARR = 1.082), PIH (ARR = 1.059), and GDM (ARR = 1.030). Effects of race/ethnicity differed across these outcomes. Greater SLE is associated with adverse pregnancy outcomes. Black women continue to experience higher SLEs and are at higher risk of HTN before pregnancy and PIH. The findings of this study indicate there is an interplay between SLEs, HTN before pregnancy, PIH, and GDM, as well as race/ethnicity. This information is vital for public health efforts to reduce the disparities in adverse pregnancy outcomes.

Objectives. We comprehensively assessed health care utilization in a population-based sample of homeless adults and matched controls under a universal health insurance system. Methods. We assessed health care utilization by 1165 homeless single men and women and adults in families and their age- and gender-matched low-income controls in Toronto, Ontario, from 2005 to 2009, using repeated-measures general linear models to calculate risk ratios and 95% confidence intervals (CIs). Results. Homeless participants had mean rates of 9.1 ambulatory care encounters (maximum = 141.1), 2.0 emergency department (ED) encounters (maximum = 104.9), 0.2 medical–surgical hospitalizations (maximum = 14.9), and 0.1 psychiatric hospitalizations per person-year (maximum = 4.8). Rate ratios for homeless participants compared with matched controls were 1.76 (95% CI = 1.58, 1.96) for ambulatory care encounters, 8.48 (95% CI = 6.72, 10.70) for ED encounters, 4.22 (95% CI = 2.99, 5.94) for medical–surgical hospitalizations, and 9.27 (95% CI = 4.42, 19.43) for psychiatric hospitalizations. Conclusions. In a universal health insurance system, homeless people had substantially higher rates of ED and hospital use than general population controls; these rates were largely driven by a subset of homeless persons with extremely high-intensity usage of health services.

Objectives. To characterize housing instability among transgender veterans using Veterans Health Administration (VHA) health care in the United States. Methods. We used administrative data on veterans screened for housing instability from 2013 to 2016; participants included 5717 transgender veterans and 17 133 cisgender veterans. We defined housing instability by a positive screen or VHA Homeless Program use. We identified gender from medical records, reflecting either birth sex or gender identity. We identified transgender identity through transgender-related International Classification of Diseases, Ninth Revision and Tenth Revision codes. A multiple logistic regression assessed the association of transgender identity with housing instability. Results. Prevalence of housing instability was nearly 3 times higher among transgender veterans than among cisgender veterans (19.9% vs 6.7%; P < .001). The difference persisted when we adjusted for sociodemographics (adjusted odds ratio = 2.32; 95% confidence interval = 2.09, 2.57). Transgender veterans experiencing housing instability were more likely than cisgender veterans to be women, younger, unmarried, and White. Conclusions. Transgender veterans experience housing instability more frequently than do cisgender veterans. An increased focus on transgender identity is critical for reducing veteran homelessness.

Food insecurity is associated with numerous adverse health outcomes. The US Veterans Health Administration (VHA) began universal food insecurity screening in 2017. This study examined prevalence and correlates of food insecurity among Veterans screened. Retrospective cross-sectional study using VHA administrative data. Multivariable logistic regression models were estimated to identify sociodemographic and medical characteristics associated with a positive food insecurity screen. All US Veterans Administration (VA) medical centres (n 161). All Veterans were screened for food insecurity since screening initiation (July 2017-December 2018). Of 3 304 702 Veterans screened for food insecurity, 44 298 were positive on their initial screen (1·3 % of men; 2·0 % of women). Food insecurity was associated with identifying as non-Hispanic Black or Hispanic. Veterans who were non-married/partnered, low-income Veterans without VA disability-related compensation and those with housing instability had higher odds of food insecurity, as did Veterans with a BMI < 18·5, diabetes, depression and post-traumatic stress disorder. Prior military sexual trauma (MST) was associated with food insecurity among both men and women. Women screening positive, however, were eight times more likely than men to have experienced MST (48·9 % v. 5·9 %). Food insecurity was associated with medical and trauma-related comorbidities as well as unmet social needs including housing instability. Additionally, Veterans of colour and women were at higher risk for food insecurity. Findings can inform development of tailored interventions to address food insecurity such as more frequent screening among high-risk populations, onsite support applying for federal food assistance programs and formal partnerships with community-based resources.

Background There has been increasing recognition that certain vulnerable populations in the United States of America struggle to meet their menstruation-related needs, including people experiencing homelessness. Media and policy attention on this subject has focused on the provision of free menstrual products to vulnerable populations, including a New York City legislative bill, which guarantees access to menstrual products for Department of Homeless Services shelter residents (Intros 1123-A). Methods This qualitative study explored the challenges people experiencing homelessness in New York City face in accessing menstrual products. Data collection was conducted from June to August 2019 and included: Semi-structured key informant interviews with staff from relevant government agencies and homeless service providers (n = 15), and semi-structured in-depth interviews with individuals with experience living on the street and in shelters (n = 22). Data were analysed using thematic analysis. Results Key themes that emerged included: (1) insufficient and inconsistent access to menstrual products; (2) systemic challenges to providing menstrual products; and (3) creative solutions to promote access to menstrual products. Both shelter- and street-living individuals reported significant barriers to accessing menstrual products. While both populations struggle, those in shelters were more likely to be able to purchase menstrual products or access free products at their shelter, while those living on the streets were more likely to have to resort to panhandling, theft, or using makeshift materials in place of menstrual products. Across both populations, individuals described barriers to accessing free products at shelters and service providers, primarily due to distribution systems that rely on gatekeepers to provide a few pads or tampons at a time, sometimes of inadequate quality and only upon request. Shelters and service providers also described challenges providing these products, including inconsistent supply. Conclusion These findings highlight the critical importance of expanding and improving initiatives seeking to provide access to menstrual products for vulnerable populations. Despite policy level efforts to support menstrual product access, individuals experiencing homelessness in New York City, whether living in shelters or on the street, are often not able to access the menstrual products that they need to manage their monthly menstrual flow.

Black women have higher rates of HIV than do White and Latina women. Additionally, numerous Black women face intersecting issues, such as intimate partner violence, trauma, homelessness, and mental health disorders. Gaps still exist in implementing culturally relevant or tailored interventions for Black women with HIV. Culturally relevant bundled intervention approaches are needed that address social determinants of health, link Black women with HIV to care, engage and retain them in care, and improve outcomes and quality of life. Central to this is building community partnerships, meaningfully involving Black women with lived experiences in decision-making regarding their care and treatment, and implementing intervention strategies. We show how Black authoritative knowledge centers Black women’s experiences and needs and promotes confidence to advocate for, empower, and inform others about their lives and health and how it becomes the basis of decision-making. We describe the use of authoritative knowledge in adapting and implementing strategies to uptake bundled evidence-informed interventions funded by the Minority HIV/AIDS Fund and the Health Resources and Services Administration’s HIV/AIDS Bureau Ryan White HIV/AIDS Program Special Projects of National Significance to help promote, shift, reimagine, and transform equitable HIV care for Black women. ( Am J Public Health. 2025;115(S1):S38–S45. https://doi.org/10.2105/AJPH.2024.307930 )

This study provides a description of the physical, psychological, and substance use problems of adult homeless women who are and are not caring for children. We also examined differences in the characteristics of these two groups of women. Interviews were conducted with 148 homeless women from three mid-sized U.S. cities, 24.3 % of whom were caring for at least one child. Our results showed that women caring for children were more likely to be sheltered and have health insurance. Homeless women caring for children and solitary homeless women were generally similar in terms of substance abuse problems. However, rates of Borderline Personality Disorder were higher among women caring for children than among solitary homeless women. Our results are somewhat consistent with previous research, with the exception of substance abuse problems and mental health problems, which were shown to be equally problematic for all women, regardless of current caregiving status.