Delaware journal of public health最新文献

Objective: In this article, we examine the issue of LGBTQ+ youth homelessness in Delaware, summarize current services available and prior research work that has been done, examining the number, needs, and experiences of unaccompanied unhoused LGBTQ+ youth.

Methods: We provide a literature review detailing risks associated with LGBTQ+ youth homelessness, resources available, and prior studies and surveys examining this population.

Results: LGBTQ+ youth experiencing homelessness are particularly vulnerable to physical and mental health challenges, abuse, and violence. The unique needs of this population necessitate specialized resources, yet there are a limited number of such resources available in Delaware and a dearth of information on youth homelessness in general, including LGBTQ+ youth. For example, administrative barriers exist for unaccompanied queer youth seeking shelter services, such as need for legal identification or being grouped in shelter populations based on sex assigned at birth rather than gender identity. Exposure to unsafe environments is a general problem for queer youth. This can make public spaces feel unsafe and increase risk of physical or mental harm, mistreatment, or abuse when seeking shelter outside of agency services and resources. In order to accurately identify and appropriately serve this population, additional research is necessary.

Conclusions: Evidence building is a critical first step in creating an effective study to examine the issue of LGBTQ+ youth homelessness in Delaware. With the evidence acquired in our literature review our next step to establish an informed methodology is to hold service provider and LGBTQ+ lived experience focus groups. Through a qualitative approach we aim to learn how to appropriately utilize the quantitative tools identified in our analysis and to assess what questions are missing to advance the needs of this population.

Objective: Assess differences in postpartum contraceptive use and pregnancy intentions in women with a recent live birth who delivered a neonatal abstinence syndrome (NAS) affected infant.

Study design: Using linked Delaware Birth Certificate Data, Hospital Discharge Data and PRAMS data for 2012-2018 (n = 6,358 singleton births), we assessed differences among women with and without a delivery of an NAS-affected infant by effective postpartum contraceptive use and pregnancy intentions. We calculated prevalence estimates, crude (cPOR), and prevalence odds ratios adjusted (aPOR) for NAS by maternal characteristics. We used alpha ≤ 0.05 to determine statistical significance.

Results: Prevalence of NAS was 2.2% (95% CI: 1.8 - 2.6). Effective postpartum contraceptive use was 60.4% (95% CI: 51.9-69.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 56.4% (95% CI: 55.1-57.8%) and cPOR was 1.2 (95% CI: 0.8-1.7). Prevalence of intended pregnancy was 26.5% (95% CI: 18.9-34.0) among women with delivery of an NAS-affected infant compared with a non-NAS delivery 53.0% (95% CI: 51.7-54.4) and cPOR was 0.3 (95% CI: 0.2-0.5). After adjustment, women who delivered an NAS-affected infant had lower odds (aPOR = 0.5; 95% CI: 0.3-0.8) of indicating that their pregnancy was intended as compared to those who did not deliver an NAS-affected infant.

Conclusions: Our study found no association between delivery of an NAS-affected infant and use of an effective postpartum contraceptive method. However, we found that pregnancy intendedness was lower among women delivering an NAS-affected infant compared with women without an NAS delivery even after accounting for maternal characteristics.

Objectives: This study investigates different approaches to integrating evictions data with Medicaid and homeless shelter utilization records at the individual level for the state of Delaware. We especially focus on evaluating the feasibility of creating an integrated dataset focused on children and adolescents through different approaches to matching.

Methods: We attempt to link existing statewide records on evictions, Medicaid, and shelter from 2017-2019. We first compare direct match and probabilistic match approaches to linking evictions and Medicaid records, and then incorporate shelter records. Finally, we consider a limited set of characteristics relevant to potential future public health research among children who experienced eviction, had a shelter stay, and were enrolled in Medicaid.

Results: Direct matching resulted in a lower match (14%) rate than probabilistic matching (22%) of eviction records to Medicaid data. Homeless shelter records had a high match rate to Medicaid records, even when using a direct match (75%). A sizeable subset of children (n=216) were linked across the three data sources, though this was from a small percentage of cases in the evictions data. Among this subset of children, most (71%) were enrolled in Medicaid in all three years considered by this study and Black children were greatly overrepresented (75%).

Conclusions: Integrating evictions records with other health and human service data involves a number of challenges. Probabilistic matching yielded a considerably higher number of matches after manual review, resulting in a possible study sample of children who have experienced eviction, a homeless shelter stay, and were enrolled in Medicaid. Strategies to increase the match rate for eviction records through using records from other, more universal services may be necessary for investigations that require more comprehensive coverage of the population.

This Commentary introduces the reality of the benefits cliff into the housing and health relationship. Improving both housing and health requires addressing the benefits cliff facing extremely low- and low-income people. Those living below the poverty line are at greatest risk of poor, inadequate, and unhealthy living conditions. They are also the group most at risk for losing benefits and economic supports on their journey toward economic self-sufficiency. Addressing the housing crisis in Delaware demands that we recognize the benefits cliff looming on the horizon for extremely low- and low-income families struggling toward self-sufficiency. Effective policies and interventions, at a minimum, need to be informed by the experiences of those struggling to navigate the benefits cliff and achieve economic mobility and need to be integrated across housing, economic benefits, and health care.

The authors provide an assessment of trends and dynamics of homelessness in Delaware since 2007, when the last systematic study of this topic was released. Using population data on homelessness in the state, the authors present evidence that, after a period of apparent stability, homelessness in Delaware is currently at levels that are unprecedentedly high, while providers of homeless services have not adapted to this change. As a first step to addressing this alarming trend, the authors call for stakeholders to regroup and develop a coordinated, statewide approach to address this problem.

Jefferson Street Center (JSC) implements community-driven priorities that support quality of life, improved community health and neighborhood vitality in Northwest Wilmington. JSC serves as a Connector and Capacity Builder in the Washington Heights Blueprint Community® and its surrounding neighborhoods and responds to the needs of residents and stakeholders. The organization focuses on two implementation strategies: opening of a shared-use community hub, in partnership with Hanover Presbyterian Church, and channeling resources to implement place-based revitalization projects and initiatives. These strategies focus on long-term efforts to cultivate place-based asset growth, aiming to alleviate poverty, promote housing stabilization and grow civic muscle. These strategies are also specific tactical responses to the public health concerns of the residents and stakeholders in Northwest Wilmington.

Objective: To quantify potential flood-related access disruptions to medication-assisted treatment for opioid use disorder (OUD) among Delawareans.

Methods: Spatial flood risk maps and infrastructure, services, and hazard risk, transportation networks, opioid treatment programs (OTPs) for the State of Delaware were integrated to visually display the relationship between these layers. A complex network theory-based simulation model was used to assess both direct (e.g., inundation with flood water) and indirect (e.g., isolation) impacts of floods.

Results: Delaware is at increasing risk from flooding associated with storms and sea-level rise, which can lead to sunny day flooding during high tides. Of the 18 OTPs in Delaware, 4 are expected to be flooded in a 100-year flood and 7 are expected to be severely disrupted, increasing to 9 by 2035 and to 10 by 2050, with service reachability less than 15 square miles due to flood-induced isolation.

Conclusions: Individuals utilizing OTPs for OUDs must be able to access treatment programs regardless of external disruptors like floods. Because these programs require consistent treatment adherence and in-person oversight by clinicians, timely restoration of services and continuity of operations for treatment facilities in post-disaster settings is critical for treatment compliance.

Policy implications: The State of Delaware has the third highest rate of drug overdose mortality in the U.S., with three-quarters of all drug-related deaths involving opioids. Impeded access to opioid treatment during a flood disaster can lead to relapse, overdose, and death. Hazard planning must develop policies and practices to address these risks.

This study provides an in-depth analysis of homelessness among people on the Delaware Sex Offender Registry (SOR) between 2021 and 2023. Delaware's SOR, as a publicly accessible database, offers a uniquely comprehensive window into an unsheltered population among a group that is, collectively, at high risk of experiencing homelessness. We retrieved data from the Delaware SOR on two separate dates, which allowed us to track homelessness among offenders within the state over time. On November 15, 2021, 4.6 percent of the persons on the SOR were homeless. Fifteen months later, this homeless prevalence rate was 5.5 percent. Of the 120 people who reported homelessness on the November date, 56 of them (46.7 percent) were either still homeless or again homeless fifteen months later. This prevalence is significantly higher than rates among the general population, and, once homeless, a substantial proportion remained homeless for extended periods of time. The high rate of unsheltered homelessness among people on the Delaware SOR emphasizes the shortcomings in Delaware's ability to supply shelter for homeless individuals, as well as the additional restrictions people on the SOR experience in their ability to receive these services, which creates hardship for these individuals and reduces communal public safety by increasing the frequency of absconding.

In a small state, collaboration is imperative to address complex public policy programs. In Delaware, homelessness is one of the state's most complex problems. The Delaware State Housing Authority (DSHA) and the Federal Home Loan Bank of Pittsburgh's (FHLBank) Home4Good program is a case study in how, through collaboration, innovative homelessness solutions can be implemented to help unhoused members of our community find stable housing. This commentary will outline the Home4Good program and explain its success. Finally, the commentary will speak to the need to continue working together to further assist Delaware's homeless population.

Objective: To determine the prevalence of clients experiencing homelessness in publicly funded substance use and mental health services in Delaware and uncover basic patterns in the demographics and service access of said clients.

Methods: We analyzed Consumer Reporting Form data for clients admitted to publicly funded substance use and mental health treatment. All clients who were admitted to services from a publicly-funded provider and completed the CRF between 2019 and 2021 were included in this analysis (n=29,495).

Results: 5,717 clients (19%) reported experiencing homelessness. 20% of men reported homelessness, compared to 18% of women, and 22% of Black clients reported homelessness, compared to 19% of White clients. 48% of admissions were to substance use treatment, 29% were to mental health treatment, and 23% were to treatment for both.

Conclusions: Nearly one-fifth of clients who received publicly funded treatment between 2019 and 2021 reported experiencing homelessness, a vast overrepresentation when compared against the less than 1% of the population who was counted as homeless through the annual PIT count in Delaware.

Policy implications: Homelessness can be experienced across the lifespan and impacts individuals and families of all demographic makeups. Individuals are often unable to access primary care, insurance supported services, and chronic disease management teams resulting in a disproportionately high use of emergency services and departments for acute needs.