Faculty Bibliography

Background The first five years of life are critical for optimal growth, health and cognitive development during which ~90% of brain development occurs. However, many children experience poverty and/or homelessness. Data from 2019 suggested there could be more than 210,000 homeless children in temporary accommodation (TA) or sofa surfing, and ~585,000 who are either homeless or at risk of becoming homeless in England. Objectives To explore the housing environmental barriers to optimal health for children under the age of five (U5s) experiencing homelessness and living in TA. Methods The study employed a mixed-methods, participatory design integrating citizen science to identify housing-level barriers to achieving optimal health. Participants were mothers of U5s living in TA, and conveniently sampled at a local charity providing support to U5s experiencing homelessness in Newham, London. Newham has the highest number of children in TA in England (1 in 12 children are homeless) and 1 in 2 children live in poverty. The study had two parts (i) Housing Survey and (ii) House Visits. A housing survey utilised citizen science methodology to collect data including mobile phone images and free text captions to describe the TA housing conditions including those which participants considered as barriers to their child's health. The survey was first piloted over two weeks on five participants, following refinement based on collaborative feedback and dialogue between the doctoral researcher and study participants. To compliment the housing survey, the doctoral researcher visited the participants' TA and took observational notes with an audio-recorder and digital photos. A thematic analysis was conducted to triangulate themes across the data. Kingfisher's Unfit Housing UK Research Report guided the categories for the results. Specific factors explored within these data included ease of access to the property, safety risks, disrepairs, visible structural problems, poor ventilation, temperature control, space (e.g., for a baby to crawl). Results In the Housing Survey, fifteen participants collected data over a period of one month at the end of 2019. In 2019-2020, four House Visits were completed (Pre-COVID), but further visits were cancelled due to the pandemic. Several themes were prominent and overlapped across the Housing Surveys and House Visits, which were noted as risks to child health and development. Thematic categories included (i) overcrowding, (ii) dampness/mould growth, (iii) poor/inadequate kitchen/toilet facilities, (iv) infestations/vermin, (v) structural problems/disrepair, (vi) unsafe electrics, (vii) excessively cold/warm due to inadequate temperature regulation and (viii) unsafe surfaces that risk causing trips or falls. Conclusions The Early Years is a short, yet vital period to ensure to the next generation have the best start in life, however U5s in TA face numerous barriers in the housing environment which have significant short- and long-term health impacts. Despite a small sample size, findings are consistent with the Children's Commissioner 'Bleak houses' report and likely to be generalisable across other similar families experiencing homelessness in England. Policy should be enacted to regulate the conditions of TA across England with greater monitoring of and accountability for the safety and regulations to ensure that these environments promote optimal growth and development for U5s

Homelessness and housing instability undermine engagement in medical care, adherence to treatment and health among persons with HIV/AIDS. However, the processes by which unstable and unsafe housing result in adverse health outcomes remain understudied and are the focus of this manuscript. From 2012 to 2014, we conducted qualitative interviews among inpatients with HIV disengaged from outpatient care (n = 120). We analyzed the content of the interviews with participants who reported a single room occupancy (SRO) residence (n = 44), guided by the Health Lifestyle Theory. Although SROs emerged as residences that were unhygienic and conducive to drug use and violence, participants remained in the SRO system for long periods of time. This generated experiences of living instability, insecurity and lack of control that reinforced a set of tendencies (habitus) and behaviors antithetical to adhering to medical care. We called for research and interventions to transform SROs into housing protective of its residents' health and wellbeing.

Nationally, opioid overdose remains strikingly persistent among people experiencing homelessness and housing instability. Limited information is available about the characteristics of this phenomenon in economically disadvantaged communities of color. This study sought to evaluate the association between key contextual factors and experiencing a non-fatal opioid overdose among people who use heroin in Washington Heights, New York City. We conducted a cross-sectional survey (N = 101) among participants seeking harm reduction services who reported heroin use in the last three months. Binary logistic regression models examined the association between key social and structural factors and the likelihood of ever experiencing a non-fatal opioid overdose and recently experiencing a non-fatal opioid overdose. The majority of the sample reported housing instability and lived in poverty; almost 42% were homeless. After adjustment, participants who injected heroin were more likely to have ever experienced a non-fatal opioid overdose. Also, younger participants who reported hunger in the last six months were more likely to have experienced a non-fatal opioid overdose in the last three months. Findings suggest the role of structural vulnerability in shaping overdose risk among the participants. Overdose prevention strategies should consider factors of the social and economic environment to mitigate barriers to accessing health and social services within the context of the current opioid crisis.

Human Immunodeficiency Virus (HIV) infection remains prevalent among the marginalized and drug using population in the United States. Testing for HIV is an important and cost-effective way to reduce HIV prevalence. Our objective was to determine if there is a difference in the number of HIV testing by injection status among users of illicit drugs and if a person's social network characteristics is a contributing factor. Using a cross-sectional design and negative binomial regression models, we assessed HIV testing behavior of people who use non-injected drugs (PWND) compared to people who use injected drugs (PWID). In an analytic sample of 539 participants, PWND tested for HIV 19% less compared to PWID, PR (95% CI) = 0.81 (0.66, 0.98), p = 0.03. Other contributing factors of testing were education, condomless sex, STIs, heroin use, and participant's sex network. The interaction term between PWND and emotional support in relation to HIV testing was significant, 1.33 (1.03, 1.69), p=0.03. These findings suggest HIV testing behavior differed by injection status, and this relationship may be dependent on emotional support. To exert a greater impact on the HIV epidemic, interventions and policies encouraging HIV testing in PWND, an understudied at-risk sub-population, are warranted.

INTRODUCTION/BACKGROUND:The purpose of this study is to assess community pharmacists' attitudes and experiences related to naloxone dispensation and counseling in non-urban areas in New York State to better understand individual and structural factors that influence pharmacy provision of naloxone. MATERIALS AND METHODS/METHODS:The study conducted interviewer-administered semistructured surveys among community pharmacists in retail, independent, and supermarket pharmacies between October 2019 and December 2019. The 29-item survey ascertained pharmacists' demographic and practice characteristics; experiences and beliefs related to naloxone dispensation; and attitudes toward expansion of pharmacy services to include on-site public health services for persons who use opioids. The study used Chi square tests to determine associations between each characteristic and self-reported naloxone dispensation (any vs. none). RESULTS:A total of 60 of the 80 community pharmacists that the study team had approached agreed to participate. A majority were supportive of expanding pharmacy-based access to vaccinations (93.3%), on-site HIV testing, or referrals (75% and 96.7%, respectively), providing information on safe syringe use (93.3%) and disposal (98.3%), and referrals to medical/social services (88.3%), specifically substance use treatment (90%). A majority of pharmacist respondents denied negative impacts on business with over half reporting active naloxone dispensation (58.3%). Pharmacists dispensing naloxone were more likely to be multilingual (p < 0.03), and to specifically support on-site HIV testing (p < 0.02) than those who were not dispensing naloxone. DISCUSSION/CONCLUSIONS:Community pharmacists were highly favorable of naloxone dispensation in rural and small metro area pharmacies in NY, and those fluent in additional language(s) and supportive of on-site HIV testing were associated with active naloxone dispensation. While active naloxone dispensation was low, pharmacists appear supportive of a "frontline public health provider" model, which could facilitate naloxone uptake and warrants large-scale investigation. CONCLUSION/CONCLUSIONS:Rural and small metro area pharmacists are generally favorable of naloxone dispensation.

In the midst of an unprecedented social movement against racism in America and call to action for all organizational sectors, medicine, both academia and practice, has become a salient focus during this time given the impact of racism on our nation"™s health. Academic departments of psychiatry, in particular, should be at the forefront of these efforts and have high potential to enact change and lead interventions across their wider institutions. We begin this article by describing the role of race and the impact of structural racism on Black patients and faculty. We go on to discuss the many complex challenges presented by the task of dismantling racist structures in order to build just organizational norms. Finally, we offer initial strategies toward racial equity modeled after those we are implementing and evaluating in our own department.

Biomedical HIV prevention uptake has not taken hold among Black and Latinx populations who use street-marketed drugs. A pilot intervention providing a PEP informational video and direct pharmacy access to a PEP starter dose was conducted among this population. Four study pharmacies were selected to help facilitate syringe customer recruitment (2012-2016). Baseline, post-video, and 3-month ACASI captured demographic, risk behavior, and psychosocial factors associated with PEP willingness, and willingness to access PEP in a pharmacy. A non-experimental study design revealed baseline PEP willingness to be associated with PEP awareness, health insurance, being female, and having a high-risk partner (n = 454). Three-month PEP willingness was associated with lower HIV stigma (APR = 0.95). Using a pre-post approach, PEP knowledge (p < 0.001) and willingness (p < 0.001) increased overtime; however, only three participants requested PEP during the study. In-depth interviews (n = 15) identified lack of a deeper understanding of PEP, and contextualized perceptions of HIV risk as PEP access barriers. Pharmacy PEP access shows promise but further research on perceived risk and HIV stigma is warranted.