lect. 14 file

Introduction

• People Experiencing Homelessness (PEH): Highly vulnerable to discrimination and violence, impacting their physical and mental health.

• Study Objective: Examine past-month discrimination and violence against PEH in Los Angeles County (LAC).

• Participants: 332 surveyed from April-July 2023.

• Key Findings:

  • 31.8% experienced daily discrimination.

  • 53.9% experienced weekly discrimination.

  • 16.0% experienced physical violence in the past month.

  • 7.5% experienced sexual violence.

• Comparison to General Population: PEH face significantly higher rates of violence than general populations in major U.S. cities.

Background

• Stigmatization: PEH are frequently viewed as unsanitary and irresponsible, leading to high levels of discrimination.

• Consequences of Homelessness: Negatively affects health, leading to a lower life expectancy compared to housed individuals.

• LAC Homelessness Statistics: Nearly 11% of the nation's homeless population resides in LAC, with over 20% experiencing unsheltered homelessness.

Methodology

• Study Design: Part of the Periodic Assessment of Trajectories of Housing, Homelessness, and Health (PATHS) program.

• Sampling Method: In-person recruitment of PEH through a mobile-based survey.

• Eligibility Criteria:

  1. Lived in a homeless shelter or unsheltered for at least one night in the past month.

  2. Resided in LAC.

  3. Aged 18 or older.

  4. Access to a smartphone.

• Data Collection: Surveys included demographics, homelessness history, health status, and measures of discrimination and violence.

Results

• Sample Characteristics:

  • Approximately half male; majority from racial/ethnic minority groups.

  • Mean age: 40.9 years.

  • Over one-third reported physical health conditions and over half had moderate/severe psychological distress.

• Discrimination Experiences:

  • Mean Everyday Discrimination Scale (EDS) score: 5.5 (high frequency of negative treatment reported).

  • 49.6% attributed discrimination to their housing situation, followed by race (39.5%) and financial status (37.6%).

• Victimization Rates:

  • Physical violence: 16% in the past month.

  • Sexual violence: 7.5% in the past month.

Associations

• Independent Variables Impacting Discrimination and Violence:

  • Discrimination: Associated with physical and psychological distress, unsheltered living conditions, and substance use.

  • Physical Violence: Linked to being sheltered or unsheltered outdoors, presence of physical health conditions, and psychological distress.

  • Sexual Violence: Increased risk for non-male individuals and those living unsheltered outdoors.

Discussion

• High Rates of Discrimination and Violence: The study aligns with prior research indicating that discrimination and violence against PEH are pervasive.

• Stigmatization Impact: The study demonstrates that discrimination is not significantly influenced by demographic factors (race/ethnicity, gender) but is related to experiences of homelessness and health issues.

• Suggestions for Interventions:

  • The healthcare system should integrate trauma-informed services and ensure safe environments for PEH in shelters.

  • Housing First models should be funded and expanded to reduce vulnerability to violence.

Limitations

• Cross-Sectional Design: Limited to testing associations rather than causative factors.

• Mobile Phone Access: Sample may exclude a subset of PEH without mobile access.

• Self-Reporting: Risk of underreporting due to sensitive topics discussed.

Conclusions

• Urgent Need for Awareness: Addressing discrimination and violence is essential for improving health outcomes among PEH.

• Future Research: Necessary to investigate the longitudinal impacts of discrimination and the effectiveness of interventions.

Please identify the following from the Homelessness, Discrimination, and Violent

Discrimination in Los Angeles paper by Padwa et al. (2024):

a. What was the purpose of the article (i.e., research question)?

b. Where was the data for this study sourced from?

c. What were the primary outcomes of concern?

d. How large was the total sample enrolled?

e. What was the inclusion criteria for being in the study (4)?

f. How were the contributions of the study different from other studies on the

topic?

1. Purpose of the Article: The study aimed to examine past-month discrimination and violence against People Experiencing Homelessness (PEH) in Los Angeles County (LAC).

2. Data Source: The data for this study was sourced from a survey of 332 participants conducted from April to July 2023.

3. Primary Outcomes of Concern: The primary outcomes measured included daily and weekly discrimination experiences, as well as incidents of physical and sexual violence in the past month.

4. Total Sample Enrolled: The total sample size for the study was 332 participants.

Inclusion Criteria: The inclusion criteria for participating in the study were:

• Lived in a homeless shelter or unsheltered for at least one night in the past month.

• Resided in LAC.

• Aged 18 or older.

• Access to a smartphone.

How did researchers measure or operationalize the primary study OUTCOMES (2)?

1. Contributions to the Field: This study provided unique insights into the prevalence of discrimination and violence faced by PEH specifically in LAC, and it examined associations with health status and living conditions, which may differ from other studies focusing on broader populations or regions.

2. Measurement of Primary Outcomes: The researchers operationalized the primary outcomes using the Everyday Discrimination Scale (EDS) for measuring discrimination and self-reported incidents of physical and sexual violence.

3. Final Analytic Sample: The final analytic sample consisted of all 332 surveyed participants.

4. Key Findings from Table 1: Key findings included that approximately half of the sample was male, the majority belonged to racial/ethnic minority groups, and over one-third reported physical health conditions alongside moderate to severe psychological distress.

5. Everyday Discrimination Results: Key findings revealed that 31.8% of participants experienced daily discrimination and 53.9% experienced it weekly, with a mean EDS score of 5.5, indicating high frequency of negative treatment.

6. Factors Associated with Increased Odds: a. Sexual Violence: Increased risk was found for non-male individuals and those living unsheltered outdoors. b. Physical Violence: Linked to being sheltered or unsheltered outdoors, having physical health conditions, and psychological distress.

7. Conclusions of the Study: The authors concluded that there is an urgent need for awareness of the discrimination and violence faced by PEH to improve their health outcomes, and emphasized the need for future research to investigate the longitudinal impacts and effectiveness of potential interventions.

Disparities Between People Experiencing Homelessness (PEH) and Those with Housing:

1. Life Expectancy:

   • People experiencing homelessness have a significantly lower life expectancy compared to housed individuals.

   • The health consequences of homelessness, including exposure to harsh living conditions and lack of access to healthcare, contribute to this disparity.

2. Violence Experienced:

   • PEH face much higher rates of violence than general populations in major U.S. cities.

   • Key findings from a study indicate that:

     • 16.0% of PEH experienced physical violence in the past month.

     • 7.5% experienced sexual violence in the same timeframe.

   • Discrimination and stigmatization contribute to their vulnerability, leading to these elevated rates of violence.

Outcomes of Discrimination

1. Prevalence of Discrimination:

   • 31.8% of surveyed People Experiencing Homelessness (PEH) experienced daily discrimination.

   • 53.9% experienced discrimination on a weekly basis.

   • Mean Everyday Discrimination Scale (EDS) score: 5.5, indicating high frequency of negative treatment.

2. Attribution of Discrimination:

   • 49.6% attributed their experiences of discrimination to their housing situation.

   • Additional factors included race (39.5%) and financial status (37.6%).

3. Associations with Health:

   • Discrimination is associated with physical and psychological distress, which exacerbates health issues among PEH.

4. Impact on Victimization and Violence:

   • Higher rates of discrimination correlate with increased risks of physical and sexual violence, highlighting the relationship between discrimination experiences and vulnerability to violent acts.

How were outcomes measured?

The researchers operationalized the primary outcomes using the Everyday Discrimination Scale (EDS) for measuring discrimination and self-reported incidents of physical and sexual violence.

PATHS (purpose, how is it used)

The PATHS (Periodic Assessment of Trajectories of Housing, Homelessness, and Health) program is designed to examine the intersections of housing status, homelessness, and health outcomes over time. Its purpose is to collect data that can inform policies and interventions aimed at improving the well-being of People Experiencing Homelessness (PEH). The program utilizes mobile-based surveys to gather information on participants' demographics, homelessness history, health status, and experiences of discrimination and violence.

Study Design

• Study Type: Part of the Periodic Assessment of Trajectories of Housing, Homelessness, and Health (PATHS) program.

• Sampling Method: In-person recruitment of People Experiencing Homelessness (PEH) through a mobile-based survey.

• Eligibility Criteria:

  • Lived in a homeless shelter or unsheltered for at least one night in the past month.

  • Resided in Los Angeles County (LAC).

  • Aged 18 or older.

  • Access to a smartphone.

• Data Collection: Surveys included demographics, homelessness history, health status, and measures of discrimination and violence.

Limitations

• Cross-Sectional Design: The study is limited to testing associations rather than causative factors, making it challenging to infer direct causality between discrimination, violence, and health outcomes.

• Mobile Phone Access: The sample may exclude a subset of People Experiencing Homelessness (PEH) who do not have mobile access, potentially impacting the representativeness of the findings.

• Self-Reporting: There is a risk of underreporting due to the sensitive nature of the topics discussed, which may lead to biases in the data collected.