Parks P, Miller JI, Cromartie Jones S
… +17 more, Attell BK, Brousseau DC, Clyde CL, Cooper WO, Dasgupta M, Desai J, Hardesty BM, Kayle M, Latta K, Mukhopadhyay A, Plaxco AP, Reeves SL, Singh A, Snyder AB, Valle J, Zhou M, Sontag MK
Public Health Rep
· 2026 · PMID 41277597
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OBJECTIVES: Understanding patterns of hospital admissions and emergency department (ED) visits among people with sickle cell disease is critical for improving care and access to care for this population. The objective of...OBJECTIVES: Understanding patterns of hospital admissions and emergency department (ED) visits among people with sickle cell disease is critical for improving care and access to care for this population. The objective of this study was to characterize acute care use among people with sickle cell disease and identify patterns of use across age groups and sex using 2018 data. METHODS: We conducted a cross-sectional study using population-based data from 8 states participating in the Centers for Disease Control and Prevention's Sickle Cell Data Collection program. The sample population consisted of children, adolescents, and adults with a confirmed or probable diagnosis of sickle cell disease, regardless of acute care use, in 2018. We analyzed data on hospital admissions, ED treat-and-release (T/R) visits, and readmissions after ED T/R or inpatient discharge, aggregated from each participating state. RESULTS: The 2018 cohort of the Sickle Cell Data Collection program consisted of 27 034 people; 40.2% had ≥1 hospital admission, and 57.0% had ≥1 ED T/R visit. Of the 98 617 people using acute care, 93.6% (n = 92 305) involved the ED in some capacity. CONCLUSIONS: Hospital admissions were frequent and occurred in less than half of the study population. More than half used the ED, with most hospital admissions initiated in the ED. Our findings call for further research to better understand differences in acute care use, high rates of ED T/R visits, and treatment of sickle cell disease in an outpatient setting.
Sherrill WW, Hall LC, Kanny S
… +4 more, Evatt J, McFall D, Dietz CJ, Parisi M
Public Health Rep
· 2026 · PMID 41277012
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OBJECTIVES: Health Extension for Diabetes (HED) is a community-based diabetes self-management support program facilitated by trained rural health and nutrition agents who lead 8 biweekly educational sessions supported by...OBJECTIVES: Health Extension for Diabetes (HED) is a community-based diabetes self-management support program facilitated by trained rural health and nutrition agents who lead 8 biweekly educational sessions supported by a diabetes clinical expert. We evaluated the program using the RE-AIM (Reach, Effectiveness, Adoption, Implementation, and Maintenance) framework. METHODS: Since the HED program's conception in 2017, ongoing longitudinal evaluation has measured participant knowledge, self-efficacy, and other health behaviors via pre- and postsurveys (at program completion, at 1 year, and at 2 years). We used paired-sample tests to assess significant changes in effectiveness outcomes from pre- to postintervention. RESULTS: Of 1526 participants enrolled in the HED program from 2018 to 2024, 1434 (94.0%) graduated. Mean physical health-related quality-of-life scores rose from 42.8 to 45.1, and mental health scores increased from 51.4 to 52.9 (on a 100-point scale). We assessed weekly diabetes self-care activities and found improvements in general diet (from 4.1 to 5.0 days/week), specific diet (from 3.9 to 4.7 days/week), exercise (from 2.6 to 3.7 days/week), blood glucose testing (from 4.2 to 5.2 days/week), and foot care (from 3.4 to 4.6 days/week). Average diabetes knowledge increased from 76.4% to 85.0%, and self-efficacy increased from 7.1 to 8.2 on a 10-point scale. Participants had reductions in weight (-3.4 pounds), body mass index (from 34.3 kg/m to 33.7 kg/m), and self-reported hemoglobin A (from 7.5% to 7.0%). All pre- to postsurvey changes were significant at α = .05. CONCLUSIONS: The HED program offers a scalable and sustainable approach to community-based diabetes self-management support. Program expansion and replication should leverage key implementation strategies identified via this RE-AIM framework evaluation.
DiLorenzo MA, Lo Piccolo A, Butler DS
… +10 more, Jano K, Oberoi A, Mansuri A, Nauth M, Bratu S, Meissner JS, Foote MMK, Mukherjee V, Postelnicu R, Chan J
Public Health Rep
· 2026 · PMID 41277010
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We investigated the proportion of mpox hospitalizations for medical indications versus infection control isolation at New York University Langone Health and NYC Health + Hospitals from May 1, 2022, through April 28, 2023...We investigated the proportion of mpox hospitalizations for medical indications versus infection control isolation at New York University Langone Health and NYC Health + Hospitals from May 1, 2022, through April 28, 2023. We reviewed the electronic medical records of people with a positive mpox nucleic acid amplification test independently. We collected demographic and clinical data on those who met our inclusion criteria, and we stratified patients by medical indication or infection control isolation based on their reason for hospitalization. This observational cohort study included 66 patients admitted for mpox, of whom 8 (12.1%) were admitted primarily for infection control isolation and 58 (87.9%) were admitted primarily for medical indications. Those hospitalized primarily for isolation (vs medical indications) were significantly less likely to have a private residence (25.0% vs 79.3%; < .001). Those hospitalized for medical indications (vs isolation) were significantly more likely to be HIV positive (63.8% vs 12.5%; = .006), to have secondary bacterial infections (65.5% vs 25.0%; = .03), and to receive antibiotics (81.0% vs 25.0%; < .001). We found no significant differences in the median cumulative length of stay per patient or the proportion of tecovirimat receipt between the 2 groups. While the small size of the isolation cohort was a limitation of this analysis, our findings argue for increased capacity for community-based isolation, which may reduce the use of hospital admissions primarily for infection control isolation in future outbreaks.
Public Health Rep
· 2026 · PMID 41277006
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OBJECTIVES: Ingesting raw water can cause illness. This study aimed to (1) assess beliefs about raw water and water practices among US adults while hiking or camping and (2) identify differences among demographic groups...OBJECTIVES: Ingesting raw water can cause illness. This study aimed to (1) assess beliefs about raw water and water practices among US adults while hiking or camping and (2) identify differences among demographic groups in those beliefs and practices. METHODS: In fall 2021, Porter Novelli Public Services and ENGINE Insights administered the PN View 360+ survey (N = 1004 US panel members aged ≥18 y), which was weighted to be representative of the US population by sex, age, region, race and ethnicity, and education. We analyzed data on 4 survey questions using Wald χ tests and post hoc Wald tests to compare subgroups for demographic variables with ≥3 levels. RESULTS: A significantly greater percentage of men (vs women) and respondents aged ≤34 years (vs ≥35 y) agreed or strongly agreed that raw water is safe to drink (59% vs 41%; 40% vs 12%-30%, respectively), contains probiotics (62% vs 38%; 49% vs 6%-30%), and is regulated by a federal agency (60% vs 40%; 43% vs 12%-29%). Among respondents (166 of 958; 17%) who reported drinking raw water in the past year, a significantly greater percentage were men than women (60% vs 40%), non-Hispanic than Hispanic (77% vs 23%), or aged ≤34 years than ≥35 years (41% vs 22%-26%). CONCLUSION: These results can inform communication materials to reduce the consequences of ingesting insufficiently treated raw water. Clear messaging and educational campaigns could improve public knowledge and help health care providers communicate recommendations.
Public Health Rep
· 2026 · PMID 41268709
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OBJECTIVE: Disease intervention specialists (DISs) play a crucial role in the public health workforce by conducting essential tasks such as contact tracing, contact interviews, and providing referrals for services to con...OBJECTIVE: Disease intervention specialists (DISs) play a crucial role in the public health workforce by conducting essential tasks such as contact tracing, contact interviews, and providing referrals for services to control disease spread. Despite the importance of DISs, research is lacking on the job tasks that they perform and the role that they serve in public health agencies. The objective of this study was to identify the unique skill sets of DISs relative to other public health occupations. METHODS: We used a national dataset of job postings in the United States to conduct a comparative analysis of the skills required for 3 occupations: DISs, epidemiologists, and community health workers. We examined job listings posted from July 2022 through February 2023 to determine the frequency of certain skills, and we tested for significant differences in skill mentions across these occupations. RESULTS: Job postings for DISs were significantly more likely than those for community health workers and epidemiologists to require expertise in areas such as case management (30%), communicable disease control (49%), infectious disease knowledge (33%), and disease prevention techniques (18%). CONCLUSIONS: This study highlights the specialized nature of DISs in managing disease-related public health interventions and supporting population health. Improved data collection is needed to support workforce planning, training, and policy development to ensure the continued effectiveness and reach of DISs in public health systems.
Public Health Rep
· 2026 · PMID 41254965
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Rapid initiation of antiretroviral therapy (rapid ART) is a clinical strategy where HIV treatment is initiated on day of HIV diagnosis, resulting in improved retention in care and virologic suppression. HIV specialists h...Rapid initiation of antiretroviral therapy (rapid ART) is a clinical strategy where HIV treatment is initiated on day of HIV diagnosis, resulting in improved retention in care and virologic suppression. HIV specialists historically have prescribed ART, but recent efforts have increased prescribing among primary care providers. Justice-involved individuals have lower rates of engagement in care along the HIV care continuum compared with the general population; evaluating the effect of rapid ART prescribing by provider type can aid in improving outcomes among this population. The purpose of this case study was to compare rates of offering rapid ART to those newly diagnosed with HIV in a California county jail following an educational intervention that aimed to increase prescribing by primary care providers in the jail. The educational intervention included an educational session, creation of an electronic health record (EHR) note template containing prompts for the offering of rapid ART, and the creation of an EHR order set for relevant laboratory tests. Forty-two individuals were newly diagnosed with HIV in the jail from May 2017 through December 2023. Medical record review indicated that rapid ART offering increased by 36% (56% [9 of 16] vs 92% [24 of 26]) after the intervention versus preintervention, with 50% (13 of 26) offered by primary care physicians following the intervention, compared with 7% (1 of 16) offered by primary care providers preintervention. This intervention serves as a test case that highlights the ability to expand rapid ART offering by primary care providers in resource-limited settings such as jails.
McGladrey ML, Hart J, Ard T
… +8 more, Nentwick C, Taylor M, Ward B, Brillakis H, Grunert C, Schmitt I, Clear ER, Hogg-Graham R
Public Health Rep
· 2026 · PMID 41239904
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The essential public health services of community health assessment (CHA) and community health improvement planning (CHIP) entailed in Healthy People 2030 and Public Health Accreditation Board standards and measures for...The essential public health services of community health assessment (CHA) and community health improvement planning (CHIP) entailed in Healthy People 2030 and Public Health Accreditation Board standards and measures for local health departments are underused in practice-based research. Innovative approaches are particularly needed to improve access to evidence-based behavioral health prevention and treatment services, given the persistent stigmatization of behavioral health conditions. We present a new way of thinking about community development in which other public health agencies can leverage their own CHA and CHIP processes for cross-sector, participatory codesign with behavioral health service providers and users to improve access to support, resources, and treatment. Codesign entails collaborative inquiry with providers and users to frame and reframe their collective understanding of challenges to accessing services and iteratively test solutions. In 2023-2024, we implemented the codesign process using photovoice to engage community members in Lexington, Kentucky, including those who had received behavioral health services, in identifying barriers (eg, stigma, transportation, financial constraints) to accessing behavioral health services. Photovoice insights led to the development of a comprehensive, coalition-sourced directory of local behavioral health resources and strategies to connect people in need with local services and promote cross-sector collaboration. These strategies included the design of media campaigns and training programs targeting the priority areas of financial stability, mental well-being, knowledge empowerment, and access to care. This study provides preliminary evidence that situating codesign methods and tools in CHA/CHIP processes is a feasible, effective, and replicable way to improve access to behavioral health services.
Coles E, Locke K, Egbo J
… +2 more, Tolentino N, Schumacher M
Public Health Rep
· 2026 · PMID 41208091
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OBJECTIVE: COVID-19 exacerbated health inequities for American Indian/Alaska Native (AI/AN) populations. Tribal public health departments and Tribal Epidemiology Centers are critical in addressing these challenges, parti...OBJECTIVE: COVID-19 exacerbated health inequities for American Indian/Alaska Native (AI/AN) populations. Tribal public health departments and Tribal Epidemiology Centers are critical in addressing these challenges, particularly among people on or near tribally owned land. In this study, we described an example of the value of Tribal Epidemiology Centers and tribal public health departments and estimated the prevalence of post-COVID-19 condition (PCC), defined as symptoms persisting ≥90 days postinfection, in a tribal community. METHODS: This retrospective cohort study evaluated the prevalence of PCC and functional limitations among adults diagnosed with COVID-19 on the Tule River Reservation from July 2020 through February 2023. Tule River Indian Health Center, Inc staff conducted telephone surveys to assess symptoms at 30 and 90 days postinfection and functional outcomes using the Post-COVID-19 Functional Status scale. We stratified prevalence rates by age and sex and compared functional limitations before and after infection. RESULTS: We estimated PCC prevalence at 21% (15 of 76). We also found that 37% (24 of 65) of survey participants reported more functional limitations after COVID-19 infection than before. CONCLUSIONS: Our study highlights the need for further research and inclusion of AI/AN communities in PCC research and new vertical policy solutions such as those used for diabetes. AI/AN communities have had inequitably higher rates of COVID-19 and appear poised to also have inequitably higher rates of PCC.
Attell BK, Marton J, Alfrey B
… +5 more, Valle J, Lakshmanan S, Shi JS, Zhou M, Snyder AB
Public Health Rep
· 2026 · PMID 41194503
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OBJECTIVE: During the past several decades, survival rates for sickle cell disease (SCD) have substantially increased, with many people now living well into middle adulthood. To understand trends in mortality and surviva...OBJECTIVE: During the past several decades, survival rates for sickle cell disease (SCD) have substantially increased, with many people now living well into middle adulthood. To understand trends in mortality and survival patterns, research has taken 2 diverging approaches to ascertaining the death status for people with SCD. Single-source approaches rely on death certificates alone to identify people with SCD who died, while multiple-source approaches first identify those with SCD and then link them to death certificates to ascertain mortality status. This study evaluated these 2 approaches in understanding SCD mortality. METHODS: We used 16 years of data (2004 through 2019) from the Sickle Cell Data Collection programs in California and Georgia. Drawing on these population-based surveillance systems and using the single- and multiple-source approaches, we constructed SCD decedent cohorts. For each approach, we examined the number of decedents with SCD, differences in demographic characteristics, and differential causes of death. RESULTS: The single-source approach identified 1788 deaths among people with SCD, while the multiple-source approach identified 2524 such deaths, an increase of 41%. While many of the demographic characteristics were similar between the approaches, the multiple-source approach identified the average age of death to be 3.5 years greater than that of the single-source approach. While the multiple-source approach identified more decedents with SCD, the death records contained a higher percentage of nonspecific cause-of-death codes relative to the single-source approach. CONCLUSIONS: Researchers should be aware of the differences between the single- and multiple-source approaches when analyzing and interpreting mortality patterns among people with SCD. Prior estimates based on single-source approaches may be biased.
Mitchell CL, Ramirez V, Santos E
… +12 more, Noumeh D, VerSchave S, Escheman H, Goetz N, Figueroa M, Wagner K, Singletary M, Kohler LN, Ellingson KD, Wagner J, Pogreba-Brown K, Cullen TA
Public Health Rep
· 2026 · PMID 41181916
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One Health clinics integrate human, animal, and environmental health to provide interdisciplinary health care and community resources to people experiencing homelessness (PEH). Five mobile, public health-led One Health c...One Health clinics integrate human, animal, and environmental health to provide interdisciplinary health care and community resources to people experiencing homelessness (PEH). Five mobile, public health-led One Health clinics were newly implemented in Pima County, Arizona, during October 2023-February 2024. Clinic locations included parks, libraries, and homeless shelters to reduce transportation-related barriers and integrate public health, veterinary, and housing services. Originally designed for PEH and their pets, Pima County One Health clinics were open to everyone in neighborhoods where clinics were hosted to promote community engagement with clinics and strengthen relationships with public health. We evaluated the performance of these clinics by describing service patterns, client perceptions, and lessons learned to support development of clinics by other jurisdictions. During clinic visits, basic demographic information was collected for people and pets, along with data on housing status, environmental and resource concerns, use of clinic services, and perceptions of clinics. The first 5 monthly mobile community clinics served 108 clients and 93 pets; 44% of clients were unhoused or unstably housed, 36% of clients were housed, and housing status was unknown for 20% of clients. Clinics facilitated partnership among service providers and with housed and unhoused community members. Clinics supported vaccine uptake among people and their pets and identified 3 cases of sexually transmitted infections that might otherwise have remained undetected. By implementing a One Health Clinic framework, our local health department helped address gaps in human and veterinary health care services. Other public health agencies might consider implementing similar models to enhance public health engagement with local communities.
Mrukowicz C, Wanat MH, Montano D
… +5 more, Bernal Gomez E, Valdez S, Carranza M, White JR, Dale A
Public Health Rep
· 2025 Nov · PMID 41181860
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OBJECTIVES: Despite recent decreases in overdose deaths in the United States, an opportunity remains to connect with people who have had a nonfatal overdose. We analyzed data collected from the Maricopa County Department...OBJECTIVES: Despite recent decreases in overdose deaths in the United States, an opportunity remains to connect with people who have had a nonfatal overdose. We analyzed data collected from the Maricopa County Department of Public Health (MCDPH) nonfatal opioid overdose case investigations program, highlighted findings from investigations conducted during the first 2 years of the program (September 1, 2021-August 31, 2023), and compared findings across the 2 years. MATERIALS AND METHODS: We reviewed data collected through the MCDPH nonfatal opioid overdose case investigations program, wherein MCDPH staff members conduct telephone interviews with a sample of case patients with a recent nonfatal opioid overdose. During interviews, MCDPH staff asked questions about overdose event circumstances, knowledge and practice of harm reduction strategies, substances used, and interest in treatment. MCDPH staff offered harm reduction kits to all case patients and transferred case patients interested in treatment to the Arizona Opioid Assistance and Referral Line. RESULTS: MCDPH interviewed 529 of 2029 case patients (29.5%) who met sampling criteria. Among 354 case patients who self-reported recreational drug use, the number of cases reporting recreational fentanyl use increased from 117 of 179 (62.6%) in year 1 to 129 of 175 (73.7%) in year 2. Of 352 case patients, 187 (53.1%) reported access to naloxone. Smoking (208 of 295 case patients; 70.5%) was the most commonly reported route of consumption. PRACTICE IMPLICATIONS: MCDPH's novel nonfatal opioid overdose surveillance program identified trends in drug use and harm reduction among people who use drugs who are at the highest risk of a subsequent overdose. The program continues to operate, and survey questions are routinely evaluated to ensure data collected inform overdose prevention strategies.
Christensen A, Lautenschlager T, Rimer M
… +8 more, Doran E, Albertson J, Trimble M, Sullivan S, Shanker N, Swift J, A C, Wilson E
Public Health Rep
· 2025 Nov · PMID 41178551
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Wastewater monitoring is a useful tool to complement case-based surveillance. A hepatitis A virus (HAV) investigation in North Carolina demonstrated that wastewater monitoring detections preceded identification of 2 clin...Wastewater monitoring is a useful tool to complement case-based surveillance. A hepatitis A virus (HAV) investigation in North Carolina demonstrated that wastewater monitoring detections preceded identification of 2 clinical cases by 12 days. State and local health officials used a preestablished decision tree to respond to wastewater detections of HAV and implement public health actions. The investigation determined that HAV detected in wastewater was likely from 2 people who had not yet developed symptoms or sought testing at the time of detection, providing early information for public health response, including vaccination of family members. Targeted outreach to hospitals as well as medically or socially vulnerable groups at high risk of HAV infection could be recommended in response to consistent HAV detections in wastewater.
Boothe D, Reyes JV, Myles RL
… +6 more, Marlow M, Luo Q, Yuan X, Nair P, Beer L, Henny KD
Public Health Rep
· 2026 · PMID 41178549
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OBJECTIVES: People with HIV (PWH) who transition back into the community after incarceration often experience treatment disruptions, increasing the risk of poor outcomes. We examined factors associated with sustained vir...OBJECTIVES: People with HIV (PWH) who transition back into the community after incarceration often experience treatment disruptions, increasing the risk of poor outcomes. We examined factors associated with sustained viral suppression (SVS) after release. METHODS: We analyzed 2015-2022 data from a nationally representative sample of PWH (N = 1012). We used weighted percentages and 95% CIs to describe the characteristics of recently incarcerated PWH by postrelease SVS status. We calculated prevalence ratios (PRs) to identify factors associated with SVS. RESULTS: Among PWH who were incarcerated at least once in the past 12 months, only 30.0% achieved SVS postrelease. PWH aged 18 to 29 years (PR = 1.16; 95% CI, 1.01-1.32) and 30 to 39 years (PR = 1.20; 95% CI, 1.06-1.35) were significantly more likely to not have SVS than PWH aged ≥50 years. PWH released within 180 days (≤60 days: PR = 1.44; 95% CI, 1.29-1.61; 61-180 days: PR = 1.18; 95% CI, 1.03-1.34) were significantly more likely to not have SVS than PWH released after ≥181 days. PWH with ≥3 incarcerations within the past 12 months were significantly more likely to not have SVS than PWH who were incarcerated once (PR = 1.25; 95% CI, 1.12-1.39). PWH with SVS were significantly more likely to be retained in HIV care (PR = 1.55; 95% CI, 1.40-1.70), taking antiretroviral therapy (ART) (PR = 1.20; 95% CI, 1.14-1.28), or adherent to ART (PR = 1.34; 95% CI, 1.15-1.56) than PWH without SVS. CONCLUSIONS: SVS outcomes among recently incarcerated PWH could improve through adherence support, discharge planning, and postrelease support, particularly for young or frequently incarcerated individuals.
Zhu X, Liu J, Hung P
… +2 more, Merchant A, Alberg AJ
Public Health Rep
· 2025 Oct · PMID 41165289
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OBJECTIVES: Pandemic-related worries and stressors were common during the COVID-19 pandemic. The objective of this study was to examine pandemic-related worries and stressors in relation to tobacco and alcohol use among...OBJECTIVES: Pandemic-related worries and stressors were common during the COVID-19 pandemic. The objective of this study was to examine pandemic-related worries and stressors in relation to tobacco and alcohol use among postpartum women in the United States early in the COVID-19 pandemic. METHODS: From May through June 2020, 792 postpartum women in the United States completed an electronic survey, the COVID-19: Health in Pregnancy and Postpartum Study. The survey assessed pandemic-related worries by using a summary score of 10 items and pandemic-related stressors by using 4 items. The primary outcomes were tobacco and alcohol use. Secondary outcomes were increased amounts of tobacco and alcohol during the pandemic among participants who used tobacco and/or alcohol. We used logistic regression models to examine the association of pandemic-related worries and stressors with each outcome. RESULTS: Among postpartum women, 24.4% used tobacco and 27.8% used alcohol. Pandemic-related worries were associated with higher odds of tobacco use (adjusted odds ratio [AOR] = 1.08; 95% CI, 1.04-1.13), alcohol use (AOR = 1.09; 95% CI, 1.05-1.13), and using both tobacco and alcohol postpartum (AOR = 1.13; 95% CI, 1.07-1.20). Both worries and stressors were associated with increased tobacco use (AOR for worries = 1.08; 95% CI, 1.01-1.16; AOR for stressors = 2.00; 95% CI, 1.33-3.00) but not with increased alcohol use. CONCLUSIONS: The association between pandemic-related worries and stressors and tobacco use underscores the need for health promotion interventions among postpartum women to reduce tobacco use. Developing pandemic-related interventions now for use in future pandemics to alleviate pandemic-related worries and stressors experienced by postpartum women is warranted.
Public Health Rep
· 2026 · PMID 41165263
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While noncongregate shelters are an increasingly common intervention for homelessness, their effect on residents' psychological well-being is not well understood. This study evaluated the effect of a low-barrier, noncong...While noncongregate shelters are an increasingly common intervention for homelessness, their effect on residents' psychological well-being is not well understood. This study evaluated the effect of a low-barrier, noncongregate shelter on the well-being of individuals experiencing homelessness in a small Northern California city in 2023. Focusing on 5 key areas of well-being-sleep quality, sense of community, sense of control, generalized anxiety, and psychological safety-this study surveyed 106 (of 170) shelter residents 9 months after the opening of the shelter. A retrospective pretest-posttest design and generalized linear models permitted an analysis of changes in well-being after previously unsheltered individuals moved into the noncongregate shelter, as well as within-subjects' differences by sex, age, and duration at the shelter. All indicators of well-being with the exception of sense of control showed significant improvement after the shelter move-in. Specifically, on a 5-point Likert scale, with higher scores meaning a more positive outcome, mean sleep quality improved from 2.6 to 4.0 ( < .001), sense of community from 3.1 to 3.4 ( = .01), and psychological safety from 3.1 to 3.5 ( < .001); on a 4-point Likert scale, with higher scores indicating higher levels of anxiety, anxiety decreased from 2.7 to 2.1 ( < .001). Additionally, interactive analyses indicated that changes in well-being differed depending on an individual's sex, age, and duration at the shelter. While this study demonstrates improvements in well-being relative to individuals living unsheltered, future research should use comparative designs to assess long-term housing stability outcomes for individuals in temporary shelters compared with those who remain unsheltered or in secure permanent supportive housing.