Severe Psychopathology and Substance Use Disorder Modify the Association Between Housing Trajectories and Food Security Among Homeless Adults

Purpose: We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association.Materials and Methods: We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project—a randomized trial of Housing First. Food security data were collected seven times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modeling. Logistic regression was used to estimate the association between housing trajectory groups and food security.Results: Three housing trajectory groups were identified: rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared with those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3–6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the never moved to stable housing group had the lowest food security status.Discussion: Severe psychopathology and substance use disorders modified the association between housing trajectories and food security.International Standard Randomized Control Trial Number Register (ISRCTN42520374).

Severe Psychopathology and Substance Use Disorder Modify the Association between Housing Trajectories and Food Security among Homeless Adults

Background We examined the housing trajectories of homeless people with mental illness over a follow-up period of 6 years, and the association of these trajectories with food security. We then examined the modifying role of psychopathology and alcohol and substance use disorders in this association.Methods We followed 487 homeless adults with mental illness at the Toronto site of the At Home/Chez-Soi project –a randomized trial of Housing First. Housing data were collected every 3 months (Phase I) or 6 months (Phase II) during follow-up. Food security data were collected 7 times during the follow-up period. Psychopathology (Colorado Symptom Index score) and alcohol and substance use disorders were assessed at baseline. Housing trajectories were identified using group-based trajectory modelling. Logistic regression was used to estimate the association between housing trajectory groups and food security.Results Three housing trajectory groups were identified: a rapid move to consistent stable housing (34.7%), slow and inconsistent housing (52.1%), and never moved to stable housing (13.2%). Individuals included in the rapid move to consistent housing trajectory group had higher odds of remaining food secure compared to those in the never moved to stable housing trajectory group over the follow-up period [AOR 2.9, 95% CI: 1.3–6.6, P-value: 0.009]. However, when interactions were considered, this association was significant among those with moderate psychopathology but not severe psychopathology. Individuals with substance use disorder and in the group never move to stable house group had the lowest food security status.Conclusion Severe psychopathology and substance use disorders modified the association between housing trajectories and food security. Housing interventions need to focus on long term housing stability as well as food security, especially among those with severe psychopathology and substance use disorder.Ethical considerations The Toronto AH/CS study received approval from the St. Michael’s Hospital Research Ethics Board (Canada), and all participants gave informed written consent to participate in the AH/CS study. The AH/CS study is also registered with the International Standard Randomized Control Trial Number Register (ISRCTN42520374).

Housing trajectories of immigrants and their children in France: Between integration and stratification

Immigrants have been found to exhibit different housing tenure patterns from the rest of the population in a number of contexts. This article tests whether observed differences in tenure in France can be explained by differences in socio-demographic characteristics or whether unexplained differences might result from housing market mechanisms that affect immigrants differentially from the rest of the population, and extends this to the second generation. The article relies on data from TeO, a survey of 21,761 persons designed to oversample and identify immigrants and their children, providing information about the outcomes of children of immigrants that is otherwise lacking in French statistics. The results indicate that while immigrants are significantly less likely to be homeowners, even after controlling for compositional difference, the gap in homeownership between the second generation and the rest of the population is smaller and not statistically significant. This suggests a progressive integration in the housing market over time and over generations rather than overall stratified housing trajectories. Differences in terms of the share of social housing residents, the level of residential crowding, and housing and neighbourhood characteristics also decline across generations. However, children of immigrants from some non-European origins are experiencing higher levels of stratification than other groups, with continued significant differences in tenure.