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  1. Article ; Online: Access to Specialty Services: Opportunities for Expansion of Telemedicine to Support Correctional Health Care in Colorado.

    Krsak, Martin / Jeffers, Alexiss / Shah, Jagruti / Johnson, Steven C / Montague, Brian T

    Telemedicine journal and e-health : the official journal of the American Telemedicine Association

    2019  Volume 26, Issue 6, Page(s) 776–783

    Abstract: Introduction: ...

    Abstract Introduction:
    MeSH term(s) Colorado ; Delivery of Health Care ; Humans ; Pilot Projects ; Prisoners ; Prisons ; Prospective Studies ; Telemedicine ; United States
    Language English
    Publishing date 2019-09-05
    Publishing country United States
    Document type Journal Article
    ZDB-ID 2035659-6
    ISSN 1556-3669 ; 1530-5627
    ISSN (online) 1556-3669
    ISSN 1530-5627
    DOI 10.1089/tmj.2019.0130
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  2. Article ; Online: Barriers to COVID-19 Prevention Measures Among People Experiencing Homelessness with Substance Use Disorder or Serious Mental Illness.

    Meehan, Ashley A / Jeffers, Alexiss / Barker, Jordan / Ray, Colleen M / Laws, Rebecca L / Fields, Victoria L / Miedema, Stephanie S / Cha, Susan / Cassell, Cynthia H / DiPietro, Barbara / Cary, Margaret / Yang, Maria / McLendon, Hedda / Marcus, Ruthanne / Mosites, Emily

    Journal of prevention (2022)

    2023  Volume 44, Issue 6, Page(s) 663–678

    Abstract: People experiencing homelessness (PEH) are at disproportionate risk of becoming infected and having severe illness from coronavirus disease 2019 (COVID-19), especially when residing in congregate settings like homeless shelters. Behavioral health ... ...

    Abstract People experiencing homelessness (PEH) are at disproportionate risk of becoming infected and having severe illness from coronavirus disease 2019 (COVID-19), especially when residing in congregate settings like homeless shelters. Behavioral health problems related to substance use disorder (SUD) and severe mental illness (SMI) may have created additional challenges for PEH to practice prevention measures like mask wearing, physical distancing, handwashing, and quarantine and isolation. The study objective was to understand the perceived barriers PEH face regarding COVID-19 non-pharmaceutical prevention strategies and identify recommendations for overcoming barriers. From August-October 2020, qualitative phone interviews with 50 purposively selected behavioral health professionals across the United States serving PEH with SUD or SMI were conducted. Professionals described that PEH faced barriers to prevention that were structural (e.g., access to necessary resources), behavioral (related to SUD or SMI), or related to the priority of other needs. Recommendations to overcome these barriers included providing free prevention resources (e.g., masks and hand sanitizer), providing education about importance of prevention strategies, and prioritizing access to stable housing. Interviews took place before COVID-19 vaccines were available, so barriers to vaccination are not included in this paper. Findings can help support tailored approaches during COVID-19 and future public health threats.
    MeSH term(s) Humans ; COVID-19 Vaccines ; COVID-19/prevention & control ; Substance-Related Disorders/epidemiology ; Mental Disorders/epidemiology ; Ill-Housed Persons
    Chemical Substances COVID-19 Vaccines
    Language English
    Publishing date 2023-09-26
    Publishing country Switzerland
    Document type Journal Article
    ISSN 2731-5541
    ISSN (online) 2731-5541
    DOI 10.1007/s10935-023-00739-x
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  3. Article ; Online: Hospitalizations for COVID-19 Among US People Experiencing Incarceration or Homelessness.

    Montgomery, Martha P / Hong, Kai / Clarke, Kristie E N / Williams, Samantha / Fukunaga, Rena / Fields, Victoria L / Park, Joohyun / Schieber, Lyna Z / Kompaniyets, Lyudmyla / Ray, Colleen M / Lambert, Lauren A / D'Inverno, Ashley S / Ray, Tapas K / Jeffers, Alexiss / Mosites, Emily

    JAMA network open

    2022  Volume 5, Issue 1, Page(s) e2143407

    Abstract: Importance: People experiencing incarceration (PEI) and people experiencing homelessness (PEH) have an increased risk of COVID-19 exposure from congregate living, but data on their hospitalization course compared with that of the general population are ... ...

    Abstract Importance: People experiencing incarceration (PEI) and people experiencing homelessness (PEH) have an increased risk of COVID-19 exposure from congregate living, but data on their hospitalization course compared with that of the general population are limited.
    Objective: To compare COVID-19 hospitalizations for PEI and PEH with hospitalizations among the general population.
    Design, setting, and participants: This cross-sectional analysis used data from the Premier Healthcare Database on 3415 PEI and 9434 PEH who were evaluated in the emergency department or were hospitalized in more than 800 US hospitals for COVID-19 from April 1, 2020, to June 30, 2021.
    Exposures: Incarceration or homelessness.
    Main outcomes and measures: Hospitalization proportions were calculated. and outcomes (intensive care unit admission, invasive mechanical ventilation [IMV], mortality, length of stay, and readmissions) among PEI and PEH were compared with outcomes for all patients with COVID-19 (not PEI or PEH). Multivariable regression was used to adjust for potential confounders.
    Results: In total, 3415 PEI (2952 men [86.4%]; mean [SD] age, 50.8 [15.7] years) and 9434 PEH (6776 men [71.8%]; mean [SD] age, 50.1 [14.5] years) were evaluated in the emergency department for COVID-19 and were hospitalized more often (2170 of 3415 [63.5%] PEI; 6088 of 9434 [64.5%] PEH) than the general population (624 470 of 1 257 250 [49.7%]) (P < .001). Both PEI and PEH hospitalized for COVID-19 were more likely to be younger, male, and non-Hispanic Black than the general population. Hospitalized PEI had a higher frequency of IMV (410 [18.9%]; adjusted risk ratio [aRR], 1.16; 95% CI, 1.04-1.30) and mortality (308 [14.2%]; aRR, 1.28; 95% CI, 1.11-1.47) than the general population (IMV, 88 897 [14.2%]; mortality, 84 725 [13.6%]). Hospitalized PEH had a lower frequency of IMV (606 [10.0%]; aRR, 0.64; 95% CI, 0.58-0.70) and mortality (330 [5.4%]; aRR, 0.53; 95% CI, 0.47-0.59) than the general population. Both PEI and PEH had longer mean (SD) lengths of stay (PEI, 9 [10] days; PEH, 11 [26] days) and a higher frequency of readmission (PEI, 128 [5.9%]; PEH, 519 [8.5%]) than the general population (mean [SD] length of stay, 8 [10] days; readmission, 28 493 [4.6%]).
    Conclusions and relevance: In this cross-sectional study, a higher frequency of COVID-19 hospitalizations for PEI and PEH underscored the importance of adhering to recommended prevention measures. Expanding medical respite may reduce hospitalizations in these disproportionately affected populations.
    MeSH term(s) Adult ; Aged ; COVID-19/epidemiology ; Cross-Sectional Studies ; Databases, Factual ; Female ; Homeless Persons/statistics & numerical data ; Hospitalization/statistics & numerical data ; Humans ; Male ; Middle Aged ; Prisoners/statistics & numerical data ; SARS-CoV-2 ; United States
    Language English
    Publishing date 2022-01-04
    Publishing country United States
    Document type Journal Article
    ISSN 2574-3805
    ISSN (online) 2574-3805
    DOI 10.1001/jamanetworkopen.2021.43407
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  4. Article ; Online: Factors Associated with Cloth Face Covering Use Among Adults During the COVID-19 Pandemic - United States, April and May 2020.

    Fisher, Kiva A / Barile, John P / Guerin, Rebecca J / Vanden Esschert, Kayla L / Jeffers, Alexiss / Tian, Lin H / Garcia-Williams, Amanda / Gurbaxani, Brian / Thompson, William W / Prue, Christine E

    MMWR. Morbidity and mortality weekly report

    2020  Volume 69, Issue 28, Page(s) 933–937

    Abstract: On April 3, 2020, the White House Coronavirus Task Force and CDC announced a new behavioral recommendation to help slow the spread of coronavirus disease 2019 (COVID-19) by encouraging the use of a cloth face covering when out in public (1). Widespread ... ...

    Abstract On April 3, 2020, the White House Coronavirus Task Force and CDC announced a new behavioral recommendation to help slow the spread of coronavirus disease 2019 (COVID-19) by encouraging the use of a cloth face covering when out in public (1). Widespread use of cloth face coverings has not been studied among the U.S. population, and therefore, little is known about encouraging the public to adopt this behavior. Immediately following the recommendation, an Internet survey sampled 503 adults during April 7-9 to assess their use of cloth face coverings and the behavioral and sociodemographic factors that might influence adherence to this recommendation. The same survey was administered 1 month later, during May 11-13, to another sample of 502 adults to assess changes in the prevalence estimates of use of cloth face coverings from April to May. Within days of the release of the first national recommendation for use of cloth face coverings, a majority of persons who reported leaving their home in the previous week reported using a cloth face covering (61.9%). Prevalence of use increased to 76.4% 1 month later, primarily associated with increases in use among non-Hispanic white persons (54.3% to 75.1%), persons aged ≥65 years (36.6% to 79.2%), and persons residing in the Midwest (43.7% to 73.8%). High rates were observed in April and by May, increased further among non-Hispanic black persons (74.4% to 82.3%), Hispanic or Latino persons (77.3% to 76.2%), non-Hispanic persons of other race (70.8% to 77.3%), persons aged 18-29 years (70.1% to 74.9%) and 30-39 years (73.9% to 84.4%), and persons residing in the Northeast (76.9% to 87.0%). The use of a cloth face covering was associated with theory-derived constructs that indicate a favorable attitude toward them, intention to use them, ability to use them, social support for using them, and beliefs that they offered protection for self, others, and the community. Research is needed to understand possible barriers to using cloth face coverings and ways to promote their consistent and correct use among those who have yet to adopt this behavior.
    MeSH term(s) Adolescent ; Adult ; Aged ; COVID-19 ; Continental Population Groups/statistics & numerical data ; Coronavirus Infections/epidemiology ; Coronavirus Infections/prevention & control ; Ethnic Groups/statistics & numerical data ; Female ; Health Knowledge, Attitudes, Practice ; Humans ; Male ; Masks/statistics & numerical data ; Middle Aged ; Pandemics/prevention & control ; Pneumonia, Viral/epidemiology ; Pneumonia, Viral/prevention & control ; Residence Characteristics/statistics & numerical data ; Socioeconomic Factors ; Surveys and Questionnaires ; United States/epidemiology ; Young Adult
    Keywords covid19
    Language English
    Publishing date 2020-07-17
    Publishing country United States
    Document type Journal Article
    ZDB-ID 412775-4
    ISSN 1545-861X ; 0149-2195
    ISSN (online) 1545-861X
    ISSN 0149-2195
    DOI 10.15585/mmwr.mm6928e3
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  5. Article ; Online: Theory-based Behavioral Predictors of Self-reported Use of Face Coverings in Public Settings during the COVID-19 Pandemic in the United States.

    Barile, John P / Guerin, Rebecca J / Fisher, Kiva A / Tian, Lin H / Okun, Andrea H / Vanden Esschert, Kayla L / Jeffers, Alexiss / Gurbaxani, Brian M / Thompson, William W / Prue, Christine E

    Annals of behavioral medicine : a publication of the Society of Behavioral Medicine

    2020  Volume 55, Issue 1, Page(s) 82–88

    Abstract: Background: Investigating antecedents of behaviors, such as wearing face coverings, is critical for developing strategies to prevent SARS-CoV-2 transmission.: Purpose: The purpose of this study was to determine associations between theory-based ... ...

    Abstract Background: Investigating antecedents of behaviors, such as wearing face coverings, is critical for developing strategies to prevent SARS-CoV-2 transmission.
    Purpose: The purpose of this study was to determine associations between theory-based behavioral predictors of intention to wear a face covering and actual wearing of a face covering in public.
    Methods: Data from a cross-sectional panel survey of U.S. adults conducted in May and June 2020 (N = 1,004) were used to test a theory-based behavioral path model. We (a) examined predictors of intention to wear a face covering, (b) reported use of cloth face coverings, and (c) reported use of other face masks (e.g., a surgical mask or N95 respirator) in public.
    Results: We found that being female, perceived importance of others wanting the respondent to wear a face covering, confidence to wear a face covering, and perceived importance of personal face covering use was positively associated with intention to wear a face covering in public. Intention to wear a face covering was positively associated with self-reported wearing of a cloth face covering if other people were observed wearing cloth face coverings in public at least "rarely" (aOR = 1.43), with stronger associations if they reported "sometimes" (aOR = 1.83), "often" (aOR = 2.32), or "always" (aOR = 2.96). For other types of face masks, a positive association between intention and behavior was only present when observing others wearing face masks "often" (aOR = 1.25) or "always" (aOR = 1.48).
    Conclusions: Intention to wear face coverings and observing other people wearing them are important behavioral predictors of adherence to the CDC recommendation to wear face coverings in public.
    MeSH term(s) Adult ; COVID-19/prevention & control ; Communicable Disease Control ; Female ; Humans ; Male ; Masks ; Pandemics/prevention & control ; Psychological Theory ; Sex Factors ; Social Norms ; United States
    Language English
    Publishing date 2020-12-10
    Publishing country England
    Document type Journal Article
    ZDB-ID 632630-4
    ISSN 1532-4796 ; 0883-6612
    ISSN (online) 1532-4796
    ISSN 0883-6612
    DOI 10.1093/abm/kaaa109
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  6. Article ; Online: Impact of Social Isolation during the COVID-19 Pandemic on Mental Health, Substance Use, and Homelessness: Qualitative Interviews with Behavioral Health Providers.

    Jeffers, Alexiss / Meehan, Ashley A / Barker, Jordan / Asher, Alice / Montgomery, Martha P / Bautista, Greg / Ray, Colleen M / Laws, Rebecca L / Fields, Victoria L / Radhakrishnan, Lakshmi / Cha, Susan / Christensen, Aleta / Dupervil, Brandi / Verlenden, Jorge V / Cassell, Cynthia H / Boyer, Alaina / DiPietro, Barbara / Cary, Margaret / Yang, Maria /
    Mosites, Emily / Marcus, Ruthanne

    International journal of environmental research and public health

    2022  Volume 19, Issue 19

    Abstract: The United States is experiencing a syndemic of homelessness, substance use disorder, and mental health conditions, which has been further exacerbated by the COVID-19 pandemic. Although it is expected that mitigation strategies will curb community ... ...

    Abstract The United States is experiencing a syndemic of homelessness, substance use disorder, and mental health conditions, which has been further exacerbated by the COVID-19 pandemic. Although it is expected that mitigation strategies will curb community transmission of COVID-19, the unintended consequences of social isolation on mental health and substance use are a growing public health concern. Awareness of changing mental health and substance use treatment needs due to the pandemic is critical to understanding what additional services and support are needed during and post-pandemic, particularly among people experiencing homelessness who have pre-existing serious mental illness or substance use disorder. To evaluate these effects and support our understanding of mental health and substance use outcomes of the COVID-19 pandemic, we conducted a qualitative study where behavioral health providers serving people experiencing homelessness described the impact of COVID-19 among their clients throughout the United States. Behavioral health providers shared that experiencing social isolation worsened mental health conditions and caused some people to return to substance use and fatally overdose. However, some changes initiated during the pandemic resulted in positive outcomes, such as increased client willingness to discuss mental health topics. Our findings provide additional evidence that the social isolation experienced during the pandemic has been detrimental to mental health and substance use outcomes, especially for people experiencing homelessness.
    MeSH term(s) COVID-19/epidemiology ; Homeless Persons/psychology ; Humans ; Mental Health ; Pandemics ; Social Isolation ; Substance-Related Disorders/epidemiology
    Language English
    Publishing date 2022-09-25
    Publishing country Switzerland
    Document type Journal Article
    ZDB-ID 2175195-X
    ISSN 1660-4601 ; 1661-7827
    ISSN (online) 1660-4601
    ISSN 1661-7827
    DOI 10.3390/ijerph191912120
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  7. Article ; Online: Behavioral Health Providers' Experience with Changes in Services for People Experiencing Homelessness During COVID-19, USA, August-October 2020.

    Marcus, Ruthanne / Meehan, Ashley A / Jeffers, Alexiss / Cassell, Cynthia H / Barker, Jordan / Montgomery, Martha P / Dupervil, Brandi / Henry, Ankita / Cha, Susan / Venkatappa, Thara / DiPietro, Barbara / Boyer, Alaina / Radhakrishnan, Lakshmi / Laws, Rebecca L / Fields, Victoria L / Cary, Margaret / Yang, Maria / Davis, Meagan / Bautista, Gregorio J /
    Christensen, Aleta / Barranco, Lindsey / McLendon, Hedda / Mosites, Emily

    The journal of behavioral health services & research

    2022  Volume 49, Issue 4, Page(s) 470–486

    Abstract: The COVID-19 pandemic caused disruptions in behavioral health services (BHS), essential for people experiencing homelessness (PEH). BHS changes created barriers to care and opportunities for innovative strategies for reaching PEH. The authors conducted ... ...

    Abstract The COVID-19 pandemic caused disruptions in behavioral health services (BHS), essential for people experiencing homelessness (PEH). BHS changes created barriers to care and opportunities for innovative strategies for reaching PEH. The authors conducted 50 qualitative interviews with behavioral health providers in the USA during August-October 2020 to explore their observations of BHS changes for PEH. Interviews were transcribed and entered into MAXQDA for analysis and to identify salient themes. The largest impact from COVID-19 was the closure or limited hours for BHS and homeless shelters due to mandated "stay-at-home" orders or staff working remotely leading to a disconnection in services and housing linkages. Most providers initiated telehealth services for clients, yielding positive outcomes. Implications for BHS are the need for long-term strategies, such as advances in communication technology to support BHS and homeless services and to ensure the needs of underserved populations are met during public health emergencies.
    MeSH term(s) COVID-19 ; Homeless Persons ; Housing ; Humans ; Pandemics ; Public Health
    Language English
    Publishing date 2022-05-26
    Publishing country United States
    Document type Journal Article
    ZDB-ID 1419909-9
    ISSN 1556-3308 ; 1094-3412
    ISSN (online) 1556-3308
    ISSN 1094-3412
    DOI 10.1007/s11414-022-09800-9
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