Mental illness among homeless populations is a significant public health issue. Community-based programs that assist the homeless are most often developed to meet local housing needs, not the needs of mental health populations. Transitional housing, a model frequently utilized to address homelessness in communities, provides program-based housing with supportive services. The purpose of this study was to examine the associations between participant- and program-level factors on the utilization of community-based transitional housing by homeless veterans diagnosed with a mental illness. The study tested a revised framework of the behavioral model of utilization for vulnerable populations theory. The sample was comprised of male homeless veterans diagnosed with a mental illness who participated in community-based transitional housing programs in 2004 and 2005 (n = 2,502). Data were collected on 288 programs throughout the United States, operated by local nonprofit or local government agencies and monitored by the U.S. Department of Veterans Affairs under the Homeless Providers Grant and Per Diem Programs. Success was defined as either completion of a course of treatment as determined by a master's prepared clinician, or if housing was obtained upon discharge, as reported by the participant. Initial bivariate results indicated that both demographic and situational variables predicted success in transitional housing. However, upon further statistical analyses, limited predictors were revealed. Participants were more likely to be successful if they were white, reported combat experience, were interested in the program prior to admission, and were enrolled in cognitive behavioral models. Participants were more likely to be housed upon discharge if they were white, received some type of public support, were homeless less than 30 days before admission, and showed interest in the program at the time of the initial interview. Participants were less likely to be successful if they were diagnosed as schizophrenic. There was an indication that participants enrolled in programs designated as faith-based were less likely to be housed than those enrolled in secular programs. No statistically significant associations were found between the level of services offered in the transitional housing programs with either successful completion or participants' housing upon discharge.

Introduction: Cigarette preference increases as a function of nicotine content, but preference can be shifted by manipulating cigarette cost. The aim of the present study is to model whether the behavioral-economic metric of unit price (cigarette cost/nicotine content) accounts for cigarette preference shifts and whether preference changes to very low nicotine content cigarettes (VLNCs) are associated with corresponding changes in smoking rate. Methods: 169 daily smokers from populations vulnerable to smoking completed sessions in which choices between smoking normal nicotine content (NNC) (15.8mg/g) and VLNC (0.4mg/g) cigarettes were concurrently available. In Condition 1, choices for both products were available ad-lib at an equal cost of 10 responses/choice. In Condition 2, VLNCs were again available ad-lib at 10 responses/choice, but NNCs were available on a progressive-ratio (PR) schedule wherein response cost (and unit price) increased following each NNC choice (10,160,320…8400 responses/choice). Results were analyzed using ANOVAs and a binomial test (p<.05). Results: Participants preferred NNCs over VLNCs in Condition 1, but shifted preference to VLNCs in Condition 2 (p<.001) immediately before the point in the PR progression where unit price for NNCs exceeded unit price for VLNCs (p<.001). Additionally, this preference shift corresponded with reduced total cigarette consumption compared to Condition 1 levels (p<.001). Conclusions: These results suggest that unit price of nicotine underpins cigarette preference and may provide a metric by which regulators can predict product preference and potentially impact it through policy. These results also demonstrate that VLNCs sustain lower smoking rates than NNCs even under acute laboratory conditions.

Adverse childhood experiences (ACEs) are linked to increased mental health problems in children, but their association with mental health services utilization is not well known. This secondary analysis used 2016 National Survey of Children’s Health data from two samples: children aged 6-17-years-old with a mental or behavioral condition in need of treatment or counseling (N = 5,723); and a subsample of children who experienced at least one ACE (n = 3,812). Multiple logistic regression and latent class analysis (LCA) were performed to examine the association between ACEs and mental health services utilization. Multiple logistic regressions also examined the associations of parent/caretaker vulnerability, school-system, and medical-system factors on mental health services utilization for children with ACEs using the Gelberg-Andersen Behavioral Model for Vulnerable Populations and a Systems of Care approach as the framework for model building. Children with increased ACE scores did not have higher odds of utilizing mental health services compared to children at lower levels of or no ACEs. For children who experienced adversity, increased parent/caretaker vulnerability was associated with lower odds and the current receipt of special education services with increased odds of mental health services utilization in adjusted models. Strengths of this study included the large dataset and generalizability to the U.S. population. There were limitations to the measurement of ACEs and other key variables. The current study identified children who experienced adversity as an underserviced population for mental health services.

U.S. military service members who are discharged from service for misconduct are at high risk for mental health and substance use disorders, homelessness, mortality, and incarceration. The purpose of this dissertation was to investigate the pre- and post-discharge experiences and characteristics of this highly vulnerable population in order to inform improved prevention and intervention strategies. Administrative data from the Department of Defense and Veterans Health Administration for veterans of recent conflicts were used to conduct 3 related retrospective cohort studies. These included (1) an evaluation of the demographic and military service characteristics and service-connected disabilities associated with discharge for misconduct; (2) an examination of post-discharge health status and healthcare utilization among misconduct-discharged veterans; and (3) the development of predictive models for homelessness and mortality among misconduct-discharged veterans. Several demographic and military service characteristics were associated with increased risk for misconduct discharge, as were exposure to sexual trauma, and post-discharge designation of service-connected disabilities related to mental illness. Misconduct-discharged veterans were found to have significant and complex healthcare needs, and used clinical services at approximately double the rate of routinely discharged veterans. Several risk factors for homelessness and mortality among this population were identified. Risk stratification models showed good predictive accuracy for homelessness, and fair predictive accuracy for mortality. Targeted counter-attrition strategies and an increased focus on health-related determinants of misconduct, including rehabilitative approaches to behavioral problems, may help to reduce misconduct-related attrition. Efforts to transition post-discharge care from specialty settings to integrated primary care settings may be successful in mitigating adverse outcomes. Risk stratification techniques can facilitate the efficient targeting of resources.

Older offenders (offenders 50 years and older) are a distinct groups within the U.S. correctional system. Studies 1 and 2 were intended to investigate mental health and stressors among jailed older offenders. Study 1 examined the prevalence rates of mental health disorders and explored the relationship between mental health disorders and stressors. Participants 50 years and older (N=330) from the 2002 wave of the Survey of Inmates in Local Jails (SILJ) were studied via descriptive analysis, factor analysis, and a logistic regression to determine which variables were related to the probability of having a mental health problem. 65.8% of participants had at least one mental health disorder, with high rates of substance abuse reported. Individuals who were between 50-59 years of age (compared with those over 60) and individuals who were unmarried had a significantly increased likelihood of being in the group with mental health problems. Caucasians and participants with fewer instances of childhood abuse were significantly less likely to be in the group with mental health problems. Study 2 compared stressors over the life course between late life first time offenders (offenders whose first arrest occurred at age 50 or older; hereafter LLFTO) and habitual older offenders, who had one or more arrests. This study descriptively and comparatively analyzed individuals who were age 50 or older at arrest and reported their age of first arrest from the 1996 and 2002 waves of SILJ, with a final sample of 62 LLFTOs and 357 older offenders with previous arrests. LLFTOs were significantly older, more likely to be married, and more likely to be female. Over the life course, LLFTOs were more likely to have lived with their father or other relative as children, were less likely to have used alcohol or had friends with a history of delinquency as adolescents, and were less likely to have been homeless as adults. This dissertation research shows that older offenders have a variety of needs during their incarceration that may persist upon release. Addressing mental health disorders, and stressors across the life span, is needed to promote successful aging.

New immigrants to Canada are identified as a vulnerable population in mental health and, as a result, organizations are signaling the need to enhance their mental health supports. The research uses focus groups and questions based on the messaging of a Canadian school mental health program to understand how new immigrant mothers interpret and develop key aspects of their mental health literacy and how they attain parent empowerment. A thematic assessment of the knowledge, interpretation, action and decision-making of the study participants (n=7), all recent immigrants to Canada and mothers of high school students, shows that new immigrant mothers are prepared to follow a path towards mental health literacy. At the same time, however, there are barriers that can block progression towards mental health literacy for this audience. These findings are supported by three umbrella themes: the first main theme “home as haven” espouses maternal roles in mental health maintenance such as protector and communicator, the second main theme “knowledge versus suspicions of mental health and mental illness” represents informed views and support of mental illness and myths and illusions of mental illness, and the third main theme, “additional barriers to mental health literacy” includes the hardships of immigration and fear of knowledge. The study concludes that new immigrant mothers appreciate the importance of fostering mental health understanding and discussion with their children at the same time that they encounter obstacles to the advancement of their mental health literacy. This study is relevant to the field of communication in that it demonstrates the experience of new immigrant mothers as a secondary audience in mental health programming. As the caregivers of their children, they are in position to enforce the messages and health maintenance behaviours of a school-based mental health program aimed at adolescents.

This thesis documents my research on the epidemiology of Human Immunodeficiency Virus (HIV), hepatitis C virus (HCV) and other transmissible infections among 'at risk' young people, injecting drug users and sex workers in inner Sydney, and how this contributed to the early understanding of these infections in these potentially vulnerable populations in Australia. It also demonstrates how this work informed the development of innovative health service models in Sydney??s Kings Cross, including the Kirketon Road Centre (KRC) and the Sydney Medically Supervised Injecting Centre (MSIC), to address the public health risks affecting these populations over time. Sub-themes include the establishment of sentinel surveillance systems at KRC to monitor HIV and HCV prevalence and incidence as well as trends in drug use in these populations, considered to be key drivers of these epidemics in Australia. Another sub-theme is the clinical trials of pharmacotherapies for both opioid and psychostimulant dependence and the development of the dual treatment approach to HIV (and later HCV) and drug dependence that built upon this. KRC has been an exemplar of this approach, which has been shown to enhance treatment adherence among people who inject drugs ?? necessary to achieve treatment outcomes comparable to other affected populations. In more recent years my research has also included a focus on the epidemiology, physiology and treatment of opioid overdose and other injecting-related harms among IDUs. Underlying my work over the past 20 years has been my commitment to the social justice belief that health is a basic human right and that these socially marginalised populations should have equitable access to high quality evidence-based health care.

The purpose of this study is to determine social factors that influence help seeking behaviors by mothers who are concurrently involved in two social service systems: Child Protective Services (CPS) and family violence advocacy programs. Through the application of the behavioral model (of service use) for vulnerable populations, this study seeks to determine predisposing, enabling and need characteristics that impact help seeking behaviors at a family violence agency after participation in an ADVANCE (Acknowledging Domestic Violence and Navigating Child Protection Effectively) course, a group intervention class developed specifically for women involved with CPS. The research design is a mixed-method approach with an ADVANCE course evaluation embedded within the overall analysis of help seeking behaviors. The analytic strategies include pre-test/post-test means comparisons through paired t-tests, qualitative thematic analysis through arts-based methodology, and ordinary least squares and logistic regression analysis. This study considers six outcome variables related to protective help seeking behaviors: seeking services, seeking protective actions related to children, seeking a safety plan, seeking a protective order, seeking safe housing, and seeking financial independence. Several social factors identified influenced help seeking behaviors amongst child welfare involved women experiencing violence, namely, number of children, age of children, level of interest in services, previous participation in services, level of social support, perceived victim status, perceived need for a safety plan, and perceived need for change in family. This study should serve to enhance intervention practices utilized by both family violence advocates and child welfare professionals.

This dissertation studies partnerships among non- governmental organizations (NGOs) and the resulting consequences of these collaborations. The presence of NGOs in the international system is recognized with scholarly works examining what they are, what they do, and what is their role. However, it is also necessary to systematically analyze the causes for collaborations among NGOs and the following consequences. I ask what determines for NGOs to partner with one another. And, who benefits from these collaborations? I carefully place my study within the broader context of the main international relations paradigms and within the specific debates concerning the NGOs. Using social network analysis, quantitative tools, and in-depth interviews I find that similarity is a main determinant for NGOs to collaborate with one another. Importantly, my findings show that not only shared altruistic goals, as proposed by the dominant literature, but also shared strategic goals matter in the choices for partners. I further show that shared altruistic and strategic goals also influence who the final beneficiaries from the collaborations are. My findings reveal that less often vulnerable populations receive a direct help, even when the organizations advance principled goals. I conclude that NGOs have not only altruistic goals but also strategic needs and wants. The forging of their partnerships and the outcomes of their collaborations are influenced by these distinct goals. NGOs, as strategic actors, make complex decisions, that momentously bring a limited impact on vulnerable populations and the international system overall.

Made available in DSpace on 2015-04-11T13:54:55Z (GMT). No. of bitstreams: 1 Dissertacao-Sonia Maria Lemos.pdf: 695519 bytes, checksum: bb2fa6ad04591a080c83bb6ae077b805 (MD5) Previous issue date: 2009-07-15 / Coordenação de Aperfeiçoamento de Pessoal de Nível Superior / The complexity of the individual-environment relation has brought about uneasiness and a search for strategies in order to minimize or avoid the negative impact of human actions upon the environment. The quest for some understanding on this complexity makes it possible to widen knowledge upon these two facts, stimulating the discussion about a proposition that one will be able to establish healthier and less aggressive ways of living as far as environmental issues are concerned based on environmental-related conceptions and their effects upon the environment .Therefore, it all starting out from a conception that environmental commitment demands engagement, be it in the production of such knowledge or in the rational use of the natural resources. That information is relatively available does not mean that people in general may feel compelled to making use of it or applying it. It is understood that the problem behind environmental issues is complex and interdependent on the social problematic issues arising from population growth, poor income division, allocation of people in big city centers being the spaces smaller and smaller and social inequity larger and larger each day. The various technical-scientific transformations have triggered ecological unbalances and a progressive deterioration on both single and collective ways of living. These changes and the population growth have led to changes in the way people feel or perceive reality. The objective of this study was to analyze people´s environmental forms of commitment at moments of vulnerability and, how these constitute the socio environmental ethos of this population. The issues on vulnerability to which the poorer classes are exposed have represented a challenge in the search for strategies after risk reduction and applicable ways that people can actively develop. The methodological strategy adopted was of a filed research of the descriptive exploratory qualitative type, carried out in an urbanized city zone in the vicinities of the Ouro Verde residential area, Coroado III, Zona Leste in Manaus. The environment is muddy, located in a flooding area and several water streams run across it and wind up in a creek that gets polluted with tossed waste and trash, causing major environmental problems and bringing about a great deal of difficulty to the dwellers. The techniques for the collection of information were the participative observation and semistructured interview, being Content the method of the analysis. A set of ethical phenomena was identified in the current study in order to justify the proposed commitment and three categories emerged from the socio-environmental reality were named after active passivity ; supportive passivity and controlled passivity , which, after all constitute the socioenvironmental ethos built by this population and browses through the environmental-related issues, their understanding and engagement. The questions arisen do not only contribute to the discussion of these people´s engagement to sharing the possibilities of facing their own problematic, but also to giving greater visibility on this process so there can be more effective and efficient interventions. / A complexidade da relação pessoa-ambiente tem produzido inquietação e busca de estratégias para minimizar ou evitar o impacto negativo da ação humana sobre o meio. A busca de entendimento desta complexidade possibilita ampliar o conhecimento sobre estes dois aspectos, estimulando a discussão de uma proposta, onde a partir da compreensão das concepções sobre o meio e dos efeitos sobre ele é possível estabelecer modos de vida mais saudáveis e menos agressivos em termos ambientais. Portanto, partiu-se de uma concepção de que o compromisso ambiental exige envolvimento, seja na produção do conhecimento ou no uso racional dos recursos naturais. O fato das informações estarem relativamente disponíveis não significa que as pessoas em geral se sintam comprometidas em sua apropriação e aplicação. Entende-se que a problemática ambiental é complexa e interdependente da problemática social decorrente do crescimento populacional, má distribuição de renda, alocação das populações em grandes cidades - com espaços cada vez mais restritos, e do alargamento das desigualdades. As diversas transformações técnico-científicas ocasionaram desequilíbrios ecológicos e progressiva deterioração nos modos de existência individuais e coletivas. Essas mudanças e o crescimento demográfico levaram a transformações no modo de viver e perceber a realidade. O objetivo deste estudo foi analisar as formas de compromisso ambiental de pessoas em situação de vulnerabilidade e como estas constituem o ethos socioambiental dessa população. As questões de vulnerabilidade a que estão expostas especialmente as populações menos favorecidas têm representado um desafio na busca das estratégias para diminuição dos riscos e envolvimento para uma participação mais ativa das pessoas no estabelecimento de meios para a sua aplicabilidade. A estratégia metodológica adotada foi de pesquisa de campo do tipo qualitativa exploratória descritiva, que foi desenvolvida em uma ocupação urbana localizada nas adjacências do conjunto Ouro Verde, Bairro Coroado III, Zona Leste na cidade de Manaus. O ambiente é alagadiço, situado em área de charco e entrecortado por vários córregos que deságuam no igarapé onde são jogados os dejetos e o lixo, causando problemas ambientais importantes e trazendo inúmeras dificuldades aos moradores. As técnicas para a coleta de informações foram a observação participante e entrevista semi-estruturada, sendo que o método de análise foi o de conteúdo. Foram identificados neste estudo um conjunto de fenômenos éticos para explicar o compromisso e propusemos três categorias que emergiram da realidade socioambiental que foram denominadas passividade ativa ; passividade suportiva e passividade cerceada que por fim constituem o ethos socioambiental construído por esta população e perpassa o seu entendimento e envolvimento com as questões mbientais. O levantamento dessas questões contribui não apenas com a discussão acerca do envolvimento das pessoas compartilhando possibilidades de enfrentamento das problemáticas vividas por elas, mas também dar maior visibilidade desse processo para intervenções mais eficazes e eficientes.