Clinical and functional characteristics of young adults living in single room occupancy housing: preliminary findings from a 10-year longitudinal study

May combine two claims.

14 youth moved from single room occupancy hotels to apartments; 4 (28.6%) returned to a single room occupancy hotel or homelessness during the same follow-up period.

“Conversely, 14 youth moved from SROs to apartments; however, 4 (28.6%)returned to SRO (n = 2) or homelessness (n = 2) during the same follow-up period.”

May combine two claims.

Nearly all participants with active HCV infection (9/10, 90.0%) or seizures (9/11, 81.8%) also had stimulant dependence.

“Notably, nearly all participants with active HCV infection (9/10, 90.0%) or seizures (9/11, 81.8%) also had stimulant dependence.”

May combine two claims.

The study found a high prevalence of psychosis, mood disorders, phobias, posttraumatic stress disorder, and anxiety.

“We found a high prevalence of psychosis, mood disorders, phobias, posttraumatic stress disorder, and anxiety.”

May combine two claims.

Youth self-reported high levels of head injury (55.1%) and high rates of recent seizures or current seizure treatment (11.1%).

“Specifically, the youth selfreported high levels of head injury (55.1%), in addition to high rates of recent seizures or current treatment for a seizure disorder (11.1%).”

May combine two claims.

For 7 (24.1%) individuals, first homelessness was preceded by time in jail, and for 6 (20.7%), by time in a treatment or recovery facility.

“(24.1%) individuals, the first period of homelessness was preceded by time in jail, and for 6 (20.7%), by time in a treatment or recovery facility.”

May combine two claims.

All participants reported alcohol use, with initiation at 13.0 years, versus the Canadian reported age of 16.0 years.

“Every individual in the study also reported alcohol use, with the age of initiation at 13.0 years, compared to the Canadian reported age of 16.0 years (95% CI 15.7-16.2).”

May combine two claims.

Mood disorders (27.7%), phobias (25.7%), post-traumatic stress disorder (15.8%), and generalized anxiety disorder (15.8%) were common.

“Mood disorders (27.7%), phobias (25.7%), post-traumatic stress disorder (15.8%), and generalized anxiety disorder (15.8%) were also common.”

May combine two claims.

The most common pairs of co-occurring illnesses were stimulant dependence with psychosis (40.6%), with anxiety (23.8%), or with opioid dependence (22.8%).

“The most common pairs of co-occurring illnesses were stimulant dependence with psychosis (40.6%), with anxiety (23.8%), or with opioid dependence (22.8%).”

Probably not a substantial claim: may not pass S3 (load-bearing).

20% of participants reported previous incarceration.

“20/101 (20%) reported previous incarceration.”

May combine two claims.

Cannabis initiation age in this group was 14.0 years, versus the Canadian average of 15.6 years.

“The age of initiation of cannabis use in the current group was 14.0 years, compared to the Canadian average of 15.6 years (95% CI 15.3-15.9)(Statistics Canada 2011).”

• cites Statistics Canada 2011Not checked yet

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May combine two claims.

Among those reporting income sources, 65.7% received income assistance and 40.4% received long-term disability assistance.

“Among those who reported sources of income, 65 (65.7%) were receiving income assistance and 40 (40.4%) were receiving long-term disability assistance.”

May combine two claims.

Three deaths occurred during follow-up, yielding an age-specific mortality rate 18.6 times the Canadian rate for this age group.

“First, three mortality events were observed in the study follow-up period, translating to an age-specific mortality rate 18.6 times greater than the Canadian mortality rates reported for this age group (Statistics Canada 2009).”

• cites Statistics Canada 2009Not checked yet

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May combine two claims.

Lifetime use was high for MDMA (86.9%), methamphetamine (82.8%), opioids (77.3%), and inhalants (36.4%).

“We also found high reported lifetime use of MDMA (86.9%), methamphetamine (82.8%), opioids (77.3%), and inhalants (36.4%).”

May combine two claims.

Completed education level was not linked to independent living, social network relationships, or overall psychosocial functioning.

“but not independent living and social network relationships, or total psychosocial functioning ability (p > 0.05).”

May combine two claims.

All participants reported previous alcohol and cannabis use, with median ages of initiation of 13 and 14 years, respectively.

“All participants reported using alcohol and cannabis previously, with a median age of initiation of 13 and 14 years, respectively.”

May combine two claims.

All participants in the study were living in marginal housing; 95% were in single room occupancy hotels, 4% in shelter or on the street, and less than 1% in supportive transitional housing.

“All participants were living in marginal housing: 96 (95%) in SROs, 4 (4%) in shelter or on the street, and 1 (< 1%) in supportive transitional housing.”

May combine two claims.

Among those who used methamphetamine, opioids, or cocaine, most reported a history of regular use (71.8%, 61.4%, and 60.7%, respectively).

“Of the individuals who used methamphetamine, opioids, or cocaine, most (71.8%,61.4%, and 60.7%, respectively) reported a history of regular use”

May combine two claims.

Confirmed HCV infection was present in 31.5% of youth, high compared with the Canadian population (0.6-0.7%).

“In regard to infectious disease, the proportion of youth with confirmed HCV infection (31.5%) was high compared to that in the Canadian population (0.6-0.7%) (Statistics Canada 2012).”

• cites Statistics Canada 2012Not checked yet

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May combine two claims.

Most participants reported cocaine and methamphetamine use (92% and 82%), versus 4.8% and 0.4% of Canadian youth.

“Further, compared to the 4.8% and 0.4% of Canadian y ou th r ep or tin g c oc ai ne a nd m et ha mp he ta min e use, respectively (Statistics Canada 2011), the overwhelming majority of our sample reported having used these substances (92% and 82%, respectively).”

• cites Statistics Canada 2011Not checked yet

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May combine two claims.

Most youth reported moving to the Downtown Eastside between ages 19 and 23 and gaining residency in a single room occupancy hotel shortly after.

“We observed that most youth reported moving to the Downtown Eastside area between the ages of 19 and 23 years and gained residency in an SRO shortly after.”

May combine two claims.

Multimorbidity was associated with worse scores in all four functional domains: work productivity (ρ=-0.309, p=0.002), independent living/self-care (ρ=-0.282, p=0.005), immediate social network relationships (ρ=-0.272, p=0.007), and extended social network relationships (ρ=-0.291, p=0.004).

“Multimorbidity was associated with worse scores in all four functional domains: work productivity (ρ(95) = -0.309,p = 0.002), independent living/self-care (ρ(95) = -0.282,p = 0.005), immediate social network relationships (ρ(95) = -0.272,p = 0.007), and extended social network relationships (ρ(95) = -0.291,p = 0.004).”

May combine two claims.

At baseline, dependence rates were 59.4% for cannabis, 43.6% for methamphetamine, and 31.0% for heroin.

“participants had high rates of cannabis (59.4%), methamphetamine (43.6%), and heroin (31.0%) dependence at baseline assessment.”

May combine two claims.

Baseline serology indicated 2.9% HIV positive, 1.4% active HBV, and 31.5% HCV positive, with 58.8% of HCV-positive participants living with active HCV.

“baseline serology results indicated 2.9% participants confirmed HIV positive, 1.4% had active HBV infection, and 31.5% confirmed HCV positive, with the majority (58.8%) living with active HCV infection.”

May combine two claims.

Only 37.6% reported seeing a psychiatrist and 25.8% reported seeing a family doctor for mental health or substance use.

“Only 37.6% young adults reported seeing a psychiatrist and 25.8% reported seeing a family doctor for their mental health or substance use.”

May combine two claims.

92.9% of participants reported ever using cocaine, with a median age of initiation of 17 years (IQR 15-19).

“Almost every participant (92.9%) reported ever using cocaine, initiating use at age 17 (IQR 15-19).”

May combine two claims.

All participants reported ever using cannabis, versus 34% of Canadian youth.

“For example, 100% of the sample reported having used cannabis at least once, when compared to 34% (95% CI 28.5-39.5%) of Canadian youth (Statistics Canada 2011).”

• cites Statistics Canada 2011Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

The median monthly income was $720 CAD (IQR $610-$908 CAD).

“had a median monthly income of $720 CAD (interquartile range (IQR) $610-$908 CAD)”

May combine two claims.

Multimorbidity was associated with poorer Social and Occupational Functioning Assessment Scale score (ρ=-0.268, p=0.008) and being unemployed (χ2(1,99)=4.211, p=0.040).

“Likewise, multimorbidity was associated with poorer SOFAS score (ρ(95) = -0.268,p = 0.008) and being unemployed (χ 2 (1,99) = 4.211, p = 0.040).”

May combine two claims.

Several other risk factors were identified: low educational achievement, high unemployment, risk-taking behaviours, crime, self-harm, and inadequate self-care.

“Several other risk factors were identified, including low educational achievement, high levels of unemployment, risktaking behaviours, crime, self-harm, and inadequate self-care.”

May combine two claims.

The median age of initiation was 15.5 years for inhalants and 18.5 years for methamphetamine.

“The median age of initiation for inhalants was lower (15.5 years) and methamphetamine was the highest at 18.5 years.”

May combine two claims.

The young people in this study often reported histories of homelessness, incarceration, foster care, and hospitalization.

“The young people in this study frequently reported a history of homelessness, incarceration, foster care, and hospitalization.”

May combine two claims.

Nearly two thirds of the sample had been hospitalized, 20% incarcerated, and 25% in foster care.

“With nearly two thirds of the sample having been hospitalized, 20% incarcerated, and 25% in foster care”

Probably not a substantial claim: may not pass S3 (load-bearing).

Young adults who are homeless or marginally housed have a mortality rate 11 to 40 times higher than that of housed youth.

“Yet, the mortality rate for this population is an astonishing 11-40 times that of housed youth (Roy et al. 2004)”

• cites Roy et al. 2004 sourceNot checked yet

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May combine two claims.

Youth in this study show poor health and social/functional disadvantages similar to adult homeless or SRO populations.

“Youth in this study show remarkably poor health, and social and functional disadvantages consistent with adult populations who are homeless or living in SROs (Kidd et al. 2017;Jones et al. 2015;Vila-Rodriguez et al. 2013;Honer et al. 2017).”

• cites Kidd et al. 2017Not checked yet

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• cites Jones et al. 2015 sourceNot checked yet

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• cites Vila-Rodriguez et al. 2013 sourceNot checked yet

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May combine two claims.

The study's young adult SRO residents experienced elevated death rates, multiple co-occurring illnesses, impaired functioning, low income, and persistent unmet mental health needs.

“This study reports high mortality rates, multimorbid illnesses, poor functioning, poverty, and ongoing unmet mental health needs among young adults living in SROs.”

• AssumptionRests on an assumption: The 101 young adults in the study are representative of the broader population of young adults in SRO housing.

Probably not a substantial claim: may not pass S3 (load-bearing).

Gender analyses were limited to participants who identified as male or female only because of cell size limitations.

“Due to cell size limitations, gender analyses are limited to participants who identified as male or female only.”

May combine two claims.

Sensitivity analyses produced similar results when restricted to baseline SRO residents, when excluding participants with missing scans/tests/assessments, and when mood and anxiety disorders were included in the multimorbidity count.

“Sensitivity analyses found similar results whether analyses were limited to only participants living in SRO at baseline (n = 96) (data not shown), whether subjects with any missing scans, tests, or assessments (n = 48) were excluded from analyses, or whether mood and anxiety disorders were included in the multimorbidity count (Supplemental Table 1).”

Probably not a substantial claim: may not pass S3 (load-bearing).

Seizure activity and substance misuse may be interrelated in this cohort, as in the literature.

“Seizure activity and substance misuse may be inter-related in this cohort, similar to that in the literature (Brown et al. 2011;Alldredge et al. 1989).”

• cites Brown et al. 2011 sourceNot checked yet

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• cites Alldredge et al. 1989 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Psychosocial functioning was assessed using the Role Functioning Scale and the Social and Occupational Functioning Assessment Scale.

“Psychosocial functioning was assessed using the Role Functioning Scale (Goodman et al. 1993) and Social and Occupational Functioning Assessment Scale (Morosini et al. 2000).”

• cites Goodman et al. 1993 sourceNot checked yet

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• cites Morosini et al. 2000 sourceNot checked yet

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May combine two claims.

Key contributors to increased and early substance dependence in this population include multigenerational poverty, early exposure through family or friends, inadequate health/addiction/social programs, lack of community prevention focus, and low education.

“Key factors contributing to increased and early substance dependence in this population include: multigenerational poverty; early substance exposure through family or close friends; inadequate access to health, addictions, and social programs; lack of focus of community programs on substance use prevention; and low levels of education (DeBeck et al. 2016;Corring et al. 2016;Cheng et al. 2016b).”

• cites DeBeck et al. 2016Not checked yet

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• cites Corring et al. 2016 sourceNot checked yet

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• cites Cheng et al. 2016bNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Incomplete scans or those with significant motion artifact were excluded.

“We excluded incomplete scans or those with significant motion artifact, as determined by neuroimaging scientist.”

Classified as probably not a substantial claim.

Psychiatric diagnoses and clinical cognitive impairment were determined by a psychiatrist using a Best Estimate Clinical Evaluation and Diagnosis according to DSM-IV TR criteria.

“A psychiatrist (WGH, FV-R) determined psychiatric diagnoses and clinical cognitive impairment by reviewing all available clinical information in a Best Estimate Clinical Evaluation and Diagnosis according to Diagnostic and Statistical Manual for Mental Disorders-TR Fourth Edition (DSM-IV TR) criteria.”

May combine two claims.

Stimulant dependence, active HCV infection, psychosis, and opioid dependence may be especially important contributors to poor psychosocial functioning (RFS) in this sample.

“Stimulant dependence (χ 2 (1,95) = 8.088, p = 0.004), active HCV infection (χ 2 (1,65) = 7.627, p = 0.006), psychosis (χ 2 (1,95) = 5.644, p = 0.018), and opioid dependence (χ 2 (1,95) = 4.601, p = 0.032) may be particularly important contributors to poor psychosocial functioning (RFS) in this sample.”

Probably not a substantial claim: may not pass S3 (load-bearing).

These substance use trends have been observed in other studies.

“These trends have been observed elsewhere (Cheng et al. 2016a;DeBeck et al. 2016).”

• cites Cheng et al. 2016aNot checked yet

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• cites DeBeck et al. 2016Not checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Sensitivity analyses were performed to assess bias from missing data.

“Sensitivity analyses to assess bias from missing data were performed.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Untreated mental illness in young adults is more likely to persist when the person is homeless or marginally housed.

“Untreated mental illness in young adults-which is more likely to persist if a person is homeless or marginally housed (Kidd et al. 2017;Forchuk et al. 2016)”

• cites Kidd et al. 2017Not checked yet

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• cites Forchuk et al. 2016 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

MRI scans were reviewed by a neuroradiologist and a neuroimaging scientist.

“A neuroradiologist and neuroimaging scientist (ATV, MKH, DJL) reviewed all scans and noted findings of possible clinical relevance.”

May combine two claims.

Young adults in marginal housing in Vancouver experience high levels of physical and mental illness, substance dependence, and social vulnerability.

“Young adults living in marginal housing in Vancouver, one of Canada's most expensive housing markets, experience high levels of physical and mental illness, substance dependence, and social vulnerability.”

Probably not a substantial claim: may not pass S3 (load-bearing).

A recent review of one-stop shop services found that young people with complex needs, like those in this study, require early service integration with rapid access to specialist social and health services.

“A recent review of these Bone-stop shop^services revealed that young people with complex needs, such as those in this study, require early integration of services with rapid access to specialist social and health services (Hetrick et al. 2017).”

• cites Hetrick et al. 2017 sourceNot checked yet

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Probably not a substantial claim: may not pass S2 (checkable).

Opportunities for supportive interventions-especially financial, health, and psychosocial supports to prevent marginalization-may have been missed.

“it can be argued that opportunities may have been missed for supportive interventions-particularly enhanced financial, health, and psychosocial supports to forestall marginalization.”

• AssumptionRests on an assumption: Supportive interventions such as financial, health, and psychosocial supports would have prevented or reduced marginalization if provided earlier.

May combine two claims.

Despite declines in HCV infection rates from 1996 to 2012, unstable housing remains an independent predictor of HCV infection.

“Despite dramatic reductions of HCV infection rates reported between 1996 and 2012 (Grebely et al. 2014), unstable housing continues to be an independent predictor associated with HCV infection (Grebely et al. 2014).”

• cites Grebely et al. 2014 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing).

Global examples of coordinated youth-centred programs exist, including the Canadian Foundry initiative.

“Global examples for coordinated youth-centred programs exist (Hetrick et al. 2017; Rickwood et al. 2014), including a new Canadian initiative called Foundry (www.foundrybc.ca).”

• cites Hetrick et al. 2017 sourceNot checked yet

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• cites Rickwood et al. 2014 sourceNot checked yet

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Probably not a substantial claim: may not pass S3 (load-bearing). May combine two claims.

The self-report measures were mainly designed and tested for adult populations not in social housing, which may reduce result precision.

“Another limitation is that the self-report measures used in this study were primarily designed and tested for adult populations not living in social housing.This may affect the precision of the results.”

Probably not a substantial claim: may not pass S3 (load-bearing).

Canada has a long history of public health involvement in housing.

“Canada has a long history of public health being involved in housing (Lang 1912;Labonte 1986).”

• cites Lang 1912Not checked yet

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• cites Labonte 1986 sourceNot checked yet

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