{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:46:10Z","timestamp":1787028370323,"version":"build-2736575974"},"reference-count":58,"publisher":"MDPI AG","issue":"19","license":[{"start":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T00:00:00Z","timestamp":1695686400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100000026","name":"National Institutes of Drug Abuse","doi-asserted-by":"publisher","award":["R01 DA037012"],"award-info":[{"award-number":["R01 DA037012"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institutes of Drug Abuse","doi-asserted-by":"publisher","award":["K24 DA039780"],"award-info":[{"award-number":["K24 DA039780"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000026","name":"National Institutes of Drug Abuse","doi-asserted-by":"publisher","award":["T32 DA007250"],"award-info":[{"award-number":["T32 DA007250"]}],"id":[{"id":"10.13039\/100000026","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Peter F. McManus Charitable Trust","award":["R01 DA037012"],"award-info":[{"award-number":["R01 DA037012"]}]},{"name":"Peter F. McManus Charitable Trust","award":["K24 DA039780"],"award-info":[{"award-number":["K24 DA039780"]}]},{"name":"Peter F. McManus Charitable Trust","award":["T32 DA007250"],"award-info":[{"award-number":["T32 DA007250"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>Stimulant use among unstably housed individuals is associated with increased risks of psychiatric co-morbidity, violence, HIV transmission, and overdose. Due to a lack of highly effective treatments, evidence-based policies targeting the prevention of stimulant use disorder are of critical importance. However, little empirical evidence exists on risks associated with initiating or returning to stimulant use among at-risk populations. In a longitudinal cohort of unstably housed women in San Francisco (2016\u20132019), self-reported data on stimulant use, housing status, and mental health were collected monthly for up to 6 months, and factors associated with initiating stimulants after a period of non-use were identified through logistic regression. Among 245 participants, 42 (17.1%) started using cocaine and 46 (18.8%) started using methamphetamine. In analyses adjusting for demographics and socio-structural exposures over the preceding month, experiencing street homelessness was associated with initiating cocaine use (AOR: 2.10; 95% CI: 1.04, 4.25) and sheltered homelessness with initiating methamphetamine use (AOR: 2.57; 95% CI: 1.37, 4.79). Other factors\u2014including race, income, unmet subsistence needs, mental health, and treatment adherence\u2014did not reach levels of significance, suggesting the paramount importance of policies directed toward improving access to permanent supportive housing to prevent stimulant use among unstably housed women.<\/jats:p>","DOI":"10.3390\/ijerph20196830","type":"journal-article","created":{"date-parts":[[2023,9,26]],"date-time":"2023-09-26T03:45:23Z","timestamp":1695699923000},"page":"6830","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":9,"title":["Housing Instability Associated with Return to Stimulant Use among Previously Abstaining Women"],"prefix":"10.3390","volume":"20","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4277-6889","authenticated-orcid":false,"given":"Nicky J.","family":"Mehtani","sequence":"first","affiliation":[{"name":"Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA"},{"name":"Whole Person Integrated Care, San Francisco Department of Public Health, San Francisco, CA 94103, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Chika C.","family":"Chuku","sequence":"additional","affiliation":[{"name":"Department of Public Health Sciences, University of Miami, Coral Gables, FL 33136, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Meredith C.","family":"Meacham","sequence":"additional","affiliation":[{"name":"Department of Psychiatry & Behavioral Sciences, University of California, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric","family":"Vittinghoff","sequence":"additional","affiliation":[{"name":"Department of Epidemiology and Biostatistics, University of California, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samantha E.","family":"Dilworth","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5867-1155","authenticated-orcid":false,"given":"Elise D.","family":"Riley","sequence":"additional","affiliation":[{"name":"Department of Medicine, University of California, San Francisco, CA 94143, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,26]]},"reference":[{"key":"ref_1","first-page":"5","article-title":"Drug overdose deaths in the United States, 2001\u20132021","volume":"457","author":"Spencer","year":"2022","journal-title":"NCHS Data Brief"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"759","DOI":"10.1177\/0269881119841569","article-title":"The Australian drug harms ranking study","volume":"33","author":"Bonomo","year":"2019","journal-title":"J. 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