A Mixed-Methods Study of Novel Housing Programs and Overdose Outcomes Among Unhoused People Who Use Drugs in San Diego, California - Project Summary As the United States continues to experience growth in both homelessness and drug overdose deaths among this population, many urban municipalities have instituted new programs aimed at reducing the visibility of homelessness, including street encampments. These programmatic measures include police- enforced involuntary displacement and temporary rapid shelters such as “safe camping” sites, so-called “tiny homes”, and motel room accommodations. While limited research has shown that some of these programs may negatively impact the health of unhoused people who use drugs (PWUD), little is known about how they may ultimately impact overdose risk and incidence. This proposed study seeks to contribute new knowledge about this association using a sequential mixed methods approach in three phases. In Aim 1, I will use secondary data from the La Frontera cohort study in a longitudinal analysis of involuntary displacement and housing program exposures on overdose outcomes; in Aim 2, I will qualitatively explore these associations and gather participant opinions on how housing programs could be improved via 60 in-depth interviews with 30 PWUD and 30 professional key informants; in Aim 3, I will collate data from the previous two aims alongside published literature to construct a mathematical model to predict future overdose incidence across several potential scenarios. I am a well-qualified candidate with the skills to undertake the proposed research and associated training. I have a strong background in both qualitative and quantitative work. During the course of the five-year award period, I will undertake five training goals: 1) gain expertise in the epidemiology of drug overdose, 2) build skills in the design and conduct of mixed methods studies, 3) acquire training in mathematical modeling of epidemics and overdose, 4) obtain expertise in the ethical conduct of research with marginaliz ed and vulnerable populations, and 5) further build my professional career development skills that will prepare me for a career as an independent academic researcher. To achieve these training goals and complete the proposed research, I have assembled a team of mentors and contributors with expertise and career accomplishments in all training areas – substance use and overdose epidemiology, mixed-methods research, mathematical modeling of infectious disease, and research ethics with vulnerable populations. Under the guidance of my mentorship team, I will engage in activities including coursework at UCSD, workshops and seminars at multiple external institutions, submit to and attend both national and international conferences, and conduct the proposed research. Few researchers possess expertise in these combined topical and methodological areas, and completion of this work will contribute significantly to our understanding of how homelessness programming and policy influences overdose risk. These findings may help shape future evidence-based programming and policy efforts.
