What Goes Up, Keeps Going Up? The Damaging Effects of Wage Stagnation and Rent Hikes on Homelessness6/28/2023 When someone faces homelessness, there are often numerous hardships that have all contributed to the situation. Arguably chief among these hardships is lack of income due to stagnant wages or unemployment. Many Americans who live paycheck to paycheck are seeing that their wages are not keeping up with the continually rising cost of living in the United States. This problem is largely due to two concurrent damaging trends: government policies that have created stagnant wages and a general rise in rent and housing prices. In order to better understand how people can slip into homelessness, it's important to understand the myriad of causes behind stagnant wages and rising costs of living in the United States.
While the average wages of today fail to keep pace with the cost of living, this wasn’t always the case. Additionally - despite globalization and automation being blamed as primary causes for wage stagnation - there are many other factors at play that reveal a consistent history of corporate neglect for employees, lack of governmental intervention, and worries of stability among workers. One big way large corporations have contributed to stagnant wages is stock buybacks. A stock buyback is when a public company quite literally purchases its own stock from the open market, driving up the price of their stock which helps increase value for shareholders and executives at the company. This was considered market manipulation prior to 1982, when the SEC cut the regulation during Ronald Reagan’s presidency (AFR; Curry; Forbes). Since then, however, buybacks have become more common in recent years, even during the pandemic, increasing in “conjunction with rising executive compensation through stock-based pay packages” (AFR). According to Americans for Financial Reform, these buybacks “exacerbate the racial wealth gap, worsen economic inequality, and divert resources from the real economy which harms workers.” When corporations use their profits to create value for stockholders, the only people who lose are the workers themselves, as those profits could have been used to increase wages, improve benefits, and strengthen workplace safety and general infrastructure. A 2021 study by the American Compass found that “that the number of companies that extracted more value from their firms (including share buybacks) than they invested in new capital expenditures had risen from only 6 percent of companies before 1985 to 49 percent of companies in 2017” (AFR). This means that since the Reagan administration SEC cut the regulation that prohibited buybacks, multiple generations of millions of American workers have lost out on significant increases in pay, job security, and workplace safety because of corporate greed. Further, stock buybacks are inherently discriminatory because of the historic lack of equity within the stock market - while “white families hold 90 percent of the stock market value, [...] black and latinx households each own only 1 percent of the total stock market value — figures that have not budged for the past 30 years” (AFR). Looking at the government's role in this, we can see less and less intervention on behalf of the workers since the 1980’s. Between 1948 and 1970, worker productivity had a direct positive relationship with wages, so the more productive the American workforce was, the more benefits workers saw from their labor (EPI). This was due to specific policy that intentionally aimed to allow workers to directly benefit from their hard work. However, the late 1970’s and subsequent decades saw the stripping of these policies, forcing workers into very difficult positions. According to the Economic Policy Institute, “net productivity rose 61.8%, while the hourly pay of typical workers grew far slower—increasing only 17.5% over four decades” since 1979 (EPI). Due to these policy choices, the federal minimum wage of $7.25 an hour has less purchasing power today than it ever has in the last 66 years, and roughly two thirds of American wages have not kept pace with inflation and rising living costs (Cerulo CBS). Further, Scott Lincicome - Director of General Economics at Cato Institute - states that “in case after case, you see that government policies were implemented to discourage labor dynamism and to discourage workers from moving to a better job or moving to a better town or city to improve their job prospects” (Lee NBC). The immense disparity between pay increases and rising costs of living is one of the main causes of homelessness, as it is both incredibly difficult and stressful to find and pay for housing when your income has not increased with the cost of living. Much like wage stagnation, affordable housing availability has decreased despite worker productivity steadily increasing. Wage disparity coupled with increasingly less availability of affordable housing leaves many at extreme risk of becoming homeless (NAEH). And as the cost of affordable housing increases, a report from the National Law Center on Homelessness & Poverty states that 1 in 4 renters in the U.S. have “extremely low income” by the metrics of United States Department of Housing and Urban Development (Reddin LC). Further, 11 million households spend more than half of their income on rent, and 38 million households spend more than a third of their income on rent (NAEH 2). Since so much of their income is used to pay for housing, these households are just one medical emergency or unexpected bill from becoming homeless (NAEH 2). One important tool available to people in these situations is the Housing Choice Voucher (referred to as HVC from here on out) program, created by the Department of Housing and Urban Development. However, HVCs are critically underfunded, and “increases in federal rental assistance have lagged far behind growth in the number of renters with very low incomes” (NAEH 2). And even though the HVC program is the largest rental assistance program in the country, only a fourth of eligible households actually receive help (NAEH). Unfortunately, economic policies that originated in the 1970’s and 1980’s have effectively made it very difficult for more than half of American households to live comfortably in an economy that prioritizes corporations and stockholders over workers. Despite the existence of government tools and programs to help people pay for housing, wages and other social safety nets continue to fall behind with the rising cost of living, which leaves millions of people living at severe risk of potential and/or certain homelessness every year. References Affordable Housing. (n.d.). National Alliance to End Homelessness. Retrieved June 26, 2023, from https://endhomelessness.org/ending-homelessness/policy/affordable-housing/ [email protected], G. R. (2019, September 29). Wage stagnation, lack of affordable housing greatest factors in homelessness. The Lawton Constitution. https://www.swoknews.com/special_reports/wage-stagnation-lack-of-affordable-housing-greatest-factors-in-homelessness/article_74e34411-f00a-5d73-ac15-49f134bf7723.html Income. (n.d.). National Alliance to End Homelessness. Retrieved June 26, 2023, from https://endhomelessness.org/homelessness-in-america/what-causes-homelessness/incomeinequality/ Lee, J. (2022, July 19). Why American wages haven’t grown despite increases in productivity. CNBC. https://www.cnbc.com/2022/07/19/heres-how-labor-dynamism-affects-wage-growth-in-america.html Most U.S. workers say their pay isn’t keeping up with inflation—CBS News. (2022, September 14). https://www.cbsnews.com/news/wages-not-keeping-up-with-inflation/ Team. (2021, November 10). Fact Sheet: Tax Corporate Stock Buybacks that Enrich Executives and Worsen Inequality. Americans for Financial Reform. https://ourfinancialsecurity.org/2021/11/fact-sheet-tax-corporate-stock-buybacks-that-enrich-executives-and-worsen-inequality/ The Productivity–Pay Gap. (n.d.). Economic Policy Institute. Retrieved June 26, 2023, from https://www.epi.org/productivity-pay-gap/ What Is A Stock Buyback? – Forbes Advisor. (n.d.). Retrieved June 26, 2023, from https://www.forbes.com/advisor/investing/stock-buyback/ Resources National Alliance to End Homelessness | https://endhomelessness.org/ Economic Policy Institute | https://www.epi.org/ Americans for Financial Reform | https://ourfinancialsecurity.org/
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By Jake Schwartz, AmeriCorps VISTA Program Coordinator The state of the healthcare system in the United States has long been the subject of intense debate - and oftentimes heavy criticism - for the perceived shortcomings of various aspects of healthcare that fail to adequately support patients. Among the most glaring issues within U.S. healthcare are the existing financial barriers for both primary care and emergency care, the variability of treatment outcomes across different socioeconomic levels, races, and genders, and the current lack of more accessible, non-traditional methods of receiving healthcare. While each of these facets can result in hardship for people from any walk of life, these negative effects are felt at a much greater intensity for those who face homelessness. When examining U.S. healthcare from a broad point of view, it becomes clear that these aforementioned issues - cost of care, treatment outcomes, lack of accessibility - serve to further the hardships of people who face homelessness.
When discussing the intersection of homelessness and healthcare, a good place to focus would be our nation’s waiting rooms. Primary care exists as a proactive measure to maintain good health in a variety of ways: routine check-ups to catch potential issues before they grow into larger problems, the ability to discuss possible concerns with a trusted professional, and overall maintenance for those with chronic conditions that require close management. These are all essential to one’s health, yet it remains incredibly difficult for those facing homelessness to access this kind of care. Even for those who are able to easily access healthcare, the ways in which this system is set up often lead to confusion and headache for those who simply want to seek some form of treatment. Between understanding the types of health insurance, eligibility for health insurance, co-pays, deductibles, out-of-pocket costs, and in- and out-of-network providers, there exists far too much complicated (and potentially expensive!) red tape that often prevents homeless patients from ever receiving any level of primary medical care (Gallardo et al., 2020). The issues with the primary care system also occur in both directions: they close doors for those who seek out healthcare while also actively shutting the door on current patients who are in danger of facing homelessness. Widespread reviews of nationwide hospital procedures and patient outcomes demonstrate that many hospitals/clinics fail at correctly screening their patients for high risk of future homelessness and/or fail to act on the knowledge that a patient is actively facing housing instability (Fargo et al., 2017). Further research done on the ease of access to primary healthcare depicts a similarly worrying trend of preventative medicine being limited to those who are without any form of instability in housing, employment, or nutrition (Currie et al., 2023). While the conversation of primary care revolves around what isn’t happening but what should be, the dialogue around emergency care concerns what is happening but what shouldn’t be. Due to the aforementioned issues with the primary care system, we understand now that there are scores of people who are in need of healthcare but often can’t receive it. What ends up happening in these situations is that in lieu of a doctor’s appointment, those without healthcare end up relying heavily on immediate/emergency care facilities, even for issues that may or may not even fall under the severity of actual emergencies (Vohra et al., 2022). This over-reliance on emergency departments for otherwise routine care sets off a chain of events that serve to harm both the facilities and, more importantly, the patients themselves. Higher use of emergency departments leads to less available bed-space to be used, requiring medical personnel to be increasingly strict in their triage and treatment decisions. Additionally, those who face homelessness are far more likely than the average patient to be prematurely discharged, which results in lower overall general health and higher rates of readmission to emergency rooms (Jenkinson et al., 2020). These disparities are further intensified when understanding that those who face homelessness are most often those who tend to over-utilize emergency rooms (known pejoratively as “frequent-flyers”). As a result of being affixed this label of being “frequent flyers”, these patients report higher instances of being denied pain medication, being denied treatment, being discharged far too early, and struggling to be taken seriously by hospital staff (Moulin et al., 2018). After reviewing the state of both primary and emergency care in a traditional healthcare setting, it begs the question of, what other alternative opportunities are available? One form of healthcare that has begun to spread across the country is street/community medicine, in which small groups of nurses and/or doctors set up small booths or work out of the back of a vehicle as a mobile clinic, in order to help provide services such as check-ups or vaccinations for populations that otherwise would not be able to get medical care. The benefits of such a system are clear to see: people facing homelessness who have access to some form of healthcare - whether it be through traditional institutions or community-based services - demonstrate far less instances of sickness, have higher rates of vaccinations, have far lower instances of mental illness, and self-report far lower instances of health-related anxiety and depression than those who do not have access to healthcare (Mares & Rosenheck, 2011). Whether it be from a comprehensive overhaul of existing healthcare structures in the United States or from a wider expansion of community-based medicine, or some combination of both avenues, it remains clear that there must be more work done at the institutional and provider level to better advocate for the health and well-being of our homeless population. Resources Care For Friends Chicago | 773.932.1010 Chicago Street Medicine | https://www.chicagostreetmedicine.org/contact.html Heartland Health Outreach | https://nhchc.org/contact/ References Currie, J., Stafford, A., Hutton, J., & Wood, L. (2023). Optimising Access to Healthcare for Patients Experiencing Homelessness in Hospital Emergency Departments. International Journal of Environmental Research and Public Health, 20(3), Article 3. https://doi.org/10.3390/ijerph20032424 Fargo, J. D., Montgomery, A. E., Byrne, T., Brignone, E., Cusack, M., & Gundlapalli, A. V. (2017). Needles in a Haystack: Screening and Healthcare System Evidence for Homelessness. In Informatics for Health: Connected Citizen-Led Wellness and Population Health (pp. 574–578). IOS Press. https://doi.org/10.3233/978-1-61499-753-5-574 Gallardo, K. R., Santa Maria, D., Narendorf, S., Markham, C. M., Swartz, M. D., & Batiste, C. M. (2020). Access to healthcare among youth experiencing homelessness: Perspectives from healthcare and social service providers. Children and Youth Services Review, 115, 105094. https://doi.org/10.1016/j.childyouth.2020.105094 Jenkinson, J., Wheeler, A., Wong, C., & Pires, L. M. (2020). Hospital Discharge Planning for People Experiencing Homelessness Leaving Acute Care: A Neglected Issue. Healthcare Policy, 16(1), 14–21. https://doi.org/10.12927/hcpol.2020.26294 Mares, A. S., & Rosenheck, R. A. (2011). A Comparison of Treatment Outcomes Among Chronically Homelessness Adults Receiving Comprehensive Housing and Health Care Services Versus Usual Local Care. Administration and Policy in Mental Health and Mental Health Services Research, 38(6), 459–475. https://doi.org/10.1007/s10488-011-0333-4 Moulin, A., Evans, E. J., Xing, G., & Melnikow, J. (2018). Substance Use, Homelessness, Mental Illness and Medicaid Coverage: A Set-up for High Emergency Department Utilization. Western Journal of Emergency Medicine, 19(6), 902–906. https://doi.org/10.5811/westjem.2018.9.38954 Vohra, N., Paudyal, V., & Price, M. J. (2022). Homelessness and the use of Emergency Department as a source of healthcare: A systematic review. International Journal of Emergency Medicine, 15(1), 32. https://doi.org/10.1186/s12245-022-00435-3 By LaFlanicea Branch, AmeriCorps State & National Member Educational strategies are useful for supporting individuals experiencing homelessness and offer positive benefits for both children and their families. Struggles among each individual are not always easy to identify, especially with poverty or traumatic situations. Educational resources are important with designated plans to foster the needs of the students, as well as their parents, experiencing homelessness. The lack of education makes it hard to break the cycle and prevent homelessness in many cities across the country. The McKinney-Vento Act of 1987 protects the students rights for quality education and to inform the parents of state regulated requirements.
Students could possibly struggle with different types of problems due to homelessness, such as their academics, unstable living situation, poor communication skills or sense of belonging. Oftentimes, the students’ homelessness issues are not a major “focus” providing the indicated problem, in which needs addressing is housing. The McKinney Vento Act reinforced residency laws, transportation services, enrollment and placement issues, ensuring the students are not distracted from their academics. In the article, “The Impact of Homelessness on Education'' written by Noelle Withers, published in Volunteers of America, Greater New York, states “Children experiencing homelessness lack the stability and support necessary to succeed academically.” Educational programs provide safe and secure environments for students experiencing homelessness to improve communication skills and receive academic support. Tutoring sessions, after-school STEAM activities and group discussions are facilitated by retired teachers, college students and other professionals to students and families experiencing homelessness. Withers states, “In addition to academic impacts, disruption to a child’s education threatens their social and emotional development.” These factors make it harder on the students to feel accomplished in their educational success. The partnership between the education system and homelessness organizations positively impacted the students everyday activities, which would potentially have an overall benefit. Public schools, community centers and shelters organize programs for students to continuously build and grow social and emotional development skills. Literacy based programs assist homeless families with the opportunity to voice their opinion, allowing them to address issues and concerns with educated, supportive staff. Decreasing the homelessness issues across the country will continue to change, yet the Department of Housing and Urban Development are working on addressing the issue. Private donations fund communities and shelters with high quality recreation, family events, parent workshops and field trips. Families experiencing homelessness issues can attempt to tackle the battle with education, support, and ongoing participation. Available resource centers for housing, employment services, school placement, local benefits, and childcare and safety are offered to homeless families. Parents are encouraged to partner with organizations in the community that respond to issues surrounding homelessness, prevention, intervention and ending homelessness. Work Cited: The Impact of Homelessness on Education | Volunteers of America. Volunteers of America: Greater New York. https://www.voa-gny.org/impact-of-homelessness-on-education United States Interagency Council on Homelessness (USICH). (2018, May 3). Article headline. United States Interagency Council on Homelessness (USICH). https://www.usich.gov/news/strengthening-partnerships-between-education-and-homelessness-services/ Sosin, C. (2022, November 19). Homelessness, Lack of Education Reinforce Each Other, Chapin Hall Report Says. Youth Today. https://youthtoday.org/2019/11/homelessness-lack-of-education-reinforce-each-other-chapin-hall-report-says/ Educating Homeless Children by Leah Davies, M.Ed. https://www.kellybear.com/teacherarticles/teachertip55.html By Sloane Shabelman, AmeriCorps State & National Member With an annual increase in homelessness throughout the United States, one statistic must be discussed more: of the U.S.’s homeless population, 50% have spent time in foster care, according to the National Foster Youth Institute. If we as a nation are committed to fighting homelessness, we must take this statistic into account and figure out what changes need to be made to the foster care system to decrease its impact on homelessness.
A report by Chapin Hall at the University of Chicago called “Missed Opportunities: Pathways from Foster Care to Youth Homelessness in America” dives deeper into the connection between foster care and homelessness. Three of the briefs’ main findings are as follows: between one-quarter and one-third of youth and young adults experiencing homelessness have a history of being in foster care, some young people perceive their entry into foster care as the beginning of their homelessness journey, and there are multiple pathways from foster care into homelessness (Dworsky et al., 2019). One major pathway from foster care into homelessness is aging out of the system. Youth who remain in foster care after their 18th birthday (or 21st in some states, including Illinois) are emancipated and no longer legally in the care of the state. However, with often little money and familial support, it is estimated that 20% of these young adults become homeless as soon as they are emancipated, according to the National Foster Youth Institute. The Midwest Evaluation of the Adult Functioning of Former Foster Youth, published in 2010, was one of the largest studies ever conducted on the experiences of young adults who have aged out of the foster care system. The study found that between 31-46% of their participants had been homeless at least once by the time they turned 26. As some states’ have increased the emancipation age to 21, homelessness has been delayed in many young adults who now have more time to learn self-dependency and life skills. However, the study showed that by age 23 they were just as likely to become homeless as those who aged out at 18, emphasized Dr. Mark Courtney, head publisher of the study. In an article by the Substance Abuse and Mental Health Services Administration (SAMHSA), Courtney shared a potential solution to this issue. “[Housing] service providers need to account for the significant mental and behavioral health challenges facing these young people as a result of their trauma histories,” Courtney said. There needs to be a more trauma-informed approach when it comes to housing, especially in cities and neighborhoods where homelessness and the number of children in foster care is at an all-time high. There must be more knowledge, understanding, and compassion among those who provide housing towards people looking for housing with less resources and privilege because of their background, such as young adults coming out of the foster care system. With increased education, specifically aimed at housing providers, about the foster care system, emancipation, and the trauma many foster children endure, they are less likely to end up on the streets and more likely to be on the path for a successful future. Additionally, whether the foster care system ages the children out at 18 or 21, there needs to be more focus on providing more behavioral and mental health support from trained professionals both while the young adults are still in the system and once they have left. These children and young adults have often dealt with severe trauma that could put them at a disadvantage moving forward in their education, socialization, physical abilities, and later on, in their careers. Currently, so many of these children lack the proper resources, such as therapy and support groups to help them move forward, and those who do have these resources often find them to be inadequate and underfunded. If we ever want these children to have a chance at a successful life outside of the foster care system, it is crucial that we are giving them the proper support and tools they need to cope with all they have been through and become sufficient, capable adults. It is important to emphasize that extra support should be provided to all foster children as they are preparing to leave the system, not just those who have aged out, as all children and young adults exiting the system are at risk of experiencing homelessness at some point. According to the Chapin Hall brief, “About half of the young people interviewed who spent time in foster care [and experienced homelessness] exited through reunification or adoption. These young people achieved permanency in the eyes of the child welfare system, but still found themselves on pathways into homelessness” (Dworsky et al., 2019). The researchers at Chapin Hall shared that in addition to providing better services and programs to prepare the young adults for leaving the system, allocating more funds and resources to housing assistance for young adults leaving to live on their own could have a big impact on their potential for experiencing homelessness (Dworsky et al., 2019). Providing extra support both financially and mentally/emotionally for reunified and adoptive families could also prevent many children and young adults from starting on a pathway into homelessness, as many find themselves put in this position when their homes become unstable and unsafe.. All of these proposed solutions, while potentially very impactful if implemented, are merely responses to a crisis that needs to be prevented in the first place: children entering the foster care system. According to the Chapin Hall brief, most child welfare funding received by states has been allocated to help children after they have already entered the system as opposed to preventing them from entering at all (Dworsky et al., 2019). If more funds and resources are allocated to strengthening and stabilizing families and providing support to new or struggling parents, less children will enter the system and less of our country’s citizens will be at risk for experiencing homelessness. In conclusion, with the proper support and help for children leaving the foster system, and with more funds allocated to prevent them from being removed from their homes in the first place, children and young adults all over the country will be better prepared for a successful future - one that hopefully does not include homelessness. Resources: Child Welfare Information Gateway iFoster Illinois DCFS: 800-232-3798 / 217-524-2029 Children’s Home + Aid Foster Care Services: 877-282-4274 To Report Suspected Child Abuse or Neglect: 1-800-25-ABUSE (252-2873) National Domestic Violence Hotline: 800.799.SAFE (800.799.7233) National Parent Helpline: 855.4APARENT (855.427.2736) (available 10 a.m. to 7 p.m., PST, weekdays) References: Dworsky, A. & Courtney, M. (2010). Extended Foster Care Delays but Does Not Prevent Homelessness. Chapin Hall at the University of Chicago. Retrieved March 19, 2023, from https://www.chapinhall.org/research/extended-foster-care-delays-but-does-not-prevent-homelessness/ Dworsky, A., Gitlow, E., Horwitz, B., & Samuels, G. M. (2019, July). Missed opportunities: Pathways from Foster Care To Youth Homelessness in America. Missed Opportunities: Pathways from Foster Care to Youth Homelessness in America | National Clearinghouse on Homeless Youth & Families. Retrieved March 19, 2023, from https://www.chapinhall.org/wp-content/uploads/Chapin-Hall_VoYC_Child-Welfare-Brief_2019-FINAL.pdf Kuehn, B. M. (2022, October 24). Chicago professor shares findings from Foster Youth Study. SAMHSA. Retrieved March 19, 2023, from https://www.samhsa.gov/homelessness-programs-resources/hpr-resources/chicago-professor-shares-findings-foster-youth-study National Foster Youth Institute. (2021, May 27). Homelessness & Foster Youth: The National Foster Youth Institute. NFYI. Retrieved March 19, 2023, from https://nfyi.org/issues/homelessness/ By: Ella Smith, AmeriCorps State & National Member Trigger Warming: Mental Health and Suicide The day-to-day lives of youth experiencing homelessness are stressful, plagued with inconsistency and often deeply traumatic. These factors inevitably take an immense toll on a child's mental health. Studies have concluded that homelessness itself can trigger a mental illness or worsen an already existing condition, even disregarding other factors such as poverty, serious medical conditions, social isolation and or other internal/external issues at play. Overall, those experiencing homelessness tend to have poorer mental health and higher prevalence of wellness issues than the general population due to living in a constant state of survival mode. With this, it becomes apparent just how prevalent the threat of depression and even suicide may become within this population. It can become easy to dismiss a young persons suicidal ideation as “childish behavior” or them “just wanting attention,” but it is crucial we treat these circumstances with the utmost care and compassion.
Among youth experiencing homelessness, the rates of depression are disproportionately high. More than 45% of youth experiencing homelessness struggle with depression, a rate 18 percentage points higher than their housed peers. Additionally, four out of five children who are experiencing homelessness have been exposed to at least one serious violent event by age 12, inevitably taking a tremendous toll on their mental health and cognitive functioning. In the United States, suicide has been found to be the leading cause of death in the homeless youth population with mortality rates due to suicide being 12 to 40 times higher than those in the housed population. A great deal of this has to do with factors typically at play before the child even realizes what’s happening to them. Some of these factors include, but are not limited to: unhealthy family relationships, neglect, poverty, life inconsistencies, physical, emotional, and sexual abuse, histories of domestic violence and lack of emotional support. With all these factors, and more, at play, it grows increasingly evident how youth experiencing homelessness are disproportionately affected by depression, anxiety, suicidal ideation, as well as other mental health issues. Though there is no single-handed solution to reduce the rates of suicide and depression among youth experiencing homelessness, it has become more and more urgent that we work to strengthen the systems that support our youth and coordinate policies which target mental health, housing, income, employment, and access to health care. Some protective factors associated with suicidality among children and adolescents experiencing homelessness are providing positive coping strategies, a supportive school environment, consistent and positive role models, and community/after school enrichment programs which provide our youth a greater sense of purpose and community. Organizations such as Covenant House provide youth experiencing homelessness, victims of trafficking, and runaway youth with services for mental and physical health, addiction treatment, workforce support, legal help, and more in order for them to advance their goals and achieve sustainable independence. Due to the disproportionately high rates of suicide within this specific population of youth, understanding the emotional, physical, and societal factors that contribute to suicidal thoughts and actions amongst them must be understood. By fully comprehending these causal factors, resources to provide positive long term outcomes for youth experiencing homelessness can be better structured and more efficiently dispersed to the populations most in need of them. Resources: If your child is in immediate danger of self-harm, please call 911. Suicide Hotline: 988 Suicide Prevention Resources: https://www.nationwidechildrens.org/specialties/behavioral-health/for-families/suicide-prevention-resources How to Talk to Children about Suicide—An Age-by-Age Guide: https://www.sprc.org/news/how-talk-children-about-suicide-age-age-guide References: Barnes, Andrew J, et al. “Emotional Health among Youth Experiencing Family Homelessness.” Pediatrics, U.S. National Library of Medicine, Apr. 2018, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5869340/. Bommersbach, Tanner J., et al. “Suicide Attempts and Homelessness: Timing of Attempts among Recently Homeless, Past Homeless, and Never Homeless Adults.” Psychiatric Services, 29 Sept. 2020, https://ps.psychiatryonline.org/doi/10.1176/appi.ps.202000073. Canadian Population Health Initiative of the Canadian Institute for Health Information. “Finding Home: Policy Options for Addressing Homelessness in Canada.” 2.3 Mental Health, Mental Illness, & Homelessness in Canada | The Homeless Hub, 2007, https://homelesshub.ca/resource/23-mental-health-mental-illness-homelessness-canada Gerke, Jane. “Health Outcomes for Youth Experiencing Homelessness.” Homeless Youth Connection, 4 Apr. 2022, https://hycaz.org/health-outcomes-for-youth-experiencing-homelessness/#:~:text=More%20than%2040%25%20of%20homeless,their%20housed%20peers%20(29%25). Razza, Timothy, and Yuri Flasch. “Suicidality in Homeless Children and Adolescents: A Systematic Review.” Science Direct, Pergamon, 11 Feb. 2021, https://www.sciencedirect.com/science/article/pii/S135917892100029X. By: Daniel Gantner, AmeriCorps State & National Member In our modern world, un-housed citizens continually suffer from a lack of access to food, health care, and social services. Due to this lack of access, they are at a higher risk of developing serious health conditions, both physical and mental. On top of all of this, people experiencing homelessness routinely deal with explicit criminalization in their everyday lives. Homeless criminalization not only makes it incredibly difficult for unhoused people to live, but it also ensures that many will be trapped in a seemingly endless cycle of poverty, incarceration and forced relocation.
According to the National Coalition for the Homeless, the criminalization of homelessness “refers to measures that prohibit life-sustaining activities such as sleeping/camping, eating, sitting, and/or asking for money/resources in public spaces” (NCH). These measures manifest themselves in sweeps of homeless encampments where tents, medications and other personal items are confiscated or destroyed by local police forces (NCH). They also include ordinances that make it illegal for people to request money, and in some cases, even prohibit sharing food with homeless people (NCH). These laws often aim to “clean up” the image of a particular city or town by simply moving homeless people out of sight. For example, in 2022, New York City arrested over four hundred homeless people for “being outstretched” and taking up more than one seat on a train or bus (Heyward). Unsurprisingly, criminalizing the lifestyles of people experiencing homelessness exacerbates the problem far more than it fixes it. For instance, having a criminal record in addition to not having a permanent address makes it incredibly difficult for unhoused citizens to find employment and housing, and often makes them ineligible for social services (NCH). Further, sending them to jail overburdens our already overpopulated criminal justice system. The punishment they unjustly receive for “crimes” costs more than finding them temporary housing, often up to three times as much (NCH). In some cities, the government will even go so far as to give people one way bus tickets to other states in attempts to cut down their homeless population. According to The Guardian, “people are routinely sent thousands of miles away after only a cursory check by authorities to establish they have a suitable place to stay once they get there. Some said they feel pressured into taking tickets, and others described ending up on the streets within weeks of their arrival” (The Guardian). Despite the immediate financial and social drawbacks of criminalizing homeless populations, cities all across the country choose to prioritize the immediate physical appearance of the city over the lives of the actual people who live there. Issues related to the ongoing criminalization of homelessness make it clear that law enforcement is not an effective tool to solve this challenge, as it instead perpetuates the cycle of homelessness and poverty. The current “solutions” of forcefully relocating or throwing un-housed citizens into the criminal justice system not only dehumanizes them, but further upholds the stigma that they are criminals. In order to effectively help people experiencing homelessness, our government must focus on providing them tangible relief and services in order to create better lives for themselves. References: Heyward, Giulia (2022, November). NYC Mayor Adams faces backlash for move to involuntarily hospitalize people. Retrieved from www.npr.org/2022/11/30/1139968573/nyc-mayor-adams-faces-backlash-for-move-to-involuntarily-hospitalize-homeless-pe Outside in America team (2017, December). Bussed out. www.theguardian.com/us-news/ng-interactive/2017/dec/20/bussed-out-america-moves-homeless-people-country-study NCH Civil rights. nationalhomeless.org/issues/civil-rights/ By: Chase Garland, Site Coordinator When defining what considers a child homeless, it comes from the “means individuals who lack a fixed, regular, and adequate nighttime residence that includes the following: sharing the housing of other persons due to loss of housing and economic hardship. Children who have a nighttime residence or regular sleeping accommodation. Children who are living in public spaces, or substandard housing. These children qualify as homeless because their circumstances are described in clauses” (NCFH 2015). Although there is a high rate of students who have children who experience homelessness, the number is also high for children who are homeless and have a disability. The term “child with a disability'' means the child has intellectual disabilities, hearing impairments, speech or language impairments, serious emotional disturbance, autism, or a specific learning disability”(NCFH 2015). Due to poor health conditions such as poor nutrition and exposure to health hazards can disrupt a child’s physical, cognitive, and emotional disabilities.
Due to the unsafe atmosphere of the household, it can be a challenge to determine what is the true factor that is contributing to the child’s disability due to the unstable condition. According to the National Center for Homeless Education, “19% of homeless students have some form of disability that compares to 14% of housed students in 2022”. (NCHE 2022) However, did you know they also reported that homeless students who receive IEPs early are more likely to remain with their grade level peers and achieve grade proficiency”.(NCHE 2022) The integrity of teachers and administration critically analyzing their IEPS plays a significant role in the child’s success in school. Homeless students whose IEP were not taken seriously are more likely to end up suspended than those who received their IEPs earlier. Even though the issue is ongoing and not enough is being done in order for these children to receive a better quality in education, it means as a society including parents, teachers, friends, or close family should do whatever it takes to ensure the federal government is keeping track of the individual categories that homeless students have and provide additional services in schools that are free. According to the Education Week Resource Center, “They found that of the schools that require the federal law to serve homeless students with disabilities, less than one quarter of districts receive federal funding to assist in that effort” (EWRC 2018). Depending on the child, there can be considered having a specific learning disability versus having an impairment that requires a different type of support. Homeless children who have a disability are currently facing consistent challenges to make sure they get the help they need. What can we do now to support our children with disabilities whose lives matter more just as much as children without disabilities? We can start providing services in school to support special education targeted for homelessness such as intervention services with behavior management plans for teachers to start with, priority seating in the classroom, creating a plan that eliminates social class expectations, assigning a peer mentor, regular meetings with parents or guardian, extra homework help and time to complete assignments, and providing free resources for children receive textbook, school supplies, food pantries, and clothing. Resources Council for Exceptional Children (CEC): dedicated to improving educational outcomes for individuals with exceptionalities, students with disabilities, and/or the gifted. National Association of State Directors of Special Education (NASDSE): established in 1938 to promote and support education programs and related services for children and youth with disabilities in the United States and outlying areas. Parent Training and Information Centers: serve families of children and young adults from birth to age 22 with all disabilities: physical, cognitive, emotional, and learning. They help families obtain appropriate education and services for their children with disabilities; work to improve education results for all children; train and inform parents and professionals on a variety of topics; resolve problems between families and schools or other agencies; and connect children with disabilities to community resources that address their needs. References Coffey, Donavyn. “Disabilities Sometimes Go Undiagnosed in Homeless Students Targeted by New Federal Education Funds, Experts Say.” Youth Today, 19 Nov. 2022, https://youthtoday.org/2022/02/disabilities-sometimes-go-undiagnosed-in-homeless-students-targeted-by-new-federal-education-funds-experts-say/. Equity and Assessment: Moving towards Culturally Responsive Assessment - Ed. https://files.eric.ed.gov/fulltext/ED574461.pdf. Weiss, Thomas C. “Homeless Children with Disabilities in America.” Disabled World, Disabled World, 9 Oct. 2021, https://www.disabled-world.com/disability/children/homeless-kids.php. The Interconnected Nature of Homelessness, Physical Health, Mental Health, and Academic Success10/31/2022 By: Jake Schwartz, AmeriCorps VISTA Member Children who face homelessness often find themselves forced to work through numerous challenges in their lives. These challenges are readily apparent in many facets of their daily lives, particularly when thinking about the ways in which their living situation directly and indirectly impacts their ability to perform at school. As it relates to academic performance, homelessness simultaneously creates and exacerbates barriers to a child’s educational success by negatively affecting their physical and mental health while also weakening their underlying support system.
When thinking about the physical effects of homelessness in a given child, it can be argued that some underlying issues could take root even before the child is born: pregnant women who face homelessness are at higher risk of developing chronic health complications, often lack adequate prenatal care, and can inadvertently expose themselves and their fetuses to environmental hazards due to unsafe living conditions. As a result of these aforementioned issues, children born into homelessness display higher rates of premature birth, developmental delays, and physical disabilities (Hart-Shegos, 1999). While these adverse effects may not be impossible to manage, they become compounded when factoring in the tendency for those facing homelessness to also be food-insecure. The effects of malnutrition through underlying food insecurity manifest in a variety of ways, most notably through the lack of critically important micronutrients that support cognitive function (Fanjiang & Kleinman, 2007). Lacking adequate nutrition is never ideal, but it is especially damaging when these deficiencies are constantly present during critical stages of cognitive and physical development in children. Mental health and physical health are often highly intertwined with each other, so it is equally important to spend time reflecting on the adverse effects of homelessness on mental health as well. As a natural consequence of lack of adequate and/or consistent shelter, children facing homelessness tend to find themselves exposed to more overall risk and adversity than their peers, and this lack of safety/security can have a direct negative impact on a child’s social and emotional wellbeing (Lafavor, 2018). There may not be concrete ways of measuring social and emotional wellbeing directly, but these aspects can be indirectly measured by observing behavioral patterns that could reflect such negative effects. Instances of lessened social/emotional wellbeing can manifest in an academic setting as a variety of traditionally unacceptable behaviors, including excessive absence/tardiness, unregulated emotional outbursts, and general antisocial behavior (Manfra, 2019). As is too often the case, school staff tend to be less educated - often through no fault of their own, to be clear - on how to effectively understand and support students working through traumas linked to homelessness. Without that base of knowledge, school systems rely on more traditional, overly-punitive discipline to enforce rules and standards -- further alienating homeless students and contributing to lower social and emotional welfare (Chow et al., 2015). With all this in mind, there are a few clear, concrete steps that must be taken in order to lessen the impact that homelessness has on a child’s academic success. As mentioned previously, there needs to be a more intentful and cohesive effort by schools and educators around the country to learn how to effectively support students that are facing homelessness. This learning process is multi-faceted and must include strong consideration for changes in discipline policy, increased sensibility and awareness towards students with atypical socialization and emotional regulation. In addition, more work must be done to ensure educators have strong foundational knowledge of the existing support systems for families facing homelessness (Havlik et al., 2014). Taken as a whole, processes like these will allow educators to best provide for students that face the countless pressures and stressors of homelessness. Resources National Center for Homeless Education | (800) 308-2145 Greater Chicago Food Depository | (773) 247-3663 Chicago Public Schools | (773) 553-1000 References Chow, K. A., Mistry, R. S., & Melchor, V. L. (2015). Homelessness in the elementary school classroom: Social and emotional consequences. International Journal of Qualitative Studies in Education, 28(6), 641–662. https://doi.org/10.1080/09518398.2015.1017855 Fanjiang, G., & Kleinman, R. E. (2007). Nutrition and performance in children. Current Opinion in Clinical Nutrition and Metabolic Care, 10(3), 342–347. https://doi.org/10.1097/MCO.0b013e3280523a9e Hart-Shegos, E. (1999). Homelessness and Its Ef ects on Children. Family Housing Fund, Midwest Plaza West, Suite 1650, 801 Nicollet Mall, Minneapolis, MN 55402. https://eric.ed.gov/?id=ED453321 Havlik, S. A., Brady, J., & Gavin, K. (2014). Exploring the Needs of Students Experiencing Homelessness from School Counselors’ Perspectives. Journal of School Counseling, 12(20). https://eric.ed.gov/?id=EJ1034769 Lafavor, T. (2018). Predictors of Academic Success in 9- to 11-Year-Old Homeless Children: The Role of Executive Function, Social Competence, and Emotional Control. The Journal of Early Adolescence, 38(9), 1236–1264. https://doi.org/10.1177/0272431616678989 Manfra, L. (2019). Impact of Homelessness on School Readiness Skills and Early Academic Achievement: A Systematic Review of the Literature. Early Childhood Education Journal, 47(2), 239 249. https://doi.org/10.1007/s10643-018-0918-6 By: Elizabeth Chun, Site Coordinator It’s been about 200 years since free compulsory education was created in the United States. While some things look quite different in American education, others do not. It is not always necessary to update the way things are done just because time is passing, however a closer look into the roots of education in the United States reveals that it was not created for many of the people that now receive it.
At its beginning, education in the United States was created to teach citizens how to become “good, productive members of their society” (A Brief History, 2016). Formal education was not created for the benefits of students, but rather was built by those in power for the benefit of those in power (A Brief History, 2016). In colonial times, only the wealthiest boys went to school (A Brief History, 2016). Eventually, textbooks were created in order to unify the nation in reaction to the Revolutionary War which began in 1775 (A Brief History, 2016). While the textbooks standardized pronunciation and spelling, they also were meant to “instill patriotism and religious beliefs in students” and included inaccurate stereotypes of Native Americans and certain immigrant groups (A Brief History, 2016). It was not until over 100 years later in the late 1800s that free compulsory education was developed allowing additional kids to go to school, though still not all kids, and a major purpose of this free compulsory education was to “prevent immigrants’ values from corrupting ‘American’ values” (A Brief History, 2016). Fast forwarding to today, the American education system struggles to close the achievement gap that stands between the students the early education system valued and those it did not. Research proves that schools, overall, do an inadequate job of providing equal learning opportunities for all students and instead benefit white students to a greater extent (Flores, 2018). If educators “are not proactive about mitigating racial exclusion in social networks, curriculum, pedagogy, course participation and extracurricular activities,” this gap “will continue to permeate schools” (Flores, 2018). There are many remedies educators can use to increase equity for their students in order to override the colonized past of American education. Using teaching strategies of decolonized pedagogies has the potential to create a large impact towards decreasing the present inequities. The pedagogies of bell hooks, Paulo Freire and the Raza Womyn de UCLA all lend themselves well to this. Though it should be noted that the following teaching strategies cannot be separated from the beliefs and worldviews of the people who created them. Moreover, understanding the overarching purpose of each pedagogy is vital for impactful implementation. The pedagogy of bell hooks (2013) works to undo the way “white-supremacist thinking informs every aspect of our culture,” she writes. This includes “the way we learn, the content of what we learn, and the manner in which we are taught” (hooks, 2013, p. 25). To combat this, hooks suggests educators encourage and emphasize the process of learning for their students, the inquiry and questioning that comes with learning, and the feeling of uncertainty that comes with not knowing something (hooks, 2013). Focused on avoiding a learning environment in which students become “indoctrinated” with any type of ideology, hooks believes educators should work towards helping students learn to open their minds and think critically (hooks, 2013). Brazilian educator Paulo Friere developed his pedagogy in order to seek “ways to offer an education to impoverished and illiterate adult students in his country that would help them improve their situation and thus transform their lives and the society in which they lived” (Wright, 2019). His teaching strategies aim to transform power dynamics present in education in order to liberate students from oppression (Wright, 2019). To do so, he recommends teachers explore new knowledge and open themselves to new ways of seeing the world. In addition, Friere believes teachers should avoid teaching in a way that merely “passes” information from teacher to student. Rather, teachers should create an environment in which teachers and students are both seen as learners who, together, engage in dialogue and collaboration. The last pedagogy included here is the Mujerista Pedagogy used by the Raza Womyn de UCLA. Created in reaction to experiencing alienation and discrimination as Chicana and Latina students at their university, the pedagogy aims to destroy “the many ‘isms,’ such as sexism, racism, homophobia, and classism that attempt to dismantle [their] communities” (Revilla, 2014). Their pedagogy developed out of student group meetings, but quite naturally works for classrooms or other learning environments. The Mujerista Pedagogy includes beginning each meeting with time to “catch up” and freely talk (Revilla, 2014). Then, there is an “opening ‘icebreaker’” for the members to answer that ranges from funny to serious, changing by the day (Revilla, 2014). Additionally, the members sit in a circle for the whole meeting (Revilla, 2014). At the end, talking circles close the meetings (Revilla, 2014). Similar to how they started, this creates a second opportunity to share how they are feeling or something about their lives (Revilla, 2014). While talking circles seem like an easy aspect of the pedagogy to eliminate when things get busy, consistent inclusion of this practice prioritizes community and is said to be “the single most unifying strategy that Raza Womyn use to maintain a ‘safe space’” (Revilla, 2014). The inequitable structures in education may not be going away as fast as we’d like due to their historical entwinement with colonization and exclusionary beginnings. However, educators can control their learning environment and the dynamics and practices that take place within them. With each individual teaching strategy comes an opportunity to create a learning environment that is increasingly inclusive of the students the early American education system tried to keep out. Resources
References [Author removed at request of original publisher]. (2016, April 08). 16.1 a brief history of education in the United States. Retrieved March 21, 2022, from https://open.lib.umn.edu/sociology/chapter/16-1-a-brief-history-of-education-in-the-unite d-states/ Flores. (2018). (Re)constructing the Language of the Achievement Gap to an Opportunity Gap: The Counternarratives of Three African American Women School Leaders. Journal of School Leadership, 28(3), 344–373. https://doi.org/10.1177/105268461802800304 hooks, b. (2013). Teaching community: A pedagogy of hope. Hoboken: Taylor and Francis. Revilla, A. T. (2004). Muxerista pedagogy: Raza Womyn Teaching Social Justice Through Student activism. The High School Journal, 87(4), 80–94. https://doi.org/10.1353/hsj.2004.0013 Wright, W. E. (2019). Foundations for teaching English Language Learners: Research, theory, policy, and practice (3rd ed.). Caslon. By: Jake Schwartz, AmeriCorps VISTA Member For many students, breakfast is typically an afterthought due to either how busy the average student is or the typical morning rush. Regardless of the reason, it seems that breakfast is seen as more of a burden instead of an important part of the day. For many other students however, breakfast plays a much more important role in their daily lives. Due to socioeconomic barriers, many students often go to school hungry, due to not having access to reliable food sources and, as a result, often have to skip breakfast entirely. The scope of this issue is well-known in this country, evidenced by the existence of a USDA initiative known as the School Breakfast Program that aims to combat this issue by working with schools to institute free breakfast programs. While this program is beneficial, and exists in around 78,000 schools serving 7.8 million children per day (USDA, 2019), there is still more that can be done for school children. Due to the effects that malnutrition can have on a student’s physical, mental, and emotional well-being - especially during the formative years for neurological development - free breakfast programs that are open to any and all students should be implemented in every primary and secondary school in the United States.
To better understand how free breakfast programs can help children in school, it is important to review the effects that poor nutrition can have on a developing student. General malnutrition has been linked to deficiencies in vitamin B12, thiamin, niacin, zinc, and iron - all of which are micronutrients that greatly influence cognitive function (Fanjiang and Kleinman, 2007). Students who are forced to skip breakfast are more likely to be lacking in some or all of these essential nutrients, and the results of these deficiencies are clear: children with defined food insufficiency between the ages of 6 and 11 years old consistently had lower arithmetic abilities and were more likely to repeat grades (Alaimo, 2001). These results are seen in older adolescence as well, with food-secure participants from 13 - 20 years of age consistently scoring higher on tests of attention, concentration, and verbal/spatial memory than their food-insecure classmates (Widenhorn-Muller, 2008). In addition to cognitive function, malnutrition also has wide-ranging effects on the mental health of students. Students with food insecurity display antisocial behavior at far higher rates than their well-fed counterparts (Alaimo, 2001) and tend to develop anxiety and depression at similarly higher rates compared to average students (Basch, 2011). The combination of these cognitive and mental/emotional effects manifest in many ways, including increased referrals to psychologists, higher instances of tardiness and truancy, and higher cases of disciplinary actions (detentions, suspensions, etc.) reported in food-insecure students (Basch, 2011). From a biological standpoint, when children are deprived of nutrition as a result of skipping breakfast, they are immediately and immensely hindered in their ability to perform well in a school setting relative to their peers. As mentioned earlier, free breakfast programs are currently being implemented across the United States. In order to better understand why these programs are essential to the opportunities for students to succeed, the impacts of the program as it currently exists needs to be evaluated. Since its inception in 1966 and its permanent status since 1975, the USDA School Breakfast Program has served millions of children across thousands of schools (USDA, 2019). The effects of this program have been measured in a variety of ways, and the overall consensus is a cause for celebration: the implementation of the School Breakfast Program - referred to as “SBP” from here on - resulted in higher nutrient intake among inner-city students (Kleinman et al., 2002). SBP implementation also contributed to lower rates of tardiness and truancy in participating schools (Cook et al., 1996) as well as improved scores on standardized testing (Meyers et al, 1989) compared to the student population prior to the inclusion of SBP. Finally, schools with SBP saw lower rates of depression, anxiety, and behavioral issues among participating students (Basch, 2011). While the SBP has shown promise in its implementation so far, and the underlying biology strengthens the argument for its importance, there is still more that can be done to ensure that all students have the opportunity to succeed in a school setting. Current guidelines allow for students at SBP-participating schools to purchase breakfast through their school. Financial assistance is built into the SBP, where students in families that make at or below 130% of the federal poverty level receive free meals, families between 130 - 185% are eligible for reduced-price meals, and families at 185% and above pay full price (USDA, 2019). Considering that the federal poverty level is between $21,330 and $34,590 for families of three and six, respectively (Amadeo, 2019), the cutoffs for the ability to receive free breakfast exist at an income that still may not be comfortable for families to be able to participate in the program. Due to the importance of proper nutrition on a student’s ability to succeed academically, socially, and emotionally, the SBP should (1) be implemented universally across every primary and secondary school in the United States and (2) should be subsidized by the federal government so that participation in the SBP is completely free to all students who wish to take part in the program. Making those adjustments to the current program will help further support future generations of students in numerous crucial ways without causing any extra financial strain on the families and the students affected by food insecurity - empowering students to be the best that they can be. Resources Greater Chicago Food Depository | (773) 247-3663 Chicago Public Schools | (773) 553-1000 USDA Food & Nutrition Services | (312) 353-1044 References Alaimo, K., Olson, C. M., & Frongillo, E. A. (2001, July 1). Food Insufficiency and American School-Aged Children's Cognitive, Academic, and Psychosocial Development. Retrieved from https://pediatrics.aappublications.org/content/108/1/44.short. Amadeo, K. (2019, November 16). Are You Eligible for Federal Benefits in 2019? Retrieved from https://www.thebalance.com/federal-poverty-level-definition- guidelines-chart-3305843. Basch, C. E. (2011). Breakfast and the Achievement Gap Among Urban Minority Youth. Journal of School Health, 81(10), 635–640. doi: 10.1111/j.1746-1561.2011.00638.x Cook, T.|Ohri-Vachaspati, J., Punam|Kelly, & Leitch, G. (1995, December 31). Evaluation of a Universally-Free School Breakfast Program Demonstration Project: Central Falls, Rhode Island. Retrieved from https://eric.ed.gov/?id=ED432375. Fanjiang, G., & Kleinman, R. E. (2007). Nutrition and performance in children. Current Opinion in Clinical Nutrition and Metabolic Care, 10(3), 342–347. doi: 10.1097/mco.0b013e3280523a9e Meyers, A. F. (1989). School Breakfast Program and School Performance. Archives of Pediatrics & Adolescent Medicine, 143(10), 1234. doi: 10.1001/archpedi.1989.02150220142035 Pollitt, E. (1995). Does Breakfast Make a Difference in School? Journal of the American Dietetic Association, 95(10), 1134–1139. doi: 10.1016/s0002-8223(95)00306-1 School Breakfast Program (SBP) Fact Sheet. (n.d.). Retrieved from https://www.fns.usda.gov/sbp/fact-sheet. Widenhorn-Muller, K., Hille, K., Klenk, J., & Weiland, U. (2008). Influence of Having Breakfast on Cognitive Performance and Mood in 13- to 20-Year-Old High School Students: Results of a Crossover Trial. Pediatrics, 122(2), 279–284. doi: 10.1542/peds.2007-0944 |
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