The Experience With Smoke-Free Policies in Affordable Multiunit Housing in North Carolina: A Statewide Survey

PURPOSE

Previous surveys of housing operators have identified concerns about enforcement, legal issues, and loss of market share as the main barriers to implementing smoke-free policies in multiunit housing. The purpose of this study was to examine enforcement practices as well as economic and legal outcomes in smoke-free affordable multiunit housing.

DESIGN

Cross-sectional.

SETTING

Affordable multiunit housing in North Carolina.

SUBJECTS

Affordable multiunit housing properties (n = 1063, 57% response rate).

MEASURES

Property representatives completed a written survey with questions regarding the existence of smoke-free policies, smoke-free policy implementation and enforcement practices, and smoking-related costs.

ANALYSIS

Descriptive statistics, χ(2) goodness-of-fit test, and t-test.

RESULTS

A total of 16.5% of properties had policies that prohibited smoking in all residential units. Half (49.8%) of smoke-free properties reported no violations to their policies in the past 12 months. Legal actions to enforce policies were rarely needed and were successful when they did occur. Compared to smoking-allowed properties, smoke-free properties did not experience a loss of market share in terms of occupancy rate (t = .09; p = .93) or residents moving away (χ(2) =. 5; p = .48).

CONCLUSION

Housing operators' concerns about enforcement, legal issues, and loss of market share associated with smoke-free policies are largely unfounded among affordable housing properties in North Carolina. Public health professionals should use messaging strategies that refute these concerns to encourage more properties to adopt smoke-free policies.

Neighborhood Interventions to Reduce Violence

Violence is a widespread problem that affects the physical, mental, and social health of individuals and communities. Violence comes with an immense economic cost to its victims and society at large. Although violence interventions have traditionally targeted individuals, changes to the built environment in places where violence occurs show promise as practical, sustainable, and high-impact preventive measures. This review examines studies that use quasi-experimental or experimental designs to compare violence outcomes for treatment and control groups before and after a change is implemented in the built environment. The most consistent evidence exists in the realm of housing and blight remediation of buildings and land. Some evidence suggests that reducing alcohol availability, improving street connectivity, and providing green housing environments can reduce violent crimes. Finally, studies suggest that neither transit changes nor school openings affect community violence.

A qualitative exploration of veteran and family perspectives on medical foster homes

Since 2008, the Veterans Health Administration Medical Foster Home (MFH) program has served as an alternative to nursing home care for Veterans. As part of a larger national research study, 55 in-person interviews with 62 Veterans and/or their families were conducted to identify reasons for selecting or declining MFH placement. Enrollment was attributed to: a need for increased care and a preference for highly individualized care oversight and family-oriented settings. Reasons for declining placement included: costs, location of MFHs, lack of readiness of family or Veteran to move, and level of confidence that MFHs would meet care needs. Experiences and perspectives regarding advantages and challenges of the MFH program are also described.

Senior Services that Support Housing First in Metro Vancouver

Housing First is a model and philosophy for housing homeless people in immediate and permanent housing. In order to implement and deliver Housing First, research is essential to understand the system of support services as they currently exist. Guided by principles of community-based participatory research, this paper presents the findings from a senior-focused deliberative dialogue workshop in Metro Vancouver, Canada. Participants (16 service providers and 1 service recipient) identified services and resources available to support seniors in maintaining housing and barriers and facilitators for accessing services. Broadly, data were organized into seven themes: (1) Housing; (2) Home support; (3) Transportation; (4) Information availability, accessibility, and navigation; (5) Cultural diversity; (6) Discrimination; and (7) Funding and financial support. Results found that affordable housing that adapts to changing health conditions, income supports, health services, homecare, transportation, and culturally appropriate and nondiscriminatory informational resources are among the supports most needed for persons as young as 50 years old to succeed under the Housing First model in Metro Vancouver. Barriers to Housing First service provision, including rigid eligibility criteria for chronically and episodically homeless, should be revised to better support the growing number of older adults who are newly entering homelessness in Metro Vancouver.

Patterns of Urban Housing Shape Dengue Distribution in Singapore at Neighborhood and Country Scales

Dengue is the most important human arboviral disease in Singapore. We classified residential areas into low-rise and high-rise housing and investigated the influence of urban drainage on the distribution of dengue incidence and outdoor breeding at neighborhood and country scales. In Geylang area (August 2014 to August 2015), dengue incidence was higher in a subarea of low-rise housing compared to high-rise one, averaging 26.7 (standard error, SE = 4.83) versus 2.43 (SE = 0.67) per 1,000 people. Outdoor breeding drains of Aedes aegypti have clustered in the low-rise housing subarea. The pupal density per population was higher in the low-rise blocks versus high-rise ones, 246 (SE = 69.08) and 35.4 (SE = 25.49) per 1,000 people, respectively. The density of urban drainage network in the low-rise blocks is double that in the high-rise ones, averaging 0.05 (SE = 0.0032) versus 0.025 (SE = 0.00245) per meter. Further, a holistic analysis at a country-scale has confirmed the role of urban hydrology in shaping dengue distribution in Singapore. Dengue incidence (2013-2015) is proportional to the fractions of the area (or population) of low-rise housing. The drainage density in low-rise housing is 4 times that corresponding estimate in high-rise areas, 2.59 and 0.68 per meter, respectively. Public housing in agglomerations of high-rise buildings could have a positive impact on dengue if this urban planning comes at the expense of low-rise housing. City planners in endemic regions should consider the density of drainage networks for both the prevention of flooding and the breeding of mosquitoes.

Indoor visible mold and mold odor are associated with new-onset childhood wheeze in a dose-dependent manner

Evidence is accumulating that indoor dampness and mold are associated with the development of asthma. The underlying mechanisms remain unknown. New Zealand has high rates of both asthma and indoor mold and is ideally placed to investigate this. We conducted an incident case-control study involving 150 children with new-onset wheeze, aged between 1 and 7 years, each matched to two control children with no history of wheezing. Each participant's home was assessed for moisture damage, condensation, and mold growth by researchers, an independent building assessor and parents. Repeated measures of temperature and humidity were made, and electrostatic dust cloths were used to collect airborne microbes. Cloths were analyzed using qPCR. Children were skin prick tested for aeroallergens to establish atopy. Strong positive associations were found between observations of visible mold and new-onset wheezing in children (adjusted odds ratios ranged between 1.30 and 3.56; P ≤ .05). Visible mold and mold odor were consistently associated with new-onset wheezing in a dose-dependent manner. Measurements of qPCR microbial levels, temperature, and humidity were not associated with new-onset wheezing. The association between mold and new-onset wheeze was not modified by atopic status, suggesting a non-allergic association.

Home Coming? A Story of Reassurance, Opportunity and Hope for Universally Designed Housing in Australia

This paper shows the complexity of housing and how it is the linch-pin for achieving economic, social and human rights imperatives. In Australia there are no minimum housing standards; the effect is now critical. In October 2017, a regulatory impact assessment was instructed, to consider Livable Housing Australia's Silver and Gold standards, for inclusion in the National Construction Code. A substantial research project provided a knowledge and evidence base of the policy perspective; an expanded statistical context; and detailed analyses of Silver, Gold and Platinum design levels. The policy perspective included greater economic focus. The effect on productivity, directly attributable to housing, is significant. 34 specific policy 'problems' were identified that could be solved or mitigated if acceptable standards of housing were introduced. It is reassuring that universal design has permeated all levels of government policy. The statistical context explored demographics, households, dwelling types; tenure; occupants; disability and carers. Detailed analyses challenged many common assumptions and re-framed accessible housing into a mainstream problem. 73% of all dwellings are separate houses and the average home has 3.1 bedrooms. There are tremendous opportunities for universally design-led mainstream solutions. The compliance gap analyses show which design features might cost more; have potential to be designed out; or be cost neutral. Many design features are cost neutral and arguably should be included within mandated standards. As there is a minimal gap between universal design standards and current housing, there is hope that all Australians will, one day, live in a universally designed home.

Mid-life social outcomes for a population-based sample of adults with ASD

Adults with autism spectrum disorders (ASD) fall short of social outcomes of non-ASD peers in mid-life, as documented by currently published research. The aim of the current study was to extend what is known about social functioning, employment, independent living, and use of social services by examining details of the current life status for a population-based sample of adults with ASD (mean age = 35.5 years, range = 22.2-51.4). We collected outcome data via direct assessment and informant report for 169 individuals. Three-fourths of the sample had cognitive abilities in the intellectually disabled range. Social functioning outcomes, as a single measure, mirror those reported previously for other samples, including samples with a high proportion of individuals with normal range intellectual abilities, with 20% achieving the most independent outcomes and 46% requiring high levels of support across most life areas. Participant subgroups who achieved maximal outcomes represented a range of social and intellectual abilities for several outcome metrics. Participants used high levels of public and private supports, yet specific areas of clear, unmet need were also identified. Autism Res 2018, 11: 142-152. © 2017 International Society for Autism Research, Wiley Periodicals, Inc.

LAY SUMMARY

This paper describes the social functioning outcomes for 169 adults with autism spectrum disorders in mid-life. Adult participants spanned the full range of functional and cognitive ability levels, with over 75% functioning in the cognitively impaired range. While summary descriptions of outcomes for this sample were similar to those reported for other groups of adults, this report provides detailed information regarding employment outcomes, social relationships, leisure activities, participation in the community, residential situations, public service use, and involvement with law enforcement.

Men's health and co-residence with older generations in Russia: better or worse?

Background

Previous studies show contradictory findings on the relationship between health and intergenerational living arrangements (ILAs), which may be due to variation in who selects themselves into and out of ILA. Addressing the selectivity into ILA and the health of the older generation, we assess whether there is a health-protective or health-damaging effect of ILA. We locate our study in the Russian context, where ILA is prevalent and men’s health has become a public health issue.

Methods

We apply a fixed-effects logistic regression to self-rated health status of 11 546 men aged 25 years or older who participated in at least two waves in the Russian Longitudinal Monitoring Survey from 1994 to 2015. To further isolate the health effect of ILA, we observe only associations after transitioning into or out of ILA.

Results

A transition into co-residence with an unhealthy older generation increases men’s odds of reporting poor health (OR=0.64, CI 0.44 to 0.93). A transition out of co-residence with a healthy older generation decreases men’s odds of reporting fine health by 63% (OR=0.37, CI 0.28 to 0.50), whereas continuing to live with an unhealthy older generation decreases the odds by half (OR=0.49, CI 0.38 to 0.63).

Conclusions

We reveal a health interlinkage between co-residing generations by finding a detrimental health effect of co-residence with an unhealthy older generation. No longer living with an older generation who was in fine health also negatively affects men’s health. Future studies should address heterogeneity related to the health of older generations, unobserved time-constant characteristics of younger generations and selectivity into/out of ILA.

Setting Housing Standards to Improve Global Health

Developing World Health Organization international guidelines is a highly formal process. Yet the resulting guidelines, which Member States are encouraged, but not required to adopt, are a powerful way of developing rigorous policy and fostering implementation. Using the example of the housing and health guidelines, which are currently being finalised, this paper outlines the process for developing WHO guidelines. This includes: forming a Guidelines Review Group that represents all regions of the world, and ensures gender balance and technical expertise; identifying key health outcomes of interest; commissioning systematic reviews of the evidence; assessing the evidence; and formulating recommendations. The strength of each recommendation is assessed based on the quality of the evidence, along with consideration of issues such as equity, acceptability, and feasibility of the implementation of the recommendation. The proposed housing guidelines will address: cold and hot indoor temperatures, home injuries, household crowding, accessibility and access to active travel infrastructure.

Prevalence of foot disorders in captive Sardinian partridges (Alectoris barbara barbara Bonnaterre, 1790) as useful indicators of fitness to natural environment

Foot health represents an issue in wild avifauna breeding practices. In particular, prevalence of digital ulceration (DU) and foot pad dermatitis (FPD) are valid indicators of welfare in wildlife conservation centres and may be interpreted as to fitness for bird's reintroduction into the wild. This study meant to test the effects of raising practices on foot pad health in captive Sardinian partridges (Alectoris barbara barbara Bonnaterre, 1790) reared for biodiversity conservation, to assess welfare and fitness to reintroduction into nature. A total of 22 couples were allotted into two experimental groups. In one group, 10 couples were housed in 10 cages for breeding partridges, consisting of two animals each, with metal wire flooring system, above trays where droppings were collected. The remaining 12 couples were housed in six aviaries, consisting of four animals each, on natural (earth and stones) ground. In both groups, partridges were fed identical diets. No significant differences of food pad scoring were found between birds housed in cages (2.3 ± 0.4) and those reared in aviaries on natural ground (2.5 ± 0.6). Moreover, scores of male foot pads for both groups (2.4 ± 0.6) had no significant differences in comparison with female foot pads, independently on housing (2.5 ± 0.4). Body mass (BM) was higher (+4.36%) than average BM reported for wild Sardinian partridges. Digital ulceration was found in the 20% of females, exclusively from the cage group. Body mass of females in cages with metal wire flooring appeared to be significantly (p < .001) and negatively correlated (r = -.528) with DU prevalence. These results suggest that housing conditions impacts differently on behaviour of females and males in one same couple, and this relates to foot health, in particular as to DU prevalence.

[How to intervene and prevent stunting of children from homes belonging to the Sisbén in Caldas]

INTRODUCTION

Growth retardation or chronic malnutrition (low height for age) indicates a failure in the natural genetic potential that allows us to growth.

OBJECTIVE

To estimate predictive models of growth retardation in households with children younger than five years in the department of Caldas and registered in the identification system of potential beneficiaries of social programs (Sistema de Identificación de Potenciales Beneficiarios de Programas Sociales, Sisbén).

MATERIALS AND METHODS

We conducted an analytical study in all households (N=56,987) included in the Sisbén III database with the presence of children younger than five years (N=33,244). The variables under study were demographic and socioeconomic characteristics, health service access, housing, poverty, education, job market, and growth retardation. The multivariate analysis was done in two phases: first, an exploratory analysis of households using hierarchical classification (cluster), then estimation of a nonlinear predictive model (probit) with growth retardation as the dependent variable.

RESULTS

The largest proportion of growth retardation in children younger than five years was found in southcentral Caldas, in urban centers, and households with monthly income lower than USD$ 65.

CONCLUSION

Poverty in Caldas women-headed households with children younger than five years registered in the Sisbén was the main predictor of growth retardation.

Do resettlement variables predict psychiatric treatment outcomes in a sample of asylum-seeking survivors of torture?

PURPOSE

Mental health clinicians who work with asylum seekers provide services to patients who face stressful everyday living conditions. However, little is known about how these problems potentially impact psychiatric treatment within these populations. The purpose of this study was thus to examine whether resettlement factors predict outcomes of a mental health intervention for a sample of asylum-seeking survivors of torture.

METHODS

The study included data from a US outpatient clinic that specialized in treating asylum-seeking survivors of torture. Patients (primarily from Iraq, Afghanistan and African Countries) were evaluated on demographic factors at intake and psychiatric symptoms throughout the course of treatment.

RESULTS

Patients experienced significant reductions in depression, anxiety and trauma symptoms, although symptoms still remained near or above clinical thresholds. Stable, uncrowded housing conditions significantly predicted lower depression, anxiety and trauma symptoms at follow-up.

CONCLUSION

These findings support the hypotheses that individuals seeking asylum within the United States who have survived torture can benefit from psychiatric treatment and emphasize the importance of stable living conditions in improving treatment effectiveness. This suggests the need for further research on social predictors of treatment outcomes, as well as the need for clinicians and policymakers to target improved housing as a potentially important tool to reduce psychiatric problems related to torture and forced migration.

Using Twitter to Explore (un)Healthy Housing: Learning from the #Characterbuildings Campaign in New Zealand

While increasingly used for research, Twitter remains largely untapped as a source of data about housing. We explore the growth of social media and use of Twitter in health and social research, and question why housing researchers have avoided using Twitter to explore housing issues to date. We use the #characterbuildings campaign, initiated by an online media platform in New Zealand in 2014 to illustrate that Twitter can provide insights into housing as a public health and social problem. We find that Twitter users share details of problems with past and present homes on this public platform, and that this readily available data can contribute to the case for improving building quality as a means of promoting public health. Moreover, the way people responded to the request to share details about their housing experiences provides insight into how New Zealanders conceive of housing problems.

Impact of improved insulation and heating on mortality risk of older cohort members with prior cardiovascular or respiratory hospitalisations

OBJECTIVES

We carried out an evaluation of a large-scale New Zealand retrofit programme using administrative data that provided the statistical power to assess the effect of insulation and/or heating retrofits on cardiovascular and respiratory-related mortality in people aged 65 and over with prior respiratory or circulatory hospitalisations.

DESIGN

Quasi-experimental cohort study based on administrative data.

SETTING

New Zealand.

PARTICIPANTS

From a larger study cohort of over 900 000 people, we selected two subcohorts: 3287 people who were aged 65 and over and had experienced pretreatment period cardiovascular-related hospitalisation (ICD-10 chapter 9), and 1561 people aged 65 and over who had experienced pretreatment respiratory-related hospitalisation (ICD-10 chapter 10).

INTERVENTIONS

Treatment group individuals lived in a home that received insulation and/or heating retrofits under the Warm Up New Zealand: Heat Smart programme. Control group individuals lived in a home that was matched to a treatment home based on physical characteristics and location.

PRIMARY AND SECONDARY OUTCOME MEASURES

HR for all-cause mortality for treatment with insulation, heating, or insulation and heating relative to control group.

RESULTS

People with pretreatment circulatory hospitalisation who occupied a household that received only insulation had an HR for all-cause mortality of 0.673 (95% CI 0.535 to 0.847) (p<0.001) relative to control group members. Individuals with a pretreatment respiratory hospitalisation who occupied a household that received only an insulation retrofit had an HR for all-cause mortality of 0.830 (95% CI 0.655 to 1.051) (p=0.122) relative to control group members. There was no evidence of an additional benefit from receiving heating.

CONCLUSIONS

We interpret the hazard rate observed for cardiovascular subcohort individuals who received insulation as evidence of a protective effect, reducing the risk of mortality for vulnerable older adults. There is suggestive evidence of a protective effect of insulation for the respiratory subcohort.

Two Futures: Financial and Practical Realities for Parents of Living With a Life Limited Child

Today more and more children are living with complex health care needs, many of these children are living with life limiting and/or threatening conditions, some are medically fragile. To live a childhood these children must live in communities and with their families. In most cases this means the child's carers, their parents, most often their mothers, are required to undertake a great deal of the child's care. During a project on parental coping I became aware of the ways in which parents were restructuring their working lives in order to meet the demands of the nursing and medical care needs of their children. In this paper I relate the stories we discovered in this qualitative study and discuss the tensions between parental and state's responsibility for children, carers and the political and cultural rights and responsibilities pertaining to children's care. I use Margret Urban Walker's ideas of expressive collaborative morality to argue that the care of life limited and life threatened children should be framed in a negotiation between the state and the carers, both informal and professional. That such an agreement should include a covenant to assist parents and siblings when a child dies to recover and adjust to their loss, in recognition of the work they have performed in caring for the child during their child's life and their death.

Housing accessibility problems for people with Parkinson's disease

OBJECTIVES

Promoting accessible housing for all citizens is high on the political agenda. Knowledge is, however, limited regarding housing accessibility problems for people with Parkinson's disease (PD). The objectives were to investigate housing accessibility problems among people with PD at different stages of disease severity and to analyze the potential impact of improved functional ability on accessibility problems.

MATERIALS AND METHODS

The study included 253 participants with PD (61% men; mean age 70 years). Disease severity was assessed by the Hoehn and Yahr (HY) I-V stages: HY I, n=50; II, n=73, III, n=66; IV-V, n=64. Using the Housing Enabler (HE) instrument, accessibility problems were investigated by combining assessments of the person's functional capacity with assessments of physical barriers in the housing environment into a person-environment fit measure (HE-score). To analyze potential impact of improved functional ability on housing accessibility problems, data simulation was applied.

RESULTS

HE-scores differed significantly (P<.001) in relation to HY stages. Overall balance problems explained 22% and walking devices 17% of the HE-scores, whereas environmental barriers contributed to a lesser extent. The environmental barriers generating the most HE-scores were "no grab bar at shower/bath/toilet" and "wall-mounted cupboards and shelves placed high". A simulation of improved balance significantly (P<.001) lowered the HE-scores in all HY stages.

CONCLUSIONS

The results suggest that actions targeting balance problems and dependence on walking devices have the greatest potential for reducing housing accessibility problems for people with PD. The study also details environmental barriers that need specific attention when providing housing adaptation services.

Therapeutic Effects of Anthocyanins and Environmental Enrichment in R6/1 Huntington's Disease Mice

BACKGROUND

Huntington's disease (HD) is a progressive neurodegenerative disease with no effective treatment or cure. Environmental enrichment has been used to slow processes leading to ageing and neurodegenerative diseases including HD. Phenolic phytochemicals including anthocyanins have also been shown to improve brain function in ageing and neurodegenerative diseases.

OBJECTIVE

This study examined the effects of anthocyanin dietary supplementation and environmental enrichment on behavioural phenotypes and brain cholesterol metabolic alterations in the R6/1 mouse model of HD.

METHODS

R6/1 HD mice and their wild-type littermate controls were randomised into the different experimental conditions, involving either environmentally enriched versus standard housing conditions, or anthocyanin versus control diet. Motor dysfunction was assessed from 6 to 26 weeks using the RotaRod and the hind-paw clasping tests. Gas chromatography - tandem mass spectrometry was used to quantify a broad range of sterols in the striatum and cortex of R6/1 HD mice.

RESULTS

Anthocyanin dietary supplementation delayed the onset of motor dysfunction in female HD mice. Environmental enrichment improved motor function and the hind paw clasping phenotype in male HD mice only. These mice also had lower levels of cholesterol oxidation products in the cortex compared to standard-housed mice.

CONCLUSION

Both anthocyanin supplementation and environmental enrichment are able to improve the motor dysfunction phenotype of R6/1 mice, however the effectiveness of these interventions was different between the two sexes. The interventions examined did not alter brain cholesterol metabolic deficits that have been reported previously in this mouse model of HD.

Housing and Health of Kiribati Migrants Living in New Zealand

Settlement is a complex process of adjustment for migrants and refugees. Drawing on recent research on the settlement experiences of Kiribati migrants and their families living in New Zealand, this article examines the role of housing as an influencer of the settlement and health of Kiribati migrants. Using qualitative methodology, in-depth interviews were conducted with fourteen Kiribati migrants (eight women and six men) representing 91 family members about the key issues and events that shaped their settlement in New Zealand. The stories told by participants affirm the association between housing and health. The study serves as an important reminder that children bear a great cost from living in poorly insulated and damp housing, and adults bear the mental costs, including social isolation resulting from inadequate rental housing. Detailed information about how this migrant group entered the private rental housing market, by taking over the rental leases of other Kiribati migrants vacating their rental properties, indicated some of the unintended consequences related to a lack of incentives for landlords to make improvements. With the most vulnerable families most at risk from inadequate housing, this research concludes that there is a need for minimum housing standards to protect tenants.

Housing as a Determinant of Tongan Children's Health: Innovative Methodology Using Wearable Cameras

Housing is a significant determinant of health, particularly in developing countries such as Tonga. Currently, very little is known about the quality of the housing in Tonga, as is the case with many developing countries, nor about the interaction between children and the home environment. This study aimed to identify the nature and extent of health risk factors and behaviours in Tongan houses from a child's perspective. An innovative methodology was used, Kids'Cam Tonga. Seventy-two Class 6 children (10 to 13-year-olds) were randomly selected from 12 randomly selected schools in Tongatapu, the main island. Each participating child wore a wearable camera on lanyards around their neck. The device automatically took wide-angled, 136° images of the child's perspective every seven seconds. The children were instructed to wear the camera all day from Friday morning to Sunday evening, inclusive. The analysis showed that the majority of Tongan children in the study live in houses that have structural deficiencies and hazards, including water damage (42%), mould (36%), and electrical (89%) and burn risk factors (28%). The findings suggest that improvements to the housing stock may reduce the associated health burden and increase buildings' resilience to natural hazards. A collaborative approach between communities, community leaders, government and non-governmental organisations (NGOs) is urgently needed. This research methodology may be of value to other developing countries.

Cumulative incidence of admission to permanent residential aged care for Australian women - A competing risk analysis

OBJECTIVE

To provide a direct estimate of the risk of admission to permanent residential aged care among older women while accounting for death, according to housing type and other variables.

METHODS

A competing risk analysis from 8,867 Australian women born 1921-26, using linked data from the Australian Longitudinal Study on Women's Health (ALSWH), Residential Aged Care (RAC), and the Australian National Death Index.

RESULTS

After accounting for deaths, around 35% of women will be admitted to RAC between ages 73 and 90. The conditional cumulative incidence of admission to RAC was 26.9% if living in a house, compared to 36.0% from an apartment, 43.6% within a retirement village, and 37.1% if living in a mobile home. Each one-year increase in age was associated with a relative 17% increased risk of RAC.

CONCLUSIONS

Around one-third of women will enter RAC between age 73 and 90. Living in a house had the lowest risk of entering residential aged care over time. Implications for public health: These findings have important implications for planning for aged care services, including the role of housing in delaying admission to residential aged care, and the need for residential care by a high proportion of women towards the end of life.

Demography of Living Arrangements Among Oldest-Old Mexican Americans: Evidence From the Hispanic Epidemiologic Study of the Elderly

OBJECTIVE

In this article, we examine the demographics of living arrangements and household headship status among Mexican-origin individuals aged 85+ years.

METHOD

Data come from the Hispanic Established Populations for the Epidemiologic Study of the Elderly (H-EPESE) caregiver and respondent surveys.

RESULTS

Finances of the elderly individual and their caregiver inform living arrangement decisions. Physical and cognitive disability differentiate among living arrangements: The most mentally and physically impaired are most likely to live with others and less likely to be the head of the household.

DISCUSSION

Motivations for living with others are clearly more complex than simple filial piety considerations might hold. Extended living arrangements provide concrete financial and instrumental benefits for both elderly parents and their adult child caregiver. Future research should address the question of the capacity of the Mexican American family to provide care for elderly parents in the face of major demographic and social changes.

Exploring the Relationship between Housing and Health for Refugees and Asylum Seekers in South Australia: A Qualitative Study

Housing is an important social determinant of health; however, little is known about the impact of housing experiences on health and wellbeing for people from refugee and asylum-seeking backgrounds. In this paper, we outline a qualitative component of a study in South Australia examining these links. Specifically, interviews were conducted with 50 refugees and asylum seekers who were purposively sampled according to gender, continent and visa status, from a broader survey. Interviews were analysed thematically. The results indicated that housing was of central importance to health and wellbeing and impacted on health through a range of pathways including affordability, the suitability of housing in relation to physical aspects such as condition and layout, and social aspects such as safety and belonging and issues around security of tenure. Asylum seekers in particular reported that living in housing in poor condition negatively affected their health. Our research reinforces the importance of housing for both the physical and mental health for asylum seekers and refugees living in resettlement countries. Improving housing quality, affordability and tenure security all have the potential to lead to more positive health outcomes.

Hippocampal volume, social interactions, and the expression of the normal repertoire of resident-intruder behavior

INTRODUCTION

Reduced hippocampal volumes are reported in individuals with disrupted emotional coping behaviors in both human clinical conditions and in experimental animal models of these populations. In a number of experimental animal models, it has been shown that social interactions can promote resilience and buffer the negative neural consequences of stimuli that disrupt effective coping.

METHODS

Hippocampal and dentate gyrus volumes were calculated in 54 male Sprague Dawley rats; (1) single housed (n = 12), (2) single housed and exposed to daily 6-min social interactions testing in a resident-intruder paradigm (n = 11); (3) group housed (n = 12); (4) single housed and sham injured (n = 12); (5) single housed, sham injured, and social interactions tested (n = 7).

RESULTS

We present data which shows that even a brief daily exposure to a conspecific in resident-intruder social interactions test is sufficient to prevent the reduction in hippocampal volume triggered by single housing.

CONCLUSION

When considered with previously published data, these findings suggest that the expression of the full repertoire of social, nonsocial, dominance, and submissive behaviors in response to the physical presence of an intruder in the home cage plays a significant role in this maintenance of hippocampal volume.

How Economic Analysis Can Contribute to Understanding the Links between Housing and Health

An economic analysis of housing's linkages to health can assist policy makers and researchers to make better decisions about which housing interventions and policies are the most cost-beneficial. The challenge is to include cobenefits. The adoption in 2015 of the UN Sustainable Development Goals underscores the importance of understanding how policies interact, and the merit of comprehensively evaluating cobenefits. We explain our approach to the empirical assessment of such cobenefits in the housing and health context, and consider lessons from empirical economic appraisals of the impact of housing on health outcomes. Critical assumptions relating to cobenefits are explicitly examined. A key finding is that when wider policy outcome measures are included, such as mental health impacts and carbon emission reductions, it is important that effects of assumptions on outcomes are considered. Another is that differing values underlie appraisal, for example, the weight given to future generations through the discount rate. Cost-benefit analyses (CBAs) can better facilitate meaningful debate when they are based on explicit assumptions about values. In short, the insights drawn from an economic framework for housing-and-health studies are valuable, but nonetheless contingent. Given that housing interventions typically have both health and other cobenefits, and incorporate social value judgements, it is important to take a broad view but be explicit about how such interventions are assessed.

Impact of a Supportive Housing Program on Housing Stability and Sexually Transmitted Infections Among Young Adults in New York City Who Were Aging Out of Foster Care

Former foster youth are at increased risk of housing instability and sexually transmitted infections (STIs) during the transitional period following foster care. We measured housing stability using sequence analysis and assessed whether a supportive housing program in New York, New York, was effective in improving housing stability and reducing STIs among former foster youth. Matched administrative records identified 895 former foster youth who were eligible for the housing program during 2007-2010. The main outcomes included housing stability (as determined from episodes of homelessness, incarceration, hospitalization, and residence in supportive housing) and diagnosed STI case rates per 1,000 person-years during the 2 years after baseline. Marginal structural models were used to assess impacts of the program on these outcomes. Three housing stability patterns (unstable housing, stable housing, and rare institutional dwelling patterns) were identified. The housing program was positively associated with a pattern of stable housing (odds ratio = 4.4, 95% confidence interval: 2.9, 6.8), and negatively associated with diagnosed STI rates (relative risk = 0.3, 95% confidence interval: 0.2, 0.7). These positive impacts on housing stability and STIs highlight the importance of the supportive housing program for youths aging out of foster care and the need for such programs to continue.

Thermoneutrality but Not UCP1 Deficiency Suppresses Monocyte Mobilization Into Blood

RATIONALE

Ambient temperature is a risk factor for cardiovascular disease. Cold weather increases cardiovascular events, but paradoxically, cold exposure is metabolically protective because of UCP1 (uncoupling protein 1)-dependent thermogenesis.

OBJECTIVE

We sought to determine the differential effects of ambient environmental temperature challenge and UCP1 activation in relation to cardiovascular disease progression.

METHODS AND RESULTS

Using mouse models of atherosclerosis housed at 3 different ambient temperatures, we observed that cold temperature enhanced, whereas thermoneutral housing temperature inhibited atherosclerotic plaque growth, as did deficiency in UCP1. However, whereas UCP1 deficiency promoted poor glucose tolerance, thermoneutral housing enhanced glucose tolerance, and this effect held even in the context of UCP1 deficiency. In conditions of thermoneutrality, but not UCP1 deficiency, circulating monocyte counts were reduced, likely accounting for fewer monocytes entering plaques. Reductions in circulating blood monocytes were also found in a large human cohort in correlation with environmental temperature. By contrast, reduced plaque growth in mice lacking UCP1 was linked to lower cholesterol. Through application of a positron emission tomographic tracer to track CCR2⁺ cell localization and intravital 2-photon imaging of bone marrow, we associated thermoneutrality with an increased monocyte retention in bone marrow. Pharmacological activation of β3-adrenergic receptors applied to mice housed at thermoneutrality induced UCP1 in beige fat pads but failed to promote monocyte egress from the marrow.

CONCLUSIONS

Warm ambient temperature is, like UCP1 deficiency, atheroprotective, but the mechanisms of action differ. Thermoneutrality associates with reduced monocyte egress from the bone marrow in a UCP1-dependent manner in mice and likewise may also suppress blood monocyte counts in man.

Predictors of summertime heat index levels in New York City apartments

During heat waves, fatal overexposure to heat most often occurs at home. It is not known how factors such as building size, floor level, and different types of air conditioning (AC) contribute to excess indoor heat. We monitored indoor temperature and humidity in 36 apartments in New York City during summers 2014 and 2015 and used these values to calculate the indoor heat index (HI). We investigated the role of AC type and building-level factors on indoor HI using multilevel regression models. Thirty-four of 36 homes had AC. Central and ductless AC types were associated with the coolest indoor conditions; homes with window and portable AC were significantly warmer. Apartments on the top floor of a building were significantly hotter during heat advisory periods than other apartments regardless of the presence of AC. High indoor HI levels persisted in some homes for approximately 1 day following the end of the two heat advisory periods. We provide concrete evidence of higher heat levels in top floor apartments and in homes with certain types of AC. High heat levels that persist indoors after outdoor heat has subsided may present an underappreciated public health risk.

Housing First for Adults with Problematic Substance Use

OBJECTIVES

This study explores the two-year housing- and non-housing-related outcomes for adults who are homeless with problematic substance use who received scattered-site housing and intensive case management services from a Housing First program in Ottawa, Canada, in comparison with a group of adults who are homeless with problematic substance use who had access to standard care in the community.

METHODS

Housing First clients (n = 89) and members of a comparison group (n = 89) completed structured interviews at baseline and were followed for two years.

RESULTS

Housing First clients moved into housing more quickly, reported a greater proportion of time housed, were more likely to spend the final six months housed, and had longer housing tenure at 24 months. There was a group by time interaction on problematic alcohol use with more rapid improvement for the comparison group; however, both groups improved over time. The comparison group had a greater decrease on problematic drug use by 24 months. There was no change in physical health and only the comparison group had improvements in mental health by 24 months. The groups had similar improvement on community functioning by 24 months. The comparison group had a greater increase in total quality of life. More specifically, the comparison group had an increase in the family relations-related quality of life, whereas the clients did not. There was a significant interaction for safety-related quality of life, but both groups experienced improvements over time and had comparable levels of satisfaction with safety at each time point. The Housing First clients reported higher levels of satisfaction with living conditions than the comparison group at baseline and 12 months, but not at 24 months. There was significant improvement over time and no main effect of group for finances, leisure, and social relations.

CONCLUSIONS

Adults who are homeless with problematic substance use can successfully be housed using a Housing First approach. However, further targeted services might be required to address other areas of functioning, such as health, substance use, and quality of life.

Evaluating pair versus solitary housing in kennelled domestic dogs (Canis familiaris) using behaviour and hair cortisol: a pilot study

Numerous studies conducted to assess welfare of domestic dogs housed in kennel facilities have reported that these dogs experience suboptimal living conditions. One important goal of improving welfare of kennelled dogs is to reduce their stress levels, and one recommended approach for improving welfare of kennelled dogs is group or social housing. The beneficial effects of management changes designed to achieve this goal should be measurable in individual animals. Stress is evident through behaviours exhibited, as well as via the concentration of cortisol, a key hormone reflecting stress. Using behavioural and hair cortisol measures, we conducted a pilot study to measure the impact of switching dogs housed in a long-term kennels facility from solitary to pair housing, using both within-subjects and between-groups comparisons. Considerable individual variation in dog responses was noted, with only two of eight pair-housed dogs showing significant declines in multiple stress-related behaviours once in pair housing. The most sensitive behaviours were active vigilance and repetitive movements (such as jumping and pacing). Barking was reduced overall in the facility following the housing change, even among dogs still in solitary housing. The long-term stress as reflected in hormone deposition in hair also provided encouraging indications that the dogs experienced lower stress levels when in paired housing; dogs showed a significant decline in hair cortisol levels from the first (prehousing change) to second (postintervention) samples. Domestic dogs are social animals, and numerous indications of potential benefit were recorded with no negative impacts seen. Based on our findings, we recommend pair or group housing of compatible dogs as a promising addition to the strategies available to those seeking to improve welfare of kennelled dogs. Future studies using higher numbers of animals and that include tracking of hair cortisol, vigilance behaviour, repetitive movements and barking would be desirable.

The moral economy of home construction in late socialist Yugoslavia

Housing shortages in Yugoslav cities were a perennial concern for authorities and citizens alike. They disproportionately affected Yugoslav workers who as a consequence were the demographic most likely to independently construct a family home. This article explores how informal builders justified home construction in moral terms, legitimizing it on the basis of physical labour that was invested in home construction. This was couched in both the language register of Yugoslav socialism and patriarchal custom (according to which a male-headed household should enjoy the right to a family home). Construction was also conditioned by the opportunities and constraints of late socialist temporalities.

Sow housing associated with reproductive performance in breeding herds

Female pigs in breeding herds can be managed through four phases-gilt development, breeding, gestation, and lactation-during which they may be housed in group or individual pens, stalls, or on pasture. In this review, we focus on housing environments that optimize outcomes during gestation and lactation. Appropriate housing is important during early gestation, to protect embryos and to confirm pregnancy, and from mid-to-late gestation, to ensure sufficient nutrition to increase placental and fetal growth. No difference in the number of pigs born alive were reported between group housing and individual stall housing, although more risk factors for reproductive performance are associated with group housing than stall housing including genetics, bedding, floor space allowance, group size, social ranking, and parity. Furthermore, lameness in pregnant pigs is more frequent in group housing than in stall housing. Housing during lactation helps protect piglets from being crushed or from contracting disease, and can foster the transfer of enough colostrum from mother to piglets. Indeed, lactating sows in pen housing tend to have higher pre-weaning mortality and lighter litter weights than those in crated housing.

Is Housing a Health Insult?

In seeking to understand the relationship between housing and health, research attention is often focussed on separate components of people’s whole housing ‘bundles’. We propose in this paper that such conceptual and methodological abstraction of elements of the housing and health relationship limits our ability to understand the scale of the accumulated effect of housing on health and thereby contributes to the under-recognition of adequate housing as a social policy tool and powerful health intervention. In this paper, we propose and describe an index to capture the means by which housing bundles influence health. We conceptualise the index as reflecting accumulated housing “insults to health”—an Index of Housing Insults (IHI). We apply the index to a sample of 1000 low-income households in Australia. The analysis shows a graded association between housing insults and health on all outcome measures. Further, after controlling for possible confounders, the IHI is shown to provide additional predictive power to the explanation of levels of mental health, general health and clinical depression beyond more traditional proxy measures. Overall, this paper reinforces the need to look not just at separate housing components but to embrace a broader understanding of the relationship between housing and health.

Differences in Living Arrangements Among Older Adults Transitioning Into the Community: Examining the Impact of Race and Choice

The federal Money Follows the Person Rebalancing Demonstration program allows nursing home residents to use Medicaid funds for home and community-based services rather than institutional care. Race, choice in housing, and challenges faced prior to transitioning may impact living arrangements following a discharge into the community. This study examines the influence of these factors on living arrangements for 659 program participants age 65 or older. Unmarried Blacks and people with financial or legal challenges are less likely to live with a live-in caregiver or in supervised housing compared with unmarried Whites. Race did not determine living arrangements among married participants, but housing transition challenges did. Findings inform policies targeting nursing home rebalancing efforts by highlighting racial diversity in living arrangements and emphasizing the need for affordable, accessible housing options for older adults of any race seeking to live in the community rather than remain in an institutional setting.

Low-Quality Housing Is Associated With Increased Risk of Malaria Infection: A National Population-Based Study From the Low Transmission Setting of Swaziland

BACKGROUND

Low-quality housing may confer risk of malaria infection, but evidence in low transmission settings is limited.

METHODS

To examine the relationship between individual level housing quality and locally acquired infection in children and adults, a population-based cross-sectional analysis was performed using existing surveillance data from the low transmission setting of Swaziland. From 2012 to 2015, cases were identified through standard diagnostics in health facilities and by loop-mediated isothermal amplification in active surveillance, with uninfected subjects being household members and neighbors. Housing was visually assessed in a home visit and then classified as low, high, or medium quality, based on housing components being traditional, modern, or both, respectively.

RESULTS

Overall, 11426 individuals were included in the study: 10960 uninfected and 466 infected (301 symptomatic and 165 asymptomatic). Six percent resided in low-quality houses, 26% in medium-quality houses, and 68% in high-quality houses. In adjusted models, low- and medium-quality construction was associated with increased risk of malaria compared with high-quality construction (adjusted odds ratio [AOR], 2.11 and 95% confidence interval [CI], 1.26-3.53 for low vs high; AOR, 1.56 and 95% CI, 1.15-2.11 for medium vs high). The relationship was independent of vector control, which also conferred a protective effect (AOR, 0.67; 95% CI, .50-.90) for sleeping under an insecticide-treated bed net or a sprayed structure compared with neither.

CONCLUSIONS

Our study adds to the limited literature on housing quality and malaria risk from low transmission settings. Housing improvements may offer an attractive and sustainable additional strategy to support countries in malaria elimination.

Service and infrastructure needs to support recovery programmes for Indigenous community mental health consumers

Mental health is a major concern in Indigenous communities, as Indigenous people experience poorer health outcomes generally, and poorer social and emotional well-being throughout their lives, compared to non-Indigenous populations. Interviews were conducted with 20 mental health workers from a housing assistance programme for Indigenous clients with mental illness. Service and infrastructure needs identified to support clients were classified under the following overarching theme 'supports along the road to recovery'. Subthemes were: (i) It is OK to seek help; (ii) linking in to the local community; (iii) trusting the workers; and (iv) help with goal setting and having activities that support their achievement. This paper highlights the importance of targeted housing and accommodation support programmes for Indigenous people to prevent homelessness, and the essential services and infrastructure required to support Indigenous clients' mental health needs. These insights may inform service review, workforce development, and further research.

Slum Upgrading and Health Equity

Informal settlement upgrading is widely recognized for enhancing shelter and promoting economic development, yet its potential to improve health equity is usually overlooked. Almost one in seven people on the planet are expected to reside in urban informal settlements, or slums, by 2030. Slum upgrading is the process of delivering place-based environmental and social improvements to the urban poor, including land tenure, housing, infrastructure, employment, health services and political and social inclusion. The processes and products of slum upgrading can address multiple environmental determinants of health. This paper reviewed urban slum upgrading evaluations from cities across Asia, Africa and Latin America and found that few captured the multiple health benefits of upgrading. With the Sustainable Development Goals (SDGs) focused on improving well-being for billions of city-dwellers, slum upgrading should be viewed as a key strategy to promote health, equitable development and reduce climate change vulnerabilities. We conclude with suggestions for how slum upgrading might more explicitly capture its health benefits, such as through the use of health impact assessment (HIA) and adopting an urban health in all policies (HiAP) framework. Urban slum upgrading must be more explicitly designed, implemented and evaluated to capture its multiple global environmental health benefits.

Variation in Older Adult Characteristics by Residence Type and Use of Home- and Community-Based Services

Background: The majority of older adults prefer to remain in their homes, or to “age-in-place.” To accomplish this goal, many older adults will rely upon home- and community-based services (HCBS) for support. However, the availability and accessibility of HCBS may differ based on whether the older adult lives in the community or in a senior housing apartment facility. Methods: This paper reports findings from the Pathways to Life Quality study of residential change and stability among seniors in upstate New York. Data were analyzed from 663 older adults living in one of three housing types: service-rich facilities, service-poor facilities, and community-dwelling in single-family homes. A multinomial logistic regression model was used to examine factors associated with residence type. A linear regression model was fitted to examine factors associated with HCBS utilization. Results: When compared to community-dwelling older adults, those residing in service-rich and service-poor facilities were more likely to be older, report more activity limitations, and provide less instrumental assistance to others. Those in service-poor facilities were more likely to have poorer mental health and lower perceived purpose in life. The three leading HCBS utilized were senior centers (20%), homemaker services (19%), and transportation services (18%). More HCBS utilization was associated with participants who resided in service-poor housing, were older, were female, and had more activity limitations. More HCBS utilization was also associated with those who received instrumental support, had higher perceived purpose in life, and poorer mental health. Conclusions: Findings suggest that older adults’ residential environment is associated with their health status and HCBS utilization. Building upon the Person–Environment Fit theories, dedicated efforts are needed to introduce and expand upon existing HCBS available to facility residents to address physical and mental health needs as well as facilitate aging-in-place.

Development and validation of a remote home safety protocol

AIM

Environmental assessments and subsequent modifications conducted by healthcare professionals can enhance home safety and promote independent living. However, travel time, expense and the availability of qualified professionals can limit the broad application of this intervention. Remote technology has the potential to increase access to home safety evaluations.

PURPOSE

This study describes the development and validation of a remote home safety protocol that can be used by a caregiver of an elderly person to video-record their home environment for later viewing and evaluation by a trained professional.

METHODS

The protocol was developed based on literature reviews and evaluations from clinical and content experts. Cognitive interviews were conducted with a group of six caregivers to validate the protocol.

RESULTS

The final protocol included step-by-step directions to record indoor and outdoor areas of the home. The validation process resulted in modifications related to safety, clarity of the protocol, readability, visual appearance, technical descriptions and usability.

CONCLUSIONS

Our final protocol includes detailed instructions that a caregiver should be able to follow to record a home environment for subsequent evaluation by a home safety professional. Implications for Rehabilitation The results of this study have several implications for rehabilitation practice The remote home safety evaluation protocol can potentially improve access to rehabilitation services for clients in remote areas and prevent unnecessary delays for needed care. Using our protocol, a patient's caregiver can partner with therapists to quickly and efficiently evaluate a patient's home before they are released from the hospital. Caregiver narration, which reflects a caregiver's own perspective, is critical to evaluating home safety. In-home safety evaluations, currently not available to all who need them due to access barriers, can enhance a patient's independence and provide a safer home environment.

Health and Wellbeing of Occupants in Highly Energy Efficient Buildings: A Field Study

Passive houses and other highly energy-efficient buildings need mechanical ventilation. However, ventilation systems in such houses are regarded with a certain degree of skepticism by parts of the public due to alleged negative health effects. Within a quasi-experimental field study, we investigated if occupants of two types of buildings (mechanical vs. natural ventilation) experience different health, wellbeing and housing satisfaction outcomes and if associations with indoor air quality exist. We investigated 123 modern homes (test group: with mechanical ventilation; control group: naturally ventilated) built in the years 2010 to 2012 in the same geographic area and price range. Interviews of occupants based on standardized questionnaires and measurements of indoor air quality parameters were conducted twice (three months after moving in and one year later). In total, 575 interviews were performed (respondents’ mean age 37.9 ± 9 years in the test group, 37.7 ± 9 years in the control group). Occupants of the test group rated their overall health status and that of their children not significantly higher than occupants of the control group at both time points. Adult occupants of the test group reported dry eyes statistically significantly more frequently compared to the control group (19.4% vs. 12.5%). Inhabitants of energy-efficient, mechanically ventilated homes rated the quality of indoor air and climate significantly higher. Self-reported health improved more frequently in the mechanically ventilated new homes (p = 0.005). Almost no other significant differences between housing types and measuring time points were observed concerning health and wellbeing or housing satisfaction. Associations between vegetative symptoms (dizziness, nausea, headaches) and formaldehyde concentrations as well as between CO₂ levels and perceived stale air were observed. However, both associations were independent of the type of ventilation. In summary, occupants of the mechanically ventilated homes rated their health status slightly higher and their health improved significantly more frequently than in occupants of the control group. As humidity in homes with mechanical ventilation was lower, it seems plausible that the inhabitants reported dry eyes more frequently.

Invited Commentary: Foreclosures and Health in a Neighborhood Context

Recent systematic reviews link foreclosure to worse health at both the individual and population levels. In this issue of the Journal, Downing et al. (Am J Epidemiol. 2017;185(6):429-435) add to what is known about foreclosure and health by examining annual measures of glycemic control in relation to local foreclosure activity. They provided evidence that between 2007 and 2010, glycemic control was not associated with rates of completed foreclosure among a continuously insured managed-care population of persons with type 2 diabetes living in 9 California counties. In this commentary, I consider 5 possible interpretations of the null results: 1) foreclosures do not affect health in general, 2) glycated hemoglobin is insensitive to local foreclosure activity, 3) the presence of real estate owned foreclosures (rather than the competed foreclosure rate) affects health, 4) an integrated health-care delivery system buffers patients from the effects of the foreclosure crisis, and 5) community conditions and responses to the foreclosure crisis buffer patients from the effects of the foreclosure crisis. I close by arguing that research on the contextual effects of foreclosure on health should continue despite the ongoing recovery of the housing market.

More tail lesions among undocked than tail docked pigs in a conventional herd

The vast majority of piglets reared in the European Union (EU) and worldwide is tail docked to reduce the risk of being tail bitten, even though EU animal welfare legislation bans routine tail docking. Many conventional herds experience low levels of tail biting among tail docked pigs, however it is not known, what the prevalence would have been had the pigs not been tail docked. The aim of this study was to compare the prevalence of tail lesions between docked and undocked pigs in a conventional piggery in Denmark with very low prevalence of tail biting among tail docked pigs. The study included 1922 DanAvl Duroc×(Landrace×Large White) female and castrated male pigs (962 docked and 960 undocked). Docked and undocked pigs were housed under the same conditions in the same room but in separate pens with 20 (±0.03) pigs/pen. Pigs had ad libitum access to commercial diets in a feed dispenser. Manipulable material in the form of chopped straw was provided daily on the floor (~10 g/pig per day), and each pen had two vertically placed soft wood boards. From weaning to slaughter, tail wounds (injury severity and freshness) were scored every 2nd week. No clinical signs of injured tails were observed within the tail docked group, whereas 23.0% of the undocked pigs got a tail lesion. On average, 4.0% of the pigs with undocked tails had a tail lesion on tail inspection days. More pens with tail lesions were observed among pigs weighing 30 to 60 kg (34.3%; P<0.05) than in pens with pigs weighing 7 to 30 kg (13.0%) and 60 to 90 kg (12.8%). Removal of pigs to a hospital pen was more likely in undocked pens (P<0.05, 47.7% undocked pens and 22.9% docked pens). Finally, abattoir meat inspection data revealed more tail biting remarks in undocked pigs (P<0.001). In conclusion, this study suggests that housing pigs with intact tails in conventional herds with very low prevalence of tail biting among tail docked pigs, will increase the prevalence of pigs with tail lesions considerably, and pig producers will need more hospital pens. Abattoir data indicate that tail biting remarks from meat inspection data severely underestimate on-farm prevalence of tail lesions.

Associations between Methamphetamine Use, Housing Status, and Incarceration Rates among Men Who Have Sex with Men and Transgender Women

The present study examined associations between methamphetamine use and social factors among men who have sex with men (MSM) and transgender women. Over a four-year period, 7,419 HIV outreach encounters were conducted with MSM (n=6,243) and transgender women (n=1,176). Logistic and negative binomial regressions estimated associations between sociodemographics, incarceration history, housing status, and methamphetamine use. Incarceration history was associated with marginal housing or homelessness (AOR=3.4) and with increased likelihood (AOR = 6.00) and rate (AIRR = 3.57) of methamphetamine use. African American/Black MSM and transgender women were more likely to report a recent incarceration history compared to non-African American/Black participants (AOR=2.18). Incarceration history was associated with a HIV-positive status (AOR=1.69), and transgender women were 5.2 times more likely to report recent incarceration relative to MSM. Understanding these associations may provide a basis for developing interventions that account for the social factors influencing health outcomes among these high-risk populations.

Dairy Cows Produce Less Milk and Modify Their Behaviour during the Transition between Tie-Stall to Free-Stall

Transfer of cattle to an unknown barn may result in a reduction in its welfare. Housing and management practices can result in signs of stress that include a long-term suppression of milk efficiency. The purpose of this study was to evaluate the influence of moving cows from the stanchion-stall housing to free-stall housing on their behaviour and production. The Holstein cows were moved into the new facility with free-stall housing from the old barn with stanchion-stall housing. Cows lay down up to ten hours (596.3 ± 282.7 min) after removing. The cows in their second lactation and open cows tended to lie sooner after removing than cows in their first lactation and pregnant cows. The times of total lying and rumination were increasing from the first day to the tenth day after removing (23.76 ± 7.20 kg vs. 30.97 ± 7.26 kg, p < 0.001). Cows produced 23.3% less milk at the first day following the transfer than at the last day prior to moving (p < 0.001). Loss of milk was gradually reduced and maximum production was achieved on the 14th day. The difference was found in milk losses due to the shift between cows on the first and second lactation (p < 0.01). The results of this study suggest that removing from the tie-stall barn with a pipeline milking system into the barn with free-stall housing and a milking parlour caused a decline in the cows' milk production. However, when the cows are moved to a better environment, they rapidly adapt to the change.

Ventilation, indoor air quality, and health in homes undergoing weatherization

Ventilation standards, health, and indoor air quality have not been adequately examined for residential weatherization. This randomized trial showed how ASHRAE 62-1989 (n=39 houses) and ASHRAE 62.2-2010 (n=42 houses) influenced ventilation rates, moisture balance, indoor air quality, and self-reported physical and mental health outcomes. Average total airflow was nearly twice as high for ASHRAE 62.2-2010 (79 vs. 39 cfm). Volatile organic compounds, formaldehyde and carbon dioxide were all significantly reduced for the newer standard and first-floor radon was marginally lower, but for the older standard, only formaldehyde significantly decreased. Humidity in the ASHRAE 62.2-2010 group was only about half that of the ASHRAE 62-1989 group using the moisture balance metric. Radon was higher in the basement but lower on the first floor for ASHRAE 62.2-2010. Children in each group had fewer headaches, eczema, and skin allergies after weatherization and adults had improvements in psychological distress. Indoor air quality and health improve when weatherization is accompanied by an ASHRAE residential ventilation standard, and the 2010 ASHRAE standard has greater improvements in certain outcomes compared to the 1989 standard. Weatherization, home repair, and energy conservation projects should use the newer ASHRAE standard to improve indoor air quality and health.

Dutch homeless people 2.5 years after shelter admission: what are predictors of housing stability and housing satisfaction?

Housing stability is an important focus in research on homeless people. Although definitions of stable housing differ across studies, the perspective of homeless people themselves is generally not included. Therefore, this study explored the inclusion of satisfaction with the participant's current housing status as part of the definition of housing stability and also examined predictors of housing stability with and without the inclusion of homeless person's perspective. Of the initial cohort consisting of 513 homeless participants who were included at baseline in 2011, 324 (63.2%) were also interviewed at 2.5-year follow-up. To determine independent predictors of housing stability, we fitted multivariate logistic regression models using stepwise backward regression. At 2.5-year follow-up, 222 participants (68.5%) were stably housed and 163 participants (51.1%) were stably housed and satisfied with their housing status. Having been arrested (OR = 0.36, 95% CI: 0.20-0.63), a high level of somatisation (physical manifestations of psychological distress) (OR = 0.52, 95% CI: 0.30-0.91) and having unmet care needs (OR = 0.77, 95% CI: 0.60-0.99) were negative predictors of housing stability. Having been arrested (OR = 0.43, 95% CI: 0.25-0.75), high debts (OR = 0.45, 95% CI: 0.24-0.84) and a high level of somatisation (OR = 0.49, 95% CI: 0.28-0.84) were negative predictors of stable housing when satisfaction with the housing status was included. Because inclusion of a subjective component revealed a subgroup of stably housed but not satisfied participants and changed the significant predictors, this seems a relevant addition to the customary definition of housing stability. Participants with characteristics negatively associated with housing stability should receive more extensive and individually tailored support services to facilitate achievement of housing stability.

The Docent Method: A Grounded Theory Approach for Researching Place and Health

To understand health, research needs to move outside of controlled research settings into the environments where health activities occur-homes, streets, and neighborhoods. I offer the docent method as a qualitative place-based approach for exploring health in a participant-driven, structured, and flexible way. The docent method is a participant-led, audiotaped, and photographed walking interview through broad "sites of interest" (SOIs). It is rooted in grounded theory and influenced by community-based participatory research and walking interviews. The three stages of the docent method involve: (a) a warm-up interview focusing on positionality, participant background, and mapping/planning SOIs; (b) a participant-led, photographed walking interview to and around the SOI; and (c) a wind-down interview in the community. I describe the methodological influences, development, and procedures of the docent method drawing from my own experiences conducting it with formerly homeless women living in permenant supportive housing in the Tenderloin neighborhood of San Francisco.

Pediatric Asthma Health Disparities: Race, Hardship, Housing, and Asthma in a National Survey

OBJECTIVE

We sought to determine if racial disparities in pediatric asthma are explained by material hardship and home ownership.

METHODS

We performed a secondary analysis of the 2011 American Housing Survey. A total of 33,201 households with children age 6 to 17 years were surveyed regarding childhood asthma diagnosis and emergency department (ED) visits for asthma (for the youngest child with asthma in the household). Material hardship included poor housing quality, housing crowding, lack of amenities, and no vehicle access. We used logistic regression to determine the association between race, material hardship, and asthma diagnosis or ED visits, adjusting for potential confounders.

RESULTS

Non-Hispanic black heads of household had a higher odds of having a child diagnosed with asthma in the home compared with non-Hispanic white heads of household (odds ratio, 1.72; 95% confidence interval [CI], 1.50-1.96), and a higher odds of ED visits for asthma (odds ratio, 3.02; 95% CI, 2.29-3.99). The race-asthma association was decreased but not eliminated after adjusting for material hardship and home ownership (ED visit adjusted odds ratio [AOR], 2.07; 95% CI, 1.50-2.86). Poor housing quality was independently associated with asthma diagnosis (AOR, 1.45; 95% CI, 1.28-1.66) and ED visits (AOR, 1.59; 95% CI, 1.21-2.10). Home ownership was associated with a lower odds of asthma-related ED visits (AOR, 0.62; 95% CI, 0.46-0.84).

CONCLUSIONS

Observed racial disparities in pediatric asthma are lessened after controlling for material hardship. Poor housing quality in particular is strongly associated with asthma morbidity. Policy makers could target improving housing quality as a means of potentially reducing asthma disparities.

Housing First: permanent supported accommodation for people with psychosis who have experienced chronic homelessness

OBJECTIVES

The objective of this study was to determine whether a 'housing first' permanent supported accommodation was effective in improving housing stability, continuity of care and reducing mental health admissions for persons experiencing chronic homelessness with psychosis.

METHODS

A quasi prospective cohort study of 42 chronic homeless persons with psychosis accommodated in a new purpose built facility in central Melbourne. Accommodation stability, mental health service contacts and psychiatric admissions were compared across the 2 years prior, the first 2 years of placement and the 2 years after leaving.

RESULTS

The mean number of mental health admissions in the first 2 years of accommodation was less (0.56, SD = 1.0) when compared with in the 2 years prior to accommodation (1.0, SD = 1.4, p = 0.05). There was an increase in the mean total number of days admitted in the 2 years after having left the supported accommodation, (33.3 days, SD = 86.7, p = 0.043) Conclusions: The accommodation of chronic homeless persons with psychosis in a 'housing first' permanent supported accommodation lead to increased housing stability and optimism, improved continuity of care and reduced psychiatric admissions.

Estimating the Cost and Payment for Sanitation in the Informal Settlements of Kisumu, Kenya: A Cross Sectional Study

Lack of sanitation facilities is a common occurrence in informal settlements that are common in most developing countries. One challenge with sanitation provision in these settlements is the cost and financing of sanitation. This study aimed at estimating the cost of sanitation, and investigating the social and economic dynamics within Kisumu's informal settlements that hinder provision and uptake of sanitation facilities. Primary data was collected from residents of the settlements, and using logistic and hedonic regression analysis, we identify characteristics of residents with sanitation facilities, and estimate the cost of sanitation as revealed in rental prices. Our study finds that sanitation constitutes approximately 54% of the rent paid in the settlements; and dynamics such as landlords and tenants preferences, and sharing of sanitation facilities influence provision and payment for sanitation. This study contributes to general development by estimating the cost of sanitation, and further identifies barriers and opportunities for improvement including the interplay between landlords and tenants. Provision of sanitation in informal settlements is intertwined in social and economic dynamics, and development approaches should target both landlords and tenants, while also engaging various stakeholders to work together to identify affordable and appropriate sanitation technologies.