Thermal Personalities of Older People in South Australia: A Personas-Based Approach to Develop Thermal Comfort Guidelines

An important consideration for future age-friendly cities is that older people are able to live in housing appropriate for their needs. While thermal comfort in the home is vital for the health and well-being of older people, there are currently few guidelines about how to achieve this. This study is part of a research project that aims to improve the thermal environment of housing for older Australians by investigating the thermal comfort of older people living independently in South Australia and developing thermal comfort guidelines for people ageing-in-place. This paper describes the approach fundamental for developing the guidelines, using data from the study participants' and the concept of personas to develop a number of discrete "thermal personalities". Hierarchical Cluster Analysis (HCA) was implemented to analyse the features of research participants, resulting in six distinct clusters. Quantitative and qualitative data from earlier stages of the project were then used to develop the thermal personalities of each cluster. The thermal personalities represent different approaches to achieving thermal comfort, taking into account a wide range of factors including personal characteristics, ideas, beliefs and knowledge, house type, and location. Basing the guidelines on thermal personalities highlights the heterogeneity of older people and the context-dependent nature of thermal comfort in the home and will make the guidelines more user-friendly and useful.

Integration and social determinants of health and wellbeing for people from refugee backgrounds resettled in a rural town in South Australia: a qualitative study

Background

There has been a recent focus on resettlement of migrants and refugee in rural settings in Australia and elsewhere. Rural resettlement is seen as an opportunity to revitalise rural communities, to fill the needs of employers in these areas, and to provide a welcoming community within which new arrivals can integrate and settle. However, challenges to rural resettlement have been identified including difficulties securing employment, discrimination and social isolation. These challenges can affect resettlement outcomes including health and wellbeing, though relatively little research has examined these links. In this paper we explored experiences of people from refugee background settling in a rural Australian town, examining interconnections between social determinants of health (SDH) and integration.

Methods

Face-to-face interviews were conducted with 44 participants from Southeast Asia and Africa in a rural setting in South Australia, covering experiences of resettlement and impacts on health and wellbeing. Participants were recruited through existing connections within the community and snowball sampling. Audio recorded data were transcribed verbatim and analysed using framework thematic analysis.

Results

The study findings revealed a mixture of settlement experiences for participants across a range of elements of SDH and integration. A sense of safety and some elements of social connectedness and support were key enablers for integration and health and wellbeing, with main challenges including limitations in employment opportunities, mismatched education provision, experiences of discrimination and constrained access to services.

Conclusions

Challenges experienced by refugees resettled in rural areas can affect integration, health and wellbeing and subsequent onward migration intentions. Attention to broader socioeconomic, cultural and environmental conditions, alongside tailored settlement support policies and practices for individual rural resettlement sites, is required to support integration and health and wellbeing.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-020-09724-z.

Renting Poorer Housing: Ecological Relationships Between Tenure, Dwelling Condition, and Income and Housing-Sensitive Hospitalizations in a Developed Country

BACKGROUND

Previous research has shown two-way associations between rental tenure, poorer housing quality, and health outcomes, but little research has looked at relative housing contributions to health outcomes.

AIMS

We investigated whether tenure and/or dwelling condition were associated with housing-sensitive hospitalizations and whether any association differed by income.

METHOD

Using a data set of housing characteristics matched to hospitalization records, rental tenure data, and income quintiles, we modeled differences in housing-sensitive hospitalization rates by ecological-level tenure and housing condition, controlling for age-group and mean temperatures.

RESULTS

There were clear associations between income, tenure, and house condition, and winter-associated hospitalization risk. In the adjusted model, the largest risk differences were associated with neighborhoods with low income (risk ratio [RR] = 1.48) and high rental tenure (RR = 1.41). There was a nonsignificant difference for housing condition (RR = 1.04).

DISCUSSION

Rental tenure and poor housing condition were risks for housing-sensitive hospitalization, but the association with income was stronger. Higher income households may be better able to offset quality and tenure-related health risks. This research illustrates the inverse housing law: Those most vulnerable, with most need for good-quality housing, are least likely to have it. Income inequity is inbuilt in tenure, quality, and health burden relationships.

CONCLUSION

These findings suggest that measures to address health inequities should include improvements to both tenure security and housing quality, particularly in low-income areas. However, policymakers aiming to reduce overall hospitalization rates should focus their efforts on reducing fuel poverty and improving the affordability of quality housing.

Geographies of insecure water access and the housing-water nexus in US cities

Safe, reliable, and equitable water access is critical to human health and livelihoods. In the United States, an estimated 471,000 households or 1.1 million individuals lack a piped water connection and 73% of households are located in cities, close to networked supply. In this study, we undertake a nationwide analysis of urban water access in the United States, with the aim of explaining the drivers of infrastructural inequality in the 50 largest metropolitan areas. Drawing on statistical analysis and regression modeling of census microdata at the household scale, our analysis reveals spatial and sociodemographic patterns of racialized, class-based, and housing disparities that characterize plumbing poverty. Among unplumbed households, we show that households headed by people of color are almost 35% more likely to lack piped water as compared to white, non-Hispanic households. Precarious housing conditions are an equally strong predictor: Renter-occupied households in the 50 largest US metros were 1.61 times more likely than owner-occupied households to lack piped water. We argue that insecure domestic water access in the United States should be understood as a housing issue that reflects structural inequalities of race and class, particularly in cities with widening wealth gaps. The article concludes with a call for research and action at the intersection of water provision, housing, and social inequality-a paradigm we call the housing-water nexus.

Effectiveness of interventions targeting community integration among individuals with lived experiences of homelessness: A systematic review

Community integration (CI) has been identified as a key outcome of programs designed to improve the lives of homeless and recently housed individuals (Gaetz, The State of Homelessness in Canada 2016, 2016). Although researchers have explored the extent to which Housing First (HF) impacts on social integration (Quilgars & Pleace, Soc. Incl., 4, 2016), little is known about the range and effectiveness of other interventions on CI more broadly. We conducted a systematic review of experimental studies using Joanna Briggs Institute (JBI) guidelines. Our search strategy was deployed in six databases: EMBASE, CINAHL, PsychINFO, Medline, Sociological Abstracts, and Proquest Dissertations and Theses. Our search was initiated in 2017 and updated on May 5, 2019. Using the definition of CI identified by Wong & Solomon (Ment. Health Serv. Res., 4:13-28, 2002), two independent raters screened 14,158 titles and abstracts after the removal of duplicates. A total of 157 articles were subjected to full-text review. Studies published in the English language and involving participants of any age were included. We conducted a critical appraisal of 25 studies using the JBI checklists for quasi-experimental and randomised controlled trials (Tufanaru, Joanna Briggs Institute Reviewers Manual, 2017), and subsequently excluded four studies as they did not meet a pre-established quality threshold score of 50/100. A total of 21 studies were included in a narrative synthesis. Critical appraisal scores ranged from 53.8-100 (Mdn = 69.2). Interventions evaluated in existing literature included housing and housing support interventions (n = 9), HF (n = 5), psychosocial interventions (n = 5), and employment interventions (n = 2). A meta-analysis could not be performed due to the heterogeneity of outcomes in included studies. Aspects of CI measured by researchers included social (n = 17), psychological (n = 6), and physical (n = 4) integration. Studies that evaluated HF and housing and housing support interventions demonstrated surprisingly mixed or a lack of effectiveness for promoting CI. Psychosocial interventions were the most promising, specifically those which incorporated an element of peer support. Findings of literature included in this review suggests that there is inconsistency in the extent to which existing interventions are effectively targeting CI as an outcome. Furthermore, we contend that existing systems-level interventions, including HF and permanent supportive housing alone may not be enough to promote CI among homeless and formerly homeless individuals. Future research should focus on the development and evaluation of interventions that more effectively target this critical construct.

Disparities of indoor temperature in winter: A cross-sectional analysis of the Nationwide Smart Wellness Housing Survey in Japan

The WHO Housing and health guidelines recommend a minimum indoor temperature of 18°C to prevent cold-related diseases. In Japan, indoor temperatures appear lower than in Euro-American countries because of low insulation standards and use of partial intermittent heating. This study investigated the actual status of indoor temperatures in Japan and the common characteristics of residents who live in cold homes. We conducted a nationwide real-world survey on indoor temperature for 2 weeks in winter. Cross-sectional analyses involving 2190 houses showed that average living room, changing room, and bedroom temperatures were 16.8°C, 13.0°C, and 12.8°C, respectively. Comparison of average living room temperature between prefectures revealed a maximum difference of 6.7°C (Hokkaido: 19.8°C, Kagawa: 13.1°C). Compared to the high-income group, the odds ratio for living room temperature falling below 18°C was 1.38 (95% CI: 1.04-1.84) and 2.07 (95% CI: 1.28-3.33) for the middle- and low-income groups. The odds ratio was 1.96 (95% CI: 1.19-3.22) for single-person households, compared to households living with housemates. Furthermore, lower room temperature was correlated with local heating device use and a larger amount of clothes. These results will be useful in the development of prevention strategies for residents who live in cold homes.

Revisiting the relationship among housing tenure, affordability and mental health: Do dwelling conditions matter?

Despite growing attention to housing as a social determinant of health, few studies have featured the interplay of its diverse impacts on health. Using the Korea Welfare Panel Study, this study used logistic regression analysis for examining how housing tenure and affordability are associated with depressive symptoms under different physical dwelling conditions among low-income households in Korea. In our findings, renters, compared with homeowners, were more likely to report depressive symptoms, and housing unaffordability was associated with a higher likelihood of having depressive symptoms. When dwelling conditions were considered, housing tenancy, compared with ownership, tended to be associated with depressive symptoms among adequate housing dwellers, whereas housing unaffordability was associated with depressive symptoms mainly among those living in substandard housing conditions. The findings suggest that the linkage of multiple housing problems to psychological well-being is dynamic. Public health policies and housing subsidy programs should, therefore, be designed based on a comprehensive account of not only tenure or income status, but also dwelling conditions.

Dairy cow trade-off preference for 2 different lying qualities: Lying surface and lying space

Lying down is an important behavior for cows, contributing to their health and welfare. With dairy cows being housed for increasingly longer periods, if not year-round, it is important to ensure that dairy cow lying comfort is not compromised when they are housed. The aim of this study was to assess cow preference for 2 different qualities of lying area that appear to be important to cows-surface type and an open lying space-to better understand how to optimize lying comfort for cows when housed. Twenty-four Holstein dairy cows were used during the study, which took place in Scotland from July to November 2018. The study consisted of 6 experimental periods, each lasting a total of 21 d. Cows were tested 4 at a time and individually housed in their own test pen. Each pen had 3 lying surfaces: sand, mattress, and straw (2.4 m × 2.4 m each) with a freestall in the middle of each, which could be removed. Cows were given access to one surface at a time (training period) with a freestall for 2 d, and then given a choice of all 3 surfaces for 2 d. When given the choice with freestalls in position, cows spent, on average, the largest amount of their lying time on straw (46.6 ± 7.8%) followed by mattress (44.3 ± 12.4%). Freestalls were then removed and the training and choice phase was repeated on the following day, with cows, on average, spending the most time lying on straw (64.4 ± 7.2%). Finally, a freestall was refitted onto each cow's most preferred surface and the cows were given a choice between lying on their most preferred surface with a freestall (P1 + freestall) or on their second or third preferred surface without a freestall (P2 + open and P3 + open, respectively) for 3 d. During this final trade-off stage, of the 19 cows for which data were available, 14 cows chose to give up the opportunity to lie down on their most preferred surface to have more space on P2 + open and P3 + open, 3 cows chose to lie down on P1 + freestall, and 2 cows made no clear choice. Overall, cows spent the largest amount of their total lying time on their second most preferred surface as an open lying space (65.7 ± 6.9%) compared with their preferred surface with a freestall (20.5 ± 5.9%) and their third preferred surface as an open lying space (13.8 ± 3.7%). The results indicate that when lying down, these dairy cows value an open lying space more than the lying surface.

Managing Free-Range Laying Hens-Part B: Early Range Users Have More Pathology Findings at the End of Lay but Have a Significantly Higher Chance of Survival-An Indicative Study

Simple Summary

Free-range facilities may present a biosecurity risk in some situations, but range use has also been associated with better hen welfare. We investigated the association between early-life range use (when hens were 18–21 weeks of age) and hen survival during the entire housing period as well as various health and welfare parameters at 74 weeks of age. Hens that preferred to use the range at early life were three times more likely to survive. Early range users were also 1.6 times more likely to become infected with gastrointestinal nematodes and showed significantly more frequent signs indicating spotty liver disease. Hens that preferred to stay in the shed during early life had a higher prevalence of Fatty Liver Syndrome and significantly less feather cover. In conclusion, hens that do not range during early life may benefit from additional management strategies to increase their likelihood of survival. Further investigations under controlled environmental conditions are warranted to quantify further the observed effects.

Abstract

While free-range laying hens frequently experience health and welfare challenges, the contribution of range use towards these risks are largely unknown. The aim of this pilot study was to investigate the survival, health and welfare of commercial free-range laying hens and explore the association with early range use. Range use of 9375 Lohmann Brown hens housed within five flocks was assessed during 18–21 weeks of age and individual hens were classified as “rangers” (frequent range users), “roamers” (intermittent range users), and “stayers” (rare/no range users) were then subject to necropsy at 74 weeks of age. Rangers and roamers were three times and 2.4 times more likely to survive than stayers, respectively (p = 0.001). Overall, rangers had significantly better feather cover and more lesions associated with spotty liver diseases compared to roamers and stayers (p = 0.001). Similarly, rangers and roamers had a higher prevalence of A. galli infection and less frequent signs of fatty liver syndrome compared to stayers. Rangers had a higher proportion of hens with full ovary follicle production compared to stayers and roamers (p = 0.035). This information is highly relevant to consider the targeted support of different flock subpopulations to improve hen health and welfare, directly affecting farm profitability. Further research on other farms is warranted to investigate the transferability of the observed results.

Effects of Social Housing Changes on Immunity and Vaccine-Specific Immune Responses in Adolescent Male Rhesus Macaques

Nonhuman primates (NHPs) in research institutions may be housed in a variety of social settings, such as group housing, pair housing or single housing based on the needs of studies. Furthermore, housing may change over the course of studies. The effects of housing and changes in housing on cell activation and vaccine mediated immune responses are not well documented. We hypothesized that animals moved indoors from group to single housing (GH-SH) would experience more stress than those separated from groups into pair housing (GH-PH), or those placed briefly into pair housing and separated 5 weeks later into single housing (GH-PH-SH). We also compared the effects of separation from group to pair housing with the separation from pair to single housing. Eighteen male rhesus macaques were followed over the course of changes in housing condition over 10–14 weeks, as well as prior to and after primary vaccination with a commercially available measles vaccine. We identified two phenotypic biomarkers, namely total CD8 population and proliferating B cells, that differed significantly across treatment groups over time. At 10 weeks post-separation, levels of proliferating B cells were higher in GH-SH subjects compared to GH-PH subjects, and in the latter, levels were lower at 10 weeks than prior to removal from group housing. At 2 weeks post-separation from group to single housing, the frequency of CD8+ T cells was higher in GH-SH subjects compared to one week post separation from pair into single housing in the GH-PH-SH subjects. Comparing the same elapsed time since the most recent separation activated CD20 populations were persistently higher in the GH-SH animals than the GH-PH-SH animals. Housing configuration did not influence vaccine-mediated responses. Overall, our study found benefits of pair housing over single housing, suggesting that perturbations in immune function will be more severe following separation from group to single housing than from pair to single housing, and supporting the use of short-duration pair housing even when animals must subsequently be separated. These findings are useful for planning the housing configurations of research NHPs used for vaccine studies and other studies where immune response is being assessed.

"So I am Stuck, but it´s OK": Residential Reasoning and Housing Decision-Making of Low-Income Older Adults with Disabilities in Baltimore, Maryland

Housing preferences and housing decision-making in later life are critical aspects of aging in place, which is a public health priority in many Western countries. However, few studies have examined the economic, social, and health factors that guide older adults' preferences and decisions about where to live, and even less so among older adults with low income or disabilities who may face greater barriers to aging in place. We sought to understand what housing decision-making and residential reasoning means for low-income older adult homeowners in Baltimore, Maryland. Using a grounded theory approach, we interviewed 12 adults with disabilities in June 2017 and February 2018. Our findings revealed how the strong desire to age in place turned into the realization that they had to age in place due to limited resources and options. The core category "shifting between wanting to age in place and having to age in place" was influenced by family needs, being a homeowner, the neighborhood, and coping at home. In conclusion, for low-income older adults with disabilities, it is important to acknowledge that sometimes aging in place may be equivalent to being stuck in place.

Cerebral Small Vessel Disease, Risk Factors, and Cognition in Tenants of Precarious Housing

BACKGROUND AND PURPOSE

We aim to describe the burden, characteristics, and cognitive associations of cerebral small vessel disease in a Canadian sample living with multimorbidity in precarious housing.

METHODS

Participants received T1, T2-fluid-attenuated inversion recovery, and susceptibility-weighted imaging 3T magnetic resonance imaging sequences and comprehensive clinical, laboratory, and cognitive assessments. Cerebral small vessel disease burden was characterized using a modified Small Vessel Disease (mSVD) score. One point each was given for moderate-severe white matter hyperintensities, ≥1 cerebral microbleeds, and ≥1 lacune. Multivariable regression explored associations between mSVD score, risk factors, and cognitive performance.

RESULTS

Median age of the 228 participants (77% male) was 44.7 years (range, 23.3-63.2). In n=188 participants with consistent good quality magnetic resonance imaging sequences, mSVD scores were 0 (n=127, 68%), 1 (n=50, 27%), and 2 (n=11, 6%). Overall, one-third had an mSVD ≥1 n=61 (32%); this proportion was unchanged when adding participants with missing sequences n=72/228 (32%). The most prevalent feature was white matter hyperintensities 53/218 (24%) then cerebral microbleed 16/191 (8%) and lacunes 16/228 (7%). Older age (odds ratio, 1.10 [95% CI, 1.05-1.15], P<0.001), higher diastolic blood pressure (odds ratio, 1.05 [95% CI, 1.01-1.09], P=0.008), and a history of injection drug use (odds ratio, 3.13 [95% CI, 1.07-9.16], P=0.037) had significant independent associations with a mSVD score of ≥1 in multivariable analysis. mSVD ≥1 was associated with lower performance on tests of verbal memory, sustained attention, and decision-making, contributing 4% to 5% of the variance in each cognitive domain.

CONCLUSIONS

The 32% prevalence of cerebral small vessel disease in this young, socially marginalized cohort was higher than expected for age and was associated with poorer cognitive performance.

Welfare Assessment in Calves Fattened According to the "Outdoor Veal Calf" Concept and in Conventional Veal Fattening Operations in Switzerland

Simple Summary

Antimicrobial use in humans and animals leads to the selection of resistant bacteria, a serious threat to human and animal health, as such bacteria can lead to treatment failure and death. With the “outdoor veal calf” concept, a novel calf fattening system was developed that allows for reducing antimicrobial use by 80% through improvements in management and housing, such as health check before purchase, short transport, vaccination, quarantine in individual hutches, and fattening in small groups in a roofed, straw-bedded paddock with a group hutch for shelter. In that system, veal calves spend their entire lives outdoors in the fresh air. In our study, we wanted to make sure that the observed reduction in antimicrobial treatments was not achieved at the cost of animal welfare, i.e., that sick animals were not left without treatment in order to obtain better figures for treatment reduction. Our results show that calves in the “outdoor veal calf” system had fewer signs of respiratory and digestive diseases than control calves and that their lungs had fewer lesions of pneumonia than controls after slaughter. Thus, not only was antimicrobial use drastically reduced, but calf health was really improved in the new “outdoor veal calf” system.

Abstract

The “outdoor veal calf” system was developed to encounter the demand for a veal fattening system that allows for reducing antimicrobial use without impairing animal welfare. Management improvements including direct purchase, short transportation, vaccination, three-week quarantine in individual hutches, and open-air housing in small groups in a roofed, straw-bedded paddock with a group hutch were implemented in a prospective intervention study (1905 calves, 19 intervention and 19 control farms, over one year): antimicrobial use was five times lower in "outdoor veal" farms compared to control farms (p < 0.001), but it was crucial to ensure that antimicrobial treatment reduction was not associated with decreased animal welfare, i.e., that sick animals were not left untreated. Welfare was assessed monthly on the farms, and organs of 339 calves were examined after slaughter. Cough and nasal discharge were observed significantly (p ≤ 0.05) less often in intervention than in control farms, mortality (3.1% vs. 6.3%, p = 0.020) and lung lesion prevalence (26% vs. 46%, p < 0.001) were lower; no group difference was seen in abomasal lesion prevalence (65% vs. 72%). Thus, besides reduced antimicrobial use, calf health and welfare were improved in "outdoor veal calf" farms in comparison to traditional operations.

Home Modification Assessments for Accessibility and Aesthetics: A Rapid Review

PURPOSE

The purpose of this study was to identify assessments used to evaluate the homes of people with disabilities in terms of accessibility, usability, activities, comfort/satisfaction, and aesthetics.

BACKGROUND

The home is increasingly becoming an environment for healthcare as more people desire to age in place. Research indicates home environmental modifications to be beneficial to promote a better person-environment fit, especially when using a standardized assessment approach. There is not a comprehensive list of assessments that address home modifications, adaptations, or interior designs for people with disabilities.

METHOD

Researchers conducted a rapid review of articles, with data collection scales, instruments, and procedures for home modifications published between 2000 and 2017.

RESULTS

A total of 26 articles met the inclusion criteria, resulting in the identification of 33 distinct assessments, including 18 assessments evaluating the accessibility of home modifications, 3 assessments examining usability, 15 assessments addressing activities of daily living or functional activities, and 5 assessments addressing comfort and/or satisfaction. No assessments for aesthetics were located.

CONCLUSION

Researchers developed a list of assessments that could be used for research or practice. Further research is needed to address the lack of assessments focusing on the aesthetics or attractiveness of home modifications, as well as more assessments tailored to specific diagnoses and population groups.

Old age is associated with decreased wealth in rural villages in Mtwara, Tanzania: findings from a cross-sectional survey

Objective

In many countries, housing is used for wealth accumulation and provides financial security in old age. We tested the hypothesis that household wealth, measured by housing quality and ownership of durable assets, would increase with age of the household head.

Methods

We conducted a survey of household heads in 68 villages surrounding Mtwara town, Tanzania and recorded relevant demographic, housing and social characteristics for each household. The primary analysis assessed the relationship between age of the household head, quality of the house structure and socio‐economic score (SES) using multivariate analysis. Principal Components Analysis (PCA) was used as a data reduction tool to estimate the social‐economic status of subjects based on relevant variables that are considered as proxy for SES.

Results

Of 13 250 household heads were surveyed of whom 49% were male. Those at least 50 years old were more likely to live in homes with an earth floor (86%) compared to younger household heads (80%; P < 0.0001), wattle and daub walls (94% vs. 90%; P < 0.0001) and corrugated iron roofs (56% vs. 52%; P < 0.0001). Wealth accumulation in the villages included in the study tends to be an inverted V‐relationship with age. Housing quality and SES rose to a peak by 50 years and then rapidly decreased. Households with a large number of members were more likely to have better housing than smaller households.

Conclusions

Housing plays a critical role in wealth accumulation and socio‐economic status of a household in rural villages in Tanzania. Households with a head under 50 years were more likely to live in improved housing and enjoyed a higher SES, than households with older heads. Larger families may provide protection against old age poverty in rural areas. Assuring financial security in old age, specifically robust and appropriate housing would have wide‐ranging benefits.

Social Determinants of Health and COVID-19 Among Patients in New York City

Background

Covid-19 testing and disease outcomes according to demographic and neighborhood characteristics must be understood.

Methods

Using aggregate administrative data from a multi-site academic healthcare system in New York from March 1 - May 14, 2020, we examined patient demographic and neighborhood characteristics according to Covid-19 testing and disease outcomes.

Results

Among the 23,918 patients, higher proportions of those over 65 years old, male sex, Hispanic ethnicity, Medicare, or Medicaid insurance had positive tests, were hospitalized, or died than those with younger age, non-Hispanic ethnicity, or private insurance. Patients living in census tracts with more non-White individuals, Hispanic individuals, individuals in poverty, or housing crowding had higher proportions of Covid-19 positive tests, hospitalizations, and deaths than counterparts.

Discussion

Variation exists in Covid-19 testing and disease outcomes according to patient and neighborhood characteristics. There is a need to monitor Covid-19 testing access and disease outcomes and resolve racist policies and practices.

The Shifting Risk of Homelessness among Persons with a Disability: Insights from a National Policy Intervention

Persons with a disability are at a far higher risk of homelessness than those without. The economic, social and health challenges faced by disabled people are addressed, in Australia, by the recently implemented National Disability Insurance Scheme (NDIS). Using nationally representative, longitudinal household panel data, we construct the Index of Relative Homelessness Risk (IRHR) to track how the risk of homelessness for disabled persons has changed since the introduction of the NDIS. We find that, overall, fewer persons with a disability face moderate risk of homelessness but that many more face high risk. We conclude that the NDIS has not effectively protected disabled people from the risk of homelessness. We reflect on the implications of these findings for policy interventions.

Is Housing Hardship Associated with Increased Adolescent Delinquent Behaviors?

Housing-related hardships, ranging from an inability to pay full housing costs to being evicted, are common experiences for families in the U.S. Despite the frequency of these hardships, little is known about their relationships with adolescent behaviors. The current paper uses longitudinal data on births in large U.S. cities from all six waves of the Fragile Families and Child Well-being Study to explore the association between childhood experiences of housing hardships and delinquent behaviors in adolescence. About 60% of the sample experiences housing hardship at one or more waves. Inabilities to meet housing costs are common among the sample: over 40% are unable to pay their full rent or mortgage payment. Results from multivariate regression and residualized change models indicate that children who experience any housing hardship are more likely to engage in delinquent behaviors than children who do not experience hardship. Exposure to higher average levels of hardship and more waves of hardship are both associated with increased delinquency. Childhood poverty does not moderate the relationship between housing hardship and delinquency suggesting that housing hardship is associated with delinquent behaviors for poor and non-poor children alike. This research builds on existing literature highlighting the importance of examining hardship as a measure of family wellbeing. It also suggests that preventing common housing-related hardships can be beneficial for youth behavioral outcomes.

Evaluation of an early discharge from hospital scheme focussing on patients' housing needs: The ASSIST Project

This study calculated a return on investment of an early discharge from hospital scheme focussing on improved responses to patients' housing needs. The study identified critical success factors of the scheme that will inform potential spread of the intervention to other localities. Financial return on investment based on service costs and benefits were calculated and the critical success factors were identified through interviews with key stakeholders. The annualised return on investment of the scheme was £3.03 for each £1 invested. Close working relationships between health and housing and aspects of the local housing stock (such as direct local control) were key to realising the return on investment.

Towards Responsible Rebellion: How Founders Deal with Challenges in Establishing and Governing Innovative Living Arrangements for Older People

In the Netherlands, there is an increasing need for collective forms of housing for older people. Such housing bridges the gap between the extremes of living in an institutionalised setting and remaining in their own house. The demand is related to the closure of many residential care homes and the need for social engagement with other residents. This study focuses on housing initiatives that offer innovative and alternative forms of independent living, which deviate from mainstream housing arrangements. It draws on recent literature on healthcare 'rebels' and further develops the concept of 'rebellion' in the context of housing. The main research question is how founders dealt with challenges of establishing and governing 'rebellious' innovative living arrangements for older people in the highly regulated context of housing and care in the Netherlands. Qualitative in-depth interviews with 17 founders (social entrepreneurs, directors and supervisory board members) were conducted. Founders encountered various obstacles that are often related to governmental and sectoral rules and regulations. Their stories demonstrate the opportunities and constraints of innovative entrepreneurship at the intersection of housing and care. The study concludes with the notion of 'responsible rebellion' and practical lessons about dealing with rules and regulations and creating supportive contexts.

How to Achieve a Healthier and More Sustainable Europe by 2040 According to the Public? Results of a Five-Country Questionnaire Survey

The aim of this paper is to understand public preferences for several future scenarios of achieving a healthier, more equitable and sustainable Europe, which differ in the way the society is organized (individualistically vs. collectively) and in the driving sector (public vs. private). To achieve this aim, we conducted a questionnaire survey using representative samples for five European countries in 2018. About three thousand respondents chose among the four scenarios presented within four different contexts (green spaces, active mobility, energy-efficient housing, food consumption) or none of them. A majority of people in the five European countries were ready to accept one of the scenarios. We found significant differences in preferences according to socioeconomic backgrounds and values of respondents. People above 35 years old, those who were less educated, and those in the lowest household income tertile were less supportive of all scenarios. The heterogeneity in preferences associated with differences in socioeconomic backgrounds was larger for the scenario in which society is organized individualistically and driven by the private sector. Smaller distinctions were found in case of the scenario in which society is organized collectively and is driven by the public sector. Departing from social psychological theories, we examine the role of altruistic, biospheric, egoistic, hedonic, and security values. People with stronger biospheric values were more likely to accept scenarios, particularly those which are driven by the public sector and where there is more collective organisation. Those with a more egoistic value orientation were more likely to have higher preferences for scenarios where the private sector had a dominant role. The policy implications, in terms of the selection and framing of policy measures to enhance public support, are discussed.

Prescribing Housing: A Scoping Review of Health System Efforts to Address Housing as a Social Determinant of Health

US health systems have begun to address housing instability within a larger effort to address social determinants of health. To explore existing themes within efforts by health systems to reduce housing instability and improve health, the authors conducted a scoping review supplemented with key informant interviews. Twenty-two articles were analyzed and 7 participants from 6 health systems were interviewed. Themes identified from the literature and interviews included intervention strategies and funding, access, coordination, and administrative processes and evaluation. As more health systems integrate housing-related interventions, findings from this study highlight the need for more upstream focus, consistent funding, and reliable evaluation strategies.

Animal Welfare Assessment Protocol for Does, Bucks, and Kit Rabbits Reared for Production

Rabbits are the third species in terms of number of animals reared for meat production in the world. However, in comparison to other species, very few studies have focused on their welfare. The aim of the present study is to implement an animal welfare-assessment protocol developed through a multidimensional approach and containing a number of animal-based measures for bucks, does, and kit rabbits. Thirty Spanish farms with conventional cages in the first year of integration in an animal welfare certification scheme were visited during 2019 and audited by the same auditor. The protocol is divided into four principles and 11 criteria. The Good Feeding principle includes eight parameters (one animal-based), Good Housing includes 15 parameters (six animal-based), Good Health includes 26 parameters (16 animal-based), and Appropriate Behavior contains nine parameters (four animal-based). In general, the main problems found were the absence of platforms, low space allowance and low height of the cage, inappropriate systems for performing emergency killing, insufficient protection of does from other adjacent does when housed individually, and absence of enrichment material. To a minor degree, but also found in an important number of farms, was a lack of temperature data records, high replacement rates of does, and lack of mortality-rate data records. However, in general, most of the farms obtained a good overall score, the maximum found being 73 out of 100 points. Nevertheless, none of the farms reached an excellent score, and four farms were scored below the 55 points required in the animal welfare certification scheme. The Good Feeding principle obtained the highest score, reaching excellent in all farms, and Appropriate Behavior the lowest one, with values ranging from 21 to 41 points out of 100. The results probably show how, for years, rabbit producers have been very focused on feeding needs and very little attention has been paid to behavioral needs.

Individualized Apartment Accommodation for People With Intellectual Disability: Protocol for a Qualitative Study Examining the Well-Being and Support Outcomes Linking Housing and Health

Background

Understanding the outcomes associated with both receiving and providing support to people with intellectual disability in specific settings can facilitate the alignment of health providers, community care providers, architects, and urban planners to strengthen levels of autonomy and community participation of people with intellectual disability living in the community. This study explores the impact of providing support (available 24 hours a day) for people with intellectual disability in a high-density apartment. It seeks the perspectives of people with intellectual disability who have moved into an apartment from a group home (where 4-6 people with disability live), their families, and support staff. It will enable comparison between two models of supported accommodation, group homes and individualized apartments, in a community setting.

Objective

The aims of this study are to explore the impact of an individualized apartment model of supported accommodation in a high-density setting on the well-being, autonomy, and participation of people with intellectual disability living and receiving support; the experience of providing care or support; and how this setting impacts the logistics of how quality support is provided.

Methods

Qualitative research methods were employed as the primary means of collecting and analyzing data. There are two main sources of data in this study: (1) semistructured interviews with participants in up to 3 waves (pre, post 1, and post 2) and (2) pre- and postoccupancy evaluation data on the design, layout, and location details of the built environments. Coded interview data will be paired with pre- and postoccupancy evaluations of the two accommodation settings.

Results

As of May 2020, we have recruited 55 participants. There have been 96 interviews conducted in 2 waves with people who have moved into supported accommodation, families, and staff. Collected data are currently being analyzed. We expect the results of the trial to be published in a peer-reviewed journal in late 2020.

Conclusions

This paper sets out a study of an alternative housing and support model for people with intellectual disability. It will capture personal experiences of people with intellectual disability receiving support in an apartment compared to their experiences in a group home. It will also capture the experiences of support staff working in the new setting and reveal how this differs from a group home setting. The inclusion of pre (group home) and post (apartment integrated into a community setting) measures addresses evaluative and comparative questions around the nature and impacts of the small-scale apartment and support model for both those who live and receive support, and those who support them.

International Registered Report Identifier (IRRID)

DERR1-10.2196/18248