Influence of maternal socioeconomic deprivation and living environment on newborn bloodspot 25-hydroxyvitamin D levels

Objectives

Vitamin D deficiency in neonates can have life-threatening consequences, hence the knowledge of risk factors is essential. This study aimed to explore the effect of maternal socioeconomic status (SES) on newborn 25-hydroxyvitamin D (25OHD) concentrations.

Design

Over two 1-week periods (winter and summer of 2019), 3000 newborn heel prick dried blood spots (DBS) and additional data of newborns, from a regional newborn screening laboratory (52° N) in the West Midlands, UK, were gathered. Post code was replaced with lower layer super output area (LSOA). Index of Multiple Deprivation (IMD) quintiles for the corresponding LSOA was used to assess SES [quintile one (Q1): most deprived 20%, quintile five (Q5): least deprived 20%]. Each of the seven domains of deprivation were examined (income, employment, education, health, barriers to housing and services, crime and living environment). 25OHD was measured on 6mm sub-punch from DBS using quantitative liquid chromatography tandem mass spectrometry and equivalent plasma values were derived.

Results

In total 2999 (1500 summer-born, 1499 winter-born) newborn DBS (1580 males) were analysed. Summer-born newborns had significantly higher 25OHD (IQR) concentrations [49.2 (34.3; 64.8) nmol/l] than winter-born newborns [29.1 (19.8; 40.6) nmol/l, p<0.001].25OHD levels varied significantly between the different IMD quintiles in the whole (p<0.001) and summer-born cohort (p<0.001), but not in the winter-born cohort (p=0.26), whereby Q1 had the lowest 25OHD concentrations. Among the domains of deprivation, living environment had a significant influence on 25OHD levels (β=0.07, p=0.002). In this subdomain, 25OHD levels varied significantly between quintiles in the whole (p<0.001) and summer-born cohort (mean 25OHD Q1 46.45 nmol/l, Q5 54.54 nmol/l; p<0.001) but not in the winter-born cohort (mean 25OHD Q1 31.57 nmol/l, Q5 31.72 nmol/l; p=0.16). In a regression model, living environment was still significant (p=0.018), albeit less than season of birth and ethnicity.

Conclusion

Among the seven domains of deprivation, maternal living environment had the greatest effect on newborn 25OHD levels. Whilst improved living environment positively influenced vitamin D status in the summer-born babies, winter-born had low 25OHD levels irrespective of the environment. Strategies such as enhanced supplementation and food fortification with vitamin D should be considered to overcome the non-modifiable main risk factors for vitamin D deficiency.

Housing status, mortgage debt and financial burden as barriers to health among older adults in the U.S

We examine relations between housing status, mortgage, financial burden, and healthy aging among older U.S. adults. We combine cross-sectional data from 2012 to 2014 Health and Retirement Study cohorts. Using regression models, we examined associations between owners and renters, mortgage and non-mortgage holders, financial strain, and difficulty paying bills, and poor self-rated health (SRH), heart condition (HC) and hospitalization (past two years). We find that compared to owners, renters had greater likelihood of poor SRH and hospitalization. Regardless of tenure, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Mortgage holders had lower likelihood of poor SRH. Accounting for mortgage status, financial strain was associated with greater likelihood of poor SRH, HC and hospitalization, while difficulty paying bills was associated with poor SRH and HC. Associations between tenure or mortgage status and health were not modified by either financial burden factors. We conclude that there need to be more robust and inclusive programs that assist older populations with housing could improve self-rated health, with particular attention to renters, mortgage holders and those experiencing financial burden.

Politics, power, and precarity: how tenant organizations transform local political life

As the coronavirus pandemic exacerbated housing precarity, tenant organizations grew in numbers and salience. But membership-based tenant organizations predated the pandemic and will persist beyond it. There are (at least) hundreds of them in localities across the country. Many aim to advance sweeping change. In doing so, they face formidable tasks: politically organizing in race-class subjugated communities, working in opposition to powerful actors (corporate landlords, property managers, etc.), and navigating complex and sometimes hostile local political institutions (city councils, mayors, rent boards, etc.). How do these organizations build power and effect change in the face of such obstacles? Drawing on a rich body of original qualitative evidence (participant observation and in-depth interviews), this paper explores the politics of local tenant organizations. We assess the origins of such organizations, how they are structured, and how they pursue political change. In doing so, we offer a rich descriptive account of phenomena that have largely escaped the attention of political scientists. We find that tenant organizations can cultivate radically different ways of conceptualizing political economy, carve out a distinctive political focus on race-class subjugated communities, and create critical opportunities for otherwise marginalized actors to develop and exercise political power.

Homeless Opioid Treatment Clients Transitioning to Dependent and Independent Housing: Differential Outcomes by Race/Ethnicity

Purpose: Homeless opioid treatment clients who transition into housing generally demonstrate better outcomes, but housing environments vary widely and may not benefit racial/ethnic minority populations equally. We sought to identify how race/ethnicity moderates the association between positive opioid treatment response and moving into dependent or independent living environments. Methods: We used the Treatment Episode Dataset-Discharges (2018-2019) to identify outpatient treatment clients who were homeless at admission and indicated heroin or other opioids as their primary drug of choice (n = 20,021). We defined positive treatment response as a reduction in opioid use between admission and discharge. We used multivariable logistic regression to model treatment response. We included an interaction between housing at discharge (remained homeless [reference], dependent living, or independent living) and race/ethnicity, and adjusted for relevant confounders. Results: Transitioning from homeless to dependent living was positively associated with treatment response among White (aOR = 3.57, 95% CI = 3.15-4.06), Hispanic (aOR = 2.11, 95% CI = 1.55-2.86), and Black clients (aOR = 1.79, 95% CI = 1.41-2.27), but no association was observed for homeless American Indian/Alaska Native clients. Transitioning from homeless to independent living was strongly associated with treatment response among all groups with the strongest association observed among White clients (aOR = 4.70, 95% CI = 4.26-5.19). Conclusions: Interventions aimed at improving OUD treatment outcomes among homeless clients should identify individual and structural factors that support moving into fully housed and independent living environments. Dependent living offers needed support during crises, but should be temporary and priority should be placed on independent, permanent, and autonomous living environments.

Healthy, happy places-a more integrated approach to creating health and well-being through the built environment?

INTRODUCTION

This paper explores how the built environment impacts upon health and well-being and suggests that there are opportunities for more integrated working between professionals and citizens to create healthier, happier places.

SOURCES OF DATA

Policy and practice guidance is presented from the urban planning and design fields. Evidence and data are presented from a range of disciplines on housing, green infrastructure and mental well-being.

AREAS OF AGREEMENT

There is an overwhelming agreement around the principles and rationale of incorporating health in planning and design processes.

AREAS OF CONTROVERSY

These principles are not always implemented in practice. Challenges also exist around how different disciplines create and use evidence.

GROWING POINTS

More innovative ways of working which incorporates health, public health, planners, designers and citizens, which responds to the needs of communities, should be tested.

AREAS TIMELY FOR DEVELOPING RESEARCH

Health and public health professionals can contribute to the evidence base using objective measures to assess the impact of the built environment on mental health and well-being.

The importance of home: Satisfaction with accommodation, neighborhood, and life in adults with autism

Although good quality housing and a socially cohesive neighborhood are associated with a higher well‐being in the general population, housing is a rarely studied topic in autism research. In the present study, we describe the housing situation of a large sample of adults with autism and mostly (above) average intellectual abilities (n = 1429; 17 to 84 years), and examine predictors of independent living, accommodation satisfaction, neighborhood satisfaction, and satisfaction with life based on an online survey. The outcomes of independently living adults were compared with those from a Dutch community sample (n = 929). Nearly 80% of the autistic adults lived independently. Older participants, women, and those with higher self‐reported IQ's were more likely to live independently. Autistic adults living independently were equally satisfied with their accommodation and neighborhood as the comparison group, but were less satisfied with their life in general. In both groups, higher satisfaction with accommodation and neighborhood was associated with higher life satisfaction. We advocate further research to better understand and anticipate the housing needs of the growing group of adults with autism.

The Housing Needs of Sexual and Gender Minority Older Adults: Implications for Policy and Practice

This study identifies the interconnected needs and concerns of sexual and gender minority (SGM) older adults, with a particular focus on housing, healthcare, transportation, and social support. Data were gathered through seven groups with a sample of SGM-identified adults age 55 and over (N = 50) and analyzed using thematic analysis. The participants seek affordable and inclusive housing options. They identified that access to transportation is paramount in maintaining social support and accessing healthcare. Findings underscore the need for strategies to serve the housing needs of low-income SGM-identified older adults in a nondiscriminatory way, train housing providers in culturally responsive care, meet transportation needs, and provide SGM-inclusive community-based services that reduce isolation.

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality

The coronavirus disease 2019 (COVID-19) pandemic and associated economic crisis have placed millions of US households at risk of eviction. Evictions may accelerate COVID-19 transmission by decreasing individuals' ability to socially distance. We leveraged variation in the expiration of eviction moratoriums in US states to test for associations between evictions and COVID-19 incidence and mortality. The study included 44 US states that instituted eviction moratoriums, followed from March 13 to September 3, 2020. We modeled associations using a difference-in-difference approach with an event-study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. COVID-19 incidence and mortality increased steadily in states after eviction moratoriums expired, and expiration was associated with a doubling of COVID-19 incidence (incidence rate ratio = 2.1; 95% confidence interval (CI): 1.1, 3.9) and a 5-fold increase in COVID-19 mortality (mortality rate ratio = 5.4; CI: 3.1, 9.3) 16 weeks after moratoriums lapsed. These results imply an estimated 433,700 excess cases (CI: 365,200, 502,200) and 10,700 excess deaths (CI: 8,900, 12,500) nationally by September 3, 2020. The expiration of eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public-health rationale for eviction prevention to limit COVID-19 cases and deaths.

Pet-Friendly for Whom? An Analysis of Pet Fees in Texas Rental Housing

Previous studies have underscored the difficulty low-income pet owners often face when attempting to secure affordable rental housing. Further exacerbating this housing disparity are fees charged on top of normal monthly rent to pet owners in “pet-friendly” rental housing. In this study, we aggregated rental housing listings from the twenty most populous cities in Texas, USA from a popular online rental database. We paired the rental listings with census tract information from the American Community Survey in order to investigate economic and racial/ethnic patterns in the spatial distribution of the properties. We find that less expensive pet-friendly listings were more likely to have pet fees charged on top of rent than rental units that were more expensive. Additionally, when pet fee burden was defined as a function of average income by census tract, low-income communities and communities of color were more likely than higher income and predominantly White communities to pay disproportionately higher fees to keep pets in their homes. We also find patterns of spatial inequalities related to pet fee burden by a metric of income inequality by city. The burden of pet rental fees may contribute to both housing insecurity and companion animal relinquishment. We discuss these findings as they relate to inequalities in housing, with particular attention to marginalized and disadvantaged people with pets. We conclude with recommendations for policy and practice.

Critical Characteristics of Housing and Housing Supports for Individuals with Concurrent Traumatic Brain Injury and Mental Health and/or Substance Use Challenges: A Qualitative Study

Traumatic brain injury (TBI) and mental health and/or substance use challenges (MHSU) are commonly co-occurring and prevalent in individuals experiencing homelessness; however, evidence suggests that systems of care are siloed and organized around clinical diagnoses. Research is needed to understand how housing and housing supports are provided to this complex and understudied group in the context of siloed service systems. This study aimed to describe critical characteristics of housing and housing supports for individuals with concurrent TBI and MHSU from the perspectives of service users with TBI and MHSU and housing service providers. Using basic qualitative description, in-depth interviews were conducted with 16 service users and 15 service providers. Data were analyzed using thematic analysis techniques. Themes capture core processes in finding and maintaining housing and the critical housing supports that enabled them: (1) overcoming structural barriers through service coordination, education and awareness raising, and partnerships and collaborations; and (2) enabling engagement in meaningful activity and social connection through creating opportunities, training and skills development, and design of home and neighborhood environments. Implications for practice, including the urgent need for formalized TBI and MHSU education, support for service providers, and potential interventions to further enable core housing processes are discussed.

Routines, Time Dedication and Habit Changes in Spanish Homes during the COVID-19 Lockdown. A Large Cross-Sectional Survey

Many countries chose to establish social distancing as lockdowns after the COVID-19 outbreak. Households had to adapt their day-to-day lifestyles to new circumstances, affecting routines and time dedication to tasks. This national study was carried out to find out how the confinement by COVID-19 affected Spanish households on the perceived habit changes during this period, in relation to their socio-demographic characteristics and household composition. An online questionnaire was launched during the COVID-19 lockdown, from 30 April to 22 June 2020. Descriptive statistics were analyzed, stratified by gender, on time dedication, routine, home leaving, and habit change variables. Chi-square tests were used to explore the relations of significance with socio-demographic characteristics and home composition. All contrast analyses were performed for a 95% confidence level (significance considered for p < 0.05). In total, 1673 respondents participated from different age groups, educational level, employment status and household composition. Sixty percent of respondents maintained their routines. A third tried to establish a new one, being related to women, young people, not a university student, and living with others, including minors. Regarding dedication to tasks, adults aged 35-54 years, with more cohabitants, especially women, devoted themselves intensively to the home or to care, while those under 35 were dedicated more to rest, leisure, television or reading. People with university studies were more related to teleworking. The frequency of going outside was related to gender, age, educational level and living with elders, specifically for grocery shopping and taking out garbage. Changes in habits, routines and time dedication in confinement were strongly linked to the sociodemographic and coexistence conditions in Spanish homes. The greatest impacts were suffered by women, people with children, and adults between 35-54 years of age, especially on care and domestic chores.

Further Inspection: Integrating Housing Code Enforcement and Social Services to Improve Community Health

As a result of working inside homes, city housing inspectors witness hidden and serious threats to public health. However, systems to respond to the range of problems they encounter are lacking. In this study, we describe the impact and enabling environment for integrating a novel Social Service Referral Program within the Inspectional Services Department in Chelsea, MA. To evaluate the first eight months of the program, we used a mixed-methods approach combining quantitative data from 15 referrals and qualitative interviews with six key informants (inspectors, a case manager, and city leadership). The most common services provided to residents referred by inspectors were for fuel, food, and rent assistance; healthcare; hoarding; and homelessness prevention. Half of referred residents were not receiving other social services. Inspectors reported increased work efficiency and reduced psychological burden because of the program. Interviewees described how quality of life improved not only for referred residents but also for the surrounding neighborhood. A simple referral process that made inspectors’ jobs easier and a trusted, well-connected service provider funded to carry out the work facilitated the program’s uptake and impact. Housing inspectors’ encounters with residents present a unique opportunity to expand the public health impact of housing code enforcement.

"Housing Is Health Care": Treating Homelessness in Safety-Net Hospitals

As medicine integrates social and structural determinants into health care, some health workers redefine housing as medical treatment. This article discusses how health workers in two U.S. urban safety-net hospitals worked with patients without stable housing. We observed ethnographically how health workers helped patients seek housing in a sharply stratified housing economy. Analyzing in-depth interviews and observations, we show how health workers: (1) understood housing as health care and navigated limits of individual care in a structurally produced housing crisis; and (2) developed and enacted practices of biomedical and sociopolitical stabilization, including eligibilizing and data-tracking work. We discuss how health workers bridged individually focused techniques of clinical care with structural critiques of stratified housing economies despite contradictions in this approach. Finally, we analyze the implications of providers' extension of medical stabilization into social, economic, and political realms, even as they remained caught in the structural dynamics they sought to address.

Living Conditions and Social Outcomes in Adults With Cerebral Palsy

Objectives: To analyse the living conditions and social outcomes (housing, engagement in employment or higher education, access to personal assistance and having a partner) in adults with cerebral palsy (CP) relative to their age, sex, communication ability, and motor skills.

Methods: Cross-sectional registry-based study of 1,888 adults (1,030 males/858 females) with CP in the Swedish CP follow-up programme, median age 25 years (range 16–78 y). Type of housing, occupation, access to personal assistance and having a partner were analysed relative to their age, sex, and the classification systems for Gross Motor Function (GMFCS) and Communication Function (CFCS). Binary logistic regression models were used to calculate odds ratios (OR) for independent living, competitive employment, and having a partner.

Results: Most of the 25- to 29-year olds (55.6%) lived independently, increasing to 72.4% in 40- to 49-year olds, while the majority (91.3%) of those under 20 years lived with their parents. Independent living was almost equal in adults at GMFCS levels I (40.2%) and V (38.6%). This parity was explained by access to personal assistance, which increased with higher GMFCS and CFCS levels. Personal assistance of >160 hours/week was associated with a high probability of independent living (OR 57). In the age span 20–64 years, 17.5% had competitive employment and 45.2% attended activity centres for people with intellectual disabilities. In the younger age group up to 24 years old, 36.9% went to mainstream/higher education and 20.5% went to special schools. In total, 13.4% had a partner and 7.8% lived together. Slightly more women than men had a partner, and most individuals were classified at CFCS level I.

Conclusion: Only one in eight adults with CP has a partner, and one in six has competitive employment. Access to personal assistance is the single most important factor for independent living. It is vital to support adults with CP throughout their lifespan to achieve the best possible outcomes in all aspects of life.

Housing conditions and microbial environment do not affect the efficacy of vaccines for treatment of opioid use disorders in mice and rats

Vaccines offer a promising prophylactic and therapeutic intervention to counteract opioid use disorders (OUD) and fatal overdoses. Vaccines generate opioid-specific antibodies that bind the target opioid, reducing drug distribution to the brain and preventing drug-induced behavioral and pharmacological effects. Due to their selectivity, anti-opioid vaccines can be administered in combination with FDA-approved medications. Because patients with OUD or other substance use disorders may be affected by other multifactorial co-morbidities, such as infection or depression, it is important to test whether vaccine efficacy is modified by factors that may impact individual innate or adaptive immunity. To that end, this study tested whether housing conditions would affect the efficacy of two lead vaccine formulations targeting oxycodone and fentanyl in male mice and rats, and further analyzed whether differences in the gastrointestinal (GI) microbiome would be correlated with either vaccine efficacy or housing conditions. Results showed that housing mice and rats in either conventional (non-controlled) or specific pathogen-free (SPF, sterile barrier maintained) environment did not affect vaccine-induced antibody responses against oxycodone and fentanyl, nor their efficacy against oxycodone- and fentanyl-induced antinociception, respiratory depression, and bradycardia. Differences in the GI microbiome detected via 16S rRNA gene sequencing were related to the housing environment. This study supports use of anti-opioid vaccines in clinical populations that may display deficits in microbiome function.

Perception of feeling cold in the bedroom and sleep quality

Sleep disorders are drawing the attention of both medical and public health concern worldwide. In Japan, research suggests that one fifth of adults do not receive appropriate sleep and 40% of adults sleep less than 6 hours a day, and sleep rates are decreasing further year by year. Many studies show that cold indoor environments negatively affect sleep comfort and quality. Whereas these studies have focused on the effects of low bedroom temperature, few studies have focused on the effect of perception of coldness. Indoor temperature is typically much lower in Japan than in other countries. Therefore, the current study aimed to identify the effect of perception of bedroom coldness on sleep quality among Japanese adults. After controlling for covariates of age, presence of current disease and pain, smoking and consumption of alcohol (Model 1), participants who sometimes, often or always felt cold in the bedroom exhibited 0.57 (95% CI=0.32–0.83, p=<.0001), 1.08 (95% CI=0.82–1.35, p<.0001) or 2.25 (95% CI=1.83–2.67, p<.0001) higher PSQI scores compared to the group which didn’t feel cold in bedroom. Our findings suggest keeping the bedroom thermal environment above a minimum limit as recommended by the World Health Organization or other organization during colder, winter nights when feeling cold during sleep. Additional deficiencies in the housing infrastructure, air quality issues due to the use of a heater, and micro bed environment need to be holistically addressed. Sleep quality can be improved by certain level via providing thermally comfortable sleeping environment.

Predictors of Water Lead Levels in Drinking Water of Homes With Domestic Wells in 3 Illinois Counties

CONTEXT

Millions of US homes receive water from private wells, which are not required to be tested for lead (Pb). An approach to prioritizing high-risk homes for water lead level (WLL) testing may help focus outreach and screening efforts, while reducing the testing of homes at low risk.

OBJECTIVE

To (1) characterize distribution of WLLs and corrosivity in tap water of homes with private residential wells, and (2) develop and evaluate a screening strategy for predicting Pb detection within a home.

DESIGN

Cross-sectional.

SETTING

Three Illinois counties: Kane (northern), Peoria (central), and Jackson (southern).

PARTICIPANTS

151 private well users from 3 Illinois counties.

INTERVENTION

Water samples were analyzed for WLL and corrosivity.

MAIN OUTCOME MEASURES

(1) WLL and corrosivity, and (2) the sensitivity, specificity, and predictive value of a strategy for prioritizing homes for WLL testing.

RESULTS

Pb was detected (>0.76 ppb) in tap water of 48.3% homes, and 3.3% exceeded 15 ppb, the US Environmental Protection Agency action level for community water systems. Compared with homes built in/after 1987 with relatively low corrosivity, older homes with more corrosive water were far more likely to contain measurable Pb (odds ratio = 11.07; 95% confidence interval, 3.47-35.31). The strategy for screening homes with private wells for WLL had a sensitivity of 88%, specificity of 42%, positive predictive value of 58%, and negative predictive value of 80%.

CONCLUSIONS

Pb in residential well water is widespread. The screening strategy for prioritizing homes with private wells for WLL testing is greater than 85% sensitive.

Housing and asthma disparities

The burden of asthma disproportionately affects minority and low-income communities, resulting in racial and socioeconomic disparities in asthma prevalence, asthma exacerbations, and asthma-related death. Social determinants of health are increasingly implicated as root causes of disparities, and healthy housing is perhaps the most critical social determinant in asthma health disparities. In many minority communities, poor housing conditions and value are a legacy of historical policies and practices imbued with structural racism, including redlining, displacement, and exclusionary zoning. As a result, poor-quality, substandard housing is a characteristic feature of many underrepresented minority communities. Consequently, structurally deficient housing stock cultivates home environments rife with indoor asthma triggers. In this review we consider the historical context of urban housing policies and practices and how these policies and practices have contributed to the substandard housing conditions for many minoritized children in the present day. We describe the impact of poor housing quality on asthma and interventions that have attempted to mitigate its influence on asthma symptoms and health care utilization. We discuss the need to promote asthma health equity by reinvesting in these neighborhoods and communities to provide healthy housing.

Identifying Jurisdictions at Risk of Containing Housing Units With Deteriorated Paint: Results and Targeting Implications for the US Department of Housing and Urban Development

CONTEXT

The US Department of Housing and Urban Development provides millions in annual funding to make low-income housing lead safe, but funds are limited relative to need. To adequately target efforts, local program administrators must identify neighborhoods that are the most "at risk" of residential lead exposure; however, no federal agency currently provides a public data set for this use.

OBJECTIVES

To examine pre-1980 households with large areas of deteriorated paint, a significant and common predictor of lead dust, and identify high-risk jurisdictions. To highlight the potential use of a newly available data set for strategic lead poisoning prevention and targeting.

DESIGN

Microdata from the 2011 American Housing Survey and the 2009-2013 American Community Survey were used to develop a household-level predicted risk metric that identifies housing units at risk of containing large areas of deteriorated paint. Predicted risk, defined as the mean predicted percentage of occupied housing units at risk of containing deteriorated paint within a given jurisdiction, was summarized by state, county, and tract.

SETTING

National, all occupied housing units.

PARTICIPANTS

Occupied housing units summarized by household (n = 9 363 000), census tract (n = 72 235), county (n = 3143), and state (n = 51).

MAIN OUTCOME MEASURE

Housing units built prior to 1980 with a large area of deteriorated paint.

RESULTS

New York, Rhode Island, New Jersey, Massachusetts, and Pennsylvania had the highest predicted percentage of at-risk households (range: 2.52%-2.90%). County-level and tract-level estimates are the most useful when examining a predefined jurisdiction; New York state was presented as a case study. County-level quartile risk scores revealed Albany as an at-risk jurisdiction. Tract-level quartile risk scores further identified at-risk neighborhoods in northeastern Albany.

CONCLUSIONS

Findings can help housing and health policy makers identify and target geographic areas with a high probability of households at risk of potential exposure to deteriorated lead-based paint.

Appraisal of facility provisions in public-private partnership housing delivery in southwest Nigeria

The impact of facility provisions within housing environs cannot be overemphasized. It represents the backbone of housing development, stabilizes occupant satisfaction level, and improves living conditions of residents. It is on this premise that this study appraises facility provisions within Public-Private Partnership (PPP) constructed estates in three (3) South-western states of Nigeria to determine the provider of the major facilities in PPP housing within the study area. A quantitative research method was adopted for the study with the use of questionnaires emerging for data collection. The questionnaire was administered to 90 residents of housing units within the selected estates in which 88 questionnaires were retrieved. The study shows that apart from providing the building structures and finance, the private sector provides potable water for consumption and domestic use, waste management and disposal, the connection of PPP residential houses to the national electrical grid, and provision of a network of roads within the estates linking the government provided main access road. The study recommended that in providing facilities for any future PPP housing delivery system, parties involved in the provisions of required facilities need to understand the end-user's facility needs.

COVID-Related Victimization, Racial Bias and Employment and Housing Disruption Increase Mental Health Risk Among U.S. Asian, Black and Latinx Adults

Background: The mental health of racial/ethnic minorities in the U.S. has been disproportionately impacted by the COVID-19 pandemic. This study examined the extent to which disruptions in employment and housing, coronavirus-specific forms of victimization and racial bias independently and conjointly contributed to mental health risk among Asian, Black, and Latinx adults in the United States during the pandemic. Methods: This study reports on data from 401 Asian, Black, and Latinx adults (age 18-72) who participated in a larger national online survey conducted from October 2020-June 2021, Measures included financial and health information, housing disruptions and distress in response to employment changes, coronavirus related victimization distress and perceived increases in racial bias, depression and anxiety. Results: Asian participants had significantly higher levels of COVID-related victimization distress and perceived increases in racial bias than Black and Latinx. Young adults (<26 years old) were more vulnerable to depression, anxiety, and coronavirus victimization distress than older respondents. Having at least one COVID-related health risk, distress in response to changes in employment and housing disruptions, pandemic related victimization distress and perceived increases in racial bias were positively and significantly related to depression and anxiety. Structural equation modeling indicated COVID-related increases in racial bias mediated the effect of COVID-19 related victimization distress on depression and anxiety. Conclusions: COVID-19 has created new pathways to mental health disparities among racial/ethnic minorities in the U.S. by exacerbating existing structural and societal inequities linked to race. Findings highlight the necessity of mental health services sensitive to specific challenges in employment and housing and social bias experienced by people of color during the current and future health crises.

The Interplay between Housing Environmental Attributes and Design Exposures and Psychoneuroimmunology Profile-An Exploratory Review and Analysis Paper in the Cancer Survivors' Mental Health Morbidity Context

Adult cancer survivors have an increased prevalence of mental health comorbidities and other adverse late-effects interdependent with mental illness outcomes compared with the general population. Coronavirus Disease 2019 (COVID-19) heralds an era of renewed call for actions to identify sustainable modalities to facilitate the constructs of cancer survivorship care and health care delivery through physiological supportive domestic spaces. Building on the concept of therapeutic architecture, psychoneuroimmunology (PNI) indicators-with the central role in low-grade systemic inflammation-are associated with major psychiatric disorders and late effects of post-cancer treatment. Immune disturbances might mediate the effects of environmental determinants on behaviour and mental disorders. Whilst attention is paid to the non-objective measurements for examining the home environmental domains and mental health outcomes, little is gathered about the multidimensional effects on physiological responses. This exploratory review presents a first analysis of how addressing the PNI outcomes serves as a catalyst for therapeutic housing research. We argue the crucial component of housing in supporting the sustainable primary care and public health-based cancer survivorship care model, particularly in the psychopathology context. Ultimately, we illustrate a series of interventions aiming at how housing environmental attributes can trigger PNI profile changes and discuss the potential implications in the non-pharmacological treatment of cancer survivors and patients with mental morbidities.

Clinical Mastitis Incidence in Dairy Cows Housed on Recycled Manure Solids Bedding: A Canadian Cohort Study

Bedding can affect mammary health of dairy cows. The objectives of this study were to evaluate clinical mastitis incidence in cows housed on recycled manure solids bedding and, more specifically, to determine which pathogens were involved. We followed 26 recycled manure solids farms and 60 straw-bedded farms as a comparative group during 1 year (2018-2019). For each episode of clinical mastitis, defined as a visual alteration of the milk, with or without local or systemic signs of infection, producers sampled aseptically the affected quarter, provided some details about the animal, and sent the sample to the research team at the Université de Montréal. We received and analyzed 1,144 milk samples. The samples were cultured according to the National Mastitis Council guidelines and the different colony phenotypes were subsequently identified with mass spectrometry. In 54.6% of CM cases, a single phenotype of bacteria was cultured (pure culture), while two different phenotypes were found in 16.8% of the samples (mixed culture), and no growth was observed in 14.4% of the samples. Samples with three or more phenotypes were considered contaminated and were not included in the pathogen-specific analyses (14.3% of the submitted samples). The most frequently identified bacterial species in pure and mixed culture in farms using recycled manure solids were Streptococcus uberis (16.0%), Escherichia coli (13.8%), Klebsiella pneumoniae (13.2%), Streptococcus dysgalactiae (6.2%), and Staphylococcus aureus (3.4%). In straw farms, the most frequent species were S. aureus (16.6%), S. uberis (11.0%), E. coli (9.1%), S. dysgalactiae (8.0%), and K. pneumoniae (1.1%). The incidence of clinical mastitis (all cases together) was not higher in recycled manure solids farms (14.0 cases/100 cow-year; 95% CI: 8.3-23.7) compared with straw-bedded farms (16.3 cases/100 cow-year; 95% CI: 9.0-29.6). However, K. pneumoniae clinical mastitis episodes were 7.0 (95% CI: 2.0-24.6) times more frequent in recycled manure solids farms than in straw farms. Adjusted least square means estimates were 1.6 K. pneumoniae clinical mastitis cases/100 cow-year (95% CI: 0.8-3.4) in recycled manure solids farms vs. 0.2 cases/100 cow-year (95% CI: 0.1-0.6) in straw-bedded farms. Klebsiella pneumoniae clinical mastitis is in general severe. Producers interested in this bedding alternative need to be aware of this risk.

Music in Quarantine: Connections Between Changes in Lifestyle, Psychological States, and Musical Behaviors During COVID-19 Pandemic

Music is not only the art of organized sound but also a compound of social interaction among people, built upon social and environmental foundations. Since the beginning of the COVID-19 outbreak, containment measures such as shelter-in-place, lockdown, social distancing, and self-quarantine have severely impacted the foundation of human society, resulting in a drastic change in our everyday experience. In this paper, the relationships between musical behavior, lifestyle, and psychological states during the shelter-in-place period of the COVID-19 pandemic are investigated. An online survey on musical experience, lifestyle changes, stress level, musical behaviors, media usage, and environmental sound perception was conducted. The survey was conducted in early June 2020. Responses from 620 people in 24 countries were collected, with the large proportion of the responses coming from the U.S. (55.5%) and India (21.4%). Structural equation modeling (SEM) analysis revealed causal relationships between lifestyle, stress, and music behaviors. Elements such as stress-level change, work risk, and staying home contribute to changes in musical experiences, such as moderating emotion with music, feeling emotional with music, and being more attentive to music. Stress-level change was correlated with work risk and income change, and people who started living with others due to the outbreak, especially with their children, indicated less change in stress level. People with more stress-level change tended to use music more purposefully for their mental well-being, such as to moderate emotions, to influence mood, and to relax. In addition, people with more stress-level change tend to be more annoyed by neighbors' noise. Housing type was not directly associated with annoyance; however, attention to environmental sounds decreased when the housing type was smaller. Attention to environmental and musical sounds and the emotional responses to them are highly inter-correlated. Multi-group SEM based on musicians showed that the causal relationship structure for professional musicians differs from that of less-experienced musicians. For professional musicians, staying at home was the only component that caused all musical behavior changes; stress did not cause musical behavior changes. Regarding Internet use, listening to music via YouTube and streaming was preferred over TV and radio, especially among less-experienced musicians, while participation in the online music community was preferred by more advanced musicians. This work suggests that social, environmental, and personal factors and limitations influence the changes in our musical behavior, perception of sonic experience, and emotional recognition, and that people actively accommodated the unusual pandemic situations using music and Internet technologies.

COVID-19 Outbreaks in Settings With Precarious Housing Conditions in Germany: Challenges and Lessons Learned

Two COVID-19 outbreaks occurred in residential buildings with overcrowded housing conditions in the city of Göttingen in Germany during May and June 2020, when COVID-19 infection incidences were low across the rest of the country, with a national incidence of 2.6/100,000 population. The outbreaks increased the local incidence in the city of Göttingen to 123.5/100,000 in June 2020. Many of the affected residents were living in precarious conditions and experienced language barriers. The outbreaks were characterized by high case numbers and attack rates among the residents, many asymptomatic cases, a comparatively young population, and substantial outbreak control measures implemented by local authorities. We analyzed national and local surveillance data, calculated age-, and gender-specific attack rates and performed whole genome sequencing analysis to describe the outbreak and characteristics of the infected population. The authorities' infection control measures included voluntary and compulsory testing of all residents and mass quarantine. Public health measures, such as the general closure of schools and a public space as well as the prohibition of team sports at local level, were also implemented in the district to limit the outbreaks locally. The outbreaks were under control by the end of June 2020. We describe the measures to contain the outbreaks, the challenges experienced and lessons learned. We discuss how public health measures can be planned and implemented through consideration of the needs and vulnerabilities of affected populations. In order to avoid coercive measures, barrier-free communication, with language translation when needed, and consideration of socio-economic circumstances of affected populations are crucial for controlling infectious disease transmission in an outbreak effectively and in a timely way.

Exterior housing conditions are associated with objective measures of poor sleep among low-income older adults with disabilities

OBJECTIVE

To examine the association of housing and neighborhood conditions with sleep among disadvantaged older adults.

METHODS

We used data from 136 low-income, predominantly Black older adults with disabilities. Predictors were indices of: interior housing conditions (eg, pests, tripping hazards); exterior housing conditions (eg, broken windows); and neighborhood disorder (eg, litter, vacant buildings). Outcomes were actigraphic total sleep time (TST), wake after sleep onset (WASO), and sleep efficiency (SE).

RESULTS

In models adjusted for age, sex, education, living arrangement, comorbidities, and physical performance, each additional exterior housing problem was associated with 20.9-minutes less TST (95% confidence interval [CI]: -39.2, -2.6), 8.6-minutes more WASO (95% CI: 0.7, 16.5), and 2.3% lower SE (95% CI: -4.2, -0.4). The associations of interior housing conditions and neighborhood disorder with the sleep parameters were of smaller magnitude and not statistically significant.

CONCLUSIONS

Future studies should examine the effects of housing repair on sleep health.

Development of a homelessness risk screening tool for emergency department patients

OBJECTIVE

To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes.

DATA SOURCES

Linked data from (1) ED patient baseline questionnaires and (2) citywide administrative homeless shelter database.

STUDY DESIGN

Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires.

DATA COLLECTION/EXTRACTION METHODS

Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching.

PRINCIPAL FINDINGS

Of 1993 ED patients who were not homeless at baseline, 5.6% entered a shelter in the next 6 months. A screening tool consisting of two measures of past shelter use and one of past criminal justice involvement had 83.0% sensitivity and 20.4% positive predictive value for future shelter entry.

CONCLUSIONS

Our study demonstrates the potential of using cross-sector data to improve hospital initiatives to address patients' social needs.

Living in a block group with a higher eviction rate is associated with increased odds of preterm delivery

BACKGROUND

Housing instability is associated with adverse pregnancy outcomes. Recent studies indicate that eviction, which may affect a larger segment of the population than other forms of housing instability, is also associated with adverse pregnancy outcomes. However, these studies evaluate eviction across large areas, such as counties, so it remains unclear whether these patterns extend to individual-level pregnancy outcomes.

METHODS

We used data on a cohort of all singleton live births at a single Chicago hospital between March 2008 and March 2018 to investigate the associations between block-group eviction rates and individual adverse pregnancy outcomes. Eviction data were obtained from the Eviction Lab at Princeton University. Generalised estimating equations were used to estimate associations and account for correlations among individuals living in the same block groups.

RESULTS

Individuals living in block groups in the highest quartile for eviction filing rate were 1.17 times as likely to deliver preterm (95% CI: 1.08 to 1.27) and 1.13 times as likely to deliver a small for gestational age infant (95% CI: 1.03 to 1.25) as compared with individuals living in block groups in the lowest quartile. Further, tests for linear trend indicated that for each quartile increase in eviction filing rate, there was a corresponding increase in odds of adverse outcomes (p<0.05). Results were strongest in magnitude for those with low neighbourhood and individual socioeconomic status, who are most likely to be renters and affected by local eviction policies.

CONCLUSION

Our results suggest that individuals living in block groups with higher eviction rates are more likely to deliver preterm. Future research should explore associations of individual experience with eviction on adverse pregnancy outcomes and examine whether policies to improve tenant protections also impact pregnancy outcomes.

COVID-19 in a New York City Behavioral Health Housing and Treatment System

OBJECTIVE

This study sought to characterize the incidence of COVID-19 illness, hospitalization, and death among congregate and noncongregate cohorts served by a New York City behavioral health agency.

METHODS

From March 9 to May 3, 2020, data were collected on COVID-19 symptoms, testing, hospitalization, and mortality for 8,256 individuals living in 29 congregate programs (residences and homeless shelters) or served by 41 noncongregate programs (scattered-site housing or outpatient treatment programs).

RESULTS

Of the 218 (2.6%) individuals who developed COVID-19-like illness, 84 (39%) were able to obtain testing. Of the 77 individuals who tested positive, 49 (64%) were hospitalized and 19 (25%) died. Congregate housing, age over 45, and intellectual/developmental disabilities were significantly associated with hospitalization and death.

CONCLUSIONS

Further research on risk and preventive factors is needed to address the high risk for people with serious mental illnesses and intellectual/developmental disabilities during a pandemic, particularly for those living in congregate housing.

Activities, Housing Situation and Other Factors Influencing Psychological Strain Experienced During the First COVID-19 Lockdown in Switzerland

Background: The Coronavirus disease 2019 (COVID-19) crisis and the corresponding first nationwide lockdown from mid-March to 10 May 2020 engendered considerable psychological strain among people in Switzerland. This study analyzes determinants of changes in subjective levels of psychological strain experienced during the lockdown. Methods: An online survey conducted as part of a larger mixed methods study examined the material and emotional aspects of individual reactions to the lockdown from a socio-ecological perspective. Participants (N = 5932) were asked about their personal and employment status, housing features, changes in various activities (e.g., physical activity, watching TV, social media use) and aspects of mental distress and well-being. Results: A substantial share of participants reported to feel depressed (33%) and anxious (43%) more often during the COVID-19 lockdown than before, whereas significantly (p < 0.001) less persons reported a decrease of these negative feelings (depressed 17%; anxious 14%). Women, single people, students and people who lost their jobs or were temporally unemployed due to the lockdown experienced a particularly strong increase of subjective psychological strain. Important residential factors reducing subjective psychological strain were the general comfort of the housing situation and having a private garden or multiple types of outdoor space. Considering leisure activities, the strongest positive psychological effect resulted from increased physical activities, followed by reading and cooking. However, 45% of the participants reported a decreased frequency of physical activity during the lockdown compared to before, whereas significantly less persons (26%) reported a corresponding increase (p < 0.001). Conclusion: Consistent with other studies, the results indicate a substantial reduction of subjective psychological well-being of the population during the first COVID-19 lockdown in Switzerland. The psychological burdens which the participants experienced differ depending on personal characteristics and situational factors. Negative psychological and economic consequences and gender inequalities should accordingly be carefully considered and actively prevented when designing COVID-19 measures. Supportive economic and social, cognitive and behavioral psychological interventions need to be designed and implemented to maintain the well-being of residents during lockdown.

Home environmental interventions for prevention of respiratory tract infections: a systematic review and meta-analysis

OBJECTIVES

Poor housing conditions have been associated with increased risks of respiratory infections. This review aims to determine whether modifying the physical environment of the home has benefits in reducing respiratory infections.

CONTENT

We performed a systematic review and meta-analysis of the effectiveness of home environmental interventions for preventing respiratory tract infections. Ten electronic databases were searched to identify randomized controlled trials published from inception to July 31, 2020. Random-effects meta-analyses were used to assess the study outcomes. Our search identified 14 eligible studies across 12 countries, which comprised 87,428 households in total. The type of interventions on home environment included kitchen appliance and design, water supply and sanitation, house insulation, and home heating. Meta-analysis indicated a potential benefit of home environmental interventions in preventing overall respiratory tract infections (Absolute RR=0.89, 95% CI=0.78-1.01, p=0.07; Pooled adjusted RR=0.72, 95% CI=0.63-0.84, p<0.0001). Subgroup analyses depicted that home environmental interventions had no significant impact on lower respiratory tract infections, pneumonia, and severe pneumonia. A protective effect against respiratory infections was observed in high income country setting (RR=0.82, 95% CI=0.78-0.87, p<0.00001).

SUMMARY AND OUTLOOK

Home environmental interventions have the potential to reduce morbidity of respiratory tract infections. The lack of significant impact from stand-alone housing interventions suggests that multicomponent interventions should be implemented in tandem with high-quality health systems.

Measuring the Value of a Practical Text Mining Approach to Identify Patients With Housing Issues in the Free-Text Notes in Electronic Health Record: Findings of a Retrospective Cohort Study

Introduction: Despite the growing efforts to standardize coding for social determinants of health (SDOH), they are infrequently captured in electronic health records (EHRs). Most SDOH variables are still captured in the unstructured fields (i.e., free-text) of EHRs. In this study we attempt to evaluate a practical text mining approach (i.e., advanced pattern matching techniques) in identifying phrases referring to housing issues, an important SDOH domain affecting value-based healthcare providers, using EHR of a large multispecialty medical group in the New England region, United States. To present how this approach would help the health systems to address the SDOH challenges of their patients we assess the demographic and clinical characteristics of patients with and without housing issues and briefly look into the patterns of healthcare utilization among the study population and for those with and without housing challenges.

Methods: We identified five categories of housing issues [i.e., homelessness current (HC), homelessness history (HH), homelessness addressed (HA), housing instability (HI), and building quality (BQ)] and developed several phrases addressing each one through collaboration with SDOH experts, consulting the literature, and reviewing existing coding standards. We developed pattern-matching algorithms (i.e., advanced regular expressions), and then applied them in the selected EHR. We assessed the text mining approach for recall (sensitivity) and precision (positive predictive value) after comparing the identified phrases with manually annotated free-text for different housing issues.

Results: The study dataset included EHR structured data for a total of 20,342 patients and 2,564,344 free-text clinical notes. The mean (SD) age in the study population was 75.96 (7.51). Additionally, 58.78% of the cohort were female. BQ and HI were the most frequent housing issues documented in EHR free-text notes and HH was the least frequent one. The regular expression methodology, when compared to manual annotation, had a high level of precision (positive predictive value) at phrase, note, and patient levels (96.36, 95.00, and 94.44%, respectively) across different categories of housing issues, but the recall (sensitivity) rate was relatively low (30.11, 32.20, and 41.46%, respectively).

Conclusion: Results of this study can be used to advance the research in this domain, to assess the potential value of EHR's free-text in identifying patients with a high risk of housing issues, to improve patient care and outcomes, and to eventually mitigate socioeconomic disparities across individuals and communities.

Ecological Associations Between Inclusionary Zoning Policies and Cardiovascular Disease Risk Prevalence: An Observational Study

BACKGROUND

Providing an adequate supply of affordable housing has become an increasingly difficult challenge for US cities. Inclusionary zoning (IZ) policies have become an increasingly popular response. Substantial research has demonstrated the health benefits of stable, affordable housing. There is anecdotal but not systematic evidence that IZ policies may be associated with some health benefits of affordable housing.

METHODS

We rely on data from the 2017 500 Cities Project, the 2016 to 2017 Lincoln Institute for Land Policy survey, and the 2011 to 2015 American Community Survey. We perform bivariate tests and cluster ordinary least squares regression to examine associations at the municipal level between having inclusionary zoning (IZ) policies, the attributes of those policies, and the prevalence of several cardiovascular outcomes.

RESULTS

Cardiovascular outcomes and socioeconomic characteristics were uniformly better in cities with IZ policies. IZ policies were associated with lower blood pressure (95% CI, -0.50 to -0.13), cholesterol (CI, -0.89 to -0.31), and blood pressure medication (CI, -0.57 to -0.03) prevalence. Some characteristics of IZ programs such as being mandatory, prioritizing rental development, and allocating a larger share of affordable housing are associated with cardiovascular risk prevalence.

CONCLUSIONS

Characteristics of IZ programs that ultimately benefit low-income residents are associated with favorable municipal-level cardiovascular health. Further, IZ policies could potentially address complex health challenges among economically vulnerable households.

Housing R6/2 Mice with Wild-Type Littermates Increases Lifespan

The R6/2 murine model of Huntington's disease (HD) is extensively used in HD research. The current study replicates and extends previous work assessing the impact of housing R6/2 mice with healthy wild-type (WT) littermates on disease progression. The current study extends the previous finding by including male cohorts and the use of a standard diet and water regimen, as opposed to the enhanced diet used in the previous study. This study found that the inclusion of healthy wild-type (WT) littermates, alone, improved survivabilty in R6/2 mice, but did not have a significant impact on weight loss.

The Relationship between Animal Welfare and Antimicrobial Use in Italian Dairy Farms

Information regarding the relationship between animal welfare (AW) and antimicrobial use (AMU) in dairy cows is limited. The current study aimed to investigate this relationship on Italian farms and to identify potential targets of AMU reduction. The study was performed at 79 Italian dairy farms housing over 15,000 cows during 2019. AW was scored with an on-farm protocol assessing farm management and staff training, housing systems, and animal-based measures. AMU was estimated using a defined daily dose per kg of animal biomass (DDDAit/biomass) for Italy. The median AW score was 73% (range: 56.6-86.8%). The median AMU was 4.8 DDDAit/biomass (range: 0-11.8). No relationship between the total AMU and AW was found. Management and staff training were positively associated with the use of the European Medicines Agency's category B antimicrobials, which are critical for human medicine, and with intramammary products for dry cow therapy. In those farms, antimicrobial stewardship should aim to reduce the category B antimicrobials and selective dry cow therapy. Our results underline the importance of implementing both an integrated monitoring system (AW, AMU, etc.) and antimicrobial stewardship tailored to the specific needs of each dairy farm.

Managing the unexpected: The role of homeless service providers during the 2017-2018 California wildfires

People experiencing homelessness during the 2017-2018 California wildfires faced significant risks of disruption. Homeless service organizations (HSOs) are an essential safety net for this population. To learn about how HSOs performed during the wildfires, this study interviewed U.S. Department of Veterans Affairs (VA) staff overseeing HSOs providing transitional housing under the VA's Grant and Per Diem (GPD) program to Veterans experiencing homelessness. We employed a comparative case study approach exploring GPD organizations' disaster response actions, including evacuating Veterans from wildfire-affected areas or taking in disaster-displaced Veterans. This article presents three themes in the GPD organizations' disaster response: (1) Organizations benefitted from close collaboration and communication with the VA during the disaster, creating a safety net to ensure Veterans' well-being and enact rapid re-housing to prevent homelessness; (2) Organization staff performed heroically under stressful disaster conditions; and (3) Organizations benefitted from the written disaster plans that VA requires them to create, but were not as well-prepared for wildfires as they had been for earthquakes. As emergent threats such as the COVID-19 pandemic, wildfires, and a very active 2020 hurricane season amplify the importance of mitigating risks, comprehensive disaster planning is needed to ensure the safety and support of people experiencing homelessness.

Death and taxes: Examining the racial inequality in premature death across neighborhoods

Legacies of residential segregation have led to deep inequities felt in communities of color across the nation and have been established as a fundamental cause of health disparities. Historical practices such as the redlining of majority Black neighborhoods in cities have led to long term consequences on these communities, including concentrated poverty and disadvantage. Research shows a strong connection between living in a poor neighborhood and poorer health outcomes, including early death, but questions remain about what characteristics of poor neighborhoods drive these disparities. We combined data from the American Community Survey with administrative data from Pittsburgh, Pennsylvania to examine the difference in premature death in Black and white neighborhoods (N = 87) using measures of socioeconomic disadvantage and less commonly studied neighborhood features including vacancy, tax delinquency, and property sales and conditions. Results suggest that features of abandonment, particularly the percent of tax delinquent properties in a neighborhood, may capture an important structural difference between majority Black and majority white neighborhoods with impacts beyond socioeconomic disadvantage on community health. We discuss implications of these findings for research and practice.

The Influence of Living Conditions on Self-Rated Health: Evidence from China

Despite growing attention to living conditions as a social determinant of health, few studies have focused on its diverse impacts on self-rated health. Using data from the China Family Panel Study in 2018, this study used logistic regression analysis to examine how living conditions affect self-rated health in China, finding that people cooking with sanitary water and clean fuel were more likely to report good health, and that homeownership was associated with higher self-rated health. The self-rated health of people living in high-quality housing was lower than that of people living in ordinary housing, and people living in tidy homes were more likely to report good health. The findings suggest that the link between multiple living conditions and self-rated health is dynamic. Public health policies and housing subsidy programs should therefore be designed based on a comprehensive account of not only housing grade or income status, but also whole dwelling conditions.

A multi-scalar perspective on health and urban housing: an umbrella review

With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.

The Effect of the Climatic Housing Environment on the Growth of Dairy-Bred Calves in the First Month of Life on a Scottish Farm

Simple Summary

The climatic environment within calf housing can have an effect on calf health, but also on growth and performance. Calves have a lower threshold environmental temperature (lower critical temperature, LCT), below which can impact on the calf’s ability to maintain its core body temperature. This can cause the calf to partition more of its available energy into heat production and less into growth. The LCT decreases as the calf gets older. This year-long study followed 299 dairy-bred calves on one farm in Scotland from birth until approximately 28 days of age, and looked at the proportion of time for which the temperature was below the LCT for the individual calf, as well as the daily liveweight gain (DLWG; kg/d) of the calves during this time. For their first 6–14 days of life the calves were individually housed, and then subsequently group housed. Air temperature (°C), relative humidity (%), and wind speed (m/s) were recorded every hour of every day throughout the study, and calves were weighed regularly so that DLWG could be calculated. The study demonstrated that calves that spent a high proportion of their time below their LCT had a lower DLWG compared to calves that spent a low proportion of their time below their LCT.

Abstract

Calf housing is naturally thermodynamic, with interactions between various elements such as wind speed, air temperature, and humidity. This study investigated the effect of the proportion of time for which calves were exposed to effective environmental temperatures below their lower critical temperature (LCT) on their daily liveweight gain (DLWG) within their first month of life. This study used the naturally occurring climatic environment, whereas other such studies have been conducted under climatically controlled conditions. Air temperature (°C), relative humidity (%), and wind speed (m/s) were recorded within the calf housing from birth until approximately 28 days of age, with calves being health-scored and weighed at regular intervals. Calves were housed from birth until 6–14 days old in individual hutches, and then moved into group housing igloo pens. Whilst individually housed, calves that spent less than 32% of their time below their LCT had a DLWG of 0.06 ± 0.34 kg/d (mean ± SE) compared to calves that spent more than 97% of their time below their LCT, which had a DLWG of −0.19 ± 0.045 kg/d. When group housed, calves that spent less than 1% of their time below their LCT had a DLWG of 0.59 ± 0.18 kg/d, whereas calves that spent more than 28% of their time below their LCT had a DLWG of 0.53 ± 0.23 kg/d. The proportion of time for which calves were exposed to effective environmental temperatures below their LCT had a significant effect on DLWG when calves were individually housed. Therefore, exposure to effective environmental temperatures below the LCT can be detrimental to the growth of the calf in the early stages of its life.

Implementation of the Department of Housing and Urban Development's Smoke-Free Rule: A Socio-Ecological Qualitative Assessment of Administrator and Resident Perceptions

In July 2018, the United States Department of Housing and Urban Development (HUD) implemented a mandatory smoke-free rule in public housing. This study assessed administrator and resident perceptions of rule implementation during its initial year in the District of Columbia Housing Authority (DCHA). Assessment included nine focus groups (n = 69) with residents and in-depth interviews with administrators (n = 7) and residents (n = 26) from 14 DCHA communities (family = 7 and senior/disabled = 7). Semi-structured discussion guides based on the multi-level socio-ecological framework captured dialogue that was recorded, transcribed verbatim, and coded inductively. Emerging major themes for each socio-ecological framework level included: (1) Individual: the rule was supported due to perceived health benefits, with stronger support among non-smokers; (2) Interpersonal: limiting secondhand smoke exposure was perceived as a positive for vulnerable residents; (3) Organizational: communication, signage, and cessation support was perceived as a need; (4) Community: residents perceived mobility, disability, weather, and safety-related issues as barriers; and (5) Public Policy: lease amendments were perceived as enablers of rule implementation but expressed confusion about violations and enforcement. A majority of administrators and residents reported favorable implications of the mandated HUD rule. The novel application of a socio-ecological framework, however, detected implementation nuances that required improvements on multiple levels, including more signage, cessation support, clarification of enforcement roles, and addressing safety concerns.

Unsheltered homeless and unstably housed adults have higher levels of stress and more health risk factors than sheltered homeless adults

In the United States, approximately 580,000 individuals were homeless on a single night in 2020. Homelessness can be categorized into three subgroups: sheltered homeless, unsheltered homeless, and unstably housed. Few studies have examined the relations between homelessness subtypes, shelter service utilization, levels of stress experienced, and health risk factors. This study aimed to empirically examine whether shelter status the previous night was related to current stress, recent utilization of shelter-based mental health services, and current health risk factors. Data were collected at multiple homeless shelters in 2016 in the Oklahoma City area (N=575). All participants completed assessments of demographic characteristics, including age, sex, race, marital status, years of education, and incarceration history and victimization. Multiple linear and logistic regression analyses were conducted to examine relations between homelessness subgroups and outcomes (shelter-based service utilization, health risk factors, and stressors). Results indicated that the sheltered group was younger and more likely to be White than the unsheltered group, had higher levels of education, and reported more lifetime months in jail than the unstably housed group. In addition, unsheltered homeless and unstably housed adults used fewer shelter-based health services, exhibited more health risk factors, experienced greater levels of stress, and had higher levels of food insecurity than sheltered homeless adults. Homeless adults who reside at shelters benefit most from available shelter services. The development of policies and programs targeted toward increasing sheltering options for unsheltered and unstably housed adults is needed.

The Impact of U.S. Housing Type and Residential Living Situations on Mental Health during COVID-19

Residential environments could be associated with the mental health of residents, in general, and during the COVID-19 pandemic. However, limited studies have investigated the relationship between these two. This study used data from the Household Pulse Survey, collected between 23 April 2020 and 23 November 2020 to explore the relationship between mental health status as perceived by the residents and housing tenure (own or rent), building type, and the number of household members, while accounting for sociodemographic characteristics, general health-related variables, and week-specific unobserved heterogeneities. The findings suggest that renters had higher odds of experiencing mental health issues than homeowners. Residents in multifamily housing units had higher odds of experiencing mental health problems than single-family units. Further, more people in the household were associated with lower odds of experiencing mental health episodes during the COVID-19 pandemic.

Housing insecurity and sleep among welfare recipients in California

STUDY OBJECTIVES

To estimate the effect of housing insecurity on sleep duration and sleep quality.

METHODS

Using longitudinal data from a sample of 1,046 welfare recipients in the state of California followed from 2015-2016 through 2017-2018, we regressed self-reported measures of sleep duration and sleep quality recorded in 2017-2018 on experiences of housing insecurity in the prior year. We applied propensity score weights to attenuate potential bias from an array of observed covariates, including sleep duration and sleep quality measured prior to experiences with housing insecurity.

RESULTS

Sample members who were unable to make their rent/mortgage payments slept on average 22 fewer minutes a night and had lower quality sleep than those who were able to make their rent/mortgage payments. Sample members who were forced to move because of an inability to make rent/mortgage payments slept on average 32 fewer minutes a night and had lower quality sleep than those who were not forced to move.

CONCLUSIONS

By compromising sleep health, housing insecurity represents a distinct form of stress in the lives of economically-disadvantaged adults, which could also contribute to other health disparities.

Effect of Housing Conditions on Cortisol and Body Fat Levels in Female Rhesus Macaques

Macaques are among the most commonly used non-human primates in biomedical research. They are highly social animals, yet biomedical studies often require group-living animals to be pair-housed in a controlled environment. A change in environment causes only short-term stress in adapting individuals, while non-adapting animals may experience long-term stress that can adversely affect study results. Individuals likely differ in their ability to adapt depending on individual characteristics. Changes in cortisol and body fat levels may reflect these different individual responses. Here, we investigate the long-term effect of a change from group- to pair-housing on cortisol and body fat levels in 32 female rhesus macaques, exploring whether age, dominance rank, original cortisol, and body fat levels are related to long-term stress in pair-housing. Hair samples were analyzed for cortisol levels, while anthropometric measurements and computed tomography were performed to quantify body fat. Monkeys served as their own control with a 7.5-month period between the measurements. Cortisol levels increased, while average body fat levels did not differ when individuals were moved from group- to pair-housing. Cortisol and body fat levels were not significantly correlated. Changes in cortisol were independent of age and dominance rank, whereas individual variation in body fat alterations was related to the group-housed body fat level and dominance rank. Although this study did not identify individual characteristics related to long-term stress in pair-housing, the individual variation confirms that some individuals are more resilient to change than others and provides possibilities for future refinement studies.

America's housing affordability crisis: Perpetuating disparities among people with disability

America's housing affordability crisis has had various indirect costs on health and safety among people living with disability. The skyrocketing housing prices have exponentially increased with the onset of the COVID-19 pandemic leaving many people at risk for eviction after federal and local moratoriums providing protection during the pandemic expire. Americans with disabilities have been particularly affected by the affordability crisis and it is expected that this major public health problem will only grow as government-provided protections and supports wane. It is critical that both government and various housing organizations consider ways to support affordability, quality, and accessibility in this particularly hard-hit population.

Centennial Review: History and husbandry recommendations for raising Pekin ducks in research or commercial production

By some accounts, ducks were domesticated between 400 and 10,000 yr ago and have been a growing portion of the poultry industry for decades. Ducks specifically, and waterfowl in general, have unique health, housing, nutrition and welfare concerns compared to their galliform counterparts. Although there have been many research publications in regards to health, nutrition, behavior, and welfare of ducks there have been very few reviews to provide an overview of these numerous studies, and only one text has attempted to review all aspects of the duck industry, from breeders to meat ducks. This review covers incubation, hatching, housing, welfare, nutrition, and euthanasia and highlights the needs for additional research at all levels of duck production. The purpose of this review is to provide guidelines to raise and house ducks for research as specifically related to industry practices.

COVID-19: opportunity to improve crisis responses to homelessness?

BACKGROUND

COVID-19 struck when, despite plans to support the homeless population in Scotland, sustainable arrangements seemed beyond reach without a change of mindset by all providing support.

METHODS

Four case studies describe the experience of individuals who received support during the COVID-19 pandemic. Late in 2020 support workers selected individuals whose support would have been different without the pandemic; sought their permission; and collected information from case notes and those engaged. Two other case studies describe new models addressing homelessness in response to the pandemic. During December 2020 the author interviewed managers who had contributed to the design and delivery of those models, and accessed data collected for other purposes. These six studies are tested against the five core principles of the Plan to End Homelessness, the basis of current homelessness policy in Scotland.

RESULTS

COVID-19 stimulated new forms of support for Edinburgh's homeless people, and a new culture of working together to solve urgent problems in ways that are person-centred and relationship-based.

DISCUSSION

Tackling homelessness in these ways highlighted resistant structural problems, notably how to ensure sufficient affordable housing. Plans to prevent homelessness must address such problems.

CONCLUSION

This new approach marks a cultural change in multi-agency services support for homeless people. The challenge is to sustain these improvements, and learn lessons for the future.

"They're not leaving their home; this is where they were born, this is where they will die.": Key Informant Perspectives From the U.S. Counties With the Greatest Concentration of the Oldest Old

The "oldest old," age 85 and older, constitute one of the fastest growing segments of the U.S. population. Yet, surprisingly little is known about the characteristics of U.S. counties with the highest percentage of the oldest old, nearly all of which are rural. We used qualitative analysis of key informant interviews (n = 50) with county commissioners and other county-level representatives from rural counties with the highest prevalence of the oldest old, targeting the 54 rural counties with ≥5% of the population age 85+. We found that the rural counties with the highest proportion of residents age 85+ face unique challenges to supporting successful aging among the oldest old, including resource constraints, limited services, isolated locations, and widespread service areas. Still, interviewees identified particular reasons why the oldest old remain in their counties, with many highlighting positive aspects of rural environments and community.

The contexts of housing stability and change among HIV-positive persons in the Lower Manya Krobo Municipality, Ghana

Due to stigma, discrimination and economic insecurity, persons living with HIV/AIDS (PLWHAs) are highly vulnerable to housing instability. For instance, PLWHAs are more likely to either remain stable in inadequate homes or change residence. Yet, few studies explore the contexts of housing stability and change among PLWHAs, especially in sub-Saharan Africa, where the majority reside. This study used qualitative in-depth interviews to explore the narratives of 38 PLWHAs on the contexts of housing stability and the circumstances leading to change in residence. On diagnosis with HIV, the majority of PLWHAs (58%) changed housing locations, mostly from bad to worse conditions. Reasons for change include: eviction due to stigma and discrimination, inability to afford rent, quest to hide HIV status and death of a cohabiting partner. Our findings suggest policy makers should pay attention to the deplorable and poor housing conditions of PLWHAs in Ghana.