Severe housing-cost burden and obesity among preschool-aged low-income children in Los Angeles County

FirstStep2Health: A cluster randomised trial to promote healthy behaviours and prevent obesity amongst low-income preschoolers

OBJECTIVE

To evaluate the preliminary effects of a theory-based, multi-component intervention on improving healthy lifestyle behaviours and preventing obesity amongst low-income preschoolers.

METHODS

A cluster randomised controlled trial was conducted at 10 daycare centres. The 16-week FirstStep2Health intervention, grounded in the Actor-Partner Interdependence Model and the Social Cognitive Theory, included five components: a Facebook-based parent programme, three virtual parent meetings, three weekly motivational text messages, parent-child learning via weekly child letters and daycare centre-based child programme.

RESULTS

A total of 95 preschoolers (53 intervention and 42 control) participated. Preschoolers' mean age was 49.27 months, with 57.9% being female, 12.6% being Hispanic and 40% being African American. The intervention significantly decreased intervention preschoolers' fat intake (B = -33.76, p = 0.047) and % body fat (B = -1.18, p = 0.036) compared to the control. During year 2, there were significant intervention effects on increasing skin carotenoids (B = 87.06, p = 0.035). Although not statistically significant, the intervention showed positive effects on increasing preschoolers' fruit/vegetable intake; and decreasing screen time, body mass index z-score and proportion of overweight/obesity.

CONCLUSIONS

Even with some potential limitations (small sample size, measurement concerns and confounding with Coronavirus Disease 2019 pandemic), the study's results support the preliminary efficacy of the FirstStep2Health intervention in preventing obesity amongst low-income racially diverse preschoolers.

The effect of enriched versus depleted housing on eucalyptus smoke-induced cardiovascular dysfunction in mice

Objectives: Living conditions play a major role in health and well-being, particularly for the cardiovascular and pulmonary systems. Depleted housing contributes to impairment and development of disease, but how it impacts body resiliency during exposure to environmental stressors is unknown. This study examined the effect of depleted (DH) versus enriched housing (EH) on cardiopulmonary function and subsequent responses to wildfire smoke. Materials and Methods: Two cohorts of healthy female mice, one of them surgically implanted with radiotelemeters for the measurement of electrocardiogram, body temperature (Tco) and activity, were housed in either DH or EH for 7 weeks. Telemetered mice were exposed for 1 h to filtered air (FA) and then flaming eucalyptus wildfire smoke (WS) while untelemetered mice, which were used for ventilatory assessment and tissue collection, were exposed to either FA or WS. Animals were continuously monitored for 5-7 days after exposure. Results: EH prevented a decrease in Tco after radiotelemetry surgery. EH mice also had significantly higher activity levels and lower heart rate during and after FA and WS. Moreover, EH caused a decreased number of cardiac arrhythmias during WS. WS caused ventilatory depression in DH mice but not EH mice. Housing enrichment also upregulated the expression of cardioprotective genes in the heart. Conclusions: The results of this study indicate that housing conditions impact overall health and cardiopulmonary function. More importantly, depleted housing appears to worsen the response to air pollution. Thus, non-chemical factors should be considered when assessing the susceptibility of populations, especially when it comes to extreme environmental events.

How housing burden damages residents' health: evidence from Chinese cities

Background

Currently, China is steadily pursuing high-quality development and promoting common prosperity, for which residents' health is a precondition. However, high housing-price-to-income ratios and rent-to-income ratios have already triggered many social problems and have substantially affected people's work and life. It is of practical significance to examine the relationship between housing burden and residents' health.

Methods

Combining city-level housing price-to-income ratio data and residents' health data from the China Family Panel Studies, this study employs a binary logit model to investigate the impact and mechanism of housing burden on residents' physical and psychological health.

Results

Overall, a 1% increase in the housing-price-to-income ratio leads to a 1.2% decrease in physical health and a 1.9% decrease in psychological health. In terms of different psychological state indicators, a 1% increase in the housing price-to-income ratio leads to a 1.1% increase in depression, 1.1% increase in nervousness, 1.4% increase in relentlessness, 1.4% increase in hopelessness, 1.0% increase in a sense of incapability, and 1.4% increase in meaninglessness. According to mechanistic analyses, a 1% increase in the housing-price-to-income ratio leads to increases of 0.6 and 0.7% in the smoking rate and late sleep rate, respectively, while it leads to a 0.9% decrease in the noon nap rate.

Conclusion

A growing housing burden significantly negatively impacts both the physical and psychological health of residents and increases the possibility of negative emotions. Further investigation revealed that the housing burden damages residents' health by increasing their likelihood of smoking and sleeping late and decreasing their likelihood of taking a nap at noon, while exercise alleviates the negative impacts of the housing burden on residents' physical and psychological health. Finally, we also find that housing burdens' impacts on physical and psychological health differ significantly in terms of gender, age, and educational attainment. From the perspective of improving livelihoods, governments should consider the relationship between housing burdens and residents' health when formulating livelihood policies. Location-specific and targeted policies should be followed. Additionally, efforts should be made to promote exercise among citizens.

Cumulative housing cost burden exposures and disadvantages to children's well-being and health

Housing affordability is a growing challenge for households in the United States and other developed countries. Prolonged exposure to housing cost burden can have damaging effects on households, and, in particular, children. These burdens can exacerbate parental stress, reduce investments in children and expose households to greater neighborhood disadvantage. In this study, we use national survey data to assess whether cumulative housing cost burden exposure is associated with disadvantages to children's well-being and health. We observe that long-term exposures are linked to lower achievement in math and reading standardized test scores, as well as higher levels of behavior problems. Moreover, we identify that three mechanisms--caregiver distress, economic strain, and neighborhood disadvantage--operate as mediating pathways for these disadvantages to different degrees between these three outcomes. Overall, our study highlights how the dimension of time is increasingly important to our understanding of the challenges that families face related to housing affordability.

Racial and ethnic disparities in obesity and contributions of social determinants of health among boys with autism spectrum disorder

Children with autism spectrum disorders (ASD) are at greater obesity risk compared to typically developing peers. Although many potential risk factors for this relationship have been identified, the causal chain must be better understood, particularly modifiable social determinants of obesity risk in ASD, and especially for children with ASD from minoritized racial/ethnic groups. We aimed to: (1) examine racial/ethnic disparities in obesity status in boys with ASD; (2) assess associations between social determinants of health and obesity status; and (3) understand if social determinants of health factors mediate the relationship between race/ethnicity and obesity status for these youth. We used data for 124 boys, aged 9-10 with ASD enrolled in an ongoing longitudinal study. Social determinants of health explored included socioeconomic position, Area Deprivation Index, neighborhood safety, food and housing insecurity, and racial/ethnic discrimination. The racial/ethnic distribution was: 17.1% Black, 14.6% Latino, and 68.3% White; average age was 10 years. Both Black (PR 2.57, 95% CI: 1.26-5.26) and Latino boys (PR 2.08, 95% CI: 1.08-4.03) with ASD were more likely to be obese than their White peers. While there were significant differences in some social determinants of health by race/ethnicity, only food insecurity mediated associations between race/ethnicity (Black vs. White) and obesity. The striking disparities in obesity and differences in social determinants of health between Black and Latino children with ASD compared to White children emphasize the need to identify factors that contribute to healthy weight among these children and to address these factors in practice.

The COVID-19 Pandemic Contributed to Disparities in Housing-Cost Burden Among WIC-Participating Households in the Most Populous County in California

Affordable housing is necessary for the health and well-being of children and families. The coronavirus disease 2019 (COVID-19) pandemic affected the ability of low-income families to pay for housing. The aim of this study is to evaluate associations between household characteristics of participants of the Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and housing-cost burden during the pandemic. WIC is a federally-funded nutrition assistance program for low-income mothers, infants, and children up to the age of 5. Data were from a 2020 survey of a random sample of WIC households (n = 5815) in Los Angeles County. Ordinal logistic regression determined the odds of being housing-cost burdened by parent respondent's race/ethnicity, household composition, employment, residence, and housing cost. Logistic regression determined if the pandemic contributed to the housing-cost burden. A total of 61% of households reported housing-cost burden, with two-thirds attributing the burden to the pandemic. Spanish-speaking Hispanic parents and white parents reported a higher prevalence of pandemic-related burden, while Asian, Black, and English-speaking Hispanic parents reported a higher prevalence of burden unrelated to the pandemic. Single-parent households, those experiencing residential instability, and those with high housing costs had higher odds of burden. Spanish-speaking Hispanic parents, white parents, homeowners, and those with high housing costs were more likely to attribute the burden to the pandemic. To ensure that existing inequities are not exacerbated, it is vital that housing assistance be available to low-income households that were disproportionately affected by the pandemic.

The Effect of Built Environment on Physical Health and Mental Health of Adults: A Nationwide Cross-Sectional Study in China

At present, there is a lack of research examining the relationships between the built environment and health status from a social epidemiological perspective. With this in mind, the present study aimed to explore the construct validity of housing/neighborhood conditions and evaluate the associations between the built environment and self-rated health among Chinese residents. To conduct the analysis, data from 4906 participants were derived from the 2016 China Labor-force Dynamics Survey (CLDS). Specifically, we used exploratory factor analysis to identify construct of housing/neighborhood factors and performed principal component regression (PCR) to assess the relationship between the built environment and both self-rated physical health and mental health. This process identified five common factors that corresponded to the built environment, including housing affordability, housing quality, neighborhood services, neighborhood physical environment, and perceived environment. The regression results suggested that housing affordability was negatively related to health status. Meanwhile, the services, physical environment, and perceived environment of neighborhoods were related to positive health outcomes. The influence of housing on health exhibits group heterogeneity: respondents in the 41 to 65 age group were most vulnerable to poor built environments. Whilst the results indicated that housing factors and neighborhood conditions were related to health outcomes, their influence varied across different age groups. Future interventions should be intentionally designed to target housing affordability and neighborhood factors, which may include the provision of housing assistance programs and planning layouts.

Pediatric weight management interventions improve prevalence of overeating behaviors

OBJECTIVE

To examine changes in prevalence of overeating behaviors in a comparative effectiveness study of two pediatric weight management interventions.

METHODS

Four-hundred and seven children, ages 6-12 years, with a BMI ≥ 85th percentile were enrolled in a comparative effectiveness trial of two pediatric weight management interventions. Prevalence of "sneaking, hiding or hoarding food", and 'eating in the absence of hunger' was evaluated at baseline and 12 months. Statistical methods included McNemar's test and longitudinal logistic regression.

RESULTS

Prevalence of "sneak, hide, or hoard food" significantly decreased in all participants from 29.1% to 20.7% at 12 months. The prevalence of "eating in the absence of hunger" decreased in all participants from 46.7% to 22.4% at 12 months. Use of SNAP benefits, free/reduced meals at school, parental stress, housing, and food insecurity at baseline were associated with an increased likelihood of endorsing overeating behaviors at 12 months. Conversely, those who engaged in at least one session of the pediatric weight management intervention were significantly less likely to endorse "eating in the absence of hunger" at 12 months.

CONCLUSIONS

Participation in pediatric weight management interventions improves the prevalence of overeating behaviors and is associated with participant engagement and social determinants of health, specifically food security status. Efforts to engage populations impacted by food insecurity and other social determinants of health risk factors will be critical for success of weight management interventions.

CLINICAL TRIAL REGISTRATION

This trial has been registered at ClinicalTrials.gov (identifier: NCT03012126).

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.

Measurement of screen time among young children aged 0-6 years: A systematic review

The impact of screen-based devices on children's health and development cannot be properly understood without valid and reliable tools that measure screen time within the evolving digital landscape. This review aimed to summarize characteristics of measurement tools used to assess screen time in young children; evaluate reporting of psychometric properties; and examine time trends related to measurement and reporting of screen time. A systematic review of articles published in English across three databases from January 2009 to April 2020 was undertaken using PROSPERO protocol (registration: CRD42019132599) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Included articles measured screen time as outcome, exposure, or confounder in children 0-6 years. The search identified 35,868 records, 1035 full-text articles were screened for eligibility, and 622 met inclusion criteria. Most measures (60%) consisted of one to three items and assessed duration of screen time on a usual day. Few measures assessed content (11%) or coviewing (7%). Only 40% of articles provided a citation for the measure, and only 69 (11%) reported psychometric properties-reliability n = 58, validity n = 19, reliability and validity n = 8. Between 2009 and 2019, the number of published articles increased from 28 to 71. From 2015, there was a notable increase in the proportion of articles published each year that assessed exposure to mobile devices in addition to television. The increasing number of published articles reflects increasing interest in screen time exposure among young children. Measures of screen time have generally evolved to reflect children's contemporary digital landscape; however, the psychometric properties of measurement tools are rarely reported. There is a need for improved measures and reporting to capture the complexity of children's screen time exposures.

Severe Housing-Cost Burden and Low-Income Young Children's Exposure to Adverse Experiences: A Cross-Sectional Survey of WIC Participants in Los Angeles County

OBJECTIVE

Substantial literature has documented adverse childhood experiences' (ACEs) link with poor health in childhood and adulthood. Despite many American low-income families spending more than a third of their income toward housing costs, little research has been published about a link between severe housing-cost burden and ACEs. The objective of this study was to examine the association of severe housing-cost burden to the ACEs to which young, low-income children are exposed.

METHODS

Participants were 2-5-year-olds who participated in the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) in Los Angeles County. We used data from the 2017 Los Angeles County WIC Survey, a survey of a random sample of all WIC participants living in Los Angeles County. Separate multiple logistic regression analyses were conducted to examine the association of severe housing-cost burden (very difficult to pay for housing) with the ACEs of financial hardship (household food insecurity, extreme poverty, parent's unemployment and underemployment), household dysfunction (parent's poor mental well-being and parent's separation), housing insecurity (doubled up and residential instability), and parent's experience with homelessness.

RESULTS

Sixteen percent of children lived in severe housing-cost burdened households and 14% experienced at least 4 ACEs. After adjusting for sociodemographic characteristics and social support, severe housing-cost burden was associated with an increase in the odds of each of the ACEs.

CONCLUSIONS FOR PRACTICE

While further research is needed, findings highlight the need for policymakers to provide resources and support for housing-cost burdened children. Also, service providers should identify ACEs among housing cost-burdened children.

Parenting and social-ecological correlates with children's health behaviours: A latent profile analysis

BACKGROUND

Paediatric obesity poses dangers to children's short and long-term health. Multi-level ecological models posit how children's health behaviours are influenced by interpersonal relationships.

OBJECTIVES

To identify profiles of individual and interpersonal health behaviours and parenting skills among caregivers and their children with elevated BMI.

METHODS

Participants were 240 children (63.7% Latino) ages 5 to 12 years with body mass index ≥85th percentile and their caregivers in a paediatric weight management intervention trial. A latent profile analysis was used to identify profiles among caregiver report of parenting skills; child physical activity, eating behaviours, and food and beverage choices; family mealtime, media and sleep routines; and parent health behaviours, and associations with food and housing insecurity.

RESULTS

A three-class model was chosen based on conceptual interpretation and model fit. Profiles were differentiated by parenting skills, child food choices, child physical activity habits, family mealtime, media, and sleep routines, and parent health behaviours. Food and housing insecurity were associated with class membership while child and caregiver anthropometrics were not.

CONCLUSIONS

Distinct profiles existed among this low-income, racially/ethnically diverse sample of children with elevated BMI. Such findings emphasize the importance of assessing individual and interpersonal influences and contextual factors on childhood obesity.

Unmet Social Needs and Adherence to Pediatric Weight Management Interventions: Massachusetts, 2017-2019

Objectives. To examine effects of unmet social needs on adherence to pediatric weight management intervention (PWMI).Methods. We examined individual associations of positive screens for parental stress, parental depression, food insecurity, and housing insecurity with intervention adherence, and associations of 0, 1 or 2, and 3 or 4 unmet social needs with adherence, among children enrolled in a 2017-2019 comparative effectiveness trial for 2 high-intensity PWMIs in Massachusetts. Models were adjusted for child age, body mass index (BMI), parent BMI, and intervention arm.Results. Families with versus without housing insecurity received a mean of 5.3 (SD = 8.0) versus 8.3 (SD = 10.9) contact hours (P < .01). There were no statistically significant differences in adherence for families reporting other unmet social needs. Children with 3 to 4 unmet social needs versus without received a mean of 5.2 (SD = 8.1) versus 9.2 (SD = 11.8) contact hours (P < .01). In fully adjusted models, those with housing insecurity attended a mean difference of -3.14 (95% confidence interval [CI] = -5.41, -0.88) hours versus those without. Those with 3 or 4 unmet social needs attended -3.74 (95% CI = -6.64, -0.84) hours less than those with none.Conclusions. Adherence to PWMIs was lower among children with housing insecurity and in families with 3 or 4 unmet social needs. Addressing social needs should be a priority of PWMIs to improve intervention adherence and reduce disparities in childhood obesity.Trial Registration: ClinicalTrials.gov identifier: NCT03012126.

The Effect of the Earned Income Tax Credit on Housing and Living Arrangements

As rents have risen and wages have not kept pace, housing affordability in the United States has declined over the last 15 years, impacting the housing and living arrangements of low-income families. Housing subsidies improve the housing situations of low-income families, but less than one in four eligible families receive a voucher. In this article, we analyze whether one of the largest anti-poverty programs in the United States-the Earned Income Tax Credit (EITC)-affects the housing (eviction, homelessness, and affordability) and living arrangements (doubling up, number of people in the household, and crowding) of low-income families. Using the Current Population Survey, the American Community Survey/decennial census, and the Fragile Families and Child Wellbeing Study, we employ a parameterized difference-in-differences strategy to examine whether policy-induced expansions to the EITC affect the housing and living arrangements of single mothers. Results suggest that a $1,000 increase in the EITC improves housing by reducing housing cost burdens, but it has no effect on eviction or homelessness. Increases in the EITC also reduce doubling up (living with additional, nonnuclear family adults)-in particular, doubling up in someone else's home-and reduce three-generation/multigenerational coresidence, suggesting that mothers have a preference to live independently. We find weak evidence for a reduction in overall household size, yet the EITC does reduce household crowding. Although the EITC is not an explicit housing policy, expansions to the EITC are generally linked with improved housing outcomes for single mothers and their children.