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Kim MH, Schwartz GL. Foreclosure, memory decline, and dementia probability: A longitudinal cohort study. Alzheimers Dement 2024. [PMID: 39072906 DOI: 10.1002/alz.14145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2023] [Revised: 06/18/2024] [Accepted: 07/02/2024] [Indexed: 07/30/2024]
Abstract
INTRODUCTION Housing insecurity is rising among older adults; health researchers know little about how this may impact their cognitive health. We investigated links between foreclosure and older adults' memory and probability of dementia. METHODS Using the Health and Retirement Study (2008 to 2018), we fit mixed models comparing the memory and dementia probability scores of 249 older adults who experienced foreclosure (treated) with 15,645 who did not. Baseline covariates included sociodemographics, health, and cognition. Models were stratified by age group. RESULTS Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults (-0.007 standard deviations/year, 95% confidence interval: -0.13, -0.001). Compared to average memory decline among middle-aged older adults who were stably housed, foreclosure equated to 3.7 additional years of aging over 10 years. Among those 65+, differences between those who were and were not foreclosed upon were short-lived and less clear, potentially driven by depletion-of-susceptibles bias. DISCUSSION Foreclosure may endanger older adults' memory. HIGHLIGHTS Housing instability is a key determinant of cognitive aging. We examined foreclosure and levels and changes in memory and dementia probability scores in the US older adult population. Foreclosure was associated with faster memory decline among middle-aged (50 to 64) older adults, equivalent to 3.7 additional years of cognitive aging over 10 years. Foreclosure yielded sharp memory declines and increases in dementia probability among older adults 65 and above. Foreclosure imposes a greater risk for older adults' cognitive decline.
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Affiliation(s)
- Min Hee Kim
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
| | - Gabriel L Schwartz
- Philip R. Lee Institute for Health Policy Studies, University of California, San Francisco, California, USA
- Urban Health Collaborative and Department of Health Management & Policy, Drexel University Dornsife School of Public Health, Philadelphia, Pennsylvania, USA
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Sealy-Jefferson S, Jackson B, Francis B. Neighborhood eviction trajectories and odds of moderate and serious psychological distress during pregnancy among African American women. Am J Epidemiol 2024; 193:968-975. [PMID: 38518207 PMCID: PMC11228836 DOI: 10.1093/aje/kwae025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Revised: 02/19/2024] [Accepted: 03/19/2024] [Indexed: 03/24/2024] Open
Abstract
African American mothers are unjustly burdened by both residential evictions and psychological distress. We quantified associations between trajectories of neighborhood evictions over time and the odds of moderate and serious psychological distress (MPD and SPD, respectively) during pregnancy among African American women. We linked publicly available data on neighborhood eviction filing and judgment rates to preconception and during-pregnancy addresses from the Life-course Influences on Fetal Environments (LIFE) Study (2009-2011; n = 808). Multinomial logistic regression-estimated odds of MPD and SPD during pregnancy that were associated with eviction filing and judgment rate trajectories incorporating preconception and during-pregnancy addresses (each categorized as low, medium, or high, with two 9-category trajectory measures). Psychological distress was measured with the Kessler Psychological Distress Scale (K6) (K6 scores 5-12 = MPD, and K6 scores ≥13 = SPD). MPD was reported in 60% of the sample and SPD in 8%. In adjusted models, higher neighborhood eviction filing and judgment rates, as compared with low/low rates, during the preconception and pregnancy periods were associated with 2- to 4-fold higher odds of both MPD and SPD during pregnancy among African American women. In future studies, researchers should identify mechanisms of these findings to inform timely community-based interventions and effective policy solutions to ensure the basic human right to housing for all. This article is part of a Special Collection on Mental Health.
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Affiliation(s)
- Shawnita Sealy-Jefferson
- Division of Epidemiology, College of Public Health, Ohio State University, Columbus, OH 43210, United States
| | - Benita Jackson
- Department of Psychology, Smith College, Northampton, MA 01063, United States
| | - Brittney Francis
- FXB Center for Health and Human Rights, Harvard University, Boston, MA 02115, United States
- Harvard Center for Population and Development Studies, Harvard T.H. Chan School of Public Health, Boston, MA 02115, United States
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Stefanovics EA, Potenza MN, Tsai J. Obesity in U.S. low-income veterans:Prevalence, clinical characteristics, and homelessness. J Psychiatr Res 2024; 173:317-325. [PMID: 38574595 DOI: 10.1016/j.jpsychires.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans. METHODS A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures. RESULTS The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations. CONCLUSION The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA.
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Zhou Y, Lu Y, Wei D, He S. Impacts of social deprivation on mortality and protective effects of greenness exposure in Hong Kong, 1999-2018: A spatiotemporal perspective. Health Place 2024; 87:103241. [PMID: 38599046 DOI: 10.1016/j.healthplace.2024.103241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 02/27/2024] [Accepted: 03/28/2024] [Indexed: 04/12/2024]
Abstract
Addressing health inequality is crucial for fostering healthy city development. However, there is a dearth of literature simultaneously investigating the effects of social deprivation and greenness exposure on mortality risks, as well as how greenness exposure may mitigate the adverse effect of social deprivation on mortality risks from a spatiotemporal perspective. Drawing on socioeconomic, remote sensing, and mortality record data, this study presents spatiotemporal patterns of social deprivation, population weighted greenness exposure, and all-cause and cause-specific mortality in Hong Kong. A Bayesian regression model was applied to investigate the impacts of social deprivation and greenness exposure on mortality and examine how socioeconomic inequalities in mortality may vary across areas with different greenness levels in Hong Kong from 1999 to 2018. We observed a decline in social deprivation (0.67-0.56), and an increase in greenness exposure (0.34-0.41) in Hong Kong during 1999-2018. Areas with high mortality gradually clustered in the Kowloon Peninsula and the northern regions of Hong Kong Island. Adverse impacts of social deprivation on all-cause mortality weakened in recent years (RR from 2009 to 2013: 1.103, 95%CI: 1.051-1.159, RR from 2014 to 2018: 1.041 95%CI: 0.950-1.139), while the protective impacts of greenness exposure consistently strengthened (RR from 1999 to 2003: 0.903, 95%CI: 0.827-0.984, RR from 2014 to 2018: 0.859, 95%CI: 0.763-0.965). Moreover, the adverse effects of social deprivation on mortality risks were found to be higher in areas with lower greenness exposure. These findings provide evidence of associations between social deprivation, greenness exposure, and mortality risks in Hong Kong over the past decades, and highlight the potential of greenness exposure to mitigate health inequalities. Our study provides valuable implications for policymakers to develop a healthy city.
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Affiliation(s)
- Yuxuan Zhou
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Yi Lu
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China.
| | - Di Wei
- Department of Architecture and Civil Engineering, City University of Hong Kong, Hong Kong Special Administrative Region, China; School of Architecture and Urban Planning, Huazhong University of Science and Technology, Wuhan, China; Hubei Engineering and Technology Research Center of Urbanization, Wuhan, China.
| | - Shenjing He
- Department of Urban Planning and Design, Urban Systems Institute, And the Social Infrastructure for Equity and Wellbeing Lab, The University of Hong Kong, Hong Kong Special Administrative Region of China, China.
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Park GR. Housing cost burden and external causes of mortality: Variations across housing regimes in high-income countries, 2010-2020. Soc Sci Med 2024; 345:116672. [PMID: 38367338 DOI: 10.1016/j.socscimed.2024.116672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 12/18/2023] [Accepted: 02/07/2024] [Indexed: 02/19/2024]
Abstract
OBJECTIVES While comparative studies reported that generous welfare state improves population health, they did not take into account the roles of housing as a cornerstone of welfare state. To reduce knowledge gaps, this study aims to estimate (a) the link between housing affordability stress and mortality rate due to external causes and (b) the moderating effects of housing regime on such association. METHODS Using country level panel data from the databases of the Organisation for Economic Co-operation and Development (OECD), fixed effects were performed to estimate the effects of housing costs to income ratio on mortality rates due to external causes (accidents, intentional self-harm, and assault). Also, we tested whether housing regimes moderate the association between housing cost burden and mortality rate. RESULTS An increased level of housing cost burden predicted mortality rates due to accidents and intentional self-harm. Such association was pronounced for countries with higher rates of homeownership and limited access to market self-help. In addition, when homeownership rates and debt-to-income ratios are taken into account as time-varying variables, the elevated mortality risks associated with both increased housing cost burden and higher homeownership are mitigated in countries where debt relative to income increases. CONCLUSION Our findings suggest that different housing systems shape divergent patterns of mortality risks associated with housing affordability stress. Future studies may wish to incorporate housing in macro comparative studies on population health.
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Affiliation(s)
- Gum-Ryeong Park
- Dalla Lana School of Public Health, University of Toronto, 155 College Street, Toronto, Ontario, M5T 3M7, Canada; Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada.
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Ortiz SE, Fenelon A, Chavehpour Y. Exposing Pittsburgh Landlords To Asset-Framing Narratives: An Experiment To Increase Housing Voucher Participation. Health Aff (Millwood) 2024; 43:287-296. [PMID: 38315934 DOI: 10.1377/hlthaff.2023.01051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2024]
Abstract
Landlords are essential actors within the rental housing market, and there is much to be learned about their willingness to participate in rental assistance programs that improve access to stable housing. Because the success of these programs, such as the Mobility (Location-Based) Voucher program in Pittsburgh, Pennsylvania, can be derailed by landlord opposition, it is important to test strategies that increase landlords' participation. Using data from a unique survey of Pittsburgh landlords, we found that exposing landlords to an asset-framing narrative that highlighted the social, economic, and health benefits of receiving a mobility voucher increased landlords' reported willingness to rent to a mobility voucher recipient by 21 percentage points. Reported willingness was also higher among landlords who believed that housing affordability was connected to health. Our findings offer insight into how to increase landlords' participation in affordable housing programs that require their engagement to succeed.
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Affiliation(s)
- Selena E Ortiz
- Selena E. Ortiz , Pennsylvania State University, University Park, Pennsylvania
| | - Andrew Fenelon
- Andrew Fenelon, University of Minnesota-Twin Cities, Minneapolis, Minnesota
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Choi KH, Ramaj S. Living arrangements and housing affordability issues of young adults in Canada: Differences by nativity status. CANADIAN REVIEW OF SOCIOLOGY = REVUE CANADIENNE DE SOCIOLOGIE 2024; 61:46-66. [PMID: 38299380 DOI: 10.1111/cars.12462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2024]
Abstract
Housing prices in Canada have increased dramatically, giving rise to a housing affordability crisis. Young adults have been disproportionately affected by this crisis. To cope, many young adults have had to alter their living arrangements, contributing to the diversification of their living arrangements. Young adults' diverse living arrangements are the product of growing inequalities in young adults' economic prospects and access to family support. Extant work has yet to document how young adults' risk of having unaffordable housing varies according to their living arrangements. Our comparison of young adults' risk of having unaffordable housing according to their living arrangements reveals that co-residence with parents, relatives, or roommates reduces young adults' risk of having unaffordable housing. This protective effect is smaller for the foreign-born than the Canadian-born. The National Housing Strategy should allocate more resources to increase the supply of affordable housing earmarked for young adults, particularly the foreign-born who live alone or with children.
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Affiliation(s)
- Kate H Choi
- Department of Sociology, Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - Sagi Ramaj
- Department of Sociology, University of Toronto, Toronto, Ontario, Canada
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Marçal K. Housing hardship and maternal mental health among renter households with young children. Psychiatry Res 2024; 331:115677. [PMID: 38113812 DOI: 10.1016/j.psychres.2023.115677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/21/2023]
Abstract
Maternal mental health is crucial to healthy family functioning and child well-being. Housing hardship may increase risk for mood disorders among mothers of young children in renter households. The present study used latent class analysis to investigate manifestations of housing hardship during the postpartum year in a sample of renter mothers in the United States (N = 2,329), as well as whether housing hardship types were associated with subsequent maternal depression and anxiety. The majority of mothers were relatively stably housed ("Stable"), one in six made do with governmental rental assistance ("Rent-Assisted"), and more than one in ten struggled to afford or maintain stable housing ("Cost-Burdened" or "Housing Insecure"). The most severe housing hardship was associated with the greatest depression risk, whereas the best determinant of anxiety risk was whether rent was paid each month; mothers whose rent was paid with government assistance did not differ on anxiety risk compared to those who paid their rent independently. Findings suggest that different types of housing hardship are linked with distinct mental health sequelae. Widely available housing assistance may reduce cost burden and prevent displacement, with the potential to reduce mental disorder among low-income mothers of young children.
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Affiliation(s)
- Katherine Marçal
- School of Social Work, Rutgers University, New Brunswick, NJ, USA.
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Hernandez M, Wong R, Yu X, Mehta N. In the wake of a crisis: Caught between housing and healthcare. SSM Popul Health 2023; 23:101453. [PMID: 37456616 PMCID: PMC10338349 DOI: 10.1016/j.ssmph.2023.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession. Methods Data came from Medicare beneficiaries aged 65+ years from the 2006-2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008 and 2012. Results Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast. Conclusion This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.
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Affiliation(s)
- Monica Hernandez
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Rebeca Wong
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Neil Mehta
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
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McIntosh A, Anguelovski I, Cole H. "The trauma machine expands faster than our services": Health risks for unhoused people in an early-stage gentrifying area. Health Place 2023; 83:103035. [PMID: 37331113 DOI: 10.1016/j.healthplace.2023.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 06/20/2023]
Abstract
While homelessness continues to be a prevalent problem throughout the United States, many urban neighborhoods are also concurrently experiencing an influx of affluent neighbors through gentrification, exposing the stark inequalities in housing access nationwide. Gentrification-induced changes in neighborhood dynamics have also been shown to affect the health of low-income and non-white groups, with high risks of trauma from displacement and exposure to violent crime and criminalization. This study addresses risk factors for health among the most vulnerable, unhoused individuals, and provides a detailed case study on the potential exposures to emotional and physical traumas for unhoused people in early-stage gentrifying areas. By conducting 17 semi-structured interviews with people who work with the unhoused community - health providers, nonprofit employees, neighborhood representatives, and developers - in Kensington, Philadelphia, we analyze how early-stage gentrification impacts the risks for negative health consequences among unhoused groups. Results show that gentrification impacts the health of unhoused people in four main areas that, all together, create what we identify as a "trauma machine" - that is compounding traumas for unhoused residents by 1) reducing and compromising spaces of safety from violent crime, 2) decreasing public services, 3) threatening the quality of healthcare, and 4) increasing the likelihood of displacement and associated trauma.
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Affiliation(s)
- Andrea McIntosh
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain.
| | - Isabelle Anguelovski
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain; Institución Catalana de Investigación y Estudios Avanzados (ICREA), Passeig de Lluís Companys, 23, 08010, Barcelona, Spain.
| | - Helen Cole
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain.
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Gusoff G, Chen K, Moreno G, Elmore JG, Zimmerman FJ. The Relationship Between Homeownership and Health by Race/Ethnicity Since the Foreclosure Crisis: California Health Interview Survey 2011-2018. J Gen Intern Med 2023; 38:2718-2725. [PMID: 37227660 PMCID: PMC10506978 DOI: 10.1007/s11606-023-08228-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Accepted: 05/05/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND US housing policy places a high priority on homeownership, providing large homeowner subsidies that are justified in part by homeownership's purported health benefits. However, studies conducted before, during, and immediately after the 2007-2010 foreclosure crisis found that while homeownership is associated with better health-related outcomes for White households, that association is weaker or non-existent for African-American and Latinx households. It is not known whether those associations persist in the period since the foreclosure crisis changed the US homeownership landscape. OBJECTIVE To examine the relationship between homeownership and health and whether that relationship differs by race/ethnicity in the period since the foreclosure crisis. DESIGN We conducted a cross-sectional analysis of 8 waves (2011-2018) of the California Health Interview Survey (n = 143,854, response rate 42.3 to 47.5%). PARTICIPANTS We included all US citizen respondents ages 18 and older. MAIN MEASURES The primary predictor variable was housing tenure (homeownership or renting). The primary outcomes were self-rated health, psychological distress, number of health conditions, and delays in receiving necessary medical care and/or medications. KEY RESULTS Compared to renting, homeownership is associated with lower rates of reporting fair or poor health (OR = 0.86, P < 0.001), fewer health conditions (incidence rate ratio = 0.95, P = 0.03), and fewer delays in receiving medical care (OR = 0.81, P < 0.001) and medication (OR = 0.78, P < 0.001) for the overall study population. Overall, race/ethnicity was not a significant moderator of these associations in the post-crisis period. CONCLUSIONS Homeownership has the potential to provide significant health-related benefits to minoritized communities, but this potential may be threatened by practices of racial exclusion and predatory inclusion. Further study is needed to elucidate health-promoting mechanisms within homeownership as well as potential harms of specific homeownership-promoting policies to develop healthier, more equitable housing policy.
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Affiliation(s)
- Geoffrey Gusoff
- National Clinician Scholars Program at UCLA (University of California, Los Angeles), 1100 Glendon Avenue, Suite 900, Los Angeles, CA, 90024, USA.
| | - Katherine Chen
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Gerardo Moreno
- Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Joann G Elmore
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Frederick J Zimmerman
- Department of Health Policy and Management, Fielding School of Public Health at UCLA, Los Angeles, CA, USA
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Gu KD, Faulkner KC, Thorndike AN. Housing instability and cardiometabolic health in the United States: a narrative review of the literature. BMC Public Health 2023; 23:931. [PMID: 37221492 PMCID: PMC10203673 DOI: 10.1186/s12889-023-15875-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2023] [Accepted: 05/11/2023] [Indexed: 05/25/2023] Open
Abstract
Housing instability is variably defined but generally encompasses difficulty paying rent, living in poor or overcrowded conditions, moving frequently, or spending the majority of household income on housing costs. While there is strong evidence that people experiencing homelessness (i.e., lack of regular housing) are at increased risk for cardiovascular disease, obesity, and diabetes, less is known about housing instability and health. We synthesized evidence from 42 original research studies conducted in the United States examining the association of housing instability and cardiometabolic health conditions of overweight/obesity, hypertension, diabetes, and cardiovascular disease. The included studies varied widely in their definitions and methods of measuring housing instability, but all exposure variables were related to housing cost burden, frequency of moves, living in poor or overcrowded conditions, or experiencing eviction or foreclosure, measured at either the individual household level or at a population level. We also included studies examining the impact of receipt of government rental assistance, which serves as a marker of housing instability given that its purpose is to provide affordable housing for low-income households. Overall, we found mixed but generally adverse associations between housing instability and cardiometabolic health, including higher prevalence of overweight/obesity, hypertension, diabetes, and cardiovascular disease; worse hypertension and diabetes control; and higher acute health care utilization among those with diabetes and cardiovascular disease. We propose a conceptual framework for pathways linking housing instability and cardiometabolic disease that could be targeted in future research and housing policies or programs.
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Affiliation(s)
- Kristine D. Gu
- Division of Endocrinology, Massachusetts General Hospital, 50 Staniford Street, Suite 340, Boston, MA 02114 USA
- Harvard Medical School, Boston, MA USA
| | - Katherine C. Faulkner
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
| | - Anne N. Thorndike
- Harvard Medical School, Boston, MA USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, MA USA
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Santaularia NJ, Ramirez MR, Osypuk TL, Mason SM. Economic Hardship and Violence: A Comparison of County-Level Economic Measures in the Prediction of Violence-Related Injury. JOURNAL OF INTERPERSONAL VIOLENCE 2023; 38:4616-4639. [PMID: 36036553 PMCID: PMC9900694 DOI: 10.1177/08862605221118966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Economic hardship may lead to a wide range of negative outcomes, including violence. However, existing literature on economic hardship and violence is limited by reliance on official reports of violence and conflation of different measures of economic hardship. The goals of this study are to measure how violence-related injuries are associated with five measures of county-level economic shocks: unemployment rate, male mass layoffs, female mass layoffs, foreclosure rate, and unemployment rate change, measured cross-sectionally and by a 1-year lag. This study measures three subtypes of violence outcomes (child abuse, elder abuse, and intimate partner violence). Yearly county-level data were obtained on violence-related injuries and economic measures from 2005 to 2012 for all 87 counties in Minnesota. Negative binomial models were run regressing the case counts of each violence outcome at the county-year level on each economic indicator modeled individually, with population denominator offsets to yield incidence rate ratios. Crude models were run first, then county-level socio-demographic variables and year were added to each model, and finally fully-adjusted models were run including all socio-demographic variables plus all economic indicators simultaneously. In the fully-adjusted models, a county's higher foreclosure rate is the strongest and most consistently associated with an increase in all violence subtypes. Unemployment rate is the second strongest and most consistent economic risk factor for all violence subtypes. Lastly, there appears to be an impact of gender specific to economic impacts on child abuse; specifically, male mass-lay-offs were associated with increased rates while female mass-lay-offs were associated with decreased rates. Understanding the associations of different types of economic hardship with a range of violence outcomes can aid in developing more holistic prevention and intervention efforts.
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Affiliation(s)
- N. Jeanie Santaularia
- University of Minnesota School of
Public Health, Minneapolis, USA
- University of Minnesota, Minnesota
Population Center, Minneapolis, USA
| | | | - Theresa L. Osypuk
- University of Minnesota School of
Public Health, Minneapolis, USA
- University of Minnesota, Minnesota
Population Center, Minneapolis, USA
| | - Susan M. Mason
- University of Minnesota School of
Public Health, Minneapolis, USA
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14
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McGovern M, Rokicki S, Von Jaglinsky A, Reichman NE. Neighborhood-level housing affordability and maternal depression. SSM - MENTAL HEALTH 2023. [DOI: 10.1016/j.ssmmh.2023.100192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
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15
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Park GR, Grignon M, Young M, Dunn JR. The association between housing cost burden and avoidable mortality in wealthy countries: cross-national analysis of social and housing policies, 2000-2017. J Epidemiol Community Health 2023; 77:65-73. [PMID: 36384959 DOI: 10.1136/jech-2022-219545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 11/05/2022] [Indexed: 11/18/2022]
Abstract
BACKGROUND It has been shown that the high cost of housing can be detrimental to individual health. However, it is unknown (1) whether high housing costs pose a threat to population health and (2) whether and how social policies moderate the link between housing cost burden and mortality. This study aims to reduce these knowledge gaps. METHODS Country-level panel data from Organisation for Economic Co-operation and Development (OECD) countries are used. Housing cost to income ratio and age-standardised mortality were obtained from the OECD database. Fixed effects models were conducted to estimate the extent to which the housing cost to income ratio was associated with preventable mortality, treatable mortality, and suicides. In order to assess the moderating effects of social and housing policies, different types of social spending per capita as well as housing policies were taken into account. RESULTS Housing cost to income ratio was significantly associated with preventable mortality, treatable mortality, and suicide during the post-global financial crisis (2009-2017) but not during the pre-global financial crisis (2000-2008). Social spending on pensions and unemployment benefits decreased the levels of mortality rate associated with housing cost burden. In countries with higher levels of social housing stock, the link between housing cost burden and mortality was attenuated. Similar patterns were examined for countries with rent control. CONCLUSION Our findings suggest that housing cost burden can be related to population health. Future studies should examine the role of protective measures that alleviate health problems caused by housing cost burden.
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Affiliation(s)
- Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada
| | - Michel Grignon
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada.,Department of Economics, McMaster University, Hamilton, Ontario, Canada
| | - Marisa Young
- Department of Sociology, McMaster University, Hamilton, Ontario, Canada
| | - James R Dunn
- Department of Health, Aging & Society, McMaster University, Hamilton, Ontario, Canada.,MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
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16
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Nobari TZ, Anderson CE, Whaley SE. The COVID-19 Pandemic Contributed to Disparities in Housing-Cost Burden Among WIC-Participating Households in the Most Populous County in California. J Racial Ethn Health Disparities 2023; 10:100-109. [PMID: 34993915 PMCID: PMC8739018 DOI: 10.1007/s40615-021-01200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 02/03/2023]
Abstract
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.
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Affiliation(s)
- Tabashir Z. Nobari
- grid.253559.d0000 0001 2292 8158Department of Public Health, California State University, Fullerton, 800 N. State College Blvd., Fullerton, CA 92831 USA ,grid.19006.3e0000 0000 9632 6718Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA USA
| | | | - Shannon E. Whaley
- grid.280537.bDepartment of Research and Evaluation, PHFE WIC, Irwindale, CA USA
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17
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Prevalence of eviction, home foreclosure, and homelessness among low-income US veterans: the National Veteran Homeless and Other Poverty Experiences study. Public Health 2022; 213:181-188. [PMID: 36444823 DOI: 10.1016/j.puhe.2022.10.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Revised: 09/13/2022] [Accepted: 10/14/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES Housing stability is essential for health and social well-being, and the United States is focused on preventing homelessness among veterans, so this study examined the prevalence of different events related to housing instability among low-income US veterans. STUDY DESIGN This was a nationally representative survey. METHODS Using a sample of 1004 low-income veterans in 2021, this study examined the lifetime prevalence and characteristics associated with eviction, home foreclosure, and homelessness among low-income US veterans. RESULTS In the total sample, 10.9% reported a lifetime history of eviction, 8.0% reported a lifetime history of home foreclosure, and 19.9% reported a lifetime history of homelessness. Among those with a history of homelessness, 39.2% also reported a history of eviction, and 13.9% reported a history of home foreclosure. Hierarchical logistic regression analyses found that for eviction, sociodemographic characteristics (e.g. being Hispanic, having private insurance, and being from the Northeast was associated with lower risk of eviction) together explained 26% of the variance, and clinical characteristics explained an incremental 12% additional variance. For homelessness, sociodemographic characteristics explained 18% of the variance, and clinical characteristics explained an incremental 20% (e.g. diagnosis of schizophrenia or bipolar disorder, any history of suicide attempt, and lower physical health scores were associated with higher risk of homelessness). For home foreclosure, sociodemographic, clinical, and psychosocial variables together only explained 14% of the variance. CONCLUSION Evictions, home foreclosures, and homelessness are discrete events and occur at relatively high rates among low-income veterans. In addition, homelessness was more associated with biosocial dysfunction, whereas eviction was more closely associated with socio-economic vulnerability, which may inform intervention efforts for both events.
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18
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Doyle YG, Solomon BD, Owusu G. Cities and global health: fragmented housing policies increase health risks for vulnerable people. BMJ 2022; 379:e069671. [PMID: 36318978 DOI: 10.1136/bmj-2021-069671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - George Owusu
- Institute of Statistical, Social and Economic Research, School of Social Sciences, University of Ghana, Accra, Ghana
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19
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Abstract
IMPORTANCE The number of people living in unaffordable housing (relative to income) is projected to continue increasing as housing cost inflation outpaces incomes in the US. Although reproductive-aged women have disproportionately high housing costs, particularly around the time of childbirth, data on associations between housing costs and maternal health and the role of publicly supported affordable housing programs in mitigating those associations are lacking. OBJECTIVE To estimate associations between area-level rental housing costs and severe maternal morbidity (SMM) and assess the potential mitigating role of publicly supported affordable housing. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study linked New Jersey birth files from January 1, 2008, to December 31, 2018, to maternal hospital discharge records and municipal-level housing and demographic data from the state of New Jersey and the US Census Bureau. Data were analyzed from January to September 2022. The birth files contained records for all births in New Jersey, and the hospital discharge records contained information from all inpatient hospitalizations over the study period. A total of 1 004 000 birth records were matched to maternal discharge records and municipal-level data. EXPOSURES Municipal-level rental costs relative to income (housing cost burden), availability of publicly supported affordable housing, and housing subsidy per person with an income lower than the federal poverty level. MAIN OUTCOMES AND MEASURES Severe maternal morbidity was identified using diagnosis and procedure codes developed by the US Centers for Disease Control and Prevention to measure SMM. RESULTS Of 1 004 000 mothers (mean [SD] age at birth, 29.8 [5.9] years; 44.7% White), 20 022 (2.0%) experienced SMM. Higher municipal rental housing costs were associated with greater odds of SMM (odds ratio [OR], 1.27; 95% CI, 1.01-1.60), particularly among mothers with less than a high school education (OR, 1.81; 95% CI, 1.06-3.10), and the positive associations decreased at higher levels of affordable housing availability. Among mothers with less than a high school education, the risk of SMM was 8.0% lower (risk ratio, 0.92; 95% CI, 0.85-1.00) for each additional $1000 annual municipal-level housing subsidy per person with an income lower than poverty level after controlling for rental costs and other characteristics, which translated to a 20.7% lower educational disparity in SMM. CONCLUSIONS AND RELEVANCE In this cross-sectional study, living in a municipality with higher rental housing costs was associated with higher odds of SMM, except when there was high availability of publicly supported affordable housing. These results suggest that greater availability of publicly supported affordable housing has the potential to mitigate the association between rental housing costs and SMM and reduce socioeconomic disparities in SMM.
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Affiliation(s)
- Felix M. Muchomba
- School of Social Work, Rutgers, The State University of New Jersey, New Brunswick, New Jersey
| | - Julien Teitler
- School of Social Work, Columbia University, New York, New York
| | - Nancy E. Reichman
- Department of Pediatrics, Robert Wood Johnson Medical School, New Brunswick, New Jersey
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20
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Phillips S, Raskin SE, Harrington CB, Bishop D, Gany FM. "Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City. J Psychosoc Oncol 2022; 41:411-433. [PMID: 36271879 PMCID: PMC10322638 DOI: 10.1080/07347332.2022.2136025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify consequences of unmet housing needs in the period following cancer diagnosis. DESIGN Qualitative descriptive design. PARTICIPANTS New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers). METHODS One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm. FINDINGS Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living. CONCLUSION The simultaneous experience of cancer and unmet housing needs is broadly burdensome. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.
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Affiliation(s)
- Serena Phillips
- Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Sarah E. Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Darla Bishop
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca M. Gany
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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21
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Santaularia NJ, Osypuk TL, Ramirez MR, Mason SM. Violence in the Great Recession. Am J Epidemiol 2022; 191:1847-1855. [PMID: 35767881 PMCID: PMC10144667 DOI: 10.1093/aje/kwac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.
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Affiliation(s)
- N Jeanie Santaularia
- Correspondence to Dr. Jeanie Santaularia, Carolina Population Center, 123 West Franklin Street Chapel Hill, NC 27516 (e-mail: )
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22
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Choi NG, Marti CN, Choi BY. Job loss, financial strain, and housing problems as suicide precipitants: Associations with other life stressors. SSM Popul Health 2022; 19:101243. [PMID: 36203475 PMCID: PMC9530609 DOI: 10.1016/j.ssmph.2022.101243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Previous research has shown that job loss, financial strain, and/or loss of housing (JFH) in midlife elevate suicide risk. In this study based on the 2017–2019 National Violent Death Reporting System, we examined other suicide precipitants and contributors of decedents whose suicide was in part precipitated by JFH and the circumstances under which they died. First, we examined all adult decedents (N = 94,454; 74,042 males [78.4%] and 20,412 females [21.6%]) and then focused on decedents age 45–64 (N = 34,208; 25,640 males [75%] and 8568 females [25.0%]). The 45–64 age group had the highest rate of JFH (22.0% for males and 15.1% for females) as a suicide precipitant. The results of generalized linear models for all adult suicide decedents of both sexes showed that the 45–64 age group (IRR = 2.02, 95% CI = 1.89–2.16), compared to 65+ age group, and relationship problems, mental disorders, and alcohol problems were associated with significantly higher risk of JFH-precipitated suicide. In male decedents age 45–64, JFH was positively associated with depressed mood (IRR = 1.95, 95% CI = 1.85–2.06), alcohol problems (IRR = 1.14, 95% CI = 1.07–1.21), and number of crises (IRR = 1.48, 95% CI = 1.43–1.53). In female decedents age 45–64, JFH was positively associated with relationship problems (IRR = 1.19, 95% CI = 1.05–1.35), legal problems (IRR = 1.27, 95% CI = 1.06–1.54), depressed mood (IRR = 1.78, 95% CI = 1.59–1.99), and number of crises (IRR = 1.58, 95% CI = 1.48–1.68). In both sexes, the risk of JFH was also positively associated with a college education. In female decedents, JFH risk was higher among divorced or never-married individuals. Coroner/medical examiner and law enforcement agency reports show that some experienced depression and started misusing alcohol and/or other substances following a job loss, but others had these problems throughout life, which caused/contributed to JFH. These findings show the significance of suicide prevention approaches at both systemic (generous unemployment insurance, housing subsidies) and individual (treatment of depression and alcohol/substance misuse problems and social support/connection) levels. 16.2% of male and 13.0% of female suicide decedents age 18+ in 2017–2019 had job/finance/housing problems (JFH). Among decedents age 45–64, 22.0% of male and 15.1% of female had JFH. JFH was positively associated with number of crises, depressed mood, and relationship and alcohol problems in both sexes. Suicide prevention approaches are needed at both systemic and individual levels.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
- Corresponding author. UT Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA.
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, 19901, USA
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23
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Screening Families in Primary Care for Social and Economic Needs: Patients' Urgency and Activation for Social Care Navigation. Am J Prev Med 2022; 63:S122-S130. [PMID: 35987524 DOI: 10.1016/j.amepre.2022.03.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2021] [Revised: 02/23/2022] [Accepted: 03/01/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Social determinants of health (SDoH) screening and intervention in primary care aim to alleviate adverse influences on health, but its efficacy may be diluted when offered supports are not well matched to families' desire for such services. The purpose of this prospective cohort study was to provide guidance to social care navigation teams regarding which families would be most likely to make use of services. METHODS Analysis of registry data collected in April 1-September 30, 2021 from a social care navigation program embedded in a medical home was conducted. Multivariable regression models explored (1) whether family-reported urgency of needs, number of needs, and/or specific types of needs predicted completing program intake and (2) whether the degree of family activation regarding social needs predicted subsequent interactions with the navigation team. RESULTS Of the 1,483 families reporting any social care needs (38% of all screens completed, mean of 2.5 needs per screen), 31% indicated that their needs were urgent. Accounting for program factors and the number and type of needs reported, families whose needs were urgent were more likely to complete intake (OR=1.34; 95% CI=1.01, 1.82; p=0.04) and remain engaged with the program over time (OR=2.25; 95% CI=1.62, 3.12; p<0.01). Those who were self-advocates were substantially less likely to desire follow-up or stay engaged (OR=0.40; 95% CI=0.17, 0.93; p<0.01). CONCLUSIONS Family-reported urgency of needs and activation for social care assistance predicted engagement with the navigation team. SDoH interventions should prioritize outreach to those families expressing an interest in help with any of their identified needs.
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Wolfe JD. The Financial Correlates of Midlife Obesity. Am J Prev Med 2022; 63:S18-S27. [PMID: 35725137 PMCID: PMC9219113 DOI: 10.1016/j.amepre.2022.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 02/14/2022] [Accepted: 02/15/2022] [Indexed: 11/26/2022]
Abstract
INTRODUCTION This study explored the associations between midlife obesity and an array of common financial stressors related to wealth loss, debt, and bankruptcy. METHODS The analysis was conducted in 2022 with data from the National Longitudinal Survey of Youth 1979. The final sample included 36,122 observations on 8,059 respondents as they aged from ages 31‒39 years in 1996 to ages 51‒59 in 2016. Associations between obesity and financial stressors were estimated with logistic regression models adjusting for a comprehensive set of relevant control variables. RESULTS The analysis found significant relationships between obesity and multiple types of financial stressors, including property debt, unsecured debt, and bankruptcy. Property debt and unsecured debt increased the odds of obesity by 29% and 20%, respectively, and bankruptcy increased the odds of obesity by 43%. Average Marginal Effects (AMEs) in combination with model fit statistics confirmed that these stressors-unsecured debt, property debt, and bankruptcy-were important financial correlates of midlife obesity among the National Longitudinal Survey of Youth 1979 cohort. CONCLUSIONS The financial correlates of obesity included multiple financial stressors, but the magnitude of associations varied substantially across types of financial stressors. Results suggest that future interventions aimed at reducing obesity disparities should target populations with high levels of debt and bankruptcy.
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Affiliation(s)
- Joseph D Wolfe
- Department of Sociology, College of Arts and Sciences, The University of Alabama at Birmingham, Birmingham, Alabama.
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25
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Uppal TS, Chehal PK, Fernandes G, Haw JS, Shah M, Turbow S, Rajpathak S, Narayan KMV, Ali MK. Trends and Variations in Emergency Department Use Associated With Diabetes in the US by Sociodemographic Factors, 2008-2017. JAMA Netw Open 2022; 5:e2213867. [PMID: 35612855 PMCID: PMC9133946 DOI: 10.1001/jamanetworkopen.2022.13867] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Little is known about emergency department (ED) use among people with diabetes and whether the pattern of ED use varies across geographic areas and population subgroups. OBJECTIVE To estimate recent national- and state-level trends in diabetes-related ED use overall and by race and ethnicity, rural or urban location, and insurance status. DESIGN, SETTING, AND PARTICIPANTS This cross-sectional study of adults visiting the ED with a diabetes-related diagnosis used serial data from the Nationwide Emergency Department Sample, a nationally representative database, and discharge records from 11 state emergency department databases for 2008, 2011, 2014, and 2016 to 2017. Data were analyzed from March 16 to November 9, 2020. EXPOSURES Reported race and ethnicity, rural or urban location, and insurance status. Data were stratified to generate state-specific estimates. MAIN OUTCOMES AND MEASURES Rates of ED use for all-cause visits among adults with diabetes (all-cause diabetes visits) and visits with primary diagnoses of diabetes-specific complications. RESULTS A larger portion of all-cause diabetes ED visits (n = 32 433 015) were by female (56.8%) and middle-aged (mean [SD] age, 58.4 [16.3] years) adults with diabetes. Nationally, all-cause diabetes ED visits per 10 000 adults increased 55.6% (95% CI, 50.6%-60.6%), from 257.6 (95% CI, 249.9-265.3) visits in 2008 to 400.8 (95% CI, 387.6-414.0) visits in 2017. All-cause diabetes ED visits increased more for urban (58.3%; 95% CI, 52.5%-64.1%) and uninsured subgroups (75.3% [95% CI, 59.8%-90.8%]) than for their counterparts. Diabetes-specific ED visits (weighted number of 1 911 795) nationally increased slightly among all subgroups. State-specific ED use rates show wide state-to-state variations in ED use by race and ethnicity, rural or urban location, and insurance. On average across states, diabetes-specific ED use among Black patients was approximately 3 times (rate ratio, 3.09 [95% CI, 2.91-3.30]) greater than among non-Hispanic White patients, and among Hispanic patients, it was 29% greater (rate ratio, 1.29 [95% CI, 1.19-1.40]) than among non-Hispanic White patients. The mean rate of ED use among rural patients was 34% greater (rate ratio, 1.34 [95% CI, 1.26-1.44]) than among urban patients. The mean rates of ED use among patients with Medicaid (rate ratio, 6.65 [95% CI, 6.49-6.82]) and Medicare (rate ratio, 4.37 [95% CI, 4.23-4.51]) were greater than among privately insured adults. CONCLUSIONS AND RELEVANCE This study suggests that disparities in diabetes-related ED use associated with race and ethnicity, rural or urban location, and insurance status were persistent from 2008 to 2017 within and across states, as well as nationally. Further geographic and demographic-specific analyses are needed to understand the sources of inequity.
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Affiliation(s)
- Tegveer S. Uppal
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Puneet Kaur Chehal
- Department of Health Policy and Management, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - J. Sonya Haw
- Division of Endocrinology and Metabolism, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Megha Shah
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | - Sara Turbow
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
- Division of General Medicine and Geriatrics, Department of Medicine, School of Medicine, Emory University, Atlanta, Georgia
| | | | - K. M. Venkat Narayan
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
| | - Mohammed K. Ali
- Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, Georgia
- Department of Family and Preventive Medicine, School of Medicine, Emory University, Atlanta, Georgia
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Chrisinger BW, Springfield S, Whitsel EA, Shadyab AH, Krok-Schoen JL, Garcia L, Sealy-Jefferson S, Stefanick ML. The Association of Neighborhood Changes with Health-Related Quality of Life in the Women's Health Initiative. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5309. [PMID: 35564704 PMCID: PMC9103323 DOI: 10.3390/ijerph19095309] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 04/08/2022] [Accepted: 04/14/2022] [Indexed: 02/04/2023]
Abstract
Longitudinal studies can help us understand the effects of long-term neighborhood changes, as these can capture individual self-appraisal of current and future circumstances. We analyzed the association between neighborhood changes and health-related quality of life (HRQoL) outcomes among older women from the Women's Health Initiative (WHI) study. We used a subset (n = 49,254) of the longitudinal WHI dataset of female participants, aged 50-79 at baseline, recruited from 40 clinical centers across the U.S. beginning in 1993. Two HRQoL outcomes were explored: self-rated quality of life (SRQoL), and physical functioning-related quality of life (PFQoL). We used U.S. census tract-level changes in median household income between the 2000 census and 2007-2011 American Community Survey to classify neighborhoods as "upgrading," "declining," or "stable." Multi-level models were used to identify significant associations between neighborhood change and HRQoL outcomes over time. Compared to participants residing in upgrading neighborhoods, participants in stable and declining neighborhoods reported significantly lower PFQoL. A significant interaction was observed with income such that the effect of neighborhood change was greater at lower levels of income.
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Affiliation(s)
| | - Sparkle Springfield
- Department of Public Health Sciences, Loyola University Chicago, Chicago, IL 60660, USA
| | - Eric A. Whitsel
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA;
- Department of Medicine, School of Medicine, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599, USA
| | - Aladdin H. Shadyab
- Herbert Wertheim School of Public Health and Human Longevity Science, University of California, San Diego, CA 92093, USA;
| | - Jessica L. Krok-Schoen
- School of Health and Rehabilitation Sciences, Ohio State University, Columbus, OH 43210, USA;
| | - Lorena Garcia
- Department of Public Health Sciences, School Medicine, University of California, Davis, CA 95616, USA;
| | | | - Marcia L. Stefanick
- Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, CA 94305, USA;
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Aquino T, Brand JE, Torche F. Unequal effects of disruptive events. SOCIOLOGY COMPASS 2022; 16:e12972. [PMID: 38895138 PMCID: PMC11185416 DOI: 10.1111/soc4.12972] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Accepted: 02/07/2022] [Indexed: 06/21/2024]
Abstract
Disruptive events have significant consequences for the individuals and families who experience them, but these effects do not occur equally across the population. While some groups are strongly affected, others experience few consequences. We review recent findings on inequality in the effects of disruptive events. We consider heterogeneity based on socioeconomic resources, race/ethnicity, the likelihood of experiencing disruption, and contextual factors such as the normativity of the event in particular social settings. We focus on micro-level events affecting specific individuals and families, including divorce, job loss, home loss and eviction, health shocks and deaths, and violence and incarceration, but also refer to macro-level events such as recession and natural disasters. We describe patterns of variation that suggest a process of resource disparities and cumulative disadvantage versus those that reflect the impact of non-normative and unexpected shocks. Finally, we review methodological considerations when examining variation in the effect of disruptive events.
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Affiliation(s)
- Taylor Aquino
- University of California, Los Angeles, California, USA
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Housing Insecurity and Mental Health: the Effect of Housing Tenure and the Coexistence of Life Insecurities. J Urban Health 2022; 99:268-276. [PMID: 35303243 PMCID: PMC9033895 DOI: 10.1007/s11524-022-00619-5] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/09/2022] [Indexed: 10/18/2022]
Abstract
While the adverse effects of housing insecurity on mental health are known, much less is known about the modifiers underlying these effects. The aim of this study was to analyze the mental health of people with housing insecurity by housing tenure and considering the coexistence of other life insecurities (energy poverty and food insecurity). We conducted a cross-sectional study through a survey performed in all people attending the Platform for People Affected by Mortgages or the Alliance against Energy Poverty of Barcelona for the first time between June 2017 and December 2019 and who reported housing insecurity. The dependent variables were the risk of poor mental health, self-reported anxiety and/or depression, and the use of psychotropic drugs. We fitted age-adjusted robust Poisson regression models for each dependent variable and estimated adjusted prevalence ratios (aPR). The study included 256 women and 104 men. The prevalence of poor mental health was 89% in women and 85.3% in men, which was much higher than that in the general population of Barcelona (19.5% and 14.5%, respectively). Among women, mental health was worse in those living in a squat (aPR 1.16; 95% CI: 1.02-1.31) and in those with food insecurity (aPR 1.11; 95% CI: 1.01-1.21). The number of coexisting insecurities showed a gradient effect (3 insecurities: aPR 1.21; 95% CI: 1.01-1.45). Among men, the results showed no clear pattern. Poor mental health was highly prevalent in people with housing insecurity and was exacerbated by the coexistence of life insecurities. Public policymakers should consider the complexity of persons with housing insecurity.
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Vásquez-Vera C, Fernández A, Borrell C. Gender-based inequalities in the effects of housing on health: A critical review. SSM Popul Health 2022; 17:101068. [PMID: 35360438 PMCID: PMC8961216 DOI: 10.1016/j.ssmph.2022.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Gender and its power relations are produced and reproduced in the housing sphere, leading to inequalities in living conditions and, therefore, in gender inequalities in health outcomes. The aim of the study is to review the published literature on gender, housing and health, to critically evaluate the incorporation of the gender perspective, and to incorporate this perspective into the conceptual framework of housing and health. Using the critical review method, we conducted a literature review in MEDLINE, Scopus, WOS and Redalyc, without restriction of publication date, including studies published up to October 2020. We analyzed the gender perspective in health research using the Gender Perspective in Health Research Questionnaire and described the results according to main housing dimensions. Of the 20,988 articles identified, we selected 90 for full-text analysis, of which 18 were included in the feminist research category, 27 in gender-sensitive, 31 in sex difference and 14 did not include any gender perspective. Regarding the association between housing and health, most studies analyzed affordability (36%) and physical conditions (32%), and trends in health outcomes by gender varied according to each exposure analyzed, although overall the effects were worse for women and non-binary or trans people. To date, very few studies consider the gender perspective. It is urgent to address gender relations in housing and health studies, and to open an interdisciplinary and intersectoral agenda to address this complex relationship.
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Vieira KM, Potrich ACG, Bressan AA, Klein LL. Loss of financial well-being in the COVID-19 pandemic: Does job stability make a difference? JOURNAL OF BEHAVIORAL AND EXPERIMENTAL FINANCE 2021; 31:100554. [PMID: 36570718 PMCID: PMC9764367 DOI: 10.1016/j.jbef.2021.100554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/21/2021] [Accepted: 07/26/2021] [Indexed: 05/25/2023]
Abstract
This article aims to assess the loss of financial well-being in the COVID-19 pandemic. The developed theoretical model identifies the impacts of the perception of financial risk and financial anxiety on financial well-being. It also seeks, through a comparative analysis, to assess whether public servants, due to their status of job stability in Brazil, are less likely to have the effects of the pandemic than private employees. A survey was carried out on 1222 Brazilians with structural equation modeling and multi-group invariance tests. The results indicate that lower financial well-being is influenced by the level of financial anxiety and financial risk. Public servants perceive fewer losses in financial well-being, anxiety and risks than other professions. In the pandemic context, where the risks of unemployment and loss of income are increased, job stability works like an insurance, allowing public servants greater financial security and then minor losses of financial well-being. Evidence indicates that in countries where a large percentage of workers have temporary or informal jobs, the challenge of reducing the financial impacts of the pandemic will be great. Interventions to alleviating anxiety and public policies of income transfer and reduction of unemployment are instruments to reduce the loss of financial well-being.
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Affiliation(s)
- Kelmara Mendes Vieira
- Postgraduate Program in Management of Public Organizations, Federal University of Santa Maria (UFSM), Av. Roraima, 1000, prédio 74C, 4212, 97105-900, Santa Maria, RS, Brazil
| | - Ani Caroline Grigion Potrich
- Postgraduate Program in Administration, Federal University of Santa Catarina (UFSC), Campus Reitor João David Ferreira Lima, s/n, 88040-900, Florianópolis, SC, Brazil
| | - Aureliano Angel Bressan
- Postgraduate and Research Center in Administration (CEPEAD) of the Federal University of Minas Gerais (UFMG), Av. Pres. Antônio Carlos, 6627, Pampulha, 31270-901, Belo Horizonte, MG, Brazil
| | - Leander Luiz Klein
- Postgraduate Program in Public Administration, Federal University of Santa Maria (UFSM), Av. Roraima,1000, prédio 74B, 3250, 97105-900, Santa Maria, RS, Brazil
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31
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Turcu C, Crane M, Hutchinson E, Lloyd S, Belesova K, Wilkinson P, Davies M. A multi-scalar perspective on health and urban housing: an umbrella review. BUILDINGS & CITIES 2021; 2:734-758. [PMID: 34738085 PMCID: PMC7611930 DOI: 10.5334/bc.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
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.
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Affiliation(s)
- Catalina Turcu
- The Bartlett Faculty of the Built Environment, University College London, London, UK
| | - Melanie Crane
- The Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Hutchinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Simon Lloyd
- Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Kristine Belesova
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Paul Wilkinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Mike Davies
- UCL Institute for Environmental Design and Engineering, Faculty of the Built Environment, University College London, London, UK
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32
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Mwoka M, Biermann O, Ettman CK, Abdalla SM, Ambuko J, Pearson M, Rashid SF, Zeinali Z, Galea S, Valladares LM, Mberu B. Housing as a Social Determinant of Health: Evidence from Singapore, the UK, and Kenya: the 3-D Commission. J Urban Health 2021; 98:15-30. [PMID: 34480327 PMCID: PMC8415197 DOI: 10.1007/s11524-021-00557-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2021] [Indexed: 10/31/2022]
Abstract
Housing is a paradigmatic example of a social determinant of health, as it influences and is influenced by structural determinants, such as social, macroeconomic, and public policies, politics, education, income, and ethnicity/race, all intersecting to shaping the health and well-being of populations. It can therefore be argued that housing policy is critically linked to health policy. However, the extent to which this linkage is understood and addressed in public policies is limited and highly diverse across and within countries. This analysis seeks to describe the linkages between housing policies and health and well-being using examples from three countries at different levels of the wealth spectrum: Singapore, the UK, and Kenya.We conducted a comparative policy analysis across three country contexts (Singapore, the UK, and Kenya) to document the extent to which housing policies address health and well-being, highlighting commonalities and differences among them. To guide our analysis, we used the United Nations (UN) definition of adequate housing as it offers a broad framework to analyze the impact of housing on health and well-being.The anatomy of housing policies has a strong correlation to the provision of adequate housing across Singapore, the UK, and Kenya, especially for vulnerable groups. The paper demonstrates that contextual factors including population composition (i.e., aging versus youthful), political ideologies, legal frameworks (i.e., welfare versus market-based provision of housing), and presence (or absence) of adequate, quality, timely, reliable, robust data systems for decision-making, which are taken up by stakeholders/state, have strong implications of the type of housing policies developed and implemented, in turn directly and indirectly impacting the overall health and well-being of populations.This analysis demonstrates the value of viewing housing policies as public health policies that could significantly impact the health and well-being of populations, especially vulnerable groups. Moreover, the findings highlight the importance of the Health in All Policies approach to facilitate integrated policy responses to address social determinants of health such as housing. This is more critical than ever, given the context of the global pandemic that has led to worsening overall health and well-being.
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Affiliation(s)
- Meggie Mwoka
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Olivia Biermann
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Global Public Health, Karolinska Institutet, Solna, Sweden
| | - Catherine K Ettman
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Boston University School of Public Health, Boston, USA
| | - Salma M Abdalla
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA. .,Department of Epidemiology, Boston University School of Public Health, Boston, USA.
| | - Jane Ambuko
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,University of Nairobi, Nairobi, Kenya
| | - Mark Pearson
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,OECD, Paris, France
| | - Sabina Faiz Rashid
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Brac James P Grant School of Public Health, Brac University, Dhaka, Bangladesh
| | - Zahra Zeinali
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA
| | - Sandro Galea
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Laura Magaña Valladares
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,Association of Schools and Programs of Public Health (ASPPH), Washington DC, USA
| | - Blessing Mberu
- Rockefeller Foundation-Boston University 3-D Commission on Determinants, Data, and Decision-making, Boston, USA.,African Population and Health Research Center, Nairobi, Kenya
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Ports KA, Tang S, Treves-Kagan S, Rostad W. Breaking the cycle of Adverse Childhood Experiences (ACEs): Economic position moderates the relationship between mother and child ACE scores among Black and Hispanic families. CHILDREN AND YOUTH SERVICES REVIEW 2021; 127:106067. [PMID: 35125581 PMCID: PMC8815463 DOI: 10.1016/j.childyouth.2021.106067] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
IMPORTANCE Adverse Childhood Experiences (ACEs) are prevalent, preventable, and a public health issue that cycles from one generation to the next with serious implications for health and wellbeing, particularly. Research is needed to identify factors, including those related to economic position (i.e., wage, net family wealth, home ownership), that break the cycle of ACEs and inform decisions about policies, practices, and programs. OBJECTIVE To determine whether economic position moderates the association between mother's ACE score and child's ACE score and whether these pathways differ by race and ethnicity. DESIGN Conducted regression and moderation analysis using mother-child dyadic data from panel surveys, stratified by race. The simple slopes for the interactions were probed to determine the magnitude and significance of the interaction. SETTING Secondary data analysis utilizing data from two cohorts of the National Longitudinal Surveys: 1) National Longitudinal Survey of Youth 1979; and 2) National Longitudinal Survey of Youth 1979 Children and Young Adults. PARTICIPANTS The sample included 6,261 children and 2,967 matched mothers. MAIN OUTCOMES S AND MEASURES The outcome variable was the child's ACE score. Mother's ACE score was the independent variable. Three economic position moderators were examined: mother's and her spouse's average wage and salary, average net family wealth, and percent of time owning a home during her child's first five years of life. RESULTS Mother's ACE score was positively associated with her child's ACE score. Economic position was a significant moderator for Black families. Higher wages and net family wealth during children's first five years were associated with weakened associations between mother and child ACEs for Black families. For Hispanic families, higher wages and salary were significantly associated with weakened associations. Among White families, higher net family wealth was associated with stronger ACEs transmission. CONCLUSIONS AND RELEVANCE Taken together, these findings highlight the important role that economic position may play on breaking the cycle of ACEs. This information can inform decisions about what public assistance policies, practices, and programs may be used to improve economic stability among families as an effective ACEs prevention strategy, and for whom these strategies might be most effective at reducing the cycle of ACEs.
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Affiliation(s)
- Katie A. Ports
- Corresponding author at: Health Equity Research Applied, Atlanta, GA 30316, United States. , (K.A. Ports)
| | - Shichao Tang
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
| | - Sarah Treves-Kagan
- Division of Violence Prevention, National Center for Injury Prevention and Control, Centers for Disease Control and Prevention, United States
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Health Effects of Housing Insecurity and Unaffordability in the General Population in Barcelona, Spain. J Urban Health 2021; 98:496-504. [PMID: 34231119 PMCID: PMC8382804 DOI: 10.1007/s11524-021-00546-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 10/20/2022]
Abstract
While the negative effects of housing insecurity and unaffordability on health are well known, most of the studies in Spain have focused on very specific social groups so their findings cannot be extrapolated to the general population. The aim of this study is to assess the effects of housing stress and risk of displacement due to economic reasons, and their combined effect, on the mental and physical health of the general population from a middle-income neighborhood of Barcelona. We conducted a cross-sectional study using a household health survey which included respondents from a representative sample of 1202 non-institutionalized residents (> 18 years old) of the Horta neighborhood. We carried out a descriptive analysis, estimated the prevalence of poor mental and self-rated health (stratifying by the independent variables) and fitted robust Poisson regression models to estimate the effects of housing stress (HS) and the risk of forced displacement (RD) on self-rated health and mental health (GHQ-12). All analyses were stratified by sex. We found a higher likelihood of poor general and mental health among people affected by HS and/or RD compared to those not affected by HS and/or RD. A graded effect of HS and RD emerged mainly on mental health, even after adjusting by socioeconomic variables and housing tenure. The serious problem of housing insecurity and unaffordability in Spain is a widespread public health issue. Evidence-based public policies to improve well-being and health of people under this threat are urgently needed.
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Wolfe JD, Baker EH, Uddin J, Kirkland S. Varieties of Financial Stressors and Midlife Health Problems. J Gerontol B Psychol Sci Soc Sci 2021; 77:gbab108. [PMID: 34137839 DOI: 10.1093/geronb/gbab108] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Financial stressors such as wealth loss, indebtedness, and bankruptcy have gained the attention of public health scholars since the Great Recession. In this study, we extend this area of research by comparing the mental and physical impact of multiple financial stressors during midlife, a pivotal period in the life course for wealth accumulation and disease onset. METHODS With data from the National Longitudinal Survey of Youth 1979 (www.nlsinfo.org), an ongoing survey of adult men and women in the U.S., we used logistic regression to estimate the associations between financial stressors and the risk of a psychiatric disorder or high blood pressure diagnosis from ages 31-39 in 1996 to ages 50-59 in 2016 (N = 7,143). Financial stressors include multiple types of wealth loss, debt, and bankruptcy. RESULTS Even after adjusting for a comprehensive set of confounders, many of the financial stressors we considered had similar associations with the risk of a psychiatric disorder, whereas only debt and bankruptcy were associated with the risk of high blood pressure. The best fitting models for both health outcomes included a simple indicator of indebtedness. Stock losses were not significantly associated with either health outcome. DISCUSSION Given the recent volatility in the U.S. economy, our results highlight the potential loss of health that may occur if nothing is done to prevent economically vulnerable populations from sliding into financial crisis. Our results also emphasize the need for additional research to develop individual-level interventions to improve health among those already experiencing financial difficulties.
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Affiliation(s)
- Joseph D Wolfe
- University of Alabama at Birmingham, Department of Sociology, Birmingham, AL
| | - Elizabeth H Baker
- University of Alabama at Birmingham, Department of Sociology, Birmingham, AL
| | - Jalal Uddin
- University of Alabama at Birmingham, Department of Epidemiology, Birmingham, AL
| | - Stephanie Kirkland
- University of Alabama at Birmingham, Department of Sociology, Birmingham, AL
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Hazekamp C, Yousuf S, Khare M, MacDowell M. Unhealthy behaviours in urban Illinois communities affected by eviction: A descriptive analysis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2021; 29:867-875. [PMID: 33533076 DOI: 10.1111/hsc.13312] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 06/12/2023]
Abstract
Eviction of renter-occupied homes is an emerging public health crisis adversely impacting populations already at risk. Although housing quality and home-owner foreclosures have been linked to health outcomes, the relationship between eviction of renter-occupied homes and health has not been well established. The demographics and socioeconomic status of renters differs from homeowners, as such any relationship with health outcomes should be distinguished between the two. The aim of this study is to provide a descriptive analysis of the relationship between renter-specific eviction and unhealthy behaviours at the census tract level. Using data from the Centers for Disease Control and Prevention 500 Cities Project, the Eviction Lab and the U.S. Census Bureau, this study assesses the relationship between eviction rates and health indicators for 1,267 urban census tracts in Illinois in 2016. Binge drinking, current smoking, no leisure-time physical activity, obesity and sleeping <7 hr were used as indicators of unhealthy behaviour as categorised by the Centers for Disease Control and Prevention500 Cities Project. Unadjusted and adjusted linear regression models were used to assess and describe the relationship between each of the dependent variables and each of the independent variables. All five of the unhealthy behaviour indicators were found to be significantly associated with eviction rates and eviction filing rates after adjustment for confounding variables. This study contributes to the understudied area of research focused on how eviction rates contribute to the social determinants of health for already at-risk populations.
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Affiliation(s)
- Corey Hazekamp
- University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Sana Yousuf
- Ann & Robert H Lurie Children's Hospital of Chicago, Chicago, IL, USA
| | - Manorama Khare
- University of Illinois College of Medicine Rockford, Rockford, IL, USA
| | - Martin MacDowell
- University of Illinois College of Medicine Rockford, Rockford, IL, USA
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37
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Friedman EM, Houle JN, Cagney KA, Slaughter ME, Shih RA. The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:956-967. [PMID: 32303760 DOI: 10.1093/geronb/gbaa047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. METHOD This article uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults' cognitive health and the mechanisms responsible. RESULTS We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. DISCUSSION This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults.
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Affiliation(s)
| | - Jason N Houle
- Department of Sociology, Dartmouth College, Hanover, New Hampshire
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Opioid-related emergencies in New York City after the Great Recession. J Subst Abuse Treat 2021; 125:108311. [PMID: 34016298 DOI: 10.1016/j.jsat.2021.108311] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Revised: 01/02/2021] [Accepted: 01/19/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND The rise in opioid-related mortality and opioid-related emergency department (ED) visits has stimulated research on whether broader economic declines, such as the Great Recession, affect opioid-related morbidity. We examine in New York City whether one measure of morbidity-opioid-related ED visits-responded acutely to the large negative "shock" of the Great Recession. METHODS Data comprise outpatient "treat and release" opioid-related ED visits in New York City for the 72 months spanning January 2006 to December 2011, taken from the Statewide Emergency Department Database (n = 150,246). We modeled the monthly incidence of opioid-related ED visits using Autoregressive, Integrated, Moving Average (ARIMA) time-series methods to control for patterning in ED visits before examining its potential association with the economic shock of the Great Recession. RESULTS New York City shows a mean of 1761 outpatient ED visits per month for opioid dependence and abuse. Unexpectedly large drops in employment coincide with fewer than expected opioid dependence and abuse ED visits in that same month. The result (coefficient = 0.046, 95% Confidence Interval [CI]: 0.002, 0.090) represents a 0.8% drop in overall incidence of opioid dependence and abuse ED visits during the Great Recession. We, however, observe no association between the Great Recession and ED visits for prescription opioid overdose or heroin overdose, or with inpatient ED visits for opioid dependence and abuse. CONCLUSIONS Findings, if replicated, indicate distinct short-term reductions in opioid-related morbidity following the Great Recession. This result diverges from previous findings of increased opioid use following extended economic downturns.
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Callejo-Black P, Biederman D, Douglas C, Silberberg M. Eviction as a Disruptive Factor in Health Care Utilization: Impact on Hospital Readmissions and No-show Rates. J Health Care Poor Underserved 2021; 32:386-396. [PMID: 33678703 DOI: 10.1353/hpu.2021.0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Residential eviction is a component of housing instability that negatively affects physical and mental health, but the effect of eviction on health care utilization, specifically hospital readmissions and outpatient no-show rates, is not known. METHODS We conducted a retrospective review of health care utilization of individuals evicted from public housing between January 2013 and December 2017, investigating hospital readmissions and no-show rates one year before and after eviction. RESULTS 131 individuals who had been evicted had one year of data pre-and post-eviction. The majority were African American (97.7%) and female (80.9%). There was no significant change in 30-, 60-, and 90-day hospital readmissions (p>.05). No-show rate decreased from 27.57 per person per year to 20.13 (p=.05). CONCLUSIONS For our study population, health care utilization was not disrupted. The decreased no-show rate represents an opportunity for health systems to engage with patients on social factors affecting their health post-eviction.
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Jelle M, Morrison J, Mohamed H, Ali R, Solomon A, Seal AJ. Forced evictions and their social and health impacts in Southern Somalia: a qualitative study in Mogadishu Internally Displaced Persons (IDP) camps. Glob Health Action 2021; 14:1969117. [PMID: 34486956 PMCID: PMC8425757 DOI: 10.1080/16549716.2021.1969117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Forced evictions are common in conflict-affected settings. More than 500 internally displaced persons (IDPs) are evicted daily in Mogadishu. Context specific research is necessary to inform responsive humanitarian interventions and to monitor the effectiveness of these interventions on IDPs health. OBJECTIVE This study explored the causes of forced evictions and their health impacts among IDPs in southern Somalia. METHODS We used a qualitative approach, conducting 20 semi-structured interviews, six key informant interviews and four focus group discussions. We used maximum variation sampling to include a wide range of participants and used the framework approach and Nvivo software to analyse the data. RESULTS In this context, landlords often rented land without proper tenure agreements, resulting in risk of forced evictions. Informal tenure agreements led to fluctuations in rent, and IDPs were evicted because tenancy laws were inadequate and failed to protect IDP rights. IDP settlements often increased the value of land by clearing scrub, and landlords often sought to profit from this by evicting IDPs at short notice if a buyer was found for the land. The effect of eviction on an already marginalised population was wide ranging, increasing their exposure to violence, loss of assets, sexual assault, disruption of livelihoods, loss of social networks and family separation. Evicted IDPs reported health issues such as diarrhoea, malaria, pneumonia, measles and skin infections, as well as stress, anxiety, psychological distress and trauma. CONCLUSION Forced evictions remain one of the biggest challenges for IDPs as they exacerbate existing vulnerabilities. Prioritizing implementation of legal protection for IDP tenure rights is necessary to prevent unlawful evictions of IDPs. Humanitarian agencies should aim to respond more effectively to protect evictees and provide support to prevent poor health outcomes. Further quantitative research is needed to further examine the relationship between forced evictions and health outcomes.
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Affiliation(s)
- Mohamed Jelle
- Institute for Global Health, University College London, London, UK
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Raha Ali
- Concern Worldwide Somalia, Mogadishu, Somalia
| | | | - Andrew J Seal
- Institute for Global Health, University College London, London, UK
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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. Matern Child Health J 2020; 25:321-329. [PMID: 33205312 DOI: 10.1007/s10995-020-03032-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/05/2020] [Indexed: 11/27/2022]
Abstract
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.
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Prevalence of Social Determinants of Health Among Sexual Minority Women and Men in 2017. Am J Prev Med 2020; 59:118-122. [PMID: 32201187 DOI: 10.1016/j.amepre.2020.01.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 01/06/2020] [Accepted: 01/07/2020] [Indexed: 01/13/2023]
Abstract
INTRODUCTION Inequities in social determinants of health are plausible contributors to worse health of sexual minorities relative to heterosexuals. Sexual minorities may have higher rates of housing, food, and financial insecurity as adults owing to adverse childhood experiences or policies that induce social disadvantage. This study compares the prevalence of 3 types of social determinants of health among sexual minority and heterosexual adults. METHODS Data were from the Behavioral Risk Factor Surveillance System 2017 survey of U.S. states that administered the optional Social Determinants of Health module and Sexual Orientation and Gender Identity modules. In August 2019, authors estimated the odds of food, housing, and financial insecurity among sexual minority men and women, compared with heterosexuals. RESULTS Sexual minority women and men had higher odds of housing insecurity, housing instability, and food insecurity, but no differences were observed for perceived neighborhood safety. Sexual minority women had higher odds of financial insecurity than their heterosexual peers. CONCLUSIONS Sexual minorities have more housing and food insecurity than heterosexuals, which may contribute to their risk for poorer health. Future research should address the causes and consequences of these differences.
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Sánchez-Ledesma E, Vásquez-Vera H, Sagarra N, Peralta A, Porthé V, Díez È. Perceived pathways between tourism gentrification and health: A participatory Photovoice study in the Gòtic neighborhood in Barcelona. Soc Sci Med 2020; 258:113095. [PMID: 32559574 DOI: 10.1016/j.socscimed.2020.113095] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 05/19/2020] [Accepted: 05/27/2020] [Indexed: 10/24/2022]
Abstract
Tourism gentrification is as process of urban change and neighborhoods transformation, according to the needs of affluent visitors, increasing in some global cities. However, the link between tourism gentrification and resident's health is still an understudied topic. Using Photovoice, a participatory action research method, the aim of this study was to identify the perceived pathways that underlie the relationship between tourism gentrification and health among residents of Gòtic neighborhood, in Barcelona. The study was conducted between January 2018 and January 2019. Thirteen residents, recruited from two neighborhood organizations, took photographs of how tourism gentrification of the neighborhood was affecting their health. Participants analyzed and critically discussed their photographs in small group sessions. Through a consensus-building process, participants categorized 35 photographs and identified 7 emerging categories acknowledged as possible pathways between tourism gentrification and health, in Gòtic neighborhood: 1) decline of social networks; 2) loss of identity; 3) environmental changes; 4) pollution; 5) changes in services and stores; 6) property speculation/eviction and; 7) activism by residents. This Photovoice study recognizes important pathways underlying the relationship between tourism gentrification in the Gòtic neighborhood and the health of its residents, by altering the built environment, the social environment or psychological factors. Among them, six pathways were related to negative health outcomes, both physical and mental (respiratory diseases; worse nutrition habits; sleep deprivation; stress, anxiety and depression). 'Activism by residents' was perceived to buffer the negative health effects of living in a touristic area. The study also provides recommendations to tackle this serious urban health issue.
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Affiliation(s)
| | - Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; CEES-Departamento de Salud Pública, Universidad de La Frontera, Carrera 228, Temuco, Chile; Institut d'Investigació Biomèdica (IBB-Sant Pau), C.de Sant Quintí, 77, 08041, Barcelona, Spain
| | - Natàlia Sagarra
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Andrés Peralta
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Victoria Porthé
- Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5 (Pabellón 11. Planta 0), 28029, Madrid, Spain; Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain
| | - Èlia Díez
- Agència de Salut Pública de Barcelona, Pl. Lesseps, 1, 08023, Barcelona, Spain; Departament of Experimental and Health Sciences, Universitat Pompeu Fabra, Edificio PRBB (Campus del Mar), Doctor Aiguader, 88, 08003, Barcelona, Spain; Centro de Investigación Biomédica en Red Epidemiología y Salud Pública (CIBERESP), Avenida Monforte de Lemos, 3-5 (Pabellón 11. Planta 0), 28029, Madrid, Spain; Institut d'Investigació Biomèdica (IBB-Sant Pau), C.de Sant Quintí, 77, 08041, Barcelona, Spain
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Schafer MH, Andersson MA. Looking homeward with the life course: Early origins of adult dwelling satisfaction? ADVANCES IN LIFE COURSE RESEARCH 2020; 44:100328. [PMID: 36726247 DOI: 10.1016/j.alcr.2020.100328] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 01/01/2020] [Accepted: 02/20/2020] [Indexed: 06/18/2023]
Abstract
The long-term influence of childhood economic and social exposures on adult health and well-being is well-known. Most childhood circumstances transpire in or near the home, yet research has largely neglected how early exposures shape people's experience of their residential context in adulthood. To help address this gap, we use retrospective longitudinal data from the Midlife Development in the United States (MIDUS) study. Drawing on a life course framework, we test the potential mediating roles of adult social, economic, and mental health processes. Results suggest that childhood parental warmth and maltreatment have an enduring influence on people's satisfaction with their adult home, while there is little indication that childhood economic conditions shape adult dwelling satisfaction. Analyses of average controlled direct effects suggest that the effects of childhood parental warmth are mediated slightly by adult socioeconomic attainment and psychological adjustment but especially by supportive family relationships during adulthood. This pattern is consistent with an attachment-based interpretation of the importance of childhood conditions for adult relationships as well as home satisfaction. Taken together, our results suggest that parent-child bonds cast a long shadow over how people experience their residential context decades later, through a diffuse, multifaceted set of intervening pathways.
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Singh A, Aitken Z, Baker E, Bentley R. Do financial hardship and social support mediate the effect of unaffordable housing on mental health? Soc Psychiatry Psychiatr Epidemiol 2020; 55:705-713. [PMID: 31520129 DOI: 10.1007/s00127-019-01773-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 09/03/2019] [Indexed: 11/29/2022]
Abstract
PURPOSE Unaffordable housing has a negative impact on mental health; however, little is known about the causal pathways through which it transmits this effect. We examine the role of financial hardship and social support as mediators of this relationship. METHODS We identified households where housing costs changed from affordable to unaffordable across two waves of the Household, Income and Labour Dynamics in Australia (HILDA) Survey (2014-2015). The sequential causal mediation analysis was used to decompose the total effect of unaffordable housing on mental health into the portion attributable to financial hardship and social support [natural indirect effect (NIE)] and the portion not occurring through measured pathways [natural direct effect (NDE)]. Mental health was measured using the Mental Health Inventory (MHI) and Kessler psychological distress (KPD) scale. Baseline covariates included age, sex, household income, financial hardship, social support, marital status and employment status. Bootstrapping with 1000 replications was used to calculate 95% confidence intervals (CIs). Multiple imputations using chained equations were applied to account for missing data. RESULTS Unaffordable housing led to a change in mean mental health score on the MHI scale (- 1.3, 95% CI: - 2.1, - 0.6) and KPDS scale (0.9, 95% CI: 0.4, 1.4). Financial hardship accounted for 54% of the total effect on MHI scale and 53% on KPD scale. Collectively, financial hardship and social support explained 68% of the total effect on MHI scale and 67% on KPD scale, respectively. CONCLUSIONS In conclusion, the negative mental health effect of unaffordable housing is largely mediated through increased financial hardship.
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Affiliation(s)
- Ankur Singh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.
| | - Zoe Aitken
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emma Baker
- School of Architecture and Built Environment, The University of Adelaide, Adelaide, Australia
| | - Rebecca Bentley
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
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Schafer MH, Settels J, Upenieks L. As Goes the City? Older Americans' Home Upkeep in the Aftermath of the Great Recession. SOCIAL PROBLEMS 2020; 67:379-397. [PMID: 32362689 PMCID: PMC7176998 DOI: 10.1093/socpro/spz022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
The private home is a crucial site in the aging process, yet the upkeep of this physical space often poses a challenge for community-dwelling older adults. Previous efforts to explain variation in disorderly household conditions have relied on individual-level characteristics, but ecological perspectives propose that home environments are inescapably nested within the dynamic socioeconomic circumstances of surrounding spatial contexts, such as the metro area. We address this ecological embeddedness in the context of the Great Recession, an event in which some U.S. cities saw pronounced and persistent declines across multiple economic indicators while other areas rebounded more rapidly. Panel data (2005-6 and 2010-11) from a national survey of older adults were linked to interviewer home evaluations and city-level economic data. Results from fixed-effects regression support the hypothesis that older adults dwelling in struggling cities experienced an uptick in disorderly household conditions. Findings emphasize the importance of city-specificity when probing effects of a downturn. Observing changes in home upkeep also underscores the myriad ways in which a city's most vulnerable residents- older adults, in particular-are affected by its economic fortunes.
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Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Jayatunga W, Kelly G, Black M, Gopfert A, Roderick P, Barr B, Bambra C. Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health 2019; 19:1678. [PMID: 31842835 PMCID: PMC6915896 DOI: 10.1186/s12889-019-7895-6] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. METHODS Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. RESULTS The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. CONCLUSIONS The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. TRIAL REGISTRATION Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.
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Affiliation(s)
- Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Peter Baker
- Global Health and Development Group, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
| | - Sharif A. Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Taavi Tillmann
- Centre for Global Non-Communicable Diseases, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Darryl Quantz
- NW School of Public Health, Health Education England North West, First Floor Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL UK
| | - Frances Hillier-Brown
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN UK
| | - Wikum Jayatunga
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Gill Kelly
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Michelle Black
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Anya Gopfert
- Junior Doctor and National Medical Director’s Fellow, London, UK
| | - Peter Roderick
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Ben Barr
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Clare Bambra
- Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
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Reyes A, Vásquez-Vera H, Novoa A, González-Marín P, Puig-Barrachina V, Borrell C. [How does the employment status influence the effects of residential insecurity on health?]. GACETA SANITARIA 2019; 35:60-66. [PMID: 31732187 DOI: 10.1016/j.gaceta.2019.07.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 07/09/2019] [Accepted: 07/17/2019] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This study aims to analyze the effects of housing insecurity on health and if those are modified by employment status of people belonging to "Treball als Barris" program in Barcelona between 2015 and 2016. METHODS We conducted a longitudinal study using a survey which included sociodemographic, employment and housing status information. This was administered to 469 individuals attended by "Treball als Barris" at baseline and after one year of follow-up. Then, we carried out a descriptive analysis and fitted regression models to estimate the effects of housing insecurity and employment status on health, and the interaction between them. RESULTS Among women, we found negative effects of housing insecurity on health (PR of poor self-reported health among women who stayed under housing insecurity was 2.29 [IC95%: 1.36-3.84] compared to those who stayed secured), while, among men, main effects on health were due to employment status (PR of poor self-reported health among men who were unemployed without subsidy was 3.16 [IC95%: 1.02-6.15] compared to those who were employed after follow-up). In addition, results suggest an interaction between housing and employment status on mental health among. DISCUSSION Housing insecurity rates have increased in last years. It produces negatives effects on health and can interact with other social determinants such as employment, mainly on men's mental health.
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Affiliation(s)
- Alexia Reyes
- Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España; Agencia de Salud Pública, Barcelona, España
| | - Hugo Vásquez-Vera
- Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España; Agencia de Salud Pública, Barcelona, España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España; Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile.
| | - Ana Novoa
- Agencia de Salud Pública, Barcelona, España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España
| | - Patricia González-Marín
- Agencia de Salud Pública, Barcelona, España; CIBER de Epidemiología y Salud pública (CIBERESP), España
| | | | - Carme Borrell
- Departamento de Ciencias Experimentales y de la Salud, Facultad de Ciencias de la Salud y de la Vida, Universitat Pompeu Fabra, Barcelona, España; Agencia de Salud Pública, Barcelona, España; Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, España; CIBER de Epidemiología y Salud pública (CIBERESP), España
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Sarriá E, Recio P, Rico A, Díaz-Olalla M, Sanz-Barbero B, Ayala A, Zunzunegui MV. Financial Fraud, Mental Health, and Quality of Life: A Study on the Population of the City of Madrid, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183276. [PMID: 31489951 PMCID: PMC6766254 DOI: 10.3390/ijerph16183276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022]
Abstract
Over the past few decades, the financial system has engaged in abusive practices that meet the definition of fraud. Our objective is to compare the prevalence of psychological distress and levels of health-related quality of life according to having been exposed to financial fraud and its economic impact on family finances. The City of Madrid Health Survey 2017 included specific questions on exposure to financial fraud-this section was administered to half of the participants (n = 4425). Mental health need or caseness was defined by a score greater than two on the 12-item version of the Goldberg health questionnaire. Health-related quality of life was assessed by the Darmouth Coop Functional Health Assessment Charts/WONCA (COOP/WONCA). The prevalence of financial fraud was 10.8%. The prevalence rate ratio for caseness of those who experienced severe economic impact due to fraud was 1.62 (95%, CI 1.17-2.25; reference: no fraud), after adjustment by age, sex, social class, and immigrant status. Women experienced a decreased quality of life, even with a moderate impact of fraud, while men experienced a decreased quality of life related to fraud with severe economic impact. The current study contributes to a growing body of literature showing the effects of economic shocks on health as a result of financial fraud.
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Affiliation(s)
- Encarnación Sarriá
- Faculty of Psychology, National University for Distance Education (UNED), 28015 Madrid, Spain.
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
| | - Patricia Recio
- Faculty of Psychology, National University for Distance Education (UNED), 28015 Madrid, Spain.
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
| | - Ana Rico
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Manuel Díaz-Olalla
- Institute of Public Health, Madrid Salud, City Council of Madrid, 28029 Madrid, Spain.
| | - Belén Sanz-Barbero
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Alba Ayala
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
- Research Network on Health Services and Chronicity (REDISSEC), 48010 Bilbao, Spain.
| | - María Victoria Zunzunegui
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
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Curtis S, Norman P, Cookson R, Cherrie M, Pearce J. Recession, local employment trends and change in self-reported health of individuals: A longitudinal study in England and Wales during the ‘great recession’. Health Place 2019; 59:102174. [DOI: 10.1016/j.healthplace.2019.102174] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 07/13/2019] [Accepted: 07/18/2019] [Indexed: 12/24/2022]
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