Poor housing conditions in association with child health in a disadvantaged immigrant population: a cross-sectional study in Rosengård, Malmö, Sweden

A State-of-the-Science Review of the Effect of Damp- and Mold-Affected Housing on Mental Health

BACKGROUND

While it is well-established that exposure to dampness or mold in homes negatively affects physical health, the association with mental health remains less well evidenced. As plausible psychosocial and biological pathways exist between dampness and mold exposure and poor mental health, a review of evidence is required.

OBJECTIVE

This State-of-the-Science review sought to assess what is known about the mental health effects of dampness or mold exposure and identify gaps in the literature and priorities for further research.

METHODS

A comprehensive search of electronic databases (MEDLINE, Embase, PsycInfo, Global Health, Web of Science, and Scopus) was conducted to identify relevant studies published from 2003 to 2023. Eligible studies included observational study designs such as cohort and cross-sectional studies. Target studies for review assessed the effect of dampness and/or mold on mental health outcomes.

RESULTS

Of the 1,169 records retrieved, 19 studies met the inclusion criteria. The available evidence described positive associations between residential dampness/mold exposure and poor mental health. In adults, associations were observed for outcomes such as depression, stress, and anxiety, while for children, associations were observed for emotional symptoms and emotional dysregulation.

DISCUSSION

Identified studies generally reported associations between exposure to dampness/mold in the home and poorer mental and emotional health. Given the methodological limitations present in the current evidence base, it is recommended that more research be conducted. https://doi.org/10.1289/EHP14341.

Residential overcrowding in relation to children's health, environment and schooling - a qualitative study

AIM

To explore how overcrowding affects children's health, environment and schooling.

METHODS

A qualitative study was conducted with individual interviews among 20 participants with occupational experience from overcrowded Stockholm areas but diverse in professions, locations and employers. The interviews were recorded, transcribed and analysed with Systematic Text Condensation.

RESULTS

Almost all participants expressed that overcrowding has a negative impact on children's health, environment and schooling - based on perceptions of precarious and different living conditions for children in overcrowded areas, for example, substandard homes, vulnerability, stress, exclusion, limited resources, lack of learning opportunities, gender differences, confinement, shame, insecurity, conflicts, risk of criminality, and bodily impact, both physical and psychological.

CONCLUSIONS

Our qualitative evidence suggest that overcrowding has a negative impact on children's health, environment and schooling.

Reviewing Publicly Available Reports on Child Health Disparities in Indigenous and Remote Communities of Australia

Developing programs that ensure a safe start to life for Indigenous children can lead to better health outcomes. To create effective strategies, governments must have accurate and up-to-date information. Accordingly, we reviewed the health disparities of Australian children in Indigenous and remote communities using publicly available reports. A thorough search was performed on Australian government and other organisational websites (including the Australian Bureau of Statistics [ABS] and the Australian Institute of Health and Welfare [AIHW]), electronic databases [MEDLINE] and grey literature sites for articles, documents and project reports related to Indigenous child health outcomes. The study showed Indigenous dwellings had higher rates of crowding when compared to non-Indigenous dwellings. Smoking during pregnancy, teenage motherhood, low birth weight and infant and child mortality were higher among Indigenous and remote communities. Childhood obesity (including central obesity) and inadequate fruit consumption rates were also higher in Indigenous children, but Indigenous children from remote and very remote areas had a lower rate of obesity. Indigenous children performed better in physical activity compared to non-Indigenous children. No difference was observed in vegetable consumption rates, substance-use disorders or mental health conditions between Indigenous and non-Indigenous children. Future interventions for Indigenous children should focus on modifiable risk factors, including unhealthy housing, perinatal adverse health outcomes, childhood obesity, poor dietary intake, physical inactivity and sedentary behaviours.

An investigation of child health in relation to housing renovations for a disadvantaged immigrant population in Malmö, Sweden

Aims:

The aim of the study was to describe child health in relation to housing renovations in more than 800 rental units, consisting of repairs of dilapidated kitchens and bathrooms, in the disadvantaged neighbourhood of Herrgården in Rosengård, Malmö, Sweden.

Methods:

Data on housing conditions and self-reported health were collected during home visits to families living in Herrgården (building renovations area) and a comparison area (neighbouring Törnrosen, with generally better housing conditions). At baseline, 130 families with 359 children participated, while 51 families with 127 children participated at follow-up. All data were collected between 2010 and 2012. Additionally, regional register data on health-care usage/in- and outpatient contacts within the public health-care system between 2008 and 2013 were also collected for all 8715 children registered as living in the two areas.

Results:

Self-reported health seemed to somewhat improve in both areas, with 74% versus 86% and 78% versus 88% reporting good or very good health in Herrgården and in the comparison area at baseline and follow-up, respectively. In Herrgården, crowdedness increased, while it decreased in the comparison area. The number of health-care contacts remained stable over time in Herrgården, while it decreased in the comparison area.

Conclusions:

Partial housing renovations did not seem to result in clear health improvements as measured with the indicators used in the present study. This could possibly be due to persisting health effects due to increased crowdedness or persisting poor housing conditions, as only kitchens and bathrooms were renovated.

Residential mobility and potentially avoidable hospitalisations in a population-based cohort of New Zealand children

BACKGROUND

Residential moves are common in early childhood and associations have been found between residential mobility and adverse child health and well-being outcomes. Although there are studies on potentially avoidable hospitalisations (PAH) in children, few have examined PAH in relation to residential mobility. Our aim, therefore, was to investigate residential mobility and PAH in a population-based cohort of New Zealand children.

METHODS

Using a retrospective cohort design, we analysed data from the Integrated Data Infrastructure for a cohort of 314 283 children born since the start of 2004, who had at least one residential address recorded by 2 years of age. Residential mobility was derived from address data and PAH were determined from hospital discharge data.

RESULTS

Half of the cohort children (52%) experienced at least one residential move by 2 years of age, and 22% experienced two or more moves. Fifteen per cent of the cohort experienced one or more PAH between 2 and 4 years of age. A linear association between residential mobility and PAH was found (relative risk (RR)=1.18, CI 1.17 to 1.19) and this remained robust when adjusting for several covariates. Sensitivity analyses for ambulatory care sensitive hospitalisations (ACSH) and PAH attributable to the housing/physical environment (PAH-HE) produced results very similar to those for PAH (ACSH: adjusted RR (aRR)=1.10, CI 1.09 to 1.11; PAH-HE: aRR=1.11, CI 1.10 to 1.12).

CONCLUSION

This study found a linear association between higher residential mobility and an increased likelihood of PAH in young children. Avenues for further investigation are suggested.

Housing and Child Health in South Africa: The Value of Longitudinal Research

Research investigating the link between housing and health often produces mixed results. It does not always prove that good housing improves health. The results suggest a complex set of factors play a role, and the findings are sometimes contradictory. Two ways of addressing these concerns are longitudinal research, where the relationship between housing and health is measured in the short and medium terms, and a focus on children. We use the children’s housing and health data from the five waves of the National Income and Distribution Survey (NIDS) survey in South Africa, 2008 to 2017. We investigate the effect that continued living in informal housing over the five waves has had on these children’s health. Our results show a statistically significant relationship between prolonged residence in poor housing and poor health outcomes for some health indicators. The results call for a closer understanding of health issues in housing policy in South Africa.

The relationship between buildings and health: a systematic review

Background

The built environment exerts one of the strongest directly measurable effects on physical and mental health, yet the evidence base underpinning the design of healthy urban planning is not fully developed.

Method

This study provides a systematic review of quantitative studies assessing the impact of buildings on health. In total, 7127 studies were identified from a structured search of eight databases combined with manual searching for grey literature. Only quantitative studies conducted between January 2000 and November 2016 were eligible for inclusion. Studies were assessed using the quality assessment tool for quantitative studies.

Results

In total, 39 studies were included in this review. Findings showed consistently that housing refurbishment and modifications, provision of adequate heating, improvements to ventilation and water supply were associated with improved respiratory outcomes, quality of life and mental health. Prioritization of housing for vulnerable groups led to improved wellbeing. However, the quality of the underpinning evidence and lack of methodological rigour in most of the studies makes it difficult to draw causal links.

Conclusion

This review identified evidence to demonstrate the strong association between certain features of housing and wellbeing such as adequate heating and ventilation. Our findings highlight the need for strengthening of the evidence base in order for meaningful conclusions to be drawn.

Perspectives of Nurses and Doulas on the Use of Information and Communication Technology in Intercultural Pediatric Care: Qualitative Pilot Study

BACKGROUND

Sweden is rapidly becoming an increasingly multicultural and digitalized society. Encounters between pediatric nurses and migrant mothers, who are often primary caregivers, are impeded by language problems and cultural differences. To support mothers, doulas, who are women having the same linguistic and cultural backgrounds, serve as cultural bridges in interactions with health care professionals. In addition, information and communication technology (ICT) can potentially be used to manage interactions owing to its accessibility.

OBJECTIVE

The objective of this study was to investigate the role of ICT in managing communicative challenges related to language problems and cultural differences in encounters with migrant mothers from the perspectives of Swedish pediatric nurses and doulas.

METHODS

Deep semistructured interviews with five pediatric nurses and four doulas from a migrant-dense urban area in western Sweden were audio recorded, transcribed, and analyzed using thematic content analysis.

RESULTS

The results showed that ICT contributes to mitigating communicative challenges in interactions by providing opportunities for nurses and migrant mothers to receive distance interpreting via telephones and to themselves interpret using language translation apps. Using images and films from the internet is especially beneficial while discussing complex and culturally sensitive issues to complement or substitute verbal messages. These findings suggest that ICT helps enable migrant mothers to play a more active role in interactions with health care professionals. This has important implications for their involvement in other areas, such as child care, language learning, and integration in Sweden.

CONCLUSIONS

The findings of this study suggest that ICT can be a bridging tool between health care professionals and migrants. The advantages and disadvantages of translation tools should be discussed to ensure that quality communication occurs in health care interactions and that health information is accessible. This study also suggests the development of targeted multimodal digital support, including pictorial and video resources, for pediatric care services.

Lifetime-ever pneumonia among pre-school children across China - Associations with pre-natal and post-natal early life environmental factors

BACKGROUND

Biomass burning is associated with childhood pneumonia but few studies exist on other indoor factors.

AIM

To study pneumonia in relation to pre-natal and post-natal exposure among children across China.

METHODS

Children (3-6 y) (n = 39,782) from randomized day care centres in seven cities in China. Information on pneumonia and pre-natal and post-natal exposure to home environment factors were assessed by a parental questionnaire. Life-time outdoor temperature and GDP per capita were assessed on city level. Associations were calculated by multilevel logistic regression adjusting for fourteen co-variates.

RESULTS

Totally 32.0% had ever had pneumonia diagnosed by a physician. Children of farmer mothers (OR = 0.65), with breastfeeding (OR = 0.91) and living in rural (OR = 0.85) or suburban (OR = 0.90) areas had less pneumonia. Buying new furniture one year before conception (OR = 1.11) and after first year of life (OR = 1.10) increased the risk. Redecoration one year before conception (OR = 1.20), during pregnancy (OR = 1.18) and after first year of life (OR = 1.17) increased pneumonia risk. Children with mould (OR = 1.17), window pane condensation (WPC) (OR = 1.20) and mould odour (OR = 1.15) at home at birth only had a higher risk of pneumonia. Similar associations were seen for dampness and mould in the current home. Children in the oldest and newest homes had less pneumonia. Cockroaches (OR = 1.08), mosquitos or flies in the current home (OR = 1.18), an exhaust fan in the bathroom (OR = 1.10) and higher economic development level, measured as GDP per capita on city level (OR 1.11 per 10,000 RMB/year) were associated with childhood pneumonia.

CONCLUSIONS

Perinatal and postnatal exposure to mould, mould odour and window pane condensation at home can be early life risk factors for childhood pneumonia in China. Moreover, pre-natal and post-natal exposure to chemical emissions from new furniture and renovation could increase the risk of childhood pneumonia. Breastfeeding, farm exposure, and living in rural or suburban areas could be protective.

High burden of atopy in immigrant families in substandard apartments in Sweden - on the contribution of bad housing to poor health in vulnerable populations

Background

Atopic disorders are a global concern. Studies in migrant populations can illuminate the interplay of genetic and environmental factors. Exposures related to bad housing (indoor dampness, mould growth, crowding etc.) are likely to play a role in how socioeconomic inequalities can turn into health disparities for disadvantaged populations. The sizable immigrant population living in very poor-quality housing in Malmö, Sweden, became the focus of a cross-sectional study.

Objective

To describe atopic disorders and sensitizations in a population living in substandard housing in Malmö, Sweden, with an emphasis on their relation to harmful exposures from the built environment.

Methods

Families were recruited via identification of any children with symptomatic airway afflictions from health care records, and also asymptomatic children from school lists. Interviewer-led health questionnaire data and data from self-reports about living conditions were obtained together with data from home inspections carried out by health communicators. Families underwent skin prick tests (SPT) against common aeroallergens.

Results

As could be expected from background demographic information, it turned out that we effectively studied an immigrant population inhabiting very precarious housing outside the center of Malmö. A total of 359 children from 130 families (total 650 participants) were included. Overall the prevalence of potentially harmful environmental exposures was high (signs of moisture or mould in more than 50% of apartments, indoor smoking in 37% of households). Atopic disorders were common among both adults and children. SPTs showed a spectrum of sensitizations consistent with unselected populations in Sweden. Paternal sensitization in the SPT was associated with higher risk of sensitization for offspring than maternal sensitization. Few statistically significant associations of atopic sensitization with studied environmental exposures were detected (for example objective signs of dampness /mould in bathrooms). There were marked discrepancies between asthma diagnoses obtained from the health records and parental reports of such diagnoses and treatment for their children.

Conclusions

The atopic burden in this selected immigrant population was high, and results point to unmet medical needs. Health care systems caring for such populations need to be aware of their specific health needs; comprehensive asthma and allergy care should include consideration of harmful environmental exposures, adhering to the precautionary principle.

Mental Health and Quality of Life Among Spanish-born and Immigrant Children in Years 2006 and 2012

BACKGROUND

One of every five children and adolescents in the European Union suffers from behavioural, and emotional disturbances.

OBJECTIVES

To compare factors associated with the quality of life and mental health of immigrant and Spanish children aged 4-14years both during the years 2006 and 2012 and to evaluate changes over this time period.

DESIGN AND METHODS

An epidemiologic age and sex matched case-control study (1:2) was conducted. The study group were 677 immigrant children and 1354 matched Spanish children (controls). This study was conducted using data obtained from the Spanish National Health Surveys done in 2006 and 2012. We used the Strengths and Difficulties Questionnaire to obtain the score for variables derived from mental health and the Kidscreen-10 questionnaire to score the Health-Related Quality of Life.

RESULTS

Spanish girls scored higher in conduct problems (2.04±0.1) and better in problems with peers (1.21±0.08) regarding immigrant girls (1.82±0.12-1.92±0.13 respectively). Concerning total scores, immigrant children obtained significantly lower scores in quality of life (81.29±0.76) and in problems with peers (2.04±0.09) than their matched Spanish children (84.4±0.45 and 1.26±0.06) in 2006. Immigrant children had lower total scores in prosocial behaviour (8.62±0.11) compared to the matched Spanish children (8.92±0.06) in 2012. The total average scores of immigrant children in terms of quality of life, emotional symptoms, behavioural problems, hyperactivity and problems with peers were significantly better in 2012 (86.58; 1.84; 1.46; 3.77 and 1.48 respectively) than in 2006 (81.29; 2.15; 1.90; 4.58 and2.04).

CONCLUSIONS

Immigrant children had a poorer quality of life and mental health than matched Spanish children in 2006.

Common cold among pre-school children in China - associations with ambient PM10 and dampness, mould, cats, dogs, rats and cockroaches in the home environment

BACKGROUND

There is some evidence that dampness, mould and cockroaches can increase the risk of respiratory infections in children but few studies exist from China on this topic. Aim To study associations between domestic early life exposure to biological indoor factors (dampness, mould, cats, dogs, rats, cockroaches), cleaning habits and common cold among pre-school children across China.

METHODS

Children aged 3-6years (n=39,782) were recruited from randomly selected day care centres in seven cities in China. Data on common cold and prenatal and postnatal exposure to dampness, mould, windowpane condensation in wintertime (WPC), cats, dogs, cockroaches and rats were assessed by a parentally administered questionnaire. Data on annual ambient temperature and PM₁₀ was assessed on city level. Associations between high frequency (>5 colds per year) and long duration (≥2weeks) of common colds in the past year and exposure were calculated by multilevel logistic regression.

RESULTS

A total of 9.2% had a high frequency and 11.9% had long duration of common cold. Exposure to mould (OR=1.38, 95% CI 1.24-1.53) and WPC (OR 1.23, 95%CI 1.13-1.33) at birth was associated with frequent common cold. Exposure to dogs at birth was associated with long duration of common cold. (OR=1.22, 95% CI 1.06-1.41). Exposure to mould (OR=1.36, 95% CI 1.22-1.54), WPC (OR=1.27, 95%CI 1.17-1.39) and water leakage (OR 1.34, 95% CI 1.20-1.49) in the current home was associated with frequent common cold. Presence of cockroaches were positively (OR=1.12, 95% CI 1.02-1.24) and presence of rats (OR=0.86, 95% CI 0.77-0.96) negatively associated with high frequency of common cold. Daily cleaning was negatively associated with frequent common cold (OR=0.89, 95% CI 0.81-0.97). Similar associations for mould, WPC, cockroaches and rats were found for long duration. Ambient PM₁₀ (OR=1.21, 95% CI 1.21-1.35 per 10μg/m³) and temperature (OR=1.13, 95% CI 1.06-1.35 °C) on city level were associated with high frequency of common cold. Associations between cat keeping and high frequency of common cold were found only in southern China. Associations with cockroaches were stronger in northern China. Associations with dampness and mould were the same in the north and south.

CONCLUSIONS

Indoor mould, water damage, windowpane condensation, cockroaches and keeping cats or dogs as pets can be risk factors for common cold while daily cleaning can be protective factor. PM₁₀ and a warmer climate zone can be other risk factors for common cold.