1
|
Barlow CF, Daniel L, Bentley R, Baker E. Cold housing environments: defining the problem for an appropriate policy response. J Public Health Policy 2023; 44:370-385. [PMID: 37516807 PMCID: PMC10484804 DOI: 10.1057/s41271-023-00431-8] [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] [Accepted: 07/17/2023] [Indexed: 07/31/2023]
Abstract
Researchers across disciplines are increasing attention to cold housing environments. Public health, environmental and social sciences, architecture, and engineering each define and measure cold housing environments differently. Lack of standardisation hinders our ability to combine evidence, determine prevalence, understand who is most at risk--and to formulate policy responses. We conducted a systematic, cross-disciplinary review of literature to document the measures used. We examined benefits and limitations of each approach and propose a conceptualisation of cold housing: where temperature is too low to support optimal health and wellbeing of inhabitants, measured using one or a combination of economic, 'objective', or subjective approaches. More accurate data on home temperatures for all population groups, combined with an understanding of factors leading to cold homes, will enable appropriate policy response to reduce adverse health effects and costs. Policies targeting better building standards and energy subsidies both improve temperature conditions in housing environments.
Collapse
Affiliation(s)
- Cynthia Faye Barlow
- The Australian Centre for Housing Research, Faculty of Arts, Business, Law and Economics, University of Adelaide, Adelaide, SA 5005 Australia
| | - Lyrian Daniel
- UniSA Creative, University of South Australia, Adelaide, SA 5000 Australia
| | - Rebecca Bentley
- The Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC 3010 Australia
| | - Emma Baker
- The Australian Centre for Housing Research, Faculty of Arts, Business, Law and Economics, University of Adelaide, Adelaide, SA 5005 Australia
| |
Collapse
|
2
|
Cartagena Farias J, Brimblecombe N, Hu B. Early onset of care needs in the older population: The protective role of housing conditions. Health Place 2023; 81:103007. [PMID: 36989933 DOI: 10.1016/j.healthplace.2023.103007] [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: 10/14/2022] [Revised: 03/01/2023] [Accepted: 03/13/2023] [Indexed: 03/29/2023]
Abstract
Most older people wish to live in their own homes as they age and to have a choice over their housing and care situation. Housing has the potential to play a key role in promoting independence, delaying and/or preventing the onset of care needs and in influencing the level and type of care provision required. However, many older people live in homes that are not suitable for their comfort and needs. Our study focuses on older people living in non-specialist housing in England and aims to i) explore how housing characteristics cluster; and ii) investigate their association with an early onset of care needs. We used four waves of a large representative longitudinal sample of people aged 50 or over, covering the period 2012 to 2020. We performed Latent Class Analysis and a Cox regression survival model to provide answers to our research questions. We found that people living in poor housing conditions or living in social rented housing are more likely to experience early onset of care needs, which may lead to a higher demand for, and utilisation of, long-term care services. We believe that gaining a better understanding of the relationship between housing-related conditions and care needs is paramount from the preventative and service provision point of view, and is of relevance to policymakers, practitioners, and current and future adult long-term care users.
Collapse
Affiliation(s)
- Javiera Cartagena Farias
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, Houghton Street, London, WC2A 2AE, United Kingdom.
| | - Nicola Brimblecombe
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, United Kingdom.
| | - Bo Hu
- Care Policy and Evaluation Centre (CPEC), London School of Economics and Political Science, United Kingdom.
| |
Collapse
|
3
|
Park GR, Kim J. Cumulative exposure to poor housing conditions and psychological well-being: Does the relationship differ for young and middle-aged adults and older adults? Aging Ment Health 2022:1-8. [PMID: 35881041 DOI: 10.1080/13607863.2022.2102145] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVES This study examined whether cumulative exposure to poor housing conditions is negatively associated with psychological well-being, and whether this association varies by age. METHODS Using fifteen waves of the Korean Welfare Panel Study between 2005 and 2019 (118,500 person-observations), this study employed fixed-effects regression models to account for unobserved individual-level heterogeneity. Exposure to poor housing conditions ranged from 1 to more than 5 annual waves. To formally test for age heterogeneity, interactive models were estimated. RESULTS The trajectories of change in psychological well-being associated with cumulative exposure to poor housing conditions were different between young and middle-aged adults and older adults. Among young and middle-aged adults, the levels of depressive symptoms increased in the first year of exposure but remained at a similar level since then. In contrast, with the persistence of poor housing conditions, older adults continued to develop greater depressive symptoms over time. Similar age differences were found for life satisfaction. As exposure to poor housing conditions accumulated, life satisfaction persistently declined among older adults, but not young and middle-aged adults. CONCLUSION This study suggests that cumulative exposure to poor housing conditions has more adverse psychological consequences for older adults than young and middle-aged adults.
Collapse
Affiliation(s)
- Gum-Ryeong Park
- Department of Health, Aging & Society, McMaster University, Hamilton, ON, Canada.,Department of Health Care Policy Research, Korea Institute for Health and Social Affairs, Sejong, Republic of Korea
| | - Jinho Kim
- Department of Health Policy and Management, Korea University, Seoul, Republic of Korea.,Interdisciplinary Program in Precision Public Health, Korea University, Seoul, Republic of Korea.,Center for Demography of Health and Aging, University of Wisconsin-Madison, Madison, WI, USA
| |
Collapse
|
4
|
Chen J, Hao S, Wu Y. Housing and health in vulnerable social groups: an overview and bibliometric analysis. REVIEWS ON ENVIRONMENTAL HEALTH 2022; 37:267-279. [PMID: 34049423 DOI: 10.1515/reveh-2020-0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 05/08/2021] [Indexed: 06/12/2023]
Abstract
Previous studies have confirmed that poor living conditions can lead to a wide range of health problems. However, in the context of the COVID-19 pandemic, vulnerable groups in unstable housing are more susceptible to disease. This study aims to systematically examine the housing and health problems of vulnerable groups using a bibliometric approach to explore how housing causes health problems, types of health illnesses, and coping strategies. It is found that the poor housing mechanism, persistent inequalities, and poor housing environments have a significant impact on the health of vulnerable groups. Therefore, the government must make concerted efforts across all sectors to ensure that the housing and health care needs of vulnerable groups are improved, and that housing security standards and related policies are improved; targeted safety plans are formulated with community as the carrier, taking into account the characteristics of vulnerable groups; and new information technology is widely used to provide medical convenience for vulnerable groups. It is hoped that the research in this paper can arouse social attention to the health of vulnerable groups and improve their health from the perspective of housing, so as to point out the direction for solving the housing health problems of vulnerable groups in the future.
Collapse
Affiliation(s)
- Junhua Chen
- Department of Urban and Real Estate Management, Central University of Finance and Economics, Beijing, Beijing, China
| | - Shuya Hao
- Department of Urban and Real Estate Management, Central University of Finance and Economics, Beijing, Beijing, China
| | - Ying Wu
- National Institute of Social Development, Central University of Finance and Economics, No. 5 Jiangguomennei Street, 100732, Beijing, Beijing, China
| |
Collapse
|
5
|
Unveiling hidden energy poverty using the energy equity gap. Nat Commun 2022; 13:2456. [PMID: 35508551 PMCID: PMC9068781 DOI: 10.1038/s41467-022-30146-5] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 04/13/2022] [Indexed: 11/22/2022] Open
Abstract
Income-based energy poverty metrics ignore people’s behavior patterns, particularly reducing energy consumption to limit financial stress. We investigate energy-limiting behavior in low-income households using a residential electricity consumption dataset. We first determine the outdoor temperature at which households start using cooling systems, the inflection temperature. Our relative energy poverty metric, the energy equity gap, is defined as the difference in the inflection temperatures between low and high-income groups. In our study region, we estimate the energy equity gap to be between 4.7–7.5 °F (2.6–4.2 °C). Within a sample of 4577 households, we found 86 energy-poor and 214 energy-insecure households. In contrast, the income-based energy poverty metric, energy burden (10% threshold), identified 141 households as energy-insecure. Only three households overlap between our energy equity gap and the income-based measure. Thus, the energy equity gap reveals a hidden but complementary aspect of energy poverty and insecurity. In the summer, low-income households in the Arizona, US wait 4 - 7 °F (2.6–4.2 °C) longer than high-income households to turn on their AC units to save money on energy bills. This energy limiting behavior indicates a hidden form of energy poverty.
Collapse
|
6
|
Abbas Z, Eiden C, Salameh P, Peyriere H. Substance use among refugees in three Lebanese camps: A cross-sectional study. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2021; 94:103204. [PMID: 33839597 DOI: 10.1016/j.drugpo.2021.103204] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 03/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND There is a strong link between conflict exposure and ill health, including substance use. However, this widely acknowledged problem has not been studied yet in refugee camps in Lebanon. AIM To investigate substance use among civilians following war or displacement, and to assess its association with socio-demographic characteristics. METHOD Cross-sectional observational study carried out in three Palestinian camps in Lebanon using the World Health Organization Alcohol, Smoking and Substance Involvement Screening Test (ASSIST). Participants were Palestinian adults born in Lebanon and Palestinian and Syrian adults recently displaced from Syria due to war. The percentage of people reporting substance use and the associations between lifetime and last three months substance use and demographic features were assessed using a multivariate logistic regression. RESULTS In general, lifetime substance use was higher among Palestinians born in Lebanon compared to Syrians and Palestinians displaced from Syria (OR 7.241, 95% CI [3.781-13.869], P <0.0001). Results from ASSIST score during last three months showed that moderate and high-risk use of cannabis and cocaine were higher among Palestinians born in Lebanon than Palestinians and Syrians displaced from Syria. The multivariate analysis showed that women had lower lifetime (OR 0.188, 95%CI [0.080-0.442], P <0.0001) and lower last three months substance use than men, whereas single people were more likely to use substances than married people (OR: 2.78, 95%CI [1.588-4.866], P <0.0001). Tobacco was significantly associated with higher risk of substance use. CONCLUSION These findings suggest a higher rate of lifetime substance use among Palestinians born in Lebanon than in Palestinians and Syrians recently displaced from Syria. Substance use is influenced by different socio-demographic factors in the two groups of refugees. However, many factors other than socio-demographic characteristics and refugee status may influence substance use, particularly quality of life and health status that should be assessed in future studies.
Collapse
Affiliation(s)
- Zeinab Abbas
- Montpellier University, INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier-France.
| | - Celine Eiden
- Medical Pharmacology, and toxicology Department, Montpellier University, Montpellier-France
| | - Pascale Salameh
- Lebanese University Faculty of Pharmacy, Hadath, Lebanon; Institut National de Santé Publique, Epidémiologie Clinique et Toxicologie - Liban (INSPECT-LB), Beirut-Lebanon; University of Nicosia Medical School, Nicosia, Cyprus
| | - Hélène Peyriere
- Montpellier University, INSERM U 1058, Pathogenesis and Control of Chronic Infections (PCCI), Montpellier-France; Medical Pharmacology, and toxicology department Montpellier University, School of Pharmacy Montpellier- France
| |
Collapse
|
7
|
Sutton-Klein J, Moody A, Hamilton I, Mindell JS. Associations between indoor temperature, self-rated health and socioeconomic position in a cross-sectional study of adults in England. BMJ Open 2021; 11:e038500. [PMID: 33622938 PMCID: PMC7907859 DOI: 10.1136/bmjopen-2020-038500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 12/22/2020] [Accepted: 01/07/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE Excess winter deaths are a major public health concern in England and Wales, with an average of 20 000 deaths per year since 2010. Feeling cold at home during winter is associated with reporting poor general health; cold and damp homes have greater prevalence in lower socioeconomic groups. Overheating in the summer also has adverse health consequences. This study evaluates the association between indoor temperature and general health and the extent to which this is affected by socioeconomic and household factors. DESIGN Cross-sectional study. SETTING England. PARTICIPANTS Secondary data of 74 736 individuals living in England that took part in the Health Survey for England (HSE) between 2003 and 2014. The HSE is an annual household survey which uses multilevel stratification to select a new, nationally representative sample each year. The study sample comprised adults who had a nurse visit; the analytical sample was adults who had observations for indoor temperature and self-rated health. RESULTS Using both logistic and linear regression models to examine indoor temperature and health status, adjusting for socioeconomic and housing factors, the study found an association between poor health and higher indoor temperatures. Each one degree increase in indoor temperature was associated with a 1.4% (95% CI 0.5% to 2.3%) increase in the odds of poor health. After adjusting for income, education, employment type, household size and home ownership, the OR of poor health for each degree temperature rise increased by 19%, to a 1.7% (95% CI 0.7% to 2.6%) increase in odds of poor health with each degree temperature rise. CONCLUSION People with worse self-reported health had higher indoor temperatures after adjusting for household factors. People with worse health may have chosen to maintain warmer environments or been advised to. However, other latent factors, such as housing type and energy performance could have an effect.
Collapse
|
8
|
Mohan G. The impact of household energy poverty on the mental health of parents of young children. J Public Health (Oxf) 2021; 44:121-128. [PMID: 33532829 DOI: 10.1093/pubmed/fdaa260] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2019] [Revised: 09/11/2020] [Accepted: 12/14/2020] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Energy poverty, typified by cold homes and/or an inability affording energy bills, presents risks to the mental health of occupants. Parents of young children may be especially susceptible to a mental health toll from energy poverty since they have a significant care obligation and spend much of their day at home. METHODS Data from the Growing Up in Ireland study inform this longitudinal analysis. RESULTS A 1.64 greater odds of maternal depression were estimated for households containing young children characterized by energy poverty [P = 0.000; 95% confidence interval (CI): 1.31-2.05]. For energy poor households with older children (9 years and above), the odds of maternal depression were also higher [odds ratio (OR) 1.74, P = 0.001; 95% CI: 1.27-2.39]. Fathers of young children had greater odds of depression in energy poor households (OR 1.59, P = 0.002; 95% CI: 1.19-2.12), though the deleterious effect on mental health was not statistically significant for fathers of older children. CONCLUSIONS Energy poverty increases the likelihood of depression in parents. These findings merit policy attention since a mental health burden is in itself important, and more widely, parental well-being can influence child development and outcomes.
Collapse
Affiliation(s)
- G Mohan
- Economic and Social Research Institute, Whitaker Square, Sir John Rogerson's Quay, Dublin 2, D02 K138, Ireland.,The Irish Longitudinal Study on Ageing, Lincoln Gate, Trinity College, Dublin 2, D02 PN40, Ireland
| |
Collapse
|
9
|
Qiu QW, Li J, Li JY, Xu Y. Built form and depression among the Chinese rural elderly: a cross-sectional study. BMJ Open 2020; 10:e038572. [PMID: 33303439 PMCID: PMC7733171 DOI: 10.1136/bmjopen-2020-038572] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 11/11/2020] [Accepted: 11/29/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Few data on the association between housing structure and depression among rural elders in China are available. We examined the impact of built forms on depression. DESIGN This is a cross-sectional study. SETTING A representative sample of rural residents aged 60 years or older in China. PARTICIPANTS A total of 5090 older adults in 2019 in rural Suzhou, China. OUTCOME MEASURES Associations of built form with odds of probable and possible depression. RESULTS There was significant difference among elders living in varied sizes of house. Older age (vs 60-64 years: 75-79 years AdjOR, 1.737; 95% CI, 1.309 to 2.305; ≥80 years AdjOR, 2.072; 95% CI, 1.439 to 2.981), male sex (AdjOR, 0.719; 95% CI, 0.593 to 0.871), single (AdjOR, 1.303; 95% CI, 1.032 to 1.646), self-care disability (AdjOR, 4.761; 95% CI, 3.960 to 5.724), three or more chronic diseases (AdjOR, 2.200; 95% CI, 1.657 to 2.920), living alone (AdjOR, 1.443; 95% CI, 1.059 to 1.966), living in cottage (AdjOR, 1.426; 95% CI, 1.033 to 1.967), living space (vs <50 m2: 201-250 m2 AdjOR, 0.566; 95% CI, 0.359 to 0.893; >250 m2 AdjOR, 0.337; 95% CI, 0.223 to 0.511) and space per person (vs <30 m2: 30- m2 AdjOR, 0.502; 95% CI, 0.362 to 0.697; 40- m2 AdjOR, 0.473; 95% CI, 0.347 to 0.646; 50- m2 AdjOR, 0.418; 95% CI, 0.339 to 0.515) were associated with risk of depression among Chinese rural elders. CONCLUSION The built form was significantly and meaningfully associated with depression among Chinese rural elders. More attention should be paid to preventing mental illness among the rural elderly living in the small housing area and cottages in China.
Collapse
Affiliation(s)
- Qin-Wei Qiu
- School of Public Health, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Jing Li
- School of Public Health, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Jia-Yu Li
- School of Public Health, Soochow University Medical College, Suzhou, Jiangsu, China
| | - Yong Xu
- School of Public Health, Soochow University Medical College, Suzhou, Jiangsu, China
| |
Collapse
|
10
|
Climate Change Mitigation Policies Targeting Households and Addressing Energy Poverty in European Union. ENERGIES 2020. [DOI: 10.3390/en13133389] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Climate change mitigation measures linked to households’ energy consumption have huge greenhouse gases (GHG) emission reduction potential and positive impact on energy poverty reduction. However, measures such as renovation of residential buildings or installation of micro generation technologies based on renewable energy sources have not realized their full energy saving and GHG emission reduction potentials, due to the energy efficiency paradox and other barriers. These climate change mitigation policies targeting the households’ sector can deliver extra benefits such as energy poverty reduction and implementation of the energy justice principle; therefore, they require more attention of scholars and policy makers. The aim of this paper is to analyze the energy poverty and climate change mitigation issues in EU households based on a systematic literature review, and to provide future research paths and policy recommendations. Based on the systematic literature review, this paper develops an integrated framework for addressing energy poverty, just carbon free energy transition and climate change mitigation issues in the EU. Additionally, we argue that more targeted climate change policies and measures are necessary in the light of the shortcomings of current measures to reduce energy poverty and realize climate change mitigation potential linked to energy consumption in households.
Collapse
|
11
|
Jessel S, Sawyer S, Hernández D. Energy, Poverty, and Health in Climate Change: A Comprehensive Review of an Emerging Literature. Front Public Health 2019; 7:357. [PMID: 31921733 PMCID: PMC6920209 DOI: 10.3389/fpubh.2019.00357] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Accepted: 11/11/2019] [Indexed: 11/25/2022] Open
Abstract
Household energy is increasingly vital for maintaining good health. Unaffordable and inadequate household energy presents adverse consequences that are amplified by poverty and a changing climate. To date, the connections between energy, socioeconomic disadvantage, and well-being are generally underappreciated, and household energy connection with climate change is under-researched. Building on the energy insecurity framework, this review explores literature related to household energy, poverty, and health in order to highlight the disproportionate burdens borne by vulnerable populations in adequately meeting household energy needs. This paper is based on a comprehensive review of books, peer-reviewed articles, and reports published between 1990 and 2019, identified via databases including JSTOR and PubMed. A total of 406 publications were selected as having potential for full review, 203 received full review, and 162 were included in this paper on the basis of set inclusion criteria. From the literature review, we created an original heuristic model that describes energy insecurity as either acute or chronic, and we further explore the mediators and pathways that link energy insecurity to health. In the discussion, we posit that the extant literature does not sufficiently consider that vulnerable communities often experience energy insecurity bundled with other hardships. We also discuss energy, poverty, and health through the lens of climate change, making the criticism that most research on household energy does not consider climate change. This evidence is important for enhancing research in this field and developing programmatic and policy interventions as they pertain to energy access, affordability, and health, with special emphasis on vulnerable populations, climate change, and social inequality.
Collapse
Affiliation(s)
- Sonal Jessel
- Helibrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Samantha Sawyer
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| | - Diana Hernández
- Department of Sociomedical Sciences, Columbia University Mailman School of Public Health, New York, NY, United States
| |
Collapse
|
12
|
Solet JL, Raherison-Semjen C, Mariotti E, Le Strat Y, Gallay A, Bertrand E, Jahaly N, Filleul L. A cross sectional survey to estimate prevalence and associated factors of asthma on Reunion Island, Indian Ocean. BMC Public Health 2019; 19:663. [PMID: 31146713 PMCID: PMC6543663 DOI: 10.1186/s12889-019-7031-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Accepted: 05/22/2019] [Indexed: 12/17/2022] Open
Abstract
Background Previous studies on asthma mortality and hospitalizations in Reunion Island indicate that this French territory is particularly affected by this pathology. Epidemiological studies conducted in schools also show higher prevalence rates in Reunion than in Mainland France. However, no estimates are provided on the prevalence of asthma among adults. In 2016, a cross-sectional survey was conducted to estimate the prevalence of asthma and to identify its associated factors in the adult population of Reunion Island. Methods A random sample of 2419 individuals, aged 18–44 years, was interviewed by telephone using a standardized, nationally validated questionnaire. Information was collected on the respiratory symptoms, description of asthma attacks and triggering factors for declared asthmatics, as well as data on the indoor and outdoor home environment. “Current asthma” was defined as an individual declaring, at the time of the survey, having already suffered from asthma at some point during his/her life, whose asthma was confirmed by a doctor, and who had experienced an asthma attack in the last 12 months or had been treated for asthma in the last 12 months. “Current suspected asthma” was defined as an individual presenting, in the 12 months preceding the study, groups of symptoms suggestive of asthma consistent with the literature. Results The estimated prevalence of asthma was 5.4% [4.3–6.5]. After adjustment, women, obesity, a family member with asthma, tenure in current residence and presence of indoor home heating were associated with asthma. The prevalence of symptoms suggestive of asthma was 12.0% [10.2–13.8]. After adjustment, marital status, passive smoking, use of insecticide sprays, presence of mold in the home and external sources of atmospheric nuisance were associated with the prevalence of suspected asthma. Conclusion Preventive actions including asthma diagnosis, promotion of individual measures to reduce risk exposure as well as the development of study to improve knowledge on indoor air allergens are recommended.
Collapse
Affiliation(s)
- J-L Solet
- Santé Publique France [The French Public Health Agency], Indian Ocean Regional Office, Saint-Denis, Reunion, France.
| | - C Raherison-Semjen
- Inserm U219, Institute of Public Health, Epidemiology, and Development (ISPED), Bordeaux University, Bordeaux, France
| | - E Mariotti
- Agence de santé océan Indien [Indian Ocean Health Agency], Saint-Denis, Reunion, France
| | - Y Le Strat
- Santé publique France, [The French Public Health Agency], Saint-Maurice, France
| | - A Gallay
- Santé publique France, [The French Public Health Agency], Saint-Maurice, France
| | - E Bertrand
- Bureau d'études Synthèses [Synthesis analysis office], Saint-Denis, Réunion, France
| | - N Jahaly
- Syntheses Mauritius LTD, Quatre Bornes, Mauritius
| | - L Filleul
- Santé Publique France [The French Public Health Agency], Indian Ocean Regional Office, Saint-Denis, Reunion, France
| |
Collapse
|
13
|
Clair A, Hughes A. Housing and health: new evidence using biomarker data. J Epidemiol Community Health 2019; 73:256-262. [PMID: 30642891 PMCID: PMC6580751 DOI: 10.1136/jech-2018-211431] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/26/2018] [Accepted: 11/25/2018] [Indexed: 11/24/2022]
Abstract
Background The link between housing and health is well established and long-standing, however much of the evidence relies on self-reported health measures. While these are useful, the availability of biomarker data allows us to add to this evidence using objective indicators of health. Methods In this paper, we use C-reactive protein (CRP), a biomarker associated with infection and stress, alongside information relating to housing details, demographic characteristics and health behaviours taken from the UK Household Longitudinal Study. Hierarchical linear regression models estimate CRP for individual housing characteristics, and all available housing characteristics, controlling for confounders. Results Results indicate that housing tenure, type, cost burden and desire to stay in current home are associated with CRP. Private renters have significantly higher (worse) CRP than owners with a mortgage. In terms of housing type, respondents living in detached homes had lower CRP than those in semidetached or terraced houses, or those living in flats. Housing cost burden is associated with lower CRP, although further analysis indicates that this is the case only for low-income renters. Desire to stay in current home is significantly associated with higher CRP. Conclusions A number of housing characteristics were associated with CRP. These results further support an important role for housing in health.
Collapse
Affiliation(s)
- Amy Clair
- ESRC Research Centre on Micro-Social Change, Institute for Social and Economic Research, University of Essex, Colchester, UK
| | - Amanda Hughes
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
14
|
Rodgers SE, Bailey R, Johnson R, Poortinga W, Smith R, Berridge D, Anderson P, Phillips C, Lannon S, Jones N, Dunstan FD, Morgan J, Evans SY, Every P, Lyons RA. Health impact, and economic value, of meeting housing quality standards: a retrospective longitudinal data linkage study. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06080] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundPoor-quality housing adversely affects residents’ health but there is a paucity of high-quality evidence to support this.ObjectiveThis research investigated the health impact of bringing housing to a national quality standard.DesignA natural experiment of improvements to housing quality analysed using repeated measures of health-care utilisation and economic outcomes at an individual person level.SettingCarmarthenshire, UK.ParticipantsA total of 32,009 residents registered for a minimum of 60 days at 8558 social homes that received housing improvements between January 2005 and March 2015.InterventionsMultiple internal and external housing improvements, including wall and loft insulation, windows and doors, heating system upgrades, new kitchens and bathrooms, garden path safety improvements and electrical system upgrades (adding power sockets, and extractor fans in kitchens and bathrooms).Main outcome measuresEmergency hospital admissions for cardiorespiratory conditions and injuries. Primary health-care utilisation for respiratory and common mental health disorders, emergency department injury attendances and health-care utilisation costs.Data sourcesCarmarthenshire County Council home address and intervention records were anonymously linked within the Secure Anonymous Information Linkage databank to demographic information from the Welsh Demographic Service data set; hospital admission data from the Patient Episode Dataset for Wales; primary care contacts and prescribed medications from general practice data; emergency department attendances from the Emergency Department Data Set; and deaths from the Office for National Statistics mortality register.MethodsThe study used a longitudinal panel design to examine changes in standard of eight housing cointervention from intervention records, and linked to individuals registered at intervention homes. Health outcomes were obtained retrospectively for each individual in a dynamic cohort and were captured for up to 123 consecutive months. An additional local authority region could not be utilised as a comparator owing to different reporting pressures resulting in the recording of a different intervention. The exposure group for each cointervention was compared with an internal reference group of people living in homes that did not receive the cointervention during their tenancy. A multilevel modelling approach was used to account for repeated observations for individuals living in intervention homes. Counts of health outcomes were analysed using negative binomial regression models to determine the effect of each cointervention that reached housing quality standards during an individual’s period of tenancy, compared with those living in properties that did not. We adjusted for potential confounding factors and for background trends in the regional general population. A cost–consequences analysis was conducted as part of the health economic evaluation.ResultsResidents aged ≥ 60 years living in homes in which electrical systems were upgraded were associated with 39% fewer admissions than those living in homes in which they were not [incidence rate ratio (IRR) 0.61, 95% confidence interval (CI) 0.53 to 0.72;p < 0.01]. Reduced admissions were also associated with windows and doors (IRR 0.71, 95% CI 0.63 to 0.81;p < 0.01), wall insulation (IRR 0.75, 95% CI 0.67 to 0.84;p < 0.01) and gardens and estates (IRR 0.73, 95% CI 0.64 to 0.83;p < 0.01) for those living in homes in which these cointervention were upgraded. There were no associations of change in emergency admissions with upgrading heating (IRR 0.91, 95% CI 0.82 to 1.01;p = 0.072), loft insulation (IRR 0.98, 95% CI 0.86 to 1.11;p = 0.695), kitchens (IRR 0.98, 95% CI 0.83 to 1.17;p = 0.843) or bathrooms (IRR 0.93, 95% CI 0.81 to 1.06;p = 0.287).LimitationsThere was no randomisation, there were incomplete data on the scale of the intervention for individual households and there were no estimates for the impact of the whole programme.ConclusionsThis complex interdisciplinary study found that hospital admissions could be avoided through improving housing quality standards.Future workAt their initiation, future non-health projects should have a built-in evaluation to allow intervention exposures to be randomly allocated to residents, with the simultaneous analysis of multiple health outcomes in one statistical model.FundingThe National Institute for Health Research Public Health Research programme.
Collapse
Affiliation(s)
- Sarah E Rodgers
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rowena Bailey
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Rhodri Johnson
- Swansea University Medical School, Swansea University, Swansea, UK
| | | | - Robert Smith
- School of Geography and Planning, Cardiff University, Cardiff, UK
| | - Damon Berridge
- Swansea University Medical School, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Ceri Phillips
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Simon Lannon
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Nikki Jones
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Frank D Dunstan
- Cochrane Institute of Primary Care and Public Health, School of Medicine, Cardiff University, Cardiff, UK
| | | | | | - Pam Every
- Tenant Participation Advisory Services of Wales (TPAS Cymru), Cardiff, UK
| | - Ronan A Lyons
- Swansea University Medical School, Swansea University, Swansea, UK
| |
Collapse
|
15
|
Should We Play Games Where Energy Is Concerned? Perceptions of Serious Gaming as a Technology to Motivate Energy Behaviour Change among Social Housing Residents. SUSTAINABILITY 2018. [DOI: 10.3390/su10061729] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
|
16
|
Poortinga W, Rodgers SE, Lyons RA, Anderson P, Tweed C, Grey C, Jiang S, Johnson R, Watkins A, Winfield TG. The health impacts of energy performance investments in low-income areas: a mixed-methods approach. PUBLIC HEALTH RESEARCH 2018. [DOI: 10.3310/phr06050] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundCold homes and fuel poverty contribute to health inequalities in ways that could be addressed through energy efficiency interventions.ObjectivesTo determine the health and psychosocial impacts of energy performance investments in low-income areas, particularly hospital admissions for cardiorespiratory conditions, prevalence of respiratory symptoms and mental health status, hydrothermal conditions and household energy use, psychosocial outcomes, cost consequences to the health system and the cost utility of these investments.DesignA mixed-methods study comprising data linkage (25,908 individuals living in 4968 intervention homes), a field study with a controlled pre-/post-test design (intervention,n = 418; control,n = 418), a controlled multilevel interrupted time series analysis of internal hydrothermal conditions (intervention,n = 48; control,n = 40) and a health economic assessment.SettingLow-income areas across Wales.ParticipantsResidents who received energy efficiency measures through the intervention programme and matched control groups.Main outcome measuresPrimary outcomes – emergency hospital admissions for cardiorespiratory conditions, self-reported respiratory symptoms, mental health status, indoor air temperature and indoor relative humidity. Secondary outcomes – emergency hospital admissions for chronic obstructive pulmonary disease-related cardiorespiratory conditions, excess winter admissions, health-related quality of life, subjective well-being, self-reported fuel poverty, financial stress and difficulties, food security, social interaction, thermal satisfaction and self-reported housing conditions.MethodsAnonymously linked individual health records for emergency hospital admissions were analysed using mixed multilevel linear models. A quasi-experimental controlled field study used a multilevel repeated measures approach. Controlled multilevel interrupted time series analyses were conducted to estimate changes in internal hydrothermal conditions following the intervention. The economic evaluation comprised cost–consequence and cost–utility analyses.Data sourcesThe Patient Episode Database for Wales 2005–14, intervention records from 28 local authorities and housing associations, and scheme managers who delivered the programme.ResultsThe study found no evidence of changes in physical health. However, there were improvements in subjective well-being and a number of psychosocial outcomes. The household monitoring study found that the intervention raised indoor temperature and helped reduce energy use. No evidence was found of substantial increases in indoor humidity levels. The health economic assessment found no explicit cost reductions to the health service as a result of non-significant changes in emergency admissions for cardiorespiratory conditions.LimitationsThis was a non-randomised intervention study with household monitoring and field studies that relied on self-response. Data linkage focused on emergency admissions only.ConclusionAlthough there was no evidence that energy performance investments provide physical health benefits or reduce health service usage, there was evidence that they improve social and economic conditions that are conducive to better health and improved subjective well-being. The intervention has been successful in reducing energy use and improving the living conditions of households in low-income areas. The lack of association of emergency hospital admissions with energy performance investments means that we were unable to evidence cost saving to health-service providers.Future workOur research suggests the importance of incorporating evaluations with follow-up into intervention research from the start.FundingThe National Institute for Health Research Public Health Research programme.
Collapse
Affiliation(s)
| | - Sarah E Rodgers
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Ronan A Lyons
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Pippa Anderson
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| | - Chris Tweed
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Charlotte Grey
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Shiyu Jiang
- Welsh School of Architecture, Cardiff University, Cardiff, UK
| | - Rhodri Johnson
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Alan Watkins
- Farr Institute, College of Medicine, Swansea University, Swansea, UK
| | - Thomas G Winfield
- Swansea Centre for Health Economics, College of Human and Health Sciences, Swansea University, Swansea, UK
| |
Collapse
|
17
|
Is Housing a Health Insult? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2017; 14:ijerph14060567. [PMID: 28587139 PMCID: PMC5486253 DOI: 10.3390/ijerph14060567] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Revised: 05/12/2017] [Accepted: 05/19/2017] [Indexed: 11/24/2022]
Abstract
In seeking to understand the relationship between housing and health, research attention is often focussed on separate components of people’s whole housing ‘bundles’. We propose in this paper that such conceptual and methodological abstraction of elements of the housing and health relationship limits our ability to understand the scale of the accumulated effect of housing on health and thereby contributes to the under-recognition of adequate housing as a social policy tool and powerful health intervention. In this paper, we propose and describe an index to capture the means by which housing bundles influence health. We conceptualise the index as reflecting accumulated housing “insults to health”—an Index of Housing Insults (IHI). We apply the index to a sample of 1000 low-income households in Australia. The analysis shows a graded association between housing insults and health on all outcome measures. Further, after controlling for possible confounders, the IHI is shown to provide additional predictive power to the explanation of levels of mental health, general health and clinical depression beyond more traditional proxy measures. Overall, this paper reinforces the need to look not just at separate housing components but to embrace a broader understanding of the relationship between housing and health.
Collapse
|
18
|
City scale climate change policies: Do they matter for wellbeing? Prev Med Rep 2017; 6:265-270. [PMID: 28409088 PMCID: PMC5385580 DOI: 10.1016/j.pmedr.2017.03.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2016] [Revised: 03/23/2017] [Accepted: 03/27/2017] [Indexed: 11/24/2022] Open
Abstract
Climate change mitigation policies aim to reduce climate change through reducing greenhouse gas (GHG) emissions whereas adaption policies seek to enable humans to live in a world with increasingly variable and more extreme climatic conditions. It is increasingly realised that enacting such policies will have unintended implications for public health, but there has been less focus on their implications for wellbeing. Wellbeing can be defined as a positive mental state which is influenced by living conditions. As part of URGENCHE, an EU funded project to identify health and wellbeing outcomes of city greenhouse gas emission reduction policies, a survey designed to measure these living conditions and levels of wellbeing in Kuopio, Finland was collected in December 2013. Kuopio was the northmost among seven cities in Europe and China studied. Generalised estimating equation modelling was used to determine which living conditions were associated with subjective wellbeing (measured through the WHO-5 Scale). Local greenspace and spending time in nature were associated with higher levels of wellbeing whereas cold housing and poor quality indoor air were associated with lower levels of wellbeing. Thus adaption policies to increase greenspace might, in addition to reducing heat island effects, have the co-benefit of increasing wellbeing and improving housing insulation. Climate change policies may change wellbeing-associated living conditions in a city. Local greenspace and nature immersion associated with higher levels of wellbeing. Climate change adaption policy to increase greenspace may increase wellbeing. Housing which is cold or has low quality indoor air associated with lower wellbeing. A housing insulation policy may increase wellbeing if ventilation is adequate.
Collapse
|
19
|
Bachelder AE, Stewart MK, Felix HC, Sealy N. Health Complaints Associated with Poor Rental Housing Conditions in Arkansas: The Only State without a Landlord's Implied Warranty of Habitability. Front Public Health 2016; 4:263. [PMID: 27933288 PMCID: PMC5120100 DOI: 10.3389/fpubh.2016.00263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/09/2016] [Indexed: 11/30/2022] Open
Abstract
Arkansas is the only U.S. state that does not have a landlord's implied warranty of habitability, meaning tenants have a requirement for maintaining their rental properties at certain habitability standards, but landlords are not legally required to contribute to those minimum health and safety standards. This project assessed the possibility that this lack of landlord responsibility affects tenants' perceived health. Using surveys and interviews, we collected self-reported data on the prevalence and description of problems faced by renters who needed household repairs from their landlords. Of almost 1,000 renters, one-third of them had experienced a problem with their landlord making needed repairs; and one-quarter of those had a health issue they attributed to their housing conditions. Common issues included problems with plumbing, heating, or cooling systems, and pest or rodent control. Reported health problems included elevated stress levels, breathing problems, headaches, high blood pressure, and bites or infections. Hispanic respondents and those with less than a high school education were both significantly more likely to report problems with their landlords not making repairs as requested. These data suggest that the lack of landlord requirements may negatively impact the condition of rental properties and, therefore, may negatively impact the health of Arkansas renters.
Collapse
Affiliation(s)
- Ashley E. Bachelder
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - M. Kate Stewart
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - Neil Sealy
- Arkansas Community Institute, Little Rock, AR, USA
| |
Collapse
|
20
|
Exploring the Housing and Household Energy Pathways to Stress: A Mixed Methods Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2016; 13:ijerph13090916. [PMID: 27649222 PMCID: PMC5036749 DOI: 10.3390/ijerph13090916] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/08/2016] [Revised: 08/14/2016] [Accepted: 08/22/2016] [Indexed: 11/25/2022]
Abstract
Chronic stress, known to contribute to negative physical and mental health outcomes, is closely associated with broader issues of material hardship, poor neighborhood conditions, residential instability, and inadequate housing conditions. However, few studies have comprehensively explored pathways to stress in a low-income housing environment. A mixed-methods pilot study investigated the concept of energy insecurity by looking at the impacts of weatherization and energy efficiency interventions on low-income households in the South Bronx neighborhood of New York City. In-depth interviews were conducted with 20 low-income heads of household; participants also completed health, housing and budget assessments. Physical deficiencies, economic hardship, and health issues all interacted to directly and indirectly produce living conditions that contribute to chronic stress. Households with higher stress reported more health problems. Poor quality housing led to coping responses that increased expenses, which in turn increased stress around housing and energy affordability. This study provides further support for the connections between both health and the built environment and between low socio-economic status populations and net negative health outcomes. Energy insecurity is an important contributor to chronic stress in low-income households, and isolating pathways to stress where there is potential for interventions is important for future policy and housing-based strategies.
Collapse
|
21
|
Baker E, Lester LH, Bentley R, Beer A. Poor housing quality: Prevalence and health effects. J Prev Interv Community 2016; 44:219-232. [DOI: 10.1080/10852352.2016.1197714] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
|
22
|
Kavanagh AM, Aitken Z, Baker E, LaMontagne AD, Milner A, Bentley R. Housing tenure and affordability and mental health following disability acquisition in adulthood. Soc Sci Med 2016; 151:225-32. [DOI: 10.1016/j.socscimed.2016.01.010] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2015] [Revised: 10/19/2015] [Accepted: 01/07/2016] [Indexed: 11/29/2022]
|
23
|
Gruenberg DA, Wright RJ, Visness CM, Jaffee KF, Bloomberg GR, Cruikshank WW, Kattan M, Sandel MT, Wood RA, Gern JE. Relation between stress and cytokine responses in inner-city mothers. Ann Allergy Asthma Immunol 2015; 115:439-445.e3. [PMID: 26409873 PMCID: PMC4814156 DOI: 10.1016/j.anai.2015.07.021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2015] [Revised: 07/08/2015] [Accepted: 07/24/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND Women in poor urban neighborhoods have high rates of stress and allergic diseases, but whether stress or stress correlates such as depression promote inflammatory and type 2 cytokine responses is unknown. OBJECTIVE To examine associations among external stressors, perceived stress, depression, and peripheral blood mononuclear cell cytokine responses of mothers enrolled in the Urban Environment and Childhood Asthma Study and test the hypothesis that stress would be positively associated with type 2 and selected proinflammatory (tumor necrosis factor-α and interleukin-8) responses. METHODS Questionnaire data from mothers living in 4 inner cities included information about external stress, stress perception, and depression. The external stress domains (interpersonal problems, housing, and neighborhood stress) were combined into a Composite Stressor score. Peripheral blood mononuclear cells were stimulated ex vivo and cytokine responses to innate, adaptive, and polyclonal immune stimuli were compared with stress and depression scores for 469 of the 606 study participants. RESULTS There were no significant positive associations between Composite Stressor scores, perceived stress, or depression scores and proinflammatory or type 2 cytokine responses, and these findings were not modified by allergy or asthma status. There were some modest associations with individual stressors and cytokine responses, but no consistent relations were noted. Depression was associated with decreased responses to some stimuli, particularly dust mite. CONCLUSION Composite measurements of stressors, perceived stress, or depression were not positively related to proinflammatory or type 2 cytokine responses in these young urban women. These data do not support the hypothesis that these factors promote cytokine responses associated with allergy. TRIAL REGISTRATION ClinicalTrials.gov, identifier NCT00114881.
Collapse
Affiliation(s)
| | | | | | - Katy F Jaffee
- Rho Federal Systems Division, Inc., Chapel Hill, North Carolina
| | | | | | - Meyer Kattan
- Columbia University College of Physicians and Surgeons, New York, New York
| | | | - Robert A Wood
- Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - James E Gern
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| |
Collapse
|
24
|
Landrine H, Corral I. Advancing research on racial-ethnic health disparities: improving measurement equivalence in studies with diverse samples. Front Public Health 2014; 2:282. [PMID: 25566524 PMCID: PMC4273553 DOI: 10.3389/fpubh.2014.00282] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2014] [Accepted: 12/04/2014] [Indexed: 11/24/2022] Open
Abstract
To conduct meaningful, epidemiologic research on racial-ethnic health disparities, racial-ethnic samples must be rendered equivalent on other social status and contextual variables via statistical controls of those extraneous factors. The racial-ethnic groups must also be equally familiar with and have similar responses to the methods and measures used to collect health data, must have equal opportunity to participate in the research, and must be equally representative of their respective populations. In the absence of such measurement equivalence, studies of racial-ethnic health disparities are confounded by a plethora of unmeasured, uncontrolled correlates of race-ethnicity. Those correlates render the samples, methods, and measures incomparable across racial-ethnic groups, and diminish the ability to attribute health differences discovered to race-ethnicity vs. to its correlates. This paper reviews the non-equivalent yet normative samples, methodologies and measures used in epidemiologic studies of racial-ethnic health disparities, and provides concrete suggestions for improving sample, method, and scalar measurement equivalence.
Collapse
Affiliation(s)
- Hope Landrine
- Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| | - Irma Corral
- Department of Psychiatry and Behavioral Medicine, Brody School of Medicine, East Carolina University, Greenville, NC, USA
| |
Collapse
|
25
|
Hiscock R, Mudu P, Braubach M, Martuzzi M, Perez L, Sabel C. Wellbeing impacts of city policies for reducing greenhouse gas emissions. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:12312-45. [PMID: 25464129 PMCID: PMC4276616 DOI: 10.3390/ijerph111212312] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/13/2014] [Revised: 11/11/2014] [Accepted: 11/12/2014] [Indexed: 12/23/2022]
Abstract
To mitigate climate change, city authorities are developing policies in areas such as transportation, housing and energy use, to reduce greenhouse gas emissions. In addition to their effects on greenhouse gas emissions, these policies are likely to have consequences for the wellbeing of their populations for example through changes in opportunities to take physical exercise. In order to explore the potential consequences for wellbeing, we first explore what ‘wellbeing’ is and how it can be operationalized for urban planners. In this paper, we illustrate how wellbeing can be divided into objective and subjective aspects which can be measured quantitatively; our review of measures informs the development of a theoretical model linking wellbeing to policies which cities use to reduce greenhouse gas emissions. Finally, we discuss the extent to which the links proposed in the conceptual model are supported by the literature and how cities can assess wellbeing implications of policies.
Collapse
Affiliation(s)
- Rosemary Hiscock
- School of Geographical Sciences, University of Bristol, University Road, Clifton, Bristol BS8 1SS, UK.
| | - Pierpaolo Mudu
- Bonn Office, WHO European Centre for Environment and Health, Platz der Vereinten Nationen 1, 53113 Bonn, Germany.
| | - Matthias Braubach
- Bonn Office, WHO European Centre for Environment and Health, Platz der Vereinten Nationen 1, 53113 Bonn, Germany.
| | - Marco Martuzzi
- Bonn Office, WHO European Centre for Environment and Health, Platz der Vereinten Nationen 1, 53113 Bonn, Germany.
| | - Laura Perez
- Swiss Tropical and Public Health Institute, Socinstr. 57, Basel 4051, Switzerland.
| | - Clive Sabel
- School of Geographical Sciences, University of Bristol, University Road, Clifton, Bristol BS8 1SS, UK.
| |
Collapse
|
26
|
Mason KE, Baker E, Blakely T, Bentley RJ. Housing affordability and mental health: does the relationship differ for renters and home purchasers? Soc Sci Med 2013; 94:91-7. [PMID: 23931950 DOI: 10.1016/j.socscimed.2013.06.023] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2012] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 01/05/2023]
Abstract
There is increasing evidence of a direct association between unaffordable housing and poor mental health, over and above the effects of general financial hardship. Type of housing tenure may be an important factor in determining how individuals experience and respond to housing affordability problems. This study investigated whether a relationship exists between unaffordable housing and mental health that differs for home purchasers and private renters among low-income households. Data from 2001 to 2010 of the longitudinal Household, Income and Labour Dynamics in Australia (HILDA) survey were analysed using fixed-effects linear regression to examine change in the SF-36 Mental Component Summary (MCS) score of individuals aged 25-64 years, associated with changes in housing affordability, testing for an interaction with housing tenure type. After adjusting for age, survey year and household income, among individuals living in households in the lower 40% of the national income distribution, private renters in unaffordable housing experienced somewhat poorer in mental health than when their housing was affordable (difference in MCS = -1.18 or about 20% of one S.D. of the MCS score; 95% CI: -1.95,-0.41; p = 0.003) while home purchasers experienced no difference on average. The statistical evidence for housing tenure modifying the association between unaffordable housing and mental health was moderate (p = 0.058). When alternatives to 40% were considered as income cut-offs for inclusion in the sample, evidence of a difference between renters and home purchasers was stronger amongst households in the lowest 50% of the income distribution (p = 0.020), and between the 30th and 50th percentile (p = 0.045), with renters consistently experiencing a decline in mental health while mean MCS scores of home purchasers did not change. In this study, private renters appeared to be more vulnerable than home purchasers to mental health effects of unaffordable housing. Such a modified effect suggests that tenure-differentiated policy responses to poor housing affordability may be appropriate.
Collapse
Affiliation(s)
- Kate E Mason
- Centre for Women's Health, Gender & Society, Melbourne School of Population Health, University of Melbourne, Melbourne, VIC 3010, Australia.
| | | | | | | |
Collapse
|
27
|
|
28
|
Viggers H, Howden-Chapman P, Ingham T, Chapman R, Pene G, Davies C, Currie A, Pierse N, Wilson H, Zhang J, Baker M, Crane J. Warm homes for older people: aims and methods of a randomised community-based trial for people with COPD. BMC Public Health 2013; 13:176. [PMID: 23442368 PMCID: PMC3608967 DOI: 10.1186/1471-2458-13-176] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2012] [Accepted: 02/05/2013] [Indexed: 11/16/2022] Open
Abstract
Background Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether a NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial. Methods Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants’ houses were retrofitted with insulation. After baseline data were received, participants were randomised to either ‘early’ or ‘late’ intervention groups. The intervention was a voucher of $500 directly credited to the participants’ electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers. Discussion This community trial has successfully enrolled 522 older people with COPD. Baseline data showed that, despite having a chronic respiratory illness, participants are frequently cold in their houses and economise on heating. Trial Registration The clinical trial registration is http://NCT01627418
Collapse
Affiliation(s)
- Helen Viggers
- He Kainga Oranga/Housing and Health Research Programme, University of Otago, PO Box 7343, Wellington, Wellington South, New Zealand.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
29
|
Hernández D. Energy insecurity: a framework for understanding energy, the built environment, and health among vulnerable populations in the context of climate change. Am J Public Health 2013; 103:e32-4. [PMID: 23409876 DOI: 10.2105/ajph.2012.301179] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
30
|
Stanković A, Nikolić M, Arandelović M. Exposure to environmental tobacco smoke and absence from work in women in Nis, Serbia. Cent Eur J Public Health 2012; 20:24-8. [PMID: 22571012 DOI: 10.21101/cejph.a3701] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Exposure to environmental tobacco smoke leads to very serious health effects, especially on the respiratory system. The objective of this paper was to estimate the influence of passive smoking on absence from work because of respiratory problems in women. The study sample consisted of 497 women aged 40-56 who live in an area with identical outdoor air pollution. Environmental tobacco smoke exposure was recorded in 346 women. Data about respiratory symptoms in women were entered into a structured questionnaire. Statistics tests showed no significant difference of living conditions, keeping pets, hereditary predisposition among women. The occurrence of congested nose (OR = 3.47; 95% Cl = 1.38-9.01), nasal secretion (OR = 3.48; 95% Cl = 1.38-9.02) and sinusitis (OR = 2.88; 95% Cl = 1.22-6.89) was significantly higher in women who were exposed to environmental tobacco smoke. Primary health care need for respiratory symptoms due to the effect of passive smoking is higher in the exposed women. Passive smoking can be a risk factor for the appearance of respiratory symptoms and illness in women that causes absence from work.
Collapse
|
31
|
Impacto de un sitio de disposición final de residuos sólidos en la salud respiratoria de los adultos mayores. BIOMEDICA 2011. [DOI: 10.7705/biomedica.v31i3.346] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
32
|
Ruel E, Oakley D, Wilson GE, Maddox R. Is public housing the cause of poor health or a safety net for the unhealthy poor? J Urban Health 2010; 87:827-38. [PMID: 20585883 PMCID: PMC2937128 DOI: 10.1007/s11524-010-9484-y] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Research has shown that public housing residents have the worst health of any population in the USA. However, it is unclear what the cause of that poor health is among this population. The purpose of this paper is to investigate the association between public housing and health conditions: specifically, we ask if residents entered public housing already ill or if public housing may cause the poor health of its residents. The data used for this study come from the GSU Urban Health Initiative, which is a prospective, mixed-methods study of seven public housing communities earmarked for demolition and relocation (N = 385). We used the pre-relocation, baseline survey. We found that, while health was not the main reason residents gave for entering public housing, the majority of public housing residents entered public housing already ill. Substandard housing conditions, long tenure in public housing, and having had a worse living situation prior to public housing were not associated with an increased risk of a health condition diagnosed after entry into public housing. Our findings suggest that public housing may have provided a safety net for the very unhealthy poor.
Collapse
Affiliation(s)
- Erin Ruel
- Georgia State University, Atlanta, GA, USA.
| | | | | | | |
Collapse
|
33
|
Wright RJ, Visness CM, Calatroni A, Grayson MH, Gold DR, Sandel MT, Lee-Parritz A, Wood RA, Kattan M, Bloomberg GR, Burger M, Togias A, Witter FR, Sperling RS, Sadovsky Y, Gern JE. Prenatal maternal stress and cord blood innate and adaptive cytokine responses in an inner-city cohort. Am J Respir Crit Care Med 2010; 182:25-33. [PMID: 20194818 DOI: 10.1164/rccm.200904-0637oc] [Citation(s) in RCA: 175] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
RATIONALE Stress-elicited disruption of immunity begins in utero. OBJECTIVES Associations among prenatal maternal stress and cord blood mononuclear cell (CBMC) cytokine responses were prospectively examined in the Urban Environment and Childhood Asthma Study (n = 557 families). METHODS Prenatal maternal stress included financial hardship, difficult life circumstances, community violence, and neighborhood/block and housing conditions. Factor analysis produced latent variables representing three contexts: individual stressors and ecological-level strains (housing problems and neighborhood problems), which were combined to create a composite cumulative stress indicator. CBMCs were incubated with innate (lipopolysaccharide, polyinosinic-polycytidylic acid, cytosine-phosphate-guanine dinucleotides, peptidoglycan) and adaptive (tetanus, dust mite, cockroach) stimuli, respiratory syncytial virus, phytohemagglutinin, or medium alone. Cytokines were measured using multiplex ELISAs. Using linear regression, associations among increasing cumulative stress and cytokine responses were examined, adjusting for sociodemographic factors, parity, season of birth, maternal asthma and steroid use, and potential pathway variables (prenatal smoking, birth weight for gestational age). MEASUREMENTS AND MAIN RESULTS Mothers were primarily minorities (Black [71%], Latino [19%]) with an income less than $15,000 (69%). Mothers with the highest cumulative stress were older and more likely to have asthma and deliver lower birth weight infants. Higher prenatal stress was related to increased IL-8 production after microbial (CpG, PIC, peptidoglycan) stimuli and increased tumor necrosis factor-alpha to microbial stimuli (CpG, PIC). In the adaptive panel, higher stress was associated with increased IL-13 after dust mite stimulation and reduced phytohemagglutinin-induced IFN-gamma. CONCLUSIONS Prenatal stress was associated with altered innate and adaptive immune responses in CBMCs. Stress-induced perinatal immunomodulation may impact the expression of allergic disease in these children.
Collapse
Affiliation(s)
- Rosalind J Wright
- The Channing Laboratory, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
34
|
Markkanen Penttinen P, Pelkonen J, Tapanainen M, Mäki-Paakkanen J, Jalava PI, Hirvonen MR. Co-cultivated damp building related microbes Streptomyces californicus and Stachybotrys chartarum induce immunotoxic and genotoxic responses via oxidative stress. Inhal Toxicol 2009; 21:857-67. [PMID: 19459771 DOI: 10.1080/08958370802526873] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Oxidative stress has been proposed to be one mechanism behind the adverse health outcomes associated with living in a damp indoor environment. In the present study, the capability of damp building-related microbes Streptomyces californicus and Stachybotrys chartarum to induce oxidative stress was evaluated in vitro. In addition, the role of oxidative stress in provoking the detected cytotoxic, genotoxic, and inflammatory responses was studied by inhibiting the production of reactive oxygen species (ROS) using N-acetyl-l-cysteine (NAC). RAW264.7 macrophages were exposed in a dose- and time-dependent manner to the spores of co-cultivated S. californicus and S. chartarum, to their separately cultivated spore-mixture, or to the spores of these microbes alone. The intracellular peroxide production and cytotoxicity were measured by flow cytometric analysis, nitric oxide production was analyzed by the Griess method, DNA damage was determined by the comet assay, and cytokine production was measured by an immunochemical ELISA (enzyme-linked immunosorbent assay). All the studied microbial exposures triggered oxidative stress and subsequent cellular damage in RAW264.7 macrophages. The ROS scavenger, NAC, prevented growth arrest, apoptosis, DNA damage, and cytokine production induced by the co-culture since it reduced the intracellular level of ROS within macrophages. In contrast, the DNA damage and cell cycle arrest induced by the spores of S. californicus alone could not be prevented by NAC. Bioaerosol-induced oxidative stress in macrophages may be an important mechanism behind the frequent respiratory symptoms and diseases suffered by residents of moisture damaged buildings. Furthermore, microbial interactions during co-cultivation stimulate the production of highly toxic compound(s) which may significantly increase oxidative damage.
Collapse
|
35
|
Wilkinson P, Smith KR, Davies M, Adair H, Armstrong BG, Barrett M, Bruce N, Haines A, Hamilton I, Oreszczyn T, Ridley I, Tonne C, Chalabi Z. Public health benefits of strategies to reduce greenhouse-gas emissions: household energy. Lancet 2009; 374:1917-29. [PMID: 19942273 DOI: 10.1016/s0140-6736(09)61713-x] [Citation(s) in RCA: 271] [Impact Index Per Article: 18.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Energy used in dwellings is an important target for actions to avert climate change. Properly designed and implemented, such actions could have major co-benefits for public health. To investigate, we examined the effect of hypothetical strategies to improve energy efficiency in UK housing stock and to introduce 150 million low-emission household cookstoves in India. Methods similar to those of WHO's Comparative Risk Assessment exercise were applied to assess the effect on health that changes in the indoor environment could have. For UK housing, the magnitude and even direction of the changes in health depended on details of the intervention, but interventions were generally beneficial for health. For a strategy of combined fabric, ventilation, fuel switching, and behavioural changes, we estimated 850 fewer disability-adjusted life-years (DALYs), and a saving of 0.6 megatonnes of carbon dioxide (CO(2)), per million population in 1 year (on the basis of calculations comparing the health of the 2010 population with and without the specified outcome measures). The cookstove programme in India showed substantial benefits for acute lower respiratory infection in children, chronic obstructive pulmonary disease, and ischaemic heart disease. Calculated on a similar basis to the UK case study, the avoided burden of these outcomes was estimated to be 12 500 fewer DALYs and a saving of 0.1-0.2 megatonnes CO(2)-equivalent per million population in 1 year, mostly in short-lived greenhouse pollutants. Household energy interventions have potential for important co-benefits in pursuit of health and climate goals.
Collapse
Affiliation(s)
- Paul Wilkinson
- London School of Hygiene and Tropical Medicine, London, UK.
| | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
36
|
Suglia SF, Franco Suglia S, Duarte CS, Sandel MT, Wright RJ. Social and environmental stressors in the home and childhood asthma. J Epidemiol Community Health 2009; 64:636-42. [PMID: 19828512 DOI: 10.1136/jech.2008.082842] [Citation(s) in RCA: 106] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Both physical environmental factors and chronic stress may independently increase susceptibility to asthma; however, little is known on how these different risks may interact. The authors examined the relationship between maternal intimate partner violence (IPV), housing quality and asthma among children in the Fragile Families and Child Wellbeing Study (N=2013). METHODS Maternal reports of IPV were obtained after the child's birth and at 12 and 36 months. At the 36-month assessment, interviewers rated indoor housing conditions, regarding housing deterioration (ie, peeling paint, holes in floor, broken windows) and housing disarray (ie, dark, cluttered, crowded or noisy house). At the same time, mothers reported on housing hardships (ie, moving repeatedly, and hardships in keeping house warm). Maternal-report of physician-diagnosed asthma by age 36 months which was active in the past year was the outcome. RESULTS Asthma was diagnosed in 10% of the children. In an adjusted analysis, an increased odds of asthma was observed in children of mothers experiencing IPV chronically (OR 1.8, 95% CI 1.0 to 3.5) and in children experiencing housing disarray (OR 1.5, 95% CI 1.1 to 2.0) compared with those not exposed to these risks. In stratified analyses, a greater effect of IPV on asthma was noted among children living in disarrayed or deteriorated housing or among children whose mothers were experiencing housing hardship. CONCLUSIONS IPV and housing disarray are associated with increased early childhood asthma. Exposure to cumulative or multiple stressors (ie, IPV and poor housing quality) may increase children's risk of developing asthma more than a single stressor.
Collapse
Affiliation(s)
- Shakira Franco Suglia
- Department of Pediatrics, Boston University School of Medicine, 88 East Newton Street, Boston, MA 02118, USA.
| | | | | | | | | |
Collapse
|
37
|
Effect of social factors on winter hospital admission for respiratory disease: a case-control study of older people in the UK. Br J Gen Pract 2008; 58:400-2. [PMID: 18505611 DOI: 10.3399/bjgp08x302682] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Every winter, hospitals in the UK and other developed countries experience a surge in respiratory admissions. Ecological studies suggest that social circumstances may be an important determinant. AIM To establish the most important factors associated with winter hospital admissions among older people presenting with acute respiratory disease, especially the relative effect of social factors. DESIGN OF STUDY case-control study. SETTING Seventy-nine general practices in central England. METHOD Of a cohort of patients consulting medical services with lower respiratory tract infection or exacerbation of chronic respiratory disease, 157 hospitalised cases were compared to 639 controls. Social, medical, and other factors were examined by interview and GP records. RESULTS Measures of material deprivation were not significant risk factors for admission at either individual or area level, although social isolation (odds ratio [OR] 4.5; 95% confidence interval [CI] = 1.3 to 15.8) resulted in an increased risk of admission. The most important independent risk factor was the presence of chronic obstructive pulmonary disease (COPD; OR 4.0; 95% CI = 1.4 to 11.4), other chronic disease (OR 2.9; 95% CI = 1.2 to 7.0), or both (OR 6.7; 95% CI = 2.4 to 18.4). Being housebound was also an independent risk factor (OR 2.2; 95% CI = 1.0 to 4.8). CONCLUSION Socioeconomic factors had little relative effect compared with medical and functional factors. The most important was the presence of long-term medical conditions (especially COPD), being housebound, and having received two or more courses of oral steroid treatment in the previous year. This combination of factors could be used by primary medical services to identify older patients most vulnerable to winter admissions. Clinicians should ensure that patients with COPD are better supported to manage their condition.
Collapse
|
38
|
Groffen DAI, Bosma H, van den Akker M, Kempen GIJM, van Eijk JTM. Lack of basic and luxury goods and health-related dysfunction in older persons; findings from the longitudinal SMILE study. BMC Public Health 2008; 8:242. [PMID: 18637182 PMCID: PMC2483978 DOI: 10.1186/1471-2458-8-242] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2008] [Accepted: 07/17/2008] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND More so than the traditional socioeconomic indicators, such as education and income, wealth reflects the accumulation of resources and makes socioeconomic ranking manifest and explicitly visible to the outside world. While the lack of basic goods, such as a refrigerator, may affect health directly, via biological pathways, the lack of luxury goods, such as an LCD television, may affect health indirectly through psychosocial mechanisms. We set out to examine, firstly, the relevance of both basic and luxury goods in explaining health-related dysfunction in older persons, and, secondly, the extent to which these associations are independent of traditional socioeconomic indicators. METHODS Cross-sectional and longitudinal data from 2067 men and women aged 55 years and older who participated in the Study on Medical Information and Lifestyles Eindhoven (SMILE) were gathered. Logistic regression analyses were used to study the relation between a lack of basic and luxury goods and health-related function, assessed with two sub-domains of the SF-36. RESULTS The lack of basic goods was closely related to incident physical (OR = 2.32) and mental (OR = 2.12) dysfunction, even when the traditional measures of socioeconomic status, i.e. education or income, were taken into account. Cross-sectional analyses, in which basic and luxury goods were compared, showed that the lack of basic goods was strongly associated with mental dysfunction. Lack of luxury goods was, however, not related to dysfunction. CONCLUSION Even in a relatively wealthy country like the Netherlands, the lack of certain basic goods is not uncommon. More importantly, lack of basic goods, as an indicator of wealth, was strongly related to health-related dysfunction also when traditional measures of socioeconomic status were taken into account. In contrast, no effects of luxury goods on physical or mental dysfunction were found. Future longitudinal research is necessary to clarify the precise mechanisms underlying these effects.
Collapse
Affiliation(s)
- Daniëlle A I Groffen
- School for Public Health and Primary Care (CAPHRI), Department of Social Medicine, Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands.
| | | | | | | | | |
Collapse
|
39
|
Osman LM, Ayres JG, Garden C, Reglitz K, Lyon J, Douglas JG. Home warmth and health status of COPD patients. Eur J Public Health 2008; 18:399-405. [PMID: 18367496 DOI: 10.1093/eurpub/ckn015] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Home Energy Efficiency guidelines recommend domestic indoor temperatures of 21 degrees C for at least 9 h per day in living areas. Is health status of patients with Chronic Obstructive Pulmonary Disease (COPD) associated with maintaining this level of warmth in their homes? METHODS In a cross-sectional observational study of patients, living in their own homes, living room (LR) and bedroom (BR) temperatures were measured at 30 min intervals over 1 week using electronic dataloggers. Health status was measured with the St George's Respiratory Questionnaire (SGRQ) and EuroQol: EQ VAS. Outdoor temperatures were provided by Met Office. RESULTS One hundred and forty eight patients consented to temperature monitoring. Patients' mean age was 69 (SD 8.5) years, 67 (45%) male, mean percentage of predicted Forced Expiratory Volume in one second (FEV(1)) 41.7 (SD 17.4). Fifty-eight (39%) were current smokers. Independent of age, lung function, smoking and outdoor temperatures, poorer respiratory health status was significantly associated (P = 0.01) with fewer days with 9 h of warmth at 21 degrees C in the LR. A sub analysis showed that patients who smoked experienced more health effects than non-smokers (P < 0.01). CONCLUSION Maintaining the warmth guideline of 21 degrees C in living areas for at least 9 h per day was associated with better health status for COPD patients. Patients who were continuing smokers were more vulnerable to reduction in warmth.
Collapse
Affiliation(s)
- Liesl M Osman
- Department of Environmental & Occupational Medicine, University of Aberdeen, Liberty Safe Work Research Centre, Foresterhill Road, Aberdeen, AB252ZP, UK.
| | | | | | | | | | | |
Collapse
|
40
|
Bullen C, Kearns RA, Clinton J, Laing P, Mahoney F, McDuff I. Bringing health home: Householder and provider perspectives on the healthy housing programme in Auckland, New Zealand. Soc Sci Med 2008; 66:1185-96. [DOI: 10.1016/j.socscimed.2007.11.038] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2006] [Indexed: 10/22/2022]
|
41
|
Florey LS, Galea S, Wilson ML. Macrosocial Determinants of Population Health in the Context of Globalization. MACROSOCIAL DETERMINANTS OF POPULATION HEALTH 2007. [PMCID: PMC7121670 DOI: 10.1007/978-0-387-70812-6_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
|
42
|
Sandel M, Wright RJ. When home is where the stress is: expanding the dimensions of housing that influence asthma morbidity. Arch Dis Child 2006; 91:942-8. [PMID: 17056870 PMCID: PMC2082962 DOI: 10.1136/adc.2006.098376] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
The influence of physical housing quality on childhood asthma expression, especially the effect of exposure to moulds, allergens, and pollutants, is well documented. However, attempts to explain increasing rates and severity of childhood asthma solely through physical environmental factors have been unsuccessful, and additional exposures may be involved. Increasing evidence has linked psychological stress and negative affective states to asthma expression. At the same time, recent scholarship in the social sciences has focused on understanding how social environments, such as housing, "get under the skin" to influence health, and suggests that psychological factors play a key role. While there is relevant overlapping research in social science, psychology, economics, and health policy in this area, findings from these disciplines have not yet been conceptually integrated into ongoing asthma research. We propose to expand the dimensions of housing considered in future asthma research to include both physical and psychological aspects which may directly and indirectly influence onset and severity of disease expression. This synthesis of overlapping research from a number of disciplines argues for the systematic measure of psychological dimensions of housing and consideration of the interplay between housing stress and physical housing characteristics in relation to childhood asthma.
Collapse
Affiliation(s)
- M Sandel
- Boston University School of Medicine, Boston, MA, USA.
| | | |
Collapse
|
43
|
Richardson G, Eick S, Jones R. How is the indoor environment related to asthma?: literature review. J Adv Nurs 2006; 52:328-39. [PMID: 16194186 DOI: 10.1111/j.1365-2648.2005.03591.x] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIMS This paper reports a review conducted to identify the factors in the indoor environment that have an evidence-based link with the exacerbation or development of asthma and to identify measures that healthcare professionals can promote to reduce exposure to these risk factors in the home. BACKGROUND The indoor environment, particularly at home, has been recognized as a major source of exposure to allergens and toxic chemicals. Exposure to allergens and toxins is thought to exacerbate respiratory conditions, in particular, asthma. METHODS Searches were made of health and indoor environment databases, including Cochrane Library, National Health Services Centre for Reviews and Assessment Reports, British Medical Journal, CINAHL and Ovid library, MEDSCAPE/MEDLINE, EMBASE, INGENTA, Science Citation Index, Web of Science. Searches were also made of other Internet-based resources, including those of international and government bodies. The following keywords were used: allergens, allergen avoidance, asthma, asthma prevention, cat, damp, Der p 1, dog, environmental control, house dust mites, indoor air quality, indoor environment, meta analysis, mould, pets, remedial actions, respiratory illnesses and systematic reviews. FINDINGS There is evidence of a link between asthma and a small number of indoor environmental factors. There is currently only reasonable evidence for one causative factor for asthma in the indoor environment and that is house dust mite allergen. Although there are many studies of different remedial actions that can be taken in the home, often these give evidence of reduced risk of exposure but not clinical improvement in asthma. Although there is a lack of medical evidence for the reduction of known sensitizers such as mould, this is because of a dearth of research rather than evidence of no association. CONCLUSIONS There is some evidence of a link between the indoor environment and asthma. There are measures, which could be promoted by healthcare professionals to alleviate asthmatic symptoms.
Collapse
Affiliation(s)
- George Richardson
- Faculty of Health and Social Work, University of Plymouth, Plymouth, UK.
| | | | | |
Collapse
|
44
|
Graham JP, Corella Barud V, Avitia Diaz R, Gurian P. The In-Home Environment and Household Health: A Cross-Sectional Study of Informal Urban Settlements in Northern México. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2005; 2:394-402. [PMID: 16819094 DOI: 10.3390/ijerph2005030003] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
People living in poverty make up nearly half of the global population and a large proportion of these individuals inhabit cities, living in informal settlements. However, only limited research on in-home environmental exposures and the associated health effects in these communities is available. This research investigates the home environment in unplanned settlements of a rapidly growing city on the U.S.-México border and its impact on the health of households with children under 12 years of age. A cross-sectional design was used to assess household exposures and health outcomes at the household level. A total of 202 households were selected from two informal settlements in the peri-urban region of Ciudad Juárez, México. The following variables were significantly associated with the report of at least one household member experiencing a health outcome in a two week period. Allergies were positively associated with insecticide use inside the home (adjusted Relative Odds (RO), 2.71; 95% confidence interval (CI), 1.2-6.3). Respiratory problems were associated with households using a wood burning stove vs. a gas stove (adjusted RO, 5.64; 95% CI, 1.1-27.9). Diarrhea was negatively associated with presence of a flush toilet in the home (adjusted RO, 0.22; 95% CI,0.1-0.6). Finally, eye irritations were positively associated with indoor tobacco smoke (adjusted RO, 2.23; 95% CI, 1.1-4.5). This research highlights exposures associated with poor living conditions in informal settlements and their associations with detrimental effects on health. More efforts should be made to understand the dynamics of poor urban environments including the health effects of exposures linked with poor housing conditions.
Collapse
Affiliation(s)
- Jay P Graham
- Division of Environmental Health Engineering, Department of Environmental Health Sciences, Johns Hopkins Bloomberg School of Public Health, 615 N. Wolfe St., Room E6642, Baltimore, MD 21205, USA.
| | | | | | | |
Collapse
|
45
|
Shortt N, Rugkåsa J. "The walls were so damp and cold" fuel poverty and ill health in Northern Ireland: results from a housing intervention. Health Place 2005; 13:99-110. [PMID: 16343973 DOI: 10.1016/j.healthplace.2005.10.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2005] [Revised: 10/03/2005] [Accepted: 10/26/2005] [Indexed: 10/25/2022]
Abstract
This article reports the findings from an evaluation of a fuel poverty programme in the Armagh and Dungannon Health Action Zone in Northern Ireland. Focusing on a rural community, it adds to the debate surrounding the hidden nature of rural fuel poverty. As part of the programme, energy efficiency measures, including some central heating systems, were installed in 54 homes. Surveys were conducted both pre and post intervention and analysed to assess any changes. The programme demonstrated that energy efficiency intervention can lead to improvements in health and well being, increased comfort levels in the home and a reduction in the use of health services, therefore having potential cost savings for the NHS. Some households, however, remain in fuel poverty after having full central heating installed, reflecting the significant contribution of low income on the production of fuel poverty. The article concludes by suggesting that interventions in this area require commitment from multiple sectors of society, including health professionals and local communities.
Collapse
Affiliation(s)
- Niamh Shortt
- The Institute of Geography, University of Edinburgh, Scotland, UK.
| | | |
Collapse
|
46
|
Walker JJ, Mitchell R, Platt SD, Petticrew MP, Hopton J. Does usage of domestic heating influence internal environmental conditions and health? Eur J Public Health 2005; 16:463-9. [PMID: 16157615 DOI: 10.1093/eurpub/cki186] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Housing conditions are recognised as an important determinant of health. In the UK, interventions to improve domestic heating are in place with the expectation that they will improve health. As a component of evaluating such policies, this study assesses whether specific health outcomes are significantly associated with the extent and duration of domestic heating use, either directly or via a possible mediating effect of internal environmental conditions. METHODS Baseline data from a prospective controlled study evaluating the health effects of a publicly-funded programme of heating improvements in Scotland were used to assess associations among heating use, internal conditions, and three specific health outcomes. RESULTS There were significant associations (P < 0.01) between measures of heating use and the presence of environmental problems in the home, such as mould and condensation. The presence of such problems was, in turn, found to be significantly predictive of two health outcomes derived from the SF-36 (P < 0.01) and of adult wheezing (P < 0.05). The direction of significant associations was highly consistent: greater levels of heating were associated with reduced likelihood of environmental problems, and the presence of environmental problems was linked to poorer health status. Heating use was not directly associated with the health outcomes considered. CONCLUSIONS The study findings are consistent with a conceptual model in which health may be influenced by usage patterns of domestic heating, via the mediating effect of poor internal environmental conditions. Since these findings are based on cross-sectional data, interpretation must be carried out cautiously. However, if confirmed by planned future work they have important implications for policy initiatives relating to domestic heating and fuel poverty.
Collapse
Affiliation(s)
- Jeremy J Walker
- Research Unit in Health, Behaviour and Change, The University of Edinburgh, Edinburgh, UK.
| | | | | | | | | |
Collapse
|
47
|
Bobbitt RC, Crandall MS, Venkataraman A, Bernstein JA. Characterization of a population presenting with suspected mold-related health effects. Ann Allergy Asthma Immunol 2005; 94:39-44. [PMID: 15702814 DOI: 10.1016/s1081-1206(10)61283-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
BACKGROUND Numerous epidemiologic studies have reported a relationship between dampness and increased respiratory symptoms in adults and children, which has led to increasing concerns among the general population about potential mold-related health effects. OBJECTIVE To identify characteristics of patients with possible mold-related health effects that might help allergists better understand how to evaluate such patients in their practices. METHODS The parameters that were evaluated for the total population included age, sex, upper and lower respiratory tract symptoms, systemic symptoms, atopic status, pet ownership, smoking history, mold sensitization, mold exposure, and exposure location. Subgroups stratified by atopic status, mold sensitization, and indoor mold exposure confirmed by an environmental mold report prepared by certified industrial hygienists were also analyzed. Significant associations were determined by correlation coefficients and logistic regression analysis. RESULTS A total of 135 patients with possible mold-related health effects secondary to prolonged indoor mold exposure were evaluated. For the overall population, a strong correlation was found among atopy, mold sensitization, and sensitization to specific molds identified in the patient's environmental report. Mold intracutaneous testing was not useful for discriminating between atopic and nonatopic individuals. There were no associations among the patients' presenting symptoms, atopic status, and magnitude of mold exposure. Similar findings were identified when subgroup analysis was performed. CONCLUSIONS Patients who present with mold-related health effects manifest heterogeneous characteristics. Medical history, skin testing, and current indoor mold sampling practices have significant limitations in establishing a causal link among mold exposure health effects.
Collapse
Affiliation(s)
- R Carter Bobbitt
- Department of Internal Medicine, Division of Immunology/Allergy Section, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | | | | |
Collapse
|
48
|
Abstract
Housing hazards contribute to considerable morbidity and mortality among millions of children each year in the US, but few interventions are proven to control asthma and lead poisoning. Moreover, there is little evidence that many of the current recommendations to control residential hazards are safe and efficacious. The only interventions that have been found to work consistently are home visitation programs and home modification, such as installment of window guards and carpet removal. Altering the environment to protect the health of children requires pediatrician intervention. New models of cooperation between pediatricians and public health agencies must deal with residential hazards in an integrated manner and cannot be focused on one disease process or one method at a time. With research in more effective environmental interventions and pediatric-public-health partnerships, primary and secondary prevention of diseases from residential hazards may become a reality in the future.
Collapse
Affiliation(s)
- Megan Sandel
- Boston University Medical School, Boston, MA, USA
| | | | | | | | | |
Collapse
|
49
|
Abstract
This review considers the broad area of housing and public health, one of the traditional and core areas of public health research and intervention. The review takes into account the range of factors, acting at different levels, directly and indirectly, through which housing affects health. In public health terms, housing affects health in a myriad of relatively minor ways, in total forming one of the key social determinants of health. The paper closes by considering how the improvement of housing and neighborhoods has been a core activity of public health and a central component in tackling poverty. Investment in housing can be more than an investment in bricks and mortar: It can also form a foundation for the future health and well-being of the population. Addressing poor-quality housing and detrimental neighborhoods, in the broadest sense, is thus a task that should be grasped with vigor and determination by all those involved in public health.
Collapse
Affiliation(s)
- Mary Shaw
- Department of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, United Kingdom.
| |
Collapse
|
50
|
Abstract
This glossary has been designed to provide definitions that take account of different disciplinary and policy traditions and to consider the aspects of housing that provide scope for possible concerted research and action.
Collapse
|