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Mason KE, Alexiou A, Li A, Taylor-Robinson D. The impact of housing insecurity on mental health, sleep and hypertension: Analysis of the UK Household Longitudinal Study and linked data, 2009-2019. Soc Sci Med 2024; 351:116939. [PMID: 38749252 DOI: 10.1016/j.socscimed.2024.116939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/04/2024] [Accepted: 04/30/2024] [Indexed: 06/17/2024]
Abstract
BACKGROUND Housing insecurity is an escalating problem in the UK but there is limited evidence about its health impacts. Using nationally representative panel data and causally focussed methods, we examined the effect of insecure housing on mental health, sleep and blood pressure, during a period of government austerity. METHODS We used longitudinal survey data (2009-2019, n = 11,164 individuals with annual data) from the UK Household Longitudinal Study. Outcomes were probable common mental disorder (GHQ-12), sleep disturbance due to worry, and new diagnoses of hypertension. The primary exposure was housing payment problems in the past year. Using doubly robust marginal structural models with inverse probability of treatment weights, we estimated absolute and relative health effects of housing payment problems, and population attributable fractions. In stratified analyses we assessed potentially heterogeneous impacts across the population, and potential modifying effects of government austerity measures. A negative control analysis was conducted to detect bias due to unmeasured confounding. RESULTS Housing payment problems were associated with a 2.5 percentage point increased risk of experiencing a common mental disorder (95% CI 1.1%, 3.8%) and 2.0% increased risk of sleep disturbance (95% CI 0.7%, 3.3%). Estimates were larger for renters, younger people, less educated, households with children, and people living in areas most affected by austerity-related cuts to housing support services. We did not find consistent evidence for an association with hypertension (risk difference = 0.4%; 95% CI -0.1%, 0.9%). The negative control analysis was not indicative of unmeasured confounding. CONCLUSIONS Housing payment problems were associated with worse mental health and sleep disturbance in a large UK sample. Households at risk of falling into rent or mortgage arrears need more support, especially in areas where housing support services have been diminished. Substantial investment is urgently needed to improve supply of social and affordable housing.
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Affiliation(s)
- Kate E Mason
- Melbourne School of Population and Global Health, The University of Melbourne, Australia; Department of Public Health, Policy and Systems, University of Liverpool, UK.
| | - Alexandros Alexiou
- Department of Public Health, Policy and Systems, University of Liverpool, UK
| | - Ang Li
- Melbourne School of Population and Global Health, The University of Melbourne, Australia
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Stefanovics EA, Potenza MN, Tsai J. Obesity in U.S. low-income veterans:Prevalence, clinical characteristics, and homelessness. J Psychiatr Res 2024; 173:317-325. [PMID: 38574595 DOI: 10.1016/j.jpsychires.2024.03.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 02/15/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVE Obesity is associated with lower socioeconomic status. To date, however, scarce research has examined the prevalence, comorbidity, and incremental burden of obesity in relation to medical, psychiatric, functional, and homelessness measures among low-income veterans. METHODS A nationally representative sample of 1004 low-income U.S. veterans was examined. Bivariate and multivariable analyses were conducted to assess relationships between obesity and medical and psychiatric comorbidities, functioning, and homelessness measures. RESULTS The prevalence estimate of obesity among low-income U.S. veterans was 38.2% (confidence interval (CI): 34.2; 42.2), which is higher than previously reported for the general U.S. veteran population. It was particularly high among young, females with children. Obesity was associated with co-occurring medical (chronic pain, diabetes, sleep disorders, high blood pressure, heart disease) and psychiatric (trauma- and anxiety-related) conditions, poor functioning, and current psychiatric medication use. Veterans with obesity were less likely to have current savings and more likely to have current debt. They also were more likely to have experienced evictions and foreclosures and less likely to use active coping or positive reframing as a means of dealing with stressful situations. CONCLUSION The prevalence of obesity among U.S. veterans is high. Specific demographic groups particularly vulnerable to developing obesity warrant targeted interventions. Modifying weight management programs, understanding coping styles, and assessing, monitoring, and treating obesity in low-income veterans may help improve overall health and quality of life in multiple domains.
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Affiliation(s)
- Elina A Stefanovics
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; U.S. Department of Veterans Affairs New England Mental Illness Research and Education Clinical Center (MIRECC), West Haven, CT, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA.
| | - Marc N Potenza
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; Yale Child Study Center, Yale University, New Haven, CT, USA; Connecticut Mental Health Center, New Haven, CT, USA; Connecticut Council on Problem Gambling, Wethersfield, CT, USA; Department of Neuroscience, Yale University, New Haven, CT, USA; Wu Tsai Institute, Yale University, New Haven, CT, USA
| | - Jack Tsai
- Department of Psychiatry, Yale University School of Medicine, New Haven, CT, USA; National Center on Homelessness Among Veterans, U.S. Department of Veterans Affairs, Tampa, FL, USA; Department of Management, Policy, and Community Health, School of Public Health, University of Texas Health Science Center at Houston, Houston, TX, USA
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Ettman CK, Subramanian M, Fan AY, Adam GP, Abdalla SM, Galea S, Stuart EA. Assets and depression in U.S. adults during the COVID-19 pandemic: a systematic review. Soc Psychiatry Psychiatr Epidemiol 2024; 59:571-583. [PMID: 37838630 DOI: 10.1007/s00127-023-02565-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 09/28/2023] [Indexed: 10/16/2023]
Abstract
PURPOSE Mental health is shaped by social and economic contexts, which were altered during the COVID-19 pandemic. No study has systematically reviewed the literature on the relation between different assets and depression during the COVID-19 pandemic. METHODS We conducted a systematic review of the literature on financial (e.g. income/savings), physical (e.g., home ownership), and social (e.g., marital status, educational attainment) assets and depression in U.S. adults. For each asset type, we created binary comparisons to report on the direction of the relationship and described if each study reported insignificant, positive, negative, or mixed associations. RESULTS Among the 41 articles identified, we found that income was the most studied asset (n=34), followed by education (n=25), marital status (n=18), home ownership (n=5), and savings (n=4). 88%, 100%, and 100% of articles reported a significant association of higher income, home ownership, and higher savings, respectively, with less depression. The association between marital status and education with depression was more nuanced: 72% (13 of 18) studies showed that unmarried persons had greater risk of depression than married or cohabitating persons and 52% (13 of 25) of studies reported no significant difference in depression across educational groups. CONCLUSION This work adds to the literature a deeper understanding of how different assets relate to depression. In the context of largescale traumatic events, policies that maintain and protect access to social, physical, and financial assets may help to protect mental health.
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Affiliation(s)
- Catherine K Ettman
- Johns Hopkins Bloomberg School of Public Health, Baltimore, USA.
- Boston University School of Public Health, Boston, USA.
| | | | - Alice Y Fan
- Boston University School of Public Health, Boston, USA
| | - Gaelen P Adam
- Brown University School of Public Health, Providence, USA
| | | | - Sandro Galea
- Boston University School of Public Health, Boston, USA
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Kantz ME, Enah C, Abdallah LM, Koren A. Housing and Health in Older Adults With Low Income in the United States: An Integrative Review. J Gerontol Nurs 2024; 50:25-32. [PMID: 38417078 DOI: 10.3928/00989134-20240208-01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
PURPOSE The current integrative review was conducted to understand the relationship between housing and health in older adults with low income in the United States. METHOD A literature search yielded 20 articles that met inclusion criteria. Key data elements were extracted from each article and a five-level social ecological model (SEM) was used as a framework to analyze the findings. RESULTS The analysis yielded themes associated with each SEM level: Interaction Between Housing and Personal Traits and Behaviors (individual level); Burdens and Benefits of Social Relationships (relational Level); Building Quality and Health (environmental level); Role of Housing Assistance (structural level); and Influence of Poverty and Structural and Systemic Racism (superstructural level). CONCLUSION/IMPLICATIONS Results clarify housing's role as a social determinant of health affecting older adults with low income and may help nurses tailor patient assessments and treatment plans to better identify and address housing-related health risks. [Journal of Gerontological Nursing, 50(3), 25-32.].
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Antin TM, Sanders E, Lipperman-Kreda S, Hunt G, Annechino R. An Exploration of Rural Housing Insecurity as a Public Health Problem in California's Rural Northern Counties. J Community Health 2024:10.1007/s10900-024-01330-z. [PMID: 38372874 DOI: 10.1007/s10900-024-01330-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/25/2024] [Indexed: 02/20/2024]
Abstract
Although widely acknowledged as an important social determinant of health, until recently researchers and policymakers have primarily approached housing insecurity as an urban issue, obscuring the visibility of its impacts in rural contexts, including the ways in which housing insecurity intersects with other health and structural inequities facing rural populations. Working to address this gap in the existing literature, this paper explores the experiences of housing insecurity in a rural context by reporting on an analysis of 210 in-depth interviews with 153 adults between the ages of 18-35, living in California's rural North State, a relatively overlooked far northern region of the state comprised of 12 north central and north eastern counties. Using in-depth qualitative interview data, we conducted an exploratory pattern-level analysis of participants' narratives structured by four dimensions of housing insecurity defined in the literature (housing affordability, housing stability, housing conditions, and neighborhood context). Drawing attention to the pervasiveness of rural housing insecurity within our sample, this analysis highlights the unique ways in which rurality creates distinct experiences not currently captured in the existing literature. Further research is needed across different types of rural communities to better understand the various ways that housing insecurity affects the everyday lives and health of rural residents. By grounding research within the experiences of rural residents, we are better able to respond to the crisis of rural housing insecurity and develop solutions that are tailored to rural residents' unique needs.
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Affiliation(s)
- Tamar Mj Antin
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, CA, 94501, USA.
| | - Emile Sanders
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, CA, 94501, USA
| | - Sharon Lipperman-Kreda
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, CA, 94501, USA
| | - Geoffrey Hunt
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, CA, 94501, USA
| | - Rachelle Annechino
- Center for Critical Public Health, Institute for Scientific Analysis, Alameda, CA, 94501, USA
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Titus AR, Li Y, Mills CK, Spoer B, Lampe T, Kim B, Gourevitch MN, Thorpe LE. Associations between a Novel Measure of Census Tract-Level Credit Insecurity and Frequent Mental Distress in US Urban Areas, 2020. J Urban Health 2023; 100:1140-1148. [PMID: 38012504 PMCID: PMC10728417 DOI: 10.1007/s11524-023-00792-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2023] [Indexed: 11/29/2023]
Abstract
Access to and utilization of consumer credit remains an understudied social determinant of health. We examined associations between a novel, small-area, multidimensional credit insecurity index (CII), and the prevalence of self-reported frequent mental distress across US cities in 2020. The census tract-level CII was developed by the Federal Reserve Bank of New York using Census population information and a nationally representative sample of anonymized Equifax credit report data. The CII was calculated for tracts in 766 cities displayed on the City Health Dashboard at the time of analysis, predominantly representing cities with over 50,000 residents. The CII combined data on tract-level participation in the formal credit economy with information on the percent of individuals without revolving credit, percent with high credit utilization, and percent with deep subprime credit scores. Tracts were classified as credit-assured, credit-likely, mid-tier, at-risk, or credit-insecure. We used linear regression to examine associations between the CII and a modeled tract-level measure of frequent mental distress, obtained from the CDC PLACES project. Regression models were adjusted for neighborhood economic and demographic characteristics. We examined effect modification by US region by including two-way interaction terms in regression models. In adjusted models, credit-insecure tracts had a modestly higher prevalence of frequent mental distress (prevalence difference = 0.38 percentage points; 95% CI = 0.32, 0.44), compared to credit-assured tracts. Associations were most pronounced in the Midwest. Local factors impacting credit access and utilization are often modifiable. The CII, a novel indicator of community financial well-being, may be an independent predictor of neighborhood health in US cities and could illuminate policy targets to improve access to desirable credit products and downstream health outcomes.
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Affiliation(s)
- Andrea R Titus
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA.
| | - Yuruo Li
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | | | - Benjamin Spoer
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Taylor Lampe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Byoungjun Kim
- Department of Surgery, NYU Grossman School of Medicine, New York, NY, USA
| | - Marc N Gourevitch
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
| | - Lorna E Thorpe
- Department of Population Health, NYU Grossman School of Medicine, New York, NY, USA
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Gusoff GM, Zuckerman D, Pham BH, Ryan GW. Moving upstream: healthcare partnerships addressing social determinants of health through community wealth building. BMC Public Health 2023; 23:1824. [PMID: 37726750 PMCID: PMC10510172 DOI: 10.1186/s12889-023-16761-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 09/14/2023] [Indexed: 09/21/2023] Open
Abstract
BACKGROUND Healthcare-based interventions addressing social needs such as food and housing generally fail to impact the upstream wealth and power inequities underlying those needs. However, a small number of US healthcare organizations have begun addressing these upstream inequities by partnering with community wealth building initiatives. These initiatives include community land trusts, resident-owned communities, and worker cooperatives, which provide local residents ownership and control over their housing and workplaces. While these partnerships represent a novel, upstream approach to the social determinants of health, no research has yet evaluated them. METHODS To assess the current state and key aspects of healthcare-community wealth building partnerships, we conducted a multiple case study analysis using semi-structured interviews with thirty-eight key informants across ten partnerships identified through the Healthcare Anchor Network. To analyze the interviews, we used a two-stage coding process. First, we coded responses based on the phase of the intervention to which they corresponded: motivation, initiation, implementation, or evaluation. Then we assessed responses within each aspect for common themes and variation on salient topics. RESULTS Partnerships were generally motivated by a combination of community needs, such as affordable housing and living wage jobs, and health system interests, such as workforce housing and supply chain resilience. Initiating projects required identifying external partners, educating leadership, and utilizing risk mitigation strategies to obtain health system buy-in. Implementation took various forms, with healthcare organizations providing financial capital in the form of grants and loans, social capital in the form of convening funders and other stakeholders, and/or capacity building support in the form of strategic planning or technical assistance resources. To evaluate projects, healthcare organizations used more process and community-level metrics rather than metrics based on individual health outcomes or returns on investment. Based on best practices from each partnership phase, we provide a roadmap for healthcare organizations to develop effective community wealth building partnerships. CONCLUSIONS Assessing healthcare partnerships with community wealth building organizations yields key strategies healthcare organizations can use to develop more effective partnerships to address the upstream causes of poor health.
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Affiliation(s)
- Geoffrey M Gusoff
- National Clinician Scholars Program & Department of Family Medicine, University of California, Los Angeles, 1100 Glendon Ave, Suite 900, Los Angeles, CA, 90024, USA.
| | - David Zuckerman
- Healthcare Anchor Network, 2202 18th St. NW, Suite 317, Washington, DC, 20009, USA
| | - Bich Ha Pham
- Healthcare Anchor Network, 2202 18th St. NW, Suite 317, Washington, DC, 20009, USA
| | - Gery W Ryan
- Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, 100 South Los Robles Avenue, Pasadena, CA, 91101, USA
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Hernandez M, Wong R, Yu X, Mehta N. In the wake of a crisis: Caught between housing and healthcare. SSM Popul Health 2023; 23:101453. [PMID: 37456616 PMCID: PMC10338349 DOI: 10.1016/j.ssmph.2023.101453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 06/08/2023] [Accepted: 06/11/2023] [Indexed: 07/18/2023] Open
Abstract
Objective To measure the association between housing insecurity and foregone medication due to cost among Medicare beneficiaries aged 65+ during the Recession. Methods Data came from Medicare beneficiaries aged 65+ years from the 2006-2012 waves of the Health and Retirement Study (HRS). Two-wave housing insecurity changes are evaluated as follows: (i) No insecurity, (ii) Persistent insecurity, (iii) Onset insecurity, and (iv) Onset security. We implemented a series of four weighted longitudinal General Estimating Equation (GEE) models, two minimally adjusted and two fully adjusted models, to estimate the probability of foregone medications due to cost between 2008 and 2012. Results Our study sample was restricted to non-proxy interviews of non-institutionalized Medicare beneficiaries aged 65+ in the 2006 wave (n = 9936) and their follow up visits (n = 8753; in 2008; n = 7464 in 2010; and n = 6594 in 2012). Results from our fully adjusted model indicated that the odds of foregone medication was 64% higher among individuals experiencing Onset insecurity versus No insecurity in 2008, and also generally larger for individuals experiencing Onset Insecurity versus Persistent Insecurity. Odds of foregone medication was also larger among females, minority versus non-Hispanic white adults, those reporting a chronic condition, those with higher medical expenditures, and those living in the South versus Northeast. Conclusion This study drew from nationally representative data to elucidate the disparate health and financial impacts of a crisis on Medicare beneficiaries who, despite health insurance coverage, displayed variability in foregone medication patterns. Our findings suggest that the onset of housing insecurity is most closely linked with unexpected acute economic shocks leading households with little time to adapt and forcing trade-offs in their prescription and other needs purchases. Both housing and healthcare policy implications exist from these findings including expansion of low-income housing units and rent relief post-recession as well as wider prescription drug coverage for Medicare adults.
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Affiliation(s)
- Monica Hernandez
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Rebeca Wong
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Xiaoying Yu
- Department of Biostatistics & Data Science, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
| | - Neil Mehta
- Department of Epidemiology, School of Public and Population Health, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
- Sealy Center on Aging, University of Texas Medical Branch Galveston, 301 University Blvd, Galveston, TX 77555, USA
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McIntosh A, Anguelovski I, Cole H. "The trauma machine expands faster than our services": Health risks for unhoused people in an early-stage gentrifying area. Health Place 2023; 83:103035. [PMID: 37331113 DOI: 10.1016/j.healthplace.2023.103035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 04/20/2023] [Accepted: 05/01/2023] [Indexed: 06/20/2023]
Abstract
While homelessness continues to be a prevalent problem throughout the United States, many urban neighborhoods are also concurrently experiencing an influx of affluent neighbors through gentrification, exposing the stark inequalities in housing access nationwide. Gentrification-induced changes in neighborhood dynamics have also been shown to affect the health of low-income and non-white groups, with high risks of trauma from displacement and exposure to violent crime and criminalization. This study addresses risk factors for health among the most vulnerable, unhoused individuals, and provides a detailed case study on the potential exposures to emotional and physical traumas for unhoused people in early-stage gentrifying areas. By conducting 17 semi-structured interviews with people who work with the unhoused community - health providers, nonprofit employees, neighborhood representatives, and developers - in Kensington, Philadelphia, we analyze how early-stage gentrification impacts the risks for negative health consequences among unhoused groups. Results show that gentrification impacts the health of unhoused people in four main areas that, all together, create what we identify as a "trauma machine" - that is compounding traumas for unhoused residents by 1) reducing and compromising spaces of safety from violent crime, 2) decreasing public services, 3) threatening the quality of healthcare, and 4) increasing the likelihood of displacement and associated trauma.
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Affiliation(s)
- Andrea McIntosh
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain.
| | - Isabelle Anguelovski
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain; Institución Catalana de Investigación y Estudios Avanzados (ICREA), Passeig de Lluís Companys, 23, 08010, Barcelona, Spain.
| | - Helen Cole
- Universitat Autònoma de Barcelona (UAB), Plaça Cívica, 08193, Bellaterra, Barcelona, Spain; Institu de Ciència I Tecnologia Ambientals (ICTA), Edifici ICTA-ICP, Carrer de Les Columnes S/n, Campus de La UAB, 08193, Cerdanyola Del Vallès, Barcelona, Spain.
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Bradford AC, Maclean JC. Evictions and psychiatric treatment. JOURNAL OF POLICY ANALYSIS AND MANAGEMENT : [THE JOURNAL OF THE ASSOCIATION FOR PUBLIC POLICY ANALYSIS AND MANAGEMENT] 2023; 43:87-125. [PMID: 38249438 PMCID: PMC10798266 DOI: 10.1002/pam.22522] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Stable housing is critical for health, employment, education, and other social outcomes. Evictions reflect a form of housing instability that is experienced by millions of Americans each year. Inadequately treated psychiatric disorders have the potential to influence evictions in several ways. For example, these disorders may impede labor market performance and thus the ability to pay rent, or increase the likelihood of risky and/or nuisance behaviors that can lead to a lease violation. We estimate the effect of local access to psychiatric treatment on eviction rates. We combine data on the number of psychiatric treatment centers that offer outpatient and residential care within a county with eviction rates in a two-way fixed-effects framework. Our findings imply that 10 additional psychiatric treatment centers in a county lead to a reduction of 2.1% in the eviction rate.
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Affiliation(s)
- Ashley C. Bradford
- Georgia Institute of Technology, School of Public Policy, Atlanta, GA, United States
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Paudel R, Khadka S, Rai J, Singh R. Psychological impact of COVID-19 pandemic and lockdown among the population involved in tourism sector in Lakeside of Pokhara: A qualitative study. Health Sci Rep 2023; 6:e1382. [PMID: 37396562 PMCID: PMC10313908 DOI: 10.1002/hsr2.1382] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 05/28/2023] [Accepted: 06/18/2023] [Indexed: 07/04/2023] Open
Abstract
Background and Aims The COVID-19 pandemic has exerted a substantial influence on every sector of people's lives worldwide, including Nepal. The tourism industry is not exceptional. Lakeside Pokhara is one of the country's major tourist hubs and relies both on national and international visitors. The people residing in this area who depend on tourism-related businesses to regulate their daily living faced numerous stressors and psychological impacts due to the pandemic. This study aimed to explore the COVID-19 pandemic-related stressors and their psychological impact among people dependent on the tourism business in the Lakeside of Pokhara, located in the Gandaki Province of Nepal. Method Via the qualitative approach, semi-structured in-depth interviews were conducted to collect the data from 20 individuals related to tourism business stakeholders in Lakeside of Pokhara. Thematic analysis was performed to analyze the data. Results The study found business-related stressors among the people dependent on the tourism businesses, and these stressors were found to increase the experiences of psychological issues, including suicidal ideation. The pandemic has not only affected their economy but has also had an impact on their personal, familial, and social life. However, to combat the problems most of the study participants were found to be utilizing positive coping mechanisms, whereas some respondents were observed to consume more alcohol as a negative coping strategy. Conclusions People indulging in the tourism sectors were at greater risk of vulnerability in the future pandemic. Tourism business stakeholders struggled to combat the numerous stressors and psychological impacts carried out by the COVID-19 pandemic and lockdown. Therefore, there is a growing need for government bodies to implement favorable business-related policies, and Mental Health and Psychosocial Support (MHPSS) related programs to these stakeholders.
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Affiliation(s)
- Rajesh Paudel
- Transcultural Psychosocial Organization NepalKathmanduNepal
| | | | - Jeetendra Rai
- Transcultural Psychosocial Organization NepalKathmanduNepal
| | - Rakesh Singh
- Transcultural Psychosocial Organization NepalKathmanduNepal
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Portella MJ, González-González I, Jubero M, Trujols J, Pérez V. Depressive-Like Effects of Foreclosing: A Cross-Sectional Study of Hair Cortisol Concentration. Psychopathology 2023; 57:10-17. [PMID: 37331349 DOI: 10.1159/000530706] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2022] [Accepted: 04/12/2023] [Indexed: 06/20/2023]
Abstract
INTRODUCTION Foreclosing and home eviction have been associated with various negative health outcomes, probably due to exposure to such stressful circumstance, but there is no evidence about foreclosure and home eviction to elicit cortisol responses. METHODS Participants who recently had received a court eviction notice were compared to subjects suffering a depressive disorder and to healthy controls in terms of hair cortisol concentrations. RESULTS Subjects under the stressful circumstance of foreclosure and patients with depression showed comparable concentrations in most of the hair segments while healthy subjects displayed the lowest levels of cortisol. CONCLUSION The findings show that foreclosure and home eviction are associated with increased cumulative hair cortisol and with depressive-like symptoms. Foreclosing procedures yielded to maintain high levels of cortisol which may increase the risk to develop major depression.
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Affiliation(s)
- Maria J Portella
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | | | - Miriam Jubero
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
| | - Joan Trujols
- Mental Health, Institut d'Investigació Biomèdica Sant Pau (IIB SANT PAU), Barcelona, Spain
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Víctor Pérez
- Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- INAD Parc de Salut Mar, Barcelona, Spain
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Abstract
IMPORTANCE Prior research has identified associations between housing insecurity and poor health outcomes. OBJECTIVE To evaluate the association between US state Medicaid expansions and reductions in eviction; to examine the persistence of these associations and how they vary across US states and counties. DESIGN, SETTING, AND PARTICIPANTS This cohort study of 25 398 county-year observations (across 40 states) used US eviction and census data for the years 2002 through 2018 (ie, 17 years). County-level associations were estimated using interactive fixed effects counterfactual estimators, and models were selected using cross validation. Across-county treatment association heterogeneities were assessed using multivariable regression methods. Analyses were performed in July of 2022. EXPOSURE State-level Medicaid expansion under the Patient Protection and Affordable Care Act. MAIN OUTCOMES AND MEASURES Eviction judgments; eviction judgments per 100 renter-occupied households. RESULTS Among a total of 774 treated counties (with Medicaid expansion) and 720 control counties (untreated, without Medicaid expansion), mean (SD) eviction judgments for treated counties were 534.78 (1945.84) eviction judgments in the pre-2014 period (mean [SD] eviction rate, 2.25 [2.18] per 100 households), which decreased to 463.67 (1499.39) eviction judgments in the post-2014 period (mean [SD] eviction judgment rate, 2.02 [1.81] per 100 households). Control group mean (SD) county eviction judgments were 477.22 (1592.18) eviction judgments (mean [SD] eviction judgment rate, 1.91 per 100 households) pre-2014, and 490.22 (1575.19) eviction judgments (mean [SD] eviction judgment rate, 1.89 per 100 households) post-2014. Model estimates indicate that Medicaid expansion was associated with reductions in county eviction judgments by -66.49 (95% CI, -132.50 to -0.48; P = .047) and reductions of the eviction judgment rate by -0.25 (95% CI, -0.35 to -0.14; P < .001). Associations remained broadly consistent between 2014 and 2018, although some diminishment of associations occurred in 2018. Approximately 29% of the across-county treatment association variation was explained by across-state differences, while 9% was explained by county-level demographic and uninsurance differences. CONCLUSIONS AND RELEVANCE In this cohort study, Medicaid expansion was associated with reductions in eviction judgments and eviction judgment rates; however, these associations were found to vary considerably both across as well as within states (across counties). These findings suggest that the channel between Medicaid expansion and evictions is sensitive to state environments as well as county specific population demographics and uninsurance levels.
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Affiliation(s)
- Sebastian Linde
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee
| | - Leonard E. Egede
- Division of General Internal Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee
- Center for the Advancing Population Sciences, Medical College of Wisconsin, Milwaukee
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14
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Doyle YG, Solomon BD, Owusu G. Cities and global health: fragmented housing policies increase health risks for vulnerable people. BMJ 2022; 379:e069671. [PMID: 36318978 DOI: 10.1136/bmj-2021-069671] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - George Owusu
- Institute of Statistical, Social and Economic Research, School of Social Sciences, University of Ghana, Accra, Ghana
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15
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Phillips S, Raskin SE, Harrington CB, Bishop D, Gany FM. "Like pouring salt in a wound": A qualitative exploration of the consequences of unmet housing needs for cancer patients and survivors in New York City. J Psychosoc Oncol 2022; 41:411-433. [PMID: 36271879 PMCID: PMC10322638 DOI: 10.1080/07347332.2022.2136025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
OBJECTIVE To identify consequences of unmet housing needs in the period following cancer diagnosis. DESIGN Qualitative descriptive design. PARTICIPANTS New York City-based cancer patients and survivors (n = 21) who reported experience of unmet housing needs while receiving cancer treatment. Key informants (n = 9) with relevant expertise (e.g. oncology social workers). METHODS One-time semi-structured telephone or in-person interviews were conducted with all participants. Inductive thematic coding was conducted using a pragmatic paradigm. FINDINGS Four categories of consequences emerged: 1) cancer management and health (rest and recovery, illness/injury risk, medical care); 2) psychological (stress and anxiety, lack of control and independence, self-esteem/pride, sadness/depression, cancer coping); 3) social (relationships, consequences for others, isolation); and 4) standard of functional living. CONCLUSION The simultaneous experience of cancer and unmet housing needs is broadly burdensome. IMPLICATIONS FOR PSYCHOSOCIAL PROVIDERS Screening and resources for addressing unmet housing needs must be prioritized to holistically care for patients.
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Affiliation(s)
- Serena Phillips
- Andrew Young School of Policy Studies, Georgia State University, Atlanta, GA, USA
| | - Sarah E. Raskin
- L. Douglas Wilder School of Government and Public Affairs, Virginia Commonwealth University, Richmond, VA, USA
| | | | - Darla Bishop
- Milken Institute School of Public Health, The George Washington University, Washington, DC, USA
| | - Francesca M. Gany
- Immigrant Health and Cancer Disparities Service, Memorial Sloan Kettering Cancer Center, New York, NY, USA
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16
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Santaularia NJ, Osypuk TL, Ramirez MR, Mason SM. Violence in the Great Recession. Am J Epidemiol 2022; 191:1847-1855. [PMID: 35767881 PMCID: PMC10144667 DOI: 10.1093/aje/kwac114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 02/01/2023] Open
Abstract
Substantial evidence suggests that economic hardship causes violence. However, a large majority of this research relies on observational studies that use traditional violence surveillance systems that suffer from selection bias and over-represent vulnerable populations, such as people of color. To overcome limitations of prior work, we employed a quasi-experimental design to assess the impact of the Great Recession on explicit violence diagnoses (injuries identified to be caused by a violent event) and proxy violence diagnoses (injuries highly correlated with violence) for child maltreatment, intimate partner violence, elder abuse, and their combination. We used Minnesota hospital data (2004-2014), conducting a difference-in-differences analysis at the county level (n = 86) using linear regression to compare changes in violence rates from before the recession (2004-2007) to after the recession (2008-2014) in counties most affected by the recession, versus changes over the same time period in counties less affected by the recession. The findings suggested that the Great Recession had little or no impact on explicitly identified violence; however, it affected proxy-identified violence. Counties that were more highly affected by the Great Recession saw a greater increase in the average rate of proxy-identified child abuse, elder abuse, intimate partner violence, and combined violence when compared with less-affected counties.
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Affiliation(s)
- N Jeanie Santaularia
- Correspondence to Dr. Jeanie Santaularia, Carolina Population Center, 123 West Franklin Street Chapel Hill, NC 27516 (e-mail: )
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Choi NG, Marti CN, Choi BY. Job loss, financial strain, and housing problems as suicide precipitants: Associations with other life stressors. SSM Popul Health 2022; 19:101243. [PMID: 36203475 PMCID: PMC9530609 DOI: 10.1016/j.ssmph.2022.101243] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2022] [Revised: 09/23/2022] [Accepted: 09/25/2022] [Indexed: 11/17/2022] Open
Abstract
Previous research has shown that job loss, financial strain, and/or loss of housing (JFH) in midlife elevate suicide risk. In this study based on the 2017–2019 National Violent Death Reporting System, we examined other suicide precipitants and contributors of decedents whose suicide was in part precipitated by JFH and the circumstances under which they died. First, we examined all adult decedents (N = 94,454; 74,042 males [78.4%] and 20,412 females [21.6%]) and then focused on decedents age 45–64 (N = 34,208; 25,640 males [75%] and 8568 females [25.0%]). The 45–64 age group had the highest rate of JFH (22.0% for males and 15.1% for females) as a suicide precipitant. The results of generalized linear models for all adult suicide decedents of both sexes showed that the 45–64 age group (IRR = 2.02, 95% CI = 1.89–2.16), compared to 65+ age group, and relationship problems, mental disorders, and alcohol problems were associated with significantly higher risk of JFH-precipitated suicide. In male decedents age 45–64, JFH was positively associated with depressed mood (IRR = 1.95, 95% CI = 1.85–2.06), alcohol problems (IRR = 1.14, 95% CI = 1.07–1.21), and number of crises (IRR = 1.48, 95% CI = 1.43–1.53). In female decedents age 45–64, JFH was positively associated with relationship problems (IRR = 1.19, 95% CI = 1.05–1.35), legal problems (IRR = 1.27, 95% CI = 1.06–1.54), depressed mood (IRR = 1.78, 95% CI = 1.59–1.99), and number of crises (IRR = 1.58, 95% CI = 1.48–1.68). In both sexes, the risk of JFH was also positively associated with a college education. In female decedents, JFH risk was higher among divorced or never-married individuals. Coroner/medical examiner and law enforcement agency reports show that some experienced depression and started misusing alcohol and/or other substances following a job loss, but others had these problems throughout life, which caused/contributed to JFH. These findings show the significance of suicide prevention approaches at both systemic (generous unemployment insurance, housing subsidies) and individual (treatment of depression and alcohol/substance misuse problems and social support/connection) levels. 16.2% of male and 13.0% of female suicide decedents age 18+ in 2017–2019 had job/finance/housing problems (JFH). Among decedents age 45–64, 22.0% of male and 15.1% of female had JFH. JFH was positively associated with number of crises, depressed mood, and relationship and alcohol problems in both sexes. Suicide prevention approaches are needed at both systemic and individual levels.
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Affiliation(s)
- Namkee G. Choi
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
- Corresponding author. UT Steve Hicks School of Social Work, 1925 San Jacinto Blvd, Austin, TX 78712, USA.
| | - C. Nathan Marti
- Steve Hicks School of Social Work, University of Texas at Austin, Austin, TX, 78712, USA
| | - Bryan Y. Choi
- Department of Emergency Medicine, Philadelphia College of Osteopathic Medicine and BayHealth, Dover, DE, 19901, USA
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18
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Vásquez-Vera C, Fernández A, Borrell C. Gender-based inequalities in the effects of housing on health: A critical review. SSM Popul Health 2022; 17:101068. [PMID: 35360438 PMCID: PMC8961216 DOI: 10.1016/j.ssmph.2022.101068] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 03/07/2022] [Accepted: 03/08/2022] [Indexed: 11/09/2022] Open
Abstract
Gender and its power relations are produced and reproduced in the housing sphere, leading to inequalities in living conditions and, therefore, in gender inequalities in health outcomes. The aim of the study is to review the published literature on gender, housing and health, to critically evaluate the incorporation of the gender perspective, and to incorporate this perspective into the conceptual framework of housing and health. Using the critical review method, we conducted a literature review in MEDLINE, Scopus, WOS and Redalyc, without restriction of publication date, including studies published up to October 2020. We analyzed the gender perspective in health research using the Gender Perspective in Health Research Questionnaire and described the results according to main housing dimensions. Of the 20,988 articles identified, we selected 90 for full-text analysis, of which 18 were included in the feminist research category, 27 in gender-sensitive, 31 in sex difference and 14 did not include any gender perspective. Regarding the association between housing and health, most studies analyzed affordability (36%) and physical conditions (32%), and trends in health outcomes by gender varied according to each exposure analyzed, although overall the effects were worse for women and non-binary or trans people. To date, very few studies consider the gender perspective. It is urgent to address gender relations in housing and health studies, and to open an interdisciplinary and intersectoral agenda to address this complex relationship.
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19
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Ettman CK, Adam GP, Clark MA, Wilson IB, Vivier PM, Galea S. Wealth and depression: A scoping review. Brain Behav 2022; 12:e2486. [PMID: 35134277 PMCID: PMC8933775 DOI: 10.1002/brb3.2486] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Revised: 11/16/2021] [Accepted: 12/08/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The inverse relation between income and depression is well established. Less is understood about the relation between wealth and depression. We therefore conducted a scoping review to answer the question: What is known from the existing literature about the relation between wealth and depression? METHODS We searched for studies and articles in Medline (via PubMed), Embase, PsycINFO, PsycArticles, EconLit, and SocINDEX from inception through July 19, 2020. Ninety-six articles were included in our review. Key article characteristics were year of publication, sample size, country, study design, definition of depression, definition of wealth, and association between wealth and depression. Thirty-two longitudinal articles were included in a detailed charted review. RESULTS Depression was defined in a relatively standard manner across articles. In contrast, definitions and measurements of wealth varied greatly. The majority of studies in the full review (n = 56, 58%) and half of the studies in the longitudinal charted review (n = 16, 50%) reported an inverse relation between wealth and depression. The longitudinal charted review showed that (1) macro-economic events influenced depression, (2) wealth status influenced depression across the lifecourse, (3) wealth protected against depression in the face of stressors such as job loss, (4) subjective or psychosocial factors such as perception of wealth, relative comparison, and social status modified the relation between wealth and depression, and (5) savings interventions were successful in reducing depression and varied by context. CONCLUSION These findings suggest that wealth should be included in our consideration of the forces that shape mental health.
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Affiliation(s)
- Catherine K Ettman
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts, USA.,Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Gaelen P Adam
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Melissa A Clark
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Ira B Wilson
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA
| | - Patrick M Vivier
- Department of Health Services, Policy and Practice, Brown University School of Public Health, Providence, Rhode Island, USA.,Hassenfeld Child Health Innovation Institute, Providence, Rhode Island, USA
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts, USA
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20
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Turcu C, Crane M, Hutchinson E, Lloyd S, Belesova K, Wilkinson P, Davies M. A multi-scalar perspective on health and urban housing: an umbrella review. BUILDINGS & CITIES 2021; 2:734-758. [PMID: 34738085 PMCID: PMC7611930 DOI: 10.5334/bc.119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
With more than half the world's population living in cities, understanding how the built environment impacts human health at different urban scales is crucial. To be able to shape cities for health, an understanding is needed of planetary health impacts, which encompass the human health impacts of human-caused disruptions on the Earth's natural ecosystems. This umbrella review maps health evidence across the spatial scales of the built environment (building; neighbourhood; and wider system, including city, regional and planetary levels), with a specific focus on urban housing. Systematic reviews published in English between January 2011 and December 2020 were searched across 20 databases, with 1176 articles identified and 124 articles screened for inclusion. Findings suggests that most evidence reports on health determinants at the neighbourhood level, such as greenspace, physical and socio-economic conditions, transport infrastructure and access to local services. Physical health outcomes are also primarily reported, with an emerging interest in mental health outcomes. There is little evidence on planetary health outcomes and significant gaps in the research literature are identified. Based on these findings, three potential directions are identified for future research.
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Affiliation(s)
- Catalina Turcu
- The Bartlett Faculty of the Built Environment, University College London, London, UK
| | - Melanie Crane
- The Charles Perkins Centre, Sydney School of Public Health, The University of Sydney, Sydney, NSW, Australia
| | - Emma Hutchinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene and Tropical Medicine, UK
| | - Simon Lloyd
- Climate and Health Programme (CLIMA), Barcelona Institute for Global Health (ISGlobal), Barcelona, Spain
| | - Kristine Belesova
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Paul Wilkinson
- Public Health, Environments and Society, Faculty of Public Health and Policy, London School of Hygiene & Tropical Medicine, UK
| | - Mike Davies
- UCL Institute for Environmental Design and Engineering, Faculty of the Built Environment, University College London, London, UK
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21
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Health Effects of Housing Insecurity and Unaffordability in the General Population in Barcelona, Spain. J Urban Health 2021; 98:496-504. [PMID: 34231119 PMCID: PMC8382804 DOI: 10.1007/s11524-021-00546-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2021] [Indexed: 10/20/2022]
Abstract
While the negative effects of housing insecurity and unaffordability on health are well known, most of the studies in Spain have focused on very specific social groups so their findings cannot be extrapolated to the general population. The aim of this study is to assess the effects of housing stress and risk of displacement due to economic reasons, and their combined effect, on the mental and physical health of the general population from a middle-income neighborhood of Barcelona. We conducted a cross-sectional study using a household health survey which included respondents from a representative sample of 1202 non-institutionalized residents (> 18 years old) of the Horta neighborhood. We carried out a descriptive analysis, estimated the prevalence of poor mental and self-rated health (stratifying by the independent variables) and fitted robust Poisson regression models to estimate the effects of housing stress (HS) and the risk of forced displacement (RD) on self-rated health and mental health (GHQ-12). All analyses were stratified by sex. We found a higher likelihood of poor general and mental health among people affected by HS and/or RD compared to those not affected by HS and/or RD. A graded effect of HS and RD emerged mainly on mental health, even after adjusting by socioeconomic variables and housing tenure. The serious problem of housing insecurity and unaffordability in Spain is a widespread public health issue. Evidence-based public policies to improve well-being and health of people under this threat are urgently needed.
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22
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McGrath M, Duncan F, Dotsikas K, Baskin C, Crosby L, Gnani S, Hunter RM, Kaner E, Kirkbride JB, Lafortune L, Lee C, Oliver E, Osborn DP, Walters KR, Dykxhoorn J. Effectiveness of community interventions for protecting and promoting the mental health of working-age adults experiencing financial uncertainty: a systematic review. J Epidemiol Community Health 2021; 75:665-673. [PMID: 33931550 PMCID: PMC8223661 DOI: 10.1136/jech-2020-215574] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 03/01/2021] [Accepted: 03/23/2021] [Indexed: 02/02/2023]
Abstract
BACKGROUND The COVID-19 pandemic has created a period of global economic uncertainty. Financial strain, personal debt, recent job loss and housing insecurity are important risk factors for the mental health of working-age adults. Community interventions have the potential to attenuate the mental health impact of these stressors. We examined the effectiveness of community interventions for protecting and promoting the mental health of working-age adults in high-income countries during periods of financial insecurity. METHODS Eight electronic databases were systematically screened for experimental and observational studies published since 2000 measuring the effectiveness of community interventions on mental health outcomes. We included any non-clinical intervention that aimed to address the financial, employment, food or housing insecurity of participants. A review protocol was registered on the PROSPERO database (CRD42019156364) and results are reported in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. RESULTS From 2326 studies screened, 15 met our inclusion criteria. Five categories of community intervention were identified: advice services colocated in healthcare settings; link worker social prescribing; telephone debt advice; food insecurity interventions; and active labour market programmes. In general, the evidence for effective and cost-effective community interventions delivered to individuals experiencing financial insecurity was lacking. From the small number of studies without a high risk of bias, there was some evidence that financial insecurity and associated mental health problems were amenable to change and differences by subpopulations were observed. CONCLUSION There is a need for well-controlled studies and trials to better understand effective ingredients and to identify those interventions warranting wider implementation.
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Affiliation(s)
- Michael McGrath
- Division of Psychiatry, University College London, London, UK
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK
| | - Fiona Duncan
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - Kate Dotsikas
- Division of Psychiatry, University College London, London, UK
| | - Cleo Baskin
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Liam Crosby
- Department of Primary Care and Population Health, University College London, London, UK
| | - Shamini Gnani
- Department of Primary Care and Public Health, Imperial College London, London, UK
| | - Rachael Maree Hunter
- Department of Primary Care and Population Health, University College London, London, UK
| | - Eileen Kaner
- Institute of Health and Society, Newcastle University, Newcastle, UK
| | | | | | - Caroline Lee
- Cambridge Public Health, University of Cambridge, Cambridge, UK
- Cambridge Institute for Sustainability Leadership, Cambridge, UK
| | - Emily Oliver
- Department of Sport and Exercise Sciences, Durham University, Durham, UK
| | - David P Osborn
- Division of Psychiatry, University College London, London, UK
- Camden and Islington NHS Foundation Trust, London, UK
| | - Kate R Walters
- Department of Primary Care and Population Health, University College London, London, UK
| | - Jennifer Dykxhoorn
- Division of Psychiatry, University College London, London, UK
- Department of Primary Care and Population Health, University College London, London, UK
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23
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Ettman CK, Cohen GH, Vivier PM, Galea S. Savings, home ownership, and depression in low-income US adults. Soc Psychiatry Psychiatr Epidemiol 2021; 56:1211-1219. [PMID: 33175205 PMCID: PMC8110606 DOI: 10.1007/s00127-020-01973-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/24/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE While the association between income and depression is well established, less explored is the relation between wealth and depression, particularly among low-income adults. We studied the relation between two types of assets-savings and home ownership-and probable depression to understand how access to different assets may shape depression among low-income US adults. METHODS Study sample We conducted a serial cross-sectional, observational study with 12,019 adults with low-income in the United States using National Health and Nutrition Examination Survey (NHANES) data from 2007 to 2016. Measures We measured probable major depressive disorder (MDD) with impairment using the Patient Health Questionnaire-9. Low savings was defined as having $5000 or less in family savings. Statistical analysis We estimated adjusted and unadjusted prevalence, odds ratios, and predicted probability of probable MDD across asset groups. RESULTS Of low-income US adults, 5.4% had probable MDD with impairment, 85.9% had low savings, and 54.9% rented their home. Persons with low savings had 2.34 (95% CI 1.44-3.79) times the odds of having probable MDD relative to those with high savings. Home owners had 2.14 (95% CI 1.20-3.86) and home renters had 3.65 (95% CI 1.45-9.20) times the odds of having probable MDD if they had low savings relative to high savings. CONCLUSION Family savings and home ownership are associated with lower burden of depression among low-income adults in the US.
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Affiliation(s)
- Catherine K. Ettman
- Boston University School of Public Health, Boston, MA,Brown University School of Public Health, Providence, RI
| | - Gregory H. Cohen
- Boston University School of Public Health, Boston, MA,Columbia Mailman School of Public Health, NYC, NY
| | - Patrick M. Vivier
- Brown University School of Public Health, Providence, RI,Hassenfeld Child Health Innovation Institute, Providence, RI
| | - Sandro Galea
- Boston University School of Public Health, Boston, MA
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Mulia N, Ye Y, Karriker-Jaffe KJ, Li L, Kerr WC, Greenfield TK. The Great Recession, behavioral health, and self-rated health: An examination of racial/ethnic differences in the US. Addict Behav 2021; 118:106873. [PMID: 33652334 PMCID: PMC8483811 DOI: 10.1016/j.addbeh.2021.106873] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 02/04/2021] [Accepted: 02/04/2021] [Indexed: 01/14/2023]
Abstract
The Great Recession has been associated with racial/ethnic disparities in economic loss, alcohol-related problems and mental health in the US. In this study, we examine its effect on overall health, the role of heavy drinking and mental health, and whether these relationships vary by race/ethnicity. Using US National Alcohol Survey data collected from White, African American and Latino individuals between June 2009 and March 2010 (N = 4656), we conducted gender-stratified simultaneous path modeling to test racial/ethnic differences in hypothesized paths from recession-related hardships to overall self-rated health through current depressive symptoms and heavy drinking. Recession impacts were measured using an index of job-related, financial and housing hardships. Models accounted for demographic characteristics and heavy drinking, health conditions and alcohol-related health harms occurring prior to the Great Recession. We found that in men and women of each racial/ethnic group, more accumulated recession hardships were associated with greater depressive symptoms and more frequent heavy drinking, and depressive symptoms were associated with poorer self-rated health. Further, heavy drinking was related to poorer self-rated health in Black men and depressive symptoms in Latino men, and for Black and Latina women, prior heavy drinking was associated with current depressive symptoms. Findings highlight adverse, behavioral and overall health consequences of a severe recession for men and women of diverse racial/ethnic groups, as well as unique risks for Black and Latino men and women. Findings suggest the need for behavioral health interventions alongside multisector strategies to bolster the labor market and social safety net during severe economic downturns.
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Affiliation(s)
- Nina Mulia
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA.
| | - Yu Ye
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | | | - Libo Li
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - William C Kerr
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
| | - Thomas K Greenfield
- Alcohol Research Group, Public Health Institute, 6001 Shellmound St., Suite 450, Emeryville, CA 94608, USA
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25
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Friedman EM, Houle JN, Cagney KA, Slaughter ME, Shih RA. The Foreclosure Crisis, Community Change, and the Cognitive Health of Older Adults. J Gerontol B Psychol Sci Soc Sci 2021; 76:956-967. [PMID: 32303760 DOI: 10.1093/geronb/gbaa047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES While home foreclosures are often thought of as a household-level event, the consequences may be far-reaching, and spill over to the broader community. Older adults, in particular, could be affected by the spiral of community changes that result from foreclosures, but we know very little about how the foreclosure crisis is related to older adult health, in particular cognition. METHOD This article uses growth curve models and data from the Health and Retirement Study matched to Census and county-level foreclosure data to examine whether community foreclosures are related to older adults' cognitive health and the mechanisms responsible. RESULTS We find that higher rates of county-level foreclosures are associated with a faster decline in individual cognition at older ages. Although we examined an extensive number of individual and community mechanisms, including individual housing wealth and depressive symptoms, community structural factors, social factors, and perceptions of physical disorder and cohesion, none of the mechanisms examined here explained this relationship. DISCUSSION This study shows that the adverse consequences of home foreclosures spill over to the local community, with implications for the cognitive health of older adults.
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Affiliation(s)
| | - Jason N Houle
- Department of Sociology, Dartmouth College, Hanover, New Hampshire
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Jelle M, Morrison J, Mohamed H, Ali R, Solomon A, Seal AJ. Forced evictions and their social and health impacts in Southern Somalia: a qualitative study in Mogadishu Internally Displaced Persons (IDP) camps. Glob Health Action 2021; 14:1969117. [PMID: 34486956 PMCID: PMC8425757 DOI: 10.1080/16549716.2021.1969117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 08/12/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Forced evictions are common in conflict-affected settings. More than 500 internally displaced persons (IDPs) are evicted daily in Mogadishu. Context specific research is necessary to inform responsive humanitarian interventions and to monitor the effectiveness of these interventions on IDPs health. OBJECTIVE This study explored the causes of forced evictions and their health impacts among IDPs in southern Somalia. METHODS We used a qualitative approach, conducting 20 semi-structured interviews, six key informant interviews and four focus group discussions. We used maximum variation sampling to include a wide range of participants and used the framework approach and Nvivo software to analyse the data. RESULTS In this context, landlords often rented land without proper tenure agreements, resulting in risk of forced evictions. Informal tenure agreements led to fluctuations in rent, and IDPs were evicted because tenancy laws were inadequate and failed to protect IDP rights. IDP settlements often increased the value of land by clearing scrub, and landlords often sought to profit from this by evicting IDPs at short notice if a buyer was found for the land. The effect of eviction on an already marginalised population was wide ranging, increasing their exposure to violence, loss of assets, sexual assault, disruption of livelihoods, loss of social networks and family separation. Evicted IDPs reported health issues such as diarrhoea, malaria, pneumonia, measles and skin infections, as well as stress, anxiety, psychological distress and trauma. CONCLUSION Forced evictions remain one of the biggest challenges for IDPs as they exacerbate existing vulnerabilities. Prioritizing implementation of legal protection for IDP tenure rights is necessary to prevent unlawful evictions of IDPs. Humanitarian agencies should aim to respond more effectively to protect evictees and provide support to prevent poor health outcomes. Further quantitative research is needed to further examine the relationship between forced evictions and health outcomes.
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Affiliation(s)
- Mohamed Jelle
- Institute for Global Health, University College London, London, UK
| | - Joanna Morrison
- Institute for Global Health, University College London, London, UK
| | | | - Raha Ali
- Concern Worldwide Somalia, Mogadishu, Somalia
| | | | - Andrew J Seal
- Institute for Global Health, University College London, London, UK
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Callejo-Black P, Biederman D, Douglas C, Silberberg M. Eviction as a Disruptive Factor in Health Care Utilization: Impact on Hospital Readmissions and No-show Rates. J Health Care Poor Underserved 2021; 32:386-396. [PMID: 33678703 DOI: 10.1353/hpu.2021.0030] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND Residential eviction is a component of housing instability that negatively affects physical and mental health, but the effect of eviction on health care utilization, specifically hospital readmissions and outpatient no-show rates, is not known. METHODS We conducted a retrospective review of health care utilization of individuals evicted from public housing between January 2013 and December 2017, investigating hospital readmissions and no-show rates one year before and after eviction. RESULTS 131 individuals who had been evicted had one year of data pre-and post-eviction. The majority were African American (97.7%) and female (80.9%). There was no significant change in 30-, 60-, and 90-day hospital readmissions (p>.05). No-show rate decreased from 27.57 per person per year to 20.13 (p=.05). CONCLUSIONS For our study population, health care utilization was not disrupted. The decreased no-show rate represents an opportunity for health systems to engage with patients on social factors affecting their health post-eviction.
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Ettman CK, Cohen GH, Abdalla SM, Galea S. Do assets explain the relation between race/ethnicity and probable depression in U.S. adults? PLoS One 2020; 15:e0239618. [PMID: 33006988 PMCID: PMC7531850 DOI: 10.1371/journal.pone.0239618] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2020] [Accepted: 09/09/2020] [Indexed: 11/19/2022] Open
Abstract
Depression is a leading cause of disability in the U.S. across all race/ethnicity groups. While non-Hispanic Black and Hispanic persons have worse physical health on most indicators than non-Hispanic White persons, the literature on the association between race/ethnicity and rates of depression is mixed. Given unequal distribution of assets across racial/ethnic groups, it is possible that social and economic differences may explain differential rates of depression across race/ethnicity groups. Using National Health and Nutrition Examination Survey (NHANES) data from 2007–2016, we constructed a nationally representative sample of 26,382 adults over 18 years old (11,072 non-Hispanic White, 5,610 non-Hispanic Black, 6,981 Hispanic, and 2,719 Other race). We measured symptoms of depression using the Patient Health Questionnaire-9 (PHQ-9), with a score of 10 or more indicating probable depression. We identified three kinds of assets: financial assets (income), physical assets (home ownership), and social assets (marital status and education). We estimated the weighted prevalence of probable depression across race/ethnicity groups, odds ratios controlling for assets, and predicted probabilities of probable depression across race/ethnicity and asset groups. Three results contribute to our understanding of the differences in probable depression rates between race/ethnicity groups: 1) Non-Hispanic Black and Hispanic persons had a higher weighted prevalence of probable depression in the U.S. than non-Hispanic White persons. In models unadjusted for assets, non-Hispanic Black and Hispanic persons had 1.3 greater odds of probable depression than non-Hispanic White persons (p<0.01). 2) We found an inverse relation between assets and probable depression across all race-ethnicity groups. Also, non-Hispanic Black and Hispanic persons had fewer assets than non-Hispanic Whites. 3) When we controlled for assets, non-Hispanic Black and Hispanic persons had 0.8 times lower odds of probable depression than non-Hispanic White persons (p<0.05). Thus, when holding assets constant, minorities had better mental health than non-Hispanic White persons in the U.S. These three findings help to reconcile findings in the literature on race/ethnicity and depression. Given vastly unequal distribution of wealth in the U.S., it is not surprising that racial minorities, who hold fewer assets, would have an overall larger prevalence of mental illness, as seen in unadjusted estimates. Once assets are taken into account, Black and Hispanic persons appear to have better mental health than non-Hispanic White persons. Assets may explain much of the relation between race/ethnicity group and depression in the U.S. Future research should consider the role of assets in protecting against mental illness.
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Affiliation(s)
- Catherine K. Ettman
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Health Services, Policy, and Practice, Brown University School of Public Health, Providence, Rhode Island, United States of America
- * E-mail:
| | - Gregory H. Cohen
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Columbia Mailman School of Public Health, NYC, New York, United States of America
| | - Salma M. Abdalla
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
| | - Sandro Galea
- Office of the Dean, Boston University School of Public Health, Boston, Massachusetts, United States of America
- Department of Epidemiology, Boston University School of Public Health, Boston, Massachusetts, United States of America
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Venkataramani AS, O’Brien R, Whitehorn GL, Tsai AC. Economic influences on population health in the United States: Toward policymaking driven by data and evidence. PLoS Med 2020; 17:e1003319. [PMID: 32877406 PMCID: PMC7467305 DOI: 10.1371/journal.pmed.1003319] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Atheendar S. Venkataramani and colleagues discuss economic factors and population health in the United States.
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Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
- Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Rourke O’Brien
- Department of Sociology, Yale University, New Haven, Connecticut, United States of America
| | - Gregory L. Whitehorn
- Department of Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Alexander C. Tsai
- Center for Global Health and Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, United States of America
- Harvard Medical School, Boston, Massachusetts, United States of America
- Mbarara University of Science and Technology, Mbarara, Uganda
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Ettman CK, Abdalla SM, Cohen GH, Sampson L, Vivier PM, Galea S. Prevalence of Depression Symptoms in US Adults Before and During the COVID-19 Pandemic. JAMA Netw Open 2020; 3:e2019686. [PMID: 32876685 PMCID: PMC7489837 DOI: 10.1001/jamanetworkopen.2020.19686] [Citation(s) in RCA: 1271] [Impact Index Per Article: 317.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
IMPORTANCE The coronavirus disease 2019 (COVID-19) pandemic and the policies to contain it have been a near ubiquitous exposure in the US with unknown effects on depression symptoms. OBJECTIVE To estimate the prevalence of and risk factors associated with depression symptoms among US adults during vs before the COVID-19 pandemic. DESIGN, SETTING, AND PARTICIPANTS This nationally representative survey study used 2 population-based surveys of US adults aged 18 or older. During COVID-19, estimates were derived from the COVID-19 and Life Stressors Impact on Mental Health and Well-being study, conducted from March 31, 2020, to April 13, 2020. Before COVID-19 estimates were derived from the National Health and Nutrition Examination Survey, conducted from 2017 to 2018. Data were analyzed from April 15 to 20, 2020. EXPOSURES The COVID-19 pandemic and outcomes associated with the measures to mitigate it. MAIN OUTCOMES AND MEASURES Depression symptoms, defined using the Patient Health Questionnaire-9 cutoff of 10 or higher. Categories of depression symptoms were defined as none (score, 0-4), mild (score, 5-9), moderate (score, 10-14), moderately severe (score, 15-19), and severe (score, ≥20). RESULTS A total of 1470 participants completed the COVID-19 and Life Stressors Impact on Mental Health and Well-being survey (completion rate, 64.3%), and after removing those with missing data, the final during-COVID-19 sample included 1441 participants (619 participants [43.0%] aged 18-39 years; 723 [50.2%] men; 933 [64.7%] non-Hispanic White). The pre-COVID-19 sample included 5065 participants (1704 participants [37.8%] aged 18-39 years; 2588 [51.4%] women; 1790 [62.9%] non-Hispanic White). Depression symptom prevalence was higher in every category during COVID-19 compared with before (mild: 24.6% [95% CI, 21.8%-27.7%] vs 16.2% [95% CI, 15.1%-17.4%]; moderate: 14.8% [95% CI, 12.6%-17.4%] vs 5.7% [95% CI, 4.8%-6.9%]; moderately severe: 7.9% [95% CI, 6.3%-9.8%] vs 2.1% [95% CI, 1.6%-2.8%]; severe: 5.1% [95% CI, 3.8%-6.9%] vs 0.7% [95% CI, 0.5%-0.9%]). Higher risk of depression symptoms during COVID-19 was associated with having lower income (odds ratio, 2.37 [95% CI, 1.26-4.43]), having less than $5000 in savings (odds ratio, 1.52 [95% CI, 1.02-2.26]), and exposure to more stressors (odds ratio, 3.05 [95% CI, 1.95-4.77]). CONCLUSIONS AND RELEVANCE These findings suggest that prevalence of depression symptoms in the US was more than 3-fold higher during COVID-19 compared with before the COVID-19 pandemic. Individuals with lower social resources, lower economic resources, and greater exposure to stressors (eg, job loss) reported a greater burden of depression symptoms. Post-COVID-19 plans should account for the probable increase in mental illness to come, particularly among at-risk populations.
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Affiliation(s)
- Catherine K. Ettman
- Boston University School of Public Health, Boston, Massachusetts
- Brown University School of Public Health, Providence, Rhode Island
| | - Salma M. Abdalla
- Boston University School of Public Health, Boston, Massachusetts
| | - Gregory H. Cohen
- Boston University School of Public Health, Boston, Massachusetts
- Columbia Mailman School of Public Health, New York, New York
| | - Laura Sampson
- Boston University School of Public Health, Boston, Massachusetts
| | - Patrick M. Vivier
- Brown University School of Public Health, Providence, Rhode Island
- Hassenfeld Child Health Innovation Institute, Providence, Rhode Island
| | - Sandro Galea
- Boston University School of Public Health, Boston, Massachusetts
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Hawkley LC, Zheng B, Song X. Negative financial shock increases loneliness in older adults, 2006-2016: Reduced effect during the Great Recession (2008-2010). Soc Sci Med 2020; 255:113000. [PMID: 32439199 PMCID: PMC7310672 DOI: 10.1016/j.socscimed.2020.113000] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 03/13/2020] [Accepted: 04/14/2020] [Indexed: 10/24/2022]
Affiliation(s)
| | - Boyan Zheng
- University of Wisconsin-Madison, United States
| | - Xi Song
- University of Pennsylvania, United States
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Reeves K, O’Hare K, Shade L, Ludden T, McWilliams A, Manning M, Hogg M, Reynolds S, Shea CM, Burton EC, Calvert M, Derkowski DM, Tapp H. Evaluation of a shared decision-making intervention for pediatric patients with asthma in the emergency department. Implement Sci Commun 2020; 1:22. [PMID: 32885182 PMCID: PMC7427946 DOI: 10.1186/s43058-020-00010-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 12/09/2019] [Indexed: 01/03/2023] Open
Abstract
BACKGROUND Asthma is a difficult-to-manage chronic disease marked with associated outcome disparities including an increase rate of emergency department (ED) visits for uncontrolled asthma among patients who are most at-risk. Shared decision making (SDM) is a process by which the patient and provider jointly make a healthcare choice. SDM improves patient outcomes; however, implementation barriers of time constraints and staff availability are limitations. The use of health IT solutions may increase the adoption of SDM, but best practices for implementation are not well understood. The Consolidated Framework for Implementation Research (CFIR) is a flexible comprehensive model used to identify barriers and facilitators influencing implementation. The goal of this study is to implement an innovative web-based pediatric SDM tool in the real-world setting of two large healthcare system EDs through the following aims: (1) convene a patient, research, and ED stakeholder advisory board to oversee review of protocol and study materials prior to implementation, (2) implement the SDM intervention where providers and staff will be trained to incorporate use of this SDM intervention, (3) conduct on-going evaluation of barriers, facilitators, and implementation outcomes to tailor implementation in the EDs, (4) evaluate patient-centered outcomes of primary care utilization and changes in ED visits and hospitalizations before and after the SDM intervention, and (5) understand and document best practices for ED implementation. METHODS The CFIR model will guide the implementation evaluation. Researchers will administer surveys to the clinical team and patients at baseline, 3, 6, and 12 months to inform implementation design, determine barriers and facilitators, and resource-needs to allow for real-time process adjustments within the EDs. Focus group or key-informant interviews and analysis will provide additional feedback to the stakeholder team to iterate the implementation process. Researchers will track patient-centered outcomes including increased primary care, ED, and inpatient utilization over the duration of the study. DISCUSSION To advance asthma care and the field of implementation science, further research is needed to assess best practices for incorporating SDM into high-need healthcare settings such as the ED. This knowledge will facilitate improved outcomes and appropriate policy changes towards further use of SDM interventions in local and national acute care settings.
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Affiliation(s)
- Kelly Reeves
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Katherine O’Hare
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Lindsay Shade
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Thomas Ludden
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Andrew McWilliams
- Center for Outcomes Research and Evaluation (CORE), Atrium Health, Research Office Building, 1540 Garden Terrace, Charlotte, NC 28203 USA
| | - Melinda Manning
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Melanie Hogg
- Department of Emergency Medicine, Atrium Health, 1000 Blythe Blvd., 306 Medical Education Building, Charlotte, NC 28203 USA
| | - Stacy Reynolds
- Department of Emergency Medicine, Atrium Health, 1000 Blythe Blvd., 306 Medical Education Building, Charlotte, NC 28203 USA
| | - Christopher M. Shea
- Department of Health Policy and Management, UNC Gillings School of Global Public Health, The University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Elizabeth C. Burton
- Community Care Partners, 1423 E. Franklin St., Suite A, Monroe, NC 28112 USA
| | - Melissa Calvert
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
| | - Diane M. Derkowski
- Atrium Health, 1025 Morehead Medical Drive, Suite 600, Charlotte, NC 28204 USA
| | - Hazel Tapp
- Department of Family Medicine Research, Atrium Health, 2001 Vail Avenue, Suite 400B Mercy Medical Plaza, Charlotte, NC 28207 USA
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Affiliation(s)
- Atheendar S. Venkataramani
- Department of Medical Ethics and Health PolicyPerelman School of MedicineUniversity of PennsylvaniaPhiladelphiaPennsylvania
- Leonard Davis Institute of Health EconomicsUniversity of PennsylvaniaPhiladelphiaPennsylvania
| | - Alexander C. Tsai
- Center for Global HealthMassachusetts General HospitalBostonMassachusetts
- Harvard Medical SchoolBostonMassachusetts
- Mbarara University of Science and TechnologyMbararaUganda
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Jones A, Mamudu HM, Squires GD. Mortgage possessions, spatial inequality, and obesity in large US metropolitan areas. Public Health 2020; 181:86-93. [PMID: 31978778 DOI: 10.1016/j.puhe.2019.11.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 10/29/2019] [Accepted: 11/27/2019] [Indexed: 11/24/2022]
Abstract
OBJECTIVES As social determinants of health, mortgage possessions (primarily foreclosures in the US context) and housing instability have been associated with certain mental and physical health outcomes at the individual level. However, individual risks of foreclosure and of poor health are spatially patterned. The objective of this study is to examine the extent to which area-specific social and economic characteristics help explain the relationship between mortgage possessions and obesity prevalence in 75 of the 100 most populous US metropolitan areas. STUDY DESIGN This is a cross-sectional study. METHODS The study relies on three sources of data: the Selected Metropolitan/Micropolitan Area Risk Trends (SMART) project, RealtyTrac foreclosure data, and the American Community Survey. Focal social and economic characteristics include foreclosure rates, levels of racial residential segregation, and poverty. Obesity prevalence and several control measures for each metropolitan area are also used. Ordinary least squares regression, weighted using the SMART project data, is used, and statistical significance is set at 0.05. RESULTS The results suggest that mortgage possessions are independently associated with higher obesity prevalence and that foreclosures operate through the specific channel of racial residential segregation and its tie to the racial composition of a metropolitan area. Socio-economic status of an area, and not poverty, is related to foreclosures and obesity prevalence. CONCLUSION Mortgage possessions not only are socio-economic but also have negative health consequences, such as obesity. The findings provide an empirical base for other researchers to uncover the relationships between segregation, mortgage possessions, and obesity at the individual level of analysis. The public health community should be engaged in addressing the issue of foreclosures in the US because the failure to engage may have broad financial and health consequences across large cities.
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Affiliation(s)
- A Jones
- Department of Sociology, The George Washington University, USA; Department of Epidemiology, Department of Biostatistics and Bioinformatics, The George Washington University, USA.
| | - H M Mamudu
- College of Public Health, East Tennessee State University, USA
| | - G D Squires
- Department of Sociology, The George Washington University, USA
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Rodríguez-Rodríguez V, Pérez-Garín D, Recio-Saboya P, Rico-Gómez A. [Financial fraud and health: a qualitative approach]. GACETA SANITARIA 2020; 34:268-275. [PMID: 31964535 DOI: 10.1016/j.gaceta.2019.11.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 11/13/2019] [Accepted: 11/18/2019] [Indexed: 11/18/2022]
Abstract
During the economic crisis, developed countries have experienced financial fraud, with effects on the physical and mental health of the people affected, and on social domains. Based on the theoretical framework in literature reviews and in quantitative studies, this paper aims to obtain evidence on the effects of financial fraud on health and on the family and social environments of those affected. An intentional sample of 32 people affected by abusive and multi-currency mortgages, preferred and swap stock in Madrid was approached. In-depth interviews were conducted, and the resulting data was analysed using content analysis. Fraud-affected individuals had conditions of age, sex, educational level and occupations that possibly allowed them to accumulate economic resources throughout the course of their lives and, predictably in many cases, to take out fraudulent financial products, based on trust in the financial institutions. Financial fraud has led to the emergence of various processes of anomia and adverse health effects. The consequences on health were physical ailments (symptoms and diseases in various systems and parts of the body) and mental disorders (anxiety, depression, suicidal ideation), all affecting lifestyles, behaviour and personal and social relationships, both in affected individuals and their families. The increase in the use of medical drugs and health services serves as a final corollary to the imbalances on the affected people's health. Individuals and the Spanish society demand public health policy measures to mitigate the effects on health and the recovery of their confidence in the banking and political system.
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Affiliation(s)
- Vicente Rodríguez-Rodríguez
- Instituto de Economía, Geografía y Demografía, Consejo Superior de Investigaciones Científicas, Madrid, España.
| | | | - Patricia Recio-Saboya
- Facultad de Psicología, Universidad Nacional de Educación a Distancia, Madrid, España
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Purtle J, Nelson KL, Counts NZ, Yudell M. Population-Based Approaches to Mental Health: History, Strategies, and Evidence. Annu Rev Public Health 2020; 41:201-221. [PMID: 31905323 PMCID: PMC8896325 DOI: 10.1146/annurev-publhealth-040119-094247] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
There is growing recognition in the fields of public health and mental health services research that the provision of clinical services to individuals is not a viable approach to meeting the mental health needs of a population. Despite enthusiasm for the notion of population-based approaches to mental health, concrete guidance about what such approaches entail is lacking, and evidence of their effectiveness has not been integrated. Drawing from research and scholarship across multiple disciplines, this review provides a concrete definition of population-based approaches to mental health, situates these approaches within their historical context in the United States, and summarizes the nature of these approaches and their evidence. These approaches span three domains: (a) social, economic, and environmental policy interventions that can be implemented by legislators and public agency directors, (b) public health practice interventions that can be implemented by public health department officials, and (c) health care system interventions that can be implemented by hospital and health care system leaders.
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Affiliation(s)
- Jonathan Purtle
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | - Katherine L Nelson
- Department of Health Management and Policy, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA;
| | | | - Michael Yudell
- Department of Community Health and Prevention, Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania 19104, USA
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Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, Hillier-Brown F, Jayatunga W, Kelly G, Black M, Gopfert A, Roderick P, Barr B, Bambra C. Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health 2019; 19:1678. [PMID: 31842835 PMCID: PMC6915896 DOI: 10.1186/s12889-019-7895-6] [Citation(s) in RCA: 40] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. METHODS Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. RESULTS The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. CONCLUSIONS The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. TRIAL REGISTRATION Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.
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Affiliation(s)
- Yannish Naik
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Peter Baker
- Global Health and Development Group, School of Public Health, Imperial College London, St Mary’s Campus, Norfolk Place, London, W2 1PG UK
| | - Sharif A. Ismail
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH UK
- Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstans Road, London, W6 8RP UK
| | - Taavi Tillmann
- Centre for Global Non-Communicable Diseases, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH UK
| | - Kristin Bash
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Darryl Quantz
- NW School of Public Health, Health Education England North West, First Floor Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL UK
| | - Frances Hillier-Brown
- Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN UK
| | - Wikum Jayatunga
- Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA UK
| | - Gill Kelly
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Michelle Black
- School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA UK
| | - Anya Gopfert
- Junior Doctor and National Medical Director’s Fellow, London, UK
| | - Peter Roderick
- Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF UK
| | - Ben Barr
- University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB UK
| | - Clare Bambra
- Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP UK
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Swope CB, Hernández D. Housing as a determinant of health equity: A conceptual model. Soc Sci Med 2019; 243:112571. [PMID: 31675514 DOI: 10.1016/j.socscimed.2019.112571] [Citation(s) in RCA: 142] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 07/14/2019] [Accepted: 09/24/2019] [Indexed: 12/23/2022]
Abstract
Housing is a major pathway through which health disparities emerge and are sustained over time. However, no existing unified conceptual model has comprehensively elucidated the relationship between housing and health equity with attention to the full range of harmful exposures, their cumulative burden and their historical production. We synthesized literature from a diverse array of disciplines to explore the varied aspects of the relationship between housing and health and developed an original conceptual model highlighting these complexities. This holistic conceptual model of the impact of housing on health disparities illustrates how structural inequalities shape unequal distribution of access to health-promoting housing factors, which span four pillars: 1) cost (housing affordability); 2) conditions (housing quality); 3) consistency (residential stability); and 4) context (neighborhood opportunity). We further demonstrate that these four pillars can lead to cumulative burden by interacting with one another and with other structurally-rooted inequalities to produce and reify health disparities. We conclude by offering a comprehensive vision for healthy housing that situates housing's impact on health through a historical and social justice lens, which can help to better design policies and interventions that use housing to promote health equity.
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Affiliation(s)
- Carolyn B Swope
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA.
| | - Diana Hernández
- Sociomedical Sciences Department, Columbia University Mailman School of Public Health, New York, NY, USA
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Sarriá E, Recio P, Rico A, Díaz-Olalla M, Sanz-Barbero B, Ayala A, Zunzunegui MV. Financial Fraud, Mental Health, and Quality of Life: A Study on the Population of the City of Madrid, Spain. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16183276. [PMID: 31489951 PMCID: PMC6766254 DOI: 10.3390/ijerph16183276] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2019] [Revised: 08/31/2019] [Accepted: 09/04/2019] [Indexed: 11/16/2022]
Abstract
Over the past few decades, the financial system has engaged in abusive practices that meet the definition of fraud. Our objective is to compare the prevalence of psychological distress and levels of health-related quality of life according to having been exposed to financial fraud and its economic impact on family finances. The City of Madrid Health Survey 2017 included specific questions on exposure to financial fraud-this section was administered to half of the participants (n = 4425). Mental health need or caseness was defined by a score greater than two on the 12-item version of the Goldberg health questionnaire. Health-related quality of life was assessed by the Darmouth Coop Functional Health Assessment Charts/WONCA (COOP/WONCA). The prevalence of financial fraud was 10.8%. The prevalence rate ratio for caseness of those who experienced severe economic impact due to fraud was 1.62 (95%, CI 1.17-2.25; reference: no fraud), after adjustment by age, sex, social class, and immigrant status. Women experienced a decreased quality of life, even with a moderate impact of fraud, while men experienced a decreased quality of life related to fraud with severe economic impact. The current study contributes to a growing body of literature showing the effects of economic shocks on health as a result of financial fraud.
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Affiliation(s)
- Encarnación Sarriá
- Faculty of Psychology, National University for Distance Education (UNED), 28015 Madrid, Spain.
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
| | - Patricia Recio
- Faculty of Psychology, National University for Distance Education (UNED), 28015 Madrid, Spain.
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
| | - Ana Rico
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
| | - Manuel Díaz-Olalla
- Institute of Public Health, Madrid Salud, City Council of Madrid, 28029 Madrid, Spain.
| | - Belén Sanz-Barbero
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
- CIBER of Epidemiology and Public Health (CIBERESP), 28029 Madrid, Spain.
| | - Alba Ayala
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
- Research Network on Health Services and Chronicity (REDISSEC), 48010 Bilbao, Spain.
| | - María Victoria Zunzunegui
- Joint Research Institute IMIENS, 28029 Madrid, Spain.
- National School of Public Health, Carlos III Institute of Health, 28029 Madrid, Spain.
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40
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Jiménez-Picón N, García-Reposo A, Romero-Martín M. [Biopsychosocial consequences in Spanish population affected by an eviction process]. GACETA SANITARIA 2019; 34:289-296. [PMID: 31474382 DOI: 10.1016/j.gaceta.2019.03.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 03/26/2019] [Accepted: 03/29/2019] [Indexed: 10/26/2022]
Abstract
The biopsychosocial consequences in Spanish population affected by an eviction process were described in this paper. A scoping review was conducted, consulting the following databases: PubMed, Scopus, PsycINFO, CINAHL, LILACS, CSIC, MEDES, Scielo, Dialnet, Cuiden Plus and Cochrane. The search strategy was (Eviction OR "Home eviction" OR "Housing eviction" OR "Households at risk of eviction" OR Foreclosure) AND ("Health" OR "Mental Health" OR "Psychosocial impact" OR "Impacts on health" OR "Social impact indicators" OR "Social Determinants of Health" OR "Social Indicators").Eleven articles published between 2008 and September 2018 were selected. They followed a quantitative or qualitative methodology. The research quality was measured, and the results were organized according to the biopsychosocial model. From the physical perspective, results described a poor self-perception of health, as well as an increase of chronic diseases, pain, drug consumptions. From the psychological perspective, it was found negative thoughts, recurrent emotions and increased anxiety, depression, mental disorder and post-traumatic stress. From the social perspective, it was found that family, the offspring and the guarantor were affected, as well as the health system with greater medical visits and emergencies. This review showed worse health indicators among women, such as a headache, smoking habits, worse self-perception of health and more mental health disorders (depression, anxiety and other types of psychological distress). Daughters revealed worse self-perception of health than sons. It is necessary an approach from public health, epidemiological surveillance, action protocols and health programs, to advise, diagnose, prevent, protect and promote the health of the Spanish population affected.
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Affiliation(s)
- Nerea Jiménez-Picón
- Centro Universitario de Enfermería Cruz Roja de Sevilla, Universidad de Sevilla, Sevilla, España.
| | - Alicia García-Reposo
- Centro Universitario de Enfermería Cruz Roja de Sevilla, Universidad de Sevilla, Sevilla, España
| | - Macarena Romero-Martín
- Centro Universitario de Enfermería Cruz Roja de Sevilla, Universidad de Sevilla, Sevilla, España
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Abstract
The full scope of the impact of The Great Recession on individuals' mental health has not been quantified to date. This study aimed to determine whether financial, job-related, and housing impacts experienced by individuals during the recession predicted changes in the occurrence of symptoms of depression, generalized anxiety, panic attacks, and problematic alcohol or other substance use. Longitudinal survey data (n = 2,530 to n = 3,293) were analyzed from the national Midlife in the United States (MIDUS) study collected before (2003-2004) and after (2012-2013) The Great Recession. The population-level trend was towards improvements in mental health over time. However, for individuals each recession impact experienced was associated with long-lasting and transdiagnostic declines in mental health. These relationships were stronger for some sociodemographic groups, suggesting the need for additional support for people who suffer marked losses during recessions and for those without a strong safety net.
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Affiliation(s)
- Miriam K Forbes
- Departments of Psychiatry and Psychology, University of Minnesota, USA, 55454 Centre for Emotional Health, Department of Psychology, Macquarie University, Australia, 2109
| | - Robert F Krueger
- Department of Psychology, University of Minnesota-Twin Cities, USA, 55455
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Tsai J, Huang M. Systematic review of psychosocial factors associated with evictions. HEALTH & SOCIAL CARE IN THE COMMUNITY 2019; 27:e1-e9. [PMID: 30014532 DOI: 10.1111/hsc.12619] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2018] [Revised: 06/17/2018] [Accepted: 06/21/2018] [Indexed: 06/08/2023]
Abstract
Evictions from rented accommodations are a common pathway to homelessness and can negatively impact the lives of individuals and communities worldwide. There have been only few interventions developed to address evictions, and it is important to first understand factors associated with evictions. This systematic review included all available peer-reviewed articles on the topic published in the international literature from 1900 to 2017 and identified 10 peer-reviewed studies of evictions conducted in the United States, Canada, Amsterdam and Britain. From these studies, four categories of factors associated with evictions were identified. These factors were financial hardships, sociodemographic characteristics, substance use and other health problems. While many studies had large sample sizes, the majority of studies were cross-sectional. Together, our review found that there were several salient factors known to be associated with evictions which may benefit from intervention. However, more prospective studies on evictions and development of interventions are needed.
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Affiliation(s)
- Jack Tsai
- U.S. Department of Veterans Affairs New England Mental Illness Research, Education, and Clinical Center, VA Connecticut Healthcare System, West Haven, Connecticut
- Department of Psychiatry, Yale Univesrity School of Medicine, New Haven, Connecticut
| | - Minda Huang
- Graduate Institute of Professional Psychology, University of Hartford, West Haven, Connecticut
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Vásquez-Vera H, Fernández A, Novoa AM, Delgado L, Barcala J, Macías C, Borrell C. Our lives in boxes: perceived community mediators between housing insecurity and health using a PHOTOVOICE approach. Int J Equity Health 2019; 18:52. [PMID: 30917833 PMCID: PMC6438010 DOI: 10.1186/s12939-019-0943-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 02/25/2019] [Indexed: 11/24/2022] Open
Abstract
Background While the negative effects of housing insecurity on health are well known, the mechanisms and mediators of these effects have been less well studied. The aim of this study is to identify perceived mediators involved in the relationship between housing insecurity and health. Methods We used a participatory action research approach, the Photovoice methodology. It promotes a reflective process where participants critically discuss housing insecurity and human health and make recommendations to find solutions for the issues identified. This study was conducted with 18 members of the Platform for People Affected by Mortgages who were living in a situation of housing insecurity in Barcelona during the first half of 2017. Results Participants took 990 photographs, of which 147 were printed for analysis in discussion sessions. 109 of these photographs were then selected for categorization by the participants. 11 major categories emerged, representing various factors related to housing insecurity and health. Most categories were acknowledged as possible mediators of the housing/health problem, including: psychological changes; housing-related material aspects; health-related behaviors; eviction; harassment by financial institutions; and family, neighbors and social network. Others were considered as modifiers that could alter the effects of housing insecurity on health. Co-existing determinants may interact with housing insecurity, thereby increasing negative effects on health. Conclusions Through this participatory approach, the Photovoice project gives insight into the mechanisms underlying the relationship between housing insecurity and human health, and provides valuable recommendations to combat this serious public health issue. Electronic supplementary material The online version of this article (10.1186/s12939-019-0943-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Hugo Vásquez-Vera
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,CEES-Departamento de Salud Pública, Universidad de La Frontera, Temuco, Chile. .,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain.
| | - Ana Fernández
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain.,CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain
| | - Lucía Delgado
- Plataforma de Afectados por la Hipoteca de Barcelona, Barcelona, Spain
| | - Joaquín Barcala
- Plataforma de Afectados por la Hipoteca de Barcelona, Barcelona, Spain
| | - Carlos Macías
- Plataforma de Afectados por la Hipoteca de Barcelona, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, ES-08023, Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,CIBER de Epidemiología y Salud pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB-Sant Pau), Barcelona, Spain
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Associations between Home Foreclosure and Health Outcomes in a Spanish City. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060981. [PMID: 30893804 PMCID: PMC6466329 DOI: 10.3390/ijerph16060981] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/17/2019] [Accepted: 03/17/2019] [Indexed: 11/16/2022]
Abstract
The financial crisis has caused an exponential increase of home foreclosures in Spain. Recent studies have shown the effects that foreclosures have on mental and physical health. This study explores these effects on a sample of adults in the city of Granada (Spain), in terms of socio-demographic, socio-economic and process characteristics. A cross-sectional survey was administered to obtain information on self-perceived changes in several indicators of physical and mental health, consumption of medications, health-related behaviors and use of health services. A total of 205 persons, going through a foreclosure process, participated in the study. 85.7% of the sample reported an increase of episodes of anxiety, depression, and stress; 82.6% sleep disturbances; 42.8% worsening of previous chronic conditions, and 40.8% an increase in consumption of medication. Women, married persons and persons already in the legal stage of the foreclosure process reported higher probability of worsening health according to several indicators, in comparison with men, not married, and individuals in the initial stages of the foreclosure process. The results of this study reveal a general deterioration of health associated with the foreclosure process. These results may help to identify factors to prevent poor health among populations going through a foreclosure process.
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Schaff K, Dorfman L. Local Health Departments Addressing the Social Determinants of Health: A National Survey on the Foreclosure Crisis. Health Equity 2019; 3:30-35. [PMID: 30793093 PMCID: PMC6382054 DOI: 10.1089/heq.2018.0066] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Purpose: To examine local health department (LHD) engagement in addressing the social determinants of health by using the foreclosure crisis as an example. Methods: National survey of 166 LHD staff on the foreclosure crisis (2006-2014). Results: About one quarter (28%) of respondents reported that their LHD had engaged in work related to the foreclosure crisis, 7% planned to engage, and 65% did not or were not planning to engage. Views about the role of LHDs in addressing the foreclosure crisis varied: 30% stated that LHDs should work on foreclosure. Conclusions: A substantial number of respondents reported that their LHD addressed foreclosure, or supported engagement, yet there are divergent perceptions of appropriate LHD roles. LHDs follow a pattern described by the diffusion of innovations theory: Innovative LHDs can share their work on foreclosure and housing, early adopters are poised to act, and others may follow if they have support.
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Affiliation(s)
- Katherine Schaff
- Alameda County Public Health Department, Oakland, California
- Berkeley Media Studies Group—A Project of Public Health Institute, Berkeley, California
| | - Lori Dorfman
- Berkeley Media Studies Group—A Project of Public Health Institute, Berkeley, California
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46
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Chambers EC, Hanna DB, Hua S, Duncan DT, Camacho-Rivera M, Zenk SN, McCurley JL, Perreira K, Gellman MD, Gallo LC. Relationship between area mortgage foreclosures, homeownership, and cardiovascular disease risk factors: The Hispanic Community Health Study/Study of Latinos. BMC Public Health 2019; 19:77. [PMID: 30654781 PMCID: PMC6335763 DOI: 10.1186/s12889-019-6412-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Accepted: 01/07/2019] [Indexed: 11/26/2022] Open
Abstract
Background The risk of mortgage foreclosure disproportionately burdens Hispanic/Latino populations perpetuating racial disparities in health. In this study, we examined the relationship between area-level mortgage foreclosure risk, homeownership, and the prevalence of cardiovascular disease risk factors among participants of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). Methods HCHS/SOL participants were age 18–74 years when recruited from four U.S. metropolitan areas. Mortgage foreclosure risk was obtained from the U.S. Department of Housing and Urban Development. Homeownership, sociodemographic factors, and cardiovascular disease risk factors were measured at baseline interview between 2008 and 2011. There were 13,856 individuals contributing to the analysis (median age 39 years old, 53% female). Results Renters in high foreclosure risk areas had a higher prevalence of hypertension and hypercholesterolemia but no association with smoking status compared to renters in low foreclosure risk areas. Renters were more likely to smoke cigarettes than homeowners. Conclusion Among US Hispanic/Latinos in urban cities, area foreclosure and homeownership have implications for risk of cardiovascular disease.
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Affiliation(s)
- Earle C Chambers
- Department of Family & Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Harold and Muriel Block Building, Rm. 409, Bronx, NY, 10461, USA. .,Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA.
| | - David B Hanna
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Simin Hua
- Department of Epidemiology & Population Health, Albert Einstein College of Medicine, Bronx, NY, 10461, USA
| | - Dustin T Duncan
- NYU Spatial Epidemiology Laboratory, Department of Population Health, New York University School of Medicine, New York, NY, 10016, USA
| | - Marlene Camacho-Rivera
- Department of Community Health and Social Medicine, City University of New York School of Medicine, New York, NY, 10031, USA
| | - Shannon N Zenk
- Department of Health Systems Science, University of Illinois at Chicago College of Nursing, Chicago, IL, 60610, USA
| | - Jessica L McCurley
- Department of Medicine, Massachusetts General Hospital/Harvard Medical School, Boston, MA, 02114, USA
| | - Krista Perreira
- Department of Social Medicine, University of North Carolina, Chapel Hill, NC, 27599-7240, USA
| | - Marc D Gellman
- Behavioral Medicine Research Center, Department of Psychology, University of Miami, Miami, FL, 33136, USA
| | - Linda C Gallo
- Department of Psychology, San Diego State University, San Diego, CA, 92120, USA
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Duran AC, Zenk SN, Tarlov E, Duda S, Smith G, Lee JM, Berbaum ML. Foreclosures and weight gain: Differential associations by longer neighborhood exposure. Prev Med 2019; 118:23-29. [PMID: 30026119 PMCID: PMC6322928 DOI: 10.1016/j.ypmed.2018.07.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Revised: 07/07/2018] [Accepted: 07/16/2018] [Indexed: 10/28/2022]
Abstract
While home foreclosure can lead to mental and physical health declines in persons experiencing the foreclosure, whether neighborhood foreclosures can affect the health of other residents is debatable. Using a racially/ethnically diverse sample of Chicago metropolitan area residents linked to foreclosure data from 2008 to 2014, we assessed whether exposure to neighborhood foreclosure fillings was associated with changes in objectively measured body mass index (BMI) over time. Using a retrospective longitudinal design, we employed fixed-effects regression models that controlled for individual- and neighborhood-level covariates to test the association of neighborhood foreclosures and BMI in >60,000 individuals and for individuals who did not move during the follow-up period. We also adjusted for the non-linear association of age and BMI and comorbidities and employed a series of sensitivity analysis to test for robustness. In fully adjusted models, a standard-deviation increase in neighborhood foreclosure filings within 500 m was associated with increases in BMI for individuals who did not move (nonmovers) (mean = 0.03 BMI units, 95% confidence interval: 0.01, 0.06). Neighborhood foreclosure rates were not associated with changes in BMI for the full sample. Given the potential deleterious effects of neighborhood foreclosure on individuals with longer exposure to the local vicinity, clarifying the potential health effects of neighborhood foreclosures would help policymakers when planning actions to prevent home losses, predatory home loans, and that aim to more efficiently return foreclosure properties to productive uses.
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Affiliation(s)
- Ana Clara Duran
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA; Center for Food Studies, University of Campinas, Campinas, SP, Brazil.
| | - Shannon N Zenk
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA
| | - Elizabeth Tarlov
- Department of Health Systems Science, University of Illinois at Chicago, Chicago, IL, USA; Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, Hines, IL, USA
| | - Sarah Duda
- Institute for Housing Studies, DePaul University, Chicago, IL, USA
| | - Geoff Smith
- Institute for Housing Studies, DePaul University, Chicago, IL, USA
| | - Jin Man Lee
- Institute for Housing Studies, DePaul University, Chicago, IL, USA
| | - Michael L Berbaum
- Institute for Health Research and Policym, University of Illinois at Chicago, Chicago, IL, USA
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Niccolai LM, Blankenship KM, Keene DE. Eviction From Renter-occupied Households and Rates of Sexually Transmitted Infections: A County-level Ecological Analysis. Sex Transm Dis 2019; 46:63-68. [PMID: 30148755 PMCID: PMC6289707 DOI: 10.1097/olq.0000000000000904] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Housing instability is linked to numerous health outcomes, but the specific impact of eviction from renter-occupied households, an event that has immediate implications for residential stability for low-income individuals, on sexually transmitted infections (STI) rates has not been adequately studied. METHODS We examined county-level associations between eviction rates in 2014 and rates of chlamydia and gonorrhea in the following year using publicly available data sources (Eviction Lab National Database and AtlasPlus, respectively). Descriptive statistics compared medians and nonparametric distributions with Krusal-Wallis tests. Linear regression was used to compare tertile categories of eviction rates and STI rates while controlling for potential confounders. RESULTS Median rates of chlamydia in counties with low, medium, and high rates of eviction were 229, 270, and 358 cases per 100,000 population, respectively (P < 0.001). The corresponding median rates of gonorrhea were 25, 37, and 75 cases per 100,000 population (P < 0.001). These associations remained statistically significant after controlling for all covariates in adjusted models. The beta coefficients and 95% confidence intervals (95% CI) for chlamydia and gonorrhea comparing high to low county-level eviction rates were 63.8 (95% CI, 45.1-82.5) and 20.4 (95% CI, 13.5-27.4), respectively. Similar associations were observed across levels of poverty and in both metropolitan and nonmetropolitan counties. CONCLUSIONS County-level eviction rates are associated with chlamydia and gonorrhea rates in a significant and robust way independent of other known predictors of STI. These results suggest that evictions result in residential instability in a way that may increase STI risk.
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Affiliation(s)
| | | | - Danya E Keene
- Department of Social and Behavioral Sciences, Yale School of Public Health, New Haven, CT
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Hobbins A, Barry L, Kelleher D, Shah K, Devlin N, Goni JMR, O'Neill C. Utility Values for Health States in Ireland: A Value Set for the EQ-5D-5L. PHARMACOECONOMICS 2018; 36:1345-1353. [PMID: 30051267 PMCID: PMC6182460 DOI: 10.1007/s40273-018-0690-x] [Citation(s) in RCA: 67] [Impact Index Per Article: 11.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
OBJECTIVE Our objective was to develop a value set based on Irish utility values for the EuroQol 5-Dimension, 5-Level instrument (EQ-5D-5L). METHODS The research design and data collection followed a protocol developed by the EuroQol Group. The EuroQol Valuation Technology (EQ-VT) software was administered using computer-assisted personal interviews to a representative sample of adults resident in Ireland between 2015 and 2016. Utility values were elicited using two stated-preference techniques: time trade-off (TTO) and discrete-choice experiment (DCE). Each respondent completed a valuation exercise in which the EQ-VT system randomly selected one block of ten TTO questions from ten blocks relating to a possible 86 health states. One block of seven DCE pairs from 28 blocks of a possible 196 pairs of health states were randomly selected to accompany this. The relationship between utility values and health states was analysed using a hybrid regression model that combined data from the TTO and DCE techniques and expressed these as a function of the health state presented to the individual. This model estimated coefficients for 20 dummy variables that characterised each health state in the EQ-5D-5L framework, with the lowest level of severity providing the reference category in each domain. The relationship between weighted and unweighted TTO and DCE analyses of main effects was analysed separately. RESULTS Comparison of weighted and unweighted models revealed no substantive differences in results with respect to either DCE or TTO models. The unweighted hybrid model produced estimated effects, the ordering of which was intuitively consistent within each domain: lower levels of health were associated with lower utility values. Differences were evident between domains with respect to valuations; the disutility associated with conditions related to anxiety/depression and pain/discomfort was higher than for other domains. The decrement in utility associated with movement from the highest to the lowest level of health was 0.344 for mobility, 0.287 for self-care, 0.187 for usual activities, 0.510 for pain/discomfort and 0.646 for anxiety/depression. DISCUSSION The results present the first value set based on the EQ-5D-5L framework for a representative sample of residents in Ireland. The set reveals a higher decrement in utility associated with anxiety/depression than with other domains of health. Caution is warranted in comparisons with other value sets. That said, those in England, the Netherlands, Uruguay and China reveal that, whereas Irish values are broadly consistent with respect to mobility, self-care and usual activities, residents of Ireland attach a higher decrement to pain/discomfort and anxiety/depression than do other populations.
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Affiliation(s)
- Anna Hobbins
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland
| | - Luke Barry
- J.E. Cairnes School of Business and Economics, NUI Galway, Galway, Republic of Ireland
| | - Dan Kelleher
- J.E. Cairnes School of Business and Economics, NUI Galway, Galway, Republic of Ireland
| | | | | | | | - Ciaran O'Neill
- Centre for Public Health, Queens University Belfast, Belfast, Northern Ireland.
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Heggebø K, Tøge AG, Dahl E, Berg JE. Socioeconomic inequalities in health during the Great Recession: A scoping review of the research literature. Scand J Public Health 2018; 47:635-654. [DOI: 10.1177/1403494818801637] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Aims: The so-called ‘Great Recession’ in Europe triggered widespread concerns about population health, as reflected by an upsurge in empirical research on the health impacts of the economic crisis. A growing body of empirical studies has also been devoted to socioeconomic inequalities in health during the Great Recession. The aim of the current study is to summarise this health inequality literature by means of a scoping review. Methods: We have performed a scoping review of the research literature (English language) published in the years 2012–2017. Only empirical papers with (a) health status measured on the individual level, (b) information on socioeconomic position (i.e. employment status, educational level, income/wealth, and/or occupational class), and (c) data from European countries in both pre- and post-crisis years were considered relevant. In total, 49 empirical studies fulfilled these inclusion criteria. Results: The empirical findings in the 49 included studies predominantly show that socioeconomic inequalities in health either increased or remained stable from pre- to post-crisis years. Two-thirds (65%) of the studies found evidence of either increasing or partially increasing health inequalities. Thus, people in lower socioeconomic strata fared worse overall in terms of health during the Great Recession, compared to people with higher socioeconomic status. Conclusions: The Great Recession in Europe tends to be followed by increasing socioeconomic inequalities in health. Policymakers should take note of this finding. Widening socioeconomic inequalities in health is a major cause of concern, in particular if health deterioration among ‘vulnerable groups’ is caused by accelerating cumulative disadvantages.
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Affiliation(s)
| | - Anne Grete Tøge
- Work Research Institute (AFI), Oslo Metropolitan University, Norway
| | - Espen Dahl
- Department of Social Work, Child Welfare and Social Policy, Oslo Metropolitan University, Norway
| | - John Erik Berg
- Department of Occupational Therapy, Oslo Metropolitan University, Norway
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