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Objective: This study explores experiences of the Healthy Housing Initiative (HHI). Aimed at children at risk of housing-related illness, the HHI package includes the provision of items such as curtains, heaters, bedding, and insulation, advocacy to encourage landlords to install improvements, and education and advice to help people optimise their home environment. Methods: We conducted semi-structured, in-depth interviews with 20 people living in rental housing who received the HHI intervention. Results: Participants felt heard and supported by HHI assessors. They reported that the intervention increased the warmth and dryness of the home, improved their respiratory and mental health, reduced their bills, and enabled the use of more parts of their home. However, some continued to live in cold and damp conditions due to structural inadequacies and energy poverty. Conclusions: The qualitative evidence presented in this study shows how health-focussed interventions also benefit quality of life. Implications for public health: This research emphasises that healthy housing interventions can yield extensive benefits by adopting a holistic and home-based approach. Such interventions have the potential to create improvements in individuals' lives far beyond health.

Summary: Background: As with many Indigenous populations internationally, Māori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Māori occupants. Methods: We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Māori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Māori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. Findings: Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47–1·00]). Interpretation: Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Māori homes merits considerable policy and community effort. Funding: Health Research Council of New Zealand.

Abstract Objective: To assess homeowners’ intentions to make voluntary improvements to their homes following a warrant‐of‐fitness (WOF) assessment to highlight health and safety issues. Methods: We recruited 83 homeowners, including nine landlords, in Taranaki, New Zealand, who agreed to have a WOF assessment carried out on their homes. We interviewed 40 of the homeowners to ascertain what improvements they planned to make, and barriers to improving their homes. Results: Of the 83 properties, 76 (92%) failed the WOF. Of the 40 interview participants, 31 (76%) had addressed or planned to address at least one of the identified issues with the home. Participants were least likely to address identified issues with security stays on windows, and absence of ground vapour barrier. Reasons for not addressing identified issues included cost, and a belief that making the improvement would not benefit health and safety. Conclusions: Information about housing defects appears insufficient to encourage people to make improvements to their homes to meet a specified health and safety standard. Implications for public health: Better understanding of how particular housing defects pose a risk for health and safety, and provision of funding support in some cases, may encourage people to invest in safer, healthier homes.

Background: Living in cold housing conditions and risk of fuel poverty presents a range of physiological and psychosocial health risks. Limited research has specifically investigated the effects of fuel poverty on children and young people, and even less has been conducted with youth input into the research process. Methods: The Cool? Study used mixed methods, participatory action research carried out with youth researchers involved at all stages through questionnaire design, analysis, qualitative design, e-interviewing and dissemination of results. This article reports on results of an online survey of 656 adolescents aged 14–16 years completed at 17 schools in New Zealand. Sampling was based on selecting schools for invitation, with the probability of selection weighted proportional to school size, within strata defined by climate zone. Results from a small e-mail interview study of survey respondents who consented to follow-up are also reported. Results: The study found that almost half of the survey respondents (47%) felt their home was sometimes cold during the winter; a further 40% felt their home was often or always cold. More than two thirds of respondents (70%) had shivered inside at least once during winter. Respondents were more likely to report key indicators of fuel poverty depending on their self-reported ethnicity, with Māori at increased risk. Living in private rental housing or state-owned housing also increased risk of fuel poverty compared to those in owner-occupied dwellings. Participants of email interviews expressed concern about the widespread problem of cold housing for youth and a desire for Government intervention. Conclusion: The integrated results confirm that cold housing and risk of fuel poverty are important problems for young people in New Zealand. Results contribute to the evidence-base for policy targeting of schemes such as the Government-sponsored retrofitting of insulation to households with dependent children.

Objective: The objective of this research was to develop a principles framework to guide action on Māori/Indigenous homelessness in Aotearoa incorporating Rangatiratanga (Māori self-determination), Whānau Ora (Government policy that places Māori families at the center of funding, policy and services) and Housing First. Method: Three pathways were identified as creating opportunities for action on Māori homelessness: Te Tiriti o Waitangi/Treaty of Waitangi is the Māori self-determination pathway; Whānau Ora, a government-sponsored policy supports whānau/family as the pathway for Māori wellbeing and disparities reduction; and Housing First, an international pathway with local application for homelessness that is being implemented in parts of Aotearoa. The potential opportunities of the three pathways shaped interviews with authoritative Māori about Māori principles (derived from the three pathways) for addressing Māori homelessness. Twenty interviews were conducted with Māori experts using Kaupapa Māori research processes, eliciting advice about addressing Māori homelessness. A principles framework called Whare Ōranga was developed to synthesise these views. Results: Addressing Māori homelessness must be anchored in rights-based and culturally aligned practice empowered by Māori worldviews, principles and processes. Te Tiriti o Waitangi, which endorses Māori tribal self-determination and authority, and Whānau Ora as a government obligation to reduce inequities in Māori homelessness, are the foundations for such action. Colonisation and historical trauma are root causes of Māori homelessness. Strong rights-based frameworks are needed to enact decolonisation and guide policy. These frameworks exist in Tino Rangatiratanga/Māori self-determination and Whānau Ora. Conclusion: Whare Ōranga: An Indigenous Housing Interventions Principles Framework was developed in Aotearoa/New Zealand to end Māori homelessness. Future research is needed on the practical application of this framework in ending Māori homelessness. Moreover, the use value of the Whare Ōranga Framework as a workable approach to ending homelessness in other indigenous populations is yet to be considered. Keywords: Housing first, Homelessness, Indigenous, Māori, Treaty of waitangi, Whānau ora, Kaupapa māori, Colonisation, Wellbeing

Abstract:: Background: The Ending Homelessness in New Zealand: Housing First research programme is evaluating outcomes for people housed in a Housing First programme run by The People's Project in Hamilton, New Zealand. This baseline results paper uses administrative data to look at the scope and duration of their interactions with government services. Methods: We linked our de-identified cohort to the Integrated Data Infrastructure (IDI). This database contains administrative data on most services provided by the New Zealand Government to citizens. Linkage rates in all datasets were above 90%. This paper reports on the use of government services by the cohort before being housed. We focus on the domains of health, justice and income support. Results: The cohort of 390 people had over 200,000 recorded interactions across a range of services in their lifetime. The most common services were health, justice and welfare. The homeless cohort had used the services at rates far in excess of the general population. Unfortunately these did not prevent them from becoming homeless. Conclusion: These preliminary findings show the homeless population have important service delivery needs and a very high level of interaction with government services. This highlights the importance of analysing the contributing factors towards homelessness; for evaluation of interventions such as Housing First, and for understanding the need for integrated systems of government policy and practice to prevent homelessness. This paper also provides the baseline for post-Housing First evaluations. Keywords: New Zealand, Housing first, Homelessness, Service usage, Linked data

Abstract Objective: Report on a field test of a rental housing warrant of fitness (WOF) to assess its practicality and utility for supporting improved quality of housing. Methods: Five councils each recruited at least 25 rental houses to undergo a WOF assessment. The assessment included housing features that, based on a combination of research and practicality, were considered to have an important impact on health, safety and energy efficiency. Assessors were interviewed to get their feedback on the process. Landlords representing 81% of the rental properties were interviewed on their attitudes to the WOF. Results: Of the sample of 144 houses, 94% failed at least one of 31 criteria. The most common reasons were: unsafe water temperature; no security stays; no smoke alarms; no fixed heating; and unsuitable handrails/balustrades. If items that required little (