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Objectives: To assess the association between air pollution exposure and housing context during pregnancy and adverse birth outcomes. Methods: We linked air pollution data from the Environmental Protection Agency and housing data from the American Community Survey with birth records from Wisconsin counties over a 9-year period. We calculated average daily pregnancy exposure to fine particulate matter and ozone and modeled its relationship to preterm birth, low birthweight and NICU admission, adjusting for individual characteristics and housing context. Results: Ozone exposure and housing cost-burden had substantive and statistically significant negative associations with birthweight and gestational age, and positive associations with NICU admission, while a poor-quality housing environment had a significant negative effect on weeks of gestation. Fine particulate matter exposure had a negligible correlation with these outcomes. Conclusions for practice: An additional tenth of one part-per-million daily average exposure to ozone is associated with a 33 g decrease in birthweight. This decrease in birthweight is about the same size as the association of gestational diabetes (32 g), larger than the association of chronic hypertension (22 g), and about 40% the size of the effect of smoking during pregnancy on birthweight (84 g). Given the magnitudes of the associations with atmospheric ozone and adverse birth outcomes, reducing atmospheric ozone should be a public health priority. Inclusion of controls for housing cost-burden and poor-quality housing reduces the magnitude of the association with mothers who identify as Black, suggesting the importance of these structural factors in understanding adverse birth outcomes by race. Significance: What is already known on this subject: It is well documented that poor birth outcomes are linked to experiences of social and economic disadvantage, however, environmental correlates of poor birth outcomes are under-researched. Existing research does not account for the ways in which environmental, sociodemographic, and structural factors could confound each other given the concentration of environmental pollutants in communities of color and low-income communities. What this study adds: In this paper, we account for individual sociodemographic characteristics, access to emergency infant healthcare, and neighborhood housing factors to clarify the independent association of air pollution on birth outcomes in Wisconsin across a nine-year period. [ABSTRACT FROM AUTHOR]

By merging data from the National Health Interview Survey (2004–2016) with a census of buildings financed by the Low-Income Housing Tax Credit (LIHTC), this study provides national estimates for the health status and healthcare access among low-income adults living in LIHTC-financed housing. Compared to those not living in LIHTC-financed housing, unadjusted analyses found that younger adults (age 18–64) living in LIHTC-financed housing reported worse health status, more psychological distress, and more use of emergency department care, but they were also more likely to be insured, receive a flu vaccine, and have a usual source of care. Older adults (age 65+) living in LIHTC reported more psychological distress, more need for assistance with activities of daily living, more falls in the past year, and more use of emergency department care, as well as a slightly higher likelihood of being insured. Adjusted analyses revealed that sociodemographic characteristics helped explain some but not all of these findings, suggesting a need for further investigation of the drivers of health status and healthcare access for adults living in LIHTC-financed housing. [ABSTRACT FROM AUTHOR]

Observational evidence suggests that household floors may be an important domain for the transmission of enteric and parasitic infections. However, little work has been done to investigate how household floors can become contaminated with human and animal faeces. This study uses a mixed methods approach to postulate the proximal and distal determinants of household floor contamination with faeces in groups of rural villages in 3 counties in Kenya (Bungoma, Kwale and Narok). Quantitative data was collected through a household census and analysed descriptively and using mixed effects logistic regression models. Qualitative data was collected through unstructured observations of daily routines and in-depth interviews. These data were analysed thematically with case memos produced for routine activities that were hypothesised to be determinants of floor contamination. Possible proximal determinants of floor contamination included; (1) animal contact with floors; (2) child faeces disposal, and; (3) floor cleaning routines. Distal determinants are suggested to be rooted in the socioeconomic, environmental, and cultural context in which households were located and included; (1) the type and number of animals owned by households; (2) presence/absence of dedicated shelters for housing animals at night, which impacted whether sleeping or cooking areas were exposed to animals; (3) Accessibility of inside spaces to poultry and other roaming animals; (4) ownership of an improved floor; (5) ability of animals to access neighbours compounds; (6) seasonal changes in weather. These results will be of use in identifying the contexts in which faecal contamination of domestic floors may be contributing towards transmission of enteric and parasitic infections and in designing effective interventions to prevent this exposure. [ABSTRACT FROM AUTHOR]

Abstract Background Although social housing provides access to safe and affordable housing, recent studies have found that social housing tenants consistently have lower levels of health and well-being compared to other people. Given this, there is a need to examine multimorbidity for social housing tenants. Methods Secondary data analysis of the 2017-18 Australian National Health Survey (n = 14,327) compared the health of adults residing in social housing compared to people in other housing types (private rentals, homeowners, and homeowners/mortgagees). Results Most health factors examined were more prevalent in social housing tenants compared to those living in other housing types. Individual health problems identified as more highly prevalent in social housing tenants compared to all other housing types included mental health issues (43%), arthritis (36%), back problems (32%), hypertension (25%), asthma (22%) and COPD (11%). 24% of social housing tenants reported five or more health factors compared to 3–6% of people in other housing types. Conclusions Although these findings are not unexpected, they provide more detailed evidence that social housing providers and policy makers should consider when planning future initiatives.

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.

Background: Although social housing provides access to safe and affordable housing, recent studies have found that social housing tenants consistently have lower levels of health and well-being compared to other people. Given this, there is a need to examine multimorbidity for social housing tenants. Methods: Secondary data analysis of the 2017-18 Australian National Health Survey (n = 14,327) compared the health of adults residing in social housing compared to people in other housing types (private rentals, homeowners, and homeowners/mortgagees). Results: Most health factors examined were more prevalent in social housing tenants compared to those living in other housing types. Individual health problems identified as more highly prevalent in social housing tenants compared to all other housing types included mental health issues (43%), arthritis (36%), back problems (32%), hypertension (25%), asthma (22%) and COPD (11%). 24% of social housing tenants reported five or more health factors compared to 3–6% of people in other housing types. Conclusions: Although these findings are not unexpected, they provide more detailed evidence that social housing providers and policy makers should consider when planning future initiatives. [ABSTRACT FROM AUTHOR]

There is extensive scientific evidence showing that the characteristics of the urban and residential environment directly affect people's quality of life and health. In this framework, numerous building renovation policies have been developed in Europe, mainly focused on improving energy efficiency. However, we are dealing with a multifactorial and multicausal phenomenon of a complex system where competent institutions need quantitative diagnosis mechanisms that consider this holistic vision when making decisions and prioritizing interventions. Regarding this, the present research develops the potential of the multi-criteria methodology in a first proposal, which integrates social, energy, environmental and spatial aspects linked to the relationship between housing and the effects on the health of its inhabitants. It is a multidimensional method based on systematized and exportable vulnerability indices, which applies indicators that have been calculated using cadastral data and a typomorphological characterization of the residential stock. The analysis of the results through geostatistical techniques of autocorrelation and clustering applied to the case study of Donostia-San Sebastián shows that the proposed methodology is effective in achieving the objectives set. The associated GIS tool has proved to be agile and replicable. [ABSTRACT FROM AUTHOR]

Area regeneration of deprived neighborhoods is being used to reduce health inequality, socioeconomic deprivation and ethnic segregation. This quasi-experimental study examines if long-term graded exposure to urban regeneration is associated with primary healthcare-seeking behavior among residents. We compared general practitioner (GP) contacts from 2015-2020 in two adjacent, deprived social housing areas, one exposed to area regeneration. Populations were into Western and non-Western males and females aged 15 years and older (N = 3,960). Mean annual GP contact frequency for each group were estimated and a difference-in-difference (DiD) analysis was conducted with adjustments for propensity scores based on baseline characteristics. GP contact frequency increased for all groups across time with a systematically higher level and faster increase in the control groups. In particular, the mean difference between the exposed and control area for Western women increased from −4.67 to −5.76 annual contacts across the period. The mean differences in contact frequency increased for all groups but results of the DiD analyses were insignificant. In conclusion, an increasing gap in GP contact frequency, with the highest levels in the control area, was observed for all comparisons across time. More long-term research is needed to understand how the increasing gaps evolve. [ABSTRACT FROM AUTHOR]

The evidence linking human health and housing is overwhelming. However, less focus has been on collaborative action between the sectors to improve health. Focussing on social housing adds an important equity lens to the housing and health partnership literature. Since 2009, a unique formal partnership between a State Health Service, State Social Housing Organisation and a research organisation has existed. The partnership aims to realise potential benefits of integrating health considerations into asset and social planning within the housing sector and to empower residents to lead on outcomes they identify for the community and themselves individually. The partnership has a shared vision of working together to improve the health and wellbeing of social housing communities in one of Australia's most disadvantaged regions. This paper presents an analysis of over a decade of the partnership work. We present the history of the partnership, overview outcomes to date, and describe key mechanisms and contextual factors that have enabled action. We present our findings using two frameworks, one a practice focussed partnership toolkit and the other a theory informed approach to health focussed governance. Both frameworks enable us to present findings linking the practical successes and challenges of this partnership work with deeper insights from theory. [ABSTRACT FROM AUTHOR]

The outcomes of the Las Vegas Lead Hazard Control and Healthy Homes Program (Las Vegas LHCHHP) are characterized in this article by the prevalence, type, and location of lead-based paint and healthy homes hazards. A total of 62 participants were recruited for our program from residents of Las Vegas, Nevada, and were enrolled from 2018 until March 2020 according to U.S. Department of Housing and Urban Development requirements. Participants received a combined lead inspection and risk assessment, as well as a healthy homes visual assessment if lead-based paint hazards were identified. Occupant and housing characteristics were also recorded. The majority of Las Vegas LHCHHP housing units had [greater than or equal to]1 lead dust hazard, and most had [greater than or equal to]1 lead-based paint hazard on a variety of components. Domestic hygiene and structural issues were the most frequently identified healthy homes hazards. Lead-based paint and other health hazards were common in Las Vegas LHCHHP housing. Our findings could inform future occupant education and lead hazard control and healthy homes programs in other jurisdictions., Introduction Health and safety hazards in housing remain significant public health concerns, particularly for vulnerable populations such as children, who spend 80-95% of their time inside their homes (Breysse & [...]

Food insecurity and loneliness are shockingly large and growing problems in the older population in the U.S. and globally. Thus, the study's primary aim was to investigate the prevalence as well as the association between these two social determinants of health in the marginalised and often underserved population of older residents of urban subsidised housing (also referred to as social housing or affordable housing). Of particular interest was whether a greater sense of loneliness increases the risk of older residents being food insecure. The study uses survey data gathered through in‐person interviews conducted onsite in English or Spanish with 216 of the 300 older adults (72% response rate) living in a subsidised housing community in a central neighbourhood of a U.S. northeastern city. Amongst the 216 participants, 50% identified as Black and 45% identified as Latino. In addition to food insecurity and loneliness, the survey assessed participants' health, food access challenges, and sociodemographic characteristics. Results revealed a 34% food insecurity prevalence rate amongst the participants which is higher than the estimate of slightly less than 10% of the U.S. older population being food insecure. The participants' 34% loneliness rate was also higher than the 19%–29% prevalence range in U.S. older population studies. Bivariate analyses highlighted the interrelatedness or intertwining of food insecurity, loneliness, poor health and food access challenges whilst a series of logistic regressions further explored the significant association of loneliness with food insecurity. Loneliness increased the odds ratio of food insecurity in the binary (unadjusted) regression (p < 0.001, OR = 3.1) and the multivariate (adjusted) regression that included all covariates (p < 0.05, OR = 2.4). Overall, the findings underscore the need for greater awareness of loneliness as a public health threat as well as future research exploring how loneliness may intensify the health consequences of food insecurity in later life. [ABSTRACT FROM AUTHOR]

Affordable housing is commonly described as an important determinant of health, but there are relatively few intervention studies of the effects of housing on health. In this paper, we describe the results of a quasi-experimental, longitudinal study investigating the impacts of receiving social housing among a cohort of 502 people on waitlists for social housing in the Greater Toronto Area, Canada. Specifically, we sought to determine if adults who received housing were more likely than a control group to show improvements in depression, psychological distress, and self-rated mental health 6, 12 and 18 months after moving to housing. Amongst the participants, 137 received social housing and completed at least one follow-up interview; 304 participants did not receive housing and completed at least one follow-up interview and were treated as a control group (47 people provided data to both groups). The difference-in-differences technique was used to estimate the effect of receiving housing by comparing changes in the outcomes over time in the housed (intervention) group and the group that remained on the waitlist for social housing (control group). Adjusted mixed effects linear models showed that receiving housing resulted in significant decreases in psychological distress and self-rated mental health between the groups. Improvements in self-rated mental health between the groups were observed 6, 12 and 18 months after receiving housing (6 months, +2.9, p < 0.05; 12 months, +2.6, p < 0.05; 18 months, +3.0, p < 0.05). Reductions in psychological distress (-1.4, p < 0.05) were observed 12 months after receiving housing. Overall findings suggest that receiving subsidized housing improves mental health over a 6-to-18-month time horizon. This has policy and funding implications suggesting a need to reduce wait times and expand access to subsidized housing., (Copyright © 2024 The Authors. Published by Elsevier Ltd.. All rights reserved.)

There is extensive scientific evidence showing that the characteristics of the urban and residential environment directly affect people’s quality of life and health. In this framework, numerous building renovation policies have been developed in Europe, mainly focused on improving energy efficiency. However, we are dealing with a multifactorial and multicausal phenomenon of a complex system where competent institutions need quantitative diagnosis mechanisms that consider this holistic vision when making decisions and prioritizing interventions. Regarding this, the present research develops the potential of the multi-criteria methodology in a first proposal, which integrates social, energy, environmental and spatial aspects linked to the relationship between housing and the effects on the health of its inhabitants. It is a multidimensional method based on systematized and exportable vulnerability indices, which applies indicators that have been calculated using cadastral data and a typomorphological characterization of the residential stock. The analysis of the results through geostatistical techniques of autocorrelation and clustering applied to the case study of Donostia-San Sebastián shows that the proposed methodology is effective in achieving the objectives set. The associated GIS tool has proved to be agile and replicable.

Issue addressed: Eviction, or a forced move from rental housing, is a common experience for New Zealand renters, yet we know very little about its effects. This research investigated how eviction affects people's lives and health. Methods: We conducted semi‐structured interviews with 27 people who had experienced eviction. We coded the transcripts and grouped them into themes using template analysis. Results: Participant experienced grief at the loss of the home. Moving out and searching for a new home was highly stressful on participants and on their relationships. After being evicted, people became homeless, often staying with family and friends and lived in poor quality or unaffordable housing. They reported health issues as a result of these circumstances. Conclusions: Eviction harms health through causing stress, grief and a move to a risky living situation. Increasing the supply of housing and funding wide‐ranging support services can help minimise the harm caused by eviction. So what?: Reducing the incidence and impact of eviction should be a priority for health promotion. [ABSTRACT FROM AUTHOR]

Summary: Objective: To assess the association between household size and risk of non-severe or severe COVID-19. Design: A longitudinal observational study. Setting: This study utilised UK Biobank linked to national SARS-CoV-2 laboratory test data. Participants: 401,910 individuals with available data on household size in UK Biobank. Main outcome measures: Household size was categorised as single occupancy, two-person households and households of three or more. Severe COVID-19 was defined as a positive SARS-CoV-2 test on hospital admission or death with COVID-19 recorded as the underlying cause; and non-severe COVID-19 as a positive test from a community setting. Logistic regression models were fitted to assess associations, adjusting for potential confounders. Results: Of 401,910 individuals, 3612 (1%) were identified as having suffered from a severe COVID-19 infection and 11,264 (2.8%) from a non-severe infection, between 16 March 2020 and 16 March 2021. Overall, the odds of severe COVID-19 was significantly higher among individuals living alone (adjusted odds ratio: 1.24 [95% confidence interval: 1.14 to 1.36], or living in a household of three or more individuals (adjusted odds ratio: 1.28 [1.17 to 1.39], when compared to individuals living in a household of two. For non-severe COVID-19 infection, individuals living in a single-occupancy household had lower odds compared to those living in a household of two (adjusted odds ratio: 0.88 [0.82 to 0.93]. Conclusions: Odds of severe or non-severe COVID-19 infection were associated with household size. Increasing understanding of why certain households are more at risk is important for limiting spread of the infection. [ABSTRACT FROM AUTHOR]

Objective: To estimate the proportion of ethnic inequalities explained by living in a multi-generational household.Design: Causal mediation analysis.Setting: Retrospective data from the 2011 Census linked to Hospital Episode Statistics (2017-2019) and death registration data (up to 30 November 2020).Participants: Adults aged 65 years or over living in private households in England from 2 March 2020 until 30 November 2020 (n=10,078,568).Main Outcome Measures: Hazard ratios were estimated for COVID-19 death for people living in a multi-generational household compared with people living with another older adult, adjusting for geographic factors, socioeconomic characteristics and pre-pandemic health.Results: Living in a multi-generational household was associated with an increased risk of COVID-19 death. After adjusting for confounding factors, the hazard ratios for living in a multi-generational household with dependent children were 1.17 (95% confidence interval [CI] 1.06-1.30) and 1.21 (95% CI 1.06-1.38) for elderly men and women. The hazard ratios for living in a multi-generational household without dependent children were 1.07 (95% CI 1.01-1.13) for elderly men and 1.17 (95% CI 1.07-1.25) for elderly women. Living in a multi-generational household explained about 11% of the elevated risk of COVID-19 death among elderly women from South Asian background, but very little for South Asian men or people in other ethnic minority groups.Conclusion: Elderly adults living with younger people are at increased risk of COVID-19 mortality, and this is a contributing factor to the excess risk experienced by older South Asian women compared to White women. Relevant public health interventions should be directed at communities where such multi-generational households are highly prevalent. [ABSTRACT FROM AUTHOR]

Countries with aging populations require people to remain independent for as long as possible to reduce pressures on health and care services. England has an old housing stock, low replacement rates and little specialized housing for older people. There is grant assistance to adapt homes, but resources are restricted and service pathways complex. This article charts the findings of change management projects and national reviews that show that reform is hampered by a lack of robust data about the financial benefits of adaptations. Better evidence is needed to give housing issues greater prominence in health and care planning. [ABSTRACT FROM AUTHOR]

As home-based health services emerge as a focal point of international discussions of primary healthcare, the home environment is now recognised as a place for safe and independent living, and also delivery of care. Consequently, research into how housing improvements can directly impact health and care outcomes is an increasingly important area of trans-disciplinary research. The links between health and housing are well established and indicate that housing interventions may be an important mechanism in health maintenance and improvement. Studies of home modifications have been published across a number of fields and the extent of their effects are diverse. We undertook a scoping review according to systematic PRISMA-P (Preferred reporting items for systematic review and meta-analysis protocols) guidelines to map the breadth and scale of the evidence base, identify themes and gaps in the evidence as well as grading home modifications research quality. Seventy-seven studies from 16 countries were included and revealed that home modifications evidence is measured in terms of a diverse range of effects. Seven key themes emerged including (in decreasing order); injury and falls prevention; improved function, self-care or independence; physical health and well-being; caregiving; economic effectiveness; ageing process; and social participation. The strongest experimental evidence has been conducted in relation to falls prevention. [ABSTRACT FROM AUTHOR]