Cardiovascular Health Outcomes of Latinos in the Affordable Housing as an Obesity Mediating Environment (AHOME) Study: A Study of Rental Assistance Use

Studies have shown that households subsidized with vouchers live in higher quality units and exhibit fewer physical, mental, and social problems than do their peers living in public housing. However, none of these studies have included cardiovascular outcomes. The objective of this study was to assess if use/type of rental assistance is independently associated with poor cardiovascular health among Latino adults (ages ≥18) who are eligible for federal low-income rental assistance and living in the Bronx, NY. Data from the cross-sectional, Affordable Housing as an Obesity Mediating Environment study, collected over 18 months (January 2011 to August 2012) were used. The prevalence of cardiovascular disease (CVD) outcomes was determined by measured high blood pressure and self-reported heart attack and/or stroke. Type of housing status was defined as: public housing units, units subsidized by section 8 vouchers, and units unassisted by either federal program. Statistical techniques used were analysis of variance and multivariate logistic regression. The prevalence of CVD was significantly higher among public housing residents than unassisted participants even in the presence of all individual level covariates. Public housing residents also have higher levels of CVD than do section 8 participants. The prevalence of CVD was similar for unassisted and section 8 participants. These findings point to the potential for health benefits arising from housing voucher use even within a fairly delimited geographic area.     

Local Housing Choice Voucher Distribution Policies Impact Healthcare Utilization: a Randomized Natural Experiment

While associations between obtaining affordable housing and improved health care are well documented, insufficient funding often forces housing authorities to prioritize limited housing vouchers to specific populations. We assessed the impact of obtaining housing on health care utilization at two urban housing authorities with different distribution policies: Housing Authority A prioritized seniors and people with disabilities, while Housing Authority B prioritized medically complex individuals and families with school-aged children. Both housing authorities used random selection to distribute vouchers, allowing us to conduct a randomized natural experiment of cases and waitlisted controls. No significant demographic differences were present between those receiving vouchers and waitlisted controls. Housing Authority A vouchers were associated with increased outpatient visits (OR = 1.19; P = 0.051). Housing Authority B vouchers decreased the likelihood of emergency department visits (OR = 0.61; P = 0.042). This study provides evidence that, while obtaining housing can result in better health care outcomes overall, local prioritization policies can influence that impact.     

Characterization of Healthy Housing in Africa: Method,Profiles, and Determinants

Housing is a key social determinant of health with implications for both physical and mental health. The measurement of healthy housing and studies characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study described a methodological approach employed in the assessment and characterization of healthy housing in SSA using the Demographic and Health Survey (DHS) data for 15 countries and explored healthy housing determinants using a multiple survey-weighted logistic regression analysis. For all countries, we demonstrated that the healthy housing index developed using factor analysis reasonably satisfies both reliability and validity tests and can therefore be used to describe the distribution of healthy housing across different groups and in understanding the linkage with individual health outcomes. We infer from the results that unhealthy housing remains quite high in most SSA countries. Having a male head of the household was associated with decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68–0.95), Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64–0.78), and Senegal (OR = 0.62, CI = 0.51–0.74). Further, increasing household size was associated with reducing odds of healthy housing in Kenya (OR = 0.53, CI = 0.44–0.65), Namibia (OR = 0.34, CI = 0.24–0.48), Nigeria (OR = 0.57, CI = 0.46–0.71), and Uganda (OR = 0.79, CI = 0.67–0.94). Across all countries, household wealth was a strong determinant of healthy housing, with middle and rich households having higher odds of residing in healthy homes compared to poor households. Odds ratios ranged from 3.63 (CI = 2.96–4.44) for households in the middle wealth group in the DRC to 2812.2 (CI = 1634.8–4837.7) in Namibia’s wealthiest households. For other factors, the analysis also showed variation across countries. Our findings provide timely insights for the implementation of housing policies across SSA countries, drawing attention to aspects of housing that would promote occupant health and wellbeing. Beyond the contribution to the measurement of healthy housing in SSA, our paper highlights key policy and program issues that need further interrogation in the search for pathways to addressing the healthy housing deficit across most SSA countries. This has become critical amid the COVID-19 pandemic, where access to healthy housing is pivotal in its control.     

The Association Between Apartment Layout and Depressive Symptomology among Hispanic/Latino Residents in Low-Income Housing: the AHOME Study

In this study of low-income Hispanic/Latino adults living in 291 individual apartments in the Bronx, New York, the apartment layout was significantly associated with the odds of depressive symptomology. Women living in apartments in which the most central rooms were the living, dining, or kitchen (i.e., rooms commonly used for communal activities) were less likely to have depressive symptomology (OR = 0.44, 95% CI = 0.22–0.86) than women in apartments where the central rooms were lobbies or corridors, adjusting for demographics, health conditions, and housing and neighborhood characteristics. No statistically significant association was observed in men. We present the logic underlying the use of layout variables in this study and discuss the implications it may have for understanding the role of the home environment on psychological distress among inhabitants. The results of this study show how space syntax analysis can be used to better understanding disparities in the risk of depression and offer an additional opportunity for public health stakeholders to identify those most at risk for depression.     

Disentangling Race and Social Context in Understanding Disparities in Chronic Conditions among Men

Disparities in men’s health research may inaccurately attribute differences in chronic conditions to race rather than the different health risk exposures in which men live. This study sought to determine whether living in the same social environment attenuates race disparities in chronic conditions among men. This study compared survey data collected in 2003 from black and white men with similar incomes living in a racially integrated neighborhood of Baltimore to data from the 2003 National Health Interview Survey. Multivariable logistic regression models estimated to determine whether race disparities in chronic conditions were attenuated among men living in the same social environment. In the national sample, black men exhibited greater odds of having hypertension (odds ratio [OR] = 1.58, 95 % confidence interval [CI] 1.34, 1.86) and diabetes (OR = 1.62, 95 % CI 1.27–2.08) than white men. In the sample of men living in the same social context, black and white respondents had similar odds of having hypertension (OR = 1.05, 95 % CI 0.70, 1.59) and diabetes (OR = 1.12, 95 % CI 0.57–2.22). There are no race disparities in chronic conditions among low-income, urban men living in the same social environment. Policies and interventions aiming to reduce disparities in chronic conditions should focus on modifying social aspects of the environment.     

Bedbug Complaints among Public Housing Residents—New York City, 2010–2011

Few studies have evaluated population-level risk factors for having a bedbug infestation. We describe characteristics associated with bedbug complaints among New York City Housing Authority (NYCHA) residents. Unique households receiving bedbug extermination services in response to a complaint during January 1, 2010 to December 31, 2011 were identified from NYCHA’s central facilities work order database. We examined associations between household characteristics and having a bedbug complaint using a generalized estimating equation Poisson regression model, accounting for clustering by housing development. Of the 176,327 NYCHA households, 11,660 (6.6 %) registered a bedbug complaint during 2010–2011. Bedbug complaints were independently associated with households having five or more children versus no children (prevalence ratio [PR] = 2.0), five or more adults versus one adult (PR = 1.6), a head of household (HOH) with impaired mobility (PR = 1.3), a household member receiving public assistance (PR = 1.2), a household income below poverty level (PR = 1.1), and a female HOH (PR = 1.1). Infestations were less likely to be reported by households with employed members (PR = 0.9), and an HOH aged 30–44 years (PR = 0.9) or 45–61 years (PR = 0.9), compared with an HOH aged 18–29 years. These results indicate that bedbug control efforts in public housing should be targeted toward households with low income and high occupancy.     

Oral Health among Residents of Publicly Supported Housing in Boston

Tooth loss in adults diminishes quality of daily life, affecting eating, speaking, appearance, and social interactions. Tooth loss is linked to severe periodontitis and caries; and to risk of stroke, cardiovascular disease, rheumatoid arthritis, and dementia. At the national (USA) level, poverty and African-American race have been linked to lower utilization of dental services, suggesting that the 7.5 million residents of publicly supported housing may be at risk of tooth loss and poor overall oral health. We assessed whether residence in publicly supported housing in Boston was associated with four oral health-related indicators. Compared to residents of nonpublicly supported housing, after adjusting for covariates residents of both public housing developments (PHDs) and rental assistance units (RAUs) had significantly lower odds of having had a dental cleaning in the past year (PHD, OR = 0.64 (95 % CI, 0.44–0.93); RAU, OR = 0.67 (95 % CI, 0.45–0.99))—despite parity in having had a past year dental visit. Further, residents of RAUs had double the odds of having had six or more teeth removed (OR = 2.20 (95 % CI, 1.39–3.50)). Associations of race/ethnicity and housing type with dental insurance were interrelated. Unadjusted results document a deficit in oral health-related indicators among public housing residents, taken as a group, giving a clear picture of an oral health care gap and identifying a defined real-world population that could benefit from services. Existing public housing infrastructure could provide both a venue and a foundation for interventions to reduce oral health disparities on a broad scale.     

The Onset of Depression During the Great Recession: Foreclosure and Older Adult Mental Health

Objectives. We examined neighborhood-level foreclosure rates and their association with onset of depressive symptoms in older adults.Methods. We linked data from the National Social Life, Health, and Aging Project (2005–2006 and 2010–2011 waves), a longitudinal, nationally representative survey, to data on zip code–level foreclosure rates, and predicted the onset of depressive symptoms using logit-linked regression.Results. Multiple stages of the foreclosure process predicted the onset of depressive symptoms, with adjustment for demographic characteristics and changes in household assets, neighborhood poverty, and visible neighborhood disorder. A large increase in the number of notices of default (odds ratio [OR] = 1.75; 95% confidence interval [CI] = 1.14, 2.67) and properties returning to ownership by the bank (OR = 1.62; 95% CI = 1.06, 2.47) were associated with depressive symptoms. A large increase in properties going to auction was suggestive of such an association (OR = 1.45; 95% CI = 0.96, 2.19). Age, fewer years of education, and functional limitations also were predictive.Conclusions. Increases in neighborhood-level foreclosure represent an important risk factor for depression in older adults. These results accord with previous studies suggesting that the effects of economic crises are typically first experienced through deficits in emotional well-being.Recent evidence suggests that the foreclosure crisis, emerging in full force in 2007, has had devastating effects on the housing market and on the condition of housing units in neighborhoods with high rates of foreclosure. Economic models point to significant neighborhood externalities associated with increases in foreclosure rates,1,2 and extant research suggests that the impact of an economic downturn may first be felt through depression.3Depression, in turn, has important implications for physical health, quality of life, and the cost of medical care.4 Research on the association between neighborhood social context and depression suggests that the surrounding neighborhood environment may have independent effects on depression, over and above individual influences.5Research on foreclosure and health is limited, but ecological analyses suggest an association between a spike in foreclosures and use of health services, such as unscheduled hospital visits.6 To our knowledge, no research has examined the role of the economic downturn, or the “Great Recession,” in the onset of depression with a focus on the residential context in which individuals observe economic decline.6 We therefore explored the onset of depression over the interval of the economic downturn with a unique data source, the National Social Life, Health, and Aging Project (NSHAP), and with attention to one visible sign of economic decline—household foreclosures.Fortuitously, NSHAP wave 1 (W1) was collected in 2005 and 2006 and wave 2 (W2) in 2010 and 2011, thus bounding the economic downturn and foreclosure crisis. We linked these data with national foreclosure data to examine the effect of neighborhood foreclosure rates on the onset of depressive symptoms. NSHAP is a study of older adults (≥ 57 years), a group for whom the experience of foreclosure in the residential environment may be particularly relevant.7 More than 1.5 million older adults lost their homes between 2007 and 2011; by 2011, the foreclosure rate for this age group was more than 8 times what it had been at the inception of the crisis. The Federal Reserve reports that nearly one half of households whose head is aged 65 to 74 years have no retirement account savings,8 making the value of one’s home, and the fear of its loss, of even greater concern. Although the absolute risk of foreclosure may still be relatively low for older adults, the experience of an increase in that risk in the immediate neighborhood environment may nevertheless have consequences. Furthermore, the effects of foreclosure at the neighborhood level may be borne most heavily by older residents. Retirement and mobility limitations may diminish the radius of routine activity; the immediate neighborhood environment may then become more important because the greater share of one’s day is spent in neighborhood space.9Drawing on physical and social disorder approaches in urban sociology and research on neighborhoods and mental health in social epidemiology,10–14 we hypothesized that increased foreclosure rates in the immediate environment and the corresponding decline in the condition of housing may affect onset of depression and reports of depressive symptoms. A key component of our model was that foreclosure and deteriorated housing, the increased presence of vacant or abandoned buildings, and the associated potential for increased criminal activity15 may have significant consequences for mental health. Physical disorder (e.g., boarded-up buildings, infrastructure deterioration) may combine with indicators of social decline (e.g., crime, loitering), leading to a depressed mood, fear, and social withdrawal.16,17 Mental health states such as these may discourage contact among residents18,19 and lead to lower levels of street activity,20 further disconnecting older adults from potentially important sources of local social support and interaction. Thus the erosion of neighborhood life that accompanies high rates of foreclosure may have a significant impact on the mental health of its residents.     

Health Effects of Neighborhood Demolition and Housing Improvement: A Prospective Controlled Study of 2 Natural Experiments in Urban Renewal

Objectives. We took advantage of a 2-intervention natural experiment to investigate the impacts of neighborhood demolition and housing improvement on adult residents’ mental and physical health.Methods. We identified a longitudinal cohort (n = 1041, including intervention and control participants) by matching participants in 2 randomly sampled cross-sectional surveys conducted in 2006 and 2008 in 14 disadvantaged neighborhoods of Glasgow, United Kingdom. We measured residents’ self-reported health with Medical Outcomes Study Short Form Health Survey version 2 mean scores.Results. After adjustment for potential confounders and baseline health, mean mental and physical health scores for residents living in partly demolished neighborhoods were similar to the control group (mental health, b = 2.49; 95% confidence interval [CI] = −1.25, 6.23; P = .185; physical health, b = −0.24; 95% CI = −2.96, 2.48; P = .859). Mean mental health scores for residents experiencing housing improvement were higher than in the control group (b = 2.41; 95% CI = 0.03, 4.80; P = .047); physical health scores were similar between groups (b = −0.66; 95% CI = −2.57, 1.25; P = .486).Conclusions. Our findings suggest that housing improvement may lead to small, short-term mental health benefits. Physical deterioration and demolition of neighborhoods do not appear to adversely affect residents’ health.The quality of residential environments, at both the home and the neighborhood level, is associated with residents’ physical and mental health.1–7 Some longitudinal studies suggest that exposure to poor housing8 or to neighborhood-level deprivation9–18 increases the risk of morbidity or mortality beyond what might be predicted from individual-level socioeconomic factors. A causal association between residential environments and health would have important public health implications: improvements to residential environments might contribute positively to public health goals, and deteriorating residential environments could be harmful.Policymakers expect that improving home and neighborhood environments, particularly in disadvantaged areas, will benefit population health and help reduce health inequalities.19,20 Terms such as urban renewal and regeneration are used to describe a range of interventions, such as home improvement programs, housing clearance and demolition, and neighborhood-level improvements.19Research supports assumptions that housing-led urban renewal benefits residents’ health.21–29 A systematic review found that improvements in respiratory, general, and mental health followed housing improvement, with particularly robust evidence of health benefits relating to warmth-improvement interventions.21,30–32 More recently, an evaluation of a multisite urban renewal program in the United Kingdom found relative improvements in residents’ Medical Outcomes Study 36-item Short Form Health Survey mental health scores and self-reported general health at 10-year follow-up.33However, the evidence base is neither comprehensive nor conclusive, particularly regarding neighborhood-level renewal. Reviews have noted some evidence that such interventions may have unintended consequences.34 A study of neighborhood renewal in the United Kingdom found that self-reported health satisfaction worsened, possibly reflecting the intervention’s failure to deliver sufficient changes to residents’ lives and opportunities.35 A recent series of reviews identified 11 interventions considered to have sufficient evidence of effectiveness to warrant implementation,24–28 only 1 of which was a neighborhood-level intervention (rental vouchers to assist relocations to more desirable areas36). The reviews identified 34 interventions of unknown or inconclusive health effects and 7 that were potentially ineffective.24 Neighborhood-level interventions such as demolishing and revitalizing poor public housing (e.g., HOPE VI37), relocating residents, and various forms of neighborhood redesign yielded too little evidence to draw conclusions.28Some commentators have emphasized the social harms linked to housing clearance and demolition programs.38 Paris and Blackaby note that such programs have “frequently been accused of the ‘destruction of communities.’”39^(p18) This alleged destruction is partly a social phenomenon involving the separation of neighbors and closing down of amenities that may have been used as social hubs (e.g., schools, community centers, cafés). It is also a physical phenomenon that increases the proportion of derelict properties and turns neighborhoods into worksites and buildings into rubble.39,40 Furthermore, large-scale clearances can take years to complete, while residents waiting to be relocated are exposed to steadily worsening neighborhood environments.41 If deteriorating residential environments are harmful to health, then residents who remain in neighborhoods undergoing demolition risk being harmed. However, we have not identified any experimental or quasi-experimental study that focuses on the potentially harmful effects of continued residence in neighborhoods undergoing demolition and clearance.We studied a multifaceted renewal program implemented across the city of Glasgow, United Kingdom. In many neighborhoods, existing properties were improved to meet new government standards. However, some neighborhoods began a long-term process of demolition and rebuilding, and residents often lived for several years in neighborhoods undergoing clearance and demolition while they awaited relocation to better-quality housing.42 We treated housing improvement and the experience of living in a demolition area as 2 distinct natural experiments, and we used quasi-experimental methods to test our hypotheses: (1) residents who spent 2 years living in neighborhoods undergoing clearance and demolition would experience worsening health, and (2) residents who experienced housing improvement (and who did not live in neighborhoods undergoing clearance and demolition) would experience improved physical and mental health.     

Dutch homeless people 2.5 years after shelter admission: what are predictors of housing stability and housing satisfaction?

Housing stability is an important focus in research on homeless people. Although definitions of stable housing differ across studies, the perspective of homeless people themselves is generally not included. Therefore, this study explored the inclusion of satisfaction with the participant's current housing status as part of the definition of housing stability and also examined predictors of housing stability with and without the inclusion of homeless person's perspective. Of the initial cohort consisting of 513 homeless participants who were included at baseline in 2011, 324 (63.2%) were also interviewed at 2.5‐year follow‐up. To determine independent predictors of housing stability, we fitted multivariate logistic regression models using stepwise backward regression. At 2.5‐year follow‐up, 222 participants (68.5%) were stably housed and 163 participants (51.1%) were stably housed and satisfied with their housing status. Having been arrested (OR = 0.36, 95% CI: 0.20–0.63), a high level of somatisation (physical manifestations of psychological distress) (OR = 0.52, 95% CI: 0.30–0.91) and having unmet care needs (OR = 0.77, 95% CI: 0.60–0.99) were negative predictors of housing stability. Having been arrested (OR = 0.43, 95% CI: 0.25–0.75), high debts (OR = 0.45, 95% CI: 0.24–0.84) and a high level of somatisation (OR = 0.49, 95% CI: 0.28–0.84) were negative predictors of stable housing when satisfaction with the housing status was included. Because inclusion of a subjective component revealed a subgroup of stably housed but not satisfied participants and changed the significant predictors, this seems a relevant addition to the customary definition of housing stability. Participants with characteristics negatively associated with housing stability should receive more extensive and individually tailored support services to facilitate achievement of housing stability.     

Malnutrition: Prevalence and its associated factors in People living with HIV/AIDS,in Dilla University Referral Hospital

Background

Literatures on prevalence and factors associated with malnutrition among peoples living with HIV/AIDS are limited in Ethiopia and not well documented either. The proper implementation of nutritional support and its integration with the routine highly active antiretroviral therapy package demands a clear picture of the magnitude and associated factors of malnutrition. The objective of this study is, therefore, to assess the prevalence and factors associated with malnutrition among peoples living with HIV/AIDS.

Methods

Institution based cross sectional study was conducted in Dilla University referral Hospital including adult HIV patients who were in highly active anti retroviral therapy. Interview administered questionnaires were used to collect data on socio demographic factors. Besides, HIV related clinical information was extracted from anti retro viral therapy data base and clinical charts. The nutritional status of the patients was determined by Body Mass Index (BMI) where BMI < 18kg/m² was defined as malnutrition according to World Health Organization (WHO). Binary logistic regression was used to assess association between different risk factors and malnutrition. Confidence interval of 95% was considered to see the precision of the study and the level of significance was taken at α <0.05.

Results

A total of 520 patients were included in the analysis. The overall prevalence of malnutrition was 12.3% (95% CI 9.5–15.0). After full control of all variables; unemployment (OR = 3.61, 95% CI: 3.6 − 7.76), WHO clinical stage four (OR = 12.9, 95% CI: 2.49− 15.25), gastrointestinal symptoms (OR = 5.3, 95% CI: 2.56 − 10.78) and previous (one) opportunistic infection (OR = 3.1, 95% CI 2.06 − 5.46), and two & above previous opportunistic infections (OR = 4.5, 95% CI: 3.38 − 10.57) were significantly associated with malnutrition. However, moderately poor economic condition was found to be protective factor for malnutrition (OR = 0.4, 95% CI: 0.14 − 0.95).

Conclusion

Unemployment, WHO clinical AIDS stage four, one & more number of previous opportunistic infections and gastrointestinal symptoms were found to be important risk factors for malnutrition among People Living with HIV/AIDS. From this study it has been learnt that nutritional programs should be an integral part of HIV/AIDS continuum of care. Furthermore, it needs to improve household income of PLHIV with employment opportunity and to engage them in income generating activities as well.     

Neighborhood Social Cohesion and Smoking among Legal and Unauthorized Brazilian Migrants in Metropolitan Boston

Tobacco smoking is estimated to be the largest preventable cause of mortality in the USA, but little is known about the relationship between neighborhood social environment and current smoking behavior or how this may differ by population and geography. We investigate how neighborhood social cohesion and disorder are associated with smoking behavior among legal and unauthorized Brazilian migrant adults using data from the 2007 Harvard-UMASS Boston Metropolitan Immigrant Health and Legal Status Survey (BM-IHLSS), a probabilistic household survey of adult Brazilian migrants. We employ logistic regression to estimate associations between neighborhood social cohesion, neighborhood disorder, and current smoking. We find that neighborhood-level social cohesion is associated with lower likelihood of being a current smoker (O.R. = .836; p < .05), and neighborhood disorder, measured as crime experienced in the neighborhood, is not associated with current smoking. Neighborhood population density, age, being male, and residing with someone who smokes are each positively associated with current smoking (p < .10). The health of participants’ parents at the age of 35, being married, and individual earnings are associated with a reduction in the probability of being a current smoker (p < .05). Migrant legal status and length of residence in the USA are not associated with current smoking. Our findings suggest that neighborhood social cohesion may be protective against smoking. Alternatively, neighborhood disorder does not appear to be related to current smoking among Brazilian migrants.     

The relationship between housing subsidies and supportive housing on neighborhood distress and housing satisfaction: does drug use make a difference?

Background

Since the 1970s, the dominant model for U.S. federal housing policy has shifted from unit-based programs to tenant-based vouchers and certificates. Because housing vouchers allow recipients to move to apartments and neighborhoods of their choice, such programs were designed to improve the ability of poor families to move into neighborhoods with less concentrated poverty. However, little research has examined whether housing voucher recipients live in less distressed neighborhoods than those without housing vouchers. There is much reason to believe that drug users may not be able to access or keep federal housing subsidies due to difficulties drug users, many of whom may have criminal histories and poor credit records, may have in obtaining free market rental housing. In response to these difficulties, permanent supportive housing was designed for those who are chronically homeless with one or more disabling condition, including substance use disorders. Little research has examined whether residents of permanent supportive housing units live in more or less economically distressed neighborhoods compared to low-income renters.

Methods

This paper uses survey data from 337 low-income residents of Hartford, CT and geospatial analysis to determine whether low-income residents who receive housing subsidies and supportive housing live in neighborhoods with less concentrated poverty than those who do not. We also examine the relationships between receiving housing subsidies or supportive housing and housing satisfaction. Finally, we look at the moderating effects of drug use and race on level of neighborhood distress and housing satisfaction.

Results

Results show that low-income residents who receive housing subsidies or supportive housing were not more or less likely to live in neighborhoods with high levels of distress, although Black residents with housing subsidies lived in more distressed neighborhoods. Regarding housing satisfaction, those with housing subsidies perceived significantly more choice in where they were living while those in supportive housing perceived less choice. In addition, those with rental subsidies or supportive housing reported living closer to needed services, unless they also reported heavy drug use.

Conclusions

Housing subsidies and supportive housing have little impact on the level of neighborhood distress in which recipients live, but some effects on housing satisfaction.

     

How much choice is there in housing choice vouchers? Neighborhood risk and free market rental housing accessibility for active drug users in Hartford, Connecticut

Background  

Since the mid-1970s, the dominant model for U.S. federal housing policy has shifted from unit-based programs to tenant based vouchers and certificates, intended to allow recipients a choice in their housing and neighborhoods. Surprisingly little research has examined the question of where those with Section 8 housing vouchers are able to live, but some research suggests that voucher holders are more likely to reside in distressed neighborhoods than unsubsidized renter households. Further, federal housing policy has limited drug users' access to housing subsidies. In turn, neighborhood disorder has been associated with higher levels of injection drug risk behaviors, and higher drug-related mortality. This paper explores rental accessibility and neighborhood characteristics of advertised rental housing in Hartford CT.     

Housing Transitions and Low Birth Weight Among Low-Income Women: Longitudinal Study of the Perinatal Consequences of Changing Public Housing Policy

Objectives. We assessed the longitudinal association between housing transitions and pregnancy outcomes in a sample of public housing residents.Methods. A cohort of 2670 Black women residing in Atlanta, Georgia, housing projects with 1 birth occurring between 1994 and 2007 was created from maternally linked longitudinal birth files and followed for subsequent births. Traditional regression and marginal structural models adjusting for time-varying confounding estimated the risk of preterm low birth weight (LBW) or small for gestational age LBW by maternal housing transition patterns.Results. Women moving from public to private housing as a result of housing project demolition were at elevated risk for preterm LBW (risk ratio = 1.74; 95% confidence interval =  1.00–3.04) compared with women not affected by project demolition. Other non–policy-related housing transition patterns were not associated with pregnancy outcomes.Conclusions. Further longitudinal study of housing transitions among public housing residents is needed to better understand the relationship between housing, neighborhoods, housing policy, and perinatal outcomes.Under the auspices of Roosevelt’s New Deal in 1936, Atlanta, Georgia, led the nation by establishing Techwood Homes as the first public housing project in the United States.1 Initially envisioned as a tool for economic development, public housing evolved nationally into a critical and often criticized component of the social safety net. Although meeting demands for affordable housing, the location, design, and regulation of some high-density public housing projects in US metropolitan areas have also contributed to persistent racial residential segregation and the concentration of poverty.2,3In 1992, Congress passed the Housing Opportunities for People Everywhere initiative to support, in part, the redevelopment and deconcentration of traditional public housing projects. Before the 1996 Summer Olympics in Atlanta, the Atlanta Housing Authority (AHA) once again led the nation by initiating a decommissioning and demolition process for 29 of Atlanta’s distressed family occupied public housing projects,4 replacing them with mixed-income housing developments and transitioning most public housing recipients to Housing Choice Vouchers (formerly Section 8) for use in the private rental market.5 Residence in high poverty neighborhoods has been associated with poor health outcomes,6,7 but it is not clear whether the voluntary or involuntary transition of individuals out of traditional housing projects results in lower poverty destination neighborhoods, and if so, whether this improves health. There are mixed findings with regards to health following voluntary residential mobility interventions such as Moving to Opportunity.8–10The persistence of racial and economic disparities in pregnancy outcomes, including the 2 main components of infant low birth weight (LBW)—preterm birth (< 37 weeks’ gestation) and fetal growth restriction—have been widely described. Such disparities are hypothesized to exist in part because of the sensitivity of pregnancy to acute and cumulative social exposures and determinants.11–13 In particular, residential neighborhood characteristics, including violent crime, income inequality, residential segregation, and deprivation, explain some of the racial disparities in poor pregnancy outcomes.14–18 Social, behavioral, and medical risk factors for poor outcomes may interact through various pathways, including access to preconceptional primary care and perinatal care, accessibility of healthy foods and safe environments for physical activity, physiologic effects of accumulated exposure to stressors, or behavioral response (e.g., smoking) to stressors and targeted tobacco and alcohol marketing. Women residing in public housing projects generally have high health burdens19 and may be exposed to chronic stress from high crime and poverty rates. However, residence in housing project communities could also be a source of social support networks and result in access to targeted social and health services.There are similarities in the identified risk factors for preterm birth and fetal growth restriction (commonly operationalized as small for gestational age or < 10th percentile of weight for gestational age20). However, the relative importance of hypothesized etiologic factors such as smoking, stress, and reproductive tract infection differs for each outcome. For instance, smoking, low maternal weight gain, and pregnancy-induced hypertension may be more important population drivers of small for gestational age risk, whereas inflammation or infection and chronic stress may be relatively more important for preterm birth.21 These factors could be variably influenced by housing and neighborhood characteristics, including local access to health services and healthy foods, local social networks and support, and exposure to stressful environments.This study aims to take advantage of a unique longitudinal data set and a significant change in public housing policy to answer 2 research questions. (1) Are housing transition patterns of women ever residing in public housing projects associated with subsequent pregnancy outcomes? (2) Is housing transition resulting from public housing project decommissioning associated with subsequent pregnancy outcomes?     

Access to Care and Chronic Disease Outcomes Among Medicaid-Insured Persons Versus the Uninsured

Objectives. We sought to determine the association between Medicaid coverage and the receipt of appropriate clinical care.Methods. Using the 1999 to 2012 National Health and Nutritional Examination Surveys, we identified adults aged 18 to 64 years with incomes below the federal poverty level, and compared outpatient visit frequency, awareness, and control of chronic diseases between the uninsured (n = 2975) and those who had Medicaid (n = 1485).Results. Respondents with Medicaid were more likely than the uninsured to have at least 1 outpatient physician visit annually, after we controlled for patient characteristics (odds ratio [OR] = 5.0; 95% confidence interval [CI] = 3.8, 6.6). Among poor persons with evidence of hypertension, Medicaid coverage was associated with greater awareness (OR = 1.83; 95% CI = 1.26, 2.66) and control (OR = 1.69; 95% CI = 1.32, 2.27) of their condition. Medicaid coverage was also associated with awareness of being overweight (OR = 1.30; 95% CI = 1.02, 1.67), but not with awareness or control of diabetes or hypercholesterolemia.Conclusions. Among poor adults nationally, Medicaid coverage appears to facilitate outpatient physician care and to improve blood pressure control.Lack of health insurance is associated with lower rates of preventive care, delays in necessary care, forgone care, medical bankruptcy, and increased mortality.1–5 The Affordable Care Act (ACA; Pub L No. 111–148) expanded Medicaid insurance for people with low incomes (< 138% of the federal poverty level [FPL]) in 31 states. However, whether Medicaid coverage improves health outcomes remains controversial. Several studies described differences in chronic disease prevalence and control between uninsured persons and those with Medicaid, but have not been designed or powered to explore whether Medicaid coverage might cause these differences.6–8Some have suggested that Medicaid’s low reimbursement rates discourage physician acceptance of Medicaid patients, limiting access to care and resulting in poor health outcomes.9,10 Recently, the Oregon Health Insurance Experiment (OHIE), a randomized, controlled trial, found that Medicaid coverage increased health care use, improved patients’ financial security and self-reported health, lowered depression rates, and raised diabetes diagnosis rates.11–13 However, the OHIE did not find improvements in other important health outcomes such as control of other chronic diseases, fueling Medicaid’s critics.14,15The rigorous design of the OHIE provides strong evidence on the impact of Medicaid in the Portland, Oregon, metropolitan area where it was conducted. However, Portland’s relatively robust medical safety net for the uninsured16,17 may have attenuated the potential for health improvements from Medicaid expansion compared with other locales, or the United States as a whole.We used the nationally representative National Health and Nutrition Examination Survey (NHANES) to compare outpatient physician visit frequency among the uninsured and comparable persons with Medicaid coverage. We also assessed whether individuals with major chronic conditions had been previously diagnosed with the condition, and whether it was under control.     

Public housing accommodations for individuals with disabilities

The federal Housing Act of 1962 as amended and the subsequent laws of accommodations insure that all groups within American society, including those with disabilities, have access to housing opportunities. In spite of the clear provisions of various laws of accommodations enacted after 1962, it is questionable whether disabled individuals are adequately served by resident programs operated by Public Housing Agencies (PHAs) because rates of poverty, unemployment, domestic violence, and suicide are much higher among people with disabilities than in the nondisabled population. There are approximately 5 million residents living in 2.5 public housing units nationwide. New York, Puerto Rico, Chicago, Philadelphia and Baltimore have the five largest PHAs in the country. In combination, they rent 320,000 of the 1,300,495 inventory of rental properties owned by the country's 3,400 PHAs. Elderly and disabled residents without children account for 43% of all public housing families in the country.     

Sense of Place among Atlanta Public Housing Residents

For almost two decades now, cities around the country have been demolishing traditional public housing and relocating residents to subsidized private market rental housing. In this paper, we examine sense of place, consisting of both community and place attachment, among a sample of Atlanta public housing residents prior to relocation (N = 290). We find that 41% of the residents express place attachment, and a large percentage express some level of community attachment, though residents of senior public housing are far more attached than residents of family public housing. Positive neighborhood characteristics, such as collective efficacy and social support, are associated with community attachment, and social support is also associated with place attachment. Negative neighborhood characteristics, such as social disorder and fear of crime, are not consistently associated with sense of place. We argue that embodied in current public housing relocation initiatives is a real sense of loss among the residents. Policy makers may also want to consider the possibilities of drawing upon residents’ sense of place as a resource for renovating and revitalizing public housing communities rather than continuing to demolish them and relocating residents to other neighborhoods.     

Life Course Racism and Depressive Symptoms among Young Black Women

The objective of this study is to evaluate the life course effects of racism on depressive symptoms in young Black women and to identify particularly sensitive periods. Guided by life-course theory and using logistic regression, we analyzed baseline data on racism frequency and stress from racism at two time periods (before age 20 and during the 20s) and follow-up data (at approximate 20-month intervals) on depressive symptoms (using a modified 11-item Center for Epidemiologic Studies Depression Scale, CES-D) among 1612 Black women participants aged 23–34 years living in Detroit, MI. Of the 1612 women, 65% reported experiencing some racism at baseline, and 36.5% had high depressive symptoms at follow-up. Those who experienced high frequency of racism before age 20 had an increased risk for high depressive symptoms (RR = 1.26, 95% CI:  1.07, 1.46) compared to participants in the low racism frequency group. We observed similar associations for high vs. low stress from racism (RR = 1.30, 95% CI : 1.06, 1.54) and high vs. low combination of racism frequency and stress (RR = 1.38, 95% CI: 1.13, 1.64). These findings did not hold or were weaker when assessing racism during the 20s. Among women who experienced high racism across the two time periods, the risk of high depressive symptoms was higher than those who experienced low racism during both periods (RR = 1.49, 95% CI:  1.14, 1.86). The slightly stronger associations between racism and depressive symptoms in childhood and adolescence than in young adulthood suggest that early life might be a sensitive period for experiencing racism.