Bidirectional Relationship Between Food Insecurity and Housing Instability

BackgroundDue to the commonality of material hardship, food insecurity and housing instability are highly correlated. There is a need to assess the bidirectional relationship between food insecurity and housing instability over time.ObjectivesTo examine the potential bidirectional associations between food insecurity and housing instability over a 2-year period.DesignTwo time points from the Fragile Families and Child Wellbeing Study were used to conduct an analysis on 2368 families.Participants/settingAt baseline (1998-2000), researchers recruited primarily unmarried mothers after giving birth from 75 hospitals in 20 cities across the United States. Participants were followed up when the child was 3 years old (2001-2003) and 5 years old (2003-2005).Main outcomes measuredFood insecurity was assessed using the 18-item US Department of Agriculture’s Food Security Survey. Housing instability was assessed using 6 items that describe housing related hardship.Statistical analyses performedCross-lagged path analyses using structural equation modeling were conducted to test bidirectional relationship of food insecurity and housing instability over time, controlling for sociodemographic characteristics.ResultsFamilies who experienced food insecurity at time 1 were 62% higher odds of experiencing housing instability at time 2 (odds ratio: 1.624, B = 0.485, 95% confidence interval: 0.199, 0.778), controlling for time 1 housing instability, concurrent food insecurity, and covariates. Families who experienced housing instability at time 1 were 40% increased odds of experiencing food insecurity at time 2 (odds ratio: 1.404, B = 0.339, 95% confidence interval: 0.071, 0.619), controlling for food insecurity at time 1, concurrent housing instability, and covariates.ConclusionsThe relationships between food insecurity and housing instability were highly correlated over time, controlling for covariates that are associated with socioeconomic status. Currently, programs designed to reduce food insecurity and housing instability function in isolation. Consolidating antipoverty programs or increasing referrals to various programs may help to reduce these 2 types of economic hardships.     

Housing Instability and Incident Hypertension in the CARDIA Cohort

Housing instability, a growing public health problem, may be an independent environmental risk factor for hypertension, but limited prospective data exist. We sought to determine the independent association of housing instability in early adulthood (year 5, 1990–1991) and incident hypertension over the subsequent 15 years of follow-up (years 7, 10, 15, and 20) in the Coronary Artery Risk Development in Young Adults (CARDIA) study (N = 5,115). Because causes of inadequate housing and its effects on health are thought to vary by race and sex, we hypothesized that housing instability would exert a differential effect on incident hypertension by race and sex. At year 5, all CARDIA participants were asked about housing and those free of hypertension were analyzed (N = 4,342). We defined housing instability as living in overcrowded housing, moving frequently, or living doubled up. Of the 4,342 participants, 8.5 % were living in unstable housing. Across all participants, housing instability was not associated with incident hypertension (incidence rate ratio (IRR), 1.1; 95 % CI, 0.9–1.5) after adjusting for demographics, socioeconomic status, substance use, social factors, body mass index, and study site. However, the association varied by race and sex (p value for interaction, <0.001). Unstably housed white women had a hypertension incidence rate 4.7 times (IRR, 4.7; 95 % CI, 2.4–9.2) that of stably housed white women in adjusted analysis. There was no association among white men, black women, or black men. These findings suggest that housing instability may be a more important risk factor among white women, and may act independently or as a marker for other psychosocial stressors (e.g., stress from intimate partner violence) leading to development of hypertension. Studies that examine the role of these psychosocial stressors in development of hypertension risk among unstably housed white women are needed.     

The relationship between intimate partner violence and probable depression among adolescent girls and young women in Lilongwe,Malawi

ABSTRACT

This analysis estimates prevalence of intimate partner violence (IPV) and its association with probable depression among adolescent girls and young women (AGYW) in Lilongwe, Malawi, and whether partner’s controlling behaviour modifies this relationship. Baseline data was utilised from the Girl Power-Malawi study of 1000 15–24-year-old AGYW in Lilongwe. Emotional, physical, and sexual IPV experiences with a current or recent partner were measured using the modified Conflict Tactics Scale. Probable depression was measured by scoring ≥10 on the Centre for Epidemiologic Studies-Short Depression Scale (CES-D-10). Generalised linear models with log-link and binomial distribution estimated prevalence ratios (PR) and 95% confidence intervals (CI) for the association between IPV types and probable depression. Partner’s controlling behaviour was examined as an effect modifier. Participants’ mean age was 19.2 years, with 70% never-married. IPV prevalence varied for emotional (59%), physical (36%), sexual (46%), and all forms (20%). Prevalence of probable depression was 47%. AGYW who experienced each IPV type had a higher prevalence of probable depression: physical (PR:1.54, CI:1.28–1.86), sexual (1.46, CI:1.21–1.75), emotional (1.37, CI:1.14–1.64), all forms (1.72, CI:1.41–2.09). IPV and probable depression were prevalent and strongly associated, especially among AGYW reporting controlling behaviour. Interventions addressing IPV and controlling behaviour may positively impact depression among AGYW.     

Housing Quality and Mental Health: the Association between Pest Infestation and Depressive Symptoms among Public Housing Residents

Housing quality, which includes structural and environmental risks, has been associated with multiple physical health outcomes including injury and asthma. Cockroach and mouse infestations can be prime manifestations of diminished housing quality. While the respiratory health effects of pest infestation are well documented, little is known about the association between infestation and mental health outcomes. To address this gap in knowledge and given the potential to intervene to reduce pest infestation, we assessed the association between household pest infestation and symptoms of depression among public housing residents. We conducted a cross-sectional study in 16 Boston Housing Authority (BHA) developments from 2012 to 2014 in Boston, Massachusetts. Household units were randomly selected and one adult (n?=?461) from each unit was surveyed about depressive symptoms using the Center for Epidemiologic Study-Depression (CES-D) Scale, and about pest infestation and management practices. In addition, a home inspection for pests was performed. General linear models were used to model the association between pest infestation and high depressive symptoms. After adjusting for important covariates, individuals who lived in homes with current cockroach infestation had almost three times the odds of experiencing high depressive symptoms (adjusted OR?=?2.9, 95% CI 1.9–4.4) than those without infestation. Dual infestation (cockroach and mouse) was associated with over five times the odds (adjusted odds?=?5.1, 95% CI 3.0–8.5) of experiencing high depressive symptoms. Using a robust measure of cockroach and mouse infestation, and a validated depression screener, we identified associations between current infestation and depressive symptoms. Although the temporal directionality of this association remains uncertain, these findings suggest that the health impact of poor housing conditions extend beyond physical health to include mental health. The study adds important information to the growing body of evidence that housing contributes to population health and improvements in population health may not be possible without addressing deficiencies in the housing infrastructure.     

County-level housing affordability in relation to risk factors for cardiovascular disease among middle-aged adults: The National Longitudinal Survey of Youths 1979

BackgroundHousing is a fundamental social determinant of health yet housing affordability has diminished over much of the twenty-first century. Research on housing affordability as a determinant of health is limited, but studies to date have shown correlations with mental health. However, few studies have examined the relationship between housing affordability and risk factors for cardiovascular disease, the leading cause of morbidity and mortality among Americans.MethodsUsing a nationally-representative sample of middle-aged adults from the National Longitudinal Survey of Youths 1979 (NLSY79) and exploiting quasi-experimental variation before and after the Great Recession, we estimated the associations between the change in median county-level percentage of household income spent on housing (rent/mortgage) between 2000 and 2008 and individual-level risks of incident hypertension, obesity, diabetes, and depression from 2008 to 2014. We employed conditional fixed effects logistic regression models to reduce bias due to time-invariant confounding.ResultsEach percentage point increase in county-level median percentage of household income spent on housing was associated with a 22% increase in the odds of incident hypertension (OR = 1.22, 95% CI = 1.06 to 1.42; p = 0.01), a 37% increased odds of obesity (OR = 1.37, 95% CI = 1.00–1.87; p = 0.049), and a 15% increased odds of depression (OR = 1.15, 95% CI = 1.01–1.31; p = 0.03), controlling for individual- and area-level factors. These associations were stronger among renters than homeowners, and among men compared to women.ConclusionsOur findings suggest that lower levels of housing affordability contribute to worse risk profiles for cardiovascular disease. Policies that make housing more affordable may help to reduce the population burden of cardiovascular disease.     

Association of housing disrepair indicators with cockroach and rodent infestations in a cohort of pregnant Latina women and their children

Health burdens associated with poor housing and indoor pest infestations are likely to affect young children in particular, who spend most of their time indoors at home. We completed environmental assessments in 644 homes of pregnant Latina women and their children living in the Salinas Valley, California. High residential densities were common, with 39% of homes housing > 1.5 persons per room. Housing disrepair was also common: 58% of homes had peeling paint, 43% had mold, 25% had water damage, and 11% had rotting wood. Evidence of cockroaches and rodents was present in 60% and 32% of homes, respectively. Compared with representative national survey data from the U.S. Department of Housing and Urban Development, homes in our sample were more likely to have rodents, peeling paint, leaks under sinks, and much higher residential densities. The odds of rodent infestations in homes increased in the presence of peeling paint [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.5-3.1], water damage (OR 1.9; 95% CI, 1.2-2.7), and mold (OR 1.5; 95% CI, 1.0-2.1). The odds of cockroach infestation increased in the presence of peeling paint (OR 3.8; 95% CI, 2.7-5.6), water damage (OR 1.9; 95% CI, 1.2-2.9), or high residential density (OR 2.1; 95% CI, 1.2-3.8). Homes that were less clean than average were more prone to both types of infestations. Pesticides were stored or used in 51% of households, partly to control roach and rodent infestations. These data indicate that adverse housing conditions are common in this community and increase the likelihood of pest infestations and home pesticide use. Interventions to improve housing and promote children's health and safety in this population are needed.     

Relationship between drug abuse and intimate partner violence: a longitudinal study among women receiving methadone

OBJECTIVES: We examined whether frequent drug use increases the likelihood of subsequent sexual or physical intimate partner violence (IPV) and whether IPV increases the likelihood of subsequent frequent drug use. METHODS: A random sample of 416 women on methadone was assessed at baseline (wave 1) and at 6 months (wave 2), and 12 months (wave 3) following the initial assessment. Propensity score matching and multiple logistic regression were employed. RESULTS: Women who reported frequent crack use at wave 2 were more likely than non-drug using women to report IPV at wave 3 (odds ratio [OR]=4.4; 95% confidence interval [CI]=2.1, 9.1; P<.01), and frequent marijuana users at wave 2 were more likely than non-drug users to report IPV at wave 3 (OR=4.5; 95% CI=2.4, 8.4; P<.01). In addition, women who reported IPV at wave 2 were more likely than women who did not report IPV to indicate frequent heroin use at wave 3 (OR=2.7; 95% CI=1.1, 6.5; P=.04). CONCLUSIONS: Our findings suggest that the relationship between frequent drug use and IPV is bidirectional and varies by type of drug.     

Housing characteristics, home environmental factors and respiratory health in 14,729 Chinese children

BACKGROUND: Very few studies have assessed the relative impact of housing characteristics and home environmental factors on asthma and asthma-related symptoms in Chinese children who have lower rates of asthma. To our knowledge few studies have assessed respiratory symptoms and allergies in this context. METHODS: To assess the effects of housing characteristics, pet keeping, home decorations and other indoor environmental factors on respiratory health of Chinese children. We studied a population of 14,729 children (1-13 years old) from 12 districts in Liaoning province, Northeast China. Information on respiratory health, housing characteristics, and environmental pollutions were obtained by a standard questionnaire from the American Thoracic Society. RESULTS: Housing conditions, house adjacent to traffic or not, house with or without pollution source nearby, pet keeping, presence of pests and mold/water damage in the home, home decorations and exposure to environmental tobacco smoke (ETS) were associated with doctor-diagnosed asthma and asthma-related symptoms both in boys and girls. The vulnerability towards exposure to housing conditions and environmental factors differed between males and females. Among boys, the risk of respiratory morbidity appeared to be reduced in households with larger surface areas and more rooms; use of a ventilation device was strongly protective against persistent phlegm (OR=0.68; 95%CI: 0.48, 0.96). Asthma-related symptoms were more associated with different pets among girls than among boys. The presence of a cat in the household was associated with doctor-diagnosed asthma (OR=1.89; 95% CI, 1.11-3.20), current wheeze (OR=2.64; 95% CI, 1.52-4.59), persistent cough (OR=1.84; 95% CI, 1.18-2.87) and persistent phlegm (OR=2.17; 95% CI, 1.21-3.87) only among girls. CONCLUSION: Living within the vicinity of a source of pollution, traffic, pet keeping, home decorations, pests, mold and ETS are important determinants of children's respiratory health in China.     

Factors associated with HIV sero-status in young rural South African women: connections between intimate partner violence and HIV

BACKGROUND: This paper aims to describe factors associated with HIV sero-status in young, rural South African women and the relationship between intimate partner violence (IPV) and HIV. METHODS: A total of 1295 sexually active female volunteers, aged 15-26, from 70 villages were recruited to participate in a cluster randomized controlled trial of an HIV behavioural intervention. The main measures were HIV sero-status, and IPV and sexual practices measured using a questionnaire administered during baseline interviews. RESULTS: About 12.4% of women had HIV and 26.6% had experienced more than one episode of physical or sexual IPV. After adjusting for age, HIV infection was associated with having three or more past year partners [odds ratio (OR) 2.39; 95% confidence interval (95% CI) 1.48-3.85], sex in past 3 months (OR 3.33; 95% CI 1.87-5.94), a partner three or more years older (OR 1.69; 95% CI 1.16-2.48), and a more educated partner (OR 1.91; 95% CI 1.30-2.78). IPV was associated with HIV in two-way analyses (OR 1.56; 95% CI 1.08-2.23), but the effect was non-significant after adjusting for HIV risk behaviours. The experience of IPV was strongly associated with past year partner numbers, time of last sex, and partner's education; it was also marginally associated with partner age difference. Adverse experiences in childhood, including sexual abuse, increased the likelihood of having more past year partners (OR 1.43; 95% CI 1.21-1.69). CONCLUSIONS: IPV was strongly associated with most of the identified HIV risk factors. Our findings provide further evidence of links between IPV and HIV among women and the importance of joint prevention.     

Depressive Symptomology and Hostile Affect among Latinos Using Housing Rental Assistance: the AHOME Study

Studies show that those residing in households subsidized with federal housing vouchers exhibit fewer mental health problems than residents of public housing. The role of housing conditions and neighborhood quality in this relationship is unclear. This study investigated the relationship between rental assistance, housing and neighborhood conditions, and the risk of depressive symptomology and hostile affect among low-income Latino adults living in the Bronx, NY. Latino adults participating in the Affordable Housing as an Obesity Mediating Environment (AHOME) study were used for analysis. All AHOME participants were eligible for federal low-income housing rental assistance (n = 385) and living in the Bronx, New York (2010–2012). Housing (crowding and structural deficiencies) and neighborhood (physical disorder and social cohesion) were measured by questionnaire during in-home interview. Depressive symptomology was measured using the Center for Epidemiologic Studies Depression Scale Short Form, CES-D 10 (score ≥10). Hostile affect was measured using items from the Cook-Medley Hostility Scale (score ≥ 4). Results suggest residents of Section 8 housing have similar levels of depressive symptomology and hostility compared to residents in public housing or those receiving no federal housing assistance. However, depressive symptomology was significantly associated with maintenance deficiencies [OR = 1.17; CI 1.02, 1.35] and social cohesion [OR = 0.71; CI 0.55, 0.93]. Hostility was significantly associated with perceived crowding [OR = 1.18; CI 1.16, 2.85], neighborhood physical disorder [OR = 1.94; CI 1.12, 3.40], and social cohesion [OR = 0.70; CI 0.50, 0.98]. Low-income housing assistance did not have an independent effect on mental health outcomes. However, characteristics of the housing and neighborhood environments were associated with depressive symptomology and hostility.     

Associations among individual, social, and environmental barriers and children's walking or cycling to school

PURPOSE: To examine associations among individual, social, and environmental barriers and children's walking or cycling to school. DESIGN: Exploratory cross-sectional study. SETTING: All eight capital cities in Australia. SUBJECTS. Parents (N=720) of school-aged children (4-13 years; 27% response rate; 49% parents of boys). MEASURES: Multivariate-adjusted odds ratios (OR) and 95% confidence intervals (CI) for parental reporting of barriers to their children's walking or cycling to school, based on a computer-assisted telephone interview. RESULTS: Forty-one percent of children walked or cycled to school at least once per week. Multivariable analyses found inverse associations with individual ("child prefers to be driven" [OR = 0.4, 95% CI = 0.3-0.6], "no time in the mornings" [OR = 0.5, 95% CI = 0.3-0.8]); social ("worry child will take risks" [OR = 0.6, 95% CI = 0.3-0.9], "no other children to walk with" [OR = 0.7, 95% CI = 0.4-0.99], "no adults to walk with" [OR = 0.6, 95% CI = 0.4-0.9]); and environmental barriers ("too far to walk" [OR = 0.1, 95% CI = 0.0-0.1], "no direct route" [OR = 0.4, 95% CI = 0.2-0.7]) and positive associations with "concern child may be injured in a road accident" (OR = 1.9, 95% CI = 1.1-3.1) and active commuting. CONCLUSION: Working with parents, schools, and local authorities to improve pedestrian skills and environments may help to overcome barriers.     

Housing Stability and Hepatitis C Infection for Young Adults Who Inject Drugs: Examining the Relationship of Consistent and Intermittent Housing Status on HCV Infection Risk

Housing status affects drug using behaviors, but less is known about the relationship between housing patterns and hepatitis C virus (HCV) infection. HCV-negative young people who inject drugs (PWID) were enrolled into a prospective cohort (2003–2019) with quarterly study visits. We used Cox regression to estimate the independent association of recent housing status (housed vs. unhoused, housing stability, and housing trajectory) on HCV incidence. Among 712 participants, 245 incident HCV infections occurred over 963.8 person-years (py) (cumulative incidence 24.4/100 py). An inverse relationship between time housed and HCV incidence was observed (always unhoused 45.0/100 py, 95% confidence interval (CI) 37.1, 54.5; variably housed 18.0/100 py, 95% CI 15.0, 21.3; and always housed 7.0/100 py, 95% CI 3.0, 17.3). In Cox regression models controlling for confounders, those unhoused versus housed at baseline had a 1.9-fold increased infection risk (95% CI 1.4, 2.6). Those always unhoused versus always housed had a 1.5 times greater risk of HCV (95% CI 1.0, 2.3), and those spending a portion of time in stable housing a lower risk (adjusted relative hazard 0.05, 95% CI 0.3, 0.9) with a similar trend for those being housed for less time. Young adult PWID experiencing both recent and chronic states of being unhoused are at elevated risk for HCV infection. Importantly for this group of PWID, our findings indicate that some frequency of residential housing significantly reduces HCV infection risk.Electronic supplementary materialThe online version of this article (10.1007/s11524-020-00445-7) contains supplementary material, which is available to authorized users.     

Lifestyle factors,psychiatric and neurologic comorbidities,and drug use associated with incident seizures among adult patients with depression: a population-based nested case–control study

To investigate risk factors for incident seizures among adult patients with depression. We conducted a nested case–control analysis in adult patients with newly diagnosed depression, using data from the U.K.-based Clinical Practice Research Datalink. Among cases with incident seizures and matched controls, we estimated odds ratios (ORs) with 95 % confidence intervals (CIs) of potential risk factors for seizures as reported from data of the general population: underweight (body mass index <18.5 kg/m²), smoking, alcoholism, drug abuse, psychiatric or neurologic comorbidities, and concomitant use of drugs. Of 186,540 patients with depression, 1489 developed a seizure during follow-up. Being underweight (OR 1.67 [95 % CI 1.23–2.26]), a current smoker (OR 1.45 [95 % CI 1.26–1.67]), having alcoholism (OR 2.98 [95 % CI 2.56–3.47]), and drug abuse (OR 2.51 [95 % CI 1.94–3.24]), were associated with increased risks of seizures compared to normal weight, non-smoking, no alcoholism, and no drug abuse, respectively. Previous stroke/transient ischemic attack (OR 6.07 [95 % CI 4.71–7.83]) or intracerebral bleeding (OR 8.19 [95 % CI 4.80–13.96]), and comorbid dementia (OR 6.83 [95 % CI 4.81–9.69]), were strongly associated with seizures. Current use of cephalosporins (OR 2.47 [95 % CI 1.61–3.78]) and antiarrhythmics (OR 1.59 [95 % CI 1.26–2.01]) was associated with an increased risk of seizures compared to non-use. Among adult patients with depression, being underweight, smoking, alcoholism, and drug abuse, were associated with seizures. Remote stroke and comorbid dementia were strong risk factors for seizures. Current use of cephalosporins or antiarrhytmics was associated with an increased risk of seizures compared to non-use.     

Intimate partner violence and housing instability

BACKGROUND: The mental and physical health consequences of intimate partner violence (IPV) have been well established, yet little is known about the impact of violence on a woman's ability to obtain and maintain housing. This cross-sectional study examines the relationship between recent IPV and housing instability among a representative sample of California women. It is expected that women who have experienced IPV will be at increased risk for housing instability as evidenced by: (1) late rent or mortgage, (2) frequent moves because of difficulty obtaining affordable housing, and/or (3) without their own housing. METHODS: Data were taken from the 2003 California Women's Health Survey, a population-based, random-digit-dial, annual probability survey of adult California women (N=3619). Logistic regressions were used to predict housing instability in the past 12 months, adjusting for the following covariates; age, race/ethnicity, education, poverty status, marital status, children in the household, and past year IPV. RESULTS: In the multivariate model, age, race/ethnicity, marital status, poverty, and IPV were significant predictors of housing instability. After adjusting for all covariates, women who experienced IPV in the last year had almost four times the odds of reporting housing instability than women who did not experience IPV (adjusted odds ratio=3.98, 95% confidence interval: 2.94-5.39). CONCLUSIONS: This study found that IPV was associated with housing instability among California women. Future prospective studies are needed to learn more about the nature and direction of the relationship between IPV and housing instability and the possible associated negative health consequences.     

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.     

Estado de salud y violencia contra la mujer en la pareja

Objective

To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain.

Methods

A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI).

Results

A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV.

Conclusions

In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV.     

Dust weight and asthma prevalence in the National Survey of Lead and Allergens in Housing (NSLAH)

BACKGROUND: Settled dust has been used in studies to assess exposures to allergens and other biologically active components, but it has not been considered in the aggregate in relation to respiratory health outcomes in the general population. OBJECTIVE: We addressed whether total house dust weight, an index of total dust exposure, was associated with respiratory health outcomes in the National Survey of Lead and Allergens in Housing (1998-1999) (NSLAH). METHODS: NSLAH was a cross-sectional survey designed to represent permanently occupied housing units in the United States. In each household, a questionnaire was administered and settled dust was vacuumed from five locations. Linear regression models were used to identify predictors of dust weight; logistic regression models were used to examine the relationship between dust weight and asthma and wheeze. RESULTS: Dust weight samples were available for 829 households, and survey information was available for 2,456 participants (children and adults). Lower income, older homes, household pets, having a smoker in the house, and less frequent cleaning predicted higher dust weight levels in U.S. households. Higher levels of dust weight were associated with greater odds of current asthma and wheeze. The strongest associations were seen for wheeze [adjusted odds ratio (OR) = 1.99; 95% confidence interval (CI), 1.21-3.28 for bedroom bed dust; OR = 2.81; 95% CI, 1.52-5.21 for upholstery dust). These associations persisted when adjusting for allergen and endotoxin exposures. CONCLUSIONS: Dust weight, an index of total dust exposure in the home, may contribute to respiratory outcomes independently of the exposure to specific components.     

Screening housing to prevent lead toxicity in children

OBJECTIVE: Screening children to identify those with blood lead levels > or = 10 microg/dl fails to protect children from lead-associated cognitive deficits and behavioral problems. To broaden our efforts at primary prevention, screening criteria are needed to identify lead-contaminated housing before children are unduly exposed. The purpose of this study was to identify and validate housing characteristics associated with children having elevated blood lead levels (> or = 10 microg/dl). METHODS: Two existing studies were used to examine housing characteristics linked with undue lead exposure: a cross-sectional study of 205 children aged 12 to 31 months, and a random sample from a longitudinal study of 276 children followed from 6 to 24 months of age. Logistic regression analysis was conducted to examine the association of children's blood lead levels > or = 10 microg/dl. RESULTS: The mean age of the 481 children was 17.8 months; 99 (20.6%) had a blood lead concentration of 10 microg/dl or higher. The following characteristics were associated with blood lead concentration > or = 10 microg/dl: floor lead loading > 15 microg/ft2 (odds ratio [OR]=2.2; 95% confidence interval [CI] 1.3, 3.8); rental housing (OR=3.2; 95% CI 1.3, 7.6); poor housing condition (OR=2.1; CI 1.2, 3.6); African American race (OR=3.3; CI 1.9, 6.1); paint chip ingestion (OR=5.8; CI 1.3, 26.5); and soil ingestion (OR=2.2; CI 1.1, 4.2). Housing characteristics including rental status, lead-contaminated floor dust, and housing condition had a range of sensitivity from 47% to 92%; specificity from 28% to 76%; a positive predictive value from 25% to 34%; and a negative predictive value of 85% to 93%. CONCLUSIONS: Housing characteristics and floor dust lead levels can be used to screen housing to identify lead hazards prior to occupancy, before purchasing a home, or after renovation to prevent children's exposure to lead hazards.     

Trends and risk factors associated with the perpetration of physical intimate partner violence by women in Haiti, 2000-2012

ABSTRACT

Trends in the proportion of women reporting ever having perpetrated physical intimate partner violence (IPV) and factors associated with such IPV in Haiti between 2000 and 2012 were analyzed. We used datasets from Haitian couples in the 2000, 2005, and 2012 Demographic and Health Surveys. Physical IPV was assessed by the Conflict Tactics Scale. Trends were tested with the Cochrane–Armitage test. Women’s and spouses’ factors associated with physical IPV perpetration by women were estimated using binomial multivariable regressions. In 2000, 2005 and 2012, 3.5%, 3.4% and 3.2% women, respectively, reported perpetrating physical IPV (p for trend = 0.732). Factors associated with physical IPV by women included exposure to any IPV [Adjusted prevalence ratio (APR): 9.37; 95% Confidence Interval (CI): 5.05–17.38], living with a male partner who had a genital ulcer in the year preceding the survey [APR: 2.92; 95% CI: 1.11–7.65], living with a male partner who drank alcohol [APR: 2.58; 95% CI: 1.42–4.69], and having witnessed her father beating her mother during childhood [APR: 2.08; 95% CI: 1.14–3.81]. Exposure to IPV and history of genital ulcer in husbands/partners were the important factors associated with perpetration of physical IPV by women in Haiti over a 10-year period.     

Intimate partner violence, depression, and PTSD among pregnant Latina women

PURPOSE We undertook a study to describe factors related to depression and posttraumatic stress disorder (PTSD) among pregnant Latinas who were or were not exposed to intimate partner violence.METHODS We interviewed 210 pregnant Latinas attending prenatal clinics located in Los Angeles, California. Latinas who did and did not have histories of intimate partner violence were recruited. We then assessed the women for strengths, adverse social behavioral circumstances, posttraumatic stress disorder (PTSD), and depression.RESULTS Significantly more women exposed to intimate partner violence scored at or above the cutoff point for depression than women who were not (41% vs 18.6%; P<.001). Significantly more women exposed to intimate partner violence scored at or above the cutoff point for PTSD than women who were not (16% vs 7.6%; P <.001). Lack of mastery, which measures feelings of being in control of forces that affect life (odds ratio [OR], 0.72; 95% confidence interval [CI], 0.62–0.84), a history of trauma not associated with intimate partner violence (OR, 1.33; 95% CI, 1.08–1.63), and exposure to intimate partner violence (OR, 2.43; 95% CI, 1.16–5.11) were associated with depression after adjusting for age, language of interview, and site effects. Stress (OR, 1.72; 95% CI, 1.34–2.2) and a history of trauma (OR, 1.45; 95% CI, 1.03–2.04) were independently associated with PTSD, whereas higher income was associated with decreased risk of PTSD (OR, 0.10; 95% CI, 0.02–0.63), after adjusting for age, language of interview, and site effects.CONCLUSIONS Intimate partner violence was significantly associated with depression and PTSD but was associated with depression only after controlling for other factors in the multivariate model. The risk for depression declined with greater mastery but increased with a history of trauma or exposure to intimate partner violence. Stress, a history of trauma not associated with intimate partner violence, and lower income were all independently associated with increased risk for PTSD.