How can cities tackle hoarding? Examining an intervention program bringing together fire and health authorities in Vancouver.

Hoarded homes can pose a threat to public safety, with heightened risks of fire hazards, pest infestations and noxious odours in both the home and neighbouring dwellings. Communities across North America are responding to these public safety concerns through a harm reduction approach. This descriptive study explores the implementation and outcomes of the City of Vancouver's approach involving a partnership between fire prevention and public health. Data were collected from the team's 2016-2018 case tracking systems, consisting of health records and team intervention record, as well as notes taken from case briefing meetings. Study objectives included describing the intervention model, providing descriptive statistics on clients and their clutter volume, the interventions undertaken, and exploring predictors of clutter volume and case outcome through exploratory analyses. The sample included 82 cases involving severely hoarded conditions or more moderate hoarding conditions paired with additional client vulnerabilities (e.g. health conditions, frailty). Results from paired samples t-tests and regression analysis, suggest the Hoarding Action Response Team's (HART) model of a community-based intervention for hoarding was associated with clutter reduction and tenancy preservation. HART successfully maintained engagement with most clients, and most cases were closed within six home visits. Despite these successes, the team dealt with several barriers including client avoidance and limited resources. This paper provides guidance for communities who are working to develop a coordinated response to problems associated with hoarding and begins to establish expectations for what can be achieved through a community-based hoarding intervention model.

How well do hoarding research samples represent cases that rise to community attention?

This study used archival data from three different research groups and case file data from three independent community organizations to explore how well research samples reflect cases of hoarding that come to community attention. Using data from 824 individuals with hoarding, we found that research volunteers differ from community clients in several ways: community clients are older, more likely to be male and less likely to be partnered; they have lower socio-economic status and are less likely to demonstrate good or fair insight regarding hoarding severity and consequences. The homes of community clients had greater clutter volume and were more likely to have problematic conditions in the home, including squalor and fire hazards or fire safety concerns. Clutter volume was a strong predictor of these conditions in the home, but demographic variables were not. Even after accounting for the influence of clutter volume, the homes of community-based clients were more likely to have squalor. These findings suggest limitations on the generalizability of research samples to hoarding as it is encountered by community agencies.

Exploring the distribution of food stores in British Columbia: associations with neighbourhood socio-demographic factors and urban form.

Several studies have identified disparities in access to food retailers among urban neighbourhoods with varied socio-demographic characteristics; but few studies have examined whether key zoning and siting mechanisms described in the urban planning literature explain differences in food store access. This study assessed associations between socio-demographic and urban planning variables with the availability of large supermarkets and stores selling fresh food within one kilometre buffers from residential addresses and the proximity to the closest food stores across 630 census tracts in British Columbia, Canada. Multivariate regression results indicated that neighbourhoods with higher median household income had significantly decreased access to food stores. Inclusion of urban planning factors in multivariate models, particularly housing and transportation considerations, explained much of the relation between area income and food store access, and were significant predictors of food store availability and proximity. Public health research and practice addressing food availability would benefit by incorporating theoretical perspectives from urban planning theory.

Culture as a problem in linking material inequality to health: on residential crowding in the Arctic.

Two problems are noted in the process of measuring material inequality and linking it to health across cultural boundaries. First, comparative measurements may be used as the basis for policy making, which ends up disciplining cultural minorities. In this way, policies intended to relieve disparities can actually have the effect of extending the power of the dominant group to define appropriate cultural understanding of the world for the minority group. Second, comparative measurements may inaccurately inform theories of how inequality works to influence health and well-being. To the extent that culture mediates the relationship between inequality and outcomes of interest to researchers, those ignoring cultural differences will fail to adequately assess the impact and significance of material inequality. In this paper we discuss and illustrate these problems with reference to the study and measurement of overcrowding and its effects on health and well-being for Inuit communities in Nunavut, Canada.