Homeplace: Care and resistance among public housing residents facing mixed-income redevelopment.

Low-income communities of color experience significant political, economic, and health inequities and, not unrelatedly, are disproportionately exposed to violent crime than are residents of higher income communities. In an effort to mitigate concentrations of poverty and crime, governmental agencies have partnered with affordable housing developers to redevelop public housing "projects" into mixed-income communities and to do so within a "trauma-informed" framework. The current study analyzes how residents have historically and contemporaneously negotiated, endured, and resisted structural and interpersonal violence in 2 long-standing, predominately African American, public housing communities undergoing a public-private housing redevelopment initiative. Interviews with 44 adult public housing residents (age range = 18-75 years; 82% African American/Black) were conducted during a 2-year period while residents' homes were being demolished and rebuilt into mixed-income communities. Analysis of in-depth interviews used constructivist grounded theory principles to reveal a common theme and basic social process of the ongoing formation of homeplace, with subthemes focusing on the ways homeplace emerges through shared lineage, knowing and caring practices; how homeplace is maintained through networks of protection in unsafe contexts; how homeplace is disrupted as a result of redevelopment activities; and the reclamation of homeplace during redevelopment in the service of hope and healing. These findings offer a nuanced view of resident's lived experiences of place-based trauma and collective resistance and resilience, while also highlighting the place-specific ways in which redevelopment unsettles deeply rooted sociocultural configurations of home and community. (PsycInfo Database Record (c) 2020 APA, all rights reserved).

Community Health Worker Intervention in Subsidized Housing: New York City, 2016-2017.

From April 2016 to June 2017, the Health + Housing Project employed four community health workers who engaged residents of two subsidized housing buildings in New York City to address individuals' broadly defined health needs, including social and economic risk factors. Following the intervention, we observed significant improvements in residents' food security, ability to pay rent, and connection to primary care. No immediate change was seen in acute health care use or more narrowly defined health outcomes.

Geospatial mapping and resource utilization tool in support of a national smoke-free public housing rule.

OBJECTIVE: To advance public health support for the U.S. Department of Housing and Urban Development's smoke-free rule, the Centers for Disease Control and Prevention collaborated with the Georgia Institute of Technology to develop a geospatial mapping tool. The objective was to create a tool state and local public health agencies could use to tailor smoke-free educational materials and cessation interventions for specific public housing development resident populations. RESULTS: The resulting "Extinguish Tool" includes an interactive map of U.S. public housing developments (PHDs) and healthcare facilities that provides detailed information on individual PHDs, their proximity to existing healthcare facilities, and the demographic characteristics of residents. The tool also estimates the number of PHD residents who smoke cigarettes and calculates crude estimates of the potential economic benefits of providing cessation interventions to these residents. The geospatial mapping tool project serves as an example of a collaborative and innovative public health approach to protecting the health and well-being of the nation's two million public housing residents, including 760,000 children, from the harms of tobacco smoking and secondhand smoke exposure in the places where they live, play, and gather.

Criterios técnicos para una vivienda adecuada / Technical criteria for adequate housing

La vivienda es el núcleo del desarrollo de una persona. Es ahí en donde se desarrollan las habilidades más importantes, los valores, y en donde se forja el sentido de comunidad. Por esta razón, en el Gobierno de México reconocemos que garantizar una vivienda adecuada es un elemento central para la verdadera transformación de nuestro país. A pesar de que el derecho a una vivienda adecuada, incluido en el Pacto Internacional de Derechos Económicos, Sociales y Culturales (ONU, 1966), fue ratificado por México hace casi 40 años, el modelo de vivienda que se siguió en las últimas décadas dejó importantes rezagos en nuestro país. De acuerdo con el Consejo Nacional de Evaluación de la Política de Desarrollo Social (Coneval), existe un rezago habitacional en más de 14 millones de viviendas, 45% del total. Esto quiere decir que prácticamente la mitad de las viviendas en el país presentan carencias en sus materiales o condición de hacinamiento. Para cambiar esta realidad, es necesario entender y concebir a la vivienda como el espacio físico, social y cultural, en el que se construye un hogar; como el núcleo de nuestra sociedad y del desarrollo de la persona. Verla como un producto inmobiliario, una construcción o un mecanismo para activar la economía, lleva al desarrollo de modelos que tienden a alejarse de garantizar el derecho a la vivienda y a un hábitat adecuado. Por esta razón, la encomienda del Presidente Andrés Manuel López Obrador es cambiar la forma en que se han venido haciendo las cosas y no fallar. En apego a un estricto sentido de justicia social, las políticas públicas de vivienda atenderán de forma prioritaria a los segmentos de la población más vulnerables e históricamente olvidados. En conjunto con la Comisión Nacional de Vivienda (Conavi), se ejecutan el Programa de Vivienda Social, el Programa Nacional de Reconstrucción en la modalidad de vivienda y el Programa de Mejoramiento Urbano en la vertiente de Vivienda en Ámbito Urbano. A través de sus diferentes objetivos, se busca dotar de una vivienda adecuada a las familias mexicanas que más lo necesitan. Una pieza esencial de estos programas es el acompañamiento técnico que recibirá directamente la población beneficiaria para el diseño y la construcción de su vivienda. En este sentido, los Criterios Técnicos para una Vivienda Adecuada son una herramienta fundamental para que los asistentes técnicos proporcionen a las personas beneficiarias las opciones para una vivienda que responda a sus necesidades. Estos criterios, adecuándose a las necesidades sociales, culturales, ambientales y de riesgo de cada región, permitirán que la asistencia técnica se otorgue de manera eficiente, organizada y homologada. Extiendo mi reconocimiento a los equipos de la Secretaría de Desarrollo Agrario, Territorial y Urbano (Sedatu), Conavi y el Centro de Investigación para el Desarrollo Sostenible del Infonavit por la elaboración de este importante documento. A las y los asistentes técnicos que harán posible que miles de familias tengan una vivienda adecuada, mi admiración y agradecimiento.

Bayesian deprivation index models for explaining variation in elevated blood lead levels among children in Maryland.

Lead exposure adversely affects children's health. Exposure in the United States is highest among socioeconomically disadvantaged individuals who disproportionately live in substandard housing. We used Bayesian binomial regression models to estimate a neighborhood deprivation index and its association with elevated blood lead level (EBLL) risk using blood lead level testing data in Maryland census tracts. Our results show the probability of EBLL was spatially structured with high values in Baltimore city and low values in the District of Columbia suburbs and Baltimore suburbs. The association between the neighborhood deprivation index and EBLL risk was statistically significant after accounting for spatial dependence in probability of EBLL. The percent of houses built before 1940, African Americans, and renter occupied housing were the most important variables in the index. Bayesian models provide a flexible one-step approach to modeling risk associated with neighborhood deprivation while accounting for spatially structured and unstructured heterogeneity in risk.

Housing as a Platform for Health and Equity: Evidence and Future Directions.

The links between housing and health are now known to be strong and multifaceted and to generally span across 4 key pillars: stability, affordability, quality and safety, and neighborhood opportunity. Housing disparities in the United States are tenaciously patterned along axes of social inequality and contribute to the burden related to persistently adverse health outcomes in affected groups. Appreciating the multidimensional relationship between housing and health is critical in moving the housing and health agenda forward to inspire greater equity.We assessed the current state of research on housing and health disparities, and we share recommendations for achieving opportunities for health equity centered on a comprehensive framing of housing.Despite the vastness of existing research, we must contextualize the housing and health disparities nexus in a broader web of interrelated variables emerging from the same roots of structural inequalities. There is more we can do to maximize the extent to which existing research furthers our understanding of housing's relationship to health and potential related interventions; however, there are also several areas where new research is warranted.

"If you can, change this system" -Pregnant asylum seekers' perceptions on social determinants and material circumstances affecting their health whilst living in state-provided accommodation in Germany - a prospective, qualitative case study.

BACKGROUND: Pregnant women and new mothers seeking asylum are highly vulnerable and have special needs, yet there is dearth of research related to this group in Germany. This paper reports on material circumstances and behavioural factors as social determinants of asylum seekers' health during pregnancy and early motherhood. The study aim was to gain in-depth insights into these women's experiences and perceived needs with a focus on material circumstances whilst living in state-provided accommodation in one federal state in Southern Germany. METHODS: A qualitative, prospective approach was taken with individual semi-structured interviews of participants during pregnancy and up to the six-week postnatal assessment, aiming at interviewing each woman twice during pregnancy and once after giving birth. Two female interviewers performed interviews assisted by female professional interpreters on the telephone. Interviews were recorded digitally and transcribed verbatim. An inductive approach was taken to perform content analysis of interview material. RESULTS: 21 interviews were performed with nine women seeking asylum in pregnancy and early motherhood. Content analysis of women's perceived health-related needs revealed significant health challenges due to considerable constraints in two major themes each with associated categories: a) material circumstances and b) behavioural factors. Participants' experiences of living conditions included significant challenges in terms of housing and neighbourhood quality e.g. poor hygiene standards with fear of disease and restless sleep due to threats of violence. Consumption potential was severely limited because of a minimal living allowance. Food was a major preoccupation for all participants. Catering services in state-provided accommodation were perceived as unsatisfactory and neglecting religious practices. Institutional food provided adequate calorific intake but participants reported loss of appetite due to bland food, limited variety, little choice and unfamiliar tastes. Self-catering was prohibited further exacerbating this problem. CONCLUSIONS: Pregnant asylum seekers and new mothers living in state-provided accommodation experienced major restrictions related to material circumstances in this study. Key results identified housing and neighbourhood quality, consumption potential and nutrition as social determinants of health which women perceived to adversely affect their health, especially during pregnancy and early motherhood.

Finding HOPE: Changes in depressive symptomology following relocation from distressed public housing.

Many public housing residents suffer from poor mental health and depression, which may be a function of both socioeconomic deprivation and residing in disorderly, unstable, and disadvantaged neighborhoods. While not explicitly targeting mental health, the HOPE VI program may improve public housing residents' mental health by relocating them from distressed developments and into less-disadvantaged and disorderly neighborhoods. This paper examines post-relocation depressive symptomology among residents relocated from the Boulevard Homes public housing development in Charlotte, NC. Drawing on pre- and post-relocation surveys, as well as interviews with staff and case managers, we examine whether depressive symptomology - measured by the CES-D-10 - is associated with whether tenants relocate to other public housing or to private-market housing through the Housing Choice Voucher program. Further, we investigate whether social support, perceptions of safety, or objective neighborhood measures result in improvements in post-relocation depressive symptomology. We find that depressive symptomology substantially decreased following relocation, and those with higher CES-D-10 scores were more likely to move to other public housing rather than through the voucher program. Interviews with case managers suggest that some residents were fearful of leaving public housing and assuming the responsibilities of a private-market rental unit - e.g., basic maintenance and utility payments. Further, we find that reductions in post-relocation depressive symptomology are associated with greater perceptions of safety, greater social support in their new neighborhoods, and length of tenure at Boulevard Homes. Policy recommendations include expanding community-based mental health services, conducting pre-relocation mental health screenings, and providing additional relocation counseling to those suffering from depression.

Evaluation of Tobacco Control Policies in San Francisco Homeless Housing Programs.

BACKGROUND: The 2014 Surgeon General's Report noted that high smoking rates in vulnerable populations such as the homeless have been a persistent public health problem; smoking prevalence among individuals experiencing homelessness exceeds 70%. Historically, service providers for the homeless have not enacted comprehensive tobacco control policies. METHOD: We conducted a qualitative study of homeless housing programs in San Francisco. Administrators representing 9 of the city's 11 homeless service agencies were interviewed to assess institutional smoking-related policies and cessation programs and perceived barriers and receptivity to instituting tobacco control interventions. RESULTS: Respondents indicated that although most programs had adopted smoke-free grounds and some had eliminated evidence of staff smoking, the smoking status of clients was assessed only when required by funders. None of the programs offered smoking cessation interventions. Most administrators were receptive to adopting policies that would promote a tobacco-free culture; however, they noted that their clients had unique challenges that made traditional smoking cessation programs unfeasible. CONCLUSIONS: Homeless housing programs in San Francisco have not yet adopted a tobacco-free culture. Existing policies were created in response to external mandates, and smoking cessation programs may need to be modified in order to effectively reach clients.

Health Hazards in the Home: An Assessment of a Southern Nevada Community.

As a sub-grantee of a Department of Housing and Urban Development (HUD) Lead Hazard Control and Healthy Homes Program, the University of Nevada, Las Vegas' Department of Environmental and Occupational Health performed lead and Healthy Homes investigations and collected data regarding conditions in the home environment in Henderson, Nevada. The purpose of this research is to characterize housing conditions in southern Nevada, compare data to census data, and to highlight the health outcomes associated with adverse housing conditions. Visual home assessments were conducted in 106 homes in southern Nevada, and specific hazards were characterized using the Healthy Homes Rating System. The results were then compared, when possible, to American Housing Survey (AHS) data for the Las Vegas metropolitan area. Lead, domestic hygiene, carbon monoxide, damp and mold, excess cold and heat, and structural collapse were the most frequently identified hazards, found in at least 101 (90%) of participant households. Median household income of program participants was half (50%) that of the surrounding zip code, which was expected, as classification as "low-income" by HUD standards was a requirement for participation. Our data indicated that the AHS data may not be representative of very low income housing in southern Nevada and may underreport actual conditions. In-home inspections performed by trained personnel provide a more accurate picture of conditions than the self-report method used by the AHS. In addition, we recommend the development of a standardized Healthy Homes visual assessment tool to allow for the comparison of housing conditions between communities.

Impact of energy efficiency interventions in public housing buildings on cold-related mortality: a case-crossover analysis.

Background: Interventions to mitigate fuel poverty and particularly energy efficiency façade retrofitting (EEFR) have demonstrated positive impacts on health but the impacts of EEFR interventions on cold-related mortality have not been studied in depth. We evaluated the impact of EEFR interventions in Barcelona on the association between cold outdoor temperatures and mortality (from all natural causes and from neoplasms, circulatory system and respiratory system causes) from 1986 to 2012. Methods: A time-stratified case-crossover analysis was used. Relative risks (RR) for death related to extreme cold (lowest fifth percentile) in the no-intervention and intervention groups were obtained for temperature lag windows covering the day of the death and the previous 20 days (0-2, 3-5, 6-8, 9-11, 12-14, 15-17, 18-20). The statistical significance of the observed changes was evaluated using the RR for the cold temperature-intervention interaction. Results: In men, interventions significantly increased the extreme cold-death association for the lag window 15-17 [interaction RR 2.23, 95% confidence interval (CI) 1.14-4.36]. The impacts were stronger for respiratory system causes and in men aged 75 or older. In women, on lag window 0-2, the extreme cold-death association was not significantly reduced when analysing all natural causes of death (interaction RR 0.46, 95% CI 0.21-1.01), but it was reduced significantly when analysing only deaths from neoplasms, circulatory system and respiratory system causes together. The impacts were stronger in women who died from circulatory system causes, in women with no education and in those aged 75 or older. Conclusions: EEFR interventions had differentiated effects on cold-related mortality in men and women. Differentiated effects were also observed by cause, educational level and age.

The cunning of data in Indigenous housing and health.

This article explores why it is so difficult to provide and sustain decent public housing in Indigenous communities, highlighting the curious role that data reporting and analysis plays in perpetuating this state of affairs. Drawing on data amassed by the Housing for Health (HFH) program that has focused on "health hardware" functionality in almost 9,000 houses in over 215 communities across Australia, we note inroads made to the language of policy (through, for example, the development of a National Indigenous Housing Guide). However, we also note the more limited effect on those policy practices that ordain substandard housing function. There is an intimate relationship between this outcome and the paradoxical state of the Indigenous housing and health evidence base, a field which is simultaneously awash with multiple databases providing synoptic information at regional, state/territory, and national levels, yet lacking specificity in relation to the health-enabling status of housing infrastructure.

Public housing renewal and social determinants of health.

This article draws on the concept of residential context of housing and its relationship to health. It considers a bundle of changes through implementation of a housing renewal initiative as part of the Carlton Housing Estate Upgrading Project in Melbourne, Australia. Beyond the quality and appropriateness of the housing, pertinent factors explored include social networks, safety and security, and green open space. Data collection for the research project included in-depth interviews with public housing tenants, private residents, and service providers who live on and service the estate, as well as neighborhood observations and participation in on-site events. A key finding was that the relational processes of how tenants were related to by others-specifically, the way housing was reallocated during the processes of renewal-affected social housing tenants' self-perceived health and well-being.

Housing tenure and affordability and mental health following disability acquisition in adulthood.

Acquiring a disability in adulthood is associated with a reduction in mental health and access to secure and affordable housing is associated with better mental health. We hypothesised that the association between acquisition of disability and mental health is modified by housing tenure and affordability. We used twelve annual waves of data (2001-2012) (1913 participants, 13,037 observations) from the Household, Income and Labour Dynamics in Australia survey. Eligible participants reported at least two consecutive waves of disability preceded by two consecutive waves without disability. Effect measure modification, on the additive scale, was tested in three fixed-effects linear regression models (which remove time-invariant confounding) which included a cross-product term between disability and prior housing circumstances: housing tenure by disability; housing affordability by disability and, in a sub-sample (896 participants 5913 observations) with housing costs, tenure/affordability by disability. The outcome was the continuous mental component summary (MCS) of SF-36. Models adjusted for time-varying confounders. There was statistical evidence that prior housing modified the effect of disability acquisition on mental health. Our findings suggested that those in affordable housing had a -1.7 point deterioration in MCS (95% CI -2.1, -1.3) following disability acquisition and those in unaffordable housing had a -4.2 point reduction (95% CI -5.2, -1.4). Among people with housing costs, the largest declines in MCS were for people with unaffordable mortgages (-5.3, 95% CI -8.8, -1.9) and private renters in unaffordable housing (-4.0, 95% CI -6.3, -1.6), compared to a -1.4 reduction (95% CI -2.1, -0.7) for mortgagors in affordable housing. In sum, we used causally-robust fixed-effects regression and showed that deterioration in mental health following disability acquisition is modified by prior housing circumstance with the largest negative associations found for those in unaffordable housing. Future research should test whether providing secure, affordable housing when people acquire a disability prevents deterioration in mental health.

Service-Enriched Housing: The Staying at Home Program.

INTRODUCTION: The purpose of this research was to determine whether service-enriched housing (i.e., the Staying at Home [SAH] program) in publicly subsidized buildings for low-income older adults influenced resident outcomes. METHOD: Eleven elderly high-rise buildings were used. Seven buildings had the SAH program and four did not. Information was collected from resident questionnaires, housing managers data, and medical information. A total of 10 desired outcomes were proposed as part of SAH (e.g., health improvements, receive more non-institutional services, receive more preventive services, and be less likely to be institutionalized). Information was collected over the course of the SAH program every 6 months from December 2008 through June 2011. RESULTS: Overall, 736 surveys were completed by SAH program participants and 399 were completed by control group participants. Seven of the ten desired outcomes were achieved, and in 3 of the ten cases, no differences between the SAH group and control group were identified. The program was also beneficial with respect to cost savings. CONCLUSION: On the basis of these findings, the SAH program should be viewed as a success. In this case, service-enriched housing for elders in high-rise buildings would appear to be beneficial.

Home for now: A mixed-methods evaluation of a short-term housing support program for homeless families.

The use of short-term rental subsidy vouchers offers a new approach to addressing the housing needs of families facing homelessness. In Massachusetts, the Family Home pilot program placed homeless families in housing instead of shelter, providing two years of rental subsidy plus support services with the goal of enabling families to maintain market rate housing. This mixed-method case study complements staff and participant interview data with participant survey and administrative data to evaluate the implementation and short-term outcomes of Family Home in one region. Data point to improved family well-being in housing but also persistent barriers to achieving longer-term housing and economic stability. Of the families who had exited the program at the end of the study, one quarter were able to retain their housing at market rate, only 9% returned to shelter, and one in five moved in with families/friends. Lack of affordable housing in a high rental cost region and jobs that pay living wages were among the major reasons that families struggled to maintain housing. This research points to the need for integrating supportive services from the program's start, including targeted workforce development, to plan for the end of the short-term rental subsidy.

Professional development through policy advocacy: communicating and advocating for health and health equity.

Communicating and advocating for evidence-based public health policy is a key component of health promotion practice, but public health professionals often lack experience in policy advocacy. This article provides perspectives from public health professionals who participated in successful public health policy advocacy efforts in their community. Their experiences using evidence-based research to advocate for policies that promote health equity contributed significantly to their career development, and also contributed to community capacity to reduce tobacco-related disparities. This article builds on previous work emphasizing the value of career development opportunities that enhance and diversify the public health workforce, and provides practical tips and "lessons learned" that are relevant to a wide range of public health professionals.

National and state cost savings associated with prohibiting smoking in subsidized and public housing in the United States.

INTRODUCTION: Despite progress in implementing smoke-free laws in indoor public places and workplaces, millions of Americans remain exposed to secondhand smoke at home. The nation's 80 million multiunit housing residents, including the nearly 7 million who live in subsidized or public housing, are especially susceptible to secondhand smoke infiltration between units. METHODS: We calculated national and state costs that could have been averted in 2012 if smoking were prohibited in all US subsidized housing, including public housing: 1) secondhand smoke-related direct health care, 2) renovation of smoking-permitted units; and 3) smoking-attributable fires. Annual cost savings were calculated by using residency estimates from the Department of Housing and Urban Development and cost data reported elsewhere. Data were adjusted for inflation and variations in state costs. National and state estimates (excluding Alaska and the District of Columbia) were calculated by cost type. RESULTS: Prohibiting smoking in subsidized housing would yield annual cost savings of $496.82 million (range, $258.96-$843.50 million), including $310.48 million ($154.14-$552.34 million) in secondhand smoke-related health care, $133.77 million ($75.24-$209.01 million) in renovation expenses, and $52.57 million ($29.57-$82.15 million) in smoking-attributable fire losses. By state, cost savings ranged from $0.58 million ($0.31-$0.94 million) in Wyoming to $124.68 million ($63.45-$216.71 million) in New York. Prohibiting smoking in public housing alone would yield cost savings of $152.91 million ($79.81-$259.28 million); by state, total cost savings ranged from $0.13 million ($0.07-$0.22 million) in Wyoming to $57.77 million ($29.41-$100.36 million) in New York. CONCLUSION: Prohibiting smoking in all US subsidized housing, including public housing, would protect health and could generate substantial societal cost savings.