Housing and asthma disparities.

The burden of asthma disproportionately affects minority and low-income communities, resulting in racial and socioeconomic disparities in asthma prevalence, asthma exacerbations, and asthma-related death. Social determinants of health are increasingly implicated as root causes of disparities, and healthy housing is perhaps the most critical social determinant in asthma health disparities. In many minority communities, poor housing conditions and value are a legacy of historical policies and practices imbued with structural racism, including redlining, displacement, and exclusionary zoning. As a result, poor-quality, substandard housing is a characteristic feature of many underrepresented minority communities. Consequently, structurally deficient housing stock cultivates home environments rife with indoor asthma triggers. In this review we consider the historical context of urban housing policies and practices and how these policies and practices have contributed to the substandard housing conditions for many minoritized children in the present day. We describe the impact of poor housing quality on asthma and interventions that have attempted to mitigate its influence on asthma symptoms and health care utilization. We discuss the need to promote asthma health equity by reinvesting in these neighborhoods and communities to provide healthy housing.

Expiring Eviction Moratoriums and COVID-19 Incidence and Mortality.

The coronavirus disease 2019 (COVID-19) pandemic and associated economic crisis have placed millions of US households at risk of eviction. Evictions may accelerate COVID-19 transmission by decreasing individuals' ability to socially distance. We leveraged variation in the expiration of eviction moratoriums in US states to test for associations between evictions and COVID-19 incidence and mortality. The study included 44 US states that instituted eviction moratoriums, followed from March 13 to September 3, 2020. We modeled associations using a difference-in-difference approach with an event-study specification. Negative binomial regression models of cases and deaths included fixed effects for state and week and controlled for time-varying indicators of testing, stay-at-home orders, school closures, and mask mandates. COVID-19 incidence and mortality increased steadily in states after eviction moratoriums expired, and expiration was associated with a doubling of COVID-19 incidence (incidence rate ratio = 2.1; 95% confidence interval (CI): 1.1, 3.9) and a 5-fold increase in COVID-19 mortality (mortality rate ratio = 5.4; CI: 3.1, 9.3) 16 weeks after moratoriums lapsed. These results imply an estimated 433,700 excess cases (CI: 365,200, 502,200) and 10,700 excess deaths (CI: 8,900, 12,500) nationally by September 3, 2020. The expiration of eviction moratoriums was associated with increased COVID-19 incidence and mortality, supporting the public-health rationale for eviction prevention to limit COVID-19 cases and deaths.

Resetting Policies to End Family Homelessness.

Homelessness is a devastating experience for children and their families. Families, the majority of whose members are children, now comprise more than one-third of the overall US homeless population. Most of these children are less than six years old. Various assumptions have driven policy and the allocation of resources to programs serving these families. Although decades of research and field experience suggest strategies for preventing and reducing this problem, perspectives differ, hindering the development of effective solutions. In this article, we explore some of these assumptions, including (a) definitions of homelessness used to count the numbers of families and determine resource allocation, (b) the needs of children and responses to the impact of adverse childhood experiences, and (c) whether services matter and should be integrated with affordable housing. We conclude by suggesting various directions to ensure that these children are protected and have the opportunity to grow and thrive.

Clinical Features of Disaster-Associated Direct Deaths during Recent Inland Earthquakes in Japan.

Natural disasters, including earthquakes, cause disaster-associated direct deaths due to hazards and disaster-related deaths. This study was a retrospective and observational study that explored the effect of natural disasters on direct death. Although research reports on disaster-related deaths are common, there are few reports of disaster-associated direct death caused by events, such as house collapses, fires, and sediment-related factors. The amendment of the Building Standards Law in 1981 has made Japanese building standards more stringent. We sought to examine the determinants of the number of disaster-associated direct deaths during recent inland earthquakes in Japan. Following 2016 Kumamoto earthquakes (April 14, 21:26 [magnitude (M) 6.5], April 15, 0:03 [M 6.4], and April 16, 1:25 [M 7.3] and the subsequent numerous aftershocks), police necropsies confirmed 50 disaster-associated direct deaths (28 women [56%]). Thirty-four victims (68%) were elderly people 65 years of age or older, and 38 victims (76%) died as a result of a collapsed house. These percentages are consistent with those associated with recent inland earthquake disasters in Japan. The main finding was a linear correlation between the number of completely collapsed houses and the number of deaths due to house collapse during recent inland earthquakes in Japan (P = 0.02). It is suggested that the maintenance of houses may be important in reducing the number of disaster-associated direct deaths during inland earthquakes. The amendment of the Building Standards Law might reduce the number of disaster-associated direct deaths during inland earthquakes.

Mapping Housing Laws in the United States: A Resource for Evaluating Housing Policies' Impacts on Health.

CONTEXT: Safe, stable housing is essential to good health. Housing hazards, including mold, vermin, and lead, can contribute to the development or exacerbation of chronic illnesses such as asthma and neurological disorders. In addition, eviction has been associated with poor physical and mental health outcomes. There are many laws aimed at maintaining healthy housing, or protecting access to stable housing, but their impacts are mostly unknown. POLICY: Using scientific legal mapping, the Center for Public Health Law Research (the Center) created legal data sets on state landlord-tenant laws, state fair housing laws, and city nuisance property ordinances. These data sets track the incidence and key features of these laws, creating legal data that can be used for evaluation. Some important elements of these laws include property maintenance duties; protections against retaliation; protected classes under state fair housing laws; discriminatory acts prohibited by state fair housing laws; types of conduct that constitute nuisance activity; and required nuisance abatement actions. IMPLEMENTATION AND/OR DISSEMINATION: As of August 1, 2017, all 50 states and the District of Columbia have a state landlord-tenant law; all states except Mississippi have a state fair housing law; and 37 of the 40 most populous US cities have a local nuisance property ordinance. EVALUATION: Evaluation of these laws is needed to determine their effectiveness and impacts and to spread the use of evidence-based policies. The creation of these legal data sets is the first step toward evaluation. DISCUSSION: Law can play an important role in promoting healthy housing, but evaluating the law is essential to determining its impact. Tracking the prevalence and key elements of laws is an important first step in conducting evaluation. The legal data created by the Center can be used to evaluate the efficacy and impacts of state landlord-tenant laws, state fair housing protections, and city nuisance property ordinances.

[An older woman in the local community in Russia: the neighborhood, non-government organizations and the public utilities sector.]

The article probes into the development of local self-organization of retired women, actively involved in resolving housing issues at their place of residence in Saint-Petersburg. The socio-spatial approach to aging, also referred to as «aging in a place / in a community¼ serves the theoretical framework. This type of aging requires an active approach to the habitual environment of the elderly and their support. It is the groups of older women that generate activists who have free time and the necessary competencies and who are ready to promote the interests of all the residents of an apartment building, a neighborhood or a district. Therefore, the empirical basis of the article was mainly the materials of interviews with women activists. In the public utilities system full of intricate semi-legal schemes, invisible and incomprehensible to the majority of ordinary citizens, activists are not always able to enter into an equitable dialogue with the controlling bodies and public utilities managers. In order to make insignificant changes, older activists are sometimes required to take tremendous efforts and develop new competencies which help to overcome barriers and to defend the collective interests.

Housing problems in a changing society: regulation and training needs in Italy.

The paper focuses on the social, economic and environmental trends of recent years in Italy, highlighting the issue of housing emergency, both in quantitative and qualitative terms. What emerges are several shortages in housing especially in the suburbs of large cities, emphasizing the relevance of this issue in terms of health consequences and its priority for the definition of local policies. The authors underline that the availability of accessible and healthy housing is a human right, and a multisectoral responsibility, achievable only if a contribution is made by all relevant sectors including housing, environmental, social welfare, urban planning, building management and public health. The authors conclude by stressing the strategic role of training and illustrating a proposal addressed to all stakeholders, aiming to provide health evidences in terms of impact of housing hazards on health and to describe good building practices, helpful in order to obtain safe and healthy homes.

Hygienic and sanitary standards of housing in Europe: a comparative analysis of nine countries.

In recent years, growing interest was devoted to housing conditions from both scientific community and public health, so they are now considered among the main environmental and social health determinants of health of the population. Aim of the study is to analyze and compare the current regulations regarding housing sanitary requirements in different Countries of the EU (Sweden, United Kingdom, Denmark, the Netherlands, France, Germany, Portugal, Spain) with the contents of the Italian Health Ministerial Decree 5th July 1975. From the websites of the official channels of the various countries the regulations have been downloaded. For the comparison, only the aspects of BCs concerning the scale of the building were examined; the comparison concerned all the requirements of the Health Ministerial Decree of 5.07.1975 and some other parameters (e.g. indoor chemical pollution, ionizing radiation, non-ionizing radiation) not provided for in the Ministerial Decree, treated in the other standards regulations, and relevant for the indoor well-being of the occupants. The authors observe a wide variability in the contents and in the formulation of the hygienic-sanitary requirements among the different Building Codes, above all as regards the dimensional data and some fundamental themes (e.g. heating systems, mechanical ventilation) whose treatment is often not it is updated with respect to the technological-scientific innovation consolidated over the past few years. A diverse approach among European Countries is also observed: from a market-oriented logic (e.g. UK), to a prescriptive one (Italy), to a functionality-oriented (the Netherlands). The comparative analysis we carried out made it possible to identify convergences and divergences in the standards analysed for the different European countries. As far as the Italian legislation on the usability of residential premises, finally, considering the health, social, environmental and economic trends, many standards contained in the MD 5th July 1975 should be reviewed and updated.

Towards an update of the Italian Ministerial Decree July 5th, 1975.

In recent years, the Scientific Community and the Public Health world, in general, have devoted increasing interest to housing conditions, which are considered, to date, one of the main environmental and social determinants of the population's health. In particular, the Scientific Community has identified and studied various indoor well-being factors (e.g. lighting, temperature, ventilation, air quality, etc.). Some of these factors have been regulated by laws and regulations at various levels: the availability of clear and updated health requirements dictated by the regulations is fundamental to effectively protect public health, especially in confined environments. In the present work, we propose a revision of the Italian Ministerial Decree of July 5th, 1975 titled Modificazioni alle istruzioni ministeriali 20 giugno 1896 relativamente all'altezza minima ed ai requisiti igienico sanitari principali dei locali d'abitazione (Modifications to the ministerial instructions of June 20th, 1896 regarding the minimum height and the main hygienic-sanitary requirements of living spaces) in order to update the definition of the essential elements that qualify a space as habitable from the hygienic-sanitary point of view, taking into account the evidence gathered from the technical and scientific literature on the requirements and contents of the Building Codes of the major European countries.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.

A proposal of hygienic and sanitary standards for the new Building Code in Italy.

The traditional emphasis of Public Health on the type and quality of housing today merges with other wider determinants of health such as: the neighbourhood, the community and the "place" where a home is located, but also the policies that make access to a healthy home within everyone's reach. At the neighbourhood scale, context-related aspects heavily influence the internal quality and real usability of the buildings themselves, with particular reference to factors such as the quality of the site, the relationship between the building and the context, the presence and quality of the greenery and open spaces surrounding the building, as well as all measures that make it possible to reduce the building's impact on the environment, to protect it against environmental pollution, and to manage the building in an integrated manner for maintenance purposes. Creating healthy living environments means referring to the different dimensions mentioned above, and this not only requires the attention of Public Health operators, but also implies an integration of vision and objectives among various professional skills and competences that puts health at the center of all policies. This proposal, which starts from the analysis of existing local hygiene regulations and scientific literature, aims to take stock of a number of areas considered fundamental for the assessment of building hygiene aspects, with particular reference to the eco-sustainability of buildings and adaptation to climate change. The aspects identified can be considered as a starting point for the preparation of integrated building and hygiene regulations based on documented effective practices for the protection of Public Health.

Examining the impact of medical legal partnerships in improving outcomes on the HIV care continuum: rationale, design and methods.

BACKGROUND: Over the past two decades, we have seen a nationwide increase in the use of medical-legal partnerships (MLPs) to address health disparities affecting vulnerable populations. These partnerships increase medical teams' capacity to address social and environmental threats to patients' health, such as unsafe housing conditions, through partnership with legal professionals. Despite expansions in the use of MLP care models in health care settings, the health outcomes efficacy of MLPs has yet to be examined, particularly for complex chronic conditions such as HIV. METHODS: This on-going mixed-methods study utilizes institutional case study and intervention mapping methodologies to develop an HIV-specific medical legal partnership logic model. Up-to-date, the organizational qualitative data has been collected. The next steps of this study consists of: (1) recruitment of 100 MLP providers through a national survey of clinics, community-based organizations, and hospitals; (2) in-depth interviewing of 50 dyads of MLP service providers and clients living with HIV to gauge the potential large-scale impact of legal partnerships on addressing the unmet needs of this population; and, (3) the development of an MLP intervention model to improve HIV care continuum outcomes using intervention mapping. DISCUSSION: The proposed study is highly significant because it targets a vulnerable population, PLWHA, and consists of formative and developmental work to investigate the impact of MLPs on health, legal, and psychosocial outcomes within this population. MLPs offer an integrated approach to healthcare delivery that seems promising for meeting the needs of PLWHA, but has yet to be rigorously assessed within this population.

Evaluation of percentage-based radon testing requirements for federally funded multi-family housing projects.

Radon is a leading cause of lung cancer. Recommendations for radon testing in multi-family housing focus on testing a percentage of all units. There is considerable variability among recommendations as well as their implementation. I used the hypergeometric distribution to determine the probability of identifying one or more units with radon at or above 4.0 pCi/L for two prevalences (1:15, the U.S. average) and 1:3 (for states with many homes with radon ≥4.0 pCi/L) using two approaches. First, the distribution was used to evaluate the probability of finding one or more units with radon at or above 4.0 pCi/L when: (1) testing 10% or 25% of a range of ground-floor units; or (2) testing a varying percentage of units in 10-, 20-, or 30- ground-floor unit buildings. Second, the method was used to determine the number of units to be tested to identify one or more units with radon at or above 4.0 pCi/L with 95% probability, given a range of total ground-floor units. Analyses identified that testing 10% or 25% of ground-floor units had low probability of identifying at least one unit with radon at or above 4.0 pCi/L, especially at low prevalence. At low prevalence (1:15), at least 10 units need to be tested in structures with 20 or fewer total units; at high prevalence (1:3), at least 5 units need to be tested in units with structures having 10 or fewer units to achieve 95% probability of identifying at least one unit with radon at or above 4.0 pCi/L. These findings indicate that recommendations for radon testing in multi-family housing may be improved by applying a well-established and more rigorous statistical approach than percentage-based testing to more accurately characterize exposure to radon in multi-family housing units, which could improve lung cancer prevention efforts.

Surveillance of carbon monoxide-related incidents - Implications for prevention of related illnesses and injuries, 2005-2014.

BACKGROUND: Carbon monoxide (CO) is an insidious gas responsible for approximately 21,000 emergency department visits, 2300 hospitalizations, and 500 deaths in the United States annually. We analyzed 10 combined years of data from two Agency for Toxic Substances and Disease Registry acute hazardous substance release surveillance programs to evaluate CO incident-related injuries. METHODS: Seventeen states participated in these programs during 2005-2014. RESULTS: In those 10years, the states identified 1795 CO incidents. Our analysis focused on 897 CO incidents having injured persons. Of the 3414 CO injured people, 61.0% were classified as general public, 27.7% were employees, 7.6% were students, and 2.2% were first responders. More than 78% of CO injured people required hospital or pre-hospital treatment and 4.3% died. The location for most injured people (39.9%) were homes or apartments, followed by educational facilities (10.0%). Educational services had a high number of people injured per incident (16.3%). The three most common sources of CO were heating, ventilation, and air conditioning systems; generators; and motor vehicles. Equipment failure was the primary contributing factor for most CO incidents. CONCLUSIONS: States have used the data to evaluate trends in CO poisoning and develop targeted public health outreach. Surveillance data are useful for setting new policies or supporting existing policy such as making CO poisoning a reportable condition at the state level and requiring CO alarms in all schools and housing. Public health needs to remain vigilant to the sources and causes of CO to help reduce this injury and death.

[Identification of the party responsible for restoring the water quality according to the German Potable Water Act in buildings belonging to a semiautonomous condominium community]. / Die Bestimmung des "Unternehmers oder sonstigen Inhabers" bei Legionellenbefall einer Trinkwasserversorgungsanlage in einer Wohnungseigentümergemeinschaft (WEG).

When drinking water contaminations occur in installations belonging to a semiautonomous condominium community (Wohnungseigentumsgemeinschaft) and the water installation's final paths being owned by the various condominium owners, the German legal definition of the party responsible has a broad reach. Therefore, authorities should address the condominium community, the condominium owners and the community administrator (WEG-Verwalter).

Pathways to Housing Policy: Translating Research to Policy to Achieve Impact on Well Being.

Policy emerges from the legislative, agency, and practice levels and from several pathways, including litigation; high profile or tragic events; community-based service provision and practice innovations; and research evidence. This commentary places an emphasis throughout on discussions of the articles included in this issue. It explores pathways that influenced the development of housing policy targeting child and family well being and provides examples to illustrate each pathway. The article further highlights how research on housing and child well being has influenced policy and practice and notes gaps for further research. It concludes with suggestions for structuring research to more effectively assist policymakers to make informed decisions that achieve positive change for children, youth, and families.

Cross Section of Legislative Approaches to Reducing Indoor Dampness and Mold.

Exposure to indoor dampness and mold is associated with numerous adverse respiratory conditions, including asthma. While no quantitative health-based threshold currently exists for mold, the conditions that support excessive dampness and mold are known and preventable; experts agree that controlling these conditions could lead to substantial savings in health care costs and improvement in public health. This article reviews a sample of state and local policies to limit potentially harmful exposures. Adoption of laws to strengthen building codes, specify dampness and mold in habitability laws, regulate mold contractors, and other legislative approaches are discussed, as are key factors supporting successful implementation. Communicating these lessons learned could accelerate the process for other jurisdictions considering similar approaches. Information about effectiveness of legislation as prevention is lacking; thus, evaluation could yield important information to inform the development of model state or local laws that significantly address mold as a public health concern.

Requirements for Notification, Evaluation and Reduction of Lead-Based Paint Hazards in Federally Owned Residential Property and Housing Receiving Federal Assistance; Response to Elevated Blood Lead Levels. Final rule.

This final rule amends HUD's lead-based paint regulations to reduce blood lead levels in children under age six (6) who reside in federally-owned or -assisted pre-1978 housing, formally adopting a revised definition of "elevated blood lead level" (EBLL) in children under the age of six (6), in accordance with Centers for Disease Control and Prevention (CDC) guidance. It also establishes more comprehensive testing and evaluation procedures for the housing where such children reside. This final rule also addresses certain additional elements of the CDC guidance pertaining to assisted housing and makes technical corrections and clarifications. This final rule, which follows HUD's September 1, 2016, proposed rule, takes into consideration public comments submitted in response to the proposed rule.