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.

Disentangling residential self-selection from impacts of built environment characteristics on travel behaviors for older adults.

In the context of population ageing in many developed and developing countries, encouraging active transport behaviors of older adults, is a key public health priority. However, many cross-sectional studies assessing the impact of built environment characteristics on travel behavior fail to address residential self-selection bias, and hence the causal relationship is uncertain. A large-scale public housing scheme provided this study with a unique research opportunity to distinguish residential self-selection from the effects of built environment characteristics on the travel behaviors of older adults (N = 13,468 and 3,961 in two analyses respectively) in Hong Kong, because public housing residents have little freedom to choose their residential locations. The results showed that the elderly living in public housing estates generally have fewer trips, shorter overall travel times and distances, and fewer motorized trips including those by rail or private car than those living in private housing estates. In addition, the results for walking, walking times, numbers of trips, and travel distance for elderly people in public and private housing all exhibited markedly different associations with built environment characteristics. Strength of built environment-travel behavior associations dropped by approximately 30-50% after controlling for the effect of residential self-selection. The results indicate that both built environment characteristics and residential self-selection affect travel behaviors.

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.

A pilot study: Exploring the musculoskeletal risk exposure associated with drying laundry using the public housing pipe-socket system amongst women in Singapore.

BACKGROUND: The biomechanics of homemakers has been minimally studied. The way laundry-drying is performed in Singapore public-housing, using the pipe-socket-system (PSS), could expose the homemakers to musculoskeletal disorder risk. OBJECTIVE: This study aims to quantify the musculoskeletal risk exposure (MRE) associated with laundry-drying amongst female homemakers using the PSS in Singapore public-housing. METHODS: Using snowball sampling approach, five female homemakers familiar with the described laundry-drying method were recruited. The postures of the participants were analysed from video-recorded data and scored using the Rapid Entire Body Assessment (REBA). RESULTS: This pilot study revealed very strong evidence (p = 0.001) that the participants were exposed to medium risk (REBA score 4.3) when performing this housework task. CONCLUSIONS: Extreme awkward postures and repetitive motions were observed from the participants during the analysis. High REBA scores were frequently associated with the awkward postures adopted due to constraints of physical work space.

Perceptions about the Federally Mandated Smoke-Free Housing Policy among Residents Living in Public Housing in New York City.

Background: To assess residents' attitudes towards the United States (U.S.) Department of Housing and Urban Development's new smoke-free public housing policy, perceptions about barriers to policy implementation, and suggestions for optimizing implementation. Methods: In 2017, we conducted 10 focus groups among 91 residents (smokers and nonsmokers) living in New York City public housing. Results: Smokers and nonsmokers expressed skepticism about the public housing authority's capacity to enforce the policy due to widespread violations of the current smoke-free policy in common areas and pervasive use of marijuana in buildings. Most believed that resident engagement in the roll-out and providing smoking cessation services was important for compliance. Resident expressed concerns about evictions and worried that other building priorities (i.e., repairs, drug use) would be ignored with the focus now on smoke-free housing. Conclusions: Resident-endorsed strategies to optimize implementation effectiveness include improving the access to cessation services, ongoing resident engagement, education and communication to address misconceptions and concerns about enforcement, and placing smoke-free homes in a larger public housing authority healthy housing agenda.

Co-designing Urban Living Solutions to Improve Older People's Mobility and Well-Being.

Mobility is a key aspect of active ageing enabling participation and autonomy into later life. Remaining active brings multiple physical but also social benefits leading to higher levels of well-being. With globally increasing levels of urbanisation alongside demographic shifts meaning in many parts of the world this urban population will be older people, the challenge is how cities should evolve to enable so-called active ageing. This paper reports on a co-design study with 117 participants investigating the interaction of existing urban spaces and infrastructure on mobility and well-being for older residents (aged 55 + years) in three cities. A mixed method approach was trialled to identify locations beneficial to subjective well-being and participant-led solutions to urban mobility challenges. Spatial analysis was used to identify key underlying factors in locations and infrastructure that promoted or compromised mobility and well-being for participants. Co-designed solutions were assessed for acceptability or co-benefits amongst a wider cross-section of urban residents (n = 233) using online and face-to-face surveys in each conurbation. Our analysis identified three critical intersecting and interacting thematic problems for urban mobility amongst older people: The quality of physical infrastructure; issues around the delivery, governance and quality of urban systems and services; and the attitudes and behaviors of individuals that older people encounter. This identified complexity reinforces the need for policy responses that may not necessarily involve design or retrofit measures, but instead might challenge perceptions and behaviors of use and access to urban space. Our co-design results further highlight that solutions need to move beyond the generic and placeless, instead embedding specific locally relevant solutions in inherently geographical spaces, populations and processes to ensure they relate to the intricacies of place.

The Potential for Proactive Housing Inspections to Inform Public Health Interventions.

Municipal housing inspection data can inform planning, targeting, and evaluating interventions aimed at reducing housing hazards (lead paint, mold, pests, etc) that may affect residents' health. However, the potential of these data to inform public health initiatives is underexplored. We determined whether home health hazards identified by city inspectors during proactive inspections of single-family private rental housing are predicted by housing age, assessed value, or location in one of 26 geographic "inspector areas" in Rochester, New York. A comparison of linear mixed models, using housing inspector area as a random effect and assessment and construction year as fixed effects, shows that while a large proportion of variation (64%) in violations is due to housing stock, inspectors provide significant additional information about the presence of potential health hazards, particularly in the highest-risk housing stock. This suggests that inspector-generated housing hazard data may be valuable in designing public health interventions.

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.

Sustaining Housing First After a Successful Research Demonstration Trial: Lessons Learned in a Large Urban Center.

OBJECTIVES: This study aimed to identify challenges and facilitators of sustaining a Housing First intervention at the conclusion of a research demonstration project in Toronto. METHODS: This qualitative study included key informant interviews with organizational leaders (N=13) and focus groups with service team members (N=14) and program participants (N=9) of the At Home/Chez Soi Research Demonstration Project. Thematic analysis was used to identify key themes related to sustainability of Housing First beyond the demonstration phase. RESULTS: Factors that helped secure long-term funding support for Housing First included the positive findings of a rigorous evaluation, early stakeholder engagement, and strong local leadership. Reduced funding, poor intersectoral integration, and lack of central oversight threatened fidelity to the evidence-based model and challenged sustainability. CONCLUSIONS: Evidence-based complex interventions such as Housing First require robust intersectoral collaboration and flexible systems for funding and monitoring to ensure continuing model fidelity and responsiveness to changing contexts.

Announcement: Federally Assisted Housing Standards for Blood Lead Levels Aligned with CDC-Recommended Threshold.

On January 13, 2017, the U.S. Department of Housing and Urban Development (HUD) lowered the threshold of lead in young children's blood that triggers interventions to evaluate and control exposure hazards from 20 µg/dL to 5 µg/dL, matching the reference level used by CDC (1). The rule includes a process to continue HUD alignment with any future updates to CDC's reference level (1).

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.