Creating an e-cohort of individuals with lived experience of homelessness and subsequent mortality in Wales, UK.

BACKGROUND: Homelessness is an extreme form of social exclusion, with homeless people experiencing considerable social and health inequities. Estimates of morbidity and mortality amongst homeless populations is limited due to the lack of recording of housing status across health datasets. The aim of this study is to: (i) identify a homelessness e-cohort by linking routine health data in Wales, and (ii) explore whether a period of reported past homelessness, places this population at greater risk of morbidity and mortality. METHODS: Homelessness identified through linkage across primary, secondary care and substance misuse datasets in the Secure Anonymised Information Linkage (SAIL) Databank. Mortality was examined through linkage to the Office for National Statistics mortality data. RESULTS: E-cohort of 15 472 individuals with lived experience of homelessness identified. Of those, 21 individuals died between February and July 2020 involving coronavirus disease of 2019 (COVID-19). Those with lived experience of homelessness had increased mortality from many causes including accidents, liver diseases and suicides. CONCLUSION: Linking multiple routine datasets provides a more comprehensive dataset of a marginalized population, including individuals who are not included in government homeless statistics. Application of the cohort demonstrated that individuals with lived experience of homelessness have increased mortality involving COVID-19 and other causes. The underlying reasons, health needs and causes of death warrant further exploration.

Cold homes, fuel poverty and energy efficiency improvements: A longitudinal focus group approach.

Cold homes and fuel poverty have been identified as factors in health and social inequalities that could be alleviated through energy efficiency interventions. Research on fuel poverty and the health impacts of affordable warmth initiatives have to date primarily been conducted using quantitative and statistical methods, limiting the way how fuel poverty is understood. This study took a longitudinal focus group approach that allowed exploration of lived experiences of fuel poverty before and after an energy efficiency intervention. Focus group discussions were held with residents from three low-income communities before (n = 28) and after (n = 22) they received energy efficiency measures funded through a government-led scheme. The results show that improving the energy efficiency of homes at risk of fuel poverty has a profound impact on wellbeing and quality of life, financial stress, thermal comfort, social interactions and indoor space use. However, the process of receiving the intervention was experienced by some as stressful. There is a need for better community engagement and communication to improve the benefits delivered by fuel poverty programmes, as well as further qualitative exploration to better understand the wider impacts of fuel poverty and policy-led intervention schemes.

The short-term health and psychosocial impacts of domestic energy efficiency investments in low-income areas: a controlled before and after study.

BACKGROUND: Research suggests that living in fuel poverty and cold homes contributes to poor physical and mental health, and that interventions targeted at those living in poor quality housing may lead to health improvements. However, little is known about the socio-economic intermediaries and processes that contribute to better health. This study examined the relationship between energy efficiency investments to homes in low-income areas and mental and physical health of residents, as well as a number of psychosocial outcomes likely to be part of the complex relationship between energy efficiency measures and health outcomes. METHODS: A quasi-experimental field study with a controlled pretest-posttest design was conducted (intervention n = 364; control n = 418) to investigate the short-term health and psychosocial impacts of a domestic energy efficiency programme that took place across Wales between 2013 and 2015. Survey data were collected in the winters before and after installation of energy efficiency measures, including external wall insulation. The study used a multilevel modelling repeated measures approach to analyse the data. RESULTS: The energy efficiency programme was not associated with improvements in physical and mental health (using the SF-12v2 physical and mental health composite scales) or reductions in self-reported respiratory and asthma symptoms. However, the programme was associated with improved subjective wellbeing (B = 0.38, 95% CI 0.12 to 0.65), as well as improvements in a number of psychosocial outcomes, including increased thermal satisfaction (OR = 3.83, 95% CI 2.40 to 5.90), reduced reports of putting up with feeling cold to save heating costs (OR = 0.49, CI = 0.25 to 0.94), fewer financial difficulties (B = -0.15, 95% CI -0.25 to -0.05), and reduced social isolation (OR = 0.32, 95% CI 0.13 to 0.77). CONCLUSION: The study showed that investing in energy efficiency in low-income communities does not lead to self-reported health improvements in the short term. However, investments increased subjective wellbeing and were linked to a number of psychosocial intermediaries that are conducive to better health. It is likely that better living conditions contribute to improvements in health outcomes in the longer term. Better understanding of the impacts on recipients of energy efficiency schemes, could improve targeting of future fuel poverty policies.

Use and storage of domestic pesticides in the UK.

Several epidemiological studies, particularly from the United States, have suggested health concerns may arise from the chronic exposure of young children to pesticides in their home environment. Most of these studies are retrospective and the available pesticide exposure information is either subject to the problem of recall or derived from surrogate information. Currently, little is known about the extent of pesticide use in homes and gardens in the UK. This was investigated in this study using a sample of parents from the Avon Longitudinal Study of Parents and Children (ALSPAC) cohort in and around Bristol. The level and extent of pesticide use by parents was explored through interviews that took place at the homes of the participants during August to November 2001, followed by an inventory of products stored in the home. From the results, 93% of parents had used at least one pesticide over the preceding year with the highest use being in the garden, second inside the home, followed by treating pets and head lice. Most households reported using one to five different products over the past year, with a mean of 3.5. The frequency of pesticide use showed that a minority of parents are using pesticides in the high frequency range. Over 85 different pesticide products were found to be stored in 76% of homes, with 76 different types of pesticide active ingredients. Insecticides were the most commonly used and stored pesticide.

Socio-demographic characteristics of UK families using pesticides and weed-killers.

Pesticides are widely used in the home and garden to kill insects, weeds and other unwanted pests. There is mounting evidence that this usage may also have health consequences particularly on children. Using the ALSPAC cohort of 13,391 families with self-reported usage data up to age 4 years of the study child, the main users of pesticides appeared to be older, Caucasian, better educated, have higher incomes and more likely to own their home or to belong to non-manual social classes compared to less frequent users. There was some suggestion that different factors may affect weed-killer compared to other pesticide use. In particular, income appeared unrelated to other pesticide use. This may reflect different attitudes to indoor compared to garden applications. Alternatively, it may reflect whether the main user was the mother or the partner. Some authorities are currently encouraging domestic users to consider other non-chemical means of pest control before using pesticides. These results may help in targeting particular groups if further reductions in pesticide usage are desired. They have also helped in identifying the important confounders for adjusting future analyses on the potential health consequences of pesticides and weed-killers.

Exposure misclassification of household pesticides and risk perception and behaviour.

The aim of this paper was to compare self-reported household pesticide use or non-use in a questionnaire with reported household pesticide use from an in-depth interview, in order to elucidate any differences, and to study any differential reporting of pesticides. In the in-depth interview we asked for pesticide use, behaviour adopted while using pesticides and risk perceptions as possible factors to explain the reporting of pesticide use. The Avon Longitudinal Study of Parents and Children (ALSPAC) was used as the sampling frame. Eight hundred and thirty one parents filled out and returned the questionnaire. A random sample of 53 users and 94 non-users took part in the interview. Almost 90% of the 94 who did not report the use of pesticides in the questionnaire reported the use of pesticides during the interview. However, those who reported pesticide use in the questionnaire were more likely to report home and garden pesticide use (P < 0.05) in the interview. The parents who reported pesticide use in the questionnaire had a tendency to perceive a lower risk and higher benefit from pesticide use, and tended to be less risk averse when compared with the groups of parents who reported no pesticide use. They bought the pesticides because 'they looked safe', while those who did not report pesticide use bought them because they 'used them before'. The latter were also more likely to state that they did not understand everything on the label and that they thought that it did not provide all the information needed. They were also less likely to feel that they knew what they are doing when using pesticides and felt that pesticide use is relatively dangerous compared with other hazards. In conclusion, pesticide use is underreported in questionnaires, and behaviour and risk perception may affect the reporting.

The use and disposal of household pesticides.

Most pesticides are synthetic chemicals manufactured specifically for their toxic properties to the target species, and widely used globally. Several epidemiological studies in the United States have suggested health concerns arising from the chronic exposure of young children to pesticides in the domestic environment. In the UK very little is currently known about how nonoccupational pesticides are being used or disposed of. Any use of pesticides is a potential risk factor for children's exposure, and any potential exposure is likely to be reduced by the parents' adopting precautionary behaviour when using these pesticide products. This was investigated using a sample of 147 parents from the Avon Longitudinal Study of Parents and Children cohort in and around Bristol, through an in-depth interview between August and November 2001. The results of this study add to the understanding of the underlying behaviour of parents applying pesticide products in the home environment in the UK. Pesticides are readily available, and are normally purchased in do-it-yourself shops and supermarkets and mostly disposed of in domestic waste. Safety was stated by 45% of parents to be the most important factor to consider when buying a pesticide. When buying pesticide products, labels were stated to be the most important source of information about pesticides. However, a third of parents stated they would not follow the product label exactly when using a product, just under half felt labels were both inadequate and hard to understand, and about 10% of parents would not take notice of warnings on the pesticide label. Less than half of parents would use gloves when applying a pesticide, although the use of protective equipment such as gloves during the application of pesticides could greatly reduce the exposure. It is a public health concern that the instructions on the labels of products may not always be understood or followed, and further understanding of user behaviour is needed.