Housing and health--current issues and implications for research and programs

A review of the impact of shelter design on the health of displaced populations

There are currently millions of displaced people encamped in low-quality shelters that jeopardise the health of these displaced populations. These shelters, which exhibit poor thermal regulation and air quality, are often inhabited by households for several years. Recently, the internal environment of shelters has been recognised as a determinant of the health of the occupants and the indoor air quality (IAQ) and internal temperatures have been identified as critical factors affecting occupants' health. Attempts by researchers and private companies to develop healthier shelter solutions have mainly prioritised factors such as rapid deployment, transportability and sustainability. Via a systematic bibliometric analysis of the existing literature, this review examines the impact of shelters' internal environment on occupant health. Self-reports and building simulation are the most common methodologies reported in the literature, but there is a disconnect between the reported shelter issues and their impact on health. This is likely due to the multifaceted and site-specific factors analysed. Indoor air quality, thermal comfort and overcrowding are the most commonly identified shelter issues, which are strongly related to the presence of infectious and airborne diseases. An analysis of the available literature indicates that there is still a lack of clear guidance linking shelter quality to health. Moreover, evidence of the impact of shelters on health is harder to find, and there is a gap regarding the metrics and the methodology used to evaluate shelter quality. Therefore, further research is necessary to provide evidence of the impact of shelter design on health through transdisciplinary approaches.

Selected Research Issues of Urban Public Health

Health is created within the urban settings of people’s everyday lives. In this paper we define Urban Public Health and compile existing evidence regarding the spatial component of health and disease in urban environments. Although there is already a substantial body of single evidence on the links between urban environments and human health, focus is mostly on individual health behaviors. We look at Urban Public Health through a structural lens that addresses health conditions beyond individual health behaviors and identify not only health risks but also health resources associated with urban structures. Based on existing conceptual frameworks, we structured evidence in the following categories: (i) build and natural environment, (ii) social environment, (iii) governance and urban development. We focused our search to review articles and reviews of reviews for each of the keywords via database PubMed, Cochrane, and Google Scholar in order to cover the range of issues in urban environments. Our results show that linking findings from different disciplines and developing spatial thinking can overcome existing single evidence and make other correlations visible. Further research should use interdisciplinary approaches and focus on health resources and the transformation of urban structures rather than merely on health risks and behavior.

Socioeconomic disadvantages and vulnerability to the pandemic among children and youth: A macro-level investigation of American counties

This study intends to reveal the underlying structural inequity in vulnerability to infection of the novel coronavirus disease pandemic among children and youth. Using multi-source data from New York Times novel coronavirus disease tracking project and County Health Rankings & Roadmap Program, this study shows that children and youth in socioeconomically disadvantaged status are faced with disproportionate risk of infection in this pandemic. On the county level, socioeconomic disadvantages (i.e., single parent family, low birthweight, severe housing problems) contribute to the confirmed cases and death cases of the novel coronavirus disease. Policymakers should pay more attention to this vulnerable group to implement more targeted and effective epidemic prevention and control.

Characterization of Healthy Housing in Africa: Method, Profiles, and Determinants

Housing is a key social determinant of health with implications for both physical and mental health. The measurement of healthy housing and studies characterizing the same in sub-Saharan Africa (SSA) are uncommon. This study described a methodological approach employed in the assessment and characterization of healthy housing in SSA using the Demographic and Health Survey (DHS) data for 15 countries and explored healthy housing determinants using a multiple survey-weighted logistic regression analysis. For all countries, we demonstrated that the healthy housing index developed using factor analysis reasonably satisfies both reliability and validity tests and can therefore be used to describe the distribution of healthy housing across different groups and in understanding the linkage with individual health outcomes. We infer from the results that unhealthy housing remains quite high in most SSA countries. Having a male head of the household was associated with decreased odds of healthy housing in Burkina Faso (OR = 0.80, CI = 0.68-0.95), Cameroon (OR = 0.65, CI = 0.57, 0.76), Malawi (OR = 0.70, CI = 0.64-0.78), and Senegal (OR = 0.62, CI = 0.51-0.74). Further, increasing household size was associated with reducing odds of healthy housing in Kenya (OR = 0.53, CI = 0.44-0.65), Namibia (OR = 0.34, CI = 0.24-0.48), Nigeria (OR = 0.57, CI = 0.46-0.71), and Uganda (OR = 0.79, CI = 0.67-0.94). Across all countries, household wealth was a strong determinant of healthy housing, with middle and rich households having higher odds of residing in healthy homes compared to poor households. Odds ratios ranged from 3.63 (CI = 2.96-4.44) for households in the middle wealth group in the DRC to 2812.2 (CI = 1634.8-4837.7) in Namibia's wealthiest households. For other factors, the analysis also showed variation across countries. Our findings provide timely insights for the implementation of housing policies across SSA countries, drawing attention to aspects of housing that would promote occupant health and wellbeing. Beyond the contribution to the measurement of healthy housing in SSA, our paper highlights key policy and program issues that need further interrogation in the search for pathways to addressing the healthy housing deficit across most SSA countries. This has become critical amid the COVID-19 pandemic, where access to healthy housing is pivotal in its control.

The Benefits of Rental Assistance for Children's Health and School Attendance in the United States

Programs that provide affordable and stable housing may contribute to better child health and thus to fewer missed days of school. Drawing on a unique linkage of survey and administrative data, we use a quasi-experimental approach to examine the impact of rental assistance programs on missed days of school due to illness. We compare missed school days due to illness among children receiving rental assistance with those who will enter assistance within two years of their interview, the average length of waitlists for federal rental assistance. Overall, we find that children who receive rental assistance miss fewer days of school due to illness relative to those in the pseudo-waitlist group. We demonstrate that rental assistance leads to a reduction in the number of health problems among children and thus to fewer days of school missed due to illness. We find that the effect of rental assistance on missed school days is stronger for adolescents than for younger children. Additionally, race-stratified analyses reveal that rental assistance leads to fewer missed days due to illness among non-Hispanic White and Hispanic/Latino children; this effect, however, is not evident for non-Hispanic Black children, the largest racial/ethnic group receiving assistance. These findings suggest that underinvestment in affordable housing may impede socioeconomic mobility among disadvantaged non-Hispanic White and Hispanic/Latino children. In contrast, increases in rental assistance may widen racial/ethnic disparities in health among disadvantaged children, and future research should examine why this benefit is not evident for Black children.

COVID-19 and healthy home preferences: The case of apartment residents in Tehran

With the global spread of the COVID-19 pandemic in the world, domestic spaces have become dramatically important in terms of controlling pandemics and as an environment that must meet the needs of residents during the quarantine period. The purpose of this study is to evaluate the health parameters in the domestic space in the apartment type after COVID-19. The indicators related to physical health, mental health, and socio-economic lifestyle changes affecting the interior architecture of apartment houses have been evaluated with the use of a questionnaire with 632 respondents in Tehran. These indicators have been measured with regard to space, building structure, mental comfort, self-sufficiency, and workplace. The data were analysed using Friedman, Mean, and ANOVA tests to prioritize indicators in the SPSS software. The results indicated that variables related to mental health such as natural light, view, acoustic, and open or semi-open space are of particular importance. Therefore, attention to mental health parameters should be considered by planners, builders, and architects in apartment design.

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The relationship between interior design and healthy housing is explained.

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Dimensions of a healthy home about COVID_19 are divided into three factors of health and five indexes of home design.

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The important factors of a healthy home about COVID_19 pandemic are identified to be considered in the future designs.

Childhood maltreatment and lead levels in middle adulthood: A prospective examination of the roles of individual socio-economic and neighborhood characteristics

BACKGROUND

Lead is a common environmental hazard because of its past use as an additive to gasoline and household paint. Some evidence suggests that children with histories of child abuse and neglect are at elevated risk for residence in communities and households with less desirable characteristics and high levels of exposure to environmental hazards and toxins.

OBJECTIVES

To understand whether childhood maltreatment leads to higher levels of household dust lead and blood lead in adulthood and the extent to which characteristics of a person's physical environment or individual level socio-economic status (SES) (based on unemployment, poverty, and receipt of public assistance) contribute to understanding the relationship.

METHODS

A large prospective cohort design study in which abused and neglected children (ages 0-11) were matched with non-maltreated children and assessed in adulthood. Objective and subjective neighborhood characteristics were assessed at approximate age 40 and household dust lead (cleaned and less often cleaned) and blood lead levels were measured at age 41. Blood was collected through venipuncture by a registered nurse as part of a medical status exam.

RESULTS

Childhood maltreatment predicted higher levels of dust lead in less often cleaned household places, residence in worse neighborhoods defined by objective (census tract data) and subjective (reports of physical disorder and lack of social cohesion and control), and higher levels of poverty, receiving public assistance, and unemployment. Only objective neighborhood characteristics mediated the relationship between childhood maltreatment and dust lead level in adulthood. There were also significant paths from objective neighborhood disadvantage and individual level SES to higher levels of blood lead.

DISCUSSION

Thirty years after their childhood experiences, individuals with documented histories of childhood maltreatment are at higher risk for living in environments as adults with elevated lead levels that may impact other aspects of their lives and compromise their health.

Quality of home healthcare among Arab countries

Objective:

To examine the quality of home healthcare services provided and to systematically review publications concerning the quality of home healthcare in Arab countries.

Methods:

In 2017, we conducted an online literature search to identify relevant published studies using the following electronic databases: Embase, CINAHL, PubMed, and the Cochrane library. First, we screened the publications according to titles. Second, we evaluated the titles and abstracts of the included publications. Third, we independently reviewed and assessed the full texts of the included publications.

After the final selection, we extracted the following information from the full-text articles that met the inclusion criteria: author, year of publication, country, study design, number of participants, participant type, and the main findings.

Results:

In total, 6 of 214 studies met the inclusion criteria. These 6 studies were published from 3 countries. The country with the most number of studies was Saudi Arabia (4 articles), followed by Jordan (one article) and Iraq (one article). We found that all studies were assessed according to 3 indicators, namely, safety, efficiency, and effectiveness, out of the 6 indicators of quality by the Institute of Medicine.

Conclusion:

This review shows a clear gap in the literature regarding the quality of home healthcare in Arab countries, emphasizing the need for more studies, particularly quality studies on timely, equitable, and patient-centered care in home healthcare settings.

Housing and Healthy Child Development: Known and Potential Impacts of Interventions

Housing is often described as an important determinant of health, but less commonly of child health. Despite acknowledgment of the importance of housing to health, however, there are relatively few studies of the effects of housing interventions on health, and again even fewer on child health. This article argues that a broad focus on healthy child development-as opposed to just physical health-coupled with a conceptual framework outlining specific attributes of housing with the potential to influence child health, should be adopted to guide a comprehensive approach to public health policy for healthy child development. Most housing interventions address direct pathways linking in-home hazard exposures to child health outcomes, with promising but mixed results. But few housing interventions address the broader aspects of healthy child development. This review addresses potential housing interventions that could impact the broader determinants of healthy child development and accompanying methodological challenges.

Housing, psychosocial and adherence counseling among HIV+ persons in Ghana

As part of providing comprehensive HIV/AIDS services, the Ghana National AIDS Control Programme (NACP) and Ministry of Health recommend that Persons Living with HIV/AIDS (PLWHAs) receive psychosocial support and follow-up visits that ensure medical and drug adherence assistance. The successful implementation of these support services requires patients to have stable and quality housing, yet studies that examine associations between housing, psychosocial support, and adherence counseling among PLWHAs in Ghana and sub-Saharan Africa are limited. Data were collected from 605 PLWHAs attending check-up and receiving Anti-Retroviral Therapy (ART) from both Atua Government Hospital and St. Martin's de Porres Hospital, located in the Manya Krobo district. Results show significant relationships between housing and access to psychosocial counseling and support. Specifically, respondents with stable homes and quality housing were significantly more likely to receive psychosocial counseling and support, compared to those without stable and quality housing. It is important for policy makers to consider housing as an important element of psychosocial counseling and care.

Variability in the spatial density of vacant properties contributes to background lead (Pb) exposure in children

BACKGROUND

Heightened blood lead levels (BLL) are associated with cognitive deficiencies and adverse behavioral outcomes. Lead-contaminated house dust is the primary source of exposure in U.S. children, and evidence suggests that even background (low-level) exposure has negative consequences. Identifying sources of background exposure is of great public health significance because of the larger number of children that can be affected.

METHODS

Blood lead was assessed in a bi-racial sample of children from Syracuse, NY, aged 9-11, using established biomonitoring methods. The spatial density of vacant properties was modelled from publicly available georeferenced datasets. Further, regression models were used to measure the impact of this spatial density variable on children's BLL.

RESULTS

In a sample of 221 children, with a mean BLL of 1.06 µg/dL (SD = 0.68), results showed increases in spatial density of vacant properties predict increases in median blood-PB levels, b = 0.14 (0.06-0.21), p < .001. This association held true even after accounting for demographic covariates, and age of individual housing. Further analysis showed spatial autocorrelation of the residuals changed from a clustered pattern to a random pattern once the spatial density variable was introduced to the model.

DISCUSSION

This study is the first to identify a background-lead exposure source using spatial density modelling. As vacant properties deteriorate, lead-contaminated dust likely disperses into the surrounding environment. High-density areas have an accumulation of lead hazards in environmental media, namely soil and dust, putting more children at risk of exposure.

Healthy housing: A case study of intersectoral collaboration for better health

Residency areas are primary social factors that directly and indirectly affect health and in synergy with other factors, changes health equity indices. Qazvin as one of the provinces in the Islamic Republic of Iran has been a pioneer in the provision of an integrated health program with intersectoral collaboration approach and the participation of residents. In this study required data was gathered in a qualitative method by reviewing documents, group discussions with stakeholders and residents and interviews with key informed individuals. In the beginning, stakeholder's analysis revealed highly effective organizations and their method of cooperation. Insufficient access to housing, weak security, insufficient swage system and deficiency of entertainment and park environment are four top urgent issues which are related to housing. Strategic goals for each issue has been designed in a four-year time frame and projects for reaching the goals that are considered in three categories: promotional, facilitator and mandatory. Cooperation of multiple stakeholders including managers and residents are features of preparing this program. A change of stakeholders' perspective to health-oriented performance in housing is the added value of this public act.

Different types of housing and respiratory health outcomes

Evidence has shown that housing conditions may substantially influence the health of residents. Different types of housing have different structures and construction materials, which may affect indoor environment and housing conditions. This study aimed to investigate whether people living in different types of housing have different respiratory health outcomes. The data from the 1999-2006 National Health and Nutrition Examination Survey were used for the analyses. The types of housing included houses, townhouses, apartments, and mobile homes. Respiratory symptoms included wheezing, coughing, sputum, and dyspnea; respiratory diseases included asthma, chronic bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD). Multiple logistic regression was used to calculate odds ratio (OR) and 95% confidence interval (CI) after adjustment for potential confounding factors. A total of 11,785 participants aged 40 years and older were included in the analyses. Compared with those living in single family houses, participants living in mobile homes were more likely to have respiratory conditions, the OR (95% CI) was 1.38 (1.13-1.69) for wheezing, and 1.49 (1.25-1.78) for dyspnea; whereas participants living in apartments were less likely to have respiratory conditions, the OR (95% CI) was 0.58 (0.36-0.91) for chronic bronchitis, and 0.69 (0.49-0.97) for COPD. Compared with living in single family houses, living in mobile home was associated with worse, whereas living in apartments was associated with better, respiratory health outcomes. Further research is needed to better understand the underlying mechanisms and prevent adverse respiratory effects associated with living in mobile homes.

Residential metal contamination and potential health risks of exposure in adobe brick houses in Potosí, Bolivia

Potosí, Bolivia, is the site of centuries of historic and present-day mining of the Cerro Rico, a mountain known for its rich polymetallic deposits, and was the site of large-scale Colonial era silver refining operations. In this study, the concentrations of several metal and metalloid elements were quantified in adobe brick, dirt floor, and surface dust samples from 49 houses in Potosí. Median concentrations of total mercury (Hg), lead (Pb), and arsenic (As) were significantly greater than concentrations measured in Sucre, Bolivia, a non-mining town, and exceeded US-based soil screening levels. Adobe brick samples were further analyzed for bioaccessible concentrations of trace elements using a simulated gastric fluid (GF) extraction. Median GF extractable concentrations of Hg, As, and Pb were 0.085, 13.9, and 32.2% of the total element concentration, respectively. Total and GF extractable concentrations of Hg, As, and Pb were used to estimate exposure and potential health risks to children following incidental ingestion of adobe brick particles. Risks were assessed using a range of potential ingestion rates (50-1000mg/day). Overall, the results of the risk assessment show that the majority of households sampled contained concentrations of bioaccessible Pb and As, but not Hg, that represent a potential health risk. Even at the lowest ingestion rate considered, the majority of households exceeded the risk threshold for Pb, indicating that the concentrations of this metal are of particular concern. To our knowledge, this is the first study to quantify key trace elements in building materials in adobe brick houses and the results indicate that these houses are a potential source of exposure to metals and metalloids in South American mining communities. Additional studies are needed to fully characterize personal exposure and to understand potential adverse health outcomes within the community.

"Extra Oomph:" Addressing Housing Disparities through Medical Legal Partnership Interventions

Low-income households face common and chronic housing problems that have known health risks and legal remedies. The Medical Legal Partnership (MLP) program presents a unique opportunity to address housing problems and improve patient health through legal assistance offered in clinical settings. Drawn from in-depth interviews with 72 patients, this study investigated the outcomes of MLP interventions and compares results to similarly disadvantaged participants with no access to MLP services. Results indicate that participants in the MLP group were more likely to achieve adequate, affordable and stable housing than those in the comparison group. Study findings suggest that providing access to legal services in the healthcare setting can effectively address widespread health disparities rooted in problematic housing. Implications for policy and scalability are discussed with the conclusion that MLPs can shift professionals' consciousness as they work to improve housing and health trajectories for indigent groups using legal approaches.

Local Variability in the Impacts of Residential Particulate Matter and Pest Exposure on Children's Wheezing Severity: A Geographically Weighted Regression Analysis of Environmental Health Justice

Two assumptions have underpinned environmental justice over the past several decades: 1) uneven environmental exposures yield correspondingly unequal health impacts and 2) these effects are stable across space. To test these assumptions, relationships for residential pest and PM2.5 exposures with children's wheezing severity are examined using global (ordinary least squares) and local (geographically weighted regression [GWR]) models using cross-sectional observational survey data from El Paso (Texas) children. In the global model, having pests and higher levels of PM2.5 were weakly associated with greater wheezing severity. The local model reveals two types of asthmogenic socio-environments where environmental exposures more powerfully predict greater wheezing severity. The first is a lower-income context where children are disproportionately exposed to pests and PM2.5 and the second is a higher-income socio-environment where children are exposed to lower levels of PM2.5, yet PM2.5is counterintuitively associated with more severe wheezing. Findings demonstrate that GWR is a powerful tool for understanding relationships between environmental conditions, social characteristics and health inequalities.

Indoor fungi: companions and contaminants

This review discusses the role of fungi and fungal products in indoor environments, especially as agents of human exposure. Fungi are present everywhere, and knowledge for indoor environments is extensive on their occurrence and ecology, concentrations, and determinants. Problems of dampness and mold have dominated the discussion on indoor fungi. However, the role of fungi in human health is still not well understood. In this review, we take a look back to integrate what cultivation-based research has taught us alongside more recent work with cultivation-independent techniques. We attempt to summarize what is known today and to point out where more data is needed for risk assessment associated with indoor fungal exposures. New data have demonstrated qualitative and quantitative richness of fungal material inside and outside buildings. Research on mycotoxins shows that just as microbes are everywhere in our indoor environments, so too are their metabolic products. Assessment of fungal exposures is notoriously challenging due to the numerous factors that contribute to the variation of fungal concentrations in indoor environments. We also may have to acknowledge and incorporate into our understanding the complexity of interactions between multiple biological agents in assessing their effects on human health and well-being.

Estimates of costs for housing-related interventions to prevent specific illnesses and deaths

Public health is embracing economic analyses in an effort to use limited resources in the most efficient manner. However, users of economic analyses in the public health arena should recognize the inherent strengths and weaknesses of different types of analysis, as well as understand how the inclusion or omission of certain costs or benefits might influence study results. For example, asthma is a chronic condition that can result in health care costs that accrue well beyond the duration of a housing intervention. Thus, an economic analysis that omits long-term health care costs can underestimate the total economic benefit of the housing intervention. This article contains reviews of economic articles on housing interventions published in PubMed, examines salient differences between studies, and discusses pertinent gaps in the literature. In addition, this article attempts to provide an overview of key economic evaluation methods in relation to housing interventions to a target audience of local and state public health practitioners. Specific housing-related health issues discussed include asthma, lead, and carbon monoxide poisoning and radon-related lung cancer.

A systematic review of housing interventions and health: introduction, methods, and summary findings

Subject matter experts systematically reviewed evidence on the effectiveness of specific housing interventions in improving health. The panelists reviewed housing interventions associated with exposure to biological and chemical agents, structural injury hazards, and community-level interventions. Intervention studies were grouped together according to recommendations in the Guide to Community Preventive Services, which identifies similarities in the type of intervention, its delivery and setting, and the target population. Review panelists found that 11 interventions had sufficient evidence of effectiveness, 15 required more field evaluation, 19 needed formative research, and 7 either had no evidence of effectiveness or were ineffective. Although many housing conditions are associated with adverse health outcomes, sufficient evidence now shows that specific housing interventions can improve certain health outcomes. The results of these evidence reviews can inform a robust agenda for widespread implementation and further research. This article highlights the project's research methods and summary findings, and its companion articles detail the evidence reviews for specific housing interventions.

Risk assessment of exposure to lead in tap water among residents of Seri Kembangan, Selangor state, Malaysia

Introduction:

A cross sectional study was conducted to estimate risk of exposure to lead via tap water ingestion pathway for the population of Seri Kembangan (SK).

Methodology:

By using purposive sampling method, 100 respondents who fulfilled the inclusive criteria were selected from different housing areas of SK based on geographical population distribution. Residents with filtration systems installed were excluded from the study. Questionnaires were administered to determine water consumption-related information and demographics. Two water samples (first-flushed and fully-flushed samples) were collected from kitchen tap of each household using HDPE bottles. A total of 200 water samples were collected and lead concentrations were determined using a Graphite Furnace Atomic Absorption Spectrophotometer (GFAAS).

Results:

Mean lead concentration in first-flushed samples was 3.041± SD 6.967µg/L and 1.064± SD 1.103µg/L for fully-flushed samples. Of the first-flushed samples, four (4) had exceeded the National Drinking Water Quality Standard (NDWQS) lead limit value of 10µg/L while none of the fully-flushed samples had lead concentration exceeded the limit. There was a significant difference between first-flushed samples and fully-flushed samples and flushing had elicited a significant change in lead concentration in the water (Z = -5.880, p<0.05). It was also found that lead concentration in both first-flushed and fully flushed samples was not significantly different across nine (9) areas of Seri Kembangan (p>0.05). Serdang Jaya was found to have the highest lead concentration in first-flushed water (mean= 10.44± SD 17.83µg/L) while Taman Universiti Indah had the highest lead concentration in fully-flushed water (mean=1.45± SD 1.83µg/L). Exposure assessment found that the mean chronic daily intake (CDI) was 0.028± SD 0.034µgday^-1kg^-1. None of the hazard quotient (HQ) value was found to be greater than 1.

Conclusion:

The overall quality of water supply in SK was satisfactory because most of the parameters tested in this study were within the range of permissible limit and only a few samples had exceeded the standard values for lead and pH. Non-carcinogenic risk attributed to ingestion of lead in SK tap water was found to be negligible.

Outcomes of Asthma Education and Healthy Homes Curriculum Provided Through Community Health Workers in South Texas Colonias

Background. Childhood asthma rates are highest among minorities and among those who reside in low-income communities. This is especially true of children who reside in colonias, which are defined as substandard housing communities in irregular rural settlements located along the US-Mexico border. This study aimed to evaluate the knowledge acquired by participants before and after an educational intervention was provided. Methods. This study used the healthy homes training approach, including integrated pest management, identification of asthma triggers, and asthma case management, to increase asthma management awareness and control. This dual training approach combined a healthy homes module with asthma education and was implemented by certified promotoras (community health workers) in South Texas colonias. Promotoras are generally trusted and respected individuals who live in or around the communities in which they work. The promotoras identified and trained 108 parents of children aged between 5 and 12 years in households in Hidalgo County with lifetime asthma diagnosed by his/her physician and of children who may not have been diagnosed by a health professional with asthma but suffer from symptoms of asthma. Results. Asthma management and healthy homes knowledge, including attitudes and practices, significantly improved among parents after the implementation of the dual training program. Of the 108 participants, 78% had never received asthma education, 78% had a child with lifetime asthma diagnosed by his/her physician, and 32% reported having medical insurance. Pretest and posttest comparison results based on 9 out of 14 questions related to asthma triggers and healthy home principles showed a significant improvement in knowledge gained among the participants. Regardless of the study limitations (self-report instrument for the pretest and the posttest), the results showed that families in colonias living with asthma benefit from an integrated training approach.

Environmental health disparities in housing

The physical infrastructure and housing make human interaction possible and provide shelter. How well that infrastructure performs and which groups it serves have important implications for social equity and health. Populations in inadequate housing are more likely to have environmental diseases and injuries. Substantial disparities in housing have remained largely unchanged. Approximately 2.6 million (7.5%) non-Hispanic Blacks and 5.9 million Whites (2.8%) live in substandard housing. Segregation, lack of housing mobility, and homelessness are all associated with adverse health outcomes. Yet the experience with childhood lead poisoning in the United States has shown that housing-related disparities can be reduced. Effective interventions should be implemented to reduce environmental health disparities related to housing.

Effects of child health on housing in the urban U.S

This study exploits an exogenous health shock-the birth of a child with a severe health condition that is considered by the medical community to be random-to investigate the effect of that shock on the family's housing situation. We use population-based data from an urban birth cohort study in the U.S. that oversampled non-marital births, resulting in a relatively disadvantaged sample that may be particularly susceptible to the effects of adverse life events. The health conditions were recorded in the infants' hospital medical records and coded by a pediatric consultant to capture conditions that are considered both severe and random. Seven different housing outcomes in the domains of quality, crowding, and stability were assessed from maternal interviews and in-home assessments when the children were 3 years old. We found that poor child health increases the likelihood of both overcrowding and homelessness and that it may also increase the likelihood of having inadequate utilities and generally poor housing quality. The effect sizes ranged from 1 to 17 percentage points, depending on the measure of poor child health and housing outcome.

Exploring the efficacy of an environmental health intervention in Ciudad Juárez, Mexico

This study explores the efficacy of an environmental health intervention in several poor colonias in Ciudad Juárez (Mexico). Parents of children with respiratory problems were given environment-friendly products intended to replace hazardous products used in the home, as well as information about environmental health. Parents were surveyed before and after to measure the effectiveness of the intervention and to gauge perceptions. There was a significant reduction in hazardous chemical use (eg, cleaning products and pesticides) and breathing problems. While the intervention focused on changing in-home behaviors, open-ended responses revealed that parents were most concerned about outdoor environmental conditions over which they had less control.

The role of housing type and housing quality in urban children with asthma

The goal of this study was to assess the relationship between type and quality of housing and childhood asthma in an urban community with a wide gradient of racial/ethnic, socioeconomic, and housing characteristics. A parent-report questionnaire was distributed in 26 randomly selected New York City public elementary schools. Type of housing was categorized using the participants' addresses and the Building Information System, a publicly-accessible database from the New York City Department of Buildings. Type of housing was associated with childhood asthma with the highest prevalence of asthma found in public housing (21.8%). Residents of all types of private housing had lower odds of asthma than children living in public housing. After adjusting for individual- and community-level demographic and economic factors, the relationship between housing type and childhood asthma persisted, with residents of private family homes having the lowest odds of current asthma when compared to residents of public housing (odds ratio: 0.51; 95% confidence interval, 0.22, 1.21). Factors associated with housing quality explain some of the clustering of asthma in public housing. For example, the majority (68.7%) of public housing residents reported the presence of cockroaches, compared to 21% of residents of private houses. Reported cockroaches, rats, and water leaks were also independently associated with current asthma. These findings suggest differential exposure and asthma risk by urban housing type. Interventions aimed at reducing these disparities should consider multiple aspects of the home environment, especially those that are not directly controlled by residents.

Asthma mitigation strategies: professional, charitable, and community coalitions

BACKGROUND

Asthma symptoms, severity, and mortality are known to be affected by personal, family, and neighborhood social factors. Many groups have become involved in asthma research, education, and activism in the past 20 years. This study explores the approaches to asthma taken by community-based organizations compared with those taken by other organizations that have a focus on asthma.

METHODS

Priorities in asthma research and intervention were assessed through interviews with representatives of urban community-based participatory research (CBPR) coalitions; interviews with staff from charities focused on asthma, allergy, or lung diseases; interviews with physicians and scientists studying and treating asthma; participation in community forums; and participant observation of urban asthma coalitions. Interviews and data analysis were conducted in 2008.

RESULTS

There are marked differences in priorities and approaches to asthma among experts in the field, organizations and coalitions at the national and local levels, and other stakeholders in asthma research and activism. CBPR coalitions are more likely than asthma-focused organizations to explore environmental and community-level structural factors that exacerbate asthma or complicate its management, while disease-focused organizations, especially physician specialty groups, place more emphasis on individual-level factors. CBPR coalitions have been particularly strong in producing the data needed to demonstrate that individual communities are affected by pollution hot spots or that local neighborhoods lack geographic access to affordable medical care, and in providing this data to improve local policy-making.

CONCLUSIONS

Because of its focus on structural rather than individual factors, CBPR has helped to broaden the debate on asthma beyond clinical care and education into social and environmental justice.

The Children's Hospital of Eastern Ontario Housing Checkup: A survey of the housing needs of children and youth

BACKGROUND

Housing is a key determinant of child and youth health. A significant number of Canadian children and youth are living in housing need, but information regarding the housing status of children and youth in the Ottawa, Ontario, community is lacking.

OBJECTIVE

To examine the housing status of children and youth accessing emergency health services at the Children's Hospital of Eastern Ontario (Ottawa, Ontario), and the factors associated with housing status.

METHODS

Youth and families of children registered at the Children's Hospital of Eastern Ontario's emergency department were offered a questionnaire. Affordability, adequacy, suitability and stability of housing were evaluated through self-reporting. Housing need was defined as an inability to meet one or more of these criteria. Associations among housing and household composition, demographics and weight-for-age percentiles were examined.

RESULTS

One thousand three hundred sixty surveys were completed. Fifty-four per cent of respondents (663 of 1224) were living in housing need, including 33% of respondents (381 of 1166) who were living in unaffordable housing. Single-parent families (OR 2.82), families with six or more members (OR 2.51) and families who rented (OR 5.27) were more likely to be living in housing need. Children and youth with a primary care physician were more likely to be living in stable housing (OR 0.41). Unsuitable housing was associated with extreme weight-forage percentiles (OR 1.90).

CONCLUSION

More than one-half of the children and youth in the present study were living in housing need. Health care providers have a responsibility to identify and understand the determinants of health of their patients, including housing, and to work for the improved health of their patients and their communities.

The relationship of housing and population health: a 30-year retrospective analysis

OBJECTIVE

We analyzed the relationship between health status and housing quality over time.

METHODS

We combined data from two nationally representative longitudinal surveys of the U.S. population and its housing, the National Health and Nutrition Examination Survey and the American Housing Survey, respectively. We identified housing and health trends from approximately 1970 to 2000, after excluding those trends for which data were missing or where we found no plausible association or change in trend.

RESULTS

Changes in housing include construction type, proportion of rental versus home ownership, age, density, size, moisture, pests, broken windows, ventilation and air conditioning, and water leaks. Changes in health measures include asthma, respiratory illness, obesity and diabetes, and lead poisoning, among others. The results suggest ecologic trends in childhood lead poisoning follow housing age, water leaks, and ventilation; asthma follows ventilation, windows, and age; overweight trends follow ventilation; blood pressure trends follow community measures; and health disparities have not changed greatly.

CONCLUSIONS

Housing trends are consistent with certain health trends over time. Future national longitudinal surveys should include health, housing, and community metrics within a single integrated design, instead of separate surveys, in order to develop reliable indicators of how housing changes affect population health and how to best target resources. Little progress has been made in reducing the health and housing disparities of disadvantaged groups, with the notable exception of childhood lead poisoning caused by exposure to lead-based paint hazards. Use of these and other data sets to create reliable integrated indicators of health and housing quality are needed.

An examination of interventions to reduce respiratory health and injury hazards in homes of low-income families

We evaluated whether combining asthma trigger reduction with housing structural repairs, device disbursement and education in low-income households with children would improve self-reported respiratory health and reduce housing-related respiratory health and injury hazards (convenience sample of n=67 homes with 63 asthmatic and 121 non-asthmatic children). At baseline, a visual assessment of the home environment and a structured occupant interview were used to examine 29 potential injury hazards and 7 potential respiratory health hazards. A home-specific intervention was designed to provide the children's parents or caretakers with the knowledge, skills, motivation, supplies, equipment, and minimum housing conditions necessary for a healthy and safe home. The enrolled households were primarily Hispanic and owned their homes. On average, 8 injury hazards were observed in the homes at baseline. Four months following intervention, the average declined to 2.2 hazards per home (p<0.001), with 97% of the parents reporting that their homes were safer following the interventions. An average of 3.3 respiratory health hazards were observed in the homes at baseline. Four months following intervention, the average declined to 0.9 hazards per home (p<0.001), with 96% of parents reporting that the respiratory health of their asthmatic children improved. A tailored healthy homes improvement package significantly improves self-reported respiratory health and safety, reduces respiratory health and injury hazards, and can be implemented in concert with a mobile clinical setting.

Housing and health: intersection of poverty and environmental exposures

The importance of adequate housing for the maintenance of health and well-being has long been a topic of scientific and public health policy discussion, but the links remain elusive. Here we explore the role of the residential environment in the etiology of illness (specifically asthma) and the persistence of socioeconomic health disparities. Housing conditions, shaped by social forces, affect exposure to physical and chemical "toxicants," thereby translating social adversities into individual illness and population health disparities. We discuss the mediating role of housing in determining health outcomes at multiple levels (social-structural, neighborhood, and individual family). To date, little attention has been paid by most environmental health scientists to the social-structural conditions underlying gross inequities in the distribution of toxic exposures, with even less attention to the processes whereby these social conditions may directly affect susceptibility to the toxic exposures themselves. This chapter goes beyond traditional medical and environmental science models to incorporate a range of social and physical determinants of environmental pollutions, illustrating how these conditions result in health and illness. We focus here on childhood asthma as an example of a serious public health problem that has been associated with low income, minority status, and characteristics of the home environment. We end the chapter with a discussion of the environmental justice movement and the role of housing as a potential agent of change and focus of interventions aimed to reduce the harmful effects of environmental pollutants.

Cities of consumption: the impact of corporate practices on the health of urban populations

The increasing concentration of the world's population in cities and the growing accumulation of political and economic power by corporations create new threats to health and opportunities for improving global health. By considering the intersection of these two fundamental social determinants of well-being, we elucidate some of the mechanisms by which they influence the health of urban populations. After reviewing the changing historical impact of corporations on cities, we focus on the growth of consumption as a leading cause of mortality and morbidity and describe how the food, tobacco, automobile, and other industries promote unhealthy behaviors and lifestyles in urban settings. Cities are also sites for developing alternatives to unhealthy corporate practices, and we assess strategies used to modify practices that harm health.

Linking public health, housing, and indoor environmental policy: successes and challenges at local and federal agencies in the United States

We describe the successes and challenges faced by federal and local government agencies in the United States as they have attempted in recent years to connect public and environmental health, housing, community development, and building design with environmental, housing, and building laws, codes, and policies. These policies can either contribute to or adversely affect human physical and mental health, with important implications for economic viability, research, policy development, and overall social stability and progress. Policy impediments include tension between housing affordability and health investment that causes inefficient cost-shifting, privacy issues, unclear statutory authority, and resulting gaps in responsibility for housing, indoor air, and the built environment. We contrast this with other environmental frameworks such as ambient air and water quality statutes where the concept of "shared commons" and the "polluter pays" is more robust. The U.S. experiences in childhood lead poisoning prevention, indoor air, and mold provide useful policy insights. Local programs can effectively build healthy homes capacity through local laws and housing codes. The experience of coordinating remediation for mold, asthma triggers, weatherization, and other healthy housing improvements in Cuyahoga County, Ohio, is highlighted. The U.S. experience shows that policymakers should adopt a prevention-oriented, comprehensive multi-disciplinary approach at all levels of government to prevent unhealthy buildings, houses, and communities.

Validation of a 20-year forecast of US childhood lead poisoning: Updated prospects for 2010

We forecast childhood lead poisoning and residential lead paint hazard prevalence for 1990-2010, based on a previously unvalidated model that combines national blood lead data with three different housing data sets. The housing data sets, which describe trends in housing demolition, rehabilitation, window replacement, and lead paint, are the American Housing Survey, the Residential Energy Consumption Survey, and the National Lead Paint Survey. Blood lead data are principally from the National Health and Nutrition Examination Survey. New data now make it possible to validate the midpoint of the forecast time period. For the year 2000, the model predicted 23.3 million pre-1960 housing units with lead paint hazards, compared to an empirical HUD estimate of 20.6 million units. Further, the model predicted 498,000 children with elevated blood lead levels (EBL) in 2000, compared to a CDC empirical estimate of 434,000. The model predictions were well within 95% confidence intervals of empirical estimates for both residential lead paint hazard and blood lead outcome measures. The model shows that window replacement explains a large part of the dramatic reduction in lead poisoning that occurred from 1990 to 2000. Here, the construction of the model is described and updated through 2010 using new data. Further declines in childhood lead poisoning are achievable, but the goal of eliminating children's blood lead levels > or =10 microg/dL by 2010 is unlikely to be achieved without additional action. A window replacement policy will yield multiple benefits of lead poisoning prevention, increased home energy efficiency, decreased power plant emissions, improved housing affordability, and other previously unrecognized benefits. Finally, combining housing and health data could be applied to forecasting other housing-related diseases and injuries.

A qualitative review of housing hazard assessment protocols in the United States

While the general link between substandard housing and poor health has received increased attention recently, there are currently no widely accepted standardized protocols to assess and remediate multiple housing-related health hazards. This paper compares several protocols that assess housing health hazards, including the Hazard Assessment and Reduction Program, the American Healthy Homes Survey, the Public Housing Assessment System, the Housing Quality Standards, the American Housing Survey, the Community Environmental Health Resource Center protocol, and the National Energy Audit Tool. The comparison shows considerable variability across the protocols, particularly in the collection of environmental samples or measurements. This may be due in part to differing end uses, as well as the fact that the intersection of housing and health issues is not clearly in the domain of either profession. Housing professionals typically focus on durability and affordability, while environmental health professionals are frequently focused on specific disease or injury vectors, not on place-based interventions. Validation studies at both the national and the international level are needed to determine how well both the hazard assessment and the resulting interventions predict health outcome. Standardizing and validating such protocols can help move beyond the existing limited categorical approaches and will help improve both substandard housing quality and public health.

Thinking inside the bubble: evidence for a new contextual unit in urban mental health

OBJECTIVE

Previous quantitative research has suggested that there is a link between housing, the urban environment, and mental health. However, methodological and design issues make it difficult to disentangle the relative influence of dwelling specific and wider urban environmental influences on individual mental health. The aim of this study was to explore the link between the dwelling, the immediate urban environment, and mental health to generate a new conceptual framework by which understanding of dwelling and urban environmental influences on mental health can be advanced.

DESIGN AND PARTICIPANTS

Qualitative interviews and focus groups were conducted with 32 inner city residents. Participants, stratified by sex and mental health status, were randomly recruited from a wider quantitative survey. An almost equal number of men and women as well as people with or without mental health problems participated, allowing for comparison of experience. Data were analysed inductively to generate an appropriate theoretical framework regarding dwelling and urban environmental influences on mental health.

SETTING

An inner city neighbourhood of about 6200 people in north west London. Most of that population live in public housing.

MAIN RESULTS

The principal study finding is that between the dwelling unit and the neighbourhood unit, evidence was found for another meaningful contextual unit of analysis, the "residential bubble" through which effects on mental health can be mediated. The residential bubble describes a limited area of three dimensional space that surrounds a dwelling, encompassing immediate neighbours (above, below, and adjacent) and shared public space bordering the dwelling. Positive events and processes within the bubble had a beneficial influence on mental health whereas negative ones tended to have a damaging influence. These seemed to disproportionately have an impact on people with pre-existing mental health problems.

CONCLUSION

The concept of the "residential bubble" may be a meaningful new contextual unit of analysis in urban mental health. This may have important implications with regards to interventions and measurement development.

A multihazard, multistrategy approach to home remediation: results of a pilot study

Many residential hazards are disproportionately concentrated in older, urban dwellings and share common underlying causes, such as uncorrected moisture problems and inadequate maintenance and cleaning. Comprehensive and affordable approaches to remediation are needed, but the feasibility and efficacy of such approaches has not been well documented. To address this gap, a multihazard, multimethod intervention, addressing deteriorated lead-based paint and lead dust, vermin, mold, and safety hazards was pilot-tested in a sample of 70 pre-1940 dwellings. Dwellings received paint stabilization, dust lead cleaning, integrated pest management (IPM), mold cleaning, and safety devices, as needed. The median remediation cost for labor and materials was 864.66 dollars (range: 120.00-5235.33 dollars) per dwelling. Environmental conditions were evaluated prior to, immediately following, and an average of 5 months after remediation. Between the baseline and 5-month follow-up periods, significant reductions were achieved in the number of dwellings with multiple (i.e., three or four) problems (75% vs. 23%, P<0.0001); high levels of dust lead on floors and window sills (67% and 46% declines, P<0.01); evidence of cockroaches or rodents (43% and 36% declines, P<0.01); and fire, electrical and/or fall hazards (between 67% and 88% declines, P<0.01). Significant reductions were also observed in the geometric mean (GM) dust lead levels on floors and window sills (13.3 vs. 5.0 microg/ft2 and 210.6 vs. 81.0 microg/ft2, respectively, P<0.0001) and Blatella germanica (Blag1) levels among dwellings with elevated baseline levels (7.7 vs. 0.09 U/g, P<0.0001). Reductions in mold dust levels were of borderline statistical significance (50% decline, P=0.07). The greatest declines in dust lead and Blag1 levels occurred in dwellings having the highest baseline levels and, for Blag1, in dwellings in which occupants attended training sessions. These results indicate that a comprehensive approach to hazard remediation can be highly effective and cost efficient and that overall improvements can be maintained. Further research is needed to clarify the most effective sampling strategies, educational and behavioral interventions, and optimal intervention frequency.

Prevalence and predictors of residential health hazards: a pilot study

This article reports the results of a pilot study designed to ascertain the prevalence of lead-based paint (LBP), vermin, mold, and safety conditions and hazards and to validate observations and self-reports against environmental sampling data. Data are based on a convenience sample of 70 dwellings in a low-income, urban neighborhood in Brooklyn, New York. The vast majority of residences (96%) contained multiple conditions and/or hazards: LBP hazards (80%), vermin (79%), elevated levels of airborne mold (39%), and safety hazards (100%). Observations and occupant reports were associated with environmental sampling data. In general, the more proximate an observed condition was to an actual hazard, the more likely it was to be associated with environmental sampling results (e.g., peeling LBP was associated with windowsill dust lead levels, and cockroach sightings by tenants were associated with Blatella germanica [Bla g 1] levels). Conversely, the more distal an observed condition was to an actual hazard, the less likely it was to be associated with environmental sampling results (e.g., water damage, alone, was not statistically associated with elevated levels of dust lead, Bla g 1, or airborne mold). Based on the findings from this pilot study, there is a need for industrial hygienists and others to adopt more comprehensive and integrative approaches to residential hazard assessment and remediation. Further research--using larger, randomly drawn samples, representing a range of housing types and geographical areas--is needed to clarify the relationship between readily observable conditions, occupant reports, and environmental sampling data and to assess the cumulative impact on human health.

The relationship between housing and health: children at risk

In November 2002, the National Center for Healthy Housing convened a 2-day workshop to review the state of knowledge in the field of healthy housing. The workshop, supported with funds from the U.S. Centers for Disease Control and Prevention's National Center for Injury Prevention and Control and National Center for Environmental Health, was unique in that it focused solely on the effect of housing on children's health and the translation of research findings into practical activities in home construction, rehabilitation, and maintenance. Participants included experts and practitioners representing the health, housing, and environmental arenas. Presentations by subject-matter experts covered four key areas: asthma, neurotoxicants, injury, and translational research. Panel discussions followed the presentations, which generated robust dialogue on potential future research opportunities and overall policy gaps. Lack of consensus on standard measurements, incomplete understanding about the interaction of home hazards, inadequate research on the effectiveness of interventions, and insufficient political support limit current efforts to achieve healthy housing. However, change is forthcoming and achievable. Key words: asthma, childhood exposure, environmental toxicants, healthy housing, lead poisoning.

The environment of childhood poverty

Poor children confront widespread environmental inequities. Compared with their economically advantaged counterparts, they are exposed to more family turmoil, violence, separation from their families, instability, and chaotic households. Poor children experience less social support, and their parents are less responsive and more authoritarian. Low-income children are read to relatively infrequently, watch more TV, and have less access to books and computers. Low-income parents are less involved in their children's school activities. The air and water poor children consume are more polluted. Their homes are more crowded, noisier, and of lower quality. Low-income neighborhoods are more dangerous, offer poorer municipal services, and suffer greater physical deterioration. Predominantly low-income schools and day care are inferior. The accumulation of multiple environmental risks rather than singular risk exposure may be an especially pathogenic aspect of childhood poverty.

The built environment and mental health

The built environment has direct and indirect effects on mental health. High-rise housing is inimical to the psychological well-being of women with young children. Poor-quality housing appears to increase psychological distress, but methodological issues make it difficult to draw clear conclusions. Mental health of psychiatric patients has been linked to design elements that affect their ability to regulate social interaction (e.g., furniture configuration, privacy). Alzheimer's patients adjust better to small-scale, homier facilities that also have lower levels of stimulation. They are also better adjusted in buildings that accommodate physical wandering. Residential crowding (number of people per room) and loud exterior noise sources (e.g., airports) elevate psychological distress but do not produce serious mental illness. Malodorous air pollutants heighten negative affect, and some toxins (e.g., lead, solvents) cause behavioral disturbances (e.g., self-regulatory ability, aggression). Insufficient daylight is reliably associated with increased depressive symptoms. Indirectly, the physical environment may influence mental health by altering psychosocial processes with known mental health sequelae. Personal control, socially supportive relationships, and restoration from stress and fatigue are all affected by properties of the built environment. More prospective, longitudinal studies and, where feasible, randomized experiments are needed to examine the potential role of the physical environment in mental health. Even more challenging is the task of developing underlying models of how the built environment can affect mental health. It is also likely that some individuals may be more vulnerable to mental health impacts of the built environment. Because exposure to poor environmental conditions is not randomly distributed and tends to concentrate among the poor and ethnic minorities, we also need to focus more attention on the health implications of multiple environmental risk exposure.

Health care for homeless women

OBJECTIVE

Homelessness is a significant and growing problem in the United States. Women and families are the fastest growing segments of the homeless population. Homelessness increases the risk of having health problems and encountering barriers to care. This study determines how much perceived unmet need for medical care there is among homeless women, what homeless women perceive to be barriers to health care, and how barriers and other factors are associated with unmet needs.

DESIGN

Cross-sectional study of homeless women, utilizing structured interviews.

SETTING AND PARTICIPANTS

Community-based probability sample of 974 homeless women aged 15 to 44 years.

MAIN OUTCOME MEASURES

Perceived unmet need for medical care in the past 60 days. Relationship between unmet need and demographic variables, place of stay, source of health care, insurance, and perceived barriers to care.

RESULTS

Of the 974 women, 37% reported unmet need for medical care. Controlling for other factors, the odds of unmet need were lower among those with a regular source of care (odds ratio [OR] to.35, 95% confidence interval [CI],.21 to 58), while having health insurance was not significantly associated. The odds of unmet need were higher among those who experienced the barriers: not knowing where to go (OR 2.27, 95% CI, 1.40 to 3.69), long office waiting times (OR 1.89, 95% CI 1.27 to 2.83) and being too sick to seek care (OR 2.03, 95% CI, 1.14 to 3.62).

CONCLUSIONS

There is significant unmet need for medical care among homeless women. Having a regular source of care was more important than health insurance in lowering the odds of unmet need. Homeless women must be educated regarding sources of care, and clinics serving the homeless must decrease waiting times.

Ascorbic Acid Supplementation Does Not Improve Efficacy of meso -Dimercaptosuccinic Acid Treatment in Lead-Exposed Suckling Rats

It was suggested that ascorbic acid as a natural chelating agent can influence lead toxicokinetics and improve chelating properties of dimercaptosuccinic acid (DMSA) in adult rats. In this paper potential benefits of ascorbic acid supplementation, alone or combined with DMSA, in decreasing lead retention in suckling rats were evaluated. Such data in young mammals are not available. L-Ascorbic acid (daily dose 650 mg/kg b.wt.) and/or DMSA (daily dose 91 mg/kg b.wt.) were administered orally to suckling Wistar rats either during ongoing 8-day oral lead exposure (as acetate; daily dose 2 mg lead/kg b.wt.) or after 3-day lead exposure (total dose 12 mg lead/kg b.wt.). Lead concentrations were analysed in the carcass (skeleton), liver, kidneys and brain by atomic absorption spectrometry. By ascorbic acid supplementation lead retention was not reduced under either lead exposure condition. Lead concentration was even increased in the carcass. Treatment with DMSA under both exposure conditions significantly reduced lead in all analysed tissues. Combined treatment with ascorbic acid and DMSA during ongoing lead exposure was substantially less effective than DMSA treatment alone, and did not affect DMSA efficacy when administered after lead exposure. It was concluded that ascorbic acid administered either during or after lead exposure in suckling rats has no beneficial effect on either lead retention or DMSA chelation effectiveness.

The impact of community design and land-use choices on public health: a scientific research agenda

The design of a community's built environment influences the physical and mental health of its residents. Because few studies have investigated this relationship, the Centers for Disease Control and Prevention hosted a workshop in May 2002 to help develop a scientific research agenda on these issues. Workshop participants' areas of expertise included physical activity, injury prevention, air pollution, water quality, urban planning, transportation, architecture, epidemiology, land use, mental health, social capital, housing, and social marketing. This report describes the 37 questions in the resulting research agenda. The next steps are to define priorities and obtain resources. The proposed research will help identify the best practices for designing new communities and revitalizing old ones in ways that promote physical and mental health.

Healthy housing: a structured review of published evaluations of US interventions to improve health by modifying housing in the United States, 1990-2001

We sought to characterize and to evaluate the success of current public health interventions related to housing. Two reviewers content-analyzed 72 articles selected from 12 electronic databases of US interventions from 1990 to 2001. Ninety-two percent of the interventions addressed a single condition, most often lead poisoning, injury, or asthma. Fifty-seven percent targeted children, and 13% targeted seniors. The most common intervention strategies employed a one-time treatment to improve the environment; to change behavior, attitudes, or knowledge; or both. Most studies reported statistically significant improvements, but few (14%) were judged extremely successful. Current interventions are limited by narrow definitions of housing and health, by brief time spans, and by limited geographic and social scales. An ecological paradigm is recommended as a guide to more effective approaches.