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Lorentzen JC, Johanson G, Björk F, Stensson S. Overcrowding and Hazardous Dwelling Condition Characteristics: A Systematic Search and Scoping Review of Relevance for Health. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15542. [PMID: 36497612 PMCID: PMC9736286 DOI: 10.3390/ijerph192315542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Revised: 11/10/2022] [Accepted: 11/15/2022] [Indexed: 06/17/2023]
Abstract
Crowding in dwellings is an important public health issue. We hypothesize that overcrowding may cause indirect health effects by adversely affecting the dwelling itself, for example, by increasing dampness leading to mold. We therefore performed a systematic search and a scoping review on overcrowding leading to dwelling condition characteristics of relevance for health. A literature search was performed using the PubMed and Scopus databases up to 5 March 2021. The search yielded 100 records with relevant information. We found that overcrowding is defined in numerous ways and often address "socially deprived" populations. Six studies report associations of overcrowding with at least one dwelling condition characteristic, namely lead, cadmium, microorganism distribution, dust mite and cockroach allergens in dust, cockroach infestation, peeling paint, and mold. One of the studies reports associations between several characteristics, e.g., association of mold with cleanliness and rodent infestation, and points out the common use of pesticides. Additional characteristics were extracted from the remaining 94 records, without data on statistical associations with overcrowding. Our review suggests that multiple potentially hazardous dwelling condition characteristics often coincide in overcrowded dwellings. The epidemiological attribution of health effects to any characteristic is therefore difficult. Causal relationships are even more difficult to establish, as overcrowding is also associated with a range of social and other circumstances that may affect health. The complexity should be considered by scientists and practitioners dealing with overcrowding in dwellings.
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Affiliation(s)
- Johnny C. Lorentzen
- Institute of Environmental Medicine, Integrative Toxicology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Region Stockholm, SE-113 65 Stockholm, Sweden
| | - Gunnar Johanson
- Institute of Environmental Medicine, Integrative Toxicology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Folke Björk
- KTH Royal Institute of Technology, SE-100 44 Stockholm, Sweden
| | - Sofia Stensson
- RISE Research Institutes of Sweden, SE-501 15 Borås, Sweden
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Esser K, Moore C, Hounsell KG, Davis A, Sunderji A, Shulman R, Maguire B, Cohen E, Orkin J. Housing Need Among Children With Medical Complexity: A Cross-Sectional Descriptive Study of Three Populations. Acad Pediatr 2022; 22:900-909. [PMID: 34607051 DOI: 10.1016/j.acap.2021.09.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 09/20/2021] [Accepted: 09/26/2021] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Children with medical complexity (CMC) are hypothesized to have unique housing and accessibility needs due to their medical fragility and medical technology dependency; however, research on prevalence and types of housing need in CMC is limited. The objective was to describe housing need in families of CMC, and to compare housing need across CMC, children with one chronic condition (Type 1 diabetes; CT1D) and healthy children (HC). METHODS This cross-sectional descriptive study assessed housing suitability, adequacy, affordability, stress, stability, and accessibility using survey methodology. Participants were caregivers of CMC, CT1D and HC at a tertiary-care pediatric hospital. The association of housing need outcomes across groups was analyzed using logistic and ordinal logistic regression models, adjusting for income, educational attainment, employment status, community type, immigration status, child age, and number of people in household. RESULTS Four hundred ninety caregivers participated. Caregivers of CMC reported increased risk of housing-related safety concerns (aOR 3.1 [1.3-7.5]), using a common area as a sleeping area (5.6 [2.0-16.8]), reducing spending (4.6 [2.3-9.5]) or borrowing money to afford rent (2.9 [1.2-6.7]), experiencing housing stress (3.3 [1.8-6.0]), and moving or considering moving to access health/community services (15.0 [6.4-37.6]) compared to HC. CONCLUSIONS CMC were more likely to experience multiple indicators of housing need compared to CT1D and HC even after adjusting for sociodemographic factors, suggesting an association between complexity of child health conditions and housing need. Further research and practise should consider screening for and supporting housing need in CMC.
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Affiliation(s)
- Kayla Esser
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada
| | - Clara Moore
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada
| | - Kara Grace Hounsell
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada
| | - Adrienne Davis
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children (A Davis and A Sunderji), Toronto, Canada
| | - Alia Sunderji
- Division of Paediatric Emergency Medicine, The Hospital for Sick Children (A Davis and A Sunderji), Toronto, Canada
| | - Rayzel Shulman
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada; Division of Endocrinology, The Hospital for Sick Children (R Shulman), Toronto, Canada; Department of Paediatrics, University of Toronto (R Shulman), Toronto, Canada
| | - Bryan Maguire
- Biostatistics, Design and Analysis, Research Institute, The Hospital for Sick Children (B Maguire), Toronto, Canada
| | - Eyal Cohen
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada; Department of Paediatrics, University of Toronto (R Shulman), Toronto, Canada; Division of Paediatric Medicine, The Hospital for Sick Children (E Cohen and J Orkin), Toronto, Canada; Edwin S.H. Leong Centre for Healthy Children, University of Toronto (E Cohen), Toronto, Canada
| | - Julia Orkin
- Child Health Evaluative Sciences, The Hospital for Sick Children (K Esser, C Moore, KG Hounsell, R Shulman, E Cohen, and J Orkin), Toronto, Canada; Department of Paediatrics, University of Toronto (R Shulman), Toronto, Canada; Division of Paediatric Medicine, The Hospital for Sick Children (E Cohen and J Orkin), Toronto, Canada.
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Hounsell KG, Moore C, Zahavi A, Arje D, Weiser N, Esser K, Netten K, Soscia J, Cohen E, Orkin J. The Experience of Housing Needs Among Families Caring for Children With Medical Complexity. Pediatrics 2021; 148:peds.2020-018937. [PMID: 34158316 DOI: 10.1542/peds.2020-018937] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Caregivers of children with medical complexity (CMC) face many stressors related to their child's medical condition(s). Financial stress and its impact on housing has been reported to be a challenge among this population. However, unique housing challenges specific to CMC, including disability accommodations in the home and housing space and layout, have yet to be examined in the literature. METHODS We conducted 20 individual semistructured interviews with parents of CMC. Interviews were recorded, coded, and analyzed by using thematic analysis to emphasize, examine, and record patterns of meaning within the data. RESULTS Eighteen mothers and 2 fathers participated in individual interviews. Two major themes and subthemes (in parentheses) were identified: (1) the impact of health on housing (housing preferences, housing possibilities, and housing outcome as a trade-off) and (2) the impact of housing on health (health of the caregiver and health of the child). Parents had preferences regarding the location and layout of their home specific to their child's illness and medical needs. In addition, parents indicated their child's illness affected their income and home ownership status, which in turn shaped their housing possibilities. The location and layout of the family home was often the result of a trade-off between the caregiver's housing preferences and possibilities. CONCLUSIONS Housing outcomes among CMC are often the result of a trade-off between housing preferences and possibilities, both of which are influenced by the child's health status. Policy changes targeting housing accessibility and affordability are vital to support the health of CMC.
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Affiliation(s)
| | - Clara Moore
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | | | - Danielle Arje
- Departments of Pediatrics.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Natalie Weiser
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Kayla Esser
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Kathy Netten
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program
| | - Joanna Soscia
- Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program
| | - Eyal Cohen
- Departments of Pediatrics.,Edwin S.H. Leong Centre for Healthy Children, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.,Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
| | - Julia Orkin
- Departments of Pediatrics .,Division of Pediatric Medicine, Department of Pediatrics, Complex Care Program.,Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, Toronto, Canada
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Suleman S, Ratnani Y, Stockley K, Jetty R, Smart K, Bennett S, Gander S, Loock C. Supporting children and youth during the COVID-19 pandemic and beyond: A rights-centred approach. Paediatr Child Health 2020; 25:333-336. [PMID: 32959001 PMCID: PMC7454866 DOI: 10.1093/pch/pxaa086] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 06/30/2020] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic is an unprecedented global crisis, affecting millions globally and in Canada. While efforts to limit the spread of the infection and ‘flatten the curve’ may buffer children and youth from acute illness, these public health measures may worsen existing inequities for those living on the margins of society. In this commentary, we highlight current and potential long-term impacts of COVID-19 on children and youth centring on the UN Convention of the Rights of the Child (UNCRC), with special attention to the accumulated toxic stress for those in difficult social circumstances. By taking responsive action, providers can promote optimal child and youth health and well-being, now and in the future, through adopting social history screening, flexible care models, a child/youth-centred approach to “essential” services, and continual advocacy for the rights of children and youth.
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Affiliation(s)
- Shazeen Suleman
- Women's and Children's Health Program, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario.,Department of Pediatrics, University of Toronto, Toronto, Ontario.,Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario
| | - Yasmine Ratnani
- Department of Pediatrics, Faculty of Medicine, University of Montreal, Montreal, Quebec.,Department of Pediatrics, CCSMTL, Montreal, Quebec
| | - Katrina Stockley
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia
| | - Radha Jetty
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Katharine Smart
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, Whitehorse General Hospital, Whitehorse, Yukon
| | - Susan Bennett
- Department of Pediatrics, Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Ontario
| | - Sarah Gander
- Department of Pediatrics, Memorial University, St. John's, Newfoundland and Labrador.,Department of Pediatrics, Dalhousie University, Halifax, Nova Scotia
| | - Christine Loock
- Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, British Columbia.,Department of Pediatrics, BC Children's Hospital, University of British Columbia, Vancouver, British Columbia
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Williams RC, Biscaro A, Clinton J. Relationships matter: How clinicians can support positive parenting in the early years. Paediatr Child Health 2019; 24:340-357. [PMID: 31379438 DOI: 10.1093/pch/pxz063] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2018] [Accepted: 02/08/2019] [Indexed: 11/14/2022] Open
Abstract
A secure attachment relationship with at least one healthy adult is essential for a child to develop optimal coping abilities. Primary care providers like paediatricians and family physicians can help by supporting parents in practice settings. Every clinician encounter is an opportunity to ask parents about children's relationships and their behaviour, daily routines, and overall family function. This statement, which focuses on children aged 0 to 6 years, describes basic principles in support of positive parenting and recommends in-office practices to promote secure parent-child relationships, engage families and build trust with parents. Crying, sleep, and difficult behaviours are described as opportunities for clinicians to provide anticipatory, responsive guidance to parents.
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Affiliation(s)
- Robin C Williams
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario
| | - Anne Biscaro
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario
| | - Jean Clinton
- Canadian Paediatric Society, Early Years Task Force, Ottawa, Ontario
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Vold L, Lynch M, Martin W. A Review of Housing and Food Intersections: Implications for Nurses and Nursing Research. Can J Nurs Res 2019; 51:221-232. [PMID: 30803267 DOI: 10.1177/0844562119831891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Study Background Quality, accessibility, and affordability of housing and food are public health and nursing concerns. Yet, intersections between housing and food security are relatively understudied. Purpose The purpose of this article is to examine the evidence describing the relationship between food security and housing interventions, and second, describing specific opportunities for targeted strategies for nursing practice and research. Methods Arksey and O’Malley’s scoping review method was followed to search housing and food security research. A database search identified 46 studies that were mapped onto a social ecological theory to understand the micro, meso, exo, and macro interventions. Results Three major recommendations were identified. Micro-system recommendations include primary care screening for low-income groups. Meso- and exo-system recommendations focus on creating partnerships in research and enhancing social housing. Lastly, macro-system recommendations focus on challenging housing affordability standards. The major gap in the literature is addressing healthy housing. Conclusion Broadening housing interventions to include comprehensive approaches to meeting individuals’ needs offers more than simply packaging two interventions together. There is a significant moment in nursing in which nurses are witness to a paradigmatic shift in the ways to approach housing and food security.
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Affiliation(s)
- Lindsey Vold
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
| | - Meghan Lynch
- Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Wanda Martin
- College of Nursing, University of Saskatchewan, Saskatoon, Canada
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Phipps E, Masuda JR. Towards equity-focused intersectoral practice (EquIP) in children's environmental health and housing: the transformational story of RentSafe. Canadian Journal of Public Health 2018; 109:379-385. [PMID: 29981107 PMCID: PMC6153698 DOI: 10.17269/s41997-018-0094-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 05/28/2018] [Indexed: 11/18/2022]
Abstract
Setting This paper chronicles the transformational process through which a national intersectoral collaboration, the Canadian Partnership for Children’s Health and Environment (CPCHE), came to embrace a more upstream, equity-based focus in its mandate to advance children’s environmental health. Intervention After 15 years of working within a conventional, evidence-informed approach to health promotion and policy advocacy, in 2010–2013, CPCHE had the opportunity to collaborate on the development of equity-focused knowledge translation (EqKT). EqKT is a relational approach to knowledge practices that challenges intersectoral actors to work to uncover biases and limitations within their own institutional paradigms and professional practices that constrain their capacity to address population health inequities. Outcome The ensuing transformation towards equity-focused intersectoral practice led CPCHE to create an intersectoral initiative called RentSafe. Conceptually and operationally, RentSafe provides an intersectoral space within which the grounded expertise of people with experience of unhealthy and undignified housing provides a roadmap for public health and other practitioners to critically explore professional and institutional blind spots and barriers. With RentSafe as its watershed moment, CPCHE is shifting from a top-down “for whom” orientation to an authentically engaged “with whom” approach that seeks to work integrally with community partners to expose and challenge systemic roots of health inequity. Implications The transformational story of CPCHE underscores the competencies needed for public health professionals to acknowledge the sources of our own biases and limitations as a necessary first step in equity-focused intersectoral practice (EquIP). It also affirms the value of working in partnership with those who experience the environmental health inequities that such efforts seek to address.
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Affiliation(s)
- Erica Phipps
- Canadian Partnership for Children's Health and Environment (CPCHE), Toronto, ON, Canada. .,School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada. .,Centre for Environmental Health Equity (CEHE), Kingston, Canada.
| | - Jeffrey R Masuda
- School of Kinesiology and Health Studies, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada.,Centre for Environmental Health Equity (CEHE), Kingston, Canada.,Department of Geography, Queen's University, 28 Division Street, Kingston, ON, K7L 3N6, Canada
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Bachelder AE, Stewart MK, Felix HC, Sealy N. Health Complaints Associated with Poor Rental Housing Conditions in Arkansas: The Only State without a Landlord's Implied Warranty of Habitability. Front Public Health 2016; 4:263. [PMID: 27933288 PMCID: PMC5120100 DOI: 10.3389/fpubh.2016.00263] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 11/09/2016] [Indexed: 11/30/2022] Open
Abstract
Arkansas is the only U.S. state that does not have a landlord's implied warranty of habitability, meaning tenants have a requirement for maintaining their rental properties at certain habitability standards, but landlords are not legally required to contribute to those minimum health and safety standards. This project assessed the possibility that this lack of landlord responsibility affects tenants' perceived health. Using surveys and interviews, we collected self-reported data on the prevalence and description of problems faced by renters who needed household repairs from their landlords. Of almost 1,000 renters, one-third of them had experienced a problem with their landlord making needed repairs; and one-quarter of those had a health issue they attributed to their housing conditions. Common issues included problems with plumbing, heating, or cooling systems, and pest or rodent control. Reported health problems included elevated stress levels, breathing problems, headaches, high blood pressure, and bites or infections. Hispanic respondents and those with less than a high school education were both significantly more likely to report problems with their landlords not making repairs as requested. These data suggest that the lack of landlord requirements may negatively impact the condition of rental properties and, therefore, may negatively impact the health of Arkansas renters.
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Affiliation(s)
- Ashley E. Bachelder
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - M. Kate Stewart
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - Holly C. Felix
- University of Arkansas for Medical Sciences Fay W. Boozman College of Public Health, Little Rock, AR, USA
| | - Neil Sealy
- Arkansas Community Institute, Little Rock, AR, USA
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Greig AA, Constantin E, LeBlanc CMA, Riverin B, Li PTS, Cummings C. An update to the Greig Health Record: Executive summary. Paediatr Child Health 2016; 21:265-72. [PMID: 27441024 PMCID: PMC4933060 DOI: 10.1093/pch/21.5.265] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
The Greig Health Record is an evidence-based health promotion guide for clinicians caring for children and adolescents 6 to 17 years of age. It provides a template for periodic health visits that is easy to use and adaptable for electronic medical records. On the record, the strength of recommendations is indicated in boldface for good, in italics for fair, and in regular typeface for recommendations based on consensus or inconclusive evidence. Checklist templates include sections for Weight, Height and BMI, Psychosocial history and Development, Nutrition, Education and Advice, Specific Concerns, Examination, Assessment, Immunization, and Medications. Included with the checklist tables are five pages of selected guidelines and resources. This update includes information from recent guidelines and research in preventive care for children and adolescents 6 to 17 years of age. Regular updates are planned. The complete Greig Health Record can be found online at the Canadian Paediatric Society's website: www.cps.ca.
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