Neighborhood-Level Burden of Social Risk Factors on Respiratory Syncytial Virus Hospitalization in Ontario, Canada, 2016-2019.

Background: Beyond clinical risk factors, little is known about the impact of social determinants on respiratory syncytial virus (RSV) burden. Our study aimed to estimate RSV-related hospitalization rates across sociodemographic and housing characteristics. Methods: We conducted a population-based study of all RSV-related hospitalizations in Ontario, Canada, between September 1, 2016, and August 31, 2019, using validated hospital discharge codes and census data. Crude and age-standardized annualized RSV incidence rates and rate ratios (RRs) were estimated for a range of individual-level demographics and neighborhood-level measures of marginalization and housing characteristics. Results: Overall, the annual RSV-related hospitalization rate was 27 per 100 000, with the highest rates observed in children age <12 months (1049 per 100 000) and 12-23 months (294 per 100 000) and adults age ≥85 years (155 per 100 000). Higher RSV-related hospitalization rates were associated with increasing marginalization quintile (Q) of material resources (RR, 1.4; Q5: 33 per 100 000 vs Q1: 24 per 100 000) and household instability (RR, 1.5; Q5: 31 per 100 000 vs Q1: 22 per 100 000). Conclusions: The burden of RSV-related hospitalization was greatest in young children and older adults, with variation by sociodemographic and housing factors. Understanding the role of these social factors is crucial for informing equitable preventive program delivery.

Household and housing determinants of sleep duration during the COVID-19 pandemic: Results from the COHESION Study.

BACKGROUND: Public health measures in response to the COVID-19 pandemic forced individuals to spend more time at home. We sought to investigate the relationship between housing characteristics and sleep duration in the context of COVID-19. METHODS: Our exploratory study was part of the COvid-19: Health and Social Inequities across Neighborhoods (COHESION) Study Phase-1, a pan-Canadian population-based cohort involving nearly 1300 participants, launched in May 2020. Sociodemographic, household and housing characteristics (dwelling type, dissatisfaction, access to outdoor space, family composition, etc.), and self-reported sleep were prospectively collected through COHESION Study follow-ups. We explored the associations between housing and household characteristics and sleep duration using linear regressions, as well as testing for effect modification by income satisfaction and gender. RESULTS: Our study sample involved 624 COHESION Study participants aged 50 ± 16years (mean±SD), mainly women (78%), White (86%), and university graduates (64%). The average sleep duration was 7.8 (1.4) hours. Sleep duration was shorter according to the number of children in the household, income dissatisfaction, and type of dwelling in multivariable models. Sleep was short in those without access to a private outdoor space, or only having a balcony/terrace. In stratified analyses, sleep duration was associated with housing conditions dissatisfaction only in those dissatisfied with their income. CONCLUSION: Our exploratory study highlights the relationship between housing quality and access to outdoor space, family composition and sleep duration in the context of COVID-19. Our findings also highlight the importance of housing characteristics as sources of observed differences in sleep duration.

The Relationship Between Physical Housing Characteristics, Housing Accessibility and Different Aspects of Health Among Community-Dwelling Older People: A Systematic Review.

Objectives: To synthesize the evidence on the relationships between physical housing characteristics or housing accessibility and different aspects of health among community-dwelling people 60 years and older. Methods: A systematic review of recent evidence with a narrative synthesis was conducted. Results: We included 15 studies and found three themes covering physical housing characteristics or housing accessibility that are associated with aspects of health among community-dwelling older adults: (1) interventions by home modifications targeting housing features both at entrances and indoors; (2) non-interventions targeting indoor features; (3) non-interventions targeting entrance features, that is, the presence of an elevator or stairs at the entrance. The overall quality of evidence across studies was assessed as very low. Discussion: The findings highlight the need for studies with a stronger research design and higher methodological quality that address the physical housing environment in relation to health among older adults to strengthen the body of evidence.

The Impacts of Housing Characteristics and Built-Environment Features on Mental Health.

In this study, we examined the relationships between housing characteristics, neighborhood built-environment features, and people's mental health in Hong Kong, an Asian city well known for its high-density and high-rise housing. The potential mediating effects of people's perceived living environment were also considered in the analysis. We collected data from 221 participants from two communities in Hong Kong, i.e., Sham Shui Po (SSP) and Tin Shui Wai (TSW), using a stratified random sampling approach. Big datasets were also used to derive relevant built-environment features at the street block level. We used structural equation modeling to explore the complex relationships among housing characteristics, built-environment features, and mental health. The results indicate that the associations between built-environment quality and people's mental health are weak. For communities with relatively poor housing conditions (i.e., SSP in this study), the impact of housing characteristics on mental health may be more direct; for communities with relatively good housing conditions (i.e., TSW in this study), the effect of housing characteristics on mental health may be indirect. Our findings shed light on the importance of considering different contexts in developing policies related to housing and built environment and mental health.

Associations Between Household Socioeconomic Status, Car Ownership, Physical Activity, and Cardiorespiratory Fitness in South African Primary Schoolchildren Living in Marginalized Communities.

BACKGROUND: Little is known whether physical activity (PA)-promoting environments are equally accessible to children with divergent socioeconomic status (SES) in low-/middle-income countries. The authors, therefore, examined whether South African children from poorer versus wealthier families living in marginalized communities differed in moderate to vigorous PA and cardiorespiratory fitness. We also tested associations between family car ownership and PA/cardiorespiratory fitness. METHODS: Parents/guardians of 908 children (49% girls, mean age = 8.3 [1.4] y) completed a survey on household SES. PA was assessed via 7-day accelerometry, parental and child self-reports, and cardiorespiratory fitness with the 20-m shuttle run test. RESULTS: Based on accelerometry, most children met current moderate to vigorous PA recommendations (≥60 min/d). About 73% of the children did not engage in structured physical education lessons. Whereas children of the lowest SES quintile accumulated higher levels of device-based moderate to vigorous PA, peers from the highest SES quintile engaged in more sedentary behaviors, but self-reported higher engagement in sports, dance, and moving games after school. Families' car ownership was associated with higher parent/self-reported leisure-time PA. CONCLUSIONS: A deeper understanding is needed about why wealthier children are more sedentary, but simultaneously engage in more leisure-time PA. The fact that access to structural physical education is denied to most children is critical and needs to be addressed.

Confluent impact of housing and geology on indoor radon concentrations in Atlanta, Georgia, United States.

Radon is a naturally released radioactive carcinogenic gas. To estimate radon exposure, studies have examined various risk factors, but limited information exists pertaining to the confluent impact of housing characteristics and geology. This study evaluated the efficacy of housing and geological characteristics to predict radon risk in DeKalb County, Georgia, USA. Four major types of data were used: (1) three databases of indoor radon concentrations (n = 6757); (2) geologic maps of rock types and fault zones; (3) a database of 402 in situ measurements of gamma emissions, and (4) two databases of housing characteristics. The Getis-Ord method was used to delineate hot spots of radon concentrations. Empirical Bayesian Kriging was used to predict gamma radiation at each radon test site. Chi-square tests, bivariate correlation coefficients, and logistic regression were used to examine the impact of geological and housing factors on radon. The results showed that indoor radon levels were more likely to exceed the action level-4 pCi/L (148 Bq/m3) designated by the U.S. Environmental Protection Agency-in fault zones, were significantly positively correlated to gamma readings, but significantly negatively related to the presence of a crawlspace foundation and its combination with a slab. The findings suggest that fault mapping and in situ gamma ray measurements, coupled with analysis of foundation types and delineation of hot spots, may be used to prioritize areas for radon screening.

Housing gaps, mosquitoes and public viewpoints: a mixed methods assessment of relationships between house characteristics, malaria vector biting risk and community perspectives in rural Tanzania.

BACKGROUND: House improvement and environmental management can significantly improve malaria transmission control in endemic communities. This study assessed the influence of physical characteristics of houses and surrounding environments on mosquito biting risk in rural Tanzanian villages, and examined knowledge and perceptions of residents on relationships between these factors and malaria transmission. The study further assessed whether people worried about these risks and how they coped. METHODS: Entomological surveys of indoor mosquito densities were conducted across four villages in Ulanga district, south-eastern Tanzania. The survey involved 48 sentinel houses sampled monthly and other sets of 48 houses randomly recruited each month for one-off sampling over 12 months. Physical characteristics of the houses and surrounding environments were recorded. Questionnaire surveys were administered to 200 household heads to assess their knowledge and concerns regarding the observed housing and environmental features, and whether they considered these features when constructing houses. Focus group discussions, were conducted to clarify emergent themes on people's perceptions on relationships between housing or environmental factors and malaria transmission. RESULTS: The entomological surveys showed statistically higher indoor densities of the malaria vectors (Anopheles arabiensis and Anopheles funestus) in houses with mud walls compared to plastered or brick walls, open eaves compared to closed eaves and unscreened windows compared to screened windows. Most respondents reported that their houses allowed mosquito entry, at least partially. Participants were aware that house structure and environmental characteristics influenced indoor mosquito densities and consequently malaria transmission. They were concerned about living in poorly-constructed houses with gaps on eaves, walls, windows and doors but were constrained by low income. CONCLUSION: In rural south-eastern Tanzania, significant proportions of people still live in houses with open eaves, unscreened windows and gaps on doors. Though they are fully aware of associated mosquito biting and pathogen transmission risks, they are constrained by low-income levels. The study proposes that community-based house improvement initiatives combined with targeted subsidies could lower the financial barriers, improve access to essential construction materials or designs, and significantly accelerate malaria transmission control in these communities.

A Pilot Study to Examine Exposure to Residential Radon in Under-Sampled Census Tracts of DeKalb County, Georgia, in 2015.

While DeKalb County, Georgia, offers free radon screening for all eligible residents, portions of the county remain relatively under-sampled. This pilot study focused on 10% of the census tracts in the county with the lowest proportion of radon testing; most were in southern DeKalb County. In total, 217 households were recruited and homes were tested for indoor radon concentrations on the lowest livable floor over an eight-week period from March-May 2015. Tract-level characteristics were examined to understand the differences in socio-demographic and economic factors between the pilot study area and the rest of the county. The pilot study tracts had a higher proportion of African Americans compared to the rest of DeKalb County (82% versus 47%). Radon was detected above 11.1 Bq/m³ (0.3 pCi/L) in 73% of the indoor samples and 4% of samples were above 148 Bq/m³ (4 pCi/L). Having a basement was the strongest predictive factor for detectable and hazardous levels of radon. Radon screening can identify problems and spur homeowners to remediate but more research should be done to identify why screening rates vary across the county and how that varies with radon levels in homes to reduce radon exposure.

Geospatial Risk Factors of Canine American Trypanosomiasis (Chagas Disease) (42 Cases: 2000-2012).

American trypanosomiasis or Chagas disease caused by Trypanosoma cruzi affects many mammals, including humans and dogs, in all Latin American countries outside the Caribbean and increasingly also in the southern United States. Dogs are considered as reliable sentinels and have been identified as an important risk factor for the disease in humans in endemic countries. Factors that determine American trypanosomiasis in dogs may therefore have public health relevance. Associations of different environmental, locational, and pet owner socioeconomic conditions were evaluated retrospectively as potential risk factors for American trypanosomiasis status in dogs in a case-control study. Laboratory-confirmed cases received at the Texas A&M University Veterinary Medical Teaching Hospital between the years 2000 and 2012 and candidate risk factor variables extracted from publicly available environmental data and 2010 US Census Bureau were used. The sample included 42 dogs serologically positive and 82 dogs serologically negative determined by indirect immunofluorescent assay. The diagnostic titer was 1:160 (case). Univariate logistic regressions followed by stepwise multivariate logistic modeling were used for variable screening and to determine the strengths of variable associations with case status. Total Edge Contrast Index (odds ratio [OR] = 3.35, 95% confidence interval [CI] 3.10, 3.62), residing in homes that had rural addresses (OR = 2.48, 95% CI 2.43, 2.53), total number of owner occupied housing units in a neighborhood with a householder who is Hispanic or Latino (OR = 1.66, 95% CI 1.04, 2.66), and the total number of housing units in a neighborhood that were built on or prior to year 1980 (OR = 2.22, 95% CI 1.94, 2.55) were identified as risk factors. Suitable awareness campaigns and future research that considers pet owner housing and socioeconomic circumstances are necessary for effective prevention and control of this disease among dogs.

Determinants of house dust, endotoxin, and ß-(1→3)-D-glucan in homes of Danish children.

Little is known about the geographic variation and determinants of bacterial endotoxin and ß-(1,3)-D-glucan in Danish house dust. In a population of 317 children, we: (i) described loads and concentrations of floor dust, endotoxin, and ß-(1→3)-D-glucan and (ii) their correlations and (iii) assessed their determinants; (iv) Finally, we compared our findings with previous European studies. Bedroom floor dust was analyzed for endotoxin content by the kinetic limulus amoebocyte lysate assay and for ß-(1→3)-D-glucan by the inhibition enzyme immunoassay. The parents answered questions regarding potential determinants. We found: geometric means (geometric standard deviations) 186 mg/m(2) (4.3) for dust; 5.46 × 10(3) EU/m(2) (8.0) and 31.1 × 10(3) EU/g (2.6) for endotoxin; and 142 µg/m(2) (14.3) and 0.71 × 10(3) µg/g (7.3) for ß-(1→3)-D-glucan. High correlations (r > 0.75) were found between floor dust and endotoxin and ß-(1→3)-D-glucan loads, while endotoxin and ß-(1→3)-D-glucan concentrations were moderately correlated (r = 0.36-0.41) with the dust load. Having a carpet was positively associated with dust load and with endotoxin and ß-(1→3)-D-glucan concentrations. Pet keeping, dwelling type, and dwelling location were determinants of endotoxin concentrations. No other determinants were associated with ß-(1→3)-D-glucan concentrations. Compared with other European studies, we found lower ß-(1→3)-D-glucan loads and concentrations but higher endotoxin loads and concentrations suggesting a geographically determined different composition of Danish floor dust compared with other European regions.

Evaluation of premise condition index in the context of Aedes aegypti control in Marília, São Paulo, Brazil.

The dengue control programme in Brazil involves house-to-house inspection in each municipality, on a bimonthly basis, for vector control and education activities. The sustainability of this strategy has been questioned due to its failure in interrupting dengue transmission and also by the exhaustion of field workers and lack of active cooperation by populations due to the tedious routine of bimonthly visits to all houses. An evaluation of the infestation of Aedes aegypti by larval, pupal and adult collection, and classification of houses with the premise condition index (PCI) in conjunction with residents’ housing characteristics was performed in 11 575 houses in Marilia, Sao Paulo state, Brazil. The results showed that the surveillance tool and associated data on resident housing characteristics were useful in identifying heavily infested premises. The index could thus provide a basis for prioritizing control measures within communities during routine vector control activities.

Predictors of endotoxin levels in U.S. housing.

BACKGROUND: The relationship of domestic endotoxin exposure to allergy and asthma has been widely investigated. However, few studies have evaluated predictors of household endotoxin, and none have done so for multiple locations within homes and on a national scale. OBJECTIVES: We assayed 2,552 house dust samples in a nationwide study to understand the predictors of household endotoxin in bedroom floors, family room floors, beds, kitchen floors, and family room sofas. METHODS: Reservoir house dust from five locations within homes was assayed for endotoxin and demographic and housing information was assessed through questionnaire and onsite evaluation of 2,456 residents of 831 homes selected to represent national demographics. We performed repeated-measures analysis of variance (rANOVA) for 37 candidate variables to identify independent predictors of endotoxin. Meteorologic data were obtained for each primary sampling unit and tested as predictors of indoor endotoxin to determine if wetter or warmer microclimates were associated with higher endotoxin levels. RESULTS: Weighted geometric mean endotoxin concentration ranged from 18.7 to 80.5 endotoxin units (EU)/mg for the five sampling locations, and endotoxin load ranged from 4,160 to 19,500 EU/m(2). Bivariate analyses and rANOVA demonstrated that major predictors of endotoxin concentration were sampling location in the home, census division, educational attainment, presence of children, current dog ownership, resident-described problems with cockroaches, food debris, cockroach stains, and evidence of smoking observed by field staff. Low household income entered the model if educational attainment was removed. CONCLUSION: Increased endotoxin in household reservoir dust is principally associated with poverty, people, pets, household cleanliness, and geography.

Evaluation of premise condition index in the context of Aedes aegypti control in Marília, São Paulo, Brazil

The dengue control programme in Brazil involves house-to-house inspection in each municipality, on abimonthly basis, for vector control and education activities. The sustainability of this strategy has been questioned due to its failure in interrupting dengue transmission and also by the exhaustion of field workers and lack of active cooperation by populations due to the tedious routine of bimonthly visits toall houses. An evaluation of the infestation of Aedes aegypti by larval, pupal and adult collection, and classification of houses with the premise condition index (PCI) in conjunction with residents’ housing characteristics was performed in 11 575 houses in Marilia, Sao Paulo state, Brazil. The results showed that the surveillance tool and associated data on resident housing characteristics were useful in identifying heavily infested premises. The index could thus provide a basis for prioritizing control measures within communities during routine vector control activities.