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ABSTRACT: Home injuries are a substantial health burden worldwide, with the home setting being at least as important as the road for injury. Focusing on common injury hazards presented by the home environment, we sought to examine the justification for significant expenditure on safety-related repairs to the housing stock. Trained inspectors assessed 961 New Zealand houses for injury hazards. Using administrative data from the Accident Compensation Corporation (the national injury insurance agency), 1328 home injuries were identified amongst the 1612 occupants of these houses over the 2006-2009 period. Telephone interviews gathered data on the location and nature of these injuries, and the attitudes of those injured to potential injury hazards in their homes. Commonly occurring injury hazards that could be repaired at modest cost were identified based on their prevalence estimated by the housing inspection, and their location with respect to the areas of the home where the injuries occurred (identified during the telephone interviews). About 38% of the home injuries studied were potentially related to a structural aspect of the home environment. Common safety hazards included the lack of working smoke detectors (65% of the sample), inadequately fenced driveways (55%), hot water temperatures measured at over 60° (49%) and poorly lit access to the house (34%). A protocol for identifying and repairing important common hazards was designed. The actual safety effects of this protocol are in the process of being examined in a randomised controlled trial.
Accident; analysis and prevention 04/2013; 57C:124-130. · 1.65 Impact Factor
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Helen Viggers, Philippa Howden-Chapman,
Tristram Ingham,
Ralph Chapman,
Gina Pene,
Cheryl Davies,
Ann Currie,
Nevil Pierse,
Helen Wilson,
Jane Zhang,
Michael Baker,
Julian Crane
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ABSTRACT: BACKGROUND: Chronic Obstructive Pulmonary Disease (COPD) is of increasing importance with about one in four people estimated to be diagnosed with COPD during their lifetime. None of the existing medications for COPD has been shown to have much effect on the long-term decline in lung function and there have been few recent pharmacotherapeutic advances. Identifying preventive interventions that can reduce the frequency and severity of exacerbations could have important public health benefits. The Warm Homes for Elder New Zealanders study is a community-based trial, designed to test whether an NZ$500 electricity voucher paid into the electricity account of older people with COPD, with the expressed aim of enabling them to keep their homes warm, results in reduced exacerbations and hospitalisation rates. It will also examine whether these subsidies are cost-beneficial. METHODS: Participants had a clinician diagnosis of COPD and had either been hospitalised or taken steroids or antibiotics for COPD in the previous three years; their median age was 71 years. Participants were recruited from three communities between 2009 to early 2011. Where possible, participants' houses were retrofitted with insulation. After baseline data were received, participants were randomised to either 'early' or 'late' intervention groups. The intervention was a voucher of $500 directly credited to the participants' electricity company account. Early group participants received the voucher the first winter they were enrolled in the study, late participants during the second winter. Objective measures included spirometry and indoor temperatures and subjective measures included questions about participant health and wellbeing, heating, medication and visits to health professionals. Objective health care usage data included hospitalisation and primary care visits. Assessments of electricity use were obtained through electricity companies using unique customer numbers. DISCUSSION: This community trial has successfully enrolled 522 older people with COPD. Baseline data showed that, despite having a chronic respiratory illness, participants are frequently cold in their houses and economise on heating.Trial Registration: The clinical trial registration is NCT01627418.
BMC Public Health 02/2013; 13(1):176. · 2.00 Impact Factor
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ABSTRACT: Damp and mould in homes have been established as risk factors for respiratory health. There is a need for a relatively straightforward assessment of the home that quantifies this risk.
Using data from 891 New Zealand houses, the utility of a Respiratory Hazard Index quantifying key attributes related to damp and mould was tested by studying its associations with self-reported respiratory symptoms.
A dose-response relationship was found whereby each unit increase in the Respiratory Hazard Index was associated with an 11% increase in the odds of at least one episode of wheezing/whistling in the chest over the last 12 months (relative odds of 1.11 with a 95% CI 1.04%-1.20%). An 11% increase in the odds of an asthma attack over the last 12 months was estimated (relative odds of 1.11 with a 95% CI 1.01%-1.22%). These estimates were adjusted for household crowding levels, age, sex and smoking status. There was suggestive evidence of more steeply increasing odds of respiratory symptoms with increasing levels of the Respiratory Hazard Index for children aged under 7. In the worst performing houses according to the Index, a 33% reduction in the number of people experiencing respiratory symptoms (relative risk 0.67 with 95% CI 0.53 to 0.85) could be expected if people were housed in the best performing houses.
This study showed that increased evidence of housing conditions supporting dampness and mould was associated with increased odds of respiratory symptoms. A valid housing assessment tool can provide a rational basis for investment in improved housing quality to improve respiratory health.
Environmental Health 05/2012; 11:33. · 2.65 Impact Factor
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ABSTRACT: Although the burden of infectious diseases seems to be decreasing in developed countries, few national studies have measured the total incidence of these diseases. We aimed to develop and apply a robust systematic method for monitoring the epidemiology of serious infectious diseases.
We did a national epidemiological study with all hospital admissions for infectious and non-infectious diseases in New Zealand from 1989 to 2008, to investigate trends in incidence and distribution by ethnic group and socioeconomic status. We extended a recoding system based on the ninth revision of international classification of diseases (ICD-9) to the tenth revision (ICD-10), and applied this to data for hospital admissions from the New Zealand Ministry of Health, National Minimum Dataset. We filtered results to account for changes in health-care practices over time. Acute overnight admissions were the events of interest.
Infectious diseases made the largest contribution to hospital admissions of any cause. Their contribution increased from 20·5% of acute admissions in 1989-93, to 26·6% in 2004-08. We noted clear ethnic and social inequalities in infectious disease risk. In 2004-08, the age-standardised rate ratio was 2·15 (95% CI 2·14-2·16) for Māori (indigenous New Zealanders) and 2·35 (2·34-2·37) for Pacific peoples compared with the European and other group. The ratio was 2·81 (2·80-2·83) for the most socioeconomically deprived quintile compared with the least deprived quintile. These inequalities have increased substantially in the past 20 years, particularly for Māori and Pacific peoples in the most deprived quintile.
These findings support the need for stronger prevention efforts for infectious diseases, and reinforce the need to reduce ethnic and social inequalities and to address disparities in broad social determinants such as income levels, housing conditions, and access to health services. Our method could be adapted for infectious disease surveillance in other countries.
New Zealand Ministry of Health, New Zealand Health Research Council.
The Lancet 02/2012; 379(9821):1112-9. · 38.28 Impact Factor
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The New Zealand medical journal 01/2012; 125(1353):156-8.
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The New Zealand medical journal 01/2012; 125(1367):6-10.
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ABSTRACT: Houses designed for one climate and cultural group may not be appropriate for other places and people. Our aim is to find cost-effective ways to improve the characteristics of older homes, ill-fitted for New Zealand's climate, in order to improve the occupants' health.
We have carried out two community randomised trials, in partnership with local communities, which have focused on retrofitted insulation and more effective heating and have two other studies under way, one which focuses on electricity vouchers and the other on housing hazard remediation.
The Housing, Insulation and Health Study showed that insulating 1,350 houses, built before insulation was required, improved the occupants' health and well being as well as household energy efficiency. In the Housing, Heating and Health Study we investigated the impact of installing more effective heating in insulated houses for 409 households, where there was a child with doctor-diagnosed asthma. Again, the study showed significant results in the intervention group; indoor temperatures increased and levels of NO(2) were halved. Children reported less poor health, lower levels of asthma symptoms and sleep disturbances by wheeze and dry cough. Children also had fewer days off school.
Improving the energy efficiency of older housing leads to health improvements and energy efficiency improvements. Multidisciplinary studies of housing interventions can create compelling evidence to support policies for sustainable housing developments which improve health.
International Journal of Public Health 08/2011; 56(6):583-8. · 2.54 Impact Factor
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Journal of epidemiology and community health 07/2011; 65(7):598-9. · 3.04 Impact Factor
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ABSTRACT: Home injury is thought to constitute a major health burden in most developed countries. However, efforts to address this burden have been hampered by reluctance from outside agencies to interfere with the home environment of individuals, even if it benefits the occupant's safety. This paper outlines cost-benefit evaluation methods established in the transport safety domain applied to home safety to estimate the social cost of unintentional home injury in New Zealand. Estimates of costs imposed on society by home injury can provide an important motivator for initiating research and programmes to reduce home injury risk. Data sources used included mortality data, hospitalisation data and data on minor injuries that required medical treatment, but not hospital admission. We estimated that unintentional home injuries in New Zealand impose an annual social cost of about $NZ 13 billion (about $US 9 billion), which is about 3.5 times the annual social cost of road injury. These estimates provide a rational evidence base for decisions on housing-focused safety regulation or interventions that always carry some cost, and therefore need to be weighed against the benefits of injuries potentially prevented.
Accident; analysis and prevention 05/2011; 43(3):998-1002. · 1.65 Impact Factor
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The New Zealand medical journal 01/2011; 124(1345):90-5.
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ABSTRACT: New Zealand is a temperate country with substantial excess winter mortality. We investigated whether this excess winter mortality varies with social factors.
Records from New Zealand censuses in 1981, 1986, 1991, 1996 and 2001 were each anonymously and probabilistically linked to 3 years of subsequent mortality data creating five cohort studies of the New Zealand adult population (age 30-74 years at census) each with 3 years' follow-up. Logistic regression analysis was used to model the risk of dying in winter compared to summer with winter deaths classified '1' and summer deaths '0'. There were 75,138 eligible mortality records with complete data on social variables recorded for 58,683 (78%).
Adjusting for age, sex, census year, ethnicity and tenure, those in the lowest tertile of income were at increased risk of winter death compared to those in the highest tertile: OR 1.13 (95% CI 1.08 to 1.19). Compared to home owners, people living in rented accommodation were at greater risk of winter death: OR 1.05 (95% CI 1.01 to 1.10). Urban dwellers were also at significantly increased risk. The strongest associations were seen for infectious diseases.
There was an increased risk of dying in winter for most New Zealanders, but more so among low-income people, those living in rented accommodation and those living in cities. Exact causal mechanisms are not known but possibly include correlated poorer health status, low indoor temperatures and household crowding.
Journal of epidemiology and community health 10/2010; 66(4):379-84. · 3.04 Impact Factor
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Philippa Howden-Chapman
Social Science [?] Medicine 10/2010; 71(7):1240-3; discussion 1254-8. · 2.70 Impact Factor
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ABSTRACT: The adverse health and environmental effects of poor housing quality are well established. A central requirement for evidence-based policies and programmes to improve housing standards is a valid, reliable and practical way of measuring housing quality that is supported by policy agencies, the housing sector, researchers and the public.
This paper provides guidance on the development of housing quality-assessment tools that link practical measures of housing conditions to their effects on health, safety and sustainability, with particular reference to tools developed in New Zealand and England.
The authors describe how information on housing quality can support individuals, agencies and the private sector to make worthwhile improvements to the health, safety and sustainability of housing. The information gathered and the resultant tools developed should be guided by the multiple purposes and end users of this information. Other important issues outlined include deciding on the scope, detailed content, practical administration issues and how the information will be analysed and summarised for its intended end users. There are likely to be considerable benefits from increased international collaboration and standardisation of approaches to measuring housing hazards. At the same time, these assessment approaches need to consider local factors such as climate, geography, culture, predominating building practices, important housing-related health issues and existing building codes.
An effective housing quality-assessment tool has a central role in supporting improvements to housing. The issues discussed in this paper are designed to motivate and assist the development of such tools.
Journal of epidemiology and community health 09/2010; 64(9):765-71. · 3.04 Impact Factor
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The New Zealand medical journal 08/2010; 123(1320):6-8.
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Influenza and Other Respiratory Viruses 05/2010; 4(3):113-5. · 4.16 Impact Factor
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Medical Teacher 01/2010; 32(3):270-1. · 1.22 Impact Factor
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The New Zealand medical journal 01/2010; 123(1322):92-5.
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ABSTRACT: Social constructions of what it means to let and rent housing are revealed in language and are intimately tied to housing outcomes for both landlords and tenants. This paper is concerned with the socially constructed identities of landlords and tenants in the private rental sector and how these are revealed in language. Fairclough's methods of discourse analysis coupled with Habermas' ideal speech situation and theory of communicative action are used to form an analytical framework for examining public debate and discourse on the private rental sector in New Zealand. It is argued that current discourses about tenants and landlords are the result of public debate and stereotypes that have failed to incorporate the experiences of tenants, and further that these stereotypes conceal the multiplicity of identities and motivations for behaviour of both landlords and tenants.
Housing Studies 01/2010; 25(1):21-38. · 0.66 Impact Factor
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ABSTRACT: New Zealand homes are underheated by international standards, with average indoor temperatures below the WHO recommended minimum of 18 degrees C. Research has highlighted the connection between low indoor temperatures and adverse health outcomes, including social functioning and psychological well-being. Both health effects and social effects can impact on school absence rates. The aim of this study was to determine whether more effective home heating affects school absence for children with asthma.
A single-blinded randomised controlled trial of heating intervention in 409 households containing an asthmatic child aged 6-12 years, where the previous heating was an open fire, plug-in electric heater or unflued gas heater. The intervention was the installation of a more effective heater of at least 6 kW before the winter of 2006 in half the houses. Demographic and health information was collected both before and after the intervention. Each child's school was contacted directly and term-by-term absence information for that child obtained for 2006 and previous years where available.
Complete absence data were obtained for 269 out of 409 children. Compared with the control group, children in households receiving the intervention experienced on average 21% (p=0.02) fewer days of absence after allowing for the effects of other factors.
More effective, non-indoor polluting heating reduces school absence for asthmatic children.
Journal of epidemiology and community health 09/2009; 64(5):379-86. · 3.04 Impact Factor
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ABSTRACT: There is some evidence that medical students consider population health issues less important than other domains in the health sciences and attitudes to this field may become more negative as training progresses. A need to improve research skills among medical students has also been suggested. Therefore we piloted an integrative teaching exercise that combined teaching of research skills and public health, with real-world research.
Third year medical students at the University of Otago (Dunedin, New Zealand) filled in a questionnaire on their housing conditions and health. The students were given the results of the survey to discuss in a subsequent class. Student response to this teaching exercise was assessed using a Course Evaluation Questionnaire.
Of the 210 students in the class, 136 completed the Course Evaluation Questionnaire (65%). A majority of those who responded (77%) greatly supported or supported the use of the survey and seminar discussion for future third year classes. Most (70%) thought that the session had made them more aware and concerned about societal problems, and 72% felt that they now had an improved understanding of the environmental determinants of health. Students liked the relevance and interaction of the session, but thought it could be improved by the inclusion of small group discussion. The findings of the students' housing and health were considered by the tutors to be of sufficient value to submit to a scientific journal and are now contributing to community action to improve student housing in the city.
In this pilot study it was feasible to integrate medical student teaching with real-world research. A large majority of the students responded favourably to the teaching exercise and this was generally successful in raising the profile of public health and research. This approach to integrated teaching/research should be considered further in health sciences training and continue to be evaluated and refined.
BMC Medical Education 02/2009; 9:45. · 1.15 Impact Factor
