Browsing by Author "Howden-Chapman P"
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- ItemAssociation between home insulation and hospital admission rates: retrospective cohort study using linked data from a national intervention programme(BMJ Publishing Group Ltd, 29/12/2020) Fyfe C; Telfar-Barnard L; Howden-Chapman P; Douwes JObjectives To investigate whether retrofitting insulation into homes can reduce cold associated hospital admission rates among residents and to identify whether the effect varies between different groups within the population and by type of insulation. Design A quasi-experimental retrospective cohort study using linked datasets to evaluate a national intervention programme. Participants 994 317 residents of 204 405 houses who received an insulation subsidy through the Energy Efficiency and Conservation Authority Warm-up New Zealand: Heat Smart retrofit programme between July 2009 and June 2014. Main outcome measure A difference-in-difference approach was used to compare the change in hospital admissions of the study population post-insulation with the change in hospital admissions of the control population that did not receive the intervention over the same two timeframes. Relative rate ratios were used to compare the two groups. Results 234 873 hospital admissions occurred during the study period. Hospital admission rates after the intervention increased in the intervention and control groups for all population categories and conditions with the exception of acute hospital admissions among Pacific Peoples (rate ratio 0.94, 95% confidence interval 0.90 to 0.98), asthma (0.92, 0.86 to 0.99), cardiovascular disease (0.90, 0.88 to 0.93), and ischaemic heart disease for adults older than 65 years (0.79, 0.74 to 0.84). Post-intervention increases were, however, significantly lower (11%) in the intervention group compared with the control group (relative rate ratio 0.89, 95% confidence interval 0.88 to 0.90), representing 9.26 (95% confidence interval 9.05 to 9.47) fewer hospital admissions per 1000 in the intervention population. Effects were more pronounced for respiratory disease (0.85, 0.81 to 0.90), asthma in all age groups (0.80, 0.70 to 0.90), and ischaemic heart disease in those older than 65 years (0.75, 0.66 to 0.83). Conclusion This study showed that a national home insulation intervention was associated with reduced hospital admissions, supporting previous research, which found an improvement in self-reported health.
- ItemFactors Associated with Uptake of No-Cost Safety Modifications to Home Access Steps: Implications for Equity and Policy(MDPI (Basel, Switzerland), 2024-01-04) Keall MD; Pierse N; Cunningham CW; Baker MG; Bierre S; Howden-Chapman P; Grzebieta R(1) Background: Fall injuries in the home present a major health burden internationally for all age groups. One effective intervention to prevent falls is home modification, but safety is only increased if opportunities to install safety modifications are taken up. This study sought to identify factors that may lead to a higher uptake of no-cost home modifications when these are offered to people living in the community. (2) Methods: We studied 1283 houses in the New Zealand cities of New Plymouth and Wellington. Using logistic regression, we modelled the odds of uptake according to the number of access steps, the provider who was undertaking the modifications, occupant ethnicity, prior fall injury history, and age group. (3) Results: Homes with older residents (age 65+) had higher uptake rates (35% vs. 27% for other homes). Larger numbers of access steps were associated with higher uptake rates. There was indicative evidence that homes with Indigenous Māori occupants had a higher uptake of the modifications for one of the two providers, but not the other. (4) Conclusions: No-cost home safety modifications offered via cold calling are likely to have relatively low uptake rates but the households that do consent to the modifications may be those who are more likely to benefit from the concomitant increased safety.
- ItemHe Kāinga Oranga: reflections on 25 years of measuring the improved health, wellbeing and sustainability of healthier housing(Taylor and Francis, on behalf of Te Aparangi, The Royal Society of New Zealand, 2023-02-06) Howden-Chapman P; Crane J; Keall M; Pierse N; Baker MG; Cunningham C; Amore K; Aspinall C; Bennett J; Bierre S; Boulic M; Chapman R; Chisholm E; Davies C; Fougere G; Fraser B; Fyfe C; Grant L; Grimes A; Halley C; Logan-Riley A; Nathan K; Olin C; Ombler J; O’Sullivan K; Pehi T; Penny G; Phipps R; Plagman M; Randal E; Riggs L; Robson B; Ruru J; Shaw C; Schrader B; Teariki MA; Telfar Barnard L; Tiatia R; Toy-Cronin B; Tupara H; Viggers H; Wall T; Wilkie M; Woodward A; Zhang WThis paper reflects on the influences and outcomes of He Kāinga Oranga/Housing and Health Research Programme over 25 years, and their impact on housing and health policy in Aotearoa and internationally. Working in partnership particularly with Māori and Pasifika communities, we have conducted randomised control trials which have shown the health and broad co-benefits of retrofitted insulation, heating and remediation of home hazards, which have underpinned government policy in the Warm Up NZ-Heat Smart programme and the Healthy Homes Standards for rental housing. These trials have been included as evidence in the WHO Housing and Health Guidelines and led to our designation as a WHO Collaborating Centre on Housing and Wellbeing. We are increasingly explicitly weaving Māori frameworks, values and processes with traditional Western science.
- ItemHome modifications to prevent home fall injuries in houses with Māori occupants (MHIPI): a randomised controlled trial(Elsevier Ltd, 2021-09) Keall MD; Tupara H; Pierse N; Wilkie M; Baker MG; Howden-Chapman P; Cunningham CBACKGROUND: As with many Indigenous populations internationally, Māori in New Zealand suffer health inequity. We aimed to assess the rate of fall injuries at home with and without home modifications in houses with Māori occupants. METHODS: We did a single-blind randomised controlled trial in the Wellington and Taranaki regions of New Zealand and enrolled owner-occupied households with at least one Māori occupant. Only households who stated they intended to live at that address for the subsequent 3 years were eligible for participation. We randomly assigned (1:1) households to either the intervention group, who received home modifications (handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, repairs to window catches, high-visibility and slip-resistant edging for outside steps, fixing of lifted edges of carpets and mats, non-slip bath mats, and slip-resistant surfacing for outside areas such as decks) immediately, or the control group, who received the modifications 3 years later. Data on home injuries were obtained from the Accident Compensation Corporation and coded by study team members, who were masked to study group allocation. The primary outcome was the rate of medically treated fall injuries at home per household per year, analysed according to intention to treat. This Māori Home Injury Prevention Intervention (MHIPI) trial is now completed, and is registered with the Australian New Zealand Clinical Trials Registry, ACTRN12613000148774. FINDINGS: Between Sept 3, 2013, and Oct 1, 2014, 824 households were assessed for eligibility and 254 were enrolled, of which 126 (50%) were assigned to the intervention group and 128 (50%) were assigned to the control group. After adjustment for previous falls and geographical region, there was an estimated 31% reduction in the rate of fall injuries at home per year exposed to the intervention compared with households in the control group (adjusted relative rate 0·69 [95% CI 0·47-1·00]). INTERPRETATION: Low-cost home modifications and repairs can be an effective means to reduce injury disparities. The high prevalence of modifiable safety issues in Māori homes merits considerable policy and community effort. FUNDING: Health Research Council of New Zealand.
- ItemInclusive and collective urban home spaces: The future of housing in Aotearoa New Zealand(Elsevier Ltd, 2022) Olin CV; Berghan J; Thompson-Fawcett M; Ivory V; Witten K; Howden-Chapman P; Duncan S; Ka'ai T; Yates A; O'Sullivan KC; Keall M; Ombler J; Hinckson E
- ItemPlacemaking and public housing: the state of knowledge and research priorities(Taylor and Francis Group, 2023-05-08) Chisholm E; Olin C; Randal E; Witten K; Howden-Chapman PThis article examines the international literature on placemaking–practices or initiatives that encourage a sense of place–in public housing communities. Placemaking is likely to be particularly beneficial to public housing tenants, and is a current priority for public housing providers; yet reviews of placemaking research have failed to consider public housing. Our systematic quantitative review of 63 English-language journal articles reveals that the field is dominated by qualitative cross-sectional studies conducted in the United States, the United Kingdom, and Australia, in the context of regeneration, and published in social science journals. Our thematic analysis of this literature shows that placemaking is supported by forming relationships and participating in community activities, by access to quality public space and amenities, and by spending time and forming memories in a place. The review therefore provides guidance to public housing providers and reveals the need for particular research, including longitudinal studies, and studies conducted in both redeveloped and existing communities.
- ItemRetrofitting home insulation reduces incidence and severity of chronic respiratory disease(John Wiley and Sons, Ltd, 21/08/2022) Fyfe C; Barnard LT; Douwes J; Howden-Chapman P; Crane JTo assess whether retrofitting home insulation can reduce the risk of respiratory disease incidence and exacerbation, a retrospective cohort study was undertaken using linked data from a national intervention program. The study population was made up of 1 004 795 residents from 205 001 New Zealand houses that received an insulation subsidy though a national Energy Efficiency and Conservation Authority program. A difference-in-difference model compared changes in the number of prescriptions dispensed for respiratory illness post- insulation to a control population over the same timeframe. New prescribing of chronic respiratory disease medication at follow-up was used to compare incidence risk ratios between intervention and control groups. Chronic respiratory disease incidence was significantly lower in the intervention group at follow-up: odds ratio 0.90 (95% CI: 0.86-0.94). There was also a 4% reduction in medication dispensed for treating exacerbations of chronic respiratory disease symptoms in the intervention group compared with the control group: relative rate ratio (RRR) 0.96 (95% CI: 0.96-0.97). There was no change in medication dispensed to prevent symptoms of chronic respiratory disease RRR: 1,00 (95% CI: 0.99-1.00). These findings support home insulation interventions as a means of improving respiratory health outcomes.
- ItemToward a Framework for Resilience Assessments: Working Across Cultures, Disciplines, and Scales in Aotearoa/New Zealand(Frontiers Media S.A., 2020-05-14) Coulson G; Moores J; Waa A; Kearns R; Witten K; Batstone C; Somervell E; Olivares G; Howden-Chapman PResilience appears within diverse literatures across the physical and social sciences, pervades social, and ecological systems models and has been mobilized in the quest to change environmental practices at local and international levels. Yet common language is needed to enable cross-disciplinary conversations. We discuss a novel interdisciplinary process identifying shared terminology and developing a framework to facilitate the integration of physical and social science understandings of urban infrastructure and resilience in urban systems. Drawing on bicultural knowledge traditions unique to Aotearoa/New Zealand, we reflect on resilience as a system property having ecological, social, economic and technical dimensions that influence well-being and sustainability outcomes.
