摘要：Objectives. We explored prevalence and clustering of key environmental conditions in low-income housing and associations with self-reported health. Methods. The Health in Common Study, conducted between 2005 and 2009, recruited participants (n = 828) from 20 low-income housing developments in the Boston area. We interviewed 1 participant per household and conducted a brief inspection of the unit (apartment). We created binary indexes and a summed index for household exposures: mold, combustion by-products, secondhand smoke, chemicals, pests, and inadequate ventilation. We used multivariable logistic regression to examine the associations between each index and household characteristics and between each index and self-reported health. Results. Environmental problems were common; more than half of homes had 3 or more exposure-related problems (median summed index = 3). After adjustment for household-level demographics, we found clustering of problems in site ( P < .01) for pests, combustion byproducts, mold, and ventilation. Higher summed index values were associated with higher adjusted odds of reporting fair–poor health (odds ratio = 2.7 for highest category; P < .008 for trend). Conclusions. We found evidence that indoor environmental conditions in multifamily housing cluster by site and that cumulative exposures may be associated with poor health. Home environments can be important determinants of resident health, especially in low-income populations. The underlying mechanisms for these associations may be driven by attributes of the social 1,2 or physical 3 environments in these settings, as well as by specific environmental exposures shaped by residents' behaviors, the physical structure, or products and appliances used in the home. These housing-related environmental exposures may be important contributors to observed health disparities in low-income communities. 4 Unfortunately, risks associated with the physical environment are rarely assessed concurrently, which may highlight the presence of risk clusters and provide insight on shared pathways that may be amenable to intervention. Housing conditions are influenced by a combination of building characteristics and household characteristics. In multifamily housing, building characteristics can be shaped by construction and renovation practices, as well as by the actions of both professional staff involved in building operation and maintenance and building residents. In the home, the proximate (i.e., causal) determinants of environmental exposures include pollutant sources, product usage and resident activity patterns, presence and performance of ventilation systems, design and maintenance of building systems, and pest infestation levels. 5 In recent years, significant evidence has emerged that broadens our view of the health effects that may be caused by indoor exposure disparities. Asthma, for example, has been linked to many indoor environmental exposures 6 and indicators of housing quality. 7 Studies have shown elevated respiratory 8 and cancer risks from indoor exposure to specific volatile organic compounds that are emitted from household furnishings or products, including air fresheners. Exposure to semivolatile organic compounds that are commonly found in residential settings, such as flame retardants and plasticizers, 9 may impart significant risk; however, the evidence on exposure disparities 10 and the health effects attributable to recurrent exposures to concentrations typically found in the home is limited. Previous studies in low-income housing settings have demonstrated that these indoor environments contain elevated exposures to many agents with known or suspected health effects, such as pesticides, 11,12 pest allergens, 13,14 secondhand smoke (SHS), 15 combustion byproducts, 16 and other chemicals. Specific health endpoints include respiratory irritation, asthma development and exacerbation, and cancer. A notable example of the link between disparities in indoor environmental exposures and health effects is childhood lead poisoning attributable to deteriorating lead paint and lead-contaminated soil. 17 As we attempt to eliminate health disparities that may have environmental causes, it will be critical to address indoor environmental exposures, and this will require an understanding of the root causes for these uneven distributions in exposure. Despite the multiple known hazards in the home, few studies have examined the effect of cumulative risks in this setting. In this study, we examined the degree of clustering for key indoor environmental hazards in low-income housing developments and their association with self-reported health. We assessed individual hazards through questionnaires and in-home visual inspections.
