标题：Healthy Housing: A Structured Review of Published Evaluations of US Interventions to Improve Health by Modifying Housing in the United States, 1990–2001
摘要：We sought to characterize and to evaluate the success of current public health interventions related to housing. Two reviewers contentanalyzed 72 articles selected from 12 electronic databases of US interventions from 1990 to 2001. Ninety-two percent of the interventions addressed a single condition, most often lead poisoning, injury, or asthma. Fifty-seven percent targeted children, and 13% targeted seniors. The most common intervention strategies employed a one-time treatment to improve the environment; to change behavior, attitudes, or knowledge; or both. Most studies reported statistically significant improvements, but few (14%) were judged extremely successful. Current interventions are limited by narrow definitions of housing and health, by brief time spans, and by limited geographic and social scales. An ecological paradigm is recommended as a guide to more effective approaches. PUBLIC HEALTH RESEARCHERS and practitioners have long recognized that housing influences health. Over the last 150 years, housing reformers and public health workers have periodically joined forces to improve health by strengthening housing regulations, advocating for better housing conditions, or reducing hazards such as fire, lead poisoning, injuries, or window falls. 1– 4 A substantial body of literature demonstrates that poor housing can contribute to infectious disease transmission, injuries, asthma symptoms, lead poisoning, and mental health problems 4, 5– 7 —both directly (e.g., because of environmental hazards) 5 and indirectly (e.g., by contributing to psychosocial stress that exacerbates illness). 8 Renewed interest in housing parallels a growing interest in ecological approaches to the study of complex health problems and an examination of the social determinants of health and the causes of persistent socioeconomic, racial, and ethnic disparities in health. 9, 10 Several recent reports have demonstrated the value of considering multilevel (e.g., individual, family, social network, community, state) determinants of a variety of health outcomes. 11– 14 Public health advocates have emphasized the importance of creating interventions that address these influences on health 15, 16 and of utilizing ecological approaches that seek changes in both the physical and the social environment, at various levels of organization. Applied to housing, the ecological approach suggests the importance of looking at characteristics of and interactions among residents, housing units, buildings, blocks, and neighborhoods, as well as housing owners, policies, and institutions that provide or regulate housing and health, to understand their contributions to population health. It also suggests that environmental factors interact with psychosocial variables at several levels to produce different patterns of health and disease. 17 In this report, we assess the extent to which published studies of interventions designed to improve health by modifying housing reflect these new insights. This study differs from another recent review of the effect of improved housing on health 18 in several ways: (1) we focused on a wider range of housing interventions, (2) we used an ecological paradigm that includes behavior at different levels as producers of both housing conditions and health outcomes, and (3) we restricted the database to US studies over 10 years. Our goals were to Describe the objectives, populations, settings, intervention characteristics, and results of these studies Describe and assess the methods used to evaluate these interventions Assess the extent to which intervention studies addressed multiple levels of causation or multiple outcomes Identify the strengths, limitations, and gaps in the existing literature on housing interventions to improve health Identify directions for future research, policy, and practice
