RESUMO
Housing is a pressing problem worldwide and a key determinant of health and wellbeing. The right to adequate housing, as a pillar of the right to an adequate standard of living, means more than a roof to live under. Adequate means the dwelling must fulfill material functions and psychosocial functions, thus contributing to dwellers health and wellbeing. Social housing policies aim to fulfill the right to housing, but frequently fail in fulfilling the right to it being adequate. This study capitalizes on the implementation of a national urban regeneration program in two social housing villas in central Chile (one in Santiago, in the central valley, the other in Viña del Mar, a coastal city) to run a natural experiment assessing the impact of dwelling renovation on several dimensions of perceived habitability and housing satisfaction among the -mostly female-household homemakers. We use 5 waves of survey data collected with a step-wedge design to estimate the association between a time-varying exposure status (the intervention) and 7 binary outcomes for habitability and 5 for housing dissatisfaction, including overall housing satisfaction. We use Poisson regression models with robust variance and a random intercept at the respondent level. At baseline, reports of poor habitability and dissatisfaction across all features were markedly high, the highest levels of dissatisfaction being with acoustic insulation and dwelling size in both villas, and with indoor temperature in Santiago. The intervention resulted in statistically significant and markedly large improvements in reported habitability and dissatisfaction relative to those housing components targeted by the intervention, as well as with overall dwelling satisfaction in both study cases. Implications are, first, that the policy response to quantitative housing deficits must not overlook housing quality; second, that housing renovation appears as a promising intervention for qualitative housing crises; third, that while improvements in habitability and satisfaction are specific to the interventions in place, overall housing satisfaction can improve in more limited, tailored, dwelling renovation interventions. Social housing renovation in Latin America appears as a promising intervention to improve quality of life among the urban poor dwellers and reduce inequalities in health related to housing conditions.
Assuntos
Satisfação Pessoal , Habitação Popular , Humanos , Chile , Feminino , Masculino , Habitação Popular/estatística & dados numéricos , Habitação Popular/normas , Adulto , Pessoa de Meia-Idade , Reforma Urbana , Habitação/estatística & dados numéricos , Habitação/normas , Inquéritos e QuestionáriosRESUMO
Animal and cross-sectional epidemiological studies suggest that prenatal lead exposure is related to delayed menarche, but this has not been confirmed in longitudinal studies. We analyzed this association among 200 girls from Mexico City who were followed since the first trimester of gestation. Maternal blood lead levels were analyzed once during each trimester of pregnancy, and daughters were asked about their first menstrual cycle at a visit between the ages of 9.8 and 18.1 years. We estimated hazard ratios (HRs) and 95% confidence intervals (CI) for probability of menarche over the follow-up period using interval-censored Cox models, comparing those with prenatal blood lead level ⩾5 µg/dl to those with prenatal blood lead <5 µg/dl. We also estimated HRs and 95% CI with conventional Cox regression models, which utilized the self-reported age at menarche. In adjusted analyses, we accounted for maternal age, maternal parity, maternal education, and prenatal calcium treatment status. Across trimesters, 36-47% of mothers had blood lead levels ⩾5 µg/dl. Using interval-censored models, we found that during the second trimester only, girls with ⩾5 µg/dl prenatal blood lead had a later age at menarche compared with girls with prenatal blood lead levels <5 µg/dl (confounder-adjusted HR=0.59, 95% CI 0.28-0.90; P=0.05). Associations were in a similar direction, although not statistically significant, in the conventional Cox regression models, potentially indicating measurement error in the self-recalled age at menarche. In summary, higher prenatal lead exposure during the second trimester could be related to later onset of sexual maturation.
Assuntos
Chumbo/efeitos adversos , Exposição Materna/efeitos adversos , Menarca/efeitos dos fármacos , Efeitos Tardios da Exposição Pré-Natal/etiologia , Maturidade Sexual/efeitos dos fármacos , Adolescente , Adulto , Fatores Etários , Criança , Feminino , Humanos , Estudos Longitudinais , México , Gravidez , Efeitos Tardios da Exposição Pré-Natal/patologiaRESUMO
BACKGROUND: Bisphenol A (BPA) and phthalates metabolites are linked to a variety of adverse health consequences but studies have not explored their association with growth trajectories. OBJECTIVE: Explore body mass index (BMI) trajectories for tertile exposures to BPA and phthalates metabolites in the third trimester of pregnancy. METHODS: We constructed BMI (kg/m2 ) trajectories from birth to 14 years in a birth cohort of 249 children from Mexico City using tertiles of third trimester maternal urinary concentrations of BPA and phthalates metabolites. Fractional age polynomials and mixed effects models were fit separately by sex. Predicted models were plotted for each metabolite tertile with the covariates mother's education and BMI centered at average values. RESULTS: Highest predicted BMI trajectories for female children were observed for third tertile exposure to the phthalate metabolite mono(2-ethyl-5-carboxypentyl) phthalate. In male children, first tertile exposure to mono-isobutyl phthalate and monobenzyl phthalate and second tertile exposure to mono(2-ethylhexyl) phthalate and mono(2-ethyl-5-hydroxyhexyl) phthalate predicted the highest BMI trajectory by adolescence. There was no relationshsip between BPA and child growth trajectory. CONCLUSIONS: These results suggest sex-specific differences in BMI trajectories by levels of metabolite exposure. Additional studies are needed to consider growth through adolescence in assessing the association of pregnancy exposures on child's BMI.