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| Journal of the New Zealand Medical Association,
11-July-2003, Vol 116 No 1177
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Problems with damp and cold housing among Pacific families in
New Zealand
Sarnia Butler, Maynard Williams, Colin Tukuitonga and Janis
Paterson
Several studies have shown that exposure to damp, mouldy and
cold housing can significantly increase the risk of a number of respiratory
symptoms including the common cold and asthma, in addition to non-respiratory
problems such as fatigue and poor
concentration.1–5 However, the link
between poor housing and mental health is not as well documented as the
association with physical health.
A study by Kearns, Smith and Abbott highlighted that Pacific
households reported living in worse housing than Maori or European
households.6 Pacific people were also more
likely than other groups to have symptoms of asthma, colds and flu. The authors
acknowledged that other social and economic deprivation factors were likely to
be operating in conjunction with housing issues to contribute to the health
problems reported.6 Other research supports the
association between deprivation, ethnicity and health, with the prevalence rates
of asthma being higher in more deprived regions of the country and higher in
Maori and Pacific adults than other New
Zealanders.7 Tukuitonga proposed that poor
housing conditions coupled with inadequate nutrition and a sedentary lifestyle
have contributed to many of the health problems experienced by Pacific
peoples.8
In view of the concern about poor health and housing
conditions faced by many Pacific families, questions examining housing problems
were included in the first assessment of the Pacific Islands Families: First Two
Years of Life (PIF) Study. The purpose of the present study was to examine
problems with dampness/mould and cold housing and any associations with
postnatal depression and asthma among mothers of the PIF cohort.
MethodsData were collected as part of
the PIF Study, a longitudinal investigation of a cohort of 1398 infants born at
Middlemore Hospital, South Auckland, during the year
2000. Middlemore Hospital has the
largest number of Pacific births in New Zealand and its patient population is
representative of the major Pacific ethnicities. All potential child
participants were selected from live births at Middlemore Hospital where the
child had at least one parent who identified as being of a Pacific Island
ethnicity and also a New Zealand permanent resident. All procedures and
interview protocols had ethical approval from the National Ethics
Committee.
Approximately six weeks after the birth of their child, the mothers were visited in their homes by Pacific interviewers, fluent in both English and a Pacific language. Once eligibility criteria were confirmed and informed consent was gained, mothers participated in one-hour interviews concerning the health and development of the child and family functioning. These interviews were carried out in the preferred language of the mothers. Detailed information about the cohort and procedures is described elsewhere.9 As part of the interview protocol, mothers were asked to what extent (‘not at all’, ‘to some extent’, ‘a great deal’) their homes had problems with dampness/mould and cold. Postnatal depression was assessed with the Edinburgh Postnatal Depression Scale (EPDS), a self-report instrument for which a score above 12 is widely used to indicate probable depressive disorder.10 The reliability coefficient of the EPDS for biological mothers in the PIF Study was 0.86. Mothers were also asked whether they had any of a range of health problems, including asthma that had been diagnosed by a doctor or for which the mother was currently taking medications. Maternal and socio-demographic factors expected to influence reports of dampness/mould and cold housing problems, and relationships between these problems and depression and asthma, were assessed by univariate and multivariate logistic regression procedures. ResultsThe cohort was made up of 87.1% of
all eligible Pacific births that occurred in the period from 15 March to 17
December 2000. Of the 1376 mothers of the cohort (1.7% gave birth to twins),
47.2% self-identified their major ethnic group as Samoan, 21% as Tongan, 16.9%
as Cook Islands Maori, 4.3% as Niuean, 3.4% as Other Pacific (includes mothers
identifying equally with two or more Pacific groups, equally with Pacific and
non-Pacific groups, or with Pacific groups other than Samoan, Tongan, Cook
Island or Niuean), and 7.2% as non-Pacific. The mean (SD) age of mothers was 27
(6.2) years; 80.5% were married or in de facto partnerships; 33% were New
Zealand-born; and 27.4% had post-school qualifications.
Problems with housing dampness or mould were reported by 509
(37%) and problems with cold housing by 740 (53.8%) mothers. Since only 376
(27.4%) mothers who reported dampness/mould to be a problem also reported that
their homes were cold, the two problems were treated separately in
analyses.
Table 1 lists variables examined for potential association
with dampness/mould problems. For the categories within each variable the
numbers and percentages of mothers who reported dampness/mould problems are
shown, along with their respective univariate odds ratio (95% CI).
Table 1. Numbers and univariate odds ratios (OR) of
problems with dampness in the home by selected variables
*includes mothers identifying equally with two or more
Pacific Island groups, equally with Pacific Island and non Pacific Island
groups, or with Pacific Island groups other than Tongan, Samoan, Cook Island
Maori or Niuean
†p <0.05; ‡p <0.001; §p <0.01 NB: For some variables total participant numbers may be lower than 509 due to missing data. To adjust for potential confounding effects all variables in
Table 1 were simultaneously entered into a multiple logistic regression model.
When controlling for the effects of all other variables, factors that were
significantly associated with housing dampness or mould problems (p <0.05)
were Niuean, Tongan, and non-Pacific ethnicity, a household size of eight or
more people, state rental housing, and financial difficulty with housing
costs.
Table 2 lists variables examined for potential association
with cold housing.
Table 2. Numbers and univariate odds ratios (OR) of
problems with cold in the home by selected variables
*includes mothers identifying equally with two or more
Pacific Island groups, equally with Pacific Island and non Pacific Island
groups, or with Pacific Island groups other than Tongan, Samoan, Cook Island
Maori or Niuean
†p <0.05; ‡p <0.01; §p <0.001 NB: For some variables total participant numbers may be lower than 740 due to missing data. To adjust for potential confounding effects all variables in
Table 2 were entered simultaneously into a multiple logistic regression model.
When controlling for the effects of all other variables, factors that were
significantly associated with cold housing (p <0.05) were mother’s age
being between 20 and 29 years, a household size of eight or more people, rental
housing (state or private), and reporting great financial difficulty with
housing costs. The odds of reporting problems with cold housing were
significantly reduced for Cook Islands mothers compared with Samoan mothers;
mothers with post-school qualifications compared with mothers with no formal
qualifications; mothers fluent in English; and mothers who, relative to others
in the study, demonstrated lower levels of alignment with both New Zealand and
their Pacific cultures.11
Ninety nine mothers (7.2%) reported having asthma and 16.3%
were identified by the EPDS as being probable cases of depression. In
multivariate analyses that controlled for maternal age, ethnicity, education,
marital status, birthplace, number of years lived in New Zealand, and household
income, damp/mouldy housing was significantly associated (p <0.01) with
maternal asthma (adjusted OR = 1.82; 95% CI = 1.18–2.83), and probable
depression (p <0.05; adjusted OR = 1.40; 95% CI = 1.02–1.91). Cold
housing was also significantly associated (p = 0.02) with asthma (adjusted OR =
1.73; 95% CI = 1.10–2.71) and probable depression (p <0.01; adjusted OR
= 1.57; 95% CI = 1.14–2.15).
DiscussionThirty seven per cent of mothers
reported that their homes were damp. While this figure is in line with
international findings that show dampness rates varying from 30–37% in
Canada and Great Britain,1,12 to 60% in
Taiwan,13 it is elevated compared with the 26%
dampness rate reported by Auckland public housing applicants in another New
Zealand study.6 Cold housing, reported by 53.8%
of our mothers, also appears to be a significant problem. Cold and damp are
often related and it is possible that participants who report cold housing are
experiencing the combined effects of low temperature and high
humidity.2 While reliance on subjective
measures of housing problems used in this study could be criticised on the basis
of a lack of precision and an increased risk of reporting bias, several studies
have demonstrated that questionnaire methods are a good indicator of the
presence of housing problems and that respondents often underestimate the
existence of problems in their
homes.14,15
Several studies have linked damp/mouldy and cold housing
with respiratory
illness,1–5
with some studies demonstrating a dose-response relationship and more
severe asthma occurring as dampness levels
increased.15 Studies have also found
associations between poor housing conditions and mental
health.3,4
While the effects were small, significant links were found
in the present study between cold and damp housing and two facets of maternal
health. Multivariate analyses revealed that mothers who reported problems with
dampness/mould and cold were at greater risk of having asthma and of having
postnatal depression. As many Pacific people do not have a regular general
practitioner or use preventive medication,16
estimates of asthma in the PIF Study are likely to be conservative, especially
given that the measurement was based on diagnosis and medication rather than the
presence of symptoms.
The underlying mechanisms of how cold and damp housing
adversely affect health are not clear. Cold indoor temperatures encourage
condensation,17 and it is known that viruses,
bacteria, fungi and dust mites tend to flourish in damp
conditions.18–20 An allergic reaction to
fungi or dust mites is believed to be the most likely mechanism for triggering
respiratory symptoms, although toxic mechanisms might also play a
part.21,22 Allergen exposure, while associated
with asthma, may not have an aetiological role in the development of
asthma.23
Concerns about the ill effects of damp conditions on the
health of household members, a reluctance to host guests to a damp and mouldy
home, and the financial burden of property damage may explain emotional
distress.3 However, it is also possible that
depressed mothers may be more inclined to report housing problems.
In multivariate analyses, five factors were associated with
damp/mouldy housing problems and eight with cold housing. If knowledge of risk
factors are to be used to inform prevention efforts, attention should be
directed to factors that are amenable to change. In this regard, reducing
household size, improving standards of state rental housing and providing
high-risk groups with information to minimise dampness and cold housing should
be of priority for housing and health agencies working with Pacific
families. Factors that are not amenable to
change, such as age and ethnicity, can be used to target specific
groups.
A number of authors suggest that a reduction in dampness in
the home, such as with the provision of good home heating, would help alleviate
symptoms of poor health.4,15,24 Others advocate
increased ventilation, use of dehumidifiers or air
conditioning,25 extraction fans, and good
insulation to minimise accumulation of
moisture.26 Specific measures to reduce mould
growth and concentrations of house dust mites may also be beneficial,
particularly for asthma sufferers. Some solutions are fairly simple while
procedures such as installation of insulation come at considerable
expense.
As it has been suggested that few New Zealand homes are
heated to the recommended temperature range,27
further research is required to ascertain whether cold and damp housing problems
are more endemic among Pacific peoples and the Auckland region or more
widespread across New Zealand households. Meanwhile, it is essential to initiate
strategies to prevent respiratory disease, as it imposes a high social burden
and cost on society.19
Author information:
Sarnia Butler, Research Fellow, Pacific Islands Families: First Two Years
of Life Study; Maynard Williams, Senior Research Fellow and Statistician,
Faculty of Health Studies, Auckland University of Technology; Colin Tukuitonga,
Pacific Health Research Centre, Department of Maori & Pacific Island Health,
University of Auckland, and Co-Director, Pacific Islands Families: First Two
Years of Life Study, Auckland University of Technology; Janis Paterson,
Co-Director, Pacific Islands Families: First Two Years of Life Study, Auckland
University of Technology, Auckland.
Acknowledgements:The
Pacific Islands Families Study is
supported by grants awarded from the Foundation for Science, Research and
Technology, the Health Research Council of New Zealand and the Maurice and
Phyllis Paykel Trust. We thank the families who participated in the Study, the
Pacific Peoples Advisory Board, and other members of the PIF research
team.
Correspondence:
Sarnia Butler, Faculty of Health Studies, Auckland University of Technology,
Private Bag 92006, Auckland. Fax: (09) 917 9877. email: sarnia.butler@aut.ac.nz
References:
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