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Little is known in Aotearoa New Zealand about experiences of homelessness amongst Takatāpui/LGBTIQ+ identifying people, despite growing international literature regarding LGBTIQ+ homelessness. Using data from semi-structured interviews with eight people who identified as Takatāpui/LGBTIQ+ and had experienced homelessness, this paper explores their experiences prior to becoming homeless. These experiences are placed into the categories of: the pervasiveness of instability (especially in regards to family relationships, finances, and housing), having to grow up fast due to social and material conditions, experiences of looking for housing in stressed markets, and systems failures that resulted in a lack of autonomy. These results show that instability and systems failures are key contributors to Takatāpui/LGBTIQ+ people becoming homeless in Aotearoa New Zealand.

Housing is poorly constructed for the New Zealand climate and is a major cause of poor health and premature mortality. Private rental housing is older and in poorer condition than public housing and owner-occupied housing. This special issue describes four different approaches to improving housing, which have implications for international housing, health, and well-being policies. The first approach looks at generating the evidence base for improving the quality of the rental sector; the second, the aftereffects of the Christchurch earthquake and the unprecedented role taken by the central government to override local government and community involvement in rebuilding housing and regenerating the city; the third, measuring the effectiveness of the remediation of public housing; and finally, community-based partnerships between community workers and academics to improve the housing of children who have been hospitalized for housing-sensitive hospitalizations.

Despite the considerable injury burden attributable to falls at home among the general population, few effective safety interventions have been identified. We tested the safety benefits of home modifications, including handrails for outside steps and internal stairs, grab rails for bathrooms, outside lighting, edging for outside steps, and slip-resistant surfacing for outside areas such as decks and porches. We did a single-blind, cluster-randomised controlled trial of households from the Taranaki region of New Zealand. To be eligible, participants had to live in an owner-occupied dwelling constructed before 1980 and at least one member of every household had to be in receipt of state benefits or subsidies. We randomly assigned households by electronic coin toss to either immediate home modifications (treatment group) or a 3-year wait before modifications (control group). Household members in the treatment group could not be masked to their assigned status because modifications were made to their homes. The primary outcome was the rate of falls at home per person per year that needed medical treatment, which we derived from administrative data for insurance claims. Coders who were unaware of the random allocation analysed text descriptions of injuries and coded injuries as all falls and injuries most likely to be affected by the home modifications tested. To account for clustering at the household level, we analysed all injuries from falls at home per person-year with a negative binomial generalised linear model with generalised estimating equations. Analysis was by intention to treat. This trial is registered with the Australian New Zealand Clinical Trials Registry, number ACTRN12609000779279. Of 842 households recruited, 436 (n=950 individual occupants) were randomly assigned to the treatment group and 406 (n=898 occupants) were allocated to the control group. After a median observation period of 1148 days (IQR 1085–1263), the crude rate of fall injuries per person per year was 0·061 in the treatment group and 0·072 in the control group (relative rate 0·86, 95% CI 0·66–1·12). The crude rate of injuries specific to the intervention per person per year was 0·018 in the treatment group and 0·028 in the control group (0·66, 0·43–1·00). A 26% reduction in the rate of injuries caused by falls at home per year exposed to the intervention was estimated in people allocated to the treatment group compared with those assigned to the control group, after adjustment for age, previous falls, sex, and ethnic origin (relative rate 0·74, 95% CI 0·58–0·94). Injuries specific to the home-modification intervention were cut by 39% per year exposed (0·61, 0·41–0·91). Our findings suggest that low-cost home modifications and repairs can be a means to reduce injury in the general population. Further research is needed to identify the effectiveness of particular modifications from the package tested. Health Research Council of New Zealand.

Antibiotic treatment of Group A Streptococcus (GAS) pharyngitis is important in acute rheumatic fever (ARF) prevention, however clinical guidelines for prescription vary. GAS carriers with acute viral infections may receive antibiotics unnecessarily. This review assessed the prevalence of GAS pharyngitis and carriage in different settings. A random-effects meta-analysis was performed. Prevalence estimates for GAS+ve pharyngitis, serologically-confirmed GAS pharyngitis and asymptomatic pharyngeal carriage were generated. Findings were stratified by age group, recruitment method and country income level. Medline and EMBASE databases were searched for relevant literature published between 1 January 1946 and 7 April 2017. Studies reporting prevalence data on GAS+ve or serologically-confirmed GAS pharyngitis that stated participants exhibited symptoms of pharyngitis or upper respiratory tract infection (URTI) were included. Included studies reporting the prevalence of asymptomatic GAS carriage needed to state participants were asymptomatic. 285 eligible studies were identified. The prevalence of GAS+ve pharyngitis was 24.1% (95% CI: 22.6-25.6%) in clinical settings (which used 'passive recruitment' methods), but less in sore throat management programmes (which used 'active recruitment', 10.0%, 8.1-12.4%). GAS+ve pharyngitis was more prevalent in high-income countries (24.3%, 22.6-26.1%) compared with low/middle-income countries (17.6%, 14.9-20.7%). In clinical settings, approximately 10% of children swabbed with a sore throat have serologically-confirmed GAS pharyngitis, but this increases to around 50-60% when the child is GAS culture-positive. The prevalence of serologically-confirmed GAS pharyngitis was 10.3% (6.6-15.7%) in children from high-income countries and their asymptomatic GAS carriage prevalence was 10.5% (8.4-12.9%). A lower carriage prevalence was detected in children from low/middle income countries (5.9%, 4.3-8.1%). In active sore throat management programmes, if the prevalence of GAS detection approaches the asymptomatic carriage rate (around 6-11%), there may be little benefit from antibiotic treatment as the majority of culture-positive patients are likely carriers.

One of the key components of a grounded theory study is the creation of a theory grounded in the data collected. However, it is common to read articles that utilise grounded theory but do not present, nor mention the creation of, a resultant grounded theory despite it being a fundamental part of the method. In this State of the Methods paper, we explore this phenomenon, including in our own work, and provide a case study of a grounded theory that was created as part of a PhD on LGBTIQ + homelessness. We provide this as a resource for those new to grounded theory, who may be struggling with how to create and present a grounded theory. We end with a discussion on ways forward to ensure the rigour of grounded theory remains.

Background A robust evidence base is needed to develop sustainable cross-party solutions for public housing to promote well-being. The provision of public housing is politically contentious in New Zealand, as in many liberal democracies. Depending on the government, policies oscillate between encouraging sales of public housing stock and reducing investment and maintenance, and large-scale investment, provision, and regeneration of public housing. Aim We aimed to develop frameworks to evaluate the impact of public housing regeneration on tenant well-being at the apartment, complex, and community levels, and to inform future policies. Method Based on a systems approach and theory of change models, we developed a mixed methods quasi-experimental before-and-after outcomes evaluation frameworks, with control groups, for three public housing sites. This evaluation design had flexibility to accommodate real-world complexities, inherent in evaluating large-scale public health interventions, while maintaining scientific rigor to realize the full effects of interventions. Results Three evaluation frameworks for housing were developed. The evaluation at the apartment level confirmed proof of concept and viability of the framework and approach. This also showed that minor draught-stopping measures had a relatively big impact on indoor temperature and thermal comfort, which subsequently informed healthy housing standards. The complex and community-level evaluations are ongoing due to longer regeneration timeframes. Conclusion Public housing is one of central government’s larger social sector interventions, with Kāinga Ora – Homes and Communities the largest Crown entity. Evaluating public housing policies is important to develop an evidence base to inform best practice, rational, decision-making policy for the public as well as the private sector.

Insulating homes has been shown to provide health benefits, but benefits for home safety have not been studied. The current study analyses hospitalised falls rates, making use of a large New Zealand cohort initially set up to study health benefits. This cohort consists of just under half a million people (n = 469,666; 53.3% female; mean age 35.7), half in an intervention group (n = 236,040; 53.6% female; mean age 36.2) who had their homes retrofitted with insulation early in the study period and half in a control group (n = 233,626; 52.9% female; mean age 35.3) with homes retrofitted later. We found that retrofitting programme was associated with changes in fall rates that varied in a non-linear way with age. Cubic splines were used to estimate a non-linear but continuous relationship between age and changes in fall rates. Although other research has indicated that home insulation and heating have a positive influence on older people’s wellbeing and ability to live independently, the current analysis indicated a safety benefit only for under-70-year-olds, not for older people; the population-wide change in fall hospitalisation rates associated with the programme estimated was null. The study highlights the importance of considering the benefits of home improvements, particularly for older people, in a holistic way that encompasses wellbeing as well as health and safety outcomes.

Background Previous research has shown two-way associations between rental tenure, poorer housing quality, and health outcomes, but little research has looked at relative housing contributions to health outcomes. Aims We investigated whether tenure and/or dwelling condition were associated with housing-sensitive hospitalizations and whether any association differed by income. Method Using a data set of housing characteristics matched to hospitalization records, rental tenure data, and income quintiles, we modeled differences in housing-sensitive hospitalization rates by ecological-level tenure and housing condition, controlling for age-group and mean temperatures. Results There were clear associations between income, tenure, and house condition, and winter-associated hospitalization risk. In the adjusted model, the largest risk differences were associated with neighborhoods with low income (risk ratio [RR] = 1.48) and high rental tenure (RR = 1.41). There was a nonsignificant difference for housing condition (RR = 1.04). Discussion Rental tenure and poor housing condition were risks for housing-sensitive hospitalization, but the association with income was stronger. Higher income households may be better able to offset quality and tenure-related health risks. This research illustrates the inverse housing law: Those most vulnerable, with most need for good-quality housing, are least likely to have it. Income inequity is inbuilt in tenure, quality, and health burden relationships. Conclusion These findings suggest that measures to address health inequities should include improvements to both tenure security and housing quality, particularly in low-income areas. However, policymakers aiming to reduce overall hospitalization rates should focus their efforts on reducing fuel poverty and improving the affordability of quality housing.

Background: The association between good mental health and housing circumstances is well established. Tenure, household crowding and housing affordability have all been linked to mental health and psychological distress. These cross-sectional relationships are collinear and confounded, and so provide little information on the possible effects of changing housing circumstance on mental health or psychological distress. To do this longitudinal data are needed. Methods: In this paper we use the longitudinal data from the 11 500 NZ households in the Survey of Families, Income and Employment (SoFIE), conducted in New Zealand from 2002 to 2010. We examine the cross-sectional associations of housing factors on psychological distress and use fixed-effects modelling of longitudinal data to examine any effects of changes in selected housing factors on changes in psychological distress. Results: We show large significant cross-sectional associations between all the housing circumstances and psychological distress. These associations were not present in the fixed-effects models. Only changes in individual deprivation had a significant effect on changes in psychological distress. While a significant effect was found for moves to and from houses with a two-bedroom deficit, the small number of moves of this type means these results are not robust. Conclusions: These results show that the effect of house ownership and housing affordability on psychological distress is likely to be confounded in the cross-sectional models. Therefore, marginal changes to these housing factors are unlikely to yield large reductions in psychological distress. Our results suggest that reductions in psychological distress are more likely to be seen through interventions that target individual socioeconomic deprivation and severe household crowding.

Background Six thousand children are hospitalized each year in New Zealand with housing sensitive conditions, and 86.2% of these children are rehospitalized during childhood. The Healthy Homes Initiative, set up by the Ministry of Health, and implemented in Wellington through Well Homes, carries out housing assessments and delivers a range of housing interventions. Method Housing assessments were carried out by trained community workers. Philanthropic funding was received for the interventions through a local charitable trust. Results Well Homes saw 895 families. Mold in the home was the most commonly recorded area of poor housing quality, in 836 homes (93%). Partial or complete lack of insulation was also common, with 452 records (51%) having a documented need for further assessment and either an upgrade or full installation. Eighty-three percent of homes had insufficient sources of heating. A total of 5,537 interventions were delivered. Bedding, heaters, and draft stopping were delivered over 90% of the time. In contrast, insulation and carpets were only delivered 40% of the time. Interventions were least likely to be delivered in private rental housing. Discussion Targeted interventions using social partnerships can deliver housing improvements for relatively little health spending. Well Homes provides immediate and practical interventions, education, connection with social agencies, and advocacy for more substantial structural home improvements to help families keep their home warmer, drier, and healthier. This approach will be strengthened when combined with a new regulatory framework to raise the standards of private rental housing.