Megan Sandel1, Richard Sheward2, Stephanie Ettinger de Cuba3, Sharon Coleman4, Timothy Heeren5, Maureen M Black6, Patrick H Casey7, Mariana Chilton8, John Cook2, Diana Becker Cutts9, Ruth Rose-Jacobs2, Deborah A Frank2. 1. Department of Pediatrics, Boston Medical Center, Boston, Massachusetts; megan.sandel@bmc.org. 2. Department of Pediatrics, Boston Medical Center, Boston, Massachusetts. 3. School of Medicine, Boston University, Boston, Massachusetts. 4. Data Coordinating Center. 5. Department of Biostatistics, School of Public Health, and. 6. Department of Pediatrics, School of Medicine, University of Maryland, Baltimore, Maryland. 7. Department of Pediatrics, University of Arkansas for Medical Sciences, Little Rock, Arkansas. 8. Department of Health Management and Policy, Dornfife School of Public Health, Drexel University, Philadelphia, Pennsylvania; and. 9. Department of Pediatrics, Hennepin County Medical Center, Minneapolis, Minnesota.
Abstract
: media-1vid110.1542/5804912861001PEDS-VA_2017-4254Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear. METHODS: We interviewed 20 571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months. RESULTS: After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18-1.69), fair or poor child health (aOR 1.97; CI 1.58-2.47), and developmental delays (aOR 1.48; CI 1.16-1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76-1.18) or overweight status (aOR 1.07; CI 0.84-1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05-4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38-2.58). CONCLUSIONS: After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.
: media-1vid110.1542/5804912861001PEDS-VA_2017-4254Video Abstract OBJECTIVES: Prenatal homelessness is associated with elevated risks of adverse neonatal outcomes. How the timing and duration of homelessness during pregnancy and/or a child's early life relate to postnatal child health is unclear. METHODS: We interviewed 20 571 low-income caregivers of children <4 years old in urban pediatric clinics and/or emergency departments in 5 US cities. Categories of homelessness timing were prenatal, postnatal, both, or never; postnatal duration was >6 months or <6 months. RESULTS: After controlling for birth outcomes and other potential confounders, compared with never-homeless children, children who were homeless both pre- and postnatally were at the highest risk of the following: postneonatal hospitalizations (adjusted odds ratio [aOR] 1.41; confidence interval [CI] 1.18-1.69), fair or poor child health (aOR 1.97; CI 1.58-2.47), and developmental delays (aOR 1.48; CI 1.16-1.89). There was no significant association with risk of underweight (aOR 0.95; CI 0.76-1.18) or overweight status (aOR 1.07; CI 0.84-1.37). Children <1 year old with >6 months of homelessness versus those who were never homeless had high risks of fair or poor health (aOR 3.13; CI 2.05-4.79); children 1 to 4 years old who were homeless for >6 months were at risk for fair or poor health (aOR 1.89; CI 1.38-2.58). CONCLUSIONS: After controlling for birth outcomes, the stress of prenatal and postnatal homelessness was found to be associated with an increased risk of adverse pediatric health outcomes relative to those who were never homeless. Interventions to stabilize young families as quickly as possible in adequate and affordable housing may result in improved pediatric health outcomes.
Authors: Gary Adamkiewicz; Antonella Zanobetti; MyDzung T Chu; Stephanie Ettinger de Cuba; M Patricia Fabian; Kevin James Lane; Tamarra James-Todd; David R Williams; Brent A Coull; Fei Carnes; Marisa Massaro; Jonathan I Levy; Francine Laden; Megan Sandel Journal: J Expo Sci Environ Epidemiol Date: 2022-01-04 Impact factor: 6.371
Authors: Julie S McCrae; Jo Ann L Robinson; Angeline K Spain; Kaela Byers; Jennifer L Axelrod Journal: BMC Health Serv Res Date: 2021-01-19 Impact factor: 2.655
Authors: Jacopo Vanoli; Brent A Coull; Stephanie Ettinger de Cuba; Patricia M Fabian; Fei Carnes; Marisa A Massaro; Ana Poblacion; Rino Bellocco; Itai Kloog; Joel Schwartz; Francine Laden; Antonella Zanobetti Journal: Environ Epidemiol Date: 2021-12-16
Authors: Jongeun Rhee; M Patricia Fabian; Stephanie Ettinger de Cuba; Sharon Coleman; Megan Sandel; Kevin James Lane; Maayan Yitshak Sade; Jaime E Hart; Joel Schwartz; Itai Kloog; Francine Laden; Jonathan I Levy; Antonella Zanobetti Journal: Int J Environ Res Public Health Date: 2019-10-28 Impact factor: 3.390