Housing Improvements, Housing Relocation and Smoking Behaviours ASH Scotland & Scottish Tobacco Control Alliance Research Group 20 th September 2013

Research objectives To investigate how regeneration and housing investment affect individual and household health and wellbeing. To assess the degree to which places are transformed by policy interventions. To understand the processes that support cohesive, sustainable communities. To monitor the effects of interventions on area- based inequalities within the city. To develop and test research methods.

The Interventions Neighbourhood Transformation (Demolition &/or Renewal): in regeneration areas; in other areas? Relocation: from regeneration areas. (+ community level) Dwelling Type Change: high-rise to low-rise; existing to improved or new dwellings. Housing Improvements: external; security; warmth/energy efficiency; internal. (+community level) Tenure Mixing. Social Regeneration: interventions on human, economic, & social capital within communities. Tenant & Community Empowerment: housing; regeneration; public services.

Outcomes Residential Outcomes: housing & neighbourhood satisfaction; psychosocial benefits of home & neighbourhood; area reputation. Social & Community Outcomes: sense of community; cohesion; social networks and social support. Health & Human Capital Outcomes: physical health; health behaviours; mental wellbeing; training & skills. Empowerment Outcomes: individual (housing; household aspirations; employment objectives); collective (planning/regeneration; services).

Pathways to Outcomes Environmental Pathways: risk reduction; stress reduction; opportunity enhancement Social Pathways: cohesion; interaction & support. Psychosocial Pathways: safety and trust; control; status. Empowerment Pathways: influence; pro-activity; service responsiveness.

GoWell Study Area Types

Study components Community survey Outmovers survey Qualitative research Ecological analysis Economic evaluation

Timeline

Levels of Smoking & Drinking, 2006

Housing Improvements and Smoking Behaviours Researchers: Lyndal Bond, Ade Kearns, Julie Clark, Matt Egan and Carol Tannahill

Glasgow Housing Improvements Programme Stock transfer in 2003: 80,000 dwellings. Social housing stock has to meet Scottish Housing Quality Standard by Glasgow Housing Association Programme: –£1.2 billion on housing improvements by –By 2010 GHA had delivered: 28,000 homes over-clad; 26,000 re-roofed; 47,000 secured-by-design doors. 40,000 central heating systems; 36,000 kitchens; 35,000 bathrooms; 11,000 new windows;

Housing Improvements in Riddrie, 2007

Birness Drive – Before and after

The Background Large reduction in smoking reported by Blackman et al in a study of Scotswood, Newcastle. Calls for the incorporation of environmental factors and ‘life events’ into behaviour change theories.

GoWell Wave 1_2 Study 1,062 longitudinal cases, % reported having housing improvements in the interim period. Does HI lead to reductions in smoking or intention to quit smoking? If so, could this be explained by improvements in mental health or reductions in stress?

Findings on Smoking No reduction in rate of smoking associated with having a Housing Improvement. –Smoking rate was lower (-10%) among the HI group at baseline and remained so over time.

Findings on Intention to Quit No significant difference in I2Q rate at baseline, but at follow-up, I2Q rate was higher (+16%) among those who reported a Housing Improvement. Taking prior intentions and socio- demographic factors into account, those who had a Housing Improvement were twice as likely (OR 2.16) as others to have an Intention to Quit Smoking at follow up.

Role of Mental Health? Those who had visited a doctor for anxiety or depression at follow-up (OR 3.99), and those who reported stress symptoms which were improving at follow-up (OR 6.59) were both more likely to have an I2Q at follow-up. But these mental health measures were not associated with having had a Housing Improvement, so mental health does not seem to be the pathway from HI to I2Q.

Housing Improvements and ‘Points of Transition’ An improved house might constitute what others have called a situation of ‘motivational tension’, or a ‘point of transition’. At that point, a small ‘trigger’ might lead to behavioural adjustment among those on the ‘cusp of change’. (West and Sohal 2006)

What is the Mechanism? Behavioural Change Theories: Self Efficacy Environmental Opportunity Reasoned Action

Holistic Improvement Programmes Acting on the interface between residential change and health behaviours change. Should counselling and support for smokers be provided as part of a housing improvement programme? Could this be extended to other behaviours, such as diet, exercise and drinking?

Next Steps (2013/14) Researchers: Angela Curl & Ade Kearns Using our W1-W2-W3 longitudinal data, approx. 1,100 cases between each pair of survey waves. Matching in GHA records on works carried out to properties: types of works & dates. Looking at relationships between specific improvements and changes in: –physical health, –mental health and wellbeing –health behaviours.

Investigating pathways: –Reduction in stressors –Environmental opportunity / impacts –Psychosocial factors, including status, control –Empowerment Improvements to different dwelling types. The moderating effects of time intervals on any effects.

References Bond,L., Egan,M., Kearns,A., Clark,J. and Tannahill,C. (2013) ‘Smoking and intention to quit in deprived areas of Glasgow: Is it related to housing improvements and neighbourhood regeneration because of improved mental health?’, Journal of Epidemiology & Community Health, doi: /jech Clark,J. and Kearns,A. (2012) ‘Housing improvements, housing quality and psychosocial benefits from the home, Housing Studies, 27:8. DOI: /

Housing Relocation and Smoking Behaviours Researchers: Ade Kearns, Phil Mason

Demolition & Relocation Programme Up to 20,000 dwellings to be demolished A lot of this takes place in 8 Transformation Regeneration Areas. 86% are occupied & occupants relocated. People don’t move very far: four-fifths move up to 2km. The vast majority move to improved or newly built dwellings.

27 Red Road / Barmulloch Sighthill Shawbridge Maryhill Laurieston Gallowgate East Govan / Ibrox North Toryglen Transformational Regeneration Areas Reproduced from the Ordnance Survey mapping with the permission of Her Majesty’s Stationary Office, Crown Copyright. Unauthorised reproduction infringes Crown Copyright and may lead to prosecution or civil proceedings. Glasgow Housing Association,

Relocation & Behavioural Change? Desire to make changes to one’s life after moving home (getting a job; doing a course; changing behaviours). Moving away from the stressor of antisocial behaviour. Not wishing to smoke inside the new home…But… They are moving into areas with higher rates of smoking and drinking.

Outmovers vs Remainers 2008 More Outmovers smoked than Remainers (58% vs 35%) – partly a compositional effect. But more Outmover smokers said that they smoked less than two years previously (30% vs 19%). Around half of both groups of smokers said they Intended to Quit at some point in the future. But more Outmovers said they intended to do this in the next year (49% vs 32%). Will they do so without support?

Three-Way Comparison, 2011 Outmovers: from Regeneration Areas in the period. Remainers: in Regeneration Areas Non-Movers: in Other Areas, who had not had their houses improved in the intervening period.

Events Pathways Outcomes Environmental: risks; opportunities. Smoking: changed behaviour Relocation Social/Stress: changed social network; asb. Drinking: changed behaviour Other Life Events: positive and negative Psychosocial: sense of progress; status; time for change. Diet: main meals; snacking. Empowerment: perceived influence; self-efficacy. Physical activity: nhd walking; total activity. Relocation and Health Behaviours

GoWell is a collaborative partnership between the Glasgow Centre for Population Health, the University of Glasgow and the MRC/CSO Social and Public Health Sciences Unit, sponsored by Glasgow Housing Association, the Scottish Government, NHS Health Scotland and NHS Greater Glasgow & Clyde. Glasgow Community Health and Well-being Research and Learning Programme: Investigating the Processes and Impacts of Neighbourhood Change