Recent research on family income indicates that a lack of economic stability can affect healthy housing. Those with limited resources experience higher rates of inadequate and unstable housing many times forcing them to live in undesirable communities in which there can be several community-level health-related issues. One community-level health-related factor of concern has been the reemergence of Zika virus. Some research has indicated that a higher risk of catching Zika virus may exist in neighborhoods and areas with unhealthy housing. Therefore, this study sought to explore the existence of a relationship between rental housing and the Zika virus. Our findings indicated a significant correlation existed between renter occupied household units and the presence of Zika virus. This finding is notable as it indicates that renters have a higher chance of contracting Zika virus than non-renters. Future research should further examine the demographic and housing situation in other communities reporting cases of the Zika virus.Population Healt

Hill, Jack

Holt, Melinda

Kafle, Ram

Rathnasekara, Heranga

Scarbrough, Amanda

Diseases

Scholarly Works @ SHSU (Sam Houston State University)

diseasesArticleZika Virus and the Risk for Renter HouseholdsAmanda Scarbrough 1,*, Heranga Rathnasekara 2, Melinda Holt 2, Jack Hill 3 and Ram Kafle 21 Department of Population Health, Sam Houston State University, Huntsville, TX 77340, USA2 Department of Mathematics and Statistics, Sam Houston State University, Huntsville, TX 77340, USA;hkr009@shsu.edu (H.R.); MXM014@SHSU.EDU (M.H.); rck020@shsu.edu (R.K.)3 Office of Research and Sponsored Programs, Sam Houston State University, Huntsville, TX 77340, USA;jmh050@SHSU.EDU* Correspondence: aes060@shsu.edu; Tel.: +1-936-294-1168Received: 8 March 2018; Accepted: 11 May 2018; Published: 15 May 2018Abstract: Recent research on family income indicates that a lack of economic stability can affecthealthy housing. Those with limited resources experience higher rates of inadequate and unstablehousing many times forcing them to live in undesirable communities in which there can be severalcommunity-level health-related issues. One community-level health-related factor of concern hasbeen the reemergence of Zika virus. Some research has indicated that a higher risk of catching Zikavirus may exist in neighborhoods and areas with unhealthy housing. Therefore, this study soughtto explore the existence of a relationship between rental housing and the Zika virus. Our findingsindicated a significant correlation existed between renter occupied household units and the presenceof Zika virus. This finding is notable as it indicates that renters have a higher chance of contractingZika virus than non-renters. Future research should further examine the demographic and housingsituation in other communities reporting cases of the Zika virus.Keywords: social determinants of health; Zika virus; renters1. IntroductionSocial determinants of health have a significant impact on the heath of individuals [1,2]. Theenvironments in which people are born, live, learn, work, play, worship, and age affect a wide range ofhealth, functioning, and quality-of-life outcomes and risks [1]. According to Healthy People 2020 fivekey determinants of health exist: education, social and community context, health and health care,neighborhood, and built environment and economic stability [3].Recent research on economic stability indicates that, generally, higher income is linked to betterhealth. The greater a person’s income is, the lower that person’s likelihood of disease and prematuredeath [4]. For example, poor adults are almost five times as likely to report being in fair or poor healthas adults with family incomes at or above 400 percent of the federal poverty level [5]. Low-incomeAmerican adults have higher rates of heart disease, diabetes, stroke, and other chronic disorders thanwealthier Americans [6].In addition to negatively influencing physical health, a lack of economic stability can affect healthyhousing. A healthy home is sited, designed, built, renovated, and maintained to support health [7].Those with limited resources experience higher rates of inadequate and unstable housing. A lackof economic stability can preclude individuals from being able to afford to live in healthier, moredesirable areas leading them to struggle with the challenges related to a variety of community-levelhealth-related factors [6].One community-level health-related factor of concern has been the reemergence of Zika virus.Zika is a virus spread through the bite of the as Ae. aegypti and Ae. albopictus mosquito, sex and from aDiseases 2018, 6, 37; doi:10.3390/diseases6020037 www.mdpi.com/journal/diseasesDiseases 2018, 6, 37 2 of 6pregnant woman to the fetus and can cause fever, rash, headache, joint pain, red eyes, muscle pain andmicrocephaly in unborn children [8].Some research has indicated that a higher risk of catching Zika virus may exist in neighborhoodsand areas with unhealthy housing [9]. Therefore, this study sought to explore the existence of arelationship between housing and the Zika virus. This analysis was exempt from Institutional ReviewBoard (IRB) approval because it utilized existing data that were publically available and in which thesubjects could not be identified.2. Methods2.1. SampleCameron County, Texas sits on the border between the US and Mexico (see Figure 1). As of thecensus of 2010, there were 406,220 people, 119,631 households, and 96,579 families residing in thecounty. The racial makeup of the county was 87.0% White, 0.5% Black or African American, 0.4%Native American, 0.7% Asian, 0.03% Pacific Islander, 9.8% from other races, and 1.5% from two or moreraces. 88.1% of the population were Hispanic or Latino of any race. There were 119,631 householdsout of which 50.3% had children under the age of 18 living with them. The average household sizewas 3.36 and the average family size was 3.80. The population was 33.0% under the age of 18, 9.7%from 18 to 24, 25.6% from 25 to 44, 20.6% from 45 to 64, and 11.10% who were 65 years of age or older.The median income for a household in the county was $31,264, and the median income for a familywas $33,770. Approximately, 30.0% of families and 34.7% of the population were below the povertyline [10].Diseases 2018, 6, x 2 of 5  So e research has indicated that a higher risk of catching Zika virus ay exist in neighborhoods and areas with unhealthy housing [9]. Therefore, this study sought to explore the existence of a relationship between housing and the Zika virus. This analysis was exe pt fro  Institutional Review Board (IRB) approval because it utilized existing data that were publically available and in which the subjects could not be identified.   . . a le r  t , s sits  t  r r t  t    ic  (s  i r  ). s f t  c s s f , t r  r  ,  l , ,  s l s,  ,  f ili s r si i  i  t  c t .  r ci l  f t  c t  s .  it , .  l c  r fric  ric , .  ti  erican, 0.7% Asian, .03% Pacific Islander, 9.8% from other races, and 1.5% from two or more races. 88.1% of the population were Hisp nic or Latino of any rac . There were 119,631 households out of which 50.3% ha  children under the age of 18 living with th m. Th  averag  household size w s 3.36 and the average family size was 3.80. The population was 33.0% under the age of 18, 9.7% from 18 to 4, 25.6% from 25 to 4, 20.6% from 45 to 64, and 11.10% who wer  65 years of age or older. The medi n income for a household in the county was $31,264, and the dian income for a family was $33,770. Approximately, 30.0% of families and 34.7% of the populati n w re below the poverty line [10].  Figure 1. Zika by ZIP Code, Cameron County, Tx (2016–2017). According to the Cameron County Department of Health and Human Services, there were 5227 Zika virus cases in United States and 329 Zika virus cases in Texas including 32 Zika virus cases in Cameron County in 2016 and 2017 (until 1 April 2017). These 32 Zika virus cases were reported from six of the 22 Zip codes. Accordingly, the 16 Zip codes in Cameron County including these 6 Zip Codes in which Zika virus occurred was selected as the sample (The information was available only for 16 Figure 1. Zika by ZIP Code, Cameron County, Tx (2016–2017).According to the Cameron County Department of Health and Human Services, there were 5227Zika virus cases in United States and 329 Zika virus cases in Texas including 32 Zika virus cases inDiseases 2018, 6, 37 3 of 6Cameron County in 2016 and 2017 (until 1 April 2017). These 32 Zika virus cases were reported fromsix of the 22 Zip codes. Accordingly, the 16 Zip codes in Cameron County including these 6 Zip Codesin which Zika virus occurred was selected as the sample (The information was available only for 16 ZipCodes). Table 1 lists the Zip code name with the corresponding count of Zika virus cases (see Table 1).Table 1. Zika virus Count in 16 Zip Code in Cameron County.Zip Code 78520 78521 78526 78535 78550 78552 78559 78566Zika Virus Count 12 12 0 0 2 0 2 2Zip Code 78567 78575 78578 78583 78586 78592 78593 78597Zika Virus Count 0 0 0 0 2 0 0 02.2. Data CollectionData regarding Zika virus occurrences in Cameron County were acquired from CameronCounty Department of Health and Human Services. Demographic and socioeconomic informationwas collected using data from the Environmental Systems Research Institute (ESRI), CommunityAnalyst and the US Census. Eight demographic and socioeconomic variables were gathered as theindependent variables.2.3. Dependent VariableThe number of Zika virus cases in Cameron County was gathered to identify the possibilities toeither prevent or reduce to the spread of Zika virus across the area.2.4. Independent VariablesThe independent variables were: the Hispanic Population Percentage, (Hispanic refers to a personof Cuban, Mexican, Puerto Rican, South or Central American), the Vulnerable People’s Age Percentage(The percentage of people who are less than age 9 and more than age 65), Renter Occupied HousingUnits Percentage, (Renter Occupied refers to a housing unit wherein the dweller pays to live in ahousing unit owned by someone else), Vacant Housing Units Percentage, Median Disposable Incomeper Household, (Median Disposable Income refers to the amount of funds a household has afterspending for bills), Average Household Size, Average Money Available per Person per Householdand Higher Education Percentage (The percentage of the people who has at least a bachelor’s degree,graduate/professional degree or an associate degree) in each selected Zip code in Cameron County.3. ResultsData were analyzed using Version 23 of the IBM Statistical Package for the Social Sciences (SPSS).Pearson Correlation was used to test for bivariate correlation between the Zika virus count and all theother eight independent variables. Then an independent t-test was performed for the variables whichwere selected as statistically significant from the bivariate correlation. Moreover, the Levene’s Test forequal variance and normality test were performed in order to test for the assumptions in independentT test. Finally, the Mann Whitney’s test was conducted to identify which independent variable(s) has arelationship with the Zika virus case occurrence.In the sample, on average 81.6% of the population were Hispanic and 15.25% were in vulnerableage. With respect to housing, 20.66% of the Housing Units were Renter Occupied and 19.96% wereVacant Housing Units. Median Disposable Income per Household had a roughly even spread with42.73% reporting an income of less than $30,000. Average Household Size was 3.3 and Average MoneyAvailable per Person per Household was $10,832. With respect to education, 24% of the people whowere more than 18 years of age had at least a bachelor’s degree, graduate/professional degree or anassociate degree.Diseases 2018, 6, 37 4 of 6There was a correlation between Renter Occupied Household Units and Vacant Housing Units(r = −0.498, p = 0.049). None of the other independent variables were correlated with Renter OccupiedHousehold Units. All the other independent variables were correlated with Vacant Housing Units;Vacant Housing Units and Hispanic Population (r = −0.952, p = 0.000), Vacancy Housing Units andVulnerable People’s Age (r = 0.753, p = 0.001), Vacant Housing Units and Median Disposable Incomeper Household (r = 0.748, p = 0.001), Vacant Housing Units and Average Household Size (r = −0.823,p = 0.000), Vacant Housing Units and Average Money Available per Person (r = 0.898, p = 0.000) andVacant Housing Units and Higher Education Percentage (r = 0.5787, p = 0.000) (see Table 2).Table 2. Ranks.Zika Present N Mean Rank Sum of RanksRenter Occupied0 10 6.10 61.001 6 12.50 75.00Total 16Hence, Renter Occupied Housing Units was selected as the independent variable. Mean renteroccupancy was higher for the Zika virus present “Yes” group (M = 0.292, SD = 0.100) than Zika present“No” group (M = 0.156, SD = 0.059), t(14) = 3.426, p = 0.009. Levene’s Test indicated unequal variances(F = 10.782, p = 0.005). The data ware not normally distributed.The Mann-Whitney Test indicated that mean renter occupancy of the Zika virus present “Yes”group was significantly greater than the Zika virus present “No” group. (U = 6, p = 0.008) (see Table 3).Table 3. Mann-Whitney Test Statistics.Renter OccupiedMann-Whitney U 6.000Wilcoxon W 61.000Z −2.652Asymp. Sig. (2-tailed) 0.008Exact Sig. (2-tailed) 0.007 aa Exact Significance is not corrected for ties.4. DiscussionUsing the Social Determinants of Health as a framework, we sought to explore the potentialexistence of a relationship between housing and Zika virus. Our findings indicated a significantcorrelation existed between renter occupied household units and the presence of Zika virus. Thisfinding is notable as it indicates that renters have a higher chance of contracting Zika virusthan non-renters.Exploring why renters have a higher chance of contracting Zika virus is essential to public healthefforts. Specifically, understanding the demographics of renters will enable us to make progresstowards prevention. We believe that one of the most significant characteristics of renter demographicsto consider is income. According to the Joint Center for Houston of Harvard University, renters arebecoming increasingly concentrated at the lowest income levels. By 2010, approximately 70% of renterhouseholds had incomes below the national median and more than 40% had incomes in the bottomquartile [11]. Furthermore, the National Multi Family Housing Council reported that 51% of rentershad a household income less than $34,999 per year [12].Income-related constraints result in several notable challenges. Families and individuals withtight budgets may experience financial barriers to moving to a better housing [10]. Because theycannot afford to move, they may be forced to live in rental units with substandard or unhealthyDiseases 2018, 6, 37 5 of 6conditions, such as housing without air-conditioning, window screens or proper insulation. Suchhousing conditions provide the perfect opportunity for airborne vectors, such as Ae. aegypti and Ae.albopictus (the mosquitoes responsible for the spread of the Zika virus) to enter living units.In addition to the housing itself, the neighborhoods in which affordable housing is available mayexperience community-level health-related circumstances that contribute to the spread of the Zikavirus and other communicable diseases spread by the Ae. aegypti and Ae. albopictus, in particularDengue, Chikungunya and yellow fever. Insufficient sanitation such as inadequate trash collection orillegal dumping can contribute to the spread of the Zika virus by collecting rainwater and providinga breeding ground for mosquitoes. Therefore, the conditions of the neighborhood coupled with theconditions of affordable housing leaves renters vulnerable to conditions that are prime for the spreadof Zika and other communicable diseases [6,13,14].5. LimitationsResults of this study are limited due to the small sample size. Future research should examine thedemographic and housing situation in other communities reporting cases of the Zika virus.Author Contributions: A.S. and J.H. conceived the idea for this research. A.S. collected the data, analyzed theresults and drafted the first manuscript. M.H., H.R. and R.K. completed the data analysis and completed themethods section. J.H. completed the map. All authors reviewed and participated in the revision of the article.Conflicts of Interest: The authors declare no conflict of interest.References1. Lachance, L.; Kelly, R.P.; Wilkin, M.; Burke, J.; Waddell, S. Community-Based Efforts to Prevent and ManageDiabetes in Women Living in Vulnerable Communities. J. Community Health 2017. [CrossRef] [PubMed]2. World Health Organization. Available online: http://www.who.int/hia/evidence/doh/en/ (accessed on 5February 2018).3. Healthy People. Available online: https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health (accessed on 5 February 2018).4. National Center for Health Statistics. Health, United States, 2011: With Special Feature on SocioeconomicStatus and Health. Available online: http://www.cdc.gov/nchs/data/hus/hus11.pdf (accessed on 5February 2018).5. Braveman, P.; Egerter, S. Overcoming Obstacles to Health: Report from the Robert Wood Johnson Foundationto the Commission to Build a Healthier America. Available online: http://www.commissiononhealth.org/PDF/ObstaclesToHealth-Report.pdf (accessed on 5 February 2018).6. Urban Institute. Available online: https://www.urban.org/sites/default/files/publication/49116/2000178-How-are-Income-and-Wealth-Linked-to-Health-and-Longevity.pdf (accessed on 5 February 2018).7. Centers for Disease Control and Prevention. Available online: https://www.cdc.gov/healthyhomes/(accessed on 5 February 2018).8. Center for Disease Control and Prevention. Available online: https://www.cdc.gov/zika/about/overview.html (accessed on 3 May 2018).9. National Public Radio. Available online: https://www.npr.org/sections/goatsandsoda/2016/06/16/482345540/is-the-risk-of-catching-zika-greater-in-poor-neighborhoods (accessed on 5 February 2018).10. United States Census Bureau. Available online: https://factfinder.census.gov/faces/nav/jsf/pages/community_facts.xhtml (accessed on 8 February 2018).11. Joint Center for Housing Studies of Harvard University. Available online: http://www.jchs.harvard.edu/sites/jchs.harvard.edu/files/ahr2011-3-demographics.pdf (accessed on 5 February 2018).12. National Multifamily Housing Council. Available online: http://www.nmhc.org/Content.aspx?id=4708(accessed on 5 February 2018).13. The World Post. Available online: https://www.huffingtonpost.com/jonathan-patz/preventing-the-spread-of-zika-poverty_b_9800024.html (accessed on 5 February 2018).Diseases 2018, 6, 37 6 of 614. USA Today. Available online: https://www.usatoday.com/story/news/2016/06/30/zika-could-hit-people-poverty-hardest/86358782/ (accessed on 5 February 2018).© 2018 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open accessarticle distributed under the terms and conditions of the Creative Commons Attribution(CC BY) license (http://creativecommons.org/licenses/by/4.0/).

Zika Virus and the Risk for Renter Households

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Zika Virus and the Risk for Renter Households

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