Respiratory Problems And Quality Of Life Among Individuals Living İn Containers Following The 2023 Kahramanmaraş Earthquake

Respiratory Problems And Quality Of Life Among Individuals Living İn Containers Following The 2023 Kahramanmaraş Earthquake | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Respiratory Problems And Quality Of Life Among Individuals Living İn Containers Following The 2023 Kahramanmaraş Earthquake AHMET UTUŞ, SEMİRAMİS ÖZYILMAZ, TALAT KILIÇ, MURAT KILIÇ, MUHAMMED FURKAN ARPACI, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8315853/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 12 You are reading this latest preprint version Abstract Background: The 2023 Kahramanmaraş earthquakes displaced hundreds of thousands of individuals across Türkiye, leading to prolonged residence in temporary container settlements. Although housing conditions are recognized as key determinants of health, limited research has evaluated the combined effects of long-term container living on respiratory function, muscle strength, fatigue, sleep quality, and overall quality of life. This study aimed to comprehensively assess these parameters in adults residing in container settlements in Malatya approximately 20 months after the earthquakes. Methods: This cross-sectional field study included 247 adults aged 25–55 years who had been living in container settlements for at least 12 months. Sociodemographic data, respiratory symptoms, fatigue, allergic reactions, and sleep quality were collected through structured interviews. Spirometry (FEV₁, FVC, FEV₁/FVC, predicted values) and handgrip strength were measured using standardized protocols. Physical activity and quality of life were assessed with the IPAQ-Short Form, PSQI, and SF-36. Between-group comparisons were conducted using t-tests, Mann–Whitney U, and chi-square tests. Correlations were evaluated using Pearson or Spearman methods. Results: Participants were predominantly women (69.2%) with a mean age of 44 ± 11.75 years and a mean BMI of 27.33 ± 4.55 kg/m². Dyspnea (mMRC ≥ 1) was present in 42.9% of participants, and 28% demonstrated poor sleep quality. Mean FEV₁/FVC was 80.84 ± 6.82%, while handgrip strength values were below normative expectations (right: 27.80 ± 12.33 kg; left: 27.06 ± 13.12 kg). Dyspnea showed significant negative correlations with spirometric indices and muscle strength, and positive correlation with fatigue. Women and unemployed individuals exhibited significantly lower handgrip strength, higher fatigue, and poorer spirometric ratios. Participants reporting allergic reactions demonstrated lower physical and psychosocial health scores. Conclusion: Adults residing in container settlements nearly two years after the earthquakes exhibited measurable impairments in respiratory function, muscle strength, sleep quality, and overall well-being. These findings highlight the persistent multidimensional health burden associated with long-term temporary housing. Strengthening environmental conditions and implementing respiratory, physical activity, and psychosocial rehabilitation programs may mitigate adverse outcomes in displaced populations. Earthquake survivors Temporary housing Container settlements Respiratory function Handgrip strength Sleep quality Disaster-related health outcomes INTRODUCTION Earthquakes, beyond generating large-scale physical destruction, are among the most devastating natural disasters that profoundly alter living conditions and shape long-term physical and psychosocial health outcomes [ 1 ]. In the aftermath of disasters, housing conditions represent a critical social determinant of health; the stability, quality, safety, and affordability of housing directly influence overall health trajectories [ 2 , 3 ]. Individuals experiencing housing instability exhibit higher rates of cardiometabolic diseases, respiratory problems, obesity, and diabetes, underscoring the multidimensional health burden associated with inadequate living environments [4–6]. Socioeconomic disadvantage, suboptimal housing quality, and environmental stressors often interact in cumulative and mutually reinforcing ways to worsen health outcomes [ 7 , 8 ]. Temporary housing arrangements established after large-scale disasters—particularly container settlements—introduce substantial environmental risks. Limited living space, inadequate ventilation, poor indoor air quality, exposure to chemical pollutants, and humidity or mold growth contribute significantly to respiratory and general health impairment among residents [ 9 , 10 ]. Elevated levels of formaldehyde detected in FEMA trailers following Hurricane Katrina, and their association with increased respiratory symptoms, highlight these environmental hazards [ 10 , 11 ]. Similarly, poor air quality, volatile organic compounds, and particulate matter pollution have been shown to negatively affect respiratory function among individuals living in temporary housing units [ 12 – 14 ]. Restricted physical space and reduced mobility further diminish muscle strength, physical performance, and quality of life [ 9 , 15 , 16 ]. The 6 February 2023 Kahramanmaraş earthquakes caused massive destruction across 11 provinces in Türkiye, resulting in hundreds of thousands of individuals relocating to temporary settlements. In Malatya, where thousands of residences became uninhabitable, tens of thousands of citizens have continued to reside in container settlements even 20 months after the disaster [ 17 ]. This prolonged displacement highlights the need to evaluate not only the structural adequacy of temporary housing but also its effects on respiratory health, physical capacity, sleep quality, and overall well-being. The existing literature predominantly focuses on psychological outcomes—such as post-traumatic stress—while studies jointly examining respiratory function, muscle strength, physical activity, sleep quality, and quality of life remain scarce [18–21]. The causal pathways linking housing insecurity and health are complex, involving environmental, socioeconomic, physical, and psychological determinants [ 20 , 22 , 23 ]. Substandard housing conditions have been linked to increased respiratory diseases, asthma exacerbations, infection risk, and sleep disturbances, particularly among children but also adults [ 24 – 26 ]. Given these gaps, assessing the health impacts of container living through objective physiological measurements and validated instruments is essential. Spirometry for respiratory function, handgrip dynamometry for muscle strength, and standardized scales for physical activity, sleep, and quality of life allow for quantifiable evaluation of health status in displaced populations [ 24 , 27 ]. This study addresses a critical gap by comprehensively assessing respiratory function, muscle strength, physical activity, sleep quality, and quality of life among adults residing in container settlements in Malatya following the 2023 earthquakes. Such multidimensional assessment provides an integrated understanding of the physiological and psychosocial consequences of prolonged temporary housing and informs disaster recovery policies, public health planning, and rehabilitation strategies. MATERIALS AND METHODS Study Design and Ethical Approval This cross-sectional descriptive field study was conducted among adults residing in the AFAD Malatya Technocity and Rönesans container settlements following the Kahramanmaraş earthquakes. Data collection took place in November 2024. This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Inonu University Clinical Research Ethics Committee (Decision No: 2024-KAEK-08), and written informed consent was obtained from all participants prior to participation. Administrative permissions were granted by the Malatya Governorship. All participants provided written informed consent. Only individuals who had been living in container settlements for at least 12 months were included. Data reflect conditions approximately 20 months after the disaster. Study Population and Sampling The study population consisted of adults aged 25–55 years residing in container settlements. A minimum sample size of 246 was calculated based on a presumed 20 percent prevalence of low physical activity, 95 percent confidence level, and 5 percent margin of error. A total of 247 adults participated. Inclusion Criteria Age between 25 and 55 years Living in a container settlement for ≥ 12 months Ability to provide written informed consent No communication-limiting cognitive impairment No diagnosed severe cardiovascular or gastrointestinal disease Exclusion Criteria Outside the target age range Severe chronic disease diagnosis Cognitive/communication barriers preventing participation Data Collection Procedures Data were collected via face-to-face interviews by trained researchers. All physiological measurements were performed according to standardized protocols. Spirometry and handgrip tests were repeated three times, and the best value was recorded for analysis. Instruments and Measurements Sociodemographic Questionnaire Assessed age, sex, marital status, education, employment, social security, smoking/alcohol use, number of children, and post-disaster living conditions. Study-Specific Structured Interview Form A structured interview form was developed by the authors specifically for this study to collect sociodemographic characteristics, post-disaster living conditions, respiratory symptoms (including dyspnea), fatigue severity, and the presence of allergic reactions within the previous 30 days. The form was designed to address the unique environmental and social conditions associated with long-term residence in container settlements following the 2023 Kahramanmaraş earthquakes and has not been previously published. The structured interview form was administered in Turkish through face-to-face interviews, as all participants were native Turkish speakers. For transparency and reproducibility, an English version of the study-specific interview form is provided as a supplementary file. Spirometry Respiratory function was assessed with the CONTEC SP70B portable spirometer, following ATS/ERS guidelines in a seated position. Parameters measured included: • FEV₁ (L) • FVC (L) • FEV₁/FVC (%) Predicted FEV₁ (%) Predicted FVC (%) Handgrip Strength Measured using the Valkyrie Digital Hand Dynamometer according to ASHT protocols. Three trials per hand; the highest measurement used. Physical Activity – IPAQ Short Form Reported as MET-min/week; assessed walking, moderate/vigorous activity, and sitting time. Sleep Quality – Pittsburgh Sleep Quality Index (PSQI) Total score 0–21; scores ≥ 5 indicate poor sleep quality. Quality of Life – SF-36 Questionnaire Dyspnea – Modified Medical Research Council (mMRC) Scale Scored from 0 (no dyspnea) to 4 (dyspnea at minimal exertion). Statistical Analysis Analyses were performed using SPSS 26.0. Continuous variables: mean ± SD or median (min–max) Categorical variables: n (%) Normality: Kolmogorov–Smirnov Group comparisons: independent t-test, Mann–Whitney U, Chi-square Correlations: Pearson or Spearman Significance threshold: p < 0.05 RESULTS Demographic and Clinical Characteristics The demographic and clinical characteristics of the 247 individuals included in the study are presented in Table 1. 69.2% of the participants were female and 30.8% were male. Marital status showed that 76.5% of the participants were married. 64.8% of the participants were unemployed, and 78.9% had social security. Anthropometric measurements revealed a mean age of 44±11.75 years and a BMI of 27.33±4.55 kg/m². 45.3% of the participants were overweight and 18.7% were obese. This distribution indicates that the sample was middle-aged and predominantly female. Table 1. Demographic and Clinical Characteristics (n = 247) Variable Category n % Sex Female 171 69.2 Male 76 30.8 Marital Status Married 189 76.5 Single 39 15.8 Widowed 19 7.7 Employment Status Unemployed 160 64.8 Employed 87 35.2 Social Security Yes 195 78.9 No 52 21.1 Smoking/Alcohol None 146 59.1 Smoking only 94 38.1 Smoking + alcohol 7 2.8 Continuous Variables Variable Mean ± SD Median (Min–Max) Age (years) 44.0 ± 11.75 43 (25–65) Height (m) 1.65 ± 0.09 1.65 (1.45–2.00) Weight (kg) 74.77 ± 14.0 74 (44–135) BMI (kg/m²) 27.33 ± 4.55 27.1 (17.1–49.3) Note: SD: Standard Deviation ; Min: Minimum; Max: Maximum ; BMI: Body Mass Index . Respiratory Symptoms, Fatigue, Allergic Reactions, and Sleep Quality The distribution of participants' shortness of breath, fatigue, allergic reactions, and sleep quality is presented in Table 2. While 57.1% of participants reported no shortness of breath, 36.9% reported varying degrees of shortness of breath. The median fatigue score was 5 (range, 0–10). The proportion of those who had experienced an allergic reaction in the past month was 15.9%. The proportion of those who reported poor sleep quality was 28%. Table 2. Distribution of respiratory symptoms, fatigue, allergic reactions, and sleep quality among participants Variable Category / Value n % Dyspnea (mMRC) 0 130 52.6 1 57 23.1 2 31 12.6 3 25 10.1 4 4 1.6 Fatigue Score Median = 5 – – Allergic Reaction Yes 39 15.9 Sleep Quality (PSQI) Good–Very Good 178 72.0 Poor–Very Poor 69 28.0 Notes: · Dyspnea was assessed using the modified Medical Research Council (mMRC) scale, where higher scores indicate more severe breathlessness. · Fatigue was measured on a 0–10 numeric rating scale, with higher values representing greater fatigue severity. · Presence of an allergic reaction reflects self-reported symptoms occurring within the previous 30 days. · Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), where scores ≥5 indicate poor sleep quality. · Values are presented as counts and percentages unless otherwise specified. Respiratory Function, Muscle Strength, and Quality of Life Descriptive statistics for pulmonary function tests, handgrip strength, and SF-36 scores are shown in Table 3. The mean FEV1 was 3.03±0.80 L, and the mean FEV1/FVC was 80.84±6.82%. Right and left handgrip strengths were 27.80±12.33 kg and 27.06±13.12 kg, respectively. The lowest mean values on the SF-36 scale were observed in the general health and mental health subscales. Table 3. Spirometry parameters, handgrip strength, and SF-36 quality-of-life scores of participants Variable Mean ± SD Median (Min–Max) FEV₁ (L) 3.03 ± 0.80 – FVC (L) 3.77 ± 0.76 – FEV₁/FVC (%) 80.84 ± 6.82 – Predicted FEV₁ (%) 97.1 ± 20.47 – Right Handgrip (kg) 27.80 ± 12.33 26 (4–69) Left Handgrip (kg) 27.06 ± 13.12 24 (2–72) SF-36 General Health 39.81 ± 20.78 – SF-36 Mental Health 48.68 ± 18.44 – Notes: · Spirometry measurements were obtained following ATS/ERS standards, and the best of three acceptable maneuvers was recorded. · FEV₁/FVC (%) represents the ratio of forced expiratory volume in 1 second to forced vital capacity, an indicator of airway function. · Predicted spirometry values were calculated using GLI reference equations (2012). · Handgrip strength reflects maximum voluntary contraction, measured using a digital dynamometer according to ASHT protocols. · SF-36 scores range from 0 to 100, with higher scores indicating better perceived health status in each domain. · Values are presented as mean ± SD or median (min–max), as appropriate. Correlations Between Dyspnea, Fatigue, Muscle Strength, and Spirometry The mMRC dyspnea score was found to be positively correlated with fatigue (r=0.463; p<0.001) and negatively correlated with muscle strength. FEV1 and FEV1/FVC values were found to be negatively correlated with dyspnea. Fatigue scores were negatively correlated with both muscle strength and quality of life (Table 4). Table 4. Correlations between dyspnea, fatigue, handgrip strength, and spirometry parameters Variable Fatigue mMRC Right Grip Left Grip FEV₁ FEV₁/FVC mMRC 0.463** – −0.187** −0.163** −0.245** −0.336** Fatigue – 0.463** −0.227** −0.218** −0.142* −0.209** Right Grip −0.227** −0.187** – 0.912** 0.255** 0.209** Left Grip −0.218** −0.163** 0.912** – 0.248** 0.192** Notes: · Correlations represent Pearson or Spearman coefficients, depending on the normality of the variables. · Positive coefficients indicate a direct relationship, while negative coefficients indicate an inverse relationship. · mMRC: Modified Medical Research Council dyspnea scale (higher scores = greater breathlessness). · Handgrip strength reflects maximum voluntary isometric contraction. · Lower FEV₁ and FEV₁/FVC values are consistent with reduced airway function. · Fatigue severity (0–10 NRS) showed moderate positive correlation with dyspnea and moderate negative correlation with muscle strength. · Interpretation: Strong correlations were observed between right and left handgrip strength (r = 0.912), indicating bilateral symmetry in muscular performance. o p < 0.05, ** p < 0.01. Comparisons by Sex Women had higher fatigue scores and significantly lower handgrip strength. Additionally, the FEV1/FVC ratio was found to be lower in women. Women reported lower physical and emotional function in the quality of life subscales (Table 5). Table 5. Comparison of fatigue, handgrip strength, and spirometry values by sex Variable Women Men p Fatigue Higher Lower 0.001 Right Grip (kg) 23.1 ± 10.2 36.4 ± 12.1 <0.001 Left Grip (kg) 22.5 ± 10.1 36.2 ± 12.4 <0.001 FEV₁/FVC (%) 79.1 ± 6.5 83.9 ± 6.8 <0.001 Notes: · Comparisons were conducted using independent samples t-tests or Mann–Whitney U tests, depending on data distribution. · Women demonstrated significantly lower handgrip strength, consistent with physiological sex-based differences in muscle mass. · Higher fatigue scores among women may reflect combined effects of increased caregiving burden, environmental stress exposure, and psychosocial factors commonly documented in post-disaster settings. · The significantly lower FEV₁/FVC ratio in women suggests mildly reduced airway function, which may be influenced by anatomy, environmental exposure within the container environment, or psychosocial stress. · Values reported as mean ± SD unless otherwise specified. · p < 0.05 considered statistically significant Comparisons by Employment Status Unemployed individuals had higher fatigue, lower muscle strength, and lower FEV1/FVC. Quality of life outcomes were also significantly worse (Table 6). Table 6. Comparison of fatigue, handgrip strength, and spirometry by employment status Variable Unemployed Employed p Fatigue Higher Lower 0.009 Right Grip (kg) Lower Higher <0.001 Left Grip (kg) Lower Higher <0.001 FEV₁/FVC (%) Lower Higher 0.018 Notes: · Employment status was self-reported and categorized as actively employed vs. unemployed at the time of data collection. · Unemployed participants demonstrated significantly lower handgrip strength, which may reflect reduced physical activity levels, occupational inactivity, and deconditioning associated with prolonged displacement. · Higher fatigue among unemployed individuals may be linked to psychosocial stress, economic insecurity, and reduced daily activity routines observed in post-disaster environments. · The lower FEV₁/FVC ratio in the unemployed group suggests mildly reduced airway function, potentially reflecting increased environmental exposure within containers, limited mobility, or chronic stress. · Analyses were conducted using t-tests or non-parametric equivalents depending on distribution. · Mean ± SD reported for continuous variables; p < 0.05 considered statistically significant. Comparisons by Allergic Reaction Individuals experiencing allergic reactions had higher fatigue and lower muscle strength. Mental health and social functioning were lower. Pain scores were significantly higher (Table 7). Table 7. Comparison of fatigue, handgrip strength, and SF-36 domains by allergic reaction status Variable Allergy Present No Allergy p Fatigue Higher Lower 0.009 Handgrip Strength Lower Higher 0.032 SF-36 Mental Health Lower Higher 0.016 SF-36 Social Functioning Lower Higher 0.013 SF-36 Pain Higher Lower <0.001 Notes: · "Allergy present" refers to self-reported allergic symptoms (respiratory, dermatologic, or systemic) occurring within the past 30 days. · Individuals reporting allergic reactions demonstrated significantly higher fatigue and lower handgrip strength, suggesting possible systemic effects of inflammatory or environmental triggers within container conditions. · Lower scores in SF-36 mental health and social functioning domains indicate meaningful psychosocial impacts associated with allergy-related symptoms. · Higher pain scores among allergy-positive participants align with evidence linking chronic inflammation and environmental irritants to heightened somatic sensitivity. · Group comparisons were performed using appropriate parametric or non-parametric tests; p < 0.05 was considered statistically significant. · Values reflect mean ± SD or categorical comparisons as applicable. DISCUSSION This study comprehensively evaluated respiratory function, muscle strength, fatigue, sleep quality, and quality of life among adults living in container settlements following the 2023 Kahramanmaraş earthquakes. The predominance of women (Table 1 ) suggests disproportionate long-term exposure to temporary housing, aligning with studies showing greater burdens among displaced women [ 15 ]. The high proportion of married individuals with children underscores the vulnerability of families, consistent with evidence showing negative impacts of housing insecurity on children's growth and health [ 25 ]. High unemployment (Table 1 ) reflects disaster-related economic disruption, consistent with literature demonstrating the interplay between socioeconomic disadvantage and health [4–6]. Dyspnea prevalence (Table 2 ) and its negative correlations with spirometric indices (Table 4 ) indicate subtle but meaningful respiratory impairment potentially linked to environmental exposures within container housing, including poor ventilation and indoor pollutants [ 7 , 8 , 10 , 13 , 23 ]. Fatigue levels were high (Table 2 ) and showed strong associations with dyspnea and reduced muscle strength (Table 4 ). This aligns with studies indicating that chronic stress, sleep disturbances, and physical inactivity contribute to persistent fatigue in post-disaster populations [16,18–21]. Handgrip strength values (Table 3 ) were below population norms, suggesting deconditioning or early sarcopenic trends. Limited space and reduced mobility may contribute to decreased physical capacity [ 9 , 23 , 26 ]. Poor sleep quality (Table 2 ) affected 28 percent of participants, consistent with long-term sleep disturbances observed in post-disaster settings [18,19,21]. Quality-of-life impairments (Table 3 ) were substantial, and associations between dyspnea, fatigue, and lower SF-36 scores were evident. Gender-based results (Table 5 ) indicated greater physical and emotional burden on women. Employment status findings (Table 6 ) highlighted the interdependence between economic and health outcomes. Allergy-related impairments (Table 7 ) aligned with prior literature on environmental sensitivities within temporary housing environments [ 10 ]. LİMİTATİONS This study has several limitations. Its cross-sectional design precludes causal inferences. Environmental exposure levels within the container units were not directly measured, and allergic reactions were self-reported. Additionally, the study was conducted in a single city, which may limit generalizability. Future longitudinal and multi-center studies incorporating objective environmental assessments are warranted. CONCLUSION Adults residing in container settlements after the 2023 Kahramanmaraş earthquakes exhibited impaired respiratory function, reduced muscle strength, elevated fatigue, poor sleep, and diminished quality of life. Temporary housing conditions appear to exert multidimensional adverse effects on health. Designing temporary housing with improved ventilation, air quality, thermal comfort, noise reduction, and opportunities for physical activity is crucial. Rehabilitation programs targeting respiratory health, physical conditioning, sleep, and psychosocial well-being are recommended. Longitudinal and multi-center studies incorporating environmental measurements are needed to guide evidence-based disaster housing policies. Declarations Acknowledgements: We would like to thank İnönü University BAP unit for supporting this study with the Priority Area Project ID TOA-2025-3940. The authors would like to thank the participants living in the container settlements for their cooperation and the Malatya Governorship for administrative support. Ethics approval and consent to participate This study was approved by the Inonu University Clinical Research Ethics Committee (Decision No: 2024-KAEK-08). Administrative permissions were obtained from the Malatya Governorship. Written informed consent was obtained from all participants prior to data collection. Consent for publication Not applicable. (The study does not include any identifiable personal data, images, or individual-level information requiring additional publication consent.) Availability of data and materials The datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors. Authors’ contributions AU and SÖ designed the study. AU, MK conducted data collection and field assessments. SÖ supervised methodological development. TK,BK and MFA performed statistical analyses. AU,SÖ and TK contributed to interpretation of the findings and manuscript revisions. All authors read and approved the final manuscript. References Collado ZC. Does the intensity of conflict-induced internal displacement influence national happiness scores? The Social Science Journal. 2024;1–9. Sandel M, Sheward R, Ettinger de Cuba S, Coleman SM, Frank DA, Chilton M, et al. Unstable housing and caregiver and child health in renter families. Pediatrics. 2018;141(2):e20172199. doi:10.1542/peds.2017-2199. Taylor LA, Tan AX, Coyle CE, Ndumele C, Rogan E, Canavan M, et al. Leveraging the social determinants of health: what works? 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Topics in Geriatric Rehabilitation. 2012;28(1):11–6. Additional Declarations No competing interests reported. Supplementary Files SupplementaryFile1.StudySpecificCaseEvaluationFormEnglishVersion.docx Cite Share Download PDF Status: Under Review Version 1 posted Reviews received at journal 22 Feb, 2026 Reviews received at journal 17 Feb, 2026 Reviewers agreed at journal 14 Feb, 2026 Reviewers agreed at journal 13 Feb, 2026 Reviews received at journal 13 Feb, 2026 Reviewers agreed at journal 07 Feb, 2026 Reviewers agreed at journal 05 Feb, 2026 Reviewers invited by journal 04 Feb, 2026 Editor invited by journal 09 Jan, 2026 Editor assigned by journal 18 Dec, 2025 Submission checks completed at journal 18 Dec, 2025 First submitted to journal 18 Dec, 2025 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8315853","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":587454627,"identity":"f7e23b01-c45c-45d6-9c40-60c4e92a0c9d","order_by":0,"name":"AHMET UTUŞ","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA50lEQVRIiWNgGAWjYDACCTiL+cABKMuAsJYDYIotAUlLAlFaeOCG49fCP7s78fEHhsN1BufPfDxcUHEnsYG9eZsE4497uC25c3azwQGGwxIGN3I3HJ5x5lliA8+xMgmGhGLc1tzI3SYB0cK74TBv2+HEBokcM6AW3C6Tv5G7/QdYy/kzDyBa5N/g1wJ0zzYGsJYDOQxQW3jwazG8kbtZ4oxBuuTMG2kGh3nOHDZu40krtkhIw61F7kbuxg8VFdb8fOcPP/7MU3FYtp/98MYbH2xwa4E6D4nNBiIIaRgFo2AUjIJRgB8AAIg6WaMuYnyVAAAAAElFTkSuQmCC","orcid":"","institution":"Inonu University","correspondingAuthor":true,"prefix":"","firstName":"AHMET","middleName":"","lastName":"UTUŞ","suffix":""},{"id":587454628,"identity":"42a9ec6a-320a-41cf-92ec-6080f1ad8786","order_by":1,"name":"SEMİRAMİS ÖZYILMAZ","email":"","orcid":"","institution":"Bezmiâlem Vakıf Üniversitesi","correspondingAuthor":false,"prefix":"","firstName":"SEMİRAMİS","middleName":"","lastName":"ÖZYILMAZ","suffix":""},{"id":587454629,"identity":"139a5e13-96f7-4fd7-9190-80d4535bd651","order_by":2,"name":"TALAT KILIÇ","email":"","orcid":"","institution":"Inonu University","correspondingAuthor":false,"prefix":"","firstName":"TALAT","middleName":"","lastName":"KILIÇ","suffix":""},{"id":587454630,"identity":"6b67c7c2-51ca-4fa5-b43f-5133fc9add0b","order_by":3,"name":"MURAT KILIÇ","email":"","orcid":"","institution":"Inonu University","correspondingAuthor":false,"prefix":"","firstName":"MURAT","middleName":"","lastName":"KILIÇ","suffix":""},{"id":587454631,"identity":"c5f13d17-4fc7-497f-85a4-b12d082e5bdf","order_by":4,"name":"MUHAMMED FURKAN ARPACI","email":"","orcid":"","institution":"Malatya Turgut Özal Üniversitesi","correspondingAuthor":false,"prefix":"","firstName":"MUHAMMED","middleName":"FURKAN","lastName":"ARPACI","suffix":""},{"id":587454632,"identity":"4da49cd4-388e-4f6c-8d28-299501c6e848","order_by":5,"name":"Berna Kaygusuzoğlu","email":"","orcid":"","institution":"Gözde Hastanesi Malatya","correspondingAuthor":false,"prefix":"","firstName":"Berna","middleName":"","lastName":"Kaygusuzoğlu","suffix":""}],"badges":[],"createdAt":"2025-12-09 09:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-8315853/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8315853/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":102185542,"identity":"daec8ad6-6fb2-4078-8e3f-9e5acef6b085","added_by":"auto","created_at":"2026-02-09 08:14:10","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1424015,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8315853/v1/aad935a9-8ab6-4266-aa74-c28965988d7c.pdf"},{"id":102185535,"identity":"69e1c3b5-773e-4556-8c83-cf3b1e85cec5","added_by":"auto","created_at":"2026-02-09 08:14:02","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"supplement","size":16764,"visible":true,"origin":"","legend":"","description":"","filename":"SupplementaryFile1.StudySpecificCaseEvaluationFormEnglishVersion.docx","url":"https://assets-eu.researchsquare.com/files/rs-8315853/v1/94963a320905663ec968e2be.docx"}],"financialInterests":"No competing interests reported.","formattedTitle":"Respiratory Problems And Quality Of Life Among Individuals Living İn Containers Following The 2023 Kahramanmaraş Earthquake","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eEarthquakes, beyond generating large-scale physical destruction, are among the most devastating natural disasters that profoundly alter living conditions and shape long-term physical and psychosocial health outcomes [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. In the aftermath of disasters, housing conditions represent a critical social determinant of health; the stability, quality, safety, and affordability of housing directly influence overall health trajectories [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]. Individuals experiencing housing instability exhibit higher rates of cardiometabolic diseases, respiratory problems, obesity, and diabetes, underscoring the multidimensional health burden associated with inadequate living environments [4\u0026ndash;6]. Socioeconomic disadvantage, suboptimal housing quality, and environmental stressors often interact in cumulative and mutually reinforcing ways to worsen health outcomes [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eTemporary housing arrangements established after large-scale disasters\u0026mdash;particularly container settlements\u0026mdash;introduce substantial environmental risks. Limited living space, inadequate ventilation, poor indoor air quality, exposure to chemical pollutants, and humidity or mold growth contribute significantly to respiratory and general health impairment among residents [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. Elevated levels of formaldehyde detected in FEMA trailers following Hurricane Katrina, and their association with increased respiratory symptoms, highlight these environmental hazards [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Similarly, poor air quality, volatile organic compounds, and particulate matter pollution have been shown to negatively affect respiratory function among individuals living in temporary housing units [\u003cspan additionalcitationids=\"CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e12\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. Restricted physical space and reduced mobility further diminish muscle strength, physical performance, and quality of life [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e, \u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e16\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe 6 February 2023 Kahramanmaraş earthquakes caused massive destruction across 11 provinces in T\u0026uuml;rkiye, resulting in hundreds of thousands of individuals relocating to temporary settlements. In Malatya, where thousands of residences became uninhabitable, tens of thousands of citizens have continued to reside in container settlements even 20 months after the disaster [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. This prolonged displacement highlights the need to evaluate not only the structural adequacy of temporary housing but also its effects on respiratory health, physical capacity, sleep quality, and overall well-being.\u003c/p\u003e \u003cp\u003eThe existing literature predominantly focuses on psychological outcomes\u0026mdash;such as post-traumatic stress\u0026mdash;while studies jointly examining respiratory function, muscle strength, physical activity, sleep quality, and quality of life remain scarce [18\u0026ndash;21]. The causal pathways linking housing insecurity and health are complex, involving environmental, socioeconomic, physical, and psychological determinants [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e20\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Substandard housing conditions have been linked to increased respiratory diseases, asthma exacerbations, infection risk, and sleep disturbances, particularly among children but also adults [\u003cspan additionalcitationids=\"CR25\" citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eGiven these gaps, assessing the health impacts of container living through objective physiological measurements and validated instruments is essential. Spirometry for respiratory function, handgrip dynamometry for muscle strength, and standardized scales for physical activity, sleep, and quality of life allow for quantifiable evaluation of health status in displaced populations [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThis study addresses a critical gap by comprehensively assessing respiratory function, muscle strength, physical activity, sleep quality, and quality of life among adults residing in container settlements in Malatya following the 2023 earthquakes. Such multidimensional assessment provides an integrated understanding of the physiological and psychosocial consequences of prolonged temporary housing and informs disaster recovery policies, public health planning, and rehabilitation strategies.\u003c/p\u003e"},{"header":"MATERIALS AND METHODS","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eStudy Design and Ethical Approval\u003c/h2\u003e \u003cp\u003eThis cross-sectional descriptive field study was conducted among adults residing in the AFAD Malatya Technocity and R\u0026ouml;nesans container settlements following the Kahramanmaraş earthquakes. Data collection took place in November 2024.\u003c/p\u003e \u003cp\u003e This study was conducted in accordance with the ethical principles of the Declaration of Helsinki. Ethical approval was obtained from the Inonu University Clinical Research Ethics Committee (Decision No: 2024-KAEK-08), and written informed consent was obtained from all participants prior to participation.\u003c/p\u003e \u003cp\u003eAdministrative permissions were granted by the Malatya Governorship. All participants provided written informed consent. Only individuals who had been living in container settlements for at least 12 months were included. Data reflect conditions approximately 20 months after the disaster.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eStudy Population and Sampling\u003c/h3\u003e\n\u003cp\u003eThe study population consisted of adults aged 25\u0026ndash;55 years residing in container settlements. A minimum sample size of 246 was calculated based on a presumed 20 percent prevalence of low physical activity, 95 percent confidence level, and 5 percent margin of error. A total of 247 adults participated.\u003c/p\u003e\n\u003ch3\u003eInclusion Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eAge between 25 and 55 years\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eLiving in a container settlement for \u0026ge;\u0026thinsp;12 months\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eAbility to provide written informed consent\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNo communication-limiting cognitive impairment\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNo diagnosed severe cardiovascular or gastrointestinal disease\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eExclusion Criteria\u003c/h3\u003e\n\u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eOutside the target age range\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSevere chronic disease diagnosis\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCognitive/communication barriers preventing participation\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e\n\u003ch3\u003eData Collection Procedures\u003c/h3\u003e\n\u003cp\u003eData were collected via face-to-face interviews by trained researchers. All physiological measurements were performed according to standardized protocols. Spirometry and handgrip tests were repeated three times, and the best value was recorded for analysis.\u003c/p\u003e \u003cdiv id=\"Sec8\" class=\"Section2\"\u003e \u003ch2\u003eInstruments and Measurements\u003c/h2\u003e \u003cdiv id=\"Sec9\" class=\"Section3\"\u003e \u003ch2\u003eSociodemographic Questionnaire\u003c/h2\u003e \u003cp\u003eAssessed age, sex, marital status, education, employment, social security, smoking/alcohol use, number of children, and post-disaster living conditions.\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e\n\u003ch3\u003eStudy-Specific Structured Interview Form\u003c/h3\u003e\n\u003cp\u003eA structured interview form was developed by the authors specifically for this study to collect sociodemographic characteristics, post-disaster living conditions, respiratory symptoms (including dyspnea), fatigue severity, and the presence of allergic reactions within the previous 30 days. The form was designed to address the unique environmental and social conditions associated with long-term residence in container settlements following the 2023 Kahramanmaraş earthquakes and has not been previously published.\u003c/p\u003e \u003cp\u003eThe structured interview form was administered in Turkish through face-to-face interviews, as all participants were native Turkish speakers. For transparency and reproducibility, an English version of the study-specific interview form is provided as a supplementary file.\u003c/p\u003e \u003cdiv id=\"Sec11\" class=\"Section2\"\u003e \u003ch2\u003eSpirometry\u003c/h2\u003e \u003cp\u003e Respiratory function was assessed with the CONTEC SP70B portable spirometer, following ATS/ERS guidelines in a seated position. Parameters measured included:\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003e\u0026bull; FEV₁ (L)\u003c/h2\u003e \u003cdiv id=\"Sec13\" class=\"Section3\"\u003e \u003ch2\u003e\u0026bull; FVC (L)\u003c/h2\u003e \u003cdiv id=\"Sec14\" class=\"Section4\"\u003e \u003ch2\u003e\u0026bull; FEV₁/FVC (%)\u003c/h2\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003ePredicted FEV₁ (%)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003ePredicted FVC (%)\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eHandgrip Strength\u003c/h2\u003e \u003cp\u003eMeasured using the Valkyrie Digital Hand Dynamometer according to ASHT protocols. Three trials per hand; the highest measurement used.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec16\" class=\"Section2\"\u003e \u003ch2\u003ePhysical Activity \u0026ndash; IPAQ Short Form\u003c/h2\u003e \u003cp\u003eReported as MET-min/week; assessed walking, moderate/vigorous activity, and sitting time.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eSleep Quality \u0026ndash; Pittsburgh Sleep Quality Index (PSQI)\u003c/h2\u003e \u003cp\u003eTotal score 0\u0026ndash;21; scores\u0026thinsp;\u0026ge;\u0026thinsp;5 indicate poor sleep quality.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec18\" class=\"Section2\"\u003e \u003ch2\u003eQuality of Life \u0026ndash; SF-36 Questionnaire\u003c/h2\u003e \u003cdiv id=\"Sec19\" class=\"Section3\"\u003e \u003ch2\u003eDyspnea \u0026ndash; Modified Medical Research Council (mMRC) Scale\u003c/h2\u003e \u003cp\u003eScored from 0 (no dyspnea) to 4 (dyspnea at minimal exertion).\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv id=\"Sec20\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eAnalyses were performed using SPSS 26.0.\u003c/p\u003e \u003cp\u003e \u003cul\u003e \u003cli\u003e \u003cp\u003eContinuous variables: mean\u0026thinsp;\u0026plusmn;\u0026thinsp;SD or median (min\u0026ndash;max)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCategorical variables: n (%)\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eNormality: Kolmogorov\u0026ndash;Smirnov\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eGroup comparisons: independent t-test, Mann\u0026ndash;Whitney U, Chi-square\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eCorrelations: Pearson or Spearman\u003c/p\u003e \u003c/li\u003e \u003cli\u003e \u003cp\u003eSignificance threshold: p\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/p\u003e \u003c/li\u003e \u003c/ul\u003e \u003c/p\u003e \u003c/div\u003e"},{"header":"RESULTS","content":"\u003cp\u003e\u003cstrong\u003eDemographic and Clinical Characteristics\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe demographic and clinical characteristics of the 247 individuals included in the study are presented in Table 1. 69.2% of the participants were female and 30.8% were male. Marital status showed that 76.5% of the participants were married. 64.8% of the participants were unemployed, and 78.9% had social security. Anthropometric measurements revealed a mean age of 44\u0026plusmn;11.75 years and a BMI of 27.33\u0026plusmn;4.55 kg/m\u0026sup2;. 45.3% of the participants were overweight and 18.7% were obese. This distribution indicates that the sample was middle-aged and predominantly female.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 1. Demographic and Clinical Characteristics (n = 247)\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSex\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eFemale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e171\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMale\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e30.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMarital Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMarried\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e189\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e76.5\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSingle\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eWidowed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7.7\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEmployment Status\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eUnemployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e160\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e64.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eEmployed\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e87\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e35.2\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSocial Security\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e195\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e78.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNo\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e21.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSmoking/Alcohol\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eNone\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e146\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e59.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking only\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e94\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e38.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eSmoking + alcohol\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2.8\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eContinuous Variables\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (Min\u0026ndash;Max)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e44.0 \u0026plusmn; 11.75\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e43 (25\u0026ndash;65)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHeight (m)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.65 \u0026plusmn; 0.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.65 (1.45\u0026ndash;2.00)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eWeight (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74.77 \u0026plusmn; 14.0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e74 (44\u0026ndash;135)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eBMI (kg/m\u0026sup2;)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.33 \u0026plusmn; 4.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e27.1 (17.1\u0026ndash;49.3)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNote: SD:\u0026nbsp;\u003c/strong\u003eStandard Deviation\u003cstrong\u003e; Min:\u0026nbsp;\u003c/strong\u003eMinimum; Max: Maximum\u003cstrong\u003e; BMI:\u0026nbsp;\u003c/strong\u003eBody Mass Index\u003cstrong\u003e.\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespiratory Symptoms, Fatigue, Allergic Reactions, and Sleep Quality\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe distribution of participants\u0026apos; shortness of breath, fatigue, allergic reactions, and sleep quality is presented in \u003cstrong\u003eTable 2.\u003c/strong\u003e While 57.1% of participants reported no shortness of breath, 36.9% reported varying degrees of shortness of breath. The median fatigue score was 5 (range, 0\u0026ndash;10). The proportion of those who had experienced an allergic reaction in the past month was 15.9%. The proportion of those who reported poor sleep quality was 28%.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 2. Distribution of respiratory symptoms, fatigue, allergic reactions, and sleep quality among participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eCategory / Value\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003en\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003e%\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eDyspnea (mMRC)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e130\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e52.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e31\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e12.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e3\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e25\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e1.6\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFatigue Score\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eMedian = 5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAllergic Reaction\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eYes\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e15.9\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eSleep Quality (PSQI)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eGood\u0026ndash;Very Good\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e178\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e72.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\u003cbr\u003e\u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003ePoor\u0026ndash;Very Poor\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e69\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e28.0\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Dyspnea was assessed using the modified Medical Research Council (mMRC) scale, where higher scores indicate more severe breathlessness.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Fatigue was measured on a 0\u0026ndash;10 numeric rating scale, with higher values representing greater fatigue severity.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Presence of an allergic reaction reflects self-reported symptoms occurring within the previous 30 days.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Sleep quality was evaluated using the Pittsburgh Sleep Quality Index (PSQI), where scores \u0026ge;5 indicate poor sleep quality.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Values are presented as counts and percentages unless otherwise specified.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eRespiratory Function, Muscle Strength, and Quality of Life\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eDescriptive statistics for pulmonary function tests, handgrip strength, and SF-36 scores are shown in Table 3. The mean FEV1 was 3.03\u0026plusmn;0.80 L, and the mean FEV1/FVC was 80.84\u0026plusmn;6.82%. Right and left handgrip strengths were 27.80\u0026plusmn;12.33 kg and 27.06\u0026plusmn;13.12 kg, respectively. The lowest mean values on the SF-36 scale were observed in the general health and mental health subscales.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 3. Spirometry parameters, handgrip strength, and SF-36 quality-of-life scores of participants\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\" class=\"fr-table-selection-hover\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMean \u0026plusmn; SD\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u003cstrong\u003eMedian (Min\u0026ndash;Max)\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eFEV₁ (L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3.03 \u0026plusmn; 0.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eFVC (L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e3.77 \u0026plusmn; 0.76\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eFEV₁/FVC (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e80.84 \u0026plusmn; 6.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003ePredicted FEV₁ (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e97.1 \u0026plusmn; 20.47\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eRight Handgrip (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e27.80 \u0026plusmn; 12.33\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e26 (4\u0026ndash;69)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eLeft Handgrip (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e27.06 \u0026plusmn; 13.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e24 (2\u0026ndash;72)\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eSF-36 General Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e39.81 \u0026plusmn; 20.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd style=\"width: 132px;\"\u003e\n \u003cp\u003eSF-36 Mental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 92px;\"\u003e\n \u003cp\u003e48.68 \u0026plusmn; 18.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd style=\"width: 85px;\"\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Spirometry measurements were obtained following ATS/ERS standards, and the best of three acceptable maneuvers was recorded.\u003c/p\u003e\n\u003cp\u003e\u0026middot; FEV₁/FVC (%) represents the ratio of forced expiratory volume in 1 second to forced vital capacity, an indicator of airway function.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Predicted spirometry values were calculated using GLI reference equations (2012).\u003c/p\u003e\n\u003cp\u003e\u0026middot; Handgrip strength reflects maximum voluntary contraction, measured using a digital dynamometer according to ASHT protocols.\u003c/p\u003e\n\u003cp\u003e\u0026middot; SF-36 scores range from 0 to 100, with higher scores indicating better perceived health status in each domain.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Values are presented as mean \u0026plusmn; SD or median (min\u0026ndash;max), as appropriate.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorrelations Between Dyspnea, Fatigue, Muscle Strength, and Spirometry\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe mMRC dyspnea score was found to be positively correlated with fatigue (r=0.463; p\u0026lt;0.001) and negatively correlated with muscle strength. FEV1 and FEV1/FVC values were found to be negatively correlated with dyspnea. Fatigue scores were negatively correlated with both muscle strength and quality of life (Table 4).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 4.\u003c/strong\u003e \u003cstrong\u003eCorrelations between dyspnea, fatigue, handgrip strength, and spirometry parameters\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFatigue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003emMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRight Grip\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Grip\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFEV₁\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFEV₁/FVC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003emMRC\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.463**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.187**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.163**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.245**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.336**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eFatigue\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.463**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.227**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.218**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.142*\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.209**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eRight Grip\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.227**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.187**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.912**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.255**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.209**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eLeft Grip\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.218**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026minus;0.163**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.912**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026ndash;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.248**\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.192**\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Correlations represent Pearson or Spearman coefficients, depending on the normality of the variables.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Positive coefficients indicate a direct relationship, while negative coefficients indicate an inverse relationship.\u003c/p\u003e\n\u003cp\u003e\u0026middot; mMRC: Modified Medical Research Council dyspnea scale (higher scores = greater breathlessness).\u003c/p\u003e\n\u003cp\u003e\u0026middot; Handgrip strength reflects maximum voluntary isometric contraction.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Lower FEV₁ and FEV₁/FVC values are consistent with reduced airway function.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Fatigue severity (0\u0026ndash;10 NRS) showed moderate positive correlation with dyspnea and moderate negative correlation with muscle strength.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Interpretation: Strong correlations were observed between right and left handgrip strength (r = 0.912), indicating bilateral symmetry in muscular performance.\u003c/p\u003e\n\u003cp\u003eo p \u0026lt; 0.05, ** p \u0026lt; 0.01.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparisons by Sex\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eWomen had higher fatigue scores and significantly lower handgrip strength. Additionally, the FEV1/FVC ratio was found to be lower in women. Women reported lower physical and emotional function in the quality of life subscales (Table 5).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 5. Comparison of fatigue, handgrip strength, and spirometry values by sex\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eWomen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eMen\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRight Grip (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e23.1 \u0026plusmn; 10.2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.4 \u0026plusmn; 12.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLeft Grip (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e22.5 \u0026plusmn; 10.1\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e36.2 \u0026plusmn; 12.4\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFEV₁/FVC (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e79.1 \u0026plusmn; 6.5\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e83.9 \u0026plusmn; 6.8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Comparisons were conducted using independent samples t-tests or Mann\u0026ndash;Whitney U tests, depending on data distribution.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Women demonstrated significantly lower handgrip strength, consistent with physiological sex-based differences in muscle mass.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Higher fatigue scores among women may reflect combined effects of increased caregiving burden, environmental stress exposure, and psychosocial factors commonly documented in post-disaster settings.\u003c/p\u003e\n\u003cp\u003e\u0026middot; The significantly lower FEV₁/FVC ratio in women suggests mildly reduced airway function, which may be influenced by anatomy, environmental exposure within the container environment, or psychosocial stress.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Values reported as mean \u0026plusmn; SD unless otherwise specified.\u003c/p\u003e\n\u003cp\u003e\u0026middot; p \u0026lt; 0.05 considered statistically significant\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparisons by Employment Status\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eUnemployed individuals had higher fatigue, lower muscle strength, and lower FEV1/FVC. Quality of life outcomes were also significantly worse (Table 6).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 6. Comparison of fatigue, handgrip strength, and spirometry by employment status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eUnemployed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eEmployed\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eRight Grip (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eLeft Grip (kg)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFEV₁/FVC (%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.018\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; Employment status was self-reported and categorized as actively employed vs. unemployed at the time of data collection.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Unemployed participants demonstrated significantly lower handgrip strength, which may reflect reduced physical activity levels, occupational inactivity, and deconditioning associated with prolonged displacement.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Higher fatigue among unemployed individuals may be linked to psychosocial stress, economic insecurity, and reduced daily activity routines observed in post-disaster environments.\u003c/p\u003e\n\u003cp\u003e\u0026middot; The lower FEV₁/FVC ratio in the unemployed group suggests mildly reduced airway function, potentially reflecting increased environmental exposure within containers, limited mobility, or chronic stress.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Analyses were conducted using t-tests or non-parametric equivalents depending on distribution.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Mean \u0026plusmn; SD reported for continuous variables; p \u0026lt; 0.05 considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eComparisons by Allergic Reaction\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eIndividuals experiencing allergic reactions had higher fatigue and lower muscle strength. Mental health and social functioning were lower. Pain scores were significantly higher (Table 7).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eTable 7. Comparison of fatigue, handgrip strength, and SF-36 domains by allergic reaction status\u003c/strong\u003e\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"3\" cellpadding=\"0\"\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eVariable\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eAllergy Present\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003eNo Allergy\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u003cstrong\u003ep\u003c/strong\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eFatigue\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.009\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eHandgrip Strength\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.032\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSF-36 Mental Health\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSF-36 Social Functioning\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e0.013\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd\u003e\n \u003cp\u003eSF-36 Pain\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eHigher\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003eLower\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd\u003e\n \u003cp\u003e\u0026lt;0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u003cstrong\u003eNotes:\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u0026middot; \u0026quot;Allergy present\u0026quot; refers to self-reported allergic symptoms (respiratory, dermatologic, or systemic) occurring within the past 30 days.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Individuals reporting allergic reactions demonstrated significantly higher fatigue and lower handgrip strength, suggesting possible systemic effects of inflammatory or environmental triggers within container conditions.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Lower scores in SF-36 mental health and social functioning domains indicate meaningful psychosocial impacts associated with allergy-related symptoms.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Higher pain scores among allergy-positive participants align with evidence linking chronic inflammation and environmental irritants to heightened somatic sensitivity.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Group comparisons were performed using appropriate parametric or non-parametric tests; p \u0026lt; 0.05 was considered statistically significant.\u003c/p\u003e\n\u003cp\u003e\u0026middot; Values reflect mean \u0026plusmn; SD or categorical comparisons as applicable.\u003c/p\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eThis study comprehensively evaluated respiratory function, muscle strength, fatigue, sleep quality, and quality of life among adults living in container settlements following the 2023 Kahramanmaraş earthquakes. The predominance of women (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) suggests disproportionate long-term exposure to temporary housing, aligning with studies showing greater burdens among displaced women [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The high proportion of married individuals with children underscores the vulnerability of families, consistent with evidence showing negative impacts of housing insecurity on children's growth and health [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e25\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eHigh unemployment (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e) reflects disaster-related economic disruption, consistent with literature demonstrating the interplay between socioeconomic disadvantage and health [4\u0026ndash;6].\u003c/p\u003e \u003cp\u003eDyspnea prevalence (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and its negative correlations with spirometric indices (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e) indicate subtle but meaningful respiratory impairment potentially linked to environmental exposures within container housing, including poor ventilation and indoor pollutants [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e8\u003c/span\u003e, \u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e13\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eFatigue levels were high (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) and showed strong associations with dyspnea and reduced muscle strength (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e). This aligns with studies indicating that chronic stress, sleep disturbances, and physical inactivity contribute to persistent fatigue in post-disaster populations [16,18\u0026ndash;21].\u003c/p\u003e \u003cp\u003eHandgrip strength values (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) were below population norms, suggesting deconditioning or early sarcopenic trends. Limited space and reduced mobility may contribute to decreased physical capacity [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e26\u003c/span\u003e].\u003c/p\u003e \u003cp\u003ePoor sleep quality (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) affected 28 percent of participants, consistent with long-term sleep disturbances observed in post-disaster settings [18,19,21].\u003c/p\u003e \u003cp\u003eQuality-of-life impairments (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) were substantial, and associations between dyspnea, fatigue, and lower SF-36 scores were evident.\u003c/p\u003e \u003cp\u003eGender-based results (Table\u0026nbsp;\u003cspan refid=\"Tab5\" class=\"InternalRef\"\u003e5\u003c/span\u003e) indicated greater physical and emotional burden on women. Employment status findings (Table\u0026nbsp;\u003cspan refid=\"Tab6\" class=\"InternalRef\"\u003e6\u003c/span\u003e) highlighted the interdependence between economic and health outcomes. Allergy-related impairments (Table\u0026nbsp;\u003cspan refid=\"Tab7\" class=\"InternalRef\"\u003e7\u003c/span\u003e) aligned with prior literature on environmental sensitivities within temporary housing environments [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e10\u003c/span\u003e].\u003c/p\u003e \u003cdiv id=\"Sec36\" class=\"Section2\"\u003e \u003ch2\u003eLİMİTATİONS\u003c/h2\u003e \u003cp\u003eThis study has several limitations. Its cross-sectional design precludes causal inferences. Environmental exposure levels within the container units were not directly measured, and allergic reactions were self-reported. Additionally, the study was conducted in a single city, which may limit generalizability. Future longitudinal and multi-center studies incorporating objective environmental assessments are warranted.\u003c/p\u003e \u003c/div\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eAdults residing in container settlements after the 2023 Kahramanmaraş earthquakes exhibited impaired respiratory function, reduced muscle strength, elevated fatigue, poor sleep, and diminished quality of life. Temporary housing conditions appear to exert multidimensional adverse effects on health.\u003c/p\u003e \u003cp\u003eDesigning temporary housing with improved ventilation, air quality, thermal comfort, noise reduction, and opportunities for physical activity is crucial. Rehabilitation programs targeting respiratory health, physical conditioning, sleep, and psychosocial well-being are recommended.\u003c/p\u003e \u003cp\u003eLongitudinal and multi-center studies incorporating environmental measurements are needed to guide evidence-based disaster housing policies.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eAcknowledgements:\u003c/strong\u003e We would like to thank İn\u0026ouml;n\u0026uuml; University BAP unit for supporting this study with the Priority Area Project ID TOA-2025-3940.\u003c/p\u003e\n\u003cp\u003eThe authors would like to thank the participants living in the container settlements for their cooperation and the Malatya Governorship for administrative support.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Inonu University Clinical Research Ethics Committee (Decision No: 2024-KAEK-08). Administrative permissions were obtained from the Malatya Governorship. Written informed consent was obtained from all participants prior to data collection.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003cbr\u003e\u0026nbsp;(The study does not include any identifiable personal data, images, or individual-level information requiring additional publication consent.)\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated and analyzed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.\u003cbr\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAU and S\u0026Ouml; designed the study. AU, MK conducted data collection and field assessments. S\u0026Ouml; supervised methodological development. TK,BK and MFA performed statistical analyses. AU,S\u0026Ouml; and TK contributed to interpretation of the findings and manuscript revisions. All authors read and approved the final manuscript.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n \u003cli\u003eCollado ZC. Does the intensity of conflict-induced internal displacement influence national happiness scores? The Social Science Journal. 2024;1\u0026ndash;9.\u003c/li\u003e\n \u003cli\u003eSandel M, Sheward R, Ettinger de Cuba S, Coleman SM, Frank DA, Chilton M, et al. Unstable housing and caregiver and child health in renter families. Pediatrics. 2018;141(2):e20172199. doi:10.1542/peds.2017-2199.\u003c/li\u003e\n \u003cli\u003eTaylor LA, Tan AX, Coyle CE, Ndumele C, Rogan E, Canavan M, et al. Leveraging the social determinants of health: what works? 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Indoor air quality and its effects on humans\u0026mdash;A review of challenges and developments in the last 30 years. Energy and Buildings. 2016;130:637\u0026ndash;50. doi:10.1016/j.enbuild.2016.08.071.\u003c/li\u003e\n \u003cli\u003eKrieger J, Higgins DL. Housing and health: time again for public health action. American Journal of Public Health. 2002;92(5):758\u0026ndash;68. doi:10.2105/AJPH.92.5.758.\u003c/li\u003e\n \u003cli\u003eConzatti A, Thuraisingam T, Winner L, Gilbert J, D\u0026rsquo;Urzo K, Crisp B, et al. A review of the impact of shelter design on the health of displaced populations. Journal of International Humanitarian Action. 2022;7(1):18. doi:10.1186/s41018-022-00125-9.\u003c/li\u003e\n \u003cli\u003eRando RJ, Fortenberry GZ, Kaye WE. Respiratory health effects associated with restoration work in post-hurricane Katrina New Orleans. Journal of Environmental and Public Health. 2012;2012:462478. doi:10.1155/2012/462478.\u003c/li\u003e\n \u003cli\u003eLindell MK, Prater CS. Assessing community impacts of natural disasters. Natural Hazards Review. 2003;4(4):176\u0026ndash;85. doi:10.1061/(ASCE)1527-6988(2003)4:4(176).\u003c/li\u003e\n \u003cli\u003eOnapa H, O\u0026rsquo;Campo P, Ponka D, Stergiopoulos V. The physical and mental health effects of housing homeless people: a systematic review. Health \u0026amp; Social Care in the Community. 2022;30(2):448\u0026ndash;68. doi:10.1111/hsc.13355.\u003c/li\u003e\n \u003cli\u003eLanphear BP, Kahn RS, Berger O, Auinger P, Bortnick SM. Residential exposures associated with asthma in US children. Pediatrics. 2001;107(3):505\u0026ndash;11. doi:10.1542/peds.107.3.505.\u003c/li\u003e\n \u003cli\u003eChau CK, Hui W, Tse M. Evaluation of health benefits for improving indoor air quality in the workplace. Environment International. 2007;33(2):186\u0026ndash;98. doi:10.1016/j.envint.2006.09.010.\u003c/li\u003e\n \u003cli\u003eDudek V, Razum O, Sauzet O. Association between housing and health of refugees and asylum seekers in Germany: explorative cluster and mixed model analysis. BMC Public Health. 2022;22:48. doi:10.1186/s12889-021-12467-z.\u003c/li\u003e\n \u003cli\u003eYilmaz E, Erdem M. Post-traumatic stress disorder in earthquake survivors living in temporary shelter areas in Hatay central districts: a cross-sectional study. BMC Psychiatry. 2025;25:461. doi:10.1186/s12888-025-XXXXX.\u003c/li\u003e\n \u003cli\u003eAldrich DP, Meyer MA. Social capital and community resilience. American Behavioral Scientist. 2015;59(2):254\u0026ndash;69. doi:10.1177/0002764214550299.\u003c/li\u003e\n \u003cli\u003eKawakami N, Tsuchiya M, Umeda M, Tsutsumi A, et al. Onset and remission of common mental disorders among adults living in temporary housing for three years after the triple disaster in northeast Japan: comparisons with the general population. BMC Public Health. 2020;20:1271. doi:10.1186/s12889-020-09339-6.\u003c/li\u003e\n \u003cli\u003eYabe Y, Hagiwara Y, Sekiguchi T, et al. Sleep disturbance is associated with neck pain: a 3-year longitudinal study after the Great East Japan Earthquake. BMC Musculoskeletal Disorders. 2022;23:459. doi:10.1186/s12891-022-05437-3.\u003c/li\u003e\n \u003cli\u003eHock ES, Norris E, Cookson R, et al. Exploring the impact of housing insecurity on the health and wellbeing of children and young people in the United Kingdom: a qualitative systematic review. BMC Public Health. 2024;24:2453. doi:10.1186/s12889-024-18109-9.\u003c/li\u003e\n \u003cli\u003eDaoust AR. A multi-method assessment of the impact of stress on families\u0026rsquo; mental health during the COVID-19 pandemic. Doctoral dissertation. University of Western Ontario; 2023.\u003cbr\u003e(Tez olduğu i\u0026ccedil;in DOI bulunmamaktadır.)\u003c/li\u003e\n \u003cli\u003eFelix ED, Afifi W. The role of social support on mental health after multiple wildfire disasters. Journal of Community Psychology. 2015;43(2):156\u0026ndash;70. doi:10.1002/jcop.21671.\u003c/li\u003e\n \u003cli\u003eBonnefoy X. Inadequate housing and health: an overview. International Journal of Environment and Pollution. 2007;30(3\u0026ndash;4):411\u0026ndash;29.\u003c/li\u003e\n \u003cli\u003eQuanjer PH, Stanojevic S, Cole TJ, Baur X, Hall GL, Culver BH, et al. Multi-ethnic reference values for spirometry for the 3\u0026ndash;95-year age range: the Global Lung Function 2012 equations. European Respiratory Journal. 2012;40(6):1324\u0026ndash;43. doi:10.1183/09031936.00080312.\u003c/li\u003e\n \u003cli\u003eCutts DB, Meyers AF, Black MM, et al. US housing insecurity and the health of very young children. American Journal of Public Health. 2011;101(8):1508\u0026ndash;14. doi:10.2105/AJPH.2011.300139.\u003c/li\u003e\n \u003cli\u003eBess KD, Miller AL, Mehdipanah R. The effects of housing insecurity on children\u0026rsquo;s health: a scoping review. Health Promotion International. 2023;38(3):daac006. doi:10.1093/heapro/daac006.\u003c/li\u003e\n \u003cli\u003eBohannon RW. Measurement of sit-to-stand among older adults. Topics in Geriatric Rehabilitation. 2012;28(1):11\u0026ndash;6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Earthquake survivors, Temporary housing, Container settlements, Respiratory function, Handgrip strength, Sleep quality, Disaster-related health outcomes","lastPublishedDoi":"10.21203/rs.3.rs-8315853/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8315853/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cb\u003eBackground:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThe 2023 Kahramanmaraş earthquakes displaced hundreds of thousands of individuals across T\u0026uuml;rkiye, leading to prolonged residence in temporary container settlements. Although housing conditions are recognized as key determinants of health, limited research has evaluated the combined effects of long-term container living on respiratory function, muscle strength, fatigue, sleep quality, and overall quality of life. This study aimed to comprehensively assess these parameters in adults residing in container settlements in Malatya approximately 20 months after the earthquakes.\u003c/p\u003e\u003cp\u003e\u003cb\u003eMethods:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eThis cross-sectional field study included 247 adults aged 25\u0026ndash;55 years who had been living in container settlements for at least 12 months. Sociodemographic data, respiratory symptoms, fatigue, allergic reactions, and sleep quality were collected through structured interviews. Spirometry (FEV₁, FVC, FEV₁/FVC, predicted values) and handgrip strength were measured using standardized protocols. Physical activity and quality of life were assessed with the IPAQ-Short Form, PSQI, and SF-36. Between-group comparisons were conducted using t-tests, Mann\u0026ndash;Whitney U, and chi-square tests. Correlations were evaluated using Pearson or Spearman methods.\u003c/p\u003e\u003cp\u003e\u003cb\u003eResults:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eParticipants were predominantly women (69.2%) with a mean age of 44\u0026thinsp;\u0026plusmn;\u0026thinsp;11.75 years and a mean BMI of 27.33\u0026thinsp;\u0026plusmn;\u0026thinsp;4.55 kg/m\u0026sup2;. Dyspnea (mMRC\u0026thinsp;\u0026ge;\u0026thinsp;1) was present in 42.9% of participants, and 28% demonstrated poor sleep quality. Mean FEV₁/FVC was 80.84\u0026thinsp;\u0026plusmn;\u0026thinsp;6.82%, while handgrip strength values were below normative expectations (right: 27.80\u0026thinsp;\u0026plusmn;\u0026thinsp;12.33 kg; left: 27.06\u0026thinsp;\u0026plusmn;\u0026thinsp;13.12 kg). Dyspnea showed significant negative correlations with spirometric indices and muscle strength, and positive correlation with fatigue. Women and unemployed individuals exhibited significantly lower handgrip strength, higher fatigue, and poorer spirometric ratios. Participants reporting allergic reactions demonstrated lower physical and psychosocial health scores.\u003c/p\u003e\u003cp\u003e\u003cb\u003eConclusion:\u003c/b\u003e\u003c/p\u003e \u003cp\u003eAdults residing in container settlements nearly two years after the earthquakes exhibited measurable impairments in respiratory function, muscle strength, sleep quality, and overall well-being. These findings highlight the persistent multidimensional health burden associated with long-term temporary housing. Strengthening environmental conditions and implementing respiratory, physical activity, and psychosocial rehabilitation programs may mitigate adverse outcomes in displaced populations.\u003c/p\u003e","manuscriptTitle":"Respiratory Problems And Quality Of Life Among Individuals Living İn Containers Following The 2023 Kahramanmaraş Earthquake","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-02-09 08:12:27","doi":"10.21203/rs.3.rs-8315853/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"editorInvitedReview","content":"","date":"2026-02-23T00:49:47+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-17T17:35:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"17317740655356142787569779511506950855","date":"2026-02-14T08:38:37+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"306067042055704021718118701338475788348","date":"2026-02-13T11:06:00+00:00","index":"hide","fulltext":""},{"type":"editorInvitedReview","content":"","date":"2026-02-13T11:01:54+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"255699825286256886340084481102112211571","date":"2026-02-07T13:26:19+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"271770761083301625035036365324153182411","date":"2026-02-05T16:00:29+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-02-05T04:23:54+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-01-09T17:02:33+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2025-12-18T11:54:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2025-12-18T09:30:18+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Pulmonary Medicine","date":"2025-12-18T09:13:25+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-pulmonary-medicine","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"pulm","sideBox":"Learn more about [BMC Pulmonary Medicine](http://bmcpulmmed.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/pulm/default.aspx","title":"BMC Pulmonary Medicine","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"d81d7d4c-c5da-4d1c-b3ce-95e763db3133","owner":[],"postedDate":"February 9th, 2026","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-02-09T08:12:27+00:00","versionOfRecord":[],"versionCreatedAt":"2026-02-09 08:12:27","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8315853","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8315853","identity":"rs-8315853","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}