Experimental Evidence Shows That Housing Vouchers Provided Measurable Benefits, Including Parent Stress Reduction.

This article presents early findings on the causal effects of a housing voucher on family stress, which plays an important role in children's healthy development. Using the Housing and Children's Healthy Development study, which is the only randomized controlled trial of housing vouchers (conducted in the Cleveland, Ohio, and Dallas, Texas, metropolitan areas), we found measurable health and related benefits accruing to families who received vouchers even though half of those who leased housing with vouchers only lived in that dwelling for roughly one year or less. Vouchers also substantially improved cost burdens, sufficiency of space, adequacy of heat, and daytime neighborhood safety. Our analysis shows that the affordability secured by the voucher (reduction of cost burden) played the most important role in reducing parent stress. One policy implication of the affordability findings is the need to keep families' housing cost burden affordable.

Modeling Social Network Influences on Oral Health Outcomes among Women Living in Public Housing.

OBJECTIVE: Research into the influence and role of social networks on oral health outcomes has been limited. This study aims to demonstrate via explanatory modeling the influence of social networks on oral health outcomes among women in who live in public housing in Boston, Massachusetts. METHODS: Individual- and network-level data were obtained from a cross-sectional survey of adult female residents of 2 public housing developments in Boston, Massachusetts. Participants responded to close-ended questions about sociodemographic characteristics, oral and general health status, and health-related behaviors for themselves as well as their named social contacts. Based on this information, network-level variables were calculated for each participant, including the proportion of the social network with certain characteristics or attributes. To assess the salience of network measures in explaining the variability in self-reported oral health status, overall health status, use of dental services within the last year, and current dental treatment needs, logistic regression models with individual-level covariates were compared with corresponding models that additionally included network-level variables with McFadden R2 for comparison purposes. RESULTS: Model comparisons for each outcome of interest demonstrated that adding network-level covariates significantly improved model fit. Additionally, network-level covariates displayed strong independent associations with the outcomes of interest. The network proportion needing dental treatment was positively associated with participants' odds of reporting current dental treatment needs (odds ratio, 4.71; 95% CI, 1.47 to 15.05). An individual's odds of reporting no dental visit within the past year decreased with increasing exposure to social contacts with reported dental visits within the past year (odds ratio, 0.26; 95% CI, 0.07 to 0.89). CONCLUSION: The salience of specific network attributes depended on the outcome under study. Interventions aimed at reducing the poor oral health burden in this and similar population groups may benefit from integrating information on social networks, including tailoring intervention delivery and/or messaging to account for the potential influence of social networks. KNOWLEDGE TRANSFER STATEMENT: This work may be beneficial to those developing policy solutions and interventions aimed at reducing the burden of poor oral health outcomes in socioeconomically disadvantaged populations, such as women who reside in public housing developments. The potential for leveraging social networks to seed messaging about oral health, for example, may enhance efforts to reduce oral health disparities.

Confronting misconceptions of public housing communities: A qualitative report of community-informed narratives by community members and partners.

Objectives were (a) to understand a community-informed narrative, as told by community members (CMs) and community partners (CPs), about the strengths, experiences, and perspectives of public housing communities; and (b) to analyze similarities and differences between CMs' and CPs' experiences and perspectives. Qualitative interviews were conducted with 22 CMs of public housing (ages 26-58, 100% female caregivers, 96% Black, 4% multiethnic) and 43 CPs (ages 28-78, 67.4% female, 81.4% Black and African American). Four themes were derived from the CM and CP interviews: (1) counters to public narratives, (2) disinvestment begets disinvestment, (3) community conditions should be better, and (4) community cohesion and connection. Findings from this study present community-centered narratives and experiences that were counter to stereotyped public narratives and could influence public perceptions and behavior to inform policy changes related to improving living conditions and supporting CMs in public and low-income housing communities.

A Good Farewell? Positive Exits from Federal Housing Assistance and Lower Acute Healthcare Utilization.

Little is known regarding the health outcomes of people who exit from housing assistance and if that experience varies by the circumstances under which a person exits. We asked two questions: (1) does the type of exit from housing assistance matter for healthcare utilization? And (2) how does each exit type compare to remaining in housing assistance in terms of healthcare utilization? This retrospective cohort study of 5550 exits between 2012 and 2018 used data from two large, urban public housing authorities in King County, Washington. Exposures were exiting from housing assistance and type of exit (positive, neutral, negative). Outcomes were emergency department visits, hospitalizations, and well-child checks (among those aged < 6) in the year following exit from housing assistance. After adjustment for demographics and baseline healthcare utilization, people with positive exits had 26% (95% confident interval: 6-39%) lower odds of having 1 + ED visits in the year following exit than people with negative exits and 20% (95% CI: 6-31%) lower odds than those who continued receiving housing assistance. Neutral and negative exits did not differ substantially from each other, and both exit types appear to be detrimental to health, with higher levels of ED visits and hospitalizations and lower levels of well-child checks. Why people exit from housing assistance matters. Those with negative exits experience poorer outcomes and efforts should be made to both prevent this kind of exit and mitigate its impact.

The health and wellbeing of Australian social housing tenants compared to people living in other types of housing.

BACKGROUND: Although social housing provides access to safe and affordable housing, recent studies have found that social housing tenants consistently have lower levels of health and well-being compared to other people. Given this, there is a need to examine multimorbidity for social housing tenants. METHODS: Secondary data analysis of the 2017-18 Australian National Health Survey (n = 14,327) compared the health of adults residing in social housing compared to people in other housing types (private rentals, homeowners, and homeowners/mortgagees). RESULTS: Most health factors examined were more prevalent in social housing tenants compared to those living in other housing types. Individual health problems identified as more highly prevalent in social housing tenants compared to all other housing types included mental health issues (43%), arthritis (36%), back problems (32%), hypertension (25%), asthma (22%) and COPD (11%). 24% of social housing tenants reported five or more health factors compared to 3-6% of people in other housing types. CONCLUSIONS: Although these findings are not unexpected, they provide more detailed evidence that social housing providers and policy makers should consider when planning future initiatives.

Social and emotional wellbeing of Aboriginal and Torres Strait Islander peoples in Aboriginal controlled social housing.

BACKGROUND: Little is known about the wellbeing and aspirations of Aboriginal and Torres Strait Islander peoples living in social housing. Aboriginal and Torres Strait Islander peoples living in social housing face common social housing challenges of low income, higher incidence of mental health issues and poorer health along with specific challenges due to the impacts of colonisation and its ongoing manifestations in racism and inequity. A greater understanding of social and emotional wellbeing needs and aspirations is essential in informing the provision of appropriate support. METHODS: Surveys of social and emotional wellbeing (SEWB) were completed by 95 Aboriginal people aged 16 years and older living in Aboriginal Housing Victoria social housing in 2021. The survey addressed a range of domains reflecting social and emotional wellbeing, as defined by Aboriginal and Torres Strait Islander peoples. RESULTS: Most respondents demonstrated a strong sense of identity and connection to family however 26% reported having 6 or more health conditions. Ill health and disability were reported to be employment barriers for almost a third of people (32%). Improving health and wellbeing (78%) was the most cited aspiration. Experiences of racism and ill health influenced engagement with organisations and correspondingly education and employment. CONCLUSION: Strong connections to identity, family and culture in Aboriginal peoples living in social housing coexist along with disrupted connections to mind, body and community. Culturally safe and appropriate pathways to community services and facilities can enhance these connections. Research aimed at evaluating the impact of strengths-based interventions that focus on existing strong connections will be important in understanding whether this approach is effective in improving SEWB in this population. TRIAL REGISTRATION: This trial was retrospectively registered with the ISRCTN Register on the 12/7/21 with the study ID:ISRCTN33665735.

Community Walks: a cluster randomized controlled trial of a multilevel physical activity intervention for low income public housing residents.

BACKGROUND: Physical activity behavioral interventions to change individual-level drivers of activity, like motivation, attitudes, and self-efficacy, are often not sustained beyond the intervention period. Interventions at both environmental and individual levels might facilitate durable change. This community-based study seeks to test a multilevel, multicomponent intervention to increase moderate intensity physical activity among people with low incomes living in U.S. public housing developments, over a 2 year period. METHODS: The study design is a prospective, cluster randomized controlled trial, with housing developments (n=12) as the units of randomization. In a four-group, factorial trial, we will compare an environmental intervention (E) alone (3 developments), an individual intervention (I) alone (3 developments), an environmental plus individual (E+I) intervention (3 developments), against an assessment only control group (3 developments). The environmental only intervention consists of community health workers leading walking groups and indoor activities, a walking advocacy program for residents, and provision of walking maps/signage. The individual only intervention consists of a 12-week automated telephone program to increase physical activity motivation and self-efficacy. All residents are invited to participate in the intervention activities being delivered at their development. The primary outcome is change in moderate intensity physical activity measured via an accelerometer-based device among an evaluation cohort (n=50 individuals at each of the 12 developments) from baseline to 24-month follow up. Mediation (e.g., neighborhood walkability, motivation) and moderation (e.g., neighborhood stress) of our interventions will be assessed. Lastly, we will interview key informants to assess factors from the Consolidated Framework for Implementation Research domains to inform future implementation. DISCUSSION: We hypothesize participants living in developments in any of the three intervention groups (E only, I only, and E+I combined) will increase minutes of moderate intensity physical activity more than participants in control group developments. We expect delivery of an intervention package targeting environmental and social factors to become active, combined with the individual level intervention, will improve overall physical activity levels to recommended guidelines at the development level. If effective, this trial has the potential for implementation through other federal and state housing authorities. TRIAL REGISTRATION: Clinical Trails.gov PRS Protocol Registration and Results System, NCT05147298 . Registered 28 November 2021.

Disparities in Smokefree and Vapefree Home Rules and Smokefree Policy Attitudes Based on Housing Type and Cigarette Smoking Status, United States, 2019.

This study examined variations in cigarette smoking status, home smoking and vaping rules, and attitudes toward smoking rules among U.S. adults. We analyzed data from the 2019 U.S. Census Bureau's Current Population Survey Supplements (n = 40,296 adults) and calculated weighted prevalence estimates of adult cigarette smoking based on housing type. In 2019, multi-unit housing (MUH) residents who currently smoked were predominantly residents of privately rented housing (66.9%), followed by privately owned (17.6%) and public housing (15.5%). MUH residents who currently smoked had the highest proportions of allowing smoking (26.7%) or vaping (29.1%) anywhere inside their homes and were least likely to support rules allowing smoking inside all MUH apartments or living areas. In the adjusted models, MUH residents with a current smoking status were 92% less likely to have a complete smoking ban. More than one in four MUH residents with a current smoking status allowed all smoking inside the home and supported allowing smoking inside all MUH apartment or living areas, reinforcing how MUH residents may be at higher risk of experiencing secondhand smoke or aerosol exposure, or incursions within their places of residence. Our results can inform the development, implementation, and sustainment of strategies to reduce exposures from tobacco and nicotine products in all living environments.

Impact of the monetary value of housing assistance on adult health outcomes.

OBJECTIVE: To assess the impact of the dollar value of federal low-income housing assistance on adult health outcomes and whether this impact varies across housing assistance programs. DATA SOURCES: We use the National Health Interview Survey (NHIS) from 1999 to 2016 linked with administrative records from the Department of Housing and Urban Development (HUD) tracking receipt of low-income housing assistance from 1999 to 2017. DESIGN: We use two approaches to assess the impact of the value of housing assistance among HUD housing assistance recipients on outcomes capturing overall health and mental health, chronic and acute health conditions, health care hardship, and food insecurity. First, we use multivariable regression models that adjust for a wide array of possible confounders. Second, we use an instrumental variable approach in which the county-level supply of HUD housing serves as an instrument for the value of housing assistance. DATA COLLECTION/EXTRACTION METHODS: Our sample includes all 12,031 adult HUD linkage-eligible NHIS respondents who were currently in HUD housing at the time of their NHIS interview. PRINCIPAL FINDINGS: We find the most consistent associations between the value of housing assistance and measures of health care hardship, a relationship that is most robust for Housing Choice Voucher recipients, where we find a $100 increase in the value of housing assistance is associated with a 6.2 percentage point decrease in probability of needing but not being able to afford medical care. We find little evidence that the value of housing assistance impacts overall health or chronic health outcomes. CONCLUSIONS: The relationship between the value of housing assistance and health likely operates via an income effect, wherein receipt of a more valuable benefit frees up resources to spend on needed care. Policy changes to increase the value of housing assistance may have tangible health benefits for tenants receiving housing assistance.

"To Be Moving Is to Be Alive": A Walk-Along Study Describing Older Public Housing Tenants' Perceptions of Physical Activity.

Few studies have focused on older public housing tenants' perceptions of physical activity. Greater understanding of how they define, appreciate, and engage in physical activity could lead to better targeted promotion and reduced health inequalities for this subgroup of the population. We conducted 26 walk-along interviews with older public housing tenants in Montreal (Canada). Tenants were aged 60-93 years and lived in either one of three study sites including a commercial, a residential, and a mixed land-use area. Physical activity was described as a multidimensional construct through six interdependent dimensions: physiological, emotional, interpersonal, occupational, intellectual, and existential. Participants perceived physical activity as having potential for both well-being and ill-being. Perceptions of physical activity were a function of age, physical capacity, gender, culture, revenue, and relation to community. These results support using a life-course perspective and a broader definition in promoting physical activity to older public housing tenants.

Impact of supportive housing health homes program on medicaid utilization for persons diagnosed with HIV (PDWH).

ABSTRACTUnstable housing among persons diagnosed with HIV (PDWH) has been consistently linked to poor HIV-related care engagement. We examined the relationship between enrollment in a supportive housing program and health care utilization (use of outpatient services, emergency department (ED) visits, and hospitalizations) for a group of unstably housed, Medicaid and Health Homes (HH)-enrolled PDWH in New York State. We analyzed monthly longitudinal data consisting of linked supportive housing data, HH data, and Medicaid claims from New York State (excluding New York City) between 2012 and 2017 using time series models. Participants who had at least six consecutive months of supportive housing at month t had 20% higher odds of using an outpatient service, 19% lower odds of visiting the ED, and 24% lower odds of being hospitalized compared to those with less than six consecutive months of supportive housing after adjusting for covariates. Supportive housing may promote better medical management by increasing outpatient visits among chronically homeless PDWH.

A Matched Analysis of the Association Between Federally Mandated Smoke-Free Housing Policies and Health Outcomes Among Medicaid-Enrolled Children in Subsidized Housing, New York City, 2015-2019.

Smoke-free housing policies are intended to reduce the deleterious health effects of secondhand smoke exposure, but there is limited evidence regarding their health impacts. We examined associations between implementation of a federal smoke-free housing rule by the New York City Housing Authority (NYCHA) and pediatric Medicaid claims for asthma, lower respiratory tract infections, and upper respiratory tract infections in the early post-policy intervention period. We used geocoded address data to match children living in tax lots with NYCHA buildings (exposed to the policy) to children living in lots with other subsidized housing (unexposed to the policy). We constructed longitudinal difference-in-differences models to assess relative changes in monthly rates of claims between November 1, 2015, and December 31, 2019 (the policy was introduced on July 30, 2018). We also examined effect modification by baseline age group (≤2, 3-6, or 7-15 years). In New York City, introduction of a smoke-free policy was not associated with lower rates of Medicaid claims for any outcomes in the early postpolicy period. Exposure to the smoke-free policy was associated with slightly higher than expected rates of outpatient upper respiratory tract infection claims (incidence rate ratio = 1.05, 95% confidence interval: 1.01, 1.08), a result most pronounced among children aged 3-6 years. Ongoing monitoring is essential to understanding long-term health impacts of smoke-free housing policies.

Permanent Supportive Housing for Those Experiencing Chronic Homelessness with High Health or Social Support Needs: A Scoping Review.

Some populations have increased risks of experiencing chronic homelessness related to complex health and social needs combined with system failures. Permanent supportive housing (PSH) may improve housing and health outcomes for this population. To understand the scope of the literature on PSH, this scoping review uses Arksey and O'Malley's methodological framework enhanced by Levac and the Joanna Briggs Institute. A search was conducted across multiple databases for existing research on PSH. Forty-one studies were included, and five themes were generated: PSH sustains housing for most people; PSH is costly to implement, but costs can be recouped; PSH facilitates belonging and safety; single-site programs have social challenges but also provide efficiency and improve social networks; and visible on-site staff fundamentally helps those with highest support needs. Permanent supportive housing has been shown to be effective for those with the highest health and social support needs and is required to help prevent and end homelessness.

NB housing study protocol: investigating the relationship between subsidized housing, mental health, physical health and healthcare use in New Brunswick, Canada.

BACKGROUND: Income and housing are pervasive social determinants of health. Subsidized housing is a prominent affordability mechanism in Canada; however, waitlists are lengthy. Subsidized rents should provide greater access to residual income, which may theoretically improve health outcomes. However, little is known about the health of tenants who wait for and receive subsidized housing. This is especially problematic for New Brunswick, a Canadian province with low population density, whose inhabitants experience income inequality, social exclusion, and challenges with healthcare access.  METHODS: This study will use a longitudinal, prospective matched cohort design. All 4,750 households on New Brunswick's subsidized housing wait list will be approached to participate. The survey measures various demographic, social and health indicators at six-month intervals for up to 18 months as they wait for subsidized housing. Those who receive housing will join an intervention group and receive surveys for an additional 18 months post-move date. With consent, participants will have their data linked to a provincial administrative database of medical records.  DISCUSSION: Knowledge of housing and health is sparse in Canada. This study will provide stakeholders with a wealth of health information on a population that is historically under-researched and underserved.

Association of Promoting Housing Affordability and Stability With Improved Health Outcomes: A Systematic Review.

Importance: Housing insecurity-that is, difficulty with housing affordability and stability-is prevalent and results in increased risk for both homelessness and poor health. However, whether interventions that prevent housing insecurity upstream of homelessness improve health remains uncertain. Objective: To review evidence characterizing associations of primary prevention strategies for housing insecurity with adult physical health, mental health, health-related behaviors, health care use, and health care access. Evidence Review: Pairs of independent reviewers systematically searched PubMed, Web of Science, EconLit, and the Social Interventions Research and Evaluation Network for quantitative studies published from 2005 to 2021 that evaluated interventions intended to directly improve housing affordability and/or stability either by supporting at-risk households (targeted primary prevention) or by enhancing community-level housing supply and affordability in partnership with the health sector (structural primary prevention). Risk of bias was appraised using validated tools, and the evidence was synthesized using modified Grading of Recommendations Assessment, Development, and Evaluation criteria. Findings: A total of 26 articles describing 3 randomized trials and 20 observational studies (16 longitudinal designs and 4 cross-sectional quasi-waiting list control designs) were included. Existing interventions have focused primarily on mitigating housing insecurity for the most vulnerable individuals rather than preventing housing insecurity outright. Moderate-certainty evidence was found that eviction moratoriums were associated with reduced COVID-19 cases and deaths. Certainty of evidence was low or very low for health associations of other targeted primary prevention interventions, including emergency rent assistance, legal assistance with waiting list priority for public housing, long-term rent subsidies, and homeownership assistance. No studies evaluated health system-partnered structural primary prevention strategies. Conclusions and Relevance: This systematic review found mixed and mostly low-certainty evidence that interventions that promote housing affordability and stability were associated with improved adult health outcomes. Existing interventions may need to be paired with other efforts to address the structural determinants of health. As health care systems and insurers respond to increasing opportunities to invest in housing as a determinant of health, further research is needed to clarify where along the housing insecurity pathway interventions should focus for the most effective and equitable health impact.

The Impact of Temporary Housing Assistance Expenditures on Subcategories of Health Care Cost for U.S. Veterans Facing Housing Instability.

We sought to estimate the impact of temporary financial assistance (TFA) for housing-related expenses from the U.S. Department of Veterans Affairs on costs for a variety of health care services. We conducted a retrospective cohort study of Veterans who entered the Supportive Services for Veteran Families (SSVF) program between 10/2015 and 9/2018. We assessed the effect of TFA on health care costs using a multivariable difference-in-difference approach. Outcomes were direct medical costs of health care encounters (i.e., emergency department, outpatient mental health, inpatient mental health, outpatient substance use disorder treatment, and residential behavioral health) in the VA system. Temporary financial assistance was associated with a decrease in ED (-$11, p<.003), outpatient mental health (-$28, p<.001), outpatient substance use disorder treatment (-$25, p<.001), inpatient mental health (-$258, p<.001), and residential behavioral health (-$181, p<.001) costs per quarter for Veterans in the rapid re-housing component of SSVF. These results can inform policy debates regarding proper solutions to housing instability.

Development of a Medication Management Program in Permanent Supportive Housing.

We describe a nurse-led project that aimed to assist a permanent supportive housing facility for chronically homeless individuals to improve medication adherence by refining a medication management program. Client and staff engagement through needs assessment, feedback, and evaluation formed the foundation for a sustainable medication management program.

Guía para la vivienda adecuada en la respuesta a refugiados y migrantes de venezuela en Latino América y el Caribe / Guide for adequate housing in the response to refugees and migrants from Venezuela in Latin America and the Caribbean

Desde el Sector de Alojamiento bajo la Plataforma de Coordinación Interagencial para Refugiados y Migrantes de Venezuela (R4V), en coordinación con otros sectores regionales y organizaciones humanitarias en la región, entendemos el acceso a la vivienda adecuada como algo más que la provisión de un techo y cuatro paredes en momentos de crisis, sino como la oportunidad de reconstruir la palabra "hogar" a través del ejercicio del derecho a vivir con dignidad, protección y seguridad en un entorno saludable que permita a las personas reconstruir lo cotidiano y reactivar sus actividades económicas y sociales; compartiendo así las definiciones de "Vivienda Adecuada" de ONU-Derechos Humanos (ADNUDH) y ONU-Hábitat 1 o las recogidas en el Manual Esfera de 2018 2 . Aquellas poblaciones en situación de movilidad, como son refugiados y migrantes, se encuentran en una situación de mayor vulnerabilidad al dejar sus hogares atrás y ante la violación de sus derechos humanos fundamentales, en particular, el de acceso a la vivienda, exacerbado por situaciones de discriminación, racismo y/o xenofobia; que impiden lograr unas condiciones de vida adecuadas y sostenibles. La vivienda adecuada no provee exclusivamente protección dentro del espacio construido, sino que es un medio para acceder a un mejor nivel de vida. En particular, y dado que en la actualidad las situaciones de desplazamiento tienen una duración mayor que en periodos anteriores, llegando incluso a durar décadas, la ausencia de una vivienda adecuada acrecienta los niveles de pobreza, aumentando la brecha de desigualdad para lograr la integración socioeconómica de las personas refugiadas y migrantes a través del acceso a un trabajo digno, y, en consecuencia, a tener una sensación de seguridad física y económica y a la lograr un sentimiento de comunidad y cohesión social.