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# Do Housing Assistance Programs Help Kids? It’s Complicated!:

May 16, 2018

In a recently released issue of Pediatrics, Natalie Slopen and colleagues report on a systematic review of studies that measure the relationship between publicly-supported housing assistance programs and child health outcomes in the United States. What an interesting idea!

In a recently released issue of Pediatrics (10.1542/peds.2017-2742), Natalie Slopen and colleagues report on a systematic review of studies that measure the relationship between publicly-supported housing assistance programs and child health outcomes in the United States. What an interesting idea! Certainly with increasing recognition of the importance of the social determinants of child health, it makes great sense to look at this question and examine what the literature tells us. Just 14 studies met criteria for review, and the most frequently reported measures of child health were weight and BMI (body mass index), followed by perceived health and self-reported violent behavior. Proxies for health such as school absence, food insecurity and blood lead level that one might consider as related to housing or neighborhood were not included outcomes in this review, although health conditions such as asthma and immunization status were. The authors used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) checklist, and readers can orient themselves with Table 4, which presents a summary of studies by outcomes and findings, sorted by study design (quasi-experimental versus association studies).

The review has several very interesting findings. One that interested me was the inconsistency of the reported results, with 25% of studies showing worse outcomes, 37.5% showing no difference and just 37.5% showing improved outcome. The authors note that none of the studies was a randomized controlled trial, that most studies were cross-sectional, most were hampered by lack of good methodology to address confounding, by use of a convenience sample rather than stronger recruitment methods, and finally not all studies used objective housing and health outcome data (versus self-report). Given all of these obstacles, which were well summarized by the authors, the great variety of study results is less surprising.

A second intriguing point was the relatively small number of studies that met eligibility criteria for the review. I compared this in my mind to the impressively large federal spending of about $37 billion dollars across the three programs included (Public Housing, Multi-family Housing and the Housing Choice Voucher Program). A summary of public housing assistance programs that I found helpful is available from the National Coalition for the Homeless. Although the purpose of federal housing assistance programs is not to directly impact child health, the wellbeing of children who are housed certainly seems like a reasonable proxy for program success, especially since 26-48% of households across these programs include children. The HUD (Housing and Urban Development) website informs us that, for example, “Public housing was established to provide decent and safe rental housing for eligible low-income families, the elderly, and persons with disabilities.” Although local housing agencies administer Public Housing, the rental cost to the tenant is calculated by formula and cannot exceed 30% of expected income, welfare rent or a local minimum which may be$25/month. Ideally this should free up financial resources for families for other needs such as healthy foods. It makes sense that a variety of health outcomes could be measured among children living in public housing, versus in non-assisted housing, and these studies might provide evidence to support continued or expanded federal monies. This review certainly serves as an excellent launching point for such work, but clearly, after reading this well-done review, more studies are needed.

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