Housing instability and homelessness are widely understood to have an impact on health, and certain housing problems have been linked to specific childhood health conditions, such as mold with asthma. But it has not been clear how overall housing quality may affect children--especially those who are at risk from other social determinants of health such as food insecurity or poverty.
A new nationally representative study in the Journal of Child Health Care, led by researchers at Nationwide Children's Hospital, has found poor-quality housing is independently associated with poorer pediatric health, and suggests ways health care providers and housing programs may address those findings.
"We are really trying to pick apart the social determinants of health. What happens to a child's health if the child is hungry? What happens if a parent can't pay rent?" said Kelly Kelleher, MD, senior author of the study and vice president of Community Health at Nationwide Children's. "What we found in this study is that when housing quality is a problem, children suffer. And children are suffering now."
The authors based the study on the 2014 U.S. Census Survey of Income and Program Participation, ultimately considering 12,964 children 2-14 years of age across the country. As part of the survey, parents were asked about their children's overall health, number of medical visits and number of hospitalizations. They were also asked about the quality of their housing in four specific categories: holes or cracks in walls or ceilings; holes in the floor "big enough to catch your foot on"; plumbing features (including hot water heaters and toilets) that do not work; and problems with pests such as mice and roaches.
The study found each additional housing problem was associated with 43% greater odds of having a poorer health status.
"It was important, however, to account for other factors that are understood to impact health, and so the study used a modeling strategy that went beyond housing quality alone," said Samantha Boch, PhD, RN, the lead author of the study who completed it as a post-doctoral fellow in Nationwide Children's Patient-Centered Pediatric Research Program. She is now an assistant professor at the University of Cincinnati College of Nursing and an affiliate faculty member of the James M. Anderson Center for Health Systems Excellence at Cincinnati Children's Hospital Medical Center.
"Even when you adjust for demographic factors like race, ethnicity and disability, and housing-related issues like inability to pay rent or neighborhood safety, poor housing quality has an independent association with poorer health and higher health care use," said Dr. Boch.
When demographic factors were considered, each additional housing problem was associated with 18% greater odds of poorer health; when other housing issues were considered, there were 16% greater odds.
The authors also found poor housing quality was independently associated with a greater number of medical visits for children (as were inability to pay utilities, rent or mortgage and living in a nonmetropolitan home).
Dr. Kelleher says these findings reinforce the need for social determinants of health screening, and suggest housing quality, not just homelessness or housing insecurity, should be part of those screens. The study also puts a national lens on the convergence of health and housing Nationwide Children's has long seen locally through its Healthy Neighborhoods Healthy Families initiative, which has now built or helped improve approximately 400 homes in traditionally disadvantaged Columbus neighborhoods.
"We know anecdotally, from our experience in our own backyard, that housing quality impacts health," said Dr. Kelleher. "We can now say it's true nationally, and new housing isn't the only thing that matters--improving existing housing may be just as important."