Association of Childhood Asthma With Federal Rental Assistance

Abstract

Millions of low-income children in the United States reside in substandard or unaffordable housing. Relieving these burdens may be associated with changes in asthma outcomes.OBJECTIVES To examine whether participation in the US Department of Housing and Urban Development's (HUD) rental assistance programs is associated with childhood asthma outcomes and to examine whether associations varied by program type (public housing, multifamily housing, or housing choice vouchers).

The Benefits of Rental Assistance for Children's Health and School Attendance in the United States

“…By providing access to better and more secure housing, HUD assistance might reduce both the incidence of disease in childhood and the severity of conditions. Evidence is mixed ( Slopen et al 2018 ), but findings from several recent studies suggest that rental assistance improves mental health and reduces asthma symptoms and hospital use among children ( Boudreaux et al 2020 ; Fenelon et al 2018 ; Gubits et al 2018 ; Pollack et al 2019 ).…”

“…Housing has long represented the largest expenditure of the vast majority of U.S. families, and the fraction of income spent on housing has increased over the past three decades ( Joint Center for Housing Studies 2020 ). Children who reside in unaffordable, insecure, or poor-quality housing are more likely to experience health problems and to have difficulty managing existing conditions ( Beck et al 2014 ; Boudreaux et al 2020 ; Ma et al 2008 ; McCormack et al 2009 ; Sandel and Wright 2006 ; Warren and Font 2015 ). Gaining access to assisted housing may protect children in low-income families from these housing-related pressures; it may also help reduce children’s risk of developing chronic health conditions, experiencing hospitalizations, or being exposed to toxins, such as lead ( Ahrens et al 2016 ; Matte and Jacobs 2000 ; Rauh et al 2008 ).…”

“…To address selection bias, several recent studies used future treatment to develop a comparison group; that is, they compared rental assistance recipients with those who will receive rental assistance in the future in order to limit unobservable differences between recipients and nonrecipients (e.g., Elwert and Pfeffer 2019 ). Two recent studies using this approach demonstrated that rental assistance leads to improvements in mental health and reductions in emergency room visits for asthma, a common measure of uncontrolled asthma symptoms ( Boudreaux et al 2020 ; Fenelon et al 2018 ).…”

“…Several recent studies found that short-term health benefits of rental assistance are more substantial for public housing than for vouchers, particularly for mental health and distress outcomes ( Fenelon et al 2017 ; Fenelon et al 2018 ). Public housing has also shown stronger positive effects on asthma ( Boudreaux et al 2020 ). Public housing developments may provide access to informal social support networks that promote good mental health or facilitate accessing healthcare ( Keene and Ruel 2013 ; Simon et al 2017 ), which may reduce missed school days due to illness.…”

“…5 This approach accounts for unobserved time-invariant differences between individuals and families that obtain rental assistance and those that do not, given that all pseudo-waitlist individuals eventually enter rental assistance. 6 This approach has been applied in previous work on HUD assistance and health ( Boudreaux et al 2020 ; Keene et al 2018 ; Wong et al 2018 ) and has been suggested as a means of addressing unobserved selection in other treatments ( Elwert and Pfeffer 2019 ; Schwartz et al 2020 ).…”