Associations Between Federal Rental Housing Assistance and Childhood Asthma—A Renewed Call for Investing in Housing for Health

Abstract

In this issue of JAMA Pediatrics, the findings of Boudreaux et al 1 suggest that federal rental assistance for families with low incomes may be important for reducing emergency department visits for asthma. This study adds to the increasing body of research on the ways in which housing assistance is associated with health and has implications for housing and health care policies, especially given the emergence of value-based care and housing and health partnerships.Previous research 2 on housing and health outcomes, particularly in association with asthma, has predominately focused on housing quality. The evidence base on the associations between poor housing quality, including mold, pests, and secondhand smoke, and adverse outcomes associated with asthma has led to the development of interventions that seek to improve the quality of housing specifically for families with children diagnosed with asthma.This new study highlights an additional potential dimension of housing that affects children, especially those with special health care needs such as asthma: housing affordability. Previous research 3 at Children's HealthWatch has shown how 3 forms of housing instability and unaffordability are significantly associated with child and parent health outcomes as well as economic hardships. Families with young children who have fallen behind on rent in the previous year, moved 2 or more times in a year, and/or experienced homelessness in the lifetime of the young child experienced higher rates of child hospitalizations, developmental delays, and maternal depression compared with stably housed families. Furthermore, previous research 4 has found that families of children with special health care needs, most of whom had an asthma diagnosis, are at greater risk of housing instability compared with families with low incomes whose children do not have special health care needs. Before enrolling in a rental assistance program, the families in the wait-list group in the study by Boudreaux et al 1 were likely to be housing unstable and facing similar adverse health challenges.Federal rental assistance administered through the US Department of Housing and Urban Development (HUD) is designed to promote housing stability but may also have the added benefit of being associated with improved health. As the authors note, the high prevalence of children with asthma in this study compared with rates of asthma in the general population suggest that families who apply for assistance are particularly disadvantaged and therefore at high risk for adverse health. However, not all federal rental assistance is similarly administered, and the findings of Boudreaux et al 1 of differ-