Evictions and Infant and Child Health Outcomes

Abstract

ImportanceMillions of rental evictions occur in the United States each year, disproportionately affecting households with children. Increasing attention has been paid to the impact of evictions on child health outcomes.ObjectiveTo synthesize and assess studies examining the associations of eviction exposure with infant and child health outcomes.Evidence ReviewFor this systematic review without meta-analysis, a database search was performed using PubMed, Web of Science, and PsycINFO, through September 25, 2022. Included studies were peer-reviewed quantitative studies examining an association between exposure to eviction and at least 1 health outcome, both before age 18 years, including prenatal exposures and perinatal outcomes. This study followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) reporting guideline. Data were analyzed from March 3 to December 7, 2022.FindingsDatabase searches identified 266 studies, and 11 studies met inclusion criteria. Six studies examined associations between prenatal eviction and birth outcomes, such as gestational age, and each found that eviction was significantly associated with at least 1 adverse birth outcome. Five studies investigated other childhood outcomes, including neuropsychological test scores, parent-rated child health, lead testing rates, and body mass index, and among these 5 studies, 4 reported an association between eviction and adverse child health outcomes. Direct experience of eviction or residence in a neighborhood with more evictions was associated with adverse perinatal outcomes in 6 studies, higher neurodevelopmental risk in 2 studies, worse parent-rated child health in 2 studies, and less lead testing in 1 study. Study designs and methods were largely robust.Conclusions and RelevanceIn this systematic review without meta-analysis of the association between evictions and child health outcomes, evidence demonstrated the deleterious associations of eviction with a range of developmental periods and domains. In the context of a rental housing affordability crisis, ongoing racial disparities in evictions, and continuing harm to millions of families, health care practitioners and policy makers have an integral role to play in supporting safe, stable housing for all.

Eviction and Children’s Health—Investing in Data, Acting on What We Know

“…Existing data, combined with personal accounts from families targeted for evictions, are sufficient to spur action. To this end, Ramphal et al 6 suggest ways that health care practitioners, health systems, and policy makers can work in concert to prevent evictions.…”

“…The authors also call for structural change, addressing upstream drivers of evictions, including historical and present-day policies that perpetuate unaffordable, precarious housing, particularly in racially marginalized communities. 6 As we strive for progress, we in the research community can follow the lead of community advocates who have decades of experience sounding the alarm about the harms of evictions and organizing for action. For example, in Oakland, California, Moms 4 Housing came together to fight displacement and protect the health of their children by occupying a home purchased by real estate speculators.…”

“…As the field of eviction epidemiology comes into its own, we must continue to focus on children as a priority population. Ramphal and collegues 6 show us that there is already a compelling evidence base on the associations of evictions with worse health outcomes in childhood. However, to arrive at a comprehensive understanding of the many ways evictions can harm young people, we need to invest in data infrastructure.…”

“…The study by Ramphal and colleagues 6 takes stock of the growing research base on evictions and child health. Their systematic review identified 11 studies, all published between 2015 and 2022.…”

“…Their systematic review identified 11 studies, all published between 2015 and 2022. 6 Among these, 6 studies measured associations between evictions and birth outcomes, while the remaining 5 studies pertained to outcomes in childhood. While 6 studies measured household-level evictions, 5 studies relied on area-level eviction rates.…”