Targeting Housing Mobility Vouchers to Help Families With Children

Pollack, Craig Evan; Thornton, Rachel L. J.; DeLuca, Stefanie

doi:10.1001/jamapediatrics.2014.668

Cited by 9 publications

(5 citation statements)

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“…33,47 Indeed, a recently published cohort study showed a reduction in asthma exacerbation frequency and symptoms days after moving from a high to low-poverty neighborhood through a voucher program, with associated global improvements in household pest and pollutant/smoke exposure, neighborhood safety, and urban stress, which suggests that neighborhood-level effects on disease severity are not fixed. 47 There were some important limitations to our study. First, the COI uses data captured at a single timepoint and does not account for changing neighborhood conditions or the known disease variability that children with asthma experience over time.…”

Section: Discussionmentioning

confidence: 99%

“…Lower COI was associated with higher CASI (more severe disease) across all the asthmatics in our study. While the magnitude of the effect was small (CASI scores increased by 0.34 points for a 20‐point decrease in COI), this effect size compounded over a large difference in neighborhood conditions (e.g., moving from a neighborhood in the lowest COI quintile to a neighborhood in the highest COI quintile) could meaningfully impact asthma severity and exacerbation frequency 33,47 . Indeed, a recently published cohort study showed a reduction in asthma exacerbation frequency and symptoms days after moving from a high to low‐poverty neighborhood through a voucher program, with associated global improvements in household pest and pollutant/smoke exposure, neighborhood safety, and urban stress, which suggests that neighborhood‐level effects on disease severity are not fixed 47 …”

Section: Discussionmentioning

confidence: 99%

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The Child Opportunity Index 2.0 and exacerbation‐prone asthma in a cohort of urban children

Skeen,

Moore,

Federico

et al. 2024

Pediatric Pulmonology

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RationaleSocial determinants of health underlie disparities in asthma. However, the effects of individual determinants likely interact, so a summary metric may better capture their impact. The Child Opportunity Index 2.0 (COI) is one such tool, yet its association with exacerbation‐prone (EP) asthma is unknown.ObjectiveTo investigate the association between the COI and EP asthma and clinical measures of asthma severity in children.MethodsWe analyzed data from two prospective observational pediatric asthma cohorts (n = 193). Children were classified as EP (≥1 exacerbation in the past 12 months) or exacerbation‐null (no exacerbations in the past 5 years). Spirometry, exhaled nitric oxide, IgE, and Composite Asthma Severity Index (CASI) were obtained. The association between COI and EP status was assessed with logistic regression. We fit linear and logistic regression models to test the association between COI and each clinical measure.ResultsA 20‐point COI decrease conferred 40% higher odds of EP asthma (OR 1.4; 95%CI 1.1–1.76). The effect was similar when adjusted for age and sex (OR 1.38, 95%CI 1.1–1.75) but was attenuated with additional adjustment for race and ethnicity (OR 1.19, 95%CI 0.92–1.54). A similar effect was seen for the Social/Economic and Education COI domains but not the Health/Environment Domain. A 20‐point COI decrease was associated with an increase in CASI of 0.34. COI was not associated with other clinical measures.ConclusionsLower COI was associated with greater odds of EP asthma. This highlights the potential use of the COI to understand neighborhood‐level risk and identify community targets to reduce asthma disparities.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Child Opportunity Index 2.0 and exacerbation‐prone asthma in a cohort of urban children

Skeen,

Moore,

Federico

et al. 2024

Pediatric Pulmonology

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“…54 Ninth, this study did not consider how residential mobility from birth to early childhood may influence changes in COI or SVI over time and whether such changes may alter asthma development, an important question given recent research that showed children whose families moved into lowpoverty neighborhoods experienced significant improvements in asthma morbidity. 55 Follow-up studies in ECHO investigating these associations are possible and will be helpful to evaluate the consequences for pediatric asthma.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children

Aris,

Perng,

Dabelea

et al. 2023

JAMA Pediatr

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BackgroundThe extent to which physical and social attributes of neighborhoods play a role in childhood asthma remains understudied.ObjectiveTo examine associations of neighborhood-level opportunity and social vulnerability measures with childhood asthma incidence.Design, Setting, and ParticipantsThis cohort study used data from children in 46 cohorts participating in the Environmental Influences on Child Health Outcomes (ECHO) Program between January 1, 1995, and August 31, 2022. Participant inclusion required at least 1 geocoded residential address from birth and parent or caregiver report of a physician’s diagnosis of asthma. Participants were followed up to the date of asthma diagnosis, date of last visit or loss to follow-up, or age 20 years.ExposuresCensus tract–level Child Opportunity Index (COI) and Social Vulnerability Index (SVI) at birth, infancy, or early childhood, grouped into very low (&lt;20th percentile), low (20th to &lt;40th percentile), moderate (40th to &lt;60th percentile), high (60th to &lt;80th percentile), or very high (≥80th percentile) COI or SVI.Main Outcomes and MeasuresThe main outcome was parent or caregiver report of a physician’s diagnosis of childhood asthma (yes or no). Poisson regression models estimated asthma incidence rate ratios (IRRs) associated with COI and SVI scores at each life stage.ResultsThe study included 10 516 children (median age at follow-up, 9.1 years [IQR, 7.0-11.6 years]; 52.2% male), of whom 20.6% lived in neighborhoods with very high COI and very low SVI. The overall asthma incidence rate was 23.3 cases per 1000 child-years (median age at asthma diagnosis, 6.6 years [IQR, 4.1-9.9 years]). High and very high (vs very low) COI at birth, infancy, or early childhood were associated with lower subsequent asthma incidence independent of sociodemographic characteristics, parental asthma history, and parity. For example, compared with very low COI, the adjusted IRR for asthma was 0.87 (95% CI, 0.75-1.00) for high COI at birth and 0.83 (95% CI, 0.71-0.98) for very high COI at birth. These associations appeared to be attributable to the health and environmental and the social and economic domains of the COI. The SVI during early life was not significantly associated with asthma incidence. For example, compared with a very high SVI, the adjusted IRR for asthma was 0.88 (95% CI, 0.75-1.02) for low SVI at birth and 0.89 (95% CI, 0.76-1.03) for very low SVI at birth.ConclusionsIn this cohort study, high and very high neighborhood opportunity during early life compared with very low neighborhood opportunity were associated with lower childhood asthma incidence. These findings suggest the need for future studies examining whether investing in health and environmental or social and economic resources in early life would promote health equity in pediatric asthma.

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“…Efforts by the health care delivery system to ensure adequate individual and population health are undermined when patients do not receive the protections or benefits that these laws afford them. Despite the existence of safety-net programs such as Supplemental Nutritional Assistance Program (SNAP) [ 13 ], Section 8 housing subsidies [ 14 – 17 ], and Supplemental Security Income (SSI) [ 18 ] (among many others), inconsistent program implementation coupled with complex bureaucratic requirements can result in unlawful denial of benefits and services, leading to preventable poor health outcomes [ 19 , 20 ]. Landlords, school districts, and employers often fail to comply with a range of legal obligations they have to ensure, for example, non-discrimination in housing, education, and the workplace.…”

Section: Introductionmentioning

confidence: 99%

Burden of socio-legal concerns among vulnerable patients seeking cancer care services at an urban safety-net hospital: a cross-sectional survey

Battaglia

Gupta-Lawrence

et al. 2016

BMC Health Serv Res

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BackgroundSocial and economic conditions that affect one’s ability to satisfy life’s most basic needs such as lack of affordable housing, restricted access to education and employment, or inadequate income are increasingly well-documented barriers to optimal health. The burden of these challenges among vulnerable patients accessing cancer care services is unknown.MethodsWe conducted a cross-sectional survey of patients presenting for ambulatory cancer care services (screening and treatment) at an urban safety-net hospital to assess socio-legal concerns (social problems related to meeting life’s basic needs supported by public policy or programming and potentially remedied through legal advocacy/action).ResultsAmong 104 respondents, 80 (77 %) reported concerns with one or more socio-legal needs in the past month, with a mean of 5.75 concerns per participant. The most common socio-legal concerns related to income supports, housing, and employment/education.ConclusionOur findings support the need for innovations in cancer care delivery to address socio-legal concerns of a vulnerable patient population.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1443-1) contains supplementary material, which is available to authorized users.

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Targeting Housing Mobility Vouchers to Help Families With Children

Cited by 9 publications

References 3 publications

The Child Opportunity Index 2.0 and exacerbation‐prone asthma in a cohort of urban children

The Child Opportunity Index 2.0 and exacerbation‐prone asthma in a cohort of urban children

Neighborhood Opportunity and Vulnerability and Incident Asthma Among Children

Burden of socio-legal concerns among vulnerable patients seeking cancer care services at an urban safety-net hospital: a cross-sectional survey

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