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Background: Federal housing assistance is an important policy tool to ensure housing security for low-income households. Less is known about its impact on residential environmental exposures, particularly lead., Objectives: We conducted a quasi-experimental study to investigate the association between federal housing assistance and blood lead levels (BLLs) in a nationally representative US sample age 6 y and older eligible for housing assistance., Methods: We used the 1999-2018 National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development (HUD) administrative records to assess BLLs of NHANES participants with concurrent HUD housing assistance (i.e., current recipients, n = 3 , 0 71 ) and those receiving assistance within 2 y after the survey (i.e., pseudo-waitlist recipients, n = 1,235 ). We estimated BLL least squares geometric means (LSGMs), odds ratio (OR) for BLL ≥ 3.5 μ g / dL , and percent differences in LSGMs by HUD housing assistance status adjusting for age, sex, family income-to-poverty ratio, education, country of birth, race/ethnicity, region, and survey year. We also examined effect modification using interaction terms and stratified analyses by program type [i.e., public housing, multifamily, housing choice vouchers (HCV)], and race/ethnicity., Results: Current HUD recipients had a significantly lower LSGM [ 1.07 μ g / dL ; 95% confidence interval (CI): 1.02, 1.12] than pseudo-waitlist recipients ( 1.21   μ g / dL ; 95% CI: 1.14, 1.28), with an adjusted OR of 0.60 (95% CI: 0.42, 0.87) for BLL ≥ 3.5 μ g / dL . Some effect modification were observed: The protective association of HUD assistance on BLL was strongest among public housing ( - 19.5 % LSGM; 95% CI: - 27.5 % , - 1 0 . 7 % ), multifamily ( - 12.5 % LSGM; 95% CI: - 2 0 . 7 % , - 3.5 % ), and non-Hispanic White ( - 2 0 . 6 % LSGM; 95% CI: - 29.8 % , - 1 0 . 3 % ) recipients. It was weaker to null among HCV ( - 5.7 % LSGM; 95% CI: - 12.7 , 1.7%), non-Hispanic Black ( - 1.6 % LSGM; 95% CI: - 8.1 % , 5.4%), and Mexican American (-12.5% LSGM; 95% CI: - 31.9 % , 12.5 % ) recipients., Discussion: Our research underscores the importance of social-structural determinants like federal housing assistance in providing affordable, stable, and healthy housing to very low-income households. More attention is needed to ensure housing quality and racial equity across HUD's three major housing assistance programs. https://doi.org/10.1289/EHP12645.

Importance: Programs that provide affordable and stable housing, such as federal rental assistance, may be associated with improved mean blood glucose levels and related diabetes outcomes., Objective: To assess whether 2 different types of federal rental assistance programs are associated with glycated hemoglobin A1c (HbA1c) levels among middle-aged and older US adults., Design, Setting, and Participants: This cohort study used data from the National Health and Nutrition Examination Survey (NHANES) linked with US Department of Housing and Urban Development records of rental assistance participation. Adults aged 45 years or older who were receiving 2 types of rental assistance (project-based housing or housing vouchers) at the time of the NHANES interview and those who would receive rental assistance within the subsequent 2 years (waitlist group) were included. Data were collected from January 1999 to December 2016 and analyzed in October 2021., Exposures: Rental assistance participation, including project-based housing (subsidized housing developments including public housing) and housing vouchers (tenant-based subsidies for private market housing)., Main Outcomes and Measures: The primary outcome was continuous HbA1c level, a common measure of blood glucose reflecting diabetes control. Linear regression was used to estimate the association between the 2 rental assistance programs and HbA1c level. Logistic regression was used to assess the association between rental assistance programs and HbA1c cut points (prediabetes: 5.7% to ≤6.5%; diabetes: >6.5%; uncontrolled diabetes: ≥9% [to convert to proportion of total Hb, multiply by 0.01]). Analyses used weights created by the National Center for Health Statistics that adjust for linkage eligibility., Results: Among 1050 adults in the study (41.6% aged ≥65 years; 70.1% female), 795 were receiving rental assistance at time of the NHANES interview (450 lived in project-based housing, and 345 had housing vouchers), and 255 received rental assistance within 2 years after the interview. Participants in project-based housing had lower HbA1c levels compared with individuals in the waitlist group (β, -0.290; 95% CI, -0.599 to 0.020), but the difference was not significant. No significant differences in HbA1c levels were found between those receiving housing vouchers and those in the waitlist group (β, 0.051; 95% CI, -0.182 to 0.284). Receiving project-based housing was associated with a reduced likelihood of uncontrolled diabetes (-3.7 percentage points; 95% CI, -7.0 to -0.0 percentage points) compared with being in the waitlist group., Conclusions and Relevance: In this cohort study of a nationally representative sample of US adults, living in project-based, federally subsidized housing was associated with a reduced likelihood of uncontrolled diabetes. The findings suggest that affordable housing programs may be associated with improved diabetes outcomes.

Housing assistance policies may lead to improved mental health for children and adolescents by improving housing quality, stability, and affordability. We use a unique data linkage of the National Health Interview Survey and U.S. Department of Housing and Urban Development administrative data to examine the impact of housing assistance on parent-reported mental health outcomes for children ages 2 to 17 (N = 1,967). We account for selection into housing assistance using a pseudo-waitlist method that compares children receiving assistance to those who will enter housing assistance within two years of their interview. Compared to those in the pseudo-waitlist group, we find that children living in public housing have better mental health outcomes. We do not find similar benefits for children receiving vouchers. Our results suggest that housing assistance policies can have a positive impact on mental health among disadvantaged children.

Background: Federal surveys could play a role in measuring the association of rental assistance and health and in identifying the health needs of the assisted population. However, self-reports of rental assistance could be biased. Our objective was to assess the accuracy of reported rental assistance in the National Health Interview Survey (NHIS)., Methods: We conducted a record-check study of reports of US Department of Housing and Urban Development rental assistance in the 2004-2012 NHIS, using survey responses linked to administrative records. Misclassification measures were limited to the false-negative rate because the survey ascertained participation in all rental assistance programs, but the administrative data pertained only to US Department of Housing and Urban Development. False-negative rates were calculated for the total population, for sociodemographic subgroups, across levels of self-reported health status, and for specific assistance types (Housing Choice Vouchers, Public Housing, and Multifamily Housing)., Results: We estimated a false-negative rate of 22.6%. Misclassification was higher among Public Housing residents compared to those receiving other forms of assistance, even after controlling for sociodemographics. Rates varied across region and other demographics. Those self-reporting fair or poor health were less likely to misreport assistance compared with those in better health, but the difference was explained by covariates. Misreporting assistance had little independent impact on the adjusted association of assistance and health., Conclusions: False-negative reporting of rental assistance is moderately high in the NHIS, but we did not find evidence that it independently biased estimates of the association of health and rental assistance.

Context: Given a large and consistent literature revealing a link between housing and health, publicly supported housing assistance programs might play an important role in promoting the health of disadvantaged children., Objective: To summarize and evaluate research in which authors examine housing assistance and child health., Data Sources: PubMed, Web of Science, PsycInfo, and PAIS (1990-2017)., Study Selection: Eligible studies were required to contain assessments of public housing, multifamily housing, or vouchers in relation to a health outcome in children (ages 0-21); we excluded neighborhood mobility interventions., Data Extraction: Study design, sample size, age, location, health outcomes, measurement, program comparisons, analytic approach, covariates, and results., Results: We identified 14 studies, including 4 quasi-experimental studies, in which authors examined a range of health outcomes. Across studies, the relationship between housing assistance and child health remains unclear, with ∼40% of examined outcomes revealing no association between housing assistance and health. A sizable proportion of observed relationships within the quasi-experimental and association studies were in favor of housing assistance (50.0% and 37.5%, respectively), and negative outcomes were less common and only present among association studies., Limitations: Potential publication bias, majority of studies were cross-sectional, and substantial variation in outcomes, measurement quality, and methods to address confounding., Conclusions: The results underscore a need for rigorous studies in which authors evaluate specific housing assistance programs in relation to child outcomes to establish what types of housing assistance, if any, serve as an effective strategy to reduce disparities and advance equity across the lifespan., Competing Interests: POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose., (Copyright © 2018 by the American Academy of Pediatrics.)

To investigate whether receiving US Department of Housing and Urban Development (HUD) housing assistance is associated with improved access to health care, we analyzed data on nondisabled adults ages 18-64 who responded to the 2004-12 National Health Interview Survey that were linked with administrative data from HUD for the period 2002-14. To account for potential selection bias, we compared access to care between respondents who were receiving HUD housing assistance at the time of the survey interview (current recipients) and those who received HUD assistance within twenty-four months of completing the survey interview (future recipients). Receiving assistance was associated with lower uninsurance rates: 31.8 percent of current recipients were uninsured, compared to 37.2 percent of future recipients. Rates of unmet need for health care due to cost were similarly lower for current recipients than for future recipients. No effect of receiving assistance was observed on having a usual source of care. These findings provide evidence that supports the effectiveness of housing assistance in improving health care access., (Project HOPE—The People-to-People Health Foundation, Inc.)

Objectives: To examine whether access to housing assistance is associated with better health among low-income adults., Methods: We used National Health Interview Survey data (1999-2012) linked to US Department of Housing and Urban Development (HUD) administrative records (1999-2014) to examine differences in reported fair or poor health and psychological distress. We used multivariable models to compare those currently receiving HUD housing assistance (public housing, housing choice vouchers, and multifamily housing) with those who will receive housing assistance within 2 years (the average duration of HUD waitlists) to account for selection into HUD assistance., Results: We found reduced odds of fair or poor health for current public housing (odds ratio [OR] = 0.77; 95% confidence interval [CI] = 0.57, 0.97) and multifamily housing (OR = 0.75; 95% CI = 0.60, 0.95) residents compared with future residents. Public housing residents also had reduced odds of psychological distress (OR = 0.59; 95% CI = 0.40, 0.86). These differences were not mediated by neighborhood-level characteristics, and we did not find any health benefits for current housing choice voucher recipients., Conclusions: Housing assistance is associated with improved health and psychological well-being for individuals entering public housing and multifamily housing programs.

Housing policy in the United States has long been characterized by unequal investment in homeownership and low-income rental assistance, with implications for racial (and ethnic) inequality in access to stable housing. In this study, I examine socioeconomic status and neighborhood characteristics of non-Hispanic White and non-Hispanic Black adults with children receiving HUD rental assistance using a nationally representative linked survey-administrative dataset. Results show that Black and White adults who receive rental assistance tend to have similar (low) incomes, yet Black adults experience significantly higher levels of neighborhood disadvantage than White adults. Furthermore, living in poverty is a substantially stronger predictor of receiving HUD rental assistance for White than Black adults. The results support the notion that rental assistance programs are a last resort for White households, many of whom may benefit from historical federal government support for homeownership. Rental assistance serves as an important safety net for Black families but fails to provide significant improvement in the neighborhood environment. The results contribute to a comprehensive understanding of racial inequality in the impacts of U.S. rental housing policy and the historical legacy of racial exclusion in U.S. homeownership programs. [ABSTRACT FROM AUTHOR]

Research on the effects of federal housing assistance programs on children's outcomes has produced mixed results. Although housing assistance programs provide a rare source of affordable and stable housing for low-income families, there remains concern that living in public housing developments increases children's risk of poor health. This paper uses a unique survey-administrative linked dataset to examine the effect of living in public housing on children's risk of health problems, including frequent diarrhea, headaches, skin allergies, asthma, and fair/poor health status. Children living in public housing have more health problems than children who do not live in public housing. However, the analysis develops several comparison groups to demonstrate that the excess health problems reflect unobserved selection into public housing. The main selection adjustment compares children living in public housing to children who enter public housing in the near future. Results indicate that public housing does not increase the risk of child health problems, and it is important to consider selection into public housing on factors that are correlated with health. The effects of public housing may be mixed, but policymakers should not confuse the economic and health challenges of public housing residents for the effects of the program itself. [ABSTRACT FROM AUTHOR]